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DEMONSTRATION OF CHLAMYDIA PNEUMONIAE IN CARDIOVASCULAR TISSUES FROM CHILDREN WITH KAWASAKI DISEASE

1999; Lippincott Williams & Wilkins; Volume: 18; Issue: 1 Linguagem: Inglês

10.1097/00006454-199901000-00020

1532-0987

Erik Normann, J Nääs, Judy Gnarpe, Hans Bäckman, H Gnarpe,

Reproductive tract infections research

Kawasaki disease (KD) is an acute systemic vasculitis of childhood.1 The etiology and much of the pathogenesis are unknown. Epidemiologic evidence suggests an infectious cause. Recently Rowley et al.2 described an IgA-driven immune response in KD, suggesting an etiologic agent with a respiratory or gastrointestinal portal of entry. The diagnosis is made from clinical criteria including fever for at least 5 days, polymorphous rash, conjunctival injection, lesions of the mouth, cervical lymphadenopathy and swelling or desquamation of the hands and feet. In more severe cases KD patients may develop aneurysms, particularly in the coronary arteries. Observation. In 1971 a 3-year-old boy died from rupture of a coronary artery aneurysm during the acute phase of KD. In stored paraffin sections from the heart of this patient, Chlamydia pneumoniae was demonstrated by immunohistochemistry with the use of a C. pneumoniae-specific monoclonal antibody. In 1977 another boy age 11 died 2 1/2 years after diagnosis of KD. The autopsy revealed an occluding thrombosis in an aneurysm of a coronary artery. C. pneumoniae could be demonstrated in stored paraffin sections of the cardiac muscle, the spleen, the lung and the coronary aneurysm by immunohistochemistry. All children recently diagnosed with KD at our department have survived. From the most recent child an acute serum specimen was analyzed. The patient was 8 year old and demonstrated specific C. pneumoniae antibodies: IgG = 1/1024 and IgA = 1/512. This patient had treatment with immunoglobulins before specimen collection; therefore the IgG titer may not be relevant. Methods. The immunohistochemical procedure was based on an avidin-biotin-peroxidase method, StreptABComplex/HRP Duet Kit® (DAKO A/S, Glöstrup, Denmark), used on tissues labeled with a mouse monoclonal anti-C. pneumoniae antibody (gift of Dr. Kenneth Persson, Malmö, Sweden). For negative controls of the specificity of the staining procedure, duplicate sections were processed by the same procedure for staining, only omitting the monoclonal antibody. All control specimens were negative. The method used for serology, the microimmunofluorescence test, has been described earlier.3 Comment.C. pneumoniae is a common cause of respiratory tract infections4 and is commonly found in children as detected by PCR from throat specimens.3 The organism is emerging as a possible etiologic factor for the development of cardiovascular diseases in adults5, 6 (e.g. arteriosclerosis, aneurysm formation and myocarditis) but has not been demonstrated in coronary arteries of healthy young adults by immunohistochemistry7 and has not been detected in vascular tissues from children younger than 15 years of age by PCR.8 This is the first report about the demonstration of C. pneumoniae in cardiovascular tissues from children with KD. An appropriate control material was not available for examination and the association between KD and C. pneumoniae remains to be proved. The presence of specific IgA antibodies for C. pneumoniae in serum from another child with KD is remarkable because IgA antibodies to C. pneumoniae are found only rarely in children and may support an association. Erik Normann, M.D. Jessica Nääs, B.Sc. Judy Gnarpe, Ph.D. Hans Bäckman, M.D. Håkan Gnarpe, Ph.D. Departments of Pediatrics (EN, HB) and Clinical Microbiology (JN, JG, HG); Gävle Central Hospital; Gävle, Sweden