Journal of Pediatric Infectious Diseases - Volume 9, issue 2

Authors: Dey, Shuvra Kanti | Nahar, Shamsun | Akter, Tanzina | Sultana, Hoomyra | Akter, Anjuman | Sarkar, Omar Sadi | Ahmed, M. Firoz | Talukder, Ali Azam | Ahmed, Farjana

Article Type: Research Article

Abstract: Acute gastroenteritis is still a health burden in developed and developing countries. Acute gastroenteritis consistently ranks as one of the top causes of all deaths. The mortality among children due to acute gastroenteritis is greater in developing than in developed countries. Globally, while deaths from childhood diarrhea have decreased during the past two decades, the proportion of hospitalizations due to diarrheal diseases may have increased. In developing countries, gastroenteritis is a common cause of death …in children < 5 years of age. In developed countries, while deaths from diarrhea are less common, these illnesses lead to hospitalization or doctor visits. The viruses which cause gastroenteritis are primarily from four distinct families – group A rotaviruses, caliciviruses, enteric adenoviruses and astroviruses. Other viruses, such as picobirnaviruses and picornavirus (the Aichi virus) may also play a role. Viral gastroenteritis is still a burden of disease in most Asian countries. In many Asian countries, the most prevalent causative agent of viral gastroenteritis is rotavirus followed by norovirus, sapovirus, adenovirus, human astrovirus and aichi virus. The G1P[8] rotavirus and GII/4 norovirus are the most common genotypes responsible for acute gastroenteritis among Asian pediatric populations. The other interesting feature of this review article is the high prevalence of diarrheal viruses in developing countries (Pakistan, Bangladesh, India, Nepal, Vietnam, China) than in developed countries (Japan, South Korea). The molecular characterization of many of these gastroenteritis viruses has led to advances both in understanding of the pathogens themselves and in development of a new generation of diagnostics. Therefore, it is necessary to examine the molecular epidemiology of these viruses for controlling diarrheal diseases. The information in this review article should be useful for knowledge of diarrheal viruses, virus control, and viral vaccine design and provide clues to a strategy for developing vaccines against diarrheal viruses. Show more

Keywords: Molecular epidemiology, viral gastroenteritis, Asia

DOI: 10.3233/JPI-140419

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 53-65, 2014

Authors: Bono, Kenneth T. | Klingele, Kevin E.

Article Type: Research Article

Abstract: Some studies have suggested seasonal variations in pediatric orthopaedic infection. We sought to determine if there is seasonal variation in septic arthritis and/or osteomyeltis. We performed a query of a single pediatric hospital's database, identifying all patients diagnosed with septic arthritis and/or osteomyelitis, age 0 through 18, from 1994 through 2010. The institution is located in a temperate climate with definite seasonal variations. Our query yielded 735 pyogenic arthritis and 104 unspecified …infective arthritis diagnoses for a total of 839 combined septic arthritis cases. The query yielded 318 acute osteomyelitis, 227 chronic osteomyelitis, and 1114 unspecified osteomyelitis diagnoses for a total of 1659 combined osteomyelitis cases. We identified statistically significant differences in regard to region of body involvement, gender, age, and incidence over time. There was no statistically significant difference with regard to month or season at the time of presentation. There does not appear to be a seasonal variation in the incidence of septic arthritis or osteomyelitis in the pediatric population. This would not support the perception of an "infection season" in pediatric orthopedics. In addition, there is a stable incidence of septic arthritis and an increasing incidence of osteomyelitis noted at our institution over the last 17 years. Show more

Keywords: Osteomyelitis, infection season, septic arthritis, pyogenic arthritis

DOI: 10.3233/JPI-140415

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 67-70, 2014

Authors: Suryavanshi, Nishi | Raval, Gauri | Kanade, Savita | Nimkar, Smita | Nadgiri, Vaishali | Sahu, Prassana | Kadam, Deelip | Khadse, Savita | Mave, Vidya | Gupte, Nikhil | Gupta, Amita | Shankar, Anita

Article Type: Research Article

Abstract: Effective guidelines around disclosure of HIV status are lacking and limited data from India reveal low rates of HIV disclosure to perinatally infected children. This study, conducted in Pune, India, attempts to understand the experiences of caregivers of perinatally infected children around the HIV disclosure process. We interviewed 98 caregivers whose children were receiving care at the ART clinic of a large government hospital. Caregivers report that 23% of HIV+ children had been told of their …HIV status. Older caregivers had higher odds of disclosure as well as those who were widowed, had limited formal education, and who worked as maids/servants. Older children (14 years+) had higher odds of being disclosed to. Major themes from qualitative data included uncertainty among caregivers about disclosure, concerns about the child's well-being after disclosure, and an overall lack of guidance around disclosure. Significant concerns related to perceived and experienced stigma and discrimination as well as the child's marital future contributed to caregivers' willingness to disclose. There is need for the development and testing of behavioural interventions in India to guide health care workers and caregivers in appropriate disclosure to HIV-infected children, with the ultimate goal of informing national guidelines for pediatric HIV disclosure in resource poor settings. Show more

Keywords: Disclosure, HIV, perinatal, infection

DOI: 10.3233/JPI-140418

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 71-84, 2014

Authors: Gray, James W. | Reay, Selina R.

Article Type: Research Article

Abstract: Children are at high risk of bloodstream infection with meticillin-sensitive Staphylococcus aureus (MSSA BSI). We had previously found that the great majority of MSSA BSI (91.0%) in our hospital occurred in children with co-morbidities, suggesting that there may be opportunities to prevent at least some cases. An ongoing quality improvement programme was established, leading to a succession of interventions being introduced from August 2011 onwards. These interventions were based on data obtained from the …existing Microbiology Department blood culture database and, from October 2010, root cause analyses of each new episode of MSSA BSI. Workstreams targeted the three commonest causes of positive blood cultures: infected central venous catheters (CVCs); surgical site infections and contamination of blood cultures. Key interventions were streamlining of the response to local infections in patients with CVCs; increased dosage of flucloxacillin as prophylaxis for cardiac surgery; and campaigns to improve blood culture use. There was a marked reduction in the number of cases of MSSA BSI between the two years before and after the programme was instigated. Overall, there were 79 MSSA BSI in the first two years, compared with 45 in the latter two years. A reduction was seen in all categories of MSSA BSI; pre-48 h decreased by 46.7%; post-48 h decreased by 25%; contaminants decreased by 70.6%. By contrast, hospital activity and the number of blood cultures received in the laboratory increased by 8.7% and 12.2% over this period. However, CVCs remain the commonest cause of MSSA BSI in our hospital, suggesting that there are further opportunities to prevent MSSA BSI. Areas for future research are identified. Show more

Keywords: Staphylococcus aureus, bloodstream infection, central venous catheter, prevention

DOI: 10.3233/JPI-140417

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 85-91, 2014

Authors: Bhat, Nowneet Kumar | Dhar, Minakshi | Mittal, Garima | Chandra, Harish | Rawat, Anil | Chandar, Vipan

Article Type: Research Article

Abstract: Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent. In India, scrub typhus is being now reported from several areas where it was previously unknown. We report clinical profile and complications of an outbreak of scrub typhus in children from the north Indian state of Uttarakhand, a region not previously known to have endemic disease. We describe the results of a prospective observational study of children with scrub typhus, at a tertiary hospital …during the year 2013. The diagnosis was confirmed serologically by an IgM ELISA test. Sixty-two children were diagnosed with scrub typhus. All presented with fever. Other common symptoms were vomiting (59%), facial swelling (53%), cough (24%), abdominal pain (35%), breathlessness (26%) and decreased urine output (21%). High grade fever (> 101°F) was recorded in 95% of the children. Other common signs observed in cases of scrub typhus were hepatomegaly (77%), splenomegaly (63%), edema (37%), tender lymphadenopathy (42%) and hypotension (35%). An eschar was observed in 23% of patients. Meningoencephalitis (30.6%), severe thrombocytopenia (27.4%), shock (17.7%), hepatitis (16.1%) and acute kidney injury (11.3%) were the most commonly encountered complications. Eighty-seven percent of children became afebrile within 48 hours of initiating an appropriate antibiotic. Median time to defervescence was 24 hours. The overall mortality rate was 6.4%. Pediatricians should keep a high index of suspicion for scrub typhus in any febrile child having a maculopapular rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and features suggestive of capillary leak. Pending serological confirmation, early empirical therapy with doxycycline or azithromycin should be started, as delay in treatment would result in life threatening complications. Show more

Keywords: Scrub typhus, chigger, cschar, rash, meningoencephalitis, children

DOI: 10.3233/JPI-140420

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 93-99, 2014

Authors: McNew, Brandon R. | El-Sheikh, Ayman | Kirby, Patricia A. | Bishop, Warren P. | Abusin, Ghada A.

Article Type: Research Article

Abstract: Although current therapies for acute lymphoblastic leukemia (ALL) in children provide high cure rates, invasive fungal infections remain a significant source of mortality. We report a fatal case of cryptococcosis presenting as hepatic dysfunction in a patient with ALL and Down syndrome. Autopsy results confirmed Cryptococcus septicemia with involvement of lungs, liver, and lymph nodes. The severity of the fungal sepsis and underlying immunosuppression probably contributed to the unusual presentation and fatal …outcome. This report highlights the need to consider cryptococcal infection as a cause of sepsis syndrome in immunocompromised patients when bacterial cultures are negative. Show more

Keywords: Cryptococcus neoformans, pediatric, acute lymphoblastic leukemia, hepatobiliary dysfunction, Down syndrome

DOI: 10.3233/JPI-140416

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 101-107, 2014

Authors: Chin, Dayna | Wada, Kimberly | Holmes, W. Nathan | Singh, Jasjit

Article Type: Research Article

Abstract: A correct diagnosis can be elusive when a rare disease is present. Such was the case when two teenagers were admitted to a children's hospital. Due to their clinical presentation, imaging, and laboratory results, final diagnoses and treatment were delayed. The first patient, a 15-year old Chinese female with systemic lupus erythematosus, presented with cough and fever. She was found to have a right upper lobe consolidation with central cavitation. Subsequent chest imaging revealed a miliary …pattern, and RIPE therapy was started to cover Mycobacterium tuberculosis. The second patient was a previously healthy, 14-year old African American female, who presented with progressive spinal deformity and an enlarging right parietal scalp lesion. An AFB sputum sample was positive, and spinal imaging showed a gibbus deformity, prompting the initiation of RIPE therapy for tuberculosis. Both patients were later found to have disseminated Coccidioidomycosis, a rare diagnosis that is often mistaken for other etiologies. Both patients responded well to fluconazole therapy. Show more

Keywords: Coccidioidomycosis, tuberculosis, disseminated, immunocompromised, cavitary lesion, Coccidioides immitis, miliary

DOI: 10.3233/JPI-140421

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 109-114, 2014

Authors: Duggal, Shalini | Chugh, Tulsi Das

Article Type: Research Article

Abstract: Pasteurella multocida has rarely been reported as a cause of brain abscess. A 14 year old child was brought to the pediatric emergency department with fever, headache and weakness in left side of the body. Investigations revealed subdural and maxillary sinus abscesses from which Pasteurella multocida and Streptococcus sanguis were concurrently isolated. The case was successfully managed by parenteral ceftriaxone. History revealed frequent exposures with a pet dog. The present case underscores the importance of …educating the pet owners, especially children about cross-over of bacteria resulting in serious infections. Show more

Keywords: Pasteurella, Streptococcus, brain abscess, sinusitis, bacteremia

DOI: 10.3233/JPI-140423

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 115-118, 2014

Authors: Panja, Satarupa Mukherjee | Panja, Buddhadev

Article Type: Research Article

Abstract: Plasmablastic lymphoma (PBL) is a rare type of non-Hodgkin lymphoma frequently related to HIV infection. We report a case of PBL in a 7 year old female child with transfusion-acquired HIV infection on antiretroviral therapy (ART). The presentation was a swelling in the skull and cervical lymphadenopathy. CT scan revealed bony erosions with meningeal enhancement. The patient was started on chemotherapy and cranial irradiation but succumbed to death in 5 months. This is the first reported …case of PBL involving the skull and meninges in a HIV-infected child. Show more

Keywords: HIV, Plasmablastic lymphoma, skull

DOI: 10.3233/JPI-140422

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 119-121, 2014