Community-acquired Escherichia coli Enteritis in Korean Children: The Clinical Application of a Stool Polymerase Chain Reaction Assay

BACKGROUND: Although Escherichia coli is a common cause of bacterial enteritis in Korea, reports on community-acquired E. coli enteritis in Korean children are scarce. This study aimed to determine the clinical characteristics and pathotype distribution of community-acquired E. coli enteritis diagnosed by a multiplex polymerase chain reaction (PCR) assay in Korean children. MATERIALS AND METHODS: The medical records of children aged 18 years or less who were diagnosed with acute gastroenteritis by the attending physician between 2013 and 2016 were retrospectively reviewed. The clinical characteristics of children diagnosed with E. coli enteritis were investigated and compared with those diagnosed with Salmonella enteritis. E. coli and Salmonella infections were diagnosed by a stool PCR assay. RESULTS: Among 279 children, in whom PCR assays for E. coli and Salmonella spp. were performed, Salmonella enteritis and E. coli enteritis were diagnosed in 43 (15.4%) and 39 (14.0%) children, respectively. Among the 39 children with E. coli enteritis, enteropathogenic E. coli (n=21, 53.8%) and enteroaggregative E. coli (n=15, 38.4%) were the most common causative agents. Empirical antibiotics were administered to 33 (84.6%) children. A total of 31 (79.5%) children developed fever, and 25 (80.6%) of them had the fever for 3 days or less, which resolved a median of 1 day (range 0-3 days) after hospitalization. The most frequent gastrointestinal symptom was diarrhea (n=36, 92.3%). Significantly more children with E. coli enteritis were aged 2 years or less as compared with those with Salmonella enteritis (41.0% vs. 21.9%, P = 0.021). Children with Salmonella enteritis more frequently complained of fever (97.7% vs. 79.5%, P = 0.012), abdominal pain (90.7% vs. 64.1%, P = 0.004), and hematochezia (46.5% vs. 10.3%, P < 0.001) than those with E. coli enteritis. Erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in children with Salmonella enteritis than those with E. coli enteritis (P < 0.001). CONCLUSION: Enteropathogenic E. coli was the most frequent pathotype in Korean children with E. coli enteritis that caused mild clinical symptoms. A stool PCR assay for E. coli may be useful for epidemiological purpose and for an early diagnosis of E. coli enteritis.

Foreign body aspiration in 48 children: clinical manifestations and outcomes

PURPOSE: This study aimed to have a deeper insight into the clinical spectrum of foreign body aspiration in children and to prospect the further clinical implications of early diagnosis. METHODS: We conducted a retrospective medical chart review of 48 children with foreign bodies at The Catholic University of Korea, Seoul St. Mary's Hospital, between January 2009 and December 2013 in terms of age, sex, symptoms and signs, radiologic findings, and clinical courses. Patients were divided into 2 groups according to the time from aspiration to a definite diagnosis. The 2 groups were compared for clinical courses, radiologic findings, and the length of hospitalization. RESULTS: Approximately 85% of patients were 3 years of age or younger. About one-fifth of patients had no history of foreign body aspiration. Cough and coarse breathing sounds were the most common symptoms and signs. The most frequent radiologic finding was pulmonary air trapping (33.3%). The mostly commonly aspirated foreign body was peanut and detected in left main bronchus. Cough, sputum, and absence of aspiration history were more common in the delayed diagnosed group than in the early diagnosed group. CONCLUSION: Our results suggest that the number of accidents associated with foreign body aspiration can be reduced by keeping infants with nut formula under close observation and by conducting assertive bronchoscopic examination on children with delayed recovery from respiratory infections. After removal of foreign bodies, close monitoring and expectation of possible complications can prevent patients from a long hospital stay.

Clinical characteristics of interferon-gamma-inducible protein of 10 kDa in children with wheezing

PURPOSE: Recent studies have shown that interferon-gamma-inducible protein of 10 kDa (IP-10/CXCL10) levels is increased in acute bronchiolitis and asthma. The aim of this study was to examine the levels of IP-10 in children with wheezing and whether it correlates with other clinical variables. METHODS: A total of 62 subjects children were hospitalized for lower respiratory tract infection with wheezing and visited the Emergency Department due to an acute exacerbation of asthma. IP-10 levels were measured using enzyme-linked immunosorbent assay in the serum collected at admission. Serum IP-10 levels were evaluated for the relationships with age, sex, blood eosinophils counts, acute phase reactant, allergic sensitization, history of wheezing, and chest X-ray findings. RESULTS: Age showed a significant negative correlation with serum IP-10 levels (P=0.002). The serum levels of IP-10 were also significantly increased in patients with pneumonic infiltration on X-rays compared to those with normal or hyperinflation (P<0.009). There was no significant difference in the serum IP-10 level according to the other factors, including allergic sensitization. CONCLUSION: Serum IP-10 is significantly associated with inflammation of the lung and age, but not with allergic inflammation.

Comparison of Group A, B and C Rotaviral Gastroenteritis among Children in Korea: Prevalence and Clinical Features / 소아감염

PURPOSE: The aim of this study is that the prevalence of rotavirus infection was evaluated by each group and clinical features of group A, B and C rotaviruses infections were described respectively to compare one with another. METHODS: Between January 2010 and December 2010, we enrolled a group of children below 10 years of age admitted for management of acute diarrhea at the Catholic University of Korea Bucheon St. Mary's Hospital. A total of 310 stool samples documented to be free of common bacterial pathogens were collected from children with diarrhea. The presence of group A, B or C rotavirus is indicated by amplification of DNA segments of the expected lengths after the first and second PCRs. RESULTS: In a total of 310 stool specimens, 40 (12.9%) specimens were positive for rotaviruses. These included 23 (7.4%) positive for group A, 5 (1.6%) for group B and 12 (3.9%) for group C rotaviruses. Group B rotavirus infected patients had significantly less diarrheas per day (group A: P=0.01, group C: P=0.01) and shorter duration of vomiting days (group A: P=0.03, group C: P=0.03) than those with group A and C rotaviruses infection respectively. All the group B rotaviruses had been isolated in March and October. Group C rotavirus infections were prevalent during late summer and early winter and peaked in October. CONCLUSION: These findings indicate that group B and C rotaviruses are notable causes or the contributing causes of diarrhea among infants and children in Korea.