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A Case of Acute Idiopathic Thrombocytopenic Purpura Following Influenza B Virus Infection.

Seungwon JUNG ; Sunghee KANG ; Jin Han KANG ; Sang Hyuk MA

Pediatric Infection & Vaccine.2015;22(2):117-120. doi:10.14776/piv.2015.22.3.117

Virus-associated immune thrombocytopenic purpura (ITP) can occur following common viruses, but cases of ITP associated with influenza infection has seldom been reported. In this report we describe a previously healthy 5-year-old boy who admitted with fever, flu-like symptoms and a few bruises on both legs. Severe thrombocytopenia were found. Bone marrow aspirates and biopsy showed no abnormalities and results of coagulation tests were all in normal limit. Real-time polymerase chain reaction was positive for influenza B infection. The patient fully recovered with intravenous immunoglobulins and steroid therapy.
Biopsy ; Bone Marrow ; Child, Preschool ; Contusions ; Fever ; Humans ; Immunoglobulins, Intravenous ; Influenza B virus* ; Influenza, Human* ; Leg ; Male ; Purpura, Thrombocytopenic, Idiopathic* ; Real-Time Polymerase Chain Reaction ; Thrombocytopenia

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A Case of Posterior Reversible Leukoencephalopathy Syndrome Following Poststreptococcal Glomerulonephritis.

Eun Kyoung LEE ; Jin Han KANG ; Sang Hyuk MA

Pediatric Infection & Vaccine.2015;22(2):113-116. doi:10.14776/piv.2015.22.2.113

Posterior reversible leukoencephalopathy syndrome is a clinical radiographic syndrome of many causative factors. Sudden onset headache, vomiting, altered mental status, blurred vision and seizures are main symptoms shown in posterior reversible leukoencephalopathy syndrome. In addition, it typically shows radiological findings of edema in the white matter of posterior cerebrum, being in commonly bilateral but asymmetric. We report a case of poststreptococcal glomerulonephritis (PSGN) presenting as posterior reversible leukoencephalopathy syndrome. Immediate control of hypertension resulted in rapid and complete neurological recovery.
Cerebrum ; Edema ; Glomerulonephritis* ; Headache ; Hypertension ; Leukoencephalopathies* ; Posterior Leukoencephalopathy Syndrome ; Seizures ; Streptococcal Infections ; Vomiting

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Molecular Diagnosis of Streptococcus pneumoniae in Middle Ear Fluids from Children with Otitis Media with Effusion.

Sung Wan BYUN ; Han Wool KIM ; Seo Hee YOON ; In Ho PARK ; Kyung Hyo KIM

Pediatric Infection & Vaccine.2015;22(2):106-112. doi:10.14776/piv.2015.22.2.106

PURPOSE: The long-term administration of antibiotics interferes with bacterial culture in the middle ear fluids (MEFs) of young children with otitis media with effusion (OME). The purpose of this study is to determine whether molecular diagnostics can be used for rapid and direct detection of the bacterial pathogen in culture-negative MEFs. METHODS: The specificity and sensitivity of both polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) to the lytA gene of Streptococcus pneumoniae were comparatively tested and then applied for pneumococcal detection in the clinical MEFs. RESULTS: The detection limit of the PCR assay was approximately 10(4) colony forming units (CFU), whereas that of LAMP was less than 10 CFU for the detection of S. pneumoniae. Both PCR and LAMP did not amplify nucleic acid at over 10(6) CFU of H. influenzae or M. catarrhalis, both of which were irrelevant bacterial species. Of 22 culture-negative MEFs from children with OME, LAMP positivity was found in twelve MEFs (54.5%, 12/22), only three of which were PCR-positive (25%, 3/12). Our results showed that the ability of LAMP to detect pneumococcal DNA is over four times higher than that of PCR (P<0.01). CONCLUSIONS: As a high-resolution tool able to detect nucleic acid levels equivalent to <10 CFU of S. pneumoniae in MEFs without any cross-reaction with other pathogens, lytA-specific LAMP may be applied for diagnosing pneumococcus infection in OME as well as evaluating the impact of a pneumococcal conjugate vaccine against OME.
Anti-Bacterial Agents ; Child* ; Diagnosis* ; DNA ; Ear, Middle* ; Humans ; Influenza, Human ; Limit of Detection ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Pathology, Molecular ; Pneumonia ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Stem Cells ; Streptococcus pneumoniae* ; Streptococcus*

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Establishment and Application of a Multibead Serotyping Assay for Pneumococci in Korea.

Han Wool KIM ; Soyoung LEE ; Miae LEE ; Kyung Hyo KIM

Pediatric Infection & Vaccine.2015;22(2):97-105. doi:10.14776/piv.2015.22.2.97

PURPOSE: Serotyping pneumococcal isolates is important to monitor efficacy of pneumococcal vaccines. Because of difficulties of typing pnueumocci, a multiplex bead-based (multibead) serotyping assay was recently introduced. The aim of this study is to establish a new multibead serotyping assay and to apply this method to analyze clinical isolates of pneumococci in Korea. METHODS: To establish the multibead serotyping assay, six key reagents were transferred from University of Alabama at Birmingham (UAB) to Ewha Center for Vaccine Evaluation and Study (ECVES): bead set coated with polysaccharide and monoclonal antibody pool were used in one multiplex inhibition-type immunoassay and 2 bead sets coated DNA probe and 2 primer pools were used in two multiplex PCR-based assays. After multibead serotyping assay was set up, 75 test samples of pneumococci were analyzed whether ECVES is able to identify serotype correctly. After confirming the performance, serotyping assay was applied to identify serotypes of 528 clinical isolates of pneumococci collected from 3 different hospitals. RESULTS: After establishment of the multibead pneumococcal serotyping assay system at ECVES, 75 test samples were analyzed. There was no discrepancy of serotypes of 75 test samples between the results assigned at UAB and those at ECVES. The serotypes of 528 pneumococci isolated from patients or healthy subjects were determined in 94.3% of isolates (498/528). CONCLUSIONS: The multibead pneumococcal serotyping assay can be successfully established in Korea. With this method, surveillance of serotypes of pneumococci isolated from patients as well as healthy subjects could be studied.
Alabama ; DNA ; Humans ; Immunoassay ; Indicators and Reagents ; Korea* ; Pneumococcal Vaccines ; Serotyping* ; Streptococcus pneumoniae

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Outcomes of Child Contact Investigations of Active Pulmonary Tuberculosis Patients: A Single Center Experience from 2012 to 2014.

Taek Jin LEE ; Eun Kyung KIM ; Hye Cheol JEONG

Pediatric Infection & Vaccine.2015;22(2):91-96. doi:10.14776/piv.2015.22.2.91

PURPOSE: The study aimed to determine data collected during tuberculosis (TB) contact investigations and to evaluate the outcomes of these investigations. METHODS: We reviewed medical records for child contacts of patients with culture-positive pulmonary TB aged 19 years or older between August 2012 and July 2014. RESULTS: A total of 116 child contacts were identified for 79 patients with culture-positive pulmonary TB. Of 116 contacts identified, 22% were incompletely screened. Of 90 contacts who completed screening, 42% had negative tuberculin skin test (TST) results, 58% had positive results, and 1% had active pulmonary TB at the time of investigation. Of 50 contacts with TB patients with a negative smear, 50% had positive TST results. Age > or =5 years (OR 8.3; 95% CI 2.3-30) and male gender (OR 3.9; 95% CI 1.5-9.9) were significantly associated with being incompletely screened. CONCLUSIONS: Improvement is needed in the process of contact investigations to ensure that contacts of patients with active pulmonary TB are identified and appropriately screened.
Child* ; Humans ; Male ; Mass Screening ; Medical Records ; Skin Tests ; Tuberculin ; Tuberculosis ; Tuberculosis, Pulmonary*

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Distribution of Human Rotavirus Genotypes in a Tertiary Hospital, Seoul, Korea During 2009-2013.

Tae Hee HAN ; Sang Hun PARK ; Ju Young CHUNG ; Eung Soo HWANG

Pediatric Infection & Vaccine.2015;22(2):81-90. doi:10.14776/piv.2015.22.2.81

PURPOSE: Group A rotavirus (RV) is most common etiologic agent of acute gastroenteritis (AGE) in children worldwide. Recently, vaccination has been introduced in several countries to reduce the disease burden caused by RV infections, but continuous surveillance of RV strains is necessary to detect the emergence of potential variants induced by vaccine-immune pressure. This study aimed to investigate the changing pattern of RV genotypes in children with AGE, following the introduction of vaccination in Korea. METHODS: Genotyping of RVs by RT-PCR on the basis of VP7 and VP4 gene segment sequence was carried out on 201 rotavirus-positive stool samples, from children hospitalized with AGE between August 2009 and June 2013. We have directly sequenced PCR products and analyzed the phylogenetic tree. RESULTS: The most prevalent G genotype was G9 (33.3%), followed by G1 (22.4%), G3 (15.9%), G2 (6.0%), G4 (3.0%), G10 (1.5%), and mixed G-type (15.4%), with some nontypeable cases (2.5%). The detected P genotypes were P[4] (45.3%), P[8] (43.8%), mixed P-type (10.4%), and P[2] (0.5%). The G9P[4] genotype was predominantly observed in hospitalized cases in Seoul in 2010/2011, however G1P[8] has been re-emerged as the predominant genotype in the following season (P=0.004). CONCLUSIONS: It seems that the periodic fluctuation in predominance of the G1, G3, and G9 strains occurred in Korea during 2009-2013, following the introduction of RV vaccination.
Child ; Gastroenteritis ; Genotype* ; Humans* ; Korea* ; Polymerase Chain Reaction ; Rotavirus* ; Seasons ; Seoul* ; Tertiary Care Centers* ; Trees ; Vaccination

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Stenotrophomonas maltophilia and Ventilator-Associated Pneumonia in Critically Ill Pediatric Patients: a Retrospective Analysis at a Single Center.

Byung Kee LEE ; Soo Han CHOI ; Soo Jin KIM ; Joong Bum CHO ; Hong AE ; So Young YOO ; Ji Hye KIM ; Nam Young LEE ; Yae Jean KIM

Pediatric Infection & Vaccine.2015;22(2):75-80. doi:10.14776/piv.2015.22.2.75

PURPOSE: Ventilator-associated pneumonia (VAP) is a serious threat in critically ill pediatric patients. Data regarding Stenotrophomonas maltophilia VAP in pediatric population is limited. We evaluated the clinical data of S. maltophilia associated VAP in critically ill pediatric patients. METHODS: A retrospective chart review was performed in pediatric patients 18 years old or younger who developed S. maltophilia associated VAP at Samsung Medical Center, Seoul Korea from January 2008 to December 2012. RESULTS: A total of 31 patients were identified S. maltophilia associated VAP. Median age was 8 months (range, 0.5 month to 16.6 years) and 13 patients were male (40.6%). Underlying illnesses were cardiologic diseases (n=11, 34.4%), hematologic oncologic malignancies (n=7, 25%), neurologic diseases (n=4, 12.5%), pulmonary diseases (n=3, 9.4%), and others (n=4, 12.5%). The median duration of ventilator use before S. maltophilia VAP diagnosis was 14 days (range, 4-256 days). Overall mortality at 30 days was 12.5% (4/32). CONCLUSIONS: S. maltophilia should be also considered as a possible pathogen for VAP in critically ill pediatric patients. Empiric antibiotic choice should include agents that are active against S. maltophilia in patients who are deteriorating on broad spectrum beta-lactam antimicrobial agents.
Anti-Infective Agents ; Child ; Critical Illness* ; Diagnosis ; Humans ; Korea ; Lung Diseases ; Male ; Mortality ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Retrospective Studies* ; Seoul ; Stenotrophomonas maltophilia* ; Stenotrophomonas* ; Ventilators, Mechanical

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A Case of Cytomegalovirus Infection in a Neonate with Osteopetrosis.

Sang Hyun LEE ; Jeong Hee SHIN ; Byung Min CHOI ; Yun Kyung KIM

Pediatric Infection & Vaccine.2016;23(1):72-76. doi:10.14776/piv.2016.23.1.72

Infantile osteopetrosis is a rare congenital disorder caused by abnormal bone resorption. Patients with osteopetrosis can have severe anemia, thrombocytopenia, hepatosplenomegaly, rickets, visual impairment, and deafness. Cytomegalovirus also can cause a congenital infection with anemia, thrombocytopenia, hepatosplenomegaly, and calcifications in the brain. We report a 38-day-old infant with severe hepatosplenomegaly, thrombocytopenia, hypocalcemia, and growth failure. Real time polymerase chain reaction detected cytomegalovirus in the plasma. Skeletal radiography revealed generalized bone sclerosis. He was diagnosed with osteopetrosis along with cytomegalovirus infection. Only the test for mutation of the CLCN7 gene, representing the most common and heterogeneous form of osteopetrosis, was available, and the result was negative. With supportive care and antiviral treatment, severe thrombocytopenia due to the cytomegalovirus infection almost normalized despite the possible immunosuppression caused by osteopetrosis. We present the first report of an infant who suffered from osteopetrosis and CMV infection which was successfully treated by long term antiviral agent therapy.
Anemia ; Bone Resorption ; Brain ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Deafness ; Humans ; Hypocalcemia ; Immunosuppression ; Infant ; Infant, Newborn* ; Osteopetrosis* ; Plasma ; Radiography ; Real-Time Polymerase Chain Reaction ; Rickets ; Sclerosis ; Thrombocytopenia ; Vision Disorders

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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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