Extended spectrum beta-lactamase-positive Escherichia coli bacteremia complicating rotavirus gastroenteritis

Listeria monocytogenes Meningitis Complicating Rotavirus Gastroenteritis in an Immunocompetent Child

Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems.

The impact of Rotavirus mass vaccination on hospitalization rates, nosocomial Rotavirus gastroenteritis and secondary blood stream infections

Background

The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI).

Methods

The retrospective evaluation (2002–2009) by chart analysis included all clinically diagnosed and microbiologically confirmed RV-GE cases in a large tertiary care hospital in Austria. The pre-vaccination period (2002–2005) was compared with the recommended and early funded (2006–2007) and the funded (2008–2009) vaccination periods. Primary outcomes were RV-GE-associated hospitalizations, secondary outcomes nosocomial RV disease, secondary BSI and direct hospitalization costs for children and their accompanying persons.

Results

In 1,532 children with RV-GE, a significant reduction by 73.9% of hospitalized RV-GE cases per year could be observed between the pre-vaccination and the funded vaccination period, which was most pronounced in the age groups 0–11 months (by 87.8%), 6–10 years (by 84.2%) and 11–18 years (88.9%). In the funded vaccination period, a reduction by 71.9% of nosocomial RV-GE cases per year was found compared to the pre-vaccination period. Fatalities due to nosocomial RV-GE were only observed in the pre-vaccination period (3 cases). Direct costs of hospitalized, community-acquired RV-GE cases per year were reduced by 72.7% in the funded vaccination period. The reduction of direct costs for patients (by 86.9%) and accompanying persons (86.2%) was most pronounced in the age group 0–11 months.

Conclusions

UMV may have contributed to the significant decrease of RV-GE-associated hospitalizations, to a reduction in nosocomial RV infections and RV-associated morbidity due to secondary BSI and reduced direct hospitalization costs. The reduction in nosocomial cases is an important aspect considering severe disease courses in hospitalized patients with co-morbidities and death due to nosocomial RV-GE.

Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis

Acute gastroenteritis (AGE) caused by rotavirus (RV) is a common disease among infants and toddlers, often leading to hospitalization and, in resource-poor countries, to death. However, little is known on specific complications of severe RV-positive (RV+) AGE and on the clinical course in chronically ill children. This was a retrospective analysis of data for children <5 years of age hospitalized due to AGE during six rotavirus seasons in three large German pediatric hospitals. The primary study end point was the incidence and type of complications in RV+ versus RV-negative (RV-) cases. A total of 6,884 episodes of AGE in hospitalized children aged <5 years were included in this analysis. Of the 4,880 stools tested for RV, 2,118 (43.4%) were RV+. Hypernatremia was significantly more common in RV+ AGE (P < 0.001) and was associated with severe disease, need for intensive care treatment, and longer duration of hospitalization. Metabolic disorders, particularly hypoglycemia, were more common in RV+ AGE. In contrast, symptoms such as respiratory infections, neurological, and abdominal symptoms were more common in children with RV- AGE.

CONCLUSIONS

Hypernatremia is a specific complication of RV+ AGE. RV would therefore appear to be the cause of infant toxicosis, the traditional descriptive term for severe dehydration and clinical deterioration following AGE.

Klebsiella pneumoniae bacteraemia complicating rotavirus gastroenteritis in two infants with glucocorticoid deficiency

Rotavirus gastroenteritis was complicated by Klebsiella Pneumoniae bacteraemia in two infants with glucocorticoid deficient conditions who were treated with 'stress dose' hydrocortisone during their illness. Delayed healing in the context of glucocorticoid administration combined with damage from rotavirus infection may result in increased risk of mucosal invasion by gastrointestinal bacteria and subsequent enteric gram-negative bacteraemia.

Ancillary testing in children with rotavirus gastroenteritis

OBJECTIVES

Costly microbiological assays are frequently performed in patients with rotavirus gastroenteritis (RGE) to exclude concurrent serious bacterial infection (SBI). The incidence of concurrent SBI in this population is unknown but estimated to be low. The primary objective was to describe the incidence of SBI in children with RGE. The secondary objective was to elucidate risk factors for prolonged length of stay (LOS) in the cohort.

METHODS

All children < or =18 years seen at a community hospital for laboratory-confirmed RGE over a 4-year period were included in a retrospective cohort study to describe the incidence of concurrent SBI and to identify risk factors for prolonged LOS. Prolonged LOS was defined as hospitalization for > or =3 days.

RESULTS

Ninety-four cases of RGE were identified; 58 (61.7%) males and 80 (85.1%) African Americans. The median age was 8 months (interquartile range [IQR], 1 month to 16 years) and 83 patients (88.3%) required admission. There were no cases of SBI. The median LOS was 2 days. Age < or = 6 months (adjusted odds ratio [OR], 3.0; 95% confidence interval [CI], 1.2-7.7; P = 0.022) and collection of a peripheral blood culture (adjusted OR, 2.7; 95% CI, 1.0-7.1; P = 0.043) were associated with LOS > or = 3 days.

CONCLUSIONS

In children evaluated at a community hospital with laboratory-confirmed RGE, no episodes of SBI occurred. This finding challenges the need to perform invasive, costly, microbiological assays to exclude concurrent SBI in this population. Children 6 months and younger were at increased risk of prolonged hospitalization from RGE.

Immunization update

Although the development and licensure of new vaccines over the last 2 years has generated a lot of excitement as well as debate, there is a lot more to come. Not discussed in this article. licensure of another long-awaited vaccine albeit for use in adults was that for herpes zoster. The second HPV and rotavirus vaccines are awaiting approval in the US. Next in line are the vaccines both prophylactic as well as therapeutic against HIV. Topics of debate over the new vaccines include discussions amongst practices as to the affordability and cost of the new vaccines as well as the ethical debate amongst lawmakers and the general public regarding the rights and wrongs of compulsory vaccination against HPV. Another ongoing discussion is regarding the availability of approved vaccines. Shortages have been seen with several of the childhood vaccines including heptavalent pneumococcal conjugate vaccine, tetravalent meningococcal conjugate vaccine, hepatitis A vaccine, as well as the ongoing saga with influenza vaccines. Across the globe while the struggle against polio continues, there is encouraging news regarding the reduction in measles-related deaths, particularly in Africa. The last few years have indeed been landmark years in infectious disease research as the search continues for better and safer vaccines globally.