Primary Epstein-Barr virus infection in 2-year-old children: report of 3 cases.

Some children less than four years old have Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM). Because primary EBV infection in infants and young children is usually asymptomatic or subclinical, EBV infection diagnosis may not be easy among young children. To illustrate the clinical characteristics and diagnostic procedures for EBV infection in young children, the authors report herein three cases of primary EBV infection in two-year-old children with an evaluation of their initial clinical symptoms. The results showed that the common initial clinical manifestations are puffy eyelids and hepatosplenomegaly, and that these signs suggest a tentative diagnosis of IM. In conclusion, EBV capsid immunoglobulin (Ig)M antibodies and atypical lymphocytes are useful diagnostic measurements in very young children with symptoms suggestive of IM.

Antivenom treatment and renal dysfunction in Russell's viper snakebite in Taiwan: a case series.

Formosan Russell's viper (Daboia russelli siamensis) is the sixth most frequent cause of snakebites in Taiwan. Its bite induces greater kidney injury than other Russell's vipers in Southeast Asia. Poor availability of antivenom might be the major reason. To enhance treatment, we supplied the antivenom to the teaching hospitals that are near the areas where D. r. siamensis is found. We also used an ELISA in diagnosis. From June 1999 to December 2001, a total of 13 cases of D. r. siamensis snakebite were diagnosed with serum venom level of 10-98 ng/ml, 1-6 hours after being envenomed. Abnormal coagulation function and acute renal failure occurred early and were the two most important clinical features. Early specific antivenom treatment, 3-6 hours after systemic envenoming, restored the coagulation function in 1-2 days and seemed to be statistically effective in reducing the severity of renal damage compared with the historical and delayed group by the Wilcoxon rank-sum test. Two to four vials of antivenom were needed to block the systemic toxicity and produced few side effects. The antivenom should be administered as early as possible to prevent systemic dysfunction.

Sandwich enzyme-linked immunosorbent assay for Taiwan cobra venom.

Poisonous snake bite victims usually have difficulty identifying the species, and clinical manifestations alone are not reliable because of overlapping symptoms. Thus, it is important to develop a quick and reliable mean of identifying the snake responsible. We describe the development of a sandwich-ELISA method for detection of venom in biological samples and apply it to a case of snakebite to confirm the clinical diagnosis. The sandwich-ELISA takes 6 h to complete. Cobra venom antigen gave positive absorbance at about 500 pg/ml. Good linearity with R2 values over 0.99 were observed in dilution series of 1:100 ng/mL of cobra venom in calf serum and human urine. A snakebite initially thought to be Trimeresurus mucrosquamatus was proven cobra with a serum venom level up to 288 ngmL 3 h after envenoming. Sandwich-ELISA provides a rapid and accurate method for clinical identification and evaluation of toxic antigens circulating in individuals bitten by the Taiwan cobra snake.