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중앙대학교 의학연구소> 중앙의대지> Iron Deficiency Anemia and Febrile Seizures in Children

Iron Deficiency Anemia and Febrile Seizures in Children

권아람 ( Aram Kwon ) , 이란 ( Ran Lee ) , 곽병옥 ( Byung Ok Kwak )
  • : 중앙대학교 의학연구소
  • : 중앙의대지 43권1호
  • : 연속간행물
  • : 2018년 12월
  • : 23-29(7pages)
중앙의대지

DOI


목차

INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

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초록 보기

Purpose: Febrile seizures (FS) in young children (6~60 months old) are the most common type of seizure recorded in neurologically healthy infants and children, with a 2~5% incidence of at least one episode in this population. Iron-deficiency anemia (IDA) is defined by state of iron deficiency (ID), specifically serum ferritin <12 μg/L, and a hemoglobin (Hb) level <11 mg/dL. Iron is essential for proper growth and development. In addition to anemia, inadequate iron stores may culminate in growth and behavioral disorders, mental retardation, and impaired immune function. Because the peak ages for iron deficiency and for febrile seizures coincide, much research has been aimed at establishing a correlation.
Methods: Children (n=181; 6~60 months old) hospitalized with FS at Konkuk University Medical Center, Seoul, Korea between January, 2012 and December, 2012 was analyzed for this retrospective, case-control study. We chose ageappropriate values of MCV, RDW, and Hb to define ID and IDA in this study.
Result: Overall, 181 children with FS (boys, 100; girls, 81) and 181 control subjects were recruited for study. In our study, no significant differences in median values of hemoglobin, mean corpuscular volume (MCV), and red cell distribution width (RDW) between children with FS and age/gender matched controls. Respective rates of ID (3.3% vs. 2.8%) and IDA (2.8% vs. 2.8%) did not differ significantly. In subgroup analysis, comparing simple or complex FS subsets with controls, no significant differences in iron status were evident.
Conclusion: IDA had no impact on the risk of FS in young children. IDA is prevalent in this age group, therefore evaluation and treatment of IDA is considered irrespective of FS.
Chung-Ang J Med 2018; 43(1): 23-29

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  • : 의약학분야  > 기타(의약학)
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  • : 반년간
  • : 0253-6250
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  • : 학술지
  • : 연속간행물
  • : 2015-2018
  • : 37


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1Clinical Analysis of Acute Laryngotracheal Injuries

저자 : 심행선 ( Haeng Seon Shim ) , 김동준 ( Dong Joon Kim ) , 김정연 ( Jeong Yeon Kim ) , 김명구 ( Myung Gu Kim )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 1-5 (5 pages)

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Background and Objectives: Recently, the incidence of laryngotracheal injuries has increased steadily with the increase in traffic collisions and mechanization. Acute laryngotracheal injury is relatively uncommon but has the potential for rapid progression and can become life-threatening. Early diagnosis and appropriate airway management are essential for avoiding significant morbidity and mortality. We investigated our cases with laryngotracheal injuries to present the clinical findings and evaluate their correct management.
Subjects and Method: A retrospective chart review was done of all patients who had been treated for acute laryngotracheal injuries from January 2000 to March 2016. The patients were studied with attention to gender and age distribution, mode of injury, clinical signs and symptoms, injury mechanisms and causes, degree of injury, treatment and outcomes after the treatment.
Results: Thirty-two patients with laryngotracheal injuries were included in the study. Twenty-six cases were categorized as blunt traumas, and the other six were penetrating traumas. Acute laryngotracheal injuries were more common in males, and odynophagia and voice changes were the most common symptoms. Seventeen patients were managed conservatively, and fifteen underwent surgery. Twenty-two patients recovered their normal voices, and ten were assessed as fair. All patients showed good airway outcomes after appropriate treatment.
Conclusion: Immediate recognition of acute external laryngotracheal injury and expedient appropriate management are essential to good functional recovery from these potentially lethal injuries.
Chung-Ang J Med 2018; 43(1): 1-5

2Mycoplasma pneumoniae 폐렴으로 입원한 소아의 Macrolide 내성과 치료 양상

저자 : 강국진 ( Kook Jin Kang ) , 고정희 ( Jeong Hee Ko ) , 최경은 ( Kyong Eun Choi ) , 최유미 ( Yu Mi Choi ) , 이원욱 ( Won Wuk Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 7-13 (7 pages)

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Pediatric Mycoplasma pneumoniae (M. pneumoniae) infection in Korea is becoming difficult to treat due to the recent rise in macrolide resistance. In this study, we investigated the macrolide resistance rate, clinical features, and treatment response of mycoplasma pneumonia patients. The 23S rRNA gene mutations in 247 patients with M. pneumoniae pneumonia were analyzed and grouped into either macrolide-resistant mycoplasma pneumonia (MRMP) and macrolide-susceptible mycoplasma pneumonia (MSMP) patients. Among patients with mycoplasma pneumonia, 85.8% had MRMP and all were mutations of A2063G. All patients received macrolide antibiotics and received steroid therapy in patients with unresponsive to macrolide. Total fever days was significantly longer in MRMP (7.3 days) than in MSMP (5.6 days, p = 0.009), and febrile days after initiation of macrolides was longer in MRMP (2.1 days) than that of MSMP (1.1 days, p = 0.003). In laboratory finding, only lactate dehydrogenase was significantly higher in MRMP (p = 0.026). The steroid treatment rate was significantly higher in MRMP (36.7%) than MSMP (14.2%) (p = 0.011) and the duration of use was significantly longer in MRMP (3 days) than MSMP (1 day, p = 0.039). The results of this study suggest that steroid therapy can help lower the duration of total treatment in children with macrolide-resistant mycoplasma pneumonia.
Chung-Ang J Med 2018; 43(1): 7-13

3Clinical Efficacy of Stratified Management Protocol Using a Risk Prediction Model in Kawasaki Disease

저자 : 김유나 ( Yoo Na Kim ) , 이은혜 ( Eun Hye Lee ) , 윤경림 ( Kyung-rim Yoon ) , 한미영 ( Mi Young Han )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 15-21 (7 pages)

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Purpose: Although Kawasaki disease (KD) is a leading cause of acquired heart disease in children, a universal treatment protocol has yet to be established. This study was conducted to investigate the clinical utility of risk prediction model in the stratified management protocol of KD patients.
Methods: Data of patients with KD were collected from two affiliated centers, Kyung Hee University Hospital and Kyung Hee University Hospital at Gangdong, from January 2015 to March 2017. Exclusion criteria were as follows: whose diagnosis was recurrent Kawasaki disease, who received initial therapy at other hospital, who were either younger than 100 days or older than six years (72 months), and who were lost to follow-up. Patients are designated into two groups (group A and B) depending on whether the Kobayashi risk stratification model was used. Demographic characteristics, lab data, and patient charts were reviewed, and serial echocardiography was performed. As a primary outcome, patients' coronary artery z-scores were calculated using the McCrindle method and compared. All data were compared using SPSS v. 24, and a p-value of <0.05 was considered statistically significant.
Results: After applying exclusion criteria, 98 patients were finally included. Demographic characteristics of sex, age, and laboratory data were not significantly different between the two groups, and there were no differences in fever duration and hospitalization period. However, group A had lower z-scores over time compared to group B, with statistically significant differences (p <0.05).
Conclusion: This study suggested that initial KD risk stratification may direct selective management protocol and reduce coronary artery complications. These findings may be useful to optimize the management and outcomes of patients with KD.
Chung-Ang J Med 2018; 43(1): 15-21

4Iron Deficiency Anemia and Febrile Seizures in Children

저자 : 권아람 ( Aram Kwon ) , 이란 ( Ran Lee ) , 곽병옥 ( Byung Ok Kwak )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 23-29 (7 pages)

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Purpose: Febrile seizures (FS) in young children (6~60 months old) are the most common type of seizure recorded in neurologically healthy infants and children, with a 2~5% incidence of at least one episode in this population. Iron-deficiency anemia (IDA) is defined by state of iron deficiency (ID), specifically serum ferritin <12 μg/L, and a hemoglobin (Hb) level <11 mg/dL. Iron is essential for proper growth and development. In addition to anemia, inadequate iron stores may culminate in growth and behavioral disorders, mental retardation, and impaired immune function. Because the peak ages for iron deficiency and for febrile seizures coincide, much research has been aimed at establishing a correlation.
Methods: Children (n=181; 6~60 months old) hospitalized with FS at Konkuk University Medical Center, Seoul, Korea between January, 2012 and December, 2012 was analyzed for this retrospective, case-control study. We chose ageappropriate values of MCV, RDW, and Hb to define ID and IDA in this study.
Result: Overall, 181 children with FS (boys, 100; girls, 81) and 181 control subjects were recruited for study. In our study, no significant differences in median values of hemoglobin, mean corpuscular volume (MCV), and red cell distribution width (RDW) between children with FS and age/gender matched controls. Respective rates of ID (3.3% vs. 2.8%) and IDA (2.8% vs. 2.8%) did not differ significantly. In subgroup analysis, comparing simple or complex FS subsets with controls, no significant differences in iron status were evident.
Conclusion: IDA had no impact on the risk of FS in young children. IDA is prevalent in this age group, therefore evaluation and treatment of IDA is considered irrespective of FS.
Chung-Ang J Med 2018; 43(1): 23-29

5면역저하 환자의 혈액에서 분리된 Weissella confusa 증례와 문헌고찰

저자 : 김현지 ( Hyunji Kim ) , 정진원 ( Jin-won Chung ) , 이미경 ( Mi-kyung Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 31-36 (6 pages)

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6주 전 성인형 스틸병(Adult-onset Still's disease, AOSD)로 스테로이드 치료를 받았던 66세 남자 환자가 7일 동안 지속된 고열을 주소로 응급실에 내원하여, 경험적 항균제로 meropenem과 vancomycin을 투여받았다. 지속된 발열로 실시한 골수검사에서 혈구탐식성 림프조직구증(Hemophagocytic lymphohistiocytosis)으로 진단되어 항암화학요법을 실시하였다. 치료 3주 후 발생한 호중구감소성 발열의 확인을 위해 시행한 혈액배양검사에서 그람 양성 구간균이 확인되었고, Vitek II ANC card (bioMérieux, Inc.)로는 동정되지 않았으나, Matrix-assisted laser desorption ionizationtime of flight mass spectrometry (MALDI-TOF MS) 및 16S rRNA 검사에서 Weissella confuse로 확인되었다. W. confuse는 vancomycin 내성을 보이며, 현재 상용화된 표현형 동정법으로는 동정이 불가능하여 적절한 항균제 치료 시기를 지연시킬 수 있다. 현재, 감염의 기전이 명확히 알려진 바는 없으나, vancomycin의 사용으로 인한 장내 세균총의 변화, 항암화학요법 후의 장관벽 손상으로 인한 전위 등이 가능한 감염 경로로 생각되고 있다. 저자는 면역저하 성인에서 확인된 W. confusa 감염 1예를 통하여, W. confuse 감염에 대한 인지와 MALDI-TOF MS 및 16S rRNA 검사를 통한 추가적인 동정의 필요성을 경험하였기에 보고하는 바이다.


A 66-year-old man who had undergone steroid treatment with adult onset Still's disease (AOSD) 6 weeks ago was admitted to the emergency room with fever lasting 7 days and received meropenem and vancomycin as empirical antibiotics. Hemophagocytic lymphohistiocytosis was diagnosed in a bone marrow test to confirm the cause of persistent fever. After 3 weeks of treatment, a Gram positive coccobacillus was identified in a blood culture for the detection of febrile neutropenic fever. It was not identified as a Vitek II ANC card (bioMérieux, Inc.), but was identified as Weissella confusa by Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA test. W. confusa is resistant to vancomycin and cannot be identified by the currently available phenotype identification method, thus delayed treatment of appropriate antimicrobial agents. Currently, the mechanism of infection is not clearly known. However, it is thought that infection pathway such as change of intestinal flora due to the use of vancomycin and dislocation due to intestinal wall damage after chemotherapy is considered to be possible. We report a case of W. confusa infection diagnosed in an immunocompromised adult and the need for further identification with W. confusa infection by MALDI-TOF MS and 16S rRNA test.
Chung-Ang J Med 2018; 43(1): 31-36

6Lemierre Syndrome Diagnosed in a 10-year-old Child

저자 : 정종원 ( Jong Won Jung ) , 오승록 ( Seung Rok Oh ) , 윤승현 ( Seung Hyun Yoon ) , 김철암 ( Cheol Am Kim ) , 손병희 ( Byeong Hee Son ) , 이균우 ( Kyun Woo Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 37-41 (5 pages)

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Lemierre's syndrome is a rare disease that primarily occurs in adolescents and young adults. It is characterized by thrombophlebitis of internal jugular vein and bacteremia after acute oropharyngeal infection. The main causative bacteria of this disease is Fusobacterium necrophorum. We report a case of 10-year-old male, who presented with persistent fever and right internal jugular vein thrombosis and obliterance. The case was diagnosed based on the clinical features along with findings of computed tomography and ultrasonography.
Chung-Ang J Med 2018; 43(1): 37-41

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1Clinical Analysis of Acute Laryngotracheal Injuries

저자 : 심행선 ( Haeng Seon Shim ) , 김동준 ( Dong Joon Kim ) , 김정연 ( Jeong Yeon Kim ) , 김명구 ( Myung Gu Kim )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 1-5 (5 pages)

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Background and Objectives: Recently, the incidence of laryngotracheal injuries has increased steadily with the increase in traffic collisions and mechanization. Acute laryngotracheal injury is relatively uncommon but has the potential for rapid progression and can become life-threatening. Early diagnosis and appropriate airway management are essential for avoiding significant morbidity and mortality. We investigated our cases with laryngotracheal injuries to present the clinical findings and evaluate their correct management.
Subjects and Method: A retrospective chart review was done of all patients who had been treated for acute laryngotracheal injuries from January 2000 to March 2016. The patients were studied with attention to gender and age distribution, mode of injury, clinical signs and symptoms, injury mechanisms and causes, degree of injury, treatment and outcomes after the treatment.
Results: Thirty-two patients with laryngotracheal injuries were included in the study. Twenty-six cases were categorized as blunt traumas, and the other six were penetrating traumas. Acute laryngotracheal injuries were more common in males, and odynophagia and voice changes were the most common symptoms. Seventeen patients were managed conservatively, and fifteen underwent surgery. Twenty-two patients recovered their normal voices, and ten were assessed as fair. All patients showed good airway outcomes after appropriate treatment.
Conclusion: Immediate recognition of acute external laryngotracheal injury and expedient appropriate management are essential to good functional recovery from these potentially lethal injuries.
Chung-Ang J Med 2018; 43(1): 1-5

2Mycoplasma pneumoniae 폐렴으로 입원한 소아의 Macrolide 내성과 치료 양상

저자 : 강국진 ( Kook Jin Kang ) , 고정희 ( Jeong Hee Ko ) , 최경은 ( Kyong Eun Choi ) , 최유미 ( Yu Mi Choi ) , 이원욱 ( Won Wuk Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 7-13 (7 pages)

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Pediatric Mycoplasma pneumoniae (M. pneumoniae) infection in Korea is becoming difficult to treat due to the recent rise in macrolide resistance. In this study, we investigated the macrolide resistance rate, clinical features, and treatment response of mycoplasma pneumonia patients. The 23S rRNA gene mutations in 247 patients with M. pneumoniae pneumonia were analyzed and grouped into either macrolide-resistant mycoplasma pneumonia (MRMP) and macrolide-susceptible mycoplasma pneumonia (MSMP) patients. Among patients with mycoplasma pneumonia, 85.8% had MRMP and all were mutations of A2063G. All patients received macrolide antibiotics and received steroid therapy in patients with unresponsive to macrolide. Total fever days was significantly longer in MRMP (7.3 days) than in MSMP (5.6 days, p = 0.009), and febrile days after initiation of macrolides was longer in MRMP (2.1 days) than that of MSMP (1.1 days, p = 0.003). In laboratory finding, only lactate dehydrogenase was significantly higher in MRMP (p = 0.026). The steroid treatment rate was significantly higher in MRMP (36.7%) than MSMP (14.2%) (p = 0.011) and the duration of use was significantly longer in MRMP (3 days) than MSMP (1 day, p = 0.039). The results of this study suggest that steroid therapy can help lower the duration of total treatment in children with macrolide-resistant mycoplasma pneumonia.
Chung-Ang J Med 2018; 43(1): 7-13

3Clinical Efficacy of Stratified Management Protocol Using a Risk Prediction Model in Kawasaki Disease

저자 : 김유나 ( Yoo Na Kim ) , 이은혜 ( Eun Hye Lee ) , 윤경림 ( Kyung-rim Yoon ) , 한미영 ( Mi Young Han )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 15-21 (7 pages)

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Purpose: Although Kawasaki disease (KD) is a leading cause of acquired heart disease in children, a universal treatment protocol has yet to be established. This study was conducted to investigate the clinical utility of risk prediction model in the stratified management protocol of KD patients.
Methods: Data of patients with KD were collected from two affiliated centers, Kyung Hee University Hospital and Kyung Hee University Hospital at Gangdong, from January 2015 to March 2017. Exclusion criteria were as follows: whose diagnosis was recurrent Kawasaki disease, who received initial therapy at other hospital, who were either younger than 100 days or older than six years (72 months), and who were lost to follow-up. Patients are designated into two groups (group A and B) depending on whether the Kobayashi risk stratification model was used. Demographic characteristics, lab data, and patient charts were reviewed, and serial echocardiography was performed. As a primary outcome, patients' coronary artery z-scores were calculated using the McCrindle method and compared. All data were compared using SPSS v. 24, and a p-value of <0.05 was considered statistically significant.
Results: After applying exclusion criteria, 98 patients were finally included. Demographic characteristics of sex, age, and laboratory data were not significantly different between the two groups, and there were no differences in fever duration and hospitalization period. However, group A had lower z-scores over time compared to group B, with statistically significant differences (p <0.05).
Conclusion: This study suggested that initial KD risk stratification may direct selective management protocol and reduce coronary artery complications. These findings may be useful to optimize the management and outcomes of patients with KD.
Chung-Ang J Med 2018; 43(1): 15-21

4Iron Deficiency Anemia and Febrile Seizures in Children

저자 : 권아람 ( Aram Kwon ) , 이란 ( Ran Lee ) , 곽병옥 ( Byung Ok Kwak )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 23-29 (7 pages)

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Purpose: Febrile seizures (FS) in young children (6~60 months old) are the most common type of seizure recorded in neurologically healthy infants and children, with a 2~5% incidence of at least one episode in this population. Iron-deficiency anemia (IDA) is defined by state of iron deficiency (ID), specifically serum ferritin <12 μg/L, and a hemoglobin (Hb) level <11 mg/dL. Iron is essential for proper growth and development. In addition to anemia, inadequate iron stores may culminate in growth and behavioral disorders, mental retardation, and impaired immune function. Because the peak ages for iron deficiency and for febrile seizures coincide, much research has been aimed at establishing a correlation.
Methods: Children (n=181; 6~60 months old) hospitalized with FS at Konkuk University Medical Center, Seoul, Korea between January, 2012 and December, 2012 was analyzed for this retrospective, case-control study. We chose ageappropriate values of MCV, RDW, and Hb to define ID and IDA in this study.
Result: Overall, 181 children with FS (boys, 100; girls, 81) and 181 control subjects were recruited for study. In our study, no significant differences in median values of hemoglobin, mean corpuscular volume (MCV), and red cell distribution width (RDW) between children with FS and age/gender matched controls. Respective rates of ID (3.3% vs. 2.8%) and IDA (2.8% vs. 2.8%) did not differ significantly. In subgroup analysis, comparing simple or complex FS subsets with controls, no significant differences in iron status were evident.
Conclusion: IDA had no impact on the risk of FS in young children. IDA is prevalent in this age group, therefore evaluation and treatment of IDA is considered irrespective of FS.
Chung-Ang J Med 2018; 43(1): 23-29

5면역저하 환자의 혈액에서 분리된 Weissella confusa 증례와 문헌고찰

저자 : 김현지 ( Hyunji Kim ) , 정진원 ( Jin-won Chung ) , 이미경 ( Mi-kyung Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 31-36 (6 pages)

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6주 전 성인형 스틸병(Adult-onset Still's disease, AOSD)로 스테로이드 치료를 받았던 66세 남자 환자가 7일 동안 지속된 고열을 주소로 응급실에 내원하여, 경험적 항균제로 meropenem과 vancomycin을 투여받았다. 지속된 발열로 실시한 골수검사에서 혈구탐식성 림프조직구증(Hemophagocytic lymphohistiocytosis)으로 진단되어 항암화학요법을 실시하였다. 치료 3주 후 발생한 호중구감소성 발열의 확인을 위해 시행한 혈액배양검사에서 그람 양성 구간균이 확인되었고, Vitek II ANC card (bioMérieux, Inc.)로는 동정되지 않았으나, Matrix-assisted laser desorption ionizationtime of flight mass spectrometry (MALDI-TOF MS) 및 16S rRNA 검사에서 Weissella confuse로 확인되었다. W. confuse는 vancomycin 내성을 보이며, 현재 상용화된 표현형 동정법으로는 동정이 불가능하여 적절한 항균제 치료 시기를 지연시킬 수 있다. 현재, 감염의 기전이 명확히 알려진 바는 없으나, vancomycin의 사용으로 인한 장내 세균총의 변화, 항암화학요법 후의 장관벽 손상으로 인한 전위 등이 가능한 감염 경로로 생각되고 있다. 저자는 면역저하 성인에서 확인된 W. confusa 감염 1예를 통하여, W. confuse 감염에 대한 인지와 MALDI-TOF MS 및 16S rRNA 검사를 통한 추가적인 동정의 필요성을 경험하였기에 보고하는 바이다.

6Lemierre Syndrome Diagnosed in a 10-year-old Child

저자 : 정종원 ( Jong Won Jung ) , 오승록 ( Seung Rok Oh ) , 윤승현 ( Seung Hyun Yoon ) , 김철암 ( Cheol Am Kim ) , 손병희 ( Byeong Hee Son ) , 이균우 ( Kyun Woo Lee )

발행기관 : 중앙대학교 의학연구소 간행물 : 중앙의대지 43권 1호 발행 연도 : 2018 페이지 : pp. 37-41 (5 pages)

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Lemierre's syndrome is a rare disease that primarily occurs in adolescents and young adults. It is characterized by thrombophlebitis of internal jugular vein and bacteremia after acute oropharyngeal infection. The main causative bacteria of this disease is Fusobacterium necrophorum. We report a case of 10-year-old male, who presented with persistent fever and right internal jugular vein thrombosis and obliterance. The case was diagnosed based on the clinical features along with findings of computed tomography and ultrasonography.
Chung-Ang J Med 2018; 43(1): 37-41

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