Necrotizing fasciitis and streptococcal toxic shock syndrome secondary to varicella in a healthy child

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome

Evaluation of kidney size in children: a pilot study of renal length as a surrogate of organ growth

PurposeSomatic growth is an important indicator of health in children. Adequate organ growth is essential in growth and directly related to body growth. We consider renal length as a surrogate of organ growth in growing children. Measurement of weight, height, and many anthropometric indices, such as body surface area (BSA), body mass index (BMI), and Rohrer and Kaup indices, are used to evaluate growth status. The aim of this study was to evaluate the association between renal length and somatic parameters and analyze the affecting factors for renal size during growth.MethodsThe data for renal length in 66 children (age, 12.9±15.6 months; male/female, 34/32) were obtained. Each kidney was measured with ultrasonography and dimercaptosuccinic acid scan. The data on age, sex, height, and weight were obtained from the medical records. BSA, BMI, and Rohrer and Kaup indices were calculated from measured height and weight. BSA was calculated by 2 methods, and is expressed as BSA I and BSA II.ResultsThere were significant correlations between renal size and age, weight, height, BSA I, BSA II, and Rohrer index. In the regression analysis, the most significant contributing factor to renal growth was height (R2=0.636, P<0.001).ConclusionHeight seems to be the most important factor associated with organ growth in growing children. Further studies to evaluate adequate organ growth should be carried out

The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI). Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results. Results : VCUG was performed in 148 patients&#59; of them, 37 (25.0&#37;) had VUR: 18 (12.2&#37;) had low-grade (I-II) VUR, and 19 (10.5&#37;) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5&#37;) had cortical defects, of which 21 (63.6&#37;) had VUR: 10 (30.3&#37;), low-grade (I-II) VUR&#59; and 11 (33.3&#37;), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0&#37;) had low-grade VUR and 6 (10.5&#37;) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7&#37;, 69.9&#37;, 33.3&#37;, and 89.5&#37;, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR

Gender Differences in Relationship between Fat-Free Mass Index and Fat Mass Index among Korean Children Using Body Composition Chart

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens