BACKGROUND AND OBJECTIVES: Kawasaki disease (KD) is a febrile acute multi-systemic vasculitis, which develops into carditis and coronary aneurysm. This study was performed to investigate cardiac troponin T (cTnT), troponin I (cTnI) and creatinine kinase-MB fraction (CK-MB) for diagnostic and prognostic value in acute KD before IVGG (intravenous gamma globulin). SUBJECTS AND METHODS: The KD group comprised of 45 patients hospitalized between Jan. 2000 and Jul. 2003, with 25 non KD febrile illness subjects as controls. The KD group was subdivided into groups A (persistent normal coronary artery, n=20), B (abnormal coronary artery, n=19) and C (carditis, n=6) according to the initial echocardiography. The cTnT, cTnI and CK-MB levels were measured and compared. RESULTS: Comparing the KD and control subjects, the cTnT (0.0101+/-0.0030 vs. 0.0090+/-0.0000 ng/mL, p=0.025) and cTnI (0.0662+/-0.0581 vs. 0.0143+/-0.0112 ng/mL, p=0.000) were significantly elevated in the KD patients. However, all the data were within normal reference ranges. In a comparison among the KD groups, the number of infants, total fever duration and IVGG re-treatment were significantly higher in group B (p=0.021, 0.046 and 0.007, respectively). There were no significant differences in the cTnT, cTnI and CK-MB levels between the 3 groups. The CK-MB and cTnI levels were slightly elevated in group B compare to groups A+C, but these were not statistically significant. The CK-MB, cTnT and cTnI levels were slightly elevated in those with cardiac abnormalities (groups B+C) compare to group A, but these were not significant. The cTnT and cTnI levels were significantly decreased in the subacute phase (p=0.034 and 0.000, respectively). CONCLUSION: The levels of cTnT, cTnI, CK-MB were not very useful tools for detecting and predicting subsequent cardiac damage in KD patients. However, the cTnI level appears to be a more sensitive marker than the cTnT or CK-MB levels in KD patients.
Coronary Aneurysm ; Coronary Vessels ; Creatinine ; Echocardiography ; Fever ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Myocarditis ; Reference Values ; Troponin I* ; Troponin T* ; Troponin* ; Vasculitis

Although antenatal diagnostic technique has considerably improved, precise detection and proper management of the neonate with congenital heart disease (CHD) is always a great concern to pediatricians. Congenital cardiac malformations vary from benign to serious conditions such as complete transposition of the great arteries (TGA), critical pulmonary and aortic valvular stenosis/atresia, hypoplastic left heart syndrome (HLHS), obstructed total anomalous pulmonary venous return (TAPVR), which the baby needs immediate diagnosis and management for survival. Unfortunately, these life threatening heart diseases may not have obvious evidence early after birth, most of the clinical and physical findings are nonspecific and vague, which makes the diagnosis difficult. High index of suspicion and astute acumen are essential to decision making. When patent ductus arteriosus (PDA) is opened widely, many serious malformations may not be noticed easily in the early life, but would progress as severe acidosis/shock/cyanosis or even death as PDA constricts after few hours to days. Ductus dependent congenital cardiac lesions can be divided into the ductus dependent systemic or pulmonary disease, but physiologically quite different from each other and treatment strategy has to be tailored to the clinical status and cardiac malformations. Inevitably early presentation is often regarded as a medical emergency. Differential diagnosis with inborn error metabolic disorders, neonatal sepsis, persistent pulmonary hypertension of the newborn (PPHN) and other pulmonary conditions are necessary. Urgent identification of the newborn at such high risk requires timely referral to a pediatric cardiologist, and timely intervention is the key in reducing mortality and morbidity. This following review deals with the clinical presentations, investigative modalities and approach to management of congenital cardiac malformations presenting in the early life.
Arteries ; Decision Making ; Diagnosis, Differential ; Ductus Arteriosus, Patent ; Early Intervention (Education) ; Emergencies ; Heart ; Heart Diseases ; Humans ; Hypertension, Pulmonary ; Hypoplastic Left Heart Syndrome ; Infant, Newborn ; Lung Diseases ; Parturition ; Referral and Consultation ; Scimitar Syndrome ; Sepsis

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

BACKGROUND: Candida dubliniensis is newly described yeast that is a close phylogenetic relative of C. albicans and isolates mainly from the oral cavity. OBJECTIVE: The aim of the present study was to screen for C. dubliniensis using the 'spiking' appearance on a blood agar plate (BAP), germ tube test with human pooled serum (HPS) and fetal bovine serum (FBS) and to investigate the prevalence of C. dubliniensis from respiratory samples in Korea. METHODS: A total 434 isolates of Candida spp. were examined for the presence of 'spiking' on BAP and the germ tube test with HPS and FBS. Also all isolates were tested using the VITEK 2 ID-YST system. RESULTS: No C. dubliniensis was found in the study population. C. albicans was the most frequently isolated species (74.9%). CONCLUSIONS: No C. dubliniensis was identified in our study. Further large-scale studies are needed to isolate and to confirm the prevalence of C. dubliniensis.
Agar ; Candida ; Humans ; Korea ; Mass Screening ; Mouth ; Prevalence ; Yeasts

Edwards syndrome, also called trisomy 18, is one of the most common autosomal anomalies. The survival rate of patients with Edwards syndrome is very low and its characteristic findings include cardiac malformations, mental retardation, growth retardation, specific craniofacial anomalies, clenched hands, rocker-bottom feet, and omphalocele. Compared with the classic Edwards syndrome, the symptom of partial duplication of chromosome 18 is relatively mild with a good prognosis. We report the case of a baby with partial duplication 18q11.2-q12. The characteristic phenotype features of Edwards syndrome were observed in the patient. However, the symptom was milder than the typical Edwards syndrome. At present, we can expect better prognosis for this patient.
Chromosomes, Human, Pair 18 ; Foot ; Hand ; Hernia, Umbilical ; Humans ; Intellectual Disability ; Phenotype ; Prognosis ; Survival Rate ; Trisomy

PURPOSE: Pneumonia is one of the most common respiratory diseases in hospitalized children, and often recurs. It has been reported that asthma is one of the significant contributing factors to recurrent pneumonia. On the basis of similarities between asthma and recurrent pneumonia, we intended to evaluate the influence of allergy on recurrent pneumonia. METHODS: Seventy one children with recurrent pneumonia were defined as recurrent group(RG) and twenty one children with first episodes of pneumonia were defined as control group(CG). WBC, total eosinophil count, Eosinophilic Cationic Protein(ECP), serum total IgE and specific IgE for eleven common allergens using the CAP system were measured and compared. Recurrent pneumonia was defined as at least two pneumonia episodes in a year, or at least three episodes from birth to the time of our study. Children with previous allergic disorders were excluded. RESULTS: There were no statistical differences in WBC, total IgE, and ECP between the two groups. Total eosinophil count in RG was significantly higher than CG(P=0.021), significantly correlating with ECP(r=0.755, P<0.05) and total IgE(r=0.354, P<0.05). When the cut-off value was 0.35 kU/L in CAP test, positive prevalence of CAP in RG was significantly higher than CG(P=0.009). Also, the positive prevalence of house dust mites group, especially Dermatophagoides farinae(D.f.), was significantly higher in RG(P=0.019, 0.025, respectively). When the cut-off value was 0.7 kU/L in CAP test, only a positive prevalence of house dust mites group was significantly higher in RG than CG (P=0.042). The quantitative levels of specific IgE for Dermatophagoides pteronyssinus(D.p.) and D.f. were very high in RG(P=0.018, 0.028, respectively), significantly correlating with each other(r=0.639, P<0.05). CONCLUSION: Allergic sensitization, especially to house dust mites, is one important contributable factor in recurrent pneumonia in children. Further study, such as bronchial hyperresponsiveness, is needed in children who were sensitized by D.p. or D.f..
Allergens ; Asthma ; Child* ; Child, Hospitalized ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Eosinophils ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Parturition ; Pneumonia* ; Prevalence ; Pyroglyphidae