Suzuko Uehara

Japanese Guidelines for the Management of Respiratory Infectious Diseases in Children 2007 with focus on pneumonia

Members of the Japanese Society of Pediatric Pulmonology and the Japanese Society for Pediatric Infectious Diseases developed the Guidelines for the Management of Respiratory Infectious Diseases in Children with the objective of facilitating the appropriate diagnosis and treatment of childhood respiratory infections. To date, a first edition (2004) and a revised edition (2007) have been issued. Many problems complicate the diagnosis of the pathogens responsible for bronchopulmonary infections in children. The Guidelines were the first pediatric guidelines in the world to recommend treatment with antimicrobials suited to causative pathogens as identified from cultures of sputum and other clinical specimens collected from infection sites and satisfying assessment criteria. The major causative microorganisms for pneumonia in infants and children were revealed to be Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. This manuscript describes the Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan 2007, with a focus on pneumonia.

NASOPHARYNGEAL COLONIZATION WITH HAEMOPHILUS INFLUENZAE TYPE B AMONG INFANTS AND CHILDREN IN JAPAN

Healthy carriers of Haemophilus influenzae type b (Hib) play an important role in the spread of invasive Hib disease. The aim of the present study was to estimate Hib colonization among infants and children in Japan. Specimens from throat and nasopharyngeal cultures were obtained by thorough swabbing of both tonsils and the posterior pharynx. Specimens were inoculated on Hib antiserum agar. This was prepared with Levinthal base and Hib antiserum. Conventional methods were used concomitantly. Four of 474 infants from 1–48 months of age (0.84%) had Hib cultured from their nasopharynx. The carriage rate in 1–12 month old infants was 0.62% (2/322 cases), and that in 13–48 month old children was 1.32% (2/152 cases). Five of 167 (3.0%) 13‐year‐old children, and five of 154 (3.2%) 9‐year‐old children were asymptomatic carriers. Thirty‐five of 104 household contacts of a patient with invasive Hib disease (33.6%) had Hib colonization. The carriage rate in healthy Japanese children may not be different from that in the USA prior to the availability of the conjugate Hib vaccine. The Hib carriage rate in household contacts of patients with invasive Hib disease was higher than in healthy children (P < 0.005). Our results suggest the possibility of an outbreak of invasive Hib disease 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.

Characteristics of β-Lactamase-Producing and Amoxicillin-Clavulanate-Resistant Strains of Haemophilus influenzae Isolated from Pediatric Patients

A total of 1246 clinical isolates ofHaemophilus influenzae from pediatric patients were recovered in Chiba Municipal Hospital. We studied the characteristics of these strains with regard to β-lactamase production and in vitro activities of antimicrobial agents between January 1995 and June 1997. Two hundred and ten strains (16.8%) of these isolates produced β-lactamase. Eight β-lactamase-positive isolates were resistant to amoxicillin-clavulanate (MICs, ≥12 μg/mL). Most of these were isolated from respiratory tracts. These strains were mainly cultured from boys less than 3 years old with chronic respiratory disease. Two strains were serotype b and 6 strains were not typeable. Some of these strains were eradicated without antibiotic treatment. Although the clinical impact of β-lactamase-producing and amoxicillin-clavulanate-resistantHaemophilus influenzae remains low, the number of infections caused by these strains may increase in the near future. We must monitor this tendency.

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.

Epidemiology of Community-Acquired Pneumonia in Children

To the Editor .— We read the recent article by Michelow et al,1 “Epidemiology and Clinical Characteristics of Community-Acquired Pneumonia in Hospitalized Children,” with great interest. One hundred fifty-four children were enrolled in this study, and blood or pleural fluid cultures, pneumolysin-based polymerase chain reaction assays, and serologic tests were used to clarify the epidemiology. The study indicated that Streptococcus pneumoniae , Mycoplasma pneumoniae , Chlamydia pneumoniae , and respiratory viruses were the major pathogens involved …

Analysis of 80 cases of childhood asthma provoked by mold allergens

It has been reported that provocation test with the use of inhalant allergens is the most reliable method for confirming the causal allergens in bronchial asthrna*-5). However, reports on the studies on the significance of molds in childhood bronchial asthma using the inhalation provocation test are few even in Europe and America. Since 1964, the authors have been conducting skin tests and inhalation provocation tests on children with asthma. We have been attempting to find children with asthma in whom it could be shown to be due to mold allergy.

[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.

Recent Chemotherapy for Child Pneunomia and Empyema

Recent progress in chemotherapy has contributed to the remarkable decrease in mortality from pneumonia in infancy and childhood; however, wide use of antimicrobials has resulted in incapability of etiologic diagnosis. Appropriate chemotherapy for pneumonia should be initiated based on the relative frequency of causative organisms related to age groups, and their antimicrobial susceptibility. Therapeutic development should be reevaluated by the pathogens isolated prior to antimicrobial administration.