Changing Susceptibility of Staphylococcus aureus in Children with Skin and Soft Tissue Infections: a Single Center Experience from 2010 to 2018

PURPOSE: Staphylococcus aureus is a major cause of skin and soft tissue infections (SSTIs). This study aimed to determine the temporal trends in antibiotic susceptibility of S. aureus in SSTI patients aged <19 years.METHODS: This retrospective observational study was conducted in pediatric patients with SSTI caused by community-associated S. aureus. Microbiologic and demographic data were collected, and the trends of antibiotic susceptibility results were evaluated.RESULTS: From January 2010 to December 2018, a total of 807 S. aureus isolates were included. An overall increase in susceptibility of isolates to oxacillin was noted (P<0.001), with 75.0% of isolates being oxacillin-susceptible in 2018. S. aureus remained highly susceptible to trimethoprim/sulfamethoxazole and tetracycline, with 97.6% and 95.2% isolate susceptibility in 2018, respectively. Isolates from younger children aged 1 to 5 years had a significantly lower rate of susceptibility to oxacillin than older children aged 6 to 18 years (53.4% vs. 75.0%, P<0.001).CONCLUSIONS: The proportion of methicillin-resistant S. aureus isolates appears to decrease in pediatric patients with community-associated SSTI caused by S. aureus. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens.

Knowledge, Attitude and Practice on Maternal Immunization with Tetanus Toxoid, Reduced Diphtheria Toxoid, and Aellular Pertussis (Tdap) among Pregnant Women

PURPOSE: Despite effectiveness and safety of maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination, Tdap vaccination coverage during pregnancy remains quite low. We assessed the knowledge, attitude and practice on maternal Tdap vaccination among pregnant women. METHODS: This study was a cross-sectional survey of pregnant women who visited tertiary obstetrics and gynecologic units in Seoul and Gyeonggi province of Korea. Individual questionnaires were administered to assess knowledge, attitude and practice on maternal immunization with Tdap. RESULTS: The questionnaires were completed by 184 pregnant women; 158 (86%) had not received information from doctors about pertussis and Tdap, and 166 (90%) did not know the need for Tdap vaccination. Only 7% of pregnant women unlikely to receive Tdap vaccine during current pregnancy answered 3 or more of the 5 knowledge-based questions correctly. By logistic regression analysis, recommendation by doctor (adjusted odd ratio [OR], 236.2; 95% confidence interval [CI], 12.6–4,432), belief that the vaccine is effective (adjusted OR, 40.21; 95% CI, 2.35–687.7), and belief that the vaccine is safe (adjusted OR, 19.83; 95% CI, 1.54–255.9) were significantly important factors to respondents’ intention to be vaccinated. CONCLUSIONS: Most pregnant women seem to be neither recommended nor adequately informed about Tdap vaccination. Information given by health care professionals is very important to increase Tdap coverage among pregnant women.

Three Cases of Polycystic Ovary Syndrome Presenting with Hirsutism and Obesity in Adolescence / 대한소아내분비학회지

Polycystic ovary syndrome (PCOS) is characterized by ovulatory dysfunction and hyperandrogenism. It is a complex disorder with multiple components, including infertility, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular diseases. We report three cases of PCOS presenting with hirsutism and obesity in adolescence. They showed hirsutism, acne and acanthosis nigricans, and obesity with the body mass index above the ninety-fifth percentile for their age and sex matched reference values. Laboratory findings showed elevated luteinizing hormone, total testosterone and decreased sex hormone binding globulin. One patient was diagnosed as having impaired glucose tolerance by oral glucose tolerance test, and three patients showed insulin resistance classified by homeostasis model assessment-insulin resistance (HOMA-IR) value. All patients were treated with exercise, low calorie diet. And metformin and estrogen- progesterone oral contraceptives were administered in two of three patients, respectively. During the follow-up period, two patients have achieved weight loss and recovered regular menstruation.

A Case of Neuromyelitis Optica(Devic's Syndrome) with Acute Bilateral Central Retinal Artery Occlusion / 대한소아신경학회지

Neuromyelitis optica(NMO) or Devic's syndrome is an uncommon clinical syndrome associating with unilateral or bilateral optic neuritis and transverse myelitis. It is rarely found in children and usually reported in adults with serious neurologic manifestations. We report a case of an 8-year-old girl with neuromyelitis optica whose first clinical manifestation was acute visual loss of both eyes. Initially the patient had been diagnosed with central retinal artery occlusion and optic neuritis by ophthalmologic examination, a brain magnetic resonance imaging, and cerebrospinal fluid findings. She was treated with intravenous methylprednisolone pulse therapy and heparinization. Then the treatments were replaced with oral prednisolone and warfarin. At the fifteenth day after the start of oral prednisolone tapering, she visited our emergency room for voiding difficulty and paresthesia on both legs. A spinal magnetic resonance imaging revealed increased signal intensity in T2-weighted images from cervical to lumbar level, and neuromyelitis optica- IgG(NMO-IgG) was detected in the patient's serum. After we diagnosed her as having neuromyelitis optica, intravenous methylprednisolone and nine courses of daily plasmapheresis were tried. However, the patient still had visual loss, pain, and sensory loss below the sixth thoracic dermatome, and we tried maintenance therapy with intravenous rituximab. We report our case with reviews of the related literatures.

Usefulness of Multichannel Intraluminal Impedance-pH Metry in Children with Suspected Gastroesophageal Reflux Disease / 대한소화기학회지

BACKGROUND/AIMS: pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events. METHOS: Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring. RESULTS: While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p<0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003). CONCLUSIONS: This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children.

Partial Interferon-gamma Receptor Deficiency in Patients with Disseminated Tuberculosis / 결핵및호흡기질환

BACKGROUND: Interferon-gamma (IFN-gamma) is essential in the immune response to mycobacterial infections, and a complete or partial deficiency in the IFN-gamma receptor 1 (IFNgammaR1) or the IFN-gamma receptor 2 (IFNgammaR2) have been reported to confer susceptibility to a disseminated infection with nontuberculous mycobacteria. However, similar mutations in the IFN-gamma receptor have not been specifically examined in the patients with clinical tuberculosis. METHODS: This study searched for mutations in the IFN-gamma receptor gene that resulted in a partial IFN-gamma receptor deficiency in six patients with disseminated tuberculosis. The previously identified IFNgammaR1 and IFNgammaR2 coding regions were sequenced after amplification. RESULTS: There was no partial IFNgammaR1 deficiency including a homozygous recessive missense mutation causing an amino-acid substitution in the extracellular domain of the receptor (I87T) and a hotspot for small deletions (818delT, 818del4, 818insA) found in any of the patients. In addition, a partial IFNgammaR2 deficiency of the homozygous missense mutation (R114C) was not found in any of the patients. CONCLUSION: Genetic defects causing a partial IFN-gamma receptor deficiency were not identified in our patients with disseminated tuberculosis.