Journal of Pediatric Infectious Diseases - Volume 6, issue 3

Authors: Bezrodnik, Liliana | Gaillard, Maria Isabel | Carelli, Daniela

Article Type: Research Article

Abstract: We present the clinical and B cell immunophenotypical characterization of 94 patients with Common Variable immunodeficiency (CVID), selective IgA deficiency (SIgAD) and polysaccharide antibody deficiency syndrome (SAD). Study design: We retrospectively investigated clinical findings and B cell compartment in 31 patients with CVID, 35 with SIgAD and 28 with SAD. Regardless of underlying disease, a delay was observed between age at diagnosis and onset of first symptoms. The predominant clinical findings were upper and …lower respiratory tract infections. Allergic symptoms were more frequent in SAD and SIgAD patients, hematological and autoimmune manifestations in CVID and celiac disease in SIgAD. B-cell Immunophenotype abnormalities were observed in SAD and CVID patients: both had reduced memory B cells (CD19^{+} CD27^{+} ), and increased transitional B cells (CD24^{ + + } CD38^{+ +} ) was found in SAD. We did not find any statistically significant abnormalities in any of differentiation stages of B cells in SIgAD. Defects of the B cell compartment were associated with bronchiectasis, splenomegaly, autoimmunity and/or malignancy in CVID and SAD patients.We conclude that flow cytometric evaluation of the B cell compartment could be a useful tool for the diagnosis and follow up of these patients. Show more

Keywords: Common variable immunodeficiency, IgA deficiency, polysaccharide antibody deficiency syndrome

DOI: 10.3233/JPI-2011-0320

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 159-166, 2011

Authors: Efe, Şirin | Tuncer, Oğuz | Akça, Tülay | Korğalı, Elif | Kulaç, Sibel

Article Type: Research Article

Abstract: The patients treated in the newborn intensive care units (NICUs) are under high risk in terms of nosocomial infections. Despite the developments in antibiotherapy, these infections are still causing high mortality and morbidity. In this study, we aimed to determine the prevalence of nosocomial infections, to detect the causing pathogens and resistance patterns of antibiotics in patients in the NICU of Van Maternity and Children's Hospital. For this purpose, 621 patients in the NICU were observed …for nosocomial infections between 01/09/2007 and 31/08/2008. A total of 63 nosocomial infections developed in 54 patients. The nosocomial infection rate in the NICU was found to be 8.7% by patient count and 10.1% by infection attack count. Besides, the nosocomial infection incidence density was 12.8 by patient count and 14.9 by infection attack count. Among these infections blood stream infections were the most common by 44.4% and Klebsiella pneumoniae was the most frequent pathogen. Fifteen of 20 isolated strains of K pneumoniae were positive for extended spectrum beta lactamases (ESBL). We believe that this kind of studies on NICUs would contribute to nosocomial infection control programs and would be effective on treatment of nosocomial infections. Show more

Keywords: Newborn intensive care unit, nosocomial infection, antibiotic resistance

DOI: 10.3233/JPI-2011-0325

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 167-171, 2011

Authors: Virgimio, Agostoni Carlo | Antonio, Boccazzi | Sara, Pontari | Giorgio, Bedogni | Luigia, Prampolini | Matteo, Garotta | Erminio, Torresani | Giovanna, Lunghi

Article Type: Research Article

Abstract: Celiac disease (CD) is a clinical condition potentially impairing the immune system. We tested the hypothesis that CD could hinder seroconversion following hepatitis B vaccine (HBV). We compared 81 consecutive CD patients (24 male and 57 female) with a median [interquartile range (IQR)] age of 10 (7) yr (range 2–30 yr) and 50 controls (26 male and 24 female) with a median (IQR) age 7 (7) yr (range 1–26 yr) who received a standard immunisation schedule …with HBV given at 3, 5 and 11 mo of. The median (IQR) interval from the last dose of HBV was higher in CD patients as compared to controls [10 (7), range 2–29 yr vs. 6 (7), range 1–26 yr; P < 0.0001]. The median (IQR) age of gluten introduction was comparable in the two groups [6 (1), range 4–12 mo vs. 6(1), range 5–11 mo]. The median (IQR) duration of gluten intake in the CD group was 3.5 (4.8) yr (range 0.2–12.3 yr). 33 of 81 (40%) CD patients did not seroconvert (anti-HBs < 10 IU/mL), compared with 10 of 50 (20%) controls (P < 0.05). The odds ratio of a protective anti-HBs titer in CD patients vs. controls was 0.36 (95% 0.16–0.83, P < 0.0001), and was not associated with gender, interval from the last administration of HBV, or duration of pre-diagnosis gluten intake in CD patients. Our results are consistent with previous observations that CD patients are less likely to be protected by HBV, which may have important public health implications. Show more

Keywords: Celiac disease, HBV vaccine, seroconversion, immune network

DOI: 10.3233/JPI-2011-0321

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 173-176, 2011

Authors: Santos-Sancho, Juana María | Gil-Prieto, Ruth | Álvaro-Meca, Alejandro | Ángel Gil-de Miguel,

Article Type: Research Article

Abstract: Mumps is a benign infectious condition, but when it affects adults it may cause serious complications that require hospitalization with a high cost and that may lead to permanent sequelae. The aim of this study was to estimate the incidence of hospitalization for mumps in Spain from 1997 to 2006. A retrospective epidemiological study was made using the data of the Spanish National hospital Discharge database Minimum Basic Data Set (MBDS) for yrs 1997–2006. We selected …all those patients with code 072 for any diagnosis position (Clinical Modification of the International Classification of Diseases: ICD-9-CM), and estimated the incidence of hospitalization, length of stay, in hospital mortality and associated costs. Hospitalization for mumps was registered in 1733 cases, equating to an overall annual hospitalization rate of 0.423 per 100000 inhabitants. The mean length of the hospital stay was 5 days (interquartile range 3–9). There were 58 deaths in the study period. The mean cost per patient hospitalized for mumps was 2,572 EUR. High levels of immunization coverage are required to reduce the incidence of mumps, and prevent hospitalization from, and outbreaks with, this disease. Show more

Keywords: Mumps, hospitalization, Spain, vaccines

DOI: 10.3233/JPI-2011-0319

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 177-183, 2011

Authors: Iwalokun, Bamidele A. | Oluwadun, Afolabi C. | Iwalokun, Senapon O. | Aina, Olugbenga Ayoola | Olukosi, Yetunde A. | Agomo, Phillip U.

Article Type: Research Article

Abstract: This study determined the trends of fever in relation to parasitaemia and established Pyrogenic threshold (PYT) for malaria in Nigerian children. Two cross-sectional surveys of malaria and fever were carried out during the dry and rainy seasons of 2007 and 2008 in children aged 6 mo −11 yr attending two Primary Health Care Centres (PHC) in Lagos, Nigeria. Structured questionnaires were used to capture data. A total of 505 children attending PHC during the rainy (n …= 385) and dry (n=116) seasons were studied. Unlike in the dry season, the parasite rate increased with age until 59 mo during the rainy season, while both fever rate (19.7–25.4% vs. 14.1–17.7%) and parasite and fever rate combined (13.4–16.7% vs. 9.2–11.2%) showed a decrease with increasing age. More febrile cases with parasitaemia occurred in children aged 23 mo and below compared to those within the 24–59 mo age bracket during the rainy season only (P < 0.05). For all the age groups combined, mean PYT of 2675 and 3000 parasite/uL in 2007 and 2008 during the rainy season and 610 parasites/uL during the dry season (both years) were found. The use of non-artemisinin based combination interventions by caregivers increased the PYT, by 0.5–8.4%. We conclude that fever has become less reliable for syndromic diagnosis of malaria in children below 5 yr in this environment, and that laboratory confirmation of the diagnosis should be mandatory in all cases. Show more

Keywords: Plasmodium falciparum, malarial fever, pyrogenic threshold, Nigerian children

DOI: 10.3233/JPI-2011-0322

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 185-194, 2011

Authors: Gaurav, Jawa | Sugandha, Arya | Rajni, Gaind | Kumar, Chellani Harish

Article Type: Research Article

Abstract: This was a prospective study over one year conducted at the neonatal unit of a tertiary hospital in North India. Babies with positive blood/cerebrospinal fluid cultures for Gram-negative bacteria were taken as study cases. A screening and confirmatory test for extended-spectrum-β-lactamase (ESBL) detection with antibiotic sensitivity carried for each isolated organism. 50 out of 102 Gram-negative isolates were found to be ESBL producers. The most common species isolated were Klebsiella species (54), …of which 37 (68%) were ESBL producers. Other isolates were Acinetobacter species (2 out producers), E.coli (12/35) and Pseudomonas species (0/5). Infection with ESBL-producing bacteria was more likely after prolonged rupture of membranes and previous neonatal treatment with antibiotics. Newborns with infections with ESBL-producing bacteria were more likely to manifest lethargy (P=0.04), seizures (P=0.024) and shock (P=0.012) and had a higher mortality than the non-ESBL group. ESBL-producing bacteria were more likely to be resistant to other antibiotic classes, especially the aminoglycosides, which has important implications for the continuing suitability of routine first-line antibiotic regimens for neonatal sepsis. Show more

Keywords: ESBL, early onset neonatal sepsis, late onset neonatal sepsis, antibiotic resistance

DOI: 10.3233/JPI-2011-0323

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 195-200, 2011

Authors: Sarkar, Sumantra | Nandi, Madhumita | Mondal, Rakesh

Article Type: Research Article

Abstract: Paroxysmal autonomic instability with dystonia (PAID) is a relatively new term for a clinical condition that is characteristically associated with severe traumatic brain injury. PAID has rarely been described in association with central nervous system infections. We report its occurrence in a 3 year old child with tuberculosis meningo-encephalitis. Although PAID has been reported in association with tuberculosis meningo-encephalitis in adults, to our knowledge this is the first such report in a child.

Keywords: Paroxysmal autonomic instability with dystonia, tuberculosis meningo-encephalitis

DOI: 10.3233/JPI-2011-0318

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 201-203, 2011

Authors: Jibaly, Rima | LaChance, Jenny | Abuhammour, Walid

Article Type: Research Article

Abstract: Although herpetic infection is considered in the differential diagnosis of a patient who is immunocompromised with esophagitis, it is less thought of in the immunocompetent patient. There are few reports of esophagitis caused by herpes simplex virus in immunocompetent children and adolescents. We are reporting four cases in this age group who have been identified to have herpes simplex esophagitis. The first patient was nine-year-old boy who presented with chest pain, fever, and diarrhea. …The second patient was a six-year-old boy who presented severe chest pain and had a negative endoscopy four months prior. The third was an 18-year-old young man with history of vomiting, odynophagia, and recent weight loss of 25 lbs. The fourth patient was a six-year-old girl admitted for dehydration and febrile illness three days after tonsillectomy, complaining of chest pain and epigastric abdominal.Their endoscopic findings varied from punched-out ulceration only to erosive esophagitis or both. They were all diagnosed by PCR analysis and not by pathology. All had biopsies suggestive of esophagitis. They all responded well to acyclovir. Based on testing and available follow up, all patients appeared to be immunocompetent, although one case refused HIV testing. Herpes simplex esophagitis in children can have variable presentations. High level of suspicion is warranted even in the immunocompetent patient. This is especially important when the history of acute gastrointestinal symptoms includes a triad of fever, chest pain, and odynophagia, but also even if these symptoms are recurrent. Viral cultures and PCR of the esophageal biopsies should be performed in addition to pathology looking for Cowdry Type A bodies. Show more

Keywords: Esophagitis, herpes simplex virus

DOI: 10.3233/JPI-2011-0324

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 205-209, 2011

Authors: Al Fawaz, Tariq Saleh | Mohta, Sukesh | Zahraa, Jihad Nader

Article Type: Research Article

Abstract: Encephalitis is the most common central nervous system (CNS) complication of Mycoplasma pneumoniae infection. CNS involvement represents the second most common organ system involved other than respiratory system by M. pneumoniae. We report a case of 11-year old male child, who was referred to us with recurrent episodes of status epilepticus and worsening level of consciousness. M. pneumoniae encephalitis was diagnosed on the basis of positive serology and exclusion of other causes. High dose corticosteroid …therapy was given, which resulted in rapid improvement in the patient's neurological condition and full recovery without any neurological sequel. This case emphasizes the importance of CNS complications of M. pneumoniae and shows that corticosteroid therapy has a place for treatment of mycoplasma encephalitis. The available literature regarding this subject is also presented. Show more

Keywords: M. pneumoniae, encephalitis, corticosteroids use

DOI: 10.3233/JPI-2011-0315

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 211-216, 2011

Authors: Taksande, Amar M. | Kumar, Arvind | Vilhekar, Krishna

Article Type: Research Article

Abstract: Enteric fever is rare in children aged under 2 years. Acute acalculous cholecystitis is inflammation of the gallbladder in the absence of gallstones, and is a very rare complication of enteric fever. Here we describe an 18-month-old boy presenting with fever, vomiting, and abdominal pain who was found to have acute acalculous cholecystitis due to typhoid fever on basis of ultrasonographical findings and a positive widal test. He was treated with parental antibiotics and made a …full recovery without undue complication. Show more

Keywords: Acalculous cholecystitis, enteric fever, tphoid, ultrasonography, widal

DOI: 10.3233/JPI-2011-0314

Citation: Journal of Pediatric Infectious Diseases, vol. 6, no. 3, pp. 217-219, 2011