Deep neck infections in children.

BACKGROUND/PURPOSE: Deep neck infections (DNIs) often have a rapid onset and can progress to life-threatening complications. There are only a few reports on pediatric DNIs' clinical manifestations, diagnostic clues, and etiology in Taiwan. METHODS: A retrospective chart review of patients (aged ≤ 18 years) diagnosed with DNI from January 2005 to December 2014 was performed. DNIs were classified into retropharyngeal, parapharyngeal, peritonsillar, submandibular, and multispace abscesses. RESULTS: A total of 52 patients with DNI were identified. The most common site of DNI was the parapharyngeal space (n = 22, 42.3%). The most commonly associated antecedent illness was preceding upper respiratory tract infection (30.8%). The most common clinical presentation was neck mass or swelling (82.7%) and fever (75%). Pus drainage or needle aspiration was performed to obtain pus samples from the infection site for pus culture (n = 31). The most commonly isolated pathogen was Staphylococcus aureus (n = 7). Amoxicillin-clavulanic acid (56.6%) was the most commonly used antibiotics, followed by penicillin (15.1%). There was no long-term morbidity or mortality. CONCLUSION: When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis. The low culture rate in Taiwan and previous partial treatment of infections may have affected identification of pathogens in cultures. Performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial. The recurrence of DNI should alert the physician to the possibility of an underlying bronchogenic cyst. Excision surgery is required to cure recurrent infections.

Clinical approach to fever of unknown origin in children.

BACKGROUND/PURPOSE: Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children. METHODS: We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks. The four-stage FUO investigative guideline was used to evaluate the etiology of fever in all patients enrolled in the study. RESULTS: The etiology of FUO was identified in 79 (84.9%) of the 93 patients enrolled in the study. The most common cause of FUO was infectious disease (37.6%), followed by malignancy (17.2%), miscellaneous disease (16.1%), and collagen vascular disease (14.0%). With respect to the four-stage survey of FUO, 36 of the 79 patients (45.6%) were identified in Stage 3, 28 patients (35.4%) in Stage 2, 13 patients (16.5%) in Stage 4, and only two patients (2.5%) in Stage 1. CONCLUSION: A well-designed systemic review of the epidemiological information, medical history, physical examination, laboratory analysis, and adequate invasive procedures provide adequate data to identify the most common causes of FUO in children.

Treatment of recurrent complicated urinary tract infections in children with vesicoureteral reflux.

BACKGROUND: Urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR) are often caused by uropathogens with a high rate of drug resistance and are associated with a high rate of recurrence with a single pathogen. In this study, we evaluated the incidence of recurrent UTI and the drug resistance pattern of Escherichia coli in children with VUR. We also evaluated whether combination therapy comprising fosomycin plus one other antimicrobial agent is effective for treatment of recurrent UTIs. METHODS: We retrospectively reviewed the medical records of all children with VUR who developed at least one episode of UTI during the period January 1, 2003 to December 31, 2013 at a single medical center. The effectiveness of fosfomycin plus amikicin for Enterobacteriaceae or ceftazidime for Pseudomonas aeruginosa infections was prospectively studied in six children with recurrent relapsing UTIs. RESULTS: The study population comprised 129 children (age range, from 1month to 15 years; mean ± standard deviation, 2.37 ± 2.91 years) with VUR who developed at least one UTI during the 10-year study period; 68 (52.7%) had recurrent UTIs. The presence of an underlying urinary tract anomaly was predictive of recurrence (p = 0.028). The rates of susceptibility of E. coli to cefazolin (p < 0.001) and cefotaxime (p < 0.001) were significantly lower in patients with recurrent UTIs. Combination therapy with fosfomycin plus amikacin or ceftazidime was shown to be an effective therapeutic option for recurrent UTIs due to a single uropathogen. CONCLUSION: The rates of susceptibility of E. coli to commonly used antimicrobials were significantly lower in children who developed more than one episode of UTI. The empiric choice of cefazolin or cefotaxime was usually ineffective. Administration of fosfomycin plus amikacin or ceftazidime was an effective therapeutic and preventive strategy in children with VUR and recurrent relapsing UTI.

The dual role of protein kinase C in the regulation of telomerase activity in human lymphocytes.

Protein kinase C (PKC) has been implicated to play an essential function in the upregulation of telomerase activity in activated T cells, yet its role in the regulation of telomerase activity remains largely unknown. In this work, we present evidence that PKC activity is required both for the induction of hTERT expression and for the post-transcriptional control of telomerase enzyme activity in T lymphocytes. Of the several PKC isoforms present in lymphocytes, only the level of PKC-zeta was greatly increased during T cell activation, implicating that PKC-zeta may be required for the post-transcriptional control of telomerase enzyme activity in T lymphocytes.

Antimicrobial susceptibility of common bacterial pathogens isolated from a new regional hospital in southern Taiwan.

BACKGROUND: Antimicrobial resistance has become a major health problem in Taiwan. While some trends in antimicrobial resistance are universal, others appear to be unique for specific regions. METHODS: To determine the distribution and antimicrobial drug resistance of bacterial pathogens in a new hospital in southern Taiwan, surveillance data on major bacterial pathogens isolated from Chang Gung Memorial Hospital at Chia-Yi from January 2002 through December 2002 were retrospectively analyzed. RESULTS: The most common gram-positive isolate was Staphylococcus aureus. Escherichia coli and Klebsiella pneumoniae were the two most common gram negative isolates. Pseudomonas aeruginosa ranked the first among gram-negative, glucose non-fermenting isolates, followed in the order of frequency by Acinetobacter baumannii. Oxacillin resistance rate of S. aureus was 58%, while vancomycin and teicoplanin remained effective against all of the isolates. The penicillin non-susceptibility rate of Streptococcus pneumoniae was 52%, and it is notable that the rate of resistance to erythromycin was 87%. Resistance to various antimicrobial agents for P. aeruginosa, Aeromonas hydrophila, and gram-negative enteric bacilli was very common in our study. Infections caused by multidrug-resistant A. baumannii was not uncommon in this hospital but fortunately, imipenem resistant A. baumannii was rarely encountered. Antimicrobial resistance was common in nontyphoid Salmonella, S. choleraesuis and serogroup B isolates in particular. CONCLUSION: The high rates of antimicrobial resistance among these major bacterial pathogens in this new hospital are impressive and alarming. Judicious use of antimicrobial agents can never be overemphasized. Continued surveillance of the changes of resistance patterns over time is necessary.