Pediatric Infectious Disease Journal最新文献

Background: Congenital toxoplasmosis is both prevalent and severe in Brazil. The Minas Gerais Congenital Toxoplasmosis Control Program (PCTC-MG) used prenatal and neonatal screening to identify neonates at risk for congenital toxoplasmosis. This study aimed to evaluate the clinical and laboratory parameters used to diagnose the disease in this population.

Methods: This retrospective cohort study included children with suspected congenital toxoplasmosis who participated in the PCTC-MG between 2013 and 2020.

Results: A total of 347 children participated in the study; 228 had confirmed toxoplasmosis and 119 were excluded. The majority (314/347; 90.5%) underwent neonatal screening for IgM in filter paper (FP). Among these, 269/314 (85.7%) had positive or indeterminate results, with 186 (69.1%) confirmed infections, while 45/314 (14.3%) had nonreactive results, with 17 confirmed infections. There was an association between treatment during pregnancy (45/227; 19.8%) and a lower number of reagent IgM results in FP ( P = 0.002) and serum ( P = 0.001). A higher gestational age was associated with a higher proportion of IgM in the FP ( P = 0.001) and serum ( P = 0.004). Retinochoroiditis (73.2%; 167/228) and neurologic changes (36.9%; 75/203) were frequent in the infected children. The treatment decision was based on the presence of IgM/IgA (176/226; 77.9%), retinochoroiditis (45/226; 19.9%) or persistence/increase in IgG levels (4/226; 1.8%).

Conclusions: Screening with specific and sensitive serology identified most, but not all, children with congenital toxoplasmosis. Ophthalmologic evaluations and neuroimaging are mandatory in this context. The absence of IgM in the FP did not exclude the diagnosis.

Background: Fusobacterium has become increasingly recognized pediatric pathogen, responsible for a wide spectrum of infections, including otogenic, oropharyngeal, intra-abdominal and soft tissue infections. However, large-scale studies remain limited.

Objective: This study aimed to assess the incidence, clinical features, complications and outcomes of pediatric Fusobacterium infections.

Methods: Retrospective cohort study of children (0-18 years) diagnosed with Fusobacterium infections at a tertiary pediatric hospital between 2010 and 2023.

Results: A total of 195 cases were identified, with a 10-fold increase in incidence over 13 years. Linear regression demonstrated a significant annual rise in Fusobacterium isolations [β = 2.25, 95% confidence interval (CI): 1.99-2.60, P < 0.01], affecting both otologic (β = 0.65, 95% CI: 0.19-1.11, P < 0.01) and nonotologic sources (β = 1.58, 95% CI: 1.23-1.94, P < 0.001). Infections were primarily otogenic (50.2%), followed by skin and soft tissue, intra-abdominal and pharyngeal infections. Patients with otogenic infections were significantly younger (mean 2.6 vs. 10.3 years, P < 0.001). Hospitalization was required in 80.5%, and complications occurred in 37%. No mortality was observed.

Conclusions: Pediatric Fusobacterium infections are rising, with significant clinical complexity and complications. While often otogenic, these infections affect multiple body systems. Awareness of their evolving epidemiology is crucial for optimizing diagnosis and management.

Background: Enteroviruses (EVs)-including echoviruses (Es) and coxsackieviruses-and parechoviruses (PeVs) can cause severe illness among neonates. Recent data on which EV and PeV infections are most reported among US neonates are limited.

Methods: The National Enterovirus Surveillance System (NESS) is a US laboratory-based national surveillance system that collects reports of EV and PeV typing results from patients of all ages. We analyzed NESS data on EV and PeV infections from specimens collected during 2004-2023, including mortality data from 2014 to 2023.

Results: During 2004-2023, 11,065 EV and PeV infections were reported to NESS: 823/9393 (9%) of infections with reported age occurred among neonates. Among 690 neonatal infections with identified virus type, Coxsackievirus type B5 (CV-B5, n = 90; 13%), CV-B4 (70; 10%), CV-B3 (68; 10%), PeV-A3 (63; 9%) and E-11 (56; 8%) were reported most frequently overall, with the top virus types varying from year to year. During 2014-2023, 85/503 neonates with EV or PeV infections had reported outcome (17%), of whom 18/85 (21%) died.

Conclusions: This analysis utilized 2 decades of surveillance data to identify top EV and PeV virus types reported among US neonates. Mortality data emphasize that EV and PeV infections can be severe among neonates and result in death. The variety of enteroviruses observed highlights the need for strengthened surveillance and further research to improve the current understanding of neonatal enteroviral disease and inform future development of prevention and treatment strategies.

Background: Since March 2024, the European Center for Disease Prevention and Control has reported increased Parvovirus B19 (B19V) infections across 14 European countries. While often self-limiting in healthy children, B19V may cause severe disease in vulnerable populations.

Methods: This multicenter prospective study aimed to characterize the clinical presentation of B19V infection in hospitalized children and identify risk factors for severe outcomes. Data were collected through the INF-ACT pediatric surveillance system, as part of the National Recovery and Resilience Plan. Children hospitalized with confirmed B19V infection were enrolled from January to December 2024 in 10 Italian INF-ACT centers.

Results: A total of 135 children were included (median age 7.6 years, interquartile range 4.4-9.9), with 78.5% of cases occurring between April and July 2024. Acute myocarditis (20.7%) and neurologic complications (17.8%) were the most frequent severe manifestations. Myocarditis was significantly associated with younger age ( P < 0.001), longer hospital stays (median 19.5 vs. 6.5 days; P = 0.0018) and higher intensive care unit (ICU) admission rates (71.4% vs. 20.8%; P < 0.001). Multivariate analysis showed myocardial involvement increased the risk of ICU admission over 20-fold ( P < 0.001).

Conclusions: Although often mild, B19V infection can cause severe complications in children, particularly myocarditis and neurologic involvement. Prompt recognition is essential, even in the absence of classic features like erythema infectiosum, to ensure timely monitoring and management of potentially life-threatening outcomes.

Background: Mycoplasma pneumoniae (MP) is a common cause of lower respiratory tract infections in children. During the COVID-19 pandemic, a marked decline in MP infections was observed, with a delayed resurgence reported in some European countries. This study aimed to assess the epidemiologic trends and clinical features of MP infections in a pediatric tertiary care academic hospital in Italy from 2017 to 2024.

Methods: We conducted a retrospective, single-center study including immunocompetent patients 30 days to 17 years of age, hospitalized with confirmed MP infection. Clinical, laboratory, and radiologic data were analyzed across 3 periods: prepandemic (2017-2019), pandemic (2020-2022) and postpandemic (2023-2024). Statistical analyses were performed to compare incidence and clinical characteristics over time.

Results: Of 303 included patients, 130 were hospitalized prepandemic and 148 postpandemics. The proportion of MP among acute respiratory infection hospitalizations nearly doubled, from 3.2% in 2019 to 6.1% in 2024. Despite the higher incidence, the need for respiratory support remained stable (25.7% overall; P = 0.3), the pediatric intensive care admissions were rare and unchanged (2.0% vs. 2.0%, P = 1.0) and median hospital stay was consistent across both periods (5 days, interquartile range 4-8; P = 0.803).

Conclusions: MP incidence increased significantly postpandemic, and clinical severity remained comparable to prepandemic levels. Ongoing epidemiologic surveillance is essential to better understand infection dynamics and to guide effective clinical management strategies.

Background: Pediatric Clostridioides difficile infection (CDI) is a growing concern, yet nationwide data from Japan are scarce. Current guidelines often discourage CDI testing in infants due to a presumed low incidence of clinical disease. We aimed to characterize the epidemiology and risk factors of pediatric CDI in Japan, focusing on age-specific patterns and community-onset cases.

Methods: We performed a retrospective analysis using the Japan Medical Data Center claims database from 2013 to 2022. CDI cases were defined by the presence of both diagnostic testing and anti-CDI treatment within 7 days. Episodes that relapsed within 8 weeks were excluded. CDI onset setting was classified according to CDC/NHSN criteria. Risk factors were evaluated by age and onset setting.

Results: Of the 4090 CDI cases, 284 were pediatric. The incidence in children 0-2 years old was comparable to that in older children, challenging current assumptions. Risk factor profiles varied by age group and setting, with inflammatory bowel disease being a prominent risk factor in children (28.9% vs. 14.8% in adults/older adults), particularly in adolescents (43.5%). Critically, nearly half of community-onset pediatric CDI cases had no prior antibiotic exposure.

Conclusion: This first large-scale study of pediatric CDI in Japan revealed that CDI can occur in children without prior antibiotic exposure, particularly in community settings. These findings support consideration of revisions to management strategies for pediatric CDI.