Adenovirus infection associated with central nervous system dysfunction in children.

BACKGROUND: Adenovirus is a common pathogen in the pediatric population. No reports systemically evaluated central nervous system (CNS) dysfunction associated with adenovirus. OBJECTIVE: To describe the detailed clinical features of adenovirus-associated CNS dysfunction in children. STUDY DESIGN: Of 3298 children with a throat virus culture positive for adenovirus treated at a university-affiliated hospital, from January 2000 to June 2008, in northern Taiwan, medical charts were retrospectively reviewed and those with CNS dysfunction were included. RESULTS: 109 (3.3%) children had signs or symptoms of CNS dysfunction on admission. The median age was 3.6 years and 81 (76%) were less than 5 years of age. 64 (59%) were male. The most frequently cited CNS symptoms were seizure (64%), altered state of consciousness (13%), visual hallucination (9.3%) and lethargy (7.5%). The most common diagnoses included febrile seizure (48%), encephalitis (26%), afebrile seizure (11%) and meningitis/meningismus (8.3%). 31 (46%) of 67 patients receiving electroencephalogram examination had abnormal findings and 13 (36%) of 36 with image studies had abnormal findings. Ninety-nine (91%) children returned to normal health, 7 (6.4%) had a sequel of seizure disorder, and 3 (2.7%) had major sequelae and none died. Nine serotypes were identified, with three major serotypes (types 3, 2 and 1). CONCLUSION: CNS dysfunction was identified in 3.3% of children with adenoviral infection and most occurred in those <5 years old. The clinical prognosis seemed well. However, CNS dysfunction is a potentially serious complication of adenovirus infection in children.

Epidemiology and clinical characteristics of Listeria monocytogenes bacteremia in a Taiwanese medical center.

BACKGROUND/PURPOSE: There have been many reported cases of Listeria monocytogenes bacteremia in Europe and the United States, but only a few from Taiwan. The present study was undertaken to analyze the clinical characteristics of patients with L. monocytogenes bacteremia in Taiwan. METHODS: Patients with culture-confirmed L. monocytogenes bacteremia were identified at Chang Gung Memorial Hospital between January 2001 and December 2008. The clinical features and outcomes of the patients and the antimicrobial susceptibilities of the clinical isolates were analyzed. RESULTS: Forty-three patients, including two newborn babies (4.7%) and 41 adults (95.3%), with at least one episode of Listeria bacteremia were identified. Forty-two (97.7%) of these patients had underlying diseases. Thirty-three patients (76.7%) had fever, 14 (32.6%) had experienced respiratory distress, and 11 (25.6%) had reported changes in consciousness. Twelve patients died within 14 days of infection, corresponding to a case-fatality rate of 27.9%. All the clinical isolates tested were susceptible to ampicillin, penicillin and vancomycin. CONCLUSION: Most cases of L. monocytogenes infection occurred in adults with underlying diseases, especially malignancy, and only two cases of neonatal L. monocytogenes bacteremia were identified over the 8-year period. Penicillin, ampicillin and vancomycin could be used for the treatment of L. monocytogenes bacteremia, with the case-fatality rate lower for patients who received appropriate treatment.

Epidemiology and clinical peculiarities of norovirus and rotavirus infection in hospitalized young children with acute diarrhea in Taiwan, 2009.

BACKGROUND/PURPOSE: Acute diarrhea is one of the most common morbidities in pediatrics worldwide. We conducted a study to investigate the incidence of norovirus in young children hospitalized with acute diarrhea in Taiwan and its clinical peculiarity compared with rotavirus gastroenteritis. METHODS: Between January and December, 2009, patients younger than 5 years and admitted to hospital with acute diarrhea were randomly selected; and their stool samples were collected and tested for presence of rotavirus and norovirus by enzyme immunoassay and reverse transcription-polymerase chain reaction, respectively. The clinical manifestations and laboratory findings of the enrolled patients were analyzed. RESULTS: A total of 989 cases were enrolled with a mean age of 21.6 ± 13.7 months and a male proportion of 56.0%. Rotavirus and norovirus was detected in 20.2% and 14.6% of all patients, respectively. Genogroup II was the predominant strain of norovirus (80.6%). Children aged 6-36 months accounted for the majority of patients positive for rotavirus and norovirus (73.0% and 81.3%, respectively). The incidences of norovirus and rotavirus infection were higher during winter and early spring. Most patients with rotavirus and norovirus diarrhea experienced vomiting (74.9%vs. 74.8%, respectively) and fever (94.7%vs. 71.3%, respectively). CONCLUSION: Most young diarrheal patients presenting with vomiting were likely to have norovirus or rotavirus infection. Patients with norovirus diarrhea experienced an absence of, or low-grade fever and longer duration of vomiting compared with those positive for rotavirus infection. A family history of current gastroenteritis may suggest the possibility of norovirus infection.