Journal of Pediatric Infectious Diseases - Volume 4, issue 4
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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: Epstein-Barr virus (EBV) is known to cause infectious mononucleosis; in addition, it is strongly associated with malignancies. Studies have also demonstrated that EBV infection may trigger the development of systemic lupus erythematosus. EBV infection has been implicated in complicating treatment of juvenile idiopathic arthritis, in addition to triggering cytokine production. Awareness of a past or present EBV infection has been highlighted as an important factor in determining treatment options in several diseases. Repeated…associations have been described between EBV infection and various rheumatic diseases and complications of rheumatic disease, including Kawasaki disease, immune thrombocytopenic purpura, and hemophagocytic lymphohistiocytosis. We present a review of recent literature demonstrating the significance of EBV infection in rheumatic diseases, and complications of rheumatic disease, in children.
Abstract: It is well known that parvovirus B19 causes erythema infectiosum, a common febrile exanthema of childhood. Studies have also shown that parvovirus B19 can cause chronic arthropathy in children, and some children may meet classification criteria for juvenile idiopathic arthritis. A child's anti-B19 antibodies may cross-react with other antigens leading to autoantibody formation and immune complex deposition. This process can cause a similar clinical picture to systemic lupus erythematosus, and in some cases has been…implicated in initiation of disease. Parvovirus B19 has also been linked to the presence of antiphospholipid antibodies, juvenile dermatomyositis, vasculitides, immune thrombocytopenic purpura, and hemophagocytic lymphohistiocytosis. This review provides an extensive evaluation of the literature on parvovirus B19 and its role in rheumatic diseases in children.
Abstract: Chickenpox, caused by the varicella-zoster virus, is mostly a mild disease in healthy children, but can be debilitating in immunocompromised individuals or susceptible adults. The disease is highly contagious. The lesions start as rose-colored macules, and progress rapidly to become papules, vesicles with the classic "dew drop on a rose petal" appearance, pustules and, finally, crusts. The distribution of the lesions is typically central, with the greatest concentrations on the trunk. Characteristically, lesions are…intensely pruritic and appear in crops. The most common complication associated with chickenpox is secondary bacterial infections of the skin followed by post-inflammatory scarring of the lesions. The diagnosis is mainly clinical and treatment symptomatic. Oral acyclovir should be considered in high-risk individuals. Intravenous acyclovir is effective for the treatment of chickenpox in immunocompromised individuals and for serious complications of chickenpox in normal patients. To eradicate chickenpox, universal childhood immunization with varicella vaccine is the way to go. The Advisory Committee for Immunization Practices of the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend a routine two-dose varicella vaccination program for children, with the first dose administered at 12 to 18 months and the second dose at 4 to 6 years of age. The Advisory Committee on Immunization Practices further recommends two doses of varicella vaccine, 4 to 8 weeks apart, for all susceptible adolescents and adults and a catch-up second dose for everyone who received one dose of varicella vaccine previously.
Keywords: Chickenpox, complications, universal immunization, two doses
Abstract: Acute respiratory tract infections are a leading cause of morbidity and mortality in children worldwide. Although the clinical manifestations of respiratory tract disease are easily recognized, the etiological agent responsible for disease is often not identified. In 2001 van de Hoogen et al. reported the discovery of a novel virus from children with respiratory tract illness in the Netherlands, which was designated human metapneumovirus (hMPV). Since 2001 hMPV has been reported in most parts of the…world. hMPV seems to be an important respiratory pathogen that causes both upper and lower respiratory tract infections mostly in children, but in adults as well. The similar seasonal distribution of several other respiratory infections may result in coinfection with hMPV and other respiratory viruses, but the role that hMPV plays as a co-pathogen is still not understood completely. Retrospective serological studies have shown that hMPV, or a virus closely related to it, has been circulating for at least 50 years. Discovery of a new pathogen is always an exciting development in the field of respiratory viruses, although further studies are required to understand the pathogenesis of hMPV disease and the development of a safe and effective vaccine
Keywords: Human metapneumovirus, pediatric patients, respiratory tract infections
Abstract: Genetically determined variation in the magnitude of inflammatory response may play a role in determining the risk of developing neonatal sepsis, as well as its outcome. To test the hypothesis that interleukin-6 (IL)-6 -174, IL-10 -1082 genetic polymorphisms are associated with the risk of sepsis and clinical outcomes in full-term neonates with blood stream infections (BSIs). A total of 54 full-term neonates with BSIs and 70 matched controls were included in this case/control study. DNA amplification…using polymerase chain reaction with sequence-specific primers followed by NIaIII restriction enzyme digestion was done for detection of promoter single nucleotide polymorphism of IL-6 -174 G/C, amplification refractory mutation system-polymerase chain reaction assay was done for IL-10 -1082 G/A polymorphism in blood samples from all infants enrolled in the study. The IL-6 -174 and IL-10-1082 genotypes were not significantly different in neonates with BSIs compared to controls. Whereas, IL-6-174CC and IL-10-1082GG genotypes were associated with increased risk for mortality [Odds ratio (95% confidence intervals): 6.2 (1.3–28.4), P=0.02 and 25.0 (2.0–74.3), P < 0.01, respectively]. Moreover, IL-6 174CC and IL-10-1082GG genotypes were significantly higher in neonates who required inotropic support and those who developed disseminated intravascular coagulopathy. The IL-6 -174 CC and IL-10 -1082 GG genotypes were associated with increased risk for mortality, need for inotropic support and development of disseminated intravascular coagulopathy in full-term neonates with BSIs. These findings suggest that the genetic composition of the IL-6 and IL-10 promoter areas play a significant role in the pathogenesis of neonatal BSIs.
Abstract: To analyze neurodegeneration in brain cortex samples from human immunodeficiency virus (HIV)-vertically-infected children diagnosed with progressive or static HIV-encephalopathy. We performed a descriptive retrospective and cross-sectional study on 15 HIV-infected children. Eight children were diagnosed with progressive-encephalopathy (EP) and seven with static-EP. Autopsy samples of the frontal cortex from the 15 children were studied. Apoptotic analysis was performed by an assay, which detects apoptotic cells by labeling the fragmentation of DNA by…TdT – mediated dUTP nick end labeling (TUNEL) assay. The presence of phosphorylated p53 (p53Ser46P) indicates the beginning of the cell death process. Glial fibrillary acidic protein a marker for glial cells, and p53Ser46P were detected by immunohistochemical assays. All samples from the 15 HIV-infected children showed positive results using TUNEL and showed an increase in p53Ser46P. However, the number of apoptotic cells was higher in samples from children with progressive-EP and was comprised of a higher number of dying neurons than dying glial cells. In contrast, glial cells were more affected in children with static-EP. We observed gliosis (abnormal proliferation of astrocytes in damaged areas of the brain) in all samples, but in the static-EP samples, gliosis was observed in areas close to blood vessels, and it was more pronounced than in progressive-EP samples. Our results suggest that depending whether the diagnosis is progressive-EP or static-EP, neural affliction activates programmed cell death in brain tissue of HIV-infected children. Moreover, there are differences in the type of cellular population affected as well as in the level of glial cell activation.
Keywords: Children, HIV-encephalopathy, central nervous system, apoptosis, p53, glial activation
Abstract: Clostridium difficile is a Gram positive, spore-forming organism that has become a significant cause of nosocomial infection in hospitalized adults. Colonization with this organism results in a wide spectrum of clinical conditions, including an asymptomatic carrier state, mild self-limited diarrhea, pseudomembranous colitis, and fulminant colitis. It's role in disease in children remains controversial. This is a prospective study in which we evaluated all the patients hospitalized in the infectious diseases ward of…Mofid Children's Hospital, Tehran during 12 months (between September 2006 and September 2007). Stool samples from 250 patients were cultured for C. difficile and specimens analyzed for detection of toxin A and B. Data were analyzed by SPSS software version 11.5. Stool culture was positive for C. difficile in 113 (45.2%) patients, 10 (4%) of these were positive for both toxins A and B by enzyme-linked immunosorbent assay (ELISA). ELISA was negative in all patients with negative culture. None of the variables tested (age and antibiotic exposure) was significantly correlated with colonization. This is the first study about colonization rates of C. difficile in children in Iran. We conclude that although the C. difficile colonization rate in our children is high (45.2%), the rate of toxigenic strains is low (4%). This may explain the low rate of C. difficile associated disease (CACD) in our population.
Abstract: The objective of this study was to determine the morbidity and associated costs of rotavirus infection in Sri Lanka in anticipation of rotavirus vaccines. From April 2005 to October 2006 stool samples of 606 children (335 males) mean age 27.3 ± 31.53 months (range 1–144 months) admitted with gastroenteritis to the pediatric units of the Colombo North teaching Hospital were screened for rotavirus antigens by enzyme-immunoassay (EIA) (Rotaclone®. Severity of gastroenteritis was…assessed by the Vesikari scoring system. Using an interviewer administered questionnaire the average expense incurred per-episode of rotavirus gastroenteritis was determined among randomly selected rotavirus cases (n=45). Cost of universal rotavirus vaccination was assessed assuming a cost of US$ 7 per vaccine dose for a two-dose regime (World Bank cost-effectiveness standard for low-income countries). One hundred and sixteen (19.1% had group A rotavirus antigens. The prevalence of rotavirus infection among the 0–4 years age group was 20.8%. The mean severity score was 12.8 and 11 in rotavirus positive and non-rotavirus diarrheas, respectively (P < 0.001). Nausea, vomiting and severe dehydration were significantly associated with rotavirus. The average cost of an episode of rotavirus gastroenteritis hospitalization was Rs. 3626 (US$ 33). The estimated annual expenditure of universal rotavirus vaccination in Sri Lanka was US$ 5 million. Cost saved through averting rotavirus hospitalizations per year was US$ 0.26 million. Deaths averted were eight per year. Rotaviruses constitute an important health and economic burden in Sri Lanka. Vaccine safety, efficacy and affordability are requirements for implementation of universal rotavirus vaccination.
Keywords: Rotavirus, Sri Lanka, Vesikari score, cost analysis, vaccination
Abstract: In resource-limited settings lacking laboratory testing, clinical staging criteria may not identify all human immunodeficiency virus (HIV)-infected children who could benefit from antiretroviral therapy (ART). A retrospective analysis was conducted to identify clinical markers in children that could predict rapid progression and need for earlier ART. Pediatric HIV-infected patients receiving care at an outpatient clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from November 2004–March 2006 were enrolled. Medical…records were retrospectively reviewed for sociodemographic data, growth parameters, and medical information. Bivariable analysis was performed to identify predictors of clinical progression. Of 162 patients enrolled, 69 initially presented with mild clinical HIV disease and this analysis focuses on progression within this group. Twenty-one of those 69 progressed clinically to WHO Stage 3/4 during the 18 months of follow-up; 19 progressed within 2–9 months and two additional children were found to have progressed by the 9–18 months visit. Median (range) age at presentation among 69 patients with mild disease was 6.1 years (0.1–13.7 years), and 32 (46%) were female. Fourteen (20% of 69) patients were on ART at their first visit or started ART within the next 2 months (early ART), and an additional 20 (29% of 69) patients started ART in the following 2–18 months. Of initial visit clinical and laboratory criteria, lymphadenopathy (P=0.046), chronic upper respiratory infections (P=0.010), lower height-for-age z-score (P=0.007), lower weight-for-age z-score (P< 0.001), and CD4% (P=0.016) were associated with clinical progression. Fewer patients receiving early ART progressed, as compared to patients receiving late ART (P=0.004). Almost one third of children with clinically mild HIV disease progressed to Stage 3/4 disease within 2–18 months. In settings lacking CD4 cell counts, current guidelines would not have identified the majority of these children for treatment. Improved clinical criteria and low-tech modalities such as point-of-care CD4 testing may help improve identification of children for ART initiation.
Keywords: Pediatrics, HIV, highly active antiretroviral therapy