• Tuberculosis and Respiratory Diseases
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• v.56 no.2
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• pp.203-209
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• 2004

Background : Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.

• Tuberculosis and Respiratory Diseases
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• v.66 no.3
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• pp.230-235
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• 2009

Idiopathic bronchiolocentric interstitial pneumonia is one of idiopathic interstitial pneumonia, which has a relatively aggressive course and poor prognosis. It is characterized by diffuse centrilobular nodules radiologically with mainly bronchiolocentric inflammation and fibrosis associated with patchy alveolitis lacking interstitial granuloma histologically. This disorder is a recently classified disease category, and to our knowledge, there is no case report in Korea. We present a case of idiopathic bronchiolocentric interstitial pneumonia. A 62-year-old man presented with exertional dyspnea with a 1 month duration. The radiological findings showed extensive centrilobular lesions at both lungs. The surgical lung biopsy specimen demonstrated a centrilobular inflammatory process with small airway fibrosis and inflammation partially radiating into the interstitium. Therefore, the patient was diagnosed with idiopathic bronchiolocentric interstitial pneumonia. He was treated with immunosuppressants including steroids and azathioprine. However, his symptoms did not improve and he expired 7 months later due to an acute exacerbation of the interstitial pneumonia and probable infectious pneumonia.

• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.141-151
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• 2009

Background: There is limited data on the epidemiology and relative frequency of idiopathic interstitial pneumonia (IIP) worldwide. This survey was performed to assess the epidemiology and relative frequency of IIP in Korea. Methods: The patients with IIP and who were confirmed by lung biopsy, except those patients with idiopathic pulmonary fibrosis, (IPF) over a 5 year period (from Jan. $1^{st}$, 2003 to Dec. $31^{st}$, 2007) were registered by a web-base questionnaire. Results: A total of 3,156 cases were registered, but 970 cases were excluded due to duplicative registration, inadequate data and the unmet ATS/ERS diagnostic criteria. A total of 2,186 cases were analyzed. The male to female ratio was about 2 : 1 and their mean age was 65 (range: 11-94). The most frequent disease was IPF (77.1%), followed in decreasing order by nonspecific interstitial pneumonia (NSIP) (11.9%), cryptogenic organizing pneumonia (COP) (8.5%), acute interstitial pneumonia (AIP) (1.1%), desquamative interstitial pneumonia (DIP) (0.9%), respiratory bronchiolitis-interstitial lung disease (RB-ILD) (0.4%) and lymphocytic interstitial pneumonia (LIP) (0.1%). The mean age of the patients with IPF, NSIP and COP was 67.8, 57.1 and 57.7 years old, respectively. The most frequent symptom was dyspnea on exertion (69%) followed by coughing (61%) and sputum (33%) for the whole population. The three year survival rate was 62% for the patients with IPF and the five year survival rate was 85% in both the NSIP and COP patients. Conclusion: This survey provides helpful information for the management of IIP and to produce management guidelines for this illness in Korea.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.154-162
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• 1996

Purpose : Adenoviruses(Ad) have been shown to play an important role in the etiology of severely acute respiratory diseases, particulary in infants and young children, and the occurrence of fatal outcome and chronic pulmonary sequelae in association with adenoviral infection has been a cause of great interest and concern. This report presents the resul of a retrospective analysis on 30 cases of lower respiratory infection from which adenovirus was isolated. Patients & Methods : The 30 patients in this study represent all detected cases of adenovial infection out of 240 children who were admitted to Sang Sung Medical Center between February to June 1996 showing signs and symptoms of lower respiratory tract infection. The diagnosis of adenovirus infection was based on microscopic visualization of typical cytopathic effect in HEp-2 tissue culture and used monoclonal Ab with nasopharyngeal aspiration. Results : The male/female ratio was 2:1 and the majority of age range was below 36months. Clinical diagnoses in all 30 patients were pneumonia(n=21), bronchitis and Bronchiolitis(n=5) and ARDS(n=4). We recieved the most of patients in the month of May. The chief complaints were fever(93.3%) and cough(80%) and extrapulmonary symptoms were diarrhea(n=5), seizure(n=4), abdominal pain(n=1). The mean duration of fever was $11.95{\pm}6.54$days. Physical examination on admission were crackles(73.3%), coarse breathing sounds(60%), hepatosplenomegaly(33.3%), decreased brething sounds(30%). In WBC counts, 8cases were below $4000/mm^3$ and 14 cases were above $10,000/mm^3$. In platelets counts, 4cases were below $150,000/mm^3$ and 10 cases were above $450,000/mm^3$. 21 cases were above 1 in CRP. GOT and GPT were abnormal in some cases. Chest X-ray revealed diffuse pulmonary infiltration(n=15), pleural effusion(n=6), consolidation(n=4) and hyperaeration(n=3). Seven patients were treated at the peditric intensive care unit with respiratory support and high dose of gammaglobulin. However, one patients died even through he was treated with NO ventilation and high frequency ventilation. Conclusion : Those with adenoviral pneumonia and respiratory infection having long fever duration and symptoms like bacterial pneumonia must be carefully differentiated in order to provide proper treatement and preventive measures due to possible fatal outcome.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.145-153
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• 1996

The incidence of Adenovirus(AV) pneumonia in children is estimated at 8%. Long-term complications reported with type 7 include hyperleucent lung syndrome, bronchiolitis obliterans and may require several months to recover. We reviewed 8 case of AV pnemonia confirmed by AV culture and sero-diagnosis among selected 19 AV pneumonia suspicious cases who were admitted to the Sanggye Paik Hospital of Inje University due to clinical pneumonia from May to July 1996. From 19 children, nasal aspirates or trachial aspirates were collected: viral agents were detected by virus isolation and virus antigen was detected by indirect immunofluorescent staining. Serologic diagnosis for type-specific AV antibody was done by neutralisation test. The results are as follows: 1) Age of the patients ranged from 6 months to 47 months with a mean of $24{\pm}9$ months. 6 were male and 2 were female(M:F= 3:1). 2) Monthly distribution showed 4 cases on June, 2 cases on May and July, respectively. 3) The mean duration of admission was 20.4 days and mean duration of fever was 11.3 days 4) Peripheral leukocyte counts were elevated in 4 cases(50%) and findings of shift to left were showed in 4 cases(50%) and serum aminotransferase activities were elevated in 6 case(75%). 5) Radiologic findings include linear and streaky infiltration(1/8 cases), patchy and lobar consolidation (7/8 cases), pleural effusion(2/8 cases) and hyperleucency was seen in 3/8 cases at time of admission and increased to 6/8 cases on hospital discharge. 6) The AV serotypes were type 7, type 3, and type 1. 7) Oxygen supply was done in 4 cases(50%) and all 8 patients include 2 cases of type 7 treated with artificial ventilator were survived. In conclusion, the serotypes of AV pneumonia outbreaks in early summer of 1996 were type 7, 3, 1 and, as showed severe clinical course, continued follow up surveillance is necessary to the long term pulmonary complications.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.603-608
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• 2002

Purpose : Pertussis is a highly communicable infectious disease in children with high mortality, especially in young infants. The incidence of pertussis in South Korea has decreased to about 10 cases a year in late '90s. Doubting previously reported incidences of pertussis, we designed this study to establish exact epidemiology and a diagnostic basis of pertussis. Methods : From Mar. 2000 to Mar. 2001, polymerase chain reaction(PCR) and cultures of nasopharyngeal aspirates were taken from 49 patients who were clinically suspected of pertussis in Kangdong Sacred Heart Hospital. Results : Among 49 patients suspected of pertussis, 10 cases showed positive results by PCR method. Four out of those 10 cases were positive in culture. The peak outbreak was noticed in the spring(Mar.-May) and the autumn(Sep.-Nov.). The mean age of the patients was 3.6 months. Eight of the 10 cases which were PCR positive results proved not to be immunized against pertussis. Conclusion : Most of the pertussis patients in our study were diagnosed as bronchiolitis, pneumonia or bronchitis at the beginning of the disease and only a few patients showed typical clinical manifestations of pertussis, including whooping. When the above results are taken together, we suggest the possibility that the actual prevalence of pertussis in South Korea might be higher than that of previous reports. The importance of pertussis screen tests should be emphasized in children with severe coughs.

• Tuberculosis and Respiratory Diseases
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• v.61 no.5
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• pp.479-483
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• 2006

Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern consisting of prominent intra-alveolar fibrin and organizing pneumonia, with out hyaline membranes or prominent eosinophilia. The clinical manifestations of AFOP resemble those of acute lung injury such as acute interstitial pneumonia (AIP). However, the classic histological patterns of AFOP differ from diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia (BOOP) or acute eosinophilic pneumonia (AEP). The characteristic intra-alveolar fibrin ball and lack of classic hyaline membrane are the predominant histological features of AFOP. Although some reports suggest that its clinical course is less catastrophic than DAD, the clinical entity that distinguishes AFOP from DAD has not been established. We present a case of pathologically demonstrated AFOP in a 79-year-old man. The radiological findings of our case were similar to those of DAD, presented with diffuse bilateral lung infiltrations. However, despite the rapid development of respiratory failure, the patient had a better response and outcome to steroid therapy than what would be expected for DAD.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.266-275
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• 2005

Purpose : Acute respiratory tract infections are the most common illnesses in children. The great majority of these infections involving lower respiratory tracts infections(LRTIs) are caused by respiratory viruses such as respiratory syncytial virus(RSV), parainfluenza virus(PIV), influenza virus (Flu), and adenovirus(ADV), etc. Our purpose was to determine seasonal epidemiology and clinical characteristic features of each viral infection. Methods : Nasopharyngeal aspirate(NPA)s were collected from 4,554 hospitalized children diagnosed as LRTIs on the first day of admission. The study period was from September 1998(Autumn) through May 2003(Spring). Respiratory viruses were detected in 881(19 percent) cases by isolation of the virus or by antigen detection method using indirect immunofluorescent staining. We reviewed the medical records of 837 cases retrospectively. Results : The identified pathogens were RSV in 485 cases(55 percent), PIV in 152 cases(17 percent), FluA in 114 cases(13 percent), ADV in 79 cases(9 percent) and FluB in 51 cases(6 percent). Outbreaks of RSV occurred every year, mostly in the November through December period and of PIV in the April through June period. LRTIs by FluA reached the highest level in January, 2002. FluB infection showed an outbreak in April, 2002. The clinical diagnoses of viral LRTIs were bronchiolitis in 395 cases(47 percent), pneumonia in 305 cases(36 percent), croup in 73 cases(9 percent) and tracheobronchitis in 64 cases(8 percent). Conclusion : Viruses are one of the major etiologic agents of acute LRTIs in chidren. Therefore, we must continue to study their seasonal occurrence and clinical features to focus on management, and also for reasons of prevention.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.199-206
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• 2014

Purpose: There has been little research regarding the effectiveness of oseltamivir for influenza B infections. We sought to identify the different clinical manifestations between patients treated with and without oseltamivir. Methods: We retrospectively studied the medical records of 72 inpatients or outpatients from two medical centers diagnosed with influenza B infections by either a rapid antigen test or multiplex reverse transcriptase PCR between January 2012 and July 2012. We compared gender, age, past medical history, admission period, total fever duration, fever duration after hospitalization, post-oseltamivir medication peak temperature, laboratory test, chest X-ray, antibiotic medication, and the presence of concomitant viral or bacterial infections. Results: The number of subjects in our study was 72 who were diagnosed with influenza B pneumonia, acute bronchitis, acute bronchiolitis, croup, and mean age was $3.6{\pm}2.8$ year old. The demographic characteristics and clinical manifestations of oseltamivir and the non-oseltamivir groups, including hospitalization period ($4.18{\pm}2.10$ vs $4.79{\pm}1.49$ days, P=.17) and total fever duration ($5.32{\pm}2.07$ vs $6.41{\pm}3.25$ days, P =.09), demonstrated no significant differences. Notably, the oseltamivir group did have significantly reduced usage of antibiotic treatment than the non-oseltamivir group (P=.04). When we limited our patient group to patients under the age of three, similar results were seen. The group prescribed oseltamivir within 48 hours of fever onset had less antibiotic usage, in addition to a shorter fever duration. Conclusion: Oseltamivir appeared to have no benefit in improving the clinical course. However, if it is prescribed within the first 48 hours of symptoms, it may be more effective.

• Pediatric Infection and Vaccine
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• v.14 no.2
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• pp.136-144
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• 2007

Purpose : Human bocavirus (HBoV) was recently identified world widely in clinical specimens from infants and children with respiratory tract illness, but the role of HBoV in respiratory tract illnesses is unknown. The aim of this study was to investigate the frequency and the clinical manifestation of HBoV in pediatric patients. Methods : We retrospectively investigated 1,777 throat swab obtained between 2005 and 2006 from pediatric in-patients with acute respiratory tract diseases at the Kwang-ju Christian Hospital. The medical records of patients with positive results were reviewed for demographic and clinical data of HBoV infections. Results : HBoV DNA was found in 84 (4.7%) of the 1,777 hospitalized children and the mean age was 19 months. The most common diagnosis were pneumonia (67.8%), bronchiolitis (35.7%). HBoV infections were found year-round, though most occurred in spring and winter months. Conclusion : HBoV is frequently found in hospitalized infants and children with acute respiratory tract diseases in Korea, but an association of HBoV with a distinct respiratory tract manifestation was not apparent. To clarify the clinical significance of HBoV, further evaluation of various age groups and clinical groups is needed.