Human infection with novel G3P[25] rotavirus strain in Taiwan.

Genotype P[25] rotaviruses are rare and to date have been reported to occur only in a few countries of mainland Asia. Here we report the molecular characterization of a novel human rotavirus genotype combination, G3P[25], detected in a 17-month-old child hospitalized due to severe gastroenteritis during 2009 in central Taiwan. Sequencing and phylogenetic analysis of the VP4 gene demonstrated a distinct origin from other strains bearing the P[25] VP4 gene, whereas the VP7, VP6 and NSP4 gene phylogenies identified common origins with cognate genes of other, presumed human-porcine reassortment Taiwanese strains. These results suggest that interactions between human and animal strains appear to contribute to the generation of genetic and antigenic diversity of rotavirus strains, with potential public health importance in Taiwan.

Correlation between the temperature dependence of intrinsic MR parameters and thermal dose measured by a rapid chemical shift imaging technique.

In order to investigate simultaneous MR temperature imaging and direct validation of tissue damage during thermal therapy, temperature-dependent signal changes in proton resonance frequency (PRF) shifts, R(2)* values, and T1-weighted amplitudes are measured from one technique in ex vivo tissue. Using a multigradient echo acquisition and the Stieglitz-McBride algorithm, the temperature sensitivity coefficients of these parameters are measured in each tissue at high spatiotemporal resolutions (1.6 x 1.6 x 4 mm 3,≤ 5sec) at the range of 25-61 °C. Non-linear changes in MR parameters are examined and correlated with an Arrhenius rate dose model of thermal damage. Using logistic regression, the probability of changes in these parameters is calculated as a function of thermal dose to determine if changes correspond to thermal damage. Temperature sensitivity of R(2)* and, in some cases, T1-weighted amplitudes are statistically different before and after thermal damage occurred. Significant changes in the slopes of R(2)* as a function of temperature are observed. Logistic regression analysis shows that these changes could be accurately predicted using the Arrhenius rate dose model (Ω = 1.01 ± 0.03), thereby showing that the changes in R(2)* could be direct markers of protein denaturation. Overall, by using a chemical shift imaging technique with simultaneous temperature estimation, R(2)* mapping and T1-W imaging, it is shown that changes in the sensitivity of R(2)* and, to a lesser degree, T1-W amplitudes are measured in ex vivo tissue when thermal damage is expected to occur. These changes could possibly be used for direct validation of thermal damage in contrast to model-based predictions.

Enterobius vermicularis infection in schoolchildren: a large-scale survey 6 years after a population-based control.

Pinworm infection remains prevalent in children in many parts of the world. This study was designed to determine the prevalence of this infection in schoolchildren in Taiwan after the termination of the 15-year population-based control project in 2001. Our results showed that 2.4% of 118 190 children in 385 primary schools were found to have enterobiasis by two-consecutive-day adhesive cellophane perianal swabs. The prevalences were significantly different in the 25 counties/cities surveyed (0.6-6.6%). A significantly higher prevalence was found in boys (2.6%) than in girls (2.2%) and the prevalence decreased by grade from 3.8% in grade 1 to 1.0% in grade 6. In the primary schools, 9.1% had positive rates 10%. In addition, pinworm infection was found to be significantly associated with the socioeconomic status, personal hygiene and sanitary conditions of the children. The results indicate that the overall prevalence of enterobiasis remains at a low level after the control programme was transferred to the local governments.

Molecular epidemiology of enterovirus 71 in Taiwan.

Taiwan suffered a severe and widespread outbreak of enterovirus infection in 1998. More than 400 children were hospitalized, with seventy-eight fatalities due to central nerve system (CNS) involvement and cardiopulmonary collapse. Enterovirus 71 (EV71) was incriminated as the causative agent for the fatal cases. To understand the viral molecular epidemiology in this outbreak, fragments of 207-bp length of the VP4 region in 23 Taiwanese EV 71 isolates were sequenced. Pair-wise comparison revealed a 17.5-24.4% difference between the isolates and the prototype BrCr. However, all the changes in the VP4 region of the isolated strains were synonymous substitutions. Phylogenetic analysis was performed on these 23 isolates and 21 others deposited in GenBank. In this study, forty-four EV71 isolates from the world were separated into three distinct genotypes: A, B and C. The EV71 prototype strain, BrCr/70, is the only strain of genotype A. Group B included strains from the United States, Japan and Taiwan. Most strains in genotype B were isolated prior to 1990. Group C consisted of strains from Japan and Taiwan. Most strains of genotype C were isolated after 1990, they were further divided into 3 clusters: i.e. C-1, C-2 and C-3. In Taiwan, two genotypes, B and C-3, were co-circulating during the outbreak in 1998, although a minor group of genotype B may have appeared in Taiwan before 1986. The majority of the isolates clustered in genotype C-3. Genotype C showed a higher evolutionary rate than genotype B (3.9 x 10(-3) vs. 1.4 x 10(-3)) in the VP4 region. There seems to be a worldwide trend with strains of genotype B appearing earlier than strains of genotype C which took over later in the dominance.

Antimicrobial resistance and serotype distribution of Streptococcus pneumoniae infections in Kaohsiung from 1996 through 1999.

A total of 89 isolates of Streptococcus pneumoniae were obtained from 86 patients during the period from November 1996 through September 1999 at the Kaohsiung Medical University Hospital. The purpose of this study was to determine the antimicrobial susceptibilities and the distribution of serotypes of these isolates, and to correlate these findings with the clinical characteristics of patients. Twenty-one (23.6%) isolates were obtained from patients aged below 5 years, and 38 (42.7%) from patients aged over 65 years. These 86 patients included 53 pneumonia, 13 bacteremia (including 6 with septic shock), 8 urinary tract infection, 8 soft tissue infections, 7 acute exacerbation of chronic bronchitis, 2 ophthalmic infection, and 2 cholecystitis cases. The most frequent serotypes were types 20 (10.1%), 6 (9%), 10 (9%), 11 (9%), and 23 (9%). All isolates were included in the serotypes represented in the 23-valent pneumococcal vaccine. Thirty-four (38.2%) isolates showed reduced penicillin susceptibility by the E-test. The predominant serotypes of penicillin-resistant S. pneumoniae were types 11 (17.6%), 7 (14.7%), 6 (8.8%), 8 (8.8%), and 23 (8.8%). All isolates were susceptible to vancomycin. Resistance rate to erythromycin was 49.4%, chloramphenicol, 20.2%; and trimethoprim/sulfamethoxazole, 61.8%. Multiple resistance (> or = 3 classes of antibiotics) was found in 28 (31.5%) isolates, of which the majority were serotypes 11 (14.3%), 7 (14.3%), 6 (10.7%), 8 (10.7%), and 23 (10.7%).

Late diagnosis of Kawasaki disease is associated with haptoglobin phenotype.

BACKGROUND: Kawasaki disease (KD) is an acute febrile illness characterized by multiple clinical and biochemical features of inflammation and the most common complications of coronary artery abnormality (CAA). Haptoglobin (Hp) is an acute-phase protein whose phenotype is known to be involved in coronary artery diseases. In this paper, we report the investigation of the association of Hp phenotype with the formation of CAA in KD. PATIENTS AND METHODS: Forty-seven consecutive patients with clinically diagnosed KD were admitted. Sera were taken before therapy of intravenous immunoglobulins (IVIG) plus aspirin, and levels of serum proteins were measured by a rate immunonephelometer. The echocardiographic criteria for coronary artery abnormality were evaluated during acute or subacute stages. Hp phenotyping was performed by Western immunoblotting. RESULTS: Duration of fever at diagnosis of KD was significantly different between patients with Hp 2-2 (6.4 +/- 1.2 days, n = 25) and with Hp1 allele (Hp 2-1 plus Hp 1-1; 8.8 +/- 3.5 days, n = 22). In contrast, serum levels of Hp between KD patients with Hp2-2 and with Hp1 allele (297 +/- 121 mg dL-1 vs. 330 +/- 101 mg dL-1, respectively) was not significantly different. On the other hand, no patients with Hp 2-2 (0/25) were recognized as having KD in subacute stage. However, 5 out of 20 patients with Hp 2-1 were recognized in subacute stage, and their incidence of CAA was 80.0% (4/5). CONCLUSIONS: Patients with Hp 2-1 have patterns of delayed or incomplete presentation of clinical symptoms. Therefore, the late diagnosis of KD is associated with haptoglobin phenotype.

Pulse sequences for interventional magnetic resonance imaging.

Interventional magnetic resonance imaging (iMRI) is different from diagnostic magnetic resonance imaging (MRI) in its spatial, temporal, and contrast resolution requirements due to its specific clinical applications. As a result, the pulse sequences used in iMRI often are significantly different than those used in the more conventional diagnostic arena. The focus of this article is to summarize how iMRI is different from diagnostic MRI, to describe a variety of MRI pulse sequences and sequence strategies that have evolved because of these differences, and to describe some MRI sequence strategies that are in development and may be seen in future iMRI applications.

Improved device definition in interventional magnetic resonance imaging using a rotated stripes keyhole acquisition.

Keyhole acquisition techniques have been used to reduce image acquisition times primarily in contrast agent studies and via simulation in interventional MRI procedures. More recent simulations have suggested that improved definition of an interventional device [e.g., biopsy needles, radio frequency (RF) electrodes] could be achieved by rotating the keyhole pattern in k-space so that the read out direction lies perpendicular to the device orientation in real space. This study seeks to validate the earlier predictions of improved efficacy of a rotated stripes keyhole acquisition in actual in vitro and in vivo interventional MR imaging procedures. A true-FISP sequence was modified to perform central stripes keyhole (as known as conventional keyhole) acquisitions after a full initial reference data set was acquired. The gradients of this sequence were then modified to rotate the k-space definition and the keyhole stripes by 10 degrees, 20 degrees, 30 degrees, 45 degrees, and 60 degrees from their conventional k-space orientation. Acquisitions were performed during insertion of interventional devices in phantom and in vivo RF ablation procedures, using the modified sequence selected which placed the phase encoding axis at parallel and perpendicular orientations to the devices. Resulting images were compared between the two orientations for needle width and tip accuracy. Apparent needle width was thinner and tip position more accurately determined for placement of phase encoding parallel to the needle in all cases. Rotated keyhole imaging provides the required temporal advantage of conventional keyhole imaging along with a near optimal definition of an interventional device when the phase encoding is oriented parallel to the direction of the needle motion. Magn Reson Med 42:554-560, 1999.

An indigenous melioidosis: a case report.

Melioidosis is a rare but potentially fatal infectious disease in Taiwan, although it has been endemic in Southeast Asia, especially northeast Thailand, and northern Australia. In this article, we report a male diabetes with fulminant pneumonia, and septicemia caused by Burkholderia pseudomallei without traveling abroad before this episode. Productive cough and intermittent chills, high fever for one week, followed by progressively deteriorating dyspnea, shock, disturbed consciousness status were the major presentations. Blood culture grew B. pseudomallei on the fifth admission day. Unfortunately, the patient died on the 9th admission day, despite intensive care and the broad-spectrum antimicrobial regimen used.

Epidemiological study of human salmonellosis during 1991-1996 in southern Taiwan.

Within a 6-year period from January 1991 to December 1996, 249 patients of salmonellosis admitted to Kaohsiung Medical College Hospital were enrolled for clinical and microbiological analysis. The number of patients increased by year from 1991 (14 patients) to 1996 (79 patients), especially in the case of nontyphoid salmonellosis. There were 57 different serotypes isolated during these period. Salmonella typhimurium was the most common clinical serotype of human origin in southern Taiwan, followed by S. choleraesuis, S. schwanzengrund, and S. derby. Fever (81.1%), diarrhea (68.9%), and anorexia (44.6%) were the most common manifestations of human salmonellosis. Relative bradycardia was a more important feature in S. typhi group (100%) than nontyphoid salmonellosis. Leukocytosis, especially lymphocytosis, was found especially in nontyphoid, but not in typhoid salmonellosis. Elevated liver function tests were found in the most severe patients, such as S. choleraesuis and S. typhi infections. Malignancy (8.8%), especially hematological malignancy (5.2%), gastrointestinal diseases (8.8%), and diabetes mellitus (6.4%) were the common underlying diseases. Case fatality rate of human salmonellosis was 8% (20/249), especially high in S. choleraesuis group. The severity of underlying diseases may be the major cause in S. choleraesuis group. There was no fatal case with typhoid fever. Very high resistance rate to commonly used antimicrobial agents in nontyphoid Salmonella was noted in southern Taiwan with overall rates of resistance to ampicillin, 67.9%, chloramphenicol, 66.7%, and TMP/SMZ, 42.2%. The emergence of ciprofloxacin-resistant and multiresistant strains was also a major therapeutic problem in this study.

Salmonella choleraesuis bacteremia in southern Taiwan.

Within a 6-year period from January 1991 to December 1996, 19 patients with Salmonella choleraesuis bacteremia were enrolled for clinical and microbiological analysis. Young children, the elderly and patients with hematological malignancy (36.8%), liver cirrhosis (26.3%), systemic lupus erythematosus (10.5%), chronic renal impairment (10.5%), and peptic ulcer (10.5%) were at high risk of this infection. The ratio of male to female was 3:1. Three cases (15.8%) were nosocomially acquired. Fever (89.5%), chills (57.9%) and anorexia (52.6%) were the most common clinical manifestations. Seven patients (36.8%) presented no gastrointestinal manifestations. Normal white blood cell count was noted in seven patients (36.8%), and neutropenia caused by underlying diseases or severe infection was found in six cases (31.6%). Various types of metastatic focal infections were found, such as septic arthritis, cutaneous infection, spontaneous bacterial peritonitis, and pneumonia. The severe immunocompromised status of patients and the high virulence of this pathogen may contribute to the high case fatality rate (21%). Higher resistance rate to commonly used antimicrobial agents was noted in ampicillin (94.7%), chloramphenicol (89.5%), and TMP/SMZ (63.8%). All strains of S. choleraesuis were susceptible to third-generation cephalosporins and fluoroquinolones. Generally, S. choleraesuis bacteremia should be taken into account in the differential diagnosis of sepsis in immunocompromised patients, even without gastrointestinal manifestations. The third-generation cephalosporins and fluoroquinolones may be the first choice for treatment of this invasive infections.

Comparison of immunogenicity of simultaneous and nonsimultaneous vaccination with MMR and JE vaccine among 15-month-old children.

To evaluate the immunogenicity of measles- mumps- rubella (MMR) vaccination with Japanese encephalitis (JE) vaccine nonsimultaneously and simultaneously, 145 babies, aged 15 months were enrolled into two groups. Group A received MMR and JE vaccines nonsimultaneously at an interval of 6 weeks; group B received the vaccinations simultaneously. Antibody titers of MMR and JE were detected before and 8 weeks after vaccination. A total of 118 babies (61 in group A; 57 in group B) completed the study. In group A, mean increments of logarithmic geometric mean titers (GMTs) of MMR and JE were 4.51, 5.93, 4.07 and 1.99; seroresponse rates were 100% (61/61), 77.05% (47/61), 96.72% (59/61) and 59.02% (36/61) respectively. In group B, mean increments of logarithmic GMTs of MMR and JE were 4.35, 5.37, 4.44 and 1.93; seroresponse rates were 98.25% (56/57), 77.19% (44/57), 98.25% (56/57) and 57.89% (33/57) respectively. There were no significant differences between these two groups. These results suggest that simultaneous and nonsimultaneous vaccination with MMR and JE vaccines were similar in immunogenicity.

Heat shock treatment decreases the mortality of sepsis in rats.

Sepsis is an increasingly common and lethal diagnosis in hospitalized patients. In spite of the advances in antibiotics and medical equipment, the mortality rate has not been improved in the last decade. Recently, heat shock proteins (Hsps) have been well documented to play a self-protective role in almost all living cells under various pathological and physiological stresses through a mechanism known as thermotolerance or cross tolerance. The present study was designed to investigate the expression of Hsp72 and the protective role of pre-induction of Hsps in the mortality during different phases of sepsis. Adult male Sprague-Dawley rats were employed in the study. Sepsis was induced by cecal ligation and puncture (CLP). Heat shock treatment was performed 16 hrs before sepsis induction by heating the rats whole-bodily with an electric heating pad under general anesthesia. The mortality rates with time in both control and preheated groups were monitored. Hsp72 was detected by SDS-PAGE, Western blotting and immunostaining in the brain, heart, liver, kidney, lung, adrenal gland, muscle and lymphocytes. The results show that both early (9 hrs post-CLP) and late (18 hrs post-CLP) sepsis failed to increase the synthesis of Hsp72. Previous induction of Hsps by heat shock treatment significantly decreased the mortality rate of late sepsis. Applying a sufficient inducer to lymphocytes of late sepsis reversed the synthesis of Hsp72 from inactive state into an over-expressive situation in vitro. These results suggest that Hsps are involved in the pathogenesis of sepsis and the involvement of Hsps during the progression of sepsis could add to a first line of host defense against invasive pathogens. Searching for an acceptable agent or less invasive method that leads to increased Hsps expression may provide a means for better treatment of severe infection.

Human intestinal capillariasis (Capillaria philippinensis) in Taiwan.

A human case of intestinal capillariasis was first recognized in the Philippines in the mid-1960s. The parasitosis is a life threatening disease and has been reported from Thailand, Japan, Taiwan. Korea, Iran, and Egypt. Clinical symptoms include diarrhea, abdominal pain, borborygmi, marked weight loss, protein and electrolyte loss, and cachexia. Capillariasis may be fatal if treatment is not given early. We observed 7 cases living in the more rural areas of Taiwan. Two cases had histories of travelling to Thailand. These two cases might have been infected in Thailand while stayed there. The other 5 cases didn't have histories of going abroad. According to the route of transmission, freshwater and brackish-water fish may act as the intermediate host of the parasite. People who like to eat raw fish, and have had long term diarrhea with abdominal pain and borborygmi, capillariasis philippinensis should be highly suspected. The most simple and convenient method of diagnosing capillariasis is stool examination. Treatment with mebendazole or albendazole for 20-30 days is known to be effective. All 7 cases we observed were cured through adequate treatment with anthelmintics and general management. A case, found in Kaohsiung Medical College Hospital in 1983, may be the first case in Taiwan.

Discovery of encysted Paragonimus westermani eggs in the omentum of an asymptomatic elderly woman.

We report a case of asymptomatic chronic infiltrate of the omentum by eggs of Paragonimus westermani in an elderly woman who had immigrated to Taiwan from mainland China 46 years ago. The patient had a habit of eating raw freshwater crabs from the lakes of eastern China during her period of residence in that country. She stopped eating raw crabs after coming to Taiwan 20 years ago. During surgery for a peptic ulcer complicated by severe bleeding in 1995, her omentum was found to contain many small nodules approximately 2 x 2 x 1.5 cm in size. Biopsy of the nodules revealed eggs of P. westermani embedded in necrotic debris surrounded by capsules. A sputum examination result was negative and a chest radiograph was normal. The majority of the nodules in the omentum were removed during the surgery and praziquantel was given. At the present time, the patient remains asymptomatic.

Silent transmission of the dengue virus in southern Taiwan.

Immunoglobulin M (IgM) antibody to dengue virus was examined from a total of 3,099 serum samples collected in southern Taiwan. Of 1,232 sera collected from a junior high school and four elementary schools in Liu-Chiu, 35 were IgM-positive, demonstrating that the dengue virus has been circulating on the island, despite the fact that no epidemic has been reported in the past 10 years. Sixteen of 925 sera collected from three elementary schools in Tung-Kang in 1991 were found to be IgM-positive and two of 192 sera from adults in the local community were positive. The IgM-positive subjects tended to be aggregated around a port. Fishing boats that had stopped in neighboring endemic countries were presumed to have introduced the virus periodically, causing a low level of inapparent infections. In the Kaohsiung area, two of 108 suspected clinical cases and four of 642 community-based sera were IgM-positive. Rapid urbanization has provided appropriate circumstances for vector breeding in this area and the high population density has also increased contact frequency between humans and mosquito vectors. This has, in turn, increased the possibility of silent transmission of the dengue virus via either intermittent reintroduction of the virus or continuation of inapparent infections or both. Establishment of a early warning system using the IgM antibody capture-enzyme-linked immunosorbent assay is suggested for effective monitoring of the disease.

Pulmonary hyperinfection with Strongyloides stercoralis.

Strongyloides stercoralis is an intestinal parasite in humans. Infected patients may be asymptomatic or have mild to moderate abdominal symptoms. It may spread to the lungs and, finally, disseminate in the immunocompromised patient. S. stercoralis is an important cause of severe pulmonary infection and death in many areas of the world. Here we describe an 87-year-old man with S. stercoralis pulmonary hyperinfection. He had respiratory failure with severe abdominal distention. Chest x-ray showed infiltration over the right upper lung field. Papanicolaou stain of sputum demonstrated the rabditiform larvae of S. stercoralis. Stool examination revealed S. stercoralis larvae and eggs. He received two courses of albendazole treatment, but died 5 weeks after admission from Gram-negative bacteremia. This case is a classic presentation of the S. stercoralis pulmonary hyperinfection syndrome.

[Clinical manifestations and effects of IVGG in patients with Kawasaki disease].

From Jan 1984 till Dec 1992, 293 patients--180 males and 113 females (M:F = 1.5:1)--with Kawasaki disease visited the Pediatric Department of Kaohsiung Medical College Hospital. The mean age from the total cases were 28.5 months (2 months-10 years). Fever was the most common clinical symptom, followed by dry cracked lips (93.5%), pharyngeal injection (92.8%) and conjunctivitis (90.5%). Only 62.6% of the total cases had cervical lymph node swelling of which the prevalence was higher than the previous report of the National Taiwan University Hospital in 1985. Two hundred and ninety-three cases were divided randomly into 3 groups according to the different treatment regimens. The first group of 199 cases whose coronary artery change occurred in 85 cases (42.7%), were treated with aspirin alone. The second group of 80 cases were treated with aspirin and IVGG 400 mg/kg/day for 5 consecutive days. The prevalence of coronary artery abnormalities was 22.5% (18/80). The third group of 14 cases were treated with aspirin and single high dose IVGG (2 gm/kg) for 10-12 hours. Coronary artery abnormalities occurred in 3 cases (21.4%). IVGG, initiated within 10 days of the onset of fever, in conjunction with aspirin decreased the prevalence of coronary artery dilatation and aneurysms significantly in comparison with treatment by the aspirin alone (p < 0.05). However, there was no difference in the prevalence of coronary aneurysm between the groups of single high dose and multiple doses, though the single high dose of IVGG can improve the clinical symptoms quickly and shorten the duration of hospitalization.

A model to study cytokine profiles in primary and heterologously secondary Dengue-2 virus infections.

Roles of cytokines in primary and secondary Dengue virus (DV) infections are not completely understood. In this study, we challenged mononuclear leukocytes (MNLs) obtained from non-immune and DV-1-infected donors with DV-2 in vitro to mimic primary and heterologously secondary DV-2 infections, respectively. We found that MNLs in response to DV-2 could release a large amount of interleukin-1 (IL-1 beta) and tumor necrosis factor alpha (TNF alpha). However, IL-1 beta and TNF alpha released by MNLs with primary or heterologously secondary exposure to DV-2 were not significantly different. In contrast, MNLs with heterologously secondary DV-2 infections produced significantly higher amount of interferon gamma (IFN gamma) than those with primary DV-2 infections. These results suggest that IFN gamma, but not TNF alpha or IL-1 beta, may in part participate in the pathogenesis of Dengue shock syndrome (DSS) frequently found in heterologously secondary DV-2 infections.