A Clinical Study of Adenoviral Respiratory Infection in Children

PURPOSE: Adenoviral respiratory infection can develop a life threatening condition similar to severe bacterial pneumonia. Despite adequate intensive care, this infection progresses to acute respiratory distress syndrome and causes permanent lung damage in some patients. In this study, we analyzed clinical features and long-term follow-up clinical data of this infection in children. METHODS: Forty-seven cases of inpatients were diagnosed as adenoviral respiratory tract infection by viral culture of nasal aspirates or histopathological diagnosis at Samsung Medical Center during the period from February 1995 to July 1998. We reviewed medical records retrospectively. RESULTS: During this study, 1301 cases of acute respiratory tract infection were investigated, of which 47 cases were confirmed as adenoviral infection. Age ranged from 2 months to 6 years. Initial symptoms were productive cough(100%), fever(91%), dyspnea(62%), diarrhea(40%), and conjunctival injection(30%). Thirty-nine cases(83%) were pneumonia and 7 cases(15%) were bronchiolitis. The radiologic findings were pneumonic consolidation(60%), effusion(36%), infiltration(19 %), and atelectasis(13%). Five cases developed acute respiratory distress syndrome and 3 cases expired. In 31 cases of recovered patient, follow-up evaluation was done at a minimum of 3 months(mean duration 9.9+/-9.3 months). Under the follow-up evaluation, 13 patients(42%) showed physical and radiologic findings that consisted with bronchiolitis obliterans or bronchiectasis. CONCLUSION: Because of severe clinical manifestations and pulmonary complications, early diagnosis, adequate management, and long-term follow-up are needed for adenoviral respiratory tract infection.

A Case of Inherited Thymic Dysplasia Associated with Disseminated Cytomegalovirus Infection / 소아알레르기및호흡기학회지

No abstract available.

Two Cases of Post-traumatic Bronchial Stenosis Diagnosed by Flexible Bronchoscopy

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may be followed by bronchial stenosis and subsequent atelectasis. We reviewed two patients with traumatic tracheobronchial injuries sustained after vehicular accident. Bronchial stenosis was suspected due to atelectasis which was first detected 5 days and 11 days after the accident, respectively. They didn't respond to conservative management such as chest physiotherapy for about 2 weeks. Flexible fiberoptic bronchoscopy confirmed bronchial stenosis at the left main bronchus in one patient and at the left upper lobe bronchus in the other. The stenotic bronchi were corrected by resection and end-to-end anastomosis, and bronchoscopy performed postoperatively showed good repair. The patients were discharged without complications. Flexible bronchoscopy is useful and reliable in children as well as in adults for early diagnosis of traumatic tracheobronchial injuries. Resection and end-to-end anastomosis is successful in these cases.

Sulfidoleukotrienes Production in Blood Leukocytes Stimulated by Mite Allergen / 소아알레르기및호흡기학회지

PURPOSE: Although asthma is the most common chronic disease in childhood, accurate diagnosis in infants and young children remains challenging clinicians. Allergen challenging tests in vitro have been used productively as an investigative tool in studies of the pathophysiology and diagnosis of asthma. Therefore, we compared the sulfidoleukotrien (sLT) concentration according to allergen leukocyte stimulation test, in normal versus asthmatic patients, to find better diagnostic tools. METHODS: From May through August, 1998, nine children were enrolled who presented positive skin reaction in Dermatophagoides pteronyssinus (D.p.), Dermatophagoides farinae (D.f.) as patient groups. We measured total eosinophil count, serum IgE, sLT concentration of three different allergen stimulation (100 ng/ml, 10 ng/ml, 1 ng/ml). RESULTS: sLT concentration in three different D.p., D.f. stimulation showed significant differences (P<0.01). Allergen concentration of 10 ng/ml was fit for stimulating peripheral leukocyte. The sLT concentration is correlated with IgE, total eosinophil count, but not with age. Actual concentrations of sLT was not measured in allergen stimulation test. Its interpretation of test results was complicated by the fact that several variants were involved in determining sampling time and appropriate sampling volume. Most importantly, the diagnostic sensitivity of the sLT concentration tests varies directly with the magnitude of IgE antibody and total eosinophil count. CONCLUSION: We emphasizes the role of allergen challenge in understanding the pathophysiology of young children asthma. It focuses on more accurate diagnosis with objective techniques for analyzing the leukocyte sLT release to antigen.

Clinical characteristics of acute viral lower respiratory tract infections in hospitalized children in Seoul, 1996-1998

This study was performed to investigate the etiologic agents, age distribution, clinical manifestations and seasonal occurrence of acute viral lower respiratory tract infections in children. We confirmed viral etiologies using nasopharyngeal aspirates in 237 patients of the ages of 15 years or younger who were hospitalized for acute lower respiratory tract infection (ALRI) from March 1996 to February 1998 at Samsung Seoul Hospital, Seoul, Korea. The overall isolation rate was 22.1%. The viral pathogens identified were adenovirus (12.7%), influenza virus type A (21.1%), -type B (13.9%), parainfluenza virus type 1 (13.5%), -type 2 (1.3%), -type 3 (16.0%) and respiratory syncytial virus (21.5%). The occurrence of ALRIs was highest in the first year of life, although parainfluenza virus type 1 infection occurred predominantly in the second year of life and influenza virus caused illnesses in all age groups. The specific viruses are frequently associated with specific clinical syndromes of ALRI. The respiratory agents and associated syndromes frequently have characteristic seasonal patterns. This study will help us to estimate the etiologic agents of ALRI, and establish a program for the prevention and treatment. An annual nationwide survey is necessary to understand the viral epidemiology associated with respiratory illnesses in Korea.

The Effect of Measles Vaccination Before Turning 1 Year-old on the Measles Antibody Response to Immunization with MMR

PURPOSE: With the implementation of measles vaccination programs, the number of patients with measles has decreased. However, epidemics still occur with high morbidity in infants less than 1 year of age. This fact calls for the establishment of optimal preventive measures against measles. The study was carried out to determine the effect of measles vaccination on an infant immunized before one year of age, any the measles immunity conferred by MMR. METHODS: Seventy-seven healthy infants (13.7 +/- 1.8 months) were immunized with the MMR vaccine (Triviraten Berna : Edmonston-Zagreb strain, Rubini strain, Wistar RA 27/3 strain), 50 of the infants have received measles vaccine before turning one-year old. The antibody titers of measles-specific IgG were measured by enzyme immunoassay. RESULTS: The antibody titers before and after MMR vaccination were significantly higher in infants previously immunized with measles vaccine compared to those not immunized. However, the greater number of infants not previously immunized with measles vaccine showed significant increase of measles antibody titers after MMR vaccination compared to those previously immunized with measles vaccine. Measles vaccine failure occurred in 6 infants (12.0%), all of whom acquired measles immunity following MMR vaccination. Measles immunogenicity to MMR did not differ with respect to the age of previous measles vaccination. CONCLUSION: The results indicate that measles vaccination in infants less than 1 year of age will not decrease the measles immunity following MMR vaccination, and it is suitable to vaccinate against measles in infants between 6-12 months of age, if needed.

The Effect of Measles Vaccination Before Turning 1 Year-old on the Measles Antibody Response to Immunization with MMR

PURPOSE: With the implementation of measles vaccination programs, the number of patients with measles has decreased. However, epidemics still occur with high morbidity in infants less than 1 year of age. This fact calls for the establishment of optimal preventive measures against measles. The study was carried out to determine the effect of measles vaccination on an infant immunized before one year of age, any the measles immunity conferred by MMR. METHODS: Seventy-seven healthy infants (13.7 +/- 1.8 months) were immunized with the MMR vaccine (Triviraten Berna : Edmonston-Zagreb strain, Rubini strain, Wistar RA 27/3 strain), 50 of the infants have received measles vaccine before turning one-year old. The antibody titers of measles-specific IgG were measured by enzyme immunoassay. RESULTS: The antibody titers before and after MMR vaccination were significantly higher in infants previously immunized with measles vaccine compared to those not immunized. However, the greater number of infants not previously immunized with measles vaccine showed significant increase of measles antibody titers after MMR vaccination compared to those previously immunized with measles vaccine. Measles vaccine failure occurred in 6 infants (12.0%), all of whom acquired measles immunity following MMR vaccination. Measles immunogenicity to MMR did not differ with respect to the age of previous measles vaccination. CONCLUSION: The results indicate that measles vaccination in infants less than 1 year of age will not decrease the measles immunity following MMR vaccination, and it is suitable to vaccinate against measles in infants between 6-12 months of age, if needed.

A Case of Severe Myoclonic Epilepsy in Infancy

Severe myoclonic epilepsy of infancy(SMEI) is a condition beginning with recurrent, prolonged febrile convulsion in normal children, followed within months to 4 years by generalized tonic clonic seizures, partial seizures, atypical absences, myoclonic seizures and status epilepticus. The seizures are generally difficult to control. Carbamazepine which is appropriate for partial seizures, is not effective and may aggravate generalized seizures, but sodium valproate has been reported to be helpful. The evolution is always bad with persistent seizures and mental retardation. We experienced a severe myoclonic epilepsy of infancy in a 16-month-old male patient who had episodes of prolonged febrile convulsions followed by mixed type of seizures. We report a case of SMEI with a brief review of literatures.

Cellular Analysis of Induced Sputum to Diagnose Asthma and Evaluate the Direct Effects of Inhaled Corticosteroid on Airway in Children with Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma is characterized clinically not only by episodic wheeze and reversible airway obstruction but also by excessive airway secretion. Oppenshaw- Warwick found that 77% of asthmatic subjects reported sputum production as a prominent symptom. Invasive assessment for the airway inflammation in children has been frequently limited. Induced sputum by inhalation of hypertonic saline allows monitoring of airway inflammation in children with asthma in a non-invasive way. METHODS: Thirty subjects with asthma were selected by asthma questionares and divided two groups as 14 current symptomatic asthmatics (FEV(1)<85%: PD15) and 16 stable non-symptomatic asthmatics with 4.5% hypertonic saline challenge test, and 14 normal controls were selected. They all inhaled 4.5% hypertonic saline for 10 minutes by ultrasonic nebulizer. The expectorated sputum and saliva were collected from all subjects and collected 3 hours after corticosteroid (Beclomethasone diproprionate 200microgramX2) inhalation for asthmatics and were reduced by dithiotreitol. Total cell counts and differentials were determined. RESULTS: Sputum from current asthmatics contained a significantly higher proportion of eosinophil than stable asthmatics or normal controls (7.9+/-6.0 vs. 3.8+/-4.5% vs. 0.8+/-1.4%, P<0.05). The induced sputum after corticosteroid inhalation showed significant decrease in total cell count, eosinophil proportion in current asthma and stable asthma. CONCLUSION: The cellular analysis of induced sputum was a useful non-invasive and safe study for the diagnosis of childhood asthma and assessment for the direct effects of inhaled corticosteroid on airway inflammation in children with asthma.

A Case of Cerebral Infarction Associated with Mycoplasma pneumoniae Infection

Mycoplasma pneumoniae has been shown to be of etiologic importance in cases of upper-and lower-respiratory tract infections, especially in children and young adults. It may cause a variety of extrapulmonary manifestations in multiple organ systems, most commonly the central nervous system. The extrapulmonary syndromes include meningitis, cerebral infarction, acute transverse myelitis, psychosis, cerebellar ataxia, Guillain-Barr syndrome and Reye syndrome. Cerebral infarction as a complication of mycoplasma infection in children has been rarely reported. We report the first documented case in Korea of cerebral infarction preceded by M. pneumoniae pneumonia in a 7-year-old boy, with a brief review of literatures.