Chien-Yu Lin

The Emerging Importance of Norovirus as the Etiology of Pediatric Gastroenteritis in Taipei

BACKGROUND/PURPOSEnRotavirus is a major causative agent of pediatric gastroenteritis throughout the world. However, other viruses such as norovirus also play an important role, but have seldom been studied in Taipei, Taiwan. The aim of this study was to survey the prevalence and clinical manifestations of different types of viral gastroenteritis in Taipei, focusing especially on the disease burden of norovirus.nnnMETHODSnBetween November 2004 and April 2005, stool samples were collected from hospitalized pediatric patients with a diagnosis of acute gastroenteritis. Clinical manifestations, laboratory data, and hospitalization course of the patients were all analyzed. Stool cultures for bacteria and rotavirus antigens were performed. All samples were tested for norovirus, enteric adenovirus, and astrovirus using enzyme-linked immunosorbent assays.nnnRESULTSnA total of 75 stool specimens were collected during the 6-month period. Fifteen (20.0%) were positive for norovirus (3 genogroup I and 12 genogroup II). Three (4.0%) were positive for enteric adeno-virus, and one (1.3%) for astrovirus. Nine (12.0%) patients had positive rotavirus antigen tests. Bacterial pathogens were found in 12 patients (16.0%), including seven cases of Salmonella, and five of Campylobacter. The patients with norovirus gastroenteritis were aged between 1.5-7.5 years old (median 20 months old). Fever was found in six patients (40.0%), and bloody, mucoid stools in three (20.0%). The mean hospitalization time was 3.3 days. None of them had complications.nnnCONCLUSIONnDuring the study period, norovirus was the most common pathogen causing hospitalized pediatric gastroenteritis in our hospital. Genogroup II was the predominant type (80.0%). Clinicians in Taipei should, therefore, be aware of the emergence of norovirus infections.

Neonatal orbital abscess.

Orbital abscess is life‐threatening and rare in children. Reported herein is a term male neonate who had methicillin‐resistant Staphylococcus aureus orbital abscess, and a literature review of this disease. A total of 16 neonates diagnosed with neonatal orbital abscess are reported in the literature. There is a mild male predilection and two neonates were delivered prematurely. Leukocytosis, fever, ethmoiditis and associated upper respiratory tract infection were found in approximately half of them. Eight neonates had sepsis and 14 patients underwent surgical intervention. One patient died. Staphylococcus aureus was identified in 14 out of 17 patients. Neonatal orbital abscess is rarely encountered but may be fatal. Although streptococci are prevalent in childhood orbital infection, S.u2009aureus was predominant in neonatal orbital abscess in the present series. Appropriate antimicrobial therapy against S.u2009aureus is essential in treating neonatal orbital abscess. This case suggests that a higher initial dose of vancomycin may be an effective and safe strategy for severe S.u2009aureus infection in neonates.

Mondini Dysplasia Presenting as Otorrhea without Meningitis

Mondini dysplasia is a rare inner ear malformation that is usually only diagnosed after recurrent meningitis. Surgical intervention is mandatory. This report highlights the case of a patient with Mondini dysplasia who presented with hearing impairment and otorrhea and was diagnosed and treated before the occurrence of meningitis, thus preventing morbidity and neurologic sequelae. Hearing impairment may be the only manifestation of Mondini dysplasia, and the benefit of hearing screening is emphasized. Temporal bone computed tomography should be considered in children with unilateral sensorineural or mixed-type hearing impairment.

Hemodynamic Effects of Nasal Intermittent Positive Pressure Ventilation in Preterm Infants

AbstractNasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) have proven to be effective modes of noninvasive respiratory support in preterm infants. Although they are increasingly used in neonatal intensive care, their hemodynamic consequences have not been fully evaluated. The aim of this study was to investigate the hemodynamic changes between NIPPV and NCPAP in preterm infants.This prospective observational study enrolled clinically stable preterm infants requiring respiratory support received NCPAP and nonsynchronized NIPPV at 40/minute for 30 minutes each, in random order. Cardiac function and cerebral hemodynamics were assessed by ultrasonography after each study period. The patients continued the study ventilation during measurements.Twenty infants with a mean gestational age of 27 weeks (range, 25–32 weeks) and birth weight of 974u200ag were examined at a median postnatal age of 20 days (range, 9–28 days). There were no significant differences between the NCPAP and NIPPV groups in right (302 vs 292u200amL/kg/min, respectively) and left ventricular output (310 vs 319u200amL/kg/min, respectively), superior vena cava flow (103 vs 111u200amL/kg/min, respectively), or anterior cerebral artery flow velocity.NIPPV did not have a significant effect on the hemodynamics of stable preterm infants. Future studies assessing the effect of NIPPV on circulation should focus on less stable and very preterm infants.

Esophageal perforation, mediastinitis, and retropharyngeal abscess after eel intrusion.

ventive and therapeutic interventions for those patients with virus-induced recurrent wheezing. Despite the limitations of experimental models, in vitro studies and the gaps in knowledge derived from human studies, the stage is ready for well selected cohort studies to determine whether RSV persistence and/or RSV-induced immune response contribute to the development of chronic lung inflammation and recurrent wheezing in children.

Increased risk of pernicious anemia following scabies: a nationwide population-based matched-cohort study

Objectives Scabies is a common and annoying disorder. Pernicious anemia (PA) is a serious disease which, when untreated, leads to death. Mounting evidence suggests that immune-mediated inflammatory processes play a role in the pathophysiology of both diseases. The relationship between these two diseases has not been investigated. We conducted this study to explore the potential relationship between scabies and PA. Materials and methods This nationwide, population-based study was conducted using the National Health Insurance Research Database of Taiwan. In total, 5,407 patients with scabies were identified as a study group and 20,089 matched patients were randomly selected as a control group. We tracked patients in both groups for a 7-year period to identify the incidence of PA. The demographic characteristics and comorbidities of the patients were analyzed, and Cox proportional hazards regression was used to calculate the hazard ratios for PA. Results Of the 25,496 patients in this study, 183 (0.7%) patients with newly diagnosed PA were identified during the 7-year follow-up period; 71 of 5,407 (1.3%) from the scabies group and 112 of 20,089 (0.6%) from the control group. Patients with scabies had a higher risk of subsequent PA, with a crude hazard ratio of 2.368. After adjusting for covariates, the adjusted hazard ratio was 1.51 (95% confidence interval: 1.09–2.08). Conclusion This study demonstrated an increased risk of PA (adjusted hazard ratio 1.51) among patients with scabies. Immune-mediated inflammatory processes may contribute to this association. Further studies are warranted to investigate the entire pathological mechanisms between these two diseases. Physicians should pay attention to patients with history of scabies presented with anemia. Further confirmative tests of PA may contribute to correct diagnosis and initiation of vitamin B12 supplement.

Comparative effectiveness of azithromycin for treating scrub typhus: A PRISMA-compliant systematic review and meta-analysis.

Background: Scrub typhus is a zoonotic disease that remains an important health threat in endemic areas. Appropriate anti-rickettsial treatment ensures a successful recovery. Doxycycline is a recommended drug, but it is contraindicated in pregnant women and young children. Azithromycin is a safer alternative drug, but its effectiveness remains largely unclear. Herein, we conducted a systematic review and meta-analysis to determine the effectiveness of azithromycin. Methods: Studies that investigated azithromycin in treating scrub typhus were systematically identified from electronic databases up to December 2016. Information regarding study population, disease severity, treatment protocols, and responses was extracted and analyzed. Results: In this review, 5 studies were included, which comprised a total of 427 patients. When comparing the treatment failure rate, we observed a favorable outcome in patients treated with azithromycin (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.23–2.98). However, patients in the azithromycin group had longer time to defervescence (mean difference 4.38u200ahours, 95% CI −2.51 to 11.27) and higher rate of fever for more than 48u200ahours (RR 1.31, 95% CI 0.81–2.12). Moreover, patients treated with azithromycin had less adverse effects (RR 0.8, 95% CI 0.42–1.52). Conclusions: Azithromycin is as effective as other anti-rickettsial drugs with higher treatment success rates, lower frequency of adverse effects, and longer time to defervescence (GRADE 2B). Therefore, it is reasonable to use azithromycin as the first-line treatment against scrub typhus. Further studies are warranted to elucidate the effectiveness of azithromycin in specific patient groups, at high dose and influence of drug resistance.

Increase the risk of intellectual disability in children with scabies: A nationwide population-based cohort study

Abstract Scabies is a common and distressing disease caused by the mite Sarcoptes scabiei var. hominis. Psychiatric disorder in childhood is an important disease and easily neglected. There are several similarities in scabies and psychiatric disorders in childhood (PDC). Both of them may present with pruritus. They are relatively common in patients with lower socioeconomic status and crowded environment. Furthermore, immune-mediated inflammatory processes play a role in the pathophysiology in both diseases. An association between scabies and psychiatric disorders may exist. This nationwide population-based cohort study utilized data from the National Health Insurance Research Database to investigate the relationship between scabies and PDC. A total of 2137 children with scabies were identified as the study group and 8548 age- and sex-matched children were selected as the control group. A total of 607 (5.68%) children developed PDC during the 7-year follow-up period. The overall incidences of PDC are similar but patients with scabies had a higher risk of developing intellectual disability (ID) (scabies group vs control group: 1.3% vs 0.6%, adjusted hazard ratio: 2.04 and 95% confidence interval: 1.25–3.32). The immune-mediated inflammatory processes of both diseases were reviewed and may contribute to the 104% increased risk of interleukin in patients with scabies. We suggest a more comprehensive management in treating patients with scabies or ID. Early and comprehensive treatment of scabies and other risk factors may decrease the risk of subsequent ID. When we approach patients with ID, concurrent evaluation of scabies and other risk factors may contribute to successful management.

There is something in the ear: mondini dysplasia.

A 3-year-old boy who was immunized against pneumococcus with a 7-valent conjugate vaccine presented to our hospital with fever, headache, and vomiting for 1 day. Pneumococcal meningitis was diagnosed, and he had an uneventful recovery after complete antimicrobial treatment. Two months later, recurrent pneumococcal meningitis occurred, and cranial computed tomography was performed. Bilateral 3 semicircular canals were revealed, and accumulation of fluid in the left middle ear and mastoid area was shown (Figure 1). There was incomplete partition of the cochlea and dilatation of the vestibule, aqueduct, and ampulla of the left inner ear (Figure 2 and Video; available at www.jpeds.com). The diagnosis of Mondini dysplasia was made, and the cisternography and immune studies were unremarkable. Surgical repair was performed, and there was no recurrence after 12 months of follow-up. Mondini dysplasia is an inner ear malformation thought to be caused by the arrest of neural tube development during the seventh week of gestation. It is characterized by cochlear malformation with the dilatation of the vestibule, aqueduct, and ampulla, as well as the incomplete partitioning of the co-

Meconium peritonitis with intestinal atresia mimicking huge tumor in a preterm neonate.

A late-preterm female neonate was transferred to our hospital for evaluation of an abnormal cystic lesion noted on prenatal ultrasound. There were no other prenatal insults and the physical examination was unremarkable except for abdominal distension and mild tachypnea. Abdominal computed tomography with intravenous contrast material revealed a huge cystic lesion occupying almost the whole abdomen, encircled with minimal calcification (Figure). Intraabdominal tumor or ovarian cyst was suspected, and exploratory laparotomy showed dilated bowel loops with no visible intra-abdominal tumor or cyst. Meconium peritonitis complicated with type 1 jejunal atresia was diagnosed, and resection with primary anastomosis were performed. Tumor markers were within normal limits. Parenteral nutrition followed by oral feeding were given, and she gained weight adequately. She continues to be followed for short bowel syndrome. Meconium peritonitis may have protean clinical manifestations and meconium ileus with intestinal atresia is not uncommon. Cystic fibrosis is frequently associated in Western countries but is rarely encountered in Taiwan, as in the pres-