BACKGROUND:Pneumonia is the leading reason for hospitalization in children. The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. There has been no comprehensive study of the etiology of childhood community-acquired pneumonia (CAP), either in the pre- or postpneumococcal conjugate vaccine era, in Taiwan.METHODS:From August 2001 to July 2002, consecutive children admitted to a teaching hospital with radiologically confirmed CAP were prospectively enrolled. The following were considered indicative of infection when positive: blood or pleural effusion bacterial culture or urinary Streptococcus pneumoniae antigen test (Binax NOW), direct immunofluorescent antigen test for Chlamydia species and viruses, virus isolation and identification and viral, mycoplasmal or chlamydial serologic tests.RESULTS:A total of 209 children were included, and 102 children (48.8%) were male. Patients' ages ranged from 7 months to 16 years with a median of 4 years and 3 months. The combined tests identified at least 1 etiologic agent in 85.6% of all cases, including typical bacterial pathogens in 88 cases (42.1%; 86 S. pneumoniae, 1 methicillin-resistant Staphylococcus aureus and 1 Mycobacterium tuberculosis), Mycoplasma pneumoniae in 77 cases (36.8%), Chlamydia species in 24 cases (11.5%), viral etiology in 86 cases (41.1%) and mixed viral-bacterial infections in 69 cases (33%). Children with S. pneumoniae infection were significantly younger than those with Mycoplasma pneumoniae infection (P = 0.0055) or unknown etiology (P = 0.0140).CONCLUSION:S. pneumoniae, Mycoplasma pneumoniae and viruses were equally common etiologic agents of childhood CAP in Taiwan. Frequent coinfection increased the difficulty of both predicting the responsible organisms and choosing empiric antibiotics for the management of pediatric CAP.

Chryseobacterium meningosepticum usually causes infections in neonates and the immunocompromised. Treatment is handicapped by the organism's inherent multidrug resistance. In this study, the clinical characteristics of patients with C. meningosepticum bloodstream infection (BSI) were retrospectively reviewed. Antimicrobial susceptibilities of the clinical isolates were analysed and their ability to form biofilm was assayed by crystal violet staining and electron microscopy. During 2003-2007, 40 patients with BSI caused by C. meningosepticum were included. Mean patient age was 61.6±22.1 years. Co-morbidities were observed in 38 cases (95.0%) and a high 14-day mortality (52.5%) was observed in these patients. Susceptibility of the isolates was relatively high (>50%) only to piperacillin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole and ciprofloxacin. Multivariate analysis revealed that mortality was associated with the use of central venous catheters, initial inappropriate antimicrobial therapy and higher biofilm production by the organism. Electron microscopy confirmed the formation of biofilm microcolonies on the solid phase of the fibre of nitrocellulose paper in vitro. Time-kill studies showed that biofilm formation helps bacteria to tolerate killing by ciprofloxacin. In conclusion, C. meningosepticum is a biofilm-forming organism. The outcome of patients with biofilm-forming C. meningosepticum infection was adversely affected by the choice of inappropriate antimicrobial therapy and the use of long-term indwelling intravascular catheters.

Background: Acute infectious diarrhea is a major cause of childhood morbidity and economic burden for families. We evaluate the clinical, microbiologic, and immunologic effects of probiotics in acute infectious diarrhea. Methods: Children (n = 304) aged 3 months to 6 years hospitalized for acute diarrhea were randomized to receive Bio-three (a mixture of Bacillus mesentericus, Enterococcus faecalis, and Clostridium butyricum) or placebo orally 3 times daily for 7 days. Fecal samples were homogenized for bacterial culture and blood cells were isolated for cell culture and cytokine analysis. This study is registered (NCT00463190). Results: The mean duration of diarrhea after start of therapy was 60.1 hours in the probiotics group versus 86.3 hours in the placebo group (P = 0.003). Hospital stay was shorter in the probiotics group than in the placebo group (P = 0.009). Counts of Bifidobacteria and Lactobacillus species were elevated in stool culture of the probiotics (Bio-three) group. IL-10 was increased in the serum and supernatants of cell culture in the probiotics group, and tumor necrosis factor-&agr; values were down-regulated. Interferon-&ggr; and IL-12 were mildly elevated in the probiotics group, compared with the placebo group. Conclusions: This probiotics mixture reduced the severity of diarrhea and length of hospital stay in children with acute diarrhea. In addition to restoring beneficial intestinal flora, probiotics may enhance host protective immunity such as down-regulation of pro-inflammatory cytokines and up-regulation of anti-inflammatory cytokines.

We conducted an active, population-based laboratory surveillance study to evaluate the epidemiologic features of invasive pneumococcal disease (IPD) in Taiwan. Concurrently, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated among 1128 healthy children aged or=65 years, the 23-valent pneumococcal polysaccharide vaccine covered 70.4% of cases. In the future, a broader pneumococcal vaccine is needed.

Pertussis vaccines containing reduced amounts of antigen have been considered primarily for use in adolescents and adults to date. We evaluated a reduced antigen content combined diphtheria tetanus acellular pertussis and inactivated polio vaccine (dTpa-IPV) in 6-8 years old children in Taiwan, who had received 4 doses of DTPw (combined diphtheria, tetanus, whole cell pertussis vaccine) and OPV (oral polio vaccine). One month after the booster dose, seroprotection rates and vaccine response rates to all antigens were at least 98.8%, and significant increases in antibody concentrations were observed. Booster vaccination was associated with minor local reactions and systemic symptoms. Symptoms of severe intensity did not occur, with the exception of local pain. The dTpa-IPV vaccine was immunogenic and well tolerated in 6-8 years old children and offers an alternative to the current use of tetanus and diphtheria vaccine and OPV in Taiwan, addressing the established need for repeated booster vaccinations against pertussis at the same time.

Background/Purpose: An epidemic of severe acute respiratory syndrome (SARS) occurred in Taiwan from April to July 2003. A nosocomial outbreak of SARS occurred at Kaohsiung Chang Gung Memorial Hospital (CGMH) in May 2003. The purpose of our study was to survey the prevalence of the SARS coronavirus (CoV) in a community adjacent to Kaohsiung CGMH and collect demographic data, including basic information about health status, household, and possible risk factors for SARS-CoV infection.Methods: We randomly recruited 1030 persons living in three precincts adjacent to Kaohsiung CGMH. For all subjects, we collected demographic data and measured the seroprevalence of the SARS-CoV with an enzyme-linked immunosorbent assay (ELISA) and an immunofluorescence assay (IFA).Results: The ELISA was seropositive for 124 of 1030 participants (12%). The more sensitive and specific IFA confirmed SARS in only two cases (0.19%). Both confirmed cases were under 19 years of age and had no known SARS-related risk factors.Conclusion: There was low post-epidemic seroprevalence of SARS-CoV in a community adjacent to a hospital which had a nosocomial SARS outbreak. The SARS outbreak in Taiwan was primarily limited to hospital settings. [J Formos Med Assoc 2008; 107(11):885-891]

Objective: To evaluate antibody persistence one year after three-dose primary vaccination and booster immune response during the second year of life for a fully liquid diphtheria-tetanus-acellular pertussis-inactivated poliomyelitis-Haemophilus influenzae type b (DTaP-IPV-PRP similar to T) vaccine.Methods: Infants at 18-19 months of age were given a booster dose of either DTaP-IPV-PRP similar to T (group A) or DTaP-IPV plus PRP similar to T at separate injection sites (group B), after primary vaccination at two, four and six months of age, with the same vaccines. Antibody concentrations were measured pre- and post-booster. Reactogenicity and safety were evaluated from parent reports.Results: Before the booster dose, 93.1% of group A and 95.1% of group B children still had anti-PRP antibody titers >= 0.15 mu g/ml. All children had antibody levels believed to protect against tetanus, polio 1 (except one subject in group B), polio 2, polio 3, and diphtheria (except one subject in group A). At least 94% of children still had antibody concentrations >= 5 ELISA units (EU) to pertussis antigens (pertussis toxoid (PT), filamentous hemagglutinin (FHA), pertactin (PRN), fimbriae 2 and 3 (FIM2+3). One month after the booster dose, all subjects achieved antibody concentrations or titers believed to be protective for PRP (polyribose ribitol phosphate)(>= 1 mu g/ml), diphtheria and tetanus (>= 0.1 IU/ml) and poliovirus types 1, 2, and 3 (>= 8 1/dil.), and at least 90.5% of subjects had four-fold increases in antibody concentrations to pertussis antigens following the booster. Anti-PRP geometric mean titers (GMTs) increased from 1.07 to 59.6 mu g/ml and from 1.8 to 62.2 mu g/ml in groups A and B, respectively. Both vaccine groups showed low reactogenicity rates.Conclusions: The fully liquid pentavalent DTaP-IPV-PRP similar to T vaccine is highly immunogenic, with good antibody persistence for each antigen approximately one year after primary vaccination and strong booster responses at 18-19 months of age. Because this combined vaccine is fully liquid, requiring no reconstitution of lyophilized PRP similar to T, the ease of use and proper administration are improved. (C) 2007 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background: Nontyphoidal Salmonella (NTS) bacteremia is not rare in otherwise healthy children in Taiwan. Few studies described the clinical manifestations and outcomes of NTS bacteremia in previously healthy children.Methods: Children with blood culture positive for NTS treated at Chang Gung Children's Hospital between May 1996 and June 2003 were identified from the microbiology logbook. Patients who had underlying events or concomitant diseases were excluded.Results: We evaluated 199 patients. One hundred and eighteen (59.3%) were male children and 184 (92.5%) were between 3 months and 5 years of age. Fever (97.0%) and diarrhea (79.9%) were the most common initial presentations. Leukocytosis (leukocyte > 15,000/mm(3)) and elevated serum C-reactive protein concentration (>= 10 mg/L) were present in 14.6% and 79.4% of the patients, respectively. Eighty-three percent of 184 patients with antibiotic treatment received a third- or fourth-generation cephalosporin as definitive antibiotic therapy. Focal suppurative infections were present in 5 children (2.5%) on initial evaluation, and included meningitis in 2 and osteomyelitis in 3. Neither metastatic complications nor clinically recurrent diseases were found during a follow-up period of at least 12 months after treatment. No fatalities occurred in this series.Conclusions: In healthy children, NTS bacteremia was relatively benign and extraintestinal focal suppurative infections were infrequently seen. Less than 10 days of appropriate antibiotic treatment is probably adequate for those without a suppurative focus of infection.

To assess the immunogenicity of a fully liquid diphtheria-tetanus-five component acellular pertussis-inactivated poliomyelitis-Haemophilus influenzae type b (DTaP-IPV-Hib) conjugate vaccine compared to DTaP-IPV and lyophilized Hib conjugate vaccines given simultaneously at separate sites as a three-dose primary vaccination in Taiwanese infants.Two hundred infants were randomized to receive either DTaP-IPV-Hib or DTaP-IPV plus Hib vaccine at 2, 4, and 6 months of age. Both combined vaccines contained the same five pertussis antigens: pertussis toxoid (PT), filamentous hemagglutinin (FHA), pertactin (PRN), fimbriae 2 and 3 (FIM 2&3). Antibody concentrations were measured before the first and after the third dose. Reactogenicity was evaluated from parental reports. All subjects received hepatitis B vaccine at 0, 1, and 6 months of age following the national vaccination schedule of Taiwan.The immunogenicity after the third dose was high for each vaccine antigen in both groups, and the vaccines had low reactogenicity. Statistical analysis showed no differences in the immune responses to the fully liquid DTaP-IPV-Hib vaccine compared with those to the DTaP-IPV plus Hib control vaccines, notably the anti-PRP (polyribose ribitol phosphate capsular polysaccharide) response, with 97-99% of infants having concentrations >or=1.0 microg/mL. Approximately 95% of all infants developed seroprotective levels of anti-hepatitis B surface antigen (HBs) antibodies (>or=10 mIU/mL).Both combination vaccines had similar high immunogenicity for each antigen, and both were well tolerated. Thus, inclusion of a Haemophilus influenzae type b conjugate vaccine in the combination did not result in clinically significant decrease in the PRP response or increase reactogenicity. The fully liquid pentavalent vaccine has the advantages of not requiring reconstitution and of administration as a single injection.

Objective To determine whether different brands of intravenous immunoglobulin (IVIG) administered to children with Kawasaki disease (KD) result in different outcomes.Study design We analyzed children with KD and divided them into 4 groups according to the brand of IVIG. A coronary artery abnormality (CAA) was defined as having a lumen diameter (inner border to inner border) of >= 3 mm in KD cases < 5 years old and >= 4 mm in cases 5 years old, and giant aneurysm was defined as a lumen diameter >= 8 mm. Patients were considered nonresponsive to IVIG therapy if fever persisted longer than 2 days after completion of treatment and needed retreatment with IVIG.Results We collected 43 7 cases, 29 (6.6%) were nonresponsive, 17 (3.9%) had CAA at convalescence, and 3 (0.7%) had giant aneurysm, 2 of whom had development of myocardial infarcts. Patients receiving Brand C WIG, prepared with beta-propiolactone, had higher rates (10%, 9/93, P = .01) of CAA at convalescence and nonresponsiveness (13%, 12/93, P = .001); giant aneurysm occurred in 3/93 (3%) receiving Brand C IVIG and in 0/344 who received the other 3 brands (P = .008).Conclusions IVIG, prepared with beta-propiolactone, was most significantly associated with nonresponsiveness, CAA at convalescence, and giant aneurysm. Physicians should be cautious when using IVIG prepared with beta-propiolactone or enzyme digestion to treat KD.

Chryseobacterium meningosepticum causes severe infections in infants or adults with underlying illness. The species is highly heterogeneous, genetically composed of subgroups with different pathogenicity. Eight strains of C. meningosepticum, representing four different genomic subgroups, were evaluated for their ability to penetrate Madin-Darby Canine Kidney (MDCK) epithelial cell monolayers and serum resistance. None of the strains showed cytotoxicity or penetration to the MDCK cells. All displayed resistance to the bactericidal activity of various normal human sera. A murine pulmonary infection model was used to compare the pathogenicity between a clinical isolate and an environmental isolate. C. meningosepticum were cleared from the lung of infected mice within 7 days following the intratracheal challenge. Electron microscopy demonstrated the large membrane protrusions, indicative of ruffles, and smaller, less organized membrane structures of the respiratory epithelial cells induced by the clinical isolate. Bacteria were observed to enter the cells as single entities in spacious vacuoles. Suppressive subtraction hybridization identified in the invasive isolate 35 distinct sequences associated with systems of energy production and conversion, transport, and secretion. In most cases, the identities between the references and the amino acid sequences deduced were low, suggesting that the functions of these sequences remain unknown.

BACKGROUND:Human metapneumovirus (hMPV) was first recognized in the Netherlands in 2001 from nasopharyngeal aspirate samples and was associated with respiratory tract illness in the pediatric population. This was the first report of metapneumovirus infections in community-acquired pneumonia in Taiwan.METHODS:A total of 116 nasopharyngeal aspirate samples from patients with community-acquired pneumonia was examined by reverse transcriptase polymerase chain reaction (RT-PCR). Other respiratory tract pathogens were also examined. The clinical characteristics and laboratory data were analyzed.RESULTS:Out of the 116 patients, potential causative agents were detected in 95 (81.9%) patients. A total of six human metapneumovirus RT-PCR positive samples was identified. All of these had evidence of coinfection with bacteria (3 Streptococcus pneumoniae, 2 Mycoplasma pneumoniae, 1 Chlamydia pneumoniae). Coinfection with other respiratory viruses was also observed in two cases (1 influenza A, 1 parainfluenza type 3). The age distribution was seven to 11 years except for one patient who was two years of age (Case 1). The most common clinical findings were fever (6/6, 100%), cough (6/6,100%), rhinorrhea (5/6, 83.3%), rales (5/6, 83.3%) and wheezing (1/6, 16.7%). Chest radiographs revealed four with lobar patches and two with interstitial infiltrations. The mean duration of hospital stay was 5.5 +/- 2.8 days. All patients made a complete recovery.CONCLUSIONS:hMPV was identified in 5.2% of patients with community-acquired pneumonia. Our data showed a high rate of coinfection with hMPV in community-acquired pneumonia. Human metapneumovirus infection, like other respiratory viruses, may predispose to secondary bacterial pneumonia.

The etiology of community-acquired pneumonia (CAP) in a children's hospital was studied among 209 previously healthy children treated from August 1, 2001 to July 31, 2002. A total of 26 children (12.4%) with a diagnosis of chlamydial infection were included in this study. The diagnosis of chlamydial infection was based on either a positive immunofluorescent assay result for chlamydial antigen in sputum, or positive serologic results for immunoglobulin M (IgM), an IgG titer >/=1:640 or a 4-fold rise in IgG titer by microimmunofluorescence test. Fourteen patients (53.8%) were female and 20 (76.9%) were less than 5 years of age. The onset of infection occurred between August and January in 21 cases (80.7%). Twenty one patients (80.8%) had other pathogens identified. Fever and cough were the most common presenting symptoms. The signs and symptoms were similar for the children with and without coinfection except for tachypnea and wheezing sound, which were significantly more common in patients with mixed infection. None of the laboratory parameters seemed to be specific for chlamydial infection; however, serum C-reactive protein level was significantly higher in cases with mixed infection. Among the 26 children, 12 (46.2%) needed respiratory therapy, and most of them (91.7%, 11/12) had coinfection. Two patients (7.7%) with mixed infection were admitted to the pediatric intensive care unit. One had lobar pneumonia with pleural effusion and the other had necrotizing pneumonia requiring surgical intervention. None of the patients died. In conclusion, Chlamydia sp. was identified in 12.4% of children with CAP in this series, and mixed infections were common (80.8%) among these patients. The clinical course of chlamydial pneumonia was not serious in most patients, but alertness is needed to the possibility of developing severe pneumonia in cases with bacterial coinfection.

Background: Kikuchi's disease (KD) is characterized by cervical lymphadenopathy with or without fever. It has been recognized worldwide but seldom reported in pediatric patients. Methods: From January 1985 through December 2001, 64 patients younger than 18 years of age with pathologic proof of KD were enrolled in this study. The clinical manifestations, laboratory data and outcomes were reviewed. Results: There were 35 male patients and 29 female patients with age ranging from 2 to 18 years and a median age of 16. All patients had cervical lymphadenopathy except 1 who had generalized lymphadenopathy. Lymph nodes of 32 patients (50%) were painful or tender or both. Lymphadenopathy was unilateral in 52 patients (82.5%). Lymphadenopathy associated with fever was observed in 21 patients (32.8%). Other signs such as skin rash, hepatomegaly or body weight loss were less common. Twenty-six patients (40.6%) had leukopenia and 2 patients had leukocytosis. Nearly one-fourth of the patients had mild liver dysfunction. Virologic or immunologic studies were normal in most patients. Patients with prolonged fever were more likely to have leukopenia (P < 0.05). All patients recovered, but 1 developed systemic lupus erythematosus 5 years later, and the other had vasculitis syndrome 2 years later. Conclusions: The clinical presentation of KD in pediatric patients is similar to that of adults. KD is a benign, self-limiting disease; prolonged fever occurred only in 32.8% of pediatric patients in our cohort. Leukopenia was the only feature significantly associated with prolonged fever.

BACKGROUND:Accurate diagnosis of Bordetella pertussis infection is difficult. Polymerase chain reaction (PCR) tests are more sensitive than culture, but the reported sensitivity is variable. We prospectively compared the performance of culture, serology, and a multiplex PCR for the detection of B. pertussis.METHODS:A total of 193 paired nasopharyngeal (NP) swab specimens were examined by both culture and a multiplex PCR. Serology results were available in 103 patients. Medical charts of the patients with discrepant laboratory findings were reviewed and compared with the United States Centers for Disease Control and Prevention (CDC) clinical case definition.RESULTS:Of the 193 specimens, 11 were positive on both culture and PCR, and 14 were positive on PCR only. Of the 103 specimens with serology results, 3 were positive with all three methods, and 69 were negative with all methods. Eleven of the 14 PCR-positive only cases and 6 of the 19 serology-positive only cases were defined as true pertussis cases according to an expanded standard which includes either (1) culture positive or (2) PCR or serology positive with clinical features fulfilling the CDC clinical case definition and the patients having received macrolides treatment for more than 10 days. The sensitivity and specificity of the multiplex PCR were 79% and 98%, respectively, while those for serology were 47% and 85%, and for culture 39% and 100%.CONCLUSIONS:Our data confirm the superior sensitivity of the multiplex PCR in detection of B. pertussis, compared with conventional culture and serology. Clinical validation indicates that the multiplex PCR offers specific detection of B. pertussis from NP specimens.

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.

Kikuchi-Fujimoto disease (KFD) is a histiocytic necrotising lymphadenitis, which is a benign disease of unknown aetiology. Misdiagnosing KFD as lymphoma or systemic lupus erythematosus is not uncommon due to the similarity of clinical and histopathological features of these diseases. A 12-year-old female suffered from cervical lymphadenopathy, leukocytopenia, fever and especially skin rash. The biopsy of the lymph node was compatible with KFD. The skin biopsy showed interface alterations with vacuolar degeneration of the basal cells suggesting lupus erythematosus; however, the patient did not fulfill the diagnostic criteria for systemic lupus erythematosus. After treatment with acetaminophen, fever subsided and the skin rashes disappeared without relapse during a 10-month follow-up period. Conclusion: the histopathological findings of cutaneous lesions in KFD are usually similar to those observed in the involved lymph nodes. This report suggests that interface change might be one of the pathological features of the cutaneous manifestations of KFD.

Chryseobacterium meningosepticum bloodstream infections in 11 nonneonatal patients were reported. More than half of the infections were community acquired. PCR assays indicated that the organisms produced extended-spectrum beta-lactamases as well as metallo-beta-lactamases. Genotyping showed diverse fingerprints among the isolates. Six patients survived without appropriate antibiotic treatment. Host factors are the major determinant of the outcomes of C. meningosepticum infections.

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.

AIM:To evaluate the clinical efficacy of a short-course ceftriaxone therapy in the treatment of paediatric patients with severe non-typhoidal Salmonella enterocolitis.METHODS:During a 1 y period, all paediatric patients who were suspected having Salmonella enterocolitis by the presentation of bloody and/or mucoid diarrhoea with or without fever were eligible for the study. Patients with either negative stool cultures or bacteraemia were excluded. Severe enterocolitis was defined as a bloody and/or mucoid diarrhoea associated with high fever persisting for longer than 48 h and signs of moderate or severe dehydration. The patients with severe enterocolitis were assigned to treatment with ceftriaxone (50 mg kg(-1) d(-1)) for 3-5 d, while the rest were given supportive treatment only. Before treatment all study patients received blood testing for white blood cell (WBC) count, C-reactive protein (CRP) level and blood culture. The duration of the fevers was recorded. Patients were followed up after clinical recovery for the possibility of relapse.RESULTS:Seventy-three patients with culture-confirmed Salmonella enterocolitis without bacteraemia were analysed. The duration of fever was longer in severe cases who were treated with ceftriaxone than those who were not. However, rapid defervescene was found after short-course ceftriaxone therapy in those patients with severe enterocolitis. CRP was significantly higher in severe cases. There was no significant difference in the WBC count between the two groups of patients. No relapse was found in these patients.CONCLUSION:High CRP, prolonged high fever and signs of moderate or severe dehydration appear appropriate to define severe cases of Salmonella enterocolitis. Short-course ceftriaxone therapy is clinically beneficial to these patients. Neither clinical nor microbiological relapse was seen after therapy.