Epidemiology and Clinical Characteristics of Enterovirus Infections in Children: A Single Center Analysis from 2006 to 2010 / 소아감염

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.

Evaluation of Uricult Trio Test as a Rapid Screening of UTI in Children with Fever / 소아감염

PURPOSE: The Dipslide culture test is a rapid method for diagnosis of urinary tract infection (UTI). The aim of this study is to determine the diagnostic availability of a urine Dipslide test for evaluation of UTI in febrile children. METHODS: Urine specimens from 151 febrile infants were inoculated by a routine blood agar urine culture method and the Dipslide test at the same time. Following incubation for 16-24 hours, the results of the Dipslide test were read at the next visit. Both results of Dipslide and those of routine culture were compared. RESULTS: The mean age of subjects was 15+/-10.6 months. There were 150 infants (99.3%) who had fever with a mean duration of 2.6+/-2.6 days. Thirty two infants (21.2%) were diagnosed as having UTI. Sensitivity and specificity of Uricult Trio CLED medium were 59.4% and 84.8%, respectively. Sensitivity and specificity of Uricult Trio E. coli medium were 60.0% and 96.2%, respectively. The Pearson correlation coefficient between results of Uricult Trio CLED medium and urine culture was 0.438 (P=0.01). Correlation between results of Uricult Trio E. coli medium and urine culture was 0.617 (P=0.01). CONCLUSION: The Dipslide test requires only 16-24 hours with high specificity in terms of UTI caused by E. coli without the problems associated with specimen delay. This test seems to be helpful for exclusion of UTI in febrile infants and it may reduce unnecessary hospitalization and antibiotic use. However, further studies are required before the product can be recommended as a routine diagnostic tool.

A Study on Risk Factors of Recurrent Otitis Media / 소아감염

PURPOSE: Recurrent otitis media (ROM) is usually defined as > or =3 distinct and well-documented episodes within 6 months or > or =4 episodes within 12 months. ROM is sufficiently important to warrant consideration of chemoprophylaxis, tympanostomy tube placement. There also is evidence that children with ROM are at risk for both hearing loss and speech delay. However, studies of ROM have been notably insufficient. In addition, even though environmental, racial, and sociocultural differences can affect risk factors, few studies have been conducted with regard to recurrent otitis media in Korea. METHODS: This study was conducted from July 2009 to January 2010 with infants and children who were younger than 60 months old, who visited the out-patient clinics at Han-Il General Hospital and Kyunghee University Hospital. Data were collected by interview using a pre-formed sheet. Among a total of 892 infants and children, 457 were excluded, and the remaining 435 were allocated to 104 with ROM and 331 as a control group. RESULTS: Attendance at daycare centers (P<0.001, OR=2.85), allergic rhinitis (P=0.026, OR=2.32), past history of bronchiolitis (P=0.003, OR=2.33), and low socioeconomic status (P=0.005, OR=2.00) were found to have a close significant correlation with ROM. Risk factors such as sex, having a sibling, breast-feeding, use of pacifiers, atopy, pneumococcal vaccination, influenza vaccination, smoking of parents, and indoor smoking are not relevant. CONCLUSION: Attendance at daycare centers, allergic rhinitis, past history of bronchiolitis, and low socioeconomic status have been identified as risk factors for ROM.

A case of intestinal tuberculosis complicated by miliary tuberculosis / 소아과

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.

Clinical characteristics and risk factors for staphylococcal infections in neonatal intensive care unit / 소아과

PURPOSE: The importance of staphylococcal infections in NICU has been emphasized in terms of increased resistant strains and increased incidence of morbidity and mortality. In this study, we inrestignted the clinical characteristics and risk factors for staphylococcal infections, and looked into sensitivity trends of antibiotics in the era of a high rate of methicillin-resistant staphylococcus aureus (MRSA) in our society. METHODS: This study included 240 neonates with positive blood, urine and other sites cultures for staphylococci who were admitted to NICU of Hanil General Hospital and Kyunghee University Hospital from January 2000 to December 2004. The analyses included clinical characteristics of staphylococcal infections and the relationship of incidence rate among various factors, including invasive procedures. RESULTS: For 5 years, 3,593 patients were hospitalized in the NICU and 7,481 specimens were cultured from blood, urine, and other sites. During the study period, staphylococci were isolated from 240 patients, of whom 88 patients had MRSA, 41 patients methcillin sensitive staphylococcus aureus (MSSA), 63 patients S. epidermidis, 48 patients coagulase-negative staphylococcus (CNS) except S. epidermidis infections. The risk factors associated with staphylococcal infections were less than 37 weeks of gestational age, less than 7 on a 5 minutes Apgar score, receiving TPN, applied mechanical ventilation, use of central venous catheters and other tubes. The sensitivity to vancomycin was 100 percent. A relatively high sensitivity against teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin and low sensitivity against gentamicin and erythromycin were shown. CONCLUSION: To reduce staphylococcal infections in NICU, we need to monitor and manage premature neonates from the beginning of the birth process and to avoid as many invasive procedures as possible in NICU. Considering MRSA, control of preceding factors and early use of appropriate antibiotics is expected to reduce the morbidity and mortality caused by MRSA infections.

The Safety and Immunogenicity of a Trivalent, Live, Attenuated MMR Vaccine, Priorix (TM) / 소아과

PURPOSE: This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella (MMR) vaccine, Priorix (TM) in Korean children. METHODS: From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received Priorix (TM) at four centers: Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. RESULTS: Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days post- vaccination, were: For measles, in the age group 12-15 months, 3, 838.6 mIU/mL [3, 304.47, 4, 458.91]; in the age group 4-6 years, 1, 886.2 mIU/mL [825.83, 4, 308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1, 112.71]; in the age group 4-6 years, 2, 473.8 U/mL [1, 518.94, 4, 028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. CONCLUSION: When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine (Priorix (TM) ), adverse events were limited to those generally expected with any live vaccine. Priorix (TM) demonstrated excellent immunogenicity in this population.

A Case of Trichobezoar in a Child Who Visited with Intermittent Abdominal Pain, Nausea and Vomiting / 소아과

Bezoars are concretions commonly found in the stomach and small bowel, and four types of bezoars have been described based on their composition: trichobezoar, phytobezoar, lactorbezoar, and miscellaneous. Bezoars most often develop after gastric operations that alter the motility, emptying, and grinding of food in the stomach. Trichobezoars are most common in female children with normal gastrointestinal function and are usually associated with pica, mental retardation, and psychiatric disorders. Although uncommon, bezoars are a well-recognized cause of chronic abdominal complaints which, when undiagnosed, can result in serious complications including gastric ulceration, bleeding, perforation, intussusception and small bowel obstruction. Mortality rates of up to 30 percent have been reported in adults. Trichotillomania is behaviors surrounding hair-pulling, including stroking and playing with hair before pulling, or biting and swallowing the hair after it has been pulled(trichophagia). The most notorious of the medical sequelae of trichotillomania is the trichobezoar. We experienced a case of trichobezoar in an 11-year-old girl who frequently swallowed her hairs from age 4 years up to age 7 years, resulting in intermittent abdominal pain, nausea, and vomiting.

A Case of Subcutaneous Fat Necrosis in Neonate with Meconium Aspiration Syndrome

Subcutaneous fat necrosis in neonates is a rare disease characterized by skin lesions, which may be single or multiple, poorly circumscribed and often tender erythematous nodules or plaques on cheeks, buttocks, back, arms, and thighs. These symptoms are usually self-limited; resolution occurs over a period of weeks to months. Subcutaneous fat necrosis affects full term and healthy- appearing infants who have experienced perinatal distress such as hypoxic insult, birth trauma and hypothermia. Most skin lesions appear within the first two weeks of life. We experienced a case of subcutaneous fat necrosis in a neonate with hypoxic insult and report the case with a brief review of the literature.

A Case of Citrullinemia Diagnosed at the Neonatal Period

Citrullinemia is a rare inborn error of metabolism of the urea cycle, and was first reported by McMurray, et al. in 1962. It is inherited as an autosomal recessive trait. The normal synthesis of argininosuccinic acid is blocked in this disease due to a deficiency of argininosuccinic acid synthetase(AS), which has been demonstrated in liver cells and fibroblasts. The clinical symptoms are vomiting, lethargy or irritability, convulsion and mental retardation. The diagnosis is made by the finding of an increased plasma citrulline level. Every effort should be made to reduce the blood ammonia level as rapidly as possible before irreversible brain damage occurs. This report describes a case of citrullinemia that was diagnosed through organic acid analysis and amino acid analysis, and reviews the related literatures.

Comparison of Two Rapid Antigen Detection Tests for Diagnosis of Group A Streptococcal Pharyngotonsillitis

PURPOSE: Recently, a number of rapid antigen detection tests have been available to diagnose group A streptococcal pharyngotonsillitis. The purpose of this study was to determine the sensitivity, specificity and consistency of the two rapid antigen detection tests. METHODS: Among the patients who visited our clinic from November 2001 to February 2002, 61 patients who had clinical findings of pharyngeal erythema or edema, pharyngeal exudates and soft palatine petechiae were enrolled in our study. A total of 61 patients were tested with rapid antigen detection tests and throat culture. BD LINK2TM Strep A(Becton, Dickinson and Company, U.S.A.) and QuickVue(R) In-LineTM(Quidel Corporation, U.S.A.) were selected for rapid antigen detection tests. RESULTS: Of the 61 patients tested, 22 patients were confirmed as group A streptococcal pharyngotonsillitis by throat culture. The BD LINK2TM Strep A had a sensitivity of 81.8% and a specificity 89.7%. The positive and negative predictive values were 81.8% and 89.7%, respectively. The QuickVue(R) In-LineTM had a sensitivity of 77.3% and a specificity of 100%. The positive and negative predictive values were 100% and 88.6%, respectively. The kappa values of BD LINK2TM Strep A and QuickVue(R) In-LineTM were 0.72 and 0.81, respectively. CONCLUSION: In addition to high sensitivity, specificity and consistency, both kits are easy to use and simple to interpret, and therefore have the potential to be used with backup throat culture for diagnosis of acute pharyngotonsillitis.

Immunogenicity of Haemophilus influenzae PRP-D Conjugate Vaccine in Korean Infants

PURPOSE: Infection by Haemophilus influenzae Type B(Hib) occurs most often in infants and children who are 5 years old and less. The incidence is highest around 6 months of age, and then decreases thereafter as infants gain natural immunity. Hi PRP-D conjugate vaccine is poorly immunogenic in infants. However, immunogenicity PRP-D vaccine in Korean infants is unknown. This study was carried out to evaluate the immunogenicity of PRP-D in Korean infants. METHODS: Forty-two normal infants who were born in Hanil General Hospital from February 1994 to July 1995 were vaccinated at 2, 4, 6, 15 months after birth. The serum antibody level was measured at 2, 6, 7, 15, 16 months of age. The infants also received DTaP, TOPV at 2, 4, 6 months and MMR at 15 months. Anti-PRP antibody level was measured by radioimmnune assay at Dana Faber Cancer Institute in Boston, U.S.A. RESULTS: The geometric mean of Anti-PRP antibody titers were 0.074microgram/ml at 2 months, 0.185 microgram/ml at 6 months, 1.390microgram/ml at 7 months, and then fell to 0.501microgram/ml at 15 months(Mean values are geometric mean; L=512, P=0.0001). Anti-PRP antibody titers increased in proportion to the number of vaccinations. The proportion of infants with anti-PRP antibody titers> OR =0.15microgram/ml were 15.8% at 2 months, 44.7% at 6 months, and 94.7% at 7 months. The proportion of infants with anti-PRP antibody titers> OR =1.0microgram/ml were 2.6% at 2 months, 26.3% at 6 months, and 57.9% at 7 months(X2 test; total: X2=27.64, P<0.01; male: X2=23.05, P<0.01; female: X2=48.55, P<0.01). CONCLUSION: The immunogenicity of PRP-D conjugate vaccine may be more effective in young Korean infants than in other population published in studies. The clinical implication of good responsiveness of Korean infants to PRP-D vaccine needs further evaluations.

A Case of anhidrotic Ectodermal Dysplasia / 대한피부과학회지

Anhidrotic ectodermal dysplasia is inherited as an X linked recessive trait. This disor der is characterized by hypotrichosis, hypodontia and hypohidrosis. The diagnosis is often delayed until the first or second year of life, after repeated episodes of potentially damaging high fever. In the newborn period, the diagnosis is more difficult, but early diagnosis is of importance in ensuring that the appropriate enivironment and medical measures be taken to avoid uncontrolled hyperthermia. We have experienced a case of anhidrotic ectoclermal dysplasia in an8-day-old male patient who showed charecteristic features including hypotrichosis, peeling or scaling of the skin, recurrent fever and a characteristic face. A skin biopsy from the right palm revealed no sweat gland strutures. A brief rview with related literature is also presented.

Effects of Nebulized Budesonide in the Treatment of Patients with Mild to Moderate Croup

PURPOSE: Dexamethasone intramuscular injection and oral prednisolone have been known to be effective in the treatment of croup. The aim of this study was to determine whether nebulized budesonide leads to clinically important improvement in respiratory symptoms within four hours for child with mild to moderate croup. METHODS: Patients with croup visited to the department of Pediatrics, Han Il General Hospital from March 1995 to June 1996 were enrolled in this study. Patients were eligible if their age was between six months and six years, their total croup score was higher than 2 after breathing humidified air for at least 15 minutes. 28 patients were treated with 2mg (8ml) of nebulized budesonide and 8 patients with 8ml of normal saline as control group over the 30 minutes. Croup score, heart rate and respiratory rate were then assessed hourly for up to four hours. Side effects were also observed. RESULTS: 1) The croup score was improved from 3.6+/-0.8 to 1.9+/-0.9 at 4 hours after the nebulized budesonide treatment. 2) No significant differences in changes in heart rate were observed until 4 hours after both the nebulized budesonide group and control group. 3) Significant decrease in respiratory rate was observed at 4 hours after the nebulized budesonide group. 4) No specific side effects were noted during and 4 hours after the nebulized budesonide treatment. CONCLUSIONS: We concluded that nebulized budesonide leads to a prompt and important clinical improvement in children with mild to moderate croup without any specific side effects.

A Clinical Study of Serologically Diagnosed Yersinia Pseudotuberculosis Infection in Chidren

A retrospective analysis of clinical findings in 23 patients with Y. pseudotuberculosis infection who visited Department of Pediatrics of Han Il Hospital from May. 1990 to June, 1992 was performed. 1) The most prevalent age group was 7 to 12 years (16 case: 69.6)and male-to-female ratio was 1.1:1. 2) Monthly distribution showed a high frequency in April, May and June (22 cases:95.7%) 3) The common symptoms were fever(23 cases:100%), abdominal pain (18 cases: 78.3%) vomiting(16 cases: 69.6%), diarrhea (13 cases: 56.7%), rash (13 cases: 56.5%)and acute renal failure (6 cases: 26.1%) in order of frequency, respectively. 4) The laboratory findings were anemia (17.4%), WBC>1(10E4/mm((73.9%), ESR>20mm/hr (91.3%), CRP>3+(91.3%), Positive Widal test (13.0%), BUN>20mg/dl (26.1%) and creatinine> 1.2mg/dl (26.1%). 5) The most common serotype was 4a (30.4%), followed by 4b, 5b, 2b, 2c, 5a, 1b, 1a, 6 in order of frequency. The results suggest that Yersinia pseudotuberculosis infection is one of the important causes of the important causes of fever, eruptive skin diseases and acute renal failure in Korean children and further studies including epidemiology, pathogenesis, etc, are needed.

A case of idiopathic precocious puberty treated with a luteinizing hormone relaeasing hormone analog

No abstract available.

A Case of Acute Interstitial Nephritis Associated with Yersinia Pseudotuberculosis Infection

No abstract available.

A case of Erythema Nodosum due to Yersinia Pseudotuberculosis

No abstract available.

An Outbreak of Yersinia pseudotuberculosis Infection

No abstract available.

Two Cases of Idiopathic Hypercalciuria in Children

No abstract available.

The study on the Long-term Adimitted During 5 Years

No abstract available.