Journal of Pediatric Infectious Diseases - Volume 1, issue 2
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Journal of Pediatric Infectious Diseases is a peer-reviewed medical journal, publishing articles in the field of child infectious diseases. The journal provides an in-depth update on new subjects and current comprehensive coverage of the latest techniques in diagnosis and treatment of childhood infectious diseases.
The following articles will be considered for publication: editorials, original and review articles, rapid communications, case reports, letters to the editor and book reviews.
The aim of the
Journal of Pediatric Infectious Diseases is to share and disseminate knowledge between all disciplines that work in the field of pediatric infectious diseases.
Abstract: The incidence of nosocomial septicemia is extremely common in immature, newborn infants receiving intensive care. Developmental facets of host defense, medical interventions, and the hospital environment contribute to the septicemia rate exceeding 40% in extremely low birth weight infants. There is growing evidence that multifaceted, collaborative quality improvement measures may decrease infection rates; however, the effective implementation of these measures requires introspection and detailed analysis of hospital-specific infection control practices. Immune augmentation…with human milk has been shown to effectively reduce nosocomial infections. The efficacy of pharmacologic agents such as polyclonal intravenous immune globulin and colony stimulating factors to reduce nosocomial infections has been mixed. Systemic antimicrobial prophylaxis may decrease staphylococcal and Candida spp infection rates in hospitalized infants, but this therapy carries the risks of alteration in host microbial flora as well as the development of antimicrobial resistance. Specifically targeted immunotherapy with hyper-immunoglobulin preparations, monoclonal antibodies and probiotics are currently being investigated and may become effective tools to reduce nosocomial infections in the future.
Abstract: Hepatitis virus infection is an increasing problem with millions of affected cases all over the world. Recently, some new viruses have been identified for their association with hepatitis. These include hepatitis G, hepatitis SEN, hepatitis TT and hepatitis TT-like viruses. In this article, important information on epidemiology, pathogenicity, clinical manifestations, diagnosis and treatment of these viral infections are reviewed and presented.
Abstract: The aim of this study is to establish criteria for distinguishing between antibiotic-sensitive and insensitive pneumonia, from data available at the moment of deciding which treatment to give. Retrospective chart review of 169 consecutive children, aged 1–16 years, admitted to hospital with X-ray-verified pneumonia and treated with intravenous antibiotics, 89% with penicillin (because resistance of pneumococci and of Haemophilus influenzae to penicillin is practically non-existent in Denmark). The temperature response to intravenous…antibiotic treatment, as we define it rigorously, was the response variable. Its dependence on the clinical, laboratory and radiological variables available at the moment of diagnosis was analyzed by multiple regression analysis. From the regression model, we derived a rule for predicting the effect of antibiotic treatment on the temperature response. We identified a number of variables that independently predicted rapid resolution of the fever: young age; several days of disease before admission; oral administration of antibiotics before admission; high initial temperature; high white blood cell count; absence of wheezing and of atelectasis; the presence of a sharply delineated and/or spherical lung infiltrate; and a general appearance of being ill, but only in the absence of chest wall retractions. The resulting prediction rule explained less than 50% of the response variability. From the data available at the moment of deciding about treatment for pneumonia, we have identified the parameters that predicted temperature response to antibiotic treatment, but the prediction rule was too imprecise to be clinically useful, i.e., it could not distinguish between those children who would benefit from antibiotic treatment, and those who would not.
Abstract: Pediatric cases of invasive meningococcal disease (IMD) during the 1998 to 2001, hyperendemic period in Switzerland, were investigated. Retrospective analysis of confirmed and probable cases of IMD, in patients <16 years of age, identified at the University of Bern Children's Hospital, during a 5-year period beginning on February 1, 1997, was done. Sixty-two cases were identified (22% of nationally reported cases of pediatric IMD). Thirty-eight cases (61% were culture confirmed. Probable cases were clinically…indistinguishable, but significantly more likely to be secondary referrals and to have received pre-admission antibiotics (OR 5.4; 95% 1.8–16.4). The proportion of confirmed cases was significantly smaller than among all cases reported to the Swiss Federal Office of Public Health (83%; OR 0.32, 95%CI 0.19–0.57). The distance between the patients' place of residence and the tertiary care center did not correlate with the delay from onset of IMD to treatment and admission. The presence of petechiae (n=38) was associated with a significantly shorter median delay from onset of IMD to admission (18 vs. 25 hours, P=0.016). Case fatality rate was 5%. In conclusion, secondary referrals of IMD patients, having received pre-admission antibiotics, reduce the number of culture-confirmed cases. The large proportion of culture-negative (i.e., probable) IMD cases in comparison with national data indicates that probable cases are incompletely reported to the federal authorities. Additional efforts (e.g., meningococcal polymerase chain reaction) are needed to improve the surveillance of pediatric IMD in Switzerland.
Abstract: Early testing strategies such as human immunodeficiency virus (HIV) DNA and RNA assays have become popular, cheaper and reliable, however the measures of success of Prevention of Mother-to-Child Transmission (PMTCT) programs in predominantly breastfeeding populations often depend on long term follow-up and HIV testing of children. Diagnosis in PMTCT programs in resource-poor countries therefore remains dependent on serological assays. The use of rapid HIV tests in perinatal HIV diagnosis, as recommended by the WHO,…was based on the sensitivity and specificity of the enzyme-linked immuno-assay (ELISA) in children and not guided by an independent evaluation of rapid tests. For the purpose of ensuring a reliable diagnosis of perinatal HIV infection in predominantly breastfed children and largely resource-poor settings in Sub-Saharan Africa, we evaluated a HIV rapid test against the ELISA in serial plasma samples. We tested stored plasma samples for HIV antibodies, using a rapid test (Abbott Determine HIV1/2, Abbott Diagnostics, Wiesbaden, Germany) from a cohort of children between 12 and 18 months of age, enrolled in the PETRA (perinatal transmission) study at the Durban site, and compared to pre-determined real-time ELISA results. Using the ELISA results at 18 months as gold standard, the sensitivity of the ELISA at 12 and 15 months was 100% (95% CI 79–100), and specificity improved from 90.4% (95% CI 86–94) at 12 months to 99.5% (95% CI 97–100) at 15 months. The sensitivity of the rapid HIV test when compared to ELISA results at 18 months was 100% (95% CI 46–98) at 12 and 15 months, and the specificity was 89% (95% CI 80–94) and 99% (95% CI 92–100) at 12 and 15 months respectively. The negative predictive values for the rapid test at 12, 15 and 18 months were 100% (95% CI 94–100). Using the 18 month ELISA as the gold standard, the rapid test at 12 and 15 months demonstrated similar specificities to the corresponding ELISA tests. We concluded that the sensitivity and specificity of the rapid HIV test remained optimal (100%) for the diagnosis of HIV infection in children at 18 months. The earlier use of a rapid test at 15 months correctly excluded HIV infection in 99% of the children. Any earlier use of rapid tests without subsequent confirmation could result in an estimated 10% or more children misdiagnosed as HIV infected.
Abstract: Despite advances in the management of severe sepsis, the mortality rate of septic shock in children and adults remains high. Meningococcal disease is the leading cause of sepsis affecting previously healthy children and young adults. In a septic infection, the production and release of mediators of inflammation may lead to severe organ damage. The use of plasma exchange is intended to reduce the level of inflammatory mediators as an adjunctive therapy accompanying the standard medical care.…We retrospectively studied six patients (median age 6.5 years, range 0.8–16 years) suffering from primary septic shock (4/6 with a proven meningococcal disease) who were treated with a single plasma exchange. The inclusion criteria for plasma exchange were clinical impression of a septic shock showing typical skin lesions and a refractory hypotension after volume therapy. The plasma exchange was conducted once between 3 and 8 hours after admission for a period of 1–3.3 hours. The Pediatric Risk of Mortality (PRISM-I) score ranged from 10 to 36. The mortality rate was 33%, but all of the four patients suffering from meningococcal sepsis survived. Neither circulatory conditions nor oxygenation showed relevant improvement during plasma exchange or in the two hours afterwards. All patients with proven meningococcal sepsis survived, but based on the limited number of patients in this study further conclusions can not be drawn. From the clinical and pathophysiological studies available so far, there is insufficient evidence to justify the use of plasma exchange as standard treatment in primary septic shock in children.
Abstract: Acute disseminated encephalomyelitis is an immune-mediated inflammatory demyelinating disease of the central nervous system that can occur during or after infections. A 2-year-old female was hospitalized in an unconsciousness state with fever. She had suffered from 5 days of hand-foot-mouth disease until 2 days before admission. Magnetic resonance imaging disclosed high-intensity lesions at the cerebrum and cerebellum but not at the brainstem and spinal cord, confirming the diagnosis of acute disseminated encephalomyelitis.…Her illness was remarkably improved after the start of steroid therapy and she could recover without any sequele. The genetic analysis of the genome sequence revealed that the isolated strain was enterovirus 71. The phylogenetic analysis with the strains obtained from fatal brainstem encephalitis suggests an association between the genotypes and the neurological virulency.
Abstract: Sepsis is a rare complication following chickenpox in healthy children. Gangrene at different sites even in the absence of disseminated intravascular coagulation can result in high morbidity and mortality. Coagulase negative staphylococcus can rarely complicate in systemic sepsis and is probably a predictor of bad prognosis. Secondary skin infection following rupture of bullae requires prompt antibiotic therapy covering Streptococcus and Staphylococcus.