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.

Risk assessment of metabolic syndrome in adolescents using the triglyceride/high-density lipoprotein cholesterol ratio and the total cholesterol/high-density lipoprotein cholesterol ratio

PURPOSE: This study was conducted to investigate the distributions of the triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C) ratio and total cholesterol (TC) to HDL-C ratio, and to explore their usefulness as markers of metabolic syndrome (MetS) in Korean adolescents. METHODS: We obtained data for 2,721 adolescents (1,436 boys and 1,285 girls) aged 10–18 years who participated in the Korean National Health and Nutrition Examination Surveys from 2008 to 2010. International Diabetes Federation criteria were used to define MetS. RESULTS: There were no significant gender-related differences in TG/HDL-C or TC/HDL-C ratios. These lipid ratios showed significant associations with homeostatic model assessment for insulin resistance (HOMA-IR) and waist circumference. Areas under the receiver operating characteristic curve to identify MetS were 0.947 for TG/HDL-C and 0.924 for TC/HDL-C, which were higher than that of HOMA-IR (0.822). Optimal cutoff values (sensitivity, specificity) of TG/HDL-C and TC/HDL-C ratios for MetS prediction were 3.3 (85.7%, 89.9%), and 3.8 (92.9%, 82.8%), respectively. Odds ratio (OR; 95% confidence intervals [CIs]) for MetS in adolescents with TC/HDL-C ratio above the cutoff value was 14.8 (2.8–77.4), while that for TG/HDL-C ratio about the cutoff value was 30.6 (6.0–157.6). In adolescents who had both lipid ratios above the cutoff values, the OR (95% CI) for MetS was 36.2 (7.2–186.2). CONCLUSION: TG/HDL-C and TC/HDL-C ratios are useful markers of metabolic syndrome with high predictive value in Korean adolescents.

Drug eruption by antihistamine mistaken for chronic urticaria in a child / 소아과

Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur.

Correlation of respiratory syncytial virus infection with climate parameters and air pollution levels in Korean children during 2005–2012

PURPOSE: Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract infection (LRTI) in infants and children. We investigated the association of meteorological conditions and air pollution with the prevalence of RSV infection. METHODS: Between January 2005 and December 2012, a total of 9,113 nasopharyngeal swab specimens from children under 3 years of age who were admitted to the hospital with acute LRTI were tested for RSV antigens using a direct immunofluorescence kit. Meteorological data (mean temperature, precipitation, wind speed, and relative humidity) and air pollutant levels including PM₁₀ (particulate matter with a median aerodynamic diameter less than or equal to 10 µm in diameter), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO) in Seoul during the study period were collected from the national monitoring system. The correlations of the monthly incidence of RSV infection with climate factors and air pollutant levels were analyzed. RESULTS: RSV infection mainly occurred between October and February, and showed the peak in November. The prevalence of RSV infection had a moderate negative correlation with mean temperature (r=−0.60, P < 0.001), a weak negative correlation with relative humidity (r=−0.26, P=0.01), and precipitation (r=−0.34, P=0.001). Regarding air pollutants, RSV activity moderately correlated with NO₂ (r=0.40, P < 0.001), SO₂ (r=0.41, P < 0.001), and CO (r=0.58, P < 0.001). In the RSV peak season in Korea (between October and February), RSV epidemics showed a weak positive correlation with relative humidity (r=0.35, P=0.03) and precipitation (r=0.38, P=0.02). CONCLUSION: Meteorological factors and air pollutant levels may be associated with RSV activity. Therefore, further nationwide large-scaled intensive evaluations to prove factors affecting RSV activity are warranted.

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.