Objective:To compare the genotype frequencies of HLA class-ⅡDRB1 alleles in Giardia(G.)lamblia-infected children.Methods:A total of 490 Egyptian children aged 2-16 years were subjected to microscopic stool examinatio...Objective:To compare the genotype frequencies of HLA class-ⅡDRB1 alleles in Giardia(G.)lamblia-infected children.Methods:A total of 490 Egyptian children aged 2-16 years were subjected to microscopic stool examination to detect G.lamblia infection,and to exclude other intestinal pathogens.On the basis of their microscopic findings,a group of 80 children were chosen as giardiasis cases,another 80 children were confirmed as Giardia free control group by immunochromatographic test,and the remaining children were excluded.Both giardiasis and control groups were then subjected to blood examination to identify their genetic type of HLA-DRB1 alleles.Results:HLA class-ⅡDRB1*03:01 and DRB1*13:01 alleles were significantly associated with G.lamblia infection(P<0.001 for each variable).On the other hand,HLA class-ⅡDRB1*04:02,DRB1*10:01,DRB1*14:01 and DRB1*15:01 alleles were significantly demonstrated in Giardia free children.However,other HLA-DRB1 alleles did not show any significant association with giardiasis.Conclusions:HLA class-ⅡDRB1*03,DRB1*13,DRB1*04,DRB1*10,DRB1*14 and DRB1*15 alleles may be involved in the establishment of host immune response to G.lamblia infection.展开更多
BACKGROUND Asymptomatic cytomegalovirus(CMV)infection is common in children;in contrast,in children with a weakened immune system,invasive CMV can occur.This is the first case report of a severe manifestation of CMV e...BACKGROUND Asymptomatic cytomegalovirus(CMV)infection is common in children;in contrast,in children with a weakened immune system,invasive CMV can occur.This is the first case report of a severe manifestation of CMV esophagoenterocolitis in a girl diagnosed with anti-N-methyl-D-aspartate-receptor(antiNMDAR)encephalitis who received only a moderate dose of corticosteroid therapy.CASE SUMMARY A 12-year-old-Thai girl presented with acute behavioural change and headache for 6 d.Electroencephalogram and positivity for NMDAR autoantibodies were compatible with anti-NMDAR encephalitis.Hence,she received pulse methylprednisolone 10 mg/kg per day for 4 d and continued with prednisolone 1.2 mg/kg per day.On day 42 of corticosteroid therapy,she developed unremitting vomiting and diarrhoea.Endoscopy showed multiple ulcers and erythaematous mucosa along the gastrointestinal tract.Tissue CMV viral load and viral-infected cells confirmed CMV esophago-enterocolitis.Therefore,the patient received ganciclovir 5 mg/kg per dose every 12 h for 3 wk and then 5 mg/kg per dose once daily for 3 wk.Unremitting diarrhoea slowly improved from stool output 1-4 L per day to 1-2 L per day after 3 wk of treatment.Pulse methylprednisolone 20 mg/kg for 5 d was initiated and continued with prednisolone 1 mg/kg per day.After this repeated pulse methylprednisolone treatment,surprisingly,diarrhoea subsided.Immunologic work-up was performed to rule out underlying immune deficiency with unremarkable results.CONCLUSION Unremitting diarrhoea from CMV esophago-enterocolitis subsided with antiviral and methylprednisolone therapy,implying the immune and NMDAR dysregulation in anti-NMDAR encephalitis.展开更多
Background:The impact of chronic hepatitis C (CHC) on bone mineral density (BMD) has been well studied in adults with a relative paucity of data in children,especially concerning effect of treatment with pegylated int...Background:The impact of chronic hepatitis C (CHC) on bone mineral density (BMD) has been well studied in adults with a relative paucity of data in children,especially concerning effect of treatment with pegylated interferon (PEG-IFN) plus ribavirin (RV).In the current work,we assessed prospectively changes in BMD in children with CHC before,during,and after treatment.Methods:Forty-six consecutive children with noncirrhotic genotype 4 CHC were subjected to dual-energy X-ray absorptiometry at baseline,24 weeks,48 weeks of therapy and 24 weeks after treatment.BMD,bone mineral content (BMC),and Z score of lumbar spine (L2-L4) were reported.Tanner pubertal stage,viral load,liver function tests,serum calcium,phosphorus,alkaline phosphatase,parathyroid hormone,and liver histopathology were assessed in all included children.Results:Thirty (65.2%) patients had normal BMD,10 (21.7%) were at risk for low BMD,and 6 (13.1%) had low BMD for chronological age.Patients with low BMD were significantly older (P=0.001),with higher frequency of delayed puberty than other groups (P=0.002).Baseline densitometric parameters (BMD & BMC) were significantly positively correlated with patients' age,weight,height,body mass index and hemoglobin level;while they were insignificantly correlated with basal viral load,histopathology activity index and fibrosis score.Densitometric parameters improved significantly on PEG-IFN plus RV treatment,this improvement was found to be sustainable 24 weeks after therapy.Conclusions:Low BMD is detectable in a proportion of CHC children.Antiviral therapy leads to a sustainable increase in BMD.展开更多
文摘Objective:To compare the genotype frequencies of HLA class-ⅡDRB1 alleles in Giardia(G.)lamblia-infected children.Methods:A total of 490 Egyptian children aged 2-16 years were subjected to microscopic stool examination to detect G.lamblia infection,and to exclude other intestinal pathogens.On the basis of their microscopic findings,a group of 80 children were chosen as giardiasis cases,another 80 children were confirmed as Giardia free control group by immunochromatographic test,and the remaining children were excluded.Both giardiasis and control groups were then subjected to blood examination to identify their genetic type of HLA-DRB1 alleles.Results:HLA class-ⅡDRB1*03:01 and DRB1*13:01 alleles were significantly associated with G.lamblia infection(P<0.001 for each variable).On the other hand,HLA class-ⅡDRB1*04:02,DRB1*10:01,DRB1*14:01 and DRB1*15:01 alleles were significantly demonstrated in Giardia free children.However,other HLA-DRB1 alleles did not show any significant association with giardiasis.Conclusions:HLA class-ⅡDRB1*03,DRB1*13,DRB1*04,DRB1*10,DRB1*14 and DRB1*15 alleles may be involved in the establishment of host immune response to G.lamblia infection.
基金The Pediatric Gastroenterology and Hepatology Research Unit,ThailandGrants for Development of New Faculty Staff,Ratchadaphiseksomphot Endowment Fund,Thailand,No.RA63/012Thailand Research Fund Thailand Science Research and Innovation,Thailand,No.MRG6280190。
文摘BACKGROUND Asymptomatic cytomegalovirus(CMV)infection is common in children;in contrast,in children with a weakened immune system,invasive CMV can occur.This is the first case report of a severe manifestation of CMV esophagoenterocolitis in a girl diagnosed with anti-N-methyl-D-aspartate-receptor(antiNMDAR)encephalitis who received only a moderate dose of corticosteroid therapy.CASE SUMMARY A 12-year-old-Thai girl presented with acute behavioural change and headache for 6 d.Electroencephalogram and positivity for NMDAR autoantibodies were compatible with anti-NMDAR encephalitis.Hence,she received pulse methylprednisolone 10 mg/kg per day for 4 d and continued with prednisolone 1.2 mg/kg per day.On day 42 of corticosteroid therapy,she developed unremitting vomiting and diarrhoea.Endoscopy showed multiple ulcers and erythaematous mucosa along the gastrointestinal tract.Tissue CMV viral load and viral-infected cells confirmed CMV esophago-enterocolitis.Therefore,the patient received ganciclovir 5 mg/kg per dose every 12 h for 3 wk and then 5 mg/kg per dose once daily for 3 wk.Unremitting diarrhoea slowly improved from stool output 1-4 L per day to 1-2 L per day after 3 wk of treatment.Pulse methylprednisolone 20 mg/kg for 5 d was initiated and continued with prednisolone 1 mg/kg per day.After this repeated pulse methylprednisolone treatment,surprisingly,diarrhoea subsided.Immunologic work-up was performed to rule out underlying immune deficiency with unremarkable results.CONCLUSION Unremitting diarrhoea from CMV esophago-enterocolitis subsided with antiviral and methylprednisolone therapy,implying the immune and NMDAR dysregulation in anti-NMDAR encephalitis.
文摘Background:The impact of chronic hepatitis C (CHC) on bone mineral density (BMD) has been well studied in adults with a relative paucity of data in children,especially concerning effect of treatment with pegylated interferon (PEG-IFN) plus ribavirin (RV).In the current work,we assessed prospectively changes in BMD in children with CHC before,during,and after treatment.Methods:Forty-six consecutive children with noncirrhotic genotype 4 CHC were subjected to dual-energy X-ray absorptiometry at baseline,24 weeks,48 weeks of therapy and 24 weeks after treatment.BMD,bone mineral content (BMC),and Z score of lumbar spine (L2-L4) were reported.Tanner pubertal stage,viral load,liver function tests,serum calcium,phosphorus,alkaline phosphatase,parathyroid hormone,and liver histopathology were assessed in all included children.Results:Thirty (65.2%) patients had normal BMD,10 (21.7%) were at risk for low BMD,and 6 (13.1%) had low BMD for chronological age.Patients with low BMD were significantly older (P=0.001),with higher frequency of delayed puberty than other groups (P=0.002).Baseline densitometric parameters (BMD & BMC) were significantly positively correlated with patients' age,weight,height,body mass index and hemoglobin level;while they were insignificantly correlated with basal viral load,histopathology activity index and fibrosis score.Densitometric parameters improved significantly on PEG-IFN plus RV treatment,this improvement was found to be sustainable 24 weeks after therapy.Conclusions:Low BMD is detectable in a proportion of CHC children.Antiviral therapy leads to a sustainable increase in BMD.
