Itaru Terashima

The incidence of pediatric invasive pneumococcal disease in Chiba prefecture, Japan (2003–2005)

OBJECTIVES The purpose of the study is to evaluate the incidence, spectrum of clinical manifestations and outcome of invasive pneumococcal disease (IPD) in children in Chiba prefecture, Japan. METHODS To determine the precise incidence of IPD in Chiba prefecture, we implemented a retrospective survey of the period from 2003 to 2005. A written questionnaire was sent to 45 hospitals that have pediatric wards, and information was obtained from all hospitals. The questionnaire included the clinical diagnosis, patients age, underlying disease, prognosis and antimicrobial susceptibility of the isolated strains. RESULTS During the 3 study years, 130 patients were diagnosed with IPD. The mean annual incidence rates of IPD among children <2 and <5 years were 19.5-23.8 and 12.6-13.8 per 100,000, respectively. Among 130 patients with systemic infection, 66 patients had bacteremia, 39 had pneumonia and 16 had meningitis. Five patients had neurological sequelae and 2 patients died. Seventy-four out of 115 isolates (64.3%) exhibited resistance to penicillin G. CONCLUSIONS The annual incidence of pediatric IPD has remained constant during the study period. Two-third of isolated strains were at least partially resistant to penicillin G. Establishment of appropriate antibiotic therapy against IPD due to penicillin-resistant strains and the introduction of pneumococcal conjugate vaccines are emergent issues in Japan.

Metabolism: The Role of Haemophilus lnfluenzae in Lower Respiratory Infections in Childhood

In pediatrics, the offending microorganisms in lower respiratory infections have not yet been established. Our data based on 1,898 patients with lower respiratory tract disorders in children (1965–1979) demonstrated that washed sputum is of practical value in establishing the etiological diagnosis of bronchopulmonary infections in children. The criteria for the determination of the dominant or offending pathogens are presented.

Chemotherapy of Chronic Bronchitis in Children

Dominant pathogens in the washed sputum and the effects of antibiotics were studied in 40 children with chronic bronchitis during 1964–1974. H. influenzae, especially of type b, was found in 38 cases, associated with pneumococcus in 21 and S. aureus in 2. Administration of appropriate antibiotics, such as ampicillin, proved effective in eliminating or reducing the organisms as well as clinically. However, relapses occurred after discontinuance of antibiotics. Although large doses of ampicillin delayed the recurrence of the pathogens, superinfections were more likely to occur during the treatment. In spite of the treatment with antibiotics, only eight cases out of 21 children with chronic bronchitis had considerable clinical improvement from two years’ observation.

Effects of Intravenous Gammmaglobulin Therapy Combined with Dexamethasone for the Initial Treatment of Acute Kawasaki Disease

We studied effects of intravenous gammmaglobulin therapy (IVGG) combined with dexamethasone (DEX) for the initial treatment of acute Kawasaki disease(KD). Prospectively studied 33 KD patients received total of 2g/kg IVGG for consecutive 4-5days plus 0.3mg/kg DEX for consecutive 3days (group 1). Retrospectively studied 33 KD patients received standard IVGG therapy (2g/kg IVGG for consecutive 4-5days)(group 2) were compared to analyze the efficacy and safety of the new regimen. There were no differences in age, sex, body weight, duration of illness, or given doses of gammmaglobulin between those two groups. Clinical no responders to the initial treatment received additive IVGG treatment. Informed consent was obtained from childrens parents before therapy. No serious adverse effect was noted in both groups. The duration of high fever after the start of initial treatment in group1(1-12 days) was shorter than in group 2 (1-16 days)(p=0.07, by Mann-Whitney U-test). Two patients in group 1 and two patients in group 2 developed small coronary aneurysms. Although further analysis using larger numbers of patients are necessary to confirm the efficacy of this new regimen, we preriminaly demonstrated that IVGG combined with DEX in the initial treatment of acute KD was safe and may shorten the duration of fever.

[Studies on 145 cases of septicemia in infancy and childhood--especially on septicemic patients with malignant and hematological diseases].

Clinical and bacteriological data of 145 inpatients with septicemia, treated at the hospital of Chiba University School of Medicine from 1972 to 1987, were reviewed by dividing them into three stages. (stages I: 1972-76, stage II: 1978-82, stage III: 1983-87) Patients with underlying diseases have been increasing: 91.8% of the total patients in stage III. Among the patients with underlying diseases, malignant and hematological diseases occupied about 60%, and in the other diseases, congenital heart diseases have been increasing in number. As to the organisms isolated, gram positive bacteria have increased, while gram negative bacteria have decreased. In stage III, the rate of gram positive organisms and gram negative ones accounted for 43.1% and 41.2% of all the isolates from the septic patients with malignant & hematological diseases, respectively. In patients with malignant & hematological diseases, alpha-streptococcus, coagulase-negative staphylococcus, and Fusobacterium sp. have been increasing, whereas, Escherichia coli, Enterobacter sp., Klebsiella sp., and Pseudomonas aeruginosa decreasing. In patients with other underlying diseases, S. aureus, CNS, and non Fermenters have been increasing. Among the patients without underlying diseases, gram positive bacteria accounted for the major part. The decrease of gram negative organisms in patients with malignant and hematological diseases may partially depend on the introduction of polymixin B as the drug of gut decontamination. The outcome of septicemia in the patients with malignant & hematological diseases has been markedly improving through all the three stages. During stage III, episode mortality and case mortality rate proved to be 23% and 31%, respectively. The introduction of the third generation cephems has decreased the mortality rate for gram negative organisms and contributed to the improvement of the total prognosis. The prognosis was worst in the case of P. aeruginosa, showing a mortality rate of 50% during stage III. Coincidence rate of blood and other cultures have been largest in the case of P. aeruginosa, so, the drug sensitivity of the strain cultured from other sites is sometimes useful in the choice of antibiotics.