Journal of Pediatric infectious diseases最新文献

Objective Early onset sepsis (EOS) is a significant cause of morbidity and mortality in the newborn period. This has led to overinvestigation and antibiotic overuse, which remains a concern in EOS management. Sepsis risk calculator (SRC), a tool validated in American and European populations, aids physicians in sepsis risk stratification and has been shown to decrease antibiotics overuse for EOS. The aim of the study was to evaluate the efficacy and safety of the SRC in a tertiary referral center in Lebanon.

Methods This was a single-center retrospective cohort study, conducted at a tertiary medical center in Beirut, Lebanon, that included infants born at more than 34 weeks' gestational age between January 1, 2017 and January 1, 2019. Data was collected on risk factors for neonatal sepsis and the clinical management performed on each newborn. The SRC was used to calculate a sepsis risk score for each patient. Comparison between actual management performed and SRC recommendation was measured.

Results We reviewed 3,085 charts, out of which 257 charts were excluded. Patients were stratified into two groups: high sepsis risk and low sepsis risk. Out of the 2,828 patients included, 81 infants (2.9%) had high risk of sepsis, out of which 2 patients had positive blood cultures. There were no patients with a low SRC score who had positive blood cultures. There were no patients who were supposed to receive antibiotics per the SRC recommendation who did not undergo workup for sepsis. Implementing SRC would have prevented antibiotics administration in 42 (1.5%) patients.

Conclusion SRC was adequately capable of detecting neonates with sepsis without missing actual cases of EOS, providing initial support for its safety in the population studied. Implementing the SRC would result in reduced usage of antibiotics, laboratory tests, and admissions to the neonatal intensive care unit.

The increasing incidence of invasive fungal infections, coupled with the growing population of immunocompromised patients, has led to an increased need for antifungal agents. The newest azole, isavuconazole, plays an important role in the treatment of invasive aspergillosis in adults due to its broad spectrum, tolerability, and no need for therapeutic drug monitoring. This agent, which has not yet been approved for use in children, has significant problems with drug supply in Türkiye. We present the treatment response to isavuconazole combination therapy used in salvage treatment in a patient with breakthrough invasive aspergillosis, who had treatment failure with different antifungal combination treatment options and surgical resection.

Objective Nigeria ranks highest globally in malaria burden, disproportionately affecting children. This study investigated trends in the incidence and outcomes of 948 children with cases of severe malaria in a tertiary hospital in northwestern Nigeria.

Methods We conducted a retrospective cross-sectional study of children with severe malaria between January 1, 2019, and December 31, 2022. We extracted relevant data, including sociodemographics, clinical features, as well as hospitalization outcomes (death or discharge), and the trends analyzed over the period.

Results Of the 8,295 pediatric admissions during the study period, 948 (11.4%) were cases of severe malaria. The trends of severe malaria (incidence) showed a surge of 17.3% in 2020 from 11.4% in 2019 and subsequently declined to 9.9% in 2022 (p < 0.001). There was a decline in the proportion of under-fives with severe malaria from 47.5% observed in 2019 to 43.7% in 2022 (p = 0.019). The overall mortality rate (malaria specific) was 7.2% (68/948) which rose from 2.3% in 2019 to 10.3% in 2020 and declined to 8.5% in 2022, p = 0.003. The proportion of malaria-specific deaths (from all-cause mortality) increased from 4.6% in 2019 to 17.3% in 2020 and declined to 9.3% in 2022 (p = 0.004). Among under-fives, there was no significant change in the malaria-specific mortality rate (from 3.2% in 2019 to 10.2% in 2020, 6.4% in 2021 and 10.3% in 2022, p = 0.104) and the proportion of malaria-specific deaths in under-fives among malaria deaths (from 66.7% in 2019 to 52.9% in 2022, p = 0.653). Among the clinical features, the presence of cerebral malaria and acute kidney injury had the highest case fatality rate (57.1%).

Conclusion Despite the initial surge in severe malaria cases during the coronavirus disease 2019 era, there has been an overall progressive decline in childhood severe malaria. However, among those under-fives, the trends in malaria deaths remained unchanged.

Objective Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii, is one of the opportunistic fungal infections that can cause life-threatening pneumonia in children with underlying diseases. Due to the similarity of the symptoms of PJP with other lung infections, such as tuberculosis, differential and accurate diagnosis is necessary. The current study investigated the molecular diagnosis of P. jirovecii, predisposing factors and the outcomes, among pediatric inpatients in Northeastern Iran.

Methods In this study, 180 bronchoalveolar lavage specimens were obtained from hospitalized children with respiratory disorders. The specimens were examined using Giemsa stain, and the genomic DNA was extracted according to the protocol of the AmpliSens kit. A real-time polymerase chain reaction (PCR) technique was used to detect P. jirovecii by the AmpliSens Pneumocystis jirovecii (carinii)-FRT PCR kit.

Results Among the patients studied, 34 (18.9%) were positive and 8 (4.4%) were suspicious of the presence of P. jirovecii. Among the 34 positive cases, 12 (35%) were diagnosed before, and 22 (65%) during the coronavirus 2019 (COVID-19) pandemic. Only two cases (5.88%) among the positive ones detected by the real-time PCR method were observed using Giemsa staining. Also, no correlation was observed between positive cases of infection and the sex, the outcomes, and underlying diseases.

Conclusion The results showed that PJP has a relatively high prevalence among pediatric inpatients with respiratory disorders. Neutropenia is a significant predisposing factor in these patients. However, there is no correlation between PJP cases and outcomes and underlying diseases. Most of the patients with PJP were affected during the COVID-19 pandemic, probably due to treatment with corticosteroids.

Objective Health care-associated infections (HAIs) are important causes of morbidity and mortality in neonatal intensive care units (NICUs). This study aimed to evaluate the frequency of HAIs and related factors in the NICU.

Methods HAIs detected and monitored by daily active surveillance by the Infection Control Team at Necmettin Erbakan University Faculty of Medicine NICU between January 1, 2017 and December 31, 2022 were evaluated retrospectively. There were a total of 43 incubators in our hospital's NICU (19 secondary level units and 24 tertiary level). Between 2017 and 2022, there was an average of 982 admissions to the NICU per year.

Results A total of 5,895 newborns and 74,726 patient days were monitored in the study. The average HAIs rate for all study years was 3.4% and the incidence density was 2.68 per thousand patient days. The highest HAI rate was in newborns with birth weights < 750 g. A total of 201 HAIs were detected in 172 patients. Bloodstream infection (BSI) was the most frequent HAI. The most frequent pathogens were Klebsiella spp. (44.8%), methicillin-resistant coagulase-negative staphylococci (CoNS) (24.4%), and Acinetobacter spp. (11.6%). Note that 88.5% of Enterobacterales were extended-spectrum beta-lactamase producers, and 26% of Klebsiella spp. were carbapenem-resistant. No colistin resistance was detected in Pseudomonas aeruginosa and Acinetobacter spp. Methicillin resistance was detected in 86.5% of CoNS and 50% of Staphylococcus aureus. The vancomycin resistance rate in Enterococcus spp. was 40%. Note that 16.7% of Candida spp. were fluconazole-resistant; no resistance to caspofungin was found. The most common risk factors for development of HAI were prematurity, umbilical catheter use, total parenteral nutrition, and mechanical ventilation. The mortality rate in patients with HAIs was 20.9%.

Conclusion HAIs, including those caused by multidrug-resistant Gram-negative bacteria, are an important problem in our hospital, and also globally. Active surveillance should be continued, and changes over the years evaluated. Infection control programs should be executed by determining the risk and mortality factors attributed to infection and their implementation should be closely monitored. These practices will increase success in the fight against HAIs and antimicrobial resistance.

Objective We describe a case with natural killer cell deficiency of late-onset Oka vaccine varicella zoster virus (VZV) strain and Herpes simplex virus-1 (HSV-1) dual infection resulting in fatal clinical course.

Methods An 18-month-old boy presented with a papulovesicular rash, mucocutaneous candidiasis, encephalopathy, and severe respiratory distress 6 months after receiving varicella vaccine. VZV and HSV-1 were analysed by real-time reverse-transcriptase polymerase chain reaction (RT-qPCR) and Oka vaccine strain of VZV by gene sequencing.

Results HSV-1 and VZV dual infection was detected in the blood and skin samples by RT-qPCR. Gene sequencing of VZV isolated from vesicular lesions was compatible with the Oka vaccine strain. Flow cytometry revealed a natural killer deficiency, but whole exome analysis failed to identify an associated genetic defect.

Conclusion Vesicular rashes in immunocompromised patients who were inadvertently vaccinated should be taken seriously, and antiviral therapy should be prompt and aggressive.

Objective This study aimed to investigate the relationship between clinical characteristics and human cytomegalovirus (HCMV) glycoprotein N (gN) genotypes in children.

Methods HCMV gN gene polymorphisms in 544 patients were analyzed using semi-nested polymerase chain reaction and restriction fragment length polymorphism.

Results The highest proportion was observed for the gN3a genotype (126/544, 23.2%). The proportion of children with mixed infections presenting with the hepatitis phenotype (65/69, 94.2%) was significantly higher than that of each gN genotype, except for gN3b (34/43, 79.1%, all p < 0.0083). Patients infected with 4b genotype (56/56, 100%) had a significantly higher proportion of anemia symptoms than those infected with all other gN genotypes (all p < 0.0083). There were also significant differences in the proportion of patients infected with different gN genotypes who presented with clinical features, such as jaundice, pneumonia, and thrombocytopenic purpura. Patients with the gN2 genotype had significantly higher albumin levels than those with the gN3a genotype (p = 0.042).

Conclusion The clinical phenotypes and laboratory indicators of HCMV infection in children with different gN genotypes are somewhat different, suggesting that precise typing of gN genes has clinical value.

Objective This study aimed to examine the characteristics of Group A Streptococcus (GAS) infection and identify the emm genotypes and the superantigen gene of GAS strains isolated from children from 2011 to 2019 in Tongzhou District, Beijing.

Methods Pharyngeal swab samples from children with scarlet fever or pharyngeal infection were collected and tested for GAS. In GAS isolates, emm genotypes and superantigen genes were identified. Logistic regression models were used to explore the correlations between demographic characteristics, clinical manifestations, and GAS infection.

Results In total, 172/1,214 (14.2%) GAS were isolated. The GAS infection rate in children with scarlet fever was 47.5%, higher than 8.5% in children with pharyngeal infection (p < 0.001). The risk of GAS infection was associated with oral mucosal congestion in children with scarlet fever, and older age, tonsillitis, and rash in children with pharyngeal infection. Seven emm genotypes were detected in 164 GAS isolated strains, of which emm12 and emm1 accounted for 47.0 and 46.3%, respectively. Among 112 GAS isolates, the top 5 detection rates of superantigen genes were speF 100.0%, speG 100.0%, speB 98.2%, speC 94.6%, and smeZ 82.1%. Higher proportions of speA, speJ, and speK were detected in emm1 isolates, while speH and speI were more common in emm12 isolates (p < 0.001).

Conclusion The changing predominant type expanded the knowledge of the circulating emm types, which should be considered in future vaccine development.

Objective Our objective was to examine potential differences in inflammatory markers, specifically antimicrobial peptide (AMP) LL-37 and interleukin-6 (IL-6), in the bloodstream of children with sepsis who had varying levels of vitamin D3.

Methods A total of 59 pediatric patients diagnosed with sepsis from January 2021 to November 2021 were enrolled in this study. The pediatric patients with sepsis were categorized into three groups based on their levels of vitamin D3, and AMP LL-37, IL-6, and procalcitonin (PCT) were compared among the three groups.

Discussion The LL-37 level in the group with vitamin D3 deficiency was notably lower than in the other two groups (p_{deficiency group vs. insufficiency group} = 0.019, p_{deficiency group vs. normal group} = 0.034), whereas the disparity between the group with vitamin D3 insufficiency and the group with normal vitamin D3 levels was not statistically significant. There was a positive correlation between the level of vitamin D3 and LL-37 in pediatric patients with sepsis (r = 0.324, p = 0.012). On the other hand, the level of IL-6 in pediatric patients with sepsis showed a positive correlation with both LL-37 (r = 0.474, p = 0.000) and PCT (r = 0.527, p = 0.000).

Conclusion Pediatric patients with sepsis typically exhibit low levels of vitamin D3, which are positively correlated with the levels of serum LL-37. Furthermore, the presence of higher levels of serum LL-37 is positively correlated with higher levels of IL-6.

Objective Our aim in this study was to evaluate the clinical characteristics of patients afflicted with rhinovirus (RV) infections, compare their laboratory findings with a healthy population, determine the features of the clinical course of the illness in individuals with a chronic disease, and set out the risk factors involved in the need for mechanical ventilation (MV).

Methods The study was conducted on 318 pediatric patients aged 0 to 18 years diagnosed with RV infection. Patients were divided into two main groups, those with and without a chronic disease. The group with chronic disease was divided into four subgroups. Children with RV were compared with a control group of 231 healthy children.

Results The most common symptoms and signs were wheeze (65.4%), cough (65.1%), and tachypnea (50.3%). Compared with the healthy population, RV-positive patients showed significant increases in their white blood cell (WBC), neutrophil, and platelet counts, and in their delta neutrophil index and C-reactive protein values (all p < 0.001). The most important risk factors in terms of the need for MV were elevated WBC (odds ratio [OR] = 1.404, 95% confidence interval [CI]: 1.059–1.862), chronic lung disease (CLD) (OR = 5.196, 95% CI: 2.296–11.762), reticular involvement (OR = 3.132, 95% CI: 1.259–7.793), and lobar involvement (OR = 10.575, 95% CI: 13.434–32.564).

Conclusion It is of vital importance that individuals with asthma and CLD are closely monitored and protected during RV seasonal periods as they are most at risk of severe infection, which can require high-flow nasal cannula and MV.