title: Comprehensive pathogen detection associated with four recurrent episodes of Kawasaki disease in a patient during a single year using next-generation sequencing.
abstract: BACKGROUND
  Kawasaki disease (KD) is the most common multisystem vasculitis in childhood. Pathogens can be associated with the onset of KD. However, a lack of consistency prevails among reports about this disease.
  
  
  METHODS
  For this case of a 1-year-old boy with four recurrent episodes of KD within a year, we analysed profiles of pathogen reads in his serum and pharynx specimens using next-generation sequencing. Comparative analysis of the identified bacterial reads from serum samples found significant correlation of bacteria such asStreptococcusandHaemophilusspp. with the first and fourth episodes (R2= 0.9506) before treatment. In the first convalescent phase, the number ofStreptococcusspp. was reduced remarkably (P< 0.0001). From sequencing of the pharynx specimen from the fourth episode, a similar correlation was found with serum from the fourth episode (R2= 0.6633).
  
  
  CONCLUSIONS
  In this case,Streptococcusspp. may have been associated with onset of KD. Further studies must be undertaken to evaluate the putative association of micro-organism infection with KD pathogenesis.
authors.affiliation: Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center , 477-96 Owada-Shinden, Yachiyo, Chiba 2768524 , Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Hamada
authors.affiliation: Laboratory of Bacterial Genomics, Pathogen Genomics Center, National Institute of Infectious Diseases , 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640 , Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sekizuka
authors.affiliation: Department of Pediatrics, Showa General Hospital , 2-450 Tenjin, Kodaira, Tokyo 187-8510 , Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Oba
authors.affiliation: Department of Pathology, National Institute of Infectious Diseases , 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640 , Japan.
authors.forename: Harutaka
authors.initials: H
authors.lastname: Katano
authors.affiliation: Laboratory of Bacterial Genomics, Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan; Department of Pediatrics, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kinumaki
authors.affiliation: Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center , 477-96 Owada-Shinden, Yachiyo, Chiba 2768524 , Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Terai
authors.affiliation: Department of Virology 1, National Institute of Infectious Diseases, 4-7-1 Gakuen Musashimurayama, Tokyo 208-0011, Japan; Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwaicho, Fuchu City, Tokyo 183-8509, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizutani
authors.affiliation: Laboratory of Bacterial Genomics, Pathogen Genomics Center, National Institute of Infectious Diseases , 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640 , Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
keywords: cervical lymphadenopathy; conjunctival injection, injected lips/pharynx, IVIG+antibiotic treatment, Kawasaki disease; oedema/erythema of extremities, rash, vasculitis/fever