Acute-phase coronary artery dilations were defined as those that normalized within 1month and CS were defined as those remaining after 1month [15]. == RAISE study group == The treatment strategy was changed during the study period. were positive for anti-YPT and/or anti-YPM antibodies (positive group) and 97 (90 %) were unfavorable (unfavorable group). Cardiac sequelae (CS) occurred significantly more frequently in the positive than the unfavorable group (two patients, 18 % vs one patient, 1 %,p= 0.027). Forty patients were in the RAISE group. Two of 40 (5 %) in the RAISE group and one of 68 (1.47 %) in the conventional group had CS (p= 0.55). == Conclusions == KD patients with YPT contamination had CS significantly more frequently and treatment with RAISE protocol did not decrease the frequency of CS in our cohort, nor did YPT infection affect risk scores of no response to IVIG. However, our sample size was overly small to draw such conclusions. Further investigation in a larger cohort is necessary to confirm our findings. Additionally, further research is needed to determine whether early diagnosis of YPT can prevent KD from developing and reduce the incidence of CS. == Background == Kawasaki disease (KD), a febrile vasculitis of unknown origin, can cause coronary artery dilation and is increasing in incidence worldwide [13]. Identification of the cause and optimal treatment is usually urgently needed. Yersinia pseudotuberculosis(YPT), an enteric pathogen, causes a variety of clinical symptoms such as fever, rash, desquamation, strawberry tongue, lymphadenopathy, and conjunctivitis that sometimes satisfy the clinical criteria for KD. Some research groups have reported an association between YPT and KD [47]. YPT is commonly typed serologically according to antigenic differences in the lipopolysaccharide O antigen. There are 15 serogroups; serotypes O:1 and O:2 have subtypes a, b, and c, and serotypes O:4 and O:5 have subtypes a and b. Thus, there are 21 Biotinyl Cystamine serotypes in all [8,9]. Serotypes O:1a, O:1b, O:2a, O:2b, O:2c, O:3, O:4b, O:5a, O:5b, O:6, O:10, and O:15 are known to be pathogenic for humans [10]. The pathogenicity of YPT is determined by a number of virulence factors, including a plasmid associated withYersiniavirulence, a high-pathogenicity island, and aY. pseudotuberculosis-derived mitogen (YPM) [1113]. Among these virulence factors, YPM is usually a superantigen that activates macrophages and T cells and causes symptoms such as high fever and erythema [14]. So far, few reports concerning the relationship between KD and YPT contamination are available. The present study was designed to determine how often KD patients have associated YPT contamination by assessing anti-YPT and anti-YPM antibody titers Mouse monoclonal to BLK and to identify clinical differences between KD patients with and without YPT contamination. Additionally, about 40 % of KD patients in our cohort were treated with the RAISE (Randomized controlled trial to Assess Immunoglobulin plus Steroid Efficacy for Kawasaki disease) study protocol [15]. Clinical characteristics of patients treated with the RAISE protocol and the conventional IVIG (IntraVenous ImmunoGlobulin) protocol were compared to assess the effects of the RAISE study treatment strategy in patients with KD and the influence of YPT contamination on treatment outcomes. == Methods == == Study patient definitions and design == With approval of the Japanese Red Cross Society Himeji Hospital ethics committee, all KD patients hospitalized from April 2013 to March 2014 in the Japanese Red Cross Society Himeji Hospital were prospectively included in this study. Written informed consent for not only participating in this study but also to publish the patient data and information was obtained from all parents or guardians. Patients whose guardians Biotinyl Cystamine refused consent or for whom blood samples for detection of anti-YPT and YPM antibodies were not available were excluded. Acute- and convalescent-phase sera were obtained from participants, who were then divided into two groups: a positive group (positive anti-YPT and/or positive anti-YPM antibody titers) and a negative group (both anti-YPT and anti-YPM antibody titers unfavorable). The following clinical data were recorded and compared between the two groups: sex, age, duration of fever in days, frequency of administration of high-dose IVIG, acute-phase coronary artery dilation, cardiac sequelae (CS), abdominal symptoms, white blood cell and absolute neutrophil counts, serum concentrations of albumin, total bilirubin, aspartate Biotinyl Cystamine aminotransferase, sodium, C-reactive protein (CRP), procalcitonin, N-terminal pro-brain natriuretic peptide, and soluble interleukin-2 receptor, and urinary 2-microglobulin/creatinine ratio. == Measurement of anti-YPT antibody and anti-YPM antibody == To identify and quantitate anti-YPT.