[Show abstract][Hide abstract] ABSTRACT: Enterobacter cloacae has emerged as an important nosocomial pathogen, but is rarely a cause of sacroiliitis. Herein, we present the first reported case of Enterobacter cloacae sacroiliitis associated with sepsis and acute respiratory distress syndrome (ARDS). A previously healthy 14-year-old boy presented with low-grade fever and pain in the left side of the hip that was aggravated by walking. Pelvic computed tomography (CT) showed normal findings, and the patient received supportive care for transient synovitis with no antibiotics. However, there was no clinical improvement. On the third day of hospitalization, magnetic resonance imaging of the hip revealed findings compatible with sacroiliitis, for which vancomycin and ceftriaxone were administered. The patient suddenly developed high fever with dyspnea. Chest radiography and CT findings and a PaO2/FiO2 ratio <200 mmHg were suggestive of ARDS; the patient subsequently received ventilatory support and low-dose methylprednisolone infusions. Within one week, defervescence occurred, and the patient was able to breathe on his own. Following the timely recognition of, and therapeutic challenge to, ARDS, and after 6 weeks of parenteral antimicrobial therapy, the patient was discharged in good health with no complications.
[Show abstract][Hide abstract] ABSTRACT: This study investigated the clinical presentations of symptomatic Clostridium difficile infection (CDI) in children.
We reviewed the medical records of 43 children aged <20 years who showed either positive C. difficile culture or C. difficile toxin test results between June 2010 and April 2014.
Of the 43 patients (mean age 6.7 years), 22 were boys. Sixteen patients (37.2%) showed both positive C. difficile culture and toxin test results. Seventeen out of 43 children (39.5%) had preexisting gastrointestinal diseases, and 26 children had other medical conditions that were risk factors for CDI. Twenty-eight children had a history of antibiotic treatment for >3 days, and the most frequently prescribed antibiotic was amoxicillin-clavulanate (35.7%). Twenty-eight patients were diagnosed with CDI despite taking probiotic supplements, most commonly Lactobacillus acidophilus (53.6%). The most common symptom was diarrhea (72.1%) at the time CDI was diagnosed. C. difficile was eradicated in 11 patients (25.6%) after treatment with oral metronidazole for 10-14 days, and in the two patients (4.6%) who required two courses of oral metronidazole. Sixteen patients (37.2%) showed clinical improvement without any treatment.
This study showed the various clinical characteristics of CDI in children and that preexisting clinical conditions favored the development of CDI. In addition, CDI was found to occur in a number of patients even after probiotic prophylaxis given in conjunction with antibiotic therapy.
[Show abstract][Hide abstract] ABSTRACT: Objectives
The purpose of this study was to compare patient satisfaction and oral health-related quality of life (OHRQoL) among fully edentulous patients treated with either fixed implant-supported prostheses (FP), removable implant-supported prostheses (RP), or complete dentures (CD).Material and Methods
Eighty-six patients – 29 FP, 27 RP, and 30 CD patients – participated in this study. The survey was conducted using face-to-face interviews with a questionnaire that included a patient satisfaction scale and Oral Health Impact Profile (OHIP-14). We measured patient satisfaction after prosthetic treatments and OHRQoL before and after the treatments.ResultsAfter prosthetic treatments, OHRQoL increased in all three groups (P < 0.05). The FP and RP groups showed no significant difference in patient satisfaction and OHRQoL, and both groups showed greater improvement compared with the CD group. Specifically, the OHRQoL dimensions of functional limitation, physical pain, psychological discomfort, and psychological disability in the FP group, and functional limitation in the RP group, improved greatly in comparison with the CD group (P < 0.05).Conclusions
Although further research is still needed, prosthetic treatments may provide superior OHRQoL for fully edentulous patients. In particular, both the FP and RP treatments provided significantly greater improvement of OHRQoL and patient satisfaction than the CD treatment. Reliable information of OHRQoL and patient satisfaction helps experts and patients choose the best prosthetic treatment option.
Full-text · Article · Oct 2014 · Clinical Oral Implants Research
[Show abstract][Hide abstract] ABSTRACT: Background:With continuing occurrence of varicella despite of increasing vaccine coverage for the past 20 years, a case-based study, a case-control study, and an immunogenicity and safety study were conducted to address the impact of varicella vaccination in Korea.Subjects and methods:Varicella patients under the age of 16 years were enrolled for the case-based study. For the case-control study, varicella patients between 12 months and 15 years of age were enrolled with one control matched for each patient. For the immunogenicity and safety study, otherwise healthy children aged from 12 to 24 months were immunized with Suduvax (Green Cross, Korea). FAMA VZV antibody was measured before and 6weeks after immunization.Results:In the case-based study, the median age of the patients was 4 years. Among 152 cases aged 1-15 years, 139 children received varicella vaccine and all had breakthrough infections. Clinical courses were not ameliorated in vaccinated patients, but more vaccinated patients received outpatient rather than inpatient care. In the case-control study, the adjusted overall effectiveness of varicella vaccination was 54%. In the immunogenicity and safety study, the seroconversion rate and geometric mean titer for FAMA antibody were 76.67% and 5.31.Conclusions:Even with increasing varicella vaccine uptake, we illustrate no upward age-shift in the peak incidence, a high proportion of breakthrough disease, almost no amelioration in disease presentation by vaccination, and insufficient Immunogenicity of domestic varicella vaccine. There are needs to improve the varicella vaccine used in Korea.
No preview · Article · Mar 2014 · Clinical and vaccine Immunology: CVI
[Show abstract][Hide abstract] ABSTRACT: Patients with bipolar disorders (BDs) show a broad range of neurocognitive impairments. We compared the patterns of neuropsychological performance in depressed and euthymic patients with BDs, and explored the state-dependent cognitive markers of bipolar depression.
The study participants included 32 BD patients (15 depressed and 17 euthymic) and 42 healthy controls. All of the subjects completed tests that assessed attention, psychomotor speed, verbal and visual memory, and executive functions. Between-group neuropsychological performance differences were examined. Multidimensional scaling (MDS) was used to compare the patterns of cognitive variables in euthymic and depressed BD patients.
Compared to the euthymic BD patients and healthy controls, the depressed BD patients performed lower in verbal memory and executive functions. No significant differences were found between the three groups in attention, psychomotor speed, and visual memory. The depressed BD patients showed a lower level of association between psychomotor speed and the time to initial concept formation than the healthy controls and euthymic BD patients. In contrast, the relationship between word association and verbal memory was stronger in the depressed group than either the control or euthymic groups.
The depressed BD patients showed greater impairments in verbal memory and executive functions than the euthymic BD patients. In addition, our study identified a differential pattern of relationships between the cognitive domains of euthymic and depressed BD patients, which suggests the potential role of verbal memory and executive functions as cognitive markers of BDs.
No preview · Article · Jan 2014 · Psychiatry and Clinical Neurosciences
[Show abstract][Hide abstract] ABSTRACT: Objectives: Outbreaks of pneumonia caused by Mycoplasma pneumoniae (MP) occur every 3-4 years in Korea, most recently in 2011. The aim of our study was to determine the optimal time to perform indirect particle agglutination antibody assays to improve early diagnosis of MP pneumonia in children. Methods: A database of 206 pediatric patients treated for pneumonia at the Hanyang University Hospital from June to October 2011 was analyzed retrospectively for demographic characteristics and laboratory test results. Results: Among the 206 patients treated for pneumonia during the study period, there were 160 children (mean age, 5.44 years) diagnosed with MP pneumonia, who were studied further. The mean age of these MP pneumonia patients was 5.44 years. Antibody titers increased with increasing time between symptom onset and the collection of serum collection: MP titers were
Preview · Article · Jan 2013 · Korean Journal of Pediatric Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: To compare verbal and visual memory performances between patients with bipolar I disorder (BD I) and patients with bipolar II disorder (BD II) and to determine whether memory deficits were mediated by impaired organizational strategies.
Performances on the Korean-California Verbal Learning Test (K-CVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) in 37 patients with BD I, 46 patients with BD II and 42 healthy subjects were compared. Mediating effects of impaired organization strategies on poor delayed recall was tested by comparing direct and mediated models using multiple regression analysis.
Both patients groups recalled fewer words and figure components and showed lower Semantic Clustering compared to controls. Verbal memory impairment was partly mediated by difficulties in Semantic Clustering in both subtypes, whereas the mediating effect of Organization deficit on the visual memory impairment was present only in BD I. In all mediated models, group differences in delayed recall remained significant.
Our findings suggest that memory impairment may be one of the fundamental cognitive deficits in bipolar disorders and that executive dysfunctions can exert an additional influence on memory impairments.
Full-text · Article · Dec 2012 · Psychiatry investigation
[Show abstract][Hide abstract] ABSTRACT: The majority of Korean patients with pandemic influenza A (H1N1) during the 2009 epidemic were under 20 yr of age. The limited data on the clinical characteristics of these children led us to conduct a case note-based investigation of children admitted to 6 university hospitals with 2009 H1N1 influenza. A total of 804 children was enrolled. The median age was 5 yr; 63.8% were males; and 22.4% had at least one chronic underlying disease. Ninety-five of the patients (11.8%) were critically ill and they suffered more from shortness of breath, dyspnea and lymphopenia than the other patients. Among all the patients, 98.8% were treated with antivirals and 73% received treatment within 48 hr of illness onset. All the enrolled patients are alive and appear to have had good outcomes, probably due to the early intervention and antiviral treatment. This study deals with hospitalized children whose diagnoses of influenza A (H1N1) were confirmed, and therefore provides important new information about the clinical patterns of children with influenza A (H1N1) in Korea.
Full-text · Article · Apr 2012 · Journal of Korean medical science
[Show abstract][Hide abstract] ABSTRACT: Diseases caused by viral infections include mild illnesses such as common cold or exhibit temporary, non-life threatening symptoms such as mild fever, vomiting, diarrhea and rash, and as well as serious diseases which can be debilitating or life threatening such as measles, HIV/AIDS, and various hemorrhagic fevers. Viral infections occur in all age groups but particularly affect infants and young children. Some viral infections have become rare due to successful, widespread immunization programs. Although a high profile viral infection such as smallpox was eradicated by successful immunization efforts, the total number of human pathogenic viruses are increasing. In commemoration of the 50th anniversary for the founding of the Korean Society for Infectious Diseases, I will profile the viral diseases affecting children which have recently drawn our attention.
[Show abstract][Hide abstract] ABSTRACT: EMR without BM involvement after allogeneic HSCT is extremely rare, especially in children; only a few cases have been reported. A two-yr-old boy was diagnosed with AML (M4) and underwent allogeneic HSCT in first complete remission with BM from HLA-matched unrelated donor without GVHD. Four yr later, he had a BM relapse and after induction and consolidation chemotherapy, he received a second HSCT from an unrelated donor using peripheral blood stem cells. His second post-transplant course was complicated by extensive chronic GVHD involving the skin, oral cavity, and lungs, which was treated with tacrolimus and corticosteroid. Two yr later, he noticed a mild swelling in the right cheek area. The BM showed a complete remission marrow and a soft tissue biopsy was compatible with granulocytic sarcoma. PET-CT showed multifocal bone involvements. He received chemotherapy, and the chloromas decreased in size. We report a case of diffuse EMR of AML without BM involvement after a second allogeneic HSCT.
No preview · Article · Sep 2011 · Pediatric Transplantation
[Show abstract][Hide abstract] ABSTRACT: Children in South Korea are vaccinated with either BCG Pasteur vaccine intradermally (ID), or with BCG Tokyo vaccine given by multipuncture device (MP). Data from a recent national survey indicated that in children under 6 years old, 31.1% had received the ID vaccine and 64.5% the MP vaccine. To compare the T cell responses induced by the two vaccines, children aged 3-7 were recruited and tested for tuberculin skin test reactivity and for in vitro IFN-γ responses to mycobacterial antigens. DTH responses were not significantly different in children vaccinated by either the ID or MP vaccines. PPD-induced IFN-γ was measured in supernatants of 6-day diluted whole blood cultures. IFN-γ production to PPD was not significantly different in the two vaccine groups, although there is a trend that the MP group gives a higher proportion of IFN-γ positivity than the ID group. In addition, when IFN-γ responses to the antigens ESAT-6 and CFP-10 were assessed in the 6-7 year old group, there was no significant difference between the two vaccine groups. Thus, there was no evidence that the increasing use of MP vaccination has reduced protection against M. tuberculosis in young children in South Korea, based on immunogenicity as assessed by DTH and IFN-γ responses to PPD, and also equivalent frequency of responses to ESAT-6 and CFP-10.
[Show abstract][Hide abstract] ABSTRACT: Group B streptococcus (GBS) is the most common cause of invasive neonatal infections in developed countries. The incidence of early-onset GBS disease in Korea is known to be much lower than that in other developed countries; however neonatal GBS disease has been frequently reported in recent years in Korea. This retrospective study sought to determine the current status and clinical presentation of neonatal GBS disease in Korea.
From January 1996 through December 2005, GBS cases (n= 157) diagnosed in blood, cerebrospinal fluid, or other sterile body fluids among infants <3 months of age from 14 university hospitals in Korea were identified. Age of onset, diagnosis, underlying medical conditions, and outcomes were investigated by reviewing the medical records.
A total of 157 cases were identified during the study period. Of the cases, 32 were early-onset disease (EOD) and 125 were late-onset disease (LOD). Twenty-six of the EOD cases had symptoms during the first 24 h after birth. One hundred of the 157 GBS cases were diagnosed as meningitis. The mortality rate of EOD was 20.7%. The case fatality rate of LOD was 7.2% and 25.2% of LOD cases had sequelae.
GBS is becoming an important cause of invasive neonatal infections in Korea, with LOD being more common. It may not be currently necessary to adopt the prevention guidelines of perinatal GBS disease in Korea. However, studies of maternal GBS carriage rates and neonatal GBS disease will continue.
No preview · Article · Apr 2011 · Pediatrics International
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to identify the major etiological agents responsible for invasive bacterial infections in immunocompetent Korean children. We retrospectively surveyed invasive bacterial infections in immunocompetent children caused by eight major pediatric bacteria, namely Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species that were diagnosed at 18 university hospitals from 1996 to 2005. A total of 768 cases were identified. S. agalactiae (48.1%) and S. aureus (37.2%) were the most common pathogens in infants younger than 3 months. S. agalactiae was a common cause of meningitis (73.0%), bacteremia without localization (34.0%), and arthritis (50%) in this age group. S. pneumoniae (45.3%) and H. influenzae (20.4%) were common in children aged 3 months to 5 yr. S. pneumoniae was a common cause of meningitis (41.6%), bacteremia without localization (40.0%), and bacteremic pneumonia (74.1%) in this age group. S. aureus (50.6%), Salmonella species (16.9%), and S. pneumoniae (16.3%) were common in older children. A significant decline in H. influenzae infections over the last 10 yr was noted. S. agalactiae, S. pneumoniae, and S. aureus are important pathogens responsible for invasive bacterial infections in Korean children.
Full-text · Article · Feb 2011 · Journal of Korean medical science
[Show abstract][Hide abstract] ABSTRACT: The history of healthcare-ssociated infections in children is tied closely to the progress of medicine itself. With the advent of crucial invasive procedures and new therapies, longer survival from conditions formerly causing early death are noticed and at the same time have also increased the numbers of immunocompromised children with impaired host defenses resulting in healthcare-associated infections as the leading causes of mortality and morbidity in pediatric and neonatal intensive care units. Widespread use of new broad-spectrum antimicrobial agents has caused the rise of antibiotic resistant microorganisms and fungi as the etiologies of healthcare-associated infections. A number of pediatric collaborative studies have thus been done to attain optimal practices that result in decreasing rates of healthcare-associated infections. Furthermore, emerging evidence about risk factors for various healthcare-associated infections in children is guiding us in targeting adjunctive preventive intervention. Prevention of healthcare-associated infections is based on infection control strategies that aim to limit susceptibility to infections by enhancing host defenses, interrupting transmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. With changes in the risk factors for healthcare-associated infections, more studies on Korean children are needed to provide the optimal tools for better outcome.
[Show abstract][Hide abstract] ABSTRACT: Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.
No preview · Article · Jan 2011 · Korean Journal of Pediatric Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Townes-Brocks syndrome (TBS) is a rare autosomal dominant congenital disorder caused by mutations in the SALL1 gene. Its signs and symptoms overlap with other genetic syndromes, including VACTERL association, Pendred syndrome, Baller-Gerold syndrome, and cat eye syndrome. Structural vertebral abnormalities, hypoplasia of the thumb, and radial bone abnormalities, which are not usually associated with TBS, help in the differential diagnosis of these syndromes. We report the case of a family whose members were diagnosed with TBS with congenital hypothyroidism and had a novel SALL1 gene mutation.
Preview · Article · Dec 2010 · Korean Journal of Pediatrics
[Show abstract][Hide abstract] ABSTRACT: Bacterial meningitis remains a serious cause of morbidity and mortality in childhood, despite the availability of effective vaccines against Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae. The purpose of this study was to analyze data on bacterial meningitis cases in Korea from 1996 through 2005. The information of all hospitalized bacteria-proven meningitis cases was obtained from 17 university hospitals nationwide. A total of 402 cases were identified. Of these, 125 (29.9%) cases were neonates. Streptococcus agalactiae was the most common bacteria responsible for 99 (24.6%) of all cases regardless of age, followed by S. pneumoniae for 91 (22.6%) and H. influenzae for 67 (16.7%) patients. The common etiology beyond the neonatal period was S. pneumoniae for 91 (33.0%) followed by H. influenzae for 63 (22.8%) patients. The overall case fatality rate was 9.4%, which was similar with that in 1986-1995. In conclusion, S. agalactiae, S. pneumoniae and H. influenzae were important etiologic agents of bacterial meningitis in children in the last 10 yrs. It is required to establish the preventive strategy of the three bacteria. The nationwide epidemiologic study should be continued to evaluate immunization strategy and efficacy.
Full-text · Article · Jun 2010 · Journal of Korean medical science
[Show abstract][Hide abstract] ABSTRACT: Live, attenuated varicella vaccine has been used since 1988 in Korea. However, varicella is still prevalent among both vaccinated and unvaccinated individuals, despite a relatively high level of immunization rate up to 80%. A recent report has demonstrated approximately 20% of primary vaccine failure rate after one dose of varicella vaccine using the fluorescent antibody to membrane antigen (FAMA) assay.
The seroprevalence rate was determined using the FAMA and ELISA assays in 67 Korean infants following one dose of varicella vaccine. Positive fluorescence at a serum dilution of 1:4 or greater was considered as seropositive.
The median age at vaccination was 12 months and the post-immunization sera were obtained on average 6.3 months (range 6 weeks-12 months) after vaccination. Among the 67 vaccinated infants, 56 (83.6%) were seropositive by FAMA assay while 30 (44.8%) were seropositive by ELISA. The geometric mean titers (GMTs) of the seropositive vaccinated infants (n = 56) were significantly lower than the GMTs of 9 individuals with a history of varicella (1:17.0 vs. 1:74.7, P = 0.001). Although there were no significant differences in seropositive rates according to intervals, there was a decreasing trend in the GMTs over time among the 56 seropositive recipients (r(2) = 0.154, P < 0.001).
These data can be useful for optimizing the immunization strategy against varicella and should be confirmed by a prospective study including a large number of immunized infants.
No preview · Article · Apr 2010 · The Journal of infection
[Show abstract][Hide abstract] ABSTRACT: A 14-year-old male, who completed chemotherapy following limb salvage surgery for osteosarcoma approximately 2 years ago, was seen for routine follow-up. A CT scan revealed new scattered multifocal nodular lesions. An ultrasonography-guided percutaneous needle biopsy was done to confirm pulmonary metastasis of the underlying osteosarcoma. The lung biopsy showed findings of eosinophilic pneumonia with no evidence of malignancy. Peripheral eosinophilia was also noted. When a more thorough history revealed frequent intake of raw cow liver, we diagnosed pulmonary toxocariasis by ELISA for specific serum IgG antibody.
No preview · Article · Dec 2009 · Pediatric Blood & Cancer
[Show abstract][Hide abstract] ABSTRACT: Background: With objectives to investigate the incidence and clinical characteristics of antibiotic associated diarrhea (AAD) and Clostridium difficile Associated Diarrhea (CDAD) in Korea, a prospective study was performed.
Methods: From September 2008 through March 2009, we investigated diarrhea patients at a 900 bed tertiary care facility located in Seoul, Korea. AAD was defined as unformed stools continued at least 3 times a day for 2 days or 6 times for 36 hours with a history of antibiotics use within 2 months and without other causes of diarrhea. CDAD was diagnosed when AAD patients showed positive Clostridium difficile toxin A&B assay, direct stool CD toxin PCR, stool culture or pseudomembrane by endoscopic images or biopsy.
Results: During seven months of study period, 327 patients were included as AAD by definition, and the incidence was 226.12 cases per 100,000 patient days. 44 patients were defined as CDAD, and the incidence of hospital acquired CDAD (HA-CDAD) was 30.43 cases per 100,000 patient days. The ratio of HA-CDAD to AAD was 0.13. During the same period, 10 cases were diagnosed as healthcare-associated CDAD (HCA-CDAD) and 5 cases were identified to carry a toxigenic C. difficile without symptoms. During the follow up period (7-77 days), 1 of 5 carriers developed HA-CDAD at day 48. Mean age of HA-CDAD cases was 61.5 years. Fifteen cases (34.1%) resolved diarrhea without treatment, and no CDAD-related mortality occurred until the 30th day. The relapse rate of HA-CDAD was 12.5% (5/40) during 40 days (24-58 days). Mean age of HCA-CDAD was 67.8 years, and all of them were treated for CDAD. Pseudomembrane was more frequently observed (71.4%) than HA-CDAD (23.1%) without significance (p=0.062). There was no mortality case like HA-CDAD.
Conclusion: The incidence and clinical features of CDAD in Korea were lower and milder than other countries’ before emergence of hypervirulent strains. The high rate of a toxigenic C. difficile carriage was noticed despite of no active surveillance in the hospital.