Pediatric Infectious Disease Journal最新文献

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.

Background: Postexposure prophylaxis (PEP) is critical in preventing HIV acquisition after risky exposures, particularly in pediatric sexual assault victims. Despite its importance, adherence and follow-up remain significant challenges.

Objectives: This study evaluates PEP and follow-up adherence and efficacy among pediatric sexual assault victims treated at a tertiary care hospital in Turkey.

Methods: A retrospective analysis was conducted on 119 pediatric patients 1 month to 18 years of age, treated between September 2017 and September 2022. Data were collected on demographics, PEP initiation and completion, follow-up rates and serologic testing for HIV. PEP compliance, follow-up adherence and outcomes were analyzed.

Results: PEP was initiated in 97% of the eligible 119 patients, with 70% completing the regimen. Compliance showed no significant differences by sex or age. Follow-up adherence decreased progressively, from 55% at the first month to 30% by the sixth month. Nausea and vomiting occurred in one case, indicating a low incidence of side effects. None of the patients seroconverted to HIV.

Conclusion: A structured care system involving multidisciplinary collaboration, pioneered by pediatric infectious diseases, can lead to high PEP initiation and completion rates in children. Single-pill PEP regimens may enhance adherence. However, the decline in follow-up rates underscores the need for improved follow-up mechanisms and future interventions.