Tsunekazu Haruta

Detection of adenovirus DNA in clinical samples by SYBR Green real-time polymerase chain reaction assay

Abstract Background :u2002Adenoviruses are associated with a variety of diseases including upper respiratory tract infections, acute conjunctivitis, cystitis and gastroenteritis. Adenoviruses can also cause fatal disseminated infections in patients undergoing stem cell transplantation. Measurement of adenovirus load in clinical samples from localized adenovirus infections or disseminated adenovirus infections may provide important information for analyzing the pathogenesis of various adenovirus infections. The purpose of the present study was to develop and optimize a highly sensitive real‐time polymerase chain reaction (PCR) assay to detect a wide range of adenoviruses and to detect adenovirus DNA in clinical samples from immunocompetent children.

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.

Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin.

We report a male infant with congenital tuberculosis who developed cerebral hemorrhage associated with vitamin K deficiency during treatment with isoniazid and rifampin. Despite an absence of risk factors for vitamin K deficiency, the severe hemorrhagic disorder occurred at 4 months of age. We speculate that vitamin K deficiency in the present case may have resulted from a synergic effect of antituberculosis agents and immaturity of vitamin K metabolism and/or its absorption.

Results of a multicenter survey of diagnosis and treatment for bacterial meningitis in Japan.

An evaluation committee was organized to evaluate 464 cases of bacterial meningitis treated at 108 nationwide medical facilities participating in this survey between April 2004 and January 2007. There were 413 evaluable cases of bacterial meningitis, including 342 children (82.8%) and 71 adults (17.2%). Haemophilus influenzae (217 cases, 63.5%) and Streptococcus pneumoniae (35 cases, 49.3%) were the most frequent pathogens for meningitis in children and adults, respectively. The most used initial therapy for children was carbapenemxa0+xa0cephalosporin therapy (212 cases, 61.9%). Of the 333 children included in efficacy evaluation, 320 (96.1%) were rated as remission, 10 (3.0%) as partial remission, and three (0.9%) as poor response. The combination therapy with two drugs was also most often used in adults (41 cases, 57.7%). In efficacy analysis in 60 adults, remission was observed in 50 (83.3%), partial remission in five (8.3%) and poor response in five (8.3%). In prognosis analysis, 273 (80.3%) among 340 children were alive at the end of treatment without sequelae, but one (0.3%) died by the end of treatment, and 64 (18.8%) had sequelae. Of all adults, six (8.5%) died of bacterial meningitis and 23 (32.4%) had sequelae at the end of treatment. Among the patients followed up for 1xa0year, 26 (12.3%) of 211 children and three (7.7%) of 39 adults had sequelae. The selection of drugs and its dose level of many cases were appropriate, but the dose level of several cases was inappropriate. It is necessary to spread the method of proper antibiotic therapy.

Kawasaki disease with lymphadenopathy and fever as sole initial manifestations

Aim:u2003 Initial presentation with only cervical lymphadenopathy and fever is one of the pitfalls in the diagnosis of Kawasaki disease (KD). As the number of such patients is small, their clinical features have remained uncertain. The purpose of the present study is to characterise the features of such KD patients, especially in comparison with those of patients with common onset.

Clinical spectrum in hospitalized children with echovirus type 13 infection.

Abstract Background :u2002The aim of this study was to investigate the clinical spectrum of echovirus type 13 (E13) infection in hospitalized children.

Neutrophil alkaline phosphatase activity in respiratory viral infection

Neutrophil alkaline phosphatase (NAP) is used as a diagnostic marker in several hematological disorders. In regard to the role of NAP in infectious diseases, previous investigators have presented the hypothesis that NAP activity is useful to distinguish viral infections from bacterial infections. Because the numbers of patients enrolled in previous studies of viral infections were limited, we intended to evaluate the hypothesis by measuring NAP activity in a large number of pediatric patients with respiratory viral infections. A cytochemical analysis of NAP was performed in 160 patients with various types of respiratory infections. In patients with adenovirus or respiratory syncytial (RS) virus infection, NAP activity was significantly higher than the control value newly established at our department, while in patients with Epstein-Barr virus, measles, or influenza infection, it was comparable to the control value. On an individual basis, NAP scores (determined from NAP cytochemical activity) in 22 of 26 patients (84.6%) with adenovirus infection, and 31 of 42 patients (73.8%) with RS virus infection were found to exceed the 95% confidence upper limit of the control group. In conclusion, NAP activity is quite varied among different respiratory viral infections. When NAP activity is high in respiratory infections, adenovirus or RS virus infection, as well as bacterial infections, should be taken into consideration.

Evaluation of a rapid reagent strip test for the diagnosis of childhood meningitis.

stones of management of patients with meningitis. Determination of protein, glucose, cells and organisms in cerebrospinal fluid (CSF) facilitates the differential diagnosis of meningitis. However, quantitative determinations of CSF protein and glucose are time-consuming and in many hospitals are performed only during regular working hours. Previous studies have suggested the clinical usefulness of ‘urine reagent strips’ in detecting abnormal protein and glucose levels and leukocyte counts in CSF.1–3 However, the data are still scarce in pediatric clinical situations. In the present study, we used urine reagent strips to measure protein, glucose and nitrite in CSF samples from children with suspected meningitis and compared the strip readings with quantitative determinations performed in the hospital laboratory. We also examined whether the reagent strip test can be used as a diagnostic marker for the differential diagnosis of childhood meningitis.

Effects of the recent great Hanshin-Awaji earthquake on emergency pediatric care

KANETSU OKURA, KATSUNORI KAMIMURA, KEIGO HAMAHATA, MIDORI IIJIMA, MOMOKO YOSHIMOTO, TORU YAMAKAWA, MASARU YAMAKAWA, SHIGEKAZU KUROKI, IKUO KIRIYAMA, TSUNEKAZU HARUTA, TAKASHI FUKAYA, NOBUKO YOSHIOKA,I YASUHIKO TOMITA, TSUTOMU TSUTSUI, MIEKO YOSHIOKA, TOSHIKAZU NISHIO, AKIYOSHI NISHIMURA* AND YASUHIRO UEN02 Departments of Pediatrics, Kobe City General Hospital and 2Legal Medicine, School of Medicine, Kobe University, Kobe, Japan