Journal of Pediatric Infectious Diseases - Volume 4, issue 3

Authors: Quiñones, Dianelys | Marrero, Deisy | Llop, Alina | Kobayashi, Nobumichi | del Campo, Rosa

Article Type: Research Article

Abstract: Genetic relationships and the antibiotic resistance determinants were studied for a total of 55 Enterococcus faecalis isolates recovered from children in a pediatric hospital in Cuba between January 2001 and December 2004. These isolates were analyzed by pulsed-field gel electrophoresis, and presence of some resistance genes to aminoglycosides, macrolides and tetracycline were examined by polymerase chain reaction. A total of 17 pulsed-field gel electrophoresis patterns were identified among 54 different patterns of …pulsed-field gel electrophoresis. Particular multi-resistant E. faecalis clones were detected in different wards from the pediatric hospital. The aac(6')-aph(2")} and aph(3') genes was detected in all the isolates with high-level resistance to gentamicin and amikacin, respectively, whereas the ant(6) gene was detected in the 75% of isolates showing high-level resistance to streptomycin. The erm(B) gene was found in 72% of the erythromycin-resistant strains, and tet(M) was detected in all tetracycline resistant strains. The circulation of particular clones exhibiting antibiotic resistance in the pediatric hospital and the dissemination of drug-resistance genes among these strains indicated the need for the monitoring of antibiotic susceptibility to prevent the selection or dispersion of resistant strains in this hospital. Show more

Keywords: PFGE, Enterococcus, antibiotic resistance determinants

DOI: 10.3233/JPI-2009-0190

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 267-274, 2009

Authors: Brahmbhatt, Heena | Kigozi, Godfrey | Serwadda, David | Wabwire-Mangen, Fred | Sewankambo, Nelson | Wawer, Maria | Gray, Ronald

Article Type: Research Article

Abstract: Purpose: To assess gender differences in the risk of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). HIV-positive mothers were identified from a population cohort followed from 1994 to 2000. HIV infection in mothers was detected using two independent enzyme immunoassays and infant HIV infection was diagnosed using RNA- polymerase chain reaction. Birth weight was determined by anthropometry. Logistic regression was used to assess the univariate and multivariate risk factors of MTCT. Approximately 16% of 371 …infants were HIV-positive in the in-utero and intrapartum periods and an additional 16% were infected via breastfeeding. Female infants were significantly more likely to be HIV infected perinatally compared with male infants (20.8% vs. 12.4%, respectively, P = 0.035), but there was no significant sex differences in postnatal risk of MTCT. In adjusted analyses, among mothers with higher than median HIV viral loads, there was no significant difference in the risk of MTCT by gender, but among mothers with lower than median HIV viral loads, female infants were significantly more likely to be HIV infected (odds ratio = 4.1, confidence interval = 1.04–16.1). Low birth weight was more frequent in female than male infants born to HIV-positive mothers. Female infants could be more susceptible to HIV infection in the in-utero and peripartum period compared with male infants. Alternatively, this sex association could be due to higher in-utero mortality rates of male infants or to increased susceptibility of female infants. Show more

Keywords: MTCT, vertical transmission, perinatal transmission, viral load, low birth weight

DOI: 10.3233/JPI-2009-0168

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 275-279, 2009

Authors: Chansinghakul, Danaya | Soongswang, Kulthida | Pancharoen, Chitsanu | Thaithumyanon, Pimolrat | Limpongsanurak, Sompop | Thisyakorn, Usa

Article Type: Research Article

Abstract: Purpose: To evaluate the safety and efficacy of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected pregnant women to prevent mother-to-child transmission of HIV. Design of the study is observational retrospective evaluation of a prospective cohort. Setting of the study is King Chulalongkorn Memorial Hospital. Participants are HIV-infected Thai women and their offspring. HIV-positive pregnant women who received antenatal care were given antepartum and intrapartum zidovudine (ZDV) plus single …dose nevirapine (NVP) or HAART [ZDV + lamivudine (3TC) + NVP] to prevent HIV transmission to the neonate. All newborns received single dose NVP plus 6-weeks of ZDV. HAART was given to their parents if indicated. We followed the infants from February 2003 to June 2006 to determine HIV-status. Calculated HIV maternal-child transmission rate is the main outcome. Among 157 mother-infant pairs, 44 mothers received ZDV plus single dose NVP and 113 mothers received HAART. There was one HIV-infected child in the first group and 3 in the second group, resulting in 2.3% (95% confidence interval, -2.1 to 6.7) transmission rate in the first group versus 2.7% (95% confidence interval, -0.3 to 5.6) in the second group (P = 1.000). All non-infected infants had a normal physical examination at 18 months. Initiation of HAART in HIV-infected pregnant women had comparable efficacy with ZDV plus single dose NVP to prevent mother-to-child transmission of HIV. In addition, the program may have strengthened the role of the family unit and stimulated public awareness reproductive health planning can help in prevention of HIV/AIDS. Show more

Keywords: Mother-to-child transmission, HIV, HAART

DOI: 10.3233/JPI-2009-0172

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 281-287, 2009

Authors: Hosseini, Seyed Mohammad Milani | Ataei, Neamatollah | Sharifzadeh, Maysam | Khotaei, Ghamar Taj

Article Type: Research Article

Abstract: Obtaining uncontaminated urine samples are important to diagnosis urinary tract infection in neonates. The present study was designed to compare urine contamination rates in two common methods of urine collection: urine bag versus suprapubic aspiration. In a cross-sectional study, 119 consecutive infants (aged 3 to 28 days) with fever who were referred to Children's Hospital Medical Center in Tehran between September 2004 and March 2005 were included. Urine was collected simultaneously by bag and suprapubic aspiration. …The urine samples were analyzed and bacterial cultures performed using standard bacteriologic techniques. The rate of culture contamination differed markedly according to the method of urine culture. Suprapubic aspiration specimens were sterile in 92.4%. Pathogenic bacteria were isolated in 7.6%. No bacterial isolates were deemed to be contaminants. Only 8.5% of bag specimens were sterile. Of non-sterile cultures, 36.9% of bacterial isolates were deemed to be pathogenic and 54.6% contaminants (P < 0.001 vs. suprapubic aspiration). Pyuria (P = 0.002) and bacteriuria (P < 0.001) were more frequent in specimens obtained by bag than urine from suprapubic aspiration. The existence of a urinary tract anomaly was the main predictor for a positive culture in urine obtained by suprapubic aspiration. Contamination rates and rates of pyuria and bacteriuria are remarkably higher for urine obtained by bag specimens than for urine obtained by suprapubic aspiration. Show more

Keywords: Urinary tract infection, contamination, urine culture, neonate

DOI: 10.3233/JPI-2009-0181

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 289-293, 2009

Authors: Kenny, Benjamin | Gupta, Sanjeev | Brumby, Jarrod | Burton, Joanna | Moloney, Susan E.

Article Type: Research Article

Abstract: Group A streptococcal infection is common and has varied presentations. Group A streptococcus (GAS) is known to cause throat infections, erysipelas, scarlet fever and impetigo. Other more serious diseases caused by GAS are rheumatic fever and post streptococcal glomerulonephritis. There have been case reports showing an association with scarlet fever and jaundice postulating a direct effect of the erythrogenic toxin on the liver. We describe two cases; the first was a 13-year-old male who presented an …atypical presentation of streptococcal infection with an acute hepatic picture who later developed septic arthritis, the second was a 7-year-old male who presented with disseminated intravascular coagulopathy, sepsis, jaundice and hepatic encephalopathy. In neither of the two cases did the children develop rashes of scarlet fever, desquamation or pharyngeal erythema. These were unique presentations highlighting the wide spectrum of GAS disease. Show more

Keywords: Streptococcal infection, hepatitis, toxic shock syndrome

DOI: 10.3233/JPI-2009-0173

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 295-299, 2009

Authors: Yousef, Nida | Alhmood, Ammar | Mawri, Faisal | Kaddurah, Ahmad | Diskin, David | Abuhammour, Walid

Article Type: Research Article

Abstract: We describe a 7-year-old male with a history of fever, headache, bilateral non-purulent conjunctivitis, and photophobia. Patient was initially treated for suspected bacterial meningitis with intravenous antibiotics. Due to lack of clinical response, negative cultures, and evolving signs of Kawasaki disease, he was treated with one dose of intravenous immunoglobulin. Patient improved except for the persistence of photophobia and bilateral conjunctival injection. Eye examination showed bilateral optic neuritis and a visual acuity …of 20/80 in both eyes. Follow up eye examination after 6 weeks showed normal visual acuity, resolution of conjuctival injection, photophobia, and optic neuritis. This case highlights the posterior segment involvement in Kawasaki disease and the need for careful eye examination in patients with Kawasaki disease who have prolonged photophobia and conjunctival injection. Show more

Keywords: Kawasaki disease, optic neuritis

DOI: 10.3233/JPI-2009-0184

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 301-303, 2009

Authors: Papapetropoulou, Maria | Leontsini, Fani | Ierodiakonou, Michalis

Article Type: Research Article

Abstract: Herein we describe a unique case of previously healthy child in Greece who developed septic arthritis of hip due to Salmonella enteritidis. To the best of our knowledge, this is the first report in the literature of septic arthritis of hip in a child with no preexisting disease caused by S. enteritidis. The case was documented by culture of the aspirated joint fluid and blood cultures. The isolated microorganism was identified on species level in the …National Reference Centre for Salmonella and Shigella. Antimicrobial therapy and arthrotomy were performed. The patient developed sequalae (complete disruption of the femoral cap) and she is still followed. Show more

Keywords: Salmonella enteritidis, child, septic arthritis, hip

DOI: 10.3233/JPI-2009-0176

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 305-307, 2009

Authors: Howidi, Mohammad | Rajah, Jaishen

Article Type: Research Article

Abstract: We report a case of tuberculous meningitis in a 3.5-year-old child who presented with subtle symptoms. The symptoms were somnolence, low-grade fever, and vomiting. The physical exam revealed neck stiffness and depressed sensorioum. Encephalopathy was suspected. Lumbar puncture showed modest pleocytosis. Cerebrospinal fluid smear for acid fast bacilli and later for Mycobacterium tuberculosis were negative. Polymerase chain reaction (PCR) for M. tuberculosis was positive twice, and the patient was diagnosed early in the …course of the disease, treated accordingly, and recovered completely. Our laboratory performance consists of 36 tuberculous positive cases; 34 were PCR positive and 246 tuberculosis negative cases; nine were PCR positive, which is consistent with sensitivity of 94.4%, specificity of 96.3%, positive predictive value of 79%, negative predictive value of 99%, and likelihood ratio of 25.5. Tuberculous meningitis was diagnosed by a positive PCR whereas the smear and the Mycobacterium culture came back were negative. PCR has proven to be quite useful in the diagnosis of tuberculous meningitis and was life saving on our child in the case of this patient. Show more

Keywords: Tuberculosis, meningitis, diagnosis, PCR

DOI: 10.3233/JPI-2009-0174

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 309-313, 2009

Authors: Tebruegge, Marc | Pantazidou, Anastasia

Article Type: Research Article

DOI: 10.3233/JPI-2009-0175

Citation: Journal of Pediatric Infectious Diseases, vol. 4, no. 3, pp. 315-316, 2009