• Pediatric Infection and Vaccine
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• v.14 no.1
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• pp.47-54
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• 2007

Purpose : Viral respiratory tract infection is most common cause for admission to hospital in children. There are many cases with elevated transaminase level in patients with viral lower respiratory tract infection (LRTI). The aim of this study was to compare indexes of disease severity such as duration of assisted ventilation, length of hospital stay and Respiratory Distress Assessment Instrument (RDAI) score in children with viral LRTI with and without elevated transaminase levels and to determine the etiology related to elevated transaminase levels in this patients group. Methods : Virological analysis was done from respiratory specimens obtained from patients with LRTI admitted to Kangnam Sacred Heart Hospital from Jan. 2003 to Jun. 2005. Viral diagnosis was made by isolation of viruses employing HEp-2 cell culture from nasopharyngeal aspiration. Medical records of children were reviewed retrospectively. We compared age, sex, RDAI score, Respiratory Rate (RR) score and mean duration of hospital stay between patients with elevated transaminase levels (Patient Group) and patients with normal transaminase levels (Control Group). Results : Viruses were isolated from 181 children with LRTI. 16 cases were excluded according to criteria. 28 cases (17.0%) had elevated transaminase levels (Patient group) and 137 cases (83.0%) had normal transaminase levels (Control group). There were no significant difference in duration of fever, RR score, RDAI score, incidence of $O_2$ inhalation and duration of hospital stay between patient group and control group. We found 17 (60.7%) cases of RSV, 4 cases (14.3%) of parainfluenza, 4 cases (14.3%) of influenza B virus, 3 cases (10.7%) of adenovirus and 1 case (3.6%) of influenza A virus infection in patient group and 78 cases (56.9%) of RSV, 28 cases (20.4%) of parainfluenza virus, 13 cases (9.5%) of influenza A virus, 9 cases (6.6%) of influenza B virus, 6 cases (4.4%) of adenovirus and 3 cases (2.2%) of coxsackie virus infection in control group. Conclusion : There were 28 cases (17.0%) with elevated transaminase level among patients with virus isolated LRTI. There was no relation between elevated transaminase level and severity of disease. The viral etiologies in two groups were not significantly different. There was no significant difference of age distribution between two groups.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.17 no.1
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• pp.31-37
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• 2017

Carbamoyl phosphate synthetase 1 deficiency (CPS1D) is an autosomal recessive disorder of the urea cycle that causes hyperammonemia. Two forms of CPS1D are recognized: a lethal neonatal type and a less severe, delayed-onset type. Neonatal CPS1D cases often present their symptoms within the first days of life. Delayed-onset cases are predominantly adolescents or adults, and infantile delayed-onset cases are rare. Severe hyperammonemia in the neonatal period leads to serious brain damage, coma, and death if not treated promptly. Therefore, early diagnosis and acute treatment are crucial. Despite the improvement of treatments, including continuous hemodialysis, ammonia-lowering agents, and a low-protein diet, the overall outcome of severe forms of hyperammonemia often remains disappointing. As the liver is the only organ in which ammonia is converted into urea, liver transplantation has been considered as an elegant and radical alternative therapy to classical dietary and medical therapies. However, liver transplantation has many disadvantages, such as a considerable risk for technical complications and perioperative metabolic derangement, especially in neonates. Additionally, there is a lack of suitable donor organs in most countries. According to recent studies, liver cell transplantation is a therapeutic option and serves as a bridge to liver transplantation. Here, we report a Korean CPS1D patient with novel mutations in CPS1 who was treated by liver cell transplantation after being diagnosed in the neonatal period and showed a good neurodevelopmental outcome at the last follow-up at six months of age.

• Tuberculosis and Respiratory Diseases
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• v.58 no.3
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• pp.248-256
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• 2005

Background : Nontuberculous mycobacterial (NTM) infections are increasingly being recognized as a cause of chronic pulmonary disease. This study describes the prevalence of NTM species from clinical specimens and the clinical characteristics of NTM pulmonary disease. Material and Methods : The NTM isolated from March 2003 to December 2003 at the Kosin Medical Center were identified using an oligonucleotide chip containing the internal transcribed space (ITS) sequence. The medical records of the patients with the NTM isolates, who fulfilled the 1997 ATS diagnostic criteria for NTM pulmonary disease, were analyzed, retrospectively. Results : Twenty four species (24.2%) of NTM were isolated from 99 cultured AFB specimens. M. avium complex (MAC) (13 isolates), M. szulgai (3), M. kansasii (2), M. malmoense (2), M. abscessus (1), M. chelonae (1), M. scrofulaceum (1), and unclassified (1). Of the 23 patients with isolated NTM, 11 patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria; MAC was found in 6 cases (54.5%), M. szulgai in 2 cases (18.2%), and M. abscessus, M. szulgai, M. kansasii and M. malmoense in 1 case each (9.1%). Ten patients (91%) were male and the median age at diagnosis was 61 years. In the pre-existing diseases, malignant disease was found in 6 cases including 5 patients with lung cancer, and history of old pulmonary tuberculosis was identified in 4 cases. The radiological patterns showed lung destruction lung in 3 cases, a cavitary mass in 3 cases, a nodular pattern in 2 cases, and reticulonodular, consolidation and a bronchiectasis pattern were in 1 case each. Conclusion : Various types of NTM pulmonary diseases were found in a tertiary hospital at Busan, Korea. The NTM pulmonary diseases were caused by MAC, M. szugai, M. kansasii, M. malmoense, M. abscessus, M. chelonae, and M. scrofulaceum in the order of frequency.

• Biomedical Science Letters
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• v.4 no.1
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• pp.65-72
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• 1998

Recently there have been frequent reports on human infection caused by the Diphyllobothridae in Korea. The adequate opportunities for Koreans to eat raw fish, the primary infection medium of cestodes and the human infection through drinking water by cyclops, the first intermediate host are believed to be main reasons for the infection. The first task of this study was to classify and diagnose the species by differentiating morphological characteristic between scolex and proglottids of cestodes. However, the initially available diagnosis was done with the patient's symptoms and the eggs obtained from his stool. It is important to differentiate the species by the eggs of Diphyllobothrium latum especially in that it can help get advance information for a more reliable analysis in the near future. The morphological and diagnostic results from proglottids and eggs of Diphyllobothrium latum, Diphyllobothrium latum parvum and Spirometra erinacei are as follows； In each kind of cestodes from the patient's stool, the shape and size of 50 eggs were measured. Eggs of Diphyllobothrium latum had an operculum and were ovoidal or ellipsoid to elliptical in shape. Eggs of Diphyllobothrium latum parvum were more ovoidal in shape and smaller in size than Diphyllobothrium latum. And eggs of Spirometra erinacei were asymmetrical in width and long and slender in shape. The average lengths and widths of Diphyllobothrium latum, Diphyllobothrium latum parvum and Spirometra erinacei were 61.4$\times$41.7 $\mu\textrm{m}$, 55.9$\times$41.4 $\mu\textrm{m}$ and 66.7$\times$36.4 $\mu\textrm{m}$, respectively. After the segments of each cestode were fixed, embedding and hematoxylin-eosin dyeing on a microtome-made specimen were done. The micrographs of the semicon's aceto-carmine dyed specimen showed that Diphyllobothrium latum and Diphyllobothrium latum parvum had a centrally-located genital gland and an opened uterine pore. The yolks were observed on both sides of proglottids and had a typical rosette pattern. Yet, Diphyllobothrium latum parvum was shown smaller than Diphyllobothrium latum in the micrograph. Proglottids of Spirometra erinacei displayed that the uterus was rolled spirally more than five to seven times, and connected successively to the seminal vesicle in the cirrus sac. Shown above, this study was performed to measure the size of eggs and analyze the morphological characteristics of proglottids and provided the measurements of three types of cestodes obtained by a light microscope.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.124-134
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• 2005

Purpose : It has been known that the diagnostic confirmation of group A streptococcal pharyngitis is accompanied with the results of throat culture and/or rapid antigen detection test(RADT). This study was designed to evaluate the usefulness and cost benefits of the RADT in patients with a sore throat compared the empirical antibiotic treated group without using RADT or throat culture with the antibiotic treated group according to the results of RADT test and/or throat culture. Methods : From April 2003 to August 2003, total 369 patients were enrolled this study. They were redistributed into two groups. In one group, the RADT test and throat culture were used and the patients received antibiotic treatment according to the results of test and in the other group, no diagnostic examinations were used and the patients were treated with antibiotics which were chosen empirically. The flow sheet with questionnaire was drawing up and obtained the clinical symptoms, signs and the name of antibiotics that were administered. Results : A total of 244 patients were treated after the throat culture and/or RADT, and 125 patients were treated empirically. The prevalence of bacteriologically confirmed group A streptococcal pharyngitis was 20.1%. The sensitivity and specificity of RADT were 89.8% and 86.1%, respectively. Positive predictive value and negative predictive value were 62.0% and 97.1%, respectively. The rate of antibiotic use was high in both groups. Because the physician used the antibiotics even if the result of RADT was negative. So about 37% of reduction of antibiotics use might be possible if we used antibiotics according to the results of RADT. There were no cost differences between the RADT applied group and the empirically treated antibiotic group if we could reduce the price of RADT to 63% of the current price. Conclusion : The RADT could be applied for the easy and rapid diagnosis and prompt treatment for group A streptococcal pharyngitis, and RADT could reduced the number of antibiotics used if the price of RADT was reduced to 63% of current price. For accurate evaluation of efficacy and cost effect, further controlled study is needed.

• 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.

• Journal of radiological science and technology
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• v.26 no.3
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• pp.33-39
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• 2003

Purpose : Be aware of clinical possibilities on image quality by comparison of contrast-enhanced dynamic CT and MR imaging applied of MIP technique after the experimentally induced clonorchasis infection in dogs. Materials and Method : Twenty mongrel dogs prepared in zoo-laboratory were followed up with serial CT scans and MR imaging for 13 weeks after the experimental infection in liver. Two-phase helical CT was acquired in the supine position with the following scanning parameters. After the injection of contrast material, the arterial phase was initiated using a bolus-racking method. The portal phase scan was started 15 seconds after the arterial phase scan. CT protocol was determined after single level dynamic scans. MR imaging used the CP body coil and images get a 2D image using HASTE, FLASH, TSE pulse sequence. Bile duct MR imaging were obtained in three plans. Then each image was post processed by using target MIP algorithm. Two experimentation above, as a method of evaluation, one pathologist, three radiologist and five radiological technologist were analyzed visually for evaluation of following findings, enhancement of the bile duct wall, dilatation of bile duct tip, liver parenchyma, background suppression. Results : Five dogs was died of a disease after the infection, the rest one else shows the chronic dilatation of the intrahepatic bile duct with CT and MR imaging. Contrast administration of CT shows the contrast-enhanced of the bile duct walls with live parenchyma. MR imaging calculated of CNR and CR from pulse sequence for comparative evaluation and shows the pattern of the intrahepatic bile duct, dilatation of bile duct tip using MIP technique. CNR of the clonorchiasis, HASTE was $16{\pm}0.83$, TSE $7.06{\pm}3.0$, FLASH $1.19{\pm}0.2$ and CR, HASTE was 73.3%, TSE 62.3%, FLASH 6.4%. Conclusion : CT and MR imaging is very usefulness in diagnosis of dog clonorchiasis.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.40-48
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• 2009

Purpose : This study was performed to identify factors related to the resolution of primary vesicoureteral reflux (VUR) in infants. Methods : We reviewed 183 infants (M : F=149 : 34) diagnosed as urinary tract infection (UTI) between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture (n=97), catheterization (n=83), or collection bag method (n=3, twice positive culture of same organism). All of the infants were performed renal ultrasonography, DMSA scan and voiding cystourethrography (VCUG) study. Follow-up imaging consisted of contrast VCUG or direct isotope VCUG at interval of 1 year. We evaluated the relationship of clinical and laboratory finding, radiologic finding in infants with VUR. Results : Among 51 VUR patients, 18 infants had grade I-II, 12 infants had grade III and the other 21 patients had grade IV-V. Abnormal findings including hydronephrosis on renal ultrasonography were not correlated with severity of VUR. However, the incidence of renal defect in the first DMSA scan showed a tendency of direct correlation with severity of VUR in female patients only (P<0.001). There was significant difference of resolution rate in three VUR groups (grade I-II, III, IV-V) in male patients only (P=0.025). Resolution rate was higher for male patients with unilateral VUR than bilateral (P<0.001). But unilaterality had not any affect on VUR resolution in female VUR patients (P=0.786). Resolution rate was higher for VUR patients without renal scar than VUR patients with renal scar (P<0.001). Conclusion : According to our findings, grade of VUR, laterality and renal scar are the factors that contribute to resolution of primary VUR in male and female infants differently.

• Clinical and Experimental Pediatrics
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• v.52 no.7
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• pp.818-823
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• 2009

Purpose : We aimed to evaluate the frequency and characteristics of minor clinical manifestations of atopic dermatitis (AD) in Korean children to aid the diagnosis and treatment of AD. Methods : From April 2007 to December 2007, we enrolled 106 children (aged 1 month [infants] to 15 years) diagnosed with AD at the Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital. Clinical manifestations were examined and laboratory findings (total and specific immunoglobulin E [IgE] levels and peripheral blood eosinophil count) were analyzed and compared. Results : Minor symptoms, in order of frequency, included xerosis (78.3%), aggravation due to environmental or emotional stress (43.4%), lichenification (35.8%), orbital darkening (34.0%), periauricular eczema (33.0%), and cutaneous infection (31.1%). Older children (${\geq}2$ years) showed more orbital darkening (P=0.01), horizontal crease (P=0.01), and lichenification (P=0.001) than infants. Patients with severe AD (scoring atopic dermatitis [SCORAD] score, ${\geq}40$) showed higher frequencies of xerosis (P= 0.04), cutaneous infection (P=0.03), ichthyosis (P=0.18), keratosis pilaris (P=0.02), pityriasis alba (P=0.07), recurrent conjunctivitis (P=0.02), orbital darkening (P=0.001), aggravation due to environmental or emotional stress (P=0.05), facial eczema (P=0.001), lichenification (P=0.001), and hand/foot eczema (P=0.04) than those with mild-to-moderate AD. Children with atopic eczema showed more facial eczema (P=0.01) and lichenification (P=0.04) than those with non-atopic eczema. Conclusion : The clinical manifestations of AD were similar to those established by Hanifin and Rajka. However, we need to develop our own diagnostic criteria for AD, because the frequencies shown by our subjects differed from those observed in other countries.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.2
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• pp.146-153
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• 2010

Purpose: Recent studies have reported an increase in the incidence of community-acquired Clostridium difficile-associated disease (CA-CDAD) among children. There is an overall lack of information on CA-CDAD in the pediatric population. The aim of our study was to compare the epidemiologic and clinical features between CA-CDAD and hospital-acquired C. difficile-associated disease (HA-CDAD) in children. Methods: We retrospectively reviewed the medical records of all patients who were diagnosed with C. difficile-associated disease (CDAD) at Gil Hospital between April 2008 and March 2009. The diagnosis of CDAD was made when patients with gastrointestinal symptoms had positive results for C. difficile toxins A and B assay or stool culture. Results: Sixty-one (male, 32 and female, 29) patients were included. The mean age was 3.79${\pm}$4.54 years. Of the 61 patients, 22 (36.1%) were <1 year of age. Twenty-three patients (37.7%) had a history of antibiotic exposure in the previous 3 months. Forty-one patients (67.2%) were diagnosed with CA-CDAD. There were no significant differences in age, gender, symptoms, laboratory findings, recovery period, complications, and recurrence between the CA-CDAD and HA-CDAD groups. On the other hand, exposure to antibiotics was significantly more frequent among patients in the HA-CDAD group (p=0.005). Conclusion: This study suggests that the occurrence of CA-CDAD is increasing in the pediatric population, especially in younger children with no history of exposure to antibiotics and in outpatients. Awareness of the increasing incidence of CA-CDAD and prompt investigation of C. difficile in susceptible patients is needed to avoid misdiagnosis and for appropriate therapy.