Journal of Pediatric Infectious Diseases - Volume 5, issue 1
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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: Chronic fatigue is common during adolescence, and up to 1% of the adolescent population is unable to participate in normal activities due to persisting tiredness. The onset and perpetuation of chronic fatigue are multifactorial, and infection has often been postulated to be an important aspect of the etiology. While some infections persist for many months or even years and can be accompanied by fatigue, acute infection more frequently serves as a trigger for subsequent pathophysiologic mechanisms,…which are associated with fatigue that persists much longer than the initial, inciting infection. Altered gene expression might mediate some of these ongoing processes. Chronic fatigue is often associated with altered cytokine and natural killer cell patterns and is sometimes associated with the development of autoimmunity, even to specific neurologic receptors. Autonomic dysfunction in the form of the postural orthostatic tachycardia syndrome is frequently linked to adolescent chronic fatigue, as is cardiovascular deconditioning. Psychologic profiles both prior to and after the inciting infection have also been associated with ongoing fatigue. Thus, infectious illnesses can interact with immune, neurologic, cardiovascular, and psychologic factors to stimulate the development of chronic fatigue in adolescents.
Abstract: The global human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic has resulted in a worsening of the tuberculosis (TB) scenario, especially in the developing countries. The HIV-TB co-infection has grave epidemiological consequences for TB in terms of reactivation of latent TB infection, rapid progression of new infections to active disease and recurrence of infection in cured TB cases. A reported 33.2 million people worldwide are living with HIV/AIDS in 2007. The number of children living with…HIV in 2007 was estimated at 2.1 million (1.9–2.4 million) and those children who died of AIDS in 2007 was 290,000 (270,000–320,000). The solution to this dreaded dual infection lies in the phased implementation of TB and HIV control activities with child centered programs gradually giving way to family centered programs. To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to maximally improve TB cure rates. Public-private partnerships can enhance continuity of care for patients with TB and HIV/AIDS with political commitment and leadership from both public and private sectors.
Keywords: Pediatrics, HIV, tuberculosis, co-infection, India, global
Abstract: There are many causes of cerebral palsy (CP) apart from hypoxic events during the perinatal period. Perinatal infections and systemic inflammatory response syndrome of the mother and infant can affect the development of CP significantly. The majority of premature infants are vulnerable to CP and the association between intraamniotic infections, preterm rupture of fetal membranes and the effect of preterm birth predispose the infant to CP. Incidence of intraventricular hemorrhage, white matter disease…and periventricular leukomalacia has increased after preterm labor resulting from intraamniotic infections. Bacterial vaginosis, fever, periodontal disease of the mother, as well as bacterial, viral, protozoan and fungal infections of the newborn infant are effective during the development of CP. The balance between proinflammatory and anti-inflammatory cytokines and the combined effects of genetic predisposition, hypoxia, cytokines and bacterial products may initiate the unfavorable process. Treatments directed towards cytokines and bacterial products have not been effective until now. Fetuses and neonates should be protected from perinatal infections as much as possible and all infections should be treated promptly in order to prevent short-term and long-term adverse outcomes.
Abstract: Sudden infant death syndrome (SIDS) has been extensively investigated in the context of infection as a contributing factor in the death of otherwise apparently healthy infants. A number of infectious agents have been implicated suggesting the causal pathomechanism is related to infection, but not necessarily solely attributable to any one type of infection. An alternative provocative hypothesis is that of post-infection autoimmunity affecting critical novel neurotransmitters of the vasoactive neuropeptide family. Their…role in respiratory and cardiac functioning together with novel hypotheses postulating their autoimmune compromise may suggest a role in SIDS etiology following infection. Animal models demonstrate their vital role in neonatal survival and the neuronal control of breathing. Autoimmune compromise of vasoactive neuropeptide receptors through molecular mimicry following infection or idiopathic autoimmunity is postulated as a cause of SIDS.
Abstract: To examine effects of maternal factors on choice of infant feeding method, and to assess the effects of feeding method and other maternal and infant factors on morbidity and mortality a prospective study was conducted within the Kesho Bora study that evaluated antiretroviral therapy impact on mother to child transmission of human immune deficiency virus 1. ean age for the mothers was 27.55 years (range 18–41 years); 69.3% were homemakers and 41.4% had no formal education.…Breastfeeding was chosen by 109 mothers (81.3%) compared to 25 mothers (18.7%) choosing formulafeeding. The decision to formula feed was more common among mothers who had disclosed their human immune deficiency virus status to a family member (P=0.0036) and among women who had attained a relatively high level of education (P=0.001). Morbidity and mortality were assessed for 138 infants (113 exclusively breastfed and 25 formula fed). There were no statistically significant differences in incidence of diarrhea or upper respiratory infection between the two groups of children (P=0.7 and P=0.255, respectively), but formula fed children tended to require more frequent hospital care (P=0.016). Infant mortality after the age of 6 months was not sstatistically different in the two groups of children (7% in the exclusive breastfeeding group compared to 12% in the formula fed group, P=0.42). Premature birth and low birth weight were associated with a significant risk of infant mortality (P= 0.001 and P=0.007 respectively). Considering the prevailing socio-economic conditions in Bobo-Dioulasso, we conclude that exclusive breastfeeding should be the recommended infant feeding method for most women here.
Keywords: Exclusive breastfeeding, formula feeding, HIV-1, infant morbidity and mortality, Bobo-Dioulasso
Abstract: We evaluated the effect of interventions for preventing mother to child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) infection and studied the effect of highly active antiretroviral therapy (HAART) on clinical, hematological and immunological characteristics in a cohort of HIV-1 seropositive infants. We included 399 HIV exposed infants from July 2002 to October 2008. Of these, 49 infants received MTCT prophylaxis (intervention group); while 350 infants were born to mothers received no…prophylactic measures and comprised the non-intervention group. DNA polymerase chain reaction was done to confirm the HIV status before 18 months and enzyme-linked immunosorbent assay (ELISA) beyond 18 months of age. Children found to be HIV-1 positive were started on anti retroviral treatment (ART) as per guidelines, and followed up after 10 months interval. Hemoglobin levels and CD4 counts were also recorded at each visit. A significant difference was observed in MTCT rates between intervention and non-intervention groups (P=0.001). Antiretroviral therapy was started for 23 of the 94 HIV-1 infected children after recording baseline clinical, hematological and immunological parameters. Hemoglobin levels increased significantly after initiation of HAART (pre vs. months post zidovudine: P=0.002). The CD4 counts, CD4% and CD4/CD8 ratio improved significantly post therapy in all children. (P=0.0001, P=0.0001, and P=0.0001 respectively). Identification of maternal HIV infection at an early stage is important to maximize option and allow optimal timing of therapeutic strategies to prevent MTCT of HIV-1 infection. The early use of HAART improves clinical, hematological and immunological characteristics, delays the progression of disease and improves survival in HIV-1-infected children.
Keywords: HIV-1, MTCT, children, HAART, hemoglobin, CD4 count, India
Abstract: All over the world, meningitis remains one of the most widespread neuroinfections for adults and children. Successful initiation of treatment and prognosis depends on rapid diagnosis. Diagnosis begins with a clear differentiation between bacterial and viral characteristics of the causative agent. The aim of our research was to optimize the diagnostic procedure used in Russian infectious diseases hospitals for children with preliminary diagnosis of "meningitis". There were 232 patients (1 to 14 years of age) hospitalized…and observed in our Saratov State children infectious hospital with preliminary diagnosis of "meningitis." Diagnoses occurred on day 2.2 ± 0.7 from onset of illness. It was impossible to differentiate bacterial or viral etiology of meningitis on the basis of clinical observation or results of common laboratory assays (mixed pleocytosis in analysis) cerebrospinal fluid (CSF). The results of our research of these "acute phase of inflammation proteins" demonstrate that patients with bacterial meningitis have serum C-reactive protein (CRP) levels higher than 24 mg/L (42.2 ± 5.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content – higher than 135.0 ng/L (342.6 ± 14.2 ng/L; normal 6.39 ± 1.7 ng/L), serum procalcitonin (PCT) level – higher than 0.5 ng/mL. Patients with "viral meningitis" have serum CRP levels lower than 18.0 mg/L (9.8 ± 1.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content – lower than 120.0 ng/L (61.9 ± 7.8 ng/L, normal 6.39 ± 1.7 ng/L), serum PCT level – lower than 0.5 ng/mL. For patients with "intermediate level" of CRP in their serum samples (18.0–24.0 mg/L) or lactoferrin in their CSF samples (120.0–135.0 ng/L) test on serum PCT content is highly recommended because in all cases gives unambiguous results.
Keywords: Meningitis, enterovirus, coxsackieviruses, echoviruses, children
Abstract: Data from Latin America describing the potential differences among children with unilateral or bilateral otitis media are scarce and needed in order to implement appropriate prevention actions and specific antimicrobial recommendations. The present study analyzed the demographic and microbiologic characteristics of 1,427 Costa Rican children with unilateral and bilateral otitis media in whom a tympanocentesis was performed between 1992 and 2006 (median age: 23 months; range two to 150 months). There were no significant…differences in the demographics, microbiology and antimicrobial susceptibility among middle ear fluid isolates obtained from both populations. The only significant finding was observed in children with Moraxella catarrhalis otitis media that was observed more frequently than other bacterial pathogen in the middle ear fluid of children with unilateral acute otitis media that were < 24 months of age and during the rainy season.
Keywords: Unilateral otitis media, bilateral otitis media, M. catarrhalis
Abstract: Rotavirus (RV) is the single most important causative agent for severe dehydrating childhood diarrhea worldwide. RV diarrhea is a tremendous social and economic burden upon the people in developing countries. In Bangladesh, the proportion of RV diarrhea in children is increasing compared to other infectious diarrheal agents primarily because of improvements in water sanitation. This hospital-based cross sectional study was carried out in a children's hospital of Bangladesh to highlight the clinical presentations and…seasonal predilection of RV diarrhea. A total of 601 children under the age of 5 years presenting with acute watery diarrhea were enrolled, with collected stools tested for presence or absence of RV antigen by enzyme linked immunosorbent assay (ELISA). Forty-two percent of the samples were ELISA positive for RV antigen; 72% of those RV+ children were under 12 months of age and 92% were under 24 months. Nausea, vomiting and large families (⩾ 5 members) showed significant association with RV+ diarrhea compared to RV- diarrhea (P=0.004, 0.001 and P=00.006 respectively). In RV+ diarrhea, the purging rate was also significantly higher (P=0.043). Mild to moderate fever and dehydration were noted in 82% and 84% cases of RV+ diarrhea respectively. RV+ diarrhea peaked during winter months (January through March). The vulnerable age group, seasonality and clinical presentations of childhood RV diarrhea observed in our study are expected to assist the Bangladeshi health care professionals confidently dealing with this health problem; even if there is little or no laboratory support.
Abstract: The aim of this study was to characterize the infection by respiratory syncytial virus (RSV), identify risk factors, complications and compare treatment strategies in children admitted to two Portuguese hospitals. It was a retrospective study performed between January 2005 and December 2006. Demographic and socioeconomic data, risk factors, treatment, complications and medical follow-up were analyzed. A total of 328 children were studied (135 from Hospital Dona Estefânia and 193 from Hospital Fernando Fonseca), about half…(52.7%) being male, with a mean age of 5 months. 41% of the patients were from a poor socioeconomic context, 55.8% had older siblings, 32.2% had smoking parents and 11.3% had reactive airway disease. Complications occurred in 76.1% of the patients, namely, hypoxemia (63.5%), secondary bacterial infection (26.5%), atelectasis (11.5%), respiratory failure (10%) and apnea (2.4%). Most of the patients (92.3%) were treated with bronchodilators, 69% had oxygen supplementation, 45% were on antibiotics and 31% were treated with systemic corticosteroids. Ten percent needed mechanical ventilation. Twenty-seven (8.2%) children developed reactive airway disease. Having older siblings (63.1% vs. 49.3% P= 0.05) and being newborn (32.7% vs. 16.5% P=0.006) resulted as risk factors for complications, while the risk factors identified for bacterial infection were having older siblings (71.4% vs. 55.7%; P= 0.013) and being from a poor socioeconomic context (64.7% vs. 47.6%; P=0.017). The treatment strategies differed in the two hospitals (Hospital Fernando Fonseca vs. Hospital Dona Estefânia) regarding the use of systemic corticosteroids (1.6% vs. 73.3%, P=0.000) and antibiotics (39.4% vs. 52.6%; P=0.011). RSV infections can result in serious complications. According to the current knowledge, most of the therapeutic measures carried out in this study were probably unnecessary. It is important to establish clear national guidelines for the treatment of RSV infection.