Pediatric Infectious Disease Journal最新文献

Introduction: Promptly identifying children and adolescents living with both tuberculosis (TB) disease and human immunodeficiency virus (HIV) and ensuring they receive antiretroviral treatment (ART) can reduce TB/HIV-associated mortality. We reviewed linkage of children and young adolescents with TB to HIV services at clinical sites in 16 high TB/HIV-burden sub-Saharan African countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

Methods: PEPFAR monitoring, evaluation and reporting data describing persons <15 years of age with TB disease during October 2018-September 2022 were reviewed. Indicators included known HIV status (proportion of clients with TB who have known HIV status), HIV positivity (proportion with TB and known HIV status who have HIV, including those newly identified and those already diagnosed with HIV) and ART linkage (proportion with TB/HIV coinfection who were receiving ART). Data were collected quarterly except for ART linkage (collected annually starting in October 2021). Trend performance of indicators during the 4-year period by quarter and annual performance, stratified by sex, age, geographic region and ART status in the final year are described.

Results: Among children and adolescents <15 years old with TB during October 2018-September 2022, known HIV status quarterly coverage increased (90% [October-December 2018] to 91% [July-September 2022]); HIV positivity decreased (22%-14%), including newly positive (7%-4%); and ART coverage increased (90%-97%). In total, during October 2021-September 2022, among 73,183 children with TB, 93% (n = 67,968) had a known HIV status, of which 14% (9295/67,968) were positive (4% newly identified [2730/67,968] and 10% already diagnosed [6565/67,968]). Of 9295 with TB/HIV, 97% (9050/9295) were currently or newly started on ART. Known HIV status was lower among infants <1 year (74%, 4883/6605), and ART linkage was lower among children <1 (93%, 502/542) and 1-4 years of age (93%, 2791/2993).

Conclusions: These findings highlight effective PEPFAR-supported integration of HIV services into TB services; however, gaps among young children persist. While HIV positivity decreased among children and adolescents with TB, universal HIV testing of those with TB remains an important strategy to close pediatric HIV treatment gaps and reduce mortality in high-burden countries.

Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) and hospitalizations in infants, particularly during the first months of life. In December 2023, Argentina introduced maternal RSV immunization with the RSV-preF vaccine into its National Immunization Program. The objective of this study was to evaluate the impact of this strategy, implemented in 2024, on the burden of severe respiratory disease among infants under 6 months of age.

Methods: We conducted a controlled before-and-after quasi-experimental study using active surveillance data from 3 sentinel pediatric hospitals in Argentina (2022-2024). Hospitalized LRTI cases in children under 5 years were included and stratified into 3 age groups: <6 months (intervention group), 6-11 months and 12-59 months (age-based controls). RSV and human metapneumovirus were confirmed by molecular methods. Hospitalization rates per 1000 all-cause discharges were calculated. Impact was estimated using rate ratios, incidence rate reduction (IRR) and crude difference-in-differences.

Results: A total of 4103 hospitalized LRTI cases were included. Among infants <6 months, all-cause LRTI hospitalization rates declined by 41% (IRR: 40.7%; 95% confidence interval: 29.7-49.9), and RSV-associated hospitalizations decreased by 35% (IRR: 34.9%; 95% confidence interval: 16.9-49.0) between pre- and post-intervention periods. An estimated 258 all-cause LRTI and 102 RSV LRTI-related hospitalizations were prevented in this age group. No significant changes were observed in older age groups or in human metapneumovirus-associated hospitalizations. Crude DiD analysis estimated an attributable impact of 15%-16%, although not statistically significant.

Conclusions: Maternal RSV immunization was associated with a substantial reduction in LRTI and RSV-related hospitalizations among infants under 6 months. These findings support the use of this strategy to reduce severe respiratory illness during the RSV season.

Introduction: Early identification of invasive bacterial infections (IBI) in febrile infants under 90 days is essential, with blood biomarkers widely used for their risk evaluation. However, their diagnostic performance may vary by causative organism or type of IBI.

Methods: We conducted a retrospective, multicenter study of infants ≤90 days with IBI treated in pediatric emergency departments of 18 hospitals (Spain and Latin America) from 2008 to 2022. IBI was defined by isolation or polymerase chain reaction (PCR) detection of a pathogenic bacterium in blood or cerebrospinal fluid. Sensitivity of standard biomarker cutoffs was analyzed by pathogen and IBI type, with multivariate regression adjusting for age, sex, temperature, symptom duration and clinical presentation.

Results: Of 395 infants, Escherichia coli (45.6%) and Streptococcus agalactiae (25.6%) were the most frequently isolated bacteria, and bacteremia (43.8%) and bacteremic urinary tract infection (41.3%) were the most frequent IBI. Biomarker responses varied by organism and IBI type. E. coli IBIs showed higher white blood cell (WBC) and absolute neutrophil (ANC) counts and C-reactive protein levels than S. agalactiae IBIs. Only procalcitonin had high sensitivity for S. agalactiae IBIs. Standard cutoffs for WBC and ANC showed sensitivities below 50% for all pathogens and types of IBI.

Conclusion: Biomarker levels in young febrile infants with IBIs depend on IBI type and causing bacteria. Increases in WBC, ANC and C-reactive protein are lower in isolated bacteremias than in bacteremic urinary tract infections. Procalcitonin is the best biomarker for ruling out S. agalactiae IBIs. These distinctions are key to interpreting lab tests and preventing underdiagnosis of invasive infections.

Background and objective: Hematopoietic stem cell transplantation (HSCT) is a curative treatment but carries a high mortality risk due to infections from immunosuppression. Infections by multidrug-resistant (MDR) pathogens are rising, and rectal screening may predict bacteremia and reduce mortality. This study aims to evaluate the utility of periodic rectal screening in predicting MDR-induced bacteremia by day 100 in pediatric HSCT patients.

Materials and methods: A retrospective cohort study was conducted in patients under 18 who underwent rectal screening before HSCT at a high-complexity center between 2018 and 2022. Descriptive analysis and regression models identified risk factors for bacteremia and mortality.

Results: Two hundred ten HSCT procedures were analyzed. MDR colonization was found in 51.9% of patients, with 18.1% of colonized individuals developing bacteremia. Colonization was a significant risk factor for MDR Gram-negative bacteremia (relative risk ratio 7.25, 95% CI: 1.97-26, P = 0.003), and was associated with higher mortality ( P = 0.034).

Conclusions: Rectal screening effectively identifies MDR bacterial colonization in pediatric HSCT patients and facilitates targeted empirical antibiotic therapy adjustments, representing a valuable tool for clinical management in this population.

Background: Infant botulism accounts for many new botulism cases each year. Geographic case clustering has been previously described in California. This study aimed to describe whether case clustering was present in Victoria, Australia.

Methods: We conducted a retrospective case series of infant botulism presenting to Victorian hospitals between 1978 and 2024. Moran's I test for spatial autocorrelation was used to determine if spatiotemporal clustering was present.

Results: Twelve cases of infant botulism presented to Victorian hospitals in the study period. Using Moran's I statistic in analyzing the number of cases in each postcode of interest, a case clustering was demonstrated in the northwest of Victoria ( P < 0.01).

Conclusions: We describe a geographic case clustering within the relatively sparsely populated northwest in Victoria, Australia.

Background: Pediatric coronavirus disease (COVID-19)-associated encephalopathy can lead to severe neurologic complications. However, data comparing it with other infectious encephalopathies are limited. This study aimed to compare the clinical characteristics of COVID-19-associated encephalopathy with those of influenza-associated encephalopathy, which serves as a representative model of severe infectious encephalopathy in Japan. Additionally, we assessed the factors associated with a poor prognosis.

Methods: We conducted a retrospective cohort study of patients with COVID-19- and influenza-associated encephalopathy admitted to 7 children's hospitals in Japan between January 2017 and December 2023. Clinical characteristics were compared using the Mann-Whitney U test and Fisher exact test. Additionally, logistic regression analysis was performed to identify factors associated with a pediatric cerebral performance category score ≥4 at discharge.

Results: A total of 89 patients were included: 29 in the COVID-19 group and 60 in the influenza group. Demographics and initial clinical characteristics were similar between groups. However, a significantly higher proportion of patients in the COVID-19 group had a pediatric cerebral performance category score ≥4 at discharge (37.9% vs. 16.7%, P = 0.04). In each of the 3 separate multivariable models, COVID-19, the presence of underlying neurologic conditions and shorter time from onset to encephalopathy diagnosis were independently associated with poor prognosis.

Conclusions: The clinical characteristics of the 2 groups were similar; however, patients with COVID-19-associated encephalopathy showed worse discharge neurologic outcomes, warranting cautious interpretation. Enhancing public awareness of the severe outcomes and conducting further research is essential for better understanding its pathogenesis and treatment.

Background: Recurrent Acinetobacter infections (AIs) pose significant treatment challenges and contribute to an increased healthcare burden. Limited data exist on recurrent infections in pediatric patients, making it essential to better define their clinical and microbiological characteristics to guide effective management strategies.

Methods: We retrospectively reviewed patients 0-18 years of age hospitalized between 2019 and 2024 with confirmed AI. Recurrent infection was defined as a new episode occurring within 90 days after clinical recovery and documented negative cultures. Clinical, microbiological and laboratory data, as well as treatment regimens and outcomes, were analyzed.

Results: Among 150 pediatric patients with AI, the majority had underlying diseases (82.7%) and prolonged hospital stays exceeding 30 days (71.4%). Overall, 66.7% of isolates were multidrug- or extensively drug-resistant. Recurrent AI developed in 15.3% of patients, most frequently associated with port-catheter and bloodstream infections, and was significantly linked to longer hospitalization. Overall mortality was 34.7%, increasing to 47.8% in patients with recurrent AI. Independent risk factors for mortality included intensive care unit admission, the presence of multiple clinical findings, lymphopenia and hypocalcemia, while recurrent AI was independently associated with prolonged hospital stay.

Conclusions: Recurrent AIs in pediatric patients impose a substantial clinical burden, being associated with both prolonged hospitalization and increased mortality. Identifying high-risk groups, particularly those with underlying diseases and critical illness, and ensuring closer monitoring with targeted management strategies are essential to improve clinical outcomes.

Background: Infants who are HIV-exposed uninfected (HEU) are at greater risk of death compared with infants who are HIV-unexposed, particularly in the first 6 months of life. We investigated the causes of death (CoD) of HEU and HIV-unexposed infants using postmortem minimally invasive tissue sampling.

Methods: This prospective, observational study enrolled decedents less than 6 months of age at a secondary-tertiary level care hospital in Soweto, South Africa. The minimally invasive tissue sampling included needle core-biopsy sampling for histopathology of brain, lung and liver tissue. Microbiologic culture and/or molecular tests were performed on lungs, liver, blood and cerebrospinal fluid. Underlying, immediate and antecedent CoD were determined by a multidisciplinary team of medical experts.

Results: The median age (9 [interquartile range 3, 30] vs. 8 [interquartile range 3, 22] days) and sex distribution (female 58.5% vs. 47.9%) were similar between HEU (n = 65) and HIV-unexposed (n = 119) decedents. A larger proportion of HEU decedents (60%, 39/65) compared with HIV-unexposed decedents (44.5%, 53/119; P = 0.045) had preterm birth as an underlying CoD. Among HEU infants compared with HIV-unexposed infants, sepsis was attributed as an immediate or antecedent cause of death in 46.2% (30/65) versus 36.1% (43/119), respectively. Of the 30 HEU infants with sepsis, 76.7% (23/30) were classified as presumed hospital acquired, most commonly associated with Acinetobacter baumannii (56.5% [13/23]) and Klebsiella pneumoniae (13.0% [3/23]). Similarly, among HIV-unexposed infants with sepsis (n = 43), 72.3% (31/43) were classified as presumed hospital acquired, with A. baumannii (38.9% [12/31]) and K. pneumoniae (38.9% [12/31]) as the predominant pathogens. Pneumonia was attributed as an immediate or antecedent cause of death in 32.3% (21/65) of HEU and 36.1% (43/119) of HIV-unexposed infants. Among those with pneumonia, presumed hospital-acquired pneumonia was identified in 47.6% (10/21) of HEU and 72.1% (31/43) of HIV-unexposed infants (P = 0.035), most frequently due to A. baumannii (50.0% [5/10] HEU; 41.9% [13/31] HIV-unexposed) and K. pneumoniae (30.0% [3/10] HEU; 19.4% [6/31] HIV-unexposed). Presumed community-acquired pneumonia was identified in 52.4% (11/21) of HEU and 27.9% (12/43) of HIV-unexposed infants (P = 0.035). The predominant community-acquired pathogens were respiratory syncytial virus (36.4% [4/11] HEU; 25.0% [3/12] HIV-unexposed) and K. pneumoniae (36.4% [4/11] HEU; 8.3% [1/12] HIV-unexposed).

Conclusions: Our study highlights preterm birth as an important underlying CoD among HEU and HIV-unexposed decedents. There was a larger proportion of presumed community-acquired pneumonia deaths in HEU compared with HIV-unexposed decedents. Further research is warranted to explore these differences and develop effective preventive strategies.