• Pediatric Infection and Vaccine
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• v.9 no.2
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• pp.201-207
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• 2002

Purpose : We analyzed clinical features and causal viruses of acute lower respiratory tract infections(LRTIs) in order to improve the management of these infections. Methods : From end of April to early May 2001, amongst 30 children at a local institute for children's adoption and welfare, 13 were admitted to the hospital with the diagnostic impression of acute LRTIs. Nasopharyngeal aspirates were sent in Seoul National University Hospital for viral culture of respiratory syncytial virus(RSV), adenovirus, parainfluenza virus. Results : One or more viral agents were identified in 4 cases(30.7%) : were RSV(15.4%), adenovirus(7.7%), and a mix of these two viruses(7.7%). Initial symptoms were fever(69%), cough(100%), tachypnea(54%), chest retraction(69%), rale(85%) and wheezing(15%). Leukocytosis was noted in 23%, CRP increased more than 10 mg/L in 46%. Chest X-ray abnormalities were 69%. Conclusion : Although viruses were identified in 30.7%, further studies should be made for prevention and treatment of acute viral LRTIs.

• Pediatric Infection and Vaccine
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• v.9 no.2
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• pp.222-229
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• 2002

Human infection with the lung fluke Paragonimus westermani has become rare in Korea. Human paragonimiasis is caused by eating raw fresh-water crayfishes or crabs infected with larval metacercariae. Recently, we experienced three cases of pulmonary paragonimiasis in a family. They ate raw fresh-water crayfishes that lived in a stream in Wolchulmountain. All the parients had hypereosinophilia and pulmonary infiltrates with pleural effusion or hydropneumothorax, which did not improve on antibiotics. Ingestion of raw crayfishes was a clue for paragonimiasis. Positive results were shown both on intradermal skin test and ELISA for Paragonimus westermani specific IgG. After treatment with praziquantel, the patients showed an improvement. This is the first familial human paragonimiasis, reported from Wolchulmountain in Chonnam Province where there had been no previous cases of paragonimiasis.

• Pediatric Infection and Vaccine
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• v.11 no.2
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• pp.170-175
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• 2004

Purpose : We experienced 7 patients with Kikuchi-Fujimoto disease(KFD) who had presented a prolonged fever and lymphadenopathy. The clinical and the laboratory aspects of the patients were analyzed. Methods : The medical records of the 7 KFD patients, who were confirmed by excisional lymph node biopsy from January 1996 through December 2003, were retrospectively analyzed. Results : The mean age of the children was $11.4{\pm}2.8$ years(ranging from 8 to 15 years). The male to female ratio was 1.3 : 1. The median duration of the fever prior to admission and the total duration of the fever were 12 days(ranging from 5 to 65 days) and 27 days(ranging 9 to 75 days), respectively. One patient had supraclavicular lymphadenopathy, 5 had cercical involvement, and 1 had axillary lymphadenopathy. All the histologic findings of the lymph nodes biopsies showed the characteristic findings consistent with KFD such as paracortical necrosis with karyorrhexis and an increase in the number of phagocytic histiocytes and atypical lymphocytes. As for the laboratory findings, leukopenia($3,800{\pm}700/mm^3$), anemia(hemoglobin, $11.0{\pm}1.2g/dL$), an elevated erythrocyte sedimentation rate($42{\pm}17mm/hr$), and a relatively low C-reactive protein level($1.3{\pm}0.9mg/dL$) were noted. Four patients received conservative therapy with antipyretics, and 3 patients were treated with prednisolone. Conclusion : KFD is a rare disease, yet should be considered in the differential diagnosis for older children with prolonged fever and lymphadenopathy.

• Pediatric Infection and Vaccine
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• v.11 no.2
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• pp.153-157
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• 2004

Purpose : Ttransfusion transmitted virus(TTV) is a circular DNA and consists of diverse genotypes and variants. The pathogenecity of TTV is still unclear. Recently another circular single stranded DNA virus, distantly related to TTV was isolated from the sera of blood donors, designated as Transfusion transmitted virus like minivirus(TLMV). TTV and TLMV show greater sequence divergence from each other than between genotypes of TTV. We planned to know the prevalence of TLMV in children. Methods : TLMV DNA was detected by PCR primers from noncoding region of the genome in 88 children without hepatitis, aged 0~15 years. PCR products derived from 10 children were directly sequenced and phylogenetic analysis was undertaken. Results : TLMV DNA was detected in 49% of 88 children without hepatitis. The prevalence of TLMV varied with age : <1 y, 16%(4/25); 1~3 y, 62%(18/29); 4~6 y, 43%(7/16); 7~9 y. 16%(1/6); 10~15 y, 66%(8/12). Mixed infection with TTV was confirmed in 22% of 88 children. Pyhlogenetic analysis of 10 TLMV sequences showed much heterogeneity compared to sequences of GenBank. Conclusion : TLMV prevalence in children was 49% in Korean children. Our TLMV sequence did not cluster in any sequence of TLMV in the GenBank.

• Pediatric Infection and Vaccine
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• v.13 no.2
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• pp.180-185
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• 2006

Invasive Pseudomonas infections most often occur in the immunocompromised patients and are associated with high mortality rate. Rarely this disease may develop in healthy infants and children. We report two cases of invasive Pseudomonas aeruginosa infections that were diagnosed in otherwise healthy infants. The first case was a previously healthy 5-month-old infant with ecthyma gangrenosum and septicemia. She presented with fever, swelling of left periorbital area and multiple erythronodular skin lesions. Each skin lesion formed a black eschar surrounded by an erythematous areola over time. Cultures of blood, urine and discharge from skin lesions grew P. aeruginosa. On the day of visit, she showed pancytopenia which was normalized after 10 days. The patient responded well to the management with ceftazidime and tobramycin. The other case was a previously healthy 9-month-old infant with community-acquired pneumonia. He was referred from an outside hospital with fever and cough. Chest x-ray revealed pneumonic infiltrations on both lower lungs with pleural effusion on the right side. Cultures of blood and pleural fluid grew P. aeruginosa. Chest CT performed on the ninth day demonstrated pneumatoceles, lung abscess and necrosis of lung parenchyma. He was managed with ceftazidime and amikacin for 50 days. No residual pulmonary complications were noted during the three month follow-up. Laboratory results to evaluate immunologic defects of phagocytic cells, complement components and T- and B-lymphocytes were all within normal range in both patients. It should be kept in mind that Pseudomonas can be, though uncommon, a cause of community-acquired invasive infections in the previously healthy infants.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.185-193
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• 1996

Purpose : The incidence of measles was gradually decreased since 1963 when measles vaccination was firstly developed and liscenced in the world. But, recently the outbreaks of measles in infants and school children have been reported despite of wide spread use of measles vaccination. This study was performed to evaluate the efficacy of measles vaccination and the necessity of revaccination in Korean infants and children. Methods : 168 subjects of mothers and neonates, infants and children were enrolled in this study during the periods of 10 months from March to December in 1995. Measles specific IgG in the sera of mothers and children was measured using EIA kit (Sigma Co., MO, USA). Antibody titer of over or equal to 110 AU/ml was considered positive. Results : The results obtained were as follows. 1) Values of measles specific IgG in the sera of mother and neonate were 82.9 AU/ml and 89.3 AU/ml respectively and were rapidly decreased within 6 month after birth. Positive antibody levels (${\geq}$ 110 AU/ml) were observed in only 25 % of neonates. 2) In vaccinated children, values of measles specific IgG were 117.4 AU/ml in 9~15 month group, 76.9 AU/ml in 3~6 year group and 79.5 AU/ml in 10~15 year group after either one or two times of measles vaccination. Positive antibody levels in vaccinated children were observed in 57.7% of 9~15 month group, 38.4% of 3~6 year group and 34.7% of 10~15 year group. Conclusion : These results suggest that primary measles vaccination before 6 months of age can be considered and revaccination of measles should be recommended before 3~6 years of age. Further studies will be needed to clarify the reasons of high proportion of primary measles vaccination failure and to established the appropriate schedule of measles vaccination in korean infants and children.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.168-174
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• 1996

Purpose : Aseptic meningitis is relatively frequent in children and caused mostly by enterovirus. The aim of the present study was to determine the effect of early diagnosis (spinal tapping) on symptom duration of childhood aseptic meningitis. Methods : One hundred fifty-three children who were hospitalized due to aseptic menigitis in the Department of Pediatrics St. Benedict Hospital from July 1996 through October 1996 were included in this study. Patients were divided to two groups according to the duration from first symptom onset to diagnosis. Early diagnosis group is diagnosed within 3 days from first symptom onset. Later diagnosis group is diagnosed after 4 days from first symptom onset. Results : 1) The average age of these patients was 4.3 years old in early diagnosis group and 4.1 years old in later diagnosis group. The sex ratio(male: female) was 2.04:1 in early diagnosis group and 2.5:1 in later diagnosis group. 2) The mean duration of diagnosis of this study was 2.04 day in early diagnosis group and 5.12 day in later diagnosis group. 3) The percentage of symptom and sign of the early diagnosis group were fever(100%), headache(88.4%), vomiting(86.9%), abdominal pain(39%), neck stiffness(36.2%), skin rash(18.8%), diarrhea(16.9%) and that of later diagosis group were fever(100%), headache(83.3), vomiting(80.9%), abdominal pain(47.6%), neck stiffness(41.6%), skin rash(29.7%), diarrhea(16.6%). 4) Initial CSF findings revealed leukocyte $146.8{\pm}386.3/mm^3$ with PMNL 38%, protein 32.47mg/dl, sugar 66.23mg/dl in early diagnosis group and leukocyte $458.1{\pm}663.2/mm^3$, protein 31.22mg/dl, sugar 64.21 mg/dl in later diagnosis group. 5) There was no statistically significant differance in the peripheral blood findings between early diagnosis group and later diagnosis group. 6) The duration of disappearance of symptom after spinal tap were 2.3 days in early diagnosis group and 2.24 days in later diagnosis group. Total symptom duration was 4.34 days in early diagnosis group and 7.36 days in later diagnosis group. Conclusions : Our results demonstrate that early diagnosis(early spinal tap) shortened duration of clinical symptoms.

• 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.

• Pediatric Infection and Vaccine
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• v.13 no.2
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• pp.99-105
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• 2006

Purpose : The serotyping results of the Quellung reaction was compared with the newly developed multiplex latex assay and the sensitivity of the Quellung reaction was compared. Methods : We checked the serotypes of 35 samples obtained from patients treated at Yonsei University Medical Center using the multiplex latex bead method and compared the results with the serotypes previously obtained via the Quellung reaction. Results : A decrease in the mean fluorescence was detected in the samples tested with the multiplex assay. Seventeen samples out of the 27 samples agreed to the results of the Quellung assay. We were only able to confirm the concordance of 11 serotypes out of 14 serotypes available. Conclusion : The Quellung reaction is time consuming procedure and prone to errors even with expertise in the procedure, and other alternate methods in serotyping have been investigated to overcome these problems. The newly developed multiplex latex bead assay can test more samples at the same time and has a higher degree of sensitivity. A large scale trial is required to test the sensitivity of the new assay across various serotypes along with efforts to increase the sensitivity of the Quellung assay. The preliminary data suggests that this method may be widely used.