Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202005
Joy Morcilla, M. Gonzales, A. Ong-Lim
Background: Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB. Objectives: This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard. Methodology: This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines. Results: Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively. Conclusion: GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.
{"title":"Accuracy of Nasopharyngeal Aspirate GeneXpert Compared to Gastric Aspirate TB Culture and GeneXpert in Diagnosing Pulmonary Tuberculosis in Pediatric Patients","authors":"Joy Morcilla, M. Gonzales, A. Ong-Lim","doi":"10.56964/pidspj20212202005","DOIUrl":"https://doi.org/10.56964/pidspj20212202005","url":null,"abstract":"Background: Pulmonary TB in children remains to be a burden in the Philippines. Diagnosis remains to be a challenge for pediatricians due to its paucibacillary nature, difficulty in obtaining specimens, cost of test as well as the varied sensitivity of the different tests available. Gastric aspirate (GA), commonly used for bacteriological diagnosis of pulmonary tuberculosis (PTB) in children, involves an invasive procedure that may cause discomfort and sometimes require admission. Nasopharyngeal aspirate (NPA), on the other hand, can be easily and non-invasively obtained but is currently not a recommended specimen for testing for PTB. Objectives: This study aims to determine the accuracy of NPA GeneXpert in diagnosing PTB among pediatric patients 0-18 years old with presumptive TB using GA GeneXpert as the initial screening test and GA TB culture as gold standard. Methodology: This prospective, cross-sectional diagnostic study involved collection of single NPA and GA specimens for GeneXpert and TB culture in 100 patients with presumptive PTB seen at a tertiary government hospital in the Philippines. Results: Of the one hundred pediatric patients (mean age 6 ± 5.63 years) enrolled, 50 were clinically diagnosed PTB, 16 bacteriologically-confirmed and 34 were not PTB disease. Sensitivity, specificity and predictive values with 95% confidence intervals of the NPA GeneXpert were determined compared to GA GeneXpert and GA culture. Sensitivity, specificity, positive and negative predictive values of the NPA GeneXpert compared to GA GeneXpert were 70%, 96.67%, 70% and 96.67%, respectively. While NPA GeneXpert compared to GA TB culture were 40%,91.58%, 20% and 96.67%, respectively. Conclusion: GeneXpert testing on a single NPA specimen is a highly specific and rapid test that can be used to diagnose PTB in pediatric patients, particularly where gastric aspiration or mycobacterial culture is not feasible.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125862775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202006
Loradel Marbella Calio
Background: Donor Human Milk (DHM) is the recommended food of infants whenever mom’s own milk (MOM) is not available. However, due to the pathogenic microbiological component of DHM, concerns on the safety of the milk are inevitable. Objective: To determine the effect of storage time on the microbial growth of pasteurized and unpasteurized Donor Human Milk maintained at a constant temperature of -20°C. Methodology: This is a Quasi-experimental Research done in the Newborn Care Unit (NCU) and Bacteriology Section of a private tertiary hospital in Davao City. The effect of storage time to the microbial growth of pasteurized and unpasteurized DHM was determined using Friedman Test 2-way Analysis of Variance by Ranks. Pairwise comparison of microbial growth between pasteurized and unpasteurized DHM at different storage times was determined using the Mann-Whitney U test. Results: Baseline DHM samples had moderately heavy bacterial growth of Staphylococcus epidermidis. There was a decrease from moderately heavy to light growth of the same species in the 24-hour storage time for both pasteurized and unpasteurized DHM. Pasteurized DHM did not have any microbial isolates at 48h, 72h, 4w, 8w and 12w while unpasteurized DHM had Acinetobacter baumanii, Staphylococcus warneri, Kocuria kristinae, and Staphylococcus saprophyticus growths. The analysis revealed that there is a statistically significant difference in the microbial growth in both pasteurized and unpasteurized DHM samples when stored at different times, χ2 (6) = 28.457, p = 0.00. Conclusions: Storage time significantly interacts with the microbial growth on both pasteurized and unpasteurized DHM samples. Therefore, microbial growth in DHM samples may be affected by the length of time stored at a constant temperature of -20°C. Pasteurized DHM samples when stored at -20°C for more than 48 hours resulted to a statistically reduced microbial growth.
背景:当母亲自己的乳汁(mom)无法获得时，捐赠母乳(DHM)是婴儿的推荐食物。然而，由于DHM的致病微生物成分，对牛奶安全性的担忧是不可避免的。目的:探讨在-20℃恒温保存条件下，巴氏灭菌和未巴氏灭菌的供乳保存时间对微生物生长的影响。方法:这是在达沃市一家私立三级医院的新生儿护理科和细菌学科进行的一项准实验研究。采用弗里德曼检验(Friedman Test)进行秩数双方差分析(two -way Variance Analysis of Ranks)，比较不同贮藏时间对灭菌和未灭菌DHM微生物生长的影响。采用Mann-Whitney U检验，两两比较巴氏灭菌和未经巴氏灭菌的DHM在不同储存时间下的微生物生长情况。结果:基线DHM样品有中度重度表皮葡萄球菌细菌生长。经过巴氏灭菌和未经过巴氏灭菌的DHM在24小时的贮藏时间内，同一菌种的生长均由中等粗壮下降到轻壮。经巴氏灭菌的DHM在48h、72h、4w、8w和12w均无微生物分离，而未经巴氏灭菌的DHM有鲍曼不动杆菌、瓦纳氏葡萄球菌、克里斯坦氏葡萄球菌和腐生葡萄球菌生长。经分析，经巴氏灭菌和未经巴氏灭菌的DHM样品在不同保存时间内微生物生长差异有统计学意义，χ2 (6) = 28.457, p = 0.00。结论:在巴氏灭菌和未巴氏灭菌的DHM样品中，储存时间与微生物生长有显著的相互作用。因此，DHM样品中微生物的生长可能会受到-20℃恒温保存时间长短的影响。经巴氏灭菌的DHM样品在-20°C下储存超过48小时后，微生物生长在统计学上有所减少。
{"title":"The Effect of Storage Time on the Growth of Microorganisms in Pasteurized and Unpasteurized Donor Human Milk in a Tertiary Hospital in Davao City: A Quasi-Experimental Study","authors":"Loradel Marbella Calio","doi":"10.56964/pidspj20212202006","DOIUrl":"https://doi.org/10.56964/pidspj20212202006","url":null,"abstract":"Background: Donor Human Milk (DHM) is the recommended food of infants whenever mom’s own milk (MOM) is not available. However, due to the pathogenic microbiological component of DHM, concerns on the safety of the milk are inevitable. Objective: To determine the effect of storage time on the microbial growth of pasteurized and unpasteurized Donor Human Milk maintained at a constant temperature of -20°C. Methodology: This is a Quasi-experimental Research done in the Newborn Care Unit (NCU) and Bacteriology Section of a private tertiary hospital in Davao City. The effect of storage time to the microbial growth of pasteurized and unpasteurized DHM was determined using Friedman Test 2-way Analysis of Variance by Ranks. Pairwise comparison of microbial growth between pasteurized and unpasteurized DHM at different storage times was determined using the Mann-Whitney U test. Results: Baseline DHM samples had moderately heavy bacterial growth of Staphylococcus epidermidis. There was a decrease from moderately heavy to light growth of the same species in the 24-hour storage time for both pasteurized and unpasteurized DHM. Pasteurized DHM did not have any microbial isolates at 48h, 72h, 4w, 8w and 12w while unpasteurized DHM had Acinetobacter baumanii, Staphylococcus warneri, Kocuria kristinae, and Staphylococcus saprophyticus growths. The analysis revealed that there is a statistically significant difference in the microbial growth in both pasteurized and unpasteurized DHM samples when stored at different times, χ2 (6) = 28.457, p = 0.00. Conclusions: Storage time significantly interacts with the microbial growth on both pasteurized and unpasteurized DHM samples. Therefore, microbial growth in DHM samples may be affected by the length of time stored at a constant temperature of -20°C. Pasteurized DHM samples when stored at -20°C for more than 48 hours resulted to a statistically reduced microbial growth.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115073126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202003
Jaime Santos
This review article gives an overview of pneumonia in the Philippines, with focus on childhood pneumonia. Its primary objective is to provide information on epidemiology, etiology, economic burden, risk factors and prevention of pneumonia. A review of literature was done to gather information about the disease, with emphasis on local data. In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children<5 years of age. A prospective study on Invasive Pneumococcal Disease conducted in the Philippines looked at the incidence of chest x-ray–confirmed pneumonia (N=5,940) in three hospitals over a 2-year period. The highest incidence was seen in those 28 days to <6 months of age at two sites and those 6–12 months of age in another site. Risk factors include not exclusively breastfeeding infants <6 months, undernutrition, zinc deficiency, crowding and exposure to indoor air pollution, low birth weight, poverty and socio-economic factors, presence of underlying comorbidities and immunodeficiency states. CAP ranks number one in processed Philippine Health Insurance (PhilHealth) claims, showing the huge economic burden. Therefore, rationalizing its management with simple standardized guidelines, exclusive breastfeeding for 6 months and continued breastfeeding with appropriate complementary feeding, improving indoor air pollution, and promoting vaccination are effective interventions.
{"title":"A Review of Pneumonia in the Philippines","authors":"Jaime Santos","doi":"10.56964/pidspj20212202003","DOIUrl":"https://doi.org/10.56964/pidspj20212202003","url":null,"abstract":"This review article gives an overview of pneumonia in the Philippines, with focus on childhood pneumonia. Its primary objective is to provide information on epidemiology, etiology, economic burden, risk factors and prevention of pneumonia. A review of literature was done to gather information about the disease, with emphasis on local data. In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children<5 years of age. A prospective study on Invasive Pneumococcal Disease conducted in the Philippines looked at the incidence of chest x-ray–confirmed pneumonia (N=5,940) in three hospitals over a 2-year period. The highest incidence was seen in those 28 days to <6 months of age at two sites and those 6–12 months of age in another site. Risk factors include not exclusively breastfeeding infants <6 months, undernutrition, zinc deficiency, crowding and exposure to indoor air pollution, low birth weight, poverty and socio-economic factors, presence of underlying comorbidities and immunodeficiency states. CAP ranks number one in processed Philippine Health Insurance (PhilHealth) claims, showing the huge economic burden. Therefore, rationalizing its management with simple standardized guidelines, exclusive breastfeeding for 6 months and continued breastfeeding with appropriate complementary feeding, improving indoor air pollution, and promoting vaccination are effective interventions.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"40 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114043910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202009
Krista Maye Catibog, I. Cabaluna, A. Ong-Lim, Chrizarah San Juan, Maria Angela Villa, L. Dans
Objective: To identify specific clinical characteristics and patient signs and symptoms that increase the risk of developing severe/critical COVID-19 disease or death in the pediatric population, and identify strength of these associations Methodology: A systematic search was done in PubMed, Science Direct, Cochrane Library and grey literature databases focusing on severe and critical COVID-19 disease in the zero to eighteen year old age group until August 26, 2020. Data regarding patient characteristics, signs and symptoms on admission and disease severity were extracted. Outcomes measured were severe or critical COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) or death. Results were pooled and meta-analyzed. Results: Four eligible studies with a total of 292 pediatric patients with COVID-19 were examined. Older children (MD=6.62, 95%CI=4.23 to 9.00, p-value<0.00001, I2=33%) significantly present with a higher percentage of severe disease. Shortness of breath (OR=8.14, 95%CI=2.33 to 28.47, p-value=0.001, I2=42%) was also found to be associated with severe COVID-19 disease. The presence of a pre-existing medical condition (OR=4.02, 95%CI=1.55 to 10.43, p-value=0.004, I2=0%), especially cardiac disease (OR=6.40, 95%CI=1.45 to 28.38, p-value=0.01, I 2=13%) and diabetes (OR=7.01, 95%CI=1.54 to 31.95, p-value=0.01, I2=0%) was noted to be a risk factor for severe disease. Conclusion: Based on poor quality observational studies, older age group, shortness of breath, and a pre-existing medical condition, especially cardiac disease or diabetes were found to be associated with poor outcomes in children with COVID-19.
{"title":"Clinical Characteristics and Patient Symptoms Associated with Poor Outcomes among Children with COVID-19: A Rapid Review","authors":"Krista Maye Catibog, I. Cabaluna, A. Ong-Lim, Chrizarah San Juan, Maria Angela Villa, L. Dans","doi":"10.56964/pidspj20212202009","DOIUrl":"https://doi.org/10.56964/pidspj20212202009","url":null,"abstract":"Objective: To identify specific clinical characteristics and patient signs and symptoms that increase the risk of developing severe/critical COVID-19 disease or death in the pediatric population, and identify strength of these associations Methodology: A systematic search was done in PubMed, Science Direct, Cochrane Library and grey literature databases focusing on severe and critical COVID-19 disease in the zero to eighteen year old age group until August 26, 2020. Data regarding patient characteristics, signs and symptoms on admission and disease severity were extracted. Outcomes measured were severe or critical COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) or death. Results were pooled and meta-analyzed. Results: Four eligible studies with a total of 292 pediatric patients with COVID-19 were examined. Older children (MD=6.62, 95%CI=4.23 to 9.00, p-value<0.00001, I2=33%) significantly present with a higher percentage of severe disease. Shortness of breath (OR=8.14, 95%CI=2.33 to 28.47, p-value=0.001, I2=42%) was also found to be associated with severe COVID-19 disease. The presence of a pre-existing medical condition (OR=4.02, 95%CI=1.55 to 10.43, p-value=0.004, I2=0%), especially cardiac disease (OR=6.40, 95%CI=1.45 to 28.38, p-value=0.01, I 2=13%) and diabetes (OR=7.01, 95%CI=1.54 to 31.95, p-value=0.01, I2=0%) was noted to be a risk factor for severe disease. Conclusion: Based on poor quality observational studies, older age group, shortness of breath, and a pre-existing medical condition, especially cardiac disease or diabetes were found to be associated with poor outcomes in children with COVID-19.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132202225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202007
Maria Ronallaine Bello, Shirley Kwong-Buizon
Background: COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates. Objectives: To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied. Materials and Method: A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes. Results: Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases. Conclusion: This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.
{"title":"Maternal and Neonatal Clinico-Demographic Profile and Outcomes During the Covid-19 Pandemic at the Chinese General Hospital and Medical Center","authors":"Maria Ronallaine Bello, Shirley Kwong-Buizon","doi":"10.56964/pidspj20212202007","DOIUrl":"https://doi.org/10.56964/pidspj20212202007","url":null,"abstract":"Background: COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates. Objectives: To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied. Materials and Method: A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes. Results: Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases. Conclusion: This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122362478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202010
Dianne Alexis Millado-Riambon, E. Gallardo, Aaron Tulay
Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER). Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status. Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis. Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI. Conclusion: Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.
{"title":"Effects of Rapid Influenza Antigen Test on Antimicrobial Management of Pediatric Patients with Influenza-Like Illness in the Emergency Room","authors":"Dianne Alexis Millado-Riambon, E. Gallardo, Aaron Tulay","doi":"10.56964/pidspj20212202010","DOIUrl":"https://doi.org/10.56964/pidspj20212202010","url":null,"abstract":"Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER). Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status. Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis. Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI. Conclusion: Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116958645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202004
Aaron Tulay, E. Gallardo
Purulent pericarditis with cardiac tamponade caused by community-acquired methicillin-resistant Staphylococcus aureus is rare and fatal. There are limited data in children in the current antibiotic era, and available reports usually involve patients with immune dysfunction and prior thoracic instrumentation or has a thoracic focus of infection. Rapid recognition and treatment are paramount in the survival of patients. We report a case of purulent pericarditis with cardiac tamponade secondary to community-acquired MRSA in a previously healthy 10-month-old male infant who presented with fever, pallor, shock, and cardio-respiratory distress. CBC showed leukocytosis with neutrophilia, markedly elevated inflammatory markers, and cardiomegaly on chest radiography. The ECG showed diffuse concave ST-segment elevation, low QRS voltages on precordial leads, and electrical alternans consistent with pericarditis with probable significant pericardial effusion confirmed by 2D echocardiography with note of cardiac tamponade. He was managed effectively with pericardiostomy in combination with a 4-week course of vancomycin. Blood and pericardial fluid culture grew MRSA. This case underscores the organism’s lethality and its potential to infect immunocompetent children without predisposing factors. The value of early recognition, prompt initiation of treatment and management is of utmost importance.
{"title":"Purulent Pericarditis Secondary to Methicillin-Resistant Staphylococcus Aureus in a Previously Healthy Infant: A Case Report","authors":"Aaron Tulay, E. Gallardo","doi":"10.56964/pidspj20212202004","DOIUrl":"https://doi.org/10.56964/pidspj20212202004","url":null,"abstract":"Purulent pericarditis with cardiac tamponade caused by community-acquired methicillin-resistant Staphylococcus aureus is rare and fatal. There are limited data in children in the current antibiotic era, and available reports usually involve patients with immune dysfunction and prior thoracic instrumentation or has a thoracic focus of infection. Rapid recognition and treatment are paramount in the survival of patients. We report a case of purulent pericarditis with cardiac tamponade secondary to community-acquired MRSA in a previously healthy 10-month-old male infant who presented with fever, pallor, shock, and cardio-respiratory distress. CBC showed leukocytosis with neutrophilia, markedly elevated inflammatory markers, and cardiomegaly on chest radiography. The ECG showed diffuse concave ST-segment elevation, low QRS voltages on precordial leads, and electrical alternans consistent with pericarditis with probable significant pericardial effusion confirmed by 2D echocardiography with note of cardiac tamponade. He was managed effectively with pericardiostomy in combination with a 4-week course of vancomycin. Blood and pericardial fluid culture grew MRSA. This case underscores the organism’s lethality and its potential to infect immunocompetent children without predisposing factors. The value of early recognition, prompt initiation of treatment and management is of utmost importance.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"158 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127377163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202011
Mae Anne Rizalyn Allam, Mary Jane Dolores Ayson
Objective: Pediatric HIV is a national health concern that has grown exponentially in the past 5 years. This study aimed to determine the clinico-demographic profile and outcome of pediatric HIV/AIDS patients 0-18 years old seen at the Western Visayas Medical Center (WVMC) HIV/AIDS Treatment Hub from March 2006 to September 2018. Methods: Medical chart records of all pediatric HIV/AIDS patients seen at the treatment hub during the study period were reviewed. Data on clinical and demographic profile and outcomes were gathered and descriptive statistics was used to analyze data. Results: A total of 30 children 0-18 years old were registered consisting of 29 (97%) males and 1 (3%) female. A sudden increase in pediatric HIV patients was noted in the past 3 years, mostly among male adolescents engaged in male-to-male sexual contact (MSM). Majority (73%) were symptomatic at diagnosis with flu-like symptoms, fever and vomiting. Common physical exam findings were lymphadenopathy and rashes. HIV-related infections were tuberculosis and pneumonia. About 60% of study participants had severe immunodeficiency. Two-year mortality rate was 38%. Correlation of age and baseline CD4 count with outcome did not show any significant results. Conclusion: Pediatric HIV/AIDS patients were symptomatic, male adolescents who engaged in male to male sexual contact. Co-infections with pneumonia and tuberculosis were common and severe immunodeficiency was present at diagnosis. Thirty-eight percent of patients had poor outcomes 2 years after diagnosis
{"title":"Clinico-demographic Profile and Outcome of Pediatric HIV/AIDS Patients in Western Visayas Medical Center","authors":"Mae Anne Rizalyn Allam, Mary Jane Dolores Ayson","doi":"10.56964/pidspj20212202011","DOIUrl":"https://doi.org/10.56964/pidspj20212202011","url":null,"abstract":"Objective: Pediatric HIV is a national health concern that has grown exponentially in the past 5 years. This study aimed to determine the clinico-demographic profile and outcome of pediatric HIV/AIDS patients 0-18 years old seen at the Western Visayas Medical Center (WVMC) HIV/AIDS Treatment Hub from March 2006 to September 2018. Methods: Medical chart records of all pediatric HIV/AIDS patients seen at the treatment hub during the study period were reviewed. Data on clinical and demographic profile and outcomes were gathered and descriptive statistics was used to analyze data. Results: A total of 30 children 0-18 years old were registered consisting of 29 (97%) males and 1 (3%) female. A sudden increase in pediatric HIV patients was noted in the past 3 years, mostly among male adolescents engaged in male-to-male sexual contact (MSM). Majority (73%) were symptomatic at diagnosis with flu-like symptoms, fever and vomiting. Common physical exam findings were lymphadenopathy and rashes. HIV-related infections were tuberculosis and pneumonia. About 60% of study participants had severe immunodeficiency. Two-year mortality rate was 38%. Correlation of age and baseline CD4 count with outcome did not show any significant results. Conclusion: Pediatric HIV/AIDS patients were symptomatic, male adolescents who engaged in male to male sexual contact. Co-infections with pneumonia and tuberculosis were common and severe immunodeficiency was present at diagnosis. Thirty-eight percent of patients had poor outcomes 2 years after diagnosis","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114685631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202012
Abegail Sales Basco
Objectives: This study aims to determine the bactericidal activity of 4% acetic acid versus chlorine tablets against gram negative and gram-positive microorganisms based on percentage reduction of microorganisms in hospital surfaces and suggest that it may be an effective alternative disinfectant. Methodology: This was an experimental study where microbiological sampling of hospital surfaces was used to determine bacterial growth. The study was conducted from November to December 2020 at National Children’s Hospital, a 200 bed capacity tertiary government hospital catering to children 0 to less than 19 years old. Non-critical hospital surfaces such as beds, bed rails and bedside tables were swabbed before and after intervention cleaning with chlorine tablets or 4% acetic acid solution. Result: Pre-swabbing, hospital surfaces showed the presence of Bacillus sp., Klebsiella pneumoniae and Coagulase Negative Staphylococcus (CONS). Post-application of 4% acetic acid solution resulted to 100% reduction of Bacillus sp., 70.8% reduction of CONS, and 19.5% reduction of Klebsiella pneumoniae while post-application of chlorine tablet solution showed 100% reduction of Klebsiella pneumoniae and CONS and 95.2% reduction of Bacillus species. Conclusion: The use of 4% acetic acid solution significantly reduced more gram-positive than gram-negative organisms and is a highly effective disinfectant against Bacillus sp. but is not effective against gram-negative organisms as it does not fulfil the criteria of at least 90 percent reduction in bacterial growth. Chlorine tablet solution is a more effective disinfectant against gram-negative organisms than gram-positive organisms. Acetic acid 4% solution is not an effective alternative disinfectant to chlorine tablet solution, the currently used hospital disinfectant, but maybe used as an adjunct for better reduction of hospital environmental pathogens.
{"title":"Acetic Acid Versus Chlorine Tablet Solution as Disinfectant of Non-Critical Environmental Surfaces","authors":"Abegail Sales Basco","doi":"10.56964/pidspj20212202012","DOIUrl":"https://doi.org/10.56964/pidspj20212202012","url":null,"abstract":"Objectives: This study aims to determine the bactericidal activity of 4% acetic acid versus chlorine tablets against gram negative and gram-positive microorganisms based on percentage reduction of microorganisms in hospital surfaces and suggest that it may be an effective alternative disinfectant. Methodology: This was an experimental study where microbiological sampling of hospital surfaces was used to determine bacterial growth. The study was conducted from November to December 2020 at National Children’s Hospital, a 200 bed capacity tertiary government hospital catering to children 0 to less than 19 years old. Non-critical hospital surfaces such as beds, bed rails and bedside tables were swabbed before and after intervention cleaning with chlorine tablets or 4% acetic acid solution. Result: Pre-swabbing, hospital surfaces showed the presence of Bacillus sp., Klebsiella pneumoniae and Coagulase Negative Staphylococcus (CONS). Post-application of 4% acetic acid solution resulted to 100% reduction of Bacillus sp., 70.8% reduction of CONS, and 19.5% reduction of Klebsiella pneumoniae while post-application of chlorine tablet solution showed 100% reduction of Klebsiella pneumoniae and CONS and 95.2% reduction of Bacillus species. Conclusion: The use of 4% acetic acid solution significantly reduced more gram-positive than gram-negative organisms and is a highly effective disinfectant against Bacillus sp. but is not effective against gram-negative organisms as it does not fulfil the criteria of at least 90 percent reduction in bacterial growth. Chlorine tablet solution is a more effective disinfectant against gram-negative organisms than gram-positive organisms. Acetic acid 4% solution is not an effective alternative disinfectant to chlorine tablet solution, the currently used hospital disinfectant, but maybe used as an adjunct for better reduction of hospital environmental pathogens.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121154021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-07DOI: 10.56964/pidspj20212202008
Katherine Javier, J. Navoa-Ng, Nikki Cotoco-Chu
Background: Acute respiratory infection (ARI) is a major cause of morbidity and mortality among children worldwide however, local data on the etiologic diagnosis of ARI are limited. Objectives: To determine the prevalence and the most commonly detected respiratory pathogens using a multiplex PCR assay, known as the Respiratory Panel, among hospitalized children with ARI and compare their clinical and laboratory differences. Methods: This is a cross sectional study of children with ARI who were tested with a multiplex PCR assay. Retrospective chart review was done on these patients admitted from January 2018 to February 2020. Results: There were 47 charts reviewed, mean age was 4.2 years old. Out of 47 patients, 36 (76.6%) tested positive for a pathogen. Respiratory syncytial virus (RSV) being the most common followed by Influenza A/H1-2009 and Human metapneumovirus (hMPV). Two patients had viral co-infections and no bacteria were detected on all subjects. 61.7% patients were started on antibiotics on admission. Fever and cough were the most common sign and symptom, respectively. Normal WBC (68% with neutrophilic predominance) and platelet were detected in 72.3% and 70.2% of patients, respectively; 50% of patients had normal CRP and 60.5% had abnormal findings on chest x-ray. Only the presence of chest x-ray findings was found to have a higher probability of yielding a positive Respiratory Panel p=0.27. Conclusion: Among admitted patients with ARI, 76.6% tested positive for a respiratory pathogen. All were caused by viruses presenting as nonspecific manifestations – fever and cough. Clinical manifestations, CBC and CRP showed no association with the Respiratory Panel result while abnormal chest x-ray had a higher probability of yielding a positive Respiratory Panel result.
{"title":"Rapid Detection of Respiratory Pathogens Using a Multiplex PCR Assay Among Hospitalized Children with Acute Respiratory Infection","authors":"Katherine Javier, J. Navoa-Ng, Nikki Cotoco-Chu","doi":"10.56964/pidspj20212202008","DOIUrl":"https://doi.org/10.56964/pidspj20212202008","url":null,"abstract":"Background: Acute respiratory infection (ARI) is a major cause of morbidity and mortality among children worldwide however, local data on the etiologic diagnosis of ARI are limited. Objectives: To determine the prevalence and the most commonly detected respiratory pathogens using a multiplex PCR assay, known as the Respiratory Panel, among hospitalized children with ARI and compare their clinical and laboratory differences. Methods: This is a cross sectional study of children with ARI who were tested with a multiplex PCR assay. Retrospective chart review was done on these patients admitted from January 2018 to February 2020. Results: There were 47 charts reviewed, mean age was 4.2 years old. Out of 47 patients, 36 (76.6%) tested positive for a pathogen. Respiratory syncytial virus (RSV) being the most common followed by Influenza A/H1-2009 and Human metapneumovirus (hMPV). Two patients had viral co-infections and no bacteria were detected on all subjects. 61.7% patients were started on antibiotics on admission. Fever and cough were the most common sign and symptom, respectively. Normal WBC (68% with neutrophilic predominance) and platelet were detected in 72.3% and 70.2% of patients, respectively; 50% of patients had normal CRP and 60.5% had abnormal findings on chest x-ray. Only the presence of chest x-ray findings was found to have a higher probability of yielding a positive Respiratory Panel p=0.27. Conclusion: Among admitted patients with ARI, 76.6% tested positive for a respiratory pathogen. All were caused by viruses presenting as nonspecific manifestations – fever and cough. Clinical manifestations, CBC and CRP showed no association with the Respiratory Panel result while abnormal chest x-ray had a higher probability of yielding a positive Respiratory Panel result.","PeriodicalId":117545,"journal":{"name":"Pediatric Infectious Disease Society of the Philippines Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129752428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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