Benign Acute Childhood Myositis Associated with Influenza B Virus / 대한신경근육질환학회지

Influenza B virus infections appear to be more common extra-respiratory tract symptoms, compared to influenza A virus infections. Benign acute childhood myositis (BACM) is a benign disease that is caused mainly by many viruses like influenza A or B virus infection. Usually BACM is fully cured with only supportive treatment without unnecessary investigation or invasive procedure. This report describes an eight-year-old boy with acute bilateral calf pain and walking difficulty who diagnosed with BACM after influenza B virus infection.

Comparison of Split versus Subunit Seasonal Influenza Vaccine in Korean Children over 3 to under 18 Years of Age

PURPOSE: This study was conducted to compare immunogenicities and reactogenicities of the trivalent inactivated subunit influenza vaccine and split influenza vaccine in Korean children and adolescents.METHODS: In total, 202 healthy children aged 36 months to <18 years were enrolled at six hospitals in Korea from October to December 2008. The subjects were vaccinated with either the split or subunit influenza vaccine. The hemagglutinin inhibition antibody titers against the H1N1, H3N2, and B virus strains were measured, and the seroconversion rates, seroprotection rates, and geometric mean titers were calculated. All subjects were observed for local and systemic reactions.RESULTS: Both the split and subunit vaccine groups had similar seroprotection rates against all strains (95.9%, 94.9%, 96.9% vs. 96.0%, 90.9%, and 87.9%). In children aged 36 to <72 months, the seroprotection rates were similar between the two vaccine groups. In children aged 72 months to <18 years, both vaccines showed high seroprotection rates against the H1N1, H3N2, and B strain (98.4%, 98.4%, 98.4% vs. 97.0%, 95.5%, and 91.0%), but showed relatively low seroconversion rates (39.1%, 73.4%, 35.9% vs. 34.3%, 55.2%, and 38.8%). There were more local and systemic reactions in the split vaccine group than in the subunit vaccine group; however, no serious adverse reactions were observed in both groups.CONCLUSIONS: Both the split and subunit vaccines showed acceptable immunogenicity in all age groups. There were no serious adverse events with both vaccines.

Influence of hepatic steatosis on the outcomes of patients with chronic hepatitis B treated with entecavir and tenofovir

BACKGROUND/AIMS: The influence of hepatic steatosis (HS) on chronic hepatitis B (CHB) is unclear. We evaluated the influence of the degree of HS, assessed using the controlled attenuation parameter (CAP) of transient elastography (TE), on treatment outcomes in CHB patients initiated on antiviral therapy. METHODS: A total of 334 patients who were initiated on entecavir or tenofovir between 2007 and 2016 with available TE results were recruited. RESULTS: Of the total study population, 146 (43.7%) patients had HS (CAP > 238 dB/m). Three-hundred-three patients (90.7%) achieved complete virological response (CVR) (hepatitis B virus DNA<12 IU/L), and 25 patients (7.5%) developed hepatocellular carcinoma (HCC). Among hepatitis B e antigen (HBeAg)-positive patients (n=172, 51.5%), 37 (21.5%) experienced HBeAg loss. On univariate analysis, CAP value was not associated with the probability of HCC development (P=0.380). However, lower CAP value was independently associated with higher probability of HBeAg loss among HBeAg-positive patients (hazard ratio [HR]=0.991, P=0.026) and with CVR achievement in the entire study population (HR=0.996, P=0.004). The cumulative incidence of HBeAg loss among HBeAg-positive patients was significantly higher in patients without HS than in those with HS (log-rank, P=0.022). CONCLUSIONS: CAP values were not correlated with HCC development in patients initiated on entecavir and tenofovir. However, CAP values were negatively correlated with the probability of HBeAg loss among HBeAg-positive patients and with CVR achievement.

Incidence and Risk Factors of Pneumonia in Hospitalized Patients with Seasonal Influenza A or B / 결핵및호흡기질환

BACKGROUND: Most patients with influenza recover spontaneously or following treatment with an anti-viral agent, but some patients experience pneumonia requiring hospitalization. We conducted a retrospective review to determine the incidence and risk factors of pneumonia in hospitalized patients with influenza A or B. METHODS: A total of 213 patients aged 18 years or older and hospitalized with influenza between January 2012 and January 2015 were included in this study. A reverse-transcriptase polymerase chain reaction assay was used to detect the influenza A or B virus in the patients' sputum samples. We collected demographic and laboratory data, combined coexisting diseases, and radiologic findings. RESULTS: The incidence of pneumonia was higher in patients in the influenza A group compared to those in the influenza B group (68.6% vs. 56.9%), but this difference was not statistically significant. The presence of underlying respiratory disease was significantly associated with pneumonia in the influenza A group (adjusted odds ratio [OR], 3.975; 95% confidence interval [CI], 1.312–12.043; p=0.015). In the influenza B group, the white blood cell count (adjusted OR, 1.413; 95% CI, 1.053–1.896; p=0.021), platelet count (adjusted OR, 0.988; 95% CI, 0.978–0.999; p=0.027), and existence of an underlying medical disease (adjusted OR, 15.858; 95% CI, 1.757–143.088; p=0.014) were all significantly associated with pneumonia in multivariate analyses. CONCLUSION: The incidence of pneumonia was 65.7% in hospitalized patients with influenza A or B. The risk factors of pneumonia differed in hospitalized patients with influenza A or B.

Clinical Comparison of Influenza A and B Virus Infection in Hospitalized Children

PURPOSE: The objective of this study was to compare the clinical characteristics of influenza A and B infections and analyze the effect of oseltamivir in hospitalized children. METHODS: We investigated children under the age of 15, who were diagnosed with influenza A/H1N1, A/H3N2, or B from January to April 2014. The subjects were admitted to the Changwon Fatima Hospital and diagnosed using a rapid antigen test from nasopharyngeal swabs. The medical records of the patients were retrospectively reviewed. RESULTS: A total of 302 pediatric patients with influenza were enrolled. Influenza B infection was the most common type (n=187, 61.9%), followed by A/H3N2 (n=100, 33.1%) and A/H1N1 (n=15, 5.0%). Compared to patients diagnosed with influenza A, patients diagnosed with influenza B were older (P=0.005), and the duration of fever was significantly longer (P=0.001). A total of 161 patients (53.3%) had been vaccinated against influenza during the season, before admission. Among the patients infected with A/H3N2 and B, the duration of fever was shorter in oseltamivir recipients compared to oseltamivir non-recipients (P=0.026 and P=0.004, respectively). CONCLUSIONS: There were significant differences between influenza A and B groups in terms of age, demographics, and clinical course. Although the effectiveness of oseltamivir on influenza differs according to the type of influenza, our data provides evidence that oseltamivir is beneficial for both A and B infections.

The Efficacy of Rapid Antigen Tests for Detection of Seasonal Influenza Virus

PURPOSE: This study aimed to examine the accuracy of rapid influenza diagnostic tests (RIDT) in children with an influenza-like illness and to evaluate factors associated with greater accuracy. METHODS: Pediatric patients, who visited Hallym University Sacred Heart Hospital with an influenza-like illness between June 2011 and May 2016, were enrolled in this study. We tested 798 samples using a real-time polymerase chain reaction (PCR) for respiratory viruses and compared the results with rapid influenza tests. RESULTS: In comparison with the results of the multiplex PCR, the positive agreement rates of RIDT for influenza A and B virus were 75.7% and 60.0%, respectively. The performance of RIDT varied according to days after fever onset. The positive agreement rates of RIDT for influenza A and B tests, performed within 4 days of fever onset, were 77.6% and 73.2%, but the rates for tests performed more than 5 days after fever onset were 66.7% and 21.4%, respectively. CONCLUSIONS: The RIDT is a quick and simple aid to diagnosis, but is less sensitive than the labeled sensitivity. Moreover, test performance varied according to days after fever onset. Test specimens for RIDT should be collected as soon as possible after the onset of symptoms (less than 4 days).

Seroprevalence of Anti-hepatitis B Virus, Anti-hepatitis A Virus, and Anti-varicella Zoster Virus Antibodies in Nursing Students from 2009 to 2013 / 병원감염관리

BACKGROUND: Nursing students may be exposed to patients with infectious diseases such as hepatitis B and hepatitis A through needle stick injuries or close contact during their clinical practice. This study surveyed the presence of antihepatitis B virus (anti-HBV), anti-hepatitis A virus (anti-HAV), and anti-varicella zoster virus antibodies in nursing students before the initiation of their clinical practice to help prevent subsequent infections. METHODS: From 2009 to 2013, the junior students of a nursing college in Jeollabuk-do were tested for antibodies against the hepatitis B, hepatitis A, and varicella zoster viruses before the initiation of their clinical practice. RESULTS: The students tested positive for anti-HBV (46.2-57.1%), anti-HAV (0-10.5%), and anti-varicella zoster antibodies (80.2-90.2%). No significant differences in the positivity rates were observed with respect to the year of their enrollment. CONCLUSION: This study was a survey of the seroprevalence of anti-HBV, anti-HAV, and anti-varicella zoster antibodies in nursing students before they started their clinical practice. The positivity rate of anti-HAV was lower than 10%. In order to prevent infection, it is necessary to test nursing students for the presence of antibodies against hepatitis B, hepatitis A, varicella, measles, mumps, and rubella, and check their vaccination history as recommended in the adult immunization schedule. Vaccination must be recommended for students who test negative for the respective antibodies.

Atypical Kawasaki Disease Presenting as Acute Kidney Injury in a Patient with Influenza B Virus Infection / 이화의대지

Influenza virus infection is a common respiratory disease in children. Renal complications of influenza infection were not commonly encountered until the 2009 H1N1 influenza pandemic, when acute kidney injury (AKI) frequently developed in severely ill patients. Kawasaki disease (KD) is another rare association in pandemic influenza virus infections. There are some reports about KD coincident with influenza A H1N1/09 infection. However, simultaneous AKI and KD in influenza A or B virus infections have never been reported. Herein, we report the first case of influenza B virus infection that initially presented as AKI but was subsequently diagnosed as atypical KD.

Acute Hemorrhagic Leukoencephalopathy in a Patient with Influenza A and B Coinfection

Acute hemorrhagic leukoencephalopathy is a rare condition associated with the influenza virus, but the role of influenza in this condition has not been clarified. We experienced a patient with influenza A and B virus co-infection who initially presented mild gastrointestinal symptoms and rapidly progressed to coma. Magnetic resonance imaging showed severe brain edema and multiple intracranial hemorrhagic lesions. The patient was treated with oseltamivir and corticosteroid, and her clinical course improved without neurological sequelae.

Acute Hemorrhagic Leukoencephalopathy in a Patient with Influenza A and B Coinfection

Acute hemorrhagic leukoencephalopathy is a rare condition associated with the influenza virus, but the role of influenza in this condition has not been clarified. We experienced a patient with influenza A and B virus co-infection who initially presented mild gastrointestinal symptoms and rapidly progressed to coma. Magnetic resonance imaging showed severe brain edema and multiple intracranial hemorrhagic lesions. The patient was treated with oseltamivir and corticosteroid, and her clinical course improved without neurological sequelae.

Clinical Efficacy of Entecavir and Factors Predicting Long-Term Treatment Response in Nucleoside-Naive Patients with Chronic Hepatitis B / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to characterize the treatment response to entecavir and to examine factors affecting that response. METHODS: A total of 77 nucleoside-naive patients with chronic hepatitis B who had received entecavir (0.5 mg daily) for at least 48 weeks were consecutively enrolled between March 2007 and March 2011. The rates of virological response (hepatitis B virus [HBV] DNA < 116 copies/mL), biochemical response (alanine aminotransferase < or = upper limit of normal), hepatitis B e antigen (HBeAg) loss, and seroconversion were retrospectively analyzed. RESULTS: The cumulative rates of virological response at 12, 24, 48, 96, and 144 weeks were 59.7%, 82%, 88.3%, 89.6%, and 93.1%, respectively; biochemical response rates were 51.9%, 74%, 84.4%, 94.8%, and 98.3%, respectively; HBeAg loss rates were 10.5%, 18.4%, 28.9%, 36.8%, and 47.4%, respectively; and HBeAg seroconversion rates were 7.9%, 18.4%, 21.1%, 28.9%, and 39.5%, respectively. In multivariate analysis, independent predictors associated with HBV DNA polymerase chain reaction (PCR) negativity were the absence of HBeAg at baseline (p = 0.006) and early virological response (HBV DNA < 2,000 copies/mL after 12 weeks of therapy; p = 0.027). In univariate analysis, early virological response was an independent factor predicting HBeAg loss (p = 0.001). CONCLUSIONS: Entecavir induced excellent biochemical and virological responses in nucleoside-naive patients with chronic hepatitis B. Early virological response was an independent factor predicting HBV PCR negativity and HBeAg loss, and can be used to predict long-term treatment response to entecavir.

A Case of Polyarthritis Associated with Reactivation of Chronic Hepatitis B Virus Infection

Hepatitis viruses (hepatitis B virus (HBV) and hepatitis C virus) have been associated with development of inflammatory arthritis. Approximately 400 million people worldwide have chronic HBV infection. HBV infection is the one of the most common causes of liver disease, and the prevalence of HBV infection in Korea is almost 6%. Arthritis in patients with HBV can be encountered in two settings: as a rheumatoid arthritis (RA)-like, acute, self-limited polyarthritis during the pre-symptomatic phase of acute hepatitis B, or, more rarely, as arthritis occurring in the context of HBV-associated polyarteritis nodosa (PAN). In both cases, the pathogenesis of arthritis is attributed to the deposition of immune complexes containing viral antigens (HBsAg or HBeAg) and their respective antibodies (anti-HBs and anti-HBe) in synovial tissues. Here we report on a case of polyarthritis associated with reactivation of chronic hepatitis B virus infection with a review of the literature.

Recombinant influenza viruses as delivery vectors for hepatis B virus epitopes

PURPOSE: Neuraminidase (NA) of influenza virus contains stalk region that shows a great deal of variability in both amino acid sequence and length. In this paper, we investigated generation of recombinant influenza viruses that had hepatitis B virus (HBV) B cell epitopes in the NA stalk region as a dual vaccine candidate. MATERIALS AND METHODS: We used the WSH-HK reassortant helper virus for rescue of recombinant influenza virus containing HBV epitopes and reverse genetic protocol based on the use of micrococcal nuclease-treated virus cores for reconstitution of ribonucleoproteins. RESULTS: We successfully generated a chimeric influenza viruses which contained 22 amino acid peptides in the stalk region derived from the surface and pre-surface protein HBV. The growth kinetics of the recombinant viruses was investigated after infection of Madin-Darby canine kidney (MDCK) and Madin-Darby bovine kidney (MDBK) cells and the rIV-BVPreS virus showed higher titer than other viruses in MDCK cells. We also confirmed the presence of HBV epitopes in the chimeric viruses by enzyme-linked immunosorbent assay (ELISA) using anti-HBV polyclonal antibody. When the ratio of recombinant virus verse wild type virus was calculated by ELISA, recombinant viruses exhibited 2 fold higher values than the wild type virus. CONCLUSION: These results suggest that chimeric influenza virus which contained foreign antigens can be used as dual vaccine against both HBV and influenza viruses.

Kaposi's Sarcoma Developing on the Finger of a Patient with Liver Cancer / 대한피부과학회지

Kaposi's sarcoma (KS) is divided into four types as classic KS, AIDS-associated KS, African endemic KS and iatrogenic KS. Classic KS is most common on the distal portion of the lower extremities. KS sometimes develops on the hand, but there is currently no report of KS on the finger in Korea. Human herpes virus 8 (HHV-8) plays as a key role in development of KS and it is necessary for the development of KS, but it is not sufficient by itself. So, other etiologic factors such as environmental and racial factors, gender and the immune state have recently been considered as being involved with the development of KS. We present here a rare case of KS that developed on the finger of a 44-year-old male who had hepatocellular carcinoma due to hepatits B virus infection.

Isolation and Characterization of Avian Metapneumovirus from Broiler Breeder Chickens in Korea

Avian metapneumovirus (AMPV) is an emerging pathogen causing respiratory and reproductive illness in poultry worldwide. To demonstrate the presence of AMPV in domestic chickens in Korea, we attempted to isolate AMPV from affected chickens. A cytopathic agent was isolated using chicken tracheal ring culture from dead chickens from a broiler breeder farm with reduced egg production in Korea. This agent, termed SC1509 strain, subsequently passed in Vero cells with distinct cytopathic effects. The SC1509 strain was confirmed as avian metapneumovirus (AMPV) using both RT-PCR test and monoclonal antibody-based immunofluorescence assay. Sequence analysis based on the G glycoprotein revealed that the SC1509 strain had 22.5 to 96.0% nucleotide sequence identity and 11.1 to 92.7% predicted amino acid sequence identity with previously published AMPV strains, particularly with the highest sequence homology (95.8 to 96% for nucleotides and 92.2 to 92.7% for amino acids) to European strains belonging to genotype B. The SC1509 strain was phylogenetically clustered with genotype B viruses, confirming that the SC1509 strain belongs to genotype B. This is the first report of genotype B avian metapneumovirus from chickens in Korea.

Genetic Characteristics and Phylogenetic Analysis of Influenza Type B Viruses Isolated from Nasopharyngeal Suction Samples of Korean Patients

To investigate the genetic characteristics of human influenza type B viruses circulating in Chungbuk province, Korea, we tested 510 clinical samples of nasopharyngeal suction from pediatric patients diagnosed with respiratory illness between June 2007 and June 2008. Twelve out of thirty-six isolates were identified as type B influenza virus by RT-PCR and sequencing analysis. Interestingly, genetic characterization of type B viruses isolated in this study revealed that all type B influenza viruses were the Yamagata lineages, a vaccine strains of southern hemisphere during 2007~2008, rather than the Victoria lineage of northern hemisphere during 2007~2008. Furthermore, there were a total of twelve unique mutations (HA: H40Y, D/G230S, V252M and K272R and NA: P3H, P/T/S42Q, N59S) occurred in our type B isolates. These results suggest that relative high prevalence of type B viruses in Korea during 2007~2008 season might be due to the wrong vaccine strains selection. Taken together, the results of this study demonstrate continuous evolutions of human type B viruses by antigenic drift and also highlight the need to closely monitoring of influenza viruses to aid the early detection of potentially pandemic strains as well as underscore the need for new therapeutics.

Genetic Variation in the NSP4 Gene of Human Rotavirus Isolated in Seoul

The nonstructural protein 4 (NSP4) of rotavirus encoded by gene 10, plays an important role in rotavirus pathogenicity. In this study, NSP4 gene sequences of human rotaviruses circulating in Seoul, Korea between March 2004 and April 2005 were determined. The nucleotide sequence data indicated that the NSP4 genes of human rotavirus Korean isolates were 750 or 751 bases in length and encoded one open reading frame of 175 amino acids with two glycosylation sites. The NSP4 of Korean isolates exhibited amino acid sequence homologies between 59.4% and 98.9%. The NSP4 of CAU4 and CAU15 showed a high degree of amino acid sequence homologies with NSP4 genotype A viruses, but the NSP4 of CAU5, CAU6, CAU11, CAU14, CAU16 and CAU22 exhibited a high degree of amino acid sequence homologies with NSP4 genotype B viruses. Interestingly, CAU3 and CAU7 showed low degree of amino acid sequence homology with those of currently described NSP4 genotypes A to D and belonged a distinct lineage on the phylogenetic tree. These findings suggests that distinct NSP4 type was circulating among human rotavirus strains in the local community of Seoul and raising intriguing questions regarding possible explanations for new genotype.

Prevalence of Osteopenia in Female HBV Carriers and its Correlation with Liver Function Test / 대한진단검사의학회지

BACKGROUND: Osteopenia has been recognized as one of the potential complications of chronic liver disease. However, its correlation with hepatits B virus (HBV) carriage has not been reported. Thus this study was aimed to clarify the relationship between osteopenia and HBV carriage. METHODS: Bone density was measured in 192 HBV carrier women and 200 healthy women in the following sites: the lumbar spine and three sites of the proximal femur (the neck, Ward's triangle, greater trochanter) by dual-photon absorptiometry. Liver function tests (AST, ALT, Albumin, GGT, and ALP) were also performed. RESULTS: The levels of the bone density measured at the four sites were significantly correlated with each other (r=0.34 to 0.99, P<0.01). Compared with the control group, HBV carriers showed a significant decrease in the bone density of the femur (P<0.05); the decrease was particularly marked at the Ward's triangle. A negative correlation was found between bone density and serum total alkaline phosphatase level (r=-0.44, P<0.01). CONCLUSIONS: Osteopenia was more prevalent in HBV carriers, particularly in those younger than 50 years of age. Serum total alkaline phosphatase level was higher in those with a reduced bone density; thus, the measurement of bone density may be indicated in female HBV carriers.

Serum Hepatitis B Virus DNA Quantitative Analysis Using Polymerase Chain Reaction in Patients with Chronic Hepatits B Virus Infection / 대한진단검사의학회지

BACKGROUND: The treatment using more potent antiviral agents for the hepatitis B virus (HBV) infection has been performed widely and a highly sensitive quantification method using the polymerase chain reaction (PCR) that measures the HBV viral genome in sera is available. In this study, the HBV DNA level in each disease status including the inactive HBsAg carrier is evaluated. METHODS: Samples were obtained from 227 patients with chronic HBV infection that were grouped into chronic hepatitis (111), liver cirrhosis (71), and inactive HBsAg carrier (45). Quantification of HBV DNA was performed using the automated Cobas Amplicor HBV monitor test(TM). RESULTS: Among the chronic hepatitis B group (9.76 x 10(7) copies/mL), the liver cirrhosis group (4.88x10(5) copies/mL), and the inactive carrier group (3.18 x10(3)copies/mL), the medians of serum HBV DNA levels were significantly different from one group to another (P=0.000). Also, the median of HBV DNA levels in the patients with positive HBeAg (1.77 x10(8) copies/mL) was significantly higher than that of negative HBeAg (2.71 x 10(4) copies/mL) (P=0.000). In the patients with negative HBeAg, HBV DNA level in the inactive carrier group (Median 3.18 x 10(3) copies/mL) was significantly lower than that of the chronic hepatitis group (Median 2.2 x 10(5) copies/mL (P=0.000). CONCLUSIONS: The serum HBV DNA level varied among different disease groups, particularly according to HBeAg positivity. 40% of the chronic hepatitis group with negative HBeAg had HBV DNA levels below 10(5) copies/mL. Therefore, the quantitative analysis of HBV DNA using this sensitive and automated PCR method would be useful in detecting viral proliferation.

Combined Hepatocellular and Cholangiocarcinoma, Separate Type: A Case Report / 대한간학회지

Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon form of primary liver cancer having features of both hepatocellular and billiary epithelial differentiation. We reptitis B virus. A 36-year-old woman was diagnosed by ultrasonography with an asymptomatic tumor inort a case of cHCC-CC that separately developed in a patient who was serologically positive for hepa the left lobe of the liver. Based on radiologic and serologic findings of elevated serum alpha-fetoprotein (AFP) level, a preoperative diagnosis of hepatocellular carcinoma was made. A left lobectomy of the liver was done. On histological examination, the resected tumor was shown to consist of two separated masses. One was hepatocellular carcinoma that showed immunoreactivity for AFP. The other was cholangio- carcinoma that showed immunoreactivity for cytokeratin-19 (CK-19) in a separate form.