Journal of Pediatric Infectious Diseases - Volume 1, issue 3

Authors: Arnež, Maja | Pleterski-Rigler, Dušica | Ružić-Sabljić, Eva | Strle, Franc

Article Type: Research Article

Abstract: Slovenia is a highly endemic region for Lyme borreliosis. We present three patients with multiple erythema migrans and simultaneous isolation of Borrelia burgdorferi sensu lato from blood and cerebrospinal fluid. The patients were identified in a prospective study on children with multiple erythema migrans in whom central nervous system involvement was actively searched. The patients had no obvious symptoms and signs of central nervous system involvement. At the end of 14-day treatment with ceftriaxone the …patients were free of signs and symptoms of borrelial infection. We stressed the importance of cerebrospinal fluid investigations and early appropriate antibiotic treatment in these patients. Show more

Keywords: Lyme borreliosis, borrelia burgdorferi sensu lato, multiple erythema migrans, pathogenesis, treatment

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 123-125, 2006

Authors: Milner, Philip J. | Smith, Elizabeth H. | Spicer, Lisa | Gray, James W.

Article Type: Research Article

Abstract: Group B streptococci (GBS) have been recognized as a leading cause of serious early-onset neonatal sepsis for 30 years. Introduction of intrapartum antibiotic prophylaxis (IAP) has led to a decrease in neonatal early-onset GBS (EOGBS) disease and in early neonatal sepsis-related mortality in many countries. At present decisions concerning the administration of IAP are usually based on either the presence of risk factors at the time of labor, or on screening of women at 35–37 weeks …gestation. A new generation of rapid test for GBS suitable for point of care use offer the prospect of accurately detecting GBS during labor, which might improve targeting of IAP. Looking further ahead, active immunization of women before or during pregnancy may become the mainstay of prevention of neonatal EOGBS disease. In this article the role of GBS as a neonatal pathogen, and current and possible future strategies for prevention of neonatal EOGBS disease, are reviewed. Show more

Keywords: Group B streptococcus, neonatal infection, prevention, diagnosis

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 127-136, 2006

Authors: Salonen, Matteus J.H. | Virtanen, Jussi Oskari | Vaheri, Antti | Koskiniemi, Marjaleena

Article Type: Research Article

Abstract: Human herpesvirus 6 (HHV-6) is a highly neuro- and lymphotropic virus with an increasing number of diseases associated with it. Most children are infected at the age of 6 to 15 months. Primary infection manifests classically as exanthema subitum. This is, however, only one aspect of the clinical spectrum of the disease. Neurological symptoms are common and the virus may persist in several tissues and cells and be reactivated in various immunosuppressive conditions. In addition, HHV-6 …may be involved in many chronic diseases. The two variants HHV-6A and HHV-6B appear to have different disease associations. To conclude, diseases associated with or caused by HHV-6 seem to expand. HHV-6 needs attention and active research both in children and in adults. Show more

Keywords: HHV-6, exanthema subitum, PCR, chronic diseases, convulsions, neurological infection

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 137-142, 2006

Authors: Nambam, Bimota | Prasad, Hanuman Thappa Krishna | Sherwal, Banke Lal | Aneja, Satinder | Jain, Anju

Article Type: Research Article

Abstract: Tuberculous meningitis, an extrapulmonary manifestation of tuberculosis, is associated with poor prognosis and high mortality in the pediatric age group with delayed treatment. The main causative agent in humans is Mycobacterium tuberculosis but other members of the M. tuberculosis complex especially Mycobacterium bovis, have also been implicated as potential human pathogens. Our study utilizes the hup B gene (Rv2986c in M. tuberculosis and Mb3010c in M. bovis) …as a target for a two-step 'in house' nested polymerase chain reaction (PCR) in cerebrospinal fluid samples and can differentiate between M. tuberculosis and M. bovis. The products obtained for M. tuberculosis and M. bovis are 116 and 89 base pair respectively due to a 27 base pair deletion at the C-terminal of hup B gene of M. bovis. Fifty cases, suggestive of tuberculous meningitis, and fifty controls (admitted for other causes) were chosen as per Modified Ahuja's criteria and correlated with response to therapy. They were regrouped retrospectively as definitive tuberculous meningitis [25] and non-tuberculous meningitis [75]. Of the non-tuberculous meningitis category, 45 patients were diagnosed as pyogenic meningitis while the rest were diagnosed as febrile seizures [16], hypocalcemic seizures [11] and enteric encephalopathy [3]. Mycobacterial DNA extracted from cerebrospinal fluid samples were subjected to a two-step nested PCR. A sensitivity of 92% and specificity of 98.7% was obtained. M. tuberculosis and M. bovis infection was seen in 56% and 35% of the PCR positive cases respectively while 9% showed co-infection with both species. Thus this novel gene target shows promising potential as a rapid molecular diagnostic aid in pediatric tuberculous meningitis where rapid institution of antituberculosis therapy is essential. Show more

Keywords: Polymerase chain reaction, M. tuberculosis, M. bovis, tuberculous meningitis, cerebrospinal fluid

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 143-148, 2006

Authors: Hervouet-Zeiber, Catherine | Robert, Monique | Carceller, Ana | Chevalier, Isabelle | Dobrescu, Otilia | Lebel, Marc H.

Article Type: Research Article

Abstract: The aim of this study was to determine type, prevalence and risk factors for infectious diseases in internationally adopted children. The number of internationally adopted children is still increasing and the countries of origin change with time. Regular reassessment of the epidemiology of infectious diseases is essential in order to recommend appropriate screening and treatment for these children. A retrospective cohort study was conducted between 01/01/1998 and 12/31/2001. Of 552 children evaluated, 77% were females. …Median age was 13 months. Children originated mainly from China (n=319, 57.8%) and other Asian countries (n=112, 20.3%). Overall, 105 children (19.0%) were found to have at least one type of infection diagnosed on initial screening. In our cohort, 57 of 342 children (16.7%) were infected with one or more pathogenic intestinal parasites; the most common was Giardia lamblia, found in 44 of 342 tested children (12.8%). Increasing age was associated with an increased risk of parasitic infection, with children 12–24 months (adjusted OR: 7.9; 95% CI: 2.6–24.5), and children > 24 months (adjusted OR: 25.3; 95% CI: 7.7–83.1) being significantly more at risk than children < 12 months. Stool cultures were positive in 13 of 159 tested children (8.2%). Eleven percent (41 of 371) of children tested had a tuberculin skin testing (TST) reaction ⩾ 10 mm. Eastern European (adjusted OR: 3.5; 95% CI: 1.1–11.1) and Latin American (adjusted OR: 4.9, 95% CI: 1.5–15.8) children were more likely to have a positive TST. Serological evidence of active or chronic hepatitis B infection was found in six children (1.0%). Two children had syphilis and one had hepatitis A. All children screened for hepatitis C and HIV were negative. Our study shows a high intestinal parasite infection rate, high rates of latent tuberculosis and lower hepatitis B rates than previously reported. If undetected, some of these diseases may have serious long-term consequences. Screening should be performed for all internationally adopted children at the time of arrival into the adoptive home. Show more

Keywords: Adoption, screening, tuberculosis, intestinal parasites, hepatitis B

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 149-157, 2006

Authors: Méndez-Echevarría, Ana | Baquero-Artigao, Fernando | Jesus García-Miguel, Maria | Romero, Maria Pilar | Sastre, Noelia | del Castillo, Fernando

Article Type: Research Article

Abstract: The aim of this study is to study the management and evolution of nontuberculous mycobacterial lymphadenitis and to analyze different therapeutic options. A retrospective study was performed on patients under 14 years diagnosed from 1987 to 2004 in a tertiary care children's hospital. Inclusion criteria were: (1) Positive polymerase chain reaction or culture. (2) Histopathological features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli and sensitive skin test 6 mm above …Mantoux. (3) Histopathological features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli, Mantoux reaction less than 15 mm and absence of risk factors for tuberculous infection. In order to analyze the effectiveness of the different therapeutic options, we divided our patients into 4 groups, based on the initial treatment received: Group 1 antibiotics alone (n=21), Group 2 drainage (n=13), Group 3 excision (n=8) and Group 4 no treatment (n=6). Fifty-four patients were included. Therapy failed in 38% of patients receiving antibiotics (n=8), in 77% of patients with drainage alone n=10) and in none of the patients who underwent surgery. Healing time was shortest in patients undergoing surgery. Sinus formation occurred either spontaneously (66.6%) or despite the medical treatment (57%) or drainage (53%). No patients developed fistulas after surgical excision. Transient paresis of the mandibular branch of the facial nerve occurred in three patients (13%) after complete excision. Some nontuberculous adenitis respond to medical treatment alone, but complete surgical excision remains the most effective treatment, obtaining an early definitive healing. Transient mandibular nerve paresis was the main complication observed in the excision group. Show more

Keywords: Lymphadenitis, Mycobacterium avium, excision, macrolides

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 159-164, 2006

Authors: Bay, Ali | Oner, Ahmet Faik | Dogan, Murat | Kaya, Avni | Acikgoz, Mehmet

Article Type: Research Article

Abstract: Varicella remains a dangerous viral pathogen for pediatric cancer patients. The incidence of primary varicella infection in Eastern of Turkiye is still high because of low vaccination rate. Medical records of 27 pediatric patients with hematological malignancies that developed varicella/herpes zoster were retrospectively reviewed. All were treated at a single medical center in Eastern Turkiye between 1997 and 2006. Varicella (n=22) or herpes zoster (n=5) were diagnosed in 27 cases, of whom 14 …had acute lymphoblastic leukemia (ALL), five had acute myeloblastic leukemia (AML), and eight had non-Hodgkin lymphoma (NHL). The mean age of the children was 5.7 ± 3.2 years. None of these children had evidence of disseminated disease. The mean total leukocyte count was 2600 ± 1500/mm^{3} in ALL group, 2300 ± 1800/mm^{3} in AML group, and 3100 ± 1700/mm^{3} in NHL group. While intravenous acyclovir was administered to 21 patients, remaining six patients were received oral acyclovir. Fever was reduced in mean 5.6 ± 2.1, 5.2±1.7 and 4.4 ± 1.8 days in ALL, AML, and NHL groups, respectively. None of the 27 children worsened or developed features of visceral dissemination. Outcome of the patients were not different in terms of oral and intravenous acyclovir use. These results suggest that in our institution varicella is not associated with a high incidence of mortality in cancer patients. Early administration of acyclovir can prevent the visceral dissemination of varicella-zoster virus. Prednisolone usage during the incubation period of varicella did not result in increased severe varicella infection. Show more

Keywords: Varicella, leukemia, lymphoma, acyclovir

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 165-168, 2006

Authors: Baker, Cristina A.

Article Type: Other

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 169-171, 2006

Authors: Nikkels, Arjen F. | Nikkels-Tassoudji, Nazli | Thirion, Laurence | Piérard, Gérald E.

Article Type: Research Article

Abstract: Dual cutaneous herpesvirus (α-α, α-β infections are exceptional. We report the first case of a simultaneous α- and γ-herpesvirus infection corresponding to recurrent varicella and human γ herpesviruses 6 and 7-associated pityriasis rosea in an 8-year-old immunocompetent boy. This condition likely represents a stroke of misfortune, although a special link between two herpesvirus infections cannot be formally excluded.

Keywords: Recurrent varicella, pityriasis rosea

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 173-175, 2006

Authors: Akdeniz, Hayrettin | Beşiroǧlu, Lütfullah | Karsen, Hasan | Karahocagil, M. Kasım | Aǧargün, Mehmet Yücel

Article Type: Research Article

Abstract: Lyme disease is an infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. Its clinical hallmark, erythema migrans, is present only in about two thirds of infected patients. After erythema migrans, Bannwarth's syndrome (meningitis, polyradiculoneuritis, cranial nerve palsies) represents the second most common clinical manifestation of acute Borrelia infection, especially in Europe. We describe here two cases of Lyme neuroborreliosis presenting chiefly with neuropsychiatric symptoms displaying difficulties in diagnosis because the …patients had no history of tick bite or erythema migrans. In one of the cases, psychiatric complaints were predominant and she had a preliminary diagnosis of catatonic and psychotic disorder due to a general medical condition. The other patient had a clinical picture of meningitis with a protracted course. They were successfully treated with oral doxycycline. Apropos of these two cases, the relevant literature has been reviewed. Show more

Keywords: Lyme disease, neuroborreliosis, neuropsychiatric symptoms, meningitis, treatment

Citation: Journal of Pediatric Infectious Diseases, vol. 1, no. 3, pp. 177-183, 2006