Original Articles
Prevalence of superantigen-secreting bacteria in patients with Kawasaki disease,☆☆

https://doi.org/10.1067/mpd.2002.123664Get rights and content

Abstract

Objectives: To assess the prevalence of superantigen secreting bacteria in children with acute Kawasaki disease (KD) relative to control patients. Study design: Bacterial cultures were obtained in a blinded fashion from the throat, rectum, and groin of 45 patients with untreated acute KD and 37 febrile control patients from 6 centers in the United States. Cultures were processed for the presence of superantigen-producing bacteria at a central laboratory. Results: Staphylococci or streptococci that produced superantigens (TSST-1, SEB, SEC, SPEB, SPEC) were isolated from 25 of 45 patients with KD (56%) as compared with 13 of 37 (35%) control patients (P =.078). Because SEB- and SEC-producing Staphylococcus aureus have not been associated with KD and because they do not induce a Vβ2+ T-lymphocyte response, we analyzed the difference between groups relative to superantigens TSST-1 or SPEB/SPEC production. TSST-1 secreting S aureus or SPEB/SPEC producing group A streptococci were isolated from 20 of 45 (44%) patients with KD compared with 7 of 37 (19%) control patients (P =.019). Conclusions: The overall isolation rates of superantigen (TSST-1, SPEB, SPEC, SEB, SEC) producing bacteria between patients with KD and febrile control patients were not statistically significant. However, future studies should further examine the potential role of Vβ2-stimulatory superantigens (TSST-1 and SPEB/SPEC) in KD. (J Pediatr 2002;140:742-6)

Section snippets

Study populations

The institutional review board of each institution approved this study. Patients were enrolled between February 1998 and March 2000 at 6 sites: Arkansas Children's Hospital, New England Medical Center at Tufts University School of Medicine, Children's Memorial Hospital at Northwestern University Medical School, Children's Hospital in Denver, Texas Children's Hospital at Baylor College of Medicine, and Children's Hospital of Los Angeles. Patients who presented with classic features of KD as

Results

The present study characterized bacterial cultures from 45 patients with untreated acute KD and 37 febrile control patients seen at 6 geographically diverse institutions (Table I).The demographics of patients are shown in Table II.

. Association of Kawasaki disease with superantigen-producing bacteria

Empty CellKDControl patients
No. of patients4537
Sex (male:female)27:1821:16
Mean age (range) mo37.3 (5–96)36.6 (5–84)
Ethnic distribution (C:AA:H:A)20:7:10:814:13:8:2
TSST-producing S aureus187
SEB-producing S aureus

Discussion

Data supporting the hypothesis that superantigens play a role in the cause of KD have been conflicting. For example, several reports have described an expansion of T-cell receptor (TCR) V β2+ T-lymphocytes in patients with acute KD.15, 16, 17, 18, 19, 20 Skewing of Vβ T-lymphocytes is one of the hallmarks of superantigen stimulation. In at least one study, the V-β2 expansion was found to be polyclonal, which is consistent with a superantigen-mediated stimulation.16 However, other reports have

Acknowledgements

We thank Maureen Plourd-Sandoval for her assistance in the preparation of the manuscript and Linda K. Perry for expert technical assistance.

References (30)

  • HC Meissner et al.

    Superantigens, conventional antigens and etiology of Kawasaki syndrome

    Pediatr Infect Dis J

    (2000)
  • DYM Leung et al.

    The immunopathogenesis and management of Kawasaki syndrome

    Arthritis Rheum

    (1998)
  • ME Melish et al.

    Kawasaki syndrome is not caused by toxic shock syndrome toxin-1+ Staphylococci [abstract]

    Pediatr Res

    (1994)
  • M Terai et al.

    The absence of evidence of staphylococcal toxin involvement in the pathogenesis of Kawasaki disease

    J Infect Dis

    (1995)
  • American Heart Association Committee on Rheumatic Fever

    Diagnostic guidelines for Kawasaki disease

    JAMA

    (1990)
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    Supported in part by USPHS grants HL-37260, HL-36611, AR-41256, AR-37070, AI-28495, and AI-28495 from the National Institutes of Health, and the Ann and Louis Rudolph Kawasaki Disease Research Fund.

    ☆☆

    Reprint requests: H. Cody Meissner, MD, Pediatric Infectious Disease, New England Medical Center, 750 Washington St, Boston, MA 02111.

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