Guillain-Barré syndrome (GBS) is caused by antecedent infectious diseases in approximately two-thirds of cases. GBS is considered an autoimmune response. Among reported preceding infections, influenza virus is relatively rare. Several reports have identified antibodies related to GBS pathogenesis. However, no case report has described the detection of influenza virus in the cerebrospinal fluid (CSF) of a patient with GBS by polymerase chain reaction (PCR). Here we report the case of a 6-year-old girl who was diagnosed with influenza A 1 week prior and was treated with oseltamivir, after which she visited our hospital for headache and bilateral leg weakness that had persisted for 1 day. We diagnosed her with GBS based on physical and neurologic examination findings, CSF analysis, nerve conduction velocity test results, spinal magnetic resonance imaging, and detection of influenza A virus in her CSF by PCR. She was treated with intravenous immunoglobulin and her symptoms slowly improved. This case report suggests that GBS may be caused by influenza virus through penetration of the CSF.
Antibodies ; Autoimmunity ; Cerebrospinal Fluid ; Child ; Communicable Diseases ; Female ; Guillain-Barre Syndrome* ; Headache ; Humans ; Immunoglobulins ; Influenza A virus ; Influenza, Human* ; Leg ; Magnetic Resonance Imaging ; Neural Conduction ; Neurologic Examination ; Orthomyxoviridae* ; Oseltamivir ; Polymerase Chain Reaction

Infective endocarditis (IE) caused by methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide concern. We present a case of a 12-year-old child with IE of the native mitral valve due to MRSA infection after an invasive dental procedure. Based on the clinical symptoms and the presence of cerebrospinal fluid pleocytosis, the patient was initially diagnosed with presumed bacterial meningitis and treated with empiric antibiotics. On the third day of hospitalization, MRSA was cultured from the initial blood samples and vegetation was observed on the mitral valve during an echocardiogram, findings which are compatible with a diagnosis of IE. The revised guidelines for antibiotic prophylaxis for the prevention of IE advise that IE prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions, who are at the highest risk of adverse outcomes from IE. However, in this case, the patient had no high risk factors indicative of IE prophylaxis, except for mitral valve prolapse. She had no recurrence of IE over a follow-up period of 12 months.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Cerebrospinal Fluid ; Child ; Diagnosis ; Endocarditis* ; Follow-Up Studies ; Hospitalization ; Humans ; Leukocytosis ; Meningitis* ; Meningitis, Bacterial ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mitral Valve ; Mitral Valve Prolapse ; Recurrence ; Risk Factors

Shigella is a common cause of bacterial enteritis worldwide. Shigella sonnei accounts for 90% of Shigella infections and Shigella flexneri is rarely reported in Korea. Although the incidence of Shigella infection has decreased, the incidence of organisms with antibiotic resistance has gradually increased in Korea. An outbreak of extended-spectrum β-lactamase (ESBL)-producing S. sonnei in children was reported in Korea; however, ESBL-producing S. flexneri has not yet been reported. We report the first two cases of multidrug-resistant CTX-M-14-producing S. flexneri infections in Korean children.
beta-Lactamases ; Child* ; Drug Resistance, Microbial ; Enteritis ; Humans ; Incidence ; Korea* ; Shigella flexneri* ; Shigella sonnei ; Shigella*

PURPOSE: This study aimed to identify the differential clinical, laboratory, and imaging characteristics between patients with cervical lymphadenitis as first presentation of Kawasaki disease (CLKD) and those with acute unilateral cervical lymphadenitis (AUCL). METHODS: We surveyed 372 patients who visited Pusan National University Children's Hospital because of fever and cervical lymph node enlargement, and underwent neck computed tomography (CT) from January 2010 to December 2014. We compared 28 confirmed cases of Kawasaki disease and 28 cases of AUCL based on a retrospective review of the medical records of the patients. RESULTS: Patients with CLKD and AUCL showed no differential clinical characteristics in terms of the duration of fever, antibiotic use, or the size of lymph nodes. Patients with CLKD had higher white blood cell count, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels (P<0.05) than those of patients with AUCL. The presence of retropharyngeal edema on neck CT was similar between the groups (64% vs. 33%, P=0.686). CONCLUSIONS: CLKD and AUCL showed no differentiating clinical and radiological characteristics; hence, Kawasaki disease should be the presumptive diagnosis in patients with fever and cervical lymph node enlargements who fail to respond to antibiotic treatment.
Busan ; C-Reactive Protein ; Child ; Diagnosis ; Edema ; Erythrocyte Count ; Fever ; Humans ; Leukocyte Count ; Lymph Nodes ; Lymphadenitis* ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Neck ; Neutrophils ; Retrospective Studies

PURPOSE: This study aimed to evaluate and compare the characteristics of infective endocarditis (IE) between children and adults with congenital heart disease (CHD) at a single tertiary care center. METHODS: In this retrospective medical record review, we extracted the demographic characteristics, diagnostic variables, and outcomes of patients diagnosed with IE and CHD between 2000 and 2016. RESULTS: We identified a total of 14 pediatric patients (nine male; median age at diagnosis, 3 years). Of the 14 patients, six had a history of previous open heart surgery, while four had undergone tetralogy of Fallot repair, with transannular patch or Rastelli procedure. Among the 10 children with positive blood cultures, the most common isolated organism was Staphylococcus spp. (8/10, 80%). Eleven adult patients had IE and CHD. Among the adult patients, only four were diagnosed with CHD before IE, and ventricular septal defect was the most common CHD. The most common isolated organism was Streptococcus spp. (6/11, 55%). Compared with adult patients, pediatric patients had a higher incidence of previously diagnosed CHD (P=0.001), with Staphylococcus spp. as the causative organism (P =0.027). The median duration between the onset of symptoms and diagnosis of IE was 9 days in children and 42 days in adults (P=0.012). CONCLUSIONS: Significant differences with regard to the diagnosis and progress of IE were observed between children and adults. Ageadjusted and systematic reassessment may be necessary for the diagnosis and management of IE.
Adult* ; Arterial Switch Operation ; Child* ; Diagnosis ; Endocarditis* ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies ; Staphylococcus ; Streptococcus ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tetralogy of Fallot ; Thoracic Surgery

PURPOSE: Rotavirus vaccine (RV) was introduced in Korea since 2007, and intussusception (IS) remains an important safety concern. This study investigated the trend of IS occurrence related to RV as well as the temporal relevance between vaccination and IS in children. METHODS: We collected data of the patient aged ≤18 years with IS admitted to Gachon University Gil Medical Center, 2003 to 2015. For the patients that have occurred since 2008, the immunization records of RV were collected. The proportion of cases <1 year was calculated by the year and the temporal relationship between vaccination and IS occurrence was analyzed. RESULTS: A total of 696 IS cases were noted. The cases <1 year were 30.7% (214/696). Although the incidence of all IS has increased over the 13-year period (from 74.1 in 2003 to 89.5 in 2015, linear by linear association, P=0.003), the incidence of IS <1 year has not increased (from 56.9 in 2003 to 53.3 in 2015, P=0.910), and the proportion of cases <1 year has decreased (from 35.4 in 2003 to 18.8 in 2015, P=0.000). Of 128 cases <1 year since 2008, 53.9% received RV. In the vaccinated group, 10 cases of IS occurred within 30 days, and eight cases did within 31 to 60 days. Numbers of IS after first, second, and third dose were three, 10, and five cases, respectively. CONCLUSIONS: Occurrence of IS in children <1 year of age did not increase since the introduction of RV. Further monitoring is essential for evaluation of vaccine safety.
Child ; Humans ; Immunization ; Incidence ; Intussusception* ; Korea ; Observational Study* ; Rotavirus* ; Vaccination

PURPOSE: Monitoring pneumococcal carriage rates is important. We developed and evaluated the accuracy of a real-time reverse transcription polymerase chain reaction (RT-PCR) protocol for the detection of Streptococcus pneumoniae. METHODS: In October 2014, 157 nasopharyngeal aspirates were collected from patients aged <18 years admitted to Chung-Ang University Hospital. We developed and evaluated a real-time PCR method for detecting S. pneumoniae by comparing culture findings with the results of the real-time PCR using genomic DNA (gDNA). Of 157 samples, 20 specimens were analyzed in order to compare the results of cultures, realtime PCR, and real-time RT-PCR. RESULTS: The concordance rate between culture findings and the results of real-time PCR was 0.922 (P <0.01, Fisher exact test). The 133 culture-negative samples were confirmed to be negative for S. pneumoniae using real-time PCR. Of the remaining 24 culture-positive samples, 21 were identified as S. pneumonia-positive using real-time PCR. The results of real-time RT-PCR and real-time PCR from 20 specimens were consistent with culture findings for all S. pneumoniae-positive samples except one. Culture and real-time RT-PCR required 26.5 and 4.5 hours to perform, respectively. CONCLUSIONS: This study established a real-time RT-PCR method for the detection of pneumococcal carriage in the nasopharynx. Real-time RT-PCR is an accurate, convenient, and time-saving method; therefore, it may be useful for collecting epidemiologic data regarding pneumococcal carriage in children.
Child* ; DNA ; Humans ; Methods ; Nasopharynx ; Pneumonia ; Polymerase Chain Reaction* ; Real-Time Polymerase Chain Reaction ; Reverse Transcription* ; RNA* ; Streptococcus pneumoniae

PURPOSE: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). METHODS: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. RESULTS: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. CONCLUSIONS: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.
Alanine Transaminase ; C-Reactive Protein ; Cohort Studies ; Delayed Diagnosis ; Diagnosis, Differential* ; Fever* ; Hospitalization ; Humans ; Leukocyte Count ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases* ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Platelet Count ; Retrospective Studies

PURPOSE: This study described the post-exposure prophylaxis (PEP) and secondary varicella infection in children inadvertently exposed to varicella zoster virus (VZV) in the hospital. METHODS: We retrospectively analyzed data from patients with VZV infection who were initially not properly isolated, as well as children exposed to VZV at the Seoul National University Children's Hospital between January 2010 and December 2015. The PEP measures were determined by the presence of immunity to VZV and immunocompromising conditions. Patient clinical information was reviewed via medical records. RESULTS: Among 147 children hospitalized between 2010 and 2015, 13 inadvertent exposures were notified due to VZV infection. Five index children had a history of VZV vaccination. Eighty-six children were exposed in multi-occupancy rooms and 62.8% (54/86) were immune to VZV. The PEP measures administered to 27 exposed patients included varicella zoster immunoglobulin and VZV vaccination. Four children developed secondary varicella, which was linked to a single index patient, including one child who did not receive PEP and three of the 27 children who received PEP. The rates of secondary varicella and prophylaxis failure were 4.7% (4/85) and 11.1% (3/27), respectively. The secondary varicella rates were 1.9% (1/54) and 9.7% (3/31) among immunocompetent and immunocompromised children, respectively. CONCLUSIONS: Delayed diagnosis of VZV infection can lead to unexpected exposure and place susceptible children and immunocompromised patients at risk for developing varicella. The appropriateness of the current PEP strategy based on VZV immunity may require re-evaluation.
Chickenpox* ; Child ; Child, Hospitalized* ; Delayed Diagnosis ; Herpes Zoster ; Herpesvirus 3, Human* ; Humans ; Immunocompromised Host ; Immunoglobulins ; Medical Records ; Post-Exposure Prophylaxis* ; Retrospective Studies ; Seoul ; Vaccination

PURPOSE: Bacillus cereus has been reported as the cause of nosocomial infections in cancer patients. In our pediatric cancer ward, a sudden rise in the number of patients with B. cereus bacteremia was observed in 2013 to 2014. This study was performed to investigate the molecular epidemiology of increased B. cereus bacteremia cases in our center. METHODS: Pediatric cancer patients who developed B. cereus bacteremia were identified from January 2001 to June 2014. The B. cereus bacteremia in this study was defined as a case in which at least one B. cereus identified in blood cultures, regardless of true bacteremia. Available isolates were further tested by multilocus sequence typing (MLST) analysis. A retrospective chart review was performed. RESULTS: Nineteen patients developed B. cereus bacteremia during the study period. However, in 2013, a sudden increase in the number of patients with B. cereus bacteremia was observed. In addition, three patients developed B. cereus bacteremia within 1 week in July and the other three patients within 1 week in October, respectively, during emergency room renovation. However, MLST analysis revealed different sequence types without consistent patterns. Before 2013, five tested isolates were ST18, ST26, ST177, and ST147-like type, and ST219-like type. Isolates from 2013 were ST18, ST73, ST90, ST427, ST784, ST34-like type, and ST130-like type. CONCLUSIONS: MLST analyses showed variable ST distribution of B. cereus isolates. Based on this study, there was no significant evidence suggesting a true outbreak caused by a single ST among patients who developed B. cereus bacteremia.
Bacillus cereus* ; Bacillus* ; Bacteremia ; Cross Infection ; Disease Outbreaks ; Emergency Service, Hospital ; Humans ; Molecular Epidemiology* ; Multilocus Sequence Typing ; Pediatrics ; Retrospective Studies