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A Retrospective Analysis of Characteristics of Probiotics Associated with Invasive Bacterial Infections in Children (소아청소년에서 발생한 유산균 제제에 포함된 균주에 의한 침습성 감염증의 후향적 분석)

  • Koh, June Young;Seo, Euri;Lee, Jina
    • Pediatric Infection and Vaccine
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    • v.24 no.3
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    • pp.168-177
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    • 2017
  • Purpose: The purpose of this study was to analyze the clinical features and risk factors of invasive infections caused by Lactobacillus spp. and Saccharomyces spp., components of commercially available probiotics. Methods: We analyzed demographic and clinical data from children ${\leq}18$ years of age with an invasive infection caused by Lactobacillus spp. or Saccharomyces spp. at the Asan Medical Center Children's Hospital from January 1998 to June 2016. Probiotic consumption data were also analyzed. Results: During the study period, a total of 24 episodes of invasive infections were caused by Lactobacillus spp. (n=16) and Saccharomyces cerevisiae (n=8). Along with the increase of probiotic use (755,594 [days/1,000 patient-admission days] in 2001 to 2005, 1,444,066 in 2006 to 2010, and 6,904,736 in 2011 to 2016), the incidence of probiotic-associated invasive infection increased ($R^2=0.70$). The median age of the patients was 1.8 years (range, 2 months to 17 years), and most of them had underlying medical conditions. The 30-day mortality rate was 20.8% (5/24), and 11 (45.8%) of these patients resulted from a severe invasive infection. We determined the risk factors for invasive infection to be: previous intensive care unit stay (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.5 to 6.1] and the presence of a central venous catheter (OR, 2.2; 95% CI, 1.2 to 4.3). Conclusions: Although the probiotic-associated invasive infections rarely occurred in children, the incidence has increased along with probiotic pressure. Judicious use of probiotics is mandatory, especially in young children with underlying medical conditions and continuous surveillance will be needed to minimize the safety concerns.

Evaluation of Antibodies Against Haemophilus influenzae Type b in Korean Adults (우리나라 성인에서 Haemophilus influenzae type b에 대한 항체 평가)

  • Lee, Ji Hyen;Kim, Han Wool;Lee, Soyoung;Kim, Kyung-Hyo
    • 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.

A Retrospective Study of Invasive Bacterial Infections in Children with Asplenia (18세 이하 무비증 환자에서 발생한 침습성 세균 감염증에 대한 후향적 연구)

  • Choe, Yong-Joon;Seo, Euri;Lee, Jina
    • Pediatric Infection and Vaccine
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    • v.24 no.3
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    • pp.160-167
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    • 2017
  • Purpose: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. Methods: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. Results: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H. influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. Conclusions: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.

The First Newborn Screening Study of T-Cell Receptor Excision Circle and κ-Deleting Recombination Excision Circle for Severe Combined Immunodeficiency in Korea: A Pilot Study (국내 최초 T-Cell Receptor Excision Circle과 κ-Deleting Recombination Excision Circle 신생아 선별검사에 관한 연구)

  • Son, Sohee;Kang, Ji-Man;Kim, Jong Min;Sung, Sein;Kim, Yi-Seoul;Lee, Haejeong;Kim, BitA Reum;Lee, Yeon Kyoung;Ko, Sun Young;Shin, Son Moon;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.24 no.3
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    • pp.134-140
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    • 2017
  • Purpose: Severe combined immunodeficiency (SCID) is the most serious form of primary immunodeficiency. Infants with SCID are susceptible to life-threatening infections. To establish newborn screening for SCID in Korea, we performed a screening test for T-cell receptor excision circle (TREC) and ${\kappa}$-deleting recombination excision circle (KREC) in neonates and investigated the awareness of SCID among their parents. Methods: Collections of dried blood spots from neonates and parent surveys were performed at the Samsung Medical Center and Cheil General Hospital & Women's Healthcare Center in Korea. The amplification crossing point (Cp) value <37.0 was defined as TREC/KRECpositive based on cutoff values from measuring multiplex real-time polymerase chain reaction. A Cp value >39.0 was defined as negative. Results: For TREC/KREC screening, 141 neonates were enrolled; 63 (44.7%) were male. One hundred forty neonates (99.3%) had positive TREC/KREC results at the time of the initial test; 82.3% and 75.9% were positive and 17.0% and 23.4% were weakly positive for TREC and KREC, respectively. In one neonate (0.7%), the initial TREC/KREC test result was negative. However, repeated tests obtained and confirmed a positive result. For an awareness survey, 168 parents were engaged. Only 2% of parents (3/168) knew that the newborn screening test for SCID had been introduced and performed in other countries. Eighty-four percent of parents (141/168) replied that nationwide newborn SCID screening should be performed in Korean newborns. Conclusions: In this study, newborn SCID screening was performed along with assessment of public awareness of the SCID test in Korea. The study results showed that newborn SCID screening can be readily applied for clinical use at a relatively low cost in Korea.

Error Analysis of Image Velocimetry According to the Variation of the Interrogation Area (상관영역 크기 변화에 따른 영상유속계의 오차 분석)

  • Kim, Seojun;Yu, Kwonkyu;Yoon, Byungman
    • Journal of Korea Water Resources Association
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    • v.46 no.8
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    • pp.821-831
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    • 2013
  • Recently image velocimetries, including particle image velocimetry (PIV) and surface image velocimetry (SIV), are often used to measure flow velocities in laboratories and rivers. The most difficult point in using image velocimetries may be how to determine the sizes of the interrogation areas and the measurement uncertainties. Especially, it is a little hard for unskilled users to use these instruments, since any standardized measuring techniques or measurement uncertainties are not well evaluated. Sometimes the user's skill and understanding on the instruments may make a wide gap between velocity measurement results. The present study aims to evaluate image velocimetry's uncertainties due to the changes in the sizes of interrogation areas and searching areas with the error analyses. For the purpose, we generated 12 series of artificial images with known velocity fields and various numbers and sizes of particles. The analysis results showed that the accuracy of velocity measurements of the image velocimetry was significantly affected by the change of the size of interrogation area. Generally speaking, the error was reduced as the size of interrogation areas became small. For the same sizes of interrogation areas, the larger particle sizes and the larger number of particles resulted smaller errors. Especially, the errors of the image velocimetries were more affected by the number of particles rather than the sizes of them. As the sizes of interrogation areas were increased, the differences between the maximum and the minimum errors seemed to be reduced. For the size of the interrogation area whose average errors were less than 5%, the differences between the maximum and the minimum errors seemed a little large. For the case, in other words, the uncertainty of the velocity measurements of the image velocimetry was large. In the viewpoint of the particle density, the size of the interrogation area was small for large particle density cases. For the cases of large number of particle and small particle density, however, the minimum size of interrogation area became smaller.

Stenotrophomonas maltophilia and Ventilator-Associated Pneumonia in Critically Ill Pediatric Patients: a Retrospective Analysis at a Single Center (소아 환자에서 Stenotrophomonas maltophilia와 인공 환기요법 관련 폐렴에 관한 연구)

  • Lee, Byung-Kee;Choi, Soo-Han;Kim, Soo Jin;Cho, Joong Bum;Ae, Hong;Yoo, So-young;Kim, Ji Hye;Lee, Nam Young;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.22 no.2
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    • pp.75-80
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    • 2015
  • Purpose: Ventilator-associated pneumonia (VAP) is a serious threat in critically ill pediatric patients. Data regarding Stenotrophomonas maltophilia VAP in pediatric population is limited. We evaluated the clinical data of S. maltophilia associated VAP in critically ill pediatric patients. Methods: A retrospective chart review was performed in pediatric patients 18 years old or younger who developed S. maltophilia associated VAP at Samsung Medical Center, Seoul Korea from January 2008 to December 2012. Results: A total of 31 patients were identified S. maltophilia associated VAP. Median age was 8 months (range, 0.5 month to 16.6 years) and 13 patients were male (40.6%). Underlying illnesses were cardiologic diseases (n=11, 34.4%), hematologic oncologic malignancies (n=7, 25%), neurologic diseases (n=4, 12.5%), pulmonary diseases (n=3, 9.4%), and others (n=4, 12.5%). The median duration of ventilator use before S. maltophilia VAP diagnosis was 14 days (range, 4-256 days). Overall mortality at 30 days was 12.5% (4/32). Conclusions: S. maltophilia should be also considered as a possible pathogen for VAP in critically ill pediatric patients. Empiric antibiotic choice should include agents that are active against S. maltophilia in patients who are deteriorating on broad spectrum beta-lactam antimicrobial agents.

A Small Outbreak of Measles in 2013: In a Single Hospital in Northern Gyeonggi-do (2013년 경기 북부 한 병원에서 확인된 소규모 홍역 유행)

  • Kim, Min Jae;Kim, So Hyun;Kim, Sung Un;Jang, Mi Jin;Lee, Hyun Seung;Kim, Young Hoon;Han, Ji Whan;Kim, Jin Tack;Jang, Pil Sang
    • 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.

Effectiveness of Varicella Zoster Immune Globulin Administration within 96 Hours versus more than 96 Hours after Exposure to the Varicella-Zoster Virus (수두 바이러스에 노출 후 96시간 이내와 96시간 이후에 수두 면역 글로불린 투여시 수두 예방 효과에 관한 연구)

  • Kim, Sun-Ja;Lee, Byung-Kee;Kim, Yang-Hyun;Kim, Soo-Jin;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.22 no.2
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    • pp.55-62
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    • 2015
  • Purpose: Varicella Zoster Immune Globulin (VZIG) is available in Korea for post-exposure prophylaxis of the Varicella-zoster virus (VZV) in high-risk patients. In July 2013, the United States Centers for Disease Control and Prevention (US CDC) recommended extending the time for administration of VariZIG$^{(R)}$ from within 96 hours up to 10 days after VZV exposure. This study was performed to analyze the effectiveness of VZIG prophylaxis between the two groups of patients who received VZIG within 96 hours and more than 96 hours of exposure to varicella. Methods: A retrospective chart review was performed in pediatric patients who received VZIG at Samsung Medical Center, Seoul, Korea from January 2001 to December 2012. Results: A total of 91 patients were identified. Fifty-seven patients were male (62.6%) and the median age was 5.91 years. Thirty-nine patients (42.9%) were exposed to VZV in the hospital. Underlying diseases were solid tumors (41.8%), hematologic malignancies (40.7%), and others (17.5%). Forty-five patients (49.5%) were hematopoietic cell transplant recipients. Seventy-four patients (81.3%) received VZIG within 96 hours after VZV exposure. There was no significant difference in the development of chickenpox between the two groups (2.7% vs. 5.9%, P=0.4664). In 22 seronegative patients, we also observed no significant difference between the groups in terms of the development of chickenpox (6.6% vs. 0%, P=0.667). Conclusions: This study showed that the effectiveness of VZIG for the prevention of chickenpox was comparable between patients who received VZIG within 96 hours and those who received VZIG more than 96 hours after exposure to VZV.

Molecular Diagnosis of Streptococcus pneumoniae in Middle Ear Fluids from Children with Otitis Media with Effusion (삼출성 중이염 소아의 중이액에서 폐구균의 분자적 진단)

  • Byun, Sung Wan;Kim, Han Wool;Yoon, Seo Hee;Park, In Ho;Kim, Kyung-Hyo
    • Pediatric Infection and Vaccine
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    • v.22 no.2
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    • pp.106-112
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    • 2015
  • Purpose: The long-term administration of antibiotics interferes with bacterial culture in the middle ear fluids (MEFs) of young children with otitis media with effusion (OME). The purpose of this study is to determine whether molecular diagnostics can be used for rapid and direct detection of the bacterial pathogen in culture-negative MEFs. Methods: The specificity and sensitivity of both polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) to the lytA gene of Streptococcus pneumoniae were comparatively tested and then applied for pneumococcal detection in the clinical MEFs. Results: The detection limit of the PCR assay was approximately $10^4$ colony forming units (CFU), whereas that of LAMP was less than 10 CFU for the detection of S. pneumoniae. Both PCR and LAMP did not amplify nucleic acid at over $10^6$ CFU of H. influenzae or M. catarrhalis, both of which were irrelevant bacterial species. Of 22 culture-negative MEFs from children with OME, LAMP positivity was found in twelve MEFs (54.5%, 12/22), only three of which were PCR-positive (25%, 3/12). Our results showed that the ability of LAMP to detect pneumococcal DNA is over four times higher than that of PCR (P<0.01). Conclusions: As a high-resolution tool able to detect nucleic acid levels equivalent to <10 CFU of S. pneumoniae in MEFs without any cross-reaction with other pathogens, lytA -specific LAMP may be applied for diagnosing pneumococcus infection in OME as well as evaluating the impact of a pneumococcal conjugate vaccine against OME.

Clinical Manifestation of Eosinophilic Meningitis in Korean Children: A Single Institution's Experience (단일기관에서 소아 호산구성 수막염의 임상특징 분석)

  • Byun, Jung Hee;Choi, Seong Yeol;Kim, Dong Soo;Kim, Ki Hwan
    • Pediatric Infection and Vaccine
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    • v.22 no.1
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    • pp.23-28
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    • 2015
  • Purpose: The aim of this study was to investigate the clinical manifestations and laboratory characteristics of eosinophilic meningitis in Severance Children's Hospital. Methods: We examined 6,335 children under the age of 18 years old who had visited the tertiary hospital in Seoul, Korea, and had received cerebrospinal study results between January 2007 and July 2012. The medical records of the patients identified as eosinophilic meningitis were retrospectively reviewed. Results: Eosinophilic meningitis was diagnosed in 39 patients (0.6%). The mean age was 6 years (range 0-18 years) and the sex ratio was 1.3:1 (22 males and 17 females). The underlying diseases and past history were neurologic disease (n=36, 92%). Eosinophilic meningitis was diagnosed in thirty-five patients who had undergone postoperation neurosurgery (90%). The most common symptoms were fever (50%), headache (20%), vomiting (15%), seizure (10%), and dizziness (5%). The average duration for recovery was five days, and intravenous antibiotics or steroids were used. Conclusions: Manifestations of eosinophilic meningitis are similar to other types of meningitis. The most common cause of eosinophilic meningitis in children was neurosurgery. Eosinophilic meningitis should be considered for patients showing fever and headache after neurosurgery. Through careful investigation, use of improper antibiotics could be avoided.