Pediatric Infectious Disease最新文献

Background

Early recognition of bacteriemia and sepsis is essential for the treatment and prognosis of surgical patients. Neutrophil lymphocyte ratio may also potentially be used as biomarker to monitor and diagnosticate infection after major surgery.

Aim

To analyze the potential ability of neutrophil lymphocyte ratio compared with C reactive protein as a marker of infection following major surgery in children.

Methods

A post hoc analysis of previously collected data concerning 103 pediatric patients undergoing major who remained in pediatric intensive care unit for at least 7 days were enrolled in the study. Preoperative characteristics, analytical variables and delayed postoperative infectious complications were recorded. Patients were divided in infected (I Group) and non-infected (NI Group).

Results

Comparing NLR between I Group and NI Group we found significant differences after surgery from fifth postoperative day (3.21 ± 3.09 vs 2.32 ± 1.07, p = 0.07) to ninth postoperative day (3.58 ± 3.11 vs 2.17 ± 1.22, p = 0.05). Comparing CRP values between I Group and NI Group, we found statistically significant differences after surgery from fourth postoperative day (107.79 ± 103 vs 62.29 ± 56, p = 0.024).

A cut off of 2.32 was the optimal value for NLR to predict infectious complications at day 8, with a sensitivity of 0.82 and a specificity of 0.

Conclusions

NLR value is not useful for diagnosis postoperative septic complications after pediatric major surgery. NLR value alone does not perform better compared with CRP value alone in predicting postoperative septic complications. The developmental differences in the host inflammatory response in children compared with adults may be the responsible of the different results obtained compared with studies reported in adult patients.

Typhoid fever is still endemic in India. It is responsible for two lakh death occurring annually worldwide. Multi system involvement complicates the disease occasionally. However timely interventions may avoid fatalities. Here we present case of a six year old girl with typhoid fever who developed cardiogenic shock secondary to myocarditis at peak of illness. She also developed pseudobulbar palsy during convalescence. Child responded to ceftriaxone and anti- cardiac failure management. Pseudobulbar palsy was self limiting.

Hemophagocytic lymphohistiocytosis (HLH) has been associated with infections, hematological malignancies and autoimmune conditions. Malaria has been rarely reported as a cause of HLH, and even rarer in pediatric population. We report a case of 10-year-old female child with fever, hepatospenomegaly, pancytopenia, hyperferritinemia, hypertriglyceridemia and bone marrow hemophagocytosis, favoring the diagnosis of HLH. She required steroid administration for clinical remission.

Background

Viral fever is very common even among hospitalized patients in paediatrics. Often, antibiotics are unnecessarily prescribed leading to antibiotic misuse. In non-critical children, it is prudent to wait for clinical pattern to emerge before starting antibiotics even in hospitalized patients.

Aim

To study the clinical outcome in non-critical hospitalized children with suspected viral infections and to study the impact of antibiotic stewardship program in the institute.

Method

It was a prospective observational study carried out from November 2014 to August 2015 in the paediatric ward of Shardaben hospital affiliated to NHL Medical College. All non-critical hospitalized children with suspected viral infections fulfilling pre-defined criteria were included in the study. Patients with prolonged fever >7 days duration were excluded. The clinical course in ward of these patients was noted along with signs of improvement/deterioration. The antibiotic usage in ward over a period of 3 years before and after the implementation of antibiotic stewardship program was compared.

Results

Of all admitted patients, 1760 (56%) had suspected viral infection not requiring antibiotics on admission. Maximum patients were in 1–5 year age group. 4.6% turned out to be nonviral–bacterial infection/malaria and they required specific treatment. 56% of the study population required 1–3 days hospitalization. None of the patients required PICU admission and there was no mortality. The antibiotic usage reduced from 3.9 vials/admission to 2.36 vials/admission from 2011–12 to 2014–15.

Conclusion

Fever due to viral infections is very common even among non-critical hospitalized children. It is prudent to wait before starting antibiotics in such patients – it does not worsen the outcome. This study generates evidence for rational use of antimicrobials in paediatric practice. A protocol based ‘Antibiotic Stewardship Program’ can help in rationalizing antibiotic usage in selected group of patients.

We present a case of disseminated aspergillosis treated successfully with high-dose liposomal amphotericin B in a 16-year-old boy with primary immunodeficiency (autoimmune lymphoproliferative syndrome, ALPS). Sites of infection, including the brain, lung and multiple intra-abdominal organs, were studied using ¹⁸F-FDG and PET/MRI, which provided important morphological and functional information for monitoring the course of the disease.

Cysticercosis is a common infection that occurs in developing countries. But oral cysticercosis is a rare event and it creates difficulty in clinical diagnosis. A thorough search of the literature showed that there are only 4 cases of pediatric cysticercosis in buccal mucosa. In this report we document a case of cysticercosis in 10 years child who sought treatment for an asymptomatic nodule in right buccal mucosa that has been clinically diagnosed as a submucosal retension cyst.

A five-year-old boy was presented to a local walk-in clinic with an infection in the area of the external malleolus of the right foot, for which amoxicillin was prescribed. Upon completion of the course of the antibiotic, the inflammation in the primary area of the infection subsided but the multiple sites of nodular lymphangitis in the surrounding area persisted. Examination of those sites lead to the identification of Mycobacterium marinum as the cause of the coinfection.

Bacille Calmette–Guérin (BCG) vaccine – although considered safe in infants, is associated with complications – ranging from local and regional complications to the disseminated form of BCG disease. We report an interesting case of fever of unknown origin in an infant, closely mimicking hematological malignancy and Langerhans cell histiocytosis (LCH). Investigations revealed disseminated BCG disease with underlying immunodeficiency.

Fixed dose combination of anti-tubercular drugs is often used in treatment of tuberculosis in children. Due to change in recommended dosages of these drugs by WHO, there is a need to reformulate the preparations for the desired therapeutic effect.

Bones around the elbow joint are relatively uncommonly involved in tuberculosis, accounting for less than 2% of the cases. This article describes the role of CT and MRI in evaluating a case of tuberculosis of the radial neck.