Case of cytomegalovirus pneumonia presented as pneumothorax in 4-month-old healthy infant

Cytomegalovirus (CMV) is the most common agent of congenital infections and opportunistic infections in an immunocompromised host. CMV in an immunocompetent host has inapparent infections, which are usually asymptomatic or cause mild mononucleosis-like symptoms. However, severe CMV diseases, such as pneumonia, hepatitis, gastrointestinal disease, often occur in a healthy infant. The association of CMV pneumonia with the development of pneumothorax has rarely been reported. We experienced a case of CMV pneumonia presenting as pneumothorax in a 4-month-old healthy infant, who was successfully treated with supportive care. CMV was confirmed by using CMV polymerase chain reaction of tracheal aspirates. This case suggested that CMV should be considered as a cause of viral pneumonia during the infant period.

Early diagnostic value of the antimycoplasma antibody (IgM) in Mycoplasma pneumoniae pneumonia: A single-center study in 2015

PURPOSE: Recently, the incidence of refractory Mycoplasma pneumoniae (MP) pneumonia has increased in Korea. Given that its early diagnosis is helpful in selection of the treatment, this study aimed at investigating the value of the antimycoplasma antibody (IgM) for early diagnosis of MP pneumonia. METHODS: A total of 315 children admitted with MP pneumonia from September 2015 to May 2016 were investigated with the IgM and polymerase chain reaction (PCR) for the diagnosis of MP pneumonia. Specifically, patients were grouped into nonrefractory respiratory MP and refractory MP groups according to their response to macrolide therapy. RESULTS: In the 44 PCR-negative seroconversed children, seroconversed IgM was more frequent in the refractory MP group compared with the nonrefractory respiratory MP group with statistical significance (P<0.001). In the 264 IgM-positive children, the time of antibody reaction was more delayed in the refractory MP group compared to the nonrefractory respiratory MP group with statistical significance (P<0.001). CONCLUSION: This study showed that there was a higher incidence of seroconversed IgM and delayed antibody reaction in the refractory MP group. In children with suspect MP pneumonia, follow-up studies of antibody are necessary, even through initial antibody and PCR showed negative findings. In addition, this result may suggest that the diagnosis of refractory MP pneunomia will be helpful in establishing the strategy of the treatment.

Clinical difference between single infection and coinfection with respiratory virus: The 2014 single-center study

PURPOSE: We investigated the clinical difference between single infection and coinfection with respiratory virus in hospitalized children with acute respiratory tract infections. METHODS: We reviewed 727 patients who were admitted with the diagnosis of acute respiratory infection at the Department of Pediatrics, Bundang Jesaeng Hospital between January and December of 2014. Diagnoses were made using the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay targeting 16 viruses in nasopharyngeal swabs. Subjects were classified as the single virus infection and coinfection groups. RESULTS: A total of 439 patients were enrolled; 359 (77.2%) under 24 months. Single virus was detected in 279 (63.6%). Coinfection with multiple virus was detected in 160 (36.4%): 126 (28.7%) with 2 viruses, 30 (6.8%), and 4 (0.9%) with 3 to 4 viruses. Viral coinfection was detected in 28 samples (17.5%), with respiratory syncytial virus (RSV) A and rhinovirus being the most dominating combination. There were no clinical differences between the single infection and coinfection groups, except sputum and the frequency of high RSV load. Sputum was significantly more frequent in the coinfection group (P=0.043), and the frequency of high RSV load was significantly higher in the single infection group (P=0.029). Disease severity (high fever, the duration of fever [≥5 days], and the length of hospital stay [≥5 days], O₂ therapy) did not differ significantly between both groups. RSV was a frequent virus of single infection during winter. Coinfection was most common in winter. CONCLUSION: There were no clinical differences between single infection and coinfection, except sputum and the frequency of high RSV load.

Factors associated with obesity of acute bronchiolitis in infants: association of obesity with disease severity

PURPOSE: Both under-nutrition and obesity may be associated with severity of viral infection. We investigated the association of obesity with clinical factors and the severity of acute bronchiolitis in infants. METHODS: We reviewed 740 infants younger than 1 year of age who were admitted with the first episode of acute bronchiolitis between 2010 and 2013. Subjects were classified into 3 groups according to the weight-for-length Z-score. RESULTS: Younger age (3.6+/-2.6 months) was more frequent in the obesity group (P<0.001). Infants aged < or =6 months (90%) dominantly included in the obesity group. Logistic regression showed that age (younger than 3 months) was independently associated with the overweight and obesity groups with acute bronchiolitis in infants (odds ratio [OR], 1.77; P=0.001 for overweight; OR, 4.67; P<0.001 for obesity). Moreover, the obesity group was associated with an increased risk of chest retraction, hypoxia, respiratory syncytial virus detection, length of stay (more than 5 days), and need for oxygen supplement. These factors tended to increase from the overweight group toward the obesity group. CONCLUSION: Younger than 3 months of age was a risk factor for developing worse clinical course in overweight and obesity groups with acute bronchiolitis in infants. Careful attention should be paid to the clinical course of younger obese infants with acute bronchiolitis.

Clinical characteristics of primary spontaneous pneumothorax in adolescents: factors for recurrence

PURPOSE: The aim of this study was to investigate the clinical characteristics of primary spontaneous pneumothorax (PSP) in adolescents and identify risk factors for the recurrence of PSP. METHODS: A total of 292 patients diagnosed with PSP from January 1998 to December 2011 were retrospectively studied. Clinical data on demographics, diagnostic imaging, therapies, and risk factors of recurrence were collected and analyzed. RESULTS: The sex ratio of 292 patients was 19.8:1 (male:female), and the average age of the patients was 17.0 years. The average body mass index of the patients was 18.8 kg/m2. The most common presenting symptom was chest pain. There was no seasonal variation in the incidence of PSP. Thirty patients (10.2%) had a history of smoking. The most common location of PSP was the left side. Out of 249 patients, 169 (67.9%) had cysts (blebs/bullae). Fifty-four patients (18.5%) received oxygen therapy, 3 patients (1%) needle aspiration, 119 patients (40.8%) closed tube drainage, and 116 patients (39.7%) surgery. The recurrence rate was 38.6%. Smoking was associated with the size of pneumothorax (P=0.002). Also, the size of pneumothorax and surgery was associated with recurrence (P=0.040 and P=0.004). However, previously reported risk factors for recurrence were not identified in our patients. CONCLUSION: Pediatric PSP occurred mainly in males in late adolescence with normal body mass index. No significant risk factors were related to recurrence of PSP in our study.

Effects of Cooking Methods on Peanut Allergenicity / 소아알레르기및호흡기학회지

PURPOSE: Peanut allergy is a major cause of fatal food-induced anaphylaxis. Cooking methods can affect the allergic properties of peanut proteins. The aim of this study was to determine the allergenicity of peanut according to cooking methods. METHODS: Eight kinds of peanut were included in the study: raw peanut, boiled peanut, roasted peanut (10 min, 20 min and 30 min), peanut butter, fried peanut and vinegarish peanut. The proteins were extracted with PBS and analyzed using the SDS-PAGE IgE immunoblot assay with pooled sera from 8 patients with atopic dermatitis. These patients had peanut- specific IgE levels greater than 15 kU/L, which were measured by the CAP-FEIA. RESULTS: The SDS-PAGE IgE immunoblot assay revealed more intense protein bands of Ara h 2 in roasted peanut and peanut butter than in raw, boiled, fried and vinegarish peanut. The protein band of Ara h 1 was not undetected in fried and vinegarish peanut. Ara h 3 had a stable band pattern in all samples, but there was the most prominent band at 37-40 kDa in vinegarish peanut. The IgE immunoblot assay revealed that 10 min roasted peanut had more IgE binding to Ara h 2, and there was no IgE binding to Ara h 1 in fried and vinegarish peanut. In vinegarish peanut, there was almost no IgE binding to it. CONCLUSION: The results of this study suggest that the roasted peanut may increase the allergenicity of Ara h 2 as compared to Ara h 1. Fried and vinegarish peanut may reduce the allergenicity of peanut.

Clinical Considerations about Mycoplasma Pneumoniae Pneumonia in the Young, between 2003 and 2006 / 소아알레르기및호흡기학회지

PURPOSE: Mycoplasma pneumoniae pneumonia is one of the most common community- acquired pneumonias in childhood. Recently, it has tended to occur at a young age. We reviewed clinical manifestations of M. pneumoniae pneumonia in the young. METHODS: A total of 378 children who were admitted to the Bundang Jesaeng Hospital due to M. pneumoniae pneumonia from 2003 to 2006 were retrospectively analyzed. M. pneumoniae infection was confirmed by mycoplasma antibody titer >1:320 or four-fold increase of titer. The children were divided into an infant group (Group A, 0-4 years) and an older children group (Group B, 4-14 years). We analyzed the differences between the two groups according to incidence, clinical manifestations, laboratory and radiologic findings. RESULTS: The number of patients in Group A was 147 (38.9%) and in Group B, 231 (61.1%), respectively. Seasonal distribution showed the highest frequency in autumn and the lowest frequency in spring in both groups. The most common symptom was cough (98.6% and 96.5%, respectively) and fever (85.7% and 91.3%, respectively). The most common physical findings were crackle (72.8% and 73.3%, respectively). The common radiologic findings were lobar pneumonia in both groups (55% and 76.1%, respectively), followed by bronchopneumonia (29.2% and 11.6%, respectively). Group A had a lower incidence of high antimycoplasma antibody titer (>1:5,120) and severe pulmonary complication than Group B. CONCLUSION: Group A had the more incidence of sputum production, leukocytosis, bronchopneumonia and duration of fever less than 7days. Group B had the more incidence of weak breathing sound, lobar pneumonia and duration of fever more than 7days.

Clinical Features of the 15 Patients with Idiopathic Interstitial Pneumonia / 소아알레르기및호흡기학회지

PURPOSE: Histologic classification plays a key role in the classification of idiopathic interstitial pneumonia (IIP) into clinically meaningful categories in terms of natural history, prognosis and treatment. The implications of histological diagnosis, clinical features and prognosis in children has not been described. This study aimed to analyze the clinical features of IIP in children. METHODS: A total of 15 patients with IIP were recruited, who had a surgical lung biopsy. The age, sex, symptoms, initial oxygen saturation, radiologic findings and clinical courses were retrospectively investigated. RESULTS: The median age at diagnosis was 3 years. Cough (93.3%), tachypnea (86.7%) and dyspnea (80%) were the most common symptoms, and laboratory findings were nonspecific. Acute interstitial pneumonia (n=6), chronic pneumonitis of infancy (n=4) nonspecific interstitial pneumonia (n=3) were relatively common. All patients received corticosteroid therapy and the mortality rate was 26.7% (n=4). CONCLUSION: IIP has diverse clinical features according to subtypes. Knowledge of the underlying histopathology will allow the prediction of more accurate prognosis, the decision of appropricate therapy, and the clinical investigation of novel therapeutic agents in patients with IIP.

UDP-glucuronosyltransferase 1A1 Gene Polymorphism in Severe Neonatal Hyperbilirubinemia

PURPOSE: TATA box mutation/polymorphism in the promoter region of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase 1A1 (UGT-1A1) gene is known to be an etiology of hyperbilirubinemia. This study examined if a TATA box mutation/polymorphism in UGT-1A1 gene promoter could be associated with the development of severe early neonatal jaundice in Korean infants. METHODS: Thirty-nine neonatal jaundice patients and 40 controlled infants were analyzed for UGT-1A1 promoter genotypes by using DNA sequencing. RESULTS: The homozygote for (TA)7TAA mutation was not found in this study. Comparison of the prevalence of UGT-1A1 promoter (TA)7TAA heterozygotes revealed no difference between the group with jaundice and the controlled group (15.4% vs. 10%). The peak bilirubin level was higher and the onset of jaundice was earlier in the jaundice group with (TA)7TAA heterozygote compared to the jaundice group without (TA)7TAA heterozygote (23.2+/-1.0 mg/dL vs. 19.7+/-2.4 mg/dL, P=0.004, 5.0+/-1.5 days vs. 8.3+/-4.1 days, P= 0.057). CONCLUSION: The results of this study showed that TATA box polymorphism in UGT-1A1 gene promoter did not increase the prevalence of severe early neonatal jaundice in Korean infants.

Evaluation of Allergen Specific IgE assay on ADVIA Centaur Immunoassay System / 대한진단검사의학회지

BACKGROUND: Allergen specific IgE (sIgE) assay is an important aid in the diagnosis and treatment of allergy. We evaluated the analytical performance of a quantitative chemiluminescence immunoassay for sIgE using the continuous random access ADVIA Centaur. METHODS: Six ADVIA Centaur sIgE reagents for common inhalant allergens in Korea, d1, d2, e1, e5, t3, and t7, were evaluated for precision, dilution recovery (parallelism), comparison with Pharmacia UniCAP sIgE assay and skin prick test, sample volume, and analytical speed according to the NCCLS guidelines (I/LA20-A, EP5-A2). Commercialized positive and negative quality control materials were used for a precision study, and samples from a total of 110 patients were used for dilution recovery and comparison studies. RESULTS: Within-run coefficients of variation (CV) of the 6 items were 3.45-6.14% and within-device CVs (total CVs) of all items were below 10%. Interdilutional CVs of all items were 2.84-11.95%, which showed a good linearity and parallelism over its measuring range. Positive/negative concordance rates of the 6 items with UniCAP sIgE assay were 76.3-96.1% (d1, 88.2%; d2, 96.1%; e1, 91.0%; e5, 77.0%; t3, 90.5%; and t7, 76.3%). Concordance rates of the six items with skin prick test were all above 80%. The quantity of sample volume (25 micro L/test) needed was relatively small, and a high throughput (120 tests/hr) and rapid turnaround time (47 min) could be achieved. CONCLUSIONS: The ADVIA Centaur sIgE assay was thought to be a convenient and efficient method to be used in medium- to large-sized laboratories.

Cow's Milk Protein-specific IgE Concentrations in Two Age Groups of Children with cow's Milk Allergy / 소아알레르기및호흡기학회지

BACKGROUND: About 70-80% of children with cow's milk allergy (CMA) become outgrown clinically by the age of 3 years. Casein, one of the three major cow's milk proteins (casein, beta-lactoglobulin (BLG), alpha-lactoalbumin (ALA) ) has been reported to play an important role in the persistence of CMA. The aim of this study was to determine different effects of causative milk proteins on the persistence of CMA between two age groups. METHODS: A total of 65 patients with CMA were enrolled in this study. Their cow's milk-specific IgEs were positive ( 0.7 U/ml by Pharmacia CAP). After dividing 65 patients into two age groups, under the age of 3 years and over 3 years (persistent CMA), we compared the levels of casein-, BLG- and ALA-specific IgE antibodies between the two groups. RESULTS: There were 44 patients in the group of less than 3 years of age and 21 patients in the group of more than 3 years of age. The concentrations of the specific IgE antibodies to casein, BLG and ALA were not significantly different between the two groups. However, although statistically insignificant, those more than 3 years of age had higher mean values of casein-specific IgE antibodies and lower mean values of whey protein (BLG and ALA) - specific IgE antibodies compared with those less than 3 years of age. A single dominant allergenic milk protein was not identified within either of the two age groups, but the con centrations of the casein-specific IgE antibodies in children with more than 3 years of age tended to be higher than those of whey protein-specific IgE antibodies. CONCLUSION: Although statistically insignificant, the concentrations of the casein-specific IgE antibodies were higher in the group of more than 3 years of age than in the younger group. Moreover, the concentrations of the casein-specific IgE antibodies in children more than 3 years of age tended to be higher than those of whey proteins. These findings implicate that casein plays a certain role in the persistence of CMA.

Effect of Interleukin-9 on Cell Proliferation and Histamine Release of Cord Blood-derived Human Mast Cells / 소아알레르기및호흡기학회지

PURPOSE: Interleukin-9(IL-9), one of Th2-type cytokines, might be important in the pathophysiology of allergic diseases. We investigated the effect of IL-9 on human mast cells by assessing cell proliferation and histamine release. METHODS: Human umbilical cord blood cells were cultured in the presence of stem cell factor(SCF, 100 ng/mL) and IL-6(50 ng/mL) in liquid medium for 8 weeks. Then these cells were divided into 3 aliquots. Each aliquot was cultured for 4 more weeks in different conditions : SCF alone(100 ng/mL), IL-9 alone(50 ng/mL) and SCF+IL-9. Cell numbers were counted using hemocytometer. For evaluation of apoptosis, DNA fragmentation was determined by propidium iodide(PI) staining and flow cytometric analysis. Histamine concentration was measured by ELISA after stimulation with human IgE and anti-human IgE. RESULTS: Cell numbers increased significantly when they were cultured in the presence of SCF and IL-9 compared with SCF alone(P<0.05). Proliferation of mast cells was mediated by decreased apoptosis. Histamine release in activated mast cells was not different regardless of incubation with IL-9. CONCLUSION: IL-9 might be involved in allergic inflammation via proliferation of mast cells in target tissue.

Airway obstruction by congenital cardiovascular anomaly / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to review the clinical presentation, diagnostic methods, treatments and prognosis of children with vascular rings. METHOD: We reviewed the medical records of 7 patients with vascular ring who were admitted in Samsung medical center between 1996 and 2000 retrospectively. RESULT: Pulmonary artery sling was noted in 4 cases. Two cases had double aortic arch, and 1 case had right aortic arch with left ligamentum arteriosus and aberrant left subclavian artery. The mean age at onset of symptoms was 3.2 months(from birth to 11 months). The mean age at diagnosis was 7.0 months(from 6 weeks to 15 months). Presenting symptoms and signs were respiratory difficulty, stridor, chest retraction, coughing, grunting, wheezing, sputum, cyanosis, choking, dysphagia, and poor feeding. All patients with pulmonary artery sling had tacheobronchial and/or pulmonary anomalies and cardiac defects were associated in two of them. Surgical repair was done successfully for the patients with double aortic arch or right aortic arch, but three deaths occurred to the patients with pulmonary artery sling combined with bronchial anomaly. CONCLUSION: Vascular ring should be considered especially for infants with respiratory distress or chronic respiratory symptoms. Associated anomalies are likely to affect the prognosis in these patients.

Helicobacter pylori vacA Mosaicism and New Primers for vacA Signal Sequence Indigenous to Korea / 대한소아소화기영양학회지

PURPOSE: Helicobacter pylori has been known to have diverse vacA allelic types. The purpose of the study was to identify vacA diversity in Korea and design new primers for signal sequence alleles indigenous to Korea. METHODS: Fifty antral biopsy specimens, which had been proven to be H. pylori-positive, were examined for vacA status; signal sequence and mid-region. After PCR amplification and DNA sequencing, vacA alleles of Korean H. pylori strains were compared with those from other countries. RESULTS: Among Korean H. pylori strains vacA alleles with all combinations of signal sequence and mid-region were found, with the exception of s1b or s2. vacA genotype s1c/m1 was predominant in Korea. We found that GGGAGCGTTR in s1a and GGGGYTATTG in s1c were the indigenous sequences to Korea and constructed the new Korean specific primers for the vacA signal sequence; VASK-F, VASK-R, S1AK-F, and S1CK-F. CONCLUSION: This study showed that s1c/m1 is the predominant type of vacA allele in Korea. We designed new primers for the vacA signal sequence.

High Seroprevalence of Helicobacter pylori Infection in Korean Adolescent Athletes / 대한소아소화기영양학회지

PURPOSE: Poor living conditions such as overcrowding and sharing a bed are reported to be significant risk factors for H. pylori infection throughout childhood. We investigated the prevalence of Helicobacter pylori infection in Korean athletes who are obliged to live together in training camps over six months a year. METHODS: Blood sampling and surveying through questionnaire were performed on 440 regular high school students (228 boys and 212 girls) and 220 athletes (148 boys and 72 girls) of a physical education high school. We measured serum IgG Ab to H. pylori in order to compare the prevalence of H. pylori infection between normal adolescents and athletes. In addition, we conducted a nutritional analysis and questionnaire survey for socioeconomic status in order to compare other risk factors that might influence H. pylori infection between groups. RESULTS: The prevalence (43.2%) of H. pylori infection in athletes was higher than that (22.7%) in the controls. No significant differences in the nutritional factors or socioeconomic status, such as Hollingshead index, type of house, and crowding index, were found between the groups. Multivariate analysis showed that crowding and the difference in school type were the significant predictors of H. pylori seropositivity after controlling for dietary and socioeconomic factors. CONCLUSION: Living together in training camps might be a significant risk factor for H. pylori infection in athletes.