Journal of Pediatric Infectious Diseases - Volume 6, 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: To evaluate predictive value of blood culture as an effective alternative laboratory tool for isolation of causative organism in acute pyogenic meningitis. It is a hospital based prospective longitudinal hospital based study performed from May 2007 to May 2009. A total number of 310 children of age group 2 months-14 years who presented to the hospital with probability of bacterial meningitis were screened in the study. Eighty cases excluded by preset exclusion criteria and rest 230…formed the analytic sample. Pretreatment blood culture with concomitant lumbar puncture or lumbar puncture within 2 h of antibiotic administration for cerebrospinal fluid analysis was obtained. The main outcome parameter was the predictive value of blood culture for isolation of causative organism in acute bacterial meningitis. Blood culture revealed a sensitivity of 73.28% (95% confidence interval [CI]: 64.85%–80.63%), specificity of 87.88% (95% CI: 79.78%–93.58%), positive predictive value of 88.9% (95% CI: 81.40%–94.13%), negative predictive value of 71.31% (62.42%–79.14%), positive likelihood ratio of 5.97 and negative likelihood ratio of 0.30. Probability of isolation of causative organism by blood culture in bacterial meningitis was found to be highest among infants (82%) and least in children aged above 5~years (54.17%). When compared to gold standard cerebrospinal fluid diagnostic criteria, blood culture has a high sensitivity, specificity, positive predictive value and likelihood ratio to be an effective alternative laboratory tool for isolation of causative organism in acute bacterial meningitis especially in infants and younger children.
Abstract: Percentage CD4+ T-lymphocyte is used for immunologic monitoring human immune deficiency virus (HIV) infections in children. Given the relative ease of obtaining absolute CD4+ T-lymphocyte, we sought to investigate whether the predictors of the trends in absolute and percentage CD4+ T-lymphocytes in HIV-infected children in resource-limited setting were similar. A retrospective analysis of CD4+ T-lymphocytes data from June, 2004 to December, 2007 of the Pediatric HIV cohort at Korle-Bu Teaching Hospital, Accra, Ghana. Mixed models…were used to examine predictors of the trends in absolute and percentage CD4+ T-lymphocytes. Absolute and percentage CD4+ T-lymphocytes increased over time (p < 0.001). Baseline absolute and percentage values correlated with subsequent values (p < 0.001). Gender, age, treatment, World Health Organization clinical staging, and the source of patient referral to the clinic did not predict the changes in CD4+ T-lymphocytes. The predictors of the trends in absolute and percentage CD4+ T-lymphocytes were similar. Studies are needed to examine whether absolute CD4+ T-lymphocyte counts could be used to monitor pediatric HIV in resource-limited settings.
Keywords: HIV disease progression, CD4+ T-lymphocytes, HIV viral load, pediatrics, resource-limited settings
Abstract: Today, hospital infections with vancomycin resistant enterococci (VRE) in neonatal units have been seen with increasing frequency in recent yr. However, VRE colonized persons have greater risks for public health after discharge. We evaluated the risk factors in the prenatal and natal period of patients with VRE colonization and/or infection, as well as measures taken during VRE outbreak and after discharge occurring between the mo of February to April of 2009 in the Erciyes University, Neonatology…Unit. VRE colonization and/or infection was detected in 26 (5.9%) of the 438 patients during time of outbreak. Enterococcus faecium was isolated in rectal swab cultures of all patients, and the type of glycopeptide resistance was VanA in all patients except one. Three of cases were term (11%), the remaining 23(89%) were preterm. E. faecium isolated from the blood culture in two patients. The history of mothers including prenatal risk factors and infant related risk factors were evaluated. The number of cases with VRE-positive was 15 (57%) on discharge and three of these patients were still colonized with VRE at re-hospitalization. The outbreak of VRE, experienced in our unit usually occurs in the manner of colonization. Prevention of colonization require reduction of the use of antibiotics in the perinatology and neonatology units, infection control measurements to be maximized.
Keywords: Vancomycin resistant enterococci, neonatology unit, colonization
Abstract: We observed two consecutive episodes of an outbreak of rotavirus (RV) on our neonatal medium care unit in May-June 2009. We investigated the genotype of the RV; describe the spread of the virus among neonates and the measures taken to control the outbreak. Stool samples of symptomatic neonates, and during the second episode stool samples of all neonates, were tested for RV antigens. Reverse transcriptase polymerase chain reaction was performed on ten samples positive for RV,…followed by genotyping. Staff members and samples of the environment were also tested for RV. An infection control advisor attended shifts on the ward to observe the daily routines. Eighteen of 44 neonates were tested positive for RV antigen and RNA. Ten samples were genotyped and revealed the G9P strain. One male premature neonate developed a serious neurologic complication. None of the staff members were positive for RV. It is concluded that the RV strain G9P can present as a hard to eradicate nosocomial pathogen. Since atypical RV strains can cause severe illness among neonates, surveillance and genotyping during an outbreak is recommended.
Abstract: The aim of this study was to investigate the safety of oseltamivir in Japanese patients less than 1 year of age infected with influenza A or B. The study was retrospective and surveillance forms were used to collect safety data for all influenza-infected infants administered oseltamivir during the 2003/2004 influenza season in the 157 participating facilities. Seven hundred seventy one children (mean age 272 ± 74.86 days, range 15 to 366 days) were treated with oseltamivir…at a mean dose of 3.84 ± 0.51 mg/kg/day (range 1.85 to 6.25 mg). The incidence of adverse events (AEs) and adverse drug reactions (ADRs) was 5.3% (41 of 771 patients) and 3.2% (25 of 771 patients), respectively. Among the 51 AEs reported in 41 patients, gastrointestinal disorders were the most frequent (2.5% [19 of 771 patients]), with diarrhoea (n=15) and vomiting (n=6). Gastrointestinal disorders were also the most frequently reported ADRs, with diarrhoea (n=13) and vomiting (n=5). Four patients with afebrile or febrile convulsions (n=3) and respiratory failure (n=1) with fatal outcome were probably caused by serious AEs. Influenza infection accompanying with high fever is well known to cause these events in infants. This paper has concluded effective treatment of oseltamivir administration in influenza-infected infants less than 1 year of age; and it does not raise any safety concerns. Therefore, a further prospective survey to elucidate the ADRs should be carried out.
Keywords: Infant, under 1 year of age, oseltamivir, influenza virus, drug safety
Abstract: To describe the clinical presentation, course and management of infants that presented with the diagnosis of lymphadenitis after Bacille Calmette-Guerin (BCG) vaccination. This is a descriptive study of 89 patients that were referred to the pediatric infectious disease clinic at King Hussein Medical Center in Jordan with regional lymphadenitis after BCG vaccination. The presentation, course and treatment options of these cases were discussed. The study was conducted between September 2006 and September 2007. Eighty-nine…patients (47 males (53%) and 42 females (47%) were studied. All infants received the same type of vaccine used by our Ministry of Health, which is the Danish strain. Unilateral axillary lymph node enlargement was the most commonly seen (47%). Cervical lymph nodes were noted in 22 patients (25%) and supraclavicular lymphadenopathy was seen in 16 (18%). Sinus formation was seen in 16 (18%) patients. 27 cases (30%) had fluctuating lymph nodes. Four infants had disseminated infection. The majority (65%) of patients had their symptoms starting within the first 2 months after BCG vaccination. Forty-two (47%) infants had conservative observational management. Anti-tuberculosis medications were commenced in 27 (30%). Surgical excision was performed in 10 (11.5%) cases. All infants but one had complete recovery by the end of the study period. BCG lymphadenitis is a potential complication that necessitates an early recognition and implementing appropriate treatment protocols. Complete healing of suppurative lymphadenitis after BCG vaccine can be achieved using different treatment protocols.
Abstract: Non-typable Haemophilus influenzae (NTHi) is emerging as an important cause of invasive disease in immunized children. We describe a healthy, fully immunized 4-year old child who presented with bacteremia due to NTHi without overt acute otitis media (AOM), and subsequently developed severe mastoiditis complicated by sigmoid sinus thrombosis. Although, mastoiditis is typically regarded as a complication of AOM, those cases without antecedent AOM may represent an entirely different pathophysiological process with NTHi…bacteremia seeding the mastoid. We present another example of the potential invasiveness of NTHi with a temporal sequence of events whereby NTHi bacteremia seeds the mastoid. This may represent novel sequelae of NTHi infection.
Abstract: We report a case of polycystic ovary syndrome in a 15-year-old human immunodeficiency virus-infected female on highly active antiretroviral therapy who developed hypertriglyceridemia, hyperinsulinemia due to insulin resistance, and hyperandrogenism. Ultrasonography showed multiple small follicles at the right ovary and lobulated follicles at the left ovary. Treatment of polycystic ovary syndrome included insulin sensitizing agents (metformin, pioglitazone) and a contraceptive for hyperandrogenism. We also encouraged life style modification including regular exercise…and dietary fat restriction. She attained menarche 1 month after initiation of treatment.
Abstract: Here we report two infants with bacterial meningitis associated with restricted water diffusion in the corpus callosum. Both patients were admitted because of pyrexia and not doing well. One patient had a seizure. Group B streptococcus was isolated form blood and cerebrospinal fluid of both patients. Diffusion-weighted images showed transiently restricted water diffusion in the corpus callosum in both patients without additional neuroimaging abnormalities. The outcome of the patients is presumed to be favorable. The magnetic…resonance imaging findings of our patients will widen the spectrum of restricted water diffusion in the corpus callosum.
Keywords: Restricted diffusion in the corpus callosum, bacterial meningitis, group B streptococcus
Abstract: A 3-year-old male child presented with severe complicated Plasmodium vivax malaria with acute hepatic failure. Patient also had positive IgM antibody for Hepatitis A. Patient died of severe coagulopathy and bleeding. This case report documents a confirmed co- infection, which has not been hitherto reported in English literature to the best of our knowledge.
Keywords: Plasmodium vivax, malaria, hepatitis A, co-infection, acute hepatic failure
Abstract: We present a case report of a young child with fever for 2 weeks followed by ataxia, spastic quadriparesis, aphasia with bulbar palsy, and lastly loss of consciousness. All symptoms developed within a span of 5 days. Provisional diagnosis of infantile stroke due to infective vasculitis was made. Cranial computed tomography revealed multiple infarctions with bilateral dilated ventricles and mild cortical atrophy. Based on cerebrospinal fluid analysis, contact history and Mantoux test, anti-tubercular therapy was…started. Therapeutic failure led to a suspicion of immunosuppression. So, opportunistic infections of central nervous system along with neurotuberculosis were ruled out by relevant standard tests. Subsequently human immunodeficiency virus encephalopathy was diagnosed and highly active antiretroviral therapy was initiated immediately. Neurological abnormalities reversed and complete radiological clearance was noted with highly active antiretroviral therapy within 1 year. The unusual presentation, rare neuroimaging findings, and dramatic response make this case notable.
Keywords: HIV encephalopathy, infantile stroke, cerebral infarctions, highly active anti-retroviral therapy
Abstract: In children, cervical adenopathy and fever is a common diagnostic dilemma. We present an unusual case of fever with anterior cervical adenopathy mimicking lymphoma that was diagnosed by as Rosai-Dorfman disease (RD) by lymph node biopsy. RD disease typically presents in childhood with cervical adenopathy. Less commonly, RD may involve extra-nodal sites as well, including the skin (the most common extranodal site), central nervous system (CNS), eye, liver, spleen, pancreas, or kidney. Lymph node biopsy is…diagnostic and to differentiates RD disease from other causes of lymphadenopathy such as lymphoma.
Keywords: FUO, mimics of lymphoma, sinus histiocytosis, lympadenopathy
Abstract: A clinical case of an axillary lymphadenitis, due to Mycobacterium malmoense in an immunocompetent child is reported. The main purpose of this report is to highlight the uncommon localization of this infection, rarely described in children. This report also draws attention to the increase of incidence of this infection in immunocompetent patients and the difficulties in its diagnosis.
Abstract: We report the first case of a previously healthy term 5 week old infant with no known risk factors who developed a frontal lobe abscess from community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). To date, only 16 cases of invasive CA-MRSA with central nervous system involvement have been previously described, but the incidence of CA-MRSA has surged within the last decade, creating a growing impact on public health. Increasing numbers of invasive infections caused by CA-MRSA in previously…healthy individuals is of particular concern, and the highest rates of these infections are in children. As CA-MRSA continues to spread and develop further antibiotic resistance, cases of invasive diseases as described in this report may become more common.
Abstract: Hemorrhagic cystitis as a complication of influenza A has been described. There is only one case report describing hemorrhagic cystitis in a child with novel pandemic 2009 H1N1 influenza A infection. We report two children with confirmed novel pandemic 2009 H1N1 infection who had hemorrhagic cystitis.
Abstract: The occurrence of acute acalculous cholecystitis during hepatitis A virus (HAV) infection is very rare. Here we describe a child with history of fever, vomiting and jaundice. His serologic test showed specific IgM anti-HAV. During follow up, his abdominal ultrasonography showed thickness of the gallbladder demonstrated acalculous cholecystitis. Surgical laprotomy for acalculous cholecystitis was avoided after resolving HAV infection.
Abstract: Clostridium tertium is an uncommon human pathogen. The organism has been implicated in bacteremia, enterocolitis, posttraumatic brain abscesses, pneumonia and necrotizing fasciitis especially in neutropenic and immunocompromised patients. Unlike other clostridial species, it has not previously been reported to cause disease in neonates. This case report describes a neonate who has meningitis caused by C. tertium with no underlying risk factors.