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Li J, Xie J, Zhang M, Xiao Z, Zhang F, Huang W, Zhou Y, Yan W, Zhang R, Peng X. Analysis of mild and severe neonatal enterovirus infections in a Chinese neonatal tertiary center: a retrospective case-control study. Eur J Clin Microbiol Infect Dis 2024; 43:1119-1125. [PMID: 38607576 DOI: 10.1007/s10096-024-04805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/07/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To compare the clinical characteristics, virus serotype, and outcome in cases of mild and severe enteroviral infection at a tertiary neonatal intensive care unit in China. METHODS A retrospective analysis of cases hospitalized between June and August 2019. Samples (stool or throat swabs) were examined using reverse transcription polymerase chain reaction. Positive cases were divided into two groups: mild infection and severe infection. RESULTS A total of 149 cases were assigned to one of two groups: mild infection (n = 104) and severe infection (n = 45). There were no significant differences between the groups in terms of sex, gestational age, birth weight, mode of delivery, and onset within 7 days. Clinical symptoms in both groups mostly resembled sepsis (fever, rash, poor feeding, and lethargy); however, there were significant variations in concomitant symptoms such as hepatitis, thrombocytopenia, encephalitis, coagulopathy, and myocarditis. Severe cases were more likely to have abnormal complete blood counts, biochemical parameters, and cerebrospinal fluid markers. The predominant serotypes implicated in neonatal enterovirus infections were echoviruses and Coxsackievirus B. Invasive ventilation, intravenous immunoglobulin, vasoactive medications, and blood product transfusions were often required, with high mortality rates among severe cases. CONCLUSION We found significant differences between mild and severe cases of neonatal enterovirus infection with respect to complications, laboratory findings, and enterovirus serotypes. It is crucial to exercise caution when newborns exhibit symptoms of sepsis, during an enterovirus outbreak. Anemia, thrombocytopenia, abnormal liver function, and coagulation dysfunction should be monitored closely as they could indicate the presence of a severe enteroviral infection.
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Affiliation(s)
- Junshuai Li
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jingjing Xie
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Min Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhuojun Xiao
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Fan Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Weiqing Huang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yong Zhou
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Weiqun Yan
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Rong Zhang
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiaoming Peng
- Department of Neonatology, Hunan Children's Hospital, Changsha, China.
- The School of Pediatrics, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
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Viral agents (2nd section). Transfusion 2024; 64 Suppl 1:S19-S207. [PMID: 38394038 DOI: 10.1111/trf.17630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
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Hirade T, Abe Y, Ito S, Suzuki T, Katano H, Takahashi N, Koike D, Nariai A, Kato F. Congenital Echovirus 11 Infection in a Neonate. Pediatr Infect Dis J 2023; 42:1002-1006. [PMID: 37523578 DOI: 10.1097/inf.0000000000004052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Neonates infected with enterovirus in utero would be fulminant at birth or develop symptoms within a few days. Echovirus 11 causes life-threatening hepatic necrosis with coagulopathy and adrenal hemorrhagic necrosis. The prognosis depends on the enterovirus serotype and the absence of serotype-specific maternal antibodies at the time of delivery. We describe a fatal neonatal case of congenital echovirus 11 infection.
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Affiliation(s)
- Tomohiro Hirade
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Yasuhiro Abe
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Satoko Ito
- Department of Neonatology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Koike
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Akiyoshi Nariai
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Fumihide Kato
- Department of Neonatology, Shimane Prefectural Central Hospital, Shimane, Japan
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Fu L, Zhang XY, Jin WP, Wang C, Qian SS, Wang MJ, Wang WH, Meng SL, Guo J, Wang ZJ, Chen XQ, Shen S. Identification of a Conserved, Linear Epitope on VP3 of Enterovirus A Species Recognized by a Broad-Spectrum Monoclonal Antibody. Viruses 2023; 15:v15041028. [PMID: 37113008 PMCID: PMC10145497 DOI: 10.3390/v15041028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Outbreaks of hand, foot and mouth disease (HFMD) have occurred frequently in the Asian-Pacific region over the last two decades, caused mainly by the serotypes in Enterovirus A species. High-quality monoclonal antibodies (mAbs) are needed to improve the accuracy and efficiency of the diagnosis of enteroviruses associated HFMD. In this study, a mAb 1A11 was generated using full particles of CV-A5 as an immunogen. In indirect immunofluorescence and Western blotting assays, 1A11 bound to the viral proteins of CV-A2, CV-A4, CV-A5, CV-A6, CV-A10, CV-A16, and EV-A71 of the Enterovirus A and targeted VP3. It has no cross-reactivity to strains of Enterovirus B and C. By mapping with over-lapped and truncated peptides, a minimal and linear epitope 23PILPGF28 was identified, located at the N-terminus of the VP3. A BLAST sequence search of the epitope in the NCBI genus Enterovirus (taxid: 12059) protein database indicates that the epitope sequence is highly conserved among the Enterovirus A species, but not among the other enterovirus species, first reported by us. By mutagenesis analysis, critical residues for 1A11 binding were identified for most serotypes of Enterovirus A. It may be useful for the development of a cost-effective and pan-Enterovirus A antigen detection for surveillance, early diagnosis and differentiation of infections caused by the Enterovirus A species.
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Affiliation(s)
- Lie Fu
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Xiao-Yu Zhang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Wei-Ping Jin
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Chen Wang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Sha-Sha Qian
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Meng-Jun Wang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Wen-Hui Wang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Sheng-Li Meng
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Jing Guo
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Ze-Jun Wang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Xiao-Qi Chen
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Shuo Shen
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
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Shi MR, Xu HD, Wang H, Hei MY. [A cross-sectional study of enterovirus nucleic acid test with throat swabs for term late neonates during coronavirus disease 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:339-343. [PMID: 37073836 PMCID: PMC10120342 DOI: 10.7499/j.issn.1008-8830.2212023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To investigate the positive rate of enterovirus (EV) nucleic acid in throat swabs of term late neonates hospitalized during the coronavirus disease 2019 (COVID-19) epidemic and the clinical characteristics of the neonates. METHODS A single-center cross-sectional study was performed on 611 term late infants who were hospitalized in the neonatal center from October 2020 to September 2021. Throat swabs were collected on admission for coxsackie A16 virus/EV71/EV universal nucleic acid testing. According to the results of EV nucleic acid test, the infants were divided into a positive EV nucleic acid group (8 infants) and a negative EV nucleic acid group (603 infants). Clinical features were compared between the two groups. RESULTS Among the 611 neonates, 8 tested positive for EV nucleic acid, with a positive rate of 13.1‰, among whom 7 were admitted from May to October. There was a significant difference in the proportion of infants contacting family members with respiratory infection symptoms before disease onset between the positive and negative EV nucleic acid groups (75.0% vs 10.9%, P<0.001). There were no significant differences between the two groups in demographic data, clinical symptoms, and laboratory test results (P>0.05). CONCLUSIONS There is a certain proportion of term late infants testing positive for EV nucleic acid in throat swabs during the COVID-19 epidemic, but the proportion is low. The clinical manifestations and laboratory test results of these infants are non-specific. Transmission among family members might be an important cause of neonatal EV infection.
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Affiliation(s)
- Ming-Rui Shi
- National Center for Children's Health/Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Hai-Dong Xu
- National Center for Children's Health/Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Hong Wang
- National Center for Children's Health/Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Ming-Yan Hei
- National Center for Children's Health/Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Itani T, Chalapa V, Semenov A, Sergeev A. Laboratory diagnosis of nonpolio enteroviruses: A review of the current literature. BIOSAFETY AND HEALTH 2022. [DOI: 10.1016/j.bsheal.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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7
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Bucci S, Coltella L, Martini L, Santisi A, De Rose DU, Piccioni L, Campi F, Ronchetti MP, Longo D, Lucignani G, Dotta A, Auriti C. Clinical and Neurodevelopmental Characteristics of Enterovirus and Parechovirus Meningitis in Neonates. Front Pediatr 2022; 10:881516. [PMID: 35669403 PMCID: PMC9165715 DOI: 10.3389/fped.2022.881516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Non-polio-enteroviruses (EV) and human parechoviruses (HPeV) are small RNA viruses, which in newborns cause infections with a wide range of severity. Today molecular biology tools allow us to diagnose viral meningitis in neonates, sparing patients from useless antibiotics. Data on neurodevelopmental outcome of children who contract enterovirus meningitis in early childhood are still limited in the literature. Aims To evaluate the neurodevelopmental outcome of newborns with documented enterovirus and parechovirus meningitis contracted within the first months of life. Methods Enterovirus and parechovirus were detected on cerebrospinal fluid (CSF) and plasma by RT-PCR. The virological typing was done according to WHO recommendations. During the hospitalization each neonate underwent many diagnostic and instrumental examinations, to evaluate any neurological lesions attributable to the infection. After the discharge children entered in an outpatient interdisciplinary assessment process, comprehensive of the administration of Bayley III scales up to 12 months old. Results We observed longitudinally 30 children, born at term (mean GA 39.7 ± 0.8 weeks, mean birthweight was 3,457 ± 405 grams), who contracted enterovirus and parechovirus meningitis within the first month of life (mean age at diagnosis was 15.8 ± 7.33 days). We were able to perform the genetic typing only on 15/30 (50.0%) cerebrospinal fluid (CSF) samples from 15 neonates. We found MRI anomalies in 9/26 observed neonates (34.6%): one of them presented brainstem abnormality that are specific of enteroviral central nervous system (CNS) involvement. During the follow up children displayed an overall normal neurodevelopment and no deficit in visual and hearing areas. The mean cognitive (105.19 ± 8.71), speech (100.23 ± 8.22) and motor (97.00 ± 8.98) composite scores, assessed by Bayley III, were normal in 29/30 (96.7%). Despite this, children with pathological brain magnetic resonance imaging (MRI) scored significantly lower (p = 0.01) than children with normal brain MRI on cognitive subscale at 12 months of life. Conclusions Early enterovirus infections can be associated to brain MRI abnormalities, more frequently the earlier the infection. Although within a normal range, our children with pathological brain MRI scored significantly lower than those with normal brain MRI on cognitive subscale at 12 months of life.
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Affiliation(s)
- Silvia Bucci
- Department of Neurosciences, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Luana Coltella
- Department of Microbiology and Virology, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Ludovica Martini
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Alessandra Santisi
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Domenico Umberto De Rose
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Livia Piccioni
- Department of Microbiology and Virology, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Francesca Campi
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Maria Paola Ronchetti
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Daniela Longo
- Department of Imaging, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Giulia Lucignani
- Department of Imaging, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Andrea Dotta
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
| | - Cinzia Auriti
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children's Hospital Scientific Hospitalization and Treatment Institute (IRCCS), Rome, Italy
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Enteroviral Infections in the First Three Months of Life. Pathogens 2022; 11:pathogens11010060. [PMID: 35056008 PMCID: PMC8782040 DOI: 10.3390/pathogens11010060] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023] Open
Abstract
Enteroviruses (EVs) are an important source of infection in the paediatric age, with most cases concerning the neonatal age and early infancy. Molecular epidemiology is crucial to understand the circulation of main serotypes in a specific area and period due to their extreme epidemiological variability. The diagnosis of EVs infection currently relies on the detection of EVs RNA in biological samples (usually cerebrospinal fluid and plasma, but also throat swabs and feces) through a polymerase chain reaction assay. Although EVs infections usually have a benign course, they sometimes become life threatening, especially when symptoms develop in the first few days of life. Mortality is primarily associated with myocarditis, acute hepatitis, and multi-organ failure. Neurodevelopmental sequelae have been reported following severe infections with central nervous system involvement. Unfortunately, at present, the treatment of EVs infections is mainly supportive. The use of specific antiviral agents in severe neonatal infections has been reported in single cases or studies including few neonates. Therefore, further studies are needed to confirm the efficacy of these drugs in clinical practice.
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Xu J, Sun Z, Li W, Liu L, Gao F, Pan D. Epidemiological characteristics and cerebrospinal fluid cytokine profiles of enterovirus encephalitis in children in Hangzhou, China. J Med Virol 2021; 94:2645-2652. [PMID: 34862630 DOI: 10.1002/jmv.27504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 05/19/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022]
Abstract
Enteroviruses (EVs) are common causes of viral encephalitis in children. To better understand the epidemiological and pathological characteristics of EV encephalitis, we enrolled suspected encephalitis patients younger than 15 years old in Hangzhou, China, from October 2016 to September 2019 for cerebrospinal fluid (CSF) collection and analyses. A total of 7735 CSF samples were collected, among which 330 (4.27%) were positive for the EV genome. The positivity rate was significantly higher in boys than girls (χ2 = 5.68, p = 0.02). The monthly case numbers peaked from June to August (80.30%). Among the different age groups, the 0-2 months age group showed the highest number of cases (28.48% of all cases). The 6-7 years (10.82%) and 9-10 years (9.29%) age groups showed the highest EV-positivity rates among suspected encephalitis cases. Sixty-two EV-positive and 53 control CSF samples were collected for Bio-Plex Pro human cytokine assays that simultaneously tested 48 cytokines. Principle component analyses showed significant separation between EV-positive and control samples, but insignificant separation between children and newborns. The levels of 28 cytokines and chemokines were significantly elevated in the EV-positive group including many proinflammatory and a few anti-inflammatory cytokines, as well as chemokines belonging to the CC and CXC subfamilies. Only one cytokine, stem cell growth factor-β, showed a decrease in the EV-positive group. Thus, this study revealed age, sex, and seasonal preferences for EV encephalitis incidences in children and identified many cytokines dysregulated during EV encephalitis.
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Affiliation(s)
- Jialu Xu
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Zeyu Sun
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Lifang Liu
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Dongli Pan
- Department of Medical Microbiology and Parasitology, and Department of Infectious Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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10
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Pintos C, Mintegi S, Benito J, Aranzamendi M, Bonilla L, Gomez B. Blood enterovirus polymerase chain reaction testing in young febrile infants. Arch Dis Child 2021; 106:1179-1183. [PMID: 33906851 DOI: 10.1136/archdischild-2020-321077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS). DESIGN Observational study, subanalysis of a prospective registry. SETTING Paediatric emergency department. PATIENTS Infants ≤90 days of age with FWS seen between September 2015 and August 2019 with blood ev-PCR, blood and urine cultures and urine dipstick test performed. MAIN OUTCOME MEASURES Prevalence of invasive bacterial infection (IBI: bacterial pathogen in blood or cerebrospinal fluid) in infants with positive or negative ev-PCR test results. Secondarily, we also compared length of stay and antibiotic treatment in hospitalised infants. RESULTS Of 703 infants, 174 (24.7%) had a positive blood ev-PCR and none of them were diagnosed with an IBI (vs 2.6% (95% CI 1.3% to 4.0%) of those with a negative result, p=0.02). Prevalence of non-IBI (mainly urinary tract infection) was also lower among infants with a positive blood ev-PCR (2.3% (95% CI 0.1% to 4.5%) vs 17.6% (95% CI 14.3% to 20.8%), p<0.01).Overall, 258 infants were hospitalised (36.6%) and 193 (74.8%) of them received antibiotics. Length of hospital stay and antibiotic treatment were shorter in those with a positive blood ev-PCR (median: 3 days vs 5 days and 1 day vs 5 days, respectively; p<0.01). Differences remained statistically significant among well-appearing infants >21 days old with normal urine dipstick. CONCLUSION Blood ev-PCR identifies a group of infants under 90 days of age with FWS at very low risk of IBI. This test may help to guide clinical decision making in young febrile infants.
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Affiliation(s)
- Carla Pintos
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.,University of the Basque Country, Bilbao, Spain
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.,University of the Basque Country, Bilbao, Spain
| | | | - Leire Bonilla
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain .,University of the Basque Country, Bilbao, Spain
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11
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Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods CR. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics 2021; 148:peds.2021-052228. [PMID: 34281996 DOI: 10.1542/peds.2021-052228] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever ≥38.0°C. Exclusions are noted. After a commissioned evidence-based review by the Agency for Healthcare Research and Quality, an additional extensive and ongoing review of the literature, and supplemental data from published, peer-reviewed studies provided by active investigators, 21 key action statements were derived. For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine the strength of recommendations. When appropriate, parents' values and preferences should be incorporated as part of shared decision-making. For diagnostic testing, the committee has attempted to develop numbers needed to test, and for antimicrobial administration, the committee provided numbers needed to treat. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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Affiliation(s)
- Robert H Pantell
- Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Kenneth B Roberts
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William G Adams
- Boston Medical Center/Boston University School of Medicine, Deparment of Pediatrics, Boston, Massachusetts
| | - Benard P Dreyer
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatric, School of Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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The yield of CSF molecular testing in febrile neonates. Eur J Clin Microbiol Infect Dis 2021; 40:1553-1557. [PMID: 33523357 DOI: 10.1007/s10096-021-04168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
We retrospectively examined the yield of a cerebrospinal fluid (CSF) multiplex real-time PCR assay of febrile young infants undergoing a full sepsis work-up. Eighty infants were included in the study: Forty-nine (61%) neonates and 31 (39%) 29-90 day-old patients were included in the study. A viral pathogen was detected in 59% (47/80) of the samples, human enterovirus in 53% (42/80) and Human parechovirus in 6% (5/80). The CSF of nearly half of the subjects with CNS infection was without pleocytosis; all CSF cultures were negative. Multiplex PCR CSF testing enhances the diagnosis of pathogen-specific viral CNS infection among febrile young infants.
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13
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Suzuki Y, Aizawa Y, Izumita R, Habuka R, Watanabe K, Saitoh A. PCR detection rates for serum and cerebrospinal fluid from neonates and young infants infected with human parechovirus 3 and enteroviruses. J Clin Virol 2021; 135:104736. [PMID: 33493987 DOI: 10.1016/j.jcv.2021.104736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human parechovirus 3 (HPeV-3) and enteroviruses (EV) are commonly detected viruses in febrile neonates and young infants and are usually diagnosed by PCR. However, in this population, data on detection rates for samples from different anatomical sites are limited. OBJECTIVES To determine PCR detection rates for HPeV-3 and EVs in serum and cerebrospinal fluid (CSF) samples from febrile neonates and young infants. STUDY DESIGN This prospective study identified viruses in serum and CSF samples collected from febrile neonates and young infants (age <4 months) in Niigata, Japan, during 2014-2018. HPeV-3 or EV infection was defined as a positive quantitative real-time PCR result for the virus in serum or CSF. Genotypes were identified by sequence analyses of the viral protein 1 region. RESULTS Among 216 patients, we identified 56 HPeV-3-infected (26 %) and 48 EV-infected patients (22 %). All (56/56; 100 %) HPeV-3-infected patients had a positive PCR result for serum, and 49/56 (88 %) had a positive result for CSF. In EV-infected patients, 40/48 (83 %) were positive for serum, and 34/48 (71 %) were positive for CSF, and 22/48 (46 %) were positive for serum (n = 14) or CSF (n = 8). If only a CSF sample had been obtained, 7 (12 %) HPeV-3 infections and 14 (29 %) EV infections would have been undiagnosed. Detection rates in serum and CSF differed by genotype in EV-infected patients. CONCLUSIONS Viral RNA detection rates differed between serum and CSF in HPeV-3- and EV-infected neonates/infants. Combined evaluation of serum and CSF samples is important for accurate viral diagnosis in this population.
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Affiliation(s)
- Yuko Suzuki
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryohei Izumita
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rie Habuka
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kanako Watanabe
- Department of Laboratory Science, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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L'Huillier AG, Mardegan C, Cordey S, Luterbacher F, Papis S, Hugon F, Kaiser L, Gervaix A, Posfay-Barbe K, Galetto-Lacour A. Enterovirus, parechovirus, adenovirus and herpes virus type 6 viraemia in fever without source. Arch Dis Child 2020; 105:180-186. [PMID: 31462437 DOI: 10.1136/archdischild-2019-317382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the potential associations between fever without a source (FWS) in children and detection of human enterovirus (HEV), human parechovirus (HPeV), adenovirus (AdV) and human herpesvirus type 6 (HHV-6) in the plasma; and to assess whether the detection of viruses in the plasma is associated with a reduced risk of serious bacterial infection (SBI) and antibiotic use. DESIGN AND SETTING Between November 2015 and December 2017, this prospective, single-centre, diagnostic study tested the plasma of children <3 years old with FWS. Real-time (reverse-transcription) PCR for HEV, HPeV, AdV and HHV-6 was used in addition to the standardised institutional work-up. A control cohort was also tested for the presence of viruses in their blood. RESULTS HEV, HPeV, AdV and HHV-6 were tested for in the plasma of 135 patients of median age 2.4 months old. At least one virus was detected in 47 of 135 (34.8%): HEV in 14.1%, HHV-6 in 11.1%, HPeV in 5.9% and AdV in 5.2%. There was no difference in antibiotic use between patients with or without virus detected, despite a relative risk of 0.2 for an SBI among patients with viraemia. Controls were less frequently viraemic than children with FWS (6.0% vs 34.8%; p<0.001). CONCLUSIONS HEV, HPeV, AdV and HHV-6 are frequently detected in the plasma of children with FWS. Antibiotic use was similar between viraemic and non-viraemic patients despite a lower risk of SBI among patients with viraemia. Point-of-care viral PCR testing of plasma might reduce antibiotic use and possibly investigations and admission rates in patients with FWS. TRIAL REGISTRATION NUMBER NCT03224026.
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Affiliation(s)
- Arnaud Gregoire L'Huillier
- Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland .,Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Chiara Mardegan
- Division of General Pediatrics, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Samuel Cordey
- Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Fanny Luterbacher
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Sebastien Papis
- Division of General Pediatrics, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Florence Hugon
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Klara Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland.,Division of Infectious Diseases and Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Pediatric Emergencies, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
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15
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Xu J, Jiang J, Zhang Y, Li W. Cytokine characteristic of cerebrospinal fluid from children with enteroviral meningitis compared to bacterial meningitis. J Clin Lab Anal 2020; 34:e23198. [PMID: 31912935 PMCID: PMC7246373 DOI: 10.1002/jcla.23198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/30/2019] [Accepted: 12/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background Enteroviruses are the most common etiological agent for viral encephalitis, but it is uncertain whether the cytokines have the ability to differentiate enteroviral meningitis (EVM) from bacterial meningitis (BM). Methods A retrospective study was performed at the Children's Hospital, Zhejiang University School of Medicine from August 2016 and August 2019. CSF and/or blood specimens were collected for microbiological culture, viruses, and cytokine detection. Results Forty‐three patients were confirmed with meningitis, 27 patients with EVM, and 16 with BM. Children with EVM were older compared with BM and Control group (P < .001). The most common presenting symptom in children with EVM was fever (96.3%) followed by headache (88.9%) and vomiting (66.7%). The occurrence of seizure was lower in both EVM and BM groups (P < .001). Serum IL‐6 and serum IL‐10 were lower in EVM group than BM (P = .02) and control group (IL‐6, P = .01; IL‐10, P < .001). IL‐6, IL‐10, and IFN‐γ levels showed obviously increase in CSF (P < .001, respectively) in EVM group, while only IL‐6 increased in CSF (P < .001) in BM group. CSF concentrations of cytokines IL‐6, IL‐10, TNF, and IFN‐γ in children with EVM and BM were both higher than Control group (P < .001). But compared EVM group to BM group, CSF IL‐2 (P = .13), IL‐6 (P = .37), IL‐10 (P = .98), TNF (P = .54), and IFN‐γ (P = .53) showed no difference between two groups. Conclusions CSF cytokines elevated in both virus and bacterial meningitis, while serum elevation only occurred in bacterial infection. Still, we could not distinguish enteroviral meningitis from bacterial meningitis with the parameters of CSF cytokines IL‐2, IL‐6, IL‐10, TNF, and IFN‐γ.
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Affiliation(s)
- Jialu Xu
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Jiang
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yi Zhang
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Li
- Department of Clinical Laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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16
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Enteroviral infection in neonates. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:851-857. [PMID: 31607572 DOI: 10.1016/j.jmii.2019.08.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/26/2023]
Abstract
Enteroviruses generally cause mild and self-limited diseases, but they have been found to affect neonates much differently, and often more severely than older children. Clinical manifestations are difficult to differentiate from those of bacterial sepsis, such as fever, poor feeding, lethargy, respiratory distress and cardiovascular collapse. Severe life threatening complications, including hepatic necrosis with coagulopathy, meningoencephalitis and myocarditis, usually present during the first week of life. Factors affecting severity and outcome include virus serotype, mode of transmission, and presence or absence of passively acquired, serotype-specific maternal antibodies. Echoviruses and coxsackievirus B viruses are most common serotypes associated with the neonatal sepsis. An awareness of the clinical syndromes, recognition of the risk factors and monitoring parameters associated with severe cases and use of rapid reverse-transcriptase polymerase chain reaction test for viral load may help physicians in diagnosing severe cases in a timely manner. Prompt aggressive treatment including early intravenous immunoglobulin treatment may help in reducing morbidity and mortality. Enterovirus infections in neonates are common and should be routinely considered in the differential diagnosis of febrile neonates, particularly during enterovirus season. This article provides an overview of what is known about non-polio enteroviruses in neonates including epidemiology, transmission, clinical presentation, diagnosis, and treatment.
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17
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Hudson JA, Broad J, Martin NG, Sadarangani M, Galal U, Kelly DF, Pollard AJ, Kadambari S. Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review. Rev Med Virol 2019; 30:e2083. [PMID: 31524309 DOI: 10.1002/rmv.2083] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/18/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Abstract
Viruses are the commonest cause of childhood meningitis, but outcomes beyond hospital discharge are poorly described. We undertook a systematic literature review of long-term outcomes following paediatric viral meningitis. A search was carried out using MEDLINE, Embase, and Cochrane Review for studies from 1 January 1990 to 31 December 2018. Studies were included where specific outcome measures were available beyond hospital discharge for children <16 years old with viral meningitis. In total, 3588 papers were identified of which 14 were eligible for inclusion. Four studies reported outcomes in children with nonenterovirus 71 meningitis. A US study of 16 cases demonstrated subtle language difficulties at 3-year follow-up in infants in contrast to an Australian study, which revealed no impairment in language. A Fijian study showed that two out of eight cases had sensorineural hearing loss compared with none in a UK cohort of 668 infants. Three studies evaluated outcomes of enterovirus 71 meningitis in China and Taiwan, two showed cases recovered without sequelae, while one demonstrated an increased risk of attention deficit hyperactivity disorder. Two studies including 141 cases of human parechovirus revealed no evidence of neurodevelopmental sequelae. Conversely, an Australian study demonstrated neurodevelopmental sequelae in 11 out of 77 infants with parechovirus meningitis. Most studies identified in this review demonstrated a high proportion of good clinical outcomes following viral meningitis. However, the data are limited, so robustly conducted neurodevelopmental studies are warranted to inform the evidence-based management of viral meningitis beyond hospital discharge.
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Affiliation(s)
- Jessica A Hudson
- Department of Public Health, John Radcliffe Hospital, Oxford, UK
| | - Jonathan Broad
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Natalie G Martin
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Ushma Galal
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic F Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
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18
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DePorre A, Williams DD, Schuster J, Newland J, Bartlett J, Selvarangan R, Mann K, McCulloh R. Evaluating the Impact of Implementing a Clinical Practice Guideline for Febrile Infants With Positive Respiratory Syncytial Virus or Enterovirus Testing. Hosp Pediatr 2019; 7:587-594. [PMID: 28935665 DOI: 10.1542/hpeds.2016-0217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate clinical practice patterns and patient outcomes among febrile low-risk infants with respiratory syncytial virus (RSV) infection or enterovirus (EV) meningitis after implementing a clinical practice guideline (CPG) that provides recommendations for managing febrile infants with RSV infection and EV meningitis. METHODS Our institution implemented a CPG for febrile infants, which gives explicit recommendations for managing both RSV-positive and EV-positive infants in 2011. We retrospectively analyzed medical records of febrile infants ≤60 days old from June 2008 to January 2013. Among 134 low-risk RSV-positive infants, we compared the proportion of infants who underwent lumbar puncture (LP), the proportion of infants who received antibiotics, antibiotic hours of therapy (HOT), and length of stay (LOS) pre- and post-CPG implementation. Among 274 low-risk infants with EV meningitis, we compared HOT and LOS pre- and post-CPG implementation. RESULTS Among low-risk RSV-positive patients, the proportion of infants undergoing LP, the proportion of infants receiving antibiotics, HOT, and LOS were unchanged post-CPG. Among low-risk infants with EV meningitis, HOT (79 hours pre-CPG implementation versus 46 hours post-CPG implementation, P < .001) and LOS (47 hours pre-CPG implementation versus 43 hours post-CPG implementation, P = .01) both decreased post-CPG. CONCLUSIONS CPG implementation is associated with decreased antibiotic exposure and hospital LOS among low-risk infants with EV meningitis; however, there were no associated changes in the proportion of infants undergoing LP, antibiotic exposure, or LOS among low-risk infants with RSV. Further studies are needed to determine specific barriers and facilitators to effectively incorporate diagnostic viral testing into medical decision-making for these infants.
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Affiliation(s)
- Adrienne DePorre
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of
| | | | - Jennifer Schuster
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of
| | - Jason Newland
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of
| | - Jacqueline Bartlett
- Center for Clinical Effectiveness, Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Keith Mann
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of.,Center for Clinical Effectiveness, Children's Mercy Kansas City, Kansas City, Missouri
| | - Russell McCulloh
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of
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19
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Berardi A, Sandoni M, Toffoli C, Boncompagni A, Gennari W, Bergamini MB, Lucaccioni L, Iughetti L. Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study. Ital J Pediatr 2019; 45:94. [PMID: 31375127 PMCID: PMC6679433 DOI: 10.1186/s13052-019-0689-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated. Methods We retrospectively investigated EV infections occurring at an Italian tertiary care center during 2006–2017. Cases were confirmed with a positive polymerase chain reaction on blood or cerebrospinal fluid. Clinical and laboratory findings according to age at presentation were analyzed. Results Among 61 cases of EV infection, 56 had meningitis, 4 had encephalitis, and 1 had unspecific febrile illness. Forty-seven cases (77.0%) presented at less than 1 year of age, and most were less than 90 days of age (n = 44). Presentation with fever (p < 0.01), higher median temperature (p < 0.01), and irritability (p < 0.01) were significantly more common among infants aged less than 90 days, who also had significantly higher peak temperatures during the course of the disease (p < 0.01). In contrast, gastrointestinal symptoms were more common in infants and children aged over 90 days (p = 0.02). Only 4 of 61 infections (6.5%) were severe and all affected younger infants (p < 0.01). Conclusions We detail epidemiological, clinical, and laboratory findings in a cohort of 61 children. Infants aged less than 90 days have more severe disease; they are more likely to present with fever, higher median temperature, and irritability and less likely to develop gastrointestinal symptoms.
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Affiliation(s)
- Alberto Berardi
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy.
| | - Marcello Sandoni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - William Gennari
- Struttura Complessa di Microbiologia e Virologia-Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maria Barbara Bergamini
- Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Laura Lucaccioni
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy.,Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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20
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Lafolie J, Labbé A, L'Honneur AS, Madhi F, Pereira B, Decobert M, Adam MN, Gouraud F, Faibis F, Arditty F, Marque-Juillet S, Guitteny MA, Lagathu G, Verdan M, Rozenberg F, Mirand A, Peigue-Lafeuille H, Henquell C, Bailly JL, Archimbaud C. Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study. THE LANCET. INFECTIOUS DISEASES 2018; 18:1385-1396. [PMID: 30389482 PMCID: PMC7164799 DOI: 10.1016/s1473-3099(18)30479-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 01/24/2023]
Abstract
Background Enteroviruses are the most frequent cause of acute meningitis and are seen increasingly in sepsis-like disease and fever without source in the paediatric population. Detection of enterovirus in cerebrospinal fluid (CSF) specimens by PCR is the gold standard diagnostic test. Our aim was to assess a method of detecting enterovirus in blood specimens by PCR. Methods We did a prospective, multicentre, observational study at 35 French paediatric and emergency departments in 16 hospitals. We recruited newborn babies (aged ≤28 days) and infants (aged >28 days to ≤2 years) with fever without source, sepsis-like disease, or suspected meningitis, and children (aged >2 years to ≤16 years) with suspected meningitis, who were admitted to a participating hospital. We used a standardised form to obtain demographic, clinical, and laboratory data, which were anonymised. Enterovirus PCR testing was done in blood and CSF specimens. Findings Between June 1, 2015, and Oct 31, 2015, and between June 1, 2016, and Oct 31, 2016, we enrolled 822 patients, of whom 672 had enterovirus PCR testing done in blood and CSF specimens. Enterovirus was detected in 317 (47%) patients in either blood or CSF, or both (71 newborn babies, 83 infants, and 163 children). Detection of enterovirus was more frequent in blood samples than in CSF specimens of newborn babies (70 [99%] of 71 vs 62 [87%] of 71; p=0·011) and infants (76 [92%] of 83 vs 62 [75%] of 83; p=0·008), and was less frequent in blood samples than in CSF specimens of children (90 [55%] of 163 vs 148 [91%] of 163; p<0·0001). Detection of enterovirus was more frequent in blood samples than in CSF specimens of infants aged 2 years or younger with fever without source (55 [100%] of 55 vs 41 [75%] of 55; p=0·0002) or with sepsis-like disease (16 [100%] of 16 vs nine [56%] of 16; p=0·008). Detection of enterovirus was less frequent in blood than in CSF of patients with suspected meningitis (165 [67%] of 246 vs 222 [90%] of 246; p<0·0001). Interpretation Testing for enterovirus in blood by PCR should be an integral part of clinical practice guidelines for infants aged 2 years or younger. This testing could decrease the length of hospital stay and reduce exposure to antibiotics for low-risk patients admitted to the emergency department with febrile illness. Funding University Hospital Clermont-Ferrand.
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Affiliation(s)
- Jérémy Lafolie
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - André Labbé
- Service de Pédiatrie, Clermont-Ferrand, France
| | - Anne Sophie L'Honneur
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Virologie, Paris, France
| | - Fouad Madhi
- Centre Hospitalier Intercommunal Créteil, Service de Pédiatrie Générale, Créteil, France
| | - Bruno Pereira
- Délégation Recherche Clinique and Innovation, Méthodologie, Biostatistique, Data-management, Clermont-Ferrand, France
| | - Marion Decobert
- Groupe Hospitalier Nord Essonne, Service de Pédiatrie et Néonatologie, Orsay, France
| | - Marie Noelle Adam
- Centre Hospitalier Sud Francilien, Laboratoire de Microbiologie, Corbeil Essonnes, France
| | - François Gouraud
- Grand Hôpital de l'Est Francilien, Service de Pédiatrie, Meaux, France
| | | | - Francois Arditty
- Centre Hospitalier de Versailles André Mignot, Service de Pédiatrie, Le Chesnay, France
| | | | | | | | | | - Flore Rozenberg
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Virologie, Paris, France
| | - Audrey Mirand
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Cécile Henquell
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France
| | - Christine Archimbaud
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France.
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Song JY, Nam SO, Kim YA, Kim KM, Lyu SY, Ko A, Kim YM, Yeon GM, Lee YJ. Cerebrospinal fluid non-pleocytosis in pediatric enteroviral meningitis: Large-scale review. Pediatr Int 2018; 60:855-861. [PMID: 29998580 DOI: 10.1111/ped.13658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lack of cerebrospinal fluid (CSF) pleocytosis has been reported in some children with enteroviral meningitis (EVM). The aim of this paper was to investigate the clinical spectrum and related factors in EVM with CSF non-pleocytosis. METHODS The databases of children diagnosed with EVM on CSF polymerase chain reaction between 2011 and 2014 were retrospectively reviewed. CSF pleocytosis was defined at each age using the criteria. Clinical and laboratory variables were compared between patients with CSF pleocytosis and non-pleocytosis. RESULTS Of the 802 children of EVM, 25.4% (204/802) had CSF non-pleocytosis. In particular, CSF non-pleocytosis was found in 63.3% of the neonates versus in 22.2% of the children aged ≥1 year old, indicating that the ratio of CSF non-pleocytosis had a negative correlation with age (P < 0.001). As the main symptoms, fever (91.8% vs 86.8%, P = 0.038), headache (80.3% vs 63.7%, P < 0.001), and vomiting (75.9% vs 61.8%, P < 0.001) were significantly more frequent in CSF pleocytosis than in CSF non-pleocytosis. Patients with CSF non-pleocytosis had much lower peripheral leukocytosis (10 656 ± 3,662 vs 12 403 ± 4,207/mm3 , P = 0.014) and C-reactive protein (0.7±0.8 vs 1.2±1.5 mg/dL, P < 0.001), and earlier lumbar puncture <24 h after onset (42.6% vs 21.4%, p<0.001). No significant difference during the summer and autumn months was seen between the two groups (76.9% vs 81.9%, P = 0.169). CONCLUSION CSF non-pleocytosis in childhood EVM was frequently observed, especially in young infants, regardless of season. We propose that CSF PCR testing for enterovirus can be helpful to recognize EVM in children with CSF non-pleocytosis.
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Affiliation(s)
- Ji Yeon Song
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young A Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung Min Kim
- Department of Pediatrics, Good Gang-An Hospital, Busan, Korea
| | - Soo Young Lyu
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ara Ko
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Gyu Min Yeon
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University, Busan, Korea
| | - Yun-Jin Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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22
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Pantell RH, Roberts KB, Greenhow TL, Pantell MS. Advances in the Diagnosis and Management of Febrile Infants: Challenging Tradition. Adv Pediatr 2018; 65:173-208. [PMID: 30053923 DOI: 10.1016/j.yapd.2018.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Robert H Pantell
- Kapi'olani Medical Center for Women and Children, 1319 Punahou Street, Honolulu, HI 96824, USA.
| | | | - Tara L Greenhow
- Kaiser Permanente, Northern California, 2200 O'Farrell St, San Francisco, CA 94115, USA
| | - Matthew S Pantell
- University of California San Francisco, Suite 465, 3333 California Street, San Francisco, CA 94118, USA
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23
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Park SE, Shin K, Song D, Nam SO, Kim KM, Lyu SY, Kim YA, Kong J, Kim YM, Yeon GM, Lee YJ. Comparison of Cerebrospinal Fluid Cytokine Levels in Children of Enteroviral Meningitis With Versus Without Pleocytosis. J Interferon Cytokine Res 2018; 38:348-355. [PMID: 30052102 DOI: 10.1089/jir.2018.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In viral meningitis, proinflammatory cytokines were detected at higher levels in the cerebrospinal fluid (CSF) and might play an important role in the inflammatory process. Our goal was to compare the cytokine profiles in the CSF of children of enteroviral meningitis (EVM) with versus without CSF pleocytosis. In total, 158 patients were enrolled in this prospective cohort study and were classified as EVM (group-A, n = 101), nonenteroviral aseptic meningitis (group-B, n = 27), and control (group-C, n = 30) groups. Of the 101 children with EVM, 71 had CSF pleocytosis (group-A1) and 30 had CSF nonpleocytosis (group-A2). Fifteen cytokines/chemokines in the CSF were measured simultaneously by immunoassay. Significant differences were found in interleukin (IL)-2, IL-6, and IL-8 levels in the CSF across the 3 groups, with the highest levels in group-A, followed by group-B and group-C. The levels of IL-1β, IL-2, IL-6, IL8, IL-10, interferon-γ, and tumor necrosis factor-α were significantly higher in the CSF of group-A1 than in that of group-A2. Group-A2 was significantly younger than group-A1 (3.4 ± 2.8 years versus 5.5 ± 3.2 years, P = 0.016). Significant differences between CSF pleocytosis and nonpleocytosis in EVM appear to be associated with distinct levels of CSF cytokines.
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Affiliation(s)
- Su Eun Park
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea.,2 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Kyunghwa Shin
- 3 Department of Laboratory Medicine, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Duyeal Song
- 3 Department of Laboratory Medicine, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Sang Ook Nam
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea.,2 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Kyung Min Kim
- 4 Department of Pediatrics, Good Gang-An Hospital , Busan, Korea
| | - Soo Young Lyu
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea
| | - Young A Kim
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea.,2 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Juhyun Kong
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea
| | - Young Mi Kim
- 5 Department of Pediatrics, Pusan National University Hospital , Busan, Korea
| | - Gyu Min Yeon
- 6 Department of Pediatrics, Kosin University Gospel Hospital, Kosin University , Busan, Korea
| | - Yun-Jin Lee
- 1 Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine , Yangsan, Korea.,2 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
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24
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Harris SJ. Febrile Infant Hospitalizations: When Is the Right Time to Discharge? Hosp Pediatr 2018; 8:438-440. [PMID: 29954838 DOI: 10.1542/hpeds.2018-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Stephen J Harris
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
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25
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Blaschke AJ, Holmberg KM, Daly JA, Leber AL, Dien Bard J, Korgenski EK, Bourzac KM, Kanack KJ. Retrospective Evaluation of Infants Aged 1 to 60 Days with Residual Cerebrospinal Fluid (CSF) Tested Using the FilmArray Meningitis/Encephalitis (ME) Panel. J Clin Microbiol 2018; 56:e00277-18. [PMID: 29669791 PMCID: PMC6018345 DOI: 10.1128/jcm.00277-18] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/14/2018] [Indexed: 01/02/2023] Open
Abstract
In pediatric practice it is common for infants under 2 months of age to undergo evaluation for sepsis when they are ill, often including lumbar puncture to assess for central nervous system (CNS) infection. The FilmArray Meningitis/Encephalitis (ME) panel is a newly approved test for rapid identification of CNS pathogens. Our objective was to study the epidemiology of CNS infection in young infants and the potential impact of rapid multiplex PCR on their care. A performance evaluation of the FilmArray ME panel was conducted from February 2014 to September 2014 at 11 sites. FilmArray ME panel results were compared to reference standards but not shared with providers. In our study, medical records for infants (aged 1 to 60 days) enrolled at three sites were reviewed for clinical, laboratory, and outcome data. A total of 145 infants were reviewed. The median age was 25 days. Most of the infants were hospitalized (134/145 [92%]) and received antibiotics (123/145 [85%]), and almost half (71/145 [49%]) received acyclovir. One infant had a bacterial pathogen, likely false positive, identified by the FilmArray ME panel. Thirty-six infants (25%) had a viral pathogen detected, including 21 enteroviruses. All infants with enteroviral meningitis detected by the FilmArray ME panel and conventional PCR were hospitalized, but 20% were discharged in less than 24 h when conventional PCR results became available. The FilmArray ME panel may play a role in the evaluation of young infants for CNS infection. Results may be used to guide management, possibly resulting in a decreased length of stay and less antimicrobial exposure for infants with low-risk viral infection detected.
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Affiliation(s)
- Anne J Blaschke
- University of Utah School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Salt Lake City, Utah, USA
| | | | - Judy A Daly
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Amy L Leber
- Nationwide Children's Hospital, Columbus, Oklahoma, USA
| | | | - Ernest K Korgenski
- University of Utah School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Salt Lake City, Utah, USA
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
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26
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Ragab G, Atkinson TP, Stoll ML. Macrophage Activation Syndrome. THE MICROBIOME IN RHEUMATIC DISEASES AND INFECTION 2018. [PMCID: PMC7123081 DOI: 10.1007/978-3-319-79026-8_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH), or termed macrophage activation syndrome (MAS) when associated with rheumatic disorders, is a frequently fatal complication of infections, rheumatic disorders, and hematopoietic malignancies. Clinically, HLH/MAS is a life-threatening condition that is usually diagnosed among febrile hospitalized patients (children and adults) who commonly present with unremitting fever and a shock-like multiorgan dysfunction scenario. Laboratory studies reveal pancytopenia, elevated liver enzymes, elevated markers of inflammation (ESR, CRP), hyperferritinemia, and features of coagulopathy. In about 60% of cases, excess hemophagocytosis (macrophages/histiocytes engulfing other hematopoietic cell types) is noted on biopsy specimens from the bone marrow, liver, lymph nodes, and other organs. HLH/MAS has been hypothesized to occur when a threshold level of inflammation has been achieved, and genetic and environmental risk factors are believed to contribute to the hyperinflammatory state. A broad variety of infections, from viruses to fungi to bacteria, have been identified as triggers of HLH/MAS, either in isolation or in addition to an underlying inflammatory disease state. Certain infections, particularly by members of the herpesvirus family, are the most notorious triggers of HLH/MAS. Treatment for infection-triggered MAS requires therapy for both the underlying infection and dampening of the hyperactive immune response.
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Affiliation(s)
- Gaafar Ragab
- Faculty of Medicine, Cairo University, Cairo, Egypt
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27
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Blaschke AJ, Korgenski EK, Wilkes J, Presson AP, Thorell EA, Pavia AT, Knackstedt ED, Reynolds C, Schunk JE, Daly JA, Byington CL. Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics 2018; 141:peds.2017-2384. [PMID: 29343585 PMCID: PMC5810600 DOI: 10.1542/peds.2017-2384] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Febrile infants with viral respiratory infections have a reduced risk of bacterial infection compared with virus-negative infants. The risk of concomitant bacterial infection in febrile infants positive for human rhinovirus (HRV) by polymerase chain reaction (PCR) is unknown. METHODS Infants 1-90 days old managed using the care process model for well-appearing febrile infants and with respiratory viral testing by PCR (RVPCR) in the emergency department or inpatient setting of 22 hospitals in the Intermountain Healthcare system from 2007-2016 were identified. Relative risk (RR) of bacterial infection was calculated for infants with HRV, non-HRV viruses, or no virus detected. RESULTS Of 10 964 febrile infants identified, 4037 (37%) had RVPCR. Of these, 2212 (55%) were positive for a respiratory virus; 1392 (35%) for HRV alone. Bacterial infection was identified in 9.5%. Febrile infants with HRV detected were more likely to have bacterial infection than those with non-HRV viruses (7.8% vs 3.7%; P < .001; RR 2.12 [95% CI 1.43-3.15]). Risk of urinary tract infection was not significantly different for HRV-positive infants at any age, nor was risk of invasive bacterial infection (IBI; bacteremia and/or meningitis) meaningfully different for infants 1-28 day olds. Infants 29-90 days old with HRV had a decreased likelihood of IBI (RR 0.52 [95% CI 0.34-0.80]). CONCLUSIONS HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.
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Affiliation(s)
| | - E. Kent Korgenski
- Departments of Pediatrics,,Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jacob Wilkes
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Emily A. Thorell
- Departments of Pediatrics,,Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | | | - Carolyn Reynolds
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Judy A. Daly
- Pathology, School of Medicine, University of Utah, Salt Lake City, Utah;,Patient Centered Microbiology Laboratory, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah; and
| | - Carrie L. Byington
- Departments of Pediatrics,,College of Medicine, Texas A&M Health Sciences Center, Bryan, Texas
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28
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Epidemiology of Sepsis-like Illness in Young Infants: Major Role of Enterovirus and Human Parechovirus. Pediatr Infect Dis J 2018; 37:113-118. [PMID: 28763426 DOI: 10.1097/inf.0000000000001718] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sepsis-like illness is a main cause for hospital admission in young infants. Our aim was to investigate incidence, epidemiology and clinical characteristics of enterovirus (EV) and human parechovirus (HPeV) infections in young infants with sepsis-like illness. METHODS This is a prospective observational cohort study in which infants younger than 90 days of age, presenting with sepsis-like symptoms in a secondary care children's hospital, underwent a full sepsis work-up. Clinical signs and infectious indices were recorded. EV or HPeV RNA was detected by polymerase chain reaction in plasma and/or cerebrospinal fluid (CSF). RESULTS Infants were diagnosed with EV, HPeV, fever of unknown origin or severe infection. EV and HPeV were detected in 132 of 353 (37%) and 52 of 353 (15%) of cases, respectively. EV and HPeV have distinct seasonability. Some differences in clinical signs and symptoms occurred between children with EV and HPeV infection but were of limited clinical value. CSF pleocytosis occurred in 44% of EV positive infants, and only in 13% of those with HPeV infection. CONCLUSIONS EV and HPeV infections are major causes of sepsis-like illness in infants < 90 days of age. Neither clinical characteristics nor laboratory indices were predictive for EV/HPeV infection. CSF pleocytosis occurs, but not in all patients. Testing for EV and HPeV in all young infants with sepsis-like illness is strongly advised.
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29
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Jhaveri R, Shapiro ED. Fever Without Localizing Signs. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7151945 DOI: 10.1016/b978-0-323-40181-4.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Pellegrinelli L, Bubba L, Galli C, Anselmi G, Primache V, Binda S, Pariani E. Epidemiology and molecular characterization of influenza viruses, human parechoviruses and enteroviruses in children up to 5 years with influenza-like illness in Northern Italy during seven consecutive winter seasons (2010–2017). J Gen Virol 2017; 98:2699-2711. [DOI: 10.1099/jgv.0.000937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Giovanni Anselmi
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Valeria Primache
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
- Department of Health Sciences, CIRI-IT, University of Genoa, Via Antonio Pastore, 1 - 16132 Genoa, Italy
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31
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Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger. J Pediatr 2017; 189:169-174.e2. [PMID: 28705656 PMCID: PMC5870831 DOI: 10.1016/j.jpeds.2017.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/05/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. STUDY DESIGN We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. RESULTS Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). CONCLUSIONS Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation.
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32
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Macken M, Wacogne ID. Do antibiotics affect cerebrospinal fluid results? Arch Dis Child 2017; 102:990-993. [PMID: 28847878 DOI: 10.1136/archdischild-2017-313610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Marita Macken
- General Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - Ian D Wacogne
- General Paediatrics, Birmingham Children's Hospital, Birmingham, UK
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33
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Abstract
Infections with enteroviruses and human parechoviruses are highly prevalent, particularly in neonates, where they may cause substantial morbidity and mortality. Individuals with B-cell-related immunodeficiencies are at risk for severe enteroviral infections, usually a chronic and fatal meningoencephalitis. In transplant recipients and patients with malignancy, enterovirus infections typically involve the respiratory tract, but cases of severe, disseminated infection have been described. The mainstay of diagnosis for enterovirus and human parechovirus infections involves the use of molecular diagnostic techniques. However, routine nucleic acid-detection methods for enteroviruses will not detect human parechoviruses. Laboratory diagnosis of these viral infections is important in determining a patient's prognosis and guiding clinical management.
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34
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Abstract
PURPOSE OF REVIEW The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics. RECENT FINDINGS There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection. SUMMARY The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.
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35
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Zhao T, Zhang Z, Zhang Y, Feng M, Fan S, Wang L, Liu L, Wang X, Wang Q, Zhang X, Wang J, Liao Y, He Z, Lu S, Yang H, Li Q. Dynamic Interaction of Enterovirus 71 and Dendritic Cells in Infected Neonatal Rhesus Macaques. Front Cell Infect Microbiol 2017; 7:171. [PMID: 28540257 PMCID: PMC5423916 DOI: 10.3389/fcimb.2017.00171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Enterovirus 71 (EV71) is one of the main pathogens responsible for hand, foot, and mouth disease (HFMD). Infection with EV71 can lead to severe clinical disease via extensive infections of either the respiratory or alimentary tracts in children. Based on the previous pathological study of EV71 infections in neonatal rhesus macaques, our work using this animal model and an EV71 chimera that expresses enhanced green fluorescent protein (EGFP-EV71) primarily explored where EV71 localizes and proliferates, and the subsequent initiation of the pathological process. The chimeric EGFP-EV71 we constructed was similar to the wild-type EV71 (WT-EV71) virus in its biological characteristics. Similar clinical manifestations and histo-pathologic features were equally displayed in neonatal rhesus macaques infected with either WT-EV71 or EGFP-EV71 via the respiratory route. Fluorescent signal tracing in tissues from the animals infected with EGFP-EV71 showed that EV71 proliferated primarily in the respiratory tract epithelium and the associated lymphoid tissues. Immunofluorescence and flow cytometry analyses revealed that EV71 was able to enter a pre-conventional dendritic cell (DC) population at the infection sites. The viremia identified in the macaques infected by WT-EV71 or EGFP-EV71 was present even in the artificial presence of a specific antibody against the virus. Our results suggest that EV71 primarily proliferates in the respiratory tract epithelium followed by subsequent entry into a pre-cDC population of DCs. These cells are then hijacked by the virus and they can potentially transmit the virus from local sites to other organs through the blood circulation during the infection process. Our results suggest that the EV71 infection process in this DC population does not interfere with the induction of an independent immune response against the EV71 infection in the neonatal macaques.
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Affiliation(s)
- Ting Zhao
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Zhixiao Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Ying Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Min Feng
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Shengtao Fan
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Lichun Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Longding Liu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Xi Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Qinglin Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Xiaolong Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Jingjing Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Yun Liao
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Zhanlong He
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Shuaiyao Lu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Huai Yang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
| | - Qihan Li
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKunming, China
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Kotzbauer D, Travers C, Shapiro C, Charbonnet M, Cooley A, Andresen D, Frank G. Etiology and Laboratory Abnormalities in Bacterial Meningitis in Neonates and Young Infants. Clin Pract 2017; 7:943. [PMID: 28484584 PMCID: PMC5405363 DOI: 10.4081/cp.2017.943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
We conducted a retrospective review of electronic medical records of all cases of bacterial meningitis in neonates and young infants at our institution from 2004 to 2014. Fifty-six cases were identified. The most common causative organism was group B streptococcus, followed by Escherichia coli and then Listeria monocytogenes. Forty-four of the 56 patients in the study had abnormalities of the blood white blood cell (WBC) count. The most common WBC count abnormalities were leukopenia and elevation of the immature to total (I:T) neutrophil ratio. Six patients in the case series lacked cerebrospinal fluid (CSF) pleocytosis. Overall, just 3 of the 56 patients had normal WBC count with differential, CSF WBC count, and urinalysis. Only 1 of the 56 patients was well appearing with all normal lab studies. Our study indicates that bacterial meningitis may occur without CSF pleocytosis but very infrequently occurs with all normal lab studies and well appearance.
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Affiliation(s)
- David Kotzbauer
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Curtis Travers
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Craig Shapiro
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Margaux Charbonnet
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anthony Cooley
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Deborah Andresen
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Gary Frank
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .
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Affiliation(s)
- Adrienne G. DePorre
- Children’s Mercy Hospital, Department of Pediatrics, Division of Hospital Medicine, 2401 Gillham Rd, MO 64108 Kansas City, USA
- Department of Pediatrics, University of Missouri—Kansas City, MO 64108 Kansas City, USA
| | - Paul L. Aronson
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, 100 York St, Suite 1F, New Haven, CT 06511 USA
| | - Russell J. McCulloh
- Children’s Mercy Hospital, Department of Pediatrics, Division of Hospital Medicine, 2401 Gillham Rd, MO 64108 Kansas City, USA
- Department of Pediatrics, University of Missouri—Kansas City, MO 64108 Kansas City, USA
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Cordey S, Schibler M, L'Huillier AG, Wagner N, Gonçalves AR, Ambrosioni J, Asner S, Turin L, Posfay-Barbe KM, Kaiser L. Comparative analysis of viral shedding in pediatric and adult subjects with central nervous system-associated enterovirus infections from 2013 to 2015 in Switzerland. J Clin Virol 2017; 89:22-29. [PMID: 28214758 DOI: 10.1016/j.jcv.2017.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several enterovirus (EV) genotypes can result in aseptic meningitis, but their routes of access to the central nervous system remain to be elucidated and may differ between the pediatric and adult populations. OBJECTIVE To assess the pattern of viral shedding in pediatric and adult subjects with acute EV meningitis and to generate EV surveillance data for Switzerland. STUDY DESIGN All pediatric and adult subjects admitted to the University Hospitals of Geneva with a diagnosis of EV meningitis between 2013 and 2015 were enrolled. A quantitative EV real-time reverse transcriptase (rRT)-PCR was performed on the cerebrospinal fluid (CSF), blood, stool, urine and respiratory specimens to assess viral shedding and provide a comparative analysis of pediatric and adult populations. EV genotyping was systematically performed. RESULTS EV positivity rates differed significantly between pediatric and adult subjects; 62.5% of pediatric cases (no adult case) were EV-positive in stool and blood for subjects for whom these samples were all collected. Similarly, the EV viral load in blood was significantly higher in pediatric subjects. Blood C-reactive protein levels were lower and the number of leucocytes/mm3 in the CSF were higher in non-viremic than in viremic pediatric subjects, respectively. A greater diversity of EV genotypes was observed in pediatric cases, with a predominance of echovirus 30 in children ≥3 years old and adults. CONCLUSION In contrast to adults, EV-disseminated infections are predominant in pediatric subjects and show different patterns of EV viral shedding. This observation may be useful for clinicians and contribute to modify current practices of patient care.
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Affiliation(s)
- S Cordey
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland.
| | - M Schibler
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland
| | - A G L'Huillier
- University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - N Wagner
- University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - A R Gonçalves
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland
| | - J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, 149 Carrer del Rosselló, 08036 Barcelona, Spain
| | - S Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department of Pediatrics, University Hospital Center, 46 Rue du Bugnon, 1011 Lausanne, Switzerland; Service of Infectious Diseases, Department of Internal Medicine, University Hospital Center, 46 Rue du Bugnon, 1011 Lausanne, Switzerland
| | - L Turin
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland
| | - K M Posfay-Barbe
- University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland
| | - L Kaiser
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland
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Wallace SS, Lopez MA, Caviness AC. Impact of Enterovirus Testing on Resource Use in Febrile Young Infants: A Systematic Review. Hosp Pediatr 2017; 7:96-102. [PMID: 28082417 DOI: 10.1542/hpeds.2016-0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Enterovirus infection commonly causes fever in infants aged 0 to 90 days and, without testing, is difficult to differentiate from serious bacterial infection. OBJECTIVE To determine the cost savings of routine enterovirus testing and identify subgroups of infants with greater potential impact from testing among infants 0 to 90 days old with fever. DATA SOURCES Studies were identified systematically from published and unpublished literature by using Embase, Medline, the Cochrane database, and conference proceedings. STUDY SELECTION Inclusion criteria were original studies, in any language, of enterovirus infection including the outcomes of interest in infants aged 0 to 90 days. DATA EXTRACTION Standardized instruments were used to appraise each study. The evidence quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria. Two investigators independently searched the literature, screened and critically appraised the studies, extracted the data, and applied the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS Of the 257 unique studies identified and screened, 32 were completely reviewed and 8 were included. Routine enterovirus testing was associated with reduced hospital length of stay and cost savings during peak enterovirus season. Cerebrospinal fluid pleocytosis was a poor predictor of enterovirus meningitis. The studies were all observational and the evidence was of low quality. CONCLUSIONS Enterovirus polymerase chain reaction testing, independent of cerebrospinal fluid pleocytosis, can reduce length of stay and achieve cost savings, especially during times of high enterovirus prevalence. Additional study is needed to identify subgroups that may achieve greater cost savings from testing to additionally enhance the efficiency of testing.
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Affiliation(s)
- Sowdhamini S Wallace
- Section of Pediatric Hospital Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and
| | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and
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de Crom SCM, Rossen JWA, van Furth AM, Obihara CC. Enterovirus and parechovirus infection in children: a brief overview. Eur J Pediatr 2016; 175:1023-9. [PMID: 27156106 PMCID: PMC4930465 DOI: 10.1007/s00431-016-2725-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/25/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Enterovirus and parechovirus are a frequent cause of infection in children. This review is an overview of what is known from enterovirus and parechovirus infection in children and contains information about the epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of enterovirus and parechovirus infection in children. CONCLUSIONS EV and HPeV infections are a frequent cause of infection in childhood. The clinical presentation is diverse. RT-qPCR is the best way to detect an EV or HPeV. Cerebrospinal fluid, blood and feces have the highest sensitivity for detecting an EV or HPeV. There is no treatment for EV and HPeV infections. Two vaccines against EV 71 are just licensed in China and will be available on the private market. Little is known about the prognosis of EV and HPeV infections. WHAT IS KNOWN •EV and HPeV are a frequent cause of infection in children. What is new: •This review gives a brief overview over EV and HPeV infection in children.
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Affiliation(s)
- S C M de Crom
- Department of Pediatrics, St. Elisabeth Hospital, Tilburg, The Netherlands.
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - J W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A M van Furth
- Department of Pediatric Infectious Diseases Immunology and Rheumatology, VU Medical Centre, Amsterdam, The Netherlands
| | - C C Obihara
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Clinical and Laboratory Findings That Differentiate Herpes Simplex Virus Central Nervous System Disease from Enteroviral Meningitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:3463909. [PMID: 27563314 PMCID: PMC4983658 DOI: 10.1155/2016/3463909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
Abstract
Background. It can be difficult for clinicians to distinguish between the relatively benign enteroviral (EnV) meningitis and potentially lethal herpes simplex virus (HSV) central nervous system (CNS) disease. Very limited evidence currently exists to guide them. Objective. This study sought to identify clinical features and cerebrospinal fluid (CSF) findings associated with HSV CNS disease. Methods. Given that PCR testing often is not immediately available, this chart review study sought to identify clinical and cerebrospinal fluid (CSF) findings associated with HSV meningitis over a 6-year period. In cases where PCR was not performed, HSV and EnV were assigned based on clinical criteria. Results. We enrolled 166 consecutive patients: 40 HSV and 126 EnV patients. HSV patients had a mean 40.4 versus 31.3 years for EnV, p = 0.005, seizures 21.1% versus 1.6% for EnV, p < 0.001, altered mental status 46.2% versus 3.2% for EnV, p < 0.001, or neurological deficits 44.7% versus 3.9% for EnV, p < 0.001. CSF neutrophils were lower in HSV (median 3.0% versus 9.5%, p = 0.0002); median lymphocytes (87.0% versus 67.0%, p = 0.0004) and protein (0.9 g/L versus 0.6 g/L, p = 0.0005) were elevated. Conclusion. Our study found that HSV patients were older and more likely to have seizure, altered mental status, or neurological deficits than patients with benign EnV meningitis. HSV cases had lower CSF neutrophils, higher lymphocytes, and higher protein levels.
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Morriss FH, Lindower JB, Bartlett HL, Atkins DL, Kim JO, Klein JM, Ford BA. Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications. AJP Rep 2016; 6:e344-e351. [PMID: 27695644 PMCID: PMC5042705 DOI: 10.1055/s-0036-1593406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.
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Affiliation(s)
- Frank H Morriss
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Julie B Lindower
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Dianne L Atkins
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jean O Kim
- Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Jonathan M Klein
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa; Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Bradley A Ford
- Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Mace SE, Gemme SR, Valente JH, Eskin B, Bakes K, Brecher D, Brown MD, Brown MD, Brecher D, Byyny R, Diercks DB, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Ingalsbe GS, Kaji A, Kwok H, Lo BM, Mace SE, Nazarian DJ, Proehl JA, Promes SB, Shah K, Shih RD, Silvers SM, Smith MD, Thiessen ME, Tomaszewski CA, Valente JH, Wall SP, Wolf SJ, Cantrill SV, O’Connor RE, Whitson RR, Mitchell MA. Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever. Ann Emerg Med 2016; 67:625-639.e13. [DOI: 10.1016/j.annemergmed.2016.01.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ishii E. Hemophagocytic Lymphohistiocytosis in Children: Pathogenesis and Treatment. Front Pediatr 2016; 4:47. [PMID: 27242976 PMCID: PMC4865497 DOI: 10.3389/fped.2016.00047] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 12/13/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder in children that is characterized by persistent fever, splenomegaly with cytopenia, hypertriglyceridemia, and hypofibrinogenemia. Increased levels of various cytokines and soluble interleukin-2 receptor are biological markers of HLH. HLH can be classified into two major forms: primary and secondary. Familial hemophagocytic lymphohistiocytosis (FHL), a type of primary HLH, is an autosomal recessive disorder that typically occurs in infancy and can be classified into five different subtypes (FHL types 1-5). In Japan, >80% of patients with FHL have either PRF1 (FHL type 2) or UNC13D (FHL type 3) defects. FHL is considered to be a disorder of T-cell function because the activity of NK cells or cytotoxic T lymphocytes as target cells is usually impaired. Moreover, Epstein-Barr virus-associated HLH (EBV-HLH) is considered a major subtype of secondary HLH. Any genetic background could have an effect on the pathogenesis of secondary HLH because EBV-HLH is considered to be particularly prevalent in Asian countries. For primary HLH, hematopoietic stem cell transplantation is the only accepted curative therapy, although cord blood transplantation with a reduced-conditioning regimen has been used with superior outcomes. For secondary HLH, including EBV-HLH, immunochemotherapy based on the HLH-2004 protocol has been used. In the near future, the entire mechanism of HLH should be clarified to establish less toxic therapies, including cell therapy and gene targeting therapy.
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Affiliation(s)
- Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine , Toon, Ehime , Japan
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Rodà D, Pérez-Martínez E, Cabrerizo M, Trallero G, Martínez-Planas A, Luaces C, García-García JJ, Muñoz-Almagro C, Launes C. Clinical characteristics and molecular epidemiology of Enterovirus infection in infants <3 months in a referral paediatric hospital of Barcelona. Eur J Pediatr 2015; 174:1549-53. [PMID: 26003661 DOI: 10.1007/s00431-015-2571-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/28/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Enterovirus (EV) infection is common in infants, but the information with regard to the molecular epidemiology and the associations between types and clinical variables is very scarce. This study includes 195 children <3 months old with fever, attended from March 2010 to December 2012 in an emergency department of a tertiary paediatric hospital in whom EV infection was confirmed by real-time PCR in blood and/or cerebrospinal fluid. Clinical and epidemiological data was prospectively collected. In 152 (77.9 %) patients, EVs could be typed. The most common type was Echovirus-5 (E5; 32, 21.1 %), followed by Echovirus-11 (E11; 18, 11.8 %), Echovirus-21 and Echovirus-25 (E21, E25; 11 each one, 7.2 %) and Coxsackievirus-B4 (CVB4; 6, 6.6 %). The majority of types appeared in spring, but E5 and E25 were found mainly during summer (p < 0.01). E21 was associated with high-grade fever (p < 0.01); E5 with exanthema (p = 0.03) and CVB4 tended to cause meningitis more often than the other types (p = 0.07). CONCLUSION The most common EV types were Echovirus-5 and Echovirus-11. Some significant associations between types and epidemiologic and clinical findings were observed. What is Known-What is New • Enteroviruses cause a normally benign illness in young infants, except in some cases. • The molecular epidemiology of Enterovirus infection is not well known in European countries. • This study describes a large number of infants with Enterovirus infection and shows the seasonality of different types, and their associations with epidemiologic and clinical variables.
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Affiliation(s)
- Diana Rodà
- Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
| | - Esther Pérez-Martínez
- Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Gloria Trallero
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Aina Martínez-Planas
- Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
| | - Carles Luaces
- Emergency Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.
| | - Juan-José García-García
- Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
| | - Carmen Muñoz-Almagro
- Molecular Microbiology Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.
| | - Cristian Launes
- Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
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Hendaus MA, Jomha FA, Alhammadi AH. Virus-induced secondary bacterial infection: a concise review. Ther Clin Risk Manag 2015; 11:1265-71. [PMID: 26345407 PMCID: PMC4554399 DOI: 10.2147/tcrm.s87789] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Respiratory diseases are a very common source of morbidity and mortality among children. Health care providers often face a dilemma when encountering a febrile infant or child with respiratory tract infection. The reason expressed by many clinicians is the trouble to confirm whether the fever is caused by a virus or a bacterium. The aim of this review is to update the current evidence on the virus-induced bacterial infection. We present several clinical as well in vitro studies that support the correlation between virus and secondary bacterial infections. In addition, we discuss the pathophysiology and prevention modes of the virus–bacterium coexistence. A search of the PubMed and MEDLINE databases was carried out for published articles covering bacterial infections associated with respiratory viruses. This review should provide clinicians with a comprehensive idea of the range of bacterial and viral coinfections or secondary infections that could present with viral respiratory illness.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, Academic General Pediatrics Division, Weill-Cornell Medical College, Hamad Medical Corporation, Doha, Qatar
| | - Fatima A Jomha
- School of Pharmacy, Lebanese International University, Khiara, Lebanon
| | - Ahmed H Alhammadi
- Department of Pediatrics, Academic General Pediatrics Division, Weill-Cornell Medical College, Hamad Medical Corporation, Doha, Qatar
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Hendaus MA, Alhammadi AH, Khalifa MS, Muneer E, Chandra P. Risk of urinary tract infection in infants and children with acute bronchiolitis. Paediatr Child Health 2015; 20:e25-9. [PMID: 26175566 PMCID: PMC4472059 DOI: 10.1093/pch/20.5.e25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES: To estimate the prevalence of urinary tract infection in infants and children with bronchiolitis. METHODS: A retrospective cross-sectional study involving patients zero to 24 months of age who were hospitalized with acute bronchiolitis was conducted. RESULTS: A total of 835 paediatric patients with acute bronchiolitis were admitted to the paediatric ward between January 2010 and December 2012. The mean (± SD) age at diagnosis was 3.47±2.99 months. There were 325 (39%) girls and 510 (61%) boys. For the purpose of data analysis, the patient population was divided into three groups: group 1 included children hospitalized with respiratory syncytial virus (RSV) bronchiolitis; group 2 included children hospitalized with clinical bronchiolitis with no virus detected; and group 3 included children hospitalized with clinical bronchiolitis due to a respiratory virus other than RSV. Results revealed that urinary tract infection was present in 10% of patients, and was most common in group 3 (13.4%) followed by group 2 (9.7%), and was least common in group 1 (6%) (P=0.030). CONCLUSIONS: The possibility of a urinary tract infection should be considered in a febrile child with a diagnosis of bronchiolitis, particularly if the trigger is a respiratory virus other than RSV.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar; ; Weill-Cornell Medical College-Qatar
| | - Ahmed H Alhammadi
- Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar; ; Weill-Cornell Medical College-Qatar
| | - Mohamed S Khalifa
- Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar
| | - Eshan Muneer
- Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
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Cordey S, L'Huillier AG, Turin L, Gervaix A, Posfay Barbe K, Kaiser L. Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent. J Clin Virol 2015; 68:69-72. [PMID: 26071339 DOI: 10.1016/j.jcv.2015.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/28/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human Enterovirus (EV) and Parechovirus (HPeV) are well recognised as agents causing disease in neonates, but their importance is poorly described in the general paediatric population consulting with a suspicion of infection. OBJECTIVE We investigated the prevalence of EV- or HPeV-associated infections in children presenting to a paediatric emergency department with a suspicion of infection. STUDY DESIGN Plasma specimens collected in our paediatric emergency room for clinical reasons were screened by specific real-time RT-PCR for the presence of EV and HPeV. RESULTS Based on an analyses of 233 plasma specimens, up to 6.9% and 2.6% were positive for EV and HPeV, respectively. Amongst the population <3y.o, prevalence of EV and HPeV viraemia was 11% and 3.7%, respectively. Importantly, 56.3% of positive EV specimens were detected in infants >3 months of age. CONCLUSION The prevalence of EV and HPeV viraemia in children <3 years old is largely underestimated. Our results confirm that EV should be suspected and included in the work-up in children >3 months of age and not restricted to neonates.
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Affiliation(s)
- S Cordey
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland.
| | - A G L'Huillier
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | - L Turin
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - A Gervaix
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Emergency Division, University Hospitals of Geneva, Geneva, Switzerland
| | - K Posfay Barbe
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | - L Kaiser
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
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Chou CA, Lin TI, Chen YS, Liu PY, Huang YF, Chen YY, Hsieh KS, Chen YS, Ger LP. Comparisons of etiology and diagnostic tools of lower respiratory tract infections in hospitalized young children in Southern Taiwan in two seasons. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:539-45. [PMID: 25442857 DOI: 10.1016/j.jmii.2014.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases; however, there are limited data about LRTIs in Southern Taiwan. This study aimed to investigate the clinical and epidemiological data of LRTIs in this area. METHODS Children aged under 5 years who were hospitalized at a medical center in Southern Taiwan with acute LRTIs from July 2010 to October 2010 (summer) and from March 2011 to May 2011 (spring) were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reaction (PCR), and traditional quick tests. The clinical features, laboratory data, and imaging findings were recorded and analyzed. RESULTS A total of 90 children were enrolled, 70 of whom had detectable pathogens. The positive rate of conventional viral and bacterial cultures was 25.6%, which increased to 77.77% after combining with the two multiplex PCR methods. Adenovirus and enterovirus were the most common viral etiologies identified (26.5% of cases) and Streptococcus pneumoniae was the leading bacterial etiology (46.4%). The seasonal trend of viral infections in Southern Taiwan was different from Northern Taiwan. There were no differences in demographic data, severity of disease, or hospital stay between single and mixed infections. A similar result was found between nonpneumococcal and pneumococcal infections. CONCLUSION Viral infections were the main etiologies of LRTIs in young children. Multiplex PCR methods are rapid assays that can increase the diagnostic yield rate. Mixed infections do not seem to affect the severity of disease. Early detection may aid clinicians in appropriate decision-making and treatment.
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Affiliation(s)
- Chih-An Chou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Ting-I Lin
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yu-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung, Taiwan
| | - Po-Yen Liu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yung-Feng Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan; Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Ying-Yao Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan
| | - Yao-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Luo-Ping Ger
- Department of Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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