Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Kawasaki Disease with Influenza A Virus and Mycoplasma pneumoniae Infections: A Case Report and Review of Literature

인플루엔자 A 및 폐렴미코플라스마 감염과 병발한 가와사끼병 1례

  • Received : 2016.01.01
  • Accepted : 2016.05.05
  • Published : 2016.08.25
Download PDF
⟨ Previous Next ⟩

Abstract

Although an association of Kawasaki disease (KD) with infectious agents has been suggested, none have been proven to cause KD. In this case study, we present a case of KD with concurrent onset of influenza and Mycoplasma pneumoniae (MP) infections. A 27-month-old boy presented with prolonged fever, cough, and rhinorrhea. During the initial testing, influenza A infection was identified, and he was treated with oseltamivir. Despite the antiviral therapy, the fever persisted, and he had cervical lymph node enlargement, bilateral conjunctival injection, fissured red lips, strawberry tongue, and erythematous skin lesions on the Bacillus Calmette-$Gu{\acute{e}}rin$ vaccination site. Thus, the patient was diagnosed with KD and was treated with intravenous immunoglobulin (IVIG). The result of the initial antimycoplasma immunoglobulin M (IgM) antibody testing and was positive, and an increased IgM titer from baseline was found in a repeat test. We reviewed the hypotheses on pathogens known to be associated with KD and the etiology of KD. Based on our findings, we suspect that symptoms of KD and coronary artery lesions can occur from various infections besides those caused by Mycoplasma species and influenza viruses.

그 동안 다양한 병원체와 가와사끼병의 관련성이 제기되어 왔으나 아직 확실한 원인으로 증명된 것은 없다. 본 증례는 가와사끼병과 폐렴미코플라스마, 인플루엔자 감염이 동시에 병발한 환자를 소개한다. 27개월 남아가 발열과 기침, 콧물 등의 증상으로 내원하였다. 외래에서 인플루엔자 A 감염을 확인하고 oseltamivir를 복용하였으나 발열이 지속되고 경부 림프절 비대, 양측성 결막 충혈, 입술의 발적과 갈라짐, 딸기혀, BCG 접종 부위의 발진을 보였다. 이에 가와사끼병으로 진단하고 면역글로불린을 정맥주사 하였다. 환아는 혈청 항미코플라스마 IgM 항체가 양성이었고 비인두 도말 중합효소 연쇄반응 검사에서 폐렴미코플라스마 양성으로 나타났다. 본 증례와 더불어 가와사끼병과의 연관성이 거론되었던 병원체들을 살펴보고 가와사끼병의 병인에 대한 가설들을 고찰하여 가와사끼병의 증상이나 관상동맥 병변이 폐렴미코플라스마와 인플루엔자 뿐 아니라 다양한 감염에서 발생할 수 있을 것으로 예상하였다.

Keywords

References

  1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 1967;16:178-222.
  2. Principi N, Rigante D, Esposito S. The role of infection in Kawasaki syndrome. J Infect 2013;67:1-10. https://doi.org/10.1016/j.jinf.2013.04.004
  3. Lee KY, Han JW, Lee JS. Kawasaki disease may be a hyperimmune reaction of genetically susceptible children to variants of normal environmental flora. Med Hypotheses 2007;69:642-51. https://doi.org/10.1016/j.mehy.2006.12.051
  4. Lee KY, Rhim JW, Kang JH. Kawasaki disease: laboratory findings and an immunopathogenesis on the premise. Yonsei Med J 2012;53:262-75. https://doi.org/10.3349/ymj.2012.53.2.262
  5. American Academy of Pediatrics. Influenza. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. 2012 Red book: Report of the Committee on infectious diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2012:439-53.
  6. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004;17:697-728. https://doi.org/10.1128/CMR.17.4.697-728.2004
  7. Huang X, Huang P, Zhang L, Xie X, Xia S, Gong F, et al. Influenza infection and Kawasaki disease. Rev Soc Bras Med Trop 2015;48:243-8. https://doi.org/10.1590/0037-8682-0091-2015
  8. Esper F, Shapiro ED, Weibel C, Ferguson D, Landry ML, Kahn JS. Association between a novel human coronavirus and Kawasaki disease. J Infect Dis 2005;191:499-502. https://doi.org/10.1086/428291
  9. Okano M, Thiele GM, Sakiyama Y, Matsumoto S, Purtilo DT. Adenovirus infection in patients with Kawasaki disease. J Med Virol 1990;32:53-7. https://doi.org/10.1002/jmv.1890320109
  10. Burns JC, Geha RS, Schneeberger EE, Newburger JW, Rosen FS, Glezen LS, et al. Polymerase activity in lymphocyte culture supernatants from patients with Kawasaki disease. Nature 1986;323:814-6. https://doi.org/10.1038/323814a0
  11. Iwanaga M, Takada K, Osato T, Saeki Y, Noro S, Sakurada N. Kawasaki disease and Epstein-Barr virus. Lancet 1981;1:938-9.
  12. Kikuta H, Matsumoto S, Osato T. Kawasaki disease and Epstein-Barr virus. Acta Paediatr Jpn 1991;33:765-70. https://doi.org/10.1111/j.1442-200X.1991.tb02606.x
  13. Kato H, Fujimoto T, Inoue O, Kondo M, Koga Y, Yamamoto S, et al. Variant strain of Propionibacterium acnes : a clue to the aetiology of Kawasaki disease. Lancet 1983;2:1383-8.
  14. Ohtaki C, Tomiyama T, Suzuki M, Hayakawa H, Kaga M. Leptospiral antibody and MLNS. J Pediatr 1978;93:896.
  15. Shinomiya N, Takeda T, Kuratsuji T, Takagi K, Kosaka T, Tatsuzawa O, et al. Variant Streptococcus sanguis as an etiological agent of Kawasaki disease. Prog Clin Biol Res 1987;250:571-2.
  16. Leahy TR, Cohen E, Allen UD. Incomplete Kawasaki disease associated with complicated Streptococcus pyogenes pneumonia: a case report. Can J Infect Dis Med Microbiol 2012;23:137-9.
  17. Cho SY, Cho HK, Cho KY, Kim HS, Sohn SJ. Kawasaki disease presenting as retropharyngeal abscess. Korean J Pediatr 2008;51:1023-7. https://doi.org/10.3345/kjp.2008.51.9.1023
  18. Abe J, Kotzin BL, Jujo K, Melish ME, Glode MP, Kohsaka T, et al. Selective expansion of T cells expressing T-cell receptor variable regions V beta 2 and V beta 8 in Kawasaki disease. Proc Natl Acad Sci USA 1992;89:4066-70. https://doi.org/10.1073/pnas.89.9.4066
  19. Mancia L, Wahlström J, Schiller B, Chini L, Elinder G, D'Argenio P, et al. Characterization of the T-cell receptor V-beta repertoire in Kawasaki disease. Scand J Immunol 1998;48:443-9. https://doi.org/10.1046/j.1365-3083.1998.00415.x
  20. Leung DY, Meissner HC, Shulman ST, Mason WH, Gerber MA, Glode MP, et al. Prevalence of superantigen-secreting bacteria in patients with Kawasaki disease. J Pediatr 2002;140:742-6. https://doi.org/10.1067/mpd.2002.123664
  21. Terai M, Miwa K, Williams T, Kabat W, Fukuyama M, Okajima Y, et al. The absence of evidence of staphylococcal toxin involvement in the pathogenesis of Kawasaki disease. J Infect Dis 1995;172:558-61. https://doi.org/10.1093/infdis/172.2.558
  22. Greco F, Sorge A, Salvo V, Sorge G. Cutaneous vasculitis associated with Mycoplasma pneumoniae infection: case report and literature review. Clin Pediatr 2007;46:451-3. https://doi.org/10.1177/0009922806298638
  23. Lee MN, Cha JH, Ahn HM, Yoo JH, Kim HS, Sohn SJ, et al. Mycoplasma pneumoniae infection in patients with Kawasaki disease. Korean J Pediatr 2011;54:122-6. https://doi.org/10.3345/kjp.2011.54.3.122
  24. Youn YS, Lee KY. Mycoplasma pneumoniae pneumonia in children. Korean J Pediatr 2012;55:42-7. https://doi.org/10.3345/kjp.2012.55.2.42
  25. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumo niae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect 2008;56:326-31. https://doi.org/10.1016/j.jinf.2008.02.018
  26. Rowley AH, Baker SC, Shulman ST, Fox LM, Takahashi K, Garcia FL, et al. Cytoplasmic inclusion bodies are detected by synthetic antibody in ciliated bronchial epithelium during acute Kawasaki disease. J Infect Dis 2005;192:1757-66. https://doi.org/10.1086/497171
  27. Rodo X, Ballester J, Cayan D, Melish ME, Nakamura Y, Uehara R, et al. Association of Kawasaki disease with tropospheric wind patterns. Sci Rep 2011;1:152. https://doi.org/10.1038/srep00152
  28. Lee KY. A common immunopathogenesis mechanism for infectious diseases: the protein-homeostasis-system hypothesis. Infect Chemother 2015;47:12-26. https://doi.org/10.3947/ic.2015.47.1.12
  29. Jordan-villegas A, Chang ML, Ramilo O, Mejias A. Concomitant respiratory viral infections in children with Kawasaki disease. Pediatr Infect Dis J 2010;29:770-2. https://doi.org/10.1097/INF.0b013e3181dba70b

Cited by

  1. 패혈증 마우스 모델에서 가와사키병의 관상동맥 병변 관찰: 예비연구와 문헌고찰 vol.24, pp.2, 2016, https://doi.org/10.14776/piv.2017.24.2.102