The pathogenesis of Kawasaki disease and superantigens

Kawasaki disease (KD) is an acute febrile illness in infants and children with systemic clinical symptoms, including coronary artery aneurysms. Findings seen in KD patients such as infiltration of T cells into vascular lesions, elevation of soluble interleukin 2 receptors in serum, an imbalance of T cell subsets, and transient depletion of T cells with CD11/CD18 suggest that the activation of T cells is involved in the pathogenesis of KD. In 1992, an interesting mechanism was proposed in which T cell activation by a certain superantigen is involved in the pathogenesis of KD. Examinations have been undertaken extensively to confirm the proposed hypothesis. We, however, still do not have reliable evidence supporting the above hypothesis. In the present paper we review the research papers which support or rule out the view described above. In addition, we discuss the relation between KD and systemic Yersinia pseudotuberculosis infection that manifests clinical symptoms quite similar to those in KD.