• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1107-1115
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• 2005

Purpose : An outbreak of ESBL-producing Shigella sonnei enteritis was unprecedented not only in Korea but throughout the world in the past. We intended to devise a management guideline for ESBL-producing shigellosis based on analysis of clinical manifestations and response to therapy. Methods : We analyzed 103 patients who were admitted to the hospital with acute GI symptoms and were shown positive result for S. sonnei on stool culture. We performed sensitivity test to the antibiotics and DNA sequencing of ESBL gene in the isolated S. sonnei colonies. In addition, we retrospectively analyzed their clinical characteristics, laboratory results, and clinical and microbiological responses to the antibiotics. Results : Among the clinical manifestations, fever was the most frequent(96.1%), followed by diarrhea(93.2%), abdominal pain(76.7%), headache(71.8%), vomiting(65.0%), and nausea(41.7%). The fever was sustained for average of 2.0 days and diarrhea for 3.9 days. Watery diarrhea was the most common(69%) followed by mucoid(26%), and bloody stool(5%). On peripheral blood smear, leukocytosis was noted in 53.4% of patients, and 78.6% of patients tested positive for serum CRP response. On stool direct smear, 11.7% of patients showed more than 50 WBCs/HPF, and 9.7% of patients between 5 to 20 WBCs/HPF. Stool occult blood was positive in 71% of patients. Production of CTX-M-14 type ESBL was reported for all S. sonnei strains isolated from this outbreak. Microbiological eradication rates to various antibiotics were as follows : 100%(9/9) to ciprofloxacin, 100% 5/5) to azithromycin, 6.9%(5/72) to cefdinir, 0%(0/8) to ceftriaxone, 12.5%(1/8) to ceftizoxime, 0%(0/ 8) to TMP/SMX, 42.9%(3/7) to ampicillin/sulbactam, 20%(1/5) to amoxicillin/clavulanic acid, and 68.8 %(11/16) to imipenem/cilastatin. Conclusion : It is presumed that azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric population, given its cost-effectiveness and safety. Although ciprofloxacin is another cost-effective agent, its use in pediatric population may be a bit too premature.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.16-23
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• 2004

Purpose: In this study, we tried to evaluate the clinical characteristics or circumstances that lead to unintentionally the delay in the diagnosis of intussusception or to the wrong direction that prevent the proper management early. Methods: All the patients of intussusception with delayed diagnosis in the department of pediatrics or emergency room at Gyeongsang National University Hospital from 1990 to 2003 were enrolled and reviewed retrospectively. Results: There were 8 boys and 6 girls and their median age was 8 months (range 2 months to 10 years). Their initial symptoms and signs were vomiting, seizure, diarrhea, lethargy, irritability, bloody stool, palpable abdominal mass, foul odor of urine and tachycardia. Clinical diagnosis or impressions at admission consisted of acute gastroenteritis, shigellosis and toxic encephalopathy, convulsive disorders, urinary tract infections, sepsis, abdominal mass and intestinal obstruction. Eight patients were luckily diagnosed due to the delayed manifestations of cyclic irritability or currant jelly stool. Six patients were not paid attentions for the possibilities of intussusception and diagnosed serendipitiously by the abdominal sonography or CT during the evaluation of the abdominal mass or distension. Only five of 14 cases (35.7%) were successfully managed by barium or air reductions. The other 9 cases needed surgical operations. Conclusion: Delayed diagnosis of intussusception arise when doctors initially diagnose the patients incorrectly due to the unusual presentations or when they overlook the newly arising symptoms or signs suggestive intussusception after the admission because they are ardently attached to the first impressions or initial clinical diagnosis.

• Journal of Food Hygiene and Safety
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• v.18 no.3
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• pp.139-145
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• 2003

The purpose of this study was to investigate the awareness and practice of Korean consumer on food safety. A telephone survey was conducted from 1,040 adults randomly selected from each province and large city of Korea. Therefore, 12.4% of the subjects experienced foodborne illness at least once a year and 0.3% was hospitalized due to the illness. General restaurant (37.2%) and home (21.2%) were the main causative place of foodborne illness, and the most frequently associated foods were meat and meat products (41.7%) and fish and fish products (18.7%). Regarding the causative agent of foodborne illness, the respsondents were aware of Cholera (75.5%), Vibrio gastroenteritis (73%), Shigellosis (65.5%), Bacillary dysentery (65.5%) and Salmonellosis (47.5%) very well; however very few were aware of Listeriosis (9.9%) and brucellosis (8.3%) and ever believed they were not food-related illness. When the survey data were analyzed based on 3 models (Model 1: Knowledge about the pathogens associated food and water, Model 2: The awareness of food safety, Model 3: Attitudes and behavior about foodborne disease prevention and measure) by Multiple regression analysis. The results showed that the awareness of the causative agent of foodborne illness was significantly related with the previous experience of foodborne illness (OR: 1.714) followed by education level (OR: 0.536) and married status (OR: 0.527). The awareness of food safety was significatly related with education level (OR: 0.702). Education (OR: 0.816) and gender (OR:0.650) were the main factors affecting the awareness of the practice to prevent foodborne illness. However, the previous experience of foodborne illness and food safety education, and the awareness of food safety did not show any correlation, suggesting that the experience and awareness of foodborne illness do not affect the real practice of food safety.

• Journal of Yeungnam Medical Science
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• v.12 no.2
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• pp.191-202
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• 1995

Purpose: Acute febrile illness in children frequently accompanies with abdominal symptoms such as vomiting, diarrhea, and abdominal pain, even if its etiology is not occured from the gastrointestinal tract. If the etiology of fever was unknown and the fever was accompanied with abdominal symptoms, we should be concerned about whether the etiology of fever was originated from the gastrointestinal tract or interpretated from the abnormality in the gastrointestinal tract. This study was performed to evaluate the diagnostic value of abdominal ultrasonography in patients with fever and abdominal symptoms. Methods: We reviewed retrospectively the medical records of abdominal ultrasonographic (US) findings of 60 cases of acute febrile illness with abdominal symptoms at department of Pediatrics, Ulsan Dongang General Hospital during the period from January 1994 to June 1995. Results: The abnormal abdominal US findings obtained were as follows. 1) The abnormal US findings were seen in 56 cases (93.3%). 2) The most common abnormal US finding was the enlarged mesenteric lymph nodes in 52 cases (86.7%) 3) The enlarged mesenteric lymph nodes with or without intra-abdominal fluid were seen in 30 cases (50.0%) of a wide variety of illnesses, so their diagnostic values were absent. 4) The enlarged mesenteric lymph nodes and splenomegaly with or without ileocecitis were seen in 7 cases. Among them, 4 cases (6.7%) were confirmed as typhoid fever. 5) The US findings in 6 cases of typhoid fever were the enlarged mesenteric lymph nodes in all cases (100%), splenomegaly in 4 cases (66.7%), ileocecitis in 1 case (16.7%), enlarged mesenteric lymph nodes and splenomegaly in 4 cases (66.7%), enlarged mesenteric lymph nodes, splenomegaly and ileocecitis in 1 cases (16.7%). 6) The enlarged mesenteric lymph nodes and the abnormalities around the appendix were seen in 7 cases (11.7%), which were confirmed as appendicitis all. 7) The thickening of wall in urinary bladder was seen in 2 cases (3.3%) of acute cystitis and acute hemorrhagic cystitis. 8) The subtle thickening of wall in colon was seen in 1 cases (1.7%) of shigellosis. Conclusions: The enlarged mesenteric lymph nodes, splenomegaly and ileocolitis on the abdominal ultrasonography in patients with fever and abdominal symptoms aree suggestive findings of typhoid fever. The enlarged mesenteric lymph nodes and the abnormalities around the appendix on abdominal ultrasonography make the rapid diagnosis of acute appendicitis and its complications, when physical examination is difficult in small children and diagnosis of their illnesses is obscure in patients with fever and abdominal pain.