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Tzou-Yien Lin

Publications and source records attributed to Tzou-Yien Lin.

81 records · Page 5Linked to original sources
PubMed2002

Clinical manifestations and laboratory assessment in an enterovirus 71 outbreak in southern Taiwan.

An epidemic of enterovirus 71 (EV71) infection compatible with hand, foot and mouth disease and associated with high morbidity and mortality occurred in Taiwan in 1998. We recruited 90 patients (50 males, 40 females) with definite EV71 infections for clinical and laboratory analysis. The neurological signs and symptoms, all of which occurred during the febrile period, in patients with central nervous system (CNS) involvement (aseptic meningitis, encephalitis or myelitis) were myoclonic jerks (23/33), vomiting (10/33), ataxia (7/33), lethargy (6/33), seizure (4/33) and tremor (2/33). Patients with CNS involvement had longer durations of fever (4.6+/-0.2 vs. 3.1+/-0.3 d; p <0.01) and a higher white blood cell count (12,512+/-658 vs. 10,607+/-409 cells/mm3; p = 0.01) than patients without CNS involvement. The case fatality rate in patients with CNS involvement was 4/33 (12%), whereas no fatalities (0/57) occurred in patients without CNS involvement. Six of 11 patients subjected to MRI showed a high intensity T2-weighted signal in the brainstem. A nested fluorescent RT-PCR for detection of virus in throat and stool specimens showed higher sensitivity than viral culture. Viremia was detectable using RT-PCR in 20% of cases (3/15), whereas no virus was isolated from culture or detected by RT-PCR in cerebrospinal fluid.

Antibodies, Viral↗
PubMed2002

Cefepime versus ceftazidime as empiric monotherapy for fever and neutropenia in children with cancer.

BACKGROUND: Monotherapy with cefepime or ceftazidime is an effective alternative to combination therapy for the treatment of febrile neutropenic adult cancer patients. We compared the efficacy and safety of cefepime and ceftazidime as empiric monotherapy of febrile neutropenia in children with cancer. MATERIALS AND METHODS: A prospective, open label, randomized, comparative study in pediatric cancer patients was conducted at Chang Gung Children's Hospital from January 1, 2000, to April 15, 2001. Patients with fever and neutropenia (absolute neutrophil count of < or = 500/mm3) were randomized to receive either intravenous cefepime or ceftazidime (50 mg/kg/dose as two or three doses daily). Febrile episodes were classified as microbiologically documented infection, clinically documented infection or unexplained fever. Clinical response to therapy was classified as success and failure. RESULTS: Ninety-five pediatric cancer patients with 120 febrile neutropenic episodes were randomized to receive empiric treatment with cefepime or ceftazidime. After 72 h of treatment, 82.8% (48 of 58) of the eligible patients in the cefepime group continued with unmodified therapy, compared with 87.9% (51 of 58) in the ceftazidime group. The neutrophil count was <100/mm3 at randomization for 76% of the patients in the cefepime group and 83% of those in the ceftazidime group; the median durations of neutropenia (<500/mm3) were 8.5 and 6.5 days, respectively. Of the 96 evaluable episodes the overall success rate with unmodified empiric therapy until the end of the treatment course in the cefepime group was comparable with that in the ceftazidime group (69% vs. 71%, P = 0.95). The response rate after glycopeptides were added to the regimens was 79.2% for the cefepime group and 77.1% for the ceftazidime group. The bacterial eradication rate was 33% for the cefepime group and 20% for the ceftazidime group (P = 0.85), and the rates of new infections were 10.4% vs. 4.2% (P = 0.67), respectively. Both study drugs were well-tolerated. Three (6.4%) patients in the cefepime group and 2 (4.3%) patients in the ceftazidime group died. CONCLUSION: Cefepime appeared to be as effective and safe as ceftazidime for empiric treatment of febrile episodes in neutropenic pediatric cancer patients.

Adolescent↗
PubMed2002

Community-acquired Pseudomonas aeruginosa sepsis in previously healthy infants and children: analysis of forty-three episodes.

BACKGROUND: Pseudomonas aeruginosa sepsis is often considered to be hospital-acquired and to affect mainly children with underlying problems. Fewer than 50 cases of community-acquired sepsis associated with P. aeruginosa in previously healthy infants and children have been reported in English language literature. METHODS: We retrospectively reviewed the medical records of 121 infants and children younger than 15 years of age who had 124 episodes of P. aeruginosa sepsis and were hospitalized at Chang Gung Memorial Hospital and Chang Gung Children's Hospital during 1983 and 1998. Forty-three episodes of community-acquired infection occurring in previously healthy children were evaluable for this study. RESULTS: Thirty-two children (74%) were male and 36 (84%) were <1 year of age. Ten patients (23%) died. The onset of P. aeruginosa sepsis occurred during May to October in 34 cases (79%). Fever (91%) and diarrhea (72%) were the 2 most common initial symptoms. On admission leukopenia (leukocyte count <5,000/mm ) was present in 24 cases (57%) and in 9 of 10 fatal cases. P. aeruginosa was also isolated from other sites than bloodstream in 25 cases (58%), including 10 (43%) of 23 fecal specimens. The initial antibiotic regimen was inappropriate in 16 cases (38%), and the rate of inappropriate initial antibiotic regimen was significantly higher (P = 0.002) in fatal cases (90%) than that in nonfatal cases (24%). CONCLUSION: Community-acquired P. aeruginosa sepsis in previously healthy infants is not rare in Taiwan. During warm weather seasons, in infants with fever and diarrhea who suddenly develop a septic appearance, it is advisable to cover for P. aeruginosa sepsis with aminoglycosides and/or anti-Pseudomonas beta-lactam antibiotics.

Adolescent↗
PubMed2002

Outbreak of Acinetobacter baumannii bacteremia in a neonatal intensive care unit: clinical implications and genotyping analysis.

BACKGROUND: Outbreaks of sepsis associated with have been rarely reported in neonatal intensive care units (NICUs). We describe such an outbreak in a NICU, and the results of molecular epidemiologic investigations are presented. MATERIALS AND METHODS: Between August and September 2000, 6 premature infants hospitalized in a pediatric NICU developed sepsis. Three additional cases had infections during November and December. For an environmental culture survey, 94 environmental specimens and hand washings of all 43 health care workers involved in this unit were examined for the presence of this organism. Two genotyping methods, pulsed field gel electrophoresis of genomic DNA digested with I and infrequent restriction site polymerase chain reaction, were used to analyze the 9 bacteremic isolates and any isolates obtained from the environmental survey and the hand washings. Another 3 bacteremic isolates of collected in the same NICU in 1999 were incorporated as controls. RESULTS: The 9 infants were premature and had birth weights of <1,500 g. Before onset of sepsis 9 infants had received total parenteral nutrition, and 8 infants had had central venous catheters and received intrafat emulsion. Five (5.3%) environmental specimens and 10 (23.3%) hand washing specimens were positive for the organism. Except for the strain from Case 9, the results of both genotyping methods were concordant; 11 patterns were identified by infrequent restriction site polymerase chain reaction and 10 patterns by pulsed field gel electrophoresis. One major genotype was demonstrated in the first 6 bacteremic isolates as well as 3 hand washing isolates. The genotypes of the other 3 bacteremic isolates, the 3 control strains, the 5 environmental isolates and 7 other hand washing isolates were distinct from the genotype of outbreak strains. CONCLUSION: An outbreak of bacteremia in a NICU was clearly demonstrated by the molecular epidemiologic investigation and was possibly transmitted via the hands of health care workers.

Acinetobacter Infections↗
PubMed2002

Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan.

OBJECTIVE: In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness. METHODS: Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations. RESULTS: A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to age-specific periepidemic mortality rates (r = -0.82) or severe case rates (r = -0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r = 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4-29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9-3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3-2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2-2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1-1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2-1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children. CONCLUSIONS: An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998.

Child↗
PubMed2002

Multidrug-resistant non-typhoid Salmonella infections in a medical center.

Due to the high incidence of antimicrobial-resistant Salmonella in Taiwan, the emergence of multidrug-resistant Salmonella has become of particular concern. This retrospective study assessed the clinical features of patients with multidrug-resistant Salmonella treated from January 1998 through June 2000. A total of 201 children and 33 adults with multidrug-resistant Salmonella infections treated during a 2.5-year period were included. Sixty-percent of these patients had used antibiotics before multidrug-resistant Salmonella infection developed. The incidence of extra-intestinal infections was higher in adults (51.4%) than in children (4.9%). Infection with an invasive serotype of Salmonella, such as Salmonella choleraesuis, and host factors appeared to be predisposing factors for bacteremia or extra-intestinal infections. None of the patients had mortality attributable to multidrug-resistant salmonellosis. The increasing rate of resistance to third-generation cephalosporins and fluoroquinolones and the high multidrug-resistant rate of S. choleraesuis found in this study indicate the importance of judicious use of antimicrobial agents in both humans and animals to reduce the selection and spread of resistant strains.

Adult↗
PubMed2002

Duration of antimicrobial therapy for non-typhoid Salmonella bacteremia in healthy children.

Medical records of patients less than 17 years of age with positive blood culture for non-typhoid Salmonella from June 1996 through December 1998 at the Chang Gung Children's Hospital were collected. Patients were categorized into 3 groups according to the duration of effective antibiotic therapy they received. Group 1 received effective antibiotic therapy for less than 7 days; Group 2 for 7 to 9 days; and Group 3 for 10 days or more. Information on clinical presentations, laboratory data, and outcome were collected and analyzed. A total of 59 children were eligible, with 21 in Group 1, 17 in Group 2, and 21 in Group 3. Demographic data were similar among the 3 groups. No significant difference was found in the clinical symptoms and laboratory data among these groups, including white blood cell count, immature to total ratio of white blood cell, and serum C-reactive protein level. Salmonella group B (n = 37) were the most common isolates, followed by group D (n = 9), group C2 (n = 8), cholerasuis (n = 4), and C1 (n = 2). Third-generation cephalosporins were the final antibiotic therapy in most (90%) patients, and no isolates showed resistance to these agents in this study. No focal suppurative complications were noted at the initial evaluation and in the 1-year period after treatment. No clinical recurrent diseases were noted during a follow-up period of at least 1 year. Results suggest that for otherwise healthy children with non-typhoid Salmonella bacteremia, less than 10 days of antibiotics therapy could be adequate if they are more than 1 year old and no focal extra-intestinal infection is noted in the initial evaluation.

Anti-Bacterial Agents↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus bacteremia in neonatal intensive care units: genotyping analysis and case-control study.

To assess the relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates and to identify the risk factors for the acquisition of MRSA bacteremia in infants hospitalized in neonatal intensive care units (NICUs), 21 bloodstream isolates from 21 infants were genotyped and other 21 infants without MRSA bacteremia were matched for a case-control study. Two genotypes (A and C) were identified by pulsed-field gel electrophoresis and three genotypes (I, II and III) by infrequent-restriction-site polymerase chain reaction. Genotype C-III in 9 isolates and genotype A-I in 7 isolates were the two most common genotypes. The presence of skin infection at onset, prolonged prior duration of central venous catheter indwelling and prolonged hospital stay were significantly associated with MRSA bacteremia in these infants. With multiple logistic regression analysis, the presence of skin infection at onset was the only significant risk factor of MRSA bacteremia, with an odds ratio of 20.8 (95% CI 2.95-145.4, p =.002). Conclusively, two major clones of MRSA prevailed in our NICUs, and the presence of skin infection at onset was the risk factor for the acquisition of MRSA bacteremia in these infants.

Bacteremia↗