Mycoplasma Infection as a Cause of Persistent Fever after Intravenous Immunoglobulin Treatment of Patients with Kawasaki Disease: Frequency and Clinical Impact
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Background: Mycoplasma is a common cause of respiratory infections and may require differential diagnosis from Kawasakidisease (KD). In this study, we investigated the frequency and clinical manifestations of mycoplasma infection in patients withKD. Materials and Methods: Medical records of 375 in-patients admitted for treatment during the acute stage of KD, were collected,and reviewed retrospectively. Of these patients, 152 (40.5%) were also tested for recent mycoplasma infection. Patients withpositive results (anti-mycoplasma IgM Ab >1:640 or cold agglutinin >1:64) were designated as the case group (n = 37, 24.3%)whereas those with negative results were designated as the control group (n = 115, 75.7%). Clinical findings of the two groupswere compared. Results: Patients in the case group were older than those in the control group (mean age, 48.2 ± 32.1 months, vs. 31.7 ± 21.7months; P = 0.001). There were significant differences between the case and control groups in the changes in the extremities(78.3% vs. 57.4%, respectively; P = 0.031), and in fever duration (6.5 ± 2.5 days vs. 5.4 ± 1.5 days; P = 0.047). Of the 37 patientswith positive mycoplasma testing, 7 (18.9%) had persistent fever even after the symptoms and signs of systemic inflammation(acute phase of KD) had been resolved. These patients were positive for mycoplasma infection during further evaluation ofpersistent fever, and all of them responded to macrolide antibiotics. Conclusions: We found that mycoplasma infection is somewhat related to KD. When fever persists after resolution of the acutestage of KD, mycoplasma infection may be considered as a possible cause of fever in preschool-aged children.
Abstract
Background: Mycoplasma is a common cause of respiratory infections and may require differential diagnosis from Kawasakidisease (KD). In this study, we investigated the frequency and clinical manifestations of mycoplasma infection in patients withKD. Materials and Methods: Medical records of 375 in-patients admitted for treatment during the acute stage of KD, were collected,and reviewed retrospectively. Of these patients, 152 (40.5%) were also tested for recent mycoplasma infection. Patients withpositive results (anti-mycoplasma IgM Ab >1:640 or cold agglutinin >1:64) were designated as the case group (n = 37, 24.3%)whereas those with negative results were designated as the control group (n = 115, 75.7%). Clinical findings of the two groupswere compared. Results: Patients in the case group were older than those in the control group (mean age, 48.2 ± 32.1 months, vs. 31.7 ± 21.7months; P = 0.001). There were significant differences between the case and control groups in the changes in the extremities(78.3% vs. 57.4%, respectively; P = 0.031), and in fever duration (6.5 ± 2.5 days vs. 5.4 ± 1.5 days; P = 0.047). Of the 37 patientswith positive mycoplasma testing, 7 (18.9%) had persistent fever even after the symptoms and signs of systemic inflammation(acute phase of KD) had been resolved. These patients were positive for mycoplasma infection during further evaluation ofpersistent fever, and all of them responded to macrolide antibiotics. Conclusions: We found that mycoplasma infection is somewhat related to KD. When fever persists after resolution of the acutestage of KD, mycoplasma infection may be considered as a possible cause of fever in preschool-aged children.
참고문헌 (16)
- Takahashi K, "Pathogenesis of Kawasaki disease", Clin Exp Immunol, 164(Suppl 1), pp.S20~S22 (2011)
- Jordan-Villegas A, "Concomitant respiratory viral infections in children with Ka wasaki disease", Pediatr Infect Dis J, 29, pp.770~772 (2010)
- Chang LY, "Viral infections associated with Kawasaki disease", J Formos Med Assoc, 113, pp.148~154 (2014)
- Wang K, "Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community-acquired pneumonia", Cochrane Database Syst Rev, 10, pp.CD009175~ (2012)
- Newburger JW, "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, 110, pp.2747~2771 (2004)
- 정은희, "Mycoplasma pneumoniae 감염의 혈청학적 진단", Pediatric Infection and Vaccine, 13(1), pp.21~30 (2006), 대한소아감염학회
- Son MB, "Nelson Textbook of Pediatrics", pp.1209~ (2015), WB Saunders Co
- 이미나, "Mycoplasma pneumoniae infection in patients with Kawasaki disease", Korean Journal of Pediatrics, 54(3), pp.122~126 (2011), 대한소아과학회
- Chung SW, "Analysis of genotype distribution and detection rate of Mycoplasma pneumoniae according to respiratory disease type", Public Health Weekly Report, 7, pp.177~181 (2014)
- Greco F, "Cutaneous vasculitis associated with Mycoplasma pneumoniae infection: case report and literature review", Clin Pediatr (Phila), 46, pp.451~453 (2007)
- Atkinson TP, "Waites KB Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumonia infections", FEMS Microbiol Rev, 32, pp.956~973 (2008)
- 최명현, "한국인에서 면역글로불린-저항성 가와사키병 환자의 예측", Pediatric Infection and Vaccine, 21(1), pp.29~36 (2014), 대한소아감염학회
- 김성구, "가와사끼병에서 정맥용 면역글로불린 치료 반응 예측의 한계", Pediatric Infection and Vaccine, 17(2), pp.169~176 (2010), 대한소아감염학회
- 윤유숙, "Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study", Infection and Chemotherapy, 46(4), pp.239~247 (2014), 대한감염학회[DOI]
- Csángó PA, "Comparison of four Mycoplasma pneumonia IgM-, IgG- and IgA specific enzyme immunoassays in blood donors and patients", Clin Microbiol Infect, 10, pp.1094~1098 (2004)
- Waris ME, "Diagnosis of Mycoplasma pneumoniae pneumonia in children", J Clin Microbiol, 36, pp.3155~3159 (1998)