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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.116, No.11, November 2012
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Original Article
Title
A 30-year Clinical Study of Bacterial Meningitis in a Single Metropolitan Hospital
Author
Hisamitsu Tamaki Masahiro Ito Kosuke Nishiguchi Junji Fukuhara Tae Omori Masahiro Misawa and Masahiro Otsuka
Department of Pediatrics, Tokyo Metropolitan Bokuto Hospital
Abstract
We studied children with bacterial meningitis in our hospital between January 1981 and December 2010. The following diagnostic criteria for bacterial meningitis were used: (i) causative microorganism isolation from cerebrospinal fluid; (ii) CSF pleocytosis (cell count, >500 cells/3 μl) with causative microorganism isolation from blood (without CSF); (iii) CSF pleocytosis (cell count, >1,000 cells/3 μl), CSF protein concentration level >100 mg/dl, CSF glucose concentration level <40 mg/dl and/or CSF glucose/blood glucose ratio <0.4 without causative microorganism isolation from both CSF and blood. During this period, 119 (69 boys and 50 girls) cases of bacterial meningitis were identified. The causative microorganism was identified in 119 cases (criterion [i] or [ii]). Haemophilus influenzae was the most frequently detected causative microorganism (62 cases, 52%), followed by Streptococcus pneumoniae (34 cases, 29%), Streptococcus agalactiae (11 cases, 9%), Escherichia coli (8 cases, 7%), Listeria monocytogenes (2 cases, 1.7%), and other microorganism (Streptococcus pyogenes and Mycobacterium tuberculosis). The highest incidence of this disease was observed in the age range of 0-11 months (52 cases, 44%). H. influenzae and S. pneumoniae were the major microorganisms identified in patients aged ≥4 months, and S. agalactiae and E. coli in patients aged 0-3 months. Four (3%) patients died of S. pneumoniae infection. The most adopted initial antimicrobial chemotherapy was as follows: ampicillin+third-generation cephalosporin (44%)(1981-1990); ampicillin+third-generation cephalosporin (79%)(1991-2000); third-genelation cephalosporin+carbapenem (78%)(2001-2010). The total incidence of bacterial meningitis was 3.87 per 1,000 hospitalized children. The total incidence of bacterial meningitis patients aged 0-4 years was 6.34 per 100,000 children aged 0-4 years. In Japan, Hib and pneumococcal conjugate vaccines were introduced in 2008-2010, but were not routinely administered. Widespread Hib and pneumococcal vaccination is needed in order to decrease bacterial meningitis incidence in Japan.
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Original Article
Title
Siblings with Mitochondrial Respiratory Chain Disorder in the Neonatal Period
Author
Izumi Kato1) Kei Murayama2)3) Yasuhiro Suzuki1) Toshiyuki Iwamatsu1) Ikuko Imai1) Harumi Otsuka1) and Akira Ohtake4)
1)Department of Neonatology, Chiba Kaihin Hospital
2)Department of Metabolism, Chiba Children's Hospital
3)Chiba Cancer Center Research Institute
4)Department of Pediatrics, Saitama Medical University
Abstract
Mitochondrial respiratory chain disorder (MRCD) is the most common group of inborn errors of metabolism, and its onset is commonly seen in the neonatal period. We report siblings with MRCD manifesting hypertrophic cardiomyopathy, hypoadrenocorticism and hearing impairment. The younger sister had lactic acidosis and respiratory failure soon after birth. MRCD (complex I+III+IV deficiency) was diagnosed by enzyme assay of the mitochondrial respiratory chain after her death. Her elder brother had died at the age of 5 months, and cytochrome C oxidase deficiency (mitochondrial respiratory chain complex IV deficiency) was suspected based on muscle pathology. We re-analyzed his muscle enzymatically, and found the same results as in his sister. Here we describe the clinical courses and their autopsy findings.
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Original Article
Title
A case of Reactivation Tuberculosis after Recovery from Swine-origin Influenza A/H1N1
Author
Naoko Kimura1) Shinya Kondo1) Toshimasa Obonai1) Mami Niida1) Masanori Kohama1) Akiyo Endo1) Ryojun Takeda1) Chika Kohno1) Kimiko Tamagawa1) Rie Kuge2) and Tomoo Miyakawa3)
1)Department of Pediatrics, Tamahokubu Medical Center
2)Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
3)Department of Respiratory Medicine, Tokyo Metropolitan Children's Medical Center
Abstract
We report a previously healthy 17-year-old high-school girl with reactivation tuberculosis complicated by bacterial bronchopneumonia after recovery from influenza A infection during the 2009 swine-origin influenza A/H1N1 virus (S-OIV) pandemic. She presented to our hospital with a persistent high fever and cough and was admitted because of her poor general condition and rales on chest auscultation.
Chest radiographic images revealed extensive consolidation of the bilateral lower lobes, band-shaped shadows in the bilateral upper lobes, and left hilar lymph node calcification. The response to conventional antimicrobial therapy was poor. Sputum smears for acid-fast bacilli were negative (later cultures became positive), but DNA-PCR for Mycobacterium tuberculosis was positive. The lower lobe consolidation improved before the start of anti-tuberculosis drugs, presumably due to the antibiotic therapy. Despite the negative sputum test, it was surmised that the consolidation had probably been due to bacterial bronchopneumonia. The influenza A infection might have weakened the patient's cellular immune mechanisms and re-activated Mycobacterium tuberculosis by disrupting old tuberculous lesions in the pulmonary parenchyma and small airways. This is the first report of presumed reactivation of latent tuberculosis by S-OIV infection.
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Original Article
Title
A case of Early Childhood-onset Narcolepsy
Author
Hiromichi Ito Kenji Mori Tatsuo Mori and Shoji Kagami
Department of Pediatrics, Institute of Health Biosciences, The University of Tokushima Graduate School
Abstract
We describe a rare case of early childhood-onset (5 years of age) narcolepsy. She showed excessive daytime sleepiness on a daily basis and cataplexy when she laughed. The level of orexin in cerebrospinal fluid was less than 40 pg/ml. Her polysomnogram revealed a predominance of sleep stage I and rapid eye movement period, frequent arousal, 6 times of the sleep onset rapid eye movement period, and disrupted nocturnal sleep. She also had poor school performance, forgetfulness, and obesity. She was given methylphenidate hydrochloride and achieved good control of excessive daytime sleepiness. However, she still had poor school performance, forgetfulness, and obesity at 8 years of age. Narcolepsy is often under-recognized or underdiagnosed, especially when the onset occurs in childhood. One should consider the possibility of narcolepsy in patients who show excessive daytime sleepiness, even if the patient is in early childhood.
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Original Article
Title
Effect of Methamphetamine Abuse during Pregnancy on a Neonate: A Case Report
Author
Sakae Kumasaka Makiko Mine Mizue Nakajima Aiko Yokoyama Yusuke Terada and Yoshio Shima
Department of Neonatology, Japanese Red Cross Katsushika Maternity Hospital
Abstract
Stimulant abuse during pregnancy causes a number of symptoms in neonates, but is rare in Japan compared to other countries. A female neonate weighing 3,204 g was delivered at 39 weeks and 3 days of gestation. The mother had used stimulants twice weekly until 7 to 10 days before delivery. The neonate developed a fever, sweating and tachypnea immediately after birth. The neonate's urine was positive for stimulants including amphetamine and methamphetamine on day 2 but negative on day 8. Since the long-term effects on neonates of stimulant abuse during pregnancy are unknown, neurological follow-up of such infants is extremely important.
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