Erythema nodosum (EN) is a painful skin disease characterized by erythematous tender nodules located predominantly over the extensor aspects of the legs. Various etiological factors, including infection, drug administration, and systemic illness have been implicated as causes of EN. Mycoplasma pneumoniae is one of rare infectious agents to cause EN in children. We report a case of a 7-year-old boy with context of respiratory illness and skin lesions with arthralgia. From stepwise approaches, IgM antibody against M. pneumoniae was positive with titers of 12.18, consistent with respiratory infection of M. pneumoniae and histopathology showed findings of septal and lobular inflammation without vasculitis consistent with EN. In addition, we reviewed the pathogenesis of this disease based on our case and the previous reports.
Arthralgia ; Child ; Erythema Nodosum* ; Erythema* ; Humans ; Hypersensitivity, Delayed ; Immunoglobulin M ; Inflammation ; Leg ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Skin ; Skin Diseases ; Vasculitis

Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.
Abscess ; Anti-Bacterial Agents ; Child* ; Female ; Follow-Up Studies ; Humans ; Immunoglobulins ; Infant ; Korea* ; Leukocidins ; Mupirocin ; Needles ; Netherlands ; Skin* ; Soft Tissue Infections* ; Staphylococcus aureus ; Suppuration ; Thoracic Wall

PURPOSE: Bacille Calmette-Guérin (BCG) lymphadenitis is a relatively frequent local adverse reactions after BCG vaccination. Its incidence rate is usually <1%. However, this rate may be different according to BCG strain, vaccination method or skill, etc. In the Republic of Korea, two BCG strains are used: intradermal Danish-1331 or percutaneous Tokyo-172. We surveyed the incidence rates of BCG lymphadenitis. METHODS: This survey was performed in total 25 centers (5 general hospitals, 20 private pediatric clinics). Immunized type of BCG strain in study subjects was verified by directly observing the scar. The occurrence of BCG lymphadenitis was asked to their parent. In cases of BCG lymphadenitis, location, diameter size, progression of suppuration, and treatment method were investigated, as well. RESULTS: The total number of study subjects was 3,342. Among these, the subjects suitable for enrollment criteria (total 3,222; Tokyo strain 2,501, Danish strain 721) were analyzed. BCG lymphadenitis regardless of its size developed in each five of subjects per strains, therefore, its incidence rate was 0.20% in Tokyo and 0.69% in Danish strain, respectively (P=0.086). However, when applying the WHO criteria - the development of lymph node swelling with diameter 1.5 cm or more, the incidence rate of BCG lymphadenitis was 0.16% (4 cases) in Tokyo and 0.42% (3 cases) in Danish strain, respectively. CONCLUSIONS: The incidence rate of lymphadenitis in two BCG types, percutaneous Tokyo and intradermal Danish strain BCG, is 0.20% and 0.69%, respectively. Both rates are acceptable.
Cicatrix ; Hospitals, General ; Humans ; Incidence* ; Lymph Nodes ; Lymphadenitis* ; Mycobacterium bovis ; Parents ; Republic of Korea ; Suppuration ; Vaccination*

PURPOSE: Enterovirus (EV) infection in children can manifest various diseases from asymptomatic infection to nonspecific febrile illness, hand-foot-mouth disease, and aseptic meningitis. This study was aimed to investigate epidemiology and clinical significance of various genotypes of EV infections in pediatric inpatient. METHODS: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from March 2014 to March 2015. EV detection and genotype identification were performed by real-time RT-PCR and semi-nested RT-PCR. Phylogenetic trees were constructed by neighbor joining method. RESULTS: A total of 400 samples were collected during study period and 112 patients (28%) were diagnosed with EV infections. The mean age of EV positive patients was 2.66 years (0.1-14) and sex ratio was 1.73:1. Genetic sequences of EVs were identified; coxsackievirus B5 (17, 15.2%), coxsackievirus A16 (13, 11.6%), enterovirus 71 (10, 8.9%), and coxsackievirus A2 (9, 8.0%). Nonspecific febrile illness (96, 86%) was the most common clinical manifestation and the duration of fever was 0-11 days (mean 3.1 days). Rash (44, 39%) and meningitis (43, 38%) were followed. Patients who were attending daycare center or had siblings accounted for 82.1%. Phylogenetic relationship tree revealed 6 distinct genogroups among 56 types of EVs. CONCLUSIONS: This study is the report of epidemiology, serotype distribution and clinical manifestations of children with EV infection in Incheon. This data will be helpful for further study about the epidemiology of EV infection in Korea.
Asymptomatic Infections ; Child ; Enterovirus* ; Epidemiology* ; Exanthema ; Fever ; Genotype ; Humans ; Incheon* ; Inpatients* ; Korea ; Meningitis ; Meningitis, Aseptic ; Sex Ratio ; Siblings ; Trees

PURPOSE: The purpose of this study was to investigate the etiology of acute pharygotonsillitis in pediatric patients. METHODS: Pharyngeal swabs from patients with acute pharyngotonsillitis were evaluated for viruses and bacterial organisms from March 2010 through March 2011. RESULTS: Of 615 patients, potentially pathogenic bacteria were isolated in 40 (6.5%), viruses were isolated in 310 (50.4%), and no pathogens were isolated in 267 patients (43.4%). Both viral and bacterial pathogens were found in 2 (0.3%). Of 40 patients with bacterial pathogens, group A streptococci were found in 31 (77.5%). Among 310 patients with virus infection, adenovirus was the most frequently recovered (203 patients; 65.5%), followed by rhinovirus (65 patients; 21.0%), enterovirus (43 patients; 13.9%) and coronavirus (18 patients; 5.8%). There were 25 patients who had been coinfected with 2 viruses. In viral pharyngotonsillitis, cough, rhinorrhea, conjunctivitis and diarrhea were prominent. On the other hand, pharyngeal injection and pharyngeal petechiae were prominent in bacterial pharyngotonsillitis. CONCLUSIONS: Virus infection was a big part of acute pharyngotonsillitis and there were differences in clinical manifestations among viral and bacterial infections. Therefore, we need to distinguish between virus infection and bacterial infection using clinical signs for preventing the abuse of antibiotics.
Adenoviridae Infections ; Anti-Bacterial Agents ; Bacteria* ; Bacterial Infections ; Child* ; Conjunctivitis ; Coronavirus ; Cough ; Diarrhea ; Enterovirus ; Hand ; Humans ; Purpura ; Rhinovirus

PURPOSE: The aim of this study was to investigate the prognostic factors for Pneumocystis jirovecii pneumonia (PCP) and to evaluate the influence of PCP prophylaxis in pediatric patients. METHODS: From January 2002 to April 2015, patients aged <18 years with a diagnosis of confirmed PCP at our institute were reviewed retrospectively. Clinical characteristics and outcomes were compared according to the groups with or without PCP prophylaxis. Risk factors associated with PCP-related death were analyzed by logistic regression analysis. RESULTS: During study period, a total of 24 patients were diagnosed with PCP by immunofluorescence assay and/or PCR. The median age of the patients was 5 years (range, 3 months-18 years) and 23 (96%) had immunocompromised conditions including hematologic disorders with or without hematopoietic stem cell transplantation (n=15), solid organ transplantation (n=4), and primary immune deficiency (n=4). Most common presenting symptoms were tachypnea and cough (92%, each). At the time of diagnosis, 79% (19/24) and 25% (6/24) suffered from respiratory failure and multi-organ dysfunction syndrome (MODS), respectively. Mechanical ventilation was required in 8 (33%) patients and 5 (21%) patients died of PCP. Multivariate analysis showed that MODS at initial presentation was an indicator of poor prognosis (OR, 17.1 [95% CI 1.13-257.67]; P=0.04). Compared to the patients without PCP prophylaxis, the frequency of MODS at diagnosis, need for mechanical ventilation and length of hospital days were significantly less common in the children who received PCP prophylaxis. CONCLUSIONS: MODS at presentation was a significant predictor for poor outcome and PCP prophylaxis could alleviate the clinical courses of pediatric PCP. Prospective study will be mandatory to determine the risk factors for development and deterioration of PCP in children.
Child* ; Cough ; Diagnosis ; Fluorescent Antibody Technique ; Hematopoietic Stem Cell Transplantation ; Humans ; Logistic Models ; Multiple Organ Failure ; Multivariate Analysis ; Organ Transplantation ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Polymerase Chain Reaction ; Prognosis ; Prospective Studies ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Tachypnea ; Transplants

PURPOSE: We undertook this study to investigate discrepancies in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values, and variations following intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: A total of 123 KD patients were retrospectively enrolled. Patients were treated with IVIG 2 g/kg at 2 to 9 days after disease onset. We obtained white blood cell (WBC) count, percentage of neutrophils (% neutrophils), CRP, ESR, and N-terminal pro-brain natriuretic peptide (NT-proBNP) values before and 48 to 72 hours after IVIG treatment. Discrepancy was defined as CRP ≥10 mg/dL and ESR <50 mm/hr (Group 1), or CRP <10 mg/dL and ESR ≥50 mm/hr (Group 2). RESULTS: Thirty-six of 123 subjects (29.2%) had a discrepancy: 25 (20.3%) in Group 1 and 11 (8.9%) in Group 2. In Group 1, 15 patients (60%) had fever for <5 days (early presenter) and 10 (40%) had fever for ≥5 days (late presenter). There were six early presenters (55%) and five late presenters (45%) in Group 2. Late presenters had higher ESR than early presenters (34.3±21.0 mm/hr vs. 26.3±19.3 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT-proBNP levels normalized. In contrast, ESR increased from 37.4±21.9 mm/hr to 48.0±22.7 mm/hr (n=36, P=0.051). CONCLUSIONS: A discrepancy may be related to the duration of fever. Due to discrepancies in CRP and ESR values in acute KD, both should be measured to assess the degree of inflammatory activity before IVIG treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.
Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies

PURPOSE: There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT®-TB and QuantiFERON®-TB Gold (QFT-G) in Korean children. METHOD: This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015. RESULTS: A total of 20 patients were included, whose median age was 13.3 years (range, 3.8-18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively. CONCLUSIONS: Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.
Adolescent ; Child* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Latent Tuberculosis ; Mycobacterium bovis ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity ; Skin Tests* ; Skin* ; Tuberculin* ; Tuberculosis* ; Vaccination

PURPOSE: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. METHODS: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. RESULTS: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). CONCLUSIONS: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.
C-Reactive Protein ; Child ; Coronary Vessels ; Diagnosis ; Fever ; Heart ; Humans ; Immunoglobulins ; Lymphatic Diseases ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

The Zika virus, a flavivirus related to dengue and Japanese encephalitis was discovered in the Zika forest in Uganda, 1947. Since Zika virus was first reported in Brazil in May 2015, infections have occurred in at least 40 countries, especially in the Americas. Zika virus infection usually is asymptomatic or causes mild illness, but may be related to severe clinical manifestations, particularly microcephaly and Guillain-Barré syndrome. Although the possibility of autochthonous Zika virus transmission in South Korea is low, the imported cases and Zika virus-transmitting mosquito should be adequately monitored and promptly managed. In addition, enhancing preparedness for Zika virus infection are needed.
Americas ; Brazil ; Communicable Diseases* ; Culicidae ; Dengue ; Encephalitis, Japanese ; Flavivirus ; Guillain-Barre Syndrome ; Korea ; Microcephaly ; Specialization* ; Trees ; Uganda