Luis Adrián Rosales Hernández

Background: Before the COVID-19 pandemic, the higher prevalence of gastrointestinal symptoms, severe inflammatory response, and cardiac failure in patients with Kawasaki Disease Shock Syndrome (KDSS) lets us hypothesize that KDSS is triggered by superantigens produced by bacteria that colonize the gastrointestinal tract and activate TCRVβ2+ and TCRVβ8+ cells, leading to a massive proinflammatory stage and cardiovascular instability. Methods: This is a case–control study in patients with KDSS (cases, 8 patients) or with Kawasaki disease (KD; controls, 71 patients), in the acute phase before intravenous immunoglobulin (IVIG) treatment, from the National Institute of Pediatrics, Mexico City, from 2016 to 2019. Clinical and laboratory data were obtained with quantification of TCRVβ2+ and TCRVβ8+ T cells by flow cytometry. Superantigen-associated gene-positive bacterial isolates from stool cultures were obtained by final point-PCR assay. Statistical analysis was done with one-way ANOVA and Welch’s post hoc test, Chi-square test and odds ratio (OR). Statistical significance was defined as p < 0.05. Results: The peripheral proportion of CD4+TCRVβ2+ T cells was lower in the KDSS group than in the KD group, whereas the CD25-positive T-cell subsets showed no statistically significant differences between groups. Significant associations between staphylococcus enterotoxin A (SEA)/KDSS [OR = 23.3, CI95% = 1.8–296.2, p = 0.014] and superantigen/coronary aneurysms (p < 0.001) were found. Conclusions: These results suggest that SEA produced by bacteria that colonize the gastrointestinal tract and cross the intestinal barrier may activate CD3+/CD4+/TCRVβ2+ T cells, as a trigger of shock in a group of patients with KD. Also, each subtype of KD could have different etiologies explaining the inconsistencies in the detection of superantigens in patients with KD.

Brucella melitensis is the main cause of human brucellosis worldwide and is considered the most virulent and neurotropic species. In Mexico, this species is considered endemic, being reported since the first decade of the 20th century. Here we present a case of subacute transverse myelitis with the isolation and identification of B. melitensis as the causative agent of Neurobrucellosis in a female patient from the coastal state of Guerrero, Mexico.

Kawasaki disease (KD) has features that appear supporting an infectious cause with a secondary deranged inflammatory/autoimmune response. The association of KD in adults with human immunodeficiency virus infection and the presence of KD in patients with immunodeficiency disorders support the infectious theory. We present four KD patients associated with immunodeficiencies: one with X-linked agammaglobulinemia, one with HIV infection, and two with leukemia; one of these patients also had Down syndrome. We did a literature search to find out all reported cases of immunodeficiency with KD in children. In immunodeficiency disorders, the inability of the immune system to eradicate the pathogens coupled to an exaggerated inflammatory response, especially in chronic granulomatous disease, may lead to the development of KD. The study of patients with immunodeficiencies complicated with KD may shed light into the etiopathogenesis of the disease.