Biomedical subjects

C H Chiu

Publications and source records attributed to C H Chiu.

102 records · Page 6Linked to original sources

PubMedDate not supplied

Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and the immunocompromised, Taiwan.

From 1996 to 1999, 17 culture-documented systemic infections due to novel, atypical strains of Chryseobacterium meningosepticum occurred in two newborns and 15 immunocompromised patients in a medical center in Taiwan. All clinical isolates, which were initially misidentified as Aeromonas salmonicida by an automated bacterial identification system, were resistant to a number of antimicrobial agents. The isolates were characterized as atypical strains of C. meningosepticum by complete biochemical investigation, 16S rRNA gene sequence analysis, cellular fatty acid analysis, and random amplified polymorphic DNA fingerprinting (RAPD). This is the first report of a cluster of atypically variant strains of C. meningosepticum, which may be an emerging pathogen in newborns and the immunocompromised.

Adolescent↗

PubMedDate not supplied

Predictors for extraintestinal infection of non-typhoidal Salmonella in patients without AIDS.

To identify the risks and predictors for extraintestinal infection (EII) in patients with non-typhoidal salmonellosis, we undertook a study of 398 patients with cultures positive for non-typhoidal Salmonella seen at Chang Gung Memorial Hospital and Chang Gung Children's Hospital between November 1993 and October 1994. Salmonella choleraesuis was the most invasive serotype observed. S. panama, S. typhimurium and S. schwarzengrund were the commonest causes of EII among those serotypes usually causing gastroenteritis. Pre-existing underlying disease, particularly immunosuppressive disease, was the most important risk factor that may have predisposed adult patients to have EII. Old age (> or = 60 years) and isolation of invasive serotypes were also frequently associated with EII in adult patients. The characteristics of paediatric patients with a high probability of having EII were: < 3 years of age, abnormal blood test results (a leucocyte count > or = 15,000/mm3 or < 5000/mm3, immature leucocytes > or = 10% of total leucocytes, and a C-reactive protein concentration > or = 50 mg/l); and isolation of invasive serotypes. This information can be an aid to early diagnosis and treatment of EII caused by non-typhoidal Salmonella.

Adolescent↗

PubMedDate not supplied

Typhoid fever in children: a fourteen-year experience.

From 1982 to 1995, 71 children admitted in our medical center were diagnosed to have typhoid fever by culture or serology. Of the 71 children, most (83%) were aged 5-15 years. These children usually presented with fever and gastrointestinal symptoms, including abdominal pain, diarrhea, nausea or vomiting, and constipation. Hepatosplenomegaly was the most common physical sign observed and abdominal tenderness ranked the second. Thrombocytopenia occurring in 9 patients (13%) was the most common mode of complication. Other complications included intestinal perforation (3%), rectal bleeding (3%), ascites or pleural effusion (4%), and meningitis (1%). The incidence of complications tended to be higher among children 5 years of age or older (p = 0.31). Most patients responded well to appropriate antimicrobial therapies. There was no mortality. Relapse was observed in two children, although both had received 10 days of chloramphenicol therapy. The clinical isolates of Salmonella typhi were susceptible in vitro to all the antibiotics tested, including chloramphenicol, which, however, showed a higher MIC90 level than other drugs tested. In conclusion, there were age-specific differences of typhoid fever in children in terms of the incidence and morbidity and antibiotic resistance of S. typhi has not been a problem in this area at least up to 1995.

Adolescent↗

PubMedDate not supplied

Purpura fulminans in children: report of two cases.

Purpura fulminans, usually seen in previously healthy children acquiring severe infections, especially meningococcal sepsis and meningitis, is a rare catastrophic disease with initial hemorrhagic skin lesions rapidly progressing to gangrene accompanied by shock and frequently resulting in death. We report 2 cases of purpura fulminans who were diagnosed in the past 2 years. Both blood cultures yielded Neisseria meningitidis. One of them expired within 48 hours after admission despite aggressive therapy. The second patient, who received the treatment of heparin, antibiotics, and blood product replacement, survived with minimal sequelae. We deem young age and severe coagulopathy are especially associated with a fatal outcome in children with purpura fulminans. Early recognition of this disease and prompt appropriate therapy may be lifesaving for these patients.

Age of Onset↗

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Sonographic and color Doppler sonographic diagnosis of acute osteomyelitis: report of one case.

Acute osteomyelitis in childhood is uncommon. Early diagnosis is often difficult. We present a 7-year-old boy with clinical manifestation of fever and progressive left thigh swelling for one week. Sonography of the left thigh showed periosteal thickening with subperiosteal abscess around the metaphysis of the left distal femur. Tc-99m bone scintigraphy showed increased uptakes at the left distal femur. Osteomyelitis was suspected from the examination of ultrasound and bone scan examinations. His symptoms were not relieved following systemic antibiotic therapy and a follow-up color Doppler sonography showed vascular flows within and around the periosteum indicating active inflammation. He finally received surgical drainage and the operative findings confirmed the diagnosis of osteomyelitis. In conclusion, ultrasound may be a helpful and convenient tool for establishing the early diagnosis of pediatric osteomyelitis. Ultrasound and color Doppler sonography can be used as clinical parameters to evaluate the disease severity and the progression of osteomyelitis in children.

Acute Disease↗

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Pyogenic sacroiliitis in children: report of three cases.

We report three children who were treated for pyogenic infection of the sacroiliac joint. The disease, usually present in late childhood or adolescence, is uncommon and difficult to assess so that the diagnosis is usually delayed. The three patients were two boys and one girl, aged 14, 15 and 12 years, respectively. A detailed history and physical examination are very important for establishment of the diagnosis. All the three cases presented with typical clinical triad of fever, limping gait and buttock pain. Pelvis compression maneuver, which directly stresses the sacroiliac joint, may aggravate the joint pain and suggest this diagnosis. On physical examination, this test is positive in all our cases. Nuclear scintigraphy is useful for localization of early lesions. For detecting abscess formation, magnetic resonance imaging was performed in two cases and computed tomography in one. In one of the patients, computed tomography failed to demonstrate an iliopsoas abscess formation, which was proved by magnetic resonance imaging later. Staphylococcus aureus was isolated from blood in all three patients. Prompt antibiotic therapy reduces complication and operation is rarely needed. With rapid and appropriate medical treatment, all our patients recovered without an sequelae.

Adolescent↗

PubMedDate not supplied

Orbital cellulitis in children: clinical analysis of 16 cases.

Orbital cellulitis, defined as eyelid erythema and edema, proptosis and/or ophthalmoplegia, with or without visual acuity loss, is a rare, but severe infectious disease. The medical records were reviewed of 16 children, aged 18 years or under, who were admitted at Chang Gung Memorial Hospital with a diagnosis of orbital cellulitis during the period from January 1977 to June 1993. The 16 children included 13 males and 3 females. The mean age of the patients was 5.6 years. Sinusitis, diagnosed clinically and radiologically in eight cases, was the most common predisposing factor. From pus or blood in five patients, these pathogens were isolated: Staphylococcus aureus (2), viridans streptococci (1) and mixed bacterial flora (2). All of the patients were treated with systemic antibiotics. The mean duration of fever after initiation of antibiotic therapy was 2.9 days. Four patients subsequently developed complications: subperiosteal abscess (2), orbital abscess (1), and bacteremia (1). Five patients received surgical treatment. No mortality was reported. After a follow-up period of 1-2 months, no sequelae were found among any of these 16 patients.

Cellulitis↗

PubMedDate not supplied

Experience of intravenous immunoglobulin and acyclovir in neonates at risk for severe varicella infection--report of five cases.

Five cases of at-risk neonates for severe varicella infection were reported. Intravenous immunoglobulin (IVIG) was given soon after birth in different ways to four of them (Case 1 received 400 mg/kg/day for the first three days of life; Case 2 received a single dose of 200 mg/kg on day 2, and another dose of 160 mg/kg on day 7; Cases 3 and 4 received 400 mg/kg on day 2). All five patients were given acyclovir therapy, 40 to 45 mg/kg/day for five to nine days. (Case 1 for prophylaxis, Cases 2, 3, 4, 5 for treatment). Case 2, 3, 4, 5 developed vesicular rash, mild to moderate in degree, with rapid resolution without any constitutional symptoms. Case 1, who received both IVIG and acyclovir for prophylaxis, had no vesicle occurrence. IVIG, in combination with acyclovir, is a safe and probably effective regimen for preventing severe varicella in at-risk neonates. A multi-centered, collaborative study is mandatory to study the efficacy of prophylactic acyclovir with IVIG in these neonates.

Acyclovir↗

PubMedDate not supplied

Neonatal meningococcal meningitis: report of two cases.

Two neonates with meningococcal meningitis and meningococcemia are reported. The two, aged 28 and 16 days, respectively, presented similar symptoms of fever, poor appetite and poor activity. Both blood and cerebrospinal fluid cultures of each patient grew Neisseria meningitidis. The isolated bacteria were sensitive to penicillin, and both patients recovered completely after penicillin treatment for 22 and 15 days, respectively. In the antibiotic era, only 22 cases of neonatal meningococcal meningitis have been reported in the English literature. Among these reports, at least 7 patients survived without sequelae; 6 of those were treated with different combinations of antibiotics, including penicillin, for variable durations of 7-14 days. Therefore, effective antibiotic therapy for 14 days should be adequate in the treatment of uncomplicated neonatal meningococcal meningitis and meningococcemia.

Female↗

PubMedDate not supplied

Fever in infants less than 3 months of age.

A retrospective study of 207 febrile episodes by infants less than 3 months old was performed. Most infants had rectal temperatures ranging from 38 to 39.9 degrees C and only 6 (3%) infants had fever above 40 degrees C per rectum. One hundred and nine (53%) of 207 visits resulted in subsequent hospitalizations including most by infants under 1 month of age. Urinary tract infection was the most common bacterial infection and upper respiratory tract infection the most common viral infection observed. A total of 112 infants were assigned into high-risk or low-risk group for serious bacterial infection by the application of the criteria proposed by Dagan et al. in 1985. The overall incidence of serious bacterial infection was 20.5% (23 patients). Seven (9.2%) of the 76 infants in the low-risk group had serious bacterial infection, compared with 16 (44.4%) of the 36 in the high-risk group (p < 0.05). The negative predictive value of meeting the criteria was 90.8%, a value unacceptably lower than those of previous studies. For maximizing the negative predictive power of the criteria, the addition of another low-risk factor, a normal stool analysis, is suggested. Besides, urine cultures should be taken concomitantly with urinalyses in febrile infants, when considering nonpyuria in infants with urinary tract infections. We demonstrate the pitfalls and difficulties in the application of the criteria for excluding serious bacterial infection in febrile young infants and suggest prospective studies involving more patients should be undertaken before its wider application in clinical practice.

Bacterial Infections↗

PubMedDate not supplied

Endocarditis due to Neisseria sicca: report of one case.

Many species of the Neisseria, which are respiratory commensals in humans, have been regarded as being nonpathogenic or as causing disease in only immunocompromised hosts. We report a case in which Neisseria sicca was the cause of infective endocarditis in a child with a ventricular septal defect and review the literature on endocarditis due to N. sicca infection. Most of these patients had an underlying heart disease. Dental caries and poor oral hygiene may be two factors that predispose patients to the infection. N. sicca endocarditis usually results in a subacute onset of symptoms and, if not diagnosed early and treated, is associated with a high rate of embolic complications.

Child↗

PubMedDate not supplied

Pneumonia with pneumatocele formation caused by Mycobacterium tuberculosis: report of one case.

Pneumatoceles are usually characteristic of staphylococcal pneumonia. They are rarely formed as one of the complications of Mycobacterium tuberculosis pneumonia. We report a 1-year-and-5-month old male child with pneumonia who was confirmed to have the rare complication, pneumatocele formation, by chest radiography and computed tomography. Since the patient did not respond to empiric antibiotic therapy, gastric larvage through a nasogastric tube was performed on three consecutive mornings and, as a result, acid fast rods were found on the three specimens. The cultures subsequently yielded M. tuberculosis. He was finally cured with a 6-month course of antituberculous chemotherapy. We conclude that tuberculosis should be considered in infants or young children with pneumonia that presents radiologically as pneumatocele formation, especially in whom there has been no response to empiric antibiotic therapy.

Humans↗