Pediatric Infectious Disease Journal最新文献

Background: Myiasis is caused by the infestation of fly larvae and occurs more frequently in tropical, rural and low socioeconomic areas. We report a rare case of umbilical myiasis in a neonate, complicated by sepsis caused by Staphylococcus aureus.

Case report: The patient, born in a vulnerable family, presented on the fourth day of life with erythema in the umbilical region, accompanied by serous drainage and visible larvae. Immobilization and manual removal of the larvae were attempted 3 times but proved ineffective. On the 10th day of hospitalization, oral ivermectin (200 μg/kg) was administered. Two days after initiating the medication, no larvae were observed, and no adverse events occurred. The delay in initiating treatment, due to insufficient robust evidence of ivermectin's safety in children weighing less than 15 kg, contributed to complications and prolonged hospitalization.

Discussion: Umbilical myiasis reflects inadequate hygiene conditions and socioeconomic vulnerability. Traditional management in children under 15 kg includes occlusion with Vaseline or similar substances and mechanical removal of the larvae. This report emphasizes the critical need for safety studies on ivermectin's use in children weighing less than 15 kg, considering its potential to significantly improve the management of neglected parasitic diseases.

Background: Diarrheagenic Escherichia coli (DEC) is a major cause of pediatric diarrhea, particularly in low- and middle-income countries. Antimicrobial resistance, including extended-spectrum β-lactamase (ESBL) production, further complicates clinical management. This study investigated DEC pathotypes, resistance patterns, ESBL prevalence and integron carriage among children with acute diarrhea in Mansoura, Egypt.

Methods: A total of 120 children (median age 6 years; 50.8% male) presenting with acute diarrhea were enrolled. Clinical data were recorded, and stool samples were cultured for E. coli. Phenotypic antibiotic susceptibility testing, ESBL detection and polymerase chain reaction assays for DEC pathotypes and class I/II integrons were performed.

Results: E. coli was isolated from 60 (50%) children. The predominant pathotype was Shiga toxin-producing E. coli (STEC, 46.7%), followed by typical enteropathogenic E. coli (tEPEC, 45%) and atypical EPEC (aEPEC, 8.3%). High resistance rates were observed for amoxicillin/clavulanic acid (85%), cefadroxil (60%) and ampicillin (58.3%). ESBL production was detected in 41.7% of isolates. Class I and II integrons were identified in 51.7% and 16.7% of isolates, respectively, with a strong association between both integrons in STEC and tEPEC (P < 0.001). No significant association was found between integron carriage and ESBL production (P = 0.34) or antibiotic resistance profiles.

Conclusions: DEC is a significant cause of pediatric diarrhea in Egypt, with STEC and tEPEC predominating. The high prevalence of antimicrobial resistance, ESBL production and integron carriage underscores the urgent need for surveillance programs, antimicrobial stewardship and improved infection control to limit resistance dissemination in pediatric populations.

Background: Prolonged fever occurs in some adults with dengue and is linked to greater severity. However, its frequency, characteristics and clinical outcomes in pediatric dengue remain unclear.

Methods: We performed a prospective study in a dengue hyperendemic region of Colombia, including hospitalized children with confirmed dengue presenting warning signs or severe dengue (SD). Prolonged fever was defined as persistent temperature >38.3°C beyond day 7 of illness. We evaluated prolonged fever frequency, clinical features, immunologic status and outcomes.

Results: Among 253 children (204 dengue warning signs, 49 SD), prolonged fever was identified in 11.06%. Median duration of fever >38.3°C in prolonged fever cases was 8 days. Children with prolonged fever had a higher proportion of SD compared with those without prolonged fever, and longer hospital stay. Rates of community-acquired secondary bacterial infections did not differ significantly, but children with prolonged fever had a higher occurrence of healthcare-associated secondary bacterial infections. Children with prolonged fever showed elevated inflammatory markers (C-reactive protein, interleukin-6, interleukin-10 and interferon-g), as well as ex vivo dysfunction of monocytes. All patients experienced spontaneous clinical and laboratory resolution without the need for steroids, immunoglobulin or antibiotics, except in confirmed secondary infections.

Conclusions: Prolonged fever is relatively frequent in pediatric patients hospitalized with dengue and is associated with clinical severity, immune dysregulation and an increased risk of healthcare-associated secondary bacterial infections. These findings highlight the importance of close monitoring of children with prolonged fever for secondary complications and the microbiologic confirmation of suspected bacterial infections to guide timely and rational antimicrobial therapy.

Background: Nontuberculous mycobacterial (NTM) adenitis is increasingly recognized in children; however, optimal management strategies remain debated. The aim of this study was to describe the clinical characteristics, management and outcomes of pediatric NTM lymphadenitis in France.

Methods: We conducted a multicenter retrospective descriptive study of culture-confirmed NTM lymphadenitis cases in children across 15 French hospitals participating in the MYCOMED network between 2010 and 2019.

Results: A total of 279 patients were included, with a progressive increase in diagnoses over the study period, from 11 cases in 2010 to 33 in 2019, with peaks of 38 observed in 2015 and 2018. Most patients were female (64%) with a median age of 3 years. Mycobacterium avium was the most frequently isolated species (71%). Histologic examination revealed necrotizing granulomatous lymphadenitis in two-third of cases (71%, 112/115), and acid-fast bacilli staining was positive in 24.6% (68/276) of the cases. Of the 250 patients with available therapeutic data, 34.8% were treated with surgery alone, 24.8% with antibiotics alone, 28% with combined therapy and 12.4% received no treatment. Overall, 104 children were lost to follow-up. Among 175 patients with follow-up data, the overall cure rate was 96%, with no significant differences between therapeutic strategies. Relapse occurred in 6 children (3.4%). No cases of facial nerve palsy were reported; however, cosmetic sequelae related to scarring were observed.

Conclusions: The incidence of pediatric NTM adenitis has increased over the last decade in France, with M. avium as the predominant species. The clinical outcome was favorable in most cases, irrespective of the management strategy. Surgery with complete excision should be considered when technically feasible and safe, while antibiotics or a "wait and see" strategy remain acceptable alternatives.

Objective: To describe missed opportunities in the prevention of congenital syphilis (CS) and to analyze antenatal factors associated with clinical and/or laboratory manifestations at birth in a cohort of CS neonates in Brazil.

Methods: This cohort study included 240 neonates evaluated for CS between 2016 and 2021. Neonates were categorized as (1) Infected-clinical, laboratory or imaging findings compatible with CS or a Venereal Disease Research Laboratory titer ≥4-fold the maternal titer; (2) Reported-reactive Venereal Disease Research Laboratory (maternal and neonate samples) without clinical/laboratory abnormalities and maternal inadequate or absent treatment; and (3) Exposed-adequate maternal treatment and no signs of CS at birth. Maternal and perinatal variables were collected and compared across groups.

Results: Among the 240 neonates, 55% were male and 69% non-White. Although 94% of mothers received antenatal care (mean 7.3 visits), only 72% were treated for syphilis, and several received inadequate or delayed treatment. Thirty-three neonates (14%) met criteria for CS infection; 64 (26%) were reported and 143 (60%) were classified as exposed. Infected neonates presented with neurosyphilis (18%), bone abnormalities (6%) or nonspecific signs, including low birth weight, prematurity and hepatomegaly. Multivariate analysis identified maternal recreational drug use (odds ratio = 5.75; 95% confidence interval: 1.20-27.51) and lack of partner treatment during pregnancy (odds ratio = 3.48; 95% confidence interval: 1.08-11.23) as independent risk factors for neonatal classifications as CS infected.

Conclusions: A significant proportion of CS cases occurred due to inadequate maternal management (64/97, 67%). Interventions must prioritize comprehensive maternal-partner management and consider behavioral risk factors in the CS cascade of care.

We conducted a 5-year multicenter, retrospective cohort study to describe bacterial meningitis in Australian infants (0-180 days). Of 21 culture-positive infections, Streptococcus agalactiae (29%, 6/21), Staphylococcus aureus (19%, 4/21) and Escherichia coli (19%, 4/21) predominated. Four infants died (19%), including 3 with neurosurgical meningitis. In survivors, neurologic sequelae were common. Novel interventions to reduce the morbidity and mortality burden caused by neonatal meningitis are needed.

We characterized the clinical characteristics of invasive group A streptococcal (iGAS) cases among Los Angeles County residents <18 years of age during July 2023-June 2024. Among 53 iGAS cases, 47% had potentially delayed diagnoses and 10% died. Providers should maintain elevated levels of suspicion for iGAS in children with repeat clinical presentations or risk factors such as recent viral infections.