• Pediatric Infection and Vaccine
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• v.6 no.2
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• pp.210-218
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• 1999

Purpose : As several epidemics of aseptic meningitis had been reported in Korea since 1990, the need of epidemiologic study about enteroviral infections was recognized. We studied epidemiologic and clinical features of enteroviral infections in children. Methods : We analyzed the seasonal occurrence of enteroviral infections and age, sex and clinical diagnosis of the children admitted to five branch hospitals of Hallym University and diagnosed to have enteroviral infections by culture from January 1996 to December 1998. Results : Enterovirus was isolated in 126 out of 245(51.4%) stools, 15 out of 89(16.8%) nasopharyngeal aspirates and 195 out of 1,835(10.6%) cerebrospinal fluids. There were 273 echoviruses(Echo)(197 Echo 30, 46 Echo 9, 17 Echo 6, 13 unclassified), 24 coxsackieviruses B(CB)(11 CB 2, 2 CB 5, 11 unclassified), 7 coxsackieviruses A 24 and 32 unclassified enteroviruses. Yearly number of isolates was 65(46 Echo 9) in 1996, 239(197 Echo 30) in 1997 and 32(15 CB: 9 CB 2) in 1998. Epidemics of enteroviruses occurred mainly during the months May to October. The mean age of the infected children was $62.1{\pm}38.0$ months and 74.6% of the patients were younger than 7 years of age. There were 203 boys and 100 girls and 79.3% of the patients were diagnosed as aseptic meningitis. Conclusions : We confirmed that enteroviral infections occurred in epidemics from late spring to fall during the study period. Enteroviral infections occurred predominantly in boys and the preschool children. Aseptic meningitis was the main illness in the hospitalized children.

• Tuberculosis and Respiratory Diseases
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• v.47 no.2
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• pp.184-194
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• 1999

Backgrounds : The advent of penicillin has led to the marked reduction in the mortality from pneumococcal bacteremia, however, the mortality is still relatively high in this post-antibiotic era. Actually the prevalence of infection due to penicillin-resistant penumococci is increasing worldwide, and it is especially high in Korea due to irrelevant use of antibiotics. So, the high mortality of pneumococcal sepsis might be related to the emergence of penicillin-resistant strains, however, many other antibiotics, which eradicate pneumococci effectively, are available in these days. This has led us to suspect the role of penicillin-resistance in the high mortality rate. In this study, we evaluated the effect of penicillin resistance on the mortality of patients with penumococcal bacte remia. Methods: The study population consisted of 50 adult patients with penumococcal bacteremia who were admitted between Jan, 1990 and July, 1997. Medical records were analyzed retrospectively. Results: Most of the patients (96%) had underlying diseases. The most common local disease associated with pneumococcal bacteremia was pneumonia (42%), which was followed by spontaneous bacterial peritonitis (14%), cholangitis (10%), meningitis (8%), liver abscess (4%), pharyngotonsillitis (4%), sinusitis (2%) and cellulitis (2%). While the overall case-fatality rate in this study was 24%, it was higher when peumococcal bacteremia was associated with pneumonia (42%) or meningitis (50%). The rate of penicillin resistance was 40%, which was increased rapidly from 1991. The rate of penicillin resistance was significantly higher in patients with the history of recent antibiotics use and hospitalization within 3 months respectively. The clinical manifestations, that is, age, severity of underlying diseases, nosocomial infection, associated local diseases, and the presence of shock or acute renal failure were not statistically different between the patients with penicillin-resistant and -sensitive pneumococcal bacteremia. The mortality of patients infected with penicillin-resistant pneumococci was not statistically different from those with penicillin-sensitive pneumococcal bacteremia. Conclusion: Penicillin resistance is not associated with high mortality in adult patients with pneumococcal bacteremia. As the overall mortality is high, active penumococcal vaccination is recommended in patients with high risk of infection.

• Tuberculosis and Respiratory Diseases
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• v.40 no.1
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• pp.43-51
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• 1993

Background: The polymerase chain reaction (PCR) is a very sensitive method for the detecting of mycobacterial DNA. There are many reports revealing the efficacy of PCR for the diagnosis of M. tuberculosis, but there are many different methods for DNA extraction from Mycobacterium tuberculosis. Bead beater method is a very useful method for DNA extraction from clinical spectimens, but its procedures are relatively complicated and time-consuming. So we studied other methods for the DNA extraction from Mycobacterium tuberculosis $H_{37}Rv$ and some clinical specimens (5 smear positive sputa and 5 smear negative CSF). Method: We extracted the mycobacterial DNA with 6 different methods from H37Rv strain and clinical specimens. The methods included SDS-microwave oven method, NaOH lysis method, Triton X-100-Proteinase K method, Lysis buffer method, SDS-proteinase K method and bead beater method. The target DNA was 123bp of IS6110 and was detected by examination of ethidium bromide-stained agarose gels. Results: Among 6 methods, SDS-proteinase K method, bead beater method, lysis buffer method and triton X-100-proteinase K method were excellent, but SDS-proteinase K method was the best method in the aspect of simplicity and cost-effectiveness. Conclusion: We suggest that SDS-porteinase K method is a simple and convinient method and might be the best method for the extraction of mycobacterial DNA.

• Pediatric Infection and Vaccine
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• v.8 no.1
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• pp.94-100
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• 2001

Purpose : Enterovirus is a common cause of aseptic meningitis and nonspecific febrile illness in young children. During the summer and fall months, enterovirus-infected young children are frequently admitted and evaluated to rule out bacterial sepsis and/or meningitis. The purpose of this study was to evaluate the relationship between nonpolio enterovirus infection and febrile illness in infants under 3 months of age during the summer, fall months by using a stool culture to identify the presence of enterovirus. Methods : Patients included febrile infants under 3 months of age admitted to Masan Fatima Hospital for sepsis evaluation from May 1999 to September 1999. Cultures were performed from stool and Cerebrospinal fluid samples and then were tested for enterovirus infection. Viral isolation and serotype identification were performed by cell culture and immunofluorescent testing. Enteroviruses not typed by immunofluorescent testing were confirmed by reverse transcription-polymerase chain reaction. Results : A total of 44 febrile infants were enrolled; of those, 20(45%) were positive for enterovirus. Two enterovirus culture-positive infants had concomitant urinary tract infection and one had Kawasaki disease. All infants infected with an enterovirus recovered without complications. Serotype of 20 enteroviruses were isolated from stool, 3 of echovirus type 9, 1 of echovirus type 11, 1 Coxsachievirus type B4, 15 of untyped enteroviruses. One untyped enterovirus was isolated in the CSF. Conclusion : Nonpolio enterovirus infections are associated with nonspecific febrile illnesses in infants under 3 months of age.

• The Journal of the Korea Contents Association
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• v.12 no.9
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• pp.270-279
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• 2012

This paper explores CT findings of a rabbit brain infection model injected with Escherichia coli and investigates the changes in Hounsfield unit (HU) of arterial blood over time. The brain infection model was produced by injecting E. coli $1{\times}10^7$ CFU/ml, 0.1 ml through the burr hole in the calvarium; 2~3 mm in depth from the dura mater, and contrast-enhanced CT, dynamic CT and arterial blood CT images were gained. It was found that various brain infections such as brain abscess, ventriculitis and meningitis. The CT image of brain abscess showed a typical pattern which the peripheral area was strongly contrast-enhanced while the center was weakly contrast-enhanced. The CT image of ventriculitis showed a strong contrast-enhancement along the lateral ventricle wall, and the CT image of meningitis showed a strong contrast-enhancement in the area between the telencephalon and the diencephalon. In dynamic CT images, the HU value of the infection core before injecting contrast medium was $31.01{\pm}3.55$. By 10 minutes after the injection, the value increased gradually to $40.36{\pm}3.76$. The HU value in the areas of the marginal rim where was hyper-enhanced showed $47.23{\pm}3.12$ before contrast injection, and it increased to $63.59{\pm}3.31$ about 45 seconds after the injection. In addition, the HU value of the normal brain tissue opposite to the E. coli. injected brain was $39.01{\pm}3.24$ before the injection, but after the contrast injection, the value increased to $49.01{\pm}4.29$ in about 30 seconds, and then it showed a gradual decline. In the arterial blood CT, the HU value before the contrast injection was $87.78{\pm}6.88$, and it increased dramatically between 10 to 30 seconds until it reached a maximum value of $749.13{\pm}98.48$. Then it fell sharply to $467.85{\pm}62.98$ between 30 seconds to 45 seconds and reached a plateau by 60 seconds. Later, the value showed a steady decrease and indicated $188.28{\pm}25.03$ at 20 minutes. Through this experiment, it was demonstrated that the brain infection model can be produced by injecting E. coli., and the characteristic of the infection model can be well observed with contrast-enhanced CT scan. The dynamic CT scan showed that the center of the infection was gradually contrast-enhanced, whereases the peripheral area was rapidly contrast-enhanced and then slowly decreased. As for arterial blood, it increased significantly between 10 seconds to 30 seconds after the contrast medium injection and decreased gradually after reaching a plateau.

• The Journal of Korean Society of Virology
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• v.26 no.2
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• pp.215-225
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• 1996

Aseptic meningits, an acute inflammation of the meninges, is a common illness during childhood. Virus is the most important cause of aseptic meningitis. Especially enterovirus causes approximately above 85% of all cases of aseptic meningitis. In 1993, there was a big epidemic of aseptic meningitis by ECHO 9 and ECHO 30 viruses. And ECHO 3 virus was isolated as a causative agent of aseptic meningitis in 1994. This study was aimed to detect the causative agent of aseptic meningitis in 1995 and to analyze the 5'-noncoding region which was used to detect virus. Virus was isolated from 87 stools and cerebrospinal fluid specimens of the patients by cultured RD and HEp-2 cell. Neutralizing antibody tests using enterovirus serum pool were performed on the specimens with cytopathic effect. 3 of ECHO 7 viruses and 5 of Coxsackie B3 viruses were isolated from stool specimens and 1 of ECHO 7 and Coxsackie B3 mixed type was confirmed from cerebrospinal fluid specimens. RNA was isolated from the culture supernatants of infected cells and general primers were selected in highly conserved part of the 5'-noncoding region of the enteroviral genome for RT-PCR. PCR product from this virus showed a 152bp band on gel electrophoresis. Sequence of obtained DNA was compared with prototype sequences by accessing to the Genebank database. 5'-noncoding region of isolated Coxsackie B3 virus, which has point mutations in nucleotide sequence positions 493, 497, 502, 523, was closely related to that of polio virus type 1, Mahoney strain. In case of isolated ECHO 7 virus, nucleotide has been changed from cytosine to thymine at position 581 and from thymine to cytosine at position 583. We concluded the causative agents of the outbreak of aseptic meningitis during June to July in 1995 were both ECHO 7 and Coxsackie B3 virus, and the primer used in this study could allow a rapid diagnosis of enteroviruses by PCR.

• Journal of Preventive Medicine and Public Health
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• v.36 no.4
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• pp.349-358
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• 2003

Objectives : Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. Methods : All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3,874 cases from 136 general hospitals was peformed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive Predictive value : proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. Results : Among 3,874 cases, CSF examinations were peformed on 1,845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1,568/1,845), 86.0 (1,239/l,440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within ${\pm}7%$. Conclusions : In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be peformed.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.263-273
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• 1999

Headache is a symptom with varied etiologies and extraordinarily frequent. Headaches can be a symptom of another diseases, such as meningitis, subarachnoid hemorrhage or brain tumor, may represent the disease entity itself as the case in migraine. The international Headache Society criteria were the first to distinguish between primary and secondary headache disorders. When evaluating a patient who presents with headache, the physician abviously needs to identify or exclude the myriad conditions that can cause secondary headache and initial diagnostic workup should be considered. If patient meets the criteria for a primary headache disorder, treatment commonly initiated without additional neurodiagnostic tests. The headache type, its associated feature, and the duration and the intensity of the pain attack all can influence the choice of acute therapy in migraine. Pharmacologically, such as NSAIDs, combination analgesics, vasoactive antimigraineous drugs, neuroleptics, antidepressants, or corticosteroids. Other approches to managing headache include a headache diary to identify triggers, biofeedback, relaxation technique and behavioral modification. Daily preventive medication should be considered by his attack frequency and intensity, and maintained for 4 to 6 months. Tension-type headaches are distinguished between episodic and chronic tension-type headache, but physician must make sure that patient is not drug-overuse or independent during symptomatic abortive therapy or preventive medication. The most difficult headache patients to treat are those with chronic daily headache. They often have physical dependency, low frustration tolerance, sleep problems, and depression. So discontinuation of overused medication is crucial. New developments in migraine therapy are broadening the scope of abortive and prophylactic treatment choices available to the physician. The enhanced ease of the use of sumatriptan and DHE will likely increase patient compliance and satisfaction.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.512-518
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• 2002

Purpose : Cerebral palsies are the most common and severe motor disabilities in childhood. There is currently increased interest in their occurrence and patterns of likely cause for a variety of reasons. Therefore, a retrospective study was carried out to understand the clinical features of cerebral palsy. Methods : A retrospective chart review was conducted of all children with cerebral palsy who were diagnosed at St. Benedict Hospital between March 1999 and March 2001. Results : Cerebral palsy patients were classified into 6 major groups. Of six groups, spastic diplegia is the most common type of cerebral palsy(55.3%). The risk factors of cerebral palsy were placenta previa(1 case), placenta abruption(1 case), cytomegalovirus infection(1 case), prematurity (53 cases), neonatal asphyxia(12 cases), dystocia(2 cases), breech delivery(1 case), multiple birth(5 cases), head trauma(3 cases), meningitis(2 cases) and unknown(26 cases). Among the 59 in the preterm group, 37 patients showed MR or CT images of periventricular leukomalacia. Among the 44 in the term group, 15 patients showed MR or CT images of atrophy. Among 103 patients, 29 patients(28.2%) had a seizure disorder. Conclusion : It is very importent to understand the clinical features and risk factors of cerebral palsy for physicians to diagnose and manage cerebral palsy patient.

• The Journal of Internal Korean Medicine
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• v.19 no.2
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• pp.438-450
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• 1998

Pleural effusion means the inflammation of pleura which has a majority of respiratory disease. The main clinical manifestation is pleural effusional pain, dyspnea, cough, fever, etc. and at present the Tuberculous pleural effusion has the most frequency in which exists exudate in our country. And during studying oriental medical treatment about Tuberculous exudative pleural effusional patient, we found the clinical case about The Combination therapy of Chinese traditional and Western medicine at journal of traditional Chinese Medicine and considered it would be help in oriental medical treatment, so we adjust and report now. This study was performed by analyzing the six papers reported centering around the clinical case of The Combination therapy of Chinese traditional and Western medicine in journal of traditional Chinese Medicine published between 1990-1996. As these papers have no mistakes on diagnosis because it obtained pleurocentesis, tuberculin test positive reaction on choicing clinical case, definite results on X-ray, ultrasound as well as clinical basis, so it considers an apt conclusion. The results were as follows: 1. Western medical treatment uses chemical remedy same with pulmonary tuberculosis, and in case of tubercular pleuritis, it needs thoracic duct pyorrhea, and according to simple exudation also operates therapheutic pleural paracentesis. 2. In case of hydrothorax absorption about tuberculous pleural effusion, prescription of purge the heat accumulated in the lung and eliminate the retention of fluid with powerful purgatives shows considerable effects. 3. The latter period treatment of tuberculous pleural effusion needs Supplement qi and active the collaterals, Nourishing yin and clearing heat in addition to Supporting healthy energy to eliminate evils. 4. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in absorption of hydrothorax. 5. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in prevention of disease reappearance. 6. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in vitality recovery at the latter period of disease.