The role of superantigens of group A Streptococcus and Staphylococcus aureus in Kawasaki disease.
OBJECTIVE
Since the first suggestion of a superantigen hypothesis for Kawasaki disease over a decade ago, debate on the aetiology remains inconclusive. This article reviews recent publications that address the role of superantigens of group A Streptococcus and Staphylococcus aureus in the pathogenesis of Kawasaki disease.


RESULTS
Over the past few years, new superantigens produced by group A Streptococcus and S. aureus have been increasingly identified, bringing the total known number to more than 30. Several studies on T-cell Vbeta repertoires and seroloepidemiology have demonstrated evidence for the involvement of single or multiple superantigens produced by the two pathogens. The associated superantigens differed in those studies, including streptococcal pyrogenic toxins A and C, staphylococcal enterotoxins A-C, and toxic shock syndrome toxin 1. These disparate findings suggest that the inflammation of Kawasaki disease does not result from a single agent but rather a final common inflammatory pathway in genetically susceptible individuals after numerous infectious agents.


CONCLUSIONS
Certain staphylococcal and streptococcal superantigens are suggested to be responsible for the development of Kawasaki disease. A better understanding of the precise role of the causative agents will lead to accurate diagnosis, more targeted therapy and an improvement of coronary outcomes.
Matsubara
Kousaku
K
Department of Pediatrics, Nishi-Kobe Medical Center, Kobe, Japan. kskmatsu@s4.dion.ne.jp
Fukaya
Takashi
T
D000818:Animals; D002648:Child; D002675:Child, Preschool; D004195:Disease Models, Animal; D006801:Humans; D007223:Infant; D009080:Mucocutaneous Lymph Node Syndrome / Q000382:microbiology* / Q000503:physiopathology; D013211:Staphylococcus aureus / Q000276:immunology* / Q000472:pathogenicity; D013297:Streptococcus pyogenes / Q000276:immunology* / Q000472:pathogenicity; D018089:Superantigens
D018089:Superantigens