Pub Date : 2026-02-01Epub Date: 2025-10-08DOI: 10.1097/INF.0000000000004984
İlknur Çağlar, Özlem Bağ, Miray Yilmaz Çelebi, Elif Kiymet, Elif Böncüoğlu, Şahika Şahinkaya, Ela Cem, Mustafa Gülderen, Pelin Kaçar, Deniz Ergün, İlker Devrim
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.
{"title":"Evaluation of Adherence to HIV Postexposure Prophylaxis and Follow-up in Pediatric Sexual Assault Victims in Turkey: A Tertiary Center Experience.","authors":"İlknur Çağlar, Özlem Bağ, Miray Yilmaz Çelebi, Elif Kiymet, Elif Böncüoğlu, Şahika Şahinkaya, Ela Cem, Mustafa Gülderen, Pelin Kaçar, Deniz Ergün, İlker Devrim","doi":"10.1097/INF.0000000000004984","DOIUrl":"10.1097/INF.0000000000004984","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>This study evaluates PEP and follow-up adherence and efficacy among pediatric sexual assault victims treated at a tertiary care hospital in Turkey.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"165-169"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-07DOI: 10.1097/INF.0000000000005001
María Angélica Maya, Celeny Ortiz, Francisco Averhoff, Ana Isabel Davila, Diego Bastidas, Michael G Berg, Gavin A Cloherty, Laura S Perez-Restrepo, Karl Ciuoderis-Aponte, Jaime Usuga, Isabel Moreno, Juan P Hernandez-Ortiz, Paulina A Rebolledo, Jorge E Osorio
Background: Human Adenovirus (HAdV) is a common cause of acute respiratory infections, typically mild in healthy individuals. However, in late 2022, an outbreak of severe acute respiratory infection caused by HAdV emerged among children in Colombia and other countries.
Methods: We described an HAdV outbreak between February 2022 and April 2023. Children with severe acute respiratory infection and HAdV infection confirmed by polymerase chain reaction were included in 4 institutions in Antioquia, Colombia. Our study investigated the clinical manifestations and circulating HAdV genotypes before, during and after this HAdV outbreak.
Results: A total of 133 HAdV cases were analyzed, 37 (27.8%) cases were classified as the preoutbreak group, 88 (66.1%) as the outbreak and 8 (6.0%) as the postoutbreak group. Predominant symptoms were fever (87.0%), rhinorrhea (57.1%) and dyspnea (36.8%). The need for intensive care unit admission and supplemental oxygen increased during the outbreak and peaked in the postoutbreak period. Phylogenetic analysis revealed that 71.4% (10/14) of preoutbreak sequences belonged to genotype HAdV-C89, while during the outbreak, 75.6% (28/37) were HAdV-B3. Clinical symptoms did not significantly differ between HAdV-C89 and HAdV-B3 infections, but children infected with HAdV-B3 were significantly older.
Conclusions: This study highlights the shifting dynamics of HAdV genotypes in children and their epidemiologic impact. The emergence of HAdV-B3 in the post-COVID-19 period contributed to a severe acute respiratory infection outbreak, emphasizing the need for ongoing surveillance.
{"title":"Adenovirus Genotypes Associated With Severe Acute Respiratory Infections Outbreak in Children, in Antioquia, Colombia, 2022-2023.","authors":"María Angélica Maya, Celeny Ortiz, Francisco Averhoff, Ana Isabel Davila, Diego Bastidas, Michael G Berg, Gavin A Cloherty, Laura S Perez-Restrepo, Karl Ciuoderis-Aponte, Jaime Usuga, Isabel Moreno, Juan P Hernandez-Ortiz, Paulina A Rebolledo, Jorge E Osorio","doi":"10.1097/INF.0000000000005001","DOIUrl":"10.1097/INF.0000000000005001","url":null,"abstract":"<p><strong>Background: </strong>Human Adenovirus (HAdV) is a common cause of acute respiratory infections, typically mild in healthy individuals. However, in late 2022, an outbreak of severe acute respiratory infection caused by HAdV emerged among children in Colombia and other countries.</p><p><strong>Methods: </strong>We described an HAdV outbreak between February 2022 and April 2023. Children with severe acute respiratory infection and HAdV infection confirmed by polymerase chain reaction were included in 4 institutions in Antioquia, Colombia. Our study investigated the clinical manifestations and circulating HAdV genotypes before, during and after this HAdV outbreak.</p><p><strong>Results: </strong>A total of 133 HAdV cases were analyzed, 37 (27.8%) cases were classified as the preoutbreak group, 88 (66.1%) as the outbreak and 8 (6.0%) as the postoutbreak group. Predominant symptoms were fever (87.0%), rhinorrhea (57.1%) and dyspnea (36.8%). The need for intensive care unit admission and supplemental oxygen increased during the outbreak and peaked in the postoutbreak period. Phylogenetic analysis revealed that 71.4% (10/14) of preoutbreak sequences belonged to genotype HAdV-C89, while during the outbreak, 75.6% (28/37) were HAdV-B3. Clinical symptoms did not significantly differ between HAdV-C89 and HAdV-B3 infections, but children infected with HAdV-B3 were significantly older.</p><p><strong>Conclusions: </strong>This study highlights the shifting dynamics of HAdV genotypes in children and their epidemiologic impact. The emergence of HAdV-B3 in the post-COVID-19 period contributed to a severe acute respiratory infection outbreak, emphasizing the need for ongoing surveillance.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"112-119"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-10-17DOI: 10.1097/INF.0000000000005015
Garyfallia Syridou, Sofia Karagiannidou, Maria Eleni Papakonstantinou, Myrto Manzana Peteinelli, Konstantinos Giannakopoulos, Vasiliki Papaevangelou
Background: Visceral Leishmaniasis is a systemic vector-borne infection with a poor prognosis if not treated. Classical antiparasitic therapy with liposomal amphotericin B (LAmB) is effective, but occasionally not well-tolerated.
Case presentation: An 11-month-old male infant was admitted to our hospital due to prolonged fever, following an RSV infection. The patient had pale skin and splenomegaly, but was hemodynamically stable. An infectious cause was investigated through serology for Leishmania species , Brucella melitensis , Toxoplasma gondii , EBV, CMV, PB19 and Salmonella species . After admission, the infant developed Hemophagocytic lymphohistiocytosis (HLH, with pancytopenia, triglycerides: 346 U/L, ferritin: 1071 ng/mL; γ-globulin was administered without clinical response). On the second hospitalization day, the Leishmania rapid test was positive, while blood polymerase chain reaction identified Leishmania Infantum as the cause of infection, and LAmB was initiated. After the 4th dose, the patient developed hypokalemia, bradycardia and premature supraventricular complexes. The arrhythmia persisted despite electrolyte replacement; amphotericin-induced cardiotoxicity was suspected, and LAmB was discontinued. Oral miltefosine was started after approval by the National Public Health Organization, since the medicine was given in Greece for the first time to a pediatric patient. Miltefosine therapy lasted 1 month, with remission. Hepatotoxicity occurred at the end of the treatment and gradually resolved over the following 4 months with complete normalization of hepatic markers. The child remained asymptomatic at the 1-year follow-up.
Conclusions: Leishmaniasis should always be investigated in pediatric patients with secondary HLH, especially in endemic countries. Cardiotoxicity of LAmB is extremely rare; in this case, however, miltefosine is an effective and safe alternative.
背景:内脏利什曼病是一种全身性媒介传播感染,如果不及时治疗,预后很差。经典的两性霉素B (LAmB)脂质体抗寄生虫治疗是有效的,但有时耐受性不佳。病例介绍:一名11个月大的男婴因呼吸道合胞病毒感染后持续发热入院。患者皮肤苍白,脾肿大,但血流动力学稳定。通过血清学调查利什曼原虫、梅利氏布鲁氏菌、刚地弓形虫、EBV、CMV、PB19和沙门氏菌的感染原因。入院后患儿出现噬血细胞性淋巴组织细胞增多症(HLH,伴全血细胞减少,甘油三酯:346 U/L,铁蛋白:1071 ng/mL;给予γ-球蛋白,无临床反应)。住院第2天,利什曼原虫快速检测阳性,血液聚合酶链反应确定感染原因为婴儿利什曼原虫,启动兰姆治疗。第4次给药后,患者出现低钾血症、心动过缓和过早室上复合体。尽管补充了电解质,心律失常仍然存在;怀疑是两性霉素引起的心脏毒性,停用兰姆。口服米替福辛是在国家公共卫生组织(National Public Health Organization)批准后开始使用的,因为这种药物首次在希腊被用于儿科患者。米替福辛治疗持续1个月,缓解。肝毒性在治疗结束时出现,并在随后的4个月内逐渐消退,肝脏标志物完全正常化。在1年的随访中,儿童仍无症状。结论:在继发性HLH患儿中应始终调查利什曼病,特别是在流行国家。羊肉的心脏毒性极为罕见;然而,在这种情况下,米替福辛是一种有效和安全的替代品。
{"title":"Liposomal Amphotericin B-induced Cardiac Arrhythmias in Infantile Visceral Leishmaniasis: A Case Report.","authors":"Garyfallia Syridou, Sofia Karagiannidou, Maria Eleni Papakonstantinou, Myrto Manzana Peteinelli, Konstantinos Giannakopoulos, Vasiliki Papaevangelou","doi":"10.1097/INF.0000000000005015","DOIUrl":"10.1097/INF.0000000000005015","url":null,"abstract":"<p><strong>Background: </strong>Visceral Leishmaniasis is a systemic vector-borne infection with a poor prognosis if not treated. Classical antiparasitic therapy with liposomal amphotericin B (LAmB) is effective, but occasionally not well-tolerated.</p><p><strong>Case presentation: </strong>An 11-month-old male infant was admitted to our hospital due to prolonged fever, following an RSV infection. The patient had pale skin and splenomegaly, but was hemodynamically stable. An infectious cause was investigated through serology for Leishmania species , Brucella melitensis , Toxoplasma gondii , EBV, CMV, PB19 and Salmonella species . After admission, the infant developed Hemophagocytic lymphohistiocytosis (HLH, with pancytopenia, triglycerides: 346 U/L, ferritin: 1071 ng/mL; γ-globulin was administered without clinical response). On the second hospitalization day, the Leishmania rapid test was positive, while blood polymerase chain reaction identified Leishmania Infantum as the cause of infection, and LAmB was initiated. After the 4th dose, the patient developed hypokalemia, bradycardia and premature supraventricular complexes. The arrhythmia persisted despite electrolyte replacement; amphotericin-induced cardiotoxicity was suspected, and LAmB was discontinued. Oral miltefosine was started after approval by the National Public Health Organization, since the medicine was given in Greece for the first time to a pediatric patient. Miltefosine therapy lasted 1 month, with remission. Hepatotoxicity occurred at the end of the treatment and gradually resolved over the following 4 months with complete normalization of hepatic markers. The child remained asymptomatic at the 1-year follow-up.</p><p><strong>Conclusions: </strong>Leishmaniasis should always be investigated in pediatric patients with secondary HLH, especially in endemic countries. Cardiotoxicity of LAmB is extremely rare; in this case, however, miltefosine is an effective and safe alternative.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"e43-e46"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1097/INF.0000000000005167
Peter J O'Reilly, Madhav C Gautam, Bhishma Pokhrel, Sonu Shrestha, Meeru Gurung, Sanjeev M Bijukchhe, Elizabeth O'Mahony, Catherine Davis, Andrew Taylor, Sarah Kelly, Ruby Basi, Anushiya Kattel, Kushal Gautam, Shriya Bista, Roshan Jha, Ram Khadka, Saugat Bhandari, Puja Amatya, Ganesh Shah, Ira Shrestha, Michael Carter, Shreekrishna Maharjan, Colin Fink, Michael Levin, Aubrey J Cunnington, Andrew J Pollard, Shrijana Shrestha
Background: Identifying the cause of infection is important for clinical management and public health decisions, including vaccination strategies. In low-resource settings, causes of fever are often not identified. In this study, molecular testing panels were used to identify the causes of pediatric fever in the Kathmandu Valley, Nepal. A dengue fever outbreak facilitated the investigation of dengue diagnostics.
Methods: Children under 14 years of age were recruited to this prospective cohort study at Patan Hospital, Nepal. Clinical data and routine diagnostics were used to classify cases, including nonstructural protein 1 (NS1) antigen testing for dengue. Additional molecular diagnostics were performed on blood (12 viral, 26 bacterial and 6 fungal targets) and respiratory samples (17 viral and 3 bacterial targets).
Results: From September 1, 2021, to April 19, 2023, 565 children were enrolled, median age 3 (interquartile-range 1-7) years. Pathogens identified included dengue virus (n = 101), respiratory syncytial virus (n = 30), influenza (n = 25), typhoidal Salmonella spp. (n = 7) and Neisseria meningitidis (n = 2). During the dengue outbreak, dengue polymerase chain reaction (PCR) and NS1 positivity rates were both high early in dengue disease, but if >3 days of symptoms, PCR positivity rates declined (10.3%) while NS1 positivity remained high into the second week of illness (80%).
Conclusions: This prospective cohort study is the most comprehensive effort to date to describe the causes of pediatric fever in the Kathmandu Valley, Nepal. The United States Centers for Disease Control and Prevention recommends dengue PCR or NS1 antigen testing during the first 7 days of dengue fever. Our data indicate that PCR positivity declines after 3 days of symptoms, resulting in missed cases when relying solely on PCR.
{"title":"Causes of Fever in a Cohort of Nepali Children and the Potential Impact of Molecular Testing During a Dengue Fever Outbreak.","authors":"Peter J O'Reilly, Madhav C Gautam, Bhishma Pokhrel, Sonu Shrestha, Meeru Gurung, Sanjeev M Bijukchhe, Elizabeth O'Mahony, Catherine Davis, Andrew Taylor, Sarah Kelly, Ruby Basi, Anushiya Kattel, Kushal Gautam, Shriya Bista, Roshan Jha, Ram Khadka, Saugat Bhandari, Puja Amatya, Ganesh Shah, Ira Shrestha, Michael Carter, Shreekrishna Maharjan, Colin Fink, Michael Levin, Aubrey J Cunnington, Andrew J Pollard, Shrijana Shrestha","doi":"10.1097/INF.0000000000005167","DOIUrl":"https://doi.org/10.1097/INF.0000000000005167","url":null,"abstract":"<p><strong>Background: </strong>Identifying the cause of infection is important for clinical management and public health decisions, including vaccination strategies. In low-resource settings, causes of fever are often not identified. In this study, molecular testing panels were used to identify the causes of pediatric fever in the Kathmandu Valley, Nepal. A dengue fever outbreak facilitated the investigation of dengue diagnostics.</p><p><strong>Methods: </strong>Children under 14 years of age were recruited to this prospective cohort study at Patan Hospital, Nepal. Clinical data and routine diagnostics were used to classify cases, including nonstructural protein 1 (NS1) antigen testing for dengue. Additional molecular diagnostics were performed on blood (12 viral, 26 bacterial and 6 fungal targets) and respiratory samples (17 viral and 3 bacterial targets).</p><p><strong>Results: </strong>From September 1, 2021, to April 19, 2023, 565 children were enrolled, median age 3 (interquartile-range 1-7) years. Pathogens identified included dengue virus (n = 101), respiratory syncytial virus (n = 30), influenza (n = 25), typhoidal Salmonella spp. (n = 7) and Neisseria meningitidis (n = 2). During the dengue outbreak, dengue polymerase chain reaction (PCR) and NS1 positivity rates were both high early in dengue disease, but if >3 days of symptoms, PCR positivity rates declined (10.3%) while NS1 positivity remained high into the second week of illness (80%).</p><p><strong>Conclusions: </strong>This prospective cohort study is the most comprehensive effort to date to describe the causes of pediatric fever in the Kathmandu Valley, Nepal. The United States Centers for Disease Control and Prevention recommends dengue PCR or NS1 antigen testing during the first 7 days of dengue fever. Our data indicate that PCR positivity declines after 3 days of symptoms, resulting in missed cases when relying solely on PCR.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1097/INF.0000000000005154
Alison Gifford, Rudzani Mashau, Ruth Mpembe, David Khanyile, Thabo Maota, Mbali Dube, Boitumelo Kgoale, Adilia Warris, Nelesh P Govender
Background: Cryptococcal meningitis (CM) is associated with high mortality and neurodevelopmental sequelae and predominantly affects people living with HIV. Screening and pre-emptive treatment for cryptococcal antigen (CrAg) in blood in adults with CD4 <200 cells/µL reduces mortality. The World Health Organization does not recommend screening children <10 years due to a presumed low prevalence of CM. Nevertheless, CrAg testing is performed for all ages in South Africa in those with CD4 <100 cells/µL.
Methods: Children (<18 years) with CD4 <100 cells/µL and a CrAg screening result were identified from National Health Laboratory Service records from 2017 to 2022 in South Africa. Fifteen healthcare facilities in Gauteng province were chosen for a convenience sample of CrAg-positive and matched CrAg-negative children to collect detailed clinical information.
Results: Prevalence of cryptococcal antigenemia in South African children <18 years was 4.7% (1352/28,839) with a median age of 14 years (IQR 11-16). CrAg-positive prevalence in children <10 years was 3.5% (261/7440). Fifty-one CrAg-positive children were included for in-depth chart review. Twenty-four (24/49; 49%) CrAg-positive children had documented symptoms of meningitis at testing; 33% were diagnosed with CM. Forty-seven percent (8/17) of CrAg-positive children without documented symptoms developed their first CM episode in the subsequent 12 months. Five percent (1/19) of CrAg-positive children pre-emptively treated with fluconazole were subsequently diagnosed with CM, compared with 58% (7/12) of those without a documented prescription (P = 0.002). The 6-month mortality for CrAg-positive children was 19% (7/36). No CrAg-negative children developed CM.
Conclusions: CrAg prevalence in children with CD4 <100 cells/µL is comparable to adults (4.7% and 5.8%, respectively). CrAg screening guidelines should be extended to include all children to improve outcomes.
{"title":"Cryptococcal Antigenemia in South African Children Living With HIV.","authors":"Alison Gifford, Rudzani Mashau, Ruth Mpembe, David Khanyile, Thabo Maota, Mbali Dube, Boitumelo Kgoale, Adilia Warris, Nelesh P Govender","doi":"10.1097/INF.0000000000005154","DOIUrl":"https://doi.org/10.1097/INF.0000000000005154","url":null,"abstract":"<p><strong>Background: </strong>Cryptococcal meningitis (CM) is associated with high mortality and neurodevelopmental sequelae and predominantly affects people living with HIV. Screening and pre-emptive treatment for cryptococcal antigen (CrAg) in blood in adults with CD4 <200 cells/µL reduces mortality. The World Health Organization does not recommend screening children <10 years due to a presumed low prevalence of CM. Nevertheless, CrAg testing is performed for all ages in South Africa in those with CD4 <100 cells/µL.</p><p><strong>Methods: </strong>Children (<18 years) with CD4 <100 cells/µL and a CrAg screening result were identified from National Health Laboratory Service records from 2017 to 2022 in South Africa. Fifteen healthcare facilities in Gauteng province were chosen for a convenience sample of CrAg-positive and matched CrAg-negative children to collect detailed clinical information.</p><p><strong>Results: </strong>Prevalence of cryptococcal antigenemia in South African children <18 years was 4.7% (1352/28,839) with a median age of 14 years (IQR 11-16). CrAg-positive prevalence in children <10 years was 3.5% (261/7440). Fifty-one CrAg-positive children were included for in-depth chart review. Twenty-four (24/49; 49%) CrAg-positive children had documented symptoms of meningitis at testing; 33% were diagnosed with CM. Forty-seven percent (8/17) of CrAg-positive children without documented symptoms developed their first CM episode in the subsequent 12 months. Five percent (1/19) of CrAg-positive children pre-emptively treated with fluconazole were subsequently diagnosed with CM, compared with 58% (7/12) of those without a documented prescription (P = 0.002). The 6-month mortality for CrAg-positive children was 19% (7/36). No CrAg-negative children developed CM.</p><p><strong>Conclusions: </strong>CrAg prevalence in children with CD4 <100 cells/µL is comparable to adults (4.7% and 5.8%, respectively). CrAg screening guidelines should be extended to include all children to improve outcomes.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146065588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Candidemia is a life-threatening infection, and uncommon Candida species (UCS) are increasingly reported in pediatric patients. We aimed to evaluate the demographic and clinical characteristics of UCS candidemia in children.</p><p><strong>Materials and methods: </strong>This multicenter retrospective study included pediatric patients with UCS candidemia (species other than Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis and Candida krusei) from 14 tertiary hospitals in Turkey between January 2013 and December 2023.</p><p><strong>Results: </strong>A total of 221 episodes in 204 patients were analyzed. The median age was 29 months (interquartile range [IQR]: 7.8-78.5), and 58.8% were male. The most common UCS were Candida lusitaniae (n = 44, 19.9%), Candida kefyr (n = 40, 18.1%) and Candida guilliermondii (n = 31, 14%). Hematologic malignancy was the most frequent underlying condition (n = 50, 22.6%). Central venous catheters (CVC) were present in 76% (n = 168) of patients and were removed in 67.9% (n = 114) of episodes. Immunosuppressive therapy and recent surgery were documented in 53.8% (n = 119) and 53.4% (n = 118) of episodes, respectively, while total parenteral nutrition was used in 44.3% (n = 98). Recent antibiotic exposure was observed in 95.5% (n = 211) of episodes, and concomitant bacteremia occurred in 27.1% (n = 60). Neutropenia and thrombocytopenia were present in 59.7% (n = 132) and 48% (n = 106) of episodes, respectively. Antifungal prophylaxis was recorded in 23.5% (n = 52) of episodes, predominantly with fluconazole (76.9%). Susceptibility rates were 89.2% (116/130) for fluconazole, 90.4% (113/125) for caspofungin and 85.7% (102/119) for amphotericin B. Pediatric intensive care unit admission was required in 25.8% (n = 57) of episodes. The 7-day and 30-day mortality rates were 7.2% (n = 16) and 14.5% (n = 32), respectively. Female sex and longer hospital stay before infection were associated with increased mortality (7-day: P = 0.04 and P = 0.047; 30-day: P = 0.02 and P = 0.023). Mechanical ventilation, urinary catheterization and total parenteral nutrition were more frequent among nonsurvivors in both mortality periods (7-day: P < 0.001, P = 0.03, P < 0.001; 30-day: P < 0.001, P < 0.001, P = 0.03). The CVC removal rate was lower in mortality groups than in survivors (7-day: P = 0.005 and 30-day: P = 0.006).Thrombocytopenia was associated with both 7-day and 30-day mortality (P < 0.001 and P = 0.001), while elevated C-reactive protein levels were associated with 7-day mortality (P = 0.046).</p><p><strong>Conclusions: </strong>UCS candidemia in children most commonly occurred in patients with solid-hematologic malignancy, central venous catheters and recent antibiotic exposure within 1 week. Female sex, prolonged pre-infection hospitalization, intensive care-related interventions, thrombocytopenia, lower CVC removal rate and elevated C-reactive protein were associated wit
{"title":"Evaluation of Candidemia Due to Uncommon Candida Species in Children: A Multicenter Retrospective Study.","authors":"Gizem Guner Ozenen, Sema Yildirim Arslan, Fatma Tugba Cetin, Mustafa Genceli, Merve Kilic Cil, Sinem Irez Cetin, Kubra Aykac, Hatice Burcu Caglar Kizil, Gizem Mardinoglu, Meryem Cagla Abaci Capar, Gizem Avci Demirciler, Neslihan Mete Atasever, Esra Cakmak Taskin, Ayse Hitay Telefon, Fatma Dilsad Aksoy, Arife Ozer, Deniz Ergun, Hincal Ozbakir, Sevgen Tanir Basaranoglu, Arzu Bayram, Gulhadiye Avcu, Filiz Kibar, Ummuhan Cay, Ozge Metin Akcan, Tugce Tural Kara, Ahu Kara Aksay, Sevliya Ocal Demir, Zumrut Sahbudak Bal, Metin Dogan, Suleyha Hilmioglu Polat, Omer Kilic, Selda Hancerli Torun, Umit Celik, Solmaz Celebi, Derya Alabaz, Ali Bulent Cengiz, Mustafa Hacimustafaoglu, Ilker Devrim","doi":"10.1097/INF.0000000000005161","DOIUrl":"https://doi.org/10.1097/INF.0000000000005161","url":null,"abstract":"<p><strong>Background: </strong>Candidemia is a life-threatening infection, and uncommon Candida species (UCS) are increasingly reported in pediatric patients. We aimed to evaluate the demographic and clinical characteristics of UCS candidemia in children.</p><p><strong>Materials and methods: </strong>This multicenter retrospective study included pediatric patients with UCS candidemia (species other than Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis and Candida krusei) from 14 tertiary hospitals in Turkey between January 2013 and December 2023.</p><p><strong>Results: </strong>A total of 221 episodes in 204 patients were analyzed. The median age was 29 months (interquartile range [IQR]: 7.8-78.5), and 58.8% were male. The most common UCS were Candida lusitaniae (n = 44, 19.9%), Candida kefyr (n = 40, 18.1%) and Candida guilliermondii (n = 31, 14%). Hematologic malignancy was the most frequent underlying condition (n = 50, 22.6%). Central venous catheters (CVC) were present in 76% (n = 168) of patients and were removed in 67.9% (n = 114) of episodes. Immunosuppressive therapy and recent surgery were documented in 53.8% (n = 119) and 53.4% (n = 118) of episodes, respectively, while total parenteral nutrition was used in 44.3% (n = 98). Recent antibiotic exposure was observed in 95.5% (n = 211) of episodes, and concomitant bacteremia occurred in 27.1% (n = 60). Neutropenia and thrombocytopenia were present in 59.7% (n = 132) and 48% (n = 106) of episodes, respectively. Antifungal prophylaxis was recorded in 23.5% (n = 52) of episodes, predominantly with fluconazole (76.9%). Susceptibility rates were 89.2% (116/130) for fluconazole, 90.4% (113/125) for caspofungin and 85.7% (102/119) for amphotericin B. Pediatric intensive care unit admission was required in 25.8% (n = 57) of episodes. The 7-day and 30-day mortality rates were 7.2% (n = 16) and 14.5% (n = 32), respectively. Female sex and longer hospital stay before infection were associated with increased mortality (7-day: P = 0.04 and P = 0.047; 30-day: P = 0.02 and P = 0.023). Mechanical ventilation, urinary catheterization and total parenteral nutrition were more frequent among nonsurvivors in both mortality periods (7-day: P < 0.001, P = 0.03, P < 0.001; 30-day: P < 0.001, P < 0.001, P = 0.03). The CVC removal rate was lower in mortality groups than in survivors (7-day: P = 0.005 and 30-day: P = 0.006).Thrombocytopenia was associated with both 7-day and 30-day mortality (P < 0.001 and P = 0.001), while elevated C-reactive protein levels were associated with 7-day mortality (P = 0.046).</p><p><strong>Conclusions: </strong>UCS candidemia in children most commonly occurred in patients with solid-hematologic malignancy, central venous catheters and recent antibiotic exposure within 1 week. Female sex, prolonged pre-infection hospitalization, intensive care-related interventions, thrombocytopenia, lower CVC removal rate and elevated C-reactive protein were associated wit","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146065672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1097/INF.0000000000005160
Hincal Ozbakir, Yigit Aksoy, Deniz Ergun, Sinem Aksoy Timur, Ozlem Yilman, İlker Devrim
{"title":"Safety and Tolerability of Raltegravir in a Premature Neonate: A Case Report.","authors":"Hincal Ozbakir, Yigit Aksoy, Deniz Ergun, Sinem Aksoy Timur, Ozlem Yilman, İlker Devrim","doi":"10.1097/INF.0000000000005160","DOIUrl":"https://doi.org/10.1097/INF.0000000000005160","url":null,"abstract":"","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146065720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}