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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.128, No.10, October 2024
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Original Article
Title
Trends after a Dramatic Surge in Urinary Tract Infections Caused by Extended-spectrum Beta-lactamase-producing Escherichia coli
Author
Tomohiro Hirade1) Daisuke Koike1) Miho Wakuri2) Mizuki Akiyoshi1) Yasuhiro Haneda1) Rie Kanai1) Akiyoshi Horie3) and Akiyoshi Nariai4)
1)Department of Pediatrics, Shimane Prefectural Central Hospital
2)Department of Bacteriology, Shimane Prefectural Central Hospital
3)Department of Pediatrics, Matsue Red Cross Hospital
4)Department of Infectious Diseases, Matsue Red Cross Hospital
Abstract
Background: The increasing proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is a global health problem. In 2016, Izumo city in Shimane Prefecture, Japan experienced a surge in the number of infantile urinary tract infections (UTIs), of which 68% were caused by ESBL-producing E. coli. After this surge, flomoxef or cefmetazole were administered for patients with a first UTI, assuming the causative bacteria to be ESBL-producing E. coli. This study aimed to identify UTI trends after this surge and compare the characteristics of UTIs caused by different bacteria.
Methods: We retrospectively analyzed the medical records of 179 infants admitted to our hospital with a first UTI between 2017 and 2023.
Results: Forty-one infants were admitted with UTIs in 2017, but the number of cases decreased to 13 in 2023. The proportion of ESBL-producing E. coli gradually decreased from 71% (29/41) in 2017 to 23% (3/13) in 2023. The clinical manifestations of UTIs caused by ESBL-producing and non-ESBL-producing E. coli did not differ significantly.
Conclusion: The annual number of UTIs and proportion of ESBL-producing E. coli gradually decreased between 2017 and 2023. Although flomoxef and cefmetazole are effective against ESBL-producing E. coli, the long-term use of these antibiotics may promote the development of multidrug-resistant bacteria. Therefore, appropriate antibiotics should be selected according to the local antibiograms to prevent the development of multidrug-resistant bacteria.
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Original Article
Title
Characteristics of Patients with COVID-19 Admitted to the Children's Hospital during the Omicron Epidemic Period
Author
Kanako Morita1) Takeshi Hatachi1) Masatoshi Nozaki2) and Muneyuki Takeuchi1)
1)Intensive Care Unit, Osaka Women's and Children's Hospital
2)Neonatal Intensive Care Unit, and Infectious Diseases, Osaka Women's and Children's Hospital
Abstract
The emergence of the Omicron variant of coronavirus disease 2019 (COVID-19) in January 2022 in Japan led to a rapid increase in pediatric cases, necessitating a comprehensive understanding of the situation to establish effective healthcare systems. This report aims to elucidate the clinical trajectory of pediatric COVID-19 patients during the Omicron variant outbreak by conducting a retrospective investigation of patients admitted to our center between January and December 2022, with a focus on patient characteristics, clinical course, and outcomes.
A total of 448 hospitalizations were analyzed, of which 60.5% were male, with a median age of 5 years [1-10]. The median length of hospital stay was 4 days [3-8]. The outbreak resulted in a significant rise in pediatric COVID-19 patients requiring hospitalization. While the majority were mild cases (88.6%), the increasing number of hospitalizations led to a rise in moderate to severe cases.
The primary reasons for admission were poor oral intake (25.7%), followed by seizures (14.0%), indicating diverse admission criteria beyond respiratory symptoms. Overall, 49.8% had underlying medical conditions. Although there was no significant difference in the proportion of moderate to severe cases among those with and without underlying conditions (14.3% vs. 8.4%, P=0.054), patients with underlying conditions had a significantly prolonged hospital stay (6 days vs. 4 days, P<0.001). Patients with underlying conditions often presented with hypoxemia as the primary reason for admission, while those without underlying conditions were more likely to be admitted due to seizures.
There was one reported death due to COVID-19 during the study period. Post-discharge sequelae related to COVID-19 were observed in 2.2% of patients.
The presence or absence of underlying conditions did not correlate with disease severity. However, the prolonged hospital stay suggests potential strain on both the healthcare system and patients during the peak of the outbreak.
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Case Report
Title
A child with Cardioinhibitory Vasovagal Syncope Requiring Differentiation from Sick Sinus Syndrome Due to Asystole with Convulsions
Author
Mami Uegami1) Hiroaki Ito1) Seiji Kawamura1) and Tetsuko Ishii2)
1)Department of Pediatrics, Kameda Medical Center
2)Department of Cardiology, Chiba Children's Hospital
Abstract
Vasovagal syncope is the most common form of reflex syncope in pediatric patients, and it is generally associated with a good prognosis. We encountered a case of cardioinhibitory vasovagal syncope in a 7-year-old girl who presented with cardiac arrest lasting approximately 11 seconds.
The patient experienced an episode of syncope and tonic convulsion lasting approximately 10 seconds while standing up after taking a bath. She regained consciousness immediately after the convulsion; moreover, blood tests, electrocardiogram, echocardiogram, and electroencephalogram revealed no abnormalities. During the Holter electrocardiogram, she underwent an orthostatic test to evaluate for vasovagal syncope. She experienced another episode of loss of consciousness and tonic convulsion lasting for approximately 10 seconds, followed by cardiac arrest lasting for approximately 11 seconds. Although sick sinus syndrome was initially suspected, cardioinhibitory vasovagal syncope with convulsion was ultimately diagnosed based on the patient's medical history and the clinical context of the episodes. It is crucial to differentiate between noncardiogenic and cardiogenic diseases for accurate prognosis, emphasizing the importance of detailed interviews to ascertain physical symptoms and family history of cardiogenic disease.
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Case Report
Title
A Case of an Infant with Chilblain-like Acral Lesions and Positive Results of Anti-SARS-CoV-2 Antibodies
Author
Nozomi Toyama1) Takeshi Yamazaki1) Momo Chubachi1) Eriko Kudo1) Tomoshiro Ito1) Kinya Hatakeyama1) Yoko Hirano2) Satoko Shimizu2) Takahiro Tsuji3) and Hitomi Sano1)
1)Department of Pediatrics, Sapporo City General Hospital
2)Department of Dermatology, Sapporo City General Hospital
3)Department of Pathology, Sapporo City General Hospital
Abstract
In the COVID-19 pandemic, chilblain-like acral lesions were noted as one of the characteristic skin manifestations associated with COVID-19 and referred to as "COVID toes" due to the high frequency of its appearance. Other skin manifestations are often associated with relatively severe COVID-19, whereas COVID toes are usually observed in patients with asymptomatic or mild COVID-19 and skin rash resolves spontaneously. Most cases have been reported from North America, Europe and the United States. In Japan, a pediatric case of COVID toes has not been reported.
We present a case of an infant with chilblain-like acral lesions and suspected COVID-19 infection. The patient was an 8-month-old male infant. He presented to the hospital with a chief complaint of poor coloration of the extremities, dark purple macules and crusts on the fingers and toes. Blood tests showed elevated d-dimer levels and positive phosphatidylserine-dependent anti-prothrombin antibody. The SARS-CoV-2 nucleocapsid antibody was found to be elevated, suggesting a previous COVID-19 infection. The pathological findings obtained by skin biopsy indicated thrombi in small vessels in the shallow to deep dermis. These results were consistent with COVID toes. The patient received antithrombotic therapy and the skin manifestations improved. When a chilblain-like acral lesion without cold exposure is seen in a patient during a COVID-19 pandemic, COVID toes should be considered as a differential diagnosis.
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Case Report
Title
Intestinal Behçet's Disease with Aortic Regurgitation: A Pediatric Case Report and Review of the Literature
Author
Moeha Kaneuchi1) Ryusuke Nambu1) Makiko Nishioka2) Ami Suda3) Ayako Miyazawa1) Masashi Yoshida1) Tomoko Hara1) Yoshihiro Kurosawa3) Chikako Nakajima3) Kenji Hoshino2) and Itaru Iwama1)
1)Division of Gastroenterology and Hepatology, Saitama Children's Medical Center
2)Division of Cardiology, Saitama Children's Medical Center
3)Department of Pediatrics, Ageo Central General Hospital
Abstract
Aortic regurgitation (AR) is a known complication of Behçet's disease; however, it has rarely been reported in children. A 9-year-old girl, with a history of recurrent stomatitis and genital ulceration since childhood, was referred to us because of persistent abdominal pain, diarrhea, fever, and elevated CRP and ESR for 1 month. A pathergy reaction and a solitary ulcer of the terminal ileum were observed on Bauhin's valve upon performing lower gastrointestinal endoscopy, which led to the diagnosis of incomplete-type, intestinal Behçet's disease. A heart murmur was also noted at the time of diagnosis, and moderate asymptomatic AR was diagnosed via echocardiography. Based on the diagnosis of severe intestinal Behçet's disease, we administered adalimumab, a TNFα inhibitor, and her gastrointestinal symptoms and inflammatory marker levels promptly improved. Thereafter, the AR remained asymptomatic and stable, and early surgery could be avoided or postponed. According to previous reports, most cases of AR associated with Behçet's disease have resulted in early surgical intervention after diagnosis. This case suggests that early diagnosis before the onset of subjective symptoms or early intervention with TNFα inhibitors may delay (or avoid) the need for surgical treatment of AR associated with Behçet's disease. Previous reports have not shown any trend in the clinical features or types of Behçet's disease complicated with AR. Careful physical examination is required for the management of Behçet's disease, with particular attention to heart murmurs, regardless of the type of disease history or age of the patient.
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Brief Report
Title
Development of the Japanese Version of the Internet Gaming Disorder Scale-Short-Form and Its Usefulness
Author
Takeshi Inoue1) Shoko Morishita1) Ayako Shiihashi1) Tasuku Kitajima1) Naho Matsushima1) Yuji Oto2) Ryoko Otani1) Miho Higashi3) Mayumi Fuchigami1) Miyu Murayama1) Azusa Ogiso1) Jumpei Iwanami1) Yuki Yoshida1) Chie Kuroiwa1) and Ryoichi Sakuta1)
1)Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center
2)Department of Pediatrics, Dokkyo Medical University Saitama Medical Center
3)Department of Psychology-Graduate School of Human Relations, Keio University
Abstract
The Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) instrument was translated into Japanese, and the Japanese version (IGDS9-SF-J) was finalized after no discrepancies were found in the back translation compared to the original version. Using lifestyle and questionnaire tests (IGDS9-SF-J, SDQ, and QTA30), a cross-sectional study as the preliminary investigation was conducted among the students of a public junior high school in Saitama prefecture. In total, 278 of 340 students (81.8%) provided responses. The IGDS9-SF-J total score was 16.0±6.30, assessing the group differences between genders and the categories of hours monitored (Gaming, TV watching, etc.) and days absent. In addition, correlations were found on SDQ and QTA30 scales.
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