• Clinical and Experimental Pediatrics
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• v.46 no.11
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• pp.1085-1088
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• 2003

Purpose : This study was performed to assess the difference of organisms causing bacterial meningitis according to time. Methods : We analyzed retrospectively 40 medical records of bacteriologically proven meningitis from 1992 to 2002. We divided them into two groups; neonate's group(14 cases), and children's group(26 cases). The results of the neonate's group were compared with those of previously reported articles in Korea, in 1970s-1980s. The causative agents of the children's group were analyzed according to the stage before and after the introduction of H. influenza type b(Hib) vaccine. Results : In neonates, Group B streptococci(GBS) was the most common cause of bacterial meningitis. There was a trend in Korea that major causative agents of neonatal bacterial meningitis have changed from gram negative bacteria including E. coli to gram positive bacteria including GBS. In children, H. influenzae was isolated in six out of 11 cases(55%) in 1992-95, before the introduction of Hib vaccine, while two out of seven(29%) were isolated in 1999-2002, after the introduction of the Hib vaccine. Conclusion : Our study showed that the most common agent of neonatal bacterial meningitis was GBS. There was a trend that after the introduction of Hib vaccine, the incidence of H. influenza meningitis decreased in children.

• Pediatric Infection and Vaccine
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• v.10 no.2
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• pp.208-214
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• 2003

Purpose : We performed a retrospective study on bacterial meningitis in children, pertaining to the causative organisms, bacterial resistance to antibiotics and the effect of recent introduction of Haemophilus influenzae type b(Hib) vaccine. Methods : We analysed the forty-three cases of bacterial meningitis which had been treated at the Inha University Hospital from June 1996 to June 2003. Results : Nineteen cases(44.2%) of them were infants younger than 2 months of age, and 29 cases(67.5%) younger than 1 year of age. The common causative organisms under 2 months of age were group B streptococcus(GBS)(47.4%), E. coli(21.1%), and Klebsiella pneumoniae(21.1%). In the age group beyond 2 months of age, S. pneumoniae were seen in 50 %, H. influenzae in 16.7% and N. meningitidis in 16.7%. All of the five cases of Hib meningitis had not been vaccinated for Hib. There has been no Hib meningitis cases since 2001. Overall fatality rate was 4.5%, and complication occurred in 39%. Complications was significantly less frequent in patients resumed to be treated within 48 hours after onset compared to after 48 hours after onset. Penicillin resistance of S. pneumoniae and GBS isolated among bacterial meningitis cases was high. Conclusion : Timing of treatment after the onset of the disease appeared the most important factor for prognosis of bacterial meningitis. The cases of H. influenzae meningitis have decreased probably due to Hib vaccination.

• Pediatric Infection and Vaccine
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• v.13 no.2
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• pp.130-136
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• 2006

Purpose : The purpose of this study is to confirm the epidemiologic change of the causative organisms of neonatal and pediatric bacterial meningitis in Korea. And we tried to evaluate the risk factors correlated with prognosis which was available on the day of admission. Methods : Retrospectively, we reviewed the medical records of 57 patients admitted for bacterial meningitis at six hospitals affiliated with Catholic Medical Center for 6 years(Jan. 2000~Dec. 2005). Results : 22 cases(38.6%) of them were neonates under 28 days and 35 cases were infants and children ; 16 cases(28.1%), under 1 year ; 6 cases(10.5%), under 5 years ; 13 cases (22.8%), under 15 years. In neonates, 16 cases(72.7%) were caused by group B streptococcus (GBS). In infants and children, S. pneumoniae(25.7%), H. influenzae type b(Hib)(22.8%) and N. meningitidis(22.8%) were common cause of bacterial meningitis in order. In the informations available on the day of admission, weight deficit for age under 3 percentile, increased CRP level and decreased glucose level of CSF were related to poor prognosis(P<0.05). Conclusion : GBS became a leading cause of neonatal bacterial meningitis. Though, pneumoccocal, Hib and meningococcal meningitis were confirmed as major causes of bacterial meningitis. The routine immunization of pneumococcal and Hib vaccines will be considered, and it is necessary to introduce meningococcal vaccines to our country in the future.

• Pediatric Infection and Vaccine
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• v.26 no.3
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• pp.188-193
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• 2019

Since the implementation of conjugate Haemophilus influenzae serotype b (Hib) vaccine, the rate of infections caused by Hib has dramatically decreased, and the proportion of infections caused by non-type b H. influenzae has increased. Cerebral venous sinus thrombosis (CVST) is rare; however, it should be considered as a potential complication of bacterial meningitis. Herein, we report about a child who developed CVST after being diagnosed with H. influenzae serotype f meningitis.

• BMB Reports
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• v.33 no.3
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• pp.249-255
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• 2000

The Haemophilus influenzae type b (Hib) has been a major cause of bacterial meningitis in children who are less than two years old. The variable (V) region repertoire of adult Caucasian antibodies (Abs) to Hib polysaccharide (PS) has been characterized well. The majority of adult antibodies against Hib uses VL that is derived from the Vk gene A2 and have arginine at the N region. In order to explore the possibility those antibody responses to Hib-PS is variable in various age groups, we examined the VL regions of the antibodies to Hib-PS in Korean adults and children. We immunized Korean adults (n = 8) and children (n = 39) with Hib tetanus conjugated vaccines, isolated RNAs from the peripheral lymphocytes, and amplified the A2-derived VL regions by RT-PCR. The PCR products were subcloned and sequenced. Forty-seven out of 54 independent clones from children used the $J{\kappa}2$, or $J{\kappa}3$ gene in preference. The adults, however, used all of the $J{\kappa}$ genes evenly. With respect to the amino acid sequences of variable regions, adult $A2-J{\kappa}$ recombinants have a germline sequence. But, the 76th codon (AGC) of child $A2-J{\kappa}2$ recombinants was substituted with CGC (arginine) in most cases (88 %) and 77 percent of child clones using the $A2-J{\kappa}3$ genes have isoleucine-109 at the junction of $J{\kappa}-C{\kappa}$ instead of threonine that is found in a germline sequence. These results suggest that the mechanism of antibody production in young children is different from that of adults.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.234-240
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• 2001

Buccal cellulitis which presents with high fever and a swelling of the cheek with violaceous hue in young children is most often caused by H. influenzae. Bacteremia is common in buccal cellulitis caused by H. influenzae, and a culture of cerebrospinal fluid should be obtained because meningitis may be present despite the lack of meningeal irritation signs. Although buccal cellulitis is considered to be one of the important manifestations of H. influenzae infection, only two cases have been reported in Korea yet. We experienced a case of buccal cellulitis with H. influenzae bacteremia in an immunocompetent girl of 18-month-old. She was presented with high fever followed by rapidly progressive swelling and tenderness of both cheeks with violaceous hue in four hours. The blood culture revealed H. influenzae type b. There was no concurrent otitis media, sinusitis, or meningitis and no portal of entry was identified. Fever subsided two days after starting intravenous cefotaxime. Intravenous cefotaxime was subsequently changed to oral cefixime, and antibiotics were administered for a total of two weeks. We report this case with a review of related literature.

• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1077-1084
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• 2008

Purpose : Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. Methods : The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. Results : Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. Conclusion : In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.157-162
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• 2007

Purpose : The purpose of this study was to analyze the epidemiology, causative organism, clinical manifestation and prognosis of bacterial meningitis for children after the introduction of Haemophilus influenzae type b (Hib) vaccine in Daejeon and Chungcheong area. Methods : We analyzed retrospectively 53 medical records who had been diagnosed with bacterial meningitis at 10 general or university hospitals in Daejeon and Chungcheong area. All patients aged 1 month-14 years admitted between January 2001 through December 2005. Results : During the 5-year study period, 40 of all cases were positive for bacterial growth. Of the 40 cases that were CSF culture-proven bacterial meningitis, Streptococcus peumoniae was the most common bacteria for 17 (32.1%) of all cases, followed by H. influenzae for 10 (18.9%), Neisseria meningitidis for 3 (5.7%). In this study, the most common clinical manifestation is fever, accompanied by all cases. CSF leukocyte count was more than $100/mm^3$ in 45 (84.1%) cases. CSF glucose concentration was less than 50 mg/dL in 42 (79.2%) cases and protein concentration was more than 45 mg/dL in 49 (92.5%) cases. 45 of all cases made a recovery after treatment and were discharged. Most common complication after treatment is subdural effusion (19.0%) and hearing disturbance (9.4%). Conclusion : The most common organism of culture-proven bacterial meningitis in the children beyond neonatal period was S. pneumoniae. Continued surveillance studies were demanded to know the altered incidence of bacterial meningitis, because we expect the incidence of S. pneumoniae meninigitis will be on the decrease after more active innoculation of pneumococcal protein conjugate vaccine.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.251-257
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• 2006

Purpose : In this study, we created a questionnaire and collected answers concerning actual conditions of vaccination and parents' knowledge of vaccination issues, in order to find false knowledge of patients. We tried to give correct information and suggested the role of the pediatrician. Methods : We made questionnaires and collected answers from 466 parents from March 2004 to June 2004. Results : Places of vaccination were pediatric clinics(49.4 percent), health centers(27.7 percent), general/university hospitals(15.0 percent) and other clinics(4.9 percent). We found 38.8 percent of parents thought that the reason for vaccination at pediatric clinics was a belief of speciality, even though there is no difference in the vaccination itself. We also found 15.0 percent of parents thought that there were no differences between pediatricians and other physicians, but 52.0 percent of parents wanted to receive vaccination at pediatric clinics in the future. Our study also found that 62.4 percent of parents wanted to make out a preliminary questionnaire for vaccination. Many parents got vaccination information from vaccination record books(57.9 percent), and 52.6 percent of parents incorrectly believed that Hib vaccination could prevent all kinds of meningitis. Conclusion : Our study suggests that pediatricians need to make efforts to give out correct information. It is necessary to use preliminary questionnaires for vaccination and correct vaccination information should be written on the vaccination record book. Also, there needs to be counselling with parents about weaning, growth and development at the time of vaccination, and to point out the differences between pediatricians and other physicians.

• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.160-167
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• 2017

Purpose: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. Methods: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. Results: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H. influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. Conclusions: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.