Biomedical subjects

Li-Min Huang

Publications and source records attributed to Li-Min Huang.

At least 55 records · Page 3Linked to original sources

PubMed2004

Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis.

The severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to be transmitted primarily through dispersal of droplets, but little is known about the load of SARS-CoV in oral droplets. We examined oral specimens, including throat wash and saliva, and found large amounts of SARS-CoV RNA in both throat wash (9.58 x 10(2) to 5.93 x 10(6) copies/mL) and saliva (7.08 x 10(3) to 6.38 x 10(8) copies/mL) from all specimens of 17 consecutive probable SARS case-patients, supporting the possibility of transmission through oral droplets. Immunofluorescence study showed replication of SARS-CoV in the cells derived from throat wash, demonstrating the possibility of developing a convenient antigen detection assay. This finding, with the high detection rate a median of 4 days after disease onset and before the development of lung lesions in four patients, suggests that throat wash and saliva should be included in sample collection guidelines for SARS diagnosis.

Adult↗

PubMed2004

Community-acquired methicillin-resistant Staphylococcus aureus in children in northern Taiwan.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a well-recognized nosocomial infection of increasing incidence. Recent reports have also revealed an increment of community-acquired MRSA (CA-MRSA) infections in people without any risk factors. We reviewed the medical charts of 464 children with S. aureus infections presenting between January 1997 and August 2001, in order to understand the occurrence of CA-MRSA infections in children without any risk factors and to define the spectrum of disease. MRSA made up 74% of community-acquired S. aureus infections (59/80). Among them, patients without identifiable risk factors comprised 29 CA-MRSA infections (36%). The number of patients with CA-MRSA disease increased from 11 of 172 (6%) S. aureus infections between January 1997 and April 1999 to 48 of 292 (16%) between May 1999 and July 2001. Skin and soft tissue infections were the most common presentations of community-acquired S. aureus infections. Bacteremia was the major manifestation of nosocomial S. aureus infections, and osteomyelitis and bacteremia were not infrequently seen in patients with CA-MSSA infections. Only 13 out of 29 patients (45%) with CA-MRSA infections without risk factors received effective antibiotic therapy, while 16 cases were cured by either antibiotics without in vitro activity, or surgical drainage, or both. CA-MRSA isolates were more likely to be susceptible to minocycline, gentamicin, and trimethoprim-sulfamethoxazole, compared to hospital-acquired MRSA isolates. Our data suggest an increasing role of MRSA as a community pathogen in previously healthy children. Infection control strategies for both hospital and community should be re-evaluated.

Adolescent↗

PubMed2004

Intramuscular ceftriaxone in comparison with oral amoxicillin-clavulanate for the treatment of acute otitis media in infants and children.

In order to evaluate the clinical efficacy and safety profiles of single-dose ceftriaxone (50 mg/kg, not exceeding 1 g) and a 10-day course of amoxicillin-clavulanate (amoxi-clav) [45 mg/kg/day, in 3 divided doses] in children with acute otitis media (AOM), we conducted a prospective, comparative, randomized trial. Between February 2000 and April 2002, 110 children with a mean age of 30.73 +/- 20.79 months were enrolled. 109 patients were evaluated for the safety assessment. The intent-to treat population included 96 patients who completed at least 3 days of treatment. The standard analysis population included 73 patients who completed the 10-day treatment period without any major violation. For the standard analysis population, 57 out of 73 patients experienced treatment success; 31 out of 41 patients in the ceftriaxone group were cured compared with 25 out of 32 patients in the amoxi-clav group. The rate of persistence of middle-ear fluid did not differ between the 2 groups at day 11 or day 28. A higher treatment preference rate was observed in the ceftriaxone group (93.9% vs 58.6%). The most common drug-related adverse effects were found in the digestive system, skin and appendages in both treatment groups. A single dose of ceftriaxone is as safe and effective as amoxi-clav for curing patients with acute otitis media. In addition, a substantially higher proportion of patients receiving single-dose ceftriaxone showed a preference for the study medication compared with those treated with amoxi-clav for 10 days.

Acute Disease↗

PubMed2004

Clinical features of influenza A and B in children and association with myositis.

Influenza virus is among the most common causes of respiratory illness, which may manifest as a range of conditions, from mild upper respiratory tract infection to bronchiolitis and pneumonia. Acute childhood myositis associated with influenza occurs mostly in influenza B infection. In this retrospective study, we analyzed the characteristics of 197 children with influenza virus treated from January 2000 to December 2001. Among them, 73 children had influenza A infection and 124 had influenza B infection. Influenza A virus outbreaks occurred in January 2000, July 2001, and December 2001, while influenza B virus outbreaks occurred from March 2000 to May 2000 and from December 2000 to February 2001. The most common clinical manifestations of influenza A and influenza B virus infection included fever, cough, and rhinorrhea. These infections also frequently manifested as laryngo-tracheobronchitis, pneumonia, and unexplained fever, which led to hospitalization. The most common clinical diagnosis was upper respiratory tract infection. The rates of benign acute childhood myositis in influenza A and influenza B were 5.5% and 33.9%, respectively. Creatine kinase levels were elevated in most myositis cases and boys were more commonly affected. Acute childhood myositis was more commonly seen in influenza B infection.

Child↗

PubMed2004

Epidemiology of Haemophilus influenzae type b meningitis in Taiwan, 1997 and 2000.

In order to determine the incidence of Haemophilus influenzae type b (Hib) meningitis in Taiwan, we analyzed the National Health Insurance Research Database (NHIRD). We identified cases that were younger than 5 years old and diagnosed with Hib meningitis from the NHIRD in both 1997 and 2000. Sixteen and 8 children with Hib meningitis were identified in the NHIRD for 1997 and 2000, respectively. The majority of cases were 2 years old and under. The overall fatality rate was 8.33%. Assuming similar proportions of Hib meningitis in cases of meningitis with identified causes and meningitis without identified causes, the annual incidence of Hib meningitis in children younger than 5 years old was estimated to be 5.57 and 3.22 per 100,000 in years 1997 and 2000, respectively. The incidence of Hib meningitis in Taiwan is lower than in western countries and other Asian countries. This is consistent with the notion that Hib meningitis incidence is low in Chinese populations. The decline in incidence from 1997 to 2000 is likely a result of the introduction of a self-paid Hib vaccine in Taiwan, starting in 1993. The availability of the NHIRD provides an extra tool for the epidemiological study of infectious diseases in Taiwan and can be valuable for similar studies.

Age Distribution↗

PubMed2004

An open study of inactivated hepatitis A vaccine (VAQTA) in Taiwanese healthy adult volunteers: safety, tolerability, and immunogenicity.

The safety, tolerability and immunogenicity of inactivated hepatitis A vaccine (VAQTA, Merck and Co. Inc., West Point, PA, USA) were investigated in 28 seronegative healthy adult volunteers. The age range was 25-35 years, and the mean age was 29 years. Two doses of the vaccine, each containing 50 U of hepatitis A virus antigen, were administered into the deltoid region 24 weeks apart. No serious vaccine-related adverse reactions were reported. Four weeks after the first dose, the geometric mean titer (GMT) was 150 mIU/mL, and the seroconversion rate was 100%. Twenty eight weeks after the first dose (4 weeks following the second dose), the GMT was 4576 mIU/mL. This study demonstrated that VAQTA is safe and highly immunogenic in healthy young adults in Taiwan.

Adult↗

PubMed2004

Clinical course of children of human immunodeficiency virus-infected mothers in Taiwan.

The objective of this study was to describe the clinical courses of infants born to human immunodeficiency virus (HIV)-infected mothers in Taiwan. Eleven children, including 1 set of twins, born to 10 HIV-infected mothers were included in the study. HIV antibodies were assayed and HIV-1 polymerase chain reaction (HIV-PCR) or virus cultures were performed; HIV infection was established when there were at least 2 separate positive results of HIV-PCR or culture. Three sets of primers detecting LTR-gag, pol and env were used. The viral load of HIV RNA was measured and used as an indicator of the treatment response. Two of the children were HIV-infected and received combination therapy, including 2 kinds of nucleoside analogue reverse transcriptase inhibitors plus 1 protease inhibitor. Neither of these children exhibited HIV-related symptoms or signs during the study period. Both mothers of the infected children were Taiwanese and their HIV infection status was not known during pregnancy. In contrast, HIV infection was found in early pregnancy in the 4 women living in Taiwan who were from other countries, all of whom received prophylactic therapy. The other 4 mothers who did not transmit the infection to the infant were Taiwanese, 3 of whom were known to be HIV-seropositive during pregnancy. Based on these results, the vertical rate of transmission was 18% (2/11). Early detection of HIV-infected pregnancy is vital to reduce the incidence of HIV-infected births.

Anti-HIV Agents↗

PubMed2004

Safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in Taiwanese infants.

BACKGROUND AND PURPOSE: The prevalence of antibiotic-resistant pneumococci has increased markedly in Taiwan since the 1990s. The prevention of pneumococcal infection by effective vaccination is an urgent need. The purpose of this study was to assess the safety and immunogenicity of heptavalent pneumococcal conjugate vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F, 23F) in Taiwanese infants. METHODS: Sixty healthy Taiwanese infants received heptavalent pneumococcal conjugate vaccine at 2, 4 and 6 months of age in an open-label, non-comparative trial. Routine diphtheria-tetanus-pertussis vaccines were concomitantly administered. Side effects were recorded and the antibody titer to each of the 7 pneumococcal serotypes was measured before vaccination and 1 month after the third vaccination. RESULTS: Mild to moderate local reactions at the injection site were the common findings (17 to 30%) after vaccination but were not correlated with the number of vaccinations. Fever, restlessness, fussiness, and loss of appetite were the most common systemic reactions (22 to 53%). After 3 doses of vaccine, the geometric mean concentration of immunoglobulin G showed a significant rise (p < 0.001) to all 7 pneumococcal serotypes. More than 95% of infants had antibody titer > or = 0.15 microg/mL of all serotypes, and 93% (serotype 23F) to 100% (serotypes 4 and 19F) of infants achieved an antibody titer > pr = 1 microg/mL. CONCLUSION: Inoculation with the heptavalent pneumococcal conjugate vaccine including the prevalent serotypes in Taiwan is safe and effective in preventing pneumococcal disease in Taiwanese children.

Antibodies, Bacterial↗

PubMed2004

Disseminated tuberculosis presenting as multiple hepatosplenic microabscesses and pancytopenia in a teenage boy.

Disseminated tuberculosis usually occurs in immunocompromised hosts. Involvement of bone marrow, liver, and spleen is infrequent. A previously healthy 15-year-old boy presented with body weight loss, prolonged fever, neck lymphadenopathy, pancytopenia, and hepatosplenic microabscesses within the recent month and was transferred to our hospital. Bone marrow studies showed hypocellular marrow. Based on his clinical manifestations, hemophagocytic syndrome was initially suspected. Pancytopenia resolved after administration of intravenous immunoglobulin but caseous necrosis and/or positive acid-fast stain were subsequently demonstrated in the lymph node biopsy and sputum. Cultures from these 2 specimens grew Mycobacterium tuberculosis. Fever continued in a low-grade pattern even under antituberculous therapy with rifampin, isoniazid, pyrazinamide and ethambutol. Five months after admission, fever subsided after splenectomy and liver wedge resection. Microscopic examinations of both the liver and spleen showed mycobacteria-related granulomatous inflammation and caseating necrosis. This report suggests that tuberculosis infection should be considered in the differential diagnosis in patients with prolonged fever, pancytopenia and hepatosplenic abscesses.

Abscess↗

PubMed2003

High prevalence of antimicrobial resistance in rapidly growing mycobacteria in Taiwan.

An increasing number of clinical isolations of rapidly growing mycobacteria (RGM) at the National Taiwan University Hospital were noted from 1992 to 2001. Broth microdilution MICs of 15 antimicrobial agents were determined for 200 clinical isolates of RGM, including the Mycobacterium fortuitum group (69 isolates), M. chelonae (39 isolates), and M. abscessus (92 isolates). Our results showed that the resistance rates of these isolates to the currently available agents were remarkably high. Amikacin was active against nearly all RGM isolates. Clarithromycin was usually active against M. abscessus (79% susceptibility) and the M. fortuitum group (65% susceptibility). The majority of M. fortuitum group isolates were susceptible to ciprofloxacin (62%) and imipenem (61%). The susceptibilities to other conventional anti-RGM agents of these isolates were poor but differed markedly by species. The newer fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin) and meropenem showed better in vitro activities against the M. fortuitum group isolates than against the other two species of RGM. Linezolid had fairly good activity against these RGM isolates, particularly against M. chelonae isolates (82% susceptible). Telithromycin had poor activity against these RGM isolates (the MICs at which 50% of the isolates tested are inhibited [MIC(50)s] were 32 to 64 microg/ml, and the MIC(90)s were >64 microg/ml).

Anti-Bacterial Agents↗

PubMed2003

Severe echovirus 30 infection in twin neonates.

Although enteroviruses can cause overwhelming and fatal systemic infections in neonates, such severe neonatal infections remain uncommon and rarely involve both of twin neonates at the same time. We report the cases of twin neonates who developed fever initially, and then progressed to disseminated systemic disease with marked thrombocytopenia, coagulopathy, and hepatic failure. One of the neonates died and the other survived. Both neonates were treated with intravenous immunoglobulin and maternal fresh frozen plasma was also given to the neonate who survived. Virus cultures from the nasopharynx, rectum and cerebral spinal fluid of both neonates yielded enterovirus, later typed as echovirus 30. The surviving neonate had normal development without obvious sequelae during a follow-up period of 1 year. The major determinant of the survival from severe neonatal enterovirus infection might have been the pre-existing severity of the disease before treatment, and complete recovery could be expected if the infant survived the acute stage of illness.

Disseminated Intravascular Coagulation↗

PubMed2003

Bacteremia in hematological and oncological children with febrile neutropenia: experience in a tertiary medical center in Taiwan.

A retrospective study of bacteremia in children with febrile neutropenia admitted to a medical center in Taiwan from January 1999 to December 1999 was performed. There were 190 episodes of febrile neutropenia during this period and 46 pathogens were isolated from blood specimens in 38 bacteremic episodes (7 mixed infections). Pseudomonas aeruginosa (17.4%), Staphylococcus aureus (10.9%), Klebsiella pneumoniae (10.9%), and Enterobacter cloacae (10.9%) were the most common isolates. Three of the 5 isolates of S. aureus were resistant to methicillin. Twenty-three episodes of bacteremia (four mixed infections) were associated with recent antibiotic use. Of the 23 bacteremic episodes with recent antibiotic use, P. aeruginosa (20%), methicillin-resistant S. aureus (10%), K. pneumoniae (10%), Escherichia coli (10%), and E. cloacae (10%) were isolated most often. Relapsed leukemia (odds ratio 3, 95% confidence interval 1.4-6.5) and recent antibiotic therapy (odds ratio 3.4, 95% confidence interval 1.7-7.7) were the independent risk factors of bacteremia. There were 9 mortality cases in patients with bacteremia, including 4 cases with mixed infections, and 5 cases with P. aeruginosa, E. coli, Klebsiella oxytoca, S. aureus, and Streptococcus mitis, respectively. Broad-spectrum antibiotics were necessary in febrile neutropenic children because of the high percentage of mixed infection.

Academic Medical Centers↗

PubMed2003

Clinical manifestations of parainfluenza infection in children.

Parainfluenza viruses are major pathogens causing respiratory illness, manifesting from mild upper respiratory tract infection to bronchiolitis and pneumonia. This retrospective study aimed at providing clinical and epidemiologic data addressing the parainfluenza virus infection in Taiwan. A total of 39 patients were enrolled in this study from March 1999 to December 2000. Infants and young children were the major susceptible population, with 87.2% of them younger than 3 years. No seasonal trend was noted for parainfluenza type 1 and type 2 infections. One clustering of parainfluenza virus type 3 infections occurred in late spring of 2000 based on collected results. Parainfluenza type 1 viral isolates accounted for all of the cases of croup. Most isolates of parainfluenza virus type 3 were associated with upper and/or lower respiratory tract infections. A substantial proportion of the patients had skin involvement; the identification of one case of possible parainfluenza virus-related erythema multiforme is particularly interesting, especially because the chances of a causal relation between viral infection and skin symptoms are formerly thought to be slight. The identification of parainfluenza virus in illnesses classically considered to be due to other viruses is intriguing and may have important implications in the management of childhood illness clinically.

Adolescent↗

PubMed2003

Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement.

BACKGROUND AND PURPOSE: The appropriate type of intervention for the treatment of empyema in children remains controversial. This study analyzed whether video-assisted thoracoscopic debridement (VATD) as first-line treatment is effective in the management of pediatric parapneumonic empyema. METHODS: We retrospectively reviewed the medical and microbiological records of pediatric patients with parapneumonic empyema diagnosed at a medical center from January 1995 to December 2002. The 55 patients included in this study were initially treated with either tube thoracostomy drainage (TTD group [n = 37]) or video-assisted thoracoscopic debridement (VATD group [n = 18]). RESULTS: A comparative analysis found no significant difference in patient characteristics between these 2 groups. Patients in the VATD group had a significantly shorter duration of fever (18.9 +/- 1.7 vs 26.9 +/- 1.3 days), chest tube placement (5.3 +/- 0.7 vs 15.2 +/- 2.0 days), antibiotic therapy after the procedure (12.2 +/- 1.0 vs 26.3 +/- 2.8 days), and hospital stay (21.5 +/- 2.1 vs 33.2 +/- 2.8 days). No additional procedures were required in the VATD group, whereas 65% (24/37) of patients in the TTD group underwent salvage VATD. CONCLUSION: Primary management using video-assisted thoracoscopic decortication was more effective and reduced the duration of illness in pediatric patients with parapneumonic empyema.

Adolescent↗

PubMed2002

A comparison of safety, tolerability and immunogenicity of Oka/Merck varicella vaccine and VARILRIX in healthy children.

This study compared safety, tolerability, and immunogenicity of the Oka/Merck varicella vaccine and VARILRIX [Oka-RIT strain SmithKline Beecham Biologicals] in healthy children 12-24 months of age. Subjects were randomized in this double blind study to receive either a single dose of Oka/Merck varicella vaccine, (approximately 50,000 plaque forming units (PFU), Group A or approximately 16,000 PFU, Group B) or 1 dose of VARILRIX, (approximately 40,000 PFU/dose, Group C). Safety profiles in each treatment group were similar. The proportions of subjects achieving a 6-week postvaccination titer> or = 5 gpELISA units in Groups A, B or C were 97.1, 95.2 and 85.6%, respectively.

Antibodies, Viral↗

PubMed2002

Incidence and case-fatality rates resulting from the 1998 enterovirus 71 outbreak in Taiwan.

In 1998, an epidemic of hand-foot-and-mouth disease and herpangina caused by enterovirus 71 occurred in Taiwan, leaving many fatalities and severely handicapped survivors in its wake. The reasons this rather common pathogen would cause such a large-scale epidemic remain unknown. A seroepidemiological survey to elucidate the epidemiological characteristics of this outbreak, including its incidence and case-fatality rates was undertaken. Microneutralization tests for antibodies against enterovirus 71 were used to screen four collections of serum samples: 1) 202 specimens taken from individuals > or = 4 years old in 1994; 2) 245 specimens collected from individuals of all ages in 1997; 3) 1,258 specimens collected from individuals of all ages in 1999; and 4) sera samples from a birth cohort of 81 children who had yearly blood samples taken from 1988-98. After the maternal antibody had declined, the seropositive rates began to increase with age. Approximately half of all children aged 6 years or older were enterovirus 71 seropositive. Significantly higher seropositive rates were noted in 1999 than in 1997, in children aged 0.5-3 years. The incidence of enterovirus 71 infection during the epidemic was estimated to be 13-22%, with the higher rates in younger children. The case-fatality rate was highest (96.96 per 100,000) in infants aged 6-11 months, and declined in older children. The results showed that enterovirus 71 is endemic in Taiwan. The apparent lack of large-scale enterovirus 71 activity in the 3 years before 1998 might have been the prelude to the epidemic's appearance in 1998, and might suggest that enterovirus 71 infection will reappear every few years. The lack of a protective antibody in younger children may account for the high incidence and case-fatality rate in this age group.

Adolescent↗

PubMed2002

A new measles mumps rubella (MMR) vaccine: a randomized comparative trial for assessing the reactogenicity and immunogenicity of three consecutive production lots and comparison with a widely used MMR vaccine in measles primed children.

OBJECTIVES: A multicenter, single-blind, randomized, controlled clinical study was conducted in healthy 15-18-month-old children in order to assess the immunogenicity and reactogenicity of three consecutive lots of a new measles- mumps-rubella (MMR) vaccine, GSK MMR. DESIGN: A total of 500 enrolled subjects were randomized into four groups to receive either a single dose of one of the three lots of GSK MMR (three groups--125 subjects in each group) or Merck MMR vaccine (125 subjects). Once clinical consistency had been demonstrated, the data were pooled and compared with the widely used Merck vaccine. Solicited local and general symptoms were recorded using diary cards, and antibody levels were determined using ELISA assays. RESULTS: No differences in the incidence of local and general symptoms or seroconversion rates were seen in the groups receiving different lots of GSK MMR. Compared with Merck MMR, there was a significantly lower incidence of local pain (P<0.001) and swelling (P=0.038) in infants receiving the GSK MMR vaccine. The incidences of all other solicited local and general symptoms were comparable between the two groups. No signs of suspected meningitis were reported. No serious adverse events were reported by the investigator to be related to vaccination. Equivalent seroconversion rates and postvaccination GMTs were observed in the groups receiving the two MMR vaccines. In conclusion, the new GSK MMR vaccine administered in measles-primed children demonstrated satisfactory immunogenicity and safety profiles as good as the Merck MMR vaccine.

Antibodies, Viral↗

PubMed2002

Endocarditis caused by Abiotrophia defectiva in children.

Abiotrophia defectiva, formerly designated as the member of nutritionally variant streptococci, is a part of normal oral flora and may be a cause of culture-negative endocarditis. We report a case of infective endocarditis caused by A. defectiva involving the mitral valve in a 12-year-old girl. She received antibiotic treatment for 8 weeks and was symptom-free 6 months after discharge. We also reviewed the pediatric cases of nutritionally variant streptococcal endocarditis published in the English literature since 1971.

Anti-Bacterial Agents↗