• Pediatric Infection and Vaccine
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• v.14 no.1
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• pp.91-96
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• 2007

Purpose : This study was performed to evaluate a new rapid diagnostic kit (BIOLINE $RSV^{TM}$; Standard Diagnostics Inc., Yongin, Korea), a lateral-flow immunoassay, in the detection of respiratory syncytial virus (RSV) from the nasopharyngeal aspirates (NPA) of children with lower respiratory tract infections (LRTIs) in comparison with other diagnostic methods. Methods : Three hundred and nineteen NPAs were selected from a large pool of NPAs that had been obtained from children with LRTIs. All specimens had already been tested for RSV by culture and immunofluorescent (IF) test, and had been kept frozen. Tests with BIOLINE $RSV^{TM}$ were performed at least twice. All who conducted the experiments or interpreted the test results were blinded to the results of both culture and IF tests. Results : One hundred seven (97.3%) of 110 specimens that were positive for RSV by both culture and IF test, 29 (87.9%) of 33 that were positive by IF test only, 20 (76.9%) of 26 that were positive by culture only, and 140 (93.3%) of 150 that were negative by both methods were negative for RSV by BIOLINE $RSV^{TM}$. By combining the above results, the following 5 diagnostic values of BIOLINE $RSV^{TM}$ were determined in comparison with viral culture or IF test; sensitivity, 92.3% (156/169, 95% confidence interval [CI], 87.1-97.5%); specificity, 93.3% (140/150, 95% CI, 88.4-98.2%); positive predictive value, 94.0% (156/166, 95% CI, 89.5-98.5%); negative predictive value, 91.5% (140/143, 95% CI, 86.0-97.0%); and agreement, 95.9% (306/319, 95% CI, 92.1-99.7%), respectively. Conclusion : This study revealed that BIOLINE $RSV^{TM}$ demonstrated good sensitivity and specificity for the detection of RSV antigen from NPAs of children with LRTIs. Because of simple methods and quick results, this test may be useful for the diagnosis of RSV infection during the epidemic periods.

• Pediatric Infection and Vaccine
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• v.4 no.1
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• pp.140-149
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• 1997

Purpose : Kawasaki Disease(KD) is a febrile disease with acute multisystemic vasculitis which is seen commonly in early childhood. The cause and etiologic agents are still unknown to identify using ordinary bacterial and viral culture, but the clinical labaratory studies suggest that KD is one of autoimmune disorder caused by infectious agents, but that is not proved yet. The study was performed to investigate the IgG subclasses in acute stage of KB before treatment of IVIG(Intravenous immunoglobulin). Method : The 35 cases in acute stage of KD before treatment of IVIG who were hospitalized from jan. 1995 to dec. 1996. The obtained sera were measured level of total IgG, IgM, IgA, IgE and IgG subclasses IgGl, IgG2, IgG3, IgG4 by using EIA and SRID method. Results : 1) The sex ratio is male to female is 1.5: 1.0, and male is prone to infected. 2) Total IgG, IgM, IgA and IgE level is normal range with age adjusted, but few cases are shown slight high level of total IgG compare to normal range of age adjusted. 3) acute phage reactants such as CRP, C3, ESR are all increased in acute stage of cases. 4) IgG subclasses IgGl, IgG2, IgG3 are shown normal range of age adjusted, but remarkably low level of IgG4 in all of cases. Conclusions : The low level of IgG4 is able to increasing the incidence of KD, and may use early diagnostic tools combine with other clinical symptoms and signs. But the resulsts of reported studies are different to each other, so it needs more times and cases to get final evaluation of changes of serum immnunoglobulin levels correlate to increase the incidence of high risk group of KD patients.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.199-206
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• 2014

Purpose: There has been little research regarding the effectiveness of oseltamivir for influenza B infections. We sought to identify the different clinical manifestations between patients treated with and without oseltamivir. Methods: We retrospectively studied the medical records of 72 inpatients or outpatients from two medical centers diagnosed with influenza B infections by either a rapid antigen test or multiplex reverse transcriptase PCR between January 2012 and July 2012. We compared gender, age, past medical history, admission period, total fever duration, fever duration after hospitalization, post-oseltamivir medication peak temperature, laboratory test, chest X-ray, antibiotic medication, and the presence of concomitant viral or bacterial infections. Results: The number of subjects in our study was 72 who were diagnosed with influenza B pneumonia, acute bronchitis, acute bronchiolitis, croup, and mean age was $3.6{\pm}2.8$ year old. The demographic characteristics and clinical manifestations of oseltamivir and the non-oseltamivir groups, including hospitalization period ($4.18{\pm}2.10$ vs $4.79{\pm}1.49$ days, P=.17) and total fever duration ($5.32{\pm}2.07$ vs $6.41{\pm}3.25$ days, P =.09), demonstrated no significant differences. Notably, the oseltamivir group did have significantly reduced usage of antibiotic treatment than the non-oseltamivir group (P=.04). When we limited our patient group to patients under the age of three, similar results were seen. The group prescribed oseltamivir within 48 hours of fever onset had less antibiotic usage, in addition to a shorter fever duration. Conclusion: Oseltamivir appeared to have no benefit in improving the clinical course. However, if it is prescribed within the first 48 hours of symptoms, it may be more effective.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.40-47
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• 2011

Purpose : Norovirus infection, a common cause of community-acquired gastroenteritis, can also lead to severe illness in immunocompromised patients. We investigated clinical manifestations of norovirus infection in pediatric cancer patients. Methods : Stool specimens were collected from pediatric patients with gastrointestinal symptoms between November 2008 and September 2009 at Samsung Medical Center, Seoul, Korea. Norovirus infection was identified by reverse-transcription polymerase chain reaction (RT-PCR). A retrospective chart review was performed in pediatric cancer patients who were diagnosed with norovirus infection. Results : Ten patients were diagnosed with norovirus infection by RT-PCR in stool samples. The median age was 0.83 years (range 0.25-5.5 years) and the male to female ratio was 1.5:1 (6 males and 4 females). Underlying diseases were hematologic malignancies (4/10, 40%), neuroblastoma (4/10, 40%), and brain tumors (2/10, 20%). Three patients were infected before hematopoietic cell transplantation (HCT) and four patients after HCT. All patients had diarrhea (10/10, 100%), with a median frequency of diarrhea of 8.5 times/day (range 4-22 times/day). Median virus shedding duration was 72.5 days (range 19-299 days). Four patients with pneumatosis intestinalis were conservatively treated with bowel rest and total parenteral nutrition. One patient with severe diarrhea and bloody stool had concomitant chronic gut graft-versus-host disease (GVHD). Norovirus infection-related mortality was not observed. Conclusion : Norovirus infection can cause significant clinical manifestations with prolonged viral shedding in immunocompromised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.

• Pediatric Infection and Vaccine
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• v.22 no.2
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• pp.63-68
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• 2015

Purpose: This study analyzed a small outbreak of measles at a single hospital located in northern Gyeonggi-do in 2013. Methods: We reviewed the medical records of measles patients at The Catholic University of Korea Uijeongbu St. Mary's Hospital from August to October, 2013. Results: Fifteen children were confirmed to have measles by RT-PCR and serum IgM test; 1 neonate, 11 infants, and 3 toddlers. None of the patients had received Measles-Mumps-Rubella vaccination. All patients showed B3 type in viral genotyping. Nine children (60%) had been exposed to measles during treatment for other diseases in the pediatric ward. Incubation period was between 8 and 15 days. Fever started at a median 10 days after exposure and persisted for a median of 8 days. Rash showed at a median 13 days after exposure. Respiratory complications were observed in 40% of patients. Diarrhea developed in 53% of patients. Conclusion: Although measles has been well-controlled due to the high rate of vaccination coverage, it is possible to have an outbreak at any given time, especially in infants. We must learn from this outbreak, and remain fully aware of the possibility of reemergence and provide proper management, including vaccination or immune globulin administration, to infants exposed to measles. Reevaluation of serum IgG titer of neonates, infants, and pregnant women may be the first step to prevent further outbreaks.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.94-107
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• 2000

Purpose : The purpose of this study is to know the clinical manifestations and the severity of adenoviral lower respiratory tract infections(LRTI) in Korean children. Methods : Adenoviral respiratory infection was diagnosed by viral culture in HEp-2 cell and indirect immunofluorescent technique with nasal aspirates. Isolated adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviral lower respiratory tract infection, who were brought to Seoul National University Children's Hospital from November 1990 through February 1998. Results : Adenovirus was isolated in 87 cases. Of 84 cases serotyped, type 1 was recovered in 3 cases, type 2 in 13 cases, type 3 in 13, type 4 and 5 in 4 cases each other, type 6 in 1 cases, type 7 in 36 cases, type 11 in 1 case and the other types in 9 cases. Adenoviral lower respiratory infection occurred sporadically throughout the year but from November 1995 through February 1998, an outbreak of adenovirus type 7 lower respiratory infection was observed in number upto 36 case. The incidence of adenoviral infection peaked in young children between 6 months and 5 years of age and the mean age was 1 year 11 months old. There were 10 cases of mixed infection with another pathogen. Clinical diagnosis were pneumonia(88%), acute broncholitis(5.4%), acute tracheobronchitis(5.4%), croup(1.3%). The clinical features of adenoviral lower respiratory infection were severe especially in type 3 and 7 infections in aspect of fever duration, ventilator care. Extrapulmonary manifestations were gastrointestinal symptoms in 23 cases(31%), hepatomegaly in 36 cases(53%), seizure and mental alteration in 13 cases(20.3%). In chest radiographic findings, parahilar and peribronchial infiltration were in 49 cases(67%), hyperaeration in 21 cases(29%), atelectasis in 14 cases(19%), consolidation in 39 cases(53%) and bilateral pneumonic infiltration in 28 cases(38%). Among thirty six adenovirus type 7 LRTI, 15 patients(41.6%) had pleural effusion and 3 patients had chest tube insertion. Number of fetal cases related to adenovirus were 9 cases(12%) and fetal cases due to ventilatory failure were 7(11%). Conclusion : During 7 year period of studying adenoviral lower respiratory infection, we identified the serotypes of adenovirus. Among the serotypes, adenovirus type 7 were epidemically isolated. Adenovirus were isolated in severe lower respiratory infection of young children aged between 6 months and 5 years and related to death of the patients, especially when the patients had underlyng diseases or were infected by adenovirus type 7.

• Pediatric Infection and Vaccine
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• v.20 no.3
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• pp.168-177
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• 2013

Purpose: To identify the clinical and epidemiological characteristics of human metapneumovirus infections (hMPV) in children compared to respiratory syncytial virus A (RSV A) and B (RSV B). Method: A retrospective review of medical records was performed in 36 patients with hMPV infection, 106 with RSV A infection, and 51 with RSV B infection, from September 2007 to July 2012. Results: The peak incidence of hMPV infection was observed in May, whereas for RSV infections in November and December. hMPV infection occurred in older patients compared to RSV A and B infection ($29.9{\pm}32.5$ months vs. $13.6{\pm}15.4$ months, P<0.001; $29.9{\pm}32.5$ months vs. $12.1{\pm}13.5$ months, P<0.001, respectively). hMPV infection was more often associated with fever compared to RSV A (97.2% vs. 67.9%, P<0.001), while wheezing was less frequent compared to RSV A and B infection (16.7% vs. 47.2%, P=0.001; 16.7% vs. 37.3%, P=0.037, respectively). hMPV infection was more often diagnosed as pneumonia compared to RSV A infection (72.2% vs. 50.0%, P=0.047) while bronchiolitis was less frequent than in RSV A (5.6% vs. 34.9%, P=0.001) or RSV B infection (5.6% vs. 29.4%, P=0.006). In addition, intravenous antibiotic was more often prescribed for patients with hMPV infection than those with RSV A and B (69.4% vs. 39.6%, P=0.002; 69.4% vs. 43.1, P=0.015, respectively). Conclusion: This study identified characteristics of hMPV infection compared to RSV A and B infection. Seasonality in spring, higher age group, and higher proportion of pneumonia in hMPV infections may be a useful guide for management of respiratory viral infections in children.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.121-128
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• 2008

Purpose : The seasonality of influenza virus and rotavirus are well recognized in winter and so viral surveillance and laboratory-based diagnostics are important to guide the timing of prophylaxis and other interventions. Yet the seasonality of these two viruses are changing in Korea. We evaluated the prevalence and clinical features of influenza virus and rotavirus. Methods : From September 2001 to August 2005, nasopharyngeal aspirates were cultured from the hospitalized patients with lower respiratory infections and the stools from hospitalized patients with gastroenteritis were tested for rotavirus. We retrospectively analysed the medical records. Results : During the study period, respiratory virus was isolated in 578 (18.5%) out of 3,121 patients. Influenza virus was isolated in 143 cases. The seasonal distribution of influenza infection was from December to June of the next year. The ratio of males to females was 1.3:1 and the median age was 17 months. The most common diagnosis of influenza infection was bronchiolitis. Fever and cough were present in 94.4% and 83.9% of the patients, respectively. During the same period, 3,850 patients were admitted for gastroenteritis and 1,047 (27%) patients were positive for rotavirus. Rotavirus was prevailed from December to June of the next year and it presented in year-round. The ratio of males to females was 1.1:1 and the median age was 16 months. Diarrhea and vomiting were the most common symptoms. Conclusion : The recent peak prevalence of influenza virus and rotavirus in Korea was in winter and the late spring, respectively. So we need to expand surveillance and carefully consider the correct period to vaccinate people.

• Pediatric Infection and Vaccine
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• v.27 no.2
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• pp.117-126
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• 2020

Purpose: Epstein-Barr virus (EBV) infection is related to infectious mononucleosis or nasopharyngeal cancer, and its epidemiology may change according to the socioeconomic development of communities. This study aimed to evaluate the recent epidemiology of EBV seropositive rate in Korea. Methods: We retrospectively reviewed EBV serology test results obtained from a part of clinical care at Samsung Medical Center, Seoul, South Korea, from January 2000 to December 2017. Results: The EBV seropositive rate in 26,527 subjects during the study period was 81.0% (21,485/26,527): 44.4% (2,716/6,122) in subjects aged 0-9 years, 75.8% (2,077/2,739) in those aged 10-19 years, and 94.5% (16,692/17,666) in those aged ≥20 years. The EBV seropositive rate decreased from 89.4% (8,592/9,616) in 2000-2008 to 76.2% (12,893/16,911) in 2009-2017 (P<0.001). Especially, the EBV seropositive rate in subjects aged 0-19 years significantly decreased from 2000-2008 to 2009-2017 (0-9 years, 62.8% [1,172/1,866] in 2000-2008 and 36.3% [1,544/4,256] in 2009-2017; 10-19 years, 83.8% [745/858] in 2000-2008 and 70.8% (1,332/1,881) in 2009-2017) (P<0.001). Conclusions: The EBV seropositive rate in children has decreased in the last 20 years. As the age of patients with primary EBV infection increased, there is a need for interest in clinical manifestation, such as infectious mononucleosis, in adolescents and young adults.

• Pediatric Infection and Vaccine
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• v.5 no.2
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• pp.267-275
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• 1998

Purpose : We have studied the changes of cardiac troponin I(cTnI) level and left ventricular ejection fraction(LVEF) before and after treatment of IVGG to evaluate the efficacy of single high dose of intravenous gammaglobulin(IVGG)(2.0gm/kg) therapy for improving cardiac function and clinical symptoms and signs in patients with clinically suspected acute myocarditis. Methods : The patients consisted of 18 cases who admitted increased cTnI with clinically suspected acute myocarditis caused by viral infection, Kawasaki disease and fever unknown origin(FUO) from Jan. 1995 to Jun. 1998. The control group consisted of 20 cases suffered from hand-foot-mouth disease, herpangina and high fever with rash. The level of cTnI was measured by Chemiluminiscent immunoassay method(normal<0.1ng/ml) and cardiac function was evaluated by left ventricular ejection fraction(LVEF)(normal 64~83%) by echocardiogram. Results : The level of cTnI increased to $0.306{\pm}0.209ng/ml$ and LVEF decreased to $60.1{\pm}1.6%$ before treatment of IVGG significantly as compared with control group(P<0.05). All cases were returned to normal range of LVEF($71.4{\pm}3.7%$) and decreased cTnI significantly($0.089{\pm}0.082ng/ml$) after treated with IVGG within 1 week in patients group(P<0.05). Conclusion : The single high dose of IVGG(2.0gm/kg) therapy was rapid and effective improvement of cardiac function and clinical symptoms and signs of acute myocarditis, and the measurement of serum cTnI and LVEF may help to diagnose and evaluate efficacy of IVGG on it.