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Int J Clin Exp Pathol 2012;5(8):814-823

Original Article
Pathogenic characterization of a cervical lymph node derived from a patient with
Kawasaki disease

Harutaka Katano, Seiichi Sato, Tsuyoshi Sekizuka, Akiko Kinumaki, Hitomi Fukumoto, Yuko Sato, Hideki Hasegawa, Shigeru Morikawa,
Masayuki Saijo, Tetsuya Mizutani, Makoto Kuroda

Department of Pathology, Laboratory of Bacterial Genomics, Pathogen Genomics Center, Department of Veterinary Science, and 6Virology 1,
National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640; Division of Pediatrics and Neonatal Care Center,
Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197; Department of Pediatrics, Graduate School of Medicine, The
University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan

Received August 22, 2012; Accepted September 10, 2012; Epub October 1, 2012; Published October 15, 2012

Abstract: Kawasaki disease (KD) is the most common cause of multisystem vasculitis in childhood. Although cervical lymphadenitis is one of
the major symptoms in KD, lymph node biopsy is rarely performed, because KD is usually diagnosed by clinical symptoms. A cervical lymph
node biopsy was taken from a girl aged 1 year and 8 months who had suspected lymphoma, but she was diagnosed with KD after the biopsy.
The cervical lymph node specimen was analyzed with multivirus real-time PCR that can detect >160 viruses, and unbiased direct sequencing
with a next-generation DNA sequencer to detect potential pathogens in the lymph node. Histologically, focal necrosis with inflammatory cell
infiltration, including neutrophils and macrophages, was observed in the marginal zone of the cervical lymph node, which was compatible with
the acute phase of KD. Multivirus real-time PCR detected a low copy number of torque teno virus in the sample. Comprehensive direct
sequencing of the cervical lymph node biopsy sample sequenced more than 8 million and 3 million reads from DNA and RNA samples,
respectively. Bacterial genomes were detected in 0.03% and 1.79% of all reads in DNA and RNA samples, respectively. Although many reads
corresponded to genomes of bacterial environmental microorganisms, Streptococcus spp. genome was detected in both DNA (77 reads) and
RNA (2,925 reads) samples. Further studies are required to reveal any association of microbial or viral infection with the pathogenesis of KD.

Keywords: Kawasaki disease, lymph node, next-generation sequencer, multivirus real-time PCR, torque teno virus, streptococcus

Address all correspondence to:
Dr. Harutaka Katano, Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
Tel: +81-3-5285-1111. ext. 2627; Fax: +81-3-5285-1189; E-mail: katano@nih.go.jp