PURPOSE: This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future. METHODS: We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI. RESULTS: Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group. CONCLUSIONS: Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.
Academic Medical Centers ; Bacterial Infections ; Birth Weight ; Daegu ; Diagnosis ; Fever* ; Humans ; Infant* ; Leukocytosis ; Male ; Medical Records ; Meningitis, Aseptic ; Meningitis, Bacterial ; Pyuria ; Retrospective Studies ; Risk Factors ; Siblings ; Spinal Puncture ; Urinary Tract Infections

PURPOSE: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. METHODS: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. RESULTS: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. CONCLUSIONS: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.
Academic Medical Centers ; Bacterial Infections ; Body Temperature ; Cerebrospinal Fluid ; Consensus ; Daegu ; Enterovirus ; Humans ; Infant* ; Length of Stay ; Leukocyte Count ; Leukocytosis ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Meningitis, Viral ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies ; Sepsis ; Spinal Puncture* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*

Guillain-Barré syndrome (GBS) is characterized by ascending symmetric paralysis, paresthesia, and autonomic dysfunction. Autonomic dysfunctions develop in two-thirds of the patients, and urinary retention and paralytic ileus usually develop in severe and advanced cases. There has been no pediatric case with paralytic ileus as a presenting symptom of GBS. Reported herein is a case of GBS presenting vomiting as an initial symptom. A 28-month-old girl was brought to the emergency room due to a 2-day history of vomiting. She vomited multiple times 1 day before the visit, and had only single voiding on admission day. Her abdomen was distended, with decreased bowel sound. Intravenous fluid was given under the diagnosis with acute gastroenteritis with dehydration. The abdominal computed tomography revealed severe paralytic ileus and urinary bladder distention. After having two seizures, she developed respiratory failure necessitating ventilator care. On day 8 after admission, motor weakness with areflexia was noticed. The cerebrospinal fluid analysis showed elevated proteins (80 mg/dL) with no white blood cells (0/mm³). The nerve conduction study showed axonal-type peripheral polyneuropathy. GBS was diagnosed. During the follow-up, the patient was found to have motor weakness in the lower extremities. Paralytic ileus with protracted vomiting can be an initial presentation of GBS in children. Autonomic dysfunction with GBS can be considered in a differential diagnosis in vomiting patients with unclear etiologies.
Abdomen ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Dehydration ; Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gastroenteritis ; Guillain-Barre Syndrome* ; Humans ; Ileus ; Intestinal Pseudo-Obstruction* ; Leukocytes ; Lower Extremity ; Neural Conduction ; Paralysis ; Paresthesia ; Polyneuropathies ; Respiratory Insufficiency ; Seizures ; Urinary Bladder ; Urinary Retention ; Ventilators, Mechanical ; Vomiting

Transient magnetic resonance (MR) signal changes in the splenium of the corpus callosum (SCC) arise from many different conditions, including encephalopathy or encephalitis caused by infection, seizures, metabolic derangements, and asphyxia. Few case reports exist on reversible SCC lesions associated with rotavirus infection. A benign convulsion with mild gastroenteritis (CwG) is frequently associated with rotaviral infections. This entity is characterized by normal laboratory findings, electroencephalogram, neuroimaging, and good prognosis. We report a case of a 2.5-year-old Korean girl with rotavirus-associated CwG demonstrating a reversible SCC lesion on diffusion-weighted MR images. She developed 2 episodes of brief generalized tonic-clonic seizure with mild acute gastroenteritis without any other neurologic abnormality. Stool test for rotavirus antigen was positive. Brain MRI done on the day of admission showed a linear high signal intensity and decreased apparent diffusion coefficient values on the SCC. The lesion completely disappeared on follow-up MRI 6 days later. The patient fully recovered without any sequelae.
Asphyxia ; Brain ; Child ; Corpus Callosum ; Diffusion ; Electroencephalography ; Encephalitis ; Follow-Up Studies ; Gastroenteritis ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Prognosis ; Rotavirus ; Rotavirus Infections ; Seizures

Non-typhoidal salmonella (NTS) is a common pathogen involved in food poisoning. It has various extraintestinal complications including encephalopathy. However, NTS associated encephalopathy is rarely reported. A previously healthy 14-year-old boy was admitted for altered level of consciousness. He had profuse watery diarrhea with fever on the day of admission. Physical examination was unremarkable except slightly increased bowel sounds and altered mental state. Cerebrospinal fluid analysis revealed mild pleocytosis. Meningoencephalitis was the presumptive diagnosis. His consciousness was recovered over 24 hours, bloody and mucoid diarrhea developed the next day after admission. NTS organism was isolated from his stool. After 1 week, he fully recovered neurologically but a mild watery diarrhea persisted at the time of discharge.
Adolescent ; Consciousness ; Consciousness Disorders ; Diarrhea ; Dysentery ; Fever ; Foodborne Diseases ; Humans ; Leukocytosis ; Meningoencephalitis ; Physical Examination ; Salmonella ; Salmonella Infections

Mycoplasma pneumoniae(M. pneumoniae) is a well-known human respiratory pathogen. It also affects various organ systems and causes extrapulmonary complications, including neurologic, cutaneous, hematologic and ophthalmologic complications. M. pneumoniae has been implicated in a number of immune-mediated neurological diseases, such as ADEM, Gullian- Barre syndrome, and transverse myelitis. We present a 5-year-old boy with bilateral optic neuritis related to ADEM and pruritic skin lesions simultaneously associated with M. pneumoniae infection. He developed a headache with decreased activity six weeks before admission. He had no respiratory symptoms. Cerebral MRI showed multiple bilateral subcortical white matter lesions, suggesting a radiologic diagnosis of ADEM. M. pneumoniae was positive serologically. The cerebrospinal fluid polymerase chain reaction for M. pneumoniae was negative. The treatment with intravenous high-dose steroids and oral clarithromycin resulted in the rapid recovery of the patients visual and cutaneous problems. He was found to have returned to his normal conditions in the follow-up examination. We believe that immune-mediated injury can explain all the clinical manifestations of our case, which are ADEM-associated optic neuritis and cutaneous lesions.
Clarithromycin ; Encephalomyelitis, Acute Disseminated ; Follow-Up Studies ; Headache ; Humans ; Mycoplasma ; Mycoplasma pneumoniae ; Myelitis, Transverse ; Optic Neuritis ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Preschool Child ; Skin ; Skin Manifestations ; Steroids

A classic triad of acute external ophthalmoplegia, areflexia and ataxia characterizes Miller Fisher syndrome(MFS). Diagnosis is based on clinical findings and supported by two laboratory findings; CSF albuminocytological dissociation and serum anti-GQ1b IgG antibody testing. Anti-GQ1b antibody is a key factor in the pathogenesis of Miller Fisher syndrome and a useful marker in laboratory diagnosis. Here we report 2 cases with Miller Fisher syndrome without ataxia, whose major symptom was acute external ophthalmoplegia. Case 1 was associated with preceding Epstein-Barr virus infection and negative anti- GQ1b antibody. Case 2 was positive for the anti-GQ1b antibody. Both received intravenous immunoglobulin and fully recovered within 2 months after the onset of disease.
Ataxia* ; Clinical Laboratory Techniques ; Diagnosis ; Herpesvirus 4, Human ; Immunoglobulin G ; Immunoglobulins ; Miller Fisher Syndrome* ; Ophthalmoplegia

We present the case of a patient with Epstein-Barr virus (EBV) encephalitis who developed abnormal white matter lesions during the chronic phases of the infection. A 2-year-old-boy was admitted for a 2 day history of decreased activity with ataxic gait. The results of the physical examination were unremarkable except for generalized lethargy and enlarged tonsils with exudates. Brain magnetic resonance imaging (MRI) at admission showed multiple high signal intensities in both basal ganglia and thalami. The result of EBV polymerase chain reaction (PCR) of the cerebral spinal fluid was positive, and a serological test showed acute EBV infection. The patient was diagnosed with EBV encephalitis and recovered fully without any residual neurologic complications. Subsequently, follow-up MRI at 5 weeks revealed extensive periventricular white matter lesions. Since the patient remained clinically stable and asymptomatic during the follow-up period, no additional studies were performed and no additional treatments were provided. At the 1-year follow-up, cranial MRI showed complete disappearance of the abnormal high signal intensities previously seen in the white matter. The patient continued to remain healthy with no focal neurologic deficits on examination. This is the first case of asymptomatic self-limited white matter lesions seen in serial MRI studies in a Korean boy with EBV encephalitis.
Basal Ganglia ; Brain ; Encephalitis ; Epstein-Barr Virus Infections ; European Continental Ancestry Group ; Exudates and Transudates ; Follow-Up Studies ; Gait ; Herpesvirus 4, Human ; Humans ; Lethargy ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Palatine Tonsil ; Physical Examination ; Polymerase Chain Reaction ; Serologic Tests

Acute external ophthalmoplegia, areflexia, and ataxia compose the classic Miller-Fisher syndrome (MFS). Pupillary dysfunction is present in half of patients with MFS. However, isolated internal ophthalmoplegia is rare in children with MFS. We report a case with MFS presenting with isolated internal ophthalmoplegia following an acute Epstein-Barr virus (EBV) infection. An 11-year-old girl with flu-like symptoms was diagnosed with having an acute EBV infection on prior admission. After discharge, she complained of anorexia, poor oral intake and dizziness associated with blurred vision when in the upright position. Physical examination on readmission 10 days later showed anisocoric, mydriatic pupils with an abnormal light reflex. The patient displayed no external ophthalmoplegia, ataxia or areflexia. Cerebrospinal fluid analysis showed elevated protein with no white blood cells. Serum anti-GQ1b antibody was negative. MFS was diagnosed under clinical findings and CSF albuminocytologic dissociation. Isolated internal ophthalmoplegia can be the sole manifestation of MFS. Therefore, MFS must be considered in the differential diagnosis for children presenting with unexplained acute internal ophthalmoplegia.
Anisocoria ; Anorexia ; Ataxia ; Child ; Diagnosis, Differential ; Dissociative Disorders ; Dizziness ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Leukocytes ; Light ; Miller Fisher Syndrome ; Mydriasis ; Ophthalmoplegia ; Physical Examination ; Pupil ; Reflex ; Vision, Ocular

PURPOSE: Complex febrile seizures are known for a risk factor for developing later epilepsy and also clinical indication for lumbar puncture to exclude central nervous system (CNS) infections. The purpose of this study is to investigate clinical characteristics of first complex febrile seizures and clinical usefulness of lumbar puncture for these patients to diagnose CNS infections. METHODS: A retrospective review was performed for patients aged 3 months to 5 years who evaluated for their first complex febrile seizures between September 2006 and June 2011. RESULTS: 121 patients (22.2%) were complex type among 545 cases with febrile seizures. 43 patients (35.5%) had a previous history of simple febrile seizure, 34 cases (28.1%) had a family history. Multiple seizures were the most common subtypes of complex features (74.4%). Lumbar punctures were performed in 42 patients (34.7%). The patient's median CSF(cerebrospinal fluid) white blood cell count was 2.0+/-2.5/microL (range 0-10), and 5 patients(12.5%) had CSF pleocytosis. The causes of fever were as follows: acute pharyngotonsillitis (55.4%), pneumonia (14.9%), exanthem subitum (13.2%), mycoplasma infection (3.3%), influenza (1.7%), urinary tract infection (0.8%), gastroenteritis (0.8%), and unknown (9.9%). There were 3 patients (2.5%) with final diagnosis as encephalopathy, aseptic encephalitis; all of three cases had persistent decreased mentality. During the follow up duration (mean, 31.4+/-14.3 months), one patient(0.8%) developed epilepsy. CONCLUSION: The presence of abnormal neurologic signs is highly suggestive of underlying CNS pathology in patients with complex febrile seizures, and an important indication for lumbar puncture for these patients.
Central Nervous System ; Diagnosis ; Encephalitis ; Epilepsy ; Exanthema ; Fever ; Follow-Up Studies ; Gastroenteritis ; Humans ; Influenza, Human ; Leukocyte Count ; Leukocytosis ; Mycoplasma Infections ; Neurologic Manifestations ; Pathology ; Pneumonia ; Retrospective Studies ; Risk Factors ; Seizures ; Seizures, Febrile* ; Spinal Puncture* ; Urinary Tract Infections