Pediatric Infectious Disease Journal最新文献

Twice-daily dosing of Dolutegravir is approved for adults with HIV and integrase strand transfer inhibitor resistance, but not for children. Population pharmacokinetic modeling and simulations identified a weight-tiered twice-daily dose for children, predicted to yield dolutegravir exposures within the therapeutic window and provide similar efficacy and safety as seen in adults with HIV-1 and first-generation integrase strand transfer inhibitor resistance.

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.