Staphylococcus aureus isolates from patients with Kawasaki disease expresshigh levels of protein A

Kawasaki disease (KD) is an acute vasculitis of young children that can be complicated by coronary artery abnormalities. Recent findings suggest that a superantigen(s) may play an important role in stimulating the immune acti vation associated with the disease, although the origin of this superantige n(s) is unclear. Staphylococcus aureus, isolated from the rectum or pharynx of patients with KD, secretes toxic shock syndrome toxin 1 (TSST-1), The K D isolates express low levels of other exoproteins compared to isolates fro m patients with toxic shock syndrome (TSS). Thus, it was previously suggest ed that the KD isolates may be defective in the global regulatory locus agr (for accessory gene regulator), which positively regulates these factors ( D. Y. M, Leung et al., Lancet 342:1385-1388, 1993), Here we describe anothe r characteristic of KD isolates. When considered collectively, the KD isola tes were found to express higher levels of staphylococcal protein A than th e TSS isolates, another characteristic of an agr-defective phenotype. This correlated with a higher level of spa mRNA in these isolates. In contrast, the KD and TSS isolates expressed comparable levels of TSST-1, consistent w ith previous findings (D. Y. M. Leung et al., Lancer 342:1385-1388, 1993). Analysis of RNAIII transcript levels and nucleotide sequence analysis of th e RNAIII-coding region suggested that the KD isolates are not defective in RNAIII, the effector molecule of the agr regulatory system. However, induct ion of RNAIII transcription in the KD isolates did not result in a dramatic decrease in the amount of spa mRNA, as has been reported for other strains (F. Vandenesch, J. Kornblum, and R. P. Novick, J. Bacteriol. 173:6313-6320 , 1991).