Infections In Pediatric Population Research Articles

High frequency of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in children under 1 year old with skin and soft tissue infections

ObjectiveStaphylococcus aureus is responsible for a large number of infections in pediatric population; however, information about the behavior of such infections in this population is limited. The aim of the study was to describe the clinical, epidemiological, and molecular characteristics of infections caused by methicillin-susceptible and resistant S. aureus (MSSA–MRSA) in a pediatric population. MethodA cross-sectional descriptive study in patients from birth to 14 years of age from three high-complexity institutions was conducted (2008–2010). All patients infected with methicillin-resistant S. aureus and a representative sample of patients infected with methicillin-susceptible S. aureus were included. Clinical and epidemiological information was obtained from medical records and molecular characterization included spa typing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). In addition, staphylococcal cassette chromosome mec (SCCmec) and virulence factor genes were detected. ResultsA total of 182 patients, 65 with methicillin-susceptible S. aureus infections and 117 with methicillin-resistant S. aureus infections, were included in the study; 41.4% of the patients being under 1 year. The most frequent infections were of the skin and soft tissues. Backgrounds such as having stayed in day care centers and previous use of antibiotics were more common in patients with methicillin-resistant S. aureus infections (p≤0.05). Sixteen clonal complexes were identified and methicillin-susceptible S. aureus strains were more diverse. The most common cassette was staphylococcal cassette chromosomemec IVc (70.8%), which was linked to Panton–Valentine leukocidin (pvl). ConclusionsIn contrast with other locations, a prevalence of infections in children under 1 year of age in the city could be observed; this emphasizes the importance of epidemiological knowledge at the local level.

Parasitic Infections in Pediatric Population of India: Epidemiology, Diagnosis, and Strategies for Prevention

AbstractAlmost one-fourth of the world's population is possibly suffering from parasitic diseases. Children are more vulnerable to various parasitic infections as compared with normal adults due to their outdoor activities, immature immune system, nonadherence to good hygiene practices, and preference for street food. Parasitic infections are known to put a grave strain on their physical and cognitive growth and development. Thus, awareness and importance of pediatric parasitology need escalated recognition among pediatricians. Parasitic diseases both common and uncommon that are encountered in Indian children are contemplated in this review. We have covered epidemiology, life cycle, clinical features, and diagnosis of pediatric parasitic infections that transpire in India, including some preventive strategies.

Management of Extraocular Infections.

Extraocular infection is a frequently encountered problem in children including neonates and infants. Prompt recognition of the extraocular disease and management at first contact reduces the ocular morbidity and visual impairment. Delay in administering appropriate therapy and referral to an eye care personnel may result in blindness; sometimes bilateral, due to severe ophthalmia neonatorum. This review is mainly aimed at offering basic, brief information about common extraocular infections prevalent among infants and children living in developing countries as a ready reference to practising pediatricians and neonatologists. Through this review, the pediatricians, as the first contact may feel confident and comfortable in managing ocular infection in pediatric population particularly living in remote rural and tribal region. Literature search was made by retrieving related publications through peer reviewed journals, PUBMED and Cochrane meta-analysis.

A Retrospective Study To Assess The Resistance Profile Among Pathogens Causing Urinary Tract Infection In Pediatric Population At A Tertiary Hospital

A Retrospective Study To Assess The Resistance Profile Among Pathogens Causing Urinary Tract Infection In Pediatric Population At A Tertiary Hospital

Carbapenem-resistant Enterobacteriaceae Infections in Children: An Italian Retrospective Multicenter Study.

The spread of carbapenem-resistant Enterobacteriaceae (CRE) is a health problem of major concern. CRE-related infections have significant morbidity and mortality, but data on CRE infection in pediatric population are limited. The aim of this study was to analyze epidemiologic and clinical characteristics, risk factors, therapeutic options and outcome of CRE infections in children in Italy. We performed a retrospective, multicenter, observational study of children with confirmed CRE infection or colonization admitted between January 1, 2011, and March 1, 2014, to 7 Italian pediatric centers. Sixty-nine patients presenting 74 CRE infections and/or colonization were included. The most frequently isolated strain was Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Children with CRE infections had longer length of stay in hospital (P < 0.001), duration of disease (P = 0.001) and antimicrobial treatment (P < 0.001) than colonized children. Oncologic/immunosuppressive conditions are one of the factors significantly associated with a fatal outcome among children with CRE infections. Our study confirms that CRE infections affect mostly children with oncologic diseases and immunosuppression. Controlled studies in large cohorts are needed to evaluate the best therapeutic options and to assess further risk factors influencing outcomes and the survival of pediatric patients with infections caused by CRE.

Serotyping and Antimicrobial Susceptibility Pattern of Escherichia coli Isolates from Urinary Tract Infections in Pediatric Population in a Tertiary Care Hospital.

Urinary tract infections (UTIs) in pediatric population are associated with high morbidity and long term complications. In recent years, there is increased prevalence of Escherichia coli (E. coli) strains producing extended spectrum β-lactamase, Amp C, and Metallo β-lactamase, making the clinical management even more difficult. This study was aimed to detect the serotypes and to determine antimicrobial susceptibility profile of E. coli isolates from urine samples of children <10 yrs old. A total of 75 pure E. coli strains isolated from patients with symptoms of UTI and colony count ≥105 organisms/mL were included in the study. Antibiotic sensitivity pattern showed maximum resistance to nalidixic acid (98.7%), followed by ampicillin (97.3%), amoxi-clavulanate (96%), and fluoroquinolones (92%) while most of the isolates were found sensitive to piperacillin-tazobactam (13.3%), nitrofurantoin (5.3%), and meropenem (1.3%). 48% of the strains were ESBL producer (extended spectrum beta lactamase). 44% strains were typable withantisera used in our study and the most common serogroup was O6 (33.3%) followed by O1 (15.1%) and O15 (15.1%). To conclude, judicious use of antibiotics according to hospital antibiotic policy and infection control measures should be implemented to prevent spread of multidrug resistant organisms.

Clinical profile of human immunodeficiency virus infection in children: an interesting prospective study

Background: HIV infection has become a pandemic affecting both industrialized & developing countries. The increase in pediatric HIV infection has had a substantial impact on childhood mortality both in industrialized countries and developing countries. It is believed that this study will motivate research worker to work for further improvement of the disease, clinical presentation, diagnostic measures and management in already existing health care delivery system in a tertiary care centre in the tribal area and which may lead to even better survival and quality of life for these children. With the above background, the study is taken up to find the clinical profile of HIV infection in pediatric population in the study area. Methods: The current hospital based prospective study was carried out in the department of pediatrics, Shri V. N. Government Medical College, Yavatmal (Maharashtra), India from 1st January 2011 to 30th June 2012. 108 cases of HIV attending the pediatric OPD and IPD were included in the study. Importance of test was explained to the parents. HIV was diagnosed by using Standard Protocol. All those who were positive by ELISA, confirmed it by repeat test after 3 months. Western blot was not possible due to non availability of kits. Confirmations of all infections were done as per strategies suggested by WHO. Due to non-availability of specific but expensive test like PCR, p24 antigen assay or HIV Culture, children of PPTCT positive mother were tested on follow up after 18 month age to determine whether the transmission was vertical. Results: Majority (60.18%) cases in this study are below 5 years of age. Maximum cases 33(30.55%) were between 5-10yrs of age and 5 cases (4.62%) were below 18 months. Males 69(63.88%) outnumbered females 39(36.11%) with M: F ratio of 1.76:1. In the present study predominant route of transmission of HIV to the child was by perinatal (vertical) transmission (98.15%). Maximum 64(59.25%) were home delivered cases followed by 29(26.85%) normal hospital delivered and 6(5.55%) LSCS/instrumental delivered cases. In present study 60(55.55%) severe malnutrition (Group III and IV) was the most common examination finding. Of the total 108 cases enrolled in the study, 75 cases had regular follow up for 250 times and 33 cases did not follow up. Majority of follow ups were for respiratory complaints (23.20%) and fever (17.60%). Only 7.20% patients came for follow up were asymptomatic. Most of the follow up were for OI’s. In this study, 108 cases of the study group visited 250 times in our hospital. Out of these 90 cases had 212 episodes of OI’s and 18 cases had no evidence of OI’s. Conclusions: HIV infection is an unpredictable disease in infants, children and adolescent which involves multiple organ system and is characterized by progressive clinical deterioration and ultimate development of severe immune dysfunction with opportunistic infections and secondary cancers resulting in a chronic and very complex illness. HIV infected infant and children now survive to adolescent and adulthood, and the challenges of providing HIV care are evolving into the challenges of providing both acute and chronic, lifelong care.

Cantharidin: A well-tolerated and effective therapy for Molluscum contagiosum in children

Molluscum contagiosum (MC) is a frequent viral infection in paediatric population. Destructive therapies for MC are poorly tolerated in children, so in this study, we have assessed the efficacy and tolerability of a non-painful treatment intervention with topical cantharidin. A prospective case series was conducted in which 30 pediatric patients were recruited. Diagnosis of MC was made by dermatologist. Cantharidin collodion 0.2% was applied by dermatologist in an office setting, with a follow-up at 2 and 4 wk. Patients were evaluated about their experience with cantharidin and other treatments for MC (if they had been treated before). Pain experienced with cantharidin technique was measured using a visual analog scale called Faces Pain Rating Scale. The results of this prospective study have demonstrated that cantharidin could be considered a front line therapy for MC in children.

Multiple consecutive norovirus infections in the first 2 years of life.

Studies investigating the magnitude and breath of protective immune responses after primary and subsequent norovirus infections in pediatric populations are limited. We investigated incidence of norovirus infections and serological responses in a child from longitudinal stool and serum samples collected from birth to 2 years of age. Four consecutive infections with distinct genotypes of norovirus were detected. Serum antibodies were genotype-specific offering no protection to reinfection with heterologous virus.Conclusion: This study describes norovirus-specific serological responses in a child with four consecutive norovirus infection during the first 2 years of life. The response is type-specific and does not protect from a subsequent infection with a heterologous virus. What is Known: • Correlates of protection to norovirus infection and disease are not yet determined, and most of the presently available data concern adult population. What is New: • This manuscript describes serological immune responses after primary and subsequent infections in a child during the first 2 years of life.

Microbiological Profile of Urinary Tract Infection in Pediatric Population from a Tertiary Care Hospital in South Kerala

Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. It is estimated that at least 1% of boys and 3% of girls develop urinary tract infection during first ten years of life. UTI is mainly due to the ascending infection from the urethra. The diagnosis of UTI in young children is important as it may be the marker of urinary tract abnormalities especially in males. Early diagnosis is important to preserve renal function of the growing kidney.

Bacteriological Identification of Selected Pathogens in Infected Primary and Young Permanent Teeth Associated with Clinical Symptoms

Background: The common cause of dental infections is necrosis of the pulp of a tooth, which is followed by bacterial invasion through the pulp chamber into the deeper tissues. The bacterial infections are caused by host indigenous bacteria primarily aerobic gram positive cocci, anaerobic gram negative and gram negative rods. The aim of this study is to identify the presence of different cultivating microorganisms which cause dental infections in primary and young permanent teeth manifested by as abscesses and apical parodontitis. Material and Methods: Seventy kids ages 5 - 15 years ( 36 females, 34 males) were studied prospectively (I assume this) at the University Dental Clincal Center of Kosovo, Department of Pediatric Dentistry in cooperation with Microbiological Department of Faculty of Medicine. All patients who had clinical, and radiological confirmation of thier dental infections, followed by extraction of their teeth. Once the tooth was extracted blood and pus sample from the empty alveoli were cultured. The analysis of the sample for bacteria identification was done using the automated system VITEK 2 cards (Biomeriux, France). Results: Of 70 children’s with deciduous 73.5% of them had acute infection and 26.5% chronic infection. On the other hand 75% of children with permanent dentitions had chronic and 25% acute infection. In acute infections the most common aerobic bacteria was Streptococcus group with 47% (Streptococcus mitis and oralis) followed by the Actonomyces group (Actinomyces mayeri and Actinomyces odontoliticus) and anaerobic bacteria in 34%. In chronic infections streptococcus group was the prevalent aerobic group and in anaerobic infection Actinomyces mayeri and Actinomyces naeslundi was the most representative aerobes in 21% of samples. Conclusion: The dental infections in pediatric population (5 - 15 years old) are polymicrobial predominantly anaerobic bacteria over aerobic. This study paves the way for preventives measures that need to me implemented in this group of children.

A Case Report of Pediatric Epstein Barr Virus (EBV) Related Cholestasis from Al-Adan Hospital, Kuwait

Infectious mononucleosis is an acute illness due to Epstein Barr virus infection, which occurs commonly in young adults. Liver involvement in acute EBV infection occurs in up to 95% of patients between the 6th and 15th day of illness and is usually mild [1]. Here we report on a 7-year-old girl treated by Gastroenterology, Hepatology, and Nutrition Unit of Al-Adan Hospital pediatric Department, presented with prolonged fever, lymphadenopathy, generalized edema, hyperbilurubi- nemia and elevated liver enzymes secondary to EBV infection. This case represents a rare presentation of common viral infection in pediatric population.

Prevalencia de Streptococcus pneumoniae serotipo 19A antes y después de la introducción de la vacuna conjugada heptavalente en México

To determine the prevalence of S. pneumoniae serotype 19A (Spn19A), before and after the introduction of heptavalent pneumococcal conjugate vaccine (PCV7) in Mexico. Descriptive study carried out in Mexico with surveillance information of pneumococcal disease, generated from the Sireva network. We performed lineal regression analysis with the proportion of Spn19A by year in two study periods. Data were analyzed using SPSS v.18 software. A total of 1825 S. pneumoniae strains causing infection in pediatric population were recovered in the period 2000-2012, 225/12.3% were Spn19A, and of these, 75/6.3% were isolated in 2000-2008 and 150/23.6% in 2009-2012. There was an increase in antimicrobial resistance post-vaccination for all drugs except vancomycin. It was observed that the frequency of this serotype and antimicrobial resistance increased after the introduction of PCV7.

Evaluation of respiratory syncytial virus group A and B genotypes among nosocomial and community-acquired pediatric infections in southern Brazil

BackgroundRespiratory syncytial virus (RSV) is the main cause of lower respiratory tract illness in children worldwide. Molecular analyses show two distinct RSV groups (A and B) that comprise different genotypes. This variability contributes to the capacity of RSV to cause yearly outbreaks. These RSV genotypes circulate within the community and within hospital wards. RSV is currently the leading cause of nosocomial respiratory tract infections in pediatric populations. The aim of this study was to evaluate the G protein gene diversity of RSV amplicons.MethodsNasopharyngeal aspirate samples were collected from children with nosocomial or community-acquired infections. Sixty-three RSV samples (21 nosocomial and 42 community-acquired) were evaluated and classified as RSV-A or RSV-B by real-time PCR. Sequencing of the second variable region of the G protein gene was performed to establish RSV phylogenetics.ResultsWe observed co-circulation of RSV-A and RSV-B, with RSV-A as the predominant group. All nosocomial and community-acquired RSV-A samples were from the same phylogenetic group, comprising the NA1 genotype, and all RSV-B samples (nosocomial and community-acquired) were of the BA4 genotype. Therefore, in both RSV groups (nosocomial and community-acquired), the isolates belonged to only one genotype in circulation.ConclusionsThis is the first study to describe circulation of the NA1 RSV genotype in Brazil. Furthermore, this study showed that the BA4 genotype remains in circulation. Deciphering worldwide RSV genetic variability will aid vaccine design and development.

Nosocomial Infections in Pediatric Population and Antibiotic Resistance of the Causative Organisms in North of Iran

Background:Treatment of the nosocomial infections is complicated especially in children due to an increase in the antibiotic-resistant bacteria.Objectives:The aim of this study was to survey the nosocomial infections in children and determine the antibiotic susceptibility of their causative organisms in teaching hospitals in the north of Iran.Patients and Methods:The investigation was designed as a retrospective cross-sectional study. The study population consisted of patients under 12 years old, which were hospitalized in three teaching hospitals in the north of Iran and had symptoms of nosocomial infections in 2012. The required data of patients were extracted and entered in the information forms. The collected data were analyzed using SPSS (ver. 16). Descriptive statistics and Fisher’s exact tests (Monte Carlo) were used.Results:Out of the total number of 34556 hospitalized patients in three teaching hospitals, 61 (0.17%) patients were children under 12 years old age with nosocomial infection from which 50.81% were girls and 49.18% were boys. Most of these patients (55.73%) were admitted to the burn unit. The most common type of nosocomial infection (49.18%) was wound infection. Pseudomonas spp. (36.84%) and Acinetobacter spp. (28.02%) were the most common bacteria isolated from the clinical specimens. All the Acinetobacter spp. were multidrug-resistant. All the gram negative and gram positive bacterial species in our study showed high resistance to antibiotics.Conclusions:The rate of nosocomial infections was low in our study because the detection of nosocomial infection was based on the clinical grounds in most cases and laboratory reports might contain false-negative results. These results provide useful information for future large scale surveillance in the context of prevention programs.

Persistence of Lymphatic Filarial Infection in the Paediatric Population of Rural Community, after Six Rounds of Annual Mass Drug Administrations

Under the Global Programme to Eliminate Lymphatic Filariasis (LF), mass drug administration (MDA) is being implemented in Tamil Nadu, south India, by the State health machinery. The impact of six annual rounds of MDA using diethylcarbamazine (DEC) with and without albendazole (ALB) on filarial infection (microfilaraemia prevalence-MFP; antigenaemia prevalence-AGP) in paediatric population of 2-9 years was determined in two revenue blocks, with a population of 321 000. After each MDA, 300-400 children were screened for filarial infection. After six MDAs, an overall MFP reduction of 84.67% and 57.95% was observed in DEC+ALB and DEC alone arms, respectively. Corresponding AGP reductions were 72.88% (p < 0.001) and 41.51% (p = 0.023). Observation of microfilaraemic children after six MDAs (0.32% in DEC+ALB; 0.75% in DEC alone), necessitates the need for supplementary control strategies (viz., vector control), in order to achieve the goal of LF elimination.

Investigation of Mycoplasma pneumoniae infection in pediatric population from 12,025 cases with respiratory infection

Although Mycoplasma pneumoniae (MP) is a major pathogen of primary atypical pneumonia in children, the clinical and laboratory characteristics of MP infection in large pediatric population are less reported. Here, we retrospectively analyzed 12,025 hospitalized children with respiratory infection by using serology and polymerase chain reaction (PCR) methods simultaneously. The results showed that 2433 (20.23%) children had MP infection, which mainly occurred in November to April. The presence of sore throat and pharyngitis was peculiar to MP infection. The positive percentage of MP-DNA was higher than that of MP-IgM in children aged <1 (P < 0.0001) and 1–3 years (P < 0.0001). Moreover, the positive rate of P1 gene, the key adhesion gene for MP infection, was higher in children with MP infection than in those with other pathogens (P < 0.0001). Our work provides the clinical information of children MP infection and highlights the superiority of PCR and potential usage of P1 as a diagnosis target for MP infection.

Human Metapneumovirus M2-2 Protein Inhibits Innate Cellular Signaling by Targeting MAVS

Human metapneumovirus (hMPV) is a leading cause of respiratory infections in pediatric populations globally, with no prophylactic or therapeutic measures. Recently, a recombinant hMPV lacking the M2-2 protein (rhMPV-ΔM2-2) demonstrated reduced replication in the respiratory tract of animal models, making it a promising live vaccine candidate. However, the exact nature of the interaction between the M2-2 protein and host cells that regulates viral infection/propagation is largely unknown. By taking advantage of the available reverse genetics system and ectopic expression system for viral protein, we found that M2-2 not only promotes viral gene transcription and replication but subverts host innate immunity, therefore identifying M2-2 as a novel virulence factor, in addition to the previously described hMPV G protein. Since we have shown that the RIG-I/MAVS pathway plays an important role in hMPV-induced signaling in airway epithelial cells, we investigated whether M2-2 antagonizes the host cellular responses by targeting this pathway. Reporter gene assays and coimmunoprecipitation studies indicated that M2-2 targets MAVS, an inhibitory mechanism different from what we previously reported for hMPV G, which affects RIG-I- but not MAVS-dependent gene transcription. In addition, we found that the domains of M2-2 responsible for the regulation of viral gene transcription and antiviral signaling are different. Our findings collectively demonstrate that M2-2 contributes to hMPV immune evasion through the inhibition of MAVS-dependent cellular responses.

Molecular mechanisms of innate signaling disruption by human metapneumovirus M2-2 protein (108.15)

Abstract hMPV is a leading cause of respiratory infections in pediatric populations globally. Neither an effective cure for hMPV nor a vaccine to prevent hMPV infection is available. Recently, a recombinant hMPV lacking the M2-2 protein (ΔM2-2) demonstrated reduced replication in the respiratory tract of animal models, making ΔM2-2 a promising live vaccine candidate. However, the exact nature of the interaction between the M2-2 protein of hMPV and host cells that regulates viral infection and propagation is largely unknown. In this study, we found that, in addition to its role as a critical regulator of viral RNA synthesis, M2-2 is also an important virulence factor that antagonizes RIG-I/MAVS-mediated cellular signaling, revealing a novel function of M2-2. In reporter gene assays, the M2-2 protein specifically inhibited RIG-I- and MAVS-dependent IFN-β gene transcription, but not the one induced by downstream effectors of MAVS, suggesting that M2-2 targets MAVS in a viral-RNA-independent manner. Coimmunoprecipitation assays revealed that the M2-2 protein interacts with MAVS. In agreement with these findings, ΔM2-2-infected airway epithelial cells produced higher levels of type I interferon and other pro-inflammatory mediators than WT-infected cells. Activation of transcription factors IRF-3 and NF-κB, and induction of their dependent gene transcription were also enhanced by ΔM2-2 infection, confirming the inhibition of hMPV-induced innate signaling by M2-2.

Unique Neurological Manifestations of Dengue Virus in Pediatric Population: a Case Series

Dengue infection is endemic in developing countries posing a major public health problem. Clinical manifestations form a broad spectrum and include uncomplicated dengue fever, dengue hemorrhagic fever and dengue shock syndrome. We report three confirmed cases of dengue infection in pediatric population with central nervous system involvement with certain unreported manifestations resulting in diagnostic dilemma. Increasing evidence of neurotropism by dengue virus emphasizes that clinician be aware of such association and consider dengue infection in cases of febrile encephalitis and myelitis in endemic areas. Early diagnosis and appropriate supportive cars can reverse this potentially fatal disease.