Showing papers in "Pediatric Infectious Disease Journal in 2014"

The changing epidemiology of serious bacterial infections in young infants.

Abstract: Background:Management of febrile young infants suspected of having serious bacterial infections has been a challenge for decades. The impact of changes in prenatal screening for Group B Streptococcus and of infant immunizations has received little attention in population-based studies.Methods:This s

Middle East respiratory syndrome coronavirus disease in children.

Abstract: Background:In the initial description of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, many affected patients were adults with underlying medical comorbidities. Data on the clinical presentation and outcome of pediatric cases are lacking. We report the clinical presentation and

Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis.

Abstract: Background Late-onset sepsis (LOS) is a common complication in the neonatal intensive care unit. We aimed to describe the epidemiology, clinical characteristics and risk factors for adverse outcome in neonates with LOS. Methods We conducted a cohort study of all neonates with LOS at the neonatal intensive care unit of a Tertiary Taiwan Medical Center from January 2004 through December 2011 and used multivariate logistic regression to identify risk factors for final adverse outcome. Results Among 5010 neonates over 253,644 neonate-days, 713 (14.2%) experienced a total of 942 episodes of LOS (incidence rate, 3.71 episodes per 1000 neonate-days). Although the rates of LOS were inversely proportional to birth weight and gestational age, the incidence rates were comparable among extremely preterm, late preterm and full term neonates. Fungemia was found to have significantly higher rate of infectious complication (30.8%), persistent bloodstream infection (19.2%) and sepsis attributable mortality (23.1%). The overall mortality rate was 12.6% (90/713), and sepsis attributable mortality rate was 7.2% (68/942 episodes). Independent predictors of in-hospital mortality were Pseudomonas LOS (adjusted odds ratio [OR], 14.31; 95% confidence interval [CI]: 3.87-53.0), fungemia (OR, 5.69; 95% CI: 2.48-13.01), presence of congenital anomalies (OR, 4.12; 95% CI: 1.60-10.60), neuromuscular comorbidities (OR, 3.34; 95% CI: 1.66-6.73) and secondary pulmonary hypertension with/without cor pulmonale (OR, 23.48; 95% CI: 5.96-92.49). Conclusions LOS predisposes hospitalized neonates to increased risk of mortality or morbidity, especially caused by Pseudomonas aeruginosa or Candida spp. More aggressive treatment strategy is worth consideration in neonates with presumed LOS, particularly those with certain underlying chronic conditions.

Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia.

Abstract: Background: pneumonia is the leading cause of morbidity and mortality among children <5 years of age globally. pneumococcal conjugate vaccines (pCVs) are known to provide protection against vaccine serotype pneumococcal pneumonia; uncertainty exists regarding the optimum pCV dosing schedule. Methods: We conducted a systematic review of studies published from 1994 to 2010 (supplemented post hoc with studies from 2011) documenting the effect of pCV dosing schedules on clinical and radiologically confirmed pneumonia, pneumococcal pneumonia and empyema among children of ages targeted to receive vaccine. Data on 2- and 3-dose schedules were included. p ercent change of pneumonia incidence rates from baseline to most recent year post-pCV introduction was calculated. Results: We identified 42 primary citations that evaluated pCV schedules and pneumonia. thirty-seven (88%) were from north America, europe or Australia; 37 (88%) evaluated pCV7 and 1 (2%) pCV10. two studies (both observational) compared multiple schedules within the study. We found evidence of reduced clinical and radiologically confirmed pneumonia incidence for all schedules, including 2+1 (1 nonrandomized trial, 5 obser vational studies), 3+0 (5 randomized trials, 2 observational studies) and 3+1 (5 clinical trials, 24 observational studies) schedules. the magnitude of disease impact did not differ among schedules. evidence for impact on pneumococcal pneumonia and empyema varied. Conclusions: All schedules (2+1, 3+0 and 3+1) reduced clinical and radiologically confirmed pneumonia. Quantifying differences in pneumonia disease impact between schedules was difficult due to heterogeneity among studies in design, case definition and population. these findings support World Health Organization recommendations for 3-dose schedules administered as either 3+0 or 2+1 regimens. pneumonia impact data are still needed on expanded serotype pCV products, developing country settings and the role for a booster dose.

Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type nasopharyngeal carriage.

Abstract: Background:Pneumococcal conjugate vaccines (PCV) reduce nasopharyngeal carriage of vaccine type (VT) pneumococci, an important driver of vaccine programs’ overall benefits. The dosing schedule that best reduces carriage is unclear.Methods:We performed a systematic review of English language publicat

Temporal trends in emergency department visits for bronchiolitis in the United States, 2006 to 2010.

Abstract: Background:To examine temporal trends in emergency departments (EDs) visits for bronchiolitis among US children between 2006 and 2010.Methods:Serial, cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally representative sample of ED patients. We used International Class

Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type invasive pneumococcal disease among young children.

Abstract: Streptococcus pneumoniae can cause a variety of clinical syndromes among both children and adults. When infection spreads to a normally sterile site, such as the brain or blood, the resulting syndrome, called invasive pneumococcal disease (IPD), is associated with significant morbidity and mortality. The burden of IPD falls disproportionately on young children, especially those in low-income countries, and persons at high risk of infection because of underlying medical conditions such as HIV or sickle cell disease.1,2 A limited number of pneumococcal serotypes cause the majority of IPD in both high- and low-risk groups; 7 of these serotypes are included in the 7-valent pneumococcal conjugate vaccine (PCV7), first licensed in February 2000.3 Within 6 years of PCV7 introduction in the United States, use of a 3-dose primary series with a booster in the second year of life (a “3+1” schedule) and a national catch-up campaign among those under 5 years of age nearly eliminated vaccine-type IPD (VT-IPD) among children targeted to receive the vaccine.4 More recently, licensed PCV formulations that include 10 and 13 serotypes (PCV10 and PCV13, respectively) hold promise to further reduce the burden of pneumococcal disease. Between 2000 and 2008, PCV7 was introduced into the national immunization programs of 26 countries, including 1 middle-income country.5 As of December 2011, 77 countries offered PCV universally or had >50% coverage with the vaccine; 30 used a 3+1 schedule and 47 used a reduced dose schedule of either 3 primary doses without a booster (3+0) or 2 primary doses with a booster (2+1) (Sources: Database maintained by WHO, supplemented with data from VIMS [Vaccine Information Management System of IVAC] and individual country reports or press releases). Although immuno genicity data support the use of reduced dose schedules for most vaccine serotypes, whether reduced dose schedules can provide equivalent protection against VT-IPD to a 3+1 schedule when introduced into a national immunization program is unclear.6 The World Health Organization currently recommends that countries introduce PCV as part of the Expanded Programme on Immunisation schedule, yet specific guidance on the relative effectiveness of different PCV dosing schedules in various settings is lacking.7 Public health leaders newly considering PCV introduction, as well as those with established programs, face challenging decisions regarding the most appropriate dosing schedule for their populations, including the benefits of a 3-dose primary series compared with a 2-dose primary series, the benefits of a booster dose and whether a 3-dose series should be administered on a 2+1 or a 3+0 schedule. In this report, we attempt to provide insight into the relative benefits of different dosing schedules by presenting findings from a systematic review of the available literature on PCV dosing effects on VT-IPD among young children.

Direct and indirect effects of PCV13 on nasopharyngeal carriage of PCV13 unique pneumococcal serotypes in Massachusetts' children.

Abstract: Background:The direct impact of 13-valent pneumococcal conjugate vaccine (PCV13) on colonization with unique PCV13 serotypes and the uptake of vaccine necessary to create indirect protection in nonimmunized children were assessed.Methods:Carriage surveillance among children <60 months began in July

Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation.

Abstract: 3 Urine dipstick test was positive for leukocyte esterase or nitrite in 79% Renal ultrasound performed in 95 patients (95%) showed anatomic abnormalities in 47%; 5/26 (24%) with hydronephrosis had vesicoureteral reflux on voiding cystourethrogram Four patients had urosepsis; none had bacterial meningitis and no patients died Conclusions: UTI affects approximately 1 in 6 febrile neonates ≤30 days of age Males are affected 25-times greater than females E coli continues to be the predominant uropathogen Clinical parameters like height of fever, CBC total white blood cell count and urine dipstick test lack sensitivity in identifying UTI risk in the outpatient setting Only 4 infants had urosepsis (4%) Nearly half of neonates with UTI have a radiographically identified anatomic abnormality All febrile young infants should receive performance of a urine culture; those with UTI require imaging

Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011.

Abstract: Background To assess the recent epidemiologic features of Kawasaki disease (KD) in South Korea from the nationwide survey conducted between 2009 and 2011. Methods We collected data regarding the incidence, symptoms, treatment and coronary complications associated with acute KD by sending questionnaires to the 100 hospitals that have pediatric residency programs from 2009 to 2011. Results We received complete responses from 73 hospitals and partial responses from 14 hospitals. A total of 13,031 patients of KD were reported from the 87 hospitals (3941 in 2009, 4635 in 2010 and 4455 in 2011). The male to female ratio was 1.44:1, and the median age at diagnosis was 28 months. From the questionnaires with complete responses, we noted that the incidence of KD per 100,000 children Conclusions The average annual incidence of KD in South Korea has continuously increased to 134.4 per 100,000 children

Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective, population-based study in Nicaragua.

Abstract: Background: Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods: We followed a population-based sample of children less than5 years in Leon, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results: The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least 1 enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%) and enterotoxigenic E. coli (7.7%), with rotavirus detected among 5.3% of diarrheal stools. Enteropathogenic Escherichia coli and enterotoxigenic E. coli were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (less than2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions: In this Central American community after RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.

Systematic review of the indirect effect of pneumococcal conjugate vaccine dosing schedules on pneumococcal disease and colonization.

Abstract: Pneumococcal conjugate vaccines (PCV) have been available for use in infants for over a decade and have played an integral role in the prevention of disease caused by Streptococcus pneumoniae in children in higher income settings.1 However, until recently, availability of PCV for children living in lower income countries has been limited. This situation is now changing. In 2011, 18 GAVI-eligible countries were approved to introduce PCV; an additional 19 have been approved.2 As the feasibility of introducing PCV into childhood immunization programs has grown, the need to understand the number and the timing of doses, which will maximize both direct and indirect effects, has become a key question. Much of the evidence regarding PCV impact has focused on young children targeted to receive vaccine using 2 primary doses plus a booster (2+1) or 3 primary doses with or without a booster (3+0 or 3+1).3–6 Clinical trials and observational studies have demonstrated a significant direct impact of PCV on both vaccine-type invasive pneumococcal disease (VT-IPD) and pneumococcal and syndromic pneumonia among children <5 years of age.3,6 Reductions in nasopharyngeal (NP) carriage of vaccine-type pneumococci (VT-NP), a necessary precursor to clinical disease, have also been demonstrated among young children receiving the vaccine.4 Because pneumococci are transmitted through respiratory secretions, reductions in NP carriage of pneumococci are a key factor toward indirect effects of vaccine introduction and the establishment of “herd” protection. Through herd protection, infant immunization indirectly protects groups not targeted to receive the vaccine by reducing the circulation of vaccine-type bacteria. Prevention of disease among adults through herd protection has been shown to be an important benefit and a powerful driver of the cost effectiveness of a PCV program in high-income settings.7 Whether different PCV dosing schedules may translate into noticeable differences in herd effects is unknown. Here, we present a systematic review of the literature summarizing the evidence on the indirect effects of PCV dosing schedules on VT-IPD, VT-NP-carriage and syndromic pneumonia among groups not targeted to receive the vaccine.

Mycoplasma pneumoniae Infections in Childhood

Abstract: sible for up to 40% of community-acquired pneumonias in children over 5 years of age. Community-acquired pneumonias due to M. pneumoniae may increase several fold dur ing epidemics that occur every 4–7 years, believed to be due to waning of herd immunity and introduction of new subtypes into the population. the peak incidence reported in Scotland during the recent European epidemic was 14.2 per 100,000 population. 1 Milder presentations, typically tracheobronchitis, are at least 20 times more common than community-acquired pneumonias, and up to 20% of infections are asymptomatic. a recent Cochrane review concluded that diagnosis of infection based on clinical symptoms alone is not reliable. 2 therefore, accurate, rapid and cost-effective point of care diag

Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial.

Abstract: Background:Studies on short-course treatment of childhood pneumonia in the developed world are lacking. We compared clinical and laboratory outcomes of a 3-day or a 5-day to a 10-day treatment in young children with community-acquired alveolar pneumonia.Methods:A double-blind, randomized, placebo-co

Short intensified treatment in children with drug-susceptible tuberculous meningitis.

Abstract: Background:The World Health Organization recommends 12-month treatment (2RHZE/10RH) for children with tuberculous meningitis (TBM). Studies evaluating length of antituberculous treatment for TBM report similar completion and relapse rates comparing 6-month treatment with 12-month treatment.Methods:A

Mucormycosis outbreak associated with hospital linens.

Abstract: Background:Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections.Methods:A case was defined as a hospital-onset il

Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network.

Abstract: Background:It was the aim of this study to assess whether very-low-birth-weight (VLBW) infants born small for gestational age (SGA; birth weight less than 10th percentile) are at increased risk for late-onset sepsis.Methods:This was a prospective, multicenter study of the German Neonatal Network inc

Association between pulmonary ureaplasma colonization and bronchopulmonary dysplasia in preterm infants: updated systematic review and meta-analysis.

Abstract: Background: Previous meta-analyses have reported a significant association between pulmonary colonization with Ureaplasma and development of bronchopulmonary dysplasia (BPD). However, because few studies reporting oxygen dependency at 36 weeks corrected gestation were previously available, we updated the systematic review and meta-analyses to evaluate the association between presence of pulmonary Ureaplasma and development of BPD. Methods: Five databases were searched for articles reporting the incidence of BPD at 36 weeks postmenstrual age (BPD36) and/or BPD at 28 days of life (BPD28) in Ureaplasma colonized and noncolonized groups. Pooled estimates were produced using random effects meta-analysis. Meta-regression was used to assess the influence of difference in gestational age between the Ureaplasma-positive and Ureaplasma-negative groups. The effects of potential sources of heterogeneity were also investigated. Results: Of 39 studies included, 8 reported BPD36, 22 reported BPD28 and 9 reported both. The quality of studies was assessed as moderate to good. There was a significant association between Ureaplasma and development of BPD36 (odds ratio = 2.22; 95% confidence intervals: 1.42–3.47) and BPD28 (odds ratio = 3.04; 95% confidence intervals: 2.41–3.83). Sample size influenced the odds ratio, but no significant association was noted between BPD28 rates and difference in gestational age between Ureaplasma colonized and noncolonized infants (P = 0.96). Conclusions: Pulmonary colonization with Ureaplasma continues to be significantly associated with development of BPD in preterm infants at both 36 weeks postmenstrual age and at 28 days of life. This association at BPD28 persists regardless of difference in gestational age.

Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth.

Abstract: Background: Studies examining the etiology-specific effects of diarrheal disease on growth are limited and variable in their analytic methods, making comparisons difficult and priority setting based on these findings challenging. A study by Black et al (Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984;33:1004–1009.) examined the association between Shigella and enterotoxigenic Escherichia coli-related disease and weight gain and linear growth in Bangladeshi children aged 0–5 years. We estimated similar associations in a 2002 cohort of 0- to 6-year-old children in the Peruvian Amazon. Methods: Diarrheal surveillence was conducted using household visits 3 times per week. Anthropometry was collected monthly. Mixed-effect models were used to estimate the association between Shigella, ETEC and Campylobacter diarrhea and weight gain in a 2-month period and linear growth over a 9-month period. Diarrheal disease burdens and growth intervals were quantified so as to be as comparable as possible to the original report. Results: Shigella- and ETEC-associated diarrhea were not associated with diminished weight gain, although the association between ETEC diarrhea and weight gain (−4.5 g/percent of days spent with ETEC, P = 0.098) was twice that of other etiologic agents, as well as similar in magnitude to the original report. Shigella-associated diarrhea was associated with decreased linear growth (0.055 cm less growth/percent days, P = 0.008), also similar to the original study. Conclusions: Our findings suggest that associations between enteropathogen-specific diarrheal episodes and growth, particularly Shigella, are comparable across geographic and epidemiological contexts.

Epidemiology and clinical outcomes of multidrug-resistant, gram-negative bloodstream infections in a European tertiary pediatric hospital during a 12-month period.

Abstract: Background:Bloodstream infections caused by multidrug-resistant, Gram-negative (MDRGN) bacteria represent a significant cause of morbidity and mortality. Prompt diagnosis and appropriate empiric treatment are the most important determinants of patient outcome. The objective of our study was to asses

Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children

Abstract: BACKGROUND Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory tract infections (URI). Clinical characteristics of URIs complicated by ABS in young children have not been well studied. METHODS We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (6-35 months of age at enrollment), who were followed up for 1 year to capture all URI episodes and complications. At the initial URI visit seen by the study personnel (median day = 4 from symptoms onset), nasopharyngeal samples were obtained for bacterial cultures and viral studies. RESULTS Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. Average age at ABS diagnosis was 18.8 ± 7.2 months; White children were more likely to have ABS episodes than Blacks (P = 0.01). Hispanic/Latino ethnicity (P < 0.0001) was negatively associated, and adequate 7-valent pneumococcal conjugate vaccine immunization status (P = 0.001) appeared to increase the risk of ABS. Girls had more ABS episodes than boys (0.5 ± 0.8 vs. 0.3 ± 0.6 episodes/yr, respectively, P = 0.03). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS risk (P = 0.01). Bacterial cultures were positive in 82/83 (99%) available samples obtained at the initial URI visit; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with the risk for ABS (P = 0.04 for both). CONCLUSIONS ABS complicates 8% of URI in young children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M. catarrhalis during URI are positively correlated with the risk for ABS complication.

The burden of influenza hospitalizations in infants from 2003 to 2012, United States.

Abstract: Background:Little information is available describing the epidemiology and clinical characteristics of those <12 months hospitalized with influenza, particularly at a population level.Methods:We used population-based, laboratory-confirmed influenza hospitalization surveillance data from 2003 to 2012

Motavizumab treatment of infants hospitalized with respiratory syncytial virus infection does not decrease viral load or severity of illness.

Abstract: Background:This study was conducted to determine whether treatment with motavizumab, an anti-respiratory syncytial virus (RSV) monoclonal antibody, would decrease viral load and improve clinical outcomes in previously healthy term infants hospitalized with RSV lower respiratory tract infection.Metho

Update of Rotavirus Strains Circulating in Africa From 2007 Through 2011

Abstract: BACKGROUND The African Rotavirus Surveillance Network has been detecting and documenting rotavirus genotypes in the subcontinent since 1998, largely based on intercountry workshops conducted at Rotavirus Regional Reference Laboratories. This article reports on rotavirus genotypes generated at Regional Reference Laboratories, South Africa between 2007 and 2011 from 16 African countries. METHODS Stool samples were collected from <5-year-old children with diarrhea following World Health Organization criteria of hospital-based rotavirus surveillance. Enzyme immunoassay (EIA) was performed by National Laboratories. Regional Reference Laboratories retested 10% of randomly selected EIA positives and 10% of EIA negatives from each country as part of quality control. At least 50 rotavirus EIA positives from each country per year were subjected to reverse transcriptase polymerase chain reaction based on G-/P-types. Sequencing was conducted in 5-10% of each representative G or P genotype to confirm the genotype, as well as to type some of the samples that could not be genotyped with reverse transcriptase polymerase chain reaction-based methods. RESULTS A total of 2555 of rotavirus EIA positives were genotyped. G1 was the most predominant (28.8%), followed by G9 (17.3%), G2 (16.8%), G8 (8.2%), G12 (6.2%) and G3 (5.9%). Similarly, the P[8] strain was the most prevalent (40.6%), followed by P[6] (30.9%) and P[4] (13.9%). The top G/P combinations detected were G1P[8] (18.4%), G9P[8] (11.7%), G2P[4] (8.6%), G2P[6] (6.2%), G1P[6] (4.9%), G3P[6] (4.3%), G8P[6] (3.8%) and G12P[8] (3.1%). CONCLUSIONS There is high genetic diversity of rotavirus strains circulating in the subcontinent. Understanding the strain diversity pre- and postvaccine introduction are important in Africa to understand the broader impact of the rotavirus vaccines on regionally circulating strains.

Active surveillance of candidemia in children from Latin America: a key requirement for improving disease outcome.

Abstract: BACKGROUND Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America. METHOD Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010. RESULTS Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04). CONCLUSIONS To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.

Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema.

Abstract: Background:Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it

Respiratory Syncytial Virus Disease in Preterm Infants in the US Born at 32–35 Weeks Gestation Not Receiving Immunoprophylaxis

Abstract: Background: The Respiratory Syncytial Virus (RSV) Respiratory Events Among Preterm Infants Outcomes and Risk Tracking (REPORT) study evaluated RSV disease burden in US preterm infants 32–35 weeks gestational age (wGA) not receiving RSV prophylaxis.

Changes in childhood pneumonia and infant mortality rates following introduction of the 13-valent pneumococcal conjugate vaccine in Nicaragua

Abstract: Background:In 2010, Nicaragua became the first developing nation to add 13-valent pneumococcal conjugate vaccine (PCV-13) to its national immunization schedule, using a “3+0” dosing schedule. We assessed changes in incidence rates of health facility visits for childhood pneumonia and infant mortalit

A proposed scoring system for assessment of severity of illness in pediatric acute hematogenous osteomyelitis using objective clinical and laboratory findings.

Abstract: BACKGROUND Severity of illness in children with acute hematogenous osteomyelitis (AHO) is variable, ranging from mild, requiring short-duration antibiotic therapy without surgery, to severe, requiring intensive care, multiple surgeries and prolonged hospitalization. This study evaluates severity of illness among children with AHO using clinical and laboratory findings. METHODS Fifty-six children with AHO, consecutively treated in 2009, were retrospectively studied. Objective clinical, radiographic and laboratory parameters related to severity of illness were gathered for each child. A physician panel was assembled to rank order objective clinical parameters, review clinical data and classify each child as mild, moderate or severe. Statistically significant parameters correlated with length of hospitalization were utilized to devise a severity of illness score and applied to the cohort of children for internal validation. RESULTS The physician panel had perfect or substantial agreement regarding 7 parameters (ICU admission, intubation, pulmonary involvement, venous thrombosis, multifocal infection, surgeries and febrile days on antibiotics). Parameters that significantly correlated with total length of stay included: C-reactive protein values at admission (P < 0.0001), 48 hours (P < 0.0001) and 96 hours (P < 0.0002); febrile days on antibiotics (P < 0.0001); admission respiratory rate (P = 0.023) and evidence of disseminated disease (P = 0.016). A scoring system, derived from selected parameters, significantly differentiated children with AHO on the basis of causative organism, intensive care admission, surgeries, length of hospitalization, complications and physician panel assessment. CONCLUSIONS Severity of illness score for AHO, derived from preliminary clinical and laboratory findings, is useful stratifying children with this disease. LEVEL OF EVIDENCE Prognostic Level II.

C-reactive Protein, Procalcitonin and the Lab-Score for Detecting Serious Bacterial Infections in Febrile Children at the Emergency Department: A Prospective Observational Study

Abstract: C-reactive protein (CRP) and procalcitonin (PCT) are useful diagnostic tools to estimate the risk of serious bacterial infection (SBI) in febrile children at the emergency department (ED). The Lab-score combines these 2 biomarkers with urinalysis in an easy to use validated model. Kinetics of inflammatory markers suggests a differentiating role of duration of disease.