Journal of Pediatric Infectious Diseases - Volume 9, issue 1

Authors: Nicolini, Giangiacomo | Donà, Daniele | Mion, Teresa | Barlotta, Alessia | Girotto, Silvia | Borgia, Eleonora | Franceschetto, Genny | Scamarcia, Antonio | Picelli, Gino | Cantarutti, Luigi | Carlo Giaquintob on behalf of Pedianet,

Article Type: Research Article

Abstract: Antibiotics are the most prescribed drugs in children, often administered without any specific diagnosis. In Italy, Family Pediatricians prescribe antibiotics more frequently than in other Europe countries, the commonest being amoxicillin, amoxicillin/clavulanate and cefaclor. We conducted a retrospective cohort study of children up to 12 years old, included in the database Pedianet, who received at least one prescription of amoxicillin, amoxicillin/clavulanate or cefaclor during the period 1st January 2003 to 30th June …2007. 335,352 antibiotics prescriptions in 110,747 children were included in the study. There were 168,458 prescriptions of amoxicillin, amoxicillin/clavulanate or cefaclor, amounting to 50.2% of antibiotic prescriptions. The main indication was unspecified-upper respiratory tract infection (26.5%). Overall, amoxicillin/clavulanate was the most commonly prescribed antibiotic in older children, while amoxicillin was the most prescribed in younger patients. Amoxicillin was the most prescribed antibiotic in all age groups (p < 0.0001) for upper respiratory tract infections, otitis media and acute bronchitis. A therapeutic switch occurred in 0.6% of cases, and was most frequent in pneumonia. This was a retrospective study carried out using software designed for the routine practice and not for specific studies; therefore several limitations on the data interpretation need to be considered especially on the diagnosis. However, the study shows that antibiotic consumption in the Italian pediatric population exceeds the European average, with three beta-lactam drugs accounting for over half of all antibiotic prescriptions. Show more

Keywords: Pediatric antibiotics, amoxicillin/clavulanate, amoxicillin, cefaclor, antibiotics, children

DOI: 10.3233/JPI-140405

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 1-9, 2014

Authors: Al Laham, Nahed | Elyazji, Mansour | Al-Haddad and, Rohaifa | Ridwan, Fouad

Article Type: Research Article

Abstract: Gastroenteritis is one of the leading causes of illness and death in children under five-years old, especially in developing countries. It is also one of the leading causes of deaths among this population in Gaza strip. This study conducted to determine the incidence of different enteric pathogens causing community gastroenteritis among kindergarten children in Gaza. One hundred and fifty stool samples were collected and investigated for parasitic, viral, and bacterial pathogens at Al Azhar microbiology laboratories …using standard microbiological and serological procedures. Out of the 150 study population, the overall percentage of positive stool samples with a known enteric pathogen was 60.6%. The incidence of different enteric pathogens causing community gastroenteritis in diarrhea cases was significantly higher than in controls (88.5% versus 11.1%). The most prevalent enteric pathogens isolated were Entamoeba histolytica and Giardia lamblia (28%, 26.7% respectively). Rotavirus was found in 3.1% of cases but not detected in controls; adenovirus types 40 and 41 were not detected. The bacterial enteric pathogens Shigella and Enterohemorrhagic Escherichia coli O157:H7 (EHEC) had similar rates as rotavirus (3.1%); no Salmonella was found. 7.4% of children had more than one pathogen detected. This study demonstrated a high percentage of parasitic enteropathogens and a relatively low percentage of bacterial and viral enteropathogens among kindergarten children. Children aged three had the highest incidence of isolated enteropathogens. Show more

Keywords: Community gastroenteritis, causative agents, kindergarten, Gaza

DOI: 10.3233/JPI-140406

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 11-17, 2014

Authors: Ikhlas, Ahmad | Ahmad, Qazi Iqbal | Asif, Ahmed | Waseem, Iqbal | Ahmad, Tali Manzoor | Mushtaq, Tramboo Zubair | Shahid, Bhat Nisar

Article Type: Research Article

Abstract: Although huge advances have been made in the field of medicine, fever of unknown origin (FUO) continues to be a significant health problem and an important cause of morbidity and mortality, especially in children. The aim of this study was to study current spectrum of FUO, newly emerging challenges and outcome of FUO. A prospective observational study was conducted over a 16 month period (May 2012-September 2013). 53 children aged 4 months to 15 years met …the definition of FUO and were included. Children with known immunodeficiency disorders or other chronic disorders were excluded. A diagnosis was reached in 47 (88.7%) patients. Infections were the commonest cause accounting for FUO in 37 (69.8%) patients. Haematological disorders were found in 8 (15%) and autoimmune diseases in 2 (3.8%) patients. Among infections, the most common causes of FUO were tuberculosis (TB) (37.8%), enteric fever (29.7%), Epstein-Barr virus (EBV) (8.1%) and brucellosis (8.1%). TB was extra-pulmonary in 11 cases and pulmonary in 3 cases. Amongst the haematological disorders, 3 patients had haemophagocytic lymphohistiocytosis (HLH), 3 had leukemia, 1 had non-Hodgkin lymphoma and 1 had autoimmune lymphoproliferative syndrome. Juvenile idiopathic arthritis with systemic onset and polyarteritis nodosa accounted for the two cases of autoimmune disease. Elevated C-reactive protein (CRP) levels were associated with an infectious etiology. Bone tenderness, thrombocytopenia and neutropenia predicted haematological malignancy. 1 patient of HLH died of complications during initial hospitalization and 3 other patients (1 HIV, 2 TB) died on follow up. TB, especially extrapulmonary, and enteric fever are still significant public health problems and were the commonest causes of FUO in our population. Due to advances in diagnostic facilities, some diseases like urinary tract infection (UTI) and hepatitis have become less common; however, other diseases like EBV have become more common causes of FUO. HLH is emerging as a significant cause of morbidity and mortality in FUO patients. Show more

Keywords: Fever of unknown origin (FUO), children

DOI: 10.3233/JPI-140408

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 19-22, 2014

Authors: Conradi, Álvaro Díaz | Ferran, Ramon Clapés | Iranzo, Anna Sangorrin | Torell, Adriana Cordon | Navarro, Josep Marco | Muñoz-Almagro, Carmen

Article Type: Research Article

Abstract: Pneumococcal necrotizing pneumonia can lead to severe barotrauma resulting from air passage through a bronchopleural fistula. Here we present a case of a 15-month old infant who presented with a life-threatening tension pneumothorax that developed ten days after discharge from hospital after 14 days treatment with intravenous cefotaxime for pneumococcal empyema. The patient recovered full after urgent surgical decompression, and the fistula closed without further surgical intervention.

Keywords: Necrotizing pneumonia, pneumothorax, Streptococcus pneumoniae

DOI: 10.3233/JPI-140411

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 23-25, 2014

Authors: Das, Suman | Sarkar, Nirmalya | Chatterjee, Kaushani | Aich, Bholanath

Article Type: Research Article

Abstract: A 10-year-old-boy was admitted with high grade continuous fever, rash, arthralgia and myalgia. From the 4th day of fever, his myalgia increased in intensity and he developed flaccid quadriparesis on the 5th day. Subsequently he was diagnosed to have dengue infection and myositis. He also developed right sided Bell's palsy 4 days after he became afebrile. He was treated with intravenous methyl prednisolone for 3 days followed by oral prednisolone for 1 week with resultant dramatic …resolution of myalgia and weakness. Physiotherapy was advised for Bell's palsy. At follow up 2 months later, the child had regained grade 5/5 power in all four limbs, but the weakness of the facial muscles persisted. Show more

Keywords: Dengue, flaccid quadriparesis, myositis, Bell's palsy, methyl prednisolone

DOI: 10.3233/JPI-140412

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 27-30, 2014

Authors: Fesmire, Alyssa | Sawyer, Jeffrey | Warner, Jr., William C. | Buckingham, Steven | Bagga, Bindiya | Anand, Kanwaljeet J.S. | Kelly, Derek M.

Article Type: Research Article

Abstract: This report describes the clinical course and treatment of a C. perfringens infection in a child following an injury to the knee that resulted in sepsis and multi-organ system failure. Diagnosis of the causative agent and systemic nature of the infection was delayed because of the non-traditional presentation, in which the patient appeared to have a localized necrotizing fasciitis and did not display symptoms consistent with severe systemic involvement. He was treated with vancomycin, wound debridement …and fasciotomy. After identification of C. perfringens, vancomycin therapy was discontinued in favor of penicillin and clindamycin. With intensive supportive care, the patient recovered fully and resumed regular activities within two months. These infections are rare in children, but they can be life threatening. It is important to include systemic Clostridium infection in a differential so it can be recognized early and appropriate treatment begun as soon as possible. Show more

Keywords: Clostridium perfringens, systemic infection, pediatric

DOI: 10.3233/JPI-140410

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 31-35, 2014

Authors: Das, Suman | Sarkar, Nirmalya | Majumder, Jayitri | Chatterjee, Kaushani | Aich, Bholanath

Article Type: Research Article

Abstract: An 8-year-old boy was admitted to the Pediatric ward with high fever and severe arthritis of 4 days duration. Chikungunya virus serology was positive. As he became afebrile one week after admission, he developed acute onset right sided hemiparesis and suffered from one episode of generalized tonic clonic seizure. The next day he developed flaccid quadriplegia, loss of all sensory modalities below the C5 dermatome and urinary retention. After 4 weeks of shock stage, spasticity appeared …in all 4 limbs. Magnetic resonance imaging (MRI) brain and spine showed extensive areas of demyelination-suggestive of acute disseminated encephalomyelitis (ADEM). He was treated with intravenous methyl prednisolone for 5 days, followed by oral prednisolone for 6 weeks. He was left with gross neurodeficits, including confinement to a wheel chair, persistent sensory loss and need for bladder catheterization. Show more

Keywords: Chikungunya, ADEM, methyl prednisolone

DOI: 10.3233/JPI-140414

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 37-41, 2014

Authors: Theotokatou, Stamo | Saravakos, Panagiotis | Niopa, Maria | Kallinikos, Alexandros

Article Type: Research Article

Abstract: Bacterial perianal dermatitis is a childhood disorder, most commonly caused by the beta-hemolytic group A streptococcus. Despite being well-recognized in the literature, this condition is often not recognized by healthcare practitioners, leading to a delay in the proper diagnosis and treatment. An 8-year-old boy presented with a three-week history of perianal itching, constipation and blood-streaked stools. Clinical examination revealed a bright red, sharply demarcated rash that extended approximately 3 cm circumferentially around …the anus. Positive cultures for Enterococcus faecalis from the perianal area and the stools confirmed the diagnosis of perianal dermatitis caused by an uncommon microorganism. Therapy with systematic oral cefuroxime and topical mupirocin cream led to a resolution of the symptoms and the itchy rash by day 4. 2 weeks after the onset of symptoms in the patient, his 10-year-old brother developed perianal itching and mucous discharge. Stool cultures again identified E. faecalis and the same treatment methods were applied, resulting in rapid resolution of the symptoms. Perianal dermatitis should be included in the differential diagnosis when a child aged from 6 months to 10 years old complains of perianal symptomatology. The differential diagnosis is wide and includes candidiasis, psoriasis, inflammatory bowel disease, diaper dermatitis, parasite infections and sexual abuse. The diagnosis is confirmed with culture swabs of the affected area and treatment should be guided based on the culture and antibiotic sensitivity testing. Show more

Keywords: Childhood, Enterococcus faecalis, enterococcal infections, perianal dermatitis, perianal rash

DOI: 10.3233/JPI-140407

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 43-46, 2014

Authors: Mantadakis, Elpis | Kontogianidis, Kosmas | Deftereos, Savas | Panopoulou, Maria | Ramatani, Anna | Birbilis, Theodosios | Chatzimichael, Athanassios

Article Type: Research Article

Abstract: A 9-year-old boy with multiple decayed teeth developed right eye preseptal cellulitis and left subdural empyema due to Streptococcus constellatus. He recovered after neurosurgical evacuation of the empyema and antibiotic treatment with high-dose intravenous ampicillin for three weeks. Poor oral hygiene predisposes to hematogenous and possibly fatal dissemination of rare oral commensals to the subdural space.

Keywords: Children, Streptococcus constellatus, subdural empyema

DOI: 10.3233/JPI-140409

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 47-50, 2014

Article Type: Other

DOI: 10.3233/JPI-140413

Citation: Journal of Pediatric Infectious Diseases, vol. 9, no. 1, pp. 51-52, 2014