Journal of Pediatric Infectious Diseases - Volume 7, issue 4

Authors: Aggarwal, Mukul | Aggarwal, Kailash C. | Nair, Deepthi

Article Type: Research Article

Abstract: The diagnosis of Central Nervous System tuberculosis (CNS TB) had been always an enigma as yield of Mycobacterium tuberculosis in cerebrospinal fluid (CSF) is very low and diagnosis mainly rested on combination of clinical, CSF analysis and radiological findings. We attempted to find whether 16s rRNA primer based real time Polymerase chain reaction (PCR) aids in diagnosis of tubercular meningitis (TBM) and tuberculoma. Literature is flooded with newer techniques for the diagnosis of neuro-tuberculosis by real …time PCR. But no clear cut guidelines are available about their role. 40 cases of tubercular meningitis, diagnosed on basis of Modified Ahuja Criteria and 40 controls were included in this prospective study. All patients were evaluated clinically and investigated in detail including cerebrospinal fluid analysis, Acid Fast Bacilli staining, culture for TB by Bac T Alert 3-D system,16s rRNA real time PCR assay, chest X ray, computed tomography scans of head, contact survey using chest X-ray, Mantoux test and hemogram. Comparative analysis of real time PCR were done in control group vs. cases of TBM diagnosed on the basis of Modified Ahuja criteria. Results: CSF for tuberculosis by real time PCR was positive in 26/40 cases (65%) of TBM, as against 2/40 controls. Keeping the CSF culture as the gold standard its sensitivity is 62.50 (95% confidence intervals- 54.7, 85.2), specificity is 77.40 (95% confidence intervals- 54.7, 85.2), positive predictive value is 46.15 and negative predictive value is 88.89. Modified Ahuja criteria can serve as useful tool in diagnosis. CSF analysis by real time PCR has shown better sensitivity and quicker results than culture. However, it cannot be recommended alone as it was negative in about a third of cases. But its significance is underlined in early diagnosis and as an adjunct to culture. Show more

Keywords: Real time polymerase Chain reaction, neurotuberculosis, cerebrospinal fluid analysis, tubercular meningitis, tuberculoma

DOI: 10.3233/JPI-120362

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 139-143, 2012

Authors: Richtmann, Rosana | de A. Silva, Camila | Rodrigues, Tatiane T. | Costa, Helenilce P.F. | Baltieri, Sandra R. | Kusano, Elisa

Article Type: Research Article

Abstract: BACKGROUND: Group B streptococcus (GBS) is one of the principal agents of neonatal early onset sepsis (EOS). OBJECTIVE: To evaluate the incidence of GBS colonization and neonatal EOS due to GBS and to describe the compliance of an institutional protocol. METHODS: From January 2007 to December 2010 we conducted a retrospective cohort study to evaluate the incidence of maternal GBS colonization in high risk pregnant women. A protocol was implemented to determine anal/vaginal GBS …colonization of all women at 22 to 37 weeks of pregnancy and all patients that presented the following risk factors. Intrapartum antibiotic prophylaxis (IAP) was administered according to the Centers for Disease Control and Prevention (CDC) guidelines. From January 2009 to December 2010, data from the medical records of all newborns at the NICU were also collected to identify the incidence of newborns whose mothers were screened as indicated by the protocol. RESULTS: A total of 4,797 high risk pregnant women were included. The incidence of maternal GBS colonization was 23 EOS due to GBS was 0.09/1000 live births and a 50 Information regarding GBS maternal colonization was available for 91 the neonates admitted to the NICU. CONCLUSIONS: The maternal GBS colonization rate was similar to that described in the literature. Information regarding maternal GBS colonization was available to the majority of neonates, which is essential for management of this high risk population. The strategy of surveillance of high risk pregnant women can provide a useful and feasible strategy. Show more

Keywords: Early neonatal disease, maternal colonization, group B streptococcus

DOI: 10.3233/JPI-120363

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 145-149, 2012

Authors: Chelliah, Anjali | Saiman, Lisa | Levasseur, Stéphanie M.

Article Type: Research Article

Abstract: We sought to assess whether children with pre-existing heart disease treated for infective endocarditis (IE) were less likely to fulfill the modified Duke criteria for definite IE than those without heart disease. While the modified Duke criteria are widely accepted in research and clinical diagnosis, their applicability in diagnosing IE in children is not as well studied. We performed a retrospective single-center study of children treated for IE from January 1999-December 2009 and compared the proportion …of children with and without heart disease who fulfilled modified Duke criteria for definite IE. We also examined these criteria in children with cyanotic heart disease, hospital-acquired IE, or recent cardiac surgery. Fifty (60%) of 84 children treated for IE met modified Duke criteria for definite IE. The proportion of children with and without heart disease who fulfilled modified Duke criteria for definite IE was not significantly different (38/68, 56%, versus 12/16, 75%, respectively, p=0.26). Patients with cyanotic heart disease or hospital-associated IE were as likely to meet definite criteria as those without. However, children with early postoperative IE were less likely than those with late postoperative or without cardiac surgery to meet definite IE criteria (12/31, 39%, versus 38/53, 72%, p=0.005). Only 60% of children treated for IE met modified Duke criteria for definite IE. Children with early postoperative IE were least likely to fulfill these criteria. Future studies should evaluate potential strategies to improve the diagnosis of IE in children. Show more

Keywords: Infectious endocarditis, modified Duke criteria, congenital heart disease, postoperative endocarditis

DOI: 10.3233/JPI-120364

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 151-157, 2012

Authors: Niederer-Loher, Anita | Kahlert, Christian | Barben, Jürg | Deggim, Vanessa | Zellweger, Jean-Pierre

Article Type: Research Article

Abstract: We report the first documented patient-to-patient transmission of Multidrug resistant tuberculosis observed in Switzerland between two young, previously healthy patients from Tibet. They both lived in Switzerland for several years and did not originate from the same community. Resistance patterns and restriction fragment length polymorphism-analysis (RFLP-analysis) of both strains were identical.

Keywords: Tuberculosis, multidrug-resistance, transmission, contact-investigation

DOI: 10.3233/JPI-120370

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 159-160, 2012

Authors: Brien, James H. | Fader, Robert | Wehbe-Janek, Hania

Article Type: Research Article

Abstract: Macracanthorhynchus ingens infections in humans are rare in North America. While one case has been reported in 1985, the best therapy remains unclear. A case is presented of successful therapy in a 15-month-old child using mebendazole at a dose of 100 mg bid for three days.

Keywords: Macracanthorhynchus ingens, mebendazole

DOI: 10.3233/JPI-120365

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 161-163, 2012

Authors: Murillo, Jeremias L. | Lee, Wan-Man | Al Sheikh, Suhail | Tulsyan, Vasuda | Cohen, Morris

Article Type: Research Article

Abstract: An 801 gram very premature infant was delivered by Cesarian section at 28 weeks gestation and developed invasive Candida parapsilosis infection at 4 weeks of age complicated with obstructive uropathy, bilateral hydronephrosis and bladder fungus ball. The baby was treated with systemic amphotericin B and bladder irrigation with amphotericin B solution. Treatment resulted in complete eradication of the bladder fungus ball and resolution of the obstructive uropathy. The difficulty of performing bladder irrigation in an extremely …small premature infant is discussed. This case illustrates the need to investigate for renal involvement in newborns with persistent candidemia and the effectiveness of bladder irrigation with amphotericin B solution in the treatment of bladder fungus balls. Show more

Keywords: Bladder fungus ball, neonate, candidiasis

DOI: 10.3233/JPI-120367

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 165-169, 2012

Authors: Adams, Daniel J. | Thomas, Nicole M. | Eberly, Matthew D.

Article Type: Research Article

Abstract: Neuroinvasive disease seldom follows infection with West Nile virus, but is particularly rare in children. Most reported cases of West Nile virus encephalitis have occurred in older adults or the immunocompromised. Although individuals who are homozygous for a 32 base pair deletion in the chemokine receptor CCR5 have been shown to be resistant to infection with HIV-1, they have been reported to have in increased risk of developing severe disease following West Nile virus infection. Analysis …of the presence of the CCR5 deletion has not been previously examined in children with West Nile neuroinvasive disease. We present a case of West Nile encephalitis in a previously healthy young child whom we evaluated for the presence of the CCR5δ32 mutation. Show more

Keywords: West Nile virus, encephalitis, CCR5, children

DOI: 10.3233/JPI-120366

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 171-175, 2012

Authors: Singh, Narendra C. | Mondal, Tapas

Article Type: Research Article

Abstract: Pediatric infective endocarditis is unusual and is considered rare when caused by the pathogen Streptococcus pneumoniae. It is, nonetheless, crucial for the pediatrician to be aware of the potential manifestations of this serious disease. We report a case of an immunocompetent child with Turner's syndrome and a bicuspid aortic valve, receiving regular hormonal injections, presenting with pneumococcal endocarditis. Interestingly, the disease was confined to the structurally normal mitral valve and cardiac surgery …was necessary. Show more

Keywords: Infective endocarditis, bicuspid aortic valve, streptococcus pneumoniae

DOI: 10.3233/JPI-120368

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 177-180, 2012

Authors: Tsaknakis, Konstantinos | Hell, Anna-Kathrin | von Richthofen, Esther | Menke, Jan

Article Type: Research Article

DOI: 10.3233/JPI-120369

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 181-182, 2012

Article Type: Other

Citation: Journal of Pediatric Infectious Diseases, vol. 7, no. 4, pp. 183-185, 2012