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Tzou-Yien Lin

Publications and source records attributed to Tzou-Yien Lin.

At least 73 records · Page 4Linked to original sources
PubMed2003

Enterovirus 71 outbreaks, Taiwan: occurrence and recognition.

Enterovirus 71 (EV71) caused a large outbreak in Taiwan in 1998 with 78 deaths, and smaller outbreaks recurred in 2000 and 2001. The outbreak was recognized because of a large number of hand, foot, and mouth disease cases and the rapid deaths of children with the disease. Virologic and pathologic studies indicated that EV71 was the most important agent related to severe and fatal cases and that a neurogenic inflammatory response was involved in the pathogenesis of cardiopulmonary collapse resulting from fulminant EV71 infection. Seroepidemiologic study suggested that EV71 had circulated for at least 16 years and that the accumulation of susceptible hosts might have triggered the 1998 outbreak. However, a change in EV71 neurovirulence and host genetic susceptibility may also have affected the clinical outcome. The Taiwan outbreak shows that worldwide attention should be paid to such outbreaks, new antiviral drugs should be developed, and that vaccination of children under 5 years of age may be warranted.

Adult↗
PubMed2003

Transcranial Doppler sonography in the early stage of critical enteroviral infection.

OBJECTIVE: There is a high fatality rate in enteroviral infection with central nervous system involvement. Our aim was to investigate the change in intracranial blood flow to disclose the characteristic findings in the early stage of critical enteroviral infection. METHODS: We examined 27 patients in critical condition with enteroviral infection in our pediatric intensive care unit. We performed transcranial Doppler sonography within 12 hours of admission to the unit. The data were compared with those of a group of 11 patients with nonenteroviral encephalitis. RESULTS: The peak systolic, end-diastolic, and mean velocities of the critical enteroviral infection group were significantly higher than those of the control group (P < .05). Gosling pulsatility index and Pourcelot resistive index values for the right and left middle cerebral arteries (pulsatility index, [mean +/- SD], 0.68 +/- 0.22 and 0.77 +/- 0.19, respectively; resistive index, 0.48 +/- 0.01 and 0.52 +/- 0.01) in patients with critical enteroviral infection were significantly lower than those of patients with nonenteroviral encephalitis (pulsatility index, 1.10 +/- 0.30 and 0.98 +/- 0.22; resistive index, 0.62 +/- 0.01 and 0.60 +/- 0.01; P < .05). CONCLUSIONS: Low pulsatility index and resistive index values for cerebral blood flow were observed in the early stage of critical enteroviral infection. This characteristic finding of cerebral blood flow might be associated with the increased sympathetic discharge induced by a brain stem-involved systemic inflammatory response and dysfunction of autoregulation caused by the infection or other disorders of autoregulation that might cause severe or fatal complications.

Acute Disease↗
PubMed2003

Clinical experience with ganciclovir and anti-cytomegalovirus immunoglobulin treatment for a severe case of congenital cytomegalovirus infection.

We report on a female neonate with severe onset of congenital cytomegalovirus (CMV) infection. She was noted to have cerebral ventriculomegaly on antenatal ultrasound, and presented with petechia after birth. Laboratory tests revealed severe thrombocytopenia (platelet count, 11,000/mm3) and hypoglycemia (serum glucose level, 5 mg/dl). Hepatosplenomegaly with elevated hepatic enzymes, retinitis, conjugated hyperbilirubinemia, and diffuse brainstem anomaly were also found in subsequent examinations. The diagnosis was confirmed by positive CMV-IgM from serum and the isolation of CMV from a urine sample. The patient received intravenous ganciclovir and human anti-CMV immunoglobulin during admission. She was discharged at the age of 61 days and followed-up monthly at our clinics. Symptoms and signs subsided except for mild cerebral ventriculomegaly at her last visit. We demonstrate a successful treatment with the combined use of ganciclovir and anti-CMV immunoglobulin.

Antibodies, Viral↗
PubMed2003

Severe adenovirus infection in children.

During the period from July 1, 1999 to September 30, 2000, 9 children with severe adenovirus infection were treated at Chang Gung Children's Hospital. The mean age was 22 months (range, 5-50 months). All of them had lower respiratory tract infections, which manifested as lobar or segmental pneumonia and pleural effusion. Eight (88.9%) of the 9 patients required intensive care and 4 of them required mechanical ventilation. Abnormal laboratory findings included leukocytosis, elevated C-reactive protein, anemia, and prolonged prothrombin time and partial thromboplastin time. Extrapulmonary complications included hepatitis (6 cases), encephalitis (3), conjunctivitis (3), periorbital ecchymosis (1), and coagulopathy (2). One patient died, resulting in a mortality rate of 12.5%. Follow-up at 3 months postdischarge, 5 patients (62.5% of survivors) had bronchiolitis obliterans and/or organizing pneumonia. Seven patients were infected by serotype 3 adenovirus, 1 patient by serotype 2, and another by serotype 11. In conclusion, the clinical, laboratory, and radiographic features of severe adenovirus infection may mimic bacterial infection. Rapid progression of the clinical course despite antibiotic therapy and the presence of unusual extrapulmonary symptoms are important clinical clues in the diagnosis of severe adenoviral infection.

Adenovirus Infections, Human↗
PubMed2003

Yersinia enterocolitica sepsis in an adolescent with Cooley's anemia.

Human infections due to Yersinia enterocolitica have been reported worldwide, predominantly in Europe. However, there have been few reports of Yersinia enterocolitica infection in Taiwan. We report a case of Y. enterocolitica sepsis in a 15-year-old Taiwanese girl with Cooley's anemia and insulin-dependent diabetes mellitus. She presented at admission with fever, shock and consciousness disturbance. She had symptoms of abdominal pain, vomiting and diarrhea for three days before admission. Blood pressure stabilized after intravenous normal saline rescue. Blood culture yielded Y. enterocolitica 2 days later and ceftriaxone was administered according to the results of sensitivity tests. She recovered well after a course of antibiotic treatment. Though Y. enterocolitica sepsis is rare in Taiwan, clinicians should be aware of its tendency to develop in patients with Cooley's anemia, fever and enterocolitis and that its clinical course may include sepsis leading to shock.

Adolescent↗
PubMed2003

Clinical characteristics of children with influenza A virus infection requiring hospitalization.

From September 1997 to March 2002, a total of 84 children were admitted to Chang Gung Children's Hospital due to influenza A virus infection. Influenza A virus infection was documented in 61 cases by viral isolation from throat and in 23 cases by serologic studies. The mean age of patients was 43.8 months, ranging from 20 days to 16 years. Forty-one (49%) patients were male. Lower respiratory tract infection (53 of 84 cases) was the most common clinical manifestation, occurring predominantly in children younger than 5 years (49 of 53 cases). The types of lower respiratory tract infection included bronchiolitis/bronchopneumonia in 33 cases, pneumonia in 17, and croup in 3. Central nervous system dysfunction was noted in 26 patients, predominantly in older children (18 of 26 cases). This included encephalopathy in 11 cases, encephalitis in 10, aseptic meningitis in 2, psychosis in 1, febrile convulsions in 1, and acute disseminated encephalomyelitis in 1. Gastrointestinal symptoms were mild in most patients. Diarrhea occurred in 18.4% of the children younger than 5 years, compared with only 8.4% of the older children. By contrast, abdominal pain was more common in older children (16.7%) than in younger children (6.7%). Ten children had leukocytosis (white blood cell > or = 15000 /microL) and 9 of them were younger than 5 years. Eleven children had a C-reactive protein level greater than 100 mg/L and 10 of them were younger than 5 years. The mean duration of fever and hospitalization were 4.6 +/- 2.8 days and 7.4 +/- 5.7 days, respectively. The clinical outcomes were excellent in all but 1 patient who died from intractable pulmonary hemorrhage. The frequency and duration of hospitalization due to influenza A virus is much greater than generally thought in Taiwan, suggesting an urgent need for educational programs to increase awareness of the characteristics and risks for this illness.

Adolescent↗
PubMed2003

Safety and immunogenicity of a diphtheria, tetanus, and acellular pertussis-inactivated poliovirus vaccine/Haemophilus influenzae type B combination vaccine administered to Taiwanese infants at 2, 4, and 6 months of age.

BACKGROUND: Combined vaccines are urgently needed to ensure compliance with the increasing number of recommended vaccines for children. We evaluated the safety and antibody response to a diphtheria, tetanus, and acellular pertussis-inactivated poliovirus vaccine/Haemophilus influenzae type b (DTaP-IPV/Hib) combination vaccine administrated to infants at 2, 4, and 6 months of age. METHODS: Sixty healthy infants between 6 and 12 weeks of age were enrolled. One group of vaccines received the DTaP-IPV/Hib in a single injection, while another group concurrently received DTaP-IPV and Hib at separate injection sites. Solicited adverse events were monitored by parental observation and were recorded on a diary card. Levels of serum antibodies to DTaP and polyribosyl-ribitolphosphate-tetanus (PRP-T) antigens were collected before the first vaccine dose and 1 month after the third vaccine dose. RESULTS: The combined-injection group tended to have lower local reactions, and there was no increase in reactogenicity when compared with the separate-injection group. Seroconversion rates were 100% in both groups for all antigens, except for the anti-polio 2 antibody in the combined-injection group (96.4%). The combined-injection group had lower antibody levels of PRP (8.45 microg/ml) than did the separate-injection group (20.61 microg/ml). However, the percentage of vaccines achieving protective levels of antibody to PRP (> or = 0.15 microg/ml or > or = 1.0 microg/ml) was similar in both groups. CONCLUSIONS: DTaP-IPV/Hib may be safely and effectively administered to healthy infants, using a 2-, 4-, and 6-month vaccination schedule. This combined vaccine is cost-effective, more acceptable to parents and physicians, and minimizes distress to infants.

Antibodies, Bacterial↗
PubMed2003

Fatal bacteremic pneumonia caused by Aeromonas hydrophila in a previously healthy child.

Aeromonas hydrophila sepsis and pneumonia are rare diseases in children that carry a high mortality rate. We report a case of fatal bacteremic pneumonia caused by A. hydrophila in a previously healthy 5-year-old child. The source of infection was not determined and the child died within 4 hours of admission. In children who develop a fulminant disease of pneumonia with or without sepsis, particularly those who have underlying medical conditions, a possible A. hydrophila infection, though rare, should be considered. More reported cases are needed to establish the epidemiologic features of this disease in children.

Aeromonas hydrophila↗
PubMed2003

Rotavirus gastroenteritis associated with afebrile convulsion in children: clinical analysis of 40 cases.

BACKGROUND: The purpose of this study was to evaluate the clinical manifestations and outcomes of hospitalized children with afebrile seizures following rotavirus gastroenteritis. METHODS: We conducted a retrospective study enrolling patients under 18 years old who were admitted to our hospital during a 10-year period with the diagnosis of rotavirus gastroenteritis. We identified and further analyzed patients who presented with afebrile seizures, without previous seizure disorders, electrolyte imbalances or hypoglycemia. The statistical methods used were the Chi-square test, the Kruskal-Wallis test and the Mann-Whitney test. RESULTS: Of 1937 patients, 40 patients (24 female and 16 male patients) met the inclusion criteria. The incidence of afebrile seizures following rotavirus gastroenteritis was 2.06%. The age of the patients ranged from 6 months old to 6 years old (mean, 1.9 years). The highest incidence of afebrile seizures was 4.67% in children 1 to 2 years of age (p < 0.001). Twenty-seven patients (67.5%) had two or more seizures, which usually were in clusters within a 24-hour period. No status epilepticus was observed. More than half of the patients (52.5%) suffered from seizures on the third day of diarrhea. Only five of 35 patients showed abnormal electroencephalogram (EEG) findings, which reverted to normal in four of the patients during the follow-up period. Most patients did not require long-term anticonvulsant treatment. During the follow-up period, all patients displayed normal psychomotor development without the recurrence of seizures, except in one patient who had a febrile convulsion. CONCLUSION: We found that the course of afebrile seizures following rotavirus gastroenteritis was benign with satisfactory outcomes.

Adolescent↗
PubMed2003

Acute hematogenous osteomyelitis and septic arthritis in children.

This retrospective study analyzed the clinical, bacteriological, and radiological features of pediatric patients with acute hematogenous osteomyelitis and septic arthritis. Eighty-four patients with septic arthritis and 39 with acute hematogenous osteomyelitis were enrolled. Their age ranged from 13 days to 17 years. In patients with septic arthritis, the hip joint was the most often infected site. The tibia was the most often involved site in acute hematogenous osteomyelitis. A bacteriological diagnosis was established in 78 (63%) patients. Overall, methicillin-susceptible Staphylococcus aureus (36 cases) was the most common causative organism identified, followed by methicillin-resistant S. aureus (10 cases). The median duration of antibiotic therapy was 33 days. Serum bactericidal titers were obtained for 19 (15%) of the 123 patients. The median duration of hospitalization and antibiotic treatment was not significantly different between patients with and without serum bactericidal titer testing. More patients without serum bactericidal titer testing had symptom relapse which required re-admission for further treatment. In conclusion, the incidence of methicillin-resistant S. aureus as a cause of bone and joint infections has been increasing. Serum bactericidal titer is valuable for the management of patients receiving sequential therapy for acute hematogenous osteomyelitis and septic arthritis.

Acute Disease↗
PubMed2002

Lactoferrin inhibits enterovirus 71 infection of human embryonal rhabdomyosarcoma cells in vitro.

Enterovirus 71 (EV71), the newest member of Enterovirudae, is notable for its etiological role in epidemics of severe neurological diseases in children. It appears to be emerging as an important virulent neurotropic enterovirus in the upcoming era of poliomyelitis eradication, whereas no effective vaccine or antiviral agents are available at this moment. Human and bovine lactoferrins, iron-binding proteins belonging to the nonimmune defense system, were assayed in vitro to assess their inhibiting capacity on the cytopathic effect of EV71 on human embryonal rhabdomyosarcoma (RD) cells. Both bovine and human lactoferrins were found to be potent inhibitors of EV71 infection (mean IC(50), 10.5-24.5 microg/mL and 103.3-185.0 microg/mL, respectively). Lactoferrin probably exerts its effect at the level of viral adsorption, since the ongoing infection could not be further inhibited after the EV71 penetrated RD cells.

Antiviral Agents↗
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

The 1998 enterovirus 71 outbreak in Taiwan: pathogenesis and management.

The most recently discovered enterovirus, enterovirus 71 (EV71), is neurotropic and may cause severe disease and sudden death in children. In 1998, a large outbreak of enterovirus infection occurred in Taiwan that resulted in 405 severe cases in children and 78 deaths. Of the 78 children who died, 71 (91%) were <5 years old. EV71 was the primary agent in fatal cases of infection. Most of these patients died within 1-2 days of admission to the hospital. We hypothesize that EV71 directly attacks the central nervous system and causes neurogenic pulmonary edema and cardiac decompensation through the mechanism of sympathetic hyperactivity and inflammatory responses. Early recognition of risk factors and intensive care are crucial to successful treatment of this fulminant infection. After poliovirus is eradicated, EV71 will become the most important enterovirus that affects children, and development of a vaccine may be the only effective measure against it.

Convalescence↗
PubMed2002

The emergence in Taiwan of fluoroquinolone resistance in Salmonella enterica serotype choleraesuis.

BACKGROUND: Salmonella enterica serotype choleraesuis is a cause of serious systemic infections. Because fluoroquinolones are the drug of choice for the treatment of severe salmonella infections, the emergence and dissemination of fluoroquinolone-resistant S. enterica serotype choleraesuis have clinical consequences. METHODS: In Taiwan, a hospital-based surveillance system has been in place since 1987 to monitor the incidence of S. enterica serotype choleraesuis infections and the antimicrobial susceptibility of the isolates. We investigated the rapid emergence of fluoroquinolone resistance in this serotype in 2000 and 2001. Pigs in Taiwan were evaluated as a potential source of the resistant salmonella. RESULTS: A total of 501 clinical isolates of S. enterica serotype choleraesuis were recovered in our hospital from 1987 through 2000. The proportion of total salmonella isolates made up by S. enterica serotype choleraesuis decreased from an average of 8.4 percent before 1995 to 2.7 percent in 1996 through 1998. During 1999 and 2000, this proportion increased significantly, to an average of 5.0 percent. Ciprofloxacin resistance in S. enterica serotype choleraesuis has been observed since 2000. In the third quarter of 2001, 60 percent of isolates were resistant to ciprofloxacin. Molecular typing indicated that the primary source of S. enterica serotype choleraesuis isolates was herds of swine. All the resistant isolates from humans and swine had mutations that led to the substitution of phenylalanine for serine at position 83 and asparagine for aspartic acid at position 87 in the gene for DNA gyrase A. CONCLUSIONS: This investigation in Taiwan indicates that fluoroquinolone-resistant S. enterica serotype choleraesuis can spread from swine to humans. The use of fluoroquinolones in food animals should be prohibited.

Animals↗
PubMed2002

Responses of IgM for enterovirus 71 infection.

A rapid serological assay was developed for detection of specific IgM to enterovirus 71, a human picornavirus that is usually associated with severe central nervous system complications. The sensitivity and specificity of this "in-house" mu-capture enzyme linked-immunosorbent assay was assessed by testing 213 serum samples. With the conventional virus culture as a standard method, the sensitivity and specificity were 91.5 and 93.1%, respectively, for this newly developed immunoassay. This method allows for detection of the IgM responses from the patients either infected by genotype B or genotype C of enterovirus 71. IgM can be detected as early as the second day from the onset of disease. IgM responses exhibit 100% positive rate from enterovirus 71-infected patients with complications, including encephalitis, meningitis, polio-like syndrome, pulmonary edema, and fatal cases. These findings suggest that detection of specific IgM by the use of enzyme linked-immunosorbent assay is a rapid and valuable way for the diagnosis of enterovirus 71 infection.

Antibodies, Viral↗
PubMed2002

Psychiatric morbidity and pregnancy outcome in a disaster area of Taiwan 921 earthquake.

We investigated the prevalence of minor psychiatric morbidity in a group of women who were pregnant during or immediately after a major earthquake disaster and we investigated the prognostic factors that may have influenced the perinatal outcome of the pregnancy. The study was initiated 6 months after the earthquake and enrolled 171 women in a town near the epicentre. A Post-Earthquake Questionnaire, Chinese Health Questionnaire (CHQ-12) and posttraumatic stress disorder (PTSD) symptoms checklist were completed before delivery while the perinatal data were retrieved from hospital obstetrical records. The prevalence of minor psychiatric morbidity (MPM) was 29.2%. Women with starvation experience, higher negative attitude scores about the influence of earthquake on pregnancy and more casualties among relatives were significantly correlated with high CHQ. A significant positive correlation between the MPM and PTSD scores was noticed. Among the 115 pregnancies with known perinatal outcome, there were nine (7.8%) low-birth weight neonates, defined as birth weight < or = 2500 g. Maternal history of abdominal injury, spouse casualty and instability in living condition were significantly correlated with low birth weight. Spouse casualty was the only significant factor that predicts neonatal low birth weight.

Adult↗