A case of Guillain-Barré syndrome with meningeal irritation.

Here, we report a 5-year-old girl with Guillain-Barré syndrome who presented with a chief complaint of pain in the extremities, which was followed by neck stiffness. Bladder dysfunction was found, which required catheterization. Magnetic resonance imaging revealed marked enhancement of the nerve roots in the cauda equina on T1-weighted imaging after gadolinium injection, and nerve conduction studies led to a diagnosis of Guillain-Barré syndrome. Her symptoms improved after intravenous immunoglobulin therapy, but her neck stiffness remained 16 days after admission. Four weeks after admission, she could walk without support. As patients with signs of meningeal irritation may be diagnosed with other diseases, such as meningitis, it is important to recognize atypical cases of pediatric Guillain-Barré syndrome to achieve early diagnosis and treatment.

Influence of premature rupture of membrane on the cerebral blood flow in low-birth-weight infant after the delivery.

Cerebral white matter injury, usually called periventricular leukomalacia (PVL), is the most common form of injury to preterm infants that is associated with adverse motor and cognitive outcomes. Intrauterine infection may be an important etiological factor in PVL, and premature rupture of the membranes (PROM) can be identified antepartum. In order to investigate the pathophysiology of cerebral white matter injury induced by PROM, the cerebral blood flow (CBF) of the internal carotid artery and the vertebral artery was measured by neck ultrasonography. The CBF was determined in 84 low-birth-weight infants with gestational ages ranging from 24 to 35 weeks, including 71 infants without PROM and 13 infants with PROM. The mean blood flow velocity and diameter of each vessel were measured on postnatal days 0-70. The intravascular flow volume was determined by calculating the mean blood flow velocity and the cross-sectional area. The mean blood pressures were recorded, and the ejection fraction was determined. The total cerebral blood flow (CBF) was significantly lower in infants with PROM than in infants without PROM from day 10 to day 70. The ejection fraction was significantly higher in infants with PROM than in infants without PROM on days 0, 5, 10, 21, and 42. There was no difference in the mean blood pressure between infants with PROM and infants without PROM. The results of the present study suggest that PROM may decrease cerebral blood flow after the birth.

IL-10 and RANTES are elevated in nasopharyngeal secretions of children with respiratory syncytial virus infection.

BACKGROUND: Respiratory syncytial virus (RSV) infection causes asthma-like symptoms in infants and young children. Although an increase in several mediators in the airway during RSV infection has been reported, the mechanisms involved in airway inflammation are not fully understood. The aim of this study was to investigate the immunological deviation associated with airway inflammation by measuring cytokine and chemokine levels in the airway during RSV infection. METHODS: One hundred and ten children under 3 years of age with respiratory symptoms were enrolled in this study from November 2004 through January 2005. Nasopharyngeal secretions (NPAs) were gently aspirated and analyzed with RSV antigen, thereafter the concentrations of IL-4, IL-10, IFN-gamma, and RANTES were measured using an ELISA kit. We also investigated the prognosis of each child after 1 year by reference to clinical records or by interviews and re-evaluated the cytokine and chemokine levels. RESULTS: Of the subjects, 70 children were RSV positive and 40 were negative. Only 4 children were given a diagnosis of asthma by the pediatrician when NPAs were collected. The levels of IL-4, IL-10, and RANTES were significantly higher in the RSV-positive patients than RSV-negative patients with P values at 0.0362, 0.0007, and 0.0047, respectively. In contrast, there was no significant difference in the levels of IFN-gamma. Furthermore, there was a significant positive correlation between IL-10 and RANTES. CONCLUSIONS: The increased production of IL-4, IL-10, and RANTES in the airway may play an important role in the pathophysiological mechanisms of RSV infection.

[Prevalence of sensitization of Japanese cedar pollen in children from infancy to adolescence].

BACKGROUND: In Japan, morbidity of Japanese cedar pollinosis has dramatically increased, especially in children. However, little is known about the prevalence of pollinosis and sensitization to Japanese cedar pollen (JCP) in young children. OBJECTIVE: The aim of this study is to investigate the prevalence of sensitization to JCP in allergic and non-allergic children from infancy to adolescence. METHODS: Two hundred forty three children with allergic diseases (age 8 months-16 years, mean 5 years) and 137 children without allergic diseases (age 1 month-15 years, mean 4 years) were recruited. Their specific IgE to JCP, house dust mite, orchard grass pollen, egg white, and milk were measured with the CAP-RAST system. A questionnaire was filled out by their parents. RESULTS: The percentage of positive (> or = 2) CAP-RAST to JCP was 47.1% in children with allergic diseases and 19.9% in children without allergic diseases. In children with allergic diseases, the ratio had risen rapidly from 3 to 5 years old. In children without allergic diseases, the ratio of JCP sensitization has gradually increased from the infancy to adolescence. The youngest child who had been sensitized to JCP was 23-month-old boy with atopic dermatitis. The proportion of children who were born from January to march was significantly higher in JCP sensitized group than JCP non-sensitized group. The ratio of house dust mite and orchard grass pollen sensitization was higher in JCP sensitized group than those in JCP non-sensitized group. CONCLUSION: Large number of children acquire sensitization to JCP in their preschool age. We need to develop the way how to protect JCP sensitization in the early stage of life.