Pediatric Infectious Disease最新文献

Introduction

Although natural infection with rotavirus causes damage to the enteric tract resulting in diarrheal disease in humans and animals, recent studies evidenced the presence of serum rotavirus antigen/RNA in children with rotavirus diarrhea.

Methods

In this study, we investigated the markers of acute rotavirus infection (antigenemia, viremia and anti-rotavirus IgM antibody) in a group of 50 rotavirus infected children, using enzyme-linked immunosorbant assay and conventional polymerase chain reaction in stool and serum specimens.

Results

Rotavirus antigenemia and viremia were identified in 50% and 54% of acute-phase serum samples respectively. The mean level of rotavirus antigen in stools was greater than in serum. The rate of viremia was significantly higher in the serum of children with antigenemia than in those without (P < 0.001). Children with viremia showed significantly greater level of serum antigen and lower level of IgM titers (P < 0.001, 0.004 respectively). Among the manifestations tested, the frequency of diarrhea was significantly higher among antigenemia group (P = 0.031), and it was correlated with serum and stool antigen levels, and the level of rotavirus antigen in the sera of children with fever was significantly higher than those without fever (P = 0.002).

Conclusion

Accordingly, we can conclude that rotaviral antigenemia and viremia were common in children with rotaviral diarrhea, however, the impact of rotavirus antigenemia/viremia on clinical manifestations of infection is unknown.

Background and objectives

Cytomegalovirus (CMV) infection remains the most common and potentially severe viral complication in patients given hematopoietic stem cell transplantation. The aim of this study was to determine the incidence, risk factors and outcomes of CMV infection in pediatric BMT unit.

Material and methods

This study was a retrospective analysis of clinical, laboratory and outcome data of 131 pediatric patients who underwent BMT.

Results

The mean age of the study population was 6.5 ± 4 years. Out of 131 pediatric patients, 85 were males (64.9%). Majority of patients had hematological disorder/malignancy (n = 101; 77%) followed by solid tumors (n = 30; 23%). Most of them received allogeneic transplant (n = 92; 70.2%). CMV reactivation was observed in 38 (29%) patients; out of them, only (n = 3; 2.3%) had clinical manifestation/organ involvement and most cases of CMV were resolved (n = 35; 26.7%). Benign hematological disorder, conditioning regimen containing ATG, allogeneic BMT, graft-versus-host disease (GVHD) prophylaxis used and development of GVHD were identifiable risk factors in all patients, and lymphopenia <300/mm³ (p = 0.047) was the only identifiable risk factors in allogeneic BMT patients associated with development CMV reactivation. Patients, who had CMV reactivation had significantly higher rate of GVHD (31.6% vs 15.1%; p = 0.031), however relapse rate (21% vs 25.8%) and mortality rate (22.5% vs 33.3%) in patients with CMV reactivation vs no CMV reactivation respectively were not statistically significant. Overall survival and event free survival of patients with and without CMV antigenemia were also comparable.

Conclusions

Antigenemia-guided pre-emptive strategy with ganciclovir was very affective and CMV reactivation tended not to affect the outcome in our study cohort.

Objective

The goal of this meta-analysis was to determine whether the serum levels of C-reactive protein (CRP) and creatine kinase-MB (CK-MB) are correlated with the severity of hand-foot-and-mouth disease (HFMD).

Methods

We conducted a systematic search and meta-analysis of the MEDLINE, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP information, and Wanfang Chinese Periodical databases. The analysis included all published case–control, cohort, and cross-sectional studies of serum CRP and/or CK-MB levels in children with HFMD up to December 4, 2014. Pooled estimates were calculated using a random-effects model or a fixed-effects model.

Results

Thirty-eight articles are included in this meta-analysis. The summary estimates revealed that the average serum CRP levels, prevalence of high CRP, average serum CK-MB levels, and prevalence of high CK-MB increased with the severity of HFMD. There were no significant differences in the average levels of serum CK-MB (pooled MD = 22.29 U/L; 95% CI: −0.82–45.39 U/L, P = 0.06) between patients who were critically ill and those with severe HFMD. Therefore, we compared the average levels of serum CRP (pooled MD = 1.17 mg/L; 95% CI: −0.88–3.21 mg/L, P = 0.26) between patients infected with enterovirus 71 and those infected with coxsackievirus A16.

Conclusions

The result of these analyses indicated that the CRP and CK-MB levels are correlated with HFMD severity. Thus, these frequently used and accessible measures may aid clinicians in effectively diagnosing, treating, and predicting the prognosis of children with HFMD.

Entomophthoromycosis is a rare fungal infection seldom occurring in humans. Only very few cases of entomophthoromycosis exclusively involving the orbit have been reported in the literature. We are reporting a case of entomophthoromycosis in a toddler who presented with swelling of the left orbit following trauma to the left eye. The nonspecific clinical signs and symptoms of the patient posed us diagnostic dilemma. Histopathological examination helped us to arrive at the correct diagnosis and proper management of the patient. A high index of suspicion in required in these patients for timely diagnosis and treatment, which would improve the prognosis.

Brucellosis is a widespread zoonotic disease posing serious public health problem especially in developing countries. The diagnosis of brucellosis is a greater challenge, as it requires a high index of suspicion, clinical and laboratory evidence of diagnosis. Increased travel across the globe to endemic areas for work and pleasure over the last few years has led to increased diagnostic challenges in non-endemic countries.

Laboratory diagnosis of brucellosis is essential for diagnosis and effective treatment, as it involves two drugs or more for a prolonged period unlike many other infections. Among the various tests available, culture of the organism from the bone marrow, blood and other tissues is the gold standard for diagnosis in brucellosis. However, it is invasive, time consuming and at times less sensitive. These drawbacks have prompted the use of alternate methods to rapidly and accurately diagnose brucellosis and aid in early intervention or therapy.

The alternate methods predominantly include serological tests such as enzyme-linked immunosorbent assay, serum agglutination testing and molecular tests with varying advantages and drawbacks suited to various clinical situations. These tests help not only in diagnosis but also in follow-up of disease activity/response to therapy. This article reviews the various culture methods, serological tests and newer diagnostic methods available in making a laboratory diagnosis of brucellosis along with their advantages and drawbacks.

A 9-year-old male with history of complex congenital heart disease presented with intermittent fevers and chills of 3-month duration along with pancytopenia. Given a high suspicion of endocarditis despite negative blood cultures, a literature search for culture-negative endocarditis yielded the possibility of less common organisms, including zoonotic agents. There were only isolated case reports of Bartonella causing pancytopenia. Further testing revealed positive Bartonella henselae by DNA PCR in the patient who was treated with an antibiotic regimen consisting of doxycycline, Bactrim, and rifampin and ultimately had the homograft removed. Given the rarity of Bartonella endocarditis, ∼3% of all endocarditis,1, 2 and the additional testing necessary for diagnosis, one must consider this possible diagnosis with a high index of suspicion.

Enteric fever is a very common preventable disease seen in the Indian population. This disease is known to cause a variety of complications involving every system. We report a case of enteric fever that presented at the start as acute gastritis and then went on to develop acute pancreatitis, which is a rare complication of enteric fever, along with capillary leak syndrome in the acute phase mimicking dengue shock syndrome. This unusual presentation has not been reported in Indian or foreign literature.

Basidiobolomycosis is a rare fungal disease caused by Basidiobolus ranarum, which is an environmental saprophyte. It is a chronic inflammatory disease that is generally restricted to the subcutaneous tissue and rarely involves the gastrointestinal tract. With the intent to spread awareness of this potentially life threatening and rare infection, we report a 4-year-old boy presenting with abdominal pain and fever with eventual diagnosis of gastrointestinal basidiobolomycosis. We discuss the nonspecific and confusing symptoms of this rare infection and available treatment options in detail.

Drug-induced nephrotoxicity has evolved as one of the significant causes of renal failure in the contemporary setting accounting up to 20%. Acyclovir is an antiviral agent, which has the potential for precipitating transient crystal-induced nephrotoxicity, especially in elderly, euvolemic or renal patients when given as rapid intravenous bolus. The current case depicts evolution and management of transient nephropathy in a paediatric patient treated with acyclovir for viral encephalopathy. The case presents a contrasting scenario to the conventional milieu of risk factors and surmises the possibility of genetic factor predisposition.