Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A-14-year-old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.
Anemia, Hemolytic ; Aspartate Aminotransferases ; Bone Marrow ; Exanthema ; Female ; Ferritins ; Fever ; Hepatomegaly ; Humans ; Kaposi Varicelliform Eruption ; L-Lactate Dehydrogenase ; Lupus Erythematosus, Systemic* ; Lymphohistiocytosis, Hemophagocytic ; Macrophage Activation Syndrome* ; Macrophage Activation* ; Macrophages* ; Oral Ulcer ; Pancytopenia ; Rheumatic Diseases ; Steroids

We report the case of a 7-year-old boy who showed treatment-nonresponsive hypotension (59/29 mmHg) and decreased left ventricular systolic function (fractional shortening 22%) in the acute stage of Kawasaki disease (KD). The present case serves to highlight that methylprednisolone pulse therapy should be considered in patients with intravenous immunoglobulin nonresponsive symptomatic myocarditis during the acute stage of KD.
Adrenal Cortex Hormones ; Child ; Humans ; Hypotension ; Immunoglobulins* ; Male ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Myocarditis*

Acute maxillary sinusitis is a common disorder affecting children. Untreated acute sinusitis can develop into chronic sinusitis, and complications, such as orbital cellulitis or abscess, can occur. Maxillary sinusitis of odontogenic origin is not a well-recognized condition and is frequently missed in children. As an odontogenic source of sinusitis, the dentigerous cyst is one of the most prevalent types of odontogenic cysts, and it is associated with the crown of an unerupted or developing tooth. This report concerns a nine-year-old boy who was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. The boy visited our pediatric clinic presenting with rhinorrhea and nasal obstruction and was initially diagnosed with maxillary sinusitis only. With antibiotic treatment, his symptoms seemed to improve, but after 2 months, he came to our clinic with left facial swelling with persistent rhinorrhea and nasal obstruction. Radiographic examinations of the sinuses were performed, and he was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. After a surgical procedure involving the removal of the dentigerous cyst with supernumerary teeth, the symptoms of sinusitis gradually diminished. There are only very few cases in the pediatric medical literature that remind us that odontogenic origin can cause maxillary sinusitis in children. Our patient can act as a reminder to general pediatricians to include dentigerous cysts in the differential diagnosis of maxillary sinusitis.
Abscess ; Child* ; Crowns ; Dentigerous Cyst* ; Diagnosis, Differential ; Humans ; Male ; Maxillary Sinus* ; Maxillary Sinusitis* ; Nasal Obstruction ; Odontogenic Cysts ; Orbital Cellulitis ; Sinusitis ; Tooth ; Tooth, Supernumerary*

PURPOSE: Urinary tract infection (UTI) is a common bacterial infection in children and Escherichia coli is a predominant pathogen. The purpose of this study is to evaluate phylogenetic groups and virulence factors of E. coli causing UTI in children in Korea. METHODS: From October 2010 to April 2013, urinary E. coli strains were isolated from the 33 pediatric patients of UTI. Multiplex polymerase chain reactions were performed to evaluate the phylogenetic groups and 5 virulence factor genes (fimH, sfa, papA, hylA, and cnf1) of E. coli. Distribution of molecular characteristics of E. coli was analyzed by clinical diagnosis and accompanying vesicoureteral reflux (VUR). RESULTS: Most (84.8%) uropathogenic E. coli were belonged to phylogenetics group B2 and the others (15.2%) were belonged to group D. The virulence factors were distributed as: fimH (100%), sfa (100%), hylA (63.6%), cnfI (63.6%), and papA (36.4%). According to clinical diagnosis, phylogenetic distribution of E. coli strain was 92.3% of B2 and 7.7% of D in acute pyelonephritis and 57.1% of B2 and 42.9% of D in cystitis. Distribution of virulence factors was similar in both groups. In patients with acute pyelonephritis, phylogenetic distribution was similar in VUR and non-VUR group, but proportion of papA genes were lower in VUR group than that of non-VUR group (43.8% vs. 20.0%, P=0.399). CONCLUSIONS: This study provides current epidemiologic molecular data of E. coli causing pediatric UTI in Korea and will be a fundamental for understanding the pathogenesis of pediatric UTI.
Bacterial Infections ; Child* ; Cystitis ; Diagnosis ; Escherichia coli* ; Escherichia* ; Humans ; Korea ; Polymerase Chain Reaction ; Pyelonephritis ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux ; Virulence Factors* ; Virulence*

PURPOSE: The aim of study was to estimate the hand hygiene (HH) compliance of healthcare workers (HCWs) in a children's hospital. METHODS: This study was conducted in a hospital which is a tertiary and educational children's hospital with 313 beds and 533 HCWs. Data were collected by direct observation methods from November 1, 2010 to December 31, 2010. RESULTS: A total of 2,999 opportunities for HH were observed, and the overall HH rate was 95.3%. HH rate of the registered nurse, physicians and transferer was 97.7%, 89.2%, and 72.1%, respectively (P<0.001). Among physicians, HH rate of the fellows, professors, residents and interns was 97.5%, 93.9%, 89.7%, and 80.9%, respectively (P<0.001). HH rate in the emergency room, operation room, outpatient department (OPD), and the intensive care unit (ICU) was 97.2%, 97.2%, 95.4%, and 92.5%, respectively (P<0.001). Hand rubbing was the most frequently used (81.1%), and hand washing was frequently used in the case of 'after body fluids exposure risk' (37.7%) and 'after touching patient surroundings' (28.5%). HH methods were not statistically different from each departments (P=0.083), however, they were significantly different according to the World Health Organization (WHO) 5 Moments (P<0.001). Distributions in WHO 5 Moments by the job titles were significantly different (P<0.001). The odds ratio of physicians, ICU and OPD was 0.353 (95% CI, 0.241-0.519), 0.291 (95% CI, 0.174-0.487), and 0.484 (95% CI, 0.281-0.834), respectively. CONCLUSIONS: Compliance of HH was different by the job titles and departments. Effective custom-tailored HH programs for each job title and department need to be developed.
Body Fluids ; Compliance* ; Cross Infection ; Delivery of Health Care* ; Emergency Service, Hospital ; Hand Disinfection ; Hand Hygiene* ; Hand* ; Humans ; Infection Control ; Intensive Care Units ; Odds Ratio ; Outpatients ; Pediatrics ; World Health Organization

PURPOSE: We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years. METHODS: From January 2004 to December 2013, the antibiotic susceptibility of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed. RESULTS: The prevalence of K. pneumoniae, E. coli, P. aeruginosa, and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood cultures/year, respectively. In K. pneumoniae, resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. coli, and resistance to carbapenem rose abruptly from 11% to 71% in A. baumannii (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa. There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P=0.037). CONCLUSION: The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteremia ; Child* ; Drug Resistance, Microbial ; Escherichia coli ; Gram-Negative Bacteria* ; Humans ; Klebsiella pneumoniae ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa

Virus-associated immune thrombocytopenic purpura (ITP) can occur following common viruses, but cases of ITP associated with influenza infection has seldom been reported. In this report we describe a previously healthy 5-year-old boy who admitted with fever, flu-like symptoms and a few bruises on both legs. Severe thrombocytopenia were found. Bone marrow aspirates and biopsy showed no abnormalities and results of coagulation tests were all in normal limit. Real-time polymerase chain reaction was positive for influenza B infection. The patient fully recovered with intravenous immunoglobulins and steroid therapy.
Biopsy ; Bone Marrow ; Child, Preschool ; Contusions ; Fever ; Humans ; Immunoglobulins, Intravenous ; Influenza B virus* ; Influenza, Human* ; Leg ; Male ; Purpura, Thrombocytopenic, Idiopathic* ; Real-Time Polymerase Chain Reaction ; Thrombocytopenia

Posterior reversible leukoencephalopathy syndrome is a clinical radiographic syndrome of many causative factors. Sudden onset headache, vomiting, altered mental status, blurred vision and seizures are main symptoms shown in posterior reversible leukoencephalopathy syndrome. In addition, it typically shows radiological findings of edema in the white matter of posterior cerebrum, being in commonly bilateral but asymmetric. We report a case of poststreptococcal glomerulonephritis (PSGN) presenting as posterior reversible leukoencephalopathy syndrome. Immediate control of hypertension resulted in rapid and complete neurological recovery.
Cerebrum ; Edema ; Glomerulonephritis* ; Headache ; Hypertension ; Leukoencephalopathies* ; Posterior Leukoencephalopathy Syndrome ; Seizures ; Streptococcal Infections ; Vomiting

PURPOSE: The long-term administration of antibiotics interferes with bacterial culture in the middle ear fluids (MEFs) of young children with otitis media with effusion (OME). The purpose of this study is to determine whether molecular diagnostics can be used for rapid and direct detection of the bacterial pathogen in culture-negative MEFs. METHODS: The specificity and sensitivity of both polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) to the lytA gene of Streptococcus pneumoniae were comparatively tested and then applied for pneumococcal detection in the clinical MEFs. RESULTS: The detection limit of the PCR assay was approximately 10(4) colony forming units (CFU), whereas that of LAMP was less than 10 CFU for the detection of S. pneumoniae. Both PCR and LAMP did not amplify nucleic acid at over 10(6) CFU of H. influenzae or M. catarrhalis, both of which were irrelevant bacterial species. Of 22 culture-negative MEFs from children with OME, LAMP positivity was found in twelve MEFs (54.5%, 12/22), only three of which were PCR-positive (25%, 3/12). Our results showed that the ability of LAMP to detect pneumococcal DNA is over four times higher than that of PCR (P<0.01). CONCLUSIONS: As a high-resolution tool able to detect nucleic acid levels equivalent to <10 CFU of S. pneumoniae in MEFs without any cross-reaction with other pathogens, lytA-specific LAMP may be applied for diagnosing pneumococcus infection in OME as well as evaluating the impact of a pneumococcal conjugate vaccine against OME.
Anti-Bacterial Agents ; Child* ; Diagnosis* ; DNA ; Ear, Middle* ; Humans ; Influenza, Human ; Limit of Detection ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Pathology, Molecular ; Pneumonia ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Stem Cells ; Streptococcus pneumoniae* ; Streptococcus*

PURPOSE: Serotyping pneumococcal isolates is important to monitor efficacy of pneumococcal vaccines. Because of difficulties of typing pnueumocci, a multiplex bead-based (multibead) serotyping assay was recently introduced. The aim of this study is to establish a new multibead serotyping assay and to apply this method to analyze clinical isolates of pneumococci in Korea. METHODS: To establish the multibead serotyping assay, six key reagents were transferred from University of Alabama at Birmingham (UAB) to Ewha Center for Vaccine Evaluation and Study (ECVES): bead set coated with polysaccharide and monoclonal antibody pool were used in one multiplex inhibition-type immunoassay and 2 bead sets coated DNA probe and 2 primer pools were used in two multiplex PCR-based assays. After multibead serotyping assay was set up, 75 test samples of pneumococci were analyzed whether ECVES is able to identify serotype correctly. After confirming the performance, serotyping assay was applied to identify serotypes of 528 clinical isolates of pneumococci collected from 3 different hospitals. RESULTS: After establishment of the multibead pneumococcal serotyping assay system at ECVES, 75 test samples were analyzed. There was no discrepancy of serotypes of 75 test samples between the results assigned at UAB and those at ECVES. The serotypes of 528 pneumococci isolated from patients or healthy subjects were determined in 94.3% of isolates (498/528). CONCLUSIONS: The multibead pneumococcal serotyping assay can be successfully established in Korea. With this method, surveillance of serotypes of pneumococci isolated from patients as well as healthy subjects could be studied.
Alabama ; DNA ; Humans ; Immunoassay ; Indicators and Reagents ; Korea* ; Pneumococcal Vaccines ; Serotyping* ; Streptococcus pneumoniae