The Association of Eosinophilic Airway Inflammation in Mycoplasma pneumonia and Asthma / 소아알레르기및호흡기학회지

PURPOSE:To investigate whether airway eosinophilic degranulation develops in Mycoplasma pneumonia (M. pneumonia), and to elucidate the association between M. pneumonia and asthma. METHODS:Forty patients with M. pneumonia, 20 stable asthma patients (stable asthma) and 20 normal controls were recruited from October 2005 to February 2007. In the M. pneumonia, blood and induced sputum sampling were collected at admission (acute stage) and 6 to 8 weeks later (convalescent stage). Eosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) levels in sputum and serum were measured in all 3 groups. RESULTS:Serum levels of EDN and ECP in the acute stage of M. pneumonia were comparable to those in the stable asthma group. However, in the convalescent stage of M. pneumonia, EDN and ECP levels were significantly lower than in the stable asthma (P<0.01 and P<0.05, respectively). Sputum levels of EDN and ECP levels in the acute stage of M. pneumonia were comparable to those in the stable asthma. Sputum EDN levels in the convalescent stage of M. pneumonia were significantly lower than those in the stable asthma (P<0.05), and sputum ECP levels were lower than those in the stable asthma, which was not statistically significant. CONCLUSION:Eosinophilic degranulation may play an important role in the pathogenesis of M. pneumonia, which suggests the association between M. pneumonia and asthma.

Re-evaluation of the Efficacy and Safety of Aminophylline for Children with Acute Asthma Exacerbation / 소아알레르기및호흡기학회지

PURPOSE: Although methylxanthines (aminophylline or theophylline) have an equivalent bronchodilator effect on inhaled beta2-agonists, the GINA guidelines recommend methylxanthines as an alternative to methylxanthines becamse of their side effects. The Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGTMA 2005), however, recommends methylxanthines for the treatment of asthma attack along with systemic corticosteroids. We aimed to determine whether the addition of intravenous (IV) aminophylline with both IV corticosteroids and inhaled beta2-agonists would improve asthma symptoms better and earlier without serious adverse effects. METHODS: Thirty-seven children with acute asthma exacerbation were studied. Twenty patients were treated with a combination of IV corticosteroids, inhaled beta2 agonists and IV aminophyllines (Group A), and 17 patients were treated with IV corticosteroids and inhaled beta2 agonists only (Group B). We evaluated the changes of symptom scores, including degrees of wheezing, retraction, orthopnea, cyanosis and SpO2, before and after treatment in both groups. RESULTS: Group A patients showed faster improvement in asthma symptom score (P72 hours) resulted in need for larger dose of systemic steroids (P<0.05). Although adverse effects occurred in 20% of Group A patients, all of which them were not serious without the need for drug withdrawal. CONCLUSION: IV aminophylline may be a therapeutic option for children with acute asthma exacerbation. Further evidence is needed to substantiate the conclusion.

Lamotrigine-induced Anticonvulsant Hypersensitivity Syndrome: Treatment with Steroid and Intravenous Immunoglobulin / 대한소아신경학회지

Lamotrgine is an antiepileptic drug that is effective for multiple types of seizure and has side-effects such as headache, nausea, dizziness, diplopia, ataxia, cutaneous lesions, and anticonvulsant hypersensitivity syndrome. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, lymphadenopathy and internal organ involvement, induced by aromatic anticonvulsants, for example phenytoin, phenobarbital, carbamazepine, and lamotrigine. We report a case of 13-year-old girl who had a fever, generalized erythematous skin eruption, facial edema, eosinophilia, and elevated liver enzyme induced by lamotrigine and resolved with discontinuation of medication and intravenous steroid and immunoglobulin.

Effects of Early and Low-Dose Ribavirin Therapy on Respiratory Syncytial Virus Bronchiolitis in Previously Healthy Infants / 소아알레르기및호흡기학회지

PURPOSE: we performed this study to determine whether early and low dose ribavirin therapy for respiratory syncytial virus (RSV) bronchiolitis in previously healthy infants may reduce the duration of hospital stay. METHODS: Thirty-four Previously healthy infants with RSV bronchiolitis were enrolled in this study. Early in the course of illness, less than 5 days, aerosol ribavirin was administered at a low, single-dose (3 g/150 mL/day) and then we assessed the duration of hospital stays for 16 infants treated with ribavirin (ribavirin group) and 18 infants who received conservative treatment (control group). RESULTS: The baseline characteristics of each group were not significantly different with respect to gestational age, birth weight, age, sex, weight, and height. On admission, there were no significant differences between the two groups in the respiratory rate and body temperature. Duration of hospitalization was significantly shorter in the ribavirin group (4.4+/-0.3 days) as compared to the control group (5.5+/-0.3 days) (P=0.02). CONCLUSION: Early and low-dose ribavirin therapy for RSV bronchiolitis in previously healthy infants may decrease duration of hospital stay.

The evaluation of risk for aspiration using lipid-laden macrophage index in infants with bronchiolitis / 소아과

PURPOSE: We investigated the risk of aspiration using the lipid-laden macrophage index(LLMI) from laryngeal lavages in infants with bronchiolitis. METHODS: Laryngeal lavages from 22 infants with acute bronchiolitis caused by respiratory syncytial virus(RSV) were evaluated during the acute stage. Repeat studies were performed at 3 to 4 weeks after the initial study(remission stage). Lavage cell counts and differentials were determined. The amount of lipid per single macrophage was evaluated and the LLMI was determined by evaluating 100 cells. Comparisons between acute stage and remission stage were made. Twenty-four hour pH monitoring(pHm) was performed in 12 patients. RESULTS: The total cell number was significantly higher in the acute stage compared with the remission stage(P<0.05). The LLMIs in the acute stage were significantly higher than those in the remission stage(P<0.05). The neutrophils percentage of laryngeal lavage correlated with the LLMI(r= 0.69, P<0.001). Four children had positive pHm recordings(pH-positive infants) and eight had negative pHm recordings(pH-negative infants). The pH-positive infants had higher LLMI and higher neutrophils percentage than those of the pH-negative infants(P<0.05). CONCLUSION: These findings suggest that there is a transient increased risk of aspiration during bronchiolitis. The LLMI from laryngeal lavage may be a useful marker for pulmonary aspiration in infants with bronchiolitis.

Necessity of (99m)Tc-dimercaptosuccinic acid scan in infants with low grade vesicoureteral feflux / 소아과

OBJECTIVE: (99m)Tc-dimercaptosuccinic acid(DMSA) scan is considered to be the most sensitive examination for detection of renal scars. However, because of its high radiation exposure to the kidney and its limited usefulness for patients with low grade vesicoureteral reflux(VUR), some authors have suggested that DMSA scans should be reserved primarily for children with VUR grade 3 and above. The aim of this study was to reevaluate the necessity of DMSA scans as a screening test in infants without reflux or with low grade reflux. METHODS: In this retrospective study, 189 infants(mean age:6.2 months) diagnosed as UTI were enrolled. Voiding cystourethrogram(VCUG), DMSA scan and renal ultrasonography were performed within 1 month of UTI. VUR grade was classified into three subgroups; low grade(grade 1-2), moderate grade(grade 3), and high grade(grade 4-5), respectively. RESULTS: Renal defects were present in 67 of 189 infants, and 82 of the 378 renal units. The incidence of renal defects was significantly correlated with VUR grade(P<0.01); 28 percent without reflux, 38 percent with low grade, 53 percent with moderate grade, 100 percent with high grade, respectively. However, there was no significant differences in incidence of renal defects between the low grade and moderate grade group. CONCLUSION: In this study, renal defects were found in quite high percentages; 28 percent patients without reflux and 38 percent patients with low grade VUR, respectively. Moreover, there was no significant difference in the incidence of renal defects between the low grade and moderate grade groups. Therefore, DMSA scan should be performed for infants with UTI as a screening test regardless of the presence of VUR.