Common Infections In Children Research Articles

Antimicrobial susceptibility profiles of invasive bacterial infections among children from low- and middle-income countries in the Western Pacific Region (WPRO) – a systematic review and meta-analysis

Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region. We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes. Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. Escherichia coli revealed a pooled susceptibility to ampicillin of 17% (95% CI 12-23%, n=3292), gentamicin 63% (95% CI 59-67%, n=3956), and third-generation cephalosporins 59% (95% CI 49-69%, n=3585). Susceptibility of Klebsiella spp. to gentamicin was 71% (95% CI 61-80%, n=2323), third-generation cephalosporins 35% (95% CI 22-49%, n=2076), and carbapenems 89% (95% CI 78-97%, n=2080). Pooled susceptibility of Staphylococcus aureus to flucloxacillin was 72% (95% CI 58-83%, n=1666), and susceptibility of Streptococcus pneumoniae meningitis isolates to ampicillin was 26% (95% CI 11-44%, n=375), and 63% (95% CI 40-84%, n=246) to third-generation cephalosporins. The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary. The study was supported by an Australian GovernmentNational Health and Medical Research Council Investigator Grant. This research was funded in part by the Wellcome Trust [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

A rare presentation of measles and post-measles complications in a neonate: case report

BackgroundMeasles is a common infection in children. Measles infection in children less than 6 months of age is very rare since maternal antibodies play a major role in the prevention of the disease.Case presentationHere we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis. The patient had a strong measles contact and epidemiological linkage to the measles epicenter, Govandi (a locality in the Mumbai region of western India), so measles IgM antibody was obtained which were significantly raised.The patient was successfully revived from this critical presentation with early and appropriate resuscitation, timely ionotropic support, and the use of empirical broad-spectrum antibiotics. The patient required intensive unit care for four days and was started on feeds and discharged after 12 days of hospital stay. On follow-up, the patient is doing well and gaining weight.ConclusionUncommon presentation and the epidemiology of the disease should alert the clinician of having a high index of suspicion. Early intervention and prompt treatment can help reduce morbidity and mortality.

Clinical and laboratory features of urinary tract infection in hospitalized children

Background: Urinary tract infections (UTIs) is a common infection in children and a significant problem in Indonesia. Epidemiological data in developing countries are not widely available. This study aimed to determine the clinical and laboratory features of UTIs in hospitalized children. Methods: A retrospective study at a tertiary hospital in Denpasar–Bali. Children diagnosed with UTIs from January 1st, 2021–December 31st, 2022 were enrolled. Subjects are characterized based on age, nutritional status, and comorbidity. Clinical and laboratory features were described. Results: There were 84 children diagnosed with UTIs. A total of 30 subjects (35.7%) were <1–year-old and mostly female (52.4%). Most subjects (47.6%) were well–nourished and had comorbidities (92.9%) from a non-kidney disease (65.5%). Eight (9.5%) of the 52 subjects had hypertension. The most common symptom in the < 1–year–old group was jaundice (50%). The predominant symptom in the 1–5–year–old group was also fever (71.4%). Localized symptoms in the > 5–year–old groups showed dysuria (38.5%), urinary retention (30.8%), and frequency (26.9%). Urinalysis showed 30 subjects (35.7%) with positive nitrites and pyuria (66.7%). Leukocytosis was found in 24 subjects (72%) with a median NLR of 1.8. Abnormalities found in imaging examinations were cystitis (19.2%), hydronephrosis (42.1%), and hydroureter (11.5%). Conclusion: Age < 1–year–old, female, had comorbidities with predominant symptom was fever found in hospitalized UTIs. Half of the subjects had leukocytosis, abnormalities in urinalysis, and urology imaging. However, further research is needed to know the association and risk factors for UTIs in hospitalized children.

Metagenomic next-generation sequencing of bronchoalveolar lavage fluid assists in the diagnosis of pathogens associated with lower respiratory tract infections in children.

Worldwide, lower respiratory tract infections (LRTI) are an important cause of hospitalization in children. Due to the relative limitations of traditional pathogen detection methods, new detection methods are needed. The purpose of this study was to evaluate the value of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) samples for diagnosing children with LRTI based on the interpretation of sequencing results. A total of 211 children with LRTI admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2019 to December 2020 were enrolled. The diagnostic performance of mNGS versus traditional methods for detecting pathogens was compared. The positive rate for the BALF mNGS analysis reached 95.48% (95% confidence interval [CI] 92.39% to 98.57%), which was superior to the culture method (44.07%, 95% CI 36.68% to 51.45%). For the detection of specific pathogens, mNGS showed similar diagnostic performance to PCR and antigen detection, except for Streptococcus pneumoniae, for which mNGS performed better than antigen detection. S. pneumoniae, cytomegalovirus and Candida albicans were the most common bacterial, viral and fungal pathogens. Common infections in children with LRTI were bacterial, viral and mixed bacterial-viral infections. Immunocompromised children with LRTI were highly susceptible to mixed and fungal infections. The initial diagnosis was modified based on mNGS in 29.6% (37/125) of patients. Receiver operating characteristic (ROC) curve analysis was performed to predict the relationship between inflammation indicators and the type of pathogen infection. BALF mNGS improves the sensitivity of pathogen detection and provides guidance in clinical practice for diagnosing LRTI in children.

Perinatal and Other Risk Factors for Common Infections in Infancy: A Prospective Cohort Study.

Limited data from prospective cohort studies in high-income countries are available on the perinatal risk factors for common infections in children. Our hypothesis was that perinatal factors may be risk factors for infectious episodes during the first year of life. In this prospective Health and Early Life Microbiota birth cohort study of full-term infants (n = 1052) born in 2016-2018, the number and duration of infection episodes were collected online at weekly to monthly intervals. In a multivariate regression model, the main exposures were perinatal factors such as mode of delivery and intrapartum antibiotics. Environmental factors were additional exposures. The outcomes were the number and duration of infectious episodes in the first year of life. The mean number of infection episodes was 4.2 (2.9 SD). The mean duration of infection symptoms was 44 days (40 SD). Upper respiratory infections accounted for 83% of the episodes (3674/4455). Perinatal factors were not associated with the number nor the duration of infection episodes, but cesarean section was associated with an increased occurrence of urinary tract infections in infancy [adjusted odds ratio (aOR): 3.6; 95% confidence interval (CI): 1.13-11.1]. Of the additional exposures male sex (aOR: 1.1; 95% CI: 1.0-1.2) and the presence of siblings (aOR: 1.3; 95% CI: 1.2-1.4) were associated with the number of infection episodes. This prospective cohort study showed that perinatal factors, mode of delivery and intrapartum antibiotics were not associated with the risk of common infections in infancy, but cesarean delivery was associated with a risk of urinary tract infections.

Evaluation of Urinary Tract Infections in Pediatric Patients Admitted to the Emergency Department

Abstract Background/Aim: Urinary tract infections (UTIs) are among the most common infections in children and one of the important reasons for presentation to the pediatric emergency department. This study aimed to determine demographic characteristics, complaints, microorganisms isolated in urine culture analysis, and antibiotic resistance rates in pediatric patients diagnosed with UTIs. Material and Method: The data of patients aged under 18 years, who presented to our hospital from January 1, 2020, through December 31, 2020 with a preliminary diagnosis of UTIs and underwent urine culture analysis, were retrospectively screened from the computer registry system. The patients’ demographic characteristics, complaints, microorganisms isolated in urine culture analysis, and antibiotic resistance were evaluated. Results: The mean age of the 286 patients included in the study was 75.5±57.65 months, and 238 (83.2%) were girls. The most common complaint at presentation was dysuria (39.9%), followed by fever (35.3%) and abdominal pain (26.9%). In urine culture analysis, the most frequently detected microorganisms were Escherichia coli (n=242, 84.6%), Proteus spp. (n=21, 7.3%), and Klebsiella spp. (n=16, 5.6%). The highest antibiotic resistance was observed in ampicillin (54.9%) and the lowest in amikacin (6.6%). Conclusion: Inappropriate treatment choices in UTIs are important in terms of complications that may occur in future. Therefore, healthcare centers should evaluate their own infectious agents and antibiotic susceptibility at certain intervals and determine appropriate empirical treatment choices. Empirically initiated treatments should be re-evaluated according to urine culture and sensitivity results.

Changes in the microbiota of the upper airways and intestine in the treatment of acute respiratory infections in preschool children

Introduction. The microbiota of the upper airways and intestine in preschool children is directly involved in protecting the growing body from acute respiratory infections (ARI), which are the most common infections in children, about 65% of them turn into recurrent respiratory infections (RRI). Aim. To establish changes in the microbiota of the upper airways and intestine in the treatment of ARI in preschool children.
 Materials and methods. The study involved sixty 1–6 year (Me = 3.38 years) frequently ill children. They were divided into 3 groups depending on the chosen treatment lasting 90 days. Children of group 1 (n = 20) underwent nutrition correction. Children of group 2 (n = 20) received additional probiotics. Children of group 3 (n = 20) received both nutritional correction and probiotics at the prescribed doses. Before and after treatment, the composition of the microbiota of the oropharyngeal zone and intestine was determined by genetic sequencing of the V3–V4 region of the 16S ribosomal RNA gene, followed by bioinformatic analysis. 
 Results. Significant differences were found mainly in the relative content of Firmicutes in the microbiota of patients treated. The content of Firmicutes in the microbiota of children receiving probiotics against the background of nutrition correction (30%) was significantly higher than in patients with nutrition correction (26.91%) and in children receiving only probiotics (25.95%). In patients of different groups, after treatment, a decrease in the content of Proteobacteria in the microbiota of the oropharyngeal zone was revealed. A significant decrease in the relative content of Bacteroidota (by more than 3 times) in 95% of patients, and a decrease in Proteobacteria (by more than 4.5 times) in 100% of patients was also found in the intestinal microbiota of group 3 patients treated with probiotics. In addition, there was a significant increase in the Firmicutes microbiota from 21.97% to 30.07% in 85% of patients, and an increase in the content of Actinobacteriota from 1.9% to 5.7% in 95% of patients. The relative content of undifferentiated microbiota after therapy was also significantly higher (70.08%) than before treatment (58.40%) in 85% of patients.

Severe acute bronchiolitis in children: etiology, therapy, effectiveness of 3% hypertonic saline containing sodium hyaluronate

Introduction. Acute bronchiolitis (АB) is a common infection in children under the age of 2 years. In modern clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison with therapy without the inclusion of this drug.Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy of 3% HSCS with HS AB was conducted in comparison with historical control.Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the age younger than 3 months (40.7%). The presence of risk factors for severe course of acute respiratory failure had an impact on the average bed-day and on the need for respiratory support (p = 0.04), in addition to which patients often received drug therapy. There were no statistically significant differences in the terms of hospitalization, the duration of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma by the 2nd day of the disease.Conclusion. AB in ICU patients most often has RSV etiology, developing in the presence of risk factors for severe course. The influence of modern guidelines for the treatment of AB in the ICU remains controversial. The addition of 3% HSCS with HS can improve the flow of AB.

EVALUATION OF MODIFIED NITRITE TEST AS A DIAGNOSTIC TEST IN URINARY TRACT INFECTION OF CHILDREN

Objective: Urinary tract infection (UTI) is common infection in children. Urine culture is the gold standard method for diagnosing urine infection but it takes more than 48 h to give results. The objective is to evaluate the diagnostic ability of modified nitrite test as a rapid diagnostic screening test for diagnosis of UTI in children. Methods: An observational and cross-sectional study was conducted in a tertiary care hospital in Udaipur over a period of 1 year. Children aged up to 60 months with suspected UTI were enrolled in the study. Children with congenital urogenital anomalies and prior antibiotic treatment were excluded from the study. Urine culture and modified nitrite test was done for every children. Results: Ninety children with suspected UTI were enrolled in the study. Urine culture was positive in 14 (15.55%) out of 90 urine samples. When modified nitrite test was compared to positive urine culture, true positives were 9 and 1 was false positive. Sensitivity, Specificity, PPV, NPV, and Accuracy was 64.29%, 98.68%, 90%, 93.75%, and 93.33%, respectively. Conclusion: Sensitivity and specificity of modified nitrite test are good enough as a diagnostic test for detection of UTI. It can be used as a point of care test for rapid screening and identifying the cases.

Bactericidal Effect of Antibiotics against Bacteria Causing Urinary Tract Infection among Children

Background: Urinary Tract Infection (UTI) is one of the most common infections in children. Use of antibiotics according to updated sensitivity pattern is critical. Aim: To determine major bacteria causing UTI with drug sensitivity pattern to find best empirical therapy. Study design: Descriptive cross-sectional study. Methodology: This study was conducted at WAPDA hospital Rawalpindi from June 2022 to November 2022. A total of 71 urine culture positive children aged between 1 to 14 years were enrolled. The main variables for the study included age and sex of patient, isolated bacteria and the sensitivity pattern against different drugs. The data was analyzed using SPSS version 23.0. The variables are presented in the form of standard deviation and frequency of percentages. Results: The average age of enrolled children was 5.9 (SD ± 3.6) years. The common bacteria leading to UTI were E. coli 43 (60.6%) followed by Klebsiella 11 (15.5%) and Enterococcus 5 (7%). The most common organism isolated was E. coli. The most effective drugs against E. coli are Meropenem (97.2%), Fosfomycin (90.2%), and Amikacin (89.7%). The resistance pattern is Co-trimoxazole (86%), Amoxicillin/clavulanic acid (69.8%) and Cefixime (70.7%). Conclusion: The most common isolate was E. coli. The sensitivity of nitrofurantoin, Fosfomycin and Amikacin to the pathogens’ causing UTI is high and can be used empirically. Other commonly used antibiotics are mostly resistant, therefore regular studies in every region are necessary to update the protocols for treatment of UTI. Keywords: Urinary tract infection, E. coli, Amikacin, Urine culture and sensitivity

Clinical Profile of Children with Pyelonephritis and Cystitis in Dr. Soetomo General Academic Hospital, Surabaya

Highlights:1. In patients younger than one year old, cystitis was more frequent in boys. Meanwhile, in patients aged 1-5, girls were more frequent in pyelonephritis and cystitis.2. In pyelonephritis, all patients had fever, followed by diarrhea and lethargy.3. Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis than in pyelonephritis. AbstractIntroduction: Urinary tract infection (UTI) is a common infection in children. Prompt diagnosis and treatment of this infection are important to prevent further damage to the kidney. This study aimed to examine the clinical profile of children with pyelonephritis and cystitis in Dr. Soetomo General Academic Hospital, Surabaya.Methods: This was a descriptive study conducted in Dr. Soetomo General Academic Hospital, Surabaya, from June 2013 until December 2015, using secondary data and presented by percentage. Samples included in this study were children aged two months to five years old with UTI as a primary or secondary diagnosis of diarrhea and had urine culture results ≥ 105 CFU/ml.Results: There were 30 patients with pyelonephritis and 27 patients with cystitis. The prevalence of pyelonephritis was 0.285% and of cystitis was 0.247%. In pyelonephritis patients younger than one-year-old, boys and girls were equal. However, boys (60%) were more frequent in cystitis patients. In both pyelonephritis and cystitis patients aged 1-5, girls were more frequent (56.3%; 64.7%). In pyelonephritis patients, all patients were found with fever, followed by diarrhea (60%) and lethargy (56.7%) as the two most common symptoms. The two most common symptoms in cystitis patients were lethargy (44.4%) and irritability (33.3%). Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis (11.1%; 7.4%) patients than in pyelonephritis patients.Conclusion: Boys were more frequent to suffer urinary tract infections. Systemic symptoms were frequently found in pyelonephritis patients, while urinary symptoms were more frequent in cystitis patients.

Urinary tract infection in children - short versus standard duration antibiotic therapy

Background: Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity. Pediatric urologists are now faced with a situation that requires appropriate action- antibiotic resistance of urinary tract pathogens is significantly increasing worldwide.
 Objective: The purpose of our work is to present the clinical aspects of antibiotic use in pediatric urology. To present the benefits of both short antibiotic therapy and standard antibiotic therapy. 
 Methods and materials: A literature review was conducted in the PubMed database, using the key words: "urinary tract infection", "children", "short-term antibiotics", "antibiotics", „nephrology”.
 Results: Short-term antibiotic therapy for lower urinary tract infections appears to be as effective as standard therapy. Studies show that shorter antibiotic therapy also works well for pyelonephritis in pediatric patients. Children who have received a short course of antibiotic therapy may also be less likely to get subsequent infections in the future with a more resistant strain of the same uropathogen.
 Conclusion: Tried to reconcile the latest reports on diagnosis, treatment and follow-up in pediatric UTIs with existing practice and opinions on the use of short as well as standard antibiotic therapy. However, more clinical trials are needed to confirm efficacy, and to assess side effects of the therapy

Tests for Early Detection of Paediatric Urinary Tract Infection

Urinary tract infection is the most common of all pediatric bacterial infections. This study aims to determine the efficacy of rapid diagnostic tests vs gram stain as against gold standard test (urine culture) and to find out the validity of each screening test for early detection of urinary tract infection in children. A cross-sectional study was conducted on children aged between 3- 15 years of suspected urinary tract infections from August 2020 to January 2021. Data collection was facilitated by using a predesigned checklist. The specimen was collected in a sterile, leak proof container by clean catch midstream technique and was subjected to urine microscopy, urine dipstick nitrite and leukocyte esterase, urine gram stain, and the gold standard test urine culture and sensitivity. Using the gold standard test, the sensitivity, specificity, positive predictive value, and negative predictive value of the other screening tests were determined. The patient's mean age was 5.16 ± 2.7 years, and half were in the age group 3-5 years. The majority of the patients were male (54%). Fever (64%) was the major symptom, followed by pain in the abdomen (52%) and dysuria (40%). Escherichia coli was the most common organism isolated (54%), followed by Klebsiella (22%). Urine gram stain has sensitivity and specificity of 95% and 100% respectively. Urinary tract infection is a common infection in children. Urine gram stain is a very sensitive and specific test for diagnosing urinary tract infections compared to other screening tests.

Prevalence of Urinary Tract Infection among Children - a cross-sectional study in Arar city, Northern Border Area, KSA

Background: Urinary tract infection (UTI) is one of the most common infections in children. The prevalence of UTI during childhood varies by gender, age, and multiple other factors. The most commonly causes of UTI in children are E. coli and Klebsiella in different parts of the world. Aim: To evaluate the prevalence of UTI, its etiologic pathogens, presenting symptoms and probable risk factors in our area. Methods; A retrospective cross-sectional study was conducted on electronic files of 606 pediatric participants of confirmed UTIs from year 2015 -2020 in arar city hospital. These cases were diagnosed after urine culture positive for the respected uropathogens. Urine samples were collected either transurethral in < 1year children and clean voided midstream in elder children under aseptic techniques. The samples were sent to the hospital lab with especial request that we would use these samples for our study. Hospital laboratory followed full protocol that is followed worldwide. Results: Total of 606 confirmed cases of UTI were used. Of this, 370(61.05%) were females and 236 (38.94%) males. Among them, 253 (41.74%) were <1 year old, 229(37.78%) were 1–5-year-old whereas 124(20.46%) were above 5 years old children. We found that E. coli was the most prevalent organism 342(56.23%), followed by Klebsiella which was 175(28.8%). E. coli was more common in outpatients compared to Klebsiella which was the most common aetiologic agent isolated from hospital admitted patients. Citrobacter, Enterococci, Actinobacteria and Pseudomonas aeruginosa were commoner in hospital patients. High grade fever, dysuria and foul smelling was the main symptom of E. coli positive cases whereas foul smelling was common in Klebsiella positive cultures. Constipation was noted to be the most common 198(32.6%) risk factor in our area. Other risk factors were history of instrumentation, history of catheterization, structural abnormalities, and posterior urethral valve abnormalities which were 9.9 %, 9.9 %, 10.2% and 3.30% respectively. Conclusion: We conclude first; Prevalence of UTI was more common in females than males in < 1 year old group. Second; E.coli was the most common bacteria followed by Klebsiella. Third; it showed that along with other risk factors, constipation plays a significant role in causation of UTI in our area. Keywords; UTI, children, risk factors

Antibiotic resistance of urinary tract pathogens in Syrian children

Urinary tract infections (UTIs) are one of the most common infection in children in Syria. This study was conducted on 48 urine samples from pediatric UTI patients aged from 0 days to 18 years. The ratio female/male UTI patients was 4:1. Escherichia coli was the first cause of UTIs in childhood (63%), followed by Klebsiella pneumonia (25%). A high rate of resistance (≥ 20%) to twelve antibiotics was observed among isolated urine bacteria, while only three antibiotics showed a rate of resistance below 20%. A good in vitro antibacterial activity was observed for amikacin, imipenem and gentamycin against isolated urine bacteria. First and second generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole and other agents displayed moderate to high resistance rates and multi-antibiotic resistance was found as well. 98% of urine bacteria isolates were resistant to at least two antibiotics. Our results suggest that the antibiotic susceptibility may vary according to the bacterial infection types, since the comparison of susceptibility between Escherichia coli and Klebsiella pneumonia showed a difference of resistance rates.

Antibiotic Resistance Patterns in Pediatric Urinary Tract Infections: A Comparison Between 2013-2015 and 2019-2021 Pediatrik İdrar Yolu Enfeksiyonlarında Antibiyotik Direnç Paternleri: 2013-2015 ve 2019-2021 Arasında Bir Karşılaştırma

Objective: Urinary tract infections (UTIs) are one of the most common infections in children. The aim of this study was to assess and compare the etiology and antibiotic susceptibility results of urine cultures obtained between 2013-2015 and 2019-2021 and evaluate local epidemiologic differences over years.
 Materials and Methods: A total of 1,000 samples with positive urine cultures (500 cultures each for the 2013-2015 and 2019-2021 periods) and antibiogram results were included in this study.
 Results: The most grown uropathogens were Escherichia coli and Klebsiella spp. in both two periods. E. coli and Klebsiella spp. showed high resistance to ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, cefuroxime, and ceftriaxone. The resistance rates of E. coli to ampicillin, amoxicillin and trimethoprim-sulfamethoxazole were reported as 65%, 46%, and 45%, respectively and significantly increased in 2019-2021 compared to 2013-2015 (p

Immunotoxic chemicals, childhood infections, and long-term health effects

BACKGROUND AND AIM: Environmental chemicals can act as immunotoxicants by dysregulating the immune system, and can modulate the effects of infectious agents. Several studies link exposure to environmental chemicals with susceptibility to infectious diseases in adults and children, but results are inconclusive. Also, the role of subclinical infections in long-term health effects has been little examined. We will present specific results from ongoing analyses in children and also discuss priority areas for research on the immunotoxic effects of environmental chemicals. METHODS: Results from ongoing analyses in three European birth cohorts [Born in Bradford (BiB), UK; Environment and Childhood (INMA), Spain), and Mother Child cohort study (RHEA), Greece], with information on immunotoxic chemicals in early life, humoral response to common natural infections, and long-term health effects, will be presented. The effects of common infections in children in relation to chemical exposures and their combined effects on the immune system and long-term health effects will be reviewed. RESULTS: Results from the RHEA cohort showed that maternal levels of polychlorinated biphenyls (PCBs) may increase susceptibility to persistent viral infections in the first years of life. Also, exposure to dichlorodiphenyltrichloroethane (DDT) during pregnancy and in childhood was associated with lower immunoglobulin-G levels against varicella from 6 to 11 years of age. Evidence of the immunotoxic effects of historical persistent organic pollutants such as PCBs and DDT is strong; however, evidence is still limited for the emerging chemicals including per- and polyfluoroalkyl substances and the non-persistent ones such phthalates and phenols. CONCLUSIONS: Exposure to immunotoxic agents in early-life may modulate humoral response to common natural infections in children. The potential for some of the most widely used chemical compounds to interfere with the developing immune system during critical periods of development is of great concern for public health given the current context of emerging epidemics.

Role of Vitamin D Deficiency in Increased Susceptibility to Respiratory Infections Among Children: A Systematic Review.

Vitamin D has several roles in the immune system besides its effects on bone metabolism. Acute respiratory infections are common infections in children. Severe lower respiratory tract infections (LRTIs) even cause death in children, especially in those less than five years of age. Our study aims to examine whether children with vitamin D deficiency are susceptible to respiratory infections and to study the association between vitamin D deficiency and the severity of respiratory infections. We comprehensively searched research articles in PubMed, ScienceDirect, and Cochrane library databases. The main keywords were vitamin D deficiency, respiratory infections, and children. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this systematic review. The initial search showed 16,120 papers. A meticulous screening of research articles using the eligibility criteria and quality appraisal tools was done. Finally, 10 research articles qualified for this systematic review, including eight case-control studies, one randomized controlled trial (RCT), and one cohort study. Seven of 10 research studies reviewed found that children with low vitamin D levels are susceptible to respiratory infections. Five studies discussed the severity of respiratory infections and low vitamin D levels. This systematic review concluded that children with low vitamin D levels are prone to developing respiratory infections. But we could not find a conclusive association between the severity of respiratory infections and low vitamin D levels.

Tekrarlayan İdrar Yolu Enfeksiyonu Olan Çocuklarda Tuvalet Alışkanlıklarının Değerlendirilmesi ve Böbrek Hasarı Gelişmesinde Rol Oynayan Risk Faktörlerinin Araştırılması

Objective: Urinary tract infection is one of the common infections in children. The patients with recurrent infection are at risk for permanent renal damage in later life. In this study, it was aimed to investigate the toilet habits and risk factors for renal scarring in children with recurrent urinary tract infection without congenital anomalies of the kidney and urinary tract.Materials and Methods: Patients between the ages of 6 and 18 with a diagnosis of recurrent urinary tract infection who were toilet trained were included in this study. Data of patients with congenital anomalies of kidney and urinary tract were excluded from the study. The detailed information on the voiding postponement, infrequent voiding, holding maneuvers and renal scarring were obtained from file records.Results: The 208 patients (146 girls, 62 boys) were included in this study. The more than half of the patients (n=132, 63.5%) had a habit voiding postponement, and one third (n=65, 31.3%) had holding maneuver. There was infrequent voiding in 47 (22.6%) patients. Renal scarring was determined in 38 (18.3%) patients. The frequencies of voiding postponement, holding maneuver and infrequent voiding were higher in patients with renal scarring than those of without [30 (78.9%)/102 (60%), p=0.048; 12 (31.6%)/53 (21.2%), p=0.039; 15 (39.5%)/32 (18.8%), p=0.009, respectively]. It was determined a significant positive association between renal scarring and voiding postponement with infrequent voiding [Odds ratio=3.21, p=0.011; Odds ratio=1.46, p=0.021; Odds ratio=3.43, p=0.001, respectively]. Conclusion: Toilets habits should be questioned in routine follow-up program in children with recurrent urinary tract infection. The development of true toilet habits may be useful to prevent the development of renal scarring in children.

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

BackgroundThe most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis.Materials and methodsIn this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA.ResultsThirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease.ConclusionElevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN.