Kei Takano

Rhinovirus load and disease severity in children with lower respiratory tract infections

It has not been clarified if there is a correlation between rhinovirus (RV) load and disease severity in the lower respiratory tract infections of hospitalized children. This study was undertaken to elucidate the contribution of the viral load to the development of disease severity in 412 children ≤3 years of age who were hospitalized with lower respiratory tract infections. The RV load in nasopharyngeal aspirates obtained from the patients at the time of admission was measured by real‐time quantitative reverse‐transcription polymerase chain reaction (PCR), and the clinical symptoms of the patients were assessed using a severity scoring system. Of the 412 patients, 43 (10.4%) were diagnosed with RV infections only, and 15 were determined to have high severity scores. When all patients infected with RV were assessed, there was no correlation between the viral load and the disease severity. However, there was a significant negative correlation between the disease severity and age among children <11 months of age (n = 15, ρ = −0.677, P = 0.006) and a significant positive correlation between the viral load and the disease severity among children ≥11 months of age (n = 28, ρ = 0.407, P = 0.032). Among the patients infected with RV <11 months of age, the disease severity may be associated with an immature immune response and the small diameter of their airways rather than viral load. By contrast, in the patients ≥11 months of age, viral load may contribute to the development of disease severity. J. Med. Virol. 84: 1135–1142, 2012.

Glomerulonephritis associated with chronic infection from long-term central venous catheterization

There have been few reports on immune complex-mediated glomerulonephritis associated with chronic infection from long-term central venous catheterization in adulthood. We report here on a 13-year-old boy with nephritis who exhibited glomerulonephritis that had been induced by the long-term use of central venous catheters, and its resolution after extraction of the central venous catheter. A diagnosis of glomerulonephritis associated with chronic infection caused by long-term central venous catheterization was made, based on the absence of clinical findings after removal of the catheter, hypocomplementemia, pathology findings resembling membranoproliferative glomerulonephritis, and detection of Staphylococcus epidermidis from culture of the removed catheter culture. For clinicians using long-term central venous access for parenteral feeding, rapid catheter exchange is necessary for patients with fever of unknown origin.

Incidence and index of severity of hemolytic uremic syndrome in a 26 year period in Fukushima Prefecture, Japan

There have been a number of reports on large outbreaks of hemolytic uremic syndrome (HUS), but there have been no long‐term studies of sporadic HUS in Japan. This study therefore investigated the epidemiology and prognosis of HUS in Fukushima Prefecture over a 26 year period.

Two children with obesity-related glomerulopathy identified in a school urinary screening program.

The incidence of obesity‐related glomerulopathy (ORG) has increased over the last decade, but there have been few reports on ORG in Japanese children. Reported herein are two children with ORG identified on school urinary screening (SUS). Patient 1 was a 12‐year‐old boy in whom proteinuria was first detected on SUS. His body mass index (BMI) was 33.8 kg/m2 and he had hypertension and hyperuricemia. Patient 2, a 10‐year‐old boy, also had proteinuria identified on SUS. His BMI was 34.8 kg/m2, and he had fatty liver, hyperuricemia, and hypercholesterolemia. Both were diagnosed with ORG based on obesity, proteinuria, and renal pathological findings. After treatment, including candesartan, food restriction and physical exercise, urinary protein excretion was decreased in both cases. We believe that such school urinary screening programs may be effective for the early identification and treatment of children with ORG.

Efficacy of steroid pulse, plasmapheresis, and mizoribine in a patient with focal segmental glomerulosclerosis

There have been few reports on successful treatment for focal segmental glomerulosclerosis (FSGS) complicated by leukoencephalopathy. We report the efficacy of the steroid pulse and mizoribine (MZB) combined with plasmapheresis (PP) for a case of FSGS with leukoencephalopathy induced by cyclosporine (CyA). The patient was a 4-year-old boy with FSGS who presented with steroid-resistant nephrotic syndrome (NS) and was treated with CyA. On the 7th day after starting CyA, he complained of one visual disorder, and hypertension and tonic convulsions were observed. Electroencephalography (EEG) revealed generalized slow waves, and magnetic resonance imaging (MRI) disclosed high signal intensity in the white matter. A diagnosis of leukoencephalopathy induced by CyA was made on the basis of these findings with the improvement in clinical manifestations upon discontinuation of CyA. We treated the patient with steroid pulse therapy and MZB combined with PP, and the proteinuria gradually decreased and only microscopic hematuria remained. We report that steroid pulse and MZB combined with PP may be an effective treatment in a patient with FSGS complicated by CyA-induced leukoencephalopathy.

Efficacy of cyclosporine therapy for systemic lupus erythematosus in childhood

© 2008 Japan Pediatric Society Systemic lupus erythematosus (SLE) is a life-threatening illness associated with a multitude of signifi cant long-term complications. Treatment of SLE can pose a therapeutic challenge because most patients suffer from complications related to the disease itself, along with side-effects secondary to the long-term immunosuppression necessary to control the disease. 1 The combination of high-dose corticosteroids and cytotoxic drugs such as cyclophosphamide has led to improvement in survival and morbidity over the past several decades, 2 but prognosis and response to treatment seem to vary widely among geographically and diverse populations, with poorer outcomes noted among minorities and children. Cyclosporine A (CyA) is a cyclic lipophilic undecapeptide that has immunosuppressive effects as well as a very selective inhibitory effect on T-helper cell function by blocking the transcription of genes for specifi c cytokines such as interleukin-2 and interferon . 3 Initially used in transplantation to control tissue rejection, CyA has more recently been used for the treatment of a wide range of autoimmune disease. Some case reports and uncontrolled trials have established the use of CyA in adult SLE, generally in association with other drugs. In CyA-treated SLE patients with corticosteroid-resistant or -dependent disease, reduced steroid requirement has been observed after 2 years of treatment, along with reduction in proteinuria. 4 – 7 But there have been some reports on CyA therapy for SLE in childhood. 8 – 10 Herein we report on the effi cacy of CyA therapy for a girl with severe SLE.