Pediatric Infectious Disease Journal最新文献

Background: Human noroviruses are a leading cause of acute gastroenteritis worldwide, with GII.4 Sydney 2012 [P16], being the predominant circulating genotype in Italy in recent years. Outbreaks in pediatric hospital wards represent a major public health concern.

Methods: Eight stool samples collected between November 2023 and February 2024 at Brescia Civic Hospital were analyzed by real-time polymerase chain reaction, sequence-independent single-primer amplification and next-generation sequencing.

Results: All isolates belonged to GII.4 Sydney 2012 [P16] genotype. Five isolates from December 2023 clustered tightly together, confirming a nosocomial outbreak with near-complete sequence identity. Isolates from November 2023, January 2024 and February 2024 were phylogenetically distinct, with 1 isolate (January 2024) clustering in a completely separated tree portion, carrying 30 amino acid substitutions and 237 synonymous mutations.

Conclusions: Our analysis confirmed a nosocomial outbreak and underscored the substantial intra-genotypic diversity of GII.4 Sydney 2012 [P16] genotype. These findings highlight the importance of rapid diagnosis, infection control measures and continuous genomic surveillance to track the evolution and global circulation of epidemic noroviruses.

Background: This is a retrospective study to report our experience with a cohort of 50 patients with Kawasaki disease (KD) over 5 years.

Method: The study was conducted in the Department of Pediatrics. Data were retrieved from the medical records of patients admitted with KD collected from 2020 to 2024 and analyzed.

Results: Fifty children were included (male:female = 3.1:1; median age 2.6 years). Fever was universal, with a median duration of 7.5 days. Oral mucosal changes (68%) and rash (64%) were the most common clinical features. Coronary artery abnormalities (CAAs) were detected in 33 children (66%), comprising coronary dilatation (12.1%), small aneurysms (54.6%), medium aneurysms (24.2%), and giant aneurysms (9.1%). Left-sided coronary involvement, particularly of the left main and left anterior descending arteries, predominated and was associated with persistence of aneurysms on follow-up. Younger age and prolonged fever (>7 days) were significantly associated with CAAs (P < 0.05), while other classical clinical features showed no significant correlation. All patients received intravenous immunoglobulin and aspirin. Follow-up echocardiography was available in 72% of patients; 69.7% showed complete resolution of CAAs, while 30.3% had persistent but regressing aneurysms. No fatality or any long-term adverse effects were observed on follow-up.

Conclusion: The disease needs to be considered as a differential diagnosis in an acute febrile illness in children persisting up to 5 days. Fever >7 days is significantly correlated with coronary abnormalities. Hence, early diagnosis is important to prevent morbidity.

Introduction: Advanced microbiologic diagnostics have expanded the spectrum of bacterial species identified in otitis media (OM). The clinical significance of atypical otopathogens remains unclear. This study compares characteristics and outcomes of pediatric OM caused by atypical versus typical pathogens.

Methods: In this retrospective cross-sectional study of children (0-18 years) with culture-positive monomicrobial OM at a secondary care center (2021-2024), we assigned Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis and Pseudomonas aeruginosa from chronic suppurative OM (CSOM) cases to the typical group; other isolates were atypical. Clinical outcomes were compared using 1:1 matched cohorts and propensity scores.

Results: Thirty-one children were included in both the atypical and typical groups. Six typical cases involving P. aeruginosa from CSOM were included in a supplementary analysis. Turicella otitidis predominated among atypical isolates (n = 13, 42%). Following 1:1 matching, atypical otopathogens were significantly associated with older age (5.41 ± 5.08 vs. 2.7 ± 3.7 years, P = 0.006) and prior otologic surgery (42% vs. 10%, P = 0.008). Acute OM was more associated with typical otopathogens (87% vs. 61%, P = 0.016). CSOM was associated with atypical otopathogens (48% vs. 30%, P = 0.034). These differences remained significant after applying the inverse propensity score-weighted approach. No statistically significant differences were observed in clinical outcomes, complication rates or inflammatory biomarkers. Atypical otopathogens demonstrated markedly elevated quinolone resistance (53% vs. 7%).

Conclusions: Atypical otopathogens predominantly affect older children and are associated with distinct disease phenotypes but comparable outcomes to typical pathogens. Current management appears appropriate; however, elevated quinolone resistance warrants consideration in selecting empirical therapy.

Background: The estimated global incidence of acute otitis media (AOM) is >700 million episodes per year, with direct costs of billions of United States Dollars. This economic burden warrants continued investment in vaccine development against otopathogens. To aid in these decisions, an updated estimate of the incidence and costs of AOM and common sequelae is provided.

Methods: A structured search using PubMed and Google Scholar that included English-language articles published from January 2000 to April 2024 was conducted using keywords and Boolean operators. Costs were adjusted to 2025 United States Dollars using the consumer price index inflation calculator provided by the US Bureau of Labor Statistics.

Results: The US incidence of AOM is reported as 2- to 4-fold higher than most other high-income countries, and 3- to 6-fold higher than low- and middle-income countries (LMICs). However, studies of the point prevalence of AOM sequelae, such as chronic suppurative otitis media and acquired hearing loss, are higher in LMICs. The direct cost per AOM episode in the United States ranges from $397 to $718, for other high-income countries from $224 to $878 and for LMICs from $31 to $227. When indirect costs are incorporated, the economic burden of AOM in children under 5 years is estimated at $51-$68 billion/year.

Conclusions: The worldwide incidence of AOM may be higher than prior estimates suggest. The reported frequency of AOM complications in LMICs, especially chronic suppurative otitis media and acquired deafness, is inconsistent with the reported low incidence rates. Costs per episode vary widely but represent a much larger economic burden than previously reported, supporting investment to prevent this infectious disease.

Background: Optimizing antibiotic duration in neonatal intensive care units is essential for antimicrobial stewardship and microbiome preservation. However, the safety of short antibiotic courses for uncomplicated late-onset coagulase-negative staphylococcal (CoNS) sepsis remains uncertain.

Aim: To determine whether short (≤96 hours) antibiotic treatment of uncomplicated CoNS sepsis in premature infants admitted to a neonatal intensive care unit is noninferior to long treatment (>96 hours) by comparing relapse rates.

Methods: This multicenter, observational cohort study reviewed all proven neonatal CoNS sepsis in premature births <32 weeks admitted to 8 neonatal intensive care units in the Netherlands between 2017 and 2020. Uncomplicated CoNS sepsis was defined as clinical recovery within 24-48 hours, no central venous line in place or removed after the onset of sepsis, no signs of necrotizing enterocolitis or infected thrombus, and no Staphylococcus lugdunensis bacteremia. Data on patient characteristics, antibiotic treatment and relapse rates were systematically collected. The incidence of relapse (<72 hours after discontinuation of treatment) was calculated as the proportion (%) of the total. The noninferiority margin was set at 2%. A Pnoninferiority value <0.025 was considered significant.

Results: A total of 669 proven late-onset CoNS sepsis were identified. Of these, 390 were uncomplicated. Among uncomplicated cases, 172 were treated ≤96 hours and 218 >96 hours. Patient characteristics showed no significant differences. One relapse occurred in the short-treatment group (0.58%), none in the long-treatment group, with a significant Pnoninferiority value of 0.007.

Conclusions: The relapse rate in uncomplicated CoNS sepsis was extremely low (<1%), even with short-course treatment. In premature infants with uncomplicated CoNS sepsis, shorter antibiotic treatment is noninferior to longer treatment, confirming its safety and effectiveness.

Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, presenting with a wide clinical spectrum ranging from asymptomatic newborns to severe neurologic sequelae. The use of brain magnetic resonance imaging (MRI) in asymptomatic cCMV-infected neonates poses a diagnostic and therapeutic challenge. Although MRI is more sensitive than cranial ultrasound in detecting subclinical brain abnormalities, the prognostic significance of mild findings, such as isolated white matter abnormalities, remains unclear. Current guidelines recommend antiviral therapy primarily for symptomatic neonates, for those with persistent isolated thrombocytopenia or hepatomegaly, and for neonates with sensorineural hearing loss, while treatment for asymptomatic infants with radiologic abnormalities is controversial. This case report describes an asymptomatic infant with cCMV and isolated white matter abnormalities on brain MRI, raising the dilemma of treating or not these lesions, but also the retrospective discussion of whether an MRI was indeed needed. This case highlights the urgent need for prospective studies to better define the role of MRI and antiviral therapy in asymptomatic newborns with neuroradiological abnormalities, balancing benefits, risks, costs and psychologic impact on families.

Background: Primary sternal osteomyelitis (PSO) in children is a rare condition with less than 100 cases described in the literature. Sternal pseudotumors and Self Limiting Sternal Tumor of Childhood (SELSTOC) as a different entity seem to have similar clinical findings but a completely different approach to treatment.

Methods: We analyze a case series of 5 cases of PSO and review the literature to compare PSO and SELSTOC.

Results: Main symptoms of PSO and SELSTOC involve presternal swelling (90% vs. 100%), pain (70% vs. 58%), erythema (47% vs. 27%) and fever (60% vs. 21%). The most reliable laboratory marker is erythrocyte sedimentation rate (96% vs. 100% positive), followed by C-reactive protein (89% vs. 65% positive) and white blood cell count (64% v.s 45% elevated). A pathogen could be isolated in 88% of PSO cases, whereas only in 6% of SELSTOC cases. While intervention or surgery rates were similar (58% vs. 38%), treatment with antibiotics differed significantly (100% vs. 33%).

Conclusions: Considering the similarities in clinical and radiologic features, SELSTOC might be a phenotype of PSO rather than a separate entity. Improved pathogen detection may help clarify its relationship to PSO and guide appropriate management strategies, particularly to avoid unnecessary treatment in benign cases of PSO.