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Biomedical subjects

Tzou-Yien Lin

Publications and source records attributed to Tzou-Yien Lin.

At least 55 records · Page 3Linked to original sources
PubMed2004

Surveillance of respiratory viral infections among pediatric outpatients in northern Taiwan.

BACKGROUND: Viruses are a frequent cause of upper respiratory tract infections in children. Like Taiwan, there were few virological surveillance systems for respiratory viral infections among children in developing countries. MATERIALS AND METHODS: During August 1995 and July 1997, 6-10 throat swab specimens per week were taken from pediatric outpatients with acute, febrile upper respiratory tract infections (URTI). The specimens were randomly obtained by two pediatricians at Chang Gung Children's Hospital and sent for virus isolation and identification. RESULTS: A total of 910 specimens were collected and 365 specimens (40%) were positive for at least 1 virus and included 81 enterovirus, 73 adenovirus, 58 influenza B virus, 54 influenza A virus, 48 cytomegalovirus (CMV), 25 herpes simplex virus-1 (HSV-1), 7 parainfluenza virus, 3 respiratory syncytial virus (RSV) and 16 mixed viruses. Adenovirus and enterovirus were identified throughout the study period. No seasonal variation was noted for adenovirus while enterovirus peaked between May and July and also during September and November. Influenza viruses, both A and B, were identified during two periods, respectively and altogether, influenza viruses could be detected almost throughout the year. An association between the virus type identified and the mean age of patients was found (P-value = 0.0001 by ANOVA test). The mean age of patients infected with influenza viruses, either A or B, was significantly higher than those of patients infected with adenovirus, HSV-1, CMV and enterovirus. CONCLUSION: The results of this study demonstrate that adenovirus and enterovirus are the two most common viruses isolated from pediatric outpatients with acute, febrile URTIs and can be identified throughout the year in northern Taiwan. Influenza viruses also can be identified throughout the year and during the epidemic, a child older than 5 years of age with acute febrile URTI is likely to be a case of influenza.

Adenoviridae↗
PubMed2004

Development of tuberculoma during therapy presenting as hemianopsia.

A 6-year-old, previously healthy male presented with fever and lethargy. Tuberculous meningitis was suspected after cerebrospinal fluid examination. Antituberculous drugs were administered, and an initial computed tomographic scan of brain revealed mild ventriculomegaly only. Steroids were instituted on day 16 and gradually withdrawn 1 month later. Nine weeks after the initiation of antituberculous therapy, markedly impaired visual acuity and bitemporal hemianopsia were observed. Magnetic resonance imaging of brain revealed multiple tuberculomas, including involvement of the optic chiasm. Hydrocephalus was present. A ventriculoperitoneal shunt was inserted, and steroids were reinstituted. Visual acuity improved 9 weeks after the onset of visual acuity impairment and returned to normal 24 weeks later.Follow-up computed tomographic scan of brain 1 year later demonstrated complete resolution of tuberculomas. Development of intracranial tuberculoma during antituberculous therapy, although rare, dose not represent treatment failure, and continuation of antituberculous drugs, with or without the addition of steroids, will usually resolve the lesions.

Child↗
PubMed2004

Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002.

BACKGROUND: Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000. METHODS: The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups. RESULTS: Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone. CONCLUSIONS: Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.

Case-Control Studies↗
PubMed2004

Nasal carriage of methicillin-resistant Staphylococcus aureus in contacts of an adolescent with community-acquired disseminated disease.

OBJECTIVES: To assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in contacts after the diagnosis of community-acquired MRSA bacteremia, hip arthritis, pyomyositis and pulmonary septic emboli with necrotizing pneumonia and empyema in a previously healthy female adolescent in Taiwan. MATERIALS AND METHODS: A nasal culture survey of the 4 household members, 30 classmates and 5 teachers of the index case (class A), 28 classmates of her brother's (class B), as well as 76 health care workers (HCWs), including 58 nurses, 16 doctors and 2 assistants, working in the ordinary wards were performed 1 month after the onset. The clinical isolates from bloodstream and synovial fluid of the index case as well as all the colonized isolates, if identified, were collected and genotyped with pulsed field gel electrophoresis. RESULTS: A total of 15 subjects, including the case patient, her brother, 2 adolescents (6.7%) in class A, 6 children (21.4%) in class B and 5 HCWs (6.6%), were colonized with MRSA. Of the 15 colonizing and 2 clinical MRSA isolates, 4 genotypes with 2 major types were identified. Except for 2 isolates, the remaining 15 isolates were genotype C or D. Both clinical isolates, the isolate from her brother, 3 isolates from the children in class B and 2 isolates from the HCWs belonged to genotype D. Two isolates from the adolescents in class A, the other 3 isolates from the children in class B and 2 isolates from the HCWs were genotype C. The colonized strain from the index case was genotype A. CONCLUSIONS: Carriage of MRSA can be identified in a substantial proportion of school children without apparent risk factors in Taiwan. With transmissibility, the carriage of MRSA in school children can accelerate the spread of MRSA in the community.

Adolescent↗
PubMed2004

Systemic anaphylaxis following local lidocaine administration during a dental procedure.

We report a 4-year-old child who developed systemic anaphylactic reaction to lidocaine hydrochloride within 15 minutes after a dental procedure. Hypersensitivity to local anesthetics is not common; however, if anaphylaxis did happen, it required emergent and immediate resuscitation. To prevent such complications, complete medical history including drug allergy should be taken. Prompt administration of epinephrine and other resuscitative measures are life saving in such circumstance. All emergency room physicians should consider systemic anaphylaxis in patients with rapid vascular collapse and respiratory failure immediately following lidocaine administration for minor outpatient procedures.

Anaphylaxis↗
PubMed2004

Molecular epidemiology of clinical isolates of methicillin-resistant Staphylococcus aureus in Taiwan.

During July 2000 and October 2001, a total of 595 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) were collected from six medical centers distributed in northern, central, and southern Taiwan. Specimen sources included blood (n = 279), pus (n = 173), sputum (n = 94), body fluids (n = 21), catheter tips (n = 20), and urine (n = 8). Pulsed-field gel electrophoresis (PFGE) with SmaI digestion was used to fingerprint these isolates. A total of 31 genotypes with 97 type-subtypes were identified. Subtypes could be identified in 7 genotypes. While there were 6 to 15 genotypes in each hospital, 433 isolates (73%) were shown to belong to a major type (genotype A, with 29 subtypes). This genotype was not only the type prevailing in all six hospitals but also the predominant clone in each hospital, accounting for 46 to 89% of all isolates in each hospital. Genotype C (16 subtypes) was the second dominant genotype, accounting for 9% of all isolates, and was distributed in five hospitals. Genotypes D (11 subtypes), E (5 subtypes), and B (6 subtypes) were distributed in five, four, and three hospitals, respectively. The other 26 types (30 type-subtypes) were minor. We conclude that the majority of MRSA clinical isolates shared a common PFGE pattern, indicating the presence of a single, epidemic MRSA clone prevailing in major hospitals in Taiwan.

Electrophoresis, Gel, Pulsed-Field↗
PubMed2004

Influenza A virus PB1-F2 gene in recent Taiwanese isolates.

Influenza A virus contains eight RNA segments and encodes 10 viral proteins. However, an 11th protein, called PB1-F2, was found in A/Puerto Rico/8/34 (H1N1). This novel protein is translated from an alternative open reading frame (ORF) in the PB1 gene. We analyzed the PB1 gene of 42 recent influenza A isolates in Taiwan, including 24 H1N1 and 18 H3N2 strains. One H1N1 isolate and 17 H3N2 isolates contained the entire PB1-F2 ORF of 90 residues, three amino acids (aa) longer than the PB1-F2 of A/Puerto Rico/8/34 at the C terminal. The one remaining H3N2 isolate encoded a truncated PB1-F2 with 79 residues. The other 23 H1N1 isolates contained a truncated PB1-F2 of 57 aa. Phylogenetic analysis of both the HA and the PB1 genes showed that they shared similar clustering of these Taiwanese isolates, suggesting that no obvious reassortment occurred between the two genomic segments.

Amino Acid Sequence↗
PubMed2004

Ludwig's angina following herpetic gingivostomatitis in a toddler with tetralogy of Fallot.

Ludwig's angina is a rare but potentially lethal cellulitis of the submandibular space that occurs most often in young adults with predisposing odontogenic infection. In contrast to adult cases, most children with Ludwig's angina have no initiating factor. We report a case of Ludwig's angina in a 15-month-old boy which developed after an episode of herpetic gingivostomatitis. Under close monitoring of respiratory status, the condition was successfully managed with antibiotic treatment. This case illustrates that Ludwig's angina can develop in association with herpetic gingivostomatitis, which is a common and usually self-limited disease in pediatric patients. Prompt recognition and aggressive management of this rare and severe secondary bacterial infection are the keys to avoiding unnecessary morbidity and mortality.

Humans↗
PubMed2004

Prognostic implications of myoclonic jerk in children with enterovirus infection.

To determine the prognostic value of myoclonic jerk in children with enterovirus 71 (EV71) infection, a retrospective study was conducted on 665 enterovirus culture-confirmed patients admitted to Chang Gung Children's Hospital from January 2000 to September 2001. The mean age was 35.0 months +/- 32.2 months, ranging from 1 day to 15 years and 416 (62.6%) of them were male. Among these patients, 140 (21.1%) had EV71 isolated, and 150 (22.6%) had myoclonic jerk. Fifty one percent (72/140) of EV71 cases and only 15% (78/525) of non-EV71 cases had myoclonic jerk (p<0.001). The age of enterovirus patients with myoclonic jerk was younger than that of patients without myoclonic jerk (23.2 +/- 17.6 vs 38.4 +/- 34.6 months, p=0.005). The hospitalization and fever durations were significantly longer in the EV71 group than in the non-EV71 group (8.3 +/- 13 vs 4.2 +/- 2.7 days, p<0.001; 5.9 +/- 4.8 vs 4.2 +/- 3.0 days, p=0.009, respectively). Patients with myoclonic jerk also had higher percentages of severe illness, and neurologic sequelae (20% and 9%, respectively) than those without myoclonic jerk (5% and 1%, respectively) [p<0.001]. The positive predictive values of myoclonic jerk for EV71 infection, severe cases, and neurologic sequelae were 0.48, 0.20, and 0.09, respectively; the negative predictive values for severe cases and neurologic sequelae were 0.95 and 0.99, respectively. This study demonstrated that myoclonic jerk and EV71 infection are both independently associated with more severe disease and higher incidence of neurologic sequelae.

Adolescent↗
PubMed2004

Salmonella enterica serotype Choleraesuis infection in a medical center in northern Taiwan.

This retrospective study was conducted in order to determine the clinical and microbiologic features of infection with Salmonella enterica serotype Choleraesuis. Between March 1999 and December 2002, 55 patients with 66 isolates were enrolled for analysis. The ratio of males to females was 2.2:1. Most patients were older than 60 years (56%) and had underlying diseases (78%), such as diabetes mellitus, malignancy, and peptic ulcer. Fever (85%) was the most common clinical manifestation, followed by abdominal pain/fullness (31%). The gastrointestinal manifestations, including nausea/vomiting or diarrhea, accounted for only 13% and 11% of patients, respectively. S. enterica serotype Choleraesuis was extremely invasive, with a high predilection to cause bacteremia (78% of the isolates were from blood). Various types of metastatic focal infections were found, including infected arterial aneurysm, osteomyelitis, septic arthritis, urinary tract infection and wound infection. The crude mortality rate was 18% (10 deaths in 55 cases). Nearly all isolates were susceptible to the third-generation cephalosporins. A higher resistance rate to commonly used antimicrobial agents was found with ampicillin (85%, 56/66), trimethoprim-sulfamethoxazole (81%, 40/49), chloramphenicol (96%, 47/49), and ciprofloxacin (49%, 30/61). In view of the emergence of fluoroquinolone resistance, the third-generation cephalosporins appear to be the best choice for treatment of invasive infections caused by this organism.

Adult↗
PubMed2004

Hemophagocytic syndrome: a review of 18 pediatric cases.

This retrospective study included 18 pediatric cases (median age, 3 years) with pathologically proved hemophagocytic syndrome (HPS) from a single institution during 1992 and 2001. There were 9 males and 9 females. Prolonged fever, cytopenia, liver dysfunction and hepatomegaly were the most common features at presentation. Sixteen (88.9%) cases were previously healthy. The case fatality rate was 61.1%, and all fatal cases died within 2 months of disease onset. The infectious agents associated with HPS were identified in 11 cases (61.1%), and 8 (72.7%) of them had evidence of Epstein-Barr virus (EBV) infection or reactivation. Underlying immunologic disorder or neoplastic disease was identified in 11.1% of the cases. Children less than 3 years of age with HPS were more vulnerable to neutropenia-associated bloodstream infection (85.7% vs 27.3%; p=0.025). Pseudomonas aeruginosa (3) and Candida tropicalis (2) were the 2 most commonly isolated pathogens. Regarding specific management of HPS, intravenous immunoglobulin and steroids were the first-line agents and were administered in 16 cases and 11 cases, respectively, while etoposide was administered in 5 refractory cases during the late phase of disease. Most HPS occurred in previously healthy children, and a substantial proportion of cases rapidly progressed to death. Most cases were associated with viral infection, particularly EBV, and young children tended to develop neutropenia-associated bacteremia during the active phase of the disease.

Adolescent↗
PubMed2004

Bordetella pertussis infection in northern Taiwan, 1997-2001.

The clinical presentations of laboratory-confirmed Bordetella pertussis infection in Chang Gung Children's Hospital during 1997 and 2001 were analyzed. Of the 46 cases, 25 (54.3%) were male. The patients ages ranged from 24 days to 37 years, with a mean and median of 4.3 years and 10.5 years, respectively. Forty four patients had vaccination records, among them 23 patients (52.2%) had received > or = 3 doses of pertussis vaccine. Of the patients who were partially vaccinated (received 1 or 2 doses vaccine) or unvaccinated, 16 (69.6%) presented with whooping cough, 5 (22.2%) with post-tussive vomiting, and 13 (59.1%) with cyanosis. Leukocytosis (white blood cells > or = 15,000 cells/microL) and lymphocytosis (lymphocytes > or = 10,000 cells/microL) were observed in 17 (47.2%) and 16 (44.4%) of the patients, respectively. Fourteen patients (30.4%) developed complications, among which pneumonia was the most common (92.3%). Among infants < or = 1 year of age, 95.2% were partially vaccinated (20/21), compared with 5% (1/20) of the patients > 1 year of age (p<0.05). The overall complication rate was 37.5%, compared with 18.2% for patients > 1 year of age (p<0.05). One 2-month-old patient required ventilatory support after the development of cardiopulmonary failure. There was no mortality in this study. In summary, pertussis most commonly occurred in infants who were unvaccinated or partially vaccinated. These patients usually presented with atypical symptoms such as cyanosis or apnea. The importance of vaccination still cannot be overemphasized because immunized patients usually present with milder disease than those who are not immunized.

Adolescent↗
PubMed2003

Proinflammatory cytokine reactions in enterovirus 71 infections of the central nervous system.

Enterovirus 71 (EV71) infection can lead to devastating clinical outcomes. An appreciation of the scientific relationship between cytokine response and patient mortality may help limit the risks posed by this deadly illness. We present the results of a study that compared the cerebrospinal fluid (CSF) and serum levels of interleukin-6 (IL-6) and interleukin-1beta (IL-1beta) in 24 patients with EV71 infection. Cases in this study involved diverse manifestations or complications, including encephalitis, poliomyelitis-like syndrome, meningitis, and pulmonary edema. CSF levels of IL-6 in study patients were found to be consistently higher during the first 2 days of central nervous system (CNS) involvement than afterward. Compared with patients who did not have pulmonary edema, patients who experienced pulmonary edema had dramatically varied blood values, including IL-6, white blood cell counts, and glucose levels. Our findings suggest that the combination of CNS and systemic inflammatory response may trigger EV71-related cardiopulmonary collapse.

Central Nervous System Infections↗
PubMed2003

Serotype-specific detection of enterovirus 71 in clinical specimens by DNA microchip array.

Enterovirus 71 is an important pathogen that causes high morbidity and mortality in children in Taiwan. Virus isolation in cell cultures has been the standard method for enterovirus 71 identification in Clinical Virology Laboratories. However, virus isolation takes 5-10 days when using cell culture. A microchip for enterovirus 71 detection was developed as an alternative diagnostic method. The novel approach is based on hybridization of amplified DNA specimens with oligonucleotide DNA probes immobilized on a microchip. Two oligonucleotides were used as detection probes, the pan-enterovirus sequence located in the 5'-noncoding region (5'-NCR) and the enterovirus 71-specific sequence located in the VP2 region. The diagnostic procedure takes 6 h. One hundred specimens identified as enteroviruses by viral cultures were tested using this microchip, including 67 enterovirus 71 specimens. The sensitivity of the novel method is 89.6% and its specificity is 90.9%. The enterovirus 71-microchip can detect the amplicon derived from viral RNA corresponding to 1-10 virions in a clinical specimen. Microchip array is a potential diagnostic method for identification of enterovirus in the future.

5' Untranslated Regions↗
PubMed2003

Influenza A-associated central nervous system dysfunction in children presenting as transient visual hallucination.

Five children, ages 3 to 6 years, developed visual hallucination and inappropriate behavior within 3 days of the onset of an influenza-like illness. Electroencephalographic examinations showed generalized slow waves in all five cases. Evidence of acute influenza A viral infection was documented in all five cases. Within 8 days all five children were discharged in stable condition. Influenza A-associated central nervous system dysfunction may be more common than previously recognized, and the prognosis is not necessarily poor.

Child, Preschool↗
PubMed2003

Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections.

OBJECTIVES: Neonatal enterovirus infections have diverse manifestations, from asymptomatic to fatal. An understanding of the risk factors associated with severe cases might help to reduce enterovirus-related morbidity and mortality. METHODS: From July 1989 through June 1998, neonates with virus culture-confirmed nonpolio enterovirus infection at Chang Gung Children's Hospital were enrolled in the study and divided into three groups: nonspecific febrile illness; aseptic meningitis; and hepatic necrosis with coagulopathy (HNC). Demographic factors, clinical manifestations, laboratory data and outcome were analyzed to reveal factors associated with clinical severity and fatality. RESULTS: There were 146 cases including 43 neonates with nonspecific febrile illness, 61 with aseptic meningitis and 42 with HNC. By multiple logistic regression analysis, the most significant factors associated with HNC were prematurity, maternal history of illness, earlier age of onset (< or =7 days), higher white blood cell count (WBC > or =15 000/mm3) and lower hemoglobin (< or =10.7 g/dl). In 10 (24%) of 42 cases, HNC was fatal. In comparison with nonfatal cases of HNC, fatal cases had higher WBC, lower hemoglobin, higher bilirubin and higher incidence of concurrent myocarditis. Multivariate analysis showed the most significant factors associated with fatality from HNC to be total bilirubin >14.3 mg/dl (adjusted odds ratio, 29.1; 95% confidence interval, 2.5 to 355.5; P = 0.007) and concurrent myocarditis (adjusted odds ratio, 13.7; 95% confidence interval, 1.1 to 177.2; P = 0.04). Intravenous immunoglobulin did not correlate with clinical outcomes in cases with HNC. CONCLUSIONS: Prematurity, maternal history of illness, earlier age of onset, higher WBC and lower hemoglobin are significant factors associated with HNC; higher total bilirubin and concurrent myocarditis were most significantly associated with fatality from HNC.

Antiviral Agents↗