Pediatric Infectious Disease Journal最新文献

Oropharyngeal Kingella kingae DNA was identified in 16 of 16 children with proven K. kingae bone and joint infection (BJI) (sensitivity 100%; 95% confidence interval: 79-100) and in 33 of 112 with disproven K. kingae BJI (specificity 71%; 95% confidence interval: 61-79). Due to low specificity, we advocate against oropharyngeal K. kingae DNA testing as a diagnostic tool in children suspected of BJI.

Background: Brain abscesses/empyema are suppurated intra- or peri-cerebral accumulations. The incidence is low, and mortality is decreasing, but their management remains nonconsensual. Our aim was to describe the duration of antibiotic therapy required to cure our infected population and to identify factors associated with prolonged intravenous antibiotic therapy lasting more than 3 weeks, according to our local protocol.

Methods: Pediatric patients with cerebral abscess/empyema treated at Toulouse University Hospital between January 2002 and October 2022 were included. Clinical, biologic, radiologic and therapeutic characteristics, as well as the presence of sequelae, were recorded. A univariate analysis was performed to compare the "≤3 weeks intravenous" group with the ">3 weeks intravenous" group.

Results: Seventy patients were included. One patient died quickly of cerebellar involvement. There were no recurrences. The median total duration of antibiotic treatment was 42 days (42; 59), and 22.5 days for intravenous antibiotic therapy alone (21; 36). Factors associated with a longer period than 3 weeks of intravenous antibiotic treatment were: the presence of an abscess, epileptic seizure/neurologic deficit at diagnosis and a neurosurgical procedure. Significant cognitive sequelae were also associated with an extended period of treatment. Persistent contrast enhancement at the time of switching and of discontinuing antibiotic therapy was not associated with an extended period of antibiotic therapy.

Conclusions: This study suggested that a 3-week course of intravenous antibiotic therapy combined with a 3-week course of oral antibiotics is sufficient for full recovery in many children with brain abscesses or empyema. Complicated cases require a more extended period of antibiotic therapy.

We report a case of Epstein-Barr virus (EBV)-associated vulvar ulcer in a 17-year-old girl, with EBV DNA confirmed by polymerase chain reaction (PCR) in both blood and ulcer swab. A history of receptive orogenital exposure raises the possibility of local viral inoculation. This case highlights the value of EBV testing in adolescents presenting with acute genital ulceration of unclear etiology.

Objective: To elucidate the clinical characteristics and risk factors associated with liver injury in children with severe Mycoplasma pneumoniae pneumonia (SMPP).

Methods and materials: This 2-center retrospective study analyzed 1321 children with SMPP from Nanjing Medical University Affiliated Children's Hospital (January-December 2023), divided into liver injury (alanine aminotransferase > 80 IU/L) and nonliver injury groups. Medical records were used to compare clinical features and prognoses. External validation used data from 640 patients at Nanjing Lishui People's Hospital.

Results: Of the 1321 patients, 55 had liver injury. These patients were typically older, had more severe pulmonary manifestations (eg, pulmonary consolidation, atelectasis and pleural effusion), and higher levels of white blood cell count, neutrophil percentage, neutrophil-to-lymphocyte ratio, lactate dehydrogenase (LDH), D-dimer, alanine aminotransferase, and aspartate aminotransferase. They also had longer hospital stays, higher costs and greater need for intensive care and oxygen support, along with higher risks of pulmonary embolism, necrotizing pneumonia and refractory Mycoplasma pneumoniae pneumonia. Multivariate logistic regression identified elevated LDH (odds ratio =1.040, 95% confidence interval: 1.027-1.055, P < 0.001) and D-dimer (odds ratio = 2.149, 95% confidence interval: 1.648-2.802, P < 0.001) as independent risk factors. The combined prediction model showed an area under the curve of 0.811. External validation confirmed the reliability of LDH and D-dimer as predictive biomarkers.

Conclusions: SMPP with liver injury shows distinct clinical features. Affected children are often older and exhibit severe pulmonary symptoms. These patients face prolonged hospitalization, higher medical costs and increased need for intensive care and oxygen support. They are also at greater risk of adverse outcomes such as pulmonary embolism, necrotizing pneumonia and refractory M. pneumoniae pneumonia. External validation confirms LDH and D-dimer as reliable predictive biomarkers.

Background: Rabies is a uniformly fatal but vaccine-preventable disease. In India, the standard 4-session intradermal rabies post-exposure prophylaxis is currently administered. The World Health Organization has recommended a shortened 3-session regimen. Pediatric and adolescent-specific data for this abbreviated protocol remain sparse.

Objectives: To evaluate the immunogenicity of the 3-session intradermal rabies post-exposure prophylaxis regimen among children and adolescents under 18 years of age in India and to assess its adequacy for potential policy adoption.

Methods: A descriptive cross-sectional study was conducted at the Animal Bite Clinic of a tertiary teaching hospital in New Delhi, India. Eighty-two children and adolescents presenting for the 4th rabies vaccine dose were enrolled. Blood samples were collected before administration of the fourth dose, and IgG anti-rabies virus glycoprotein antibody values were estimated using indirect enzyme-linked immunosorbent assay. Values ≥0.5 EU/mL were considered seroprotective. Participants were followed up for 1 year for any development of rabies.

Results: Of the 82 participants, 79 (96.3%) had seroprotective values. The geometric mean value was 2.67 EU/mL. Three participants (3.7%) had values <0.5 EU/mL. Follow-up assessment post-4th dose confirmed seroconversion in 2 of them. The use and type of rabies immunoglobulin had no significant effect on seroconversion. No participants developed rabies over a 1-year follow-up.

Conclusions: Although seroconversion was achieved in 96.3% of participants after 3 sessions, the 3.7% with nonprotective values raise concerns. Given the fatal nature of rabies and infrastructural variability in Indian healthcare, continuation of the 4-session regimen is recommended until broader validation is conducted in a representative pediatric population via multicentric studies.

Infectious myositis in children is typically linked to influenza viruses and involves the lower limb muscles. We report the first pediatric case of bilateral temporal myositis associated with adenovirus infection in a 3-year-old child. Diagnosis was supported by ultrasound evidence of temporalis muscle inflammation. Symptoms resolved with supportive care, and 1-month follow-up confirmed full recovery without recurrence or complications.

Background: Maternal antibodies are critical for infant protection. We analyzed the dynamics of placental transferred antibodies generated after SARS-CoV-2 maternal infection and/or vaccination.

Methods: Prospective, multicenter, observational study of SARS-CoV-2-infected and/or vaccinated pregnant people and their infants. We collected maternal and cord blood samples at delivery and neonatal/infant samples at delivery, 1, 2, 6 and 12 months of age. Receptor Binding Domain (RBD) and Spike immunoglobulin G antibody titers were measured by Enzyme Linked Immunosorbent Assay (ELISA). Serum maternal cytokines were measured at delivery using the Olink platform. We analyzed differences in antibody transfer according to infection versus vaccination, adjusted for trimester of gestation.

Results: We collected blood samples from 193 pregnant people (infected = 96, vaccinated = 60 and infected and vaccinated = 37) and 154 infants (n = 76, n = 47 and n = 31, respectively). At birth, RBD median (interquartile range) log 10 ng/mL antibody titers of infants from vaccinated-only [4.28 (3.48-4.80)] and from infected-and-vaccinated mothers [4.61 (4.27-4.93)] were higher than from infected-only mothers [2.20 (0.10-3.30); P < 0.001]. Differences persisted through 6 months of age. Median (interquartile range) transplacental antibody transfer ratio was higher in vaccinated-only [2.94 (1.34-3.74)] versus infected-only pregnant people [1.19 (0.33-2.52); P < 0.01]. Spike antibodies showed similar results. Linear regression analysis showed that mean RBD and Spike antibodies transfer ratios were higher in infants from vaccinated-only versus infected-only mothers, adjusted for trimester of infection or vaccination. Maternal concentrations of CXCL10, CXCL11, IL-18 and IFNg at delivery were inversely correlated with placental antibody transfer.

Conclusions: Antibodies generated by maternal vaccination were transplacentally transferred more efficiently and persisted longer in infants than those generated by SARS-CoV-2 infection alone.