Are intestinal pathogens declining in Taiwan?
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Child↗
Biomedical subjects
L M Huang
Publications and source records attributed to L M Huang.
Effect of local massage on vaccination: DTP and DTPa.
We previously demonstrated that local massage for one minute can enhance immunogenicity of diphtheria, tetanus, and whole-cell pertussis (DTPw) vaccination. This study further analyzes the effects of more intense local manipulation on infants after DTPw and DTPa (diphtheria, tetanus, and acellular pertussis) vaccination. A total of 808 infants aged two months were recruited to be vaccinated with either DTPw or DTPa. Vaccinees in both groups were further divided into two groups; those receiving local manipulation (massage and hot packing after vaccinations) and those receiving only vaccinations. Results showed that safety profiles were largely similar between those who had local manipulation following vaccination and those without. The only significant difference was more frequent local reactions including pain and swelling following the first two doses in both the DTPa and DTPw groups receiving manipulation compared with the groups not receiving manipulation. Serologic tests revealed that local manipulation had no significant effect on antibody response to pertussis toxin and filamentous hemagglutinin, and diphtheria and tetanus toxins. The effect of local massage on DTPw was related to the intensity of local massage. Too vigorous a local manipulation caused adverse local reactions and no beneficial effect on antibody response. As for the infants receiving DTPa and local massages for two minutes with hot packing, no significant effect on either the reactogenicity or immunogenicity was found.
Antibodies, Viral↗
Croup syndrome in children: five-year experience.
To investigate the etiology and clinical features of croup syndrome, clinical records of hospitalized children with a diagnosis of croup syndrome were reviewed from April 1990 to January 1996. There was a total of 132 children, aged between three months and seven years with a mean age of 21.3 +/- 16.8 months. A diagnosis of laryngotracheobronchitis was made in 123 (93.2 percent) children. Twenty-three pathogens were identified in twenty-two of them, including seven parainfluenza viruses, five respiratory syncytial viruses, four influenza A viruses, four Mycoplasma pneumoniae, and three adenoviruses. Bacterial tracheitis was confirmed by bronchoscopic examination in seven cases (5.3 percent). Cultures of the respiratory secretions yielded viridans streptococci in six and Staphylococcus aureus in one child. Two children (1.5 percent) had spasmodic croup. No case with epiglottitis was noted in the present study. A fever lasting for more than three days was noted in five (71 percent) children with bacterial tracheitis and thirty-five (28 percent) children with laryngotracheobronchitis (p = 0.048). Among children with laryngotracheobronchitis, an associated diagnosis of pneumonia, acute otitis media, or paranasal sinusitis was more frequently observed in those with fever > 3 days (40 percent) than those with a shorter duration of fever (17 percent, p = 0.013). In conclusion, a child with a longer duration of fever and more severe manifestations of airway obstruction probably has a bacterial cause of croup syndrome or a bacterial complication. Bacterial tracheitis is more common than epiglottitis in Taiwan.
Child↗
Efficacy and safety of oral cefixime therapy in common infectious diseases in children.
Twenty-nine children, including 20 boys and 9 girls, were enrolled in an open trial of oral cefixime therapy for common pediatric infectious diseases. Patients aged between 0.5 month and 12 years with a mean +/- standard deviation of 2.3 +/- 2.8 years. The diagnoses included 10 of acute otitis media, 2 of purulent rhinitis, 4 of acute enterocolitis, and 13 of urinary tract infection. Most children received 6-12 mg/kg/day of cefixime granules, orally twice daily for more than five days. All 10 cases (100%) of acute otitis media and 2 cases of purulent rhinitis were either cured, or improved by oral cefixime treatment. None of them was microbiologically evaluable. Four cases (100%) of acute enterocolitis, 3 due to Salmonella group B, one due to Shigella flexneri, were also successfully treated with bacteria eradication. However, the cure rate of 13 cases of urinary tract infection was only 85% (11/13). Seven Escherichia coli and 4 Proteus mirabilis infections were eradicated, whereas one each of Enterobacter cloacae and Klebsiella pneumoniae infections did not respond to treatment; these two cases had a complicated course. The overall cure and improvement rate was 93%. Although five patients had transient episodes of mild diarrhea, no significant adverse reaction was observed. In summary, oral cefixime given twice daily was effective and safe in the treatment of a variety of common infectious diseases in pediatric patients.
Administration, Oral↗
[Disseminated cryptococcosis mimicking lymphoreticular malignancy: report of one case].
Disseminated cryptococcosis is a rare and often fatal disease in children. The majority of cases usually occur in individuals with defective cell-mediated immunity. We herein reported a 10-year-old boy who presented with fever, body weight loss, lymphadenopathy and marked hepatosplenomegaly. He was admitted under the impression of Hodgkin's disease. However lymph node biopsy revealed diffuse infiltration with polynuclear giant cell and macrophage. Numerous ovoid-shaped microorganisms were found in the cytoplasma of those cells. Cultures of blood, CSF, lymph node, bone marrow and urine all yielded cryptococcus neoformans. The cryptococcal antigen titer of blood was 1:1024 X and that of CSF was 1:64 X. The immune function in terms of T-cell number, mitogen responses, serum immunoglobulin and complement was normal. After the diagnosis of disseminated cryptococcosis was established, the patient was treated with amphotericin B (0.6 mg/kg/day) and 5-fluorocytosine (150 mg/kg/day) for 6 weeks. The patient responded to the treatment very well. Lymphadenopathy and hepatospelomegaly disappeared and no more recurrence was found during the follow-up period of more than 18 months.
Child↗
A clinical evaluation of sulbactam/ampicillin in the treatment of pediatric infections.
We have treated 42 episodes of pediatric infections with sulbactam/ampicillin since 1987. Included were 9 cellulitis, 9 urinary tract infections, 5 cervical lymphadenitis, 4 meningitis, 2 thoracic empyema, 2 osteomyelitis, 2 sepsis, 1 furuncle, 1 perianal abscess, 1 dental abscess, 1 peritonsillitis, 1 salmonellosis, 1 shigellosis, 1 peritonitis, 1 suppurative thyroiditis, 1 infective endocarditis. Responsible pathogens were Escherichia coli in 8, Staphylococcus aureus in 6, Hemophilus influenzae in 2, Streptococcus pneumoniae in 3, Streptococcus viridans in 2, Staphylococcus epidermidis in 1, Bacteroides fragilis in 1, Salmonella D1 in 1, Shigella sonnei in 1, Klebsiella pneumoniae in 1, Enterobacter agglomerans in 1, Acinetobacter calcoaceticus in 1, Enterobacter cloacae in 1, group A beta-hemolytic streptococcus in 1, and polymicrobial infection in 4 cases. Thirty-nine out of 41 (95%) clinically evaluable patients cured and all (34/34) bacteriologically evaluable patients eradicated their pathogens after treatment with sulbactam/ampicillin. Side reactions were seen in five patients; one maculopapular skin rash, one hemolytic anemia, two diarrhea, and one liver function impairment plus leukopenia. All these reactions were transient and did not require interruption of therapy. These results indicate that sulbactam/ampicillin is safe and effective in the treatment of common pediatric infections beyond the neonatal period.
Adolescent↗
Outbreak of aseptic meningitis in Taipei in spring 1993.
An outbreak of aseptic meningitis in the Taipei area occurred from January to August 1993. A total of 114 cases were identified by cerebrospinal fluid (CSF) examination at National Taiwan University Hospital. Most of the cases were found from February to May 1993. The peak of age distribution was 3 to 11 years. The male-to-female ratio was 2.1 to 1. Most patients had fever, headache, and vomiting and nausea. On initial CSF examination, protein concentrations > 400 mg/L were noted in 38 of 93 CSF samples, while 19 of 70 initial samples had hypoglycorrhachia (CSF/serum glucose ratio < 0.5). CSF white cell counts of the initial lumbar puncture were 0-9 x 10(6) cells/L in 4 patients, 10-99 x 10(6) cells/L in 42 patients, 100-199 x 10(6) cells/L in 27 patients, 200-499 x 10(6) cells/L in 24 patients, 500-999 x 10(6) cells/L in 12 patients and > or = 1,000 x 10(6) cells/L in 5 patients. Polymorphonuclear cells predominated in 73 of 114 cases. Viral cultures from CSF, throat swabs and rectal swabs were done with a majority yielding enteroviruses. Enterovirus as a definite etiology was found in 58 of 114 cases and was the presumptive etiology in 15 of 114 cases. The serotypes of the enteroviruses isolated were mostly echovirus type 30. All patients recovered without obvious sequelae.
Adolescent↗
Prevalence of Legionella pneumophila infection in children and its role in pediatric community-acquired atypical pneumonia.
The infection status of Legionella pneumophila in children and its role in pediatric community-acquired pneumonia were investigated. Because exposure to Legionella pneumophila may be highly variable and there has been no unanimously agreed-upon cut-off values in previous seroprevalence studies, 60 serum samples collected from infants aged 12 to 18 months were examined using immunofluorescence antibody test to determine the cut-off titer which represents past Legionella pneumophila infection. An IFA titer of greater than or equal to 32 was found to be suitable to represent past L. pneumophila infection. A seroepidemiological study of the prevalence of L. pneumophila in 180 children showed the prevalences in children aged 7 to 18 years to be between 28.4 and 35%. Fifty-three paired sera were tested to determine the role of Legionella pneumophila in pediatric, community-acquired, atypical pneumonia. The frequency of confirmed disease was 0% and of presumptive cases was 5.7%. Legionella pneumophila was not a common etiologic agent of pediatric pneumonia in Taiwan.
Adolescent↗
Group B streptococcal cellulitis of perineum and lower abdomen: report of one case.
This report describes a 4-week-old female baby with disseminated group B streptococcus (GBS) infection. The illness began as a swelling with violaceous hue of perineum and lower abdomen, a manifestation that may be falsely attributed to a traumatic injury. GBS septicemia, meningitis and cellulitis of lower abdomen was confirmed by cultures. This case illustrated an unusual presentation of GBS infection as cellulitis of lower abdomen. The presence of concurrent septicemia and meningitis in this case indicated that a more extensive diagnostic work-up and a more aggressive therapeutic approach are needed for young infants with cellulitis.
Ampicillin↗
A seroepidemiological study of Varicella-Zoster virus in Taipei City.
Varicella has been considered a common and benign disease of children. However, adults tend to have severe disease and in some high risk groups, such as neonates and leukemic patients, varicella infection can be fatal. A large-scale seroepidemiological study on varicella was performed to reveal the current varicella infection status and to serve as a prevaccination survey before the possible implementation of vaccination program in Taiwan. This study included a total of 1384 individuals whose ages ranged from newborns to old adults. Enzyme-linked immunosorbent assay was adopted to determine the IgG antibodies against Varicella-Zoster virus. The results showed: (1) only 24% of infants aged birth to three months had maternal antibodies, (2) the seroprevalence increased slowly during the first 3 years after birth, (3) most infections occurred between 3 and 10 years old, (4) 10% (female) to 20% (male) of adults were still susceptible to varicella infection, and (5) 85% of pregnant women had antibodies against VZV. These data suggest that if varicella vaccination is to be done in Taiwan, the appropriate inoculation age would be between 12 and 24 months. Besides, there exists a pool of uninfected adults who potentially will develop severe illnesses once infected and should be screened and protected by varicella vaccines.
Adolescent↗
Prolonged fever in children.
During a four-year period, 86 children with fever lasting for at least 6 days without diagnosis at admission after initial physical examination and preliminary laboratory tests were included in a retrospective analysis. Their ages ranged from 2 months to 16 years, and there were 55 males and 31 females. Bacterial infections occurred in 19 patients (22%), viral infections in 17 (20%), mycoplasmal infections in 3 and malaria in 1. Collagen vascular diseases were diagnosed in 13 children (15%), including 7 juvenile rheumatoid arthritis and 5 systemic lupus erythematosus. Thirteen children (15%) had neoplastic or hematological diseases, including leukemia, lymphoma, myelodysplastic syndrome, and neuroblastoma. The fevers of the other 14 patients (16%) were attributed to central fever. The overall diagnostic rate was 98%. Twenty-two children had a poor outcome, including 6 children with collagen vascular diseases and 12 with neoplasms. Diagnoses were made mainly through a complete medical history, meticulous physical examination, regular laboratory tests, and an observation of clinical course. Invasive tissue studies can be fruitful when used appropriately and should be considered for specific indication only.
Adolescent↗
Human herpesvirus 6 infection.
Human herpesvirus 6 (HHV-6) was identified in 1986 and roseola infantum was the first disease linked to HHV-6. To date, a large variety of clinical syndromes have been associated with HHV-6. Age of the patient is the most important factor when considering HHV-6 as a possible cause of infection. It is a major pathogen for children aged 6 to 24 months. In addition, HHV-6 is an important pathogen in the immunocompromised host and may cause ailments of the central nervous system. These later two conditions are most likely to be benefited from the application of anti-viral drug when it becomes available. HHV-6 is an example that virus hides within the immunologic cells and displays a complex interaction with the host cells. The discovery of HHV-6 offers a lesson for clinicians to anticipate new viruses deriving from unexpected sites within the human body; furthermore, HHV-6 provides a model for studying the clinical role of a new herpesvirus.
Herpesviridae Infections↗
Evaluation of a live attenuated varicella vaccine in 15- to 18-month-old healthy children.
A clinical trial was conducted in Taiwan in 15- to 18- month-old healthy children to study the reactogenicity and immunogenicity of live varicella vaccine combined with standard measles-mumps-rubella vaccine. A total of 118 varicella antibody-negative children were enrolled. They received one dose of varicella vaccine and one dose of measles-mumps-rubella vaccine at the same time. The vaccines were well tolerated; adverse reactions were mild and infrequent, with 2% of vaccines developed skin rash. No vesicular rash was seen. Concomitant varicella vaccination did not significantly increase the incidences of reactions associated with MMR vaccine. The seroconversion rates to varicella, measles, mumps and rubella all approached 100%. This study confirmed that simultaneous administration of live attenuated varicella vaccine and MMR vaccine was safe and immunogenic in healthy young children in Taiwan.
Antibodies, Viral↗