Purpose: Mycoplasma pneumoniae pneumonia (MP) is a major cause of community-acquired pneumonia (CAP) in children and is associated with extrapulmonary manifestations (EPM). The incidence and risk factors for EPM in children are unknown. Methods: This was a retrospective study involving 65,243 pediatric patients with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Medical records were reviewed to collect information regarding the clinical characteristics, radiological results, and laboratory findings. Logistic regression with multivariate analysis was performed to evaluate the risk factors associated with EPM in MP. Results: The incidence of EPM was 23.9%, including elevation of liver enzymes (18.1%), mucocutaneous manifestations (4.4%), proteinuria (4.1%), cardiovascular and neurological manifestations (0.4%), hematologic manifestations (0.2%), and arthritis (0.2%). Statistical analysis showed that mucocutaneous manifestations significantly increased with elevated alanine aminotransferase (adjusted odds ratio [aOR], 3.623; 95% confidence interval [CI], 1.933-6.790) and atopic sensitization (aOR, 2.973; 95% CI, 1.615–5.475) and decreased with respiratory virus coinfection (aOR, 0.273; 95% CI, 0.084–0.887). Elevated liver enzymes were significantly associated with elevated lactate dehydrogenase (aOR, 3.055; 95% CI, 2.257–4.137), presence of pleural effusion (aOR, 2.635; 95% CI, 1.767–3.930), and proteinuria with respiratory virus coinfection (aOR, 2.245; 95% CI, 1.113–4.527). Conclusion Approximately 24% of pediatric patients with MP had various EPM. As the risk factors associated with each EPM were different, it is necessary to evaluate the various clinical aspects and findings of MP to predict and prepare for the occurrence of EPM.

Food allergy is an immune-mediated adverse reaction that occurs mainly by food ingestion. Some children with food allergies manifest fatal symptoms like anaphylaxis. Oral immunotherapy (OIT) may offer an effective therapeutic modality for persistent and severe forms of food allergies. We report our experience with OIT in 3 patients with IgE-mediated hen’s egg allergy. Our treatment strategy consists of 1–3 days of initial escalation, 47 to 65 weeks of build-up phase, and 1 year of maintenance phase. Lactobacillus plantarum CJLP133, 1×1010 colony-forming unit/day was taken during OIT. As a result, 1 patient achieved successful desensitization, and 1 patient reached maintenance therapy, but did not obtain desensitization. In addition, 1 patient withdrew from treatment due to anxiety symptoms. Despite the limited number of patients, we experienced and herein presented 3 cases of OIT in egg allergy. More trials of OIT need to be performed as a treatment option in Korean children with food allergies.

PURPOSE: Croup is known to have epidemics in seasonal and biennial trends, and to be strongly associated with epidemics of parainfluenza virus. However, seasonal and annual epidemics of croup have not been clearly reported in Korea. This study aimed to examine the seasonal/annual patterns and etiologies of childhood croup in Korea during a consecutive 6-year period. METHODS: Pediatric croup data were collected from 23 centers in Korea from 1 January 2010 to 31 December 2015. Electronic medical records, including multiplex reverse transcription polymerase chain reaction (RT-PCR) results, demographics and clinical information were cross-sectionally reviewed and analyzed. RESULTS: Overall, 2,598 childhood croup patients requiring hospitalization were identified during the study period. Among them, a total of 927 who underwent RT-PCR were included in the analysis. Males (61.5%) predominated, and most (63.0%) of them were younger than 2 years of age (median, 19 months; interquartile range, 11–31 months). Peak hospitalization occurred in 2010 and 2012 in even-numbered years, and parainfluenza virus (PIV, 39.7%) was the most common cause of childhood croup requiring hospitalization, followed by respiratory syncytial virus (14.9%), human rhinovirus (12.5%), Mycoplasma pneumonaie (10.6%), and human coronavirus (7.3%). CONCLUSION: It is concluded that croup hospitalization has a biennial pattern in even-numbered years. PIV may be the most common cause of childhood croup; however, croup epidemics could be attributed to other viruses.
Child ; Coronavirus ; Croup ; Demography ; Electronic Health Records ; Hospitalization ; Humans ; Korea ; Male ; Mycoplasma ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Reverse Transcription ; Rhinovirus ; Seasons

OBJECTIVE: This study aimed to investigate the difference in micronutrient levels between oral feeding and enteral feeding in chronic stroke patients to assess the risks of enteral feeding. METHODS: Patients with chronic stroke who were admitted to the Department of Rehabilitation Medicine between January 2011 and June 2012 were enrolled. The serum concentrations of iron, copper, zinc, folate, and vitamin B12, as well as the absolute CD4 and CD8 lymphocyte counts, were assessed. RESULTS: Of the 73 patients enrolled in this study, 50 were fed orally, while the other 23 were fed through a percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. The serum concentrations of vitamin B12 and folate were significantly higher in the enteral feeding group than in the oral feeding group. However, the serum concentration of zinc was significantly lower in the enteral feeding group. CONCLUSION: There is little difference between enteral feeding and oral feeding in terms of micronutrient provision except that the serum concentration of zinc in the enteral feeding group was significantly lower than that in the oral feeding group. Clinicians should recognize that chronic stroke patients who require tube feeding have a risk of micronutrient deficiency. Early detection of malnutrition and micronutrient deficiency is important for providing the necessary nutrients.
Copper ; Enteral Nutrition* ; Folic Acid ; Gastrostomy ; Humans ; Iron ; Lymphocyte Count ; Malnutrition ; Micronutrients* ; Rehabilitation ; Stroke* ; Vitamin B 12 ; Zinc

PURPOSE: We aimed to translate the Test for Respiratory and Asthma Control in Kids (TRACK) instrument into Korean, with subsequent linguistic validation. METHODS: The multistep process of forward translation, reconciliation, back-translation, cognitive debriefing, and proofreading of the Korean version of the TRACK was completed. RESULTS: Two bilingual medical personnel independently translated the original English version of the TRACK into Korean one. After moderating the translation into a single reconciled one, 4 other bilingual persons were invited to translate the Korean draft back into an English one. Discrepancies between the original English version and the back-translated one were reviewed, and the need to modify the reconciled Korean draft was discussed. Twenty caregivers of asthmatic children took part in interviews that examine the appropriateness of the Korean version of the TRACK. The feedback from caregivers were then reviewed by a panel of pediatric allergists and reflected in the final Korean version. The document was finally proofread to check the spelling, grammar, layout and formatting. CONCLUSION: Translation and linguistic validation of the Korean version of the TRACK instrument were completed.
Asthma* ; Caregivers ; Child ; Humans ; Linguistics* ; Translations

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.
Acute Kidney Injury ; Allopurinol ; Biopsy ; Busan ; Carbamazepine ; Ceftriaxone ; Child ; Drug Hypersensitivity Syndrome ; Edema ; Eosinophilia* ; Exanthema* ; Fever ; Glomerulonephritis* ; Humans ; Kidney Tubular Necrosis, Acute ; Lymphatic Diseases ; Male ; Necrosis* ; Nephritis, Interstitial ; Proteinuria ; Sulfasalazine ; Vancomycin*

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.
Acute Kidney Injury ; Allopurinol ; Biopsy ; Busan ; Carbamazepine ; Ceftriaxone ; Child ; Drug Hypersensitivity Syndrome ; Edema ; Eosinophilia* ; Exanthema* ; Fever ; Glomerulonephritis* ; Humans ; Kidney Tubular Necrosis, Acute ; Lymphatic Diseases ; Male ; Necrosis* ; Nephritis, Interstitial ; Proteinuria ; Sulfasalazine ; Vancomycin*

Actinomyces meyeri is a Gram positive, strict anaerobic bacterium, which was first described by Meyer in 1911. Primary actinomycotic osteomyelitis is rare and primarily affects the cervicofacial region, including mandible. We present an unusual case of osteomyelitis of a long bone combined with myoabscess due to A. meyeri. A 70-year-old man was admitted for pain and pus discharge of the right elbow. Twenty-five days before admission, he had hit his elbow against a table. MRI of the elbow showed a partial tear of the distal triceps tendon and myositis. He underwent open debridement and partial bone resection for the osteomyelitis of the olecranon. Biopsy showed no sulfur granules, but acute and chronic osteomyelitis. The excised tissue grew A. meyeri and Peptoniphilus asaccharolyticus. Intravenous ceftriaxone was administered and switched to oral amoxicillin. Infection of the extremities of actinomycosis often poses diagnostic difficulties, but it should not be neglected even when the characteristic pathologic findings are not present.
Actinomyces* ; Actinomycosis ; Aged ; Amoxicillin ; Biopsy ; Ceftriaxone ; Debridement ; Elbow ; Extremities ; Humans ; Magnetic Resonance Imaging ; Mandible ; Myositis ; Olecranon Process* ; Osteomyelitis* ; Sulfur ; Suppuration ; Tears ; Tendons

Cantrell's syndrome is a rare congenital anomaly, consists of five malformations. There are the midline abdominal wall defect, the defect of sterna lower part, an agenesis of the anterior part of the diaphragm, an absence of the diaphragmatic pericardium, and the congenital intracardiac problem. We diagnosed Cantrell's syndrome with left ventricular diverticulum in a female neonate with no perinatal problems. She experienced an one-staged operation and discharged with no complications. We report a case with brief review of the literature.
Abdominal Wall ; Diaphragm ; Diverticulum* ; Female ; Humans ; Infant, Newborn* ; Pericardium

BACKGROUND: In the clinical setting, for convenience of transfusion, blood is requested in advance, even though 'the type and screen' method has been used for the efficient supply of blood. We employed the precedent antibody screening test method for all patients who were scheduled for surgery, and compared the disposal rate and the clear rate pre and post-activity. METHODS: We evaluated the disposal rate and the cancellation ratio before and after employment of the precedent antibody screening test method for all patients expected to undergo surgery. A comparison of the frequency and type of side effects of transfusion was also performed. RESULTS: The disposal rate and the cancellation ratio showed a decrease, from 1.48% to 1.29%, and from 17.0% to 11.0%. No significant change was observed in the cause of disposal and the side effects of transfusion. CONCLUSION: Enforcement of a precedent antibody screening test resulted in a decrease in the disposal and clear rates. In addition, it aided in reduction of the amount of work performed at the blood bank by establishing the proper utilization of blood and reducing unnecessary cross match testing. There appears to be no problem regarding the stability of transfusion. However, for the sample showing a positive result on the antibody screening test, an effort to decrease the side effects of transfusion, such as exhaustive cross-matching and increasing the rate of identification, would be needed.
Blood Banks ; Blood Transfusion ; Employment ; Humans ; Mass Screening