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Kawasaki Disease with Influenza A Virus and Mycoplasma pneumoniae Infections: A Case Report and Review of Literature.

Hyeok Soo MOON ; Jae Seong HUH ; Mi Kyung KIM ; Mulakwa Morisho LAMBERT

Pediatric Infection & Vaccine.2016;23(2):149-154. doi:10.14776/piv.2016.23.2.149

Although an association of Kawasaki disease (KD) with infectious agents has been suggested, none have been proven to cause KD. In this case study, we present a case of KD with concurrent onset of influenza and Mycoplasma pneumoniae (MP) infections. A 27-month-old boy presented with prolonged fever, cough, and rhinorrhea. During the initial testing, influenza A infection was identified, and he was treated with oseltamivir. Despite the antiviral therapy, the fever persisted, and he had cervical lymph node enlargement, bilateral conjunctival injection, fissured red lips, strawberry tongue, and erythematous skin lesions on the Bacillus Calmette-Guérin vaccination site. Thus, the patient was diagnosed with KD and was treated with intravenous immunoglobulin (IVIG). The result of the initial antimycoplasma immunoglobulin M (IgM) antibody testing and was positive, and an increased IgM titer from baseline was found in a repeat test. We reviewed the hypotheses on pathogens known to be associated with KD and the etiology of KD. Based on our findings, we suspect that symptoms of KD and coronary artery lesions can occur from various infections besides those caused by Mycoplasma species and influenza viruses.
Bacillus ; Child, Preschool ; Coronary Vessels ; Cough ; Fever ; Fragaria ; Humans ; Immunoglobulin M ; Immunoglobulins ; Influenza A virus* ; Influenza, Human* ; Lip ; Lymph Nodes ; Male ; Mucocutaneous Lymph Node Syndrome* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Orthomyxoviridae ; Oseltamivir ; Pneumonia, Mycoplasma* ; Skin ; Tongue ; Vaccination

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A Case of Lemierre Syndrome Manifests with Persistent Fever and Neck Stiffness Following Acute Oropharyngeal Infection.

Yena LEE ; Ye Seul HONG ; Sung Soo KIM

Pediatric Infection & Vaccine.2016;23(2):143-148. doi:10.14776/piv.2016.23.2.143

Lemierre syndrome is a rare disease involving multiple organs affected by septic emboli following oropharyngeal infection. After the introduction of penicillin in the 1940s, it became a "forgotten" disease. However, due to the development of diagnostic image modalities including neck computed tomography (CT) scan, the number of published reports of Lemierre syndrome and diagnosis has been increasing since the 1990s. In this report, we describe a case of Lemierre syndrome, following oropharyngeal infection in a 16-year-old patient, who manifested with persistent fever and neck stiffness. Neck ultrasonography confirmed thrombus formation in the right internal jugular vein without definite evidence of septic emboli to other organs. After the three-week-long antibiotics therapy was completed, the thrombus in the right internal jugular vein finally disappeared.
Adolescent ; Anti-Bacterial Agents ; Diagnosis ; Fever* ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Neck* ; Penicillins ; Rare Diseases ; Thrombophlebitis ; Thrombosis ; Ultrasonography

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Severe Cytomegalovirus Infection in a Late-Preterm Infant at 2 Months of Age.

Seo Yeol CHOI ; Kun Song LEE

Pediatric Infection & Vaccine.2016;23(2):137-142. doi:10.14776/piv.2016.23.2.137

Severe cytomegalovirus (CMV) infection involving multiorgan is very rare except in very low-birth weight infants, or in immunocompromised pediatric patients. We report an unusual case of severe CMV infection involving multiple organs including the central nervous system, liver, lung, and gastrointestinal tract in a late-preterm infant at 2 months of age.
Central Nervous System ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Gastrointestinal Tract ; Humans ; Infant* ; Liver ; Lung

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Clinical Characteristics of Fever without Localizing Sign in Infants Younger than 100 Days of Age in a Single Center.

Hyun Suk LEE ; Kye Hyang LEE

Pediatric Infection & Vaccine.2016;23(2):128-136. doi:10.14776/piv.2016.23.2.128

PURPOSE: This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future. METHODS: We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI. RESULTS: Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group. CONCLUSIONS: Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.
Academic Medical Centers ; Bacterial Infections ; Birth Weight ; Daegu ; Diagnosis ; Fever* ; Humans ; Infant* ; Leukocytosis ; Male ; Medical Records ; Meningitis, Aseptic ; Meningitis, Bacterial ; Pyuria ; Retrospective Studies ; Risk Factors ; Siblings ; Spinal Puncture ; Urinary Tract Infections

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Vaccine Evaluation Studies Performed in Korea from 2000 to 2014.

Jihei CHA ; Han Wool KIM ; Soyoung LEE ; Hye Kyung CHO ; Jong Gyun AHN ; Kyung Hyo KIM

Pediatric Infection & Vaccine.2016;23(2):117-127. doi:10.14776/piv.2016.23.2.117

PURPOSE: Vaccine evaluation studies were initiated from 2000 by the Ministry of Food and Drug Safety to produce proper data about the safety and immunogenicity of vaccines. The purpose of this study was to review studies and reports on evaluation of vaccine such as immunogenicity, efficacy, effectiveness, safety and other related topics in order to find and analyze the data on the usefulness of each vaccine. METHODS: From 2000 to 2014, the project "The vaccine evaluation" had been performed by several researchers, and studies and reports of vaccine evaluation. We reviewed the results and outcomes of studies regarding the evaluation of vaccine's usefulness and analyzed the possibilities of applying these data for establishing vaccine policies. For each vaccine, data analysis and organization were done according to evaluation fields. RESULTS: A total of 83 studies were performed on vaccines from 2000 to 2014. For each vaccine, 8 studies were performed on BCG, 14 on DTaP/Td, 1 on poliovirus, 5 on Hib, 3 on pneumococcus, 11 on influenza, 3 on hepatitis A, 11 on MMR, 11 on varicella, and 16 on Japanese encephalitis. All studies were analyzed by the following evaluation area, such as safety, immunogenicity, seroprevalence, persistence of immunity, efficacy, effectiveness, vaccine evaluation methods, quality control product for vaccine, and others. CONCLUSIONS: Vaccine evaluation studies performed in Korea may be useful as references for establishing vaccination strategy and policy and could be used as baseline data for future studies on vaccine evaluation, vaccine policy establishment, and public/expert vaccine education in Korea.
Chickenpox ; Education ; Encephalitis, Japanese ; Haemophilus influenzae type b ; Hepatitis A ; Influenza, Human ; Korea* ; Mycobacterium bovis ; Poliovirus ; Quality Control ; Republic of Korea ; Seroepidemiologic Studies ; Statistics as Topic ; Streptococcus pneumoniae ; Vaccination ; Vaccines

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Vitamin D and Risk of Respiratory Tract Infections in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Jong Gyun AHN ; Dokyung LEE ; Kyung Hyo KIM

Pediatric Infection & Vaccine.2016;23(2):109-116. doi:10.14776/piv.2016.23.2.109

PURPOSE: Recent observational studies have found that vitamin D deficiency is associated with respiratory tract infections. However, randomized controlled trials (RCTs) regarding the efficacy of vitamin D in childhood respiratory tract infection (RTI) have yield inconsistent results. We performed a systematic review and meta-analysis to evaluate the association between vitamin D supplementation and the risk of RTI. METHODS: A comprehensive search was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trial. Randomized controlled trials of vitamin D supplementation for prevention of RTI in children were included for the analysis. Cochrane Collaboration's tool for assessing the risk of bias was used to assess the quality of the studies. Pooled risk ratios with 95% confidence intervals (CIs) were meta-analyzed using Review Manager 5.3. RESULTS: A total of seven RCTs were included in the meta-analysis. According to a random-effects model, the risk ratio for vitamin D supplementation was 0.82 (95% CI: 0.69-0.98) and I2=62% for heterogeneity. On subgroup analysis, heterogeneity decreased in the subgroup with follow-up less than 1 year, participants ≥5 years of age, patients subgroup, and subgroup with dosing daily. Funnel plot showed that there might be publication bias in the field. CONCLUSIONS: The present meta-analysis supports a beneficial effect of vitamin D supplementation for the prevention of RTI in children. However, the result should be interpreted with caution due to limitations including a small number of available RCTs, heterogeneity among the studies, and potential publication bias.
Bias (Epidemiology) ; Child* ; Follow-Up Studies ; Humans ; Odds Ratio ; Population Characteristics ; Publication Bias ; Respiratory System* ; Respiratory Tract Infections* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

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Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease.

Song Ee YOUN ; Hee Young JU ; Kyung Suk LEE ; Sung Ho CHA ; Mi Young HAN ; Kyung Lim YOON

Pediatric Infection & Vaccine.2016;23(2):102-108. doi:10.14776/piv.2016.23.2.102

PURPOSE: Kawasaki disease (KD) shows a variety of clinical signs of multi-system involvement, including clinical diagnostic criteria. It is unknown that the severity of the clinical signs is associated with the risk of coronary artery lesions (CALs). We wanted to evaluate clinical characteristics and the risk of CALs in the patient groups who had severe skin lesions or those with arthritis. METHODS: We retrospectively reviewed the medical records of 220 KD patients who were treated with intravenous immunoglobulin (IVIG). We compared clinical and laboratory data between the group with severe skin lesions (n=52) and those with mild or no skin lesions (n=168), and between the group with arthritis (n=6) and those without arthritis (n=214). RESULTS: The mean age of total patients was 2.23±1.87 years of age, and the male-to-female ratio was 1.5:1 (138/82). Among 220 patients, 52 patients had CALs (23.6%), and 29 patients (13.2%) showed incomplete KD. The patients with CALs had a higher mean age, longer total fever duration, and higher rate of IVIG non-responsiveness. The patient group with severe skin lesions showed a higher mean age (P<0.001), more prolonged fever duration (P=0.041), higher frequency of CALs (P=0.033), higher WBC, neutrophil, and neutrophil-to-lymphocyte ratio levels, compared to the patient group without severe skin lesions. The patients with arthritis had a tendency of further treatment with methylprednisolone or infliximab. CONCLUSIONS: The frequency of CALs was higher in patient group with severe skin lesions. Our results suggest that the intensity of clinical signs of KD such as skin rash, cervical lymphadenopathy and possibly arthritis may be associated the risk of CALs.
Arthritis* ; Coronary Vessels* ; Exanthema ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infliximab ; Lymphatic Diseases ; Medical Records ; Methylprednisolone ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies ; Skin*

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A Tuberculosis Contact Investigation on Health Care Workers in One Hospital.

Tae Hee KIM ; Yoon Suk JANG ; Sun Ju JUNG ; Yeon Jae KIM ; Hyun Joo PAI ; Sung Hee OH

Pediatric Infection & Vaccine.2016;23(2):94-101. doi:10.14776/piv.2016.23.2.94

PURPOSE: This study aimed to describe the results of a contact investigation on health care workers after exposure to a house officer with smear-positive pulmonary tuberculosis (TB). METHODS: Eighty nine out of 101 subjects who had close contact with the index patient agreed to be enrolled in the investigation. The first contact investigation was conducted approximately 30 days after the index patient's onset of symptoms, followed by the second investigation after 10 weeks. In both, clinical manifestations were studied, and chest X-ray and tuberculin skin test (TST)/QuantiFERON-TB Gold (QFT-G) in dual screening strategy were conducted. RESULTS: The first TST resulted in positive in 34 subjects (38.2%). QFT-G was conducted on 16 subjects who tested positive in the first TST and aged under 36. Six of them (37.5%) were positive. The second TST was conducted on 41 subjects with negative results in the first TST. Seventeen (41.5%) were positive and among them, three (17.6%) showed positive QFT-G. None of the subjects were diagnosed with active TB. The probability of TB infection through contact with the index patient was 7.3% (3/41) in dual screening strategy while it was 41.5% (17/41) in TST strategy. CONCLUSIONS: This first hospital-setting contact investigation for tuberculosis in Korea revealed that latent tuberculosis infection (LTBI) rates vary depending on different diagnostic strategies. This indicates the need for systematic guidelines for diagnosing LTBI in health care workers who have professional exposure to TB.
Delivery of Health Care* ; Humans ; Interferon-gamma Release Tests ; Korea ; Latent Tuberculosis ; Mass Screening ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis* ; Tuberculosis, Pulmonary

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Influenza A Outbreak in a Neonatal Intensive Care Unit During the 2011-2012 Influenza Season in Korea.

Ok Sung SON ; Chi Eun OH ; Seom Gim KONG ; Yu Jin JUNG ; Yoo Rha HONG

Pediatric Infection & Vaccine.2016;23(2):87-93. doi:10.14776/piv.2016.23.2.87

PURPOSE: An outbreak of influenza virus is uncommon in neonatal intensive care unit (NICU). The clinical presentation of influenza virus infection in neonates is diverse. This study was aimed to report an outbreak of influenza A in a NICU and to investigate the clinical characteristics of influenza virus infection in neonates especially preterm infants during the 2011-2012 influenza season in Korea. METHODS: We reviewed the medical records of 29 patients who were evaluated by respiratory virus multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) at NICU of Kosin University Gospel Hospital during the 2011-2012 seasonal influenza outbreak in Korea. RESULTS: Eleven patients (37.9%) were influenza A virus RT-PCR positive during the survey periods. They were all preterm infants and three of them had no symptoms. Eight patients had symptoms and it was fever (18%, 2/11), respiratory difficulty (72.7%, 8/11) without symptoms of upper respiratory infection, and gastrointestinal symptoms (27.3%, 3/11). The median duration of symptom was 5 days. There were differences of duration of admission at the test of respiratory RT-PCR, Clinical Risk Index for Babies (CRIB) score, use of mechanical ventilation, and use of dexamethasone before infection between influenza A virus RT-PCR positive and negative group. All 11 patients with influenza A were discharged without any complications. CONCLUSIONS: The symptoms of influenza A virus infection in the preterm infants is nonspecific. Influenza A virus should be considered as a possible cause of infection in NICU during the influenza season in the community.
Dexamethasone ; Fever ; Humans ; Infant, Newborn ; Infant, Premature ; Influenza A virus ; Influenza, Human* ; Intensive Care Units ; Intensive Care, Neonatal* ; Korea* ; Medical Records ; Orthomyxoviridae ; Respiration, Artificial ; Seasons*

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A Survey of Doctors' Awareness of Simultaneous Vaccination.

Hojun LEE ; Hyun Seok SEO ; Seok Won CHOI ; Ji Sung KIM ; Eun Eui KIM ; Cheol Am KIM ; Byeong Hee SON ; Kyun Woo LEE

Pediatric Infection & Vaccine.2015;22(2):69-74. doi:10.14776/piv.2015.22.2.69

PURPOSE: In this study, doctors were surveyed with a questionnaire to determine whether they performed simultaneous vaccination and whether there were any concerns about safety or anxiety. The purpose of this study was to determine any problems associated with doctors readily performing simultaneous vaccination. METHODS: A trained surveyor visited 241 doctors from every institution registered with the National Immunization Program (NIP) located within six districts (gu) in the City of Busan (Dongnae-gu, Geumjeong-gu, Yeonje-gu, Suyeong-gu, Busanjin-gu, Haeundae-gu); a total of 155 (64%) valid responses were obtained. RESULTS: Of the 155 respondents, 144 (93%) were already performing simultaneous immunizations and 141 (91%) had a positive view of the practice. However, among the 144 doctors performing simultaneous immunizations, 67 (47%) were not confident about its safety; side effects were seen after simultaneous immunization by 86 doctors, 35 (41%) of whom believed that the frequency or possibility of side effects in simultaneous immunizations was higher than that in sequential immunizations. CONCLUSIONS: The use of simultaneous immunization is expanding quickly. However, among the doctors performing simultaneous immunizations, a high percentage had concerns over its unproven safety and potential side effects, indicating the need for academic societies or government institutions to present evidence to address such concerns.
Anxiety ; Busan ; Surveys and Questionnaires ; Immunization ; Immunization Programs ; Vaccination*

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