Korean J Pediatr.  2019 Jun;62(6):235-239. 10.3345/kjp.2018.06989.

High antistreptolysin O titer is associated with coronary artery lesions in patients with Kawasaki disease

• Min DE
• Kim DH
• Han MY
• Cha SH
• Yoon KL

• KMID: 2452035
• DOI: http://doi.org/10.3345/kjp.2018.06989

Abstract

PURPOSE
In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions.
METHODS
A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017.
RESULTS
Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group.
CONCLUSION
It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.

Keyword

Antistreptolysin; Kawasaki disease; Coronary disease; Streptococcal infections

MeSH Terms

Antistreptolysin*
Coronary Disease
Coronary Vessels*
Follow-Up Studies
Humans
Immunoglobulins
Incidence
Mucocutaneous Lymph Node Syndrome*
Prognosis
Retrospective Studies
Streptococcal Infections
Antistreptolysin
Immunoglobulins