• The Journal of Korean Society of Virology
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• v.30 no.1
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• pp.71-81
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• 2000

We have determined and analyzed the full-length cDNA sequence of a coxsackievirus B3 (CVB3) Korean isolate (CVB3-Korea/97) which has been known as a general human pathogen. The whole genome contains 7,400 nucleotides and has a single large open reading frame with 6,555 nucleotides that encodes a potential polyprotein precursor of 2,185 amino acids. The genome also contains a 5' non-coding region (NCR) of 741 bases and a 3' NCR of 104 bases followed by poly(A) tail. Sequence homologies of nucleotides and deduced amino acids between the CVB3-Korea/97 strain and the prototype (Nancy strain) were 81.7% and 91.5%, respectively. The genes encoding the functional proteins including viral protease and RNA dependent RNA polymerase showed higher homology than those encoding the structural proteins. We have further analyzed the sequences of 5' NCR, VP1 and VP2 of CVB3-Korea/97, which are known as cardiovirulent determining factors at the nucleotide and amino acid levels. Although the CVB 3-Korea/97 strain was isolated from an aseptic meningitis patient without cardiomyopathy, its 234th nucleotide and 165th amino acid were uracil and Asn as same as those of other cardiovirulent strains one. However, the 155th amino acid of VP1, which closely associated with cardiovirulence, was replaced with $Arg^{155}$ by single nucleotide substitution from $A^{2916}$ to $T^{2916}$. Moreover, additional amino acid substitutions were observed in the flanking region of $Asp^{155}$. Taken together, amino acid(s) substitution in VP1 may playa critical role in determining cardiovirulence of the CVB3-Korea/97 strain rather than individual nucleotide replacements in the 5' NCR and/or an amino acid substitution in VP2.

• Journal of Life Science
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• v.14 no.4
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• pp.620-626
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• 2004

Viruses causing acute conjuntivitis were isolated from 675 patients carrying eye infections for year 2001 to 2003 in Busan reagion and their antigenic properties characterized by a serological survey. In 2001, adenoviruses (serotype 8) were found in 5 of 48 cases. In 2002, the isolated viruses were 7 adenoviruses (serotype 8 and 37), 8 coxsakieviruses (serotype A24 and B3) and 1 echoviruses (serotype 6) from 324 specimens that are known as the causative agents of acute hemorrhagic conjuctivitis (AHC). In 2003, 25 case of 303 specimens were 7 adenoviruses (serotype 3, 4, 8 and 37), 7 echoviruses (serotype 6 and 7) and 4 untypable enteroviruses. Although coxsakievirus (serotype B3) and echoviruses (serotype 6 and 7) were generally known as causative agent of aseptic meningitis, it hasn't been reported until now that they were isolated from the conjunctival swabs. The out break of AC was observed from April to October in Busan. These isolated viruses showed a strong cytophatic effects on HEp-2, RD, Vero and BGM cell strains. Analysis of electron micrograph of those viruses showed that adenovirus consists of a 80 nm diameter and nonenvloped icosahedron and then echovirus and coxsackievirus were small nonenveloped and isometric-shaped viruses. Adenovirus showing a cytophatic effect was resulted in a 458 bp single band by PCR and echovirus, coxsackievirus and untypable enterovirus were detected a 437 bp products by RT-PCR.

• Journal of Life Science
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• v.18 no.3
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• pp.374-380
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• 2008

Rapid detection of enterovirus (EVs) is important in the management of aseptic meningitis. We examined the relative efficiency and specificity of the real-time nucleic acid sequence-based amplification (NASBA) comparing with the established reverse transcription polymerase chain reaction (RT-PCR) and viral culture method which were used for the detection of enterovirus RNA in clinical specimens. Of the total 292 samples, 145 were found to be positive to enterovirus RNA by real-time NASBA, 101 were positive by viral culture, and 86 were positive by RT-PCR. 147 samples and 46 samples were determined to be negative and positive by all methods respectively, but 4 samples were positive only by real-time NASBA. To compare the specificity of each method, various clinical samples which were diagnosed for herpes simplex virus (HSV)-1, HSV-2, adenovirus, mumps, and rhinovirus were applied. Except one rhinovirus sample which was false positive to enterovirus RNA by RT-PCR, the other different samples were negative to all three methods. The real-time NASBA procedure can be completed within 5 hours in contrast with 9 hours for the RT-PCR and 3-14 days for the viral culture. From this study, it was suggested that the real-time NASBA assay could be a standardized, rapid, specific, and sensitive procedure for the detection of enterovirus RNA.

• Journal of Preventive Medicine and Public Health
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• v.34 no.1
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• pp.89-99
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• 2001

Objectives : To describe the characteristics of a mumps epidemic in Cheju-do, 1998 and to identify the risk factors associated with mumps infection. Methods : To estimate attack rate, previously collected data from the Nationally Notifiable Communicable Disease Reporting System and School Health Reporting System, temporarily administered by Division of Education. as well as additional surveillance data were used. In order to identify the clinical characteristics and risk factors associated with mumps, we conducted a questionnaire survey in 17 schools (9 elementary, 4 middle, and 4 high schools) among a population that included healthy students. Results : From March 3 to August 31, 2,195 cases of mumps were identified, and patients under 20 years of age accounted for 2,162 cases (attack rate 13.2, 95% CI 12.6-13.7/1,000). The attack rate for the population under 20 years of age was the highest in Nam county (44.7/1,000), nod in the 7-12 years old sub-group(>20.0/1,000). There was no sexual difference. 80.5% and 59.7% of patients presented periauricular and submandibular swelling respectively. Aseptic meningitis was a complication in 2.9% of cases, orchitis in 1.3%, epididymitis in 0.9% and oophoritis in 0.6% respectively. The overall MMR vaccination rate was 59.1% and it decreased in accordance with increasing age. In students aged 10 years old or below, household contact and MMR vaccination status was significantly associated with infection, and only among students with household contact, the risk of one dose MMR(OR=10.22, 95% CI 2.92-35.78) and non-vaccination (OR=11.62, 95% CI 1.96-68.96) was significantly greater when. compared with that of two dose vaccination. Among students aged 11 years old or above, household contact history was significantly associated and MMR vaccination status was not associated. Conclusions : Low vaccination rate and vaccine failure were thought to predispose the population for this large outbreak. To prevent sustained mumps outbreaks, a second MMR vaccination should be encouraged and catch up vaccinations should be given to elderly children who remain susceptible.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.46-53
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• 2016

Purpose: Enterovirus (EV) infection in children can manifest various diseases from asymptomatic infection to nonspecific febrile illness, hand-foot-mouth disease, and aseptic meningitis. This study was aimed to investigate epidemiology and clinical significance of various genotypes of EV infections in pediatric inpatient. Methods: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from March 2014 to March 2015. EV detection and genotype identification were performed by real-time RT-PCR and semi-nested RT-PCR. Phylogenetic trees were constructed by neighbor joining method. Results: A total of 400 samples were collected during study period and 112 patients (28%) were diagnosed with EV infections. The mean age of EV positive patients was 2.66 years (0.1-14) and sex ratio was 1.73:1. Genetic sequences of EVs were identified; coxsackievirus B5 (17, 15.2%), coxsackievirus A16 (13, 11.6%), enterovirus 71 (10, 8.9%), and coxsackievirus A2 (9, 8.0%). Nonspecific febrile illness (96, 86%) was the most common clinical manifestation and the duration of fever was 0-11 days (mean 3.1 days). Rash (44, 39%) and meningitis (43, 38%) were followed. Patients who were attending daycare center or had siblings accounted for 82.1%. Phylogenetic relationship tree revealed 6 distinct genogroups among 56 types of EVs. Conclusions: This study is the report of epidemiology, serotype distribution and clinical manifestations of children with EV infection in Incheon. This data will be helpful for further study about the epidemiology of EV infection in Korea.

• Pediatric Infection and Vaccine
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• v.23 no.2
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• pp.128-136
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• 2016

Purpose: This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future. Methods: We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI. Results: Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group. Conclusions: Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.

• Pediatric Infection and Vaccine
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• v.8 no.1
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• pp.94-100
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• 2001

Purpose : Enterovirus is a common cause of aseptic meningitis and nonspecific febrile illness in young children. During the summer and fall months, enterovirus-infected young children are frequently admitted and evaluated to rule out bacterial sepsis and/or meningitis. The purpose of this study was to evaluate the relationship between nonpolio enterovirus infection and febrile illness in infants under 3 months of age during the summer, fall months by using a stool culture to identify the presence of enterovirus. Methods : Patients included febrile infants under 3 months of age admitted to Masan Fatima Hospital for sepsis evaluation from May 1999 to September 1999. Cultures were performed from stool and Cerebrospinal fluid samples and then were tested for enterovirus infection. Viral isolation and serotype identification were performed by cell culture and immunofluorescent testing. Enteroviruses not typed by immunofluorescent testing were confirmed by reverse transcription-polymerase chain reaction. Results : A total of 44 febrile infants were enrolled; of those, 20(45%) were positive for enterovirus. Two enterovirus culture-positive infants had concomitant urinary tract infection and one had Kawasaki disease. All infants infected with an enterovirus recovered without complications. Serotype of 20 enteroviruses were isolated from stool, 3 of echovirus type 9, 1 of echovirus type 11, 1 Coxsachievirus type B4, 15 of untyped enteroviruses. One untyped enterovirus was isolated in the CSF. Conclusion : Nonpolio enterovirus infections are associated with nonspecific febrile illnesses in infants under 3 months of age.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.45-49
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• 2010

Purpose: Several radiopharmaceuticals were used for cisternography. But recently, due to more short acquisition time, high resolution than other radiopharmaceuticals like In-111 DTPA, we were using Tc-99m DTPA in cisternography. Using of Tc-99m DTPA for intrathecal, was not officially recognised by the FDA. And there are matters of aseptic meningitis, muscular tetany, seizures by inappropriate radiopharmaceuticals handling. So, it is necessary to prevent adverse reactions while handling the radiopharmaceuticals using in cisternography. Therefore, this study aims to evaluation of usefulness and procedures for safety of radiopharmaceuticals in cisternography. Materials and Methods: Subjects were 12radioactive tracer vials using in cisternography in 2008 Dec. 16 - 2009 Dec. 30. (1) Radioactive tracer Vial test - We were measured NaPertechnetate radiation dose and volume, normal saline volume for dilution, source volume and dose activity for patient injection. And then, calculated mass of pure DTPA. (2) Bacterial endotoxin test - We performed pyrogen test using by negative/positive control vials which was added normal saline 0.2 mL and added normal saline 0.1 mL, Tc-99m DTPA 0.1 mL in test control vial. And then, reacted by digital hot plate in $37.5^{\circ}C$ for 1 hour and compared of gel-clot in each control vials. (3) Compliance safety procedure - We were checked safety issues and wrote out a safety procedure exam sheet. Results: (1) Radioactive tracer Vial test - Mass of DTPA per dose for patient injection (mg) was 0.88 (mg) on average, and Mass of DTPA per volume for patient injection (mg) was 0.74 (mg) on average. (2) Bacterial endotoxin test - All control test vials showed negative reactions. (3) Compliance safety procedure - We were checked safety issues and wrote out a safety exam sheet in all the exams. So, there were no adverse reactions. Conclusion: We could examine easier to safety tests using by Techscan - DTPA (Mallinckrodt): CaNa3. Each test results were passed the safety tests and there are no adverse reactions. The use of Tc-99m DTPA for cisternography, always has been become an issue. Since it has occur adverse reaction while examine the cisternography using by Tc-99m DTPA, it needs to set up the 'Standard Operating procedures'.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.213-221
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• 2001

Propose : Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children. Methods : This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis. Results : The age of patients was $6.9{\pm}3.6$ years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was $1.4{\pm}0.8$ days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence. Conclusions : Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.960-968
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• 2005

Purpose : This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella(MMR) vaccine, $Priorix^{TM}$ in Korean children. Methods : From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received $Priorix^{TM}$ at four centers : Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. Results : Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days pos-tvaccination, were : For measles, in the age group 12-15 months, 3,838.6 mIU/mL [3,304.47, 4,458.91]; in the age group 4-6 years, 1,886.2 mIU/mL [825.83, 4,308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1,112.71]; in the age group 4-6 years, 2,473.8 U/mL [1,518.94, 4,028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. Conclusion : When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine ($Priorix^{TM}$), adverse events were limited to those generally expected with any live vaccine. $Priorix^{TM}$ demonstrated excellent immunogenicity in this population.