Should KD patients be screened for Yersinia infection?

Routine screening for Yersinia infection is not recommended for patients with Kawasaki disease (KD), suggests a recent study.

This procedure must be “limited to patients in high-risk areas and those who are refractory to the standard KD treatment,” according to the investigators.

This prospective, multicentre study described the clinical characteristics and prevalence of Yersinia infection presenting with KD-like symptoms. Patients who received a KD diagnosis between January 2021 and January 2022 at two hospitals in Tokyo, Japan, were included.

The investigators then collected stool samples within 3 days of the start of KD treatment and performed cultures for Yersinia. They evaluated the clinical history and symptoms suggestive of Yersinia infection.

A total of 141 patients with KD were screened, and 117 with evaluable stool samples were registered. Of these, only one tested positive for Yersinia pseudotuberculosis, which was detected from both stool and blood cultures. This patient exhibited resistance to KD treatment but eventually improved following initiation of the appropriate antibiotic therapy.

“Yersinia infection is known to present with KD-like symptoms, although differentiating the two has been a challenge,” the investigators said.

According to a recent study, KD is an acute systemic vasculitis that has no clear aetiology. Some children exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or infected by Yersinia develop symptoms of KD. [Clin Transl Immunology 2021;10:e1284]

“These microbes provoke a rapid cell-damaging process, called 'pyroptosis', which is characterized by a subsequent release of proinflammatory cellular components from damaged endothelial and innate immune cells,” the authors said.