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A Case of an Imported Dengue Hemorrhagic Fever with Spontaneous Bleeding: Case Report and Review of the Literature.

Hyun Hyi CHOI ; Jeong A PARK ; Jun Soo KIM ; Yun Jung HUR ; Min Seop SONG ; Tae Gyu HWANG ; Yong CHOI

Korean Journal of Pediatric Infectious Diseases.2011;18(2):207-211.

Dengue is an acute febrile viral disease which is found in tropical and sub-tropical regions around the world. Dengue fever has steadily increased in both incidence and distribution over the past 50 years. Even though Korea is not an endemic country for dengue fever, with the increasing numbers of overseas travelers in Korea, the numbers of imported dengue cases are steadily increasing. Here, we report a case of imported dengue hemorrhagic fever in a Korean child presenting with fever and epistaxis. Dengue fever should be considered if a patient who has a recent travel history to endemic areas showed classical symptoms.
Child ; Dengue ; Dengue Hemorrhagic Fever ; Epistaxis ; Exanthema ; Fever ; Humans ; Incidence ; Korea ; Purpura ; Virus Diseases

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Clinical Characteristics of Bacteremia in Children with Cancer.

Mi Sun CHANG ; Ki Woong SUNG ; Yae Jean KIM

Korean Journal of Pediatric Infectious Diseases.2011;18(2):201-206.

PURPOSE: Bacteremia is one of the most common causes of morbidity and mortality in children with cancer. The aim of this study was to evaluate the clinical features of bacteremia in pediatric cancer patients. METHODS: We retrospectively analyzed bacteremia episodes occurred in pediatric cancer patients at Samsung Medical Center from January 2008 to December 2010. We excluded bacteremia episodes after hematopoietic stem cell transplantation. RESULTS: A total of 141 blood cultures were positive in 121 patients. Thirteen cultures due to contamination were excluded. For analysis, 128 bacteremia episodes in 108 children were included. Gram-positive organisms accounted for 46.9% (60/128) and gram-negative organisms for 53.1% (68/128). The source of bacteremia was identified in 21.1% of episodes. Bacteremia due to catheter related infection was observed in 9.4% of episodes (12/128 episodes) and gram-positive organisms were isolated in 75% of episodes (9/12). There were 10 cases (7.8%) of bacteremia associated with septic shock and gram-negative organisms were isolated in 80% of episodes (8/10). Relapses were documented within 30 days in 2 patients who cleared bacteremia which was confirmed after negative blood cultures. Mortality associated with bacteremia was not observed. CONCLUSION: Continuous monitoring is needed to maintain the tailored strategies to manage pediatric cancer patients with neutropenic fever who are at high risk of developing bacteremia in each institution.
Bacteremia ; Catheters ; Child ; Fever ; Hematopoietic Stem Cells ; Humans ; Recurrence ; Retrospective Studies ; Shock, Septic

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Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment.

Yu Rak SOHN ; Jong Hee KIM ; Sang Hyuk MA ; Kyung Yil LEE ; Jin Han KANG

Korean Journal of Pediatric Infectious Diseases.2011;18(2):193-200.

PURPOSE: The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. METHODS: A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. RESULTS: The mean age and male-to-female ratio of the patients were 6.5+/-2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4+/-0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. CONCLUSION: For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.
Adrenal Cortex Hormones ; Aged ; Antiviral Agents ; Child ; Dyspnea ; Fever ; Humans ; Influenza, Human ; Medical Records ; Methylprednisolone ; Orthomyxoviridae ; Oseltamivir ; Oxygen ; Pandemics ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Thorax ; Viruses

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A Case of Therapy of Aerosolized Ribavirin in a Leukemia Infant with RSV Infection.

Hyo Jin KWON ; Myung Jin OH ; Jae Wook LEE ; Nak Gyun CHUNG ; Bin CHO ; Hack Ki KIM ; Jin Han KANG

Korean Journal of Pediatric Infectious Diseases.2012;19(3):162-167.

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

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Acute Acalculous Cholecystitis with Bacteremia Caused by Streptococcus anginosus Following Dental Procedure in a Previously Healthy Adolescent.

Hyun O KIM ; Sook Kyung YUM ; Seung Beom HAN ; Hyo Jin KWON ; Jin Han KANG

Korean Journal of Pediatric Infectious Diseases.2012;19(3):157-161.

Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.
Acalculous Cholecystitis ; Adolescent ; Bacteremia ; Cholecystitis ; Fever ; Gastrointestinal Tract ; Humans ; Mouth Mucosa ; Respiratory System ; Risk Factors ; Streptococcus ; Streptococcus anginosus ; Streptococcus milleri Group ; Vomiting

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Protective Field Efficacy Study of Influenza Vaccines for Korean Children and Adolescent in 2010-2011 Season.

Seung Youn KIM ; Nam Hee KIM ; Byung Wook EUN ; So Hee KIM ; Ki Won PARK ; Hyun Oh JANG ; Eun Kyeong KANG ; Dong Ho KIM

Korean Journal of Pediatric Infectious Diseases.2012;19(3):149-156.

PURPOSE: We conducted a prospective comparative clinical study to determine the field efficacy of the 2010-2011 influenza vaccines [Influenza virus strains; A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2), B/Brisbane/60/2008] in healthy Korean children under 18 years of age. METHODS: In this study, we enrolled subjects aged between 6 months and 18 years and divided them into 2 study groups: a group who received the influenza vaccines (407 subjects), and a control group who did not receive the influenza vaccines (230 subjects). Ours was a multicenter study that involved 7 hospitals, including the Korea Cancer Center Hospital. The study was conducted between September 2010 and February 2011. We collected nasal wash or throat swab samples from subjects who presented with acute febrile respiratory or influenza-like illnesses at the hospital. We used PCR to confirm the presence of the influenza virus in the respiratory samples and characterize the virus type. RESULTS: In this study, we collected 22 respiratory samples from the influenza-vaccinated group and found 3 cases of influenza virus infection. Similarly, we collected 21 samples from the control group and found 12 cases of influenza virus infection among 10 subjects during the study period. We determined the field efficacy of the 2010-2011 seasonal influenza vaccines to be 83.2% in healthy Korean children and adolescents. CONCLUSION: In this study, we determined the field efficacy of the 2010-2011 seasonal influenza vaccines in healthy Korean children and adolescents. We found that the field efficacy of 2010-2011 seasonal influenza vaccines was adequate.
Adolescent ; Aged ; Child ; Humans ; Influenza Vaccines ; Influenza, Human ; Korea ; Orthomyxoviridae ; Pharynx ; Polymerase Chain Reaction ; Prospective Studies ; Seasons ; Viruses

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A Fifteen-year Epidemiological Study of Ventriculoperitoneal Shunt Infections in Pediatric Patients: A Single Center Experience.

Yeon Kyung KIM ; Hyung Jin SHIN ; Yae Jean KIM

Korean Journal of Pediatric Infectious Diseases.2012;19(3):141-148.

PURPOSE: Ventriculoperitoneal (VP) shunt insertion is an important treatment modality in children with hydrocephalus. VP shunt infection is a major complication and an important factor that determines the surgery outcome. This 15-year study was performed to evaluate the epidemiology of VP shunt infections in pediatric patients treated at our center. METHODS: A retrospective review of medical records was performed in patients 18 years old or younger who underwent VP shunt insertion surgery from April 1995 to June 2010. RESULTS: Three hundred twenty-seven VP shunt surgeries were performed in a total of 190 pediatric patients (83 females, 107 males). The median age of the patients was 2.4 years (range, 0.02-17.9 years). Having a malignant brain tumor was the most frequent cause for VP shunt insertion. The shunt infection rate was 6.7% (22/327) per 100 operations and 9.5% (18/190) per 100 patients, and the incidence rate was 0.45 infection cases per 100 shunt operations-year. The most common pathogen was coagulase-negative staphylococcus (n=7) followed by methicillin resistant Staphylococcus aureus (n=1). Ten cases were treated with vancomycin and beta-lactam antibiotic (cephalosporin or carbapenem) combination therapy and 7 cases were treated with vancomycin monotherapy. The median duration of antibiotic treatment was 26 days (range, 7 to 58 days). Surgical intervention was performed in 18 cases (18/22, 81.8%). CONCLUSION: Epidemiologic information regarding VP shunt infections in pediatric patients is valuable that will help guide proper antibiotic management. Additional studies on the risk factors for developing VP shunt infections are also warranted.
Brain Neoplasms ; Child ; Epidemiologic Studies ; Female ; Humans ; Hydrocephalus ; Incidence ; Medical Records ; Methicillin Resistance ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Staphylococcus aureus ; Vancomycin ; Ventriculoperitoneal Shunt

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Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study.

Ji Eun KANG ; Joon Young SEOK ; Ki Wook YUN ; Hyoung Jin KANG ; Eun Hwa CHOI ; Kyung Duk PARK ; Hee Young SHIN ; Hoan Jong LEE ; Hyo Seop AHN

Korean Journal of Pediatric Infectious Diseases.2012;19(3):131-140.

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.
Amikacin ; Bacteremia ; Bacteria ; Cefotaxime ; Child ; Escherichia coli ; Fever ; Fungi ; Gentamicins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella ; Neutropenia ; Oxacillin ; Penicillins ; Retrospective Studies ; Shock ; Staphylococcus aureus ; Vancomycin

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A Case of Fatal Myocarditis Associated with Mycoplasma pneumoniae Pneumonia.

Dae Il KIM ; Jin Hyoung CHOI ; Eun Young CHO ; Young June CHOI ; Ji Yeon SUNG ; Mi Ae YANG ; Chi Eun OH ; So Hee KIM ; Jun Ho LEE ; Jina LEE ; Eun Hwa CHOI ; Hoan Jong LEE

Korean Journal of Pediatric Infectious Diseases.2009;16(1):92-96.

Mycoplasma pneumoniae is a common cause of respiratory tract infections. And M. pneumoniae infection frequently manifests with extrapulmonary symptoms such as central nervous system complications, skin or mucosal involvement, and gastrointestinal problems. However, cardiac complications associated with M. pneumoniae are rarely reported. We report the case of a 47-month-old girl who died of fulminant myocarditis associated with M. pneumoniae pneumonia.
Central Nervous System ; Mycoplasma ; Mycoplasma pneumoniae ; Myocarditis ; Pneumonia ; Pneumonia, Mycoplasma ; Preschool Child ; Respiratory Tract Infections ; Skin

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A Case of Deep Vein Thrombosis Associated with Myositis due to Streptococcus pyogenes.

Jae Sook LEE ; Tae Young JANG ; Young Min AHN

Korean Journal of Pediatric Infectious Diseases.2009;16(1):87-91.

A 5-year-old boy was admitted to the hospital with a high fever and abnormal gait. Magnetic resonance imaging showed extensive swelling of the quadriceps and adductor muscles around the right hip and anterior thigh. A duplex scan demonstrated a thrombus from the external iliac vein to below the popliteal vein. The blood culture revealed Streptococcus pyogenes. The patient was immediately treated with antibiotics and anticoagulants. Follow-up sonography demonstrated complete disappearance of the venous thrombosis. We report a case of streptococcal myositis complicated by deep vein thrombosis.
Anti-Bacterial Agents ; Anticoagulants ; Fever ; Follow-Up Studies ; Gait ; Hip ; Humans ; Iliac Vein ; Magnetic Resonance Imaging ; Muscles ; Myositis ; Popliteal Vein ; Preschool Child ; Streptococcus ; Streptococcus pyogenes ; Thigh ; Thrombosis ; Veins ; Venous Thrombosis

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