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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.128, No.1, January 2024
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Original Article
Title
Consideration of a Nosocomial Infection Case Caused by Mycobacterium abscessus
Author
Kiyoshi Takemoto1) Saori Kuratani1) Masahisa Funato1) Yoshitaka Iijima1) Tamami Katayama1) Atsuko Kashiwagi1) Natsuko Shiomi1) Aya Kajihara2) Shiomi Yoshida3) Kazunari Tsuyuguchi3) Jun Noda4) and Satoshi Mitarai5)
1)Department of Pediatrics, Osaka Developmental Rehabilitation Center
2)Department of Nursing, Osaka Developmental Rehabilitation Center
3)Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center
4)Rakuno Gakuen University Graduate school of Veterinary Medicine
5)Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association
Abstract
In the same ward of a medical facility for children with severe physical and intellectual disabilities, six bedridden children under tracheostomy management were found to have Mycobacterium abscessus isolated from their tracheal suction samples. The matching variable numbers of tandem repeats (VNTR) patterns strongly indicated the possibility of nosocomial infection. An investigation was conducted to determine the transmission route. The same bacterium was detected on the gloved hands of staff immediately after the patients' procedures, as well as on the bedside table, pressure adjustment dial of the suction apparatus, front panel of the ventilator, bed rails, and washbasin within the room. This strongly suggested environmental contamination around the patients and cross-infection through staff. The bacteria were not detected in medical equipment, tap water, or airborne aerosols. It was speculated that the compromised physiological barrier due to tracheostomy and the significantly reduced ability to cough caused by being bedridden might have contributed to a significant decline in airway clearance, thus playing a role in the establishment of cross-infection.
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Original Article
Title
Diagnosis and Treatment Selection of Acute Gastric Volvulus Based on Six Cases Experienced at Our Institution and Previously Reported Cases
Author
Akito Hattori1) Kaho Aoyama1) Osamu Sasaki1) Daisuke Suzuki1) Sadae Wakiguchi1) Masashi Minato2) Go Ohba2) Koji Okuhara1) Hidefumi Tonoki1) Hiroshi Yamamoto2) and Nobuhiro Takahashi1)
1)Department of Pediatrics, Tenshi Hospital
2)Department of Pediatric Surgery, Tenshi Hospital
Abstract
Acute short-axis gastric volvulus is a rare but potentially fatal condition, and early diagnosis is important. We retrospectively reviewed 6 cases of acute short-axis gastric volvulus treated in our hospital over the past 10 years. Four cases had accompanying anomalies such as diaphragmatic relaxation disorder and intestinal rotation abnormality or underlying diseases. The main symptom was vomiting. Borchardt's triad known as abdominal distension, difficulty in inserting a gastric tube, and vomiting without the presence of vomitus are characteristic of gastric volvulus. However, none of the cases exhibited all the symptoms at once. Gastric dilation on abdominal X-ray was detected in all cases, which was considered a characteristic finding. Upper gastrointestinal contrast studies were performed in all cases, and CT in 4 cases. When acute short-axis gastric volvulus is suspected, prompt gastric decompression is necessary to prevent perforation caused by gastric distension. Subsequent upper gastrointestinal contrast study can lead to the diagnosis even if the patient is stable and perforation is not suspected. CT examination and emergency surgery should be performed in patients who are strongly suspected to have developed gastric perforation. It is important to be aware that even in cases treated initially with conservative treatment or endoscopic reduction, recurrence is not rare, and surgery should be considered as the primary option.
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Case Report
Title
Multisystem Inflammatory Syndrome in Children Presenting with Cardiogenic Shock during the Acute Period after Close Contact with a COVID-19 Patient
Author
Keiya Nishikawa1) Takayuki Tanaka1) Jun Ishiduka1) Toshiki Miki1) Koji Nakajima1) Saki Otsuka1) Minoru Suehiro1) Tomoo Daifu1) Kazuhiro Akasugi1) Takahiro Mima1) Shuya Kaneko2) Masaki Shimizu2) and Yoshihisa Higuchi1)
1)Department of Pediatrics, Otsu Red Cross Hospital
2)Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
Abstract
Following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection outbreaks, reports of multisystem inflammatory syndrome in children (MIS-C) increased in Japan. MIS-C is associated with severe inflammation in multiple organs in children who had been infected with SARS-CoV-2. The typical interval between SARS-CoV-2 infection and the onset of MIS-C is about 1 month, and school-aged children are the most frequent patients. Here, we report a 1-year-old girl without a history of coronavirus disease 2019 (COVID-19) who developed fever and cardiogenic shock shortly after close exposure to a COVID-19 patient. Based on the surrounding epidemic situation and physical and laboratory findings, we successfully treated the patient with intravenous immunoglobulin and steroids in addition to cardiovascular care. MIS-C-targeted treatment may be effective for children who develop cardiogenic shock after close contact with a COVID-19 patient, even if the child is young and the interval between the exposure and the onset of symptoms is short.
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Case Report
Title
A Case of an Adolescent with Pediatric Graves' Disease Manifesting Weight Gain and Pretibial Edema
Author
Satomi Kondo Ikuma Musha Hiroshi Kawana Toru Kikuchi Akira Ohtake and Yuko Akioka
Department of Pediatrics, Saitama Medical University Hospital
Abstract
Children and adolescents with Graves' disease often show diffuse goiter, tachycardia, finger tremor, weight loss, and increased height, but rarely experience pretibial edema or weight gain. We present a case of Graves' disease in which the patient, a 14-year-old adolescent girl, presented with pretibial edema and weight gain. The patient had goiter, tachycardia, and marked pretibial edema upon presentation at our hospital. She had gained 3 kg in weight in the preceding 4 months. Markedly elevated levels of free-triiodothyronine and free-thyroxine levels were observed, while the thyroid-stimulating hormone (TSH) level was below 0.01 μIU/mL. Positive results were obtained for both TSH-receptor and thyroid-stimulating antibodies. Thyroid gland echography revealed goiter enlargement and increased blood flow, leading to a diagnosis of Graves' disease. Chest radiography revealed mild cardiac enlargement, but cardiac echography showed a normal ejection fraction with no apparent pericardial fluid retention or valvular abnormalities. No arrhythmias were detected on electrocardiography. Pharmacotherapy using thiamazole and β-blockers resulted in subsequent improvement of thyroid function and pretibial edema. We speculated that the pathology of this case was as follows: thyroid hormone excess increased cardiac output, activating the renin-angiotensin-aldosterone-system leading in turn to increased circulating plasma volume. The increase in circulating plasma volume exceeded the increase in cardiac output, resulting in fluid retention, subsequent weight gain, and pretibial edema. It should be noted that goiter and pretibial edema are not always indicative of hypothyroidism. Hyperthyroidism produces various physiological effects, and the presentation of symptoms can vary substantially between cases.
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Case Report
Title
Megaloblastic Anemia Caused by Child Neglect
Author
Yurie Yamaga1) Masahiko Kouroki1) Jiro Inagaki1) Toshiya Matsuishi1) Kensuke Moriyoshi2) Tetsuji Sato1) and Masahiro Yasui1)
1)Department of Pediatric Hematology/Oncology, Kitakyushu City Yahata Hospital
2)Department of Pediatrics, Kitakyushu City Yahata Hospital
Abstract
A 2-year-old girl was referred to our hospital by her family physician after she presented with loss of appetite and with pallor and weakness. Peripheral blood examination revealed macrocytic anemia and thrombocytopenia with hypersegmented neutrophils and erythrocytes of various sizes. Bone marrow examination revealed erythroblastic hyperplasia and megaloblastic change, large band-form nuclei, and hypersegmented neutrophils. Vitamin B12 and folate levels were also deficient; megaloblastic anemia was therefore diagnosed. Treatment comprised intravenous infusions of a multivitamin complex-containing electrolyte solution, and the patient showed rapid resolution of pancytopenia, increased appetite, and weight gain. Interviews with the family revealed extremely imbalanced diets. The care giver was unable to provide proper meals for the child. We suspected child neglect and contacted a local child welfare agency. In this case, the vitamin deficiency was caused by child neglect, which is rarely reported as a cause of megaloblastic anemia. Megaloblastic anemia and pancytopenia may manifest concurrently. Patients presenting with pancytopenia should be investigated for hematological malignancies. However, if megaloblastic anemia is the cause of the pancytopenia, the patient's nutritional and social environment should be assessed. The physician must inform child protective services in cases where maltreatment is suspected.
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Case Report
Title
The Potential of Nasal High-Flow Therapy during Interhospital Transport: Experience of a Pediatric Case with Acute Respiratory Failure
Author
Shinya Miura1) Yoshihiro Igarashi2) Tadahito Kato1) and Atsushi Kawaguchi1)
1)Department of Pediatrics, St. Marianna University School of Medicine
2)Department of Clinical Engineering and Technology, St. Marianna University of Medical Sciences
Abstract
Providing appropriate respiratory support according to the severity of the acute respiratory failure is crucial. In recent years, nasal high-flow therapy has been increasingly used in pediatric intensive care units, pediatric wards, and emergency departments due to its effectiveness and simplicity as a first-line respiratory support for children with acute respiratory failure. In particular, when using nasal high-flow therapy for children with acute respiratory failure in pediatric wards, patients may be transferred between hospitals for pediatric intensive care and monitoring in preparation for the possible escalation of respiratory support. In other countries, nasal high-flow therapy is recognized as one of the respiratory support options during interhospital transport, and a system for providing "seamless" respiratory intensive care has been adopted. In contrast, there are few reports on nasal high-flow therapy during interhospital transport in Japan, and discussions on the challenges, effectiveness, and roles of the implementation have not progressed. In this case, a child with bronchial asthma-like symptoms experienced worsening respiratory status and level of consciousness despite asthma medications and high-flow nasal therapy in the pediatric ward, and was transferred to a pediatric intensive care unit on high-flow nasal therapy. After transport, the patient did not require subsequent escalation of respiratory support as high-flow nasal therapy and asthma management were seamlessly continued and intensified. By introducing high-flow nasal therapy during interhospital transport in Japan, appropriate respiratory support can be provided seamlessly according to the severity of the patient, similar to patients treated in pediatric intensive care units.
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