Search

Air pollution is associated with the prevalence of respiratory diseases. This study aimed to evaluate the impacts of outdoor air pollutants and indoorThis study recruited 59 atopic mild-to-moderate asthmatic children and 23 atopic non-asthmatic children. Data on personal characteristics, FeNO, EBC pH, and pulmonary function were collected. Group 1 allergens ofExposure levels of outdoor air pollutants, except for particulate matter (PM)Outdoor PM

Checklists are usually employed to assess the inhalation techniques in patients, but partial techniques are difficult to evaluate visually. This study aimed to assess the checklist validity and an agreement between checklists and an aerosol inhalation monitor (AIM) assessments.This study used a checklist and an AIM to evaluate the participants' inhalation techniques with a pressurized metered-dose inhaler (MDI) and two dry powder inhalers (DPIs). The kappa (κ) coefficient, prevalence-adjusted and bias-adjusted κ (PABAK), sensitivity, specificity, positive predictive value, and negative predictive value were all calculated to determine the agreement between the checklist and AIM in an MDI and DPIs with different inhalation technique steps.The checklist and AIM exhibited poor agreement in the MDI for actuation and inhalation time, and a moderate agreement for inspiratory flow. The fair agreement was observed in DPIs for inspiratory flow between the checklist and AIM. The steps of holding breath in MDI and DPIs were highly correlated between both assessments. The lowest accuracy evaluated with an AIM was found in the step of actuation and inhalation time in the MDI and in the inspiratory flow step in DPIs.The checklist tended to overestimate the accuracy of critical techniques including the actuation and inhalation time in MDIs and the inspiratory flow in DPIs. Thus, the AIM device can be used as an objective auxiliary tool to assess and quantify the specific steps of inhalation technique for the users with MDI and DPIs.

Background/Aims: Atopic dermatitis (AD) is a common disease in infancy, for which topical steroids are the first-line therapy but have side effects. Innovative approaches are needed to reduce the burden of AD and corticosteroid usage in infants. Methods: The once-daily consumption of heat-treated probiotic Lactobacillus paracasei GM-080 or placebo for 16 weeks as supplementary approach to topical treatment with fluticasone propionate cream was compared in AD infants aged 4–30 months. Outcomes were SCORAD and its subscores, TEWL, Infants’ Dermatitis Quality of Life Index (IDQOL), corticoid “sparing effect,” CCL17/TARC, and IgE status. Results: SCORAD, objective SCORAD, itching, and IDQOL decreased significantly (p < 0.001) over the treatment period in both treatment groups. Slight decreases (ns) were noted in TEWL in lesional and unaffected skin and CCL17 levels. There were no differences between the treatment groups. Total IgE increased over the treatment period in both groups, with significantly higher increase in the heat-treated probiotic group (p = 0.038). There was no evidence of a corticoid “sparing effect” by the probiotic. Conclusions: In this design, the probiotic L. paracasei was not beneficial as a complementary approach to topical corticosteroids in infants with AD. However, slight beneficial effects may have been masked by the moderate potency corticoid.

Background: Correct inhalation techniques are essential for optimum delivery of drugs to the airways for patients with asthma and chronic obstructive pulmonary disorder. Checklists often are used to assess the techniques, but the validity of checklists is unknown and few studies have been conducted to date. We investigated the validity and reliability of checklists.Methods: A prospective, observational study was conducted at a tertiary care teaching hospital in Taiwan using an objective tool, the aerosol inhalation monitor (AIM). Inhalation techniques using pressurized metered-dose inhalers (pMDIs) were assessed by checklist and AIM. The κ coefficient and prevalence and bias-adjusted κ (PABAK) were calculated to determine the consistency between the checklist and AIM in four specific techniques, including actuation, inspiratory flow, inhalation time, and breath hold time. Sensitivity and specificity were used to evaluate the validity of the checklist using these techniques.Results: The κ and PABAK values were −0.023 and −0.176 for actuation, 0.43 and 0.529 for inspiratory flow, −0.046 and −0.412 for inhalation time, and 0.12 and 0.686 for breath hold time, respectively. Sensitivity and specificity for the four individual steps were 0.706 versus 0.265, 0.833 versus 0.600, 1 versus 0.1, and 0.955 versus 0.143, respectively.Conclusion: Our results invalidate use of the checklist alone as a reliable tool to assess inhalation techniques. The low specificity indicates that the checklist tends to overestimate the accuracy of inhalation techniques. AIM can be added as an objective tool to assess and quantify specific steps for MDIs.

Background Diagnosing intestinal strangulation as a complication of small bowel obstruction (SBO) remains a considerable challenge in children. We evaluated the clinicoradiological parameters for predicting the presence of a strangulated intestine. Methods We reviewed the medical records of 69 pediatric patients who underwent operation for acute SBO. Regression analysis was used to identify the parameters for predicting strangulated SBO. Results Of the 69 patients with SBO, 27 patients had intestinal strangulation and were awarded one point each towards the overall clinical score: intractable continuous abdominal pain, tachycardia, white blood cell count >13,600/mm 3 , and abdominal distention. Patients with a clinical score ≥2 combined with the presence of ascites in ultrasound (US) results or with wall thickness and reduced wall contrast enhancement in abdominal computed tomography (CT) scans showed strong evidence for intestinal strangulation. Conclusion The combination of two or more clinical parameters, including intractable continuous abdominal pain, tachycardia, leukocytosis, and abdominal distention with the presence of ascites in US or wall thickness and reduced wall contrast enhancement in, is useful for the identification of strangulated SBO. The type of study and level of evidence Prognosis study; Level III.

Atopic dermatitis (AD) is a common disease in infancy, for which topical steroids are the first-line therapy but have side effects. Innovative approaches are needed to reduce the burden of AD and corticosteroid usage in infants.The once-daily consumption of heat-treated probiotic Lactobacillus paracasei GM-080 or placebo for 16 weeks as supplementary approach to topical treatment with fluticasone propionate cream was compared in AD infants aged 4-30 months. Outcomes were SCORAD and its subscores, TEWL, Infants' Dermatitis Quality of Life Index (IDQOL), corticoid "sparing effect," CCL17/TARC, and IgE status.SCORAD, objective SCORAD, itching, and IDQOL decreased significantly (p0.001) over the treatment period in both treatment groups. Slight decreases (ns) were noted in TEWL in lesional and unaffected skin and CCL17 levels. There were no differences between the treatment groups. Total IgE increased over the treatment period in both groups, with significantly higher increase in the heat-treated probiotic group (p = 0.038). There was no evidence of a corticoid "sparing effect" by the probiotic.In this design, the probiotic L. paracasei was not beneficial as a complementary approach to topical corticosteroids in infants with AD. However, slight beneficial effects may have been masked by the moderate potency corticoid.

CD4(+)CD25(+) regulatory T cells (Treg), if properly expanded from umbilical cord blood (UCB), may provide a promising immunotherapeutic tool. Our previous data demonstrated that UCB CD4(+)CD25(+) T cells with 4-day stimulation have comparable phenotypes and suppressive function to that of adult peripheral blood (APB) CD4(+)CD25(+) T cells. We further examined whether 2-week culture would achieve higher expansion levels of Tregs. UCB CD4(+)CD25(+) T cells and their APB counterparts were stimulated with anti-CD3/anti-CD28 in the presence of IL-2 or IL-15 for 2 weeks. The cell proliferation and forkhead box P3 (FoxP3) expression were examined. The function of the expanded cells was then investigated by suppressive assay. IL-21 was applied to study whether it counteracts the function of UCB and APB CD4(+)CD25(+) T cells. The results indicate that UCB CD4(+)CD25(+) T cells expanded much better than their APB counterparts. IL-2 was superior to expand UCB and APB Tregs for 2 weeks than IL-15. FoxP3 expression which peaked on Day 10-14 was comparable. Most importantly, expanded UCB Tregs showed greater suppressive function in allogeneic mixed lymphocyte reaction. The addition of IL-21, however, counteracted the suppressive function of expanded UCB and APB Tregs. The results support using UCB as a source of Treg cells.

Background: To analyze the major health problems and trends among hospitalized children in a medical center in the 10 years period. Methods: We retrospectively reviewed all records of patients younger than 18 years who admitted to the Chang Gung Memorial’s Hospital between January 1, 2003, and December 31, 2012. The study was composed of categories about the diagnosis, age and gender. We collected and utilized data to examine the leading diagnostic categories and trends by age in the 10 years period. Results: Children had age differences among hospitalized diagnoses categories. Prematurity or condition from the perinatal periods and congenital anomaly were the top two hospitalized disease categories in newborn. Acute respiratory tract infection was the major diagnoses category in infant. Acute intestinal infectious disease was the top diagnosis in children aged between 1 to 2 years old. Pneumonia was leading diagnoses of children aged in 2 to 6 years and in 6 to 12 years. Fracture was the leading cause of adolescents aged in 12 to 18 years. Congenital anomaly decrease in infant stage but pneumonia still threatened children aged in 2 to 6 years and 6 to 12 years. Conclusions: The characteristics of major health problems were different among age variables in children. All health promotion programs and policies should effectively provide the respective services and measure the outcome efficiently.

Azithromycin (AZM), a macrolide antibiotic for treating mycoplasma infections, may exhibit anti-inflammatory activity aside from its antimicrobial effect, providing additional therapeutic benefit. Natural killer (NK) cells, a first-line innate immune defense against microbial invasions, paradoxically exert a detrimental effect in protecting mycoplasma infection. Little was known regarding the effect of AZM on NK cells. In the present study, we investigated the ability of azithromycin to influence natural killer (NK) cell function with regard to activation, apoptosis and cytotoxic function. AZM had little effect on NK receptor expression and cytotoxic function of NK-92 cells. However, AZM did show a dose-dependent suppression on IL-15-induced CD69 expression of primary NK cells. AZM inhibited the cytotoxicity against K562 cells of resting and IL-15 activated primary NK cells possibly through down-regulation of perforin expression, especially on CD16(+)CD56(+) NK subsets. AZM exerted a dose-dependent inhibition of IFN-gamma and TNF-alpha production from NK-92 cells, but did not affect the cytokine production of IL-15 activated primary NK cells. Taken together, AZM down-regulates NK cytotoxicity and cytokine production and may provide therapeutic benefits aside from its antimicrobial activity.

Because of its easier accessibility and less severe graft-versus-host disease, umbilical cord blood (UCB) has been increasingly used as an alternative to bone marrow for hematopoietic stem cell transplantation. Naiveté of UCB lymphocytes, however, results in delayed immune reconstitution and infection-related mortality in transplant recipients. This review updates the phenotypic and functional deficiencies of various immune cell populations in UCB compared with their adult counterparts and discusses clinical implications and possible therapeutic strategies to improve the outcome of stem cell transplantation.

Aim: To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children. Methods: This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis. Results: There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis. Conclusions: Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.

Owing to its easier accessibility and less severe graft-versus-host disease, umbilical cord blood (UCB) has been increasingly used as an alternative to bone marrow for hematopoietic stem-cell transplantation. Naiveté of UCB lymphocytes, however, results in delayed immune reconstitution and infection-related mortality in transplant recipients. This article reviews UCB immunology and addresses the potential therapeutic role of interleukin (IL)-15, a pleiotropic gamma chain signaling cytokine, in modulating immune reconstitution, graft-versus-host disease (GVHD), graft-versus-leukemia effect, and infection susceptibility during the post-UCB transplant period. Cytokine immunotherapy using IL-15 simultaneously modulates several immune compartments, thus holds promise for facilitating post-transplant recovery and augmenting antitumor effect without aggravating GVHD in the setting of UCB transplantation.

We conducted a study during an outbreak of coxsackievirus B3 infection in 2005 and found that viral RNA could be detected in patients' blood specimens soon after the onset of fever, and the level of viral RNA was positively correlated with disease severity. Timely diagnosis is possible in severe neonatal enterovirus infection.

Background The prevalence of asthma and allergic diseases in children has increased worldwide. Objective To perform the phase 3 survey of the International Study of Asthma and Allergies in Children (ISAAC) to report the time trend of the prevalence and severity of asthma and allergic diseases in children in Taipei. Methods Two junior high schools in each of the 12 school districts in Taipei were randomly chosen to enter the study. All students aged 13 to 14 years in the chosen schools were invited to participate in written and video questionnaires in Chinese (identical to those of the ISAAC phase 1 survey). The study was performed between December 1, 2001, and January 31, 2002. All data analysis followed the protocol of the ISAAC and then was submitted to the ISAAC International Data Center. Results Of 6,653 eligible children from 23 high schools (1 school refused participation), 6,381 (95.9%) participated. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in the past 12 months in 13- to 14-year-old children increased by 37%, 51%, and 193%, respectively, on written questionnaires during a 7-year period. The severity of asthma symptoms, including more than 4 wheezing attacks in the past 12 months, wheezing that disturbs sleep more than once per week, and wheezing that limited speech in the past 12 months, did not show any significant changes on written questionnaires during the 7 years. Conclusion The increasing prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in 13- to 14-year-old children in Taipei in a 7-year period is a significant burden on public health systems in Taiwan.

The use of the Glasgow Coma Scale may be limited by the experience of physicians, errors resulting from subjectivity, the inability of patients to respond, and discontinuity. This study demonstrates that the Bispectral Index scores correlate well with scores from the Glasgow Coma Scale and that Bispectral Index scores can provide real-time, objective, and continuous monitoring of the consciousness level of critically ill children. Sixteen patients with consciousness disturbance, who were admitted to a pediatric intensive care unit of a tertiary university-affiliated children's hospital, were enrolled in this study. The patients received 34 Glasgow Coma Scale assessments and Bispectral Index scores. The age of patients ranged from 10 to 192 months (mean +/- S.E. = 68.4 +/- 12.3 months). Glasgow Coma Scale ranged from 3 to 11 (mean +/- S.E. = 6.3 +/- 0.4), and Bispectral Index score ranged from 0 to 100 (mean +/- S.E. = 55.4 +/- 5.6). A positive correlation was found to exist between Glasgow Coma Scale and Bispectral Index score (r = 0.76, P < 0.001). In conclusion, the Bispectral Index score correlates well with the Glasgow Coma Scale in critically ill children who score between 3 and 11 on the Glasgow Coma Scale.

Background: RANTES promoter polymorphisms were found associated with asthma/atopy in some studies but not others, possibly reflecting the genetic heterogeneity among different ethnicities and different asthma severity. Objective: The purpose of this investigation was to test the genetic association between the RANTES −28C/G and −403G/A polymorphisms and asthma/atopy in a cohort of Chinese children, with particular emphasis on those patients who had experienced life-threatening asthma attacks. Methods: Forty-eight children with near-fatal asthma, 134 children with mild-to-moderate asthma, 69 children with allergic disorders but no asthma, and 107 nonasthmatic nonatopic control children were genotyped through use of a PCR-based assay. Results: No significant difference was demonstrated for frequency of the RANTES −28C/G polymorphism when the mild-to-moderate asthma, atopic/nonasthmatic, and normal control groups were compared. The RANTES −28G allele was present in a significantly higher proportion of the children with near-fatal asthma compared with the nonasthmatic nonatopic controls (odds ratio, 2.93 [1.41-6.06]; P = .006) and the children with mild-to-moderate asthma (odds ratio, 3.52 [1.73-7.16]; P = .001). The frequency of −28G allele carriage correlated with asthma severity. The RANTES −28G allele was also associated with an increased blood eosinophil count and a higher degree of bronchial hyperresponsiveness. The RANTES −403G/A polymorphism did not influence asthma/atopy susceptibility, blood eosinophil count, or bronchial hyperresponsiveness. Interestingly, a higher frequency of −403A allele carriage was observed in the moderate asthma subgroup compared with the mild asthma analog. Conclusions: We conclude that the RANTES −28C/G polymorphism exacerbates asthma severity, representing a genetic risk factor for life-threatening asthma attacks in Chinese children. In addition, the linkage disequilibrium between these 2 polymorphisms is a potential confounder that must be considered in the design and interpretation of RANTES gene association studies. (J Allergy Clin Immunol 2003;111:1285-92.)

The decreased incidence of graft-vs.-host disease found following umbilical cord blood (CB) transplantation, and the increased susceptibility of newborns to infections, have been attributed, in part, to functional and phenotypic immaturity of neonatal T cells. We investigated the phenotypic changes of CB T cells induced by two immunoregulary cytokines, interleukin (IL)-12 and IL-15, alone or in combination. Adult peripheral blood (APB) mononuclear cells (MNCs) were also tested for comparison. Prior to culture, the percentages of CD3 + CD8 + , CD3 + CD25 + , and CD3 + CD56 + cells were significantly lower in CB MNCs than in APB MNCs. IL-15, but not IL-12. significantly increased CD3 + CD8 + expression among the CB MNCs after 1 week of culture. Combining IL-12 and IL-15, however, resulted in decreased CB CD3 + CD8 + expression compared with IL-15 alone. The percentage of CD3 + CD25 + cells in CB MNCs spontaneously increased in the absence of cytokines, while that of CD3 + CD56 + cells in CB MNCs could not be enhanced with cytokines. In contrast, the percentages of CD3 + CD25 + and CD3 + CD56 + cells among the APB MNCs could be increased with IL-12, IL-15, and further with IL-12 and IL-15 combined. Thus, different patterns of T-cell subset changes were demonstrated between CB MNCs and APB MNCs in response to IL-12 and/or IL-15. These data may serve as a foundation for using cytokine therapy in newborns and children receiving CB transplants.

(2001). IDIOPATHIC CD4+ T LYMPHOCYTOPENIA IN TWO SIBLINGS. Pediatric Hematology and Oncology: Vol. 18, No. 2, pp. 153-156.

We investigated the influence of atopy as determined by allergen-specific IgE and concomitant sinusitis on serum eosinophil cationic protein (S-ECP) levels in 62 newly diagnosed asthmatic children at exacerbation. Children with atopic asthma had higher S-ECP levels (37.9 ± 5.5 μg/L) as compared to those with nonatopic asthma (8.8 ± 2.1 μg/L, p < 0.01) and controls (6.7 ± 1.1 μg/L,p < 0.01). Neither S-ECP levels nor absolute eosinophil counts (AEC) in peripheral blood correlated with % predicted forced expiratory volume in one second (% FEV1 in children with atopic asthma. In asthmatic children with atopy, there is no difference of % FEV1, serum total IgE levels, and AEC between those who also had sinusitis and those who did not. However, S-ECP levels were significantly higher in asthmatic children with concomitant sinusitis, compared to those without, in atopic children (49.5 ± 8.0 μg/L vs. 22.9 ± 5.9 μg/L, p < 0.01), and in nonatopic children alike (15.1 ± 3.0 μg/L vs. 6.7 ± 1.5 μg/L,p = 0.012)....

Endotoxin, a component of the cell walls of gram-negative bacteria, is a contaminant in organic dusts (house dust) and aerosols. In humans, small amounts of endotoxin may cause a local inflammatory response. Exhaled nitric oxide (eNO) levels, an inflammation indicator, are associated with the pH values of exhaled breath condensate (EBC). This study evaluated seasonal changes on indoor endotoxin concentrations in homes and the relationships between endotoxin exposure and eNO/EBC pH levels for healthy children and children with allergy-related respiratory diseases. In total, 34 children with allergy-related respiratory diseases and 24 healthy children were enrolled. Indoor air quality measurements and dust sample analysis for endotoxin were conducted once each season inside 58 surveyed homes. The eNO, EBC pH levels, and pulmonary function of the children were also determined. The highest endotoxin concentrations were on kitchen floors of homes of children with allergy-related respiratory diseases and healthy children, and on bedroom floors of homes of asthmatic children and healthy children. Seasonal changes existed in endotoxin concentrations in dust samples from homes of children with allergic rhinitis, with or without asthma, and in EBC pH values among healthy children and those with allergy-related respiratory diseases. Strong relationships existed between endotoxin exposure and EBC pH values in children with allergic rhinitis.

This study examined seasonal changes in indoor Dermatophagoides pteronyssinus 1 (Der p 1)/Blattella germanica 1 (Bla g 1) antigen concentrations in the homes of atopic asthmatic and atopic nonasthmatic children. Possible associations between environmental allergen exposure and levels of exhaled breath indices were also evaluated. A total of 38 atopic children were recruited for this cross-sectional study: 22 were asthmatic and 16 were nonasthmatic. Home visits were conducted for indoor air and dust sampling each season. Exhaled nitric oxide (eNO)/spirometric measurements were taken and exhaled breath condensate (EBC) was collected after sampling of the domestic environment. The highest Der p 1 concentrations were on the top of mattresses in the homes of recruited children. The floors of kitchens and living rooms had the highest Bla g 1 concentrations in the homes of atopic asthmatic children. A positive correlation was found between Der p 1 exposure of mattress, bedroom floor, and living room floor and eNO levels in the atopic asthmatic children. The Der p 1 concentrations on the surfaces of mattress and bedroom floor were positively related to high eNO levels in the atopic asthmatic children after adjusting for season. No association was found between Der p 1 exposure and EBC pH values in the recruited children. A positive correlation was found between Der p 1 exposure and high eNO levels in atopic asthmatic children, especially in Der p 1 exposure of mattress and bedroom floor.

Cysteinyl leukotrienes are important mediators of airway inflammation, whereas 8-isoprostane is a biomarker of oxidative stress. This study evaluated the distributions of cysteinyl leukotriene and 8-isoprostane concentrations in exhaled breath condensates (EBCs) of children. The relationship between cysteinyl leukotriene and 8-isoprostane concentrations in the EBCs was also evaluated.The EBCs were collected from 34 children with allergic respiratory diseases and 24 healthy children. All recruited children underwent pulmonary function testing every season. The severity of allergic respiratory diseases and medication status were assessed every month in children with allergic respiratory diseases.The EBC cysteinyl leukotriene and 8-isoprostane levels were higher in children with asthma and allergic rhinitis than in those with asthma only and healthy children. In asthmatic children, cysteinyl leukotriene and 8-isoprostane levels peaked in the summer. All children showed a clear association between EBC cysteinyl leukotriene and EBC 8-isoprostane levels.The cysteinyl leukotriene and 8-isoprostane concentrations in the EBCs of children significantly varied by season. Oxidative stress correlated with airway inflammation in children.

BackgroundAlthough ultrasound is often the preferred pediatric imaging modality for the evaluation of intussusception in children, many institutions lack access to ultrasound at night. This study characterized the day- and nighttime use of radiographic imaging for evaluation of intussusception.MethodsThe charts of pediatric patients evaluated for intussusception between January 2010 and December 2010 were reviewed retrospectively to evaluate the day- and nighttime use of radiographic imaging. Patients were stratified into day and night groups according to when the imaging studies were performed, and differences in the clinical characteristics, imaging studies, cost, and final diagnosis were compared.ResultsPediatric consultations were performed for 86 suspected intussusceptions: 40 (46.5%) during the day [38 (95%) ultrasounds and 33 (82.5%) plain abdominal X-rays] and 46 at night [3 (6.5%) computed tomography and 39 (84.7%) plain abdominal X-rays]. The rate of positive enemas was significantly higher during the day than at night (97.5% vs. 52.2%, p

To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children.This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis.There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis.Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.

To identify clinical features that distinguish children with appendicitis who visited the emergency department twice or more from those diagnosed on the first visit to the emergency department.A retrospective review of all children with appendicitis diagnosed in the emergency department between January and December 2004 was conducted. Records were reviewed for all patients on their initial presentation to the emergency department. Clinical features were compared between those children who were misdiagnosed and those who were diagnosed correctly.One hundred seventy-three cases were included (mean age, 10.4 years). Twenty-six (15%) were seen twice or more in the emergency department before appendicitis was diagnosed. Misdiagnosed patients had a relatively shorter duration of symptoms at their initial visit, and most presented late at night. Eighteen misdiagnosed patients (69.2%) initially visited the emergency department within 24 hours of onset of symptoms. Compared with patients diagnosed correctly on initial presentation, misdiagnosed patients had a significantly shorter hospital stay, fewer laboratory tests, and fewer physical findings of right lower quadrant tenderness, muscle guarding, rebound tenderness, fever, and migrating pain. Patients diagnosed late at night had a significantly shorter hospital stay and fewer abdominal ultrasound evaluations. On final presentation, initially misdiagnosed patients had a higher rate of appendiceal perforation than did correctly diagnosed patients.Misdiagnosed appendicitis is a problem in the emergency department. A shorter stay in the emergency department, fewer laboratory tests, less diagnostic imaging, and fewer physical findings may be responsible for misdiagnosed appendicitis late at night in the emergency department.

Background: Childhood asthma is a type 2 helper T (Th2) cell-driven inflammatory airway disease characterized by recurrent episodes of airway obstruction. Azithromycin (AZM), a macrolide antibiotic exhibiting anti-inflammatory activity aside from its antibacterial effect, may prove beneficial for asthmatic children. This study aimed to determine the effect of AZM on Th2 cells from atopic asthmatic children and non-atopic controls. Methods: CD4+ cells were isolated from peripheral blood mononuclear cells of 9 patients with asthma and 9 non-atopic individuals. Cells were activated as Th0 and differentiated into Th2 cells. The effect of AZM on activated CD4+ cells was evaluated with respective cell proliferation and cytokine production. Results: Th0 and Th2 CD4+ T cells from atopic asthmatic children produced greater interleukin (IL)-5 (Th2 cytokine) but lower interferon (IFN)-γ (Th1 cytokine) compared to the non-atopic controls, respectively. AZM inhibited IL-5 production of Th0 and Th2 cells from atopic asthmatics in a dose-dependent fashion, without significantly affecting their IL-13 and IFN-γ production. A similar effect was observed in non-atopic controls except that AZM did inhibit IFN-γ production of their Th0 cells. AZM at a higher dose decreased cell viability by inhibiting CD4+ T cell proliferation and enhanced their apoptosis, an effect similarly observed in Th0 and Th2 cells, and did not differ between asthmatic children and controls. Conclusion: Our finding that AZM preferentially downregulates IL-5 production suggests its therapeutic potentials in controlling childhood asthma.

Publisher Summary The prevalence of allergic disease has dramatically increased worldwide in the past 20 years. Allergic diseases are characterized by abnormal inflammatory responses to allergens with a bias towards T-helper type-2 cytokine production. Natural killer (NK) cells have been conventionally associated with immune surveillance of tumor cells as well as anti-viral defence. However, recent advances in phenotypic and functional characterization of NK cells support their capacity to regulate the immune response to allergens. NK cells play a role in the pathogenesis of allergic inflammation through their interaction with dendritic cells (DCs) and T cells. They potentially are also involved in two of the most commonly encountered allergic diseases: asthma and atopic dermatitis (AD). The role of NK cells in allergy remains elusive. NK cells are large granular lymphocytes that play a crucial role in innate immunity due to their cytotoxic ability to destroy virus-infected cells and tumor cells. NK cells may modulate allergic responses through their interactions with DCs, which are important cells in initiating and shaping adaptive immune responses. NK cells have been found in close contact with DCs in lesions of allergen-induced atopic eczema. NK cells lyse immature DCs, and this function appears to require pathogen-dependent activation of both NK cells and Dcs. NK cells may facilitate the development of eosinophilic airway inflammation and participate in IgE-mediated allergic response. On the other hand, deficiency of certain NK subsets with regulatory function may promote a highly polarized Th2 response characteristic of allergy. Further elucidation of the pathogenic mechanisms of NK cells in allergic diseases may provide insight in designing novel therapeutic approaches.

SummaryPneumococcal meningitis causes high morbidity or mortality in childhood despite the progress inmedicine. Children with pneumococcal meningitis were identified and retrospectively reviewed. Forty-nine children were eligible, with mortality in 24.5% of all and neurological sequelae in 40.5% ofsurvivors. In the analysis of clinical profiles, ventilator support (p^0.001), septic shock (p_0.001),multiple organ failure (p_0.001) and lower cerebrospinal fluid (CSF) leukocyte count (p¼0.001) weremore frequently found in non-survivors. Besides, CSF protein (p^0.006) was higher in survivors withneurological sequelae. Initial dexamethasone usage and disease severity did not affect the occurrence ofneurological sequelae. Multivariate logistic regression analysis revealed that CSF leukocyte count·200mm 2 3 (p^0.013) and protein level ¸330gl 1 (p^0.022) were significantly risk factorsassociated with poor outcomes, and physicians should be cautious if such conditions occur.Key words: meningitis, Streptococcus pneumoniae, children, outcomes.IntroductionStreptococcus pneumoniae is the most commonpathogen of bacterial meningitis in children beyondthe neonatal period [1–3]. Despite continuingimprovements in antibiotic therapy, pneumococcalmeningitis still causes high morbidity or evenmortality in childhood, with fatality rates as high as20% [2, 4, 5].Recently, patients with suspected pneumococcalmeningitis were treated with penicillin or extended-spectrum cephalosporins; however, resistance toantibiotics has complicated the management ofinvasive S. pneumoniae infections, with more andmore reports of treatment failure in the useof penicillin or extended-spectrum cephalosporins[6–11]. Therefore, the American Academy ofPediatrics recommends vancomycin in addition toan extended-spectrum cephalosporin for treatment ofsuspected pneumococcal meningitis [12].However, there is little evidence that the use ofvancomycin improved clinical outcomes of invasivedisease caused by drug-resistant S. pneumoniae andseveral studies have not demonstrated differencesin outcomes of patients with meningitis caused bynon-susceptible pneumococci compared with thoseinfected with susceptible organisms [11, 13–16].Therefore, it seems that the results of high morbidityand mortality were not influenced by the antibioticsusceptibility of the pneumococci and factors relatedto poor clinical outcomes are needed to be furtherinvestigated.We conducted a retrospective review of childrenwith meningitis caused by S. pneumoniae. Thepurpose of our study was to characterize the clinicalfeatures of pneumococcal meningitis. In addition, theassociation between clinical parameters and pooroutcomes such as neurological sequelae or evenmortality were also evaluated.Materials and MethodsFrom January 1984 to December 2002, patients518years of age with pneumococcal meningitis admittedto Chang Gung Children’s Hospital were included inthis study. Pneumococcal meningitis was defined asisolation of S. pneumoniae from cerebrospinal fluid

Adnexal torsion is an acute abdominal condition often confused with other diseases in children. The objective of this study is to evaluate the diagnosis and characteristics of adnexal torsion in children.We reviewed the medical records of all cases of children whose adnexal torsion diagnosis was proven by surgery from 1992 to 2005. Neonatal cases were excluded.A total of 49 cases were included in this study, with a mean age of 12.5 years. Sixteen (32.6%) cases were premenarchal girls, who were more likely to have adnexal torsion missed at first clinical diagnosis when compared with postmenarchal girls (P = 0.032). Presenting symptoms included severe abdominal pain (32%) and a history of recurrent pain of more than 2 weeks (14.2%). Abdominal gray-scale ultrasound (US) in 43 patients revealed 41 cases that were suggestive of ovarian pathology and identified 3 torsions. Seventeen patients had both US and abdominal computed tomography, but no definitive adnexal torsion was diagnosed with the combined studies. When multiple radiographic studies were used, there was a significantly longer time from studies to operation as compared with US alone.Ultrasound usually plays an important, but not definitive, role in diagnosis. Multiple radiographic studies with combined computed tomography and US did not provide a diagnostic advantage over US alone. Most pediatric adnexal torsion occurs in postmenarchal patients, but the potential exists for this diagnosis in premenarchal girls. Adnexal torsion should be considered in any girl with an abdominal mass and any degree of abdominal pain.

Acute appendicitis is an uncommon diagnosis in early childhood. It is frequently complicated by delays in diagnosis, perforation, and prolonged hospital stay. The aim of this study was to evaluate the usefulness of ultrasonography (US) in the management of suspected appendicitis in children younger than 3 years of age.Seventy-one children under age 3 with acute abdomen and possible acute appendicitis, but with atypical findings, were included. All of the children underwent a US scan to rule out appendicitis.There were 41 positive US results for appendicitis. Three children had false-positive scan results and 2 children had false-negative results. Twenty-eight patients had ruptured appendicitis with tumor formation on US. Eighteen of the 28 patients received emergency appendectomy and the other 10 patients received initial conservative treatment with interval appendectomy. Compared with those who received emergency appendectomy, patients who received initial conservative treatment had a significantly smoother postoperative course, including shorter postoperative hospital stay and earlier postoperative oral intake. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of abdominal US to diagnose acute appendicitis in cases of atypical findings in early childhood are 95.0%, 90.3%, 92.9%, 92.6%, and 93.3%, respectively.US is a useful and highly accurate tool to assess acute appendicitis in early childhood. US has the potential to aid in diagnosis of early childhood appendicitis to avoid the frequent rupture with tumor formation seen at this age. Initial conservative treatment for ruptured appendicitis with tumor formation is safe and is associated with a smoother postoperative course in early childhood.

To compare differences between clinical features and outcome in bacterial meningitis caused by penicillin-susceptible Streptococcus pneumoniae (PSSP) with that caused by penicillin-non-susceptible Streptococcus pneumoniae (PNSP).All patients18 yrs hospitalised with pneumococcal meningitis between January 1984 and December 2002 at Chang Gung Children's Hospital, Taipei were reviewed retrospectively.There were 28 PNSP (63.6%) and 16 PSSP cases of meningitis eligible for the study. The incidence of PNSP meningitis increased significantly over the 8-yr period (p = 0.007). Age4 yrs (78.6% vs 50%), a lower initial white blood count (mean 11.7 vs 19.9 x10(9)/L), admission to the intensive care unit (70.4% vs 50%) and mortality (28.6% vs 6.3%) were more common in the PNSP group. However, the only significant finding was a lower proportion of polymorphic neutrophils in the CSF of the PNSP meningitis group (p = 0.04).There was an increase in PNSP isolates from patients with meningitis over the 8-yr study period. No major differences were observed in clinical or laboratory features or outcome between the PSSP and PNSP groups.

Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.

Interleukin(IL)-15 is a promising immunotherapeutic agent for immune reconstitution following stem cell transplantation. To investigate whether IL-15 would aggravate graft-versus-host disease (GVHD) in the setting of unrelated umbilical cord blood (CB) transplantation, we examined the effect of IL-15 on activation marker expression, proliferation and cytokine production of CB in a one-way mixed lymphocyte culture (MLC) assay. We found that IL-15 differentially enhanced CD69 and CD25 expression on CB T cells following allo-stimulation. The maximum degree of allo-specific CB proliferation was achieved on Day 6. IL-15 down-regulated the CB alloreactive proliferative response on Days 4, 6, and 8, with preferentially enhanced autologous proliferation. Exogenous IL-15 further enhanced CB TNF-alpha and IL-10 production in both autologous and allogeneic MLC 6 days after allopriming. Thus, IL-15 was effective in enhancing activation marker expression and cytokine production during CB alloreactivity, but failed to enhance allospecific proliferation. Further studies would be needed to study the role of IL-15 on GVHD in the setting of CB transplantation.

Increased susceptibility of umbilical cord blood (CB) T cells to FK506 immunosuppression may contribute to the lessened severity of graft-vs-host disease in CB transplantation.To investigate the FK506 sensitivity of interleukin 15 (IL-15)- and IL-2-driven proliferation and apoptosis of anti-CD3-stimulated CB T cells compared with adult peripheral blood (APB) T cells.Surface flow cytometric analysis (CD25 and CD95), carboxyfluorescein diacetae succinimidyl ester staining to track CD3+ T-cell division, and flow cytometric analysis of apoptotic cell death using Annexin V were performed to determine the effect of FK506 on CD3+ T-cell activation and apoptosis after anti-CD3 stimulation in the presence of IL-15 or IL-2.IL-15 is superior to IL-2 in promoting CD25 expression and proliferation of anti-CD3-stimulated CB and APB T cells. Although IL-15-driven proliferation evaluated by carboxyfluorescein diacetae succinimidyl ester staining revealed comparable sensitivity to FK506 in anti-CD3-stimulated CB and APB T cells, IL-15-driven CD25 up-regulation in CB T cells was more sensitive to FK506 inhibition than APB T cells. FK506 down-regulated anti-CD3-induced apoptosis in CB and APB T cells (P.01). However, the FK506 sensitivity of anti-CD3-induced T-cell apoptosis was lost in IL-15-supplemented CB cultures (P = .51) but not in corresponding APB cultures (P = .002). The IL-15-enhanced Fas expression on CB T cells (CD95) was decreased by FK506, similar to that observed with adults.We observed differential FK506 sensitivity of IL-15-driven CD25 up-regulation and apoptotic response comparing CB and APB T cells. This finding suggests the potential therapeutic benefit of FK506 in ameliorating graft-vs-host disease by decreasing IL-15-driven donor T-cell proliferation without inhibiting associated activation-induced apoptosis during CB transplantation.

The characteristics of Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) in Chinese children are rarely reported. To evaluate the clinical presentations and risk factors for complications of EBV-associated IM in previously healthy children in Taiwan, hospitalized children with the diagnosis of IM due to EBV infection from January 1998 to December 2002 were enrolled. Patients had to fulfill the serologic criteria for the diagnosis of primary EBV infection [viral capsid antigen immunoglobulin M (IgM)-(+), viral capsid antigen IgG-(+), and anti-Epstein-Barr nuclear antigen (EBNA) antibody-(-) with exclusion of other concurrent infections or underlying diseases]. Ninety eight children were eligible, with 79% younger than 5 years old (mean, 4.0 +/- 2.3 years). The male-to-female ratio was 2:1. Nearly all patients suffered from fever (mean duration 10.3 +/- 6.0 days). Cough/rhinorrhea, tonsillopharyngitis, cervical lymphadenopathy and hepatosplenomegaly were found over half of the patients. Atypical lymphocytosis (mean, 12 +/- 13%) and elevated serum aspartate aminotransferase (AST; mean, 167 +/- 183 IU/L) and alanine aminotransferase (mean, 221 +/- 222 IU/L) were the most striking laboratory findings. Various complications, including hematologic, hepatobiliary, central nervous system, and obstructive airway problems occurred in about 20% of patients with significantly prolonged course of hospitalization. All patients recovered uneventfully under supportive and immunomodulating management. Female gender, no signs of tonsillopharyngitis, white blood cell countor =10,000/mm3 and ASTor =150 IU/L were significant risk factors for the occurrence of complications. Clinicians should monitor such patients closely and give proper treatment to decrease possible morbidity or even mortality should complications occur.

Background: Kikuchi's disease (KD) is characterized by cervical lymphadenopathy with or without fever. It has been recognized worldwide but seldom reported in pediatric patients. Methods: From January 1985 through December 2001, 64 patients younger than 18 years of age with pathologic proof of KD were enrolled in this study. The clinical manifestations, laboratory data and outcomes were reviewed. Results: There were 35 male patients and 29 female patients with age ranging from 2 to 18 years and a median age of 16. All patients had cervical lymphadenopathy except 1 who had generalized lymphadenopathy. Lymph nodes of 32 patients (50%) were painful or tender or both. Lymphadenopathy was unilateral in 52 patients (82.5%). Lymphadenopathy associated with fever was observed in 21 patients (32.8%). Other signs such as skin rash, hepatomegaly or body weight loss were less common. Twenty-six patients (40.6%) had leukopenia and 2 patients had leukocytosis. Nearly one-fourth of the patients had mild liver dysfunction. Virologic or immunologic studies were normal in most patients. Patients with prolonged fever were more likely to have leukopenia (P < 0.05). All patients recovered, but 1 developed systemic lupus erythematosus 5 years later, and the other had vasculitis syndrome 2 years later. Conclusions: The clinical presentation of KD in pediatric patients is similar to that of adults. KD is a benign, self-limiting disease; prolonged fever occurred only in 32.8% of pediatric patients in our cohort. Leukopenia was the only feature significantly associated with prolonged fever.

The aims of this study were to determine whether renal pelvis dilation on ultrasound was reliable in predicting vesicoureteral reflux (VUR) and to assess the relationship of other clinical information of VUR in children with urinary tract infection (UTI).We retrospectively reviewed clinical data, renal echo, and voiding cystourethrogram (VCUG) results in hospitalized children with their first episode of UTI, aged from 1 month to 5 years, during a 1-year period.There were 114 children with 228 kidneys eligible for the study. Unilateral pelvis size greater than 8 mm had 2.4 (p = 0.049, 95% CI: 1.0-5.9) and 3.7 (p = 0.025, 95% CI: 1.2-11.3) times greater risk for VUR and severe reflux, respectively. The sensitivity in detecting severe reflux was 27.8%, and the specificity was 90.5%. The positive and negative predictive values in suggesting severe VUR were 20.0% and 93.6%, respectively. The sum of bilateral pelvis sizes greater than 16 mm had higher risk for VUR and severe reflux (4.1 and 4.6 times) and similar specificity and negative predictive value for severe reflux. Age, gender, C-reactive protein, leukocytosis, pyuria and acute pyelonephritis did not show significant relationships to the reflux.Unilateral pelvis size greater than 8 mm or the sum of the bilateral pelvis sizes greater than 16 mm was associated with VUR, especially severe VUR. The possibility of severe reflux was lower than 10% when the reverse criteria were applied. However, the dilation of the renal pelvis did not predict all VUR precisely. We concluded that VCUG should still be performed in hospitalized children with UTI.

The main purpose of the National Asthma Education Program was to provide asthma education to school nurses in Taiwan. It was also designed to enhance the knowledge and competence of school nurses in managing the asthmatic problems that children experience while in school. In addition to providing instruction about current asthma management skills, tools, and other relevant information, the program demonstrated the use of the peak flow meter for asthmatic children. A single, 4-hr session conducted in each county and city in Taiwan, the National Asthma Education Program began on August 1, 1999, and ended December 31, 2000. A total of 829 school nurses joined the program, with an overall attendance rate of 74%. Significant effects of this program on nurses' asthma care knowledge and competence and case management efficacy were noted. The participating school nurses' demographics, however, were found to be irrelevant to these effects. Expecting the training activities to help relieve the anxieties of managing asthmatic cases in the school environment, participants reported that the training was of much benefit to them. Development of a teaching program to elevate school nurses' capabilities in asthmatic student care in the school environment and the implications of such a program within Taiwanese schools were also discussed.

Hyperimmunoglobulin M syndrome is a rare primary immunodeficiency disorder. We report a case of a 6-month-old boy who suffered from developmental delays, frequent respiratory tract infection, and unusual fungal and bacterial infection. X-linked hyperimmunoglobulin M syndrome was ultimately diagnosed with decreasing immunoglobulin-G, A, and E (immunoglobulin G = 51.3 mg/dL, immunoglobulin A = 8.32 mg/dL, immunoglobulin E17.5 mg/dL), elevating immunoglobulin M (immunoglobulin M = 140 mg/dL), and decreasing T-cell expression of the CD40 ligand over flow cytometry. Seizure episodes and hypotonia developed with greater signal intensity at the putamen in a brain magnetic resonance imaging, which is compatible with hypoxic ischemic encephalopathy. This is the youngest proven case of hyper-IgM syndrome in Taiwan ever reported.

Background Defective T-cell function and susceptibility to apoptosis following activation may contribute to the immunodeficiency observed in common variable immunodeficiency (CVID) patients. Interleukin (IL) 2 benefits CVID children by boosting T-cell function. Objective To investigate the effect of another IL-2 common γ-chain signaling cytokine, IL-15, on T-cell activation and apoptosis of peripheral blood mononuclear cells (PBMCs) from children with CVID compared with IL-2. Methods Five children treated at the Chang Gung Children's Hospital, Taoyuan, Taiwan, during 1998 to 2002 who fulfilled World Health Organization criteria for CVID and 8 age-matched, healthy controls were enrolled. The PBMCs were stimulated with anti-CD3 in the presence or absence of IL-2 and IL-15 for 4 days, followed by 24-hour incubation with anti-Fas to induce apoptosis. Surface expression of CD69, CD25, and CD95 (Fas) on CD3+ T cells was evaluated by flow cytometry. The degree of apoptosis was evaluated by propidium iodide-phycoerythrin/annexin V–fluorescein isothiocyanate flow cytometric staining. Results Following anti-CD3 activation, CD69 and CD25 expression of CVID CD3+ PBMCs was enhanced to levels comparable to controls. Exogenous IL-15 resulted in further enhancement of anti-CD3–induced CD69 expression to a greater extent than that achieved with IL-2. A greater degree of apoptosis was found in CVID patients than controls following anti-CD3 stimulation (P = 0.001). IL-15 but not IL-2 further increased anti-CD3–induced apoptosis in control PBMCs (P = 0.001). In contrast, the degree of anti-CD3–induced apoptosis in CVID PBMCs was unaffected by IL-15 or IL-2. Addition of anti-Fas to cultures prestimulated with anti-CD3 further increased the apoptosis in control PBMCs but had no effect on apoptosis of CVID PBMCs. Conclusion Comparable anti-CD3–induced activation and enhanced apoptosis were observed in PBMCs from children with CVID compared with controls. The degree of apoptosis in CVID PBMCs was not affected by exogenous IL-15 or anti-Fas, suggesting a preactivated status in vivo.

We investigated the effect of two immunoregulatory cytokines, interleukin (IL)-12 and IL-15, alone or in combination, on intercellular adhesion molecule 1 (ICAM-1, CD54) expression on mononuclear cells (MNC) obtained from umbilical cord blood (CB) and adult peripheral blood (APB). We established that (1) ICAM-1 expression was deficient on freshly isolated CB T and natural killer (NK) cells compared with that on adult cells; (2) ICAM-1 expression on T cells (CD3+/CD54+), but not on NK cells (CD16+/CD54+), was spontaneously upregulated after 7 days' culture in RPMI with 10% fetal calf serum (FCS) in the absence of cytokines, for CB and APB MNC alike; (3) removal of 10% FCS from the medium did not affect the spontaneous CD3+/CD54+ upregulation on APB MNC; (3) CB NK cells responded more readily to IL-12 and IL-15 than did APB NK cells in terms of ICAM-1 expression, while ICAM-1 expression on APB T cells, but not on CB T cells, could be enhanced with IL-12 plus IL-15; (4) the combination of IL-12 and IL-15 downregulated ICAM-1 expression on both CB and APB NK cells. Thus, we demonstrated the different patterns of ICAM-1 regulation by CB MNC and APB MNC in response to IL-12 and/or IL-15 and the differential effect of cytokines on the regulation of adhesion molecules on neonatal NK and T cells.

Background. Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation. Patients and Methods. During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined. Results. One of 15 family members sampled—the sister of the index case—and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype. Conclusion. We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.