Pediatric Infectious Disease Journal最新文献

Background: This study aims to assess whether Swiss guidelines for pneumococcal vaccination in children with cochlear implants are followed and whether they elicit adequate pneumococcal vaccine immunity.

Methods: We performed a retrospective analysis at the Western Switzerland University Cochlear Implants Center, reviewing data between January 2009 and December 2023. Vaccination records and serotype-specific pneumococcal IgG concentrations were extracted from computerized medical records.

Results: Fifty children were included, with a median implantation age of 1.5 years. In children <2 years old, 82% (27/33) were up to date with routine pneumococcal vaccination (3 doses of the 13-valent pneumococcal conjugate vaccine administered at 2, 4 and 12 months), yet only 56% (15/27) achieved protective pneumococcal seroprotection. In contrast, among children ≥2 years of age, 24% (4/17) received both the age-appropriate routine schedule and the additional recommended dose of 13-valent pneumococcal conjugate before implantation, and all of these (100%) showed protective seroprotection. An overall decline in seroprotection was observed within 5 years postvaccination, particularly around 5 years of age. Vaccine-induced immunity differed by serotype; serotypes 6B, 14 and 19 elicited higher antibody levels, whereas serotypes 4, 9V and 18C produced lower responses. Notably, children 2-5 years of age tended to exhibit lower overall pneumococcal immunity.

Conclusions: Our findings support the proactive administration of an additional pneumococcal vaccine dose at the time of planning cochlear implant surgery for children ≥2 years old. In addition, periodic monitoring of serotype-specific pneumococcal antibody levels (every 5 years) is recommended to determine the need for booster vaccinations.

The study analyzed pregnancy outcomes among 498 women living with HIV in East Asia. We found 15% had pregnancies postdiagnosis, with 57% resulting in live births. Older age at antiretroviral therapy initiation and higher pre-antiretroviral therapy viral loads were negatively associated with pregnancy. High rates of unplanned pregnancies (61%) and terminations (26%) highlight the need for improved reproductive counseling.

Background and aims: This study aimed to analyze liver fibrosis using transient elastography (TE) and serum biomarkers [aspartate transaminase-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4)] in children with chronic hepatitis C before antiviral treatment and to compare the results of these noninvasive methods.

Methods: All consecutive patients 3-17 years old treated with direct-acting antivirals for hepatitis C virus infection between August 2019 and July 2024 were included. Evaluation of liver stiffness measurement (LSM) was performed before starting treatment with TE. Liver fibrosis was considered significant if the median LSM was >7 kPa, corresponding to a METAVIR F score of ≥2 points. Simultaneously, TE, APRI and FIB-4 evaluations were performed, and their accuracy in the detection of significant fibrosis and cirrhosis was determined by calculating areas under the receiver operating characteristic curve (AUROC) using the LSM results as a reference.

Results: One hundred fifty patients with a median age of 11 years were included. TE evaluation revealed that 139/150 (92.7%) of the participants presented with normal LSMs (≤7.0 kPa), whereas in the remaining 11/150 (7.3%) participants, significant fibrosis was confirmed, correlating to a score of F2 on the METAVIR scale in 6 (4%), F3 in 2 (1.3%) and F4 in 3 (2%). Among the independent predictors of significant fibrosis were age >10 years and duration of infection >10 years. The median APRI and FIB-4 values were significantly greater in children with significant liver fibrosis on TE evaluation. For detecting significant fibrosis, the AUROC was 0.706 for the APRI and 0.802 for the FIB-4, with cutoff values >0.53 for the APRI and >0.24 for the FIB-4. When the accuracies of the APRI and the FIB-4 for detecting cirrhosis were analyzed, the AUROCs were greater: 0.879 for the APRI, with a cutoff >0.53, and 0.96 for the FIB-4, with a cutoff >0.40.

Conclusion: There is some agreement between the results of biomarker (APRI and FIB-4) and TE evaluation, but with the assumption of lower cutoff thresholds indicating significant fibrosis/cirrhosis than previously validated in adults.

Background: Diagnosing extrapulmonary tuberculosis (EPTB) in children is challenging due to nonspecific presentations and poor diagnostic yield from conventional microbiologic tests. Host gene expression signatures offer a non-sputum-based diagnostic alternative. This systematic review evaluates their diagnostic performance in pediatric EPTB.

Methods: We systematically reviewed host-based gene expression diagnostics for pediatric EPTB. PubMed, Embase and Cochrane Library (January 1965-May 2025) were searched for studies in children (0-18 years) with EPTB. Exclusions were adult-only studies, mixed data on pulmonary TB and EPTB without disaggregation, pulmonary TB-only studies, reviews and abstracts. Two reviewers screened data, resolving disagreements by discussion.

Results: Of 830 records, 2 studies met the inclusion criteria: Pan et al. (2017) and Olbrich et al. (2024), both in low and middle-income countries, enrolling a total of 891 children under 15 years. Olbrich et al.'s 3-gene MTB-HR prototype showed 59.8% sensitivity against a strict culture-confirmed reference standard and 50.0% in isolated EPTB with a low risk of bias. Using a microbiologic, clinical and radiologic composite standard, Pan et al.'s miRNA-29a assay achieved 67.2% sensitivity, 88.5% specificity in peripheral blood mononuclear cells; 81.1% sensitivity, 90.0% specificity in cerebrospinal fluid; 84.4% sensitivity, 95.4% specificity in combined peripheral blood mononuclear cell/cerebrospinal fluid with a high risk of bias.

Conclusions: Evidence for host gene expression diagnostics in pediatric EPTB is limited by few studies, small sample sizes, bias and lack of disaggregated data, with accuracy falling short of the World Health Organization targets.

Background: Human bocavirus 1 (HBoV1) is a respiratory pathogen predominantly affecting children. However, its epidemiology and clinical impact remain poorly understood. This study aimed to investigate the seasonality, disease burden and clinical features of HBoV1 infection in hospitalized pediatric patients in Japan.

Methods: We conducted a retrospective study at Tokyo Metropolitan Children's Medical Center from September 2023 to August 2024. Children ≤15 years old hospitalized with respiratory tract infections requiring oxygen therapy and/or noninvasive/invasive mechanical ventilation were included. HBoV1 DNA levels were quantified using real-time polymerase chain reaction (PCR), and acute HBoV1 infection was defined as ≥10 5 copies/mL. A quantitative PCR test was also performed for respiratory viruses simultaneously detected by a multiplex PCR, to distinguish between HBoV1 monoinfection and coinfection with other viruses.

Results: Among 327 eligible patients, acute HBoV1 infection was found in 13% (44/327), with peak incidence in June and July 2024. HBoV1 monoinfection was 41% (18/44). The patients with HBoV1 monoinfection had a median age of 25 months (interquartile range, 14-50), and 39% had underlying diseases. Fever and cough were common symptoms, and wheezing was observed in half of the patients. Intensive care unit admission was required in 33% of the patients with HBoV1 monoinfection, with 67% of them requiring mechanical ventilation. HBoV1 was the 3rd most common cause in patients admitted to the intensive care unit (19%).

Conclusions: HBoV1 was prevalent in the late spring and early summer during the 2023 to 2024 season in Tokyo, Japan. HBoV1 may contribute substantially to the burden of severe pediatric respiratory tract infections.

We conducted verbal autopsies and abstracted medical records of deceased youth living with HIV to identify missed opportunities for intervention. Of 60 deceased youth, the median age was 20 years, 65% acquired HIV perinatally and 67% were female. Overall, 55% of deaths occurred in hospitals, and 74% had adherence challenges. Mental health challenges and viral failure were key contributors to mortality.