• Pediatric Infection and Vaccine
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• v.29 no.2
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• pp.96-104
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• 2022

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disorder presenting with sterile osteomyelitis, most often presenting in childhood. Although the etiology is understood incompletely, its association with other auto-inflammatory diseases including inflammatory bowel disease (IBD); psoriasis; Wegener's disease; arthritis; and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome suggests that dysregulated innate immunity may play an important role in the pathogenesis. We report a case of a 13-year-old boy with CRMO associated with Crohn's disease (CD) successfully treated with infliximab after failure of non-steroidal anti-inflammatory drug (NSAID) treatment. He initially was diagnosed with CRMO based on symmetric and aseptic bone lesions with no fever, lack of response to antibiotic treatment, vertebral involvement, and normal blood cell counts. Despite five months of NSAID treatment, his musculoskeletal symptoms were aggravated, and he developed gastrointestinal symptoms. Finally, he was diagnosed with CRMO associated with CD. Due to the severity of symptoms, infliximab was initiated and produced symptom improvement. This case supports infliximab as another choice for treatment of bowel symptoms in addition to the bone and joint symptoms of CRMO when other first-line treatments are ineffective.

• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.108-113
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• 2010

Purpose : The aim of this study was to identify clinical availability of serum procalcitonin (PCT) compared with C-reactive protein (CRP) in prediction of bacterial infection in children. Methods : A retrospective study was conducted with children who had been admitted to the Department of Pediatrics with bacterial and viral infection between April 2008 and March 2009 and children who were admitted with Juvenile rheumatoid arthritis (JRA) between August 2007 and July 2009. Serum PCT levels were measured using an enzyme-linked fluorescent assay. Results : The study population included 10 patients with bacterial infection (group I), 69 with viral infection (group II), and 35 with JRA (group III). Mean PCT levels were significantly higher in group I than in group II or group III (P<0.05). Mean CRP levels were significantly higher in group I than in group II (P<0.05); however, mean CRP levels were not significantly higher in group I than in group III (P>0.05). Using a cutoff of 0.5 ng/mL for PCT and 8 mg/L for CRP, sensitivity and specificity in distinguishing between group I and the other groups were 60.0% and 92.3% for PCT and 60.0% and 40.1% for CRP, respectively. Positive and negative predictive values were 42.9% and 96.0% for PCT and 10.0% and 92.6% for CRP, respectively. Conclusion : Measurement of PCT concentrations appears to be more useful than CRP for distinguishing between bacterial infection and non-bacterial diseases in children.

• Pediatric Infection and Vaccine
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• v.4 no.2
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• pp.210-217
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• 1997

Purpose: To prevent residual physical disability and chronic infection, prompt diagnosis and adequate treatment are important in the skeletal infections in children. Although radioisotope scanning is knwon as the method of choice for early diagnosis of bone infection, we conducted a study on twenty nine children who had skeletal infections to reevaluate the most appropriate way in diagnosis and management. Methods: A retrospective study was conducted on twenty nine children, who were admitted to the departments of Pediatrics and Orthopedic Surgery and who had acute osteomyelitis or septic arthritis, through review of medical records, radiologic & radioisotope study results. Their diagnoses were confirmed by bacteriologic cultures on the aspirated specimens from suspected bony lesions. Results: 1) Among twenty nine patients, there were 6 infants including 5 newborn infants, and 23 children were aged between 1 and 15 years. Male to female ratio was 1.4 to 1. 2) Point tenderness was noted in all cases, and the common physical signs were swelling, limitation of motion, fever and local heat in the order of frequency. 3) Fifty two percents of the patients were diagnosed within a week after onset of symptoms and all cases were within 15 days. 4) Leukocytosis was noted in only 58.6% of cases but erythrocyte sedimentation rate was increased in all cases except only one case. Staphylococcus aureus was revealed as the most common etiologic agent. 5) Radioisotope scans showed hot uptake in five of six cases(83.3%) who had no abnormal finding on plain skeletal radiolograms. Conclusions: Although radioisotope scan and MRI are helpful in early diagnosis before radiologic finding was detected on plain X-ray film, the antimicrobial therapy can be started after bacteriologic study of the aspirated specimens from the suspected skeletal lesions if skeletal infection is highly suspected clinically.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.154-163
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• 2015

Purpose: Osteoarticular infections in children and adolescents are important because it can cause functional compromise if appropriate treatment is delayed. Therefore, this study was designed to describe the clinical presentations and causative organisms of osteoarticular infections in children and adolescents in order to propose early diagnosis method and an appropriate empiric antimicrobial therapy. Methods: Forty-two medical records were reviewed retrospectively, which were confirmed as osteomyelitis (OM) or septic arthritis (SA) at Department of Pediatrics or Orthopedic Surgery in patients under 18 years old of Ewha Womans University Mokdong Hospital from March 2008 to March 2015. Results: We identified 21 cases of OM, 13 cases of SA and 8 cases of OM with SA. There were 31 males and 11 females and mean age was 7.1 years old. The most common symptoms were pain and tenderness of involved site. Major involved bones were femur (10 cases, 34.5%), tibia (7 cases, 24.1%) and major involved joints were hip (9 cases, 42.9%), and knee (5 cases, 23.8%). Increased serum C-reactive protein and erythrocyte sedimentation rate were observed in 37 cases (88.1%) respectively. Magnetic resonance imaging was performed in 40 cases among 42 cases and was used to demonstrate osteoarticular infections and other adjacent infections. Nine cases (23.7%) among 38 cases and 20 cases (50.0%) among 40 cases were positive in blood culture and infected site culture respectively. The most common causative organism was Staphylococcus aureus, which was represented in 22 cases (75.9%), of which nine cases (40.9%) were resistant to methicillin. Conclusions: S. aureus was the most common causative organism of osteoarticular infections in children and adolescents and the proportion of MRSA was high in this study. Therefore, we recommend vancomycin as the first empiric antimicrobial therapy and suggest that further study is necessary to elucidate an appropriate guideline for treatment which takes into account MRSA proportion.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.114-123
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• 2005

Purpose : A wide, epidemic outbreak of M. pneumoniae pneumonia occurred throughout Korea in late 2003. Compared with previous years, the 2003 outbreak resulted in more severe cases and in an increased incidence of extrapulmonary symptoms and/or complications. We compared the clinical characteristics for M. pneumoniae pneumonia of 2003 to those of the past years. Methods : One hundred six children diagnosed with M. pneumoniae pneumonia by serologic tests at Bundang Cha General Hospital between Aug 2003 to April 2004 were enrolled. Medical records were reviewed retrospectively, for clinical, laboratory and radiological aspect as well as complications. The pleural effusions of 3 patients who underwent thoracentesis were also analyzed. Results : The duration of fever, cough, rhinorrhea, and sore throat was $8.2{\pm}4.7$, $22.1{\pm}4.8$, $8.4{\pm}2.1$, $4.3{\pm}1.2$ days, respectively. The incidence (percentage) and duration of abdominal pain, vomiting, diarrhea, headache, skin rash, arthralgia was $5.1{\pm}2.5$ (21.9%), $3.4{\pm}2.1$ (17.1%), $4.3{\pm}1.8$ (16.2%), $3.5{\pm}2.1$ (14.4%), $5.5{\pm}0.7$ (5.9%) and $4.6{\pm}1.3$ days (4.9%), respectively. The mean duration of admission and treatment were $7.4{\pm}4.3$ days and $21.6{\pm}11.1$ days. Higher values of CRP and ESR on admission were positively correlated with the duration of fever and length of admission. The findings of pleural effusion were similar to those seen in TB pleurisy. Complications, including myocarditis (2 cases), arthritis (3 cases), vasculitis (5 cases), asthma (3 cases), ARDS (1 case), and DIC (2 cases) were observed in 14.1% of patients. Conclusion : We found a number of characteristics of M. pneumoniae pneumonia among cases from late 2003 that were different from those of previous years. This outbreak resulted in more severe cases and in an increased incidence of extrapulmonary symptoms and/or complications. A multicenter study is needed to verify the changes in clinical characteristics observed during the 2003 outbreak from previous ones.

• Pediatric Infection and Vaccine
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• v.24 no.2
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• pp.79-86
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• 2017

Purpose: This study was aimed at analyzing the serotypes of group B streptococcus (GBS) isolated from Korean infants with invasive disease and evaluating their association with disease manifestation. Methods: Data were retrospectively collected from invasive GBS infections at Gachon University Gil Medical Center from January 2006 to June 2012 and at Samsung Medical Center from April 2010 to November 2012. Serotypes were determined by slide agglutination test. Results: A total of 37 cases were identified, which included 22 full-term infants and 15 preterm infants. Fifteen cases (40.5%) were early-onset, 19 (51.4%) was late-onset, and three (8.1%) was very late-onset. Early-onset diseases among preterm infants were higher than those among full-term infants (60.0% [9/15] vs. 27.3% [6/22], P=0.17). The most common manifestation was bacteremia (70.3%), followed by meningitis and septic arthritis. Among 24 isolates retrievable for serotyping, serotype III (41.7%) was most common, followed by V (16.7%), Ia, Ib, and II (12.5%, respectively), and non-typeable (4.2%). Serotype III was more common in isolates from full-term infants (10/22) than from preterm infants (0/15), whereas serotype V was more common in isolates from preterm infants (4/15) than from full-term infants (0/22) (P=0.002). No penicillin-resistant strain was detected, and resistance to erythromycin and clindamycin were both 64.9%. Conclusions: GBS is an important pathogen in both preterm and full-term infants, and serotype distribution of GBS causing invasive diseases can differ between preterm and full-term infants. It is necessary to monitor the nationwide epidemiology of GBS diseases, including in preterm infants, in order to prepare preventive measures without underestimating early-onset diseases.