Group B streptococcal infection in Taiwan: maternal colonization and neonatal infection.

BACKGROUND: There is no national data on group B streptococcus (GBS) infection in Taiwan. We investigated incidence of maternal GBS colonization and neonatal GBS infection rate and clinical pictures of neonatal GBS infection to estimate the value of intrapartum chemoprophylactic strategy in Taiwan. METHODS: From January 2004 to June 2005, a prospective study to estimate maternal colonization rate by maternal rectovaginal culture at six hospitals was conducted. Neonatal GBS infection rate based on inborn infants was calculated retrospectively from January 2001 to June 2005; clinical pictures of infants diagnosed with invasive GBS disease were reviewed. RESULTS: Maternal colonization rate of GBS was around 20% at hospital base, incidence of neonatal GBS infection was 1 per 1000 live births of infants born at hospitals. There were 221 infants with GBS infection: in 142, the disease occurred within 7 days of birth (early-onset disease, EOD), and in 79, it developed later (late-onset disease). Infantile EOD was more often seen in mothers with premature rupture of membrane, often accompanied by respiratory failure necessitating ventilator support. Infants with late-onset disease often manifested fever, leukopenia, thrombocytopenia, and meningitis. Fifteen infants died, mostly of EOD type (12 of 15). Risk factors of mortality included rescue at delivery room, leukopenia, thrombocytopenia, sepsis, respiratory distress, persistent hypertension of newborn, respiratory failure needing intensive respiratory support (intermittent mandatory ventilator and high frequency oscillatory ventilator), surfactant use, shock, and congenital heart diseases. CONCLUSIONS: We concluded that universal maternal rectovaginal culture of GBS with intrapartum antibiotic prophylaxis is an urgent call to reduce EOD and mortality because of GBS infection in neonates in Taiwan.

Clinical manifestations of primary spontaneous pneumothorax in pediatric patients: an analysis of 78 patients.

BACKGROUND: The aims of this investigation were to explore primary spontaneous pneumothorax (PSP) in pediatric patients and to evaluate the clinical manifestations and outcomes of the PSP. METHODS: Seventy-eight patients diagnosed with PSP between January 2004 and December 2009 was retrospectively studied. The clinical data on demographics, diagnostic imaging, therapeutic approach, and outcomes were collected and analyzed. RESULTS: The sex ratio of 78 PSP patients was 7.7:1 (male:female=69:9), and the age distribution concentrated between 15 years and 18 years (66 patients, 84.6%). The most common presenting symptom was chest pain (69 patients, 88.5%). The average body mass index was 18.2±1.6 (n=66). Autumn was the more likely attack season for PSP in this study (p=0.005). Twenty-eight patients (35.9%) had tension pneumothorax. Only nine (11.5%) patients had a past history of cigarette smoking. All 21 outpatients received supportive treatment. Out of 57 inpatients, 10 (17.5%) received oxygen therapy, 39 (68.4%) received closed-tube drainage, and 6 (10.5%) received video-assisted thoracoscopic surgery. Apical bleb and subpleural bullae formation were common pathological findings (21 patients, 91.3%). Twenty-four (42.1%) patients experienced a second attack, and six (10.5%) patients had a third attack. CONCLUSION: Pediatric PSP occurred mainly in boys of the late teenage group with lower body mass index. Autumn was the most likely attack season. There was only a small portion of the patients who smoked. There was no evidence to find a correlation between smoking and pediatric PSP attacks. Length of stay was shorter in supportive treatment and closed-tube drainage patients than that in video-assisted thoracoscopic surgery-treated patients. The outcomes were satisfactory.

Clinical and genetic analysis of invasive and non-invasive group A streptococcal infections in central Taiwan.

To evaluate the clinical, bacteriologic, and genetic relatedness between invasive and non-invasive infections caused by group A Streptococcus (GAS), we retrospectively analyzed the GAS isolates in our hospital from the past decade. A total of 70 GAS-infected cases were enrolled in our study from the period 1993 to 2002. Twenty one cases had invasive disease, and 49 were non-invasive. Their medical records were reviewed, and demographic data were collected for analysis. Antimicrobial susceptibility testing was conducted according to the National Committee for Clinical Laboratory Standards for Streptococcus spp. Isolates were subjected to chromosomal SmaI (Invitrogen) digestion of pulsed-field gel electrophoresis (PFGE), and emm typing was also performed. The mean age of the invasive group was 41.1 +/- 22.4 years compared with 13.0 +/- 16.6 years for the non-invasive group (p<0.05). Eighty one percent of the invasive group had underlying diseases. Diabetes and malignancy were the 2 most common medical conditions. All isolates were susceptible to penicillin. The resistance rate was 42.8% and 55.1% for erythromycin in the invasive and non-invasive groups, respectively. A total of 51 different PFGE types were identified among the GAS isolates without particular genotypes. Serotype M12 was the most common one (28.4%), followed by M4 (19.4%). Our study demonstrated that the patients in the invasive group were older, with more underlying diseases, and with a higher mortality rate. Antimicrobial susceptibility of the isolates was the same in both groups. There was no epidemic strain, nor did PFGE reveal a more invasive clone.

Influenza B virus associated pneumonia: report of one case.

Influenza A virus is a more common cause of pneumonia than influenza B virus. Influenza virus pneumonia complicated with acute respiratory distress syndrome (ARDS) is rare and has a high mortality rate. In addition to pneumonia, influenza occasionally causes neurologic, cardiac, renal, or muscular complications. Hepatic involvement in influenza virus infection has been rarely reported. We reported the case of a 7-year-old girl who was initially treated for upper respiratory tract infection, but she was transferred to the pediatric intensive care unit for intubation and ventilation after her condition deteriorated to lobar pneumonia with ARDS and liver function impairment within 7 days. Influenza B virus infection was confirmed by virus culture and serological study. Respiratory viruses, such as respiratory syncytial virus, adenovirus, influenza virus, and parainfluenza virus, are common causes of pneumonia in children; moreover, they should be considered especially in the presence of persistent leukopenia, low CRP value, lack of growth of bacterial cultures, and poor response to antimicrobial therapy. We should describe its course, diagnosis, and treatments in detail; furthermore, we reported this case to emphasize that influenza B virus may cause transient liver dysfunction and it is an etiology of pneumonia as well as ARDS.

Is combination antimicrobial therapy required for urinary tract infection in children?

This retrospective study examined the characteristics of 338 pediatric patients presenting with a first episode of symptomatic urinary tract infection at Taichung Veterans General Hospital from November 1996 to December 2001. Escherichia coli was the most common pathogen (72.5%), followed by Proteus mirabilis (8.3%), Enterococcus (5.6%), and Klebsiella pneumoniae (4.7%). They were more susceptible to first-generation cephalosporin in comparison with other first-line antimicrobial agents such as trimethoprim/sulfamethoxazole, ampicillin, and gentamicin. Two hundred and eighty-seven (84.9%) of the 338 patients were divided into 3 groups according to the type of antibiotic treatment received, and the susceptibility rate and the averaged day of defervescence after effective antibiotic therapy were compared among the groups. Group 1 consisted of those patients treated with cefazolin or cephalexin alone (95%, 2.1 days); Group 2, cefazolin plus gentamicin (88.9%, 2.8 days); and Group 3, ampicillin plus gentamicin (76.1%, 2.3 days). A total of 38 (13.2%) cases from the 3 antibiotic groups did not respond to empiric antibiotics. For non-susceptible infections, when the antibiotic regimen was switched from cefazolin plus gentamicin to ampicillin alone, only 4 (20%) strains became susceptible, compared with 10 strains (62.5%) becoming susceptible after switching from ampicillin plus gentamicin to cefazolin alone (p < 0.01). The results indicated that first-generation cephalosporin alone is an appropriate treatment for pediatric cases of community-acquired urinary tract infection and suggest that antimicrobial combinations should be reserved for serious or critical cases.

Clinical experience of managing empyema thoracic in children.

Data of 54 children with a diagnosis of thoracic empyema at a medical center in central Taiwan from January 1991 through April 2001 were analyzed. Their mean age was 4.4 years and the mean hospital stay was 13 days. Streptococcus pneumoniae was the most common pathogen, followed by Staphylococcus aureus and Haemophilus influenzae. These patients were divided into 2 groups according to the treatment method. Twenty-two patients were treated successfully with antibiotics and tube thoracostomy, whereas the other 32 children required further pleural decortication with antibiotic treatment. In patients with empyema, decortication allowed for more rapid defervescence than did closed tube thoracostomy (1.94 vs 5.04 days; p<0.001) and there were no complications in the group that underwent decortication treatment (p<0.03). In conclusion, the decortication of loculated empyema thoracis in children is a safe and effective management procedure.