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Clinical Spectrum of Norovirus Gastroenteritis Compared to Rotavirus Gastroenteritis at a Single Center in Gwanju, Korea during 2005-2006; Compared to Rotaviral Gastroenteritis.

Yang Jin LEE ; Seong Nam JEONG ; Ju Hee YOO ; Hyoung Min CHO ; Eun Jung YOO ; Eun Young KIM ; Yong Wook KIM ; Kyoung Sim KIM ; Sun Hee KIM

Korean Journal of Pediatric Infectious Diseases.2009;16(1):61-72.

PURPOSE:We evaluated the clinical features of Norovirus gastroenteritis compared with Rotavirus gastroenteritis in hospitalized children. METHOD:We detected causative agents in 3,261 samples of children hospitalized with gastroenteritis symptoms at a single center of pediatrics between 2005 and 2006. Among 266 and 303 samples which tested positive for Norovirus and Rotavirus, we selected 73 and 182 samples of children with relatively pure gastroenteritis symptoms and retrospectively analyzed the corresponding medical records. RESULTS:The male-to-female ratio of the Norovirus (+) and Rotavirus (+) groupswas 1.43:1 and 1.56:1 both groups were predominantly in males. The mean age of the Norovirus (+) and Rotavirus (+) groups was 36.7 and 24.4 months, respectively the children in the former group were older than the children in the latter group. The incidence in the Norovirus (+) group was more concentrated in the winter. The symptoms in the Norovirus (+), in decreasing order, included vomiting, diarrhea, and fever. The duration of vomiting, diarrhea, and fever was 2.1, 1.2, and 1.2 days. The maximum number of episodes of vomiting and diarrhea per day was 3.5 and 4.5, respectively. The severity score was 10.16. The symptoms inthe Rotavirus (+) group, in decreasing order, included diarrhea, vomiting, and fever. The duration of diarrhea, vomiting, and fever was 2.2, 4.3, and 2.2 days, respectively. The maximum number of episodes of vomiting and diarrhea per day was 3.3 and 6.5, respectively. The severity score was 11.9. The severity in the Norovirus (+) group was somewhat lower than the Rotavirus (+) group. The younger the child, the more severe the symptoms in the Norovirus (+) group. There was no difference between mono-and co-infection in severity and between the two groups regarding the hematologic findings. CONCLUSION:Based on the findings reported herein, additional studies about prophylaxis, as well as the epidemiology and clinical features of pediatric Norovirus gastroenteritis, are required.
Child ; Child, Hospitalized ; Coinfection ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Incidence ; Korea ; Male ; Norovirus ; Pediatrics ; Retrospective Studies ; Rotavirus ; Vomiting

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Adverse Events Following Yellow Fever Vaccination in Korean Children.

Jae Yo LEE ; Tae Hee KIM ; Hyang Mi PARK ; Hye Jung SHIN ; Kyeung Eun KIM ; Sang Taek LEE ; Jae Yoon KIM

Korean Journal of Pediatric Infectious Diseases.2009;16(1):54-60.

PURPOSE:Yellow fever, a mosquito-borne viral hemorrhagic fever, is one of the most lethal diseases. Recently there have been an increasing number of Korean children who have travelled to yellow fever endemic zones and were administered yellow fever vaccine (YFV). Therefore, we carried out this study to provide child travelers with safety information of YFV. METHODS:This study was conducted at the International Clinic of National Medical Center in Seoul between April 2007 and June 2008 for the evaluation of adverse events of YFV. One hundred twenty- five children received YFV (17-DD) and were prospectively monitored for adverse events through telephone interviews on day 3, 6, 9, 16, 23 and 30 after vaccination. RESULTS:Adverse events were observed in 31 (24.8%) of 125 child travelers who received the YFV. The mean age was 12.5+/-5.0 years. Sixty-six of the child travelers (52.8%) were males. The common adverse events were pain in 11 (8.8%), swelling in 8 (6.4%) and redness in 7 children (5.6%) at the injection site. The systemic adverse events included mild fever in 5 (4.0%), headache in 5 (4.0%), cough in 4 (3.2%), abdominal pain in 3 (2.4 %), and vomiting in 2 children (1.6%). Most of the adverse events were detected within 7 days of administration and there were no differences in adverse events by gender or age. All travelers who had complained of symptoms improved spontaneously or following symptomatic treatment. CONCLUSION:This study showed that YFV is well-tolerated and there were no reports of severe adverse events. Studies are ongoing to clarify the cause and risk factors for rare adverse events.
Abdominal Pain ; Child ; Cough ; Fever ; Headache ; Hemorrhagic Fevers, Viral ; Humans ; Interviews as Topic ; Male ; Prospective Studies ; Risk Factors ; Vaccination ; Vomiting ; Yellow Fever ; Yellow Fever Vaccine

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Molecular Serotyping of Group B Streptococcus Isolated from the Pregnant Women by Polymerase Chain Reaction and Sequence Analysis.

Chi Eun OH ; Hyun Oh JANG ; Nam Hee KIM ; Jina LEE ; Eun Hwa CHOI ; Hoan Jong LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(1):47-53.

PURPOSE:This study was performed to investigate the serotype distribution of group B streptococcus (GBS) isolated from pregnant Korean women using molecular methods. METHODS:The study materials included 42 GBS isolates obtained from the vagina and anorectum of pregnant women in Seoul, Korea between 2005 and 2006. Four clinical isolates with known serotypes (Ia, Ib, III, and V) were used for validation of molecular serotyping. We used serotype-specific primers for identification of the serotypes (Ia, Ib, III, V, and VI). To determine the ambiguous serotypes by serotype-specific PCR, sequence analysis of the PCR amplicons which had been amplified with GBS-common primers was used. RESULTS:The serotypes determined by the molecular methods agreed with the previously known 4 serotypes (Ia, Ib, III, and V). The serotypes of all 42 isolates were successfully determined by molecular methods. The distribution of the GBS serotype was as follows in order of frequency: serotype III was found in 12 isolates (28.6%), serotype V was found in 11 isolates (26.2%), serotype Ia was found in 11 isolates (26.2%), serotype VI was found in 4 isolates (9.5%), serotype Ib was found in 2 isolates (4.8%), and serotype II was found in 2 isolates (4.8%). CONCLUSION:Serotypes III, V, and Ia were the most frequently identified serotypes in pregnant Korean women. Molecular serotyping is useful for surveillance of the serotype distribution of GBS in colonized pregnant women and GBS diseases of neonates.
Colon ; Female ; Humans ; Korea ; Polymerase Chain Reaction ; Pregnant Women ; Sequence Analysis ; Serotyping ; Streptococcus ; Vagina

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Predictors of Meningitis in Febrile Infants Aged 3 Months or Younger.

Hyang Soon SONG ; Eun Ok KIM ; Young Taek JANG

Korean Journal of Pediatric Infectious Diseases.2009;16(1):40-46.

PURPOSE:The purpose of this study was to identify useful predictors for diagnosing bacterial meningitis and performing CSF studies in febrile infants three months or younger. METHODS:Six hundred and fifty two febrile infants with a rectal temperature > or =38.0 degreesC presented from January 2003 to April 2008 and were retrospectively studied. The total white blood cell count (WBC), band count, absolute neutrophil count (ANC), quantitative C-reactive protein (CRP) and blood cultures were performed on admission. The clinical variables associated with bacterial meningitis were analyzed. RESULTS:In patients with bacterial meningitis, the clinical variables including CRP (P= 0.036), band count (P=0.037), ANC (P=0.036) and age (P=0.001) were significantly different. The area under the receiver-operating characteristic curve was 0.969 for CRP, 0.946 for the band count, 0.765 for the ANC and 0.235 for age. A CRP cutoff point of 8 mg/dL was determined to maximize both the sensitivity and specificity (sensitivity 83%, specificity 95%, likelihood ratio 16.6). A CRP concentration of <7 mg/dL "ruled-out" bacterial meningitis, with a likelihood ratio of 0.17, a posttest probability of <0.1% and negative predictive value 91%. A CRP concentration greater than 9 mg/dL had a much higher likelihood ratio (20.1) than the band count (16.6) and ANC (2.2). CONCLUSION:The CRP concentration was a useful laboratory test for the differential diagnosis of bacterial meningitis among febrile infants three months of age or younger. A CRP concentration of<7 mg/dL effectively ruled out bacterial meningitis; a value > or =9 mg/dL increased the clinical suspicion of bacterial meningitis and the need for CSF evaluation.
Aged ; C-Reactive Protein ; Diagnosis, Differential ; Fever ; Humans ; Infant ; Leukocyte Count ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity

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Carriage Rates and Serogroups of Neisseria meningitides in Children Attending Day Care Centers.

Nam Hee KIM ; Jina LEE ; Jung Won LEE ; Soo Young LEE ; Eun Hwa CHOI ; Kyung Hyo KIM ; Jin Han KANG ; Eui Chong KIM ; Hoan Jong LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(1):31-39.

PURPOSE:Neisseria meningitides is one of the most common causative pathogens of bacteremia and meningitis. Recently protein-conjugated vaccines have been developed and included in the routine vaccination schedule in a few countries. In Korea, carriage rates of N. meningitides among healthy adults have been reported. However, systematic data for childhood carriage rates are not available. This study was performed to evaluate the carriage rates of N. meningitides and the serotype distribution among healthy children attending day care centers. METHODS:During the period of January through May 2005, nasopharyngeal swabs and culture were obtained from 904 children attending 13 different day care centers located in Seoul and Gyeonggi Province. The Vitek NHI card was used to identify N. meningitides and the crgA gene was detected via polymerase chain reaction (PCR). Serotype determination was performed by agglutination test using N. meningitides antisera to serotypes A, B, C, D, 29E, W135, X, Y, and Z. PCR for detection of the org2 and saiD gene confirmed serotypes A, B, C, W135, and Y. RESULTS:The mean age among 904 children was 4.5 years; 6.5% (59/904) were children < 2 years old, 53.8% (486/904) were 2-5 years old, and 39.7% (359/904) were >5 years old; 52.0% (468/904) were male. N. meningitides was isolated from only 7 children attending 5 different day care centers and the overall carriage rate of N. meningitides was 0.8%. The detected serotypes of N. meningitides were serotype A (n=2), C (n=2), and Y (n=3). CONCLUSION:The carriage rate of N. meningitides among healthy children attending day care centers was very low in Korea and the detected serotypes were A, C, and Y.
Adult ; Agglutination Tests ; Appointments and Schedules ; Bacteremia ; Child ; Day Care, Medical ; Humans ; Immune Sera ; Korea ; Male ; Meningitis ; Neisseria ; Polymerase Chain Reaction ; Vaccination ; Vaccines

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Reappraisal of Live Vaccines and Immunity in These Modern Days.

Kyung Hyo KIM

Korean Journal of Pediatric Infectious Diseases.2009;16(1):24-30.

The vaccines has been developed over the first two hundred years since Jenner's smallpox vaccination. In modern days, vaccination has had the largest impact on the incidence and persistence of infections. Although natural infection induces lifelong immunity, the assumption that the vaccine also confers permanent protection has been reconsidered following outbreaks of measles in students who had been vaccinated 15-20 years prior to infection in the US in the 1980s. Clinical studies have proposed several mechanisms such as vaccine failure in some individuals and the subsequent loss of immunity after vaccination. An ideal vaccine is relatively easy to define, but few real vaccines approach the ideal. Many difficulties account for the failure in producing these ideal vaccines. However, recent advances in methods for studying immune response to pathogens have provided a better understanding of immune mechanisms. Based on these findings, the development of good vaccine formulations allowing stimulation of optimal and prolonged protective immunity and immunization policies or schedules should lead to the introduction of vaccines for previously resistant organisms.
Appointments and Schedules ; Disease Outbreaks ; Humans ; Immunization ; Incidence ; Measles ; Smallpox ; Vaccination ; Vaccines

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Vaccines for Prevention of Otitis Media and Pneumonia in Children.

Hoan Jong LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(1):13-23.

Acute otitis media (AOM) and pneumonia are among the most common infectious diseases of children. Both are mucosal infections and share many common features such as etiological agents, pathogenesis and immunity. Influenza plays an important role in the pathogenesis of AOM and pneumonia. A vaccine against influenza may have substantial impact on these diseases during the influenza season. In clinical trials, influenza vaccine has reduced the incidence of AOM and pneumonia complicating influenza in children. However, the efficacy of vaccines has been controversial in children less than 2 years of age. Similarly, vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), both common causes of AOM and pneumonia, have the potential to reduce the impact of disease. Clinical trials showed that the currently licensed 7-valent pneumococcal conjugate vaccine (PCV), administered during infancy, had an efficacy of 6-7% for the prevention of AOM, however, visits to the clinic for AOM were reduced by up to 20-30% after routine use in the U.S. Both Hib and PCVs have a proven effectiveness of >20% for prevention of radiologically confirmed pneumonia in children. The recently introduced pnuemococcal vaccine conjugated with protein D is expected to reduce AOM and pneumonia caused by non-typable H. influenzae, in addition to its effects on pneumococcal diseases. Considering their high incidence in children, recent achievements in the prevention of AOM and pneumonia with vaccines may have a significant economic and social impact.
Achievement ; Child ; Communicable Diseases ; Haemophilus influenzae type b ; Humans ; Incidence ; Influenza Vaccines ; Influenza, Human ; Otitis ; Otitis Media ; Pneumonia ; Seasons ; Social Change ; Streptococcus pneumoniae ; Vaccines

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New Antimicrobial Agents for Children.

Byung Wook EUN

Korean Journal of Pediatric Infectious Diseases.2009;16(1):6-12.

There are relatively few novel antimicrobial agents despite the dramatic increase in antimicrobial resistance and multiple drug resistance of clinical isolates worldwide. Vancomycin is still the most widely used antibiotic for treating resistant Gram-positive coccal infections in children, especially for methicillin-resistant Staphylococcus aureus. For children with Gram-positive coccal infections where vancomycin is not effective or older therapeutic agents cannot be tolerated, linezolid, quinupristin-dalfopristin or daptomycin may be useful in the appropriate clinical setting. For Gram-negative infections, new carbapenems await clinical application. Tebipenem pivoxil is a novel oral carbapenem undergoing clinical trials for acute otitis media in pediatric patients. Antiviral drug development is now progressing at the pace of antibiotic development 30 years ago. Newer antiviral agents used for the treatment of herpes viruses and hepatitis C virus infections in children are included in this review.
Acetamides ; Anti-Bacterial Agents ; Anti-Infective Agents ; Antiviral Agents ; Carbapenems ; Child ; Daptomycin ; Drug Resistance, Multiple ; Hepacivirus ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Otitis Media ; Oxazolidinones ; Vancomycin ; Virginiamycin ; Linezolid

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Clinical Manifestation and Treatment of Methicillin-resistant Staphylococcus aureus Infections in Children.

Eun Hwa CHOI

Korean Journal of Pediatric Infectious Diseases.2009;16(1):1-5.

Methicillin-resistant Staphylococcus aureus (MRSA), a leading cause of nosocomial infections, has been increasingly recognized in communities of the United States. This article will review the clinical spectrum and treatment of MRSA infections in children in the context of recent epidemiological changes of MRSA infections. In general, community-associated (CA) MRSA most frequently causes skin and soft tissue infections and has an increased association with invasive infections, particularly pneumonia and musculoskeletal infections. Hospital-associated (HA) MRSA strains tend to be associated with bloodstream infections, pneumonia, and surgical site infections. Different from the United States, CA-MRSA infections are not common in Korea (only 5.9%); however, there are some CA-MRSA clones that are different from HA- MRSA clones in Korea and from CA-MRSA clones in other countries. The treatment of MRSA infections should be guided by antimicrobial susceptibility testing, the site of infection, and the infection severity. Vancomycin is the treatment of choice for invasive MRSA infections. Other agents such as trimethoprim- sulfamethoxazole, clindamycin, linezolid, quinupristin-dalfopristin, and daptomycin have been used for some conditions.
Acetamides ; Child ; Clindamycin ; Clone Cells ; Cross Infection ; Daptomycin ; Humans ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxazolidinones ; Pneumonia ; Skin ; Soft Tissue Infections ; Staphylococcus aureus ; Sulfamethoxazole ; United States ; Vancomycin ; Virginiamycin ; Linezolid

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Prevention of Invasive Candida Infections in the Neonatal Intensive Care Unit.

Chun Soo KIM

Korean Journal of Pediatric Infectious Diseases.2011;18(1):15-22.

Invasive Candida infections (ICI) have become the third most common cause of late-onset infection among premature infants in the neonatal intensive care unit (NICU). Risk factors include birth weight less than 1,000 g, exposure to more than two antimicrobials, third generation cephalosporin exposure, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery. Candida colonization of the skin and gastrointestinal tract is an important first step in the pathogenesis of invasive disease. Strict infection control measures against the infection should be done in the NICU. The following practices are likely to contribute to reducing the rate of ICI: (1) restriction of broad-spectrum antibiotics, antacids and steroid; (2) introduction of early feeding and promoting breast milk. Fluconazole prophylaxis may be an effective control measure to prevent Candida colonization and infections in individual units with high incidence of fungal infection. In addition, there is a need of further data including the development of resistant strains and the effect on long-term neurodevelopmental outcomes of infants exposed to drugs before the initiation of routine application of antifungal prophylaxis in the NICU.
Antacids ; Anti-Bacterial Agents ; Birth Weight ; Candida ; Central Venous Catheters ; Colon ; Fluconazole ; Gastrointestinal Tract ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infection Control ; Intensive Care, Neonatal ; Milk, Human ; Parenteral Nutrition ; Resin Cements ; Risk Factors ; Skin

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