Search

Background: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children., Methods: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses., Results: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42 ± 0.14 years. The mean hospitalization duration was 4.21 ± 0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78 ± 1 days (range, 1-7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm(3), and 63 (45%) patients had leukocytosis (>15,000/mm(3)). The mean serum C-reactive protein (CRP) level was 44.1 ± 3.3 mg/L (normal, <10 mg/L) and 62 (44%) had a CRP level >40 mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully., Conclusions: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good., (Copyright © 2011. Published by Elsevier B.V.)

Background/purpose: Coxsackievirus A2 (Cox A2) was the predominant serotype in the enterovirus outbreak in Taiwan, 2008. However, detailed clinical features of Cox A2 infection have not been reported. In this study, we compared Cox A2 with enterovirus 71 (EV71) in terms of clinical manifestation and epidemiology during the 2008 enterovirus outbreak in Taiwan., Methods: A total of 280 hospitalized patients (97 with culture-proven EV71 infection and 183 with culture-proven Cox A2 infection) in 2008 at the Chang Gung Children's Medical Center were enrolled in this study. Epidemiologic data, clinical manifestations, and outcomes for these patients were collected and compared., Results: Both Cox A2 and EV71 serotypes peaked in June and declined soon afterwards. Seventy-one percent of the patients were younger than 3 years of age. Both groups had the same male-to-female ratio of 1.6:1. Patients with EV71 infection had a significantly longer hospitalization period (4.1 vs. 3.0 days, p< 0.001). Fever, fever for more than 3 days with a temperature above 39 degrees C, lethargy, poor activity, poor appetite and a myoclonic jerk were significantly associated with EV71 infection. Fever, or fever with a temperature above 39 degrees C, febrile seizure, elevated white cell counts, and elevated serum C-reactive protein concentrations were significantly associated with Cox A2 infection. Most patients with EV71 infection presented with hand-foot-mouth disease (78.3%), while most Cox A2-infected patients presented with herpangina (83.6%). Central nervous system complications were found in 18.6% of EV71-infected children, but only in 1.1% of Cox A2-infected children. All the patients with Cox A2 infection showed total recovery. One patient with EV71 infection died from encephalitis with cardiopulmonary failure, and 6.2% of EV71-infected children had neurologic sequelae., Conclusion: Both Cox A2 and EV71 serotypes accounted for the enterovirus outbreak in Taiwanese children in 2008. Compared with those infected by EV71, the children with Cox A2 infection mostly presented with herpangina, had fewer central nervous system complications, and had better overall outcome., (Copyright 2010 Taiwan Society of Microbiology. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: Neisseria meningitidis usually causes severe infection in children, but occurs only sporadically in Taiwan. However, the number of infections increased in 2001 and 2002. This study was performed to ascertain the epidemiology and clinical manifestations of infections caused by meningococcus in a pediatric population., Methods: The medical charts of patients with meningococcal diseases who were admitted to Chang Gung Children's Hospital, Taoyuan, Taiwan, from July 1998 to December 2005 were retrospectively reviewed. Data were analyzed for age distribution, serogroups, clinical diagnoses, treatment, acute complications, and outcomes., Results: Sixteen children with meningococcal disease were identified. Their ages ranged from 1 month to 15 years (average, 3 years). Most patients (62.5%) were younger than 1 year and the second most frequent age group was 6 to 15 years (18.75%). There were 56.25% boys and 43.75% girls. The identified serogroups were B (43.75%), W135 (31.25%), A (6.25%), Y (6.25%), and undetermined (12.5%). The antibiotics used in this study were ampicillin, ceftriaxone, cefotaxime, and aqueous penicillin; the mean total treatment duration was 10 days. Purpura fulminans (37.5%), disseminated intravascular coagulopathy (31.25%), respiratory failure (25.0%), and shock (25.0%) were the commonest acute complications. Most (87.5%) of the patients survived. One patient had long-term sequelae of hearing impairment and speech delay. The mortality rate was 12.5%., Conclusions: Serogroup B and W-135 were 2 predominant serogroups to cause pediatric meningococcus, and the majority of infections occurred in children younger than 1 year. Continuous surveillance and prevention of meningococcal infections are of great importance.

Septic arthritis in children can be difficult to diagnose and may be associated with severe morbidity. A majority of apparent septic arthritis cases may have negative culture, thereby creating a dilemma regarding treatment. The medical charts of 209 children with the diagnosis of septic arthritis were retrospectively reviewed to evaluate the differences between culture-negative (n = 64) and culture-positive (n = 145) cases. Demographic data, clinical manifestations, treatment, and outcome were analyzed. Laboratory data recorded included white blood cell count, erythrocyte sedimentation rate, C-reactive protein, imaging studies, and culture results. Patients with culture-negative arthritis had a significantly lower incidence of fever (56.3% vs 70.3%, p=0.047), local pain or tenderness (42.2% vs 69.7%, p=0.0001), changes in the overlying skin (45.3% vs 62.1%, p=0.024), motion limitation (25.0% vs 42.8%, p=0.014), and osteomyelitis (25.0% vs 40.7%, p=0.029). Culture-negative patients had a longer duration of symptoms or signs before diagnosis (10.1 +/- 8.9 days vs 6.5 +/- 5.7 days, p=0.046) and a shorter antimicrobial course (24.5 +/- 5.1 days vs 35.7 +/- 8.1 days, p=0.001). Children with culture-negative septic arthritis had a lower prevalence of residual joint dysfunction at 6 months after treatment (3.1% vs 11.7%, p=0.046). In conclusion, children with culture-negative septic arthritis have milder clinical manifestations, earlier response to treatment, and a better outcome than those with culture-positive disease.

Nosocomial meningitis is uncommon in children. We reviewed the medical records of all children who developed bacterial meningitis at least 72 hours after admission to Mackay Memorial Hospital for the period July 1992 through June 2000. Clinical manifestations, predisposing factors, pathogens, and outcomes were analyzed. Twenty-two cases of nosocomial meningitis were identified, comprising 9.2% (22/239) of all pediatric cases of bacterial meningitis during the study period. The male-to-female ratio was 14:8. All patients were younger than 6 months of age except for one, who was 7 years old. The mean duration between admission and onset of meningitis was 15.3 days (range, 3 to 58 days). Twenty-two organisms were isolated, including 13 Gram-negative bacteria (59%) and 9 Gram-positive bacteria (41%). The most common pathogen was Escherichia coli (5 cases), followed by Enterobacter cloacae (3), Staphylococcus aureus (3), and Chryseobacterium meningosepticum (3). Seventeen patients (77%) had concomitant bacteremia. Predisposing factors for acquisition of nosocomial meningitis included previous treatment with broad-spectrum antibiotics (68%), prematurity with very low birth weight (41%), and total parenteral nutrition (32%). Two patients (9%) had previous neurosurgical intervention. Four patients (18%) died, 3 of whom were low birth weight premature infants. Nine patients (41%) had sequelae, including developmental delay, hydrocephalus, hearing impairment, and epilepsy. Neurosurgery was not a significant risk factor for the development of nosocomial meningitis, while very low birth weight played an important role. Previous intraventricular hemorrhage or hydrocephalus, prematurity with very low birth weight, infection with Gram-negative bacteria, and prior broad-spectrum antibiotic administration were associated with poor outcome.

Acute pharyngitis is a common upper respiratory tract disease in children. The aim of this study is to find the associated microorganisms and determinate whether antibiotics is needed. This study included a total of 416 children with a diagnosis of acute pharyngitis who were treated in an outpatient clinic In Taipei. Throat swabs for viral and bacterial cultures were taken. Antibiotics were prescribed when bacterial pharyngitis was suspected on the initial visit. The prescription was adjusted according to the results of bacterial culture and clinical manifestations on the second visit 3 to 4 days later. The mean age of the patients was 52.9 +/- 36.9 months. A total of 297 potential pathogens were isolated in 242 patients. Viruses were isolated in 123 (29.6%) patients. Bacteria were isolated in 73 (17.5%) patients, whereas group A streptococci were isolated in only 7 (1.7%) patients. Viruses mixed with bacteria were found in 46 (11.1%) patients. The mean age of patients with viral infections was lower than those with bacterial infections (47.5 +/- 30.4 vs 62.4 +/- 43.7 months, p = 0.01). There was a longer duration of fever in patients older than 2 years with viral isolates (p < 0.01). Antibiotics were prescribed for acute pharyngitis on the first visit in 43 (10.3%) patients, and on the second visit in 19 (4.6%) patients. In children with viral infection, mixed isolates, or no growth, there was significantly less prescription of antibiotics on the second visit. Given the low isolation rate of significant bacterial pathogens, routine throat cultures and antibiotics are not indicated in children with acute pharyngitis.

From January 1999 through December 2000, a total of 111 cases of Plesiomonas shigelloides infections were diagnosed in a medical center of northern Taiwan. The patients ranged in age from 22 days to 72 years. One third (39/111, 35%) of the positive cultures were found in young children (<2 years old). There was no significant difference in the incidence between males (56/111, 50%) and females (55/111, 50%). The peak seasons for the disease were summer (45/111, 41%) and autumn (42/111, 38%). The major clinical presentations in children were diarrhea (66/69, 96%) and fever (38/69, 55%), whereas diarrhea (41/42, 98%) and abdominal pain (30/42, 71%) were the most common presentations in adults. Most adults with P. shigelloides infection visited the emergency room (38/42, 90%) and received empirical antimicrobials (37/42, 88%), whereas children were more likely to be treated as outpatients (53/69, 77%) and inpatients (27/69, 39%). One third (23/69, 33%) of pediatric patients had mixed enteric infection, and 74% (17/23) of them were younger than 2 years. Salmonella species (17/24, 71%), especially group B Salmonella (12/17, 71%), were the most common mixed enteric pathogen. The disease is usually mild and self-limited. Symptomatic management is adequate and antimicrobial therapy is seldom required.