• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4549-4553
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• 2014

Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. Materials and Methods: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. Results: Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. Conclusions: Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

• Clinical and Experimental Pediatrics
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• 제60권3호
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• pp.77-85
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• 2017

Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ${\geq}38.0^{\circ}C$ for longer than ${\geq}14days$ and failure to reach a diagnosis after one week of investigations were included. Results: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.

• 대한간호학회지
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• 제2권1호
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• pp.73-85
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• 1971

A epidemiological study was conducted by author on 925 official reported patients with the first grade legal communicable disease during the period from January 1969 to December 1970 in all area of Kangwon province. As the results of this study, tile following conclusion were obtained. A) Typhoid fever 1. Of all 925 patients surveyed, typhoid fever showed the highest rate as 50.7 percent. 2. Age group from 10 to 14 years old showed the highest rates 3. High epidemic period was from June to September. 4. As for the occupational distribution, unemployed showed the highest rate as 63.2 percent, followed by-21.1 percent in farmer and 9.4 percent in student. 5. Most of all patients(93.7%) were isolated in their own house 6. The morbidity rate was 16.0 per 100, 000 population and case fatality rate was 1.76 percent 7. The mean of the duration from onset to diagnosis and carnation were 11.7$\pm$7.1 days and 25.1$\pm$13, 8 days respectively. 8. Main diagnostic method was almost the clinical examination B) Dysentery 1, Of all 925 patients surveyed, dysentery showed 44.4 percent 2. Age group from 0 to 9 years old showed the highest rate 3. High epidemic period of this disease was from April to August 4. As for the occupational distribution, unemployed showed the highest rate as 73.9 percent, followed by 17.7 person in farmers and 7.0 percent in student 5. the attack rate of agricultural area was higher than of fishing area 6. The mean of the duration from onset to diagnosis and crating duration were 10.4$\pm$4.3 days and 15.7$\pm$8.8 days respectively. 7. The morbidity rate and case fatality rate were 21.8 per 100.000 population and 1.46 percent, respectively. 8. Most of all patients were isolated in own house 9. Most of all patients (97.6%) were diagnosed by the clinical examination C) Diphtheria 1. As for the age distribution, 0-4 years old group showed the highest rate as 44.4 percent followed by 27.7 percent in 5-9 years old group and 22.2 percent in 10-14 years old group 3. Epidemic season was almost in autumn, winter and spring 3. The morbidity rate was 0.96 per 100.000 population and case fatality rate was high as 26.6 percent 4. 66.6 percent of this disease was isolated in their own house and the others were admitted in hospital D) Paratyphoid fever 1. Most of all patients were attacked below 20 years old 2. Epidemic season was almost was almost in late summer 3. The morbidity rate was 0.53 per 100.000 population 4. The mean of the duration from onset to diagnosis and crating duration were 18.3$\pm$1.3 day and 13.7$\pm$0.2 day. respectively.

• Clinical and Experimental Pediatrics
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• 제52권10호
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• pp.1161-1166
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• 2009

목 적 : 현재 소아 연령에서 가장 흔한 후천적 심질환의 원인이 되고 있는 가와사키 병은 해마다 발병률이 증가하고 있으며 합병증 발생 또한 증가될 것으로 예상된다. 따라서 가와사키 병 환아의 임상적 소견, 검사실 소견을 바탕으로 가와사키 병의 관상동맥 합병증을 예측할 수 있는 인자를 알아보고자 하였다. 방 법 : 가천의과학대학교 길병원 소아과에서 2005년 1월부터 2008년 3월까지 가와사키 병으로 진단 및 치료를 받은 환아 201명을 대상으로 관상동맥 병변이 없었던 군(group I; 150명)과 있었던 군(group II; 51명)로 나누어 임상적 소견과 검사실 소견을 비교하였고 이 때 선별된 인자들을 바탕으로 관상동맥 병변에 미치는 영향을 도출하였다. 임상적 소견으로는, 나이, 성별, 총 발열기간, IVIG 투여 후 지속된 발열기간, 발열 후 치료 시작되기까지 걸린 기간, IVIG 총 투여횟수, 관상동맥 병변 여부, 검사실 소견으로는, 총 백혈구 수, 중성구 수, 혈색소, 적혈구 용적, 혈소판 수, 혈구침강속도, CRP, 알부민, 총 콜레스테롤, 중성지방 등의 수치가 사용되었다. 결 과 : 두 집단 간의 비교분석에서는, 2군(group II) 이 총 발열기간(P<0.05), IVIG 투여 후 지속된 발열기간(P<0.05), 발열 후 IVIG 치료 시작되기까지 걸린 기간(P<0.05)에서 1군(group I)보다 유의하게 길었다. 치료기간 동안 IVIG 투여 횟수는 1군(group I)이 2군(group II)보다 통계적으로 유의하게 낮은 결과를 보였다(P<0.05). 검사실 소견은 CRP 수치가 2군(group II)에서 의미 있게 높았으나 그 외의 다른 수치들은 양 군 간의 유의한 차이를 보이지 않았다. 앞서 선별된 인자들 중에서, 총 발열기간이 10일 이상일 때, IVIG 투여 후 48시간동안 열이 지속될 때, 발열 후 10일 이상 치료가 지연된 경우에, 각각 약 6배(OR=5.95, P=0.003) 5배(OR=5.11, P=0.005) 3.5배(OR=3.47, P=0.049) 관상동맥 병변 위험이 증가하였다. 또한 IVIG 초 치료보다 IVIG 재 치료(2회 이상)인 경우가 관상동맥 병변 위험이 4배(OR=4.02, P=0.001) 증가하였다. CRP는 6 mg/dL 미만인 집단에 비해 관상동맥 병변 위험이 6-9 mg/dL인 집단에서는 2배(OR=2.32, P=0.049), 9 mg/dL 이상인 집단은 3배(OR=3.18, P=0.003)로 CRP 수치의 증가에 따라 위험도가 증가하는 양상을 보였다. 그러나 위의 다섯 인자를 다변량 분석을 시행하였을 때 의미 있는 위험인자는 IVIG 재 치료(2회 이상) 경우(OR=5.29, P=0.034)와 CRP 6-9 mg/dL (OR=2.63, P=0.040), 9 mg/dL 이상(OR=2.84, P=0.014)만이 확인되었다. 결 론 : 기존 연구와 마찬가지로, 본 연구에서도 발열기간은 관상동맥 병변의 위험도와 가장 관련이 깊은 것으로 나타났으며 가와사키 병의 치료에 있어서 발열 후 IVIG의 신속한 투여로 인해 총 발열기간을 줄이려는 노력의 중요성이 확인되었다. 관상동맥 합병증의 예측인자를 선별하기 위해서는 기존의 알려진 예측인자 간의 연관성을 밝히고 객관화된 평가법의 마련을 위한 추가적인 연구가 더 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제80권1호
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• pp.45-51
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• 2017

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA. Methods: A total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6-8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over $37.8^{\circ}C$. Results: Fever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5-32 hours) after EBUS-TBNA and 7 hours (range, 1-52 hours), respectively, and the median peak body temperature was $38.3^{\circ}C$ (range, $137.8-39.9^{\circ}C$). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA. Conclusion: Fever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.

• Tuberculosis and Respiratory Diseases
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• 제49권2호
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• pp.169-178
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• 2000

연구배경 : 발열은 폐결핵 환자에서 흔히 볼 수 있는 임상증상 중 하나로서, 4제 병합 1차 항결핵요법($6HREZ_2$) 시작 후 90% 이상에서 1주 이내에 열이 소실되며, 2주 이상 지속되는 경우는 드문 것으로 보고되어 있다. 치료 후에도 열이 지속되는 경우 일부에서는 다른 감염의 동반, 약제 내성, 또는 약제열 등을 의심하여 조기에 약제를 변경하게 되고, 이로 인하여 치료기간이 연장되기도 한다. 아직 약제내성율이 높은 국내의 현실에서 치료에도 불구하고 열이 지속되는 폐결핵 환자의 원인 및 임상상을 알아보고, 적절한 치료지침을 만들기 위하여 본 연구를 수행하였다. 방법 : 1996년 1월부터 1999년 3월까지 서울중앙병원에 입원하여 폐결핵으로 진단된 후 4제 병합 1차 항결핵요법을 시작한 환자를 대상으로 후향적으로 의무기록을 조사하였다. 2주 이상 열이 지속된 환자를 대상으로 지속적 발열의 원인을 조사하였고, 이 중에서 지속적 발열의 다른 원인이 없으며 약제감수성인 환자를 "지속적 발열군"으로 정하였다 (22명). 진단 당시 발열이 없었던 환자(비발열군)와 치료 시작 후 2주이내에 열이 소설된 환자(열소실군)에서 무작위로 같은 숫자의 환자를 추출하여 각 군간에 임상상 및 검사소견을 비교하였다. 결과 : 598명의 폐결핵환자 중 28명 (4.8%)에서 치료에도 불구하고 2주 이상 열이 지속되었다. 134명 (22.4%)은 2주 이내에 열이 소설되었으며, 435명(72.7%)은 진단 당시부터 열이 없었다. 2주 이상 열이 지속된 28명 중 2명은 약제열, 3명은 다제내성결핵, 그리고 l명은 Mycobacterium kansasii 감염이 지속적 발열의 원인이었다. 나머지 22명은 약제감수성이면서 결핵 자체이외의 다른 발열의 원인이 없었다. 지속적 발열군은 비발열군 및 열소실군에 비하여 결핵발병의 위험인자가 많았고, 중성구의 증가 및 임파구의 감소와 빈혈 소견이 많았으며, 혈청단백질, 알부민 및 나트륨이 감소되어 있었고, 흉부방사선 소견상 폐침윤의 범위가 넓었으며, 3개 이상의 공동이 존재하는 빈도가 더 높아서, 장기적이고 진행된 폐결핵임을 시사하였다. 결론 : 아직 결핵의 유병율 및 약제 내성율이 높은 국내의 현실에도 불구하고 1차 항결핵약재 치료 후 지속적 발열의 주된 원인은 약제 내성보다는 진행된 폐결핵 자체가 원인이었다. 약제내성의 위험인자가 없고 진행된 폐결핵의 경우에는 성급한 약제변경에 신중을 기하여야 하겠다.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.15-20
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• 2017

Purpose: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. Methods: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. Results: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. Conclusions: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.

• Clinical and Experimental Pediatrics
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• 제54권1호
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• pp.11-16
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• 2011

Purpose: Enterovirus 71, one of the enteroviruses that are responsible for both hand-foot-and-mouth disease and herpangina, can cause neural injury. During periods of endemic spread of hand-foot-andmouth disease caused by enterovirus 71, CNS infections are also frequently diagnosed and may lead to increased complications from neural injury, as well as death. We present the results of our epidemiologic research on the clinical manifestations of children with CNS infections caused by enterovirus 71. Methods: The study group consisted of 42 patients admitted for CNS infection by enterovirus 71 between April 2009 and October 2009 at the Department of Pediatrics of 5 major hospitals affiliated with the Catholic University of Korea. We retrospectively reviewed initial symptoms and laboratory findings on admission, the specimen from which enterovirus 71 was isolated, fever duration, admission period, treatment and progress, and complications. We compared aseptic meningitis patients with encephalitis patients. Results: Of the 42 patients (23 men, 19 women), hand-foot-and-mouth disease was most prevalent (n=39), followed by herpangina (n=3), upon initial clinical diagnosis. Among the 42 patients, 15 (35.7%) were classified as severe, while 27 (64.3%) were classified as mild. Factors such as age, fever duration, presence of seizure, and use of intravenous immunoglobulin (IVIG) were statistically different between the 2 groups. Conclusion: Our results indicate that patients with severe infection caused by enterovirus 71 tended to be less than 3 years old, presented with at least 3 days of fever as well as seizure activity, and received IVIG treatment.

• Clinical and Experimental Pediatrics
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• 제59권9호
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• pp.368-373
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• 2016

Purpose: This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy. Methods: This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis. Results: Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05-1.81; diarrhea: OR, 1.94; 95% CI, 1.08-3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78-3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11-1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19-1.82; P<0.05) were associated with the delayed diagnosis. Conclusion: To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.

• Journal of Forest and Environmental Science
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• 제38권1호
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• pp.55-63
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• 2022

The African swine fever virus (ASFV) remains contagious for a long time, not only in the carcass, but also in the bone marrow of an infected animal. The scavenging activity of various animals on ASFV-infected carcasses is a likely risk factor for ASFV transmission. Thus, we conducted this study to determine whether scavengers are potential vectors for ASFV. In nonprotected wild boar carcasses on the forest floor, we investigated the seasonal patterns of carcass decomposition and scavenger visits for feeding on them. The duration from fresh to early skeletonization (only bones and leather remaining) of adult carcasses was 37.6±23.1 days (n=3, range=11-51 days) in winter. The duration from fresh to later skeletonization (only bones and some fur remaining) of all carcasses, including subadult carcasses, was 8.3±2.5 days (n=4, range=7-12 days) in summer. At all three study sites, leopard cats (30.3%), large-billed crows (21.6%), and golden eagles (18.1%) were the frequently visiting species, representing more than 10% of the total visits (343 visits) in winter, whereas raccoons (21.9%), grey-backed thrushes (39.4%), and eyebrowed thrushes (14.7%) were the most frequent visitors in summer. In winter, crows or cinereous vultures were the first animals to arrive at a carcass; in summer, raccoons or crows arrived first. Our results showed that wild boars, raccoons, and leopard cats relatively frequently visited wild boar carcasses and stayed there for a long time. Wild rodents chewing on or staying near carcasses were photographed during winter. In addition to wild boars, thus, mammals, such as raccoons, leopard cats and rodents, and birds, such as accipitrids and thrushes, may be spreaders of ASFV in South Korea.