Retropharyngeal abscess is a deep neck infection that causes an immediate life-threatening emergency with potential for airway compromise and other catastrophic complications. Mediastinal abscess is also a serious and potentially fatal process. Thus, both early diagnosis and adequate treatment of these diseases are critical. We report a case of dyspnea caused by retropharyngeal abscess and mediastinal abscess in a 9-month-old male patient. The patient had continuous fever and cough after foreign body removal, but had only been diagnosed as, and been treated for, bronchiolitis. He underwent surgical abscess drainage and systemic broad-spectrum antibiotics treatment successfully.
Abscess* ; Anti-Bacterial Agents ; Bronchiolitis ; Cough ; Drainage ; Dyspnea* ; Early Diagnosis ; Emergencies ; Fever ; Foreign Bodies ; Humans ; Infant ; Male ; Neck ; Retropharyngeal Abscess*

Necrotizing pneumonia is a complication of severe, sometimes fatal, lobar pneumonia that leads to extensive necrosis of lung parenchyme. The plain chest X-ray shows many small lucencies and pneumatoceles while the chest CT demonstrates cavities, that do not show contrast enhancement. Major bacteriae that cause necrotizing pneumonia are anaerobes in immune deficient patients and nosocomial infections, and Streptococcus pneumoniae and Mycoplasma pneumoniae in children of healthy environments. Cases of necrotizing pneumonia in children, unlike those observed in adults, show less need for invasive surgery and lead to a favorable outcome once an early diagnosis is made and a course of appropriate antibiotics is initiated. Empirical antibiotic treatment is important because the specific causative agent may not be found. We report two cases of successful treatment of healthy children who had lung abscesses combined with extensive necrotizing pneumonia.
Adult ; Anti-Bacterial Agents ; Bacteria ; Child* ; Cross Infection ; Early Diagnosis ; Humans ; Lung ; Lung Abscess ; Mycoplasma pneumoniae ; Necrosis ; Pneumonia* ; Pneumonia, Mycoplasma ; Streptococcus pneumoniae ; Thorax ; Tomography, X-Ray Computed

Acute generalized exanthematous pustulosis(AGEP) is a relatively rare exfoliative skin syndrome. It consists of a generalized eruption of pustules in response to medication or infection. Antibiotics are the most commonly implicated medications. Nonsteroidal anti-inflammatory drugs(NSAID) can also trigger AGEP. However, So far, a case of AGEP due to ibuprofen has not been reported in Korea. Therefore we report a case of acute generalized exanthematous pustulosis as a result of use of ibuprofen in a 10 years old female.
Acute Generalized Exanthematous Pustulosis* ; Anti-Bacterial Agents ; Child ; Female ; Humans ; Ibuprofen ; Korea ; Skin

PURPOSE: The purpose of this study was to evaluate the utility of rapid antigen detection test for group A streptococci in children with acute pharyngitis. METHODS: Seventy children with acute pharyngitis enrolled the study, who visited the Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym Medical Center from September 2004 to August 2005. The presence of clinical features such as tonsillar exudates, fever, scarletiniform rash and previous antibiotic use were evaluated and throat swab culture, rapid antigen detection test for group A Streptococci, CBC, ASO, and CRP were performed. RESULTS: Among 70 children with acute pharyngitis, the prevalence of group A beta-hemolytic Streptococcus by throat swab culture and rapid antigen detection test was 14(20.0 %) and 22(31.4%), respectively. The sensitivity of the rapid antigen detection test was 78.6 %, specificity was 80.4%, the positive predictive value was 50.0% and the negative predictive value was 93.8%. The positivity of the throat swab culture and rapid antigen detection test showed no signigicant differences according to the presence of the clinical symptoms except scarletiniform rash. Laboratory data such as CBC, ASO or CRP proved not valuable to predict the positivity of the throat swab culture and/or rapid antigen detection test for group A Streptococcus. There was a tendency of negative throat swab culture and positive rapid antigen detection test in cases of previous antibiotic use. CONCLUSION: The rapid antigen detection test can be a useful diagnostic tool for early detection of the group A Streptococcus in children with acute pharyngitis and can be helpful for the clinician to reduce the inappropriate use of antibiotics.
Anti-Bacterial Agents ; Child* ; Exanthema ; Exudates and Transudates ; Fever ; Heart ; Humans ; Pediatrics ; Pharyngitis* ; Pharynx ; Prevalence ; Sensitivity and Specificity ; Streptococcus

PURPOSE: Mycoplasma pneumoniae is a common respiratory pathogen responsible for acute respiratory infections in young children. The standard laboratory methods for the specific diagnosis of M. pneumoniae infection have been isolation in culture and serological methods. The objective of this study was to compare the performance of enzyme-linked immunosorbent assays (ELISA) for the detection of M. pneumoniae specific IgG and IgM antibodies and polymerase chain reaction (PCR) in diagnosis of M. pneumoniae pneumonia. METHODS: For a 1-year period, 111 patients admitted to Severance Hospital and Yongdong Severance Hospital with clinical features of pneumonia and radiographically defined pneumonia were included. Serum specimens and throat swab specimens were obtained at the time of admission. Patients who showed M. pneumoniae antibody titer 1:320 or greater or a fourfold increase in M. pneumoniae antibody titer between acute and convalescent sera obtained 5 days to 3 weeks after the onset of illness were diagnosed as having M. pneumoniae pneumonia. PCR and ELISA were also performed. RESULTS: The sensitivity, specificity, false positivity, and false negativity of PCR were 40.6 percent, 63.3 percent, 69.1 percent, and 27.5 percent, respectively. The sensitivity, specificity, false positivity, and false negativity of ELISA IgM were 9.4 percent, 100 percent, 0 percent, and 26.9 percent, respectively. The sensitivity, specificity, false positivity, and false negativity of the use of PCR and ELISA in combination were 46.9 percent, 63.3 percent, 65.9 percent, and 25.4 percent, respectively. CONCLUSION: These observations suggest that the use of PCR and ELISA in addition to the detection of serum antibody to Mycoplasma pneumoniae using microparticle agglutination would allow the maximal number of diagnoses to be made at a very early phase of infection.
Agglutination ; Antibodies ; Child ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Respiratory Tract Infections ; Sensitivity and Specificity

PURPOSE: Over the past several decades, the survival rates of low birth weight(LBW; birth weight <2,500 g) infants have been improving. Many of these infants have had bronchial asthma(BA) at childhood and aldolescence. The aim of this study is to investigate whether LBW influenced the severity of BA in prealdolescent children and aldolescence by a retrospective case control study. METHODS: 15 LBW children(1,500 gPediatric Allergy and Respiratory Disease. PFT(Pulmonary function test) were measured using a portable spirometer. The value are expressed as percentage predicted using standard reference values. Total IgE and specific IgE Ab. were assessed by the PRIST method and MAST Allergy Test. Methacholine challenge test and PC20 was assessed by the Masterlab. RESULTS: LBW group had:a significantly more severe symptoms between 8 year-old and 18 year-old than control group.(P=0.015) A significantly more used to ICSs(Inhaled corticosteroids) and add-on therapy than control group.(P=0.009)(P=0.0001) There were no significant differences in the PFT and PC20 and specific IgE Ab. between LBW group and control group. But, total IgE level is higher in the control group than in the LBW group. CONCLUSION: These results suggest that LBW is a risk factor for the severity of BA. We suggest that infants with birth weight of less than 2,500 g have a more severe risk of asthma during prealdolescent children and aldolescence than who were birth weight of more than 2,500 g.
Adolescent ; Asthma* ; Birth Weight ; Case-Control Studies ; Child* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant ; Infant, Low Birth Weight* ; Infant, Newborn ; Methacholine Chloride ; Parturition ; Reference Values ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: Our study was designed to evaluate the prevalence of secondary skin infection in patients with atopic dermatitis and their sensitivity to antibiotics for appropriate choice of antibiotics. METHODS: We studied skin culture and their sensitivity results for 218 patients who visited to pediatric allergy clinic from June 2003 to August 2004. After determining minimal inhibitory concentrations(MICs) of antibiotics from randomly selected 40 cases of them, we compared the result with previous data. RESULTS: Age distribution was as follows; 28 cases(12.8%) were under 1 year old, 64 cases(29.4%) were 1 to 3 years old, 63 cases(28.9%) were 4 to 6 years old, and 63 cases (28.9%) were over 7 years old. 121 cases(55.5%) of 218 cases were found to have secondary skin infection. The most common organism was Staphylococcus aureus(S. aureus; 85 cases, 70.2%). The next was Staphylococcus epidermides(S. epidermidis; 22 cases, 18.2%). S. aureus were highly resistant to ampicillin and penicillin, but were relatively highly sensitive to 1st and 2nd generation cephalosporin, gentamicin, and erythromycin. To teicoplanin and vancomycin, they were entirely sensitive. On the other hand, S. epidermidis was highly resistant to 1st generation cephalosporin in addition to ampicillin and penicillin. Moreover, alpha- and beta-hemolytic streptococcus, which were co-infected with S. aureus, showed highly resistance to ampicillin, oxacillin and cephalosporin. In MIC test, methicillin-resistant S. aureus were found in 4 cases. CONCLUSION: Skin culture, sensitivity test and the appropriate choice of antibiotics might be important to control secondary skin infection and atopic dermatitis.
Age Distribution ; Ampicillin ; Anti-Bacterial Agents* ; Child ; Child, Preschool ; Dermatitis, Atopic* ; Erythromycin ; Gentamicins ; Hand ; Humans ; Hypersensitivity ; Methicillin Resistance ; Oxacillin ; Penicillins ; Prevalence ; Skin* ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Teicoplanin ; Vancomycin

No abstract available.
Clinical Laboratory Techniques* ; Mycoplasma Infections* ; Mycoplasma*

Variable airway obstruction, increased bronchial hyperresponsiveness, allergic inflammatory reaction and airway remodeling are main characteristics of asthma. Matrix metalloproteinases (MMPs) and their inhibitors, tissue inhibitors of metalloproteinases(TIMPs) do play important roles to pathogenesis and pathology of asthma via influence on the function and migration of inflammatory cells as well as extracellular matrix(ECM) deposition and degradation. MMP-9 is the predominant MMP in asthma and chronic obstructive pulmonary disease(COPD), and its expression is enhanced when asthma patients have spontaneous exacerbations or in response to local instillation of allergen in the airway. As acute inflammation of asthma resolves, MMP-9 levels return to normal. TIMPs bind MMPs in a 1:1 fashion. Thus, an increase in the molar ratio of MMP/TIMP can favor tissue injury, while the reverse ratio could be associated with increased fibrosis. Glucocorticosteroids could downregulate MMPs and enhance TIMPs. Even though it is clear that stimulated allergic inflammation in airway is associated with increased expression of MMPs, whether specific inhibitors of MMPs could reduce airway structural changes and facilitate orderly healing in asthma is still unknown.
Airway Obstruction ; Airway Remodeling ; Asthma* ; Fibrosis ; Humans ; Inflammation ; Matrix Metalloproteinase 9* ; Matrix Metalloproteinases ; Molar ; Pathology

PURPOSE: To review the role of food additives in asthma and provide a practical approach for evaluation, diagnosis, and management of additive-induced asthma. METHODS: Information was gathered from original articles, selected reviews and abstracts published in peer-reviewed journals and from selected textbook chapters, supplemented by the clinical experience of the authors. RESULTS: In some patients, food additive ingestion can induce bronchospasm or exacerbation of symptoms in patients with chronic asthma. The most implicated agents are sulfites, followed by tartrazine, monosodium glutamate and others. However, geographic variations exist depending on the dietary habits. CONCLUSION: Food additives are worth considering as possible causes of bronchospasm or worsening of asthma. The medical history may be suggestive, particularly when symptoms occur to commercially prepared foods or to multiple unrelated foods. Physicians should also think of food additives in patients whose asthma is poorly controlled in spite of appropriate routine allergy evaluation, environmental control, and optimal pharmacologic therapy. Except for a few natural additives, allergy skin test and in-vitro tests are unreliable. A titrated oral challenge testing, preferably in a blind fashion would be the definitive diagnostic procedure.
Asthma* ; Bronchial Spasm ; Coloring Agents ; Diagnosis ; Eating ; Food Additives* ; Food Habits ; Humans ; Hypersensitivity ; Skin Tests ; Sodium Glutamate ; Sulfites ; Tartrazine