Résumé
PURPOSE: Surveillance for detecting and managing latent tuberculosis infection (LTBI) is a key component of tuberculosis control. The classic surveillance tool, the tuberculin skin test (TST), may have some limitations when used in the Bacillus Calmette-Guerin (BCG)-vaccinated population. The object was to perform a blood test QuantiFERON(R)-TB Gold In Tube (QFT-G IT) based on the detection of interferon-gamma (IFN-gamma) released by T cells in response to Mycobacterium tuberculosis-specific antigens, and to compare the efficacy of this new diagnostic tool for LTBI with that of TST. METHODS: For six months, between October 1, 2006 and April 30, 2007, data were collected from 111 patients under 15 years of age at Severance Children's Hospital. TST and QFT-G IT tests were performed with children with or without contact histories of tuberculosis. In addition to these tests, we examined comparative data from 29 adults who had tuberculosis, to detect false negative rates in the QFT-G IT method. RESULTS: Thirty-three children had household contact histories. In this group, 15% and 42% of cases were found to be positive using the QFT-G IT assay and TST, respectively. Agreement was low between these two tests (kappa=0.39). In the adult active tuberculosis group, the QFT-G IT false negative rate defined as a positive culture and a negative QFT-G IT result was 12.5%. CONCLUSION: In diagnosing LTBI in children, the usefulness of a whole-blood IFN-gamma assay employing TB-specific antigens will be revealed only by examining additional longitudinal clinical data; this study serves as a starting point in that process.
Sujets)
Adulte , Enfant , Humains , Bacillus , Caractéristiques familiales , Tests hématologiques , Interféron gamma , Tests de libération d'interféron-gamma , Tuberculose latente , Mycobacterium , Peau , Tests cutanés , Lymphocytes T , Tuberculine , TuberculoseRésumé
PURPOSE: Surveillance for detecting and managing latent tuberculosis infection (LTBI) is a key component of tuberculosis control. The classic surveillance tool, the tuberculin skin test (TST), may have some limitations when used in the Bacillus Calmette-Guerin (BCG)-vaccinated population. The object was to perform a blood test QuantiFERON(R)-TB Gold In Tube (QFT-G IT) based on the detection of interferon-gamma (IFN-gamma) released by T cells in response to Mycobacterium tuberculosis-specific antigens, and to compare the efficacy of this new diagnostic tool for LTBI with that of TST. METHODS: For six months, between October 1, 2006 and April 30, 2007, data were collected from 111 patients under 15 years of age at Severance Children's Hospital. TST and QFT-G IT tests were performed with children with or without contact histories of tuberculosis. In addition to these tests, we examined comparative data from 29 adults who had tuberculosis, to detect false negative rates in the QFT-G IT method. RESULTS: Thirty-three children had household contact histories. In this group, 15% and 42% of cases were found to be positive using the QFT-G IT assay and TST, respectively. Agreement was low between these two tests (kappa=0.39). In the adult active tuberculosis group, the QFT-G IT false negative rate defined as a positive culture and a negative QFT-G IT result was 12.5%. CONCLUSION: In diagnosing LTBI in children, the usefulness of a whole-blood IFN-gamma assay employing TB-specific antigens will be revealed only by examining additional longitudinal clinical data; this study serves as a starting point in that process.
Sujets)
Adulte , Enfant , Humains , Bacillus , Caractéristiques familiales , Tests hématologiques , Interféron gamma , Tests de libération d'interféron-gamma , Tuberculose latente , Mycobacterium , Peau , Tests cutanés , Lymphocytes T , Tuberculine , TuberculoseRésumé
PURPOSE: The purpose of this study was to analyze the association of peripheral neutrophil count with the development of respiratory failure in preterm infants. METHODS: A retrospective study was conducted from January 1993 to December 1999 on 44 preterm infants, who were admitted to the neonatal intensive care unit of St. Francisco hospital. Preterm infants(birth weight 500 to 1,350 gm) who had a complete blood count obtained within 2 hours after delivery. Patients in the lowest of neutrophil count(early neutropenia, <1.0X10(9)/L) were compared with patients in the remaining group. RESULTS: Low neutrophil count were transient in early neutropenia group. The concentration the circulating neutrophil count rose from 0.85+/-0.11X10(9)/L at average of 2 hours after delivery to 5.3+/-2.7X10(9)/L at 24 hours after delivery in the early neutropenia group and from 3.6+/-1.6X10(9)/L to 5.8+/-3.2X10(9)/L in the non-neutropenia group during the same time period. Compare to the non-neutropenia group, the neutropenia group had a lower birth weight(1,046.50+/-180.76 gm Vs 1,156.70+/-124.99 gm), a lower Apgar score(1 min : 3.41+/-1.18 Vs 4.30+/-1.46, 5 min : 5.41+/-0.87 Vs 6.15+/-0.95), and a higher incidence of bronchopulmonary dysplasia(27.27% Vs 7.0%). Patients who had early neutropenia were more likely to require mechanical ventilation, supplemental oxygen and hospital stay. Also, main effect factors for the two groups were birth weight(Odds ratio=5.457, 95 % CI=1.551-27.525), initial peripheral blood white cells(odds ratio=8.308, 95% CI=2.054-52.699), and bronchopulmonary dysplasia(odds ratio=0.099, 95% CI=0.017-0.397). CONCLUSION: A low count of neutrophil in the systemic circulation of premature infants within 2 hours of birth is associated with more severe respiratory distress.
Sujets)
Humains , Nouveau-né , Hémogramme , Dysplasie bronchopulmonaire , Incidence , Prématuré , Soins intensifs néonatals , Durée du séjour , Neutropénie , Granulocytes neutrophiles , Oxygène , Parturition , Ventilation artificielle , Insuffisance respiratoire , Études rétrospectivesRésumé
Acrodermatitis enteropathica(AE) which starts in early infancy after weaning is a rare hereditary chronic disorder of zinc absorption. AE is characterized by alopecia, diarrhea and skin lesions localized to periorificial areas and acrally on the extremities. However, recent reports presented Transient Symptomatic Zinc Deficiency(TSZD) in preterm infants. TSZD is clinically similar to AE and skin lesions rapidly heals after zinc supplementation. When the treatment was withheld, no recurrence was seen. We experienced a TSZD case in a cow's milk fed, preterm infant, so We report it with a brief review of literature.
Sujets)
Humains , Nourrisson , Nouveau-né , Absorption , Acrodermatite , Alopécie , Diarrhée , Membres , Prématuré , Lait , Récidive , Peau , Sevrage , ZincRésumé
Stickler syndrome is an autosomal dominant disorder of connective tissue with a wide range of expressivity and incomplete penetrance which is called hereditary progressive arthro-ophthalmopathy. Affected neohates may present with the Pierre-Robin syndrome, progressive myopia, retinal detachment, flat face, hypertelorism, progressive arthritis. Early recognition of the syndrome is important, not only for genetic counselling but also to offer a more precise prognosis and proper treatment of many serious disorders that may occur in affected children. We experienced a case of Stickler syndrome with large eyeballs in a 3-day-old female baby who showed Pierre-Robin anomaly, flat face, hypertelorism, epicanthal folds, long philtrum, micrognathia, deft palate, high congenital myopia, chorioretinal degeneration, thin habitus and hyperextensible joints.
Sujets)
Enfant , Femelle , Humains , Arthrite , Tissu conjonctif , Hypertélorisme , Articulations , Lèvre , Myopie , Myopie dégénérative , Palais , Pénétrance , Syndrome de Pierre Robin , Pronostic , Décollement de la rétineRésumé
Pulmonary artery sling is a rare vascular anomaly in which the left pulmonary artery arises from the right pulmonary artery and then traverses between the esophagus and the trachea toward the hilum of the left lung. Despite the availability of a corrective operation, the mortality rate remains very high due to the high incidence of associated obstructive anomalies of tracheobronchial trees. We experienced a 8 month old female infant who was admitted because of recurrent pneumonia and expiratory wheezing. She was diagnosed as pulmonary sling by esophagography, echocardiography, computed tomography. We report this with a brief review and related literature.
Sujets)
Femelle , Humains , Nourrisson , Échocardiographie , Oesophage , Incidence , Poumon , Mortalité , Pneumopathie infectieuse , Artère pulmonaire , Bruits respiratoires , TrachéeRésumé
Mesenteric lymphangioma was first recognized when an autopsy case was recorded in 1507 by Benevieni. It has been known clinically rare disease and probably a congenital developmental abnormality due to failure of drainage of peripheral primary lymphatic spaces. We experienced a case of abnormal rotation in intestine by mesenteric lymphangioma in a 8 years old male who showed vomiting and abdominal pain. A brief review of related literatures is also presented.
Sujets)
Enfant , Humains , Mâle , Douleur abdominale , Autopsie , Drainage , Intestins , Lymphangiome , Maladies rares , VomissementRésumé
Primary endodermal sinus tumor (yolk sac tumor) of the mediastinum is rare. Most patients are young and male, and the great majority of tumors are found in the anterior mediastinum, and spontaneous hemothorax is a rare presentation of intrathoracic tumors. We report a case of spontaneous hemothorax associated with a posterior mediastinal endoderml sinus tumor occuring in a female patient. Brief review and related literatures were also presented.
Sujets)
Femelle , Humains , Mâle , Endoderme , Tumeur du sac vitellin , Hémothorax , MédiastinRésumé
We experienced a case of spondylothoracic dysplasia in a 1 day old male who has short neck with limitation of movement, asymmetric thorax, marked scoliosis and a systolic heart murmur. He was born with normal weight and full term. The history of his family and mother is not specific. On x-ray, multiple hemivertebrae in thorax, spina bifida and maldevelopmental thoacic cavity were detected. On echocardiogram, he had small ASD and PDA.
Sujets)
Humains , Mâle , Cardiopathies congénitales , Souffles cardiaques , Mères , Cou , Scoliose , Dysraphie spinale , ThoraxRésumé
Breast feeding is one of many factors that have been associated with the development of lower respiratory tract illnesses. To assess the relation between breast feeding and subsequent experience of lower respiratory tract illness, we performed this study, retrospectively, on 366 infants who had been admitted to the pediatric ward, St. Francisco General Hospital, or had been brought to the well baby clinic from November, 1992 to March, 1993. The results were as foolows: 1) Among 366 infants, the number of all first illnesses observed at each interval were 259 cases (70.8%), of which 198 (54.1%) were associated with wheezing illnesses and 61 (16.7%) with non-wheezing lower respiratory illnesses. 2) Duration of breast feeding regardless of-whether other foods were given, was categorized as 3 grups, i. e., none or for less than a month (group), one to 4 months (group B), and 4 or more months (group C). Incidences of wheezing illnesses in the first 4 months of life were lower in group B(10.1%) and group C (8.4%) than group A (27.3%), respectively (p<0.01). Wheezing illnesses beyond 4 months of life and non-wheezing illnesses in all intervals seemed to be unrelated to the duration of breast feeding. 3) Considering a variety of other fisk factors, including sharing a room, parental childhood reapiratory trouble, sex and maternal education, children who received minimal breast feeding (group A) had the greater risk of early wheezing illnesses in the simultaneous exposure to sharing a room than group B and C (p<0.005). Our results suggest that decreased breast feeding is associated with a higher incidence of wheezing illnesses in the first 4 months of life, particularly in combination with other risk factors, such as sharing a room.
Sujets)
Enfant , Humains , Nourrisson , Allaitement naturel , Région mammaire , Éducation , Hôpitaux généraux , Incidence , Parents , Bruits respiratoires , Appareil respiratoire , Études rétrospectives , Facteurs de risqueRésumé
Among 666 premature infants or low birthweight infants who were admitted in NICU of St. Francisco General Hospital from January 1990 to Jun 1992, 96 infants were diagnosed as retinopathy of prematurity by indirect ophthalmoscope. The result were follows: 1) Among 666 patients, retinopathy of prematurity developed in 96 patients(14.1%) 2) The high incidence was observed in low birthweight and small gestational age. 3) Mean age of first diagnosing time was 42.0( 12 day of life and mean gestational age was 31.8 2.5 weeks and mean birthweight was 1646.5 (350.7gm. 4) In gestational age, birthweight and duration of oxygen therapy, there was statistically difference between cryotherapy group and spontaneous regression group. Other possible risk factors-hyaline membrane disease, apnea, anemia-were showed higher incidence in cryotherapy group. 5) Among the 20 infants who were treated with cryotherapy, 16 infants (80%) showed regression of neovascularization.