Fang-Liang Huang

Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine.

BACKGROUND The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children. METHODS This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively. RESULTS Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p=0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included. CONCLUSIONS Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.

Reduced expression of transforming growth factor‐β1 and correlated elevation of interleukin‐17 and interferon‐γ in pediatric patients with chronic primary immune thrombocytopenia (ITP)

Dysregulated T helper (Th) cells are considered important in the pathophysiology of chronic primary immune thrombocytopenia (ITP). The present study investigated whether levels of Th cytokines in pediatric patients with chronic ITP were different compared with healthy controls.

An outbreak of enterovirus 71 in a nursery

Abstract In this article we report a nosocomial outbreak of enterovirus 71 (EV71) in a newborn nursery and describe the clinical presentations of infected infants. Community outbreaks of EV71 are quite common in epidemic areas, but a nosocomial outbreak of EV71 is a rare occurrence. A total of 7 out of 19 infants (37%) had symptoms. All infants had poor activity, 6 (86%) had fever, 4 (57%) had drowsiness, 3 (43%) had diarrhoea, and 2 (29%) had oral ulcers. Four infants (57%) suffered from encephalitis. There were no deaths. EV71 was isolated from 3 (43%) of the young infants, while all were positive when tested for EV71 using a reverse transcription polymerase chain reaction. A sequence analysis of the EV71 partial gene revealed a 98.6–100% nucleotide similarity. Control measures included staff hand washing, disinfecting all materials exposed to potentially infected biological fluid, increasing staff hygiene precautions in the kitchen, and using a different basin for bathing each baby. We conclude that it is difficult to diagnose EV71 infection in young infants by clinical presentation alone and, similar to other enteroviruses, EV71 can spread efficiently amongst young infants in a nursery unit.

Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome.

Abstract:  The natural course of acute immune thrombocytopenic purpura (ITP) in infants is poorly described in the literature. A retrospective study of 17 consecutive patients <1 yr of age admitted and treated for acute ITP between 1996 and 2005 was conducted. We investigated their demographics, vaccination history, clinical features, laboratory examinations, response to treatment and long‐term outcome. There were 11 male and six female infants. Their ages ranged from 24 d to 12 months with a median of 3 months. All infants presented with petechiae and/or ecchymoses. Fourteen cases had platelet counts below 20 × 109/L at the time of admission. They all had good response to a single course of treatment (14/17) or multiple courses of treatment (3/17). None had progressed into chronic ITP. Seven infants had a causal relationship with immunization, five associated with hepatitis B, one diphtheria–pertussis–tetanus, one diphtheria–tetanus–acellular pertussis‐inactivated poliovirus vaccine‐conjugated Haemophilus influenza vaccines. These seven infants responded to treatment within 3–9 d after therapy with intravenous immunoglobulin, high‐dose methylprednisolone or oral steroids. Re‐boosters with vaccines revealed no recurrence of the disease in all of these seven patients. The study suggests that further immunization is not contraindicated in infants experiencing acute ITP associated with vaccines.

Mycoplasma pneumoniae—Associated Cerebral Infarction in a Child

The central nervous systems involvement is the most common reported extra-pulmonary manifestations of Mycoplasma pneumoniae infection, and stroke was one of the most special situations. We presented a 4-year-old child who presented with acute stroke on the third day of the onset of Mycoplasma respiratory tract infection. Brain magnetic resonance angiography demonstrated that occlusion of bilateral internal carotid arteries and vertebral arteries above the level of the first cervical vertebrate which is not been reported previously.

Clinical and laboratory analysis of influenza B infection in children in Taichung, Taiwan during the 2006-2007 flu season.

BACKGROUND An epidemic of influenza B/Malaysia/2506/2004 was reported in Taiwan during the 2006-2007 flu season. We investigated the flu vaccination history and clinical and Laboratory characteristics of children with influenza B infection. METHODS We enrolled children younger than 18 years old who visited one of two hospitals between November 2006 and February 2007 with influenza-like illnesses. Throat swabs were taken on their first visit and cultured for viruses. Complete and differential blood counts and blood biochemical parameters were analyzed in some children. RESULTS Influenza virus was cultured from 51.0% of patients (101/198), 87 (86.1%) of who were infected with influenza virus type B. The remaining 14 (13.9%) were infected with influenza virus type AH3. The 87 children (median age 7.8 years) with culture-proven influenza B virus infection were enrolled. Nine parents reported that enrolled children had been vaccinated against influenza. Leukopenia was found in 56.1% (32/57) of patients, leukocytosis in 3.5% (2/57), and thrombocytopenia in 1.8% (1/57). Thirteen of 23 patients (56%) tested for creatine kinase (CK) had elevated levels ( >160 U/L), and 11 of 23 (47.8%) had myalgia associated with raised CK (p < 0.05). Twenty-six children developed complications, including one case of pneumonia with acute respiratory distress syndrome and one case of flu-associated encephalitis. CONCLUSION Most children who contracted influenza B infection had not been vaccinated. Almost half the children had leukopenia, and some had leukocytosis, but thrombocytopenia was rare. There was a significant association between raised CK levels and myalgia in influenza B infection.

Influenza B virus associated pneumonia: report of one case.

Influenza A virus is a more common cause of pneumonia than influenza B virus. Influenza virus pneumonia complicated with acute respiratory distress syndrome (ARDS) is rare and has a high mortality rate. In addition to pneumonia, influenza occasionally causes neurologic, cardiac, renal, or muscular complications. Hepatic involvement in influenza virus infection has been rarely reported. We reported the case of a 7-year-old girl who was initially treated for upper respiratory tract infection, but she was transferred to the pediatric intensive care unit for intubation and ventilation after her condition deteriorated to lobar pneumonia with ARDS and liver function impairment within 7 days. Influenza B virus infection was confirmed by virus culture and serological study. Respiratory viruses, such as respiratory syncytial virus, adenovirus, influenza virus, and parainfluenza virus, are common causes of pneumonia in children; moreover, they should be considered especially in the presence of persistent leukopenia, low CRP value, lack of growth of bacterial cultures, and poor response to antimicrobial therapy. We should describe its course, diagnosis, and treatments in detail; furthermore, we reported this case to emphasize that influenza B virus may cause transient liver dysfunction and it is an etiology of pneumonia as well as ARDS.

Co-morbidity of Kawasaki Disease

Despite more than four decades of investigation, the etiology of Kawasaki disease remains obscure, and none of the proposed etiologic theories for the disease have achieved independent confirmation. Clinical and epidemiologic features support an infectious cause, but the etiology remains unclear. The authors present a case of Kawasaki disease associated with Epstein-Barr virus and Mycoplasma pneumoniae infection in a 3.5-y-old boy. He received two doses of intravenous immunoglobulin due to prolonged course of Kawasaki disease but later had complicated autoimmune haemolytic anaemia. His prolonged fever subsided after azithromycin administration. Epstein-Barr virus infection was confirmed by molecular microbiological pathology of cervical lymph node and serological tests. The serological tests for Mycoplasma pneumoniae also revealed a positive result. Thus, it is concluded that Mycoplasma pneumoniae and Epstein-Barr virus infections may occur simultaneously in a child with Kawasaki disease. In addition, autoimmune hemolytic anaemia may be noted in Kawasaki disease patients after high-dose IVIG administration. To the authors’ knowledge, this is the first report of Kawasaki disease with Epstein-Barr virus and Mycoplasma pneumoniae in the English-language literature.

Haemorrhagic bullae associated with a chicken scratch.

Abstract Complicated skin and soft tissue infection caused by a chicken scratch has rarely been reported. A 3-year-old boy who developed haemorrhagic bullae and necrotising fasciitis following a chicken scratch is reported. Morganella morganii and enterococci were cultured from the aspirate. He received antimicrobial treatment, surgical debridement and a skin graft, and recovered uneventfully.

Reversible oxacillin‐associated hepatitis in a 9‐month‐old boy

Abstract:  Herein we present a case of a 9‐month‐old boy admitted to our hospital for acute femoral osteomyelitis and hip septic arthritis treatment. Acute hepatitis with concomitant skin rash developed on the sixth day of intravenous oxacillin therapy. No other known virus‐ or drug‐related skin eruption or hepatitis was suspected. The boy recovered completely after antibiotics were shifted to teicoplanin, and no sequelae were noted. To our knowledge, this boy is the youngest case of reported oxacillin‐related hepatitis in the literatures.