Journal of Pediatric Infectious Diseases - Volume 3, issue 2

Authors: Shah, Pooja | Sen, Millie | Michie, Colin A.

Article Type: Other

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 79-81, 2008

Authors: Ricci, Giampaolo | Dondi, Arianna | Patrizi, Annalisa

Article Type: Research Article

Abstract: The skin of patients affected by atopic dermatitis (AD) is extremely susceptible to colonization by Staphylococcus aureus, which plays an important role in AD exacerbations and is correlated with AD extent and severity. The mechanisms by which the bacterium colonizes and infects the skin of patients with AD can be summarized by three different and subsequent steps: 1) a defective skin barrier, on which 2) S. aureus is able to adhere and proliferate thanks to 3) …the defective immune response of the skin. Several S. aureus strains can secrete enterotoxins, which can act as superantigens thus contributing to disease severity by inducing a polyclonal T-cell activation and the release of proinflammatory cytokines such as TNFα, IL-1β, IL-2. The production of immunoglobulin E antibodies against staphylococcal exotoxins has also been demonstrated, and the staphylococcal wall protein A has been suggested to act as a "superallergen". Therapeutical actions against S. aureus skin overinfection include both pharmacological (antimicrobial and/or anti-inflammatory therapy and the newer topical calcineurin inhibitors) and nonpharmacological treatments (silk fabric textiles), and are aimed at minimizing skin colonization in order to reduce clinical exacerbations and AD severity. Show more

Keywords: Childhood eczema, atopic dermatitis, S. aureus, superantigens, superallergens

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 83-90, 2008

Authors: Abuhammour, Walid | Yousef, Nida

Article Type: Research Article

Abstract: Due to lack of a specific diagnostic test, the diagnosis of Kawasaki disease (KD) can only be made based on fever associated with characteristic clinical features and exclusion of other diseases with similar presentation. Incomplete presentation has been repeatedly described and often leads to delay in diagnosis, which may result in coronary artery involvement. During an eight-year study period (1991–1998), 14 patients with incomplete KD with cardiac complications were identified. Age range was 3.5 months to …13 years; 11 patients were ⩽ 5 years of age. Fever lasting ⩾ 5 days was present in all 14 patients, 10 of whom had a temperature ⩾ 40°C. Three diagnostic clinical criteria of KD were present in seven patients, two criteria in five patients, and one criterion in two patients. Echocardiography showed ectasia/aneurysm of at least one coronary artery in all patients. Coronary artery involvement was detected and treated after 5–7 days of illness in 50% of the patients, after 7–10 days in 29%, and after 10 days in 21% of the patients. All patients had elevated erythrocyte sedimentation rate (ESR) (mean ESR =48 mm/h). Twelve patients had leukocyte count ⩾ 16,000/mm^{3} . All patients were treated with Intravenous Immunoglobulin (IVIG) and oral aspirin. Clinical and echocardiographic resolution occurred in 13 patients. One patient, whose diagnosis was made 25 days after the onset of fever, died of pulmonary hemorrhage secondary to a pulmonary artery aneurysm. Although this retrospective study is limited by the small number of patients, it showed that children with incomplete KD-especially ⩽ 5 years of age-with high fever (⩾40°C), leukocytosis (⩾ 16.000/mm^{3} ) and elevated ESR (⩾ 40 mm/h), developed cardiac complications as early as the fifth day of illness. We suggest that earlier diagnosis and prompt treatment with intravenous gamma globulin before the fifth day of fever might reduce cardiac complications. Show more

Keywords: Incomplete Kawasaki disease, cardiac complications

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 91-95, 2008

Authors: Bakeera-Kitaka, Sabrina | McKellar, Mehri | Snider, Cynthia | Kekitiinwa, Adeodata | Piloya, Theresa | Musoke, Philippa | Ronald, Allan | Javanbakht, Marjan | Colebunders, Robert

Article Type: Research Article

Abstract: There is a paucity of knowledge about perinatally infected human immunodeficiency virus (HIV) positive children surviving into their adolescent years, especially from sub-Saharan Africa. Although studies have described the effects of the disease on the physical and sexual maturation of this population, their response to highly active antiretroviral therapy has not been systematically studied. At the pediatric infectious diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral therapy …(ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents between the ages of 10–19 for 12 months. We monitored physical growth using The Centers for Disease Control and Prevention and recently published World Health Organization (WHO) reference growth standards for height and weight measurements as well as sexual maturation using Tanner staging. Laboratory tests including: complete blood count, absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at baseline and at 3-month intervals. Of 118 children, 64% were female; the median age was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and IV, with a median CD4 count of 124 cells/ul. Apart from four adolescents, all were on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median CD4 count was 304 cells/μL, increasing to 370 cells/μL, by 12 months. Antiretroviral therapy was virologically suppressive (HIV-1 RNA viral load <400 copies/mL) in 79% of the adolescents at 6 months and in 89% at 12 months. Six (5%) patients died during the 12-month study. The median baseline height for age Z score was −2.41 which improved to a median of −1.96 by 12 months (P < 0.0001). The median baseline weight for age Z score was −2.61 and improved to −1.26 by 12 months (P < 0.0001). The median body mass index Z score increased from −1.39 to −0.47 by 12 months (P < 0.0001). At baseline, 63% of the adolescents were noted to have delayed pubertal maturation; this only reduced slightly to 60% after 12 months. Adolescents with predominantly perinatally-acquired HIV infection and significant disease burden showed appropriate virologic and immunological response to ART in addition to having clinically significant improvements in growth and some improvement in sexual maturation. Show more

Keywords: Adolescents, HIV, Africa, antiretroviral therapy

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 97-104, 2008

Authors: Borchardt, Stephanie M. | Hunt, Kae | Dworkin, Mark S.

Article Type: Research Article

Abstract: Varicella vaccine was licensed in the United States in March 1995. During 1995 to 2000, active surveillance sites observed a 71% to 84% decrease in cases of varicella infection. We describe an evaluation of the passive varicella surveillance system in Illinois including trends in the incidence of varicella and the impact of a school-entry vaccine requirement. Varicella surveillance data and varicella-specific hospital discharge data collected by the Illinois Department of Public Health (IDPH) during January …1995 through December 2005 were reviewed and summarized. IDPH received 29,189 aggregate reports representing 138,177 cases of varicella infection and 136 individual case reports. Incidence of varicella infection declined 95% from 2.0 cases per 1000 population in 1995 to 0.1 cases per 1000 population in 2005. Hospital discharge data also demonstrated a notable decline (78%). IDPH policy requiring vaccination of children ⩾ 2 years of age enrolled in child care facilities or school-operated programs at or below the kindergarten level was temporally associated with a decline from 10,805 cases in 2002 to 3,829 cases in 2003 (65%). Widespread use of the varicella vaccine has resulted in a marked decline in cases of varicella infection, thereby decreasing the burden of reporting and increasing the feasibility of case-based reporting. Show more

Keywords: Varicella vaccine, varicella incidence

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 105-110, 2008

Authors: Livni, Gilat | Chodik, Gabriel | Yaari, Arnon | Tirosh, Naama | Ashkenazi, Shai

Article Type: Research Article

Abstract: The aim of this study was to identify factors that affect influenza vaccination in order to devise means to increase compliance. In February 2003, pediatricians attending a national medical conference and nurses in a university hospital in central Israel were asked to complete a questionnaire regarding occupational data, knowledge issues, and reasons for undergoing/not undergoing vaccination themselves. Physicians also reported their practice of recommending the vaccine. A total of 181 physicians and 217 nurses answered the …questionnaires (compliance rate, 51%). Almost half (46.8%) had been vaccinated against influenza. There was a higher rate for physicians (60.8%) compared to nurses (35.2%), board-certified or board-eligible pediatricians (67.4%) compared to residents (44.7%), and for in-hospital physicians (67%) compared to community physicians (53%). Most frequent reason for vaccination was self-protection; and most frequent reason for non-vaccination was doubt about vaccine effectiveness. Physicians had better knowledge scores (68 ± 22 vs. 51 ± 23, p=0.01). On multivariate regression analysis, the variables associated with getting influenza vaccine by physicians were knowledge concerning influenza vaccine (OR=1.31), recommending the vaccine to patients (OR=3.37), and specialist status (OR=2.61). Increased knowledge concerning influenza vaccine is associated with increased vaccination rates among pediatric healthcare workers and their recommendation to vaccinate children. Show more

Keywords: Influenza, vaccination, healthcare workers, pediatrics, compliance acceptance of influenza vaccine by pediatric healthcare workers

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 111-117, 2008

Authors: Nacro, Boubacar | Konate, Souleymane | Gaudreault, Suzanne | Sangare, Lassana

Article Type: Research Article

Abstract: To improve the epidemiologic surveillance of bacterial meningitis in Burkina Faso, cerebrospinal fluid samples from suspected acute bacterial meningitis in the Department of Pediatrics at Centre Hospitalier Universitaire Souro Sanou (CHU-SS), Bobo Dioulasso were tested by polymerase chain reaction (PCR) assay and results were compared to standard bacteriologic methods. The study was conducted over 13 months (March 2002 until March 2003) and included 170 suspected cases of meningitis in which lumbar punctures were performed. …Cerebrospinal fluid samples were cultured on selective media and bacterial isolates were identified in 60 cases as follows; 56% Neisseria meningitidis, 22% Streptococcus pneumoniae, and 22% Haemophilus influenzae type b. Etiologic agents were detected by PCR in 77 cases as follows; 53% N. meningitidis, 21% S. pneumoniae, and 26% H. influenzae type b. Of the 162 samples evaluated by Gram stain, 64 (39.5%) were positive compared to 77 (45.5%) of the same samples that tested positive by PCR. Of the 88 samples selected for bacterial culture, 60 (68.2%) or 37% of the 162 total samples were positive. In the latex agglutination performed on 83 samples, 74 (89.2%), or 45.7% of the 162 total were positive. Sensitivity, specificity, positive predictive value, and negative predictive value of PCR measured against the results of standard cultures of Streptococcus were 76.92%, 97.3%, 83.33% and 96% respectively; for H. influenzae type b, values were 84.6%, 89.18%, 57.89% and 97.05%, respectively and for N. meningitidis, values were 100%, 86.8%, 82.92%, and 100%, respectively. These results suggest that PCR is a useful technique for the evaluation of bacterial meningitis, when used in conjunction with bacterial cultures. Show more

Keywords: Acute bacterial meningitis, Burkina Faso, child, PCR

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 119-124, 2008

Authors: Aslam, Muhammad | Cohen, Jennifer N.

Article Type: Research Article

Abstract: We present a case of multiple antibiotic resistant Escherichia coli meningitis in a premature neonate. He developed subdural empyema, hydrocephalus and seizures and was treated with six weeks of meropenem therapy, phenobarbital and serial lumbar punctures to relieve hydrocephalus. He was discharged home in stable condition.

Keywords: E. coli, neonatal meningitis, antibiotic resistance, GBS prophylaxis

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 125-130, 2008

Authors: Cherian, Mathew P.

Article Type: Research Article

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has been now recognized as major pathogen in adults and children, causing a variety of infections including osteomyelitis. Deep venous thrombosis in children with S. aureus osteomyelitis occurs rarely. Two siblings of a Saudi family who acquired MRSA bacteremia and osteomyelitis concurrently are described in this report. The second patient had an invasive infection characterized by bacteremia, multifocal osteomyelitis and septic arthritis complicated by deep venous thrombosis of …the left popliteal vein, necessitating anticoagulant treatment with heparin. To my best knowledge, such simultaneous occurrence of MRSA bacteremia and osteomyelitis affecting two family members has not been reported. Also, deep venous thrombosis complicating osteomyelitis is rare and has not been reported from this region of the world. Show more

Keywords: MRSA, community-acquired, bacteremia, osteomyelitis, deep venous thrombosis

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 131-135, 2008

Authors: Papapetropoulou, Maria | Tzanakaki, Georgina | Papapetropoulos, Spiridon | Guevara-Salcedo, Alexandra | Leontsini, Fani | Kremastinou, Jenny | Karpathios, Themistoklis

Article Type: Research Article

Abstract: A case of a 5-year-old child with signs and symptoms of bacterial meningitis was admitted to the "Iatrikon Athinon" Medical Center, Athens, Greece. The isolated strain was identified as Neisseria lactamica. Susceptibility to penicillin, cefotaxime, ceftriaxone, tetracycline, sulfonamides, rifampicin, ciprofloxacin, erythromycin and chloramphenicol was determined twice by E-test. The isolate was resistant to penicillin (8 μg/mL) and erythromycin (64 μg/mL). Since antibiotic susceptibility testing revealed that the isolate was resistant to penicillin, …the patient was successfully treated with ceftriaxone. This is a first report of a meningitis case due to penicillin-resistant N. lactamica in Greece. Show more

Keywords: Neisseria lactamica, meningitis, penicillin, resistance

Citation: Journal of Pediatric Infectious Diseases, vol. 3, no. 2, pp. 137-139, 2008