Journal of Pediatric Infectious Diseases - Volume 4, issue 3

Authors: Michie, Colin A. | Jewell, Andy

Article Type: Research Article

DOI: 10.3233/JPI-2009-0177

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 193-195, 2009

Authors: Van Rostenberghe, Hans

Article Type: Research Article

DOI: 10.3233/JPI-2009-0165

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 197-198, 2009

Authors: Tebruegge, Marc | Pantazidou, Anastasia | Yau, Carmen | Chisti, Mohammod Jobayer | Curtis, Nigel

Article Type: Research Article

Abstract: Bacterial tracheitis is a rare, but potentially life-threatening infection, which predominately affects children. The existing literature on this condition is relatively limited. Objective: To provide a comprehensive review of the published literature on bacterial tracheitis by systematically summarizing epidemiological, radiological, clinical and microbiological aspects of the disease combined with a discussion of potential mechanisms involved in the pathogenesis and recommendations for the management of suspected cases. Methods: Search of multiple databases including …Medline/PubMed, the Web of Science, EMBASE, the Cochrane database, Scopus and CINAHL. All original reports in English with four or more cases of bacterial tracheitis were included, with the exception of one paper, which provided insufficient detail. All relevant publications were searched for further references. Results: Nineteen publications were identified, which included a combined total of 300 patients. The male-to-female ratio was 1.3:1. The majority (72%) of patients required intubation or tracheostomy. While short-term complications including hypotension, pulmonary edema and pneumothorax were not uncommon, long-term sequelae were rare. Fatality rates varied considerably between reports (range 0–40%). The most common reported causative organisms were Staphylococcus aureus (41%), Haemophilus influenzae (18%), Streptococcus pneumoniae (15%), Moraxella catarrhalis (13%) and Streptococcus pyogenes (9%). Other bacterial organisms were relatively uncommon (< 3%). Conclusions: Bacterial tracheitis remains a potentially fatal infection. However, in contrast to the high mortality rates documented in some of the earlier publications, fatal outcomes in recent reports were overall relatively rare. Active management, including timely intubation, is vital to prevent complete upper airway obstruction and consequent respiratory arrest. Based on the data presented, initial antibiotic therapy should consist of broad-spectrum coverage, including an appropriate anti-staphylococcal agent, with a view to optimizing antibiotic therapy once culture and susceptibility results become available. Show more

Keywords: Bacterial tracheitis, laryngotracheobronchitis, infectious upper airway obstruction, child, pediatric

DOI: 10.3233/JPI-2009-0179

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 199-209, 2009

Authors: Hays, John P.

Article Type: Research Article

Abstract: Moraxella catarrhalis is a human-specific bacterium previously discounted as a simple commensal organism with only limited pathogenic potential. This view has changed considerably and we now know that M. catarrhalis is associated with a range of disease states affecting both children and adults. In particular, M. catarrhalis tends to be associated with upper respiratory tract infections, including otitis media and sinusitis in children and lower respiratory tract infections in adults with pre-existing …pulmonary disease, e.g., exacerbations of chronic obstructive pulmonary disease. Colonization with this bacterium is especially common in infants and young children, the age group most affected by M. catarrhalis-mediated disease. Research is just beginning to unravel the complex interaction between this pathogen and the human host and is providing insights into its diverse genetic population structure and numerous virulence traits. These latter markers include multiple potential cellular adhesion molecules that are currently being researched as potential vaccine candidates. This mini-review is intended to provide the reader with a short introduction to M. catarrhalis as a pathogen and includes recent advances in the understanding of mechanisms associated with bacterial virulence. Show more

Keywords: Moraxella catarrhalis, colonization, immune response, beta-lactamase

DOI: 10.3233/JPI-2009-0167

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 211-220, 2009

Authors: Di Carlo, Paola | Romano, Amelia | Melis, Mario | Abbagnato, Luisa | Caccamo, Nadia | Meraviglia, Serena | Dieli, Francesco

Article Type: Research Article

Abstract: The most significant immunological studies of tuberculosis (TB) infection have involved adult patients. Few studies about the immune repertoire have been conducted in children. The purpose of this paper is to focus on cellular immune response to Mycobacterium tuberculosis by reviewing our studies conducted on children with different forms of TB infection between 1998 and 2006. Although the gold standard of TB diagnosis remains isolation of TB bacillus that also allows estimation of pattern of resistance …of M. tuberculosis, the study of immune response can be useful for the early diagnosis and therapeutic follow-up of pediatric TB. Show more

Keywords: Immune response, tuberculosis, children

DOI: 10.3233/JPI-2009-0178

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 221-228, 2009

Authors: Edlich, Richard F. | Chase, Margot E. | Cross, Catherine L. | Wack, Courtney A. | Brock, Carroll M. | Fisher, Allyson L. | Gubler, K. Dean | Lin, Kant Y. | Britt, L.D. | Long III, William B. | Zura, Robert B.

Article Type: Research Article

Abstract: Thimerosal is a mercurial preservative that was widely used in vaccines in the United States and Europe until 2001. By 1999, expanding recommendations for infant vaccinations indicated that United States children who received a complete series of vaccines that contained thimerosal received up to 187.5 μg of ethyl mercury during the first six months of life. This cumulative exposure could exceed the United States Environmental Protection Agency's recommended safe intake level, estimated in 1997, to be …no more than 0.1 μg of mercury per kilogram of body weight per day. This observation lead to a recommendation by the American Academy of Pediatrics that thimerosal is removed to all vaccines that are administered to infants in the United States. Realizing the potential dangers of thimerosal in vaccines, six states have enacted legislations that have limited the amount of thimerosal that can be used in vaccines in their States (Iowa, California, New York, Missouri, Delaware and Washington). In 1987, Congress established the Vaccine Injury Compensation Program to provide compensation to family of individuals who suffer injuries from vaccines. Until recently, these judgments have been paid only to families of non-autistic children who received complications due to the vaccines. In 2008, the Government conceded its first vaccine-autism case in Federal Court. Scientific studies of this autistic child suggested that the autism was related to a mitochondrial disorder. The Federal Government should enact legislation that prohibits the use of thimerosal in vaccines given to pregnant women and their infants. Show more

Keywords: Thimerosal, vaccine legislation, children, pregnancy, autism, infants, mitochondrial

DOI: 10.3233/JPI-2009-0166

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 229-232, 2009

Authors: Omar, Said A. | Wooliever, Diane | Herrington, Carolyn J. | Lorenz, John M. | Rawas, Fisal | Huard, Thomas

Article Type: Research Article

Abstract: T-cells express two surface antigen isoforms that represent two different maturational stages. Naive T-cells express CD45RA and memory T-cell express CD45RO. Naive T-cells can convert to memory T-cells after antigenic exposure. We hypothesized that naive T-cell expression would be high in healthy newborns compared with adults and that memory T-cell expression would remain low in septic newborns. The expression of naive and memory T-cells was examined using flow cytometry on peripheral blood samples from 15 newborn …infants (gestational age 36 ± 1 weeks) with clinical or culture positive sepsis, cord blood samples from 20 healthy newborn infants (gestational age 37 ± 1 weeks) and peripheral blood samples from 24 healthy adults. Both healthy and septic newborns demonstrated a significantly higher percentage of naive T-cells compared with adults (57 ± 2%, 67 ± 4% vs. 40 ± 2%; P < 0.05). Expression of memory T-cells was significantly lower in healthy newborns than adults (8 ± 1 % vs. 46 ± 2%, P < 0.0001). However, septic newborns had a significantly higher percentage expression (14 ± 2% vs. 8 ± 1%, P < 0.01) and absolute number of memory T-cells (812 ± 112/mm^{3} vs. 600 ± 222/mm^{3} ; P < 0.01) than healthy newborns. The percentage expression and absolute number of memory T-cells remained persistently high in septic newborns compared with healthy newborns even after they had completed a full course of antibiotics and recovered from sepsis. The marked predominance of naive T-cells in newborns is consistent with our hypothesis that T-cell immune system is immature at birth. However, newborn infants are capable of increasing expression of memory T-cells in response to sepsis. Show more

Keywords: Memory T-cells, naive T-cells, neonatal sepsis, newborn infants

DOI: 10.3233/JPI-2009-0180

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 233-239, 2009

Authors: Sundaram, Venkataseshan | Kumar, Praveen | Narang, Anil

Article Type: Research Article

Abstract: Traditional division of neonatal sepsis into early (EOS) and late onset sepsis (LOS) may be fallible. We analyzed the bacteriological profile of neonatal sepsis day wise to see if the organisms causing EOS and LOS are really different in the current era. This retrospective study was conducted in a tertiary care neonatal unit from 1995–2006. Neonates with proven sepsis were included. The exact age of the neonate when the blood culture was obtained was extracted. To …identify the overlap between vertically and hospital acquired sepsis, a similar percentage contribution of a particular organism on a day wise analysis in the first 7 days of life was required. Day wise analysis was done by χ2 for trends. One thousand and four hundred and ninety-one neonates had blood culture proven sepsis (38.6 per 1000 live births). EOS was caused predominantly by Klebsiella pneumoniae and non-fermenting Gram-negative bacilli; whereas LOS was caused mainly by Staphylococcus aureus. All organisms were isolated on all the days of life. Thirty one percent developed culture proven sepsis in first 24 hours of life. Non-fermenting Gram-negative bacilli significantly contributed on day 1 while S. aureus sepsis was significantly higher from day 7 onward on trend analysis. The definition of EOS and LOS based on day of isolation alone may not be applicable. A prospective evaluation of the source of early bacterial infections is required. Show more

Keywords: Bacterial sepsis, neonate, organisms, trends, EOS, LOS

DOI: 10.3233/JPI-2009-0171

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 241-245, 2009

Authors: Hermos, Christina R. | Shiau, Rita | Hsiang, Michelle | Chambers, Henry F. | Pan, Erica

Article Type: Research Article

Abstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in children is increasing worldwide, yet limited prospective studies have assessed epidemiologic risk factors for CA-MRSA infection in children. Our aim is to describe the clinical and microbiological characteristics of and potential epidemiologic risk factors for pediatric CA-MRSA infection in San Francisco. S. aureus isolate information from subjects 0–18 years old were prospectively collected over 6~months. Demographics and clinical details were gathered for subjects by chart review. …Patients and/or guardians were interviewed about underlying conditions and potential risk factors for CA-MRSA such as a) previous MRSA/skin or soft tissue infection (SSTI) in patient or household; b) direct or indirect exposure to healthcare setting (recent antibiotics, emergency room visits, chronic disease or healthcare worker in household); c) community exposures (daycare, team sports, history of homelessness/group home, injection drug use or incarceration). Among S. aureus isolates from 216 subjects, 180 isolates from 170 subjects had community-acquired SA, 85 (50%) of whom had CA-MRSA. 91% of CA-MRSA patients had a SSTI. CA-MRSA resistance to clindamycin and ciprofloxacin were 7.8% and 50% respectively. Compared to community-associated methicillin-sensitive Staphylococcus aureus (CA-MSSA) patients, a significantly higher proportion of CA-MRSA patients were African-American, a smaller proportion were Asian/Pacific Islander, and a larger proportion were hospitalized. Among deep SSTI, 60/62 (97%) were MRSA. Over 50% of CA-MRSA patients were < 4 years old. 97% of interviewed MRSA patients had at least one potential risk factor; 85% of whom had an exposure to healthcare setting, 47% had or lived with someone who had previous MRSA or SSTI; and 60% had a potential community exposure. Fifty percent had an underlying atopic condition. This pediatric population had a high prevalence of potential epidemiologic risk factors for CA-MRSA and underlying conditions. Future studies comparing exposures of patients with CA-MRSA to those with CA-MSSA are needed to determine if these exposures are unique to subjects with CA-MRSA in this population. Show more

Keywords: Staphylococcus aureus, methicillin resistance, community-associated infections, soft tissue infections, risk factors

DOI: 10.3233/JPI-2009-0169

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 247-259, 2009

Authors: Armin, Shahnaz | Karimi, Abdollah | Fallah, Fatemeh | Fahimzad, Alireza | Kiomarci, Azadeh

Article Type: Research Article

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important health care-associated pathogen, but community-acquired MRSA has emerged as a pathogen in children without established risk factors. S. aureus nasal carriage is a risk factor for infection in humans, particularly in hospitals, and appears to antedate bacteremic as well as non-bacteremic infection. A cross sectional study was implemented from July 2004 to 2006 in Mofid Children's Hospital. Trained technicians obtained nasal swab samples from …neonates. Questionnaires were completed for each and MRSA colonies were detected. One thousand and three hundred and sixty six neonates were included in this study. Age on admission had direct correlation with staphylococcus colonization. History of previous antibiotic consumption had an indirect relationship with nasal colonization. We did not find any correlation between MRSA colonization and different variables (such as birth weight, age, sex, history of antibiotic consumption). These predictors may help inform clinical decision making when starting empiric antibiotic therapy. First, older neonates admitted to the ward are more likely to be carriers of S. aureus. When clinicians encounter infections in this group, especially in areas of the body where staphylococcal infections are common, such as the skin, treatment should include an antibiotic that is effective against S. aureus. Fortunately, MRSA carriage rate is low in our neonates; therefore, clinicians should not start antibiotic therapy against MRSA until the presence of this organism is documented by laboratory methods. Show more

Keywords: MRSA, colonization, S. aureus, neonates

DOI: 10.3233/JPI-2009-0170

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 261-265, 2009

Authors: Quiñones, Dianelys | Marrero, Deisy | Llop, Alina | Kobayashi, Nobumichi | del Campo, Rosa

Article Type: Research Article

Abstract: Genetic relationships and the antibiotic resistance determinants were studied for a total of 55 Enterococcus faecalis isolates recovered from children in a pediatric hospital in Cuba between January 2001 and December 2004. These isolates were analyzed by pulsed-field gel electrophoresis, and presence of some resistance genes to aminoglycosides, macrolides and tetracycline were examined by polymerase chain reaction. A total of 17 pulsed-field gel electrophoresis patterns were identified among 54 different patterns of …pulsed-field gel electrophoresis. Particular multi-resistant E. faecalis clones were detected in different wards from the pediatric hospital. The aac(6')-aph(2")} and aph(3') genes was detected in all the isolates with high-level resistance to gentamicin and amikacin, respectively, whereas the ant(6) gene was detected in the 75% of isolates showing high-level resistance to streptomycin. The erm(B) gene was found in 72% of the erythromycin-resistant strains, and tet(M) was detected in all tetracycline resistant strains. The circulation of particular clones exhibiting antibiotic resistance in the pediatric hospital and the dissemination of drug-resistance genes among these strains indicated the need for the monitoring of antibiotic susceptibility to prevent the selection or dispersion of resistant strains in this hospital. Show more

Keywords: PFGE, Enterococcus, antibiotic resistance determinants

DOI: 10.3233/JPI-2009-0190

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 267-274, 2009

Authors: Brahmbhatt, Heena | Kigozi, Godfrey | Serwadda, David | Wabwire-Mangen, Fred | Sewankambo, Nelson | Wawer, Maria | Gray, Ronald

Article Type: Research Article

Abstract: Purpose: To assess gender differences in the risk of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). HIV-positive mothers were identified from a population cohort followed from 1994 to 2000. HIV infection in mothers was detected using two independent enzyme immunoassays and infant HIV infection was diagnosed using RNA- polymerase chain reaction. Birth weight was determined by anthropometry. Logistic regression was used to assess the univariate and multivariate risk factors of MTCT. Approximately 16% of 371 …infants were HIV-positive in the in-utero and intrapartum periods and an additional 16% were infected via breastfeeding. Female infants were significantly more likely to be HIV infected perinatally compared with male infants (20.8% vs. 12.4%, respectively, P = 0.035), but there was no significant sex differences in postnatal risk of MTCT. In adjusted analyses, among mothers with higher than median HIV viral loads, there was no significant difference in the risk of MTCT by gender, but among mothers with lower than median HIV viral loads, female infants were significantly more likely to be HIV infected (odds ratio = 4.1, confidence interval = 1.04–16.1). Low birth weight was more frequent in female than male infants born to HIV-positive mothers. Female infants could be more susceptible to HIV infection in the in-utero and peripartum period compared with male infants. Alternatively, this sex association could be due to higher in-utero mortality rates of male infants or to increased susceptibility of female infants. Show more

Keywords: MTCT, vertical transmission, perinatal transmission, viral load, low birth weight

DOI: 10.3233/JPI-2009-0168

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 275-279, 2009

Authors: Chansinghakul, Danaya | Soongswang, Kulthida | Pancharoen, Chitsanu | Thaithumyanon, Pimolrat | Limpongsanurak, Sompop | Thisyakorn, Usa

Article Type: Research Article

Abstract: Purpose: To evaluate the safety and efficacy of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected pregnant women to prevent mother-to-child transmission of HIV. Design of the study is observational retrospective evaluation of a prospective cohort. Setting of the study is King Chulalongkorn Memorial Hospital. Participants are HIV-infected Thai women and their offspring. HIV-positive pregnant women who received antenatal care were given antepartum and intrapartum zidovudine (ZDV) plus single …dose nevirapine (NVP) or HAART [ZDV + lamivudine (3TC) + NVP] to prevent HIV transmission to the neonate. All newborns received single dose NVP plus 6-weeks of ZDV. HAART was given to their parents if indicated. We followed the infants from February 2003 to June 2006 to determine HIV-status. Calculated HIV maternal-child transmission rate is the main outcome. Among 157 mother-infant pairs, 44 mothers received ZDV plus single dose NVP and 113 mothers received HAART. There was one HIV-infected child in the first group and 3 in the second group, resulting in 2.3% (95% confidence interval, -2.1 to 6.7) transmission rate in the first group versus 2.7% (95% confidence interval, -0.3 to 5.6) in the second group (P = 1.000). All non-infected infants had a normal physical examination at 18 months. Initiation of HAART in HIV-infected pregnant women had comparable efficacy with ZDV plus single dose NVP to prevent mother-to-child transmission of HIV. In addition, the program may have strengthened the role of the family unit and stimulated public awareness reproductive health planning can help in prevention of HIV/AIDS. Show more

Keywords: Mother-to-child transmission, HIV, HAART

DOI: 10.3233/JPI-2009-0172

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 281-287, 2009

Authors: Hosseini, Seyed Mohammad Milani | Ataei, Neamatollah | Sharifzadeh, Maysam | Khotaei, Ghamar Taj

Article Type: Research Article

Abstract: Obtaining uncontaminated urine samples are important to diagnosis urinary tract infection in neonates. The present study was designed to compare urine contamination rates in two common methods of urine collection: urine bag versus suprapubic aspiration. In a cross-sectional study, 119 consecutive infants (aged 3 to 28 days) with fever who were referred to Children's Hospital Medical Center in Tehran between September 2004 and March 2005 were included. Urine was collected simultaneously by bag and suprapubic aspiration. …The urine samples were analyzed and bacterial cultures performed using standard bacteriologic techniques. The rate of culture contamination differed markedly according to the method of urine culture. Suprapubic aspiration specimens were sterile in 92.4%. Pathogenic bacteria were isolated in 7.6%. No bacterial isolates were deemed to be contaminants. Only 8.5% of bag specimens were sterile. Of non-sterile cultures, 36.9% of bacterial isolates were deemed to be pathogenic and 54.6% contaminants (P < 0.001 vs. suprapubic aspiration). Pyuria (P = 0.002) and bacteriuria (P < 0.001) were more frequent in specimens obtained by bag than urine from suprapubic aspiration. The existence of a urinary tract anomaly was the main predictor for a positive culture in urine obtained by suprapubic aspiration. Contamination rates and rates of pyuria and bacteriuria are remarkably higher for urine obtained by bag specimens than for urine obtained by suprapubic aspiration. Show more

Keywords: Urinary tract infection, contamination, urine culture, neonate

DOI: 10.3233/JPI-2009-0181

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 289-293, 2009

Authors: Kenny, Benjamin | Gupta, Sanjeev | Brumby, Jarrod | Burton, Joanna | Moloney, Susan E.

Article Type: Research Article

Abstract: Group A streptococcal infection is common and has varied presentations. Group A streptococcus (GAS) is known to cause throat infections, erysipelas, scarlet fever and impetigo. Other more serious diseases caused by GAS are rheumatic fever and post streptococcal glomerulonephritis. There have been case reports showing an association with scarlet fever and jaundice postulating a direct effect of the erythrogenic toxin on the liver. We describe two cases; the first was a 13-year-old male who presented an …atypical presentation of streptococcal infection with an acute hepatic picture who later developed septic arthritis, the second was a 7-year-old male who presented with disseminated intravascular coagulopathy, sepsis, jaundice and hepatic encephalopathy. In neither of the two cases did the children develop rashes of scarlet fever, desquamation or pharyngeal erythema. These were unique presentations highlighting the wide spectrum of GAS disease. Show more

Keywords: Streptococcal infection, hepatitis, toxic shock syndrome

DOI: 10.3233/JPI-2009-0173

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 295-299, 2009

Authors: Yousef, Nida | Alhmood, Ammar | Mawri, Faisal | Kaddurah, Ahmad | Diskin, David | Abuhammour, Walid

Article Type: Research Article

Abstract: We describe a 7-year-old male with a history of fever, headache, bilateral non-purulent conjunctivitis, and photophobia. Patient was initially treated for suspected bacterial meningitis with intravenous antibiotics. Due to lack of clinical response, negative cultures, and evolving signs of Kawasaki disease, he was treated with one dose of intravenous immunoglobulin. Patient improved except for the persistence of photophobia and bilateral conjunctival injection. Eye examination showed bilateral optic neuritis and a visual acuity …of 20/80 in both eyes. Follow up eye examination after 6 weeks showed normal visual acuity, resolution of conjuctival injection, photophobia, and optic neuritis. This case highlights the posterior segment involvement in Kawasaki disease and the need for careful eye examination in patients with Kawasaki disease who have prolonged photophobia and conjunctival injection. Show more

Keywords: Kawasaki disease, optic neuritis

DOI: 10.3233/JPI-2009-0184

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 301-303, 2009

Authors: Papapetropoulou, Maria | Leontsini, Fani | Ierodiakonou, Michalis

Article Type: Research Article

Abstract: Herein we describe a unique case of previously healthy child in Greece who developed septic arthritis of hip due to Salmonella enteritidis. To the best of our knowledge, this is the first report in the literature of septic arthritis of hip in a child with no preexisting disease caused by S. enteritidis. The case was documented by culture of the aspirated joint fluid and blood cultures. The isolated microorganism was identified on species level in the …National Reference Centre for Salmonella and Shigella. Antimicrobial therapy and arthrotomy were performed. The patient developed sequalae (complete disruption of the femoral cap) and she is still followed. Show more

Keywords: Salmonella enteritidis, child, septic arthritis, hip

DOI: 10.3233/JPI-2009-0176

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 305-307, 2009

Authors: Howidi, Mohammad | Rajah, Jaishen

Article Type: Research Article

Abstract: We report a case of tuberculous meningitis in a 3.5-year-old child who presented with subtle symptoms. The symptoms were somnolence, low-grade fever, and vomiting. The physical exam revealed neck stiffness and depressed sensorioum. Encephalopathy was suspected. Lumbar puncture showed modest pleocytosis. Cerebrospinal fluid smear for acid fast bacilli and later for Mycobacterium tuberculosis were negative. Polymerase chain reaction (PCR) for M. tuberculosis was positive twice, and the patient was diagnosed early in the …course of the disease, treated accordingly, and recovered completely. Our laboratory performance consists of 36 tuberculous positive cases; 34 were PCR positive and 246 tuberculosis negative cases; nine were PCR positive, which is consistent with sensitivity of 94.4%, specificity of 96.3%, positive predictive value of 79%, negative predictive value of 99%, and likelihood ratio of 25.5. Tuberculous meningitis was diagnosed by a positive PCR whereas the smear and the Mycobacterium culture came back were negative. PCR has proven to be quite useful in the diagnosis of tuberculous meningitis and was life saving on our child in the case of this patient. Show more

Keywords: Tuberculosis, meningitis, diagnosis, PCR

DOI: 10.3233/JPI-2009-0174

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 309-313, 2009

Authors: Tebruegge, Marc | Pantazidou, Anastasia

Article Type: Research Article

DOI: 10.3233/JPI-2009-0175

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 315-316, 2009