Circulating Respiratory Syncytial Virus Genotypes and Genetic Variability of the G Gene during 2017 and 2018/2019 Seasonal Epidemics Isolated from Children with Lower Respiratory Tract Infections in Daejeon, Korea

Background@#Respiratory syncytial virus (RSV) is a major pathogen causing respiratory tract infections in infants and young children. The aim of this study was to confirm the genetic evolution of RSV causing respiratory infections in children at Daejeon in Korea, through G gene analysis of RSV-A and RSV-B strains that were prevalent from 2017 to 2019. @*Methods@#Pediatric patients admitted for lower respiratory tract infections at The Catholic University of Korea Daejeon St. Mary's Hospital in the 2017 and 2018/2019 RSV seasonal epidemics, who had RSV detected via multiplex polymerase chain reaction (PCR) were included. The nucleic acid containing RSV-RNA isolated from each of the patients' nasal discharge during standard multiplex PCR testing was stored. The G gene was sequenced and phylogenetic analysis was performed using MEGA X program and the genotype was confirmed. @*Results@#A total of 155 specimens including 49 specimens from 2017 and 106 specimens from 2018-2019 were tested. The genotype was confirmed in 18 specimens (RSV-A:RSV-B = 4:14) from 2017 and 8 specimens (RSV-A:RSV-B = 7:1) from 2018/2019. In the phylogenetic analysis, all RSV-A type showed ON1 genotype and RSV-B showed BA9 genotype. @*Conclusion@#RSV-B belonging to BA9 in 2017, and RSV-A belonging to ON1 genotype in 2018/2019 was the most prevalent circulating genotypes during the two RSV seasons in Daejeon, Korea.

Circulating Respiratory Syncytial Virus Genotypes and Genetic Variability of the G Gene during 2017 and 2018/2019 Seasonal Epidemics Isolated from Children with Lower Respiratory Tract Infections in Daejeon, Korea

Background@#Respiratory syncytial virus (RSV) is a major pathogen causing respiratory tract infections in infants and young children. The aim of this study was to confirm the genetic evolution of RSV causing respiratory infections in children at Daejeon in Korea, through G gene analysis of RSV-A and RSV-B strains that were prevalent from 2017 to 2019. @*Methods@#Pediatric patients admitted for lower respiratory tract infections at The Catholic University of Korea Daejeon St. Mary's Hospital in the 2017 and 2018/2019 RSV seasonal epidemics, who had RSV detected via multiplex polymerase chain reaction (PCR) were included. The nucleic acid containing RSV-RNA isolated from each of the patients' nasal discharge during standard multiplex PCR testing was stored. The G gene was sequenced and phylogenetic analysis was performed using MEGA X program and the genotype was confirmed. @*Results@#A total of 155 specimens including 49 specimens from 2017 and 106 specimens from 2018-2019 were tested. The genotype was confirmed in 18 specimens (RSV-A:RSV-B = 4:14) from 2017 and 8 specimens (RSV-A:RSV-B = 7:1) from 2018/2019. In the phylogenetic analysis, all RSV-A type showed ON1 genotype and RSV-B showed BA9 genotype. @*Conclusion@#RSV-B belonging to BA9 in 2017, and RSV-A belonging to ON1 genotype in 2018/2019 was the most prevalent circulating genotypes during the two RSV seasons in Daejeon, Korea.

Anaphylaxis to honey

Honey is a food ingested worldwide. Allergic reaction to honey is rare and only a few cases have been reported in the literature. A 20-month-old boy developed angioedema 30 minutes after eating rice cake containing honey. After 2 weeks, we performed food challenge tests with honey which resulted in anaphylaxis. This is the first case report on anaphylaxis to honey in Korea.

Nasal eosinophilia and eosinophil peroxidase in children and adolescents with rhinitis / 소아과

BACKGROUND: Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. PURPOSE: To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. METHODS: We recruited patients <18 years of age with rhinitis for more than 2 weeks or more than 2 episodes a year whose nasal eosinophil and EPO were measured at a single allergy clinic. The eosinophil percentage was calculated by dividing the eosinophil count by the number of total cells under light microscopy at ×1,000 magnification. EPO and protein were measured from nasal secretions. We retrospectively analyzed the correlation between nasal eosinophils and protein-corrected EPO (EPO/protein) value. RESULTS: Of the 67 patients enrolled, 41 were male (61.2%); the mean age was 8.2±4.0 years. The median nasal eosinophil count was 1 and percentage was 1%. The median protein-corrected EPO value was 12.5 ng/μg (range, 0–31 ng/μg). There was a statistically significant correlation between eosinophil count and percentage (P<0.001). However, the eosinophil percentage and EPO did not correlate. The eosinophil count and EPO had a statistically significant correlation (P =0.01). The EPO cutoff value examined for nasal eosinophil counts of 2, 5, 10, and 20 was 17.57 ng/μg regardless of the reference count. The largest area under the curve value was obtained when the receiver operating characteristic curve was drawn using the eosinophil count of 2. CONCLUSION: Nasal eosinophil count was significantly associated with protein-corrected EPO.

Diagnostic value of serum IgM enzyme-linked immunosorbent assays in polymerase chain reaction-positive Mycoplasma pneumonia in children

PURPOSE: Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP. METHODS: Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP real-time PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed. RESULTS: PCR was positive in 57 cases. Longer fever duration before admission (P < 0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P < 0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P < 0.001). CONCLUSION: Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy.

The association between nasal eosinophilia and aeroallergen sensitization in children and adolescents with rhinitis

PURPOSE: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. METHODS: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. RESULTS: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. CONCLUSION: Nasal eosinophilia was significantly associated with sensitization to aeroallergens.

Chest radiographs and computed tomography scans in children with airway foreign body

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.

Additional corticosteroids or alternative antibiotics for the treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia / 소아과

No abstract available.

Usefulness of flexible bronchoscopy in children with suspected pulmonary tuberculosis who have difficulty in sputum expectoration

PURPOSE: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration. METHODS: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid. RESULTS: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the remaining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy. CONCLUSION: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspecting PTB in children who have difficulty expectorating sputum.

Effects of Methylprednisolone Pulse Therapy on Refractory Mycoplasma pneumoniae Pneumonia in Children

PURPOSE: Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. The clinical course is typically self-limited and benign; however, rare cases of severe pneumonia can develop despite appropriate antibiotic therapy. We studied the effects of methylprednisolone pulse therapy on severe refractory M. pneumoniae pneumonia in children. METHODS: The clinical effects of methylprednisolone therapy were evaluated retrospectively in 12 children with severe refractory M. pneumoniae pneumonia, which was diagnosed serologically. All patients developed respiratory distress, high fever, and initial lobar pneumonic consolidation based on radiological findings. All clinical symptoms deteriorated despite appropriate antibiotic therapy. Thus, children were treated with intravenous methylprednisolone pulse therapy in addition to antibiotics. RESULTS: The average febrile period before admission was 4.9+/-1.7 days, and fever persisted in all children until steroid administration. Methylprednisolone pulse therapy (30 mg/kg) was given 5.4+/-2.5 days after admission. After methylprednisolone pulse therapy, clinical symptoms improved in all patients without adverse events. The fever subsided 0-2 h after initiation of corticosteroid therapy. The abnormal radiological findings resolved within 2.6+/-1.3 days, and the high C-reactive protein levels (6.7+/-5.9 mg/dL) on admission decreased to 1.3+/-1.7 mg/dL within 3.0+/-1.1 days after starting corticosteroid therapy. CONCLUSIONS: Three-day methylprednisolone pulse therapy could be applied to treatment of refractory M. pneumoniae pneumonia despite appropriate antibiotic therapy and appeared to be efficacious and well-tolerated.

Clinical Characteristics of Children with Lobar Pneumonia Caused by Mycoplasma pneumoniae / 소아알레르기및호흡기학회지

PURPOSE: This study was conducted to evaluate the prevalence, clinical characteristics and laboratory findings of lobar pneumonia in children caused by Mycoplasma pneumonia and to find a diagnostic tool for identifying M. pneumoniae infection in children. METHODS: We analyzed medical records of 78 children between March 2010 and December 2011, who were admitted to our hospital and diagnosed with lobar pneumonia on the basis of chest X-rays. White blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), specific antibodies to M. pneuomoniae, and cold agglutinin (CA) were measured at the time of admission. Children were divided into 2 groups: those with M. pneuomoniae infection (group A) and those without infection (group B). Group A children were also subdivided into 2 categories: those with increased CA (group 1) and those without (group 2). RESULTS: The prevalence of lobar pneumonia was higher in the year 2011 than in 2010. M. pneuomoniae infection usually occurs in summer and autumn. Group A children accounted for 75.6% (59/78) of all the cases. The onset ages was higher in group A than in group B (P=0.016). WBC counts and PCT values were higher in group B than in group A.(P=0.015 and P=0.011, respectively) Radiologic findings showed that the lower lobe was most commonly involved without predilection for either side and pleural effusion was present in 13.6% of all the cases. The duration of fever before admission was longer in group 1 than in group 2.(P=0.019) CONCLUSION: It is concluded that lobar pneumonia caused by M. pneuomoniae can be more accurately diagnosed using serum PCT values than using CRP values.

Clinical Usefulness of Procalcitonin as Guideline of Antibiotic Treatment in Children with Respiratory Tract Infection / 소아알레르기및호흡기학회지

PURPOSE: Procalcitonin (PCT), a precursor of calcitonin, has been described as a biomarker of bacterial infection and inflammation. This study was performed to evaluate the clinical usefulness of PCT levels and to reduce the unnecessary usage of antibiotics in children with lower respiratory tract infection (RTI). METHODS: Eighty-eight children, with lower RTI, under the age of 5 years, who were admitted to Chungnam National University Hospital, between May 2010 and December 2010, were enrolled. White blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and PCT were measured. Blood and sputum cultures were performed to identify the causative bacteria and reverse transcription-polymerase chain reaction for the viruses. Clinical features were reviewed, retrospectively. RESULTS: The mean participant age was 1.9+/-1.5 years. The cut-off value for serum PCT levels, which was derived from the receiver-operator characteristic curve, was 0.11 ng/mL. In 29 patients (33.0%) with low PCT levels ( or =0.11 ng/mL), hospitalization (P=0.005) and fever (P=0.054) exhibited a shorter duration, after antibiotic therapy. CONCLUSION: A single initial serum PCT levels (> or =0.11 ng/mL) may be clinically useful to give a guideline for antibiotic treatment in children with lower respiratory tract infection and to reduce the unnecessary usage of antibiotics.

Methylprednisolone Pulse Therapy for Focal Segmental Glomerulosclerosis in Children: with the Mendoza Protocol / 대한신장학회지

PURPOSE: The clinical characteristics and pathological findings of patients with focal segmental glomerulosclerosis (FSGS) receiving methylprednisolone pulse therapy (MP pulse therapy) according to the Mendoza protocol were studied to evaluate its therapeutic efficacy. METHODS: The clinical course and pathological findings of 12 patients that were diagnosed with FSGS and treated according to the Mendoza protocol from 2001 to 2006 were reviewed retrospectively. RESULTS: Only three patients among the total twelve patients finished MP pulse therapy, who were diagnosed with minimal change nephrotic syndrome on the first renal biopsy and have preserved renal function at the recent follow-up. Among them, one patient (8%) achieved complete remission, but relapsed 28-months after the end of therapy, and one patient (8%) had a partial remission. Eight patients progressed to end-stage renal disease (ESRD) and four regressed during therapy. All eight patients that were diagnosed with FSGS, on the first renal biopsy, progressed to ESRD and required hemodialysis or kidney transplantation. The frequency of ESRD in this group was statistically significant. CONCLUSION: MP pulse therapy according to the Mendoza protocol showed low therapeutic efficacy; it appeared effective in only 17% and most of the patients (67%) progressed to ESRD. There may be close correlation between the severity of glomerular sclerosis at biopsy and ESRD. These results suggest that the indications for MP pulse therapy according to the Mendoza protocol in nephrotic patients with FSGS requires further clarification.

Clinical Usefulness of Ambulatory Blood Pressure Monitoring in Children and Adolescents

PURPOSE: With increasing prevalence of hypertension (HTN) in children and adolescent, pediatricians have become more interested in blood pressure (BP) measurements. The ambulatory blood pressure monitoring (ABPM) is known to be useful to differentiate true HTN and white coat HTN. The object of this study is to assess the clinical usefulness of ABPM in Korean children and adolescents. METHODS: A retrospective review of 51 patients in Kyungpook National University Hospital from January 2002 to February 2010 was done. All patients were 6-18 years old and underwent ABPM. We calculated the mean value of ABP, BP load, nocturnal dip and compared the results with the patients' diagnosis and characteristics. RESULTS: The mean age of the 51 patients was 17.8+/-1.8 years and 19 children were obese. 37 patients (72.5%) were truly hypertensive and 1 patient was diagnosed as masked HTN and 7 children (14%) as white coat HTN. The rest of the patients were normotensive. Among patients with white coat HTN, 5 were in a prehypertensive state. Mean systolic and diastolic BP load of patients with true HTN were significantly higher than non-hypertensive children (P<0.001). Although the nocturnal dip of all patients were below 10%, there was no statistical significance. The obese patients showed higher systolic and diastolic BP. Their systolic and diastolic BP load were significantly higher than non-obese patients (P<0.001). CONCLUSION: ABPM in children and adolescents seems to be a valuable tool in the assessment of white coat HTN and in the confirmation of true HTN. A considerable number of white coat HTN patients are revealed to be in a prehypertensive state and need close follow-up.

Secondary renal amyloidosis in a 13-year-old girl with bronchiectasis / 소아과

A 13-year-old girl was diagnosed with non-cystic fibrosis (CF)-related multifocal bronchiectasis accompanied by nephrotic-range proteinuria of unknown cause. On renal biopsy, there were many segmental homogeneous deposits of amyloid tissue with positive Congo red staining in the glomeruli and interstitium. On electron microscopy, relatively straight, non-branching, randomly arranged amyloid fibrils were showed in the mesangium of the glomeruli. These fibrils were approximately 10 nm in diameter, compatible with secondary amyloidosis. Her level of serum amyloid A was remarkably elevated. To our knowledge, this girl is the first case of secondary renal amyloidosis induced by bronchiectasis in Korean children.

Clinical Usefulness of Serum Procalcitonin as a Biomarker of Acute Pyelonephritis / 대한신장학회지

PURPOSE: The clinical usefulness of serum procalcitonin (PCT) was evaluated for the diagnosis of acute pyelonephritis (APN) in infants with urinary tract infections (UTIs). METHODS: A total of 46 infants (between 1 and 12 months of age) were enrolled in this study. Laboratory studies including the WBC count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and PCT were measured before initiation of intravenous antibiotic treatment and a (99m)Tc-DMSA renal scan was performed during treatment. RESULTS: There were no significant differences in the mean age, gender and microorganisms detected between the patients with a lower UTI and those with APN. The duration of fever before and after treatment was significantly longer in the APN group. Except for the WBC count, there was a significantly higher ESR, serum CRP and PCT levels detected in the APN group. Although the serum CRP and PCT showed similar sensitivity and specificity for the diagnosis of APN, simultaneous measurement of the ESR, serum CRP and PCT increased the specificity and accuracy for the diagnosis of APN. Furthermore, only the serum PCT showed a statistically significant difference between the groups with no or only a very mild renal lesion (group 1) and the groups with significant renal lesions (group 2). CONCLUSION: The serum PCT combined with the ESR and serum CRP was a helpful marker for the diagnosis of APN. In addition, the serum PCT could be a useful predictor of the severity of renal parenchymal involvement associated with APN.

Prevention of Recurrent FSGS with Cyclosporine and Plasmapheresis Prior to Renal Transplantation

We report on two children with a high risk of recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation that could be effectively prevented by prophylactic administration of cyclosporine combined with preemptive plasmapheresis prior to renal transplantation.

Two Cases of Slipped Capital Femoral Epiphysis in Children Receiving Growth Hormone Therapy / 대한소아내분비학회지

Slipped capital femoral epiphysis is a rare hip disorder that mainly occurs in pubertal children. Although the exact cause of this disorder is unknown, it is known to be associated with obesity, trauma, delayed sexual development, delayed bone maturation, chronic renal failure, genetic diseases, endocrine disorders (growth hormone deficiency, hypothyroidism, hypogonadism), growth hormone therapy, and gonadotropin releasing hormone agonist (GnRH agonist) therapy. We report 2 cases of slipped capital femoral epiphysis in adolescent females who were receiving growth hormone therapy. The first case is of a 16 year-old-girl with chronic renal failure and renal osteodystrophy. The second case is of an 11 year-old-girl with idiopathic precocious puberty who had received GnRH agonist and growth hormone therapy. Unilateral or bilateral slipped capital femoral epiphysis developed at 1 year 3 months after treatment in both the cases. The chief complaints were pain in the hip joint and lower extremities. Growth hormone and/or GnRH agonist therapy was stopped, and in situ screw fixations of the involved hip epiphyses were performed.