Primary Epstein-Barr virus-associated acute acalculous cholecystitis and Gianotti-Crosti syndrome

AbstractA 15-year-old boy presented with fever, upper respiratory tract symptoms, cervical lymphadenopathy, and vague abdominal symptoms. Abdominal ultrasound findings were consistent with acute acalculous cholecystitis. Serology was positive for acute Epstein-Barr virus (EBV) infection. The patient recovered and was discharged, but returned 1 week later with an acute, symmetric, papulovesicular exanthem on his forearms and lower legs, which was consistent with Gianotti-Crosti syndrome. Although the latter is not uncommonly associated with EBV infection, acalculous cholecystitis of viral origin is exceedingly rare in children

Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis

BackgroundCerebrospinal fluid (CSF) cell count and biochemical examinations and cultures form the basis for the diagnosis of bacterial meningitis. However, some patients do not have typical findings and are at a higher risk of being missed or having delayed treatment. To better understand the correlation between CSF results and outcomes, we evaluated CSF data focusing on the patients with atypical findings.MethodsThis study enrolled CSF culture-proven bacterial meningitis patients aged from 1 month to 18 years in a medical center. The patients were divided into “normal” and “abnormal” groups for each laboratory result and in combination. The correlations between the laboratory results and the outcomes were analyzed.ResultsA total of 175 children with confirmed bacterial meningitis were enrolled. In CSF examinations, 16.2% of patients had normal white blood cell counts, 29.5% had normal glucose levels, 24.5% had normal protein levels, 10.2% had normal results in two items, and 8.6% had normal results in all three items. In logistic regression analysis, a normal CSF leukocyte count and increased CSF protein level were related to poor outcomes. Patients with meningitis caused by Streptococcus pneumoniae and hyponatremia were at a higher risk of mortality and the development of sequelae.ConclusionsIn children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis

Serologic Status for Pandemic (H1N1) 2009 Virus, Taiwan

We studied preexisting immunity to pandemic (H1N1) 2009 virus in persons in Taiwan. A total of 18 (36%) of 50 elderly adults in Taiwan born before 1935 had protective antibodies against currently circulating pandemic (H1N1) 2009 virus. Seasonal influenza vaccines induced antibodies that did not protect against pandemic (H1N1) 2009 virus

Novel Swine-origin Influenza Virus A (H1N1): The First Pandemic of the 21st Century

An influenza epidemic was detected in April 2009 at the border between the United States and Mexico. The virus was identified soon after to be a swine-origin influenza virus A (S-OIV A) (H1N1). This virus has an HA gene that is derived from the 1918 swine influenza virus and other genes from human, avian, and Eurasian swine influenza viruses. Clinically, it behaves similarly to seasonal influenza. The only differentiating characteristics are vomiting and diarrhea in a quarter of infected patients, which are rare in seasonal influenza. On June 11, 2009, the World Health Organization declared the first pandemic of the 21st century, caused by S-OIV A (H1N1). Vaccination is the only way to dampen this pandemic. Many questions await answers, including the clinical impact of the pandemic, optimal doses of vaccine, and the future destiny of the virus. A breakthrough in vaccinology against influenza is needed to address the recurring influenza pandemic

A National Seroepidemiologic Survey of Pertussis among School Children in Taiwan

BACKGROUND:: In 2009, a booster dose of acellular pertussis vaccine for children at or before entry to elementary school was added to the national immunization program in Taiwan, which includes pertussis vaccination at 2, 4, 6, and 18 months of age. In 2013, a study to assess the level of humoral immunity against pertussis in elementary and junior high school children and adolescents was conducted. METHODS:: A multistage stratified systematic sampling method was applied to randomly selected grade 1 to 9 school children for testing. Serum samples were tested for IgG antibodies to Bordetella pertussis using commercial ELISA kits. The study collected information on socio-demographic characteristics, vaccination history, sibling number, and disease history of pertussis. RESULTS:: The study recruited 2,782 school children from 58 schools around the country. By questionnaire, only 1% (28/2,782) students had history of pertussis. The overall positivity rate of anti-B. pertussis IgG was 42.5%, and the rates were not different between the 5 geographical areas (range from 39.6% to 44.6%. P=0.375). Age-stratified data showed that the positivity rates were 43.6-48.8% among Grade 1-3 students, 26.6-28.7% in Grade 4-5 students, and increased progressively from 39.4% to 51.3% in Grade 6-9 students. The overall positivity rate was significantly higher in the non-booster group (46.4% vs. 38.6%, P\u3c0.01). CONCLUSION:: The prevalence of anti-B. pertussis antibody was 42.5% in Grade 1-9 students under the current vaccination program in Taiwan. Antibody induced by the booster vaccination before entry of primary school waned rapidly in 3-4 years. Rapid waning of anti-B. pertussis antibody may explain the resurgence of whooping cough in recent decades. Additional booster doses should be considered in adolescents and adults

Vancomycin dosing and target attainment in children

Background/Purpose: The aim of this study is to determine the best dosing strategy for vancomycin by studying the associated factors and examining correlations between the area under the plasma concentration-time curve (AUC) values and trough concentrations in children. Methods: Children aged 3 months to 18 years were included if they received vancomycin for more than three doses between January 1, 2010 and December 31, 2012 and had one or more serum vancomycin trough concentrations. Vancomycin clearance (CL) was calculated using the following model: CL = 0.248*Wt0.75*(0.48/serum creatinine)0.361*[ln (age)/7.8]0.995. The AUC (mg-h/L) was calculated by 24-hour dose (mg/kg/d)/CL(L/h). The value of AUC divided by the minimum inhibitory concentration (MIC) of vancomycin was AUC/MIC. Results: A total of 218 children were included. The mean age was 6.0 ± 5.1 years and the mean body weight was 20 ± 11.7 kg. Vancomycin trough concentrations were moderately correlated with AUC values (r2 = 0.232, p < 0.01). Dosing of 15 mg/kg/dose q6h produced significantly higher AUC values (p < 0.001) and vancomycin trough concentrations (p < 0.001) compared to dosing of 10 mg/kg/dose q6h. In children receiving a 10-mg/kg/dose q6h, 5.6% (5/90) achieved the target trough concentrations of 15–20 μg/mL and 9.5% (5/90) achieved the goal AUC/MIC ≥ 400. In children receiving a 15-mg/kg/dose q6h, 13% (6/46) achieved the target trough concentrations of 15–20 μg/mL, whereas 54.3% (25/46) achieved the goal AUC/MIC ≥ 400. Conclusion: A 15-mg/kg/dose q6h compared to a 10-mg/kg/dose q6h is more likely to achieve target trough concentrations of 15–20 μg/mL and the goal AUC/MIC ≥ 400

Changing of bloodstream infections in a medical center neonatal intensive care unit

Background/Purpose: Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. Methods: We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992–2001 and 2002–2007). Results: The mortality rate decreased from 16.3% in 1992–2001 to 5.6% in 2008–2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. Conclusion: Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI

Table1_Jaundice-predominant manifestation of Kawasaki disease in children.xlsx

BackgroundA jaundice-predominant presentation of Kawasaki disease (KD) is atypical.MethodsA total of 12 children with KD with a predominant manifestation of jaundice at MacKay Children's Hospital were reviewed, along with 42 cases reported in the literature since 1990.ResultsThe median age of the 12 patients was 1.85 years (range: 3 months–4 years), and 66.6% were male. All of the patients had elevated liver function at presentation, 50% had hydrops of the gallbladder, and almost 60% had gastrointestinal symptoms and signs. Complete KD was evident in 11 of the 12 patients (91.7%), and two patients (16.7%) had recurrent episodes. All of the patients received intravenous immunoglobulin (IVIG); however, one-third were refractory to treatment. Corticosteroids were used in five (41.7%) of the patients. Three (25%) of the patients had shock, and seven (58.3%) had coronary artery abnormalities, of whom one (8.3%) had persistent coronary artery aneurysm and the others recovered. A review of the 42 cases in the literature showed that the children with a jaundice-predominant presentation of KD had high rates of IVIG-refractory disease (25%), coronary artery abnormalities (25%), shock (13.2%), and corticosteroid treatment (24.2%).ConclusionsChildren with KD presenting with a jaundice-predominant manifestation are at a higher risk of IVIG-refractory disease, coronary artery abnormalities, and more recurrent episodes. Physicians should be aware of the risk of shock in this population.</p

Changing of bloodstream infections in a medical center neonatal intensive care unit

AbstractBackground/PurposeBloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts.MethodsWe reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992–2001 and 2002–2007).ResultsThe mortality rate decreased from 16.3% in 1992–2001 to 5.6% in 2008–2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013.ConclusionThrough the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI