|
THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
|
Vol.118, No.4, April 2014
|
Review
Title
Recommended Selenium Dose for Japanese Children with Selenium Deficiency Arising from Gastrointestinal Disorders
Author
Katsuhiro Arai1) Rie Funayama1)5) Hirotaka Shimizu1) Kei Minowa1)6) Reiko Ito2) Ichiro Nomura3) and Akira Matsui4)
1)Division of Gastroenterology, National Center for Child Health and Development
2)Division of Hepatology, National Center for Child Health and Development
3)Division of Allergy, National Center for Child Health and Development
4)Hospital Director, National Center for Child Health and Development
5)Faculty of Home Economics, Tokyo Kasei University
6)Department of Pediatrics, Juntendo University School of Medicine
Abstract
Objective: Although selenium supplementation is necessary to prevent or treat clinical deficiency in children with gastrointestinal disorders who receive long-term parenteral or enteral nutrition that does not contain selenium, there is a lack of detailed reports on the correct dosage. The aim of this study is to determine the appropriate dose of selenium to treat this type of patient.
Methods: Six children with gastrointestinal disorders and selenium deficiency (serum selenium<10 μg/dl) were included in the study. Sodium selenite was administered orally. The daily dose of selenium supplementation was determined at two levels based on the Dietary Reference Intakes for Japanese (DRIs-2010). The initial dose was set above the intermediate value between the recommended dietary allowance (RDA) and the tolerable upper intake level (UL), while the second dose was equivalent to the UL. Serum selenium level was monitored after the first dose. When serum selenium level was not normalized after the initial dose, the second dose ensued.
Results: The baseline selenium level was 4.9± 1.5 μg/dl. The serum selenium level was increased to 7.8± 2.4 μg/dl by the initial dose (p=0.063), and significantly increased to 10.4± 2.2 μg/dl by the second dose (p=0.0013). The second dose increased the serum selenium level (p=0.0065) significantly from the initial dose.
Conclusion: We propose that a selenium dose above the RDA is required to treat selenium deficiency in children with gastrointestinal disorders. It may be necessary to monitor this category of patients routinely to adjust the dosage of selenium supplementation accordingly.
|
|
Original Article
Title
Clinical Features and Laboratory Diagnosis of Mycoplasma pneumoniae Pneumonia in Pediatric Patients
Author
Kensei Gotoh Naoko Nishimura Suguru Takeuchi Fumihiko Hattori Kazuhiro Horiba Mai Isaji Yu Okai Yasunori Ohshima Haruki Hosono Koji Takemoto and Takao Ozaki
Department of Pediatrics, Konan Kosei Hospital
Abstract
Recently, an outbreak of macrolide-resistant Mycoplasma pneumoniae infection has been reported in Japan. However, detailed reports describing the clinical characteristics are limited. Moreover, rapid diagnosis of M. pneumoniae pneumonia is necessary to accelerate its treatment with effective antimicrobial agents. Furthermore, DNA detection using the loop-mediated isothermal amplification (LAMP) assay has been recommended for a definitive diagnosis in the acute phase of M. pneumoniae infection, but additional studies evaluating the clinical utilities of these assays for macrolide-resistant M. pneumoniae are necessary. In this prospective study, we analyzed the clinical features of pediatric patients with M. pneumoniae pneumonia confirmed by laboratory diagnosis. We enrolled 1,567 children with community-acquired pneumonia, who were admitted to our hospital between April 2009 and March 2012. We obtained a throat swab during the acute phase from each patient to detect M. pneumoniae DNA. We also collected paired serum samples from the acute and convalescent phases for determining M. pneumoniae antibody titers. M. pneumoniae pneumonia was diagnosed through either a positive LAMP assay or by performing an assay for a 4-fold increase in the antibody titer. Overall, 556 children (36% of the pneumonia patients) were diagnosed with M. pneumoniae pneumonia: 255 (46%) by LAMP only, 27 (5%) by serology only, and 274 (49%) by both methods. The peak age at onset was between four and eight years of age, with half of all cases occurring in preschoolers; the epidemics occurred mainly during summer and autumn. Furthermore, the incidence of clinically macrolide-resistant M. pneumoniae pneumonia (finally treated with tetracycline or fluoroquinolones) has increased along with the proportion of older children and patients diagnosed through positive LAMP assay alone. The duration of pharyngeal carriage, as measured by positive LAMP assay, was statistically longer in cases involving clinically macrolide-resistant M. pneumoniae pneumonia than in those with clinically macrolide-sensitive M. pneumoniae pneumonia. We could appropriately change the treatment in clinically macrolide-resistant M. pneumoniae cases with positive LAMP assay. Moreover, based on the LAMP assay results, we could avoid unnecessary administration of antibiotics in patients with pneumonia caused by pathogens other than M. pneumoniae. Taken together, we conclude that the LAMP assay is useful for the appropriate use of antibiotics for pneumonia treatment in children.
|
|
Original Article
Title
Transient Loss of Consciousness with Influenza Infection: A Case Series
Author
Mitsuru Kashiwagi1) Takuya Tanabe2) Mitsugu Kajiura3) Shuichi Shimakawa4) and Hiroshi Tamai4)
1)Department of Pediatrics, Hirakata City Hospital
2)Department of Pediatric Neurology, Tanabe Pediatric Clinic
3)Osaka Center for Cancer and Cardiovascular Diseases Prevention
4)Department of Pediatrics, Osaka Medical College
Abstract
Transient loss of consciousness is one of the neurologic symptoms of influenza infection, but its clinical menchanism is not clear. In this report, we provide a detailed account of its clinical manifestations in 8 children who presented with transient loss of consciousness during influenza infection. Of the 173 children who were hospitalized for influenza infection between January and December 2009, 8 children (4.6%) presented with transient loss of consciousness. We retrospectively studied the history of events and physical, electrocardiogram, blood examination, neuroimaging, electroencephalography, and orthostatic test findings.
In 7 cases, transient loss of consciousness was observed after a fall in a restroom or after a visit to a restroom and in 1 case, after a fall following vomiting. Unconsciousness lasted for approximately 5 minutes in 7 patients and 10 minutes in 1 patient, and recovery of consciousness was spontaneous and quick. We diagnosed these children with syncope based on the history of events, physical findings, and the results of electroencephalographic and electrocardiographic examinations. We ascertained the cause of transient loss of consciousness to be neurally mediated syncope (NMS).
Therefore, an orthostatic test was performed for 5 children. Based on the results of this test, 1 child was diagnosed with NMS; 2, with postural tachycardia syndrome (POTS); 1, with delayed orthostatic hypotension (OH); and 1, with POTS and delayed OH.
NMS caused transient loss of consciousness in children with influenza infection. We conclude that the mechanisms responsible for syncope are associated with vomiting, defecation and micturition, as well as orthostatic intolerance.
|
|
Original Article
Title
Evaluation of a Dysfunctional Voiding Symptom Score for Use in Children with Lower Urinary Tract Symptom
Author
Hirokazu Ikeda Masaki Fuyama Hiroki Tsukada Ryousuke Matuno Daisuke Toyama Yoko Fujimoto and Keiichi Isoyama
Department of Pediatrics, Showa University Fujigaoka Hospital
Abstract
Objective: Although lower urinary tract symptoms (LUTS) such as daytime incontinence and urgency are common in pediatric cases, no universally accepted quantitative approach for evaluating and treating LUTS in children has yet been developed. The international prostate symptom score and the overactive bladder symptom score have been widely accepted as quantitative instruments for assessing LUTS in adults. This study evaluated the effectiveness of dysfunction voiding symptom score as a quantitative instrument in children with LUTS.
Materials and Methods: A total of 36 children aged 5-15 years with a history of daytime incontinence more than once a day between 2009 and 2011 were enrolled in this study. The dysfunction voiding symptom score was initially calculated on the first visit to our clinic. All patients underwent a bladder behavioral modification program for the next 12 weeks. Then the patients were given anticholinergic therapy using propiverine hydrochloride for 12 weeks along with the continuation of the bladder behavioral modification program. The dysfunction voiding symptom score was calculated at every visit. A retrospective analysis was performed at the end of the study, comparing the dysfunction voiding symptom scores calculated at the first visit, after the bladder behavioral modification program, and after anticholinergic therapy.
Results: Significant improvement was observed in the mean dysfunction voiding symptom score over the duration of therapy (initial visit, 11± 2.3; 12 weeks, 9± 2.3; 24 weeks, 4± 2.7). Subjective responses to the questionnaire revealed improvement in daytime incontinence (> 50% decrease in wetting episodes) in 23 patients (63.8%) and no improvement (< 50% decrease in wetting episodes) in 13 (36.2%) patients. Although no significant difference was noted in patient characteristics between the 2 groups, the dysfunction voiding symptom score was significantly higher in the no-improvement group than that in the improvement group at each time point.
Conclusion: The results of this study demonstrated that the dysfunction voiding symptom score provides a quantitative means to monitor response to therapy in patients. It also acts as a good predictor of response to therapy in children with LUTS.
|
|
Original Article
Title
Distinguishing Congenital Combined Pituitary Hormone Deficiency from Biliary Atresia as a Cause of Cholestasis in Infants
Author
Yuka Ashikari Koichi Ito Tokio Sugiura Takeshi Endo Shin Kato Atushi Ishida Hiroki Kakita Hiroki Imamine Rika Nagasaki Haruo Mizuno Tetsuya Ito Ineko Kato Satoshi Suzuki and Hajime Togari
Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University
Abstract
Neonatal cholestasis is caused by either biliary atresia or intrahepatic cholestasis. Congenital combined pituitary hormone deficiency (CPHD) is a rare disease and a recognized cause of intrahepatic cholestasis. It is important to differentiate cholestasis due to this entity from cholestasis due to biliary atresia, since both diseases can cause jaundice at about 1 month of age. However, doing so in a timely fashion remains a diagnostic dilemma.
This retrospective study was performed to clarify differences between cholestasis due to congenital CPHD and cholestasis due to biliary atresia. From 2004 to 2010, 4 infants (2 boys and 2 girls) with cholestasis due to congenital CPHD were admitted to Nagoya City University Hospital. Head magnetic resonance imaging of the 4 infants revealed a previously invisible pituitary stalk; 3 of these 4 infants had an ectopic posterior pituitary. Liver biopsy was performed in 3 of the 4 infants, and histological findings included giant cell hepatitis. Findings from these 4 infants were then compared with those from 55 infants treated in our hospital for cholestasis due to biliary atresia. The results showed a significant difference in mean gamma-glutamyl transpeptidase (GGT) levels between the two groups of infants (115.0 IU/l vs. 553.0 IU/l, respectively). In this study, the GGT level was found to be useful for distinguishing congenital CPHD from biliary atresia as the cause of cholestasis. The diagnosis of hypopituitarism should always be considered in infants with unexplained neonatal hepatitis.
|
|
Original Article
Title
Four Cases of Listeria Meningitis
Author
Chihiro Hatano1) Tatsuya Fukasawa1) Yuichi Kato1) Yuji Miyajima1) Akimasa Ogawa1) Syotaro Ando2) Masayuki Hasegawa2) Masanobu Iwase3) Midori Yamada3) Yumi Maehara4) Seiko Itomi4) and Tetsuo Kubota1)
1)Department of Pediatrics, Anjo Kosei Hospital
2)Department of Pediatrics, Nagoya Ekisaikai Hospital
3)Department of Pediatrics, Kariya Toyota General Hospital
4)Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital
Abstract
Listeria is rarely a causative agent of infection in immunocompetent children other than neonates. Half of all pediatric patients with Listeria infection develop meningitis, so this pathogen must be considered as a cause of meningitis. We report the clinical courses of four immunocompetent children with Listeria meningitis, diagnosed in Aichi Prefecture from 2010 to 2011. All four patients were healthy before and after the episode and ranged in age from 1 to 10 years. The symptoms of these patients were fever in all four cases, seizures in two cases, vomiting in three cases (cases 1, 3, and 4,), and diarrhea in three cases (cases 1, 2, and 3). Diarrhea is rare in meningitis with causes other than Listeria. Owing to the atypical symptoms, such as diarrhea, and the patients' relatively mild symptoms, it took 3-7 days to diagnose the meningitis. The symptoms seemed to progress more slowly than in other types of bacterial meningitis, and were milder than those of meningitis caused by other pathogens. No organisms were detected on Gram staining in all cases. We based the diagnosis on cerebrospinal fluid or blood cultures. All four patients were treated with antibiotics, and three with dexamethasone. Fortunately, no patient developed a neurological deficit after treatment. Listeria infection should be considered as a cause of meningitis, especially in cases accompanied by atypical symptoms such as diarrhea, even in immunocompetent children.
|
|
Original Article
Title
Successful Linezolid Treatment for a Case of Calcaneal Osteomyelitis Caused by Methicillin-resistant Staphylococcus aureus
Author
Tomoya Koda1) Kenichi Suga2) Masafumi Suzue2) Aya Goji2) Nami Inoue2) Kazuhiro Mori2) and Yasuto Yuasa2)
1)Registrar, Tokushima Prefectural Central Hospital
2)Department of Pediatrics, Tokushima Prefectural Central Hospital
Abstract
We report a 10-year-old girl who presented calcaneal osteomyelytis caused by methicillin-resistant Staphylococcus aureus (MRSA). She complained of pain and swelling of the left heel, and fever. She did not have any trauma episode. Although she suffered from atopic dermatitis, she had not recently received any treatment such as ointment. Magnetic resonance imaging and blood culture confirmed the diagnosis of calcaneal osteomyelitis caused by MRSA. After initiation of Linezolid (LZD) treatment, clinical symptoms rapidly relieved. But after 14 days of LZD, bone marrow suppression was found and we changed LZD to Minocycline (MINO). After antibiotic treatment for 6 weeks, she was cured without any surgical operation.
|
|
Original Article
Title
A Case of Fitz-Hugh-Curtis Syndrome Diagnosed during Laparoscopic Examination in a Fourteen-year-old Girl
Author
Akio Takamura Sachie Shigemitu Kazuya Nogi Hyoja Kim and Hideki Sasaki
Department of Pediatrics, Kawasaki Kyodo Hospital
Abstract
A 14-year-old girl presented to our hospital complaining of abdominal pain, with a probable diagnosis of acute appendicitis.
Considering the possibility of pelvic inflammatory disease owing to her active sexual life, we performed a laparoscopic examination before surgery. Numerous filmy adhesions were observed on the liver surface and the adjacent abdominal walls (violin string sign). Fitz-Hugh-Curtis syndrome (FHCS) was diagnosed, and confirmed by an elevated Chramydia trachomatis (ChT). serum antibody titer. Ascites and cervical discharge were ChT-positive by real-time polymerase chain reaction. Following administration of azithromycin hydrate and minocycline hydrochloride, the abdominal pain disappeared and the laboratory data improved gradually.
The frequency of FHCS among Japanese adolescents is poorly documented. Since early sexual activity among adolescents is likely to increase in the near future., pediatricians should understand the problem, and effective sex education for schoolchildren, nurses, educational staff, and parents are required.
|
|
Original Article
Title
A Case of Protein-losing Enteropathy in a Patient Treated with Disodium Cromoglycate, Tranexamic Acid, and Medium-chain Triglycerides
Author
Chihiro Hatano Tatsuya Fukasawa Tetsuo Kubota Yuji Miyajima and Akimasa Ogawa
Department of Pediatrics, Anjo Kosei Hospital
Abstract
We report a 2-year-old girl with protein-losing enteropathy. She was admitted to our hospital due to progressive facial edema following an upper respiratory infection. Upon arrival at our hospital, she had severe hypoproteinemia, but no diarrhea, proteinuria, ascites, or pleural effusion. She was otherwise healthy and had no food allergy or autoimmune disease. We diagnosed her with protein-losing enteropathy based on 99mTc-labeled human serum albumin scintigraphy results. Endoscopy could not be performed due to a high fever secondary to the influenza infection. Because she had not experienced any allergic episodes, autoimmune diseases, or acute infection as potential causes of the protein-losing enteropathy, we suspected primary intestinal lymphangiectasia (PIL). Sodium cromoglycate, tranexamic acid, and midium-chain triglycerides are reported treatments for PIL. This patient had severe hypoproteinemia and emergency treatment was required. Thus, we began administration of sodium cromoglycate, tranexamic acid, and midium-chain triglycerides without performing endoscopy. These treatments were selected because their potential adverse effects were less severe. After administration of these medications, the patient did not require intravenous albumin or globulin. Her hypoproteinemia did not recur after discharge.
As shown in former reports, this case may demonstrate the usefulness of sodium cromoglycate, tranexamic acid, and midium-chain triglycerides for protein-losing enteropathy. Each medicine has a different effect. No severe adverse effects were reported in previous studies or in the present case. Endoscopy and biopsies are much riskier in children than in adults. If protein-losing enteropathy caused by PIL is suspected, administration of tranexamic acid, sodium cromoglycate, and medium-chain triglycerides can be considered without performing endoscopy or biopsies.
|
|
Original Article
Title
Femoral Osteomyelitis in a Woman with Profound Multiple Disabilities that Improved with Negative Pressure Wound Therapy
Author
Shinya Murata1) Mitsuru Kashiwagi1) Takuya Tanabe2) and Hiroshi Tamai3)
1)Departments of Pediatrics, Hirakata City Hospital
2)Tanabe Children's Clinic
3)Department of Pediatrics, Osaka Medical College
Abstract
The patient was an 18-year-old woman with juvenile neuronal ceroid-lipofuscinosis who had severe motor and intellectual disabilities and had been bedridden for many years. She had a pressure ulcer at the buttocks that became infected and then developed into osteomyelitis. Negative pressure wound therapy (NPWT) was performed to treat the pressure ulcer and the osteomyelitis. NPWT promoted the formation of healthy granulation tissue, and her wound improved relatively quickly.
NPWT is a new wound management technique through which continuous negative pressure is delivered within a closed environment; it is used to accelerate wound healing. Although NPWT has been widely used as an effective therapy for intractable wounds in adults, the details of NPWT are not well known to most pediatricians, who have little experience treating intractable skin diseases such as pressure ulcers.
The risk of pressure ulcers is high in bedridden, handicapped children. There are many cases of recurrent pressure ulcers in bedridden, handicapped patients due to aggravation of their general condition, with progression of limb contractures and exacerbation of their underlying disease. When bacteremia or osteomyelitis complicate pressure ulcers, the mortality rate is high. Pediatricians whose practice includes bedridden children, such as multiply handicapped patients, should have some knowledge of the prevention and therapy of pressure ulcers. This case is reported along with a review of the relevant literature.
|
|
|
Back number
|
|
