Journal of Pediatric Infectious Diseases - Volume 5, issue 2

Authors: Tagare, Amit | Kadam, Sandeep | Vaidya, Umesh | Deodhar, Jayant | Pandit, Anand

Article Type: Research Article

Abstract: Multidrug resistant (MDR) Klebsiella pneumoniae an increasing cause of neonatal sepsis in India. This observational study was designed to monitor temporal change in prevalence of K. pneumoniae as a causative organism for neonatal sepsis and its sensitivity pattern. The time period was divided into four time frames of six months each [designated A (1/10/2006–31/03/2007) to D (1/04/2008–30/09/2008)]. K. pneumoniae isolation in all cultures sent from neonatal intensive care units doubled in time …frame D (6.3%) compared to time frame A (3.0). Similarly, the percentage of total positive cultures in the neonatal intensive care unit that were K. pneumoniae also doubled (27.8% in A to 55.6% in D). K. pneumoniae sepsis tripled in inborn neonates (15.4% in A to 47.1% in D). Incidence of MDR K. pneumoniae increased from 0% in time frame A to 76.5% in time frame D. Resistance against ampicillin and third generation cephalosporins (cefotaxime and ceftazidime) remained 100% in all time frames. Carbapenem (meropenem and imipenem) resistance increased from 0% in time frame A and B to 41.2% in time frame D. Death due to K. pneumoniae sepsis showed brisk resurgence in time frame D (17.6%) compared to time frame C (10%). Lower gestational age and birth weight were associated with higher mortality. MDR K. pneumoniae is emerging as a more frequent cause of neonatal sepsis. There is an dincreasing threat of combined quinolone and carbapenem resistant MDR K. pneumoniae. Show more

Keywords: Neonatal sepsis, antibiotics, carbapenems, blood culture

DOI: 10.3233/JPI-2010-0245

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 119-124, 2010

Authors: Kabeer, Basirudeen Syed Ahamed | Perumal, Venkatesan | Paramasivam, Paulkumaran | Raja, Alamelu

Article Type: Research Article

Abstract: We assessed the yield of the QuantiFERON-TB Gold in tube test (QFT-GIT) and the tuberculin skin test (TST) in healthy persons from our general population, where tuberculosis is endemic and Bacillus Calmette-Guérin is mandatory. The yield of QFT-GIT (2% and TST (1% were very low among children, where the test was positive in 42% and 24% of adults, respectively. Our study results show that QFT-GIT and TST are not influenced by prior Bacillus Calmette-Guérin vaccination. Applying …the reduced cut-off point of 0.13 IU/mL is adequate in a pediatric population. Moreover, both the TST and the QFT-GIT demonstrated a low yield in the pediatric population, which suggests that either TST or QFT-GIT alone or in combination can be used to diagnose Mycobacterium tuberculosis infection in our setting. Show more

Keywords: Tuberculosis, diagnosis, QuantiFERON-TB Gold in tube, healthy children, endemic population

DOI: 10.3233/JPI-2010-0236

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 125-129, 2010

Authors: Santos-Sancho, Juana María | Gil-Prieto, Ruth | Álvaro-Meca, Alejandro | Gil-de Miguel, Angel

Article Type: Research Article

Abstract: Measles causes considerable morbidity and mortality and can present serious complications despite the existence of effective vaccines. The objective of this study was to estimate the incidence of hospitalizations from measles in Spain from 1997 to 2006. A retrospective study was conducted using data from the National Epidemiological Surveillance System for hospital data (hospital discharge minimum basic data set) and information was obtained on the incidence of hospitalizations, age, of stay, mortality, and associated costs. …In this period, 347 hospitalizations from measles (International Classification of Diseases-9, clinical modification code 055 in any diagnostic position) were recorded, which equals an overall annual hospitalization rate of 0.086 per 100,000 inhabitants. The hospitalization rate significantly changed during two outbreaks that occurred during the study time period. The median length of stay was 5 days. There were five deaths over the 10 year period; all patients who died were over 30 years of age. The death rate in hospitalized measles cases was 1.4%. The annual average total cost due to hospitalizations for the National Health System was 81,540 Euros. The epidemiological pattern suggests that despite the vaccination success, there are groups susceptible to falling ill, as is demonstrated by the outbreaks that occurred. Therefore, the World Health Organization recommendations for the elimination of measles must be carefully followed, so that the number of hospitalizations and of complications entailed with the disease continue to decrease. Show more

Keywords: Measles, hospitalization, Spain, vaccines

DOI: 10.3233/JPI-2010-0232

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 131-137, 2010

Authors: Tan, Natalie Woon Hui | Pan, Woei-Jack | Yunos, Hernie Haryati Binte Mohd | Tan, Wei Chuen | Lim, Kevin Boon-Leong

Article Type: Research Article

Abstract: Pyogenic abscess formation is a known but rare complication following childhood immunization. We present a retrospective review of seven infants in Singapore with methicillin-sensitive Staphylococcus aureus abscesses following a 5-in-1 vaccine (diphtheria toxoid-tetanus toxoid-acellular pertussis, inactivated Poliomyelitis and Haemophilus influenzae type b) administration in the thigh that required surgical drainage. The children were 4 to 7 months old at the time of diagnosis. All of them presented with thigh swelling and fever …was manifested in six infants. Four patients had ultrasound examination prior to surgery. A breach of sterility during immunization at one center most likely accounted for a cluster of four cases. Health care personnel should have a high index of suspicion for post-vaccination abscess especially in a child that presents with limb swelling, with or without fever, and with a history of recent vaccination in the same limb. An ultrasound examination to diagnose intramuscular abscess is recommended for equivocal cases. Prevention strategies include strict adherence to sterility during immunization and timely reporting of post-vaccination abscesses to health care authorities. Show more

Keywords: Vaccination, abscess, surgical drainage

DOI: 10.3233/JPI-2010-0239

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 139-147, 2010

Authors: Olaosebikan, Rasaq | Mokuolu, Olugbenga | Ernest, Kolade | Adeoye, Adeniyi

Article Type: Research Article

Abstract: Successful control of malaria depends upon the detailed knowledge of its epidemiology, including the knowledge of environmental, behavioral, socio-economic and socio-demographic factors that influence its prevalence, and on the knowledge and use of preventive measures. We carried out a cross-sectional study to assess the risk factors for malaria in children presenting with fever in rural Gambia. Three hundred and seventy-six children aged 5 months to 10 years presenting to Farafenni health centre, the Gambia …with fever or history of fever were enrolled. The socio-demographic characteristics, clinical findings, and knowledge and use of preventive measures in malaria were documented. Finger-prick blood sampling for malaria was obtained and two sets of smears (thick and thin) were prepared and stained with Giemsa stain. One hundred and eighty two children (48.4% had malaria. The significant risk factors associated with malaria were non-use of insecticide treated bed nets [χ ^{2} = 8.82, P =0.01, (95% confidence interval 0.10–0.67)] and age [χ ^{2} = 9.18, P=0.004, (95% confidence interval 0.31–0.78)]. There were no significant associations identified between the development of malaria and parental education, occupation, knowledge of the cause of malaria, type of roof or wall in the home, or whether the parents reared livestock. Show more

Keywords: Risk factors, uncomplicated malaria, fever, Gambia

DOI: 10.3233/JPI-2010-0242

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 149-154, 2010

Authors: Prasarnphanich, Thanong

Article Type: Research Article

Abstract: There is a lack of data assessing the accuracy of clinical diagnosis of influenza in children. This study aimed to identify the clinical predictors of influenza infections and to validate the use of clinical criteria of influenza-like illness definition for the diagnosis of influenza in children. Virological influenza surveillance was conducted by collecting throat swab specimens for viral culture and clinical data from febrile children with acute respiratory tract infection at Prapokklao Hospital from July 2005 …to September 2007. The criteria of influenza-like illness definition was modified for children and defined by the presence of fever > 38°C plus two of the following three symptoms: headache, cough and sore throat. Two hundred and four of 838 specimens (24%) yielded positive results for influenza virus isolates. Influenza A virus infections were more common than influenza B virus infections. In the multivariate analysis positive predictors of influenza infections were cough [odds ratio (OR)=2.07 95% confidence interval (CI)= 1.26–3.39] and age > 5 years old (OR=2.30, 95% CI=1.66–3.19), whereas diarrhea was inversely associated with influenza (OR=0.29, 95% CI=0.12–0.69). Both the World Health Organization criteria (OR=1.82, 95% CI=1.04–3.18) and the modified criteria for children (OR=1.86, 95% CI=1.38–2.56) showed a positive association with influenza infections. World Health Organization criteria showed high sensitivity and negative predictive value but low specificity and positive predictive value. The modified criteria for children showed fair sensitivity and specificity, high negative predictive value but low positive predictive value. According to the average proportion of positive isolates of 24%, influenza should be recognized as an important cause of acute respiratory tract infections in children especially in the endemic season, but the diagnosis of pediatric influenza cannot be established on clinical criteria alone. Show more

Keywords: Influenza, human, diagnosis, fever, cough, sensitivity, specificity, child

DOI: 10.3233/JPI-2010-0244

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 155-159, 2010

Authors: Demirkol, Demet | Biçer, Suat | Karaböcüoğlu, Metin

Article Type: Research Article

Abstract: Nosocomial infections threaten hospitalized patients and can lead to complications in 25–50% of those admitted to intensive care units. Nosocomial infections increase both morbidity and mortality. Infection control has a particularly important role in pediatric intensive care units; it must take into account the specificity of critically ill pediatric patients' needs and environment. Multidrug-resistant organisms cause severe and extensive disease. The prevention and control of multidrug-resistant organisms is a national priority, one …that will require that all care facilities and agencies assume responsibility. Evidence-based process improvement can lead to significant reductions in hospital-acquired infections in children. Most of the process and practices, when performed routinely and appropriately, can lead to reductions in hospital-acquired infections. This review addresses issues that characterize infection control in pediatric intensive care units. Show more

Keywords: Nosocomial infections, pediatric intensive care unit, critically ill, pediatrics

DOI: 10.3233/JPI-2010-0237

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 161-169, 2010

Authors: Kawashima, Hisashi | Yamanaka, Gaku | Ishii, Chiako | Kashiwagi, Yasuyo | Takekuma, Kouji | Watanabe, Yasuo

Article Type: Research Article

Abstract: The number of children with a new type of influenza-associated encephalopathy is increasing in Japan on a nationwide scale. It is associated with a high mortality rate of approximately 30% and there are no efficient treatments. Approximately half of the patients have sequelae despite anti-cytokine therapies. Severe cases showed high levels of free radicals in serum and cerebrospinal fluid, and previous studies suggest that free-radical scavengers may be effective to reduce sequelae. We presented two cases …where a new radical scavenger, edaravone, was administered in addition to anti-cytokine therapies and reviewed our findings in the context of previously published papers. Show more

Keywords: Nitrite, nitrate, encephalopathy, edaravone, free radical scavengers, influenza

DOI: 10.3233/JPI-2010-0228

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 171-176, 2010

Authors: Dawson, Tom C.

Article Type: Research Article

Abstract: In 2005, a 13-year-old child presented with a 1-day history of fever and encephalopathy and later, abdominal pain. We report a case of strongyloides, one of only 17 cases reported in the UK that year. The presentation was consistent with a heavy strongyloides infection, seen occasionally with a high nematode load, in this case Enterobius vermicularis. It is an illness of the tropics and rare in an indigenous setting. We suggest that the diagnosis should be …considered in children presenting with signs of sepsis. Show more

Keywords: Children, pediatric, strongyloidiasis, pinworm, enterobius, abdominal pain

DOI: 10.3233/JPI-2010-0238

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 177-180, 2010

Authors: Mondal, Rakesh | Nandi, Madhumita | Sabui, Tapas

Article Type: Research Article

Abstract: Acrodermatitis enteropathica is an autosomal recessive disorder due to defective absorption of zinc. It may be associated with defective cell mediated immunity, which makes these patients prone to various infections. We hereby report a case of acrodermatitis enteropathica in a child associated with disseminated tuberculosis, which has not been previously reported in the literature.

Keywords: Acrodermatitis enteropathica, zinc deficiency

DOI: 10.3233/JPI-2010-0229

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 181-183, 2010

Authors: Howell, Victoria | Mahabeer, Prasha | Coovadia, Yacoob | Singh, Radhika

Article Type: Research Article

Abstract: Streptococcus agalactiae is a well-established cause of neonatal meningitis, whereas Acinetobacter baumannii, often seen as a contaminant, has only rarely been reported to cause meningitis without a neurosurgical predisposition. We report of a case of neonatal meningitis in a preterm neonate in which both S. agalactiae and A. baumannii were considered the pathogens. This case highlights the pathogenicity of A. baumannii, and suggests that it may be frequently underestimated.

Keywords: A. baumannii, group B streptococcus, meningitis, antimicrobial resistance

DOI: 10.3233/JPI-2010-0230

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 185-187, 2010

Authors: Viswanathan, Rajlakshmi | Singh, Arun | Mukherjee, Ranajit | Sardar, Syamal | Dasgupta, Sudipta | Mukherjee, Suchandra

Article Type: Research Article

Abstract: Sepsis is an important cause of morbidity and mortality among neonates. Enteric Gram-negative bacteria and Staphylococcus aureus are common causes of neonatal sepsis in the developing world. We report a case of neonatal sepsis caused by Brevundimonas vesicularis. To the best of our knowledge, this is the first case report of invasive B. vescularis infection in a newborn in the English literature.

Keywords: B. vesicularis, neonatal sepsis

DOI: 10.3233/JPI-2010-0231

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 189-191, 2010

Authors: Naija, Ouns | Trabelsi, Monique | Massoud, Ines Ben | Lakhoua, Mohamed Rachid

Article Type: Research Article

Abstract: We report a case of post-yersinial reactive arthritis in a 4-year-old child. Three weeks after the onset of diarrhea, he developed tenderness of joints and bilateral conjunctivitis. Serological tests revealed antibodies to Yersinia pseudotuberculosis type IV. After a follow-up of 4~months, he has no complaints. Our recent case illustrates the typical features and highlights the need to look for the diagnosis.

Keywords: Reactive arthritis, yersinia infection

DOI: 10.3233/JPI-2010-0243

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 193-194, 2010

Authors: Latif, Lamia Abdel | Shee, Anutosh | Shakra, Leena Abu

Article Type: Research Article

Abstract: Enterococcus faecalis meningitis in children generally occurs when some predisposing factors are present, particularly central nervous system malformations and previous neurological surgery. In this article, we present a case of a relapse of E. faecalis meningitis in a 4-month-old previously healthy, well-grown infant who did not have any predisposing factors. He was discharged in good condition following a full 3 week course of an antibiotic that the organism was sensitive to, vancomycin. No cause was …identified for the relapse and it was assumed to be due to persistence of the infection in the meningeal and/or parameningeal foci. Subsequent clearance of the infection following three more weeks of therapy suggests there is a need to increase the initial treatment duration of the sensitive antibiotic Show more

Keywords: E. faecalis, bacterial meningitis, childhood, vancomycin-resistant Enterococci

DOI: 10.3233/JPI-2010-0233

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 195-198, 2010

Authors: Broides, Arnon | Lev-Tzion, Raffi | Leibovitz, Eugene

Article Type: Research Article

Abstract: We present a case of a child with generalized convulsions and dysentery caused by Campylobacter jejunii and review the pediatric literature published on this topic. Our case, as well as previous reports, suggests that in a child with convulsions and dysentery, the differential diagnosis should include shigellosis and also Campylobacter spp. infection. Because azithromycin provides appropriate coverage for both etiologies and in light of the present case, we suggest that it be considered …in addition to parenteral ceftriaxone in severe cases of dysentery with or without convulsions. Show more

Keywords: Campylobacter spp, dysentery, convulsions, children, shigellosis

DOI: 10.3233/JPI-2010-0234

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 199-201, 2010

Authors: Misra, Saheli | Pal, Priyankar | Das, Dipankar

Article Type: Research Article

Abstract: Though cavernous sinus thrombosis is not uncommon, concurrent involvement of the internal carotid artery leading to hemiparesis has only occasionally been described. In this article, we present a 15-month-old boy with unilateral cavernous sinus thrombosis and left sided hemiplegia following a folliculitis in the forehead. Prompt diagnosis and confirmation by magnetic resonance imaging assisted in early management.

Keywords: Cavernous sinus thrombosis, hemiplegia

DOI: 10.3233/JPI-2010-0235

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 203-206, 2010

Authors: Farahmand, Fatemeh | Sabbaghian, Mozhgan | Taj Khotaie, Ghamar | Eftekhari, Kambiz

Article Type: Research Article

Abstract: Neonates and young infants with human herpes virus 6 (HHV-6) may present with hepatitis, which is rarely fulminant. However, because HHV-6 is prevalent as a latent infection in humans, causality must be proven in patients with fulminant hepatitis. We describe a rare case of fulminant hepatitis induced by HHV-6 with concomitant central nervous system involvement and without any classic skin rash. An immunocompetent, breast-fed 14-month-old girl was admitted to our hospital because of gastrointestinal bleeding, fever, …excessive sleepiness and inability to recognize parents, markedly elevated serum transaminase and severe coagulopathy. Cerebrospinal fluid polymerase chain reaction assay for viral agent was positive for HHV-6. Fortunately, the patient demonstrated a rapid improvement thereafter and did not require liver transplantation. Show more

Keywords: Fulminant hepatitis, human herpes virus 6, central nervous system

DOI: 10.3233/JPI-2010-0240

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 207-209, 2010

Authors: Sheiko, Melissa | Soma, Viju | Moss, Nicholas | Frenkel, Lisa

Article Type: Research Article

Abstract: A 15-month-old male with fever, malaise, rash, cracked lips and influenza A in respiratory secretions was noted to have slight edema of his feet and a rising C-reactive protein. Echocardiography revealed dilated coronary arteries, which confirmed concomitant Kawasaki disease. During influenza season, heightened suspicion for Kawasaki disease is warranted, as symptoms shared between these illnesses can cause delayed diagnosis and treatment.

Keywords: Kawasaki disease, influenza A, diagnosis

DOI: 10.3233/JPI-2010-0241

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 2, pp. 211-213, 2010