Antibody Status in Children with Steroid-Sensitive Nephrotic Syndrome

PURPOSE: The pathophysiology of hypogammaglobulinemia in nephrotic syndrome (NS) remains unknown. We evaluated the differences in the distribution of anti-bacterial antibodies and anti-viral antibodies, and those of immune antibodies and natural antibodies in steroid-sensitive NS. MATERIALS AND METHODS: We examined the antibody status of 18 children who had routine vaccinations. The levels of immnunoglobulin G (IgG), the IgG subclasses, and the antibodies induced by vaccinations such as diphtheria-pertussis-tetanus and measles-mumpsrubella were analyzed in children with steroid-sensitive NS. RESULTS: There was a positive correlation between the albumin and IgG values (r = 0.6, p < 0.01), and the four IgG subclasses were all evenly depressed in the nephrotic children during the acute stage of the disease. The antibodies induced by bacterial antigens were depressed and the seropositivity of anti-viral antibodies tended to be lower than those of age-matched control children during the acute stage. The depressed immune antibody status recovered rapidly in the remission stage of NS, despite corticosteroid treatment. CONCLUSIONS: IgG levels correlated positively with albumin levels, and all antibodies, including immune and natural antibodies, were depressed in the acute stage of NS. Our results suggest that hypogammaglobulinaemia in NS may be associated with intravascular homeostasis of oncotic pressure.

Corticosteroid Treatment in Siblings Affected with Severe Mycoplasma pneumoniae Pneumonia

Numerous evidences support the pathogenesis that M. pneumoniae pneumonia is associated with cell-mediated immune reaction. We report 2 cases of severe M. pneumoniae pneumonia in previously healthy sisters, who were both admitted during an epidemic of M.pneumoniae pneumonia. The elder sister, who was 16 years old, was admitted with M. pneumoniae pneumonia. She showed no response to treatment with clarithromycin and levofloxacin, and eventually progressed to severe ARDS, requiring mechanical ventilation. After treatment with hydrocortisone (200 mg/day), there were rapid improvements in clinical manifestations and chest radiographic findings. The younger sister, who was 14 years old, was admitted 10 days later, presenting with fever but no pneumonic lesions on chest radiograph. Just like her sister, the infection showed no response to clarithromycin. Fever persisted and pneumonic consolidation with mild pleural effusion was noticed in the left lower lobe on the 5th hospital-day. After treatment with oral prednisolone (1 mg/kg), she showed rapid defervescence and on the 8th hospital day, no pneumonic lesions were detectable on chest radiograph. Given the fact that the pathogenesis of pneumonia and extrapulmonary manifestations in M. pneumoniae infection is immune-mediated, an immunosuppressive therapy would be validated for selected patients with M. pneumoniae infections.

Corticosteroid Treatment in Siblings Affected with Severe Mycoplasma pneumoniae Pneumonia

Numerous evidences support the pathogenesis that M. pneumoniae pneumonia is associated with cell-mediated immune reaction. We report 2 cases of severe M. pneumoniae pneumonia in previously healthy sisters, who were both admitted during an epidemic of M.pneumoniae pneumonia. The elder sister, who was 16 years old, was admitted with M. pneumoniae pneumonia. She showed no response to treatment with clarithromycin and levofloxacin, and eventually progressed to severe ARDS, requiring mechanical ventilation. After treatment with hydrocortisone (200 mg/day), there were rapid improvements in clinical manifestations and chest radiographic findings. The younger sister, who was 14 years old, was admitted 10 days later, presenting with fever but no pneumonic lesions on chest radiograph. Just like her sister, the infection showed no response to clarithromycin. Fever persisted and pneumonic consolidation with mild pleural effusion was noticed in the left lower lobe on the 5th hospital-day. After treatment with oral prednisolone (1 mg/kg), she showed rapid defervescence and on the 8th hospital day, no pneumonic lesions were detectable on chest radiograph. Given the fact that the pathogenesis of pneumonia and extrapulmonary manifestations in M. pneumoniae infection is immune-mediated, an immunosuppressive therapy would be validated for selected patients with M. pneumoniae infections.

A case of congenital syphilis mistaken for possible child abuse / 소아과

We describe the case of a 4-month-old male infant diagnosed with early congenital syphilis during evaluation of a left distal humerus fracture. This report emphasizes the importance of screening for syphilis among pregnant women and newborns, and is a reminder of the continued existence of congenital syphilis.

Comparison of Diagnostic Methods and the Changes of IgG Subclasses in Children with Mycoplasma pneumoniae pneumonia / 소아알레르기및호흡기학회지

PURPOSE: This study aimed to investigate the positive rate of 3 serologic methods and polymerase chain reaction (PCR) and the changes of IgG and IgG subclasses in children with Mycoplasma pneumoniae pneumonia (MP). METHODS: Fifty children with pneumonia admitted to Daejeon St. Mary's Hospital, Korea, during MP outbreaks were evaluated for the diagnostic antibody status using 3 serologic methods: indirect micro-particle agglutinin assay (MAA, Serodia-Myco II, Fujirebio, Tokyo, Japan), cold agglutinins and enzyme-linked immunoassay (EIA, Platelia M. pneumoniae IgM & IgG BIO-RAD, Marnes-la-Coquette, France) and PCR. The levels of antibody for MP in each method were measured 2 times during hospitalization: at presentation and at discharge (mean interval, 6.5 days). The levels of IgG and IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were also analyzed 2 times (at presentation and at discharge) using stored sera. RESULTS: At presentation, the positive rates of the diagnostic methods were 52%, 38%, 30% and 12% for MAA, cold agglutinins, EIA and PCR assay, respectively. Following analysis of the repetitive measurement of the antibody, the positive rates of the diagnostic methods were 76%, 60% and 56% for MAA, cold agglutinins and EIA, respectively. The mean IgG level of MP patients increased during hospitalization (973+/-184 vs. 1,040+/-205 mg/dL; P=0.008). Among the IgG subclasses, the levels of IgG1 and IgG3 showed a significant increase during hospitalization (553+/-129 vs. 611+/-151 mg/dL, P=0.003 for IgG1; 43+/-27 vs. 47+/-30 mg/dL, P=0.005 for IgG3). CONCLUSION: For the accurate and relatively rapid diagnosis of MP, a paired sample examination is mandatory, especially within a short-time period. The sensitivity of serologic tests for the diagnosis of MP may differ among commercially available kits. IgG1 and IgG3 appear to be the main IgG subclasses that show an increase after MP infection.

The Change of Immunologic Parameters in Acute Poststreptococcal Glomerulonephritis

PURPOSE: This study was aimed to evaluate the changes of immunologic parameters during hospitalization, and the relationship between IgG and other laboratory or clinical indices in patients with acute poststreptococcal glomerulonephritis (APSGN). METHODS: We reviewed the medical charts of 36 children with APSGN who showed ASO titer >250 Todd U/L and C3125 mmHg), gross hematuria, and weight gain were observed in 27.8% (10/36), 80.1% (29/36), and 80% (24/30) of the patients, respectively. The mean IgG level was 1,432+/-322 mg/dL (1,025+/-234 mg/dL in control group, P8 years of age (15 cases) (-0.6% vs. -5.7%, P=0.01). The IgG and ASO levels did not change, but C3 (P=0.001) and IgM (P=0.02) levels increased during admission. CONCLUSION: Increased IgG and ASO levels in APSGN did not change, but C3 level increased during admission. IgG level was not correlated with other laboratory parameters (ASO and C3) and the severity of the disease. Younger children seem to have less severe clinical course compare to older children. With our hypothetic pathogenesis of APSGN, further studies are needed to resolve the pathogenesis of the disease including the increase of IgG.

Clinico-epidemiologic Study of Nosocomial Rotaviral Gastroenteritis, 2001-2005 / 소아감염

PURPOSE: This study was performed to determine the clinical and epidemiologic characteristics of nosocomial rotavirus gastroenteritis. METHODS: We retrospectively analyzed 628 medical records of patients with rotavirus gastroenteritis between 2001 and 2005. The patients were divided into two groups (the community-acquired group [528 cases] and the nosocomial group [100 cases]. The epidemiologic and clinical indices between the groups were analysed. For clinical comparison, 100 age- matched cases were selected from the community-acquired group. RESULTS: The male-to-female ratio was similar (1.4:1 vs. 1.5:1), but the mean age was lower in the nosocomial group compared to the community-acquired group (21.9+/-15.5 months vs. 16.6+/-10.3 months, P20 mg/dL were more in the community-acquired group (16% vs. 4%, P=0.01). CONCLUSION: The clinical and epidemiologic charateristics of nosocomial rotavirus gastroenteritis were similar and correlated to those of the community-acquired gastroenteritis.

Normal antistreptolysin O titers of children by age group in the Gyeonggi-Incheon region / 소아과

PURPOSE: Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. METHODS: ASO in normal individual concentrations were measured quantitatively by nephelometry on sera from 753 children (Male:381, Female:372). ULN were determined by separating the upper 20% from the lower 80% of the group (80 percentile). RESULTS: The mean ASO concentration calculated in a total cases was 149.9+/-7.2 IU/mL. The ASO concentration in neonates was 83.4+/-10.7 IU/mL, and lowest in the 1 year of age group, 26.7+/-6.6 IU/ mL, and increased to 318.0+/-33.2 IU/mL gradually in the 9 years of age group. Thereafter, ASO concentration decreased. The ULN for neonates was 122 IU/mL, for 0-3 years, 40 IU/mL; for 4-6 years, 113 IU/ mL; for 7-9 years, 489 IU/mL; for 10-19 years, 433 IU/mL; for 20-29 years, 122 IU/mL. CONCLUSION: The age-specific ULN for children in the Gyeonggi-Incheon area were determined. The distribution of ASO concentration according to age groups was different from previous reports. These results should be of clinical value to physicians to interprete the ASO results of their patients.

The alteration of the positive rate of cytomegalovirus IgG antibody among preschool period children / 소아과

PURPOSE: In order to evaluate the time of disappearance of cytomegalovirus(CMV) IgG antibodies from mothers, and the alteration of the positive rate of CMV IgG antibodies among preschool period children, we investigated the positive rate of CMV antibodies among preschool children. METHODS: We studied 391 children who visited the Department of Pediatrics from March, 2001 to February, 2004. We measured the serum CMV IgG of 217 children and the serum CMV IgM of 358 children. RESULTS: The positive rate of CMV IgG antibodies is 83.9 percent(the number of positive IgG children is 182 out of 217). The alteration of the positive rate is 92.9 percent in 0-3 months, 75.0 percent in 4-6 months and the nadir was 20.0 percent in 7-9 months. Then, the positive rate increased to 83.9 percent in 22-24 months. After 22 months, the positive rate was 92.1 percent(the number of positive IgG children was 105 out of 114). The positive rate of CMV IgM antibody by age is 3.3 percent in 0-1 months, 3.6 percent in 1-2 months, 10.5 percent in 2-3 months, 14.3 percent in 3-4 months, 14.3 percent in 4-5 months, and then the results of five children among 148 children were positive. The distribution was one in 22-23 months, one in 25-26 months, one in 27-28 months, one in 28-29 months, one in 40-41 months. We discovered IgM positive children succesively from birth to 5 months, but sporadically after 5 months. CONCLUSION: The CMV IgG from mothers has decreased since birth and the time of nadir is 7-9 months. But it increases to a mean value of 83.9 percent at 22-24 months because of perinatal or postnatal infections.

A case of multicystic dysplastic kidney and cystic adenomatoid malformation of the lung identified as incidental findings / 소아과

Multicystic dysplastic kidney and congenital cystic adenomatoid malformation of the lung are independent disorders, but both result from abnormal morphogenesis during embryogenesis. Congenital cystic adenomatoid malformation of the lung is associated with renal anomalies as well as other extrapulmonary anomalies and almost all cases with these anomalies are stillborn. We report a case of a 21-month-old male who was admitted with the impression of acute infectious gastroenteritis; multicystic dysplastic kidney with congenital cystic adenomatoid malformation of the lung was detected incidentally during evaluation.

A Case of Young-Simpson Syndrome / 소아과

Young Simpson syndrome is a rare malformation syndrome characterized by congenital hypothyroidism, dysmorphic face, mental retardation, severe postnatal growth retardation, hypotonia and congenital heart abnormalities. In the present study, we report a case of 4-year-old girl with Young Simpson syndrome for the first case in Korea.

Detection of Cytokeratin-19 caused by Intestinal Epithelial Cell Damage in Childhood Diarrhea / 소아과

PURPOSE: Acute gastroenteritis in infancy is a very common disease with a frequency of a billion diarrhea per year, leading to 3 to 5 million deaths. Since the etiology is not always clear, the treatment plan can be quite difficult to make. The laboratory examinations of stool culture, along with complete blood counts may sometimes be helpful to find bacterial etiology, while occult blood in stool merely means the presence of gastrointestinal tract bleeding. We evaluated the presence of cytokeratin-19 in stools in differentiating bacterial and non-bacterial causes of childhood diarrhea to establish appropriate treatment plans. METHODS: Among 201(male 124 patients, female 77 patients) patients with diarrhea, cytokeratin-19 examined by ELISA was positive in 40 patients. Laboratory findings including peripheral blood leukocytes count with differential count, ESR, CRP were compared between the cytokeratin-19 positive and negative groups. We also investigated the correlation between cytokeratin-19 and stool culture, leukocytes, rotavirus antegen test, and occult blood in stool. RESULTS: The leukocytes count, neutrophil count in peripheral blood and ESR were higher in cytokeratin-19 positive group(P=0.030). There was significant correlation between serum CRP and cytokeratin-19(P=0.007). Sensitivity of cytokeratin-19 was 0.30 and specificity was 0.86 in serum CRP positive group and negative group. CONCLUSION: Cytokeratin-19 in stool was significantly increased in correlation with leukocytes and neutrophil count in peripheral blood, ESR, serum CRP and the specificity of cytokeratin-19 was 0.86 in the serum CRP positive group and the negative group. Therefore, the quantitification of cytokeratin-19 in stool was considered as indicator of differential diagnosis between clinically bacterial and non-bacterial infection groups.

A Case of Hemophagocytic Lymphohistiocytosis in a Child with Systemic Lupus Erythematosus

Hemophagocytic lymphohistiocytosis is a reactive disorder characterized by a generalized non-malignant histiocytic proliferation with prominent hemophagocytosis by stimulated histiocytes in the bone marrow and reticuloendothelial systems resulting in pancytopenia and liver dysfunction. Several diseases including infection, malignancy and autoimmune disease are known to be causative disorders. This case demonstrated histiocytic hemophagocytosis in the bone marrow, resulting in pancytopenia during treatment of systemic lupus erythematosus and did not show any underlying disease.