Zinc deficiency can result from acrodermatitis enteropathica, an inadequate dietary intake, malabsorption, increased body loss, or intravenous feeding. Unlike acrodermatitis enteropathica, breast feeding-induced acrodermatitis is transient and improves when nursing ends. Breast feeding-induced acrodermatitis is caused by a ZnT-2 transporter dysfunction in the mother's mammary glands. We report a case of a 6-month-old male infant who presented with erythematous patches and plaques involving the perioral, perineal, and acral areas and loose stools since 2 weeks after birth. Atopic dermatitis was considered initially, but the lesions did not respond to topical antibiotics, corticosteroids, or maternal dietary restriction from allergenic food. The patient's serum zinc concentration was low, and the mother's serum and milk had low zinc levels. The differential diagnosis for atopic dermatitis is extensive. Physicians should be alert for the possibility of zinc deficiency dermatitis in breast milk fed infants that mimics atopic dermatitis.
Acrodermatitis ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Breast ; Dermatitis ; Dermatitis, Atopic ; Diagnosis, Differential ; Humans ; Infant ; Male ; Mammary Glands, Human ; Milk ; Milk, Human ; Parenteral Nutrition ; Parturition ; Zinc

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Congenital short trachea is a rare congenital anomaly in which the trachea is composed of reduced number of cartilage rings, which result in an abnormally high position of the carina and an abnormal course of the main bronchi. Hazards of congenital short trachea in infants and children include inadvertent bronchial intubation, because it causes bronchiostenosis, pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, and ipsilateral atelectasis. Laryngeal cleft is a rare condition, as well. Symptoms range from mild stridor to massive aspiration and respiratory distress, depending on the severity of the cleft. Until now, a case with combination of these two rare congenital defects has not been reported. Herein, we report a 13 month-old boy who has congenital short trachea with laryngeal cleft.
Bronchi ; Cartilage ; Child ; Congenital Abnormalities ; Emphysema ; Humans ; Infant ; Intubation ; Larynx ; Mediastinal Emphysema ; Pneumothorax ; Pulmonary Atelectasis ; Respiratory Sounds ; Trachea

PURPOSE: Atopic dermatitis (AD) is a genetically determined, chronic relapsing skin disease. The pathogenesis of AD is complex and the course is unpredictable. Atopy is an important risk factor for the development of AD. Cysteinyl leukotrienes (Cys-LTs) were implicated in the pathophysiology of allergic diseases, and are being targeted for their diagnosis and treatments. Early detection of tissue inflammation of target organ is important to enable early prevention and management of allergic diseases. The aim of our study is to evaluate the differences in urinary leukotrienes E4 (LTE4) levels, according to AD symptom score and aeroallergen sensitization in children with AD by using noninvasive techniques. METHODS: We recruited 46 children with AD, using predetermined criteria. Clinical features of AD were evaluated by a physician, using scoring atopic dermatitis (SCORAD) index. Aeroallergen sensitization was measured by using a skin prick test and UniCap. Urine samples were also collected on day of the 1st and 2nd visits, and were analyzed for LTE4 with an enzyme-linked immunoassay kit. RESULTS: SCORAD indeces of children with AD were correlated with urinary LTE4 levels. Total immunoglobulin E (IgE) and eosinophil counts also had significant correlation with urinary LTE4 levels. Especially, aeroallergen sensitization of atopic AD significantly correlated with urinary LTE4 of these patients. CONCLUSION: Urinary LTE4 levels significantly correlated with serum total IgE and number of sensitized aeroallergen in children with AD. Clinical features of AD evaluated with SCORAD index related with urinary LTE4 level. Urinary LTE4 might be a valuable, noninvasive marker for different pathogenesis of AD.
Child ; Dermatitis, Atopic ; Eosinophils ; Humans ; Immunoassay ; Immunoglobulin E ; Immunoglobulins ; Inflammation ; Leukotriene E4 ; Leukotrienes ; Risk Factors ; Skin ; Skin Diseases

PURPOSE: Pandemic influenza viruses have caused significant morbidity and mortality. Pandemic influenza A (H1N1) was detected in April 2009 and caused worldwide outbreak. We investigated the differences in clinical characteristics and courses between pandemic and seasonal influenzas. METHODS: We reviewed the medical records of pediatric patients, (< or =18 years) with influenza hospitalized to Gachon University Gil Medical Center from the 1 April 2009 to the 31 August 2011. RESULTS: Two hundred twenty-six patients with pandemic influenza and 118 patients with seasonal influenza were included. Age, sex, and proportion of underlying diseases were similar between the two groups. Hypoxemia, shortness of breath, and tachypnea were more common in pandemic influenza.(P<0.05) Oxygen supplementation and radiologically confirmed pneumonia were more common in pandemic influenza.(P<0.005) However, there were no significant differences in the mean duration of hospitalization, proportion of patients admitted to the intensive care unit, need for mechanical ventilation, and death. CONCLUSION: Pandemic influenza caused more frequently lower respiratory tract infection and pneumonia. However, the courses of pandemic influenza were not different from those of seasonal influenza; probably, due to the effects of several factors, including antiviral therapy.
Anoxia ; Dyspnea ; Hospitalization ; Humans ; Influenza, Human ; Intensive Care Units ; Medical Records ; Orthomyxoviridae ; Oxygen ; Pandemics ; Pediatrics ; Pneumonia ; Respiration, Artificial ; Respiratory Tract Infections ; Seasons ; Tachypnea

PURPOSE: The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients. METHODS: Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test. RESULTS: The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R2=0.07, P=0.029) and after (R2=0.059, P=0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R2=0.086, P=0.001) and after (R2=0.141, P=0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R2=0.112, P=0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation. CONCLUSION: The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.
Asthma ; Bronchoconstriction ; Bronchodilator Agents ; Child ; Dyspnea ; Eosinophil Cationic Protein ; Eosinophils ; Forced Expiratory Volume ; Humans ; Hypersensitivity ; Inflammation ; Korea ; Methacholine Chloride ; Nitric Oxide ; Respiratory Sounds ; Spirometry

PURPOSE: It has been identified that eosinophilic bronchitis (EB) in adults can progress to asthma or fixed airway obstruction. In the present study, we evaluated the clinical course and prognosis of EB in children and their relationship with accompanying rhinosinusitis. METHODS: A total of 55 children with EB followed up for over than a year after the diagnosis were enrolled for the present study. We classified the subjects into two groups according to the prognosis and the presence of rhinosinusitis, respectively, and compared them with respect to clinical characteristics, eosinophil percentage in induced sputum, fractional exhaled nitric oxide (FeNO) and pulmonary function test. The poor prognostic group was defined as the children with asthma or asthma-like symptoms, or persistent or recurrent chronic cough in the long-term follow-up. RESULTS: The poor prognosis was achieved in 12 children (22%), and 3 children (5%) amongst them were diagnosed with asthma. There were no significant differences in clinical characteristics, eosinophil percentages in induced sputum, FeNO, spirometry and IOS according to the prognosis and the presence of rhinosinusitis. Additionally, the children with rhinosinusitis did not show any poorer outcome than those without rhinosinusitis. CONCLUSION: There were some limitations of this study for which the relationship between EB and rhinosinusitis in children was evaluated. However, in case of either poor short-term response to inhaled corticosteroids or elevated eosinophilic inflammation in airways or abnormal airway reversibility in impulse oscillometry, the long-term prognosis of EB in children needs to be considered, regardless of the presence of rhinosinusitis.
Adrenal Cortex Hormones ; Adult ; Airway Obstruction ; Asthma ; Bronchitis ; Child ; Cough ; Eosinophils ; Humans ; Inflammation ; Nitric Oxide ; Oscillometry ; Prognosis ; Respiratory Function Tests ; Spirometry ; Sputum

PURPOSE: This study was performed to investigate the epidemiologic and clinical features of respiratory viruses in children with acute lower respiratory tract infection (ALRTI) in Busan and Gyeongsangnam-do, Korea. METHODS: From May 2010 to April 2011, we tested nasopharyngeal aspiration specimens in 1,520 hospitalized children with ALRTI with multiplex real time-polymerase chain reaction (RT-PCR) to identify 7 kinds of common pathogens (adenovirus [ADV], influenza virus type A [influ A], influenza virus type B [influ B], human metapneumovirus [hMPV], parainfluenza virus [PIV], human rhinovirus [hRV], respiratory syncytial virus [RSV]). We analyzed positive rates and clinical features by retrospective review of the chart. RESULTS: Virus agents were isolated from 72.5% of cases. The identified pathogens were RSV, 35.5%; hRV, 25.6%; PIV, 13.8%; ADV, 12.8%; hMPV, 7.1%; influ A, 5.0%; and influ B, 0.3%. The major period of viral ALRTI was the first year of life. Clinical diagnoses of viral ALRTI were pneumonia, 52.3%; bronchiolitis, 21.2%; tracheobronchitis, 1.0%; croup, 10.8%; and asthma, 8.8%. The most frequent case of pneumonia and bronchiolitis was RSV. Croup was frequently caused by PIV. The number of hMPV infections peaked between April and June and were primarily caused due to pneumonia. CONCLUSION: Although this study was confined to one year, this study described the features of ALRTI associated with 7 respiratory viruses in children in Busan and Gyeongsangnam-do, Korea. Additional investigations are required to define the role of respiratory viruses in children with ALRTI in this area.
Asthma ; Bronchiolitis ; Child ; Child, Hospitalized ; Croup ; Humans ; Korea ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Rhinovirus ; Viruses

PURPOSE: This study was conducted to evaluate the prevalence, clinical characteristics and laboratory findings of lobar pneumonia in children caused by Mycoplasma pneumonia and to find a diagnostic tool for identifying M. pneumoniae infection in children. METHODS: We analyzed medical records of 78 children between March 2010 and December 2011, who were admitted to our hospital and diagnosed with lobar pneumonia on the basis of chest X-rays. White blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), specific antibodies to M. pneuomoniae, and cold agglutinin (CA) were measured at the time of admission. Children were divided into 2 groups: those with M. pneuomoniae infection (group A) and those without infection (group B). Group A children were also subdivided into 2 categories: those with increased CA (group 1) and those without (group 2). RESULTS: The prevalence of lobar pneumonia was higher in the year 2011 than in 2010. M. pneuomoniae infection usually occurs in summer and autumn. Group A children accounted for 75.6% (59/78) of all the cases. The onset ages was higher in group A than in group B (P=0.016). WBC counts and PCT values were higher in group B than in group A.(P=0.015 and P=0.011, respectively) Radiologic findings showed that the lower lobe was most commonly involved without predilection for either side and pleural effusion was present in 13.6% of all the cases. The duration of fever before admission was longer in group 1 than in group 2.(P=0.019) CONCLUSION: It is concluded that lobar pneumonia caused by M. pneuomoniae can be more accurately diagnosed using serum PCT values than using CRP values.
Antibodies ; C-Reactive Protein ; Calcitonin ; Child ; Cold Temperature ; Fever ; Humans ; Leukocytes ; Medical Records ; Mycoplasma ; Mycoplasma pneumoniae ; Pleural Effusion ; Pneumonia ; Pneumonia, Mycoplasma ; Prevalence ; Protein Precursors ; Thorax

PURPOSE: We investigated the prevalence of allergic diseases in preschoolers and children attending elementary, middle and high schools in Seogwipo city, Jeju, South Korea. METHODS: A cross-sectional survey in November 2008 was conducted, using questionnaires, translated in Korean, from the International Study of Asthma and Allergies in Childhood group. All the attendees, 29,606, in 136 nurseries and kindergartens, 47 elementary schools, 15 middle schools and 10 high schools in Seogwipo city were surveyed in this study. RESULTS: Of the 25,312 (85.5%) questionnaires retrieved, 25,024 were appropriately completed and analyzed. For asthma, the prevalence of "wheeze, last 12 months" was 15.4% for the preschool children, 6.4% for the elementary school students, 5.3% for the middle school students and 5.8% for the high school students. The prevalence of "allergic rhinitis, last 12 months" was 23.9%, 30.0%, 31.4% and 34.2%, respectively. The prevalence of "atopic dermatitis, last 12 months" was 19.0%, 17.4%, 12.3% and 11.4%, respectively. The prevalence of "allergic conjunctivitis, last 12 months" was 8.5%, 12.3%, 20.3% and 23.4%, respectively. The prevalence of "food allergy, last 12 months" was 5.4%, 4.2%, 4.2% and 5.1%, respectively. The prevalence of "drug allergy, last 12 months" was 0.7%, 0.3%, 0.6%, and 0.8% for each group. CONCLUSION: In Seogwipo city, the prevalence of asthma and atopic dermatitis decreases with age. However, allergic rhinitis and allergic conjunctivitis are increasing by age. The prevalence of food allergy and drug allergy showed no difference by age.
Asthma ; Child ; Child, Preschool ; Conjunctivitis ; Conjunctivitis, Allergic ; Cross-Sectional Studies ; Dermatitis ; Dermatitis, Atopic ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Nurseries ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial