Interferon-alpha treatment in children and young adults with chronic hepatitis B: a long-term follow-up study in Taiwan.

BACKGROUND/AIMS: The short- and long-term benefits of interferon (IFN)-alpha therapy in young patients with chronic hepatitis B (CHB) acquiring infection perinatally or during early childhood have been questioned. METHODS: Twenty-one Taiwanese hepatitis B envelope antigen (HBeAg)-positive CHB patients aged 1.8-21.8 years (median 14.0 years) with alanine aminotransferase (ALT)>80 IU/L at entry were enrolled for IFN-alpha therapy. They received IFN-alpha therapy with a dose of 3 MU/m(2)/day three times a week for 24 weeks. A control group included untreated 21 CHB patients closely matched for gender, age, duration of ALT >80 IU/L and HBeAg status. All 42 patients were prospectively followed for 6.5-12.5 years after the end of therapy. RESULTS: The cumulative rate of virological response [anti-HBe seroconversion and serum hepatitis B virus (HBV)-DNA <10(5) copies/ml] was not different between the IFN-treated patients and control patients at 1 year (41 vs 44%) and at 6 years (88 vs 89%) after stopping treatment. Serum hepatitis B surface antigen loss occurred in two (9.5%) treated patients and in one (4.8%) control patient. Patients with a successful treatment response (anti-HBe seroconversion, HBV-DNA <10(2) copies/ml and ALT normalization at 1 year after stopping treatment) were younger than those without a successful response (P=0.03). A lower pretreatment serum HBV-DNA level (<2 x 10(8) copies/ml) is not only a significant factor to predict successful treatment response (P=0.008) but also has a beneficial effect on the long-term cumulative rate of virological response in IFN-treated patients (P=0.021), but not in control patients. Genotype difference or emergence of a precore stop codon mutant before treatment was not predictive for HBeAg clearance. CONCLUSION: For young CHB patients in Taiwan with infection occurring perinatally or in early childhood, the real advantage of IFN-alpha therapy was not observed. IFN-alpha therapy showed a beneficial effect on short- and long-term virological outcomes only in those with a lower pretreatment serum HBV-DNA level.

Rothia dentocariosa bacteremia in children: report of two cases and review of the literature.

Rothia dentocariosa, a pleomorphic, fastidious, Gram-positive rod, is a normal inhabitant of the oropharynx. It is a well-known causative agent of dental plaques and periodontal disease. Generally regarded as of low virulence to humans, R. dentocariosa has been increasingly recognized as a pathogen in adults and often associated with infective endocarditis. It should not necessarily be regarded as a contaminant when the isolate comes from areas other than the oropharynx, especially from the blood. We report two cases of R. dentocariosa bacteremia, including an 8-month-old boy with repaired transposition of the great arteries, and a healthy 20-month-old girl with herpangina.

Childhood vulvovaginitis: report of two cases.

Vaginal discharge in young prepubertal girls is a common problem in clinical practice. No specific infective pathogen is identified in most of the children. The reported common microbes include group A beta-hemolytic streptococci, Haemophilus influenzae and some Gram-negative bacilli. Sexually transmitted pathogens such as Neisseria gonorrhoeae and Chlamydia trachomatis are important causes of vulvovaginitis in children suffering from sexual abuse. We report two cases of prepubertal vulvovaginitis presenting with profuse purulent vaginal discharge, and H. influenzae and N. gonorrhoeae identified respectively. Both girls denied any sexual exposure and there was no evidence of sexual abuse. They responded well to antibiotic treatment, and no symptoms recurred in the following months. We would like to emphasize the defined etiology of childhood vulvovaginitis and appropriate treatment, in addition to gynecological evaluation for evidence of sexual abuse.

Lyme disease in childhood: report of one case.

We report a pediatric patient of Lyme disease in Taiwan, confirmed by laboratory tests. An 8-year-old overseas Chinese girl from New Jersey, USA, visited our dermatological clinic with joint pain and multiple expanding annular erythema rashes (measured up to 17x10 cm) for three days. Lyme disease was diagnosed by the presence of the antibody against Borrelia burgdorferi. The skin lesions and arthralgia were resolved after amoxicillin treatment, and she got well in the following one year. This presented work tries to remind physicians to be aware of Lyme disease in Taiwan, particularly for children or young people with recurrent expanding annular skin rashes and chronic arthralgia of undetermined causes.