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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.117, No.1, January 2013
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Original Article
Title
Psychosexual Development and Parental Acceptance in Patients with Androgen Receptor Defect
Author
Akira Ishii1) Daisuke Ariyasu2) Akira Ootake3) Hiroshi Mochizuki4) Utako Satou5) Sachiko Kitanaka5) Mari Satou6) and Yukihiro Hasegawa1)
1)Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center
2)Department of Pediatrics, Keio University School of Medicine
3)Department of Pediatrics, Saitama Medical University
4)Department of Endocrinology and Metabolism, Saitama Children's Medical Center
5)Department of Pediatrics, Graduate School of Medicine, University of Tokyo
6)Department of Pediatrics, Toho University Omori Medical Center
Abstract
Androgen receptor defect is an X-linked disorder leading to incomplete androgenization of the external genitalia due to androgen insufficiency associated with the 46,XY karyotype. The external genitalia range from a completely female phenotype to a completely male phenotype depending on the severity of the androgen insufficiency, secondary to defective androgen receptor genes. If the patient has been raised as a girl, she and her parents may experience confusion and distress depending on when and how the XY karyotype and the presence of testes are explained, as well as how old the patient is at the time of this explanation. In this study, we retrospectively examined the correlations between the contents of the explanations given regarding the disease condition and the patient's subsequent psychosexual development, gender identity, gender orientation, gender role, or the patient's/parental acceptance. The subjects were 12 patients with an established diagnosis of an androgen receptor defect. As reported previously, the psychosexual development and gender identity of these subjects was determined by the gender in which they had been raised. Confusion occurred with regard to parental acceptance in 3 cases after an explanation in which the testes and the XY karyotype were mentioned. While compliance with the medical principle of fully explaining the facts is essential, testes and the XY karyotype should be explained at an appropriate time with terms less likely to cause anxiety depending on the situations of individual cases. Further studies with more cases and feedback on their results, applicable to clinical practice, are needed.
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Original Article
Title
Effectiveness of Interventions in an Area in Which Haemophilus influenzae Type b Is in Circulation
Author
Taketo Otsuka1) Yugo Shobugawa2) Koyata Fujii1) Naruhiko Ishiwada3) and Minoru Okazaki1)
1)Department of Pediatrics, Sado General Hospital
2)Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University
3)Division of Control and Treatment of Infectious Diseases, Chiba University Hospital
Abstract
We previously reported 8 pediatric patients given diagnoess of invasive or non-invasive Haemophilus influenzae type b (Hib) infections in the southern area of Sado Island, Japan. In this area, the relative risk for Hib infections was 24.74, as evaluated by cluster analysis using Scan statistics. Of 55 attendees of a day care center A in the area, 5 (9.1%) had Hib and were given oral rifampicin for eradication of the Hib colonization. In addition, we strongly recommended Hib vaccination for all children in the southern area of Sado Island. No attendee of day care center A had Hib at 3 months after the interventions. However, we faced 2 problems with the above strategy against Hib colonization. First, some Hib vaccinees could have Hib regardless of the concentration of anti-polyribosylribitol phosphate antibodies. Second, Hib vaccination is generally implemented only in children aged <5 years, in emergency cases. Therefore, new strategies, including Hib vaccination for children aged ≥5 years and better methods for recognizing and reducing the number of Hib vaccinees who have Hib, are needed. In addition, further studies that consider the many recent changes in the conditions surrounding children (particularly Hib vaccine coverage) are needed.
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Original Article
Title
The Appropriate Duration of Steroid Treatment in Clinically Macrolide-resistant Mycoplasma pneumoniae Pneumonia in Children
Author
Masayuki Tanaka and Shie Akahori
Department of Pediatrics, National Hospital Organization, Shiga Hospital
Abstract
(Background) Mycoplasma pneumoniae (Mp) is a common pathogen causing pediatric community-acquired pneumonia. Macrolides are first-line treatment for Mp pneumonia. Occasionally, prolonged fever occurs despite appropriate antibiotic therapy and steroids have been used. (Objective) To clarify the appropriate duration of steroid administration in clinically macrolide-resistant Mp pneumonia in children less than 8 years old. (Design and setting) This was an open-label, prospective, observational study clarifying the appropriate duration of steroid treatment in our department from April, 2011 to September, 2011. We evaluated the effect of prednisolone sodium succinate on Mp pneumonia in children less than 8 years old whose clinical course worsened despite macrolide treatment. We added the steroid (1-1.5 mg/kg/day, intravenously) on day 1 of admission in addition to macrolide therapy. (Results) In total, 8 patients (4 male, 4 female) were enrolled in this study. The median age was 7 years. All fevers subsided within 24 hrs. Three children had fever again and steroid therapy was administered again. (Conclusion) Prednisolone treatment for 1 or 2 days appeared to be associated with clinical improvement of macrolide-nonresponsive Mp pneumonia.
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Original Article
Title
Clinical Efficacy of Tebipenem Pivoxil Treatment in Children with Pneumonia Classified According to Guideline-based Severity
Author
Keisuke Sunakawa1) Kazunobu Ouchi2) Satoshi Iwata3) Osamu Komiyama4) Hiroshi Sakata5) Haruo Kuroki6) Naohisa Kawamura7) Naoki Tsumura8) Takeshi Tajima9) Tomomichi Kurosaki10) Masahiro Bamba11) Yoshitake Sato12) Akiyoshi Nariai13) and Tomohiro Oishi14)
1)Kitasato Institute for Life Sciences, Kitasato University
2)Department of Pediatrics, Kawasaki Medical School
3)Center for Infectious Diseases and Infection Control, Keio University School of Medicine
4)Department of Pediatrics, National Hospital Organization Tokyo Medical Center
5)Department of Pediatrics, Asahikawa Kosei Hospital
6)Sotobo Children's Clinic, Medical Corporation Shigyo-no-kai
7)Department of Pediatrics, Osaka Rosai Hospital
8)Department of Pediatrics and Child Health, Kurume University School of Medicine
9)Department of Pediatrics, Hakujikai Memorial Hospital
10)Kurosaki Children's Clinic
11)Department of Pediatrics, Yokosuka Kyosai Hospital
12)Department of Pediatrics, Fuji Heavy Industries Ltd., Health Insurance Society General Ota Hospital
13)Department of Pediatrics, Yokohama Minami Kyosai Hospital
14)Department of Pediatrics, Niigata University Medical and Dental Hospital
Abstract
The efficacy and safety of tebipenem pivoxil (TBPM-PI) were evaluated in 35 children with moderate to severe pneumonia, in whom hospitalization for treatment by intravenous injection is recommended in the 2007 Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan, as well as in 3 children with mild pneumonia who were suspected of having an infection caused by resistant bacteria for such reasons as having been treated with an antimicrobial agent within the past month. As a result of orally administering TBPM-PI twice daily at a dose level of 4 or 6 mg (titer)/kg, the principal symptoms resolved within 3 days in 17 of the patients and within 5 days in 18 of the patients (response rate 92.1%). Twenty-seven patients (71.1%) had a reduction in fever to less than 37.5°C by the day after the initial administration (mean time, 29.1 hours). In the comparison of mean values before and after treatment, there was significant decrease in neutrophil count and CRP, from 7,870/μl to 4,230/μl (p=0.0003) and from 4.89 mg/dl to 0.9 mg/dl (p<0.0001), respectively. Moreover, the 35 patients in the group, excluding children who did not visit the hospital again, were judged to be cured on the basis of clinical findings, chest X-ray film images and results of examinations (cure rate 100%). Tebipenem exhibited potent antimicrobial activity, inhibiting the growth of the 16 strains of Streptococcus pneumoniae and 27 strains of Haemophilus influenzae isolated as causative pathogens, at concentrations of 1 μg/ml or less. The main adverse drug reaction (ADR) was diarrhea (4 cases), but no serious ADRs were observed. These findings clearly indicate that TBPM-PI is an antimicrobial useful in treating children who would be expected to be hospitalized for treatment by intravenous injection or are suspected of having an infection caused by resistant bacteria.
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Original Article
Title
The Appropriateness of Usual-dose Oral Antimicrobial Therapy, as Recommended in the Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan
Author
Tomomichi Kurosaki1) Naruhuko Ishiwada2) Tadashi Hoshino3) Nobue Inoue1) Katsuaki Abe1) Fumie Ishiwada1) Junko Tanaka2) Haruka Hishiki2) Chie Fukasawa3) Yoshiko Takahashi4) Hiroko Ohshima5) Nobuyasu Ishikawa6) Yoshio Kohri8) Kenichi Shizuno8) Itaru Terashima7) and Yoichi Kohno2)
1)Department of Pediatrics, Chiba Kaihin Municipal Hospital
2)Department of Pediatrics, Graduate School of Medicine, Chiba University
3)Division of Infectious Diseases, Chiba Children's Hospital
4)Department of Pediatrics, Kimitsu Chuo Hospital
5)Department of Pediatrics, National Hospital Organization Chiba Medical Center
6)Department of Pediatrics, Chiba Aoba Municipal Hospital
7)Department of Pediatrics, Chibaken Saiseikai Narashino Hospital
8)Department of Laboratory Medicine, Chiba Kaihin Municipal Hospital
Abstract
The Guidelines for the Management of Respiratory Infectious Diseases in Children recommend usual-doses of amoxicillin (AMPC), cefcapen pivoxil (CFPN-PI), or cefditren pivoxil (CDTR-PI) among other drugs for the initial treatment of acute bronchitis with suspected bacterial involvement or of mild pneumonia of unknown etiology even in the era when Haemophilus influenzae and Streptococcus pneumoniae are becoming increasingly multidrug-resistant. We conducted a multicenter comparison study to evaluate the efficacy of AMPC, CFPN-PI, and CDTR-PI.
The study subjects were patients younger than 16 years of age who visited the pediatric outpatient departments of 7 medical institutions in Chiba Prefecture with a primary complaint of fever and productive cough. The Geckler' quality score of their sputum was 4 or higher, as confirmed by smear microscopy, and showed predominantly Gram-positive diplococcus and Gram-negative short bacilli microscopically. We included 59 AMPC patients, 50 CFPN-PI patients, and 56 CDTR-PI patients in the analyses. The clinical response was 83.1% for AMPC, 82.0% for CFPN-PI, and 76.8% for CDTR-PI. The differences among the three groups were not statistically significant. Although CDTR showed the highest antimicrobial activity against both isolated Haemophilus influenzae and Streptococcus pneumoniae, the clinical effects of CDTR-PI did not differ from those of the other antibiotics: the clinical results were inconsistent with the results of in vitro antimicrobial activity tests. This inconsistency may be explained by differences in blood concentration after intake and/or the protein binding rate among these antibiotics.
The results of our study verified the appropriateness of the recommendations by the Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan.
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Original Article
Title
Current Status and Complications of Adult Patients with Childhood-onset Steroid-sensitive Nephrotic Syndrome
Author
Shingo Ishimori Hiroshi Kaito Hiromi Ohtsubo Fusako Hashimoto Takeshi Ninchoji Yuya Hashimura Naoya Morisada and Kazumoto Iijima
Department of Pediatrics, Kobe University Graduate School of Medicine
Abstract
Pediatric steroid-sensitive nephrotic syndrome (SSNS) is a disorder with a good prognosis. However, various complications may develop in patients who make a transition from pediatric to adult care because their duration of disease is prolonged. We retrospectively examined the current status and complications in 20 patients younger than 15 years of age at the first diagnosis of SSNS and older than 18 years of age at the final observation, who received continuous treatment as outpatients at our hospital. The median age at presentation and the median observation time were 4 years and 18.8 years, respectively. All the patients had frequent relapses and were given immunosuppressive drugs. Cyclosporine (CyA) was the most commonly used drug, and 80% of the patients received it. CyA-induced chronic renal toxicity was observed in 40% of the patients, but no patient with irreversible lesion was detected. It was observed that safe and long-term treatment with CyA is possible by evaluating renal toxicity periodically via renal biopsy and by ensuring breaks in the administration of medication. Although 4 of 13 patients who made transition to adults tried to discontinue immunosuppressive drugs, this attempt could not be accomplished because of the increase of relapse. Additionally, even though 55% of the patients achieved remission in the past year, only 15% of the patients were off medication; most of the patients required immunosuppressive drugs to maintain remission, even in adulthood. The results showed that it was not uncommon for patients to choose an alternative therapy with steroids when they reached the applicable age for specific childhood chronic diseases; this was because they could not continue the use of immunosuppressive drugs for economical reasons. For management of patients, social approaches such as providing more grants for medical expenses are important.
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Original Article
Title
Infliximab Therapy for Children with Crohn's Disease: A Single Center Experience in Japan
Author
Hirotaka Shimizu1) Katsuhiro Arai1) Tadahiro Yanagi1)2) Shigeo Nishimata1)3) Sachi Koinuma1) and Reiko Ito1)
1)Division of Gastroenterology and Hepatology, Department of Medical Specialties, National Center for Child Health and Development
2)Department of Pediatrics, School of Medicine, Keio University
3)Department of Pediatrics, Tokyo Medical University
Abstract
We report our experience of 9 Japanese children with Crohn's disease, who were treated with infliximab (IFX) therapy at the National Center for Child Health and Development, Japan, between September 2006 and December 2010. The therapeutic effect, steroid-sparing effect, impact on growth retardation, and any adverse reactions of this therapy were retrospectively evaluated. Pediatric Crohn's Disease Activity Index (PCDAI) was used as an index of therapeutic effect. "Clinical response" was defined as a decrease of at least 15 points in the PCDAI score from the baseline and a PCDAI score of no more than 30 points. "Clinical remission" was defined as a PCDAI score of 10 points or lower.
Montreal Classification was used to classify the disease location. One patient was categorized as L1 (terminal ileum), 2 as L2 (colon), and 6 as L3 (ileocolon). The mean age of onset was 11 years 2 months, the mean age of diagnosis was 12 years and 8 months, and the mean duration between diagnosis and initiation of IFX was 430 days. At week 10, of the 9 patients, 5 (55.6%) responded to IFX and 4 (44.4%) achieved clinical remission. At week 54, of 8 patients, 6 (75.0%) and 4 (50.0%) were in clinical response and clinical remission, respectively. Five of 7 patients with growth retardation showed improved z-scores, but this improvement was not statistically significant. Three of 8 patients required a higher dose of IFX because of reduced therapeutic response. One patient had to discontinue IFX use because of the onset of SAPHO syndrome.
IFX is a useful drug for improving the disease activity of children with Crohn's disease. However, patients may require long term use of IFX as maintenance therapy, and the risks and benefits of IFX should be well discussed before initiating the first dose.
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Original Article
Title
Dengue Fever in an Infant after Return from the Philippines
Author
Yasutaka Mizuno Shinji Fukushima and Hiroyuki Shimizu
Travellers' Medical Center, Department of Infection Control and Prevention, Tokyo Medical University Hospital
Abstract
We reported a case of dengue fever in an infant who returned from the Philippines accompanied by her mother. Dengue fever was diagnosed because she showed a clinical course similar to that of her mother, who was also suspected to have dengue fever. Patients suspected to have tropical diseases, especially dengue fever, are rarely encountered in routine pediatric practice in Japan; therefore, pediatricians in Japan may find it difficult to appropriately diagnose and treat such cases. On the other hand, the number of infants, accompanied by their parents, visiting areas endemic for tropical diseases has increased in recent years.
Our report suggests a need for proper knowledge concerning tropical diseases among pediatricians in Japan and the creation of a specialized network for pediatric tropical diseases so that appropriate management can be provided, whenever needed.
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Original Article
Title
Transient White Matter Lesions in a Child with Mutism and Ataxia: A Case Report
Author
Meiwa Toyofuku Toshimasa Obonai Mami Niida Akiyo Endo Masanori Kohama Toshihiko Fukahori Chika Kono Kimiko Tamagawa and Shinya Kondo
Department of Pediatrics, Tama-Hokubu Medical Center
Abstract
A previously healthy 11-year-old girl was admitted because of mutism and ataxia after a 2-day prodromal high fever associated with influenza. On admission (day 1), she was apyretic and her vital signs were normal. Her consciousness was clear, but she was irritable and exhibited mutism and ataxia. She could not maintain a standing position. After 12 hours, these symptoms disappeared. Diffusion-weighted images (DWI) obtained on day 2 showed markedly hyperintense lesions in bilateral white matter and corpus callosum except in a splenial lesion. A second DWI performed on day 7 showed the complete resolution of these lesions. We suppose that her encephalopathy may be classified as clinically mild encephalitis/encephalopathy with reversible splenial lesions despite the lack of that lesion. In this case, the MR imaging findings could not explain the clinical manifestations.
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Original Article
Title
Wernicke's Encephalopathy in a 21-trisomy Girl with Acute Lymphoblastic Leukemia
Author
Hiroyoshi Takahashi Katsuyoshi Koh Naoko Yasui Makiko Mori Kosuke Akiyama Masahumi Seki Motohiro Kato and Ryoji Hanada
Department of Hematology/Oncology, Saitama Children's Medical Center
Abstract
We report a 15-year-old girl with Wernicke's encephalopathy (WE) who was successfully treated with high-dose vitamin B1. She also had acute lymphoblastic leukemia (ALL) with 21-trisomy (Down syndrome, DS). She suffered from mental retardation and befuddlement, leading to weight loss after admission. After early intensification therapy, she developed generalized seizures, nystagmus, and disturbance of consciousness. Magnetic resonance imaging revealed high signal intensity inside the bilateral thalamus and periaquaductal gray matter on fluid-attenuated inversion recovery, and WE was suspected. Intravenous administration of vitamin B1 was initiated immediately. A high dosage of vitamin B1(450 mg/day) was required to improve her clinical symptoms. At a later date, low levels of vitamin B1 were given. She was ultimately cured without any sequel. Adverse events often occur after the initiation of ALL therapy in DS patients; however, WE should be considered when weight loss due to decreased oral intake is observed.
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Original Article
Title
Three Pediatric Cases of Urologic Tumor Detected with a Chief Complaint of Gross Hematuria
Author
Hironobu Eguchi Ryugo Hiramoto Shinsuke Matsumoto and Shunsuke Shinozuka
Department of Pediatrics, Matsudo City Hospital
Abstract
We treated 3 pediatric cases of urological tumor (6-year-old girl with Wilms tumor, 13-year-old boy with renal cell carcinoma, and 3-year-old girl with rhabdomyosarcoma arising from urinary bladder). All cases had a chief complaint of gross hematuria at the onset. Imaging examinations including abdominal ultrasound were extremely useful for diagnosis. Wilms tumor is the most frequently observed renal malignancy in children, but the number of cases originally found by gross hematuria is comparatively small. On the other hand, renal cell carcinoma occurs mainly in adult patients and rarely in children. Regarding rhabdomyosarsoma affecting the urogenital system, the prognosis is considered to be extremely poor, especially in cases invading the urinary bladder or prostate. In general, the major causes of gross hematuria in children are benign. In rare cases, however, urological malignancy might cause gross hematuria. When treating children with gross hematuria, it is essential to examine them carefully in order not to overlook malignancy, which requires both early detection and rapid intervention.
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Original Article
Title
Three Infants with Loeys-Dietz Syndrome Showing Severe Progressive Complications
Author
Yukiko Kawazu1) Nobuhiko Okamoto2) Noboru Inamura1) Ryo Ishii1) Hiroki Nanjyo3)4) Naritaka Mochizuki3) Hiroko Morisaki5) and Futoshi Kayatani1)
1)Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health
2)Department of Medical Genetics, Osaka Medical Center and Research Institute for Maternal and Child Health
3)Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health
4)Kagayaki Clinic
5)Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute
Abstract
We report three infants with Loeys-Dietz syndrome (LDS). Case 1 was a girl with multiple joint contractures including clubfeet at birth. Remarkable dilatation of the aortic root, aortic valve insufficiency, tortuosity of the descending aorta, and patent ductus arteriosus were detected at age 2 months. She developed subluxation of the cervical spine and spinal cord compression leading to apnea and quadriplegia. Molecular analysis showed a heterozygous mutation in the TGFBR2 gene. She died of subarachnoid hemorrhage at age 18 months. Case 2 was a boy with thin and hyperextensible skin, joint laxity, arachnodactyly, and inguinal hernia in early infancy. Remarkable dilatation of the aortic root with aortic valve insufficiency was detected at age 20 months, and could not be controlled by administration of losartan. A cranial CT showed craniosynostosis, which was surgically treated at age 2. He was found to have a heterozygous TGFBR2 mutation. Case 3 was a boy with double outlet right ventricle and interruption of the aortic arch accompanied by a dilated pulmonary artery (PA) detected at 36 weeks of gestation. He had thin skin and respiratory insufficiency requiring mechanical ventilation. He underwent bilateral PA banding for increased pulmonary blood flow at age 9 days, resulting in marked dilatation of the right PA. Losartan, initiated at 17 days, was also ineffective. He died of rupture of the right PA at 21 days, and was found to have a heterozygous TGFBR2 mutation.
Patients with LDS not detected prenatally could have serious skeletal (subluxation of cervical spine, craniosynostosis) and cardiovascular (progressive dilatation of aortic root and PA) complications. Prenatal genetic diagnosis is recommended for those with craniofacial (hypertelorism), skeletal (contractures), and cardiovascular (aortic and/or PA dilatation, arterial tortuosity) characteristics of LDS on prenatal imaging.
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Original Article
Title
Infantile Crohn Disease Successfully Treated with Elemental Diet and Mesalazine Enema Therapy
Author
Eisuke Inage1)2) Tsuyoshi Makanae1)3) Shun-ichi Maisawa1) Zekou Suzuki1) Akio Takahashi1) Yuhei Takasago1) and Toshiaki Shimizu2)
1)Department of Pediatrics, Morioka Children's Hospital
2)Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine
3)Department of Pediatrics, Kawakubo Hospital
Abstract
Infantile Crohn disease is a rare gastrointestinal disorder with unknown etiology, and has a poor prognosis. We report on a case of infantile Crohn disease. A 4-month-old boy was admitted for intractable anal and oral ulcers. Total colonoscopy showed linear rectal ulceration and longitudinal aphthous colonic ulceration. Histologic examination revealed chronic, discontinuous inflammation of the colonic mucosa.
Elemental diet therapy with mesalazine enema successfully treated the oral and anal lesions.
Mucosal healing was shown with an endoscopic follow up study two months later. Infantile Crohn Disease has a poor outcome, and is usually refractory to anti-inflammatory treatment.
However, our case was successfully treated with elemental diet therapy and topical enema and corticosteroid therapy was not necessary. An exclusive elemental diet can be the treatment of choice for infantile Crohn disease. We report the details of this case and discuss the management of infantile Crohn disease.
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Title
Increasing Macrolide-resistant Mycoplasma
Author
Chigusa Oyama1) Takeshi Taketani1)2) Momoko Yokoyama1) Shizuka Machida3) Atsuro Saito1) Jun Mine1) Noriaki Minami1) Akiyoshi Horie1) Rie Kanai1) and Seiji Yamaguchi1)
1)Department of Pediatrics, Shimane University of School of Medicine
2)Division of Blood Transfusion, Shimane University Hospital
3)Department of Pediatrics and Developmental Biology, Graduate School of Medicine, Tokyo Medical and Dental University
Abstract
Introduction: Mycoplasma pneumoniae (MP) infection is a common community-acquired respiratory infection in childhood. Most patients who suffer from this infection are uneventfully cured with macrolide, but some patients show macrolide-resistant Mycoplasma. Moreover, early and accurate diagnosis of Mycoplasma pneumoniae is not easy.
Objective: Using throat swabs from 48 patients with respiratory symptoms, we performed a loop-mediated isothermal amplification (LAMP)technology to make an accurate diagnosis of MP, and identify the macrolide-resistant strain by detecting mutations of 23S ribosomal RNA gene. We also examined the clinical characteristics of macrolide-resistant MP infection.
Results: Mycoplasma DNA was detected by the LAMP method in 13 of 48 patients (27%), whereas the IgM antibody of Mycoplasma was positive in 31 patients (65%). Surprisingly, 12 (92%) of 13 patients who were positive by the LAMP method had 23S ribosomal RNA mutation, A2063 G. Patients with this macrolide-resistant mutation tended to be older (median age; 7.0 years old), and had slightly increased inflammatory reaction (white blood cell count; mean 7,131 /μL, CRP; mean 2.9 mg/dL). Their febrile period was a mean of 7.9 days although the timing when macrolide was administered was different in each patient.
Conclusions: The LAMP method is useful for identification of MP. In our community, there was a high frequency of macrolide-resistant Mycoplasma, and patients affected with this organism had a long febrile period, suggesting that we need to discuss the most appropriate treatment for severe or refractory Mycoplasma infection.
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