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http://dx.doi.org/10.3345/kjp.2018.06989

High antistreptolysin O titer is associated with coronary artery lesions in patients with Kawasaki disease  

Min, Dong Eun (Department of Pediatrics,, College of Medicine, Kyung Hee University)
Kim, Do Hee (Department of Pediatrics,, College of Medicine, Kyung Hee University)
Han, Mi Young (Department of Pediatrics,, College of Medicine, Kyung Hee University)
Cha, Sung Ho (Department of Pediatrics,, College of Medicine, Kyung Hee University)
Yoon, Kyung Lim (Department of Pediatrics, Kyung Hee University Hospital at Gangdong)
Publication Information
Clinical and Experimental Pediatrics / v.62, no.6, 2019 , pp. 235-239 More about this Journal
Abstract
Purpose: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognosis, with respect to treatment response and development of coronary artery lesions. Methods: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. Results: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3,27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. Conclusion: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.
Keywords
Antistreptolysin; Kawasaki disease; Coronary disease; Streptococcal infections;
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1 Amano S, Hazama F, Kubagawa H, Tasaka K, Haebara H, Hamashima Y. General pathology of Kawasaki disease. On the morphological alterations corresponding to the clinical manifestations. Acta Pathol Jpn 1980;30:681-94.
2 McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135:e927-99.   DOI
3 Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-71.   DOI
4 Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; American Heart Association. Diagnostic guidelines for Kawasaki disease. Circulation 2001;103:335-6.   DOI
5 Lloyd AJ, Walker C, Wilkinso M. Kawasaki disease: is it caused by an infectious agent? Br J Biomed Sci 2001;58:122-8.
6 Rowley AH, Baker SC, Shulman ST, Rand KH, Tretiakova MS, Perlman EJ, et al. Ultrastructural, immunofluorescence, and RNA evidence support the hypothesis of a "new" virus associated with Kawasaki disease. J Infect Dis 2011;203:1021-30.   DOI
7 Benseler SM, McCrindle BW, Silverman ED, Tyrrell PN, Wong J, Yeung RS. Infections and Kawasaki disease: implications for coronary artery outcome. Pediatrics 2005;116:e760-6.   DOI
8 Matsubara K, Fukaya T. The role of superantigens of group A Streptococcus and Staphylococcus aureus in Kawasaki disease. Curr Opin Infect Dis 2007;20:298-303.   DOI
9 Meissner HC, Leung DY. Superantigens, conventional antigens and the etiology of Kawasaki syndrome. Pediatr Infect Dis J 2000;19:91-4.   DOI
10 Rowley AH. The etiology of Kawasaki disease: superantigen or conventional antigen? Pediatr Infect Dis J 1999;18:69-70.   DOI
11 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.   DOI
12 Lo JY, Minich LL, Tani LY, Wilkes J, Ding Q, Menon SC. Factors associated with resource utilization and coronary artery dilation in refractory Kawasaki disease (from the Pediatric Health Information System Database). Am J Cardiol 2016;118:1636-40.   DOI
13 Kitano N, Suzuki H, Takeuchi T, Suenaga T, Kakimoto N, Shibuta S, et al. Epidemiologic features and prognostic factors of coronary artery lesions associated with Kawasaki disease based on a 13-year cohort of consecutive cases identified by complete enumeration surveys in Wakayama, Japan. J Epidemiol 2014;24:427-34.   DOI
14 Hingorani AD, Cross J, Kharbanda RK, Mullen MJ, Bhagat K, Taylor M, et al. Acute systemic inflammation impairs endothelium-dependent dilatation in humans. Circulation 2000;102:994-9.   DOI
15 Binak E, Gunduz H, Binak D, Yilmaz F. Association between recent group A beta-hemolytic. Internet J Cardiol 2006;4:1-5.
16 Kobayashi T, Fuse S, Sakamoto N, Mikami M, Ogawa S, Hamaoka K, et al. A new Z score curve of the coronary arterial internal diameter using the Lambda-Mu-Sigma method in a pediatric population. J Am Soc Echocardiogr 2016;29:794-801.   DOI
17 Steer AC, Smeesters PR, Curtis N. Streptococcal serology: secrets for the specialist. Pediatr Infect Dis J 2015;34:1250-2.   DOI
18 Sen ES, Ramanan AV. How to use antistreptolysin O titre. Arch Dis Child Educ Pract Ed 2014;99:231-8.   DOI
19 Cox F, Foshee W, Miller J Jr, Moore S. Simultaneous Kawasaki disease and group A streptococcal pharyngitis. Clin Pediatr (Phila) 1993;32:48-50.   DOI
20 Machado CS, Ortiz K, Martins Ade L, Martins RS, Machado NC. Antistreptolysin O titer profile in acute rheumatic fever diagnosis. J Pediatr (Rio J) 2001;77:105-11.
21 Hoare S, Abinun M, Cant AJ. Overlap between Kawasaki disease and group A streptococcal infection. Pediatr Infect Dis J 1997;16:633-4.   DOI
22 Burns JC, Cayan DR, Tong G, Bainto EV, Turner CL, Shike H, et al. Seasonality and temporal clustering of Kawasaki syndrome. Epidemiology 2005;16:220-5.   DOI
23 Ha S, Seo GH, Kim KY, Kim DS. Epidemiologic study on Kawasaki disease in Korea, 2007-2014: based on Health Insurance Review & Assessment Service Claims. J Korean Med Sci 2016;31:1445-9.   DOI
24 Han SB, Lee SY. Antibiotic use in children with Kawasaki disease. World J Pediatr 2018;14:621-2.   DOI
25 Shet A, Kaplan EL. Clinical use and interpretation of group A streptococcal antibody tests: a practical approach for the pediatrician or primary care physician. Pediatr Infect Dis J 2002;21:420-6.   DOI