Risk Factors for Failure of Initial Intravenous Immunoglobulin Treatment in Kawasaki Disease

The aims of this study were to determine the occurrence and variables associated with the initial intravenous immunoglobulin (IVIG) treatment failure in Kawasaki disease (KD) and to categorize differences in clinical characteristics between responders and nonresponders to initial IVIG treatment. Patients were classified into two groups. Group A included 33 patients who received a single dose of IVIG treatment and responded. Group B included 18 patients who received more than two doses of IVIG due to failure of the initial treatment. The mean duration of fever after initial treatment in group B was significantly longer than it was in group A. In group B, we found that higher bilirubin, aspartate aminotransferase (AST), polymorphonuclear cells (PMN) (%), and lower platelet values at baseline were independent predictors of persistent or recurrent fever in patients with KD. Coronary artery abnormalities were found in 8 patients (44.4%) in group B and in two patients (6.1%) in group A. We found that abnormal liver function tests and a lower platelet count at baseline were possible predictors of nonresponders to IVIG in patients with KD. There is a need for a prospective study focused on baseline hepatobiliary parameters.

Trends of the Incidence of Erythromycin-Resistant Group A Streptococci in Korea from 1998 through 2002 / 감염과화학요법

BACKGROUND: Although the incidence of resistance to macrolides in group A streptococci (GAS) was low in the past, high incidences have now been reported from several countries. We tried to find out trends of the incidence of erythromycin-resistant GAS in Korea before and after adopting the separation of the dispensary from medical practice in the middle of the year 2000. METHODS: Five hundred thirty two isolates from children with suspected pharyngotonsillitis from 1998 through 2002 were serotyped by T-agglutination. Minimal inhibitory concentrations of 330 out of 532 isolates were determined by agar dilution methods. RESULTS: The prevalent T-serotypes were T12 (36.1%), T4 (12.8%), T1 (10.9%), T2/28 (8.8%), and nontypable (7.1%). Resistance rates to erythromycin (EM) by year were 46.2% in 1998, 18.4% in 1999, 15.4% in 2000, 27.6% in 2001, 36.5% in 2002. T12 in 1999 and 2000 were 36.4% and 25.9%, respectively, which seem to be lower than any other year. This relative low percentage of T12 is associated with increasing percentage of T1 in the same year. The frequency of T12, T1,and T4 were high in each group of isolates of Seoul and Masan. From this viewpoint, there was a similarity between the distribution of T-serotypes of both groups of Seoul and Masan. CONCLUSION: The frequency of serotype T12 and T4 of GAS were relatively high in Korea from 1998 through 2002. The low rate of EM resistance in 1999 and 2000 seemed to be caused by a sudden increase of T1. The increasing rate of EM resistance from 2000 to 2002 seemed to be caused by the increase in consumption of new macrolides and the increase of T12.

Trends of the Incidence of Erythromycin-Resistant Group A Streptococci in Korea from 1998 through 2002 / 감염과화학요법

BACKGROUND: Although the incidence of resistance to macrolides in group A streptococci (GAS) was low in the past, high incidences have now been reported from several countries. We tried to find out trends of the incidence of erythromycin-resistant GAS in Korea before and after adopting the separation of the dispensary from medical practice in the middle of the year 2000. METHODS: Five hundred thirty two isolates from children with suspected pharyngotonsillitis from 1998 through 2002 were serotyped by T-agglutination. Minimal inhibitory concentrations of 330 out of 532 isolates were determined by agar dilution methods. RESULTS: The prevalent T-serotypes were T12 (36.1%), T4 (12.8%), T1 (10.9%), T2/28 (8.8%), and nontypable (7.1%). Resistance rates to erythromycin (EM) by year were 46.2% in 1998, 18.4% in 1999, 15.4% in 2000, 27.6% in 2001, 36.5% in 2002. T12 in 1999 and 2000 were 36.4% and 25.9%, respectively, which seem to be lower than any other year. This relative low percentage of T12 is associated with increasing percentage of T1 in the same year. The frequency of T12, T1,and T4 were high in each group of isolates of Seoul and Masan. From this viewpoint, there was a similarity between the distribution of T-serotypes of both groups of Seoul and Masan. CONCLUSION: The frequency of serotype T12 and T4 of GAS were relatively high in Korea from 1998 through 2002. The low rate of EM resistance in 1999 and 2000 seemed to be caused by a sudden increase of T1. The increasing rate of EM resistance from 2000 to 2002 seemed to be caused by the increase in consumption of new macrolides and the increase of T12.

T Protein Serotyping and Antibiotic Sensitivity Test for Streptococcus pyogenes Obtained from Patients with Pharyngotonsillitis and Healthy School Children / 감염

BACKGROUND: In the mid-1970s and late 1980s, outbreaks of erythromycin-resistant streptococci in Japan and Finland were likely to be associated with the increased consumption of macrolides. Because of the lack of routine antibiotic sensitivity for Streptococcus pyogenes, the reported percentage of resistant strains was only 2% in 1994 in Korea. We tried to determine the rate of resistant strains considering the high occurrence of penicillin-resistant pneumococci and antibiotic purchase without prescription in our country. METHODS: Twenty-four strains of S. pyogenes were isolated from children with pharyngotonsillitis in Kyunghee University Hospital, Seoul, Korea from Feb. through Aug. 1998. Forty-four strains obtained from healthy school children living in Uljin, Kyongsang-bukdo and Hongreung, Seoul in 1998. All isolates were serotyped by T-agglutination (Sevapharma, Czech Rep) and minimal inhibitory concentrations were determined for penicillin, erythromycin, vancomycin, tetracycline, cefotaxime, and clindamycin by agar dilution method according to National Committee for Clinical Laboratory Standards. RESULTS: The carrier rates in Hongreung and Uljin were 4.1% and 13.3%, respectively. Twenty-two out of 24 (91.6%) strains from pharyngitis and 32 out of 44 (72.7%) strains from normal children were typed by T agglutination test. The most common T types were T12 (54.2%) and T4 (33.3%) in pharyngitis, whereas the most common T types were T12 (45.5%), non typable (27.3%), and T4 (15.9%) in healthy carriers. All of the strains from pharyngitis were susceptible to penicillin, vancomycin, and cefotaxime. However, 13 out of 24 (54.2%) strains were resistant to erythromycin, and 11 isolates (45.8%) were resistant to clindamycin and tetracycline. Ten out of 13 isolates of T12 and one isolate of T28 were multi-resistant to erythromycin, clindamycin, and tetracycline. Two isolates of T4 were resistant to erythromycin. CONCLUSION: Almost half of isolates obtained from a university hospital in Seoul are multidrug-resistant Streptococcus pyogenes. Serial monitoring of antibiotic susceptibility test and a nationwide survey accompanied by molecular epidemiologic studies are needed to determine the occurrence and spread of resistant strains from different geographic areas.

Serotyping of Group A Streptococci Isolated from Healthy School Children and Patients with Pharyngotonsillitis / 감염

BACKGROUND: To evaluate serological typing of T(epidemiologic marker) and M protein(major virulence antigen) is important to understand pathogenesis and epidemiology of streptococcal infection. The purpose of this study is to find out whether there were major difference in distribution of serotypes isolated from healthy school children and patients with pharyngotonsillitis, and to characterize the geographical differences in distribution of the serotypes. METHOD: Twenty-three strains of group A streptococci were isolated from healthy school children in two different areas(Dongdaemun-Ku and Kangsuh-Ku) in Seoul in April and July 1996. 23 strains came from patients living in Dongjak-Ku with pharyngotonsillitis in April 1996. All isolated were serotyped by T agglutination, M precipitation and opacity factor at the WHO Collaborative Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis. RESULTS: 89.1% of the strains were typable by T agglutination, 56.5% by M precipitation, and 52.2% were positive in opacity factor. T types 1, 25, 4, and 12 accounted for 65.2% of patients with pharyngotonsillitis, T types 12, and 25 accounted for 71.5% of healthy children in Dongdaemun-Ku, and T types 28, 6, and 3 accounted for 62.6% of healthy children in Kangsuh-Ku. T types 1, 25, 28, 12, 4 and M types 1, 75, 28, 4, 12 were typed in decreasing order. CONCLUSION: We characterized the differences in serotypes of group A streptocpcci between healthy children and patients. The periodic and seasonal serotyping analysis is important in monitoring and understanding of the epidemiologic patterns of group A streptococci.

Relationship between Antistreptolysin O Titer and Number of Colonies from Throat Swab Culture Plate in Group A Beta-hemolytic Streptococcal Carriers and Normal School Children

PURPOSE: To know the true carrier rate and the immunologic responses (antistreptolysin O :ASO) to beta-hemolytic streptococci which obtained from normal school children with or without carrying streptococci. And to study the clinical meaning of the number of organisms found in culture. METHODS: One hundred ninty-eight first grade of elementary school children were included. I obtained throat swab culture from tonsil and tonsilar fossa with sterile cotton ball stick and plated on sheep blood agar dish, counted number of colonies of beta-hemolytic streptococci (BHS) after overnight incubation, examined ASO titer (Rantz-Randall method) simultaneously, and differentiated grouping of BHS with Streptex. RESULTS: 1) Of the 198 normal school children, 34 (17.2%) had cultured BHS. 16 (8.1%) were group A, 4 (2.0%) were group C, 2 (1.0%) were group G, and 12 (6.1%) were non-grouping BHS. 2) 14 (22.2%) out of 63 normal children without carrying BHS and 16 (47.1%) out of 34 with carrying BHS had come out above 250 units of ASO. 13 (59.1%) out of 22 group A,C,G streptococcal carriers had showed above 250 units of ASO. The true carrier rate of BHS were 18 (9.0%) out of 198 elementary school children. 3) When I had counted the number of colonies from 34 carrier of BHS, 1+ was 67.6% and 2+ was 17.6%. It was 85.2% of total children with carrier. 4) There were significant differences between the mean titer of logarithmic ASO obtained from group A BHS carrier and that of normal children without carrying BHS (P=0.001), and differences between that of group A and group B,C,G streptococci (P= 0.0005). CONCLUSIONS: The ASO titer obtained from BHS carrier is higher than normal school children, which suggests the possibility of subclinical infection, the possibility of persistent habor of organism since past infection had contracted, and the possibility of replaced old organism in past infection with new organism. It should be performed follow-up study for identifying the persistence of immunologic response in accordance with or without culturing organism.