No abstract

Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a populationbased study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiella pneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not signifi cantly change death rates for the 506 patients from the hospital.T he epidemiology of pyogenic liver abscess has changed dramatically in recent years (1). Previously, although incidence was considered rare, the condition was associated with high illness and death rates, usually due to underlying hepatobiliary diseases and polymicrobial infection (2), with Escherichia coli as the major pathogen (3). More recently, investigations in Taiwan suggest the role of cryptogenic or primary liver abscess, i.e., abscesses without underlying hepatobiliary diseases, in pyogenic liver abscess (4,5). These reports also indicate that diabetes is the major predisposing factor of liver abscess and that Klebsiella pneumoniae is the primary pathogen. However, these results were obtained from small-scale hospital-based surveys, which could not provide a panoramic view of the disease. To confi rm these observation-based results, we conducted a large-scale, unbiased investigation.In addition to epidemiology, the pathogenesis of liver abscess caused by Klebsiella spp. has also been extensively studied, but the mechanism is still not clear. MagA, an outermembrane protein contributing to capsular polysaccharide formation, coexists with serotype K1 and has been identifi ed as the major virulence factor of K. pneumoniae (6). MagApositive (or serotype K1) K. pneumoniae is accordingly recognized as the main pathogen of pyogenic liver abscess (7,8). Nevertheless, how diabetes increases the risk for Klebsiella spp. liver abscess is still not clear. Further research is needed on whether pyogenic liver abscess is affected by immunocompromised conditions, such as malignancy, renal failure, postorgan transplantation, or HIV infection.To clarify the epidemiology and pathogenesis of pyogenic liver abscess, we used information gathered by the Taiwan National Health Insurance (NHI) program, which was initiated in 1995 by the government to cover most Taiwanese citizens. In 2005, 91.25% of healthcare providers were enrolled in the program and 99% of Ta...

Enterovirus 71 infection with CNS involvement and cardiopulmonary failure may be associated with neurologic sequelae, delayed neurodevelopment, and reduced cognitive functioning. Children with CNS involvement without cardiopulmonary failure did well on neurodevelopment tests. (ClinicalTrials.gov number, NCT00172393 [ClinicalTrials.gov].).

BackgroundIn 2010, an outbreak of coxsackievirus A6 (CA6) hand, foot and mouth disease (HFMD) occurred in Taiwan and some patients presented with onychomadesis and desquamation following HFMD. Therefore, we performed an epidemiological and molecular investigation to elucidate the characteristics of this outbreak.MethodsPatients who had HFMD with positive enterovirus isolation results were enrolled. We performed a telephone interview with enrolled patients or their caregivers to collect information concerning symptoms, treatments, the presence of desquamation, and the presence of nail abnormalities. The serotypes of the enterovirus isolates were determined using indirect immunofluorescence assays. The VP1 gene was sequenced and the phylogenetic tree for the current CA6 strains in 2010, 52 previous CA6 strains isolated in Taiwan from 1998 through 2009, along with 8 reference sequences from other countries was constructed using the neighbor-joining command in MEGA software.ResultsOf the 130 patients with laboratory-confirmed CA6 infection, some patients with CA6 infection also had eruptions around the perioral area (28, 22%), the trunk and/or the neck (39, 30%) and generalized skin eruptions (6, 5%) in addition to the typical presentation of skin eruptions on the hands, feet, and mouths. Sixty-six (51%) CA6 patients experienced desquamation of palms and soles after the infection episode and 48 (37%) CA6 patients developed onychomadesis, which only occurred in 7 (5%) of 145 cases with non-CA6 enterovirus infection (p < 0.001). The sequences of viral protein 1 of CA6 in 2010 differ from those found in Taiwan before 2010, but are similar to those found in patients in Finland in 2008.ConclusionsHFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities.

EV 71 illness is more severe with significantly greater frequency of serious complications and fatality than is illness caused by Cox A16.