Journal of Pediatric Infectious Diseases - Volume 5, issue 3
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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: Neonatal hepatic abscess is a rare, but serious complication of umbilical line catheterization, conferring a high level of mortality. Given the infrequency of this condition, no evidenced-based data exists on treatment. To assess factors correlated with increased survival of published cases of neonatal hepatic abscess and discern implications for treatment. A systematic search of PubMed, MEDLINE, LEXIS-NEXIS Academic Universe, Biological Abstracts, BioMed Central and the Institute for Scientific Improvement's Web of Knowledge…and Web of Science bibliographies was performed to identify reports, case reviews and studies of neonatal hepatic abscess. Post-surgical incidences of hepatic abscess were excluded. A dataset of cases, which met inclusion criteria, was constructed including year of publication, cultured organisms in abscess, treatment (antibiotics or antibiotics plus surgical drainage), gestational age and outcome. Fisher's exact test in bivariate analysis and multivariate logistic regression were performed to identify factors associated with survival. From 1967 to 2007, 41 cases of non-surgical neonatal hepatic abscess were identified with an overall mortality of 58.5%. A sharp decline in mortality (82.6% to 27.8%) after 1990 was noted. Use of vancomycin, single infectious organism and use of surgical drainage in conjunction with antibiotics were associated with survival in bivariate analysis. Using logistic regression, Gram-negative infection was associated with increased mortality and the use of vancomycin showed a trend toward improved survival. Neonatal hepatic abscess is a rare, highly lethal condition. Increased morbidity is seen in patients with Gram-negative infection. Based on the statistical review of published cases, use of vancomycin (regardless of organism) and use of surgical drainage in the treatment regimen may improve survival.
Keywords: Hepatic abscess, neonatal intensive care
Abstract: Effective prevention and treatment of pertussis may be more likely to occur if physicians are knowledgeable about this highly communicable infectious disease. Multiple studies have documented under-diagnosis of pertussis in adolescents and adults, but very little data is available regarding physician knowledge of pertussis. The Advisory Committee on Immunization Practices has recommended booster vaccination for all adolescents and adults through 64 years of age against pertussis since 2006. Despite the recommendations, vaccination…coverage with the Tdap (tetanus toxoid, reduced dose diphtheria, acellular pertussis) vaccine among adolescents 13–17 years was 40.8% compared with 72.2% for Td vaccine in 2008. This survey of physicians from McHenry and Kane counties in Illinois administered from July 2002 to February 2003 and from July 2003 to February 2004 respectively, demonstrated significant gaps in pertussis knowledge and that physicians reported a minority of suspected pertussis cases to the health department. Review of board preparation materials available during this same period of time-demonstrated gaps in pertussis coverage. Baseline and follow-up data quantifying physician knowledge may help target education and determine associations with pertussis vaccination and reporting.
Keywords: Pertussis, physician knowledge, attitudes, and practices, vaccine-preventable diseases
Abstract: Infectious gastroenteritis is one of the most common illnesses among children and is caused by many etiological agents; however, viruses are responsible for 50 to 75% of all cases. A laboratory-based study was carried out from 2005–2006 aiming to describe epidemiological aspects of rotavirus (RV), astrovirus, and adenovirus associated with gastroenteritis in Mexican children. Children younger than 5 years with acute diarrhea from four clinics and eight daycare centers were studied. The presence of RV was…determined using polyacrylamide gel electrophoresis (PAGE) with silver staining. Negative samples were further tested for RV, adenovirus, and astrovirus using immunoassays. A total of 727 children were studied. The RV prevalence by PAGE was 56.8% (413/727). Out of 314 samples that were PAGE negative, 18.1% (57/314) were positive for any virus; the prevalence for the specific viruses was 9.5% (30/314); for RV, 4.4% (14/314); for astrovirus; 3.8% (12/314); for adenovirus, and 0.3% (1/314) with RV and astrovirus mixed infection. Viruses are responsible of more than 60% of acute diarrhea diseases among Mexican children.
Abstract: Chronic hepatitis C has been described as a mild disease in children, but fibrosis progression and end stage liver disease have been documented. Thus, the problem of therapy has become a challenging issue. Our preliminary results using the standard treatment regimen of alternate day interferon (IFN) plus ribavirin yielded 21.4% sustained virological response (SVR). In this study, we evaluate the efficacy and safety of daily IFN alpha-2a induction regimen plus ribavirin in treatment of children with…chronic hepatitis C genotype 4. The study included 40 children with chronic hepatitis C. Thirty patients were naive hepatitis C and 10 were previously non-responders to the standard treatment regimen. All children were assigned to receive daily IFN plus ribavirin for 1 month, then alternate day IFN plus ribavirin for 11 months. The mean age of children was 11.7 ± 0.35 years and 27 (67.5%) were males. Twenty-nine (72.5%) had low, three (7.5%) moderate and eight (20%) high viremia. Thirty-four (85%) had rapid virological response and 33 (82.5%) had SVR. One patient had a breakthrough at 6~months duration of therapy. Adverse effects were mild, and were not treatment limiting. Low viral load was significantly associated with higher rate of SVR. Rapid virological response had 90% positive predictive value for subsequent SVR with 100% sensitivity. Daily IFN induction regimen showed a high efficacy and safety for treatment of children with chronic hepatitis C virus genotype 4.
Abstract: Although two classes of antiviral drugs, M2 ion channel blockers and neuraminidase (NA) inhibitors, are available to combat seasonal H1N1 and H3N2, and highly pathogenic avian (e.g., H5N1) influenza, the emergence and spread of drug-resistant viruses is of great concern. Animal studies suggest that combination chemotherapy with M2 and NA inhibitors may be an effective option to reduce the emergence of drug-resistant viruses. In this study, we evaluated the antiviral susceptibility of clinical isolates from immunocompetent…children infected with a seasonal influenza A virus and treated with a combination of amantadine and oseltamivir. We found that amantadine-resistant viruses emerged during this combination treatment. While viruses with mutations known to confer oseltamivir resistance were not detected, we found viruses with mutations in NA that reduced sialidase activity and viruses with hemagglutinin mutations. These findings suggest that while the amantadine-oseltamivir combination is an effective therapeutic option for influenza, drug-resistant viruses do appear with this combination therapy.
Keywords: Influenza A virus, combination therapy, drug-resistant mutants
Abstract: Acute respiratory infections (ARI) are the leading cause of pediatric morbidity and mortality worldwide. Information on etiological agents of ARI in developing countries is still limited. This study conducted in Alexandria, Egypt, was designed to determine the prevalence of several microorganisms in 113 children hospitalized with ARI. Overall, 65 agents were identified; 58 (51.3%) individuals were found to be positive for at least one pathogen, and seven of them were also positive for two agents. Chlamydophila…pneumoniae was the most commonly detected agent (n=32; 28.3%), followed by Mycoplasma pneumoniae, respiratory syncytial and influenza. Positivity for C. pneumoniae, which was the most commonly detected agent, was associated with male sex and with mild disease of the upper respiratory tract.
Abstract: Bronchiolitis is one of the most common lower respiratory diseases in infants. A correlation between the severity of bronchiolitis and a co-infection with respiratory syncytial virus (RSV) as well as other viruses has not yet been elucidated. The purpose of this study was to clarify the impact of RSV co-infection with other viruses on the severity of bronchiolitis and airway inflammation. One hundred and twelve hospitalized children with clinical symptoms of bronchiolitis were prospectively enrolled in…this study. Nasopharyngeal aspirates were analyzed to identify RSV, human bocavirus, human metapneumovirus and nine other respiratory viral pathogens. Inflammatory cell counting and concentrations of cytokines/chemokines were also evaluated. The severity of the disease was further determined on the basis of symptom score and duration of hospitalization. Viral pathogens were detected in 84 samples (75%). RSV was detected in 62 samples (55.36%), 31 of which also possessed other viruses. No difference was found between children with bronchiolitis that had RSV as the sole infecting viral agent and those that were infected with RSV and other viruses with respect to the prevalence of symptoms prior to admission to the hospital, the duration of hospitalization and the diagnosis of severe bronchiolitis. The median cellularity, concentrations of cytokines and cell counts of nasopharyngeal aspirates were similar between the two groups of children. The severity of bronchiolitis is not dependent on the co-infection of RSV with other respiratory viruses.
Abstract: Streptococcus pneumoniae is a prevalent cause of invasive diseases in children, justifying continuous surveillance programs such as by the SIREVA group (Pan American Health Organization). The aim of this study was to determine the serotype distribution of S. pneumoniae causing invasive disease in children < 6 years old, the serotype coverage of the pneumococcal conjugate vaccine 7-valent (PCV7), 10-valent (PCV10) and 13-valent (PCV13), and antibiotic resistance, from 1994 to 2007. During this period, 2205…invasive S. pneumoniae were included in the study. Although 49 different capsular types were identified, 12 serotypes accounted for 86% of all isolates. These were prevalent throughout the study period with serotype 14 predominating. Penicillin non-susceptible S. pneumoniae was detected in 33.2% of all isolates. The coverage of PCV7, PCV10 and PCV13 from 2004 to 2007 for children < 2 years old was 51.7%, 72.4% and 84.5%, respectively. The data demonstrates a decline in serotype 14, and an increase in serotypes 1 and 19A in the study period. Resistance to penicillin and trimethoprim-sulfamethoxazole decreased, while resistance to erythromycin increased. These results demonstrate the need for the introduction of a conjugate pneumococcal vaccine and continuing surveillance to monitor changes in serotypes distribution and antimicrobial resistance.
Keywords: Invasive pneumococcal diseases, S. pneumoniae, epidemiology, infectious diseases
Abstract: Serratia marcescens previously was thought to be a low pathogenic bacterium but has recently being recognized as a nosocomial pathogen. In May 2007, patients with nosocomial septicemia caused by S. marcescens were identified in a neonatal intensive care unit (NICU) at a tertiary-teaching hospital. The objective of this report is to highlight the rare source of the S. marcescens outbreak. Here, we describe the investigations and outcomes of this outbreak. Case subject was defined as any…neonate receiving medical care at the NICU, from one week before the index patient became symptomatic and onwards, with clinical signs and symptoms of sepsis, with or without a positive blood culture, which yielded S. marcescens. Chart reviews were conducted for case subjects. Various samples from the NICU were sent for sterility testing including medications, solutions, used and freshly prepared total parenteral nutrition (TPN) from the NICU and the pharmacy unit. The specimens were processed and positive isolates were identified as S. marcescens using standard microbiological methods. it S. marcescens isolates were subjected to pulsed field gel electrophoresis for molecular typing and source identification. S. marcescens were isolated from five neonates, used TPN and freshly prepared TPN of different batches in pharmacy. None of the environmental samples and medications grew S. marcescens. Analysis of macrorestriction patterns of genomic DNA by pulsed field gel electrophoresis demonstrated indistinguishable patterns. This outbreak was related to bacterial contamination of TPN. This report points at a rare source of S. marcescens outbreak. However, targeted investigations and immediate active interventions enabled the managing team to control the outbreak in the NICU.
Keywords: S. marcescens, outbreak, septicemia, total parenteral nutrition, neonatal intensive care unit
Abstract: Exchange transfusion (ET) is the most effective method for treatment of severe hyperbilirubinemia and is often required in Rhesus hemolytic disease of the newborn. The use of ET is also associated with adverse reactions, including severe catheter related infectious complications. We report a term neonate with Rhesus hemolytic disease of the newborn treated with an ET through an umbilical venous catheter who developed brain abscesses due to a Bacillus cereus sepsis. This severe complication…has not previously been reported. We discuss possible causes for this severe infection and provide suggestions on prevention.