• Clinical and Experimental Pediatrics
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• 제54권1호
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• pp.11-16
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• 2011

Purpose: Enterovirus 71, one of the enteroviruses that are responsible for both hand-foot-and-mouth disease and herpangina, can cause neural injury. During periods of endemic spread of hand-foot-andmouth disease caused by enterovirus 71, CNS infections are also frequently diagnosed and may lead to increased complications from neural injury, as well as death. We present the results of our epidemiologic research on the clinical manifestations of children with CNS infections caused by enterovirus 71. Methods: The study group consisted of 42 patients admitted for CNS infection by enterovirus 71 between April 2009 and October 2009 at the Department of Pediatrics of 5 major hospitals affiliated with the Catholic University of Korea. We retrospectively reviewed initial symptoms and laboratory findings on admission, the specimen from which enterovirus 71 was isolated, fever duration, admission period, treatment and progress, and complications. We compared aseptic meningitis patients with encephalitis patients. Results: Of the 42 patients (23 men, 19 women), hand-foot-and-mouth disease was most prevalent (n=39), followed by herpangina (n=3), upon initial clinical diagnosis. Among the 42 patients, 15 (35.7%) were classified as severe, while 27 (64.3%) were classified as mild. Factors such as age, fever duration, presence of seizure, and use of intravenous immunoglobulin (IVIG) were statistically different between the 2 groups. Conclusion: Our results indicate that patients with severe infection caused by enterovirus 71 tended to be less than 3 years old, presented with at least 3 days of fever as well as seizure activity, and received IVIG treatment.

• Parasites, Hosts and Diseases
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• 제61권4호
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• pp.449-454
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• 2023

Free-living amoebae (FLA) rarely cause human infections but can invoke fatal infections in the central nervous system (CNS). No consensus treatment has been established for FLA infections of the CNS, emphasizing the urgent need to discover or develop safe and effective drugs. Flavonoids, natural compounds from plants and plant-derived products, are known to have antiprotozoan activities against several pathogenic protozoa parasites. The anti-FLA activity of flavonoids has also been proposed, while their antiamoebic activity for FLA needs to be emperically determined. We herein evaluated the antiamoebic activities of 18 flavonoids against Naegleria fowleri and Acanthamoeba species which included A. castellanii and A. polyphaga. These flavonoids showed different profiles of antiamoebic activity against N. fowleri and Acanthamoeba species. Demethoxycurcumin, kaempferol, resveratrol, and silybin (A+B) showed in vitro antiamoebic activity against both N. fowleri and Acanthamoeba species. Apigenin, costunolide, (-)-epicatechin, (-)-epigallocatechin, rosmarinic acid, and (-)-trans-caryophyllene showed selective antiamoebic activity for Acanthamoeba species. Luteolin was more effective for N. fowleri. However, afzelin, berberine, (±)-catechin, chelerythrine, genistein, (+)-pinostrobin, and quercetin did not exhibit antiamoebic activity against the amoeba species. They neither showed selective antiamoebic activity with significant cytotoxicity to C6 glial cells. Our results provide a basis for the anti-FLA activity of flavonoids, which can be applied to develope alternative or supplemental therapeutic agents for FLA infections of the CNS.

• Clinical and Experimental Pediatrics
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• 제50권4호
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• pp.376-380
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• 2007

목 적 : 중추 신경계를 제외한 기타 경미한 감염의 경우에 유발성 경련 및 열성 경련과의 연관성에 대해 조사하였고, 또한 이러한 경련 환아들을 추적해 보았을 때 비유발성 경련으로의 발현과는 어떠한 관련성을 보이는가에 관해 통계적으로 분석하고자 하였다. 방 법 : 첫 경련을 주소로 내원한 환아 중에서 중추 신경계에 관련된 감염을 제외한 경미한 감염을 원인으로 하는 경우를 대상으로 하였고, 이를 유발성 경련과 열성 경련으로 구분하여 이에 따른 원인별 비교 및 역학적 조사를 실시하였다. 또한 이러한 유발성 경련과 열성 경련 환아를 대상으로 1년 이상의 추적 관찰을 시행하여 비유발성 경련으로의 이행 여부를 조사하고 통계 분석을 실시하였다. 결 과 : 총 120명의 환아들 중에서 유발성 경련은 36명, 열성 경련은 84명이었고, 여러 원인들 가운데 위장관염과 호흡기계 감염이 대부분을 차지하여 두 원인 군에 따른 비교 분석을 시행하였다. 유발성 경련의 경우는 위장관염이 가장 많은 원인을 차지하였고, 열성 경련의 경우는 호흡기계 감염이 많은 원인을 차지하였으며 이러한 경미한 감염원인 인자들과 경련과의 분포 차이는 통계적으로 유의하게 나타났다. 그러나 경련에 따른 비유발성 경련으로의 이행의 차이는 통계적으로 유의하지 않은 것으로 나타나 향후 보다 장기적인 추적관찰이 시행되어져야 할 것으로 사료된다. 결 론 : 소아에서 감염에 관련된 이러한 경련의 경우는 중추 신경계에 관련된 경우보다 경련에 대한 주의와 신속한 대처가 상대적으로 미흡했다고 볼 수 있다. 그러나 앞으로는 이러한 경미한 감염이 있는 경우에도 세심한 관찰과 주의가 필요하다고 보여지며 향후 비유발성 경련 발현에 대한 지속적인 추적관찰이 필요하다고 생각된다.

• Pediatric Infection and Vaccine
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• 제23권3호
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• pp.165-171
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• 2016

목적: Human parechovirus (HPeV)는 영아에서 중추신경계 감염 및 패혈증의 주요한 원인의 하나로 최근에 새로이 주목받고 있는 바이러스이다. 그러나, 영아 이후 시기에 발병하는 HPeV 감염에 대한 연구나 보고는 거의 없다. 본 연구는 소아기 전 연령대에 걸친 HPeV의 국내 유병률 및 그 임상적 특징을 알아보고자 하였다. 방법: 2013년 1월부터 2014년 7월까지 발열 혹은 수막염 의심 증상으로 서울대학교병원에 내원하여 뇌척수액 검사를 시행 받은 소아의, 보호자 서면 동의를 얻어 수집한 잉여 뇌척수액 검체를 대상으로 하였다. 뇌척수액 검체에서 HPeV 특이 5' untranslated region을 역전사 중합효소연쇄반응(reverse transcription polymerase chain reaction)으로 증폭하여 HPeV 감염을 진단하고, HPeV의 viral protein 3/1 (VP3/VP1) region의 염기서열을 분석하여 유전자형을 확인했다. 이들의 임상 및 진단검사적 특징을 후향적 의무기록분석을 통해 평가하고, 같은 시기에 뇌척수액 GeneXpert (Cepheid)검사로 진단된 장바이러스(enterovirus [EV]) 수막염 환자군과 비교하였다. 결과: 총 102개의 뇌척수액 검체를 분석하였다. 이 중 HPeV 양성인 검체는 6개(5.9%)였고, 21개의 EV양성 검체 중 2개에서 HPeV가 함께 검출되었다. HPeV는 2013년 6월과 2014년 5월에서 7월 사이에 수집된 검체에서 나타났고, 모두 HPeV3형이었다. HPeV 양성인 환자 중 2명이 3개월 이하의 영아였고, 나머지 4명은 1세 이상이었다(19-180개월). 1세 이하의 HPeV 환자들은 특별한 신경학적 증상 없이 발열과 같은 비특이적 증상을 보였으나, 1세 이상의 HPeV 환자들에서는 발열과 함께 뇌전증, 의식소실과 같은 중증 신경학적 증상이 동반되었다. EV 양성인 뇌척수액 검체의 대다수(73.7%)에서 뇌척수액 내 백혈구 증다증이 관찰된 반면, HPeV의 경우 연령 대비 정상 범위를 보였다. 결론: HPeV에 의한 중추신경 감염증은 주로 3개월 이하의 영아에서 호발하는 것으로 알려져 있으나, 본 연구에 의하면 영아기 이후의 소아청소년에서도 HPeV 감염이 발생할 수 있다. 특히, 영아기 이후의 소아청소년에서 신경학적 증상을 동반한 발열이 있으나 정상 뇌척수액 검사 소견을 보이는 경우 HPeV를 병원체의 하나로 고려할 필요가 있겠다. 국내 소아 전반에 있어서 HPeV 감염의 역학과 임상적 특징을 밝히기 위해 향후 추가 연구가 필요하다.

• Clinical and Experimental Pediatrics
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• 제53권1호
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• pp.14-20
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• 2010

Cytomegalovirus (CMV) is currently the most common agent of congenital infection and the leading infectious cause of brain damage and hearing loss in children. Symptomatic congenital CMV infections usually result from maternal primary infection during early pregnancy. One half of symptomatic infants have cytomegalic inclusion disease (CID), which is characterized by involvement of multiple organs, in particular, the reticuloendothelial and central nervous system (CNS). Moreover, such involvement may or may not include ocular and auditory damage. Approximately 90% of infants with congenital infection are asymptomatic at birth. Preterm infants with perinatal CMV infection can have symptomatic diseases such as pneumonia, hepatitis, and thrombocytopenia. Microcephaly and abnormal neuroradiologic imaging are associated with a poor prognosis. Hearing loss may occur in both symptomatic and asymptomatic infants with congenital infection and may progress through childhood. Congenital infection is defined by the isolation of CMV from infants within the first 3 weeks of life. Ganciclovir therapy can be considered for infants with symptomatic congenital CMV infection involving the CNS. Pregnant women of seronegative state should be counseled on the importance of good hand washing and other control measures to prevent CMV infection. Heat treatment of infected breast milk at $72{^{\circ}C}$ for 5 seconds can eliminate CMV completely.

• Journal of Medicine and Life Science
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• 제19권1호
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• pp.26-29
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• 2022

Cryptococcus neoformans infection usually occurs in patients with advanced human immunodeficiency virus (HIV) infection or with a CD4 T lymphocyte count of <100 cells/µL. Pulmonary and central nervous system infections are the most frequently encountered forms of cryptococcosis; however, colonic cryptococcosis is uncommon. We describe the case of a 41-year-old antiretroviral-naïve man with HIV infection diagnosed eight years prior and intermittent diarrhea for 4 months who presented to the emergency department with a 1-day history of low-grade fever and confusion. Brain magnetic resonance imaging and cerebrospinal fluid analysis revealed normal results; however, he was diagnosed with Pneumocystis jirovecii pneumonia based on chest computed tomography and bronchoalveolar lavage analysis. Trimethoprim-sulfamethoxazole administration was initiated followed by antiretroviral treatment. Although his condition gradually improved, he developed fever and abdominal discomfort, and the diarrhea worsened. Endoscopy revealed a small ulcer in the distal transverse colon. Histopathological examination of a colon tissue sample revealed cryptococcal infection. He improved substantially during liposomal amphotericin B and fluconazole treatment. We encountered a rare case of colonic cryptococcosis that caused chronic diarrhea in a patient with advanced HIV infection. Colonic cryptococcosis should be considered when patients with acquired immune deficiency syndrome present with gastrointestinal symptoms.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.44-50
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• 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that affects multiple organs. More than half of the patients with SLE have kidney involvement, and up to 10% of patients with lupus nephritis develop end-stage renal disease (ESRD). Central nervous system (CNS) involvement in SLE occurs in 21% to 95% of patients. Severe neurological manifestations such as seizures, cerebrovascular disease, meningitis, and cerebrovascular accidents can develop in childhood-onset SLE, but cerebral infections, such as brain abscess and hemorrhage, are seldom reported in lupus nephritis, even in adults. Here, we report a rare case of childhood-onset SLE with ESRD, cerebral abscess, and hemorrhage. A 9-year-old girl diagnosed with lupus nephritis was administered high-dose steroids and immunosuppressant therapy to treat acute kidney injury (AKI) and massive proteinuria. The AKI deteriorated, and after 3 months, she developed ESRD. She received hemodialysis three times a week along with daily peritoneal dialysis to control edema. She developed seizures, and imaging showed a brain abscess. This was complicated by spontaneous cerebral hemorrhage, and she became unstable. She died shortly after the hemorrhage was discovered. In conclusion, CNS complications should always be considered in clinical practice because they increase mortality, especially in those with risk factors for infection.

• Safety and Health at Work
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• 제11권2호
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• pp.173-177
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• 2020

Background: Indoor air dampness microbiota (DM) is a big health hazard. Sufficient evidence exists that exposure to DM causes new asthma or exacerbation, dyspnea, infections of upper airways and allergic alveolitis. Less convincing evidence has yet been published for extrapulmonary manifestations of dampness and mold hypersensitivity syndrome). Methods: We investigated the prevalence of extrapulmonary in addition to respiratory symptoms with a questionnaire in a cohort of nurses and midwives (n = 90) exposed to DM in a Helsinki Obstetric Hospital. The corresponding prevalence was compared with an unexposed cohort (n = 45). Particular interest was put on neurological symptoms and multiple chemical sensitivity. Results: The results show that respiratory symptoms were more common among participants of the study vs. control cohort, that is, 80 vs 29%, respectively (risk ratio [RR]: 2.56, p < 0.001). Symptoms of the central or peripheral nervous system were also more common in study vs. control cohort: 81 vs 11% (RR: 6.63, p < 0.001). Fatigue was reported in 77 vs. 24%, (RR: 3.05, p < 0.001) and multiple chemical sensitivity in 40 vs. 9%, (RR: 3.44, p = 0.01), the so-called "brain fog", was prevalent in 62 vs 11% (RR: 4.94, p < 0.001), arrhythmias were reported in 57 vs. 2.4% (RR: 19.75, p < 0.001) and musculoskeletal pain in 51 vs 22% (RR: 2.02, p = 0.02) among participants of the study vs. control cohort, respectively. Conclusion: The results indicate that the exposure to DM is associated with a plethora of extrapulmonary symptoms. Presented data corroborate our recent reports on the health effects of moist and mold exposure in a workplace.

• 한국임상약학회지
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• 제22권1호
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• pp.55-64
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• 2012

The quinolones are broad-spectrum antibiotics and enhanced antimicrobial activity has extended the use of the quinolones beyond the traditional indications for quinolone antibiotics in the treatment of urinary tract infections. The quinolones are effective in a wider variety of infectious diseases, including skin and respiratory infections. Because of their excellent safety and tolerability, they have become popular alternatives to penicillin and cephalosporin derivatives in the treatment of various infections. A retrospective study was performed to evaluate efficacy and safety of IV quinolones for inpatient use. Total 117 patients who administerd quinolones for longer than 3 continuous days at community hospital from October 1st, 2008 to December 31st, 2008 were reviewed. The criterias for drug evaluation were included the validation of indication, outcome, dosage and side effects. In the results, ciprofloxacin 13 (total 93), levofloxacin 3 (total 59) and moxifloxacin 2 (total 19) cases were not met the criterias based on the culture results. Major indications were pneumonia (ciprofloxacin 16.3%, levofloxacin 67.8%, moxifloxacin 84.2%), urinary tract infection (ciprofloxacin 44.1%), skin infection (ciprofloxacin 7.5%, levofloxacin 20.3%, moxifloxacin 10.5%), intra-abdominal infection (ciprofloxacin 10.8%, moxifloxacin 5.3%), etc.. In the results of quinolone monotherapy, the frequencies were each ciprofloxacin 74.2%, levofloxacin 50.8% and moxifloxacin 47.4%. In the results of dosage validation, the validities were each ciprofloxacin 54.8%, levofloxacin 94.9% and moxifloxacin 100.0%. In the results of duration validation, the validities were each ciprofloxacin 59.1%, levofloxacin 78.0% and moxifloxacin 89.5%. Adverse drug reactions were reported for total 49 cases and those were gastrointestinal tract effects including nausea, vomiting, diarrhea and central nervous system effects including headache, dizziness. In summary, the quinolones appropriately used for hospitalized patients based on this study. A focused approach emphasizing "correct use of quinolones" may reduce development of antimicrobial resistance and maximize class efficacy. Consequently, correct use of antibiotics will contribute to decrease medical expenses for person and community.

• 대한바이러스학회지
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• 제30권3호
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• pp.171-178
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• 2000

Herpes simplex virus, Varicella zoster virus and Human herpes virus-6 caused central nervous system infections and latent infections but there is no data of the 3 viruses being tested from the same cerebrospinal fluid samples with aseptic meningitis or encephalitis in adults patients. These viruses produced similar neurologic symptoms but difficulties existed in differentiating of etiologic agents and therefore the viruses needed to be detected in the early state. Herpes simplex virus encephalitis (HSVE) in adults, if not treated promptly was fatal. If treated with antiviral drugs in the early phase of encephalitis, neurologic sequales decreased by 65%. Recently, a PCR method for detection of HSVE with CSF was developed. VZV primary and secondary infections caused neurologic symptoms of encephalitis or meningitis. The second frequency of adult encephalitis that caused VZV were reported. HHV-6 caused CNS latent infection that was studied with normal adults brains. But there is no data of HSV, VZV and HHV-6 for aseptic meningitis and encephalitis of Korean adults through etiologic study. We cultured CSFs on HEp-2 cells and simultaneously tested for HSV PCR, VZV nested PCR and HHV-6 PCR with 8 specific primers. The PCR results of CSF from meningitis Korean adults were 13/19 (68.4%) for HSV, 10/19 (52.6%) for VZV and 12/19 (63.2%) for HHV-67/19 (36.8%) cases were triple infected HSV PCR, VZV PCR and HHV-6 PCR positive; 3/19 (15.8%) cases were dual infected HSV PCR and HHV-6 PCR positive; 1119 (0.5%) cases was VZV PCR positive. Strong viral DNA amplification of CSF means a causative virus may be present in aseptic meningitis or encephalitis patients and may cause clinical neurologic symptoms. HSV and HHV-6 viruses detection rate were higher than VZV by PCR with CSFs.