• Pediatric Infection and Vaccine
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• v.20 no.3
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• pp.178-185
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• 2013

Objective: Cytopenia is a common hematologic complication of viral infections. However, information regarding hematologic effects of common respiratory virus infections is scarce. This study aimed to evaluate hematologic complications and the clinical course of patients infected with common respiratory viruses. Methods: We retrospectively analyzed 496 patients with respiratory tract infections admitted to the Department of Pediatrics, Wonkwang University Hospital from November 2011 to March 2012 using multiplex real-time polymerase chain reaction to detect the presence of respiratory viruses and hematologic abnormalities. Results: Respiratory viruses were identified in 379 patients. Respiratory syncytial virus (RSV) was most frequently detected (55.7%), followed by influenza A (Flu-A, 23.0%). Further, cytopenia was observed in 35.5% of RSV-infected patients, 25.0% of Flu-A-infected patients, and 34% of patients infected by other viruses. Each virus caused a decrease in 3 blood cell component values, which corresponded with cytopenia frequency. Of the 379 infected patients, 83 had anemia ($9.71{\pm}1.09g/dL$); 46 had neutropenia ($803.70{\pm}263.09cells/mm^3$); and 23 had transient thrombocytopenia ($142,434.78{\pm}86,835.18cells/mm^3$). However, no patient required treatment. A comparison of clinical characteristics between RSV- and Flu-A-positive patients with anemia revealed that RSV-infected patients had significantly longer duration of hospitalization. RSV was detected more commonly in young neutropenic patients, who had a shorter duration of fever. Conclusions: Our findings suggest that infections, particularly RSV and Flu-A, result in varying degrees of cytopenia, which usually improves without treatment and does not affect the clinical course of the infection.

• Pediatric Infection and Vaccine
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• v.20 no.3
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• pp.147-160
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• 2013

Purpose: Although the overall incidence of hepatitis A in Korea has been decreasing recently, the adolescents born before the introduction of the hepatitis A vaccine remain to be highly vulnerable to outbreak. This study examines the unvaccinated adolescents' and their parents' knowledge and health beliefs toward hepatitis A vaccination. Methods: Healthy adolescents aged 13-19 years old who had no previous history of hepatitis A vaccine and hepatitis A infection, and their parents or legal guardians were the subjects of the study. The survey was conducted using a structured questionnaire based on the Health Belief Model, and examined the subjects' demographics, knowledge, and health beliefs (i.e., perceived susceptibility, severity, benefits, and barriers). Results: We included 157 adolescents and their parents/guardians (mean age: $16.0{\pm}1.6$ and $45.6{\pm}4.7$ years, respectively). The average knowledge item score for adolescents and parents was $6.4{\pm}3.7$ and $7.3{\pm}3.4$ (out of 18), respectively. Similarly, average Health Belief Model item scores were: susceptibility, $5.6{\pm}1.6$ and $5.9{\pm}1.7$ (range: 2-10); severity, $16.3{\pm}4.1$ and $18.3{\pm}3.6$ (range:5-25); benefits, $19.7{\pm}3.3$ and $20.6{\pm}2.1$ (range:5-25); and barriers, $41.3{\pm}8.9$ and $39.0{\pm}9.1$ (range:7-85). The major reason for not undergoing hepatitis A vaccination was lack of knowledge about its importance. Conclusions: Refresher health lectures about hepatitis A and the vaccine are needed by both the adolescents and their parents. Furthermore, the inclusion of hepatitis A vaccine in the national immunization program should be considered to reduce the risk of hepatitis A outbreak and to raise the vaccination coverage among the adolescents in Korea.

• Pediatric Infection and Vaccine
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• v.6 no.1
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• pp.93-100
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• 1999

Purpose : For evaluation of acute Mycoplasma pneumoniae(M. pneumoniae) pneumonia in children, we have studied the Mycoplasma indirect particle agglutination test, cold hemagglutinin test, ESR, CRP, and total white blood cell counts and it's differential count retrospectively. Methods : The total numbers of patients whom compatible with diagnostic criteria of acute M. pneumoniae peumonia were 56 cases from Jan. to Dec. 1997. The diagnostic criteria were 1) onset of fever(${\geq}38.0^{\circ}C$) and coughing were within 7 days, 2) rhonchi and/or role was audible on chest, 3) pneumonic infiltration on chest X-ray, and 4) M. pneumoniae indirect particle agglutination test titer was higher than 1:640, or initial titer was less than 1:640 but increased more than 4 folds after week. We classified the enrolled patients according to initial antibody titer, such as soup A(${\leq}1:640$) and group B(${\geq}1:320$). We compared group A and B by demographic findings, clinical symptoms and signs, and laboratory findings. Results : 1) The male and female sex ratio was 1:1.4, and average onset age was $5.8{\pm}2.96$ years. 2) The average body temperature on admission was $38.5{\pm}0.1^{\circ}C$ and productive coughing was noticed in 52 cases(93%). 3) The average total white cell counts were $10,470{\pm}877.0/mm^3$ in group B patients, which was significantly higher compared to $7,761{\pm}508.5/mm^3$ in group A(p<0.014). 4) The average value of ESR and CRP were within normal range in both group. 5) The most common site of pneumonic infiltration was right lower lobe of lung in both groups. 6) There were no correlation between antibody titer and cold hemagglutinine titer in patients and cold hemagglutination titer were less than 1:64 in 25 cases(45%). Conclusion : The clinical manifestations of pneumonia, findings of chest x-ray, and indirect particle agglutination test were useful on diagnosis of M. pneumoniae pnumonia onset within 7 days, but cold hemagglutinin test was a little diagnostic meaning.

• Pediatric Infection and Vaccine
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• v.5 no.2
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• pp.258-266
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• 1998

Purpose : Cases of adenoviral penumonia with rapidly progressive clinical course were experienced. We reviewed these patients in viewpoint of clinical manifestation and adenoviral serotypes. Methods : Culture and indirect immunofluorescence for respiratory viruses including respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus was done with nasopharyngeal aspirates from patients who admitted due to respiratory infections in Fatima Hospital, Masan from Nov. 1996 to Jul. 1997. Cultured adenovirus was serotyped by both neutralization and hemagglutination inhibition test. Medical records were reviewed for 5 patients with respiratory failure from adenovirus was isolated and serotyped. Results : The total number of examined patients was 460 patients. We isolated respiratory viruses in 143(30.9%) patients. Adenovirus was isolated from 66 out of 143(46.2%) patients. During Jan 1997 to May 1997, five patients with ages of 18 days to 11 months who were infected by adenovirus and had high fever with dyspnea and required assisted mechanical ventilation. One patients discharged against doctor's advice then died. Two of four patients had complications of disseminated intravascular coagulation; two had bronchiolitis obliterans. Two isolates were serotype 7, and one was serotype 5, and two were untyped. Conclusion : Severe pneumonia caused by serotype 7 continued to occur in 1997 following the epidemic in 1996, and severe pneumonia may also be caused by serotype 5 and other serotypes.

• Pediatric Infection and Vaccine
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• v.7 no.2
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• pp.233-239
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• 2000

Purpose : A great deal of youngsters suffer from otitis media, for which antimicrobials are frequently prescribed. Increased antimicrobial resistance forces physicians to judiciously use antimicrobial agents in treating patients with acute otitis media. There have however been few references with regard to otitis media in Korean children, and authors proceeded investigation to look for the causative agents of otitis media in Korean children and their antimicrobial susceptibility. Methods : The study included 65 patients younger than 15 years old who had been cared at the department of pediatrics and otolaryngology in Hanyang University Hospital from July 1994 to June 1999, and diagnosed of otitis media with otorrhea which contained microorganisms isolated in otorrhea culture. The medical records were reviewed for demographic data, isolated organisms and their antimicrobial susceptibility. Results : Among 65 patients, 37(57%) were boys and 28(43%) girls. Distribution of the patients was reciprocal to the age of the patients; 27 patients(41.5%) were younger than 1 year old, 24(36.9%) were 1 to 3 years old with the average of 2.9 years of age. Staphylococus aureus was isolated in 32 patients(49.2%), Streptococcus pneumoniae in 19 patients(29.2%) Haemophilus influenzae in 9 patients(13.8%), Streptococcus oralis in 3 patients(4.6%), Moraxella catarrhalis in 1 patient(1.5%). The isolated microorganisms were not different whether patients had cleft lip/palate or not. The antibiotic resistance rates of S. aureus were ${\geq}90%$ to erythromycin, imipenem, cephalothin, and clindamycin, 86.2% to oxacillin, 25% to chloramphenicol, 12.5% to trimethoprim/sulfamethoxazole(TMP/SMX), and 0% to vancomycin and teicoplanin. The antibiotic resistance rates of S. pneumoniae were 71.4% to penicillin and greater than 60% to erythromycin, tetracycline, TMP/SMX, 7.1% to chloramphenicol, and 0% to vancomycin and teicoplanin. The antibiotic resistance rates of H. influenzae were 55% to ampicillin and TMP/SMX, and 0% to chloramphenicol, ceftriaxone, aztreonam, imipenem and ciprofloxacin. Conclusion : With otorrhea culture, the causative organisms of otitis media appear to be S. aureus, S. pneumoniae and H. influenzae. The high antibiotic resistance rates of the isolated organisms should affect the choice of antibiotics in treating patients with otitis media. Prospective investigations utilizing tympanocentesis in microbiologic studies are needed.

• Pediatric Infection and Vaccine
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• v.7 no.2
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• pp.193-200
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• 2000

Purpose : This study was designed and performed for evaluations of clinical manifestation and course of the children under 2 year of age with respiratory tract infection and positive respiratory syncytial virus(RSV) antigen. Methods : The selection criteria of the patients were children under 24 month-of-age, Clinical manifestation of respiratory tract infection, and positive RSV antigen that was detected by Vitek ImmunoDiagnostic Assay System(VIDAS) from nasal cavity. The additional laboratory and simple chest X-ray findings were reviewed from the chart of children who were admitted Wonkwang university hospital from October 1999 to March 2000. Results : Total number of patients enrolled on this study was 102. The 48(47%) children were RSV antigen positive by VIDAS method. Abnormal chest X-ray findings were noticed in 38 cases. The male to female sex ratio of 48 RSV antigen positive cases was 1.2 : 1. The mean and range of age was $10.2{\pm}5.9$ and 1.0~24 months. The peak outbreak of cases was noticed on November, 1999. All of the cases shows coughing but rale was audible in 30 cases(60%). Dyspnea, wheezing, and intercostal retraction were noticed 11(23%), 15(31%), and 10(21%) cases respectively. The most common chest X-ray finding was scattered patch infiltration that was noticed in 30 cases(63%). The mean total white blood cell counts in peripheral blood was $12,608{\pm}4,686/mm^3$. The mean blood level of IgA and IgE were $50.8{\pm}20.9$ and $72.1{\pm}98.3mg/dL$ respectively. The C-reactive protein was $16.0{\pm}18.5mg/L$. Total 5 cases need a mechanical respiraton. The duration of admission was under 7 days in 36 cases(75%). Conclusion : The RSV antigen was detected commonly in late fall and winter season. The severity of children under 2 years old with RSV respiratory tract infection take in some degree a gave courses.

• Pediatric Infection and Vaccine
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• v.11 no.2
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• pp.176-182
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• 2004

Purpose : The etiologic agents of aseptic meningitis remain mostly unknown due to difficulty of viral culture and identification. There was an outbreak of aseptic meningitis in northern area of Seoul from June to August, 2002. We report the clinical features, laboratory data and causative viruses on 196 children with aseptic meningitis during this period. Methods : We retrospectively studied about clinical manifestations and laboratory findings 196 patients diagnosed as aseptic meningitis at Sanggye-Paik hospital. Virus isolation and serotype identification were performed by cell culture and reverse transcription polymerase chain reaction(RT-PCR) of the cerebrospinal fluid. Results : The male to female ratio was 1.39 : 1 and the mean age was 5.8+3 years. The clinical manifestations were fever, headache and vomiting. It occurred mostly in June, July and August. The numbers of peripheral blood leukocytes were $4,800{\sim}24,360/mm^3$. On cerebrospinal fluid examinations, leukocytes were in range of 10~2,000(mean 105)/$mm^3$, protein level in range of 15~171(mean 41.4) mg/dL and glucose level from 16~97(mean 57.9) mg/dL. Viral culture of cerebrospinal fluid showed 3 cases of Echovirus 9, 1 case of 25 and 30. In stool culture, 2 cases of Echovirus 6, 2 cases of Echovirus 13 and 1 case of Echovirus 30 were isolated. Conclusion : The etiologic viruses of the aseptic meningitis in northern area of Seoul in 2002 are presumed to be Echovirus 6, 9, 13, 25, 30.

• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.125-133
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• 2017

Purpose: After the introduction of Haemophilus influenzae type b (Hib) vaccine in 1995 in Korea, it was included in the national immunization program in 2013. In the post-Hib vaccine era, some studies in other countries reported that invasive Hib disease affects adults, especially the elderly and immunocompromised persons, more often than it affects children. To evaluate disease susceptibility, quantitative and qualitative analysis of anti-polyribosylribitol phosphate (PRP) antibodies were carried out in Korean adults aged 20 to 85 years. Methods: Sera were collected from 39 healthy adults (20 to 50 years of age) and from 30 elderly adults (75 to 85 years of age) who did not have immune-compromising conditions. The concentration of anti-PRP immunoglobulin G (IgG) and serum bactericidal indices (SBIs) were measured by enzyme-linked immunosorbent assay and serum bactericidal assay. Results: Geometric mean concentrations of anti-PRP IgG and geometric mean SBIs were $0.88{\mu}g/mL$ (95% confidence interval [CI], 0.17 to 3.85) and 354 (95% CI, 50 to 2,499) in young adults and $1.67{\mu}g/mL$ (95% CI, 0.53 to 5.24) and 449 (95% CI, 146 to 1,376) in elderly adults, respectively. When the threshold of seropositivity for anti-PRP IgG was applied as 0.15 or $1.0{\mu}g/mL$, which is the protective antibody level in children, seropositive rates were 87.2% or 53.8% in young adults and 100% or 60% in elderly adults. The seropositivity rates of the SBI ($SBI{\geq}4$) were 82.1% and 100% in the groups, respectively. Conclusions: Most subjects in the adult and elderly adult groups display immunity to Hib based on quantitative and qualitative antibody levels, but not all. Because high immunization and low Hib circulation rates may reduce the natural Hib immunity in the population, monitoring Hib immunity as well as disease are needed continuously.

• Pediatric Infection and Vaccine
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• v.26 no.2
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• pp.99-111
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• 2019

Purpose: Respiratory syncytial virus (RSV) and human rhinovirus (hRV) are the most common causes of child respiratory viral infections. We aimed to investigate epidemiological and clinical characteristics of RSV and hRV single infections and coinfections. Methods: Nasopharyngeal aspirates of hospitalized children aged <5 years were tested using multiplex reverse transcription polymerase chain reaction (RT-PCR) from October 2014 to April 2017. Their medical records were retrospectively reviewed. Results: RSV or hRV was detected in 384 patients who divided into 3 groups: patients with RSV (R group, n=258); patients with hRV (H group, n=99); and patients with both (RH group, n=27). The R group (median age, 6 months) consisted of 248 (96.1%) patients with lower respiratory tract infection (LRTI), and 14 (5.4%) needed oxygen inhalation. Infants aged <12 months (63.2%) had respiratory difficulty and were supplied oxygen more often. The H group (median age, 16 months) consisted of 56 (56.6%) patients with LRTI, 4 (4%) required oxygen inhalation, and 1 (1.0%) required mechanical ventilation. Infants (40.4%) showed longer hospitalization compared to patients aged ${\geq}12$ months (5 vs. 4 days, P<0.05). The RH group consisted of 24 (88.9%) patients with LRTI, and 2 (7.4%) needed oxygen inhalation. Hospitalization days and oxygen inhalation and mechanical ventilation rates did not differ between single infections (R and H groups) and coinfections (RH group). Conclusions: RSV was detected more often in younger patients and showed higher LRTI rates compared to hRV. Single infections and coinfections of RSV and hRV showed no difference in severity.

• Pediatric Infection and Vaccine
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• v.30 no.3
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• pp.173-179
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• 2023

Complete DiGeorge syndrome (cDGS) refers to DGS with profound T cell deficiency. Herein, we present the case of an infant with cDGS suffering from refractory cytomegalovirus (CMV) infection and who was treated with CD45RA+ depleted lymphocyte infusion. The patient was diagnosed with cDGS by fluorescence in situ hybridization which verified 22q11.2 deletion and as well as by the observed profound T cell deficiency (CD3+ T cells 69/μL, CD4+ T cells 7/μL). On the 45th day of age, CMV viremia was first detected with a plasma viral load (VL) of 120,000 IU/mL. Ganciclovir treatment effectively reduced VL post 56 days of treatment; however, VL subsequently rebounded. A CMV UL97 phosphotransferase M460V mutation conferring ganciclovir resistance emerged and foscarnet was incorporated. Despite this, high titers of CMV viremia (VL 2,820,000 IU/mL) and CMV retinitis were complicated. To restore T cell immunity and treat refractory CMV infection, CD45RA+ depleted CMV-specific lymphocytes from the patient's father were infused twice on the 196th and 207th days after birth. After receiving the second infusion, a decline in CMV VL was observed, with a decrease to 87,100 IU/mL by the tenth day following infusion, despite the failure in maintaining T cell increase. The patient died of Pneumocystis jirovecii pneumonia and Elizabethkingia meningoseptica sepsis on the 222nd day after birth. CD45RA+ depleted lymphocyte infusion may be a therapeutic option for refractory CMV disease in cDGS patients.