title: Yersinia pseudotuberculosis infection in Kawasaki disease and its clinical characteristics.
abstract: BACKGROUND
  The etiology of Kawasaki disease (KD) is unknown. Reportedly, there is an association between KD and Yersinia pseudotuberculosis (YPT). Steroid therapy for KD patients with high risk of cardiac sequelae (CS) has been reported; however, the number of reports is limited.
  
  
  METHODS
  We conducted a prospective study of 108 patients with newly diagnosed KD in one year to determine how many KD patients have positive anti-YPT antibody titers and/or positive anti-YPT-derived mitogen (YPM) antibody titers. In addition, we tried to identify clinical differences between KD patients in whom YPT infection was or not a contributing factor. We also compared clinical characteristics of patients treated with the protocol of the Randomized controlled trial to Assess Immunoglobulin plus Steroid Efficacy for Kawasaki disease (RAISE) study (RAISE group) and with the conventional Intravenous immunoglobulin (IVIG) protocol (conventional group).
  
  
  RESULTS
  Eleven patients (10%) were positive for anti-YPT and/or anti-YPM antibodies (positive group) and 97 (90%) were negative (negative group). Cardiac sequelae (CS) occurred significantly more frequently in the positive than the negative group (two patients, 18% vs one patient, 1%, p = 0.027). Forty patients were in the RAISE group. Two of 40 (5%) in the RAISE group and one of 68 (1.47%) in the conventional group had CS (p = 0.55).
  
  
  CONCLUSIONS
  KD patients with YPT infection had CS significantly more frequently and treatment with RAISE protocol did not decrease the frequency of CS in our cohort, nor did YPT infection affect risk scores of no response to IVIG. However, our sample size was overly small to draw such conclusions. Further investigation in a larger cohort is necessary to confirm our findings. Additionally, further research is needed to determine whether early diagnosis of YPT can prevent KD from developing and reduce the incidence of CS.
authors.affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. tomoko.hatono@gmail.com.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Horinouchi
authors.affiliation: Department of Pediatrics, Kobe University Hospital, Kobe, Japan. nozu@med.kobe-u.ac.jp.
authors.forename: Kandai
authors.initials: K
authors.lastname: Nozu
authors.affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. hamahira68@hotmail.com.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hamahira
authors.affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. yinaguma0709@yahoo.co.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inaguma
authors.affiliation: Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan. abe-j@ncchd.go.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Abe
authors.affiliation: Department of Bacteriology, Okayama Prefectural Institute for Environmental Science and Public Health, Okayama, Japan. hiroshi_nakajima@pref.okayama.lg.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan. m.kugo@hrc-hp.com.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kugo
authors.affiliation: Department of Pediatrics, Kobe University Hospital, Kobe, Japan. iijima@med.kobe-u.ac.jp.
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
mesh_terms: D000907:Antibodies, Bacterial / Q000032:analysis; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome; D015011:Yersinia pseudotuberculosis / Q000276:immunology; D015012:Yersinia pseudotuberculosis Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone