A Study on the Association between Kawasaki Disease and <i>Mycoplasma pneumoniae </i>Infection


  • Yeol Ryoon Woo Department of Pediatrics, Bundang Jesaeng General Hospital
  • Hyun Jin Kim Department of Pediatrics, Bundang Jesaeng General Hospital
  • Min Ah Cha Department of Pediatrics, Bundang Jesaeng General Hospital
  • Jong Woon Choi Department of Pediatrics, Bundang Jesaeng General Hospital


Kawasaki disease, Mycoplasma pneumonia, Antibody, Infection


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.


Rauch AM, “Kawasaki syndrome: review of new epidemiologic and laboratory developmentsâ€, 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 Koreaâ€, 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 Statesâ€, 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 Coloradoâ€,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 diseaseâ€, 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 antibodyâ€, J Infect Dis,vol.190, no. 4, pp.856-65, 2004.

Waites KB, “New concepts of Mycoplasma pneumoniae infections in childrenâ€,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 diseaseâ€, 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 pneumoniaâ€, 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 Diseaseâ€, 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 associationâ€, Open J Pediatr, vol.2, no.3, pp. 250-2, 2012.

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

Leen C, Ling S,“Mycoplasma infection and Kawasaki diseaseâ€, 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 diseaseâ€, 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 reportâ€. 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 Associationâ€, 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 infectionâ€, 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 diseaseâ€,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 aureusâ€, 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 diseaseâ€, 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 infectionâ€,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 syndromeâ€, Lancet ,vol.2, no.7819, pp.42, 1973.

Shulman S, Rowley A, “Does Kawasaki disease have a retroviral etiology?â€,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 diseaseâ€, 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 diseaseâ€, 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 diseasesâ€,MicrobiolImmunol, vol.38, no. 4, pp.245-56, 1994.

Uchiyama T, Kato H, “The pathogenesis of Kawasaki diseaseand superantigensâ€,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]â€, The 15th International Kawasaki Disease Symposium; 2015 Feb 3-6; Honolulu, Hawaii. Dallas, Texas: National Center; pp. 98-9, 2015.




How to Cite

Woo, Y. R., Kim, H. J., Cha, M. A., & Choi, J. W. (2016). A Study on the Association between Kawasaki Disease and <i>Mycoplasma pneumoniae </i>Infection. Asian Journal of Pharmacy, Nursing and Medical Sciences, 4(3). Retrieved from https://ajouronline.com/index.php/AJPNMS/article/view/3793