Showing papers by "Carrie L. Byington published in 2006"
TL;DR: PPE in the post-PCV-7 era is more common, representing one-third of the IPD in children in UT, and remains the most common cause of PPE, but serotypes 3 and 19A are emerging.
Abstract: Background:Pediatric pneumococcal parapneumonic empyema (PPE) has become increasingly common. In the last decade, Utah has had one of the highest rates of PPE in the United States, 14/100,000 children, attributed primarily to Streptococcus pneumoniae serotype 1. Our objective was to describe the tem
257 citations
TL;DR: Proven influenza infection in children results in substantial hospital resource utilization and morbidity and supports the Advisory Committee on Immunization's recommendations to expand the use of influenza vaccine to children >2 years of age.
Abstract: BACKGROUND Influenza causes significant morbidity among children Previous studies used indirect case ascertainment methods with little cost data We sought to measure the burden of laboratory-confirmed influenza from hospitalized children METHODS We conducted a retrospective cohort study during 3 viral seasons at Primary Children9s Medical Center (Salt Lake City, UT) Children ≤18 years of age who were hospitalized with laboratory-confirmed influenza infection were included Outcomes included hospitalization rates, complications including intensive care unit stays, mechanical ventilation, length of stay, and total hospital costs RESULTS A total of 325 children had hospitalizations attributable to influenza over 3 viral seasons: 28% 2 years of age; 37% had high-risk medical conditions Population-based rates of hospitalization for Salt Lake County residents ranged from 63 to 2527 per 100000 children The highest rates were in children younger than 6 months, and rates decreased with increasing age Forty-nine (15%) children had an ICU stay; 27 required mechanical ventilation, and half of these patients were >2 years of age Total hospital cost for the cohort was $2 million; 55% was accounted for by children >2 years of age Length of stay and total hospital costs were significantly higher in all children >2 years of age compared with children CONCLUSIONS Proven influenza infection in children results in substantial hospital resource utilization and morbidity Nationwide, the median hospital costs may total $55 million Our data support the Advisory Committee on Immunization9s recommendations to expand the use of influenza vaccine to children >2 years of age
210 citations
TL;DR: The baseline trends in meningococcal disease can be compared with those seen after widespread vaccination to assess the success of routine immunization.
Abstract: OBJECTIVES. Meningococcal disease continues to result in substantial morbidity and mortality in children, but there is limited recent surveillance information regarding serogroup distribution and outcome in children in the United States. The objective of this study was to collect demographic, clinical, laboratory, and outcome information for infants and children who had Neisseria meningitidis infections of various serogroups and were cared for in 10 pediatric hospitals. METHODS. Investigators at each of the participating hospitals identified children with meningococcal infections and collected demographic and clinical information using a standard data form. Meningococcal isolates were sent to a central laboratory for serogrouping by slide agglutination and penicillin susceptibility. RESULTS. From January 1, 2001, through March 15, 2005, 159 episodes of systemic meningococcal infections were detected. The greatest numbers of children were younger than 12 months (n = 41) or were 12 to 24 months of age (n = 22). Meningitis was the most common clinical manifestation of disease accounting for 112 (70%) cases; 43 (27%) children had bacteremia only. Children who were younger than 5 years (17 of 102) were significantly less likely to require mechanical ventilation than children who were 5 to 10 years of age (12 of 24) or children who were older than 10 years (13 of 33). Overall, 55 (44%) isolates were serogroup B, 32 (26%) were serogroup C, and 27 (22%) were serogroup Y. All but 1 isolate (intermediate) were susceptible to penicillin. The overall mortality rate was 8% (13 of 159) but was greater for children who were ≥11 years of age (7 [21.2%] of 33) than for children who were younger than 11 years (6 [4.8%] of 126). Unilateral or bilateral hearing loss occurred in 14 (12.5%) of 112 children with meningitis. CONCLUSIONS. The morbidity and the mortality of meningococcal infections are substantial. With the recent licensure of meningococcal conjugate vaccines, our baseline trends in meningococcal disease can be compared with those seen after widespread vaccination to assess the success of routine immunization.
105 citations
TL;DR: An infant who had herpes simplex virus (HSV) encephalitis and sustained severe bilateral damage to the posterior frontal lobes, postcentral gyri, and the thalami despite intravenous acyclovir treatment is reported.
Abstract: Here we report an infant who had herpes simplex virus (HSV) encephalitis and sustained severe bilateral damage to the posterior frontal lobes, postcentral gyri, and the thalami despite intravenous acyclovir treatment. At 7 months of age, the patient developed infantile spasms and was treated with corticotropin injections. After 10 days of corticotropin treatment, she developed lethargy, fever, and opisthotonic posturing. Her cerebrospinal fluid again was positive for HSV DNA, indicating recurrent HSV encephalitis, and repeat MRI revealed new lesions of the right frontal, parietal, temporal, and occipital lobes. Immunosuppression by corticotropin may have led to the reactivation of the HSV encephalitis. Corticotropin should be relatively contraindicated for use when a patient has a history of HSV infection, or intravenous acyclovir should be administered concurrently.
21 citations
TL;DR: The clinical and laboratory features of RF and SA demonstrate substantial overlap and patients with monoarticular arthritis and sterile synovial fluid cultures should have RF included in their differential diagnoses.
Abstract: Background: Monoarticular arthritis in children is most often suppurative septic arthritis (SA) of bacterial origin. We recently cared for 3 patients with monoarticular arthritis who developed carditis while receiving antibiotics for SA. Distinguishing SA from rheumatic fever (RF) is critical to avoid lifelong cardiac complications associated with RF. Methods: We compared the 3 cases of RF presenting with monoarticular arthritis with 12 cases of culture-confirmed SA to assess the clinical and laboratory differences between the 2 groups. Results: Erythrocyte sedimentation rate, C-reactive protein and mean synovial fluid white blood cell counts were elevated in both groups. Mean antistreptolysin O (ASO) and anti-DNase B titers were elevated in patients with RF. Conclusions: The clinical and laboratory features of RF and SA demonstrate substantial overlap. Patients with monoarticular arthritis and sterile synovial fluid cultures should have RF included in their differential diagnoses. Patients with an elevated ASO and/or anti-DNase B titer should have a careful cardiac examination looking for clinical evidence of carditis. Echocardiogram should be considered if clinical carditis associated with RF is suspected.
21 citations
TL;DR: A case of fatal neonatal enteroviral infection caused by echovirus 7.7 was described and multiple treatments, including specific antiviral therapy, were attempted and failed.
Abstract: We describe a case of fatal neonatal enteroviral infection caused by echovirus 7. Multiple treatments, including specific antiviral therapy, were attempted and failed. Studies of the viral isolate, maternal plasma, intravenous immunoglobulin preparations and pleconaril were performed to identify potential causes for treatment failure.
17 citations
TL;DR: A case of fatal neonatal enteroviral infection caused by echovirus 7.7 was described and multiple treatments, including specific antiviral therapy, were attempted and failed.
Abstract: We describe a case of fatal neonatal enteroviral infection caused by echovirus 7. Multiple treatments, including specific antiviral therapy, were attempted and failed. Studies of the viral isolate, maternal plasma, intravenous immunoglobulin preparations and pleconaril were performed to identify potential causes for treatment failure.
7 citations
1 citations
TL;DR: Findings support ascertaining a history of IPA exposure in young infants who are suspected of having an SBI and for recommending that, consistent with national guidelines, penicillin be used as an IPA rather than ampicillin.
Abstract: ARTICLE In Reply .—
We appreciate the interest of Drs Edwards and Duff in our article. We reported that previously healthy term infants younger than 90 days who were hospitalized because of serious bacterial infections (SBIs) were more likely to have been exposed to intrapartum antibiotics (IPAs) than were age-matched healthy controls. We also found that the causative organisms in infants with an SBI were more likely to be ampicillin-resistant if the infant's mother had been exposed to an IPA, which in our cases was mostly ampicillin.1 We argue that these findings support ascertaining a history of IPA exposure in young infants who are suspected of having an SBI and for recommending that, consistent with national guidelines, penicillin be used as an IPA rather than ampicillin. Edwards and Duff apparently believe that the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and Centers for Disease Control and Prevention recommendations for penicillin over ampicillin as an IPA …
1 citations