A Study on the Association between Kawasaki Disease and Mycoplasma pneumoniae Infection

Yeol Ryoon Woo, Hyun Jin Kim, Min Ah Cha, Jong Woon Choi


The etiology of Kawasaki disease (KD) remains unknown, although severeal infectious agents have been proposed as potential causes. Some studies suggested association between KD and Mycoplasma pneumoniae(MP) infection. This retrospective study analyzed the association between KD and MP infection. Subjects were 36 patients with KD who admitted to the Bundang Jesaeng General Hospital from January 2013  through August 2014. Patients were assigned to one of two groups, the MP and control group, based on the results of anti-mycoplasmal IgM antibody (AMA) test. Clinical features, laboratory findings, courses and outcomes of the illness were compared between the two groups. The results of AMA tests were positive or indeterminate in 11 patients (30.6%; MP group) and negative in 25 (69.4%; control group). There were no significant differences between the two groupos with respect to age and sex distributions, duration of fever, laboratory results, chet roentgenographic findings, and echocardiographic findings. AMA titers were rechecked in 6 patients in the MP groupo, of who titer decreased in 5 patients (83.3%) and increased in 1 (16.7%). Although AMA titer were positive in some patients with KD, it did not appear to influence clinical feature, laboratory findings, and courses and outcomes of the illness. AMA titers decreased in the follow-up measurements in most patients in the MP group, suggesting that positive AMA titers were related to previous infections rather than concurrent infections, thus reducing the likelihood of MP infection being a causative factor for KD.


Kawasaki disease; Mycoplasma pneumonia; Antibody; Infection

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Rauch AM, “Kawasaki syndrome: review of new epidemiologic and laboratory developments”, Pediatr Infect Dis J, vol.6, no. 11, pp.1016-21, 1987.

Kim GB, Park S, Kwon BS, Han JW, Park YW, Hong YM,“Evaluation of the temporal association between Kawasaki disease and viral infections in South Korea”, Korean Circ J, vol.44, no.4, pp.250-4, 2014.

Bell DM, Brink EW, Nitzkin JL, Hall CB, Wulff H, Berkowitz ID, Feorino PM, Holman RC, Huntely CL, Meade RH 3rd, et al, “Kawasaki syndrome: description of two outbreaks in the United States”, N Engl J Med, vol.304, no.26, pp.1568-75, 1981.

Treadwell TA, Maddox RA, Holman RC, Belay ED, Shahriari A, Anderson MS, Burns J, Glodé MP, Hoffman RE, Schonberger LB, “Investigation of Kawasaki syndrome risk factors in Colorado”,Pediatr Infect Dis J, vol.21, no. 10, pp. 976-8, 2002.

Rowley AH, Shulman ST, Mask CA, Finn LS, Terai M, Baker SC, Galliani CA, Takahashi K, Naoe S, Kalelkar MB, “IgA plasma cell infiltration of proximal respiratory tract, pancreas, kidney, and coronary artery in acute Kawasaki disease”, J Infect Dis, vol.182, no. 4, pp.1183-91, 2000.

Rowley AH, Baker SC, Shulman ST, Garcia FL, Guzman-Cottrill JA, Chou P, Terai M, Kawasaki T, Kalelkar MB, Crawford SE, “Detection of antigen in bronchial epithelium and macrophages in acute Kawasaki disease by use of synthetic antibody”, J Infect Dis,vol.190, no. 4, pp.856-65, 2004.

Waites KB, “New concepts of Mycoplasma pneumoniae infections in children”,Pediatr Pulmonology, vol.36, no. 4, pp.267-78,2003.

Lee MN, Cha JH, Ahn HM, Yoo JH, Kim HS, Sohn SJ, Hong YM, “Mycoplasma pneumoniae infection in patients with Kawasaki disease”, Korean J Pediatr, vol.54, no. 3, pp.123-7, 2001.

Lee SM, Park SE, Kim YW, Hong JY,“A case of Kawasaki disease with mycoplasma pneumonia”, Korean J Pediatr, vol.48, no.4, pp438-42, 2005.

Huang FL, Chang TK, Jan SL, Tsai CR, Wang LC, Lai MC, Chen PY, “Co-morbidity of Kawasaki Disease”, Indian J Pediatr, vol.79, no.6, pp. 815-7, 2012.

Chemli J, Hassayoun S, Ketata S, Houda A, Mokni M, Zouari N, AbrougSaoussen, “Kawasaki disease, Mycoplasma pneumoniae infection and anaplastic large cell lymphoma: an uncommon association”, Open J Pediatr, vol.2, no.3, pp. 250-2, 2012.

Chanana N, Noronha P, “Mycoplasma pneumoniae and Kawasaki disease”, CFP, vol. 12, pp.333-4, 2013.

Leen C, Ling S,“Mycoplasma infection and Kawasaki disease”, Arch Dis Child, vol.75, no.3, pp.266-7, 1996.

Wang JN, Wang SM, Liu CC, Wu JM,“Mycoplasma pneumoniae infection associated with Kawasaki disease”, ActaPaediatr, vol.90, no. 5, pp. 594-5, 2001.

Ebrahim M, Gabay M, Rivas-Chacon RF,“Evidence of acute mycoplasma infection in a patient with incomplete and atypical Kawasaki disease: a case report”. Case Rep Med, vol.2011:606920, 2011.

Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC,Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, 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”, Pediatrics, vol.114, no. 6, pp.1708-33, 2004.

Research Committee on Kawasaki Disease, Report of Subcommittee on Standardization of Diagnostic Criteria and Reporting of Coronary Artery Lesions in Kawasaki Disease, Tokyo, Japan: Japanese Ministry of Health and Welfare, 1984.

Kim S, Um TH, Cho CR, “Evaluation of the Chorus Mycoplasma pneumoniae IgM assay for the serological diagnosis of Mycoplasma pneumoniae infection”, J Lab Med QualAssur, vol.34, no.1, pp.57-62,2012.

Leung DYM, Sullivan KE, Brown-Whitehorn TF, Fehringer AP, Allen S, Finkel TH,Washington RL, Makida R, Schlievert PM, “Association of toxic shock syndrome toxin-secreting and exfoliative toxin-secreting Staphylococcus aureus with Kawasakisyndrome complicated by coronary artery disease”,Pediatr Res, vol.42, no.3, pp.268-72, 1997.

Hall M, Hoyt L, Ferrieri P, Schlievert PM, Jenson HB, “Kawasaki syndrome-like illness associated with infection caused by enterotoxin B-secreting Staphylococcus aureus”, Clin Infect Dis, vol.29, no.3, pp.586-9, 1999.

Kato H, Fujimoto T, Inoue O, Kondo M, Koga Y, Yamamoto S, Shingu M, Tominaga K, Sasaguri Y, “Variant strain of Propionibacterium acnes:a clue to the aetiology of Kawasaki disease”, Lancet, vol.2, no. 8364, pp.1383-7, 1983.

Konishi N, Baba K, Abe J, Maruko T, Waki K, Takeda N, Tanaka M,“A case of Kawasaki disease with coronary artery aneurysms documenting Yersinia pseudotuberculosis infection”,ActaPaediatr, vol.86, no. 6, pp.661-4, 1997.

Hamashima Y, Kishi K, Tasaka K,“Rickettsia-like bodies in infantile acute febrile mucocutaneous lymph-node syndrome”, Lancet ,vol.2, no.7819, pp.42, 1973.

Shulman S, Rowley A, “Does Kawasaki disease have a retroviral etiology?”,Lancet, vol.2, no. 8506, pp545-6,1986 .

Abe J, Kotzin BL, Jujo K, Melish ME, Glode MP, Kohsaka T, Leung DY,“Selective expansion of T cells expressing T-cell receptor variable regions Vß2 and Vß8 in Kawasaki disease”, Proc Natl AcadSci USA, vol.89, no. 9, pp.4066-70, 1992.

Abe J, Kotzin BL, Meissner C, Melish ME, Takahashi M, Fulton D,Romagne F, Malissen B, Leung DY,“Characterization of T cell repertoire changes in acute Kawasaki disease”, J Exp Med, vol.177, vol. 3, pp.791-6, 1933.

Uchiyama T, Yan XJ, Imanishi K, Yagi J, “Bacterial superantigens - Mechanism of T cell activation by the superantigens and their role in the pathogenesis of infectious diseases”,MicrobiolImmunol, vol.38, no. 4, pp.245-56, 1994.

Uchiyama T, Kato H, “The pathogenesis of Kawasaki diseaseand superantigens”,Jpn J Infect Dis, vol.52, no. 4, pp.141-5, 1999.

Dominguez SR, Anderson MS, Heizer HR,Jone PN, Robinson CC, Glode MP, “Evidence against Mycoplasma pneumoniae as an etiologic agent of Kawasaki disease [abstract]”, The 15th International Kawasaki Disease Symposium; 2015 Feb 3-6; Honolulu, Hawaii. Dallas, Texas: National Center; pp. 98-9, 2015.

DOI (PDF): https://doi.org/10.24203/ajpnms.v4i3.3793.g2132


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