Comparison of clinical severity between single- and coinfections of respiratory syncytial virus and influenza virus with common respiratory viruses

PURPOSE: Multiple virus infections may affect clinical severity. We investigated the effect of coinfection of respiratory syncytial virus (RSV) and influenza virus with other respiratory viruses on clinical severity. METHODS: Data from 634 samples of a single tertiary hospital between September 2014 and April 2015 were analyzed for clinical characteristics (fever duration and O2 need, steroid use, and ICU care) between single infection and coinfection of RSV (n=290) and influenza virus (n=74) with 16 common respiratory viruses from hospitalized children. RESULTS: The RSV coinfection group (n=109) (3.1±2.7 days) showed significantly longer fever duration than the RSV single infection group (n=181) (2.6±2.6 days) (P=0.04), while there was no difference in O2 need, steroid use or ICU care in the 2 groups. The influenza coinfection group (n=38) showed significantly higher O2 need than the influenza single infection group (n=36) (21.1% vs. 5.6%, P=0.05), while there was no difference in fever duration between the 2 groups. CONCLUSION: The results indicate that RSV and Influenza coinfections can increase clinical severity and that the severity may be influenced by the nature of coinfecting viruses.

Related factors for and changes in clinical manifestations in mycoplasma pneumonia nonresponsive to macrolide treatment

PURPOSE: Mycoplasma pneumonia is known to be a major cause of community-acquired pneumonia in children. Macrolide has been the first-line treatment for mycoplasma pneumonia, but recently there has been an increasing tendency of macrolide-resistant Mycoplasma pneumoniae (MRMP). Therefore, this study aimed to investigate the clinical tendency and the therapeutic responsibility of mycoplasma pneumonia in terms of the fever duration after treatment and its associated factors. METHODS: A total of 346 children admitted with mycoplasma pneumonia during 3 recent periods (2008–2009, 2011–2012, and 2015–2016) were investigated with clinical manifestations, laboratory test results and chest x-ray findings. Patients were grouped according to fever duration and analyzed for differences in clinical features. RESULTS: There was no statistically significant difference in age or sex between the 3 periods (P=0.284 and P=0.559, respectively). Total fever duration during mycoplasma pneumonia was increased with time (P for trend < 0.001). The patients with a longer fever duration (≥3 days) after macrolide treatment presented with a higher CRP (P < 0.001) and with lobar-type pneumonia (P=0.020) compared to those with a shorter fever duration. Fever duration after steroid treatment became longer in the longer fever group in 2011 (P=0.015) and 2015 (P < 0.001), but not in 2008 (P=0.536). CONCLUSION: This study showed that the therapeutic effect of macrolide or steroid for mycoplasma pneumonia is recently attenuating and that high CRP, lobar-type pneumonia and presence of pleural effusion were the associated factors. Therefore, efforts to decrease MRMP and to develop better treatment guidelines for mycoplasma pneumonia are needed in the future.

Is vaginal reflux associated with urinary tract infection in female children under the age of 36 months? / 소아과

PURPOSE: To determine the relationship between vaginal reflux (VR) and urinary tract infection (UTI) in female children aged < 36 months. METHODS: A single center retrospective study was performed for 191 girls aged < 36 months, with a diagnosis of febrile UTI, who underwent a voiding cystourethrography (VCUG) for assessment of vesicoureteral reflux (VUR) at Sanggye Paik Hospital. Fifty-one girls, who underwent VCUG for assessment of congenital hydronephrosis or renal pelvis dilatation, without a UTI, formed the control group. The correlation between the presence and grade of VR and UTI was evaluated. RESULTS: The prevalence rate of VR was higher in the UTI (42.9%) than control (13.7%) group (P < 0.05), with a higher VR severity grade in the UTI (mean, 0.64) than control (mean, 0.18) group (P < 0.05). On subanalysis with age-matching (UTI group: n=126, age, 5.28±2.13 months; control group: n=22, age, 4.79±2.40 months; P=0.33), both VR prevalence (43.65% vs. 18.18%, P < 0.05) and grade (0.65 vs. 0.22, P < 0.05) remained higher in the UTI than control group. Presence and higher grade of VR were associated with UTI recurrence (P < 0.05). VR was correlated to urosepsis (P < 0.05). The renal defect rate of patients with VR (VR [+]/VUR [+]) was not different from that of patients without VR (74% vs. 52%, P=0.143) in the VUR group; however, it was higher than that of VR (+)/VUR (−) patients (74% vs. 32%, P=0.001). If a child with VR (+)/VUR (+) is exposed to a UTI, the risk of renal defect increases. CONCLUSION: Occurrence of VR is associated with UTI recurrence and urosepsis in pediatric female patients.

Comparison between Patients with Persistent Pulmonary Hypertension of Neonates Concomitant with Parenchymal Lung Disease and Idiopathic Persistent Pulmonary Hypertension of Neonates

PURPOSE: We aimed to compare the clinical characteristics between neonates with persistent pulmonary hypertension of neonates (PPHN) with parenchymal lung disease (PLD) and those with idiopathic PPHN. METHODS: We reviewed the medical records of 67 neonates with gestational ages not lesser than 34⁺⁰ weeks who were born at Inje University Sanggye Paik Hospital between June 1, 2005 and December 31, 2016. We excluded 10 neonates who presented with congenital anomalies (n=3), dextrocardia (n=1), triple X syndrome (n=1), death before treatment (n=1), neonatal asphyxia (n=2), and congenital diaphragmatic hernia (n=2). Neonates were categorized into 2 groups—PPHN with PLD (PLD group, those diagnosed with PLD such as respiratory distress syndrome or meconium aspiration syndrome, n=36) and idiopathic PPHN (idiopathic group, n=21). We compared the clinical characteristics, treatment, and laboratory findings between the groups. RESULTS: The PLD group neonates showed a greater requirement for positive pressure ventilation in the delivery room, higher frequency of meconium staining of amniotic fluid, and greater need for surfactant application than those belonging to the idiopathic group. In contrast, epinephrine use was more common in the idiopathic PPHN group than in the PLD group. The 1-minute Apgar score and pH observed on initial capillary blood gas analysis were lower in the PLD than in the idiopathic group. Severity scores were higher in the idiopathic than in the PLD group 4–7 days after birth. CONCLUSION: In our study, an overall simplified severity score in the first week after birth was higher in the idiopathic than in the PLD group. These results were particularly statistically significant over postnatal days 4–7.