PURPOSE: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions. METHODS: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. RESULTS: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. CONCLUSION: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.
Antistreptolysin ; Coronary Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Immunoglobulins ; Incidence ; Mucocutaneous Lymph Node Syndrome ; Prognosis ; Retrospective Studies ; Streptococcal Infections

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.
Adult* ; Anemia ; Antistreptolysin ; C-Reactive Protein ; Child* ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin M ; Mycoplasma pneumoniae ; Nephrotic Syndrome ; Pneumonia, Mycoplasma ; Prognosis* ; Proteinuria ; Purpura* ; Renal Insufficiency, Chronic ; Retrospective Studies* ; Risk Factors ; Uric Acid

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.
Adult* ; Anemia ; Antistreptolysin ; C-Reactive Protein ; Child* ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin M ; Mycoplasma pneumoniae ; Nephrotic Syndrome ; Pneumonia, Mycoplasma ; Prognosis* ; Proteinuria ; Purpura* ; Renal Insufficiency, Chronic ; Retrospective Studies* ; Risk Factors ; Uric Acid

PURPOSE: The incidence of acute poststreptococcal glomerulonephritis (APSGN) in Korea has changed. This study aimed to evaluate the epidemiological and clinical changes of APSGN observed in a single Korean institution over two decades. METHODS: We retrospectively analyzed the data of 99 children (0-15 years of age) who were admitted to our institution with APSGN between 1987 and 2013. The patients were selected based on the depression of serum complement 3 (C3, <70 mg/dL) and elevated titer of antistreptolysin O (ASO, >250 IU/dL) as evidence of previous streptococcal infection. RESULTS: In the 99 patients, the mean age was 8.3 +/- 2.7 years, and the male-tofemale ratio was 2.2:1 (66:30). The annual number of cases fluctuated markedly, and most cases were observed during the late autumn and winter months. However, there have been few cases reported in the past 5 years. Clinical manifestations at presentation, including hypertension and generalized oedema, and the duration of hospitalization were higher and longer in patients admitted during the first half of the study period than during the most recent half-period, suggesting a more severe clinical course in the former group. CONCLUSIONS: APSGN has become a rare disease in Korea with a trend towards a less severe clinical course. This finding suggests that the prevalence of infection-related immune-mediated diseases could change over-time, together with environmental and possibly pathogen-host relationship changes.
Antistreptolysin ; Child ; Complement C3 ; Depression ; Epidemiology ; Glomerulonephritis* ; Hospitalization ; Humans ; Hypertension ; Incidence ; Korea ; Prevalence ; Rare Diseases ; Retrospective Studies ; Streptococcal Infections

Rheumatic fever is an acute inflammatory sequela following a group A, beta-hemolytic streptococcal infection. Rheumatic fever is characterized by polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum as the major diagnostic criteria. Rarely, advanced heart block may also occur. A 13-year-old boy was admitted to the Pediatric Department for evaluation and management of complete atrioventricular block. The patient had exertional dyspnea for 1 month. Based on the findings of mitral regurgitation, fever, elevated acute phase reactants, and a high antistreptolysin O titer, the patient was diagnosed with rheumatic fever. A benzathine penicillin injection was administered, as well as salicylate therapy. On the 5th day of hospitalization, the electrocardiogram revealed a normal sinus rhythm with a 1st degree atrioventricular block. After discharge, the electrocardiogram normalized with the monthly penicillin injections. Herein we report a case of complete atrioventricular block associated with rheumatic fever. The heart block resolved without specific cardiac treatment, other than a non-steroidal anti-inflammatory medication.
Acute-Phase Proteins ; Adolescent ; Antistreptolysin ; Arthritis ; Atrioventricular Block ; Chorea ; Dyspnea ; Electrocardiography ; Erythema ; Ethylenediamines ; Fever ; Heart Block ; Hospitalization ; Humans ; Mitral Valve Insufficiency ; Myocarditis ; Penicillin G Benzathine ; Penicillins ; Rheumatic Fever ; Streptococcal Infections

PURPOSE: Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. METHODS: Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. RESULTS: Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8+/-8.2 days, gross hematuria within 11.3+/-17.2 days and microscopic hematuria within 3.5+/-3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. CONCLUSION: Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.
Antistreptolysin ; Child ; Glomerulonephritis ; Hematuria ; Humans ; Hypertension ; Incidence ; Infant ; Medical Records ; Pediatrics ; Pharyngitis ; Pharynx ; Proteinuria ; Retrospective Studies ; Urinary Tract Infections

In recent years, arteriosclerosis obliterans (ASO) has become one of the most common diseases with obesity, high blood pressure and other lifestyle-related diseases such as hyperlipemia. Westernization of the eating habits of the Japanese and progress of the aging society accounts for the increasing occurrence of these health problems. Early detection and early treatment of ASO help not only improve the quality of life of the patients but also get off without amputation of lower limbs and better the prognosis for survival. It is necessary to evaluate the narrowing of blood vessels or the form of occlusion for treatment of ASO. It is particularly important to know the state of the peripheral arteries below the obstructed region in cases with the complete occlusion. Lately, with the addition of many lines to multislice CT (MSCT) and the improvement of the performance of the workstation, angiography for diagnostic purposes has gradually been replaced by MSCT. In this paper, we report two cases of ASO and the successful application of MSCT using 64 Data Acquisition System (DAS) in the examination prior to ASO bypass surgery.
Antistreptolysin O antibody titer ; System ; X-Ray Computed Tomography ; Cases ; seconds

PURPOSE: Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. METHODS: ASO in normal individual concentrations were measured quantitatively by nephelometry on sera from 753 children (Male:381, Female:372). ULN were determined by separating the upper 20% from the lower 80% of the group (80 percentile). RESULTS: The mean ASO concentration calculated in a total cases was 149.9+/-7.2 IU/mL. The ASO concentration in neonates was 83.4+/-10.7 IU/mL, and lowest in the 1 year of age group, 26.7+/-6.6 IU/ mL, and increased to 318.0+/-33.2 IU/mL gradually in the 9 years of age group. Thereafter, ASO concentration decreased. The ULN for neonates was 122 IU/mL, for 0-3 years, 40 IU/mL; for 4-6 years, 113 IU/ mL; for 7-9 years, 489 IU/mL; for 10-19 years, 433 IU/mL; for 20-29 years, 122 IU/mL. CONCLUSION: The age-specific ULN for children in the Gyeonggi-Incheon area were determined. The distribution of ASO concentration according to age groups was different from previous reports. These results should be of clinical value to physicians to interprete the ASO results of their patients.
Antistreptolysin* ; Child* ; Diagnosis ; Glomerulonephritis ; Humans ; Infant, Newborn ; Nephelometry and Turbidimetry ; Pediatrics ; Reference Values ; Rheumatic Fever ; Streptococcal Infections

PURPOSE: In developed countries, acute rheumatic fever appears to be a vanishing disease. In Korea, the incidence and severity of acute rheumatic fever (ARF) has significantly decreased in recent 30 years. According to this report, Korea sustained low incidence of ARF. METHODS: The medical records of 5 children diagnosed as ARF from January 2000 to September 2006 were reviewed retrospectively about clinical manifestations and laboratory findings. RESULTS: The average incidence of rheumatic fever was 0.17 per annual pediatric in-ward 1,000 patients. During study period, only 1 case had a definite history of preceding infection. Among 5 patients, the incidence of major manifestations were as follows:carditis 5 cases, chorea 1 case, arthritis 1 case and erythema marginatum 2 cases. Clinical findings of carditis were cardiac murmur, cardiomegly, congestive heart failure and pericardial effusion. Significant valvular lesions were mitral and aortic insufficiency. Minor manifestations and other clinical manifestations were fever, arthralgia, dyspnea, coughing, palpitation, weakness and chest pain. Laboratory findings were increased antistreptolysin O titer, positive C reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). CONCLUSION: The incidence of ARF has reduced but rheumatic carditis varies in severity from moderate to severe cardiac involvement. For many reasons ARF is being diagnosed inappropriately resulting from lack of awareness about the disease due to rarity and secondary prophylaxis. We should be aware of acute rheumatic fever and should pay attention to the treatment of the patients with streptococcal pharyngitis.
Antistreptolysin ; Arthralgia ; Arthritis ; Blood Sedimentation ; C-Reactive Protein ; Chest Pain ; Child ; Chorea ; Cough ; Developed Countries ; Dyspnea ; Erythema ; Fever ; Heart Failure ; Heart Murmurs ; Humans ; Incidence ; Korea ; Medical Records ; Myocarditis ; Pericardial Effusion ; Pharyngitis ; Retrospective Studies ; Rheumatic Fever*

PURPOSE: Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. METHODS: Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. RESULTS: At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. CONCLUSION: All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.
Alanine ; Antistreptolysin ; Aspartic Acid ; Aspirin ; Blood Sedimentation ; Child ; Echocardiography ; Fever ; Follow-Up Studies* ; Humans ; Leukocytes ; Leukocytosis ; Logistic Models ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Pyuria ; Risk Factors ; Thrombocytosis ; Urinalysis