Competition of infectious hypodermal and haematopoietic necrosis virus (IHHNV) with white spot syndrome virus (WSSV) for binding to shrimp cellular membrane.

Infectious hypodermal and haematopoietic necrosis virus (IHHNV) and white spot syndrome virus (WSSV) are two widespread shrimp viruses. The interference of IHHNV on WSSV was the first reported case of viral interference that involved crustacean viruses and has been subsequently confirmed. However, the mechanisms underlying the induction of WSSV resistance through IHHNV infection are practically unknown. In this study, the interference mechanisms between IHHNV and WSSV were studied using a competitive ELISA. The binding of WSSV and IHHNV to cellular membrane of Litopenaeus vannamei was examined. The results suggested that there existed a mutual competition between IHHNV and WSSV for binding to receptors present on cellular membrane of L. vannamei and that the inhibitory effects of WSSV towards IHHNV were more distinct than those of IHHNV towards WSSV.

A real-time PCR for the detection of hepatopancreatic parvovirus (HPV) of penaeid shrimp.

Hepatopancreatic parvovirus (HPV) causes a common shrimp disease that occurs in many shrimp farming regions, especially in the Indo Pacific, and infects most of the cultured penaeid species. There are seven geographic HPV isolates known, so a method to detect different HPV types is needed. We developed a sensitive and generic real-time PCR assay for the detection of HPV. A pair of primers and TaqMan probe based on an HPV sequence obtained from samples of Fenneropenaeus chinensis from Korea were selected, and they were used to amplify a 92 bp DNA fragment. This real-time PCR was found to be specific to HPV and did not react with other shrimp viruses. A plasmid (pHPV-2) containing the target HPV sequence was constructed and used for determination of the sensitivity of this assay. The assay could detect a single copy of plasmid DNA, and it was used successfully in finding HPV in shrimp samples from the China-Yellow Sea region, Taiwan, Korea, Thailand, Madagascar, New Caledonia and Tanzania.

Non-traumatic colon perforation in children: a 10-year review.

Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.

Decreased intercellular adhesion molecule-1 (CD54) and L-selectin (CD62L) expression on peripheral blood natural killer cells in asthmatic children with acute exacerbation.

BACKGROUND: The capacity of inflammatory cells to adhere involves an array of adhesion molecules, and is critical to the inflammatory responses seen in childhood asthma. We aimed to determine the changes of intercellular adhesion molecule-1 (ICAM-1) and L-selectin expressed on peripheral blood (PB) T lymphocytes and natural killer (NK) cells in asthmatic children with acute exacerbation and after prednisolone therapy. METHODS: Flow cytometric analysis was performed to determine the expression of ICAM-1 (CD54) and L-selectin (CD62L) on T (CD3+) cells and NK (CD3-/CD56+) cells of PB from children with allergic asthma with acute exacerbation and in a stable condition after prednisolone therapy. Atopic subjects without asthma and age-matched controls were also included for comparison. RESULTS: Percentages of PB non-CD3, CD56+ NK cells, but not CD3+ T cells, increased in asthmatic children with acute exacerbation, compared to those assessed in a stable condition after a course of prednisolone. However, significant decrease of ICAM-1 (P = 0.01) and L-selectin (P = 0.01) expression on PB NK cells, but not on T cells, were found in children with acute asthma compared to those in a stable condition. NK cells in children with acute asthma showed minimal expression of CD69 and CD25. CONCLUSIONS: Results suggests that either NK cells expressing ICAM-1 and L-selectin selectively migrated into inflamed lung tissues, or subsets of NK cells not expressing ICAM-1/L-selectin were expanded during acute exacerbation of childhood asthma.

Expression of adhesion molecules on T lymphocytes in young children and infants--a comparative study using whole blood lysis or density gradient separation.

We investigated the use of two sample preparation techniques (whole blood lysis [WBL], and Ficoll-Hypaque density separation [FDS]) for flow cytometric estimation of adhesion molecule (CD54, CD62L and CD11b) expression on T lymphocytes from children less than 2 years old, comparing the results with normal adult controls. Using WBL methods, young children had lower percentages of CD3+/CD54+ and CD3+/CD11b+ lymphocytes, but not of CD3+/CD62L+ lymphocytes than adult controls. FDS was associated with significantly higher percentages of CD3+/CD62L+ and CD3+/CD11b+ lymphocytes in young children and adults alike, while the percentages of CD3+/CD54+ cells from adults was not affected by FDS. The percent expression of CD54, CD62L, and CD11b on T cells from both children and adults were significantly higher following FDS, with a greater increase in CD11b expression on T cells from young children, reaching adult levels. The mean fluorescence intensity (MFI) of CD62L on T cells from young children, which was lower than that of adults using WBL preparation, was significantly higher following FDS, reaching adult levels. The higher levels of adhesion molecule expression associated with FDS did not result from T-cell activation, as assessed by CD69, CD25, and HLA-DR expression. Thus, adhesion molecule expression on T lymphocytes from young children is more sensitive to modification by isolation procedures than that on adult T cells. Caution should therefore be exercised in interpreting adhesion molecule expression data on T cells from children.

Time trends and seasonal variations in hospital admissions for childhood asthma in Taiwan from 1990 to 1998.

The aim of the study was to determine the trends and seasonal variations in hospital admissions for childhood asthma in a tertiary medical center since 1990. Data were collected according to the age and sex of patients and obtained from hospital registries between 1990 and 1998. Children between 2 and 14 years of age admitted with the diagnosis of asthma, or asthmatic bronchitis (ICD-9 code 493) were included. Age-specific and sex-specific hospital admission rates for asthma were calculated for each calendar year. The asthma admission rates were defined as the number of asthma admissions divided by the total number of all pediatric admissions in a year. Seasonal admission rates were calculated in a similar fashion. In addition, the number of readmissions was also calculated during the study period with comparisons of sex and age differences. The asthma admission rates showed a significant upward trend throughout the period studied, particularly among the 2-4 years of age group (relative risk = 2.08; p = 0.0001). Seasonal admission rates revealed a statistically significant increase during the October-December period, peaking in November or December of each calendar year (relative risk = 1.84; p = 0.0001). There was a male predominance in both age categories during the 9-year period. Comparisons of readmissions for asthma (at least three admissions) disclosed that girls were far more likely to be readmitted than boys among the 5-14 years of age group (p = 0.01). Our results indicate 1) an increased prevalence and severity of childhood asthma in Taiwan; 2) boys and younger children aged 2-4 years with asthma had increased risks of admission for asthma (relative risks were 1.22 and 1.96, respectively) and 3) girls among the older children with asthma tend to present with greater severity than boys owing to higher relative risks of readmission for asthma.

Clinical characteristics of juvenile rheumatoid arthritis in Taiwan.

This study aimed to investigate the clinical features of juvenile rheumatoid arthritis among Taiwan children. The medical records of 228 children who had juvenile rheumatoid arthritis treated in the Chang Gung Medical Center in Taiwan from 1978 through 1998 were retrospectively reviewed. A total of 146 boys and 82 girls (M:F ratio, 1.8:1) were included in this study. Clinical and laboratory data of these patients were collected from medical charts. Pauciarticular onset (56%) was the most common type of juvenile rheumatoid arthritis, followed by polyarticular (36%) and systemic (8%) type. The positive rate for rheumatoid factor, human leukocyte antigen B27, and antinuclear antibody were 9.2%, 55.2%, and 16.2%, respectively. Uveitis was observed in 5.7% of patients. Compared with previous reports in other regions and populations, remarkably different features of juvenile rheumatoid arthritis were found in this study, which included a higher prevalence among boys than girls, a high positive rate of human leukocyte antigen B27, and a low rate of uveitis.

A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation.

BACKGROUND: Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation. PATIENTS AND METHODS: During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined. RESULTS: One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype. CONCLUSION: We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.

Phenotypic changes of T-lymphocyte subsets induced by interleukin-12 and interleukin-15 in umbilical cord vs. adult peripheral blood mononuclear cells.

The decreased incidence of graft-vs.-host disease found following umbilical cord blood (CB) transplantation, and the increased susceptibility of newborns to infections, have been attributed, in part, to functional and phenotypic immaturity of neonatal T cells. We investigated the phenotypic changes of CB T cells induced by two immunoregulary cytokines, interleukin (IL)-12 and IL-15, alone or in combination. Adult peripheral blood (APB) mononuclear cells (MNCs) were also tested for comparison. Prior to culture, the percentages of CD3+ CD8+, CD3+ CD25+, and CD3+ CD56+ cells were significantly lower in CB MNCs than in APB MNCs. IL-15, but not IL-12, significantly increased CD3+ CD8+ expression among the CB MNCs after 1 week of culture. Combining IL-12 and IL-15, however, resulted in decreased CB CD3+ CD8+ expression compared with IL-15 alone. The percentage of CD3+ CD25+ cells in CB MNCs spontaneously increased in the absence of cytokines, while that of CD3+ CD56+ cells in CB MNCs could not be enhanced with cytokines. In contrast, the percentages of CD3+ CD25+ and CD3+ CD56+ cells among the APB MNCs could be increased with IL-12, IL-15, and further with IL-12 and IL-15 combined. Thus, different patterns of T-cell subset changes were demonstrated between CB MNCs and APB MNCs in response to IL-12 and/or IL-15. These data may serve as a foundation for using cytokine therapy in newborns and children receiving CB transplants.

Different articular outcomes of Still's disease in Chinese children and adults.

The clinical manifestations, treatment and course, and articular outcomes of 24 children with juvenile-onset Still's disease (JOSD) and 21 adults with adult-onset Still's disease (AOSD) were compared retrospectively. There was no significant difference in the initial clinical and laboratory manifestations except that more adults presented with a sore throat (81% vs. 46%, p = 0.03). Although serum ferritin was almost always elevated in both diseases, adults had significantly higher serum ferritin concentrations compared with those of children. Steroid treatment was required in 71% of children and 52% of adults, while disease-modifying antirheumatic drugs were used in 42% of children and 24% of adults during the course. Chronic arthritis (>6 months) occurred in comparable proportions of patients with JOSD and AOSD (46% vs 38%, p = 0.82), irrespective of the disease pattern (monocyclic or polycyclic). However, severe deforming arthritis with marked functional limitation occurred only in JOSD, particularly with polyarthritis at disease onset (more than five affected joints). In contrast, AOSD patients with chronic arthritis had a favourable functional outcome at the end of the follow-up. Our study suggested different articular outcomes of Still's disease in Chinese children and adults.

ICAM-1 (CD54) expression on T lymphocytes and natural killer cells from umbilical cord blood: regulation with interleukin-12 and interleukin-15.

We investigated the effect of two immunoregulatory cytokines, interleukin (IL)-12 and IL-15, alone or in combination, on intercellular adhesion molecule 1 (ICAM-1, CD54) expression on mononuclear cells (MNC) obtained from umbilical cord blood (CB) and adult peripheral blood (APB). We established that (1) ICAM-1 expression was deficient on freshly isolated CB T and natural killer (NK) cells compared with that on adult cells; (2) ICAM-1 expression on T cells (CD3+/CD54+), but not on NK cells (CD16+/CD54+), was spontaneously upregulated after 7 days' culture in RPMI with 10% fetal calf serum (FCS) in the absence of cytokines, for CB and APB MNC alike; (3) removal of 10% FCS from the medium did not affect the spontaneous CD3+/CD54+ upregulation on APB MNC; (3) CB NK cells responded more readily to IL-12 and IL-15 than did APB NK cells in terms of ICAM-1 expression, while ICAM-1 expression on APB T cells, but not on CB T cells, could be enhanced with IL-12 plus IL-15; (4) the combination of IL-12 and IL-15 downregulated ICAM-1 expression on both CB and APB NK cells. Thus, we demonstrated the different patterns of ICAM-1 regulation by CB MNC and APB MNC in response to IL-12 and/or IL-15 and the differential effect of cytokines on the regulation of adhesion molecules on neonatal NK and T cells.

Serum eosinophil cationic protein determination in asthmatic children-effect of different collecting tubes used for blood sampling.

We compared the effect of using 2 different serum collecting tubes, serum separation tubes (SST, with clot activator and gel barrier) and conventional glass tubes (with no additives), on circulating levels of eosinophil cationic protein (ECP) in asthmatic children and controls. The serum ECP values obtained from both SST and glass tubes were significantly higher in asthmatic children than in corresponding controls. ECP values were higher in serum samples using SST than in those using glass tubes (P<0.01), while no difference was found between the two in controls. ECP levels correlated with peripheral eosinophil counts, for SST samples and glass tube samples alike. The difference in ECP levels between these two tubes also correlated with circulating eosinophil counts (r = 0.62, P = 0.004) After 18-hour storage at room temperature, the ECP values increased significantly in samples obtained from asthmatic children. No difference in ECP values between SST samples and glass tube samples was found for 18 hour samples. Thus, ECP levels obtained from SST samples and glass tube samples, though reliable, should not be directly compared, especially in asthmatic children with eosinophilia.

Orthopedic manifestation in a child with hyperimmunoglobulin E syndrome.

We report a 12-year-old girl with hyperimmunoglobulin E (HIE) syndrome who presented with genu vulgus of left knee, joint deformities involving both hands, and frequent fractures. She had had chronic eczema and recurrent skin and soft tissue infections since infancy, and was found to have a pneumatocele during admission. Immunologic abnormalities included extremely elevated serum IgE levels (18989 IU/ml) and cutaneous anergy to candida, purified protein derivative, and tetanus toxoid. The results of polymorphonuclear leukocyte function tests including the nitroblue tetrazolium test and chemotaxis were normal. A high index of suspicion for HIE syndrome should be given in patients with recurrent skin infections and orthopedic complaints. The physician should anticipate orthopedic problems in caring for patients with HIE syndrome, and optimal antibiotics prophylaxis should be used.

Swyer James syndrome following Mycoplasma pneumoniae pneumonia: report of one case.

A previous healthy 5 year-old girl developed a right hyperlucent lung following Mycoplasma pneumoniae pneumonia 14 months before admission. Serial chest radiographs revealed a persistent right upper lobe atelectasis and gradual development of the right hyperlucent lung associated with frequent bouts of wheezing and exertional dyspnea. Physical examination showed markedly decreased breathing sounds in the right hemithorax with fine inspiratory crackles and expiratory wheezes. A diagnosis of Swyer James syndrome was confirmed by the exclusion of other causes of unilateral hyperlucent lung using computed tomographic scans of chest, fiberoptic bronchoscopy and lung perfusion scintigraphy. She has been followed up at our hospital using anti-asthmatic medication.

Serial echocardiographic assessment of left atrioventricular valve function in young children with ventricular inversion.

BACKGROUND: Regurgitation of the morphologic tricuspid valve (mTV) adversely influences the clinical outcome of patients with ventricular inversion. METHODS AND RESULTS: To evaluate the mTV regurgitation (TR), we reviewed serial echocardiograms for 25 children with ventricular inversion, with and without congenital heart surgery. Patient age was from 6 months to 19.0 (median 5.8) years. Follow-up was from 5 months to 15.0 (median 4.1) years. Initial assessment was at a median 65 days of age; only nine (36%) of 25 had TR. At follow-up, 16 (64%) of 25 had TR, with two requiring valve replacement. The mTV was abnormal in 16 (64%) of 25 patients and in 11 (69%) of 16 TR worsened compared with one (11%) of nine patients with "normal" mTVs. Nine (36%) of 25 had Ebstein's anomaly, three of whom had new TR develop. Of 17 patients who underwent cardiac surgery, 10 (59%) had new or increased TR compared with three (37%) of eight nonoperative patients. After intracardiac repairs, eight (73%) of 11 had increased TR develop compared with two (33%) of six patients after extracardiac surgery. CONCLUSIONS: (1) Young patients with ventricular inversion had TR develop during follow-up, without cardiac surgery. (2) Surgical patients with intracardiac repairs had more TR develop than with extracardiac procedures. (3) Anatomic abnormalities of the mTV were associated with an increased risk of TR developing. These data help elucidate the factors that affect the development of TR in patients with ventricular inversion.

Latex allergy in hospital employees.

The purpose of this study was to investigate the prevalence and risk factors of latex-allergy in hospital personnel and the presence of latex-specific IgE in a latex-allergic group in Taiwan. A total of 1,021 hospital employees were initially screened for latex allergy with a questionnaire, which included sex, age, job categories, number of years of employment, daily working hours, frequency of latex glove wearing, symptoms of immediate reactions to latex gloves and history of previous atopic diseases. Among them, 70 hospital employees (6.8%; 95% confidence interval 1.9%-11.8%) had symptoms associated with glove wearing. The frequencies in different job categories were 28.3% of surgical nurses, 9.2% of surgeons, 5.8% of regular floor nurses, 5.2% of technicians, 4.6% of physicians, and 4.5% of laboratory researchers. The symptoms were significantly related to the frequency of latex glove exposure, surgical work, current hand eczema and history of atopic dermatitis. In contrast, the number of years of employment, daily working hours and previous history of hand eczema were not correlated with the symptoms of latex allergy. Latex-specific IgE was assayed by the dot blot method in 36 hospital employees of the latex allergic group (positive rate, 55.6%). We concluded that the prevalence of latex-allergy among hospital personnel was 6.9% and certain predisposing factors such as atopic dermatitis, current hand eczema ad surgical work may play a critical role in triggering and aggravating the symptoms.

Childhood leukemia mimicking juvenile rheumatoid arthritis.

Arthritis is a known manifestation of childhood leukemia. When it is the sole clinical finding, diagnosis of juvenile rheumatoid arthritis (JRA) may be impressed initially and hence delay diagnosis of the underlying malignancy. This review analysed the clinical pictures of six such patients whose acute lymphoblastic leukemia (ALL) was diagnosed after a variable period of delay, ranging from 2 weeks to 44 months. In general, initial articular and extra-articular symptoms, and responses to conventional treatment, are not helpful in differentiating leukemic arthropathy from juvenile rheumatoid arthritis. However, the six ALL patients did have significantly less leukocytosis (6834 +/- 1586 vs 13365 +/- 8039/mm3, p < 0.05) and relative lymphocytosis (61 +/- 17% vs 30 +/- 13%, p < 0.05) on the initial hemograms when compared with JRA patient findings. JRA patients with initial hemograms showing less leukocytosis and relative lymphocytosis should be followed up with a high index of suspicion. Work-up for leukemia should be performed in any JRA patient with an evolving hemogram showing anemia, thrombocytopenia, leukopenia and lymphocytosis. Those who have an intractable clinical course necessitating immunosuppressive therapy should also receive bone marrow examination to obviate confusion in interpreting follow-up laboratory data. It can not be overemphasized that the differential diagnosis of acute leukemia should be made before JRA is impressed.

Intravenous cyclophosphamide pulse therapy on children with severe active lupus nephritis.

We conducted a preliminary study of monthly intravenous cyclophosphamide (IVCY) therapy on children with active lupus nephritis to evaluate the clinical efficacy and safety of IVCY pulse therapy. From June 1993 to May 1994, 13 patients (mean age: 14 +/- 0.9 years old; female: male = 11:2) with active lupus nephritis were treated with intermittent IVCY in addition to their regular corticosteroid therapy. Criteria for patients who received intermittent IVCY therapy were associated with any one of the following conditions: 1) with renal biopsy-proved diffuse proliferative glomerulonephritis; 2) with nephrotic syndrome and are inert to high dose of prednisolone therapy; and 3) with severe side effect of steroid therapy. Cyclophosphamide (CY) was administrated monthly for the first 6 doses, and at 2 to 3-month interval afterward for 2 years. The mean IVCY pulses per patient was 6.5 +/- 0.5 times. The initial dose of CY was 0.5 gm/mm2, then gradually increased to 1 gm/mm2 with a monthly increment of 0.25 gm/mm2. After 6 months, cyclophosphamide treatment was associated with significant improvement in mean levels of serum C3 (41.6 +/- 5.1 vs. 96.7 +/- 11.3 mg/dl), C4 (11.7 +/- 1.1 vs. 35.3 +/- 5.0 mg/dl) and anti-DNA titer (65.4 +/- 17.1 vs. 9.1 +/- 2.8 IU/ml) (all p < 0.01), despite a significant reduction in mean prednisolone dosage (48.5 +/- 4.8 vs. 15.6 +/- 3.2 mg/day; p < 0.01). The mean creatinine clearance also improved significantly from 44.7 +/- 5.7 to 81.9 +/- 2.7 ml/min/1.73 mm2 (p < 0.01) after 6 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)