Usefulness of Short-term Follow-up Enzyme Immunoassay in Mycoplasma pneumoniae Infection / 소아알레르기및호흡기학회지

PURPOSE: The diagnosis of Mycoplasma pneumoniae (M. pneumoniae) infection is usually based on serology using complement fixation assay (CFA), particle agglutination test (PA), enzyme immunoassay (EIA) and polymerase chain reaction (PCR). The objective of this study is to compare the performance of EIA and PCR in diagnosis of M. pneumoniae infection. We also evaluated the usefulness of EIA which were checked on short-term follow-up (3-5 days). METHODS: We included 234 pneumonia children. We used serum specimens for EIA test, which were obtained on admission and 3-5 days after admission. We collected throat swabs or sputums for PCR test, which were obtained on admission or next morning after admission. RESULTS: Of 234 patients, 124 (53.0%) met the diagnostic criteria. The median age was 6 years (from 10 months to 12 years). On admission, the sensitivity and specificity of EIA-specific IgM were 46.1% and 72.8%, respectively. The rate of agreement between PCR and EIA was 64.1%.(kappa=0.187, P=0.004) On 3-5 days after admission, the sensitivity and specificity rates of EIA specific IgM were 85.5%, 69.6%, respectively. The rate of agreement between PCR and EIA was 74.8%.(kappa=0.490, P=0.000) Days after onset had no relation with sensitivity of EIA.(P>0.05) The sensitivity and specificity rates of PCR were 57.5% and 90.0%, respectively. CONCLUSION: This study suggests that PCR and EIA may be the useful diagnostic methods for detecting early phase of M. pneumoniae infection. And EIAs which checked on short-term follow up is also useful. PCR has shown a higher specificity but lower sensitivity. Therefore, PCR must be performed with serologic tests.

The Investigation of Hypoproteinemia in Severe Infantile Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to understand the clinical features and to analyze the risk factors for a severe complication such as hypoproteinemia in infants with severe atopic dermatitis. METHODS: Twenty-four infants with severe atopic dermatitis with SCORAD score >50 were enrolled, who visited pediatric allergy clinic between January 2005 and December 2007. Infants with blood protein level of 5 g/dL as Group B (n=16). Age, sex, onset age, breast feeding, marternal protein-restriction diet during breast feeding, family history of allergy, and prior treatment before visit were studied. We examined serum ECP, total IgE, and allergen specific IgE by immuno CAP system (Phadia AB, Uppsala, Sweden) and tried to identify organisms by the culture of skin wound. Infants with blood protein level of 5 g/dL as Group B (n=16). We also analyzed the risk factors for hypoproteinemia. RESULTS: Blood protein level was inversely correlated with total IgE (r=-0.610), SCORAD score (r=-0.686) and the number of sensitized allergens (r=-0.636). The sentisization of the house dust mite was also one of the risk factors for hypoproteinemia. CONCLUSION: Our study suggests that the risk factors for hypoproteinemia in infantile atopic dermatitis are high SCORAD score and the sentisization of the house dust mite and that hypoproteinemia associates with high serum levels of IgE and increased number of food sensitized allergens.

Liver Abscess Associated with Maternal Perinatal Infection in a Premature Infant

Neonatal liver abscesses are rare, carry a high mortality rate, and are difficult to diagnose. The diagnosis of liver abscesses in the neonate cannot be established from the clinical presentation alone. Risk factors for liver abscesses in neonates are maternal infection, sepsis, umbilical venous catheterization, omphalitis, and necrotizing enterocolitis. In this report, we describe a preterm infant (32 weeks, 1,580 g) who presented with abdominal distension, respiratory difficulties, and a persistent inflammatory response in spite of broad spectrum antibiotic treatment; a large (6x5 cm) solitary pyogenic liver abscess was identified at 9 days of age. It appeared that the liver abscess had originated in the uterus and umbilical venous catheterization facilitated its spread. Percutaneous drainage under abdominal ultrasound guidance was performed and prolonged antibiotics were treated for 5 weeks, effecting a cure.