1
|
Khatami A, Britton PN, Farrow G, Phelps M, Kakakios A. Meningitis and the military: the remarkable story of the first use of penicillin in Australia (1943). Med J Aust 2020; 213:508-510.e1. [PMID: 33197958 DOI: 10.5694/mja2.50846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ameneh Khatami
- The University of Sydney, Sydney, NSW.,Sydney Children's Hospital Network, Sydney, NSW
| | - Philip N Britton
- The University of Sydney, Sydney, NSW.,Sydney Children's Hospital Network, Sydney, NSW
| | | | | | - Alyson Kakakios
- The University of Sydney, Sydney, NSW.,Sydney Children's Hospital Network, Sydney, NSW
| |
Collapse
|
2
|
Mehr S, Frith K, Barnes EH, Campbell DE, Allen K, Barnes E, Campbell DE, Frith K, Gold M, Joshi P, Kakakios A, Loh R, Mehr S, Peake J, Smart J, Smith P, Tang M, Wainstein B, Wong M, Zurynski Y. Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012-2014. J Allergy Clin Immunol 2017; 140:1323-1330. [DOI: 10.1016/j.jaci.2017.03.027] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 11/25/2022]
|
3
|
Mehr S, Allen R, Boros C, Adib N, Kakakios A, Turner PJ, Rogers M, Zurynski Y, Singh-Grewal D. Cryopyrin-associated periodic syndrome in Australian children and adults: Epidemiological, clinical and treatment characteristics. J Paediatr Child Health 2016; 52:889-95. [PMID: 27650144 DOI: 10.1111/jpc.13270] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/04/2016] [Accepted: 03/26/2016] [Indexed: 11/29/2022]
Abstract
AIM Cryopyrin-associated periodic syndromes (CAPS) encapsulate three auto-inflammatory conditions, ranging in severity from mild (familial cold auto-inflammatory syndrome: FCAS), moderate (Muckle-Wells syndrome: MWS) and severe (neonatal onset multi-inflammatory disorder: NOMID). We aimed to describe the epidemiology, clinical features and outcomes of Australian children and adults with CAPS. METHODS Patients were identified and clinical data collected through a questionnaire sent during 2012-2013 to clinicians reporting to the Australian Paediatric Surveillance Unit and subscribing to the Australasian Societies for Allergy/Immunology, Rheumatology and Dermatology. RESULTS Eighteen cases of CAPS were identified (8 NOMID; 8 MWS, 2 FCAS); 12 in children <18 years of age. The estimated population prevalence of CAPS was 1 per million persons. Diagnostic delay was frequent, particularly in those with milder phenotypes (median diagnostic delay in MWS/FCAS 20.6 years compared with NOMID 2.1 years; P = 0.04). Common presenting features included urticaria (100%), periodic fever (78%), arthralgia (72%) and sensorineural hearing loss (61%). Almost all (90%) MWS patients had a family member similarly affected compared with none in the NOMID group (P = 0.004). A significant proportion of patients on anti-interleukin (IL)-1 therapy (n = 13) no longer had systemic inflammation. Only 50% with sensorineural hearing loss had hearing restored on anti-IL-1 therapy. CONCLUSIONS Although CAPS are rare, patients often endured prolonged periods of systemic inflammation. This is despite almost all MWS patients having family members with similar symptoms and children with NOMID presenting with chronic infantile urticaria associated with multi-system inflammation. Hearing loss in NOMID/MWS was frequent, and reversible in only 50% of cases.
Collapse
Affiliation(s)
- Sam Mehr
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Roger Allen
- Department of Rheumatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christina Boros
- University of Adelaide, Discipline of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Navid Adib
- Queensland Paediatric Rheumatology Services, Wesley Hospital, Brisbane, Queensland, Australia
| | - Alyson Kakakios
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,School of Maternal and Child Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Paul J Turner
- School of Maternal and Child Health, The University of New South Wales, Sydney, New South Wales, Australia.,Section of Paediatrics, Imperial College London, London, United Kingdom
| | - Maureen Rogers
- Department of Dermatology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Davinder Singh-Grewal
- School of Maternal and Child Health, The University of New South Wales, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Rheumatology, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Merico D, Roifman M, Braunschweig U, Yuen RKC, Alexandrova R, Bates A, Reid B, Nalpathamkalam T, Wang Z, Thiruvahindrapuram B, Gray P, Kakakios A, Peake J, Hogarth S, Manson D, Buncic R, Pereira SL, Herbrick JA, Blencowe BJ, Roifman CM, Scherer SW. Compound heterozygous mutations in the noncoding RNU4ATAC cause Roifman Syndrome by disrupting minor intron splicing. Nat Commun 2015; 6:8718. [PMID: 26522830 PMCID: PMC4667643 DOI: 10.1038/ncomms9718] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/25/2015] [Indexed: 11/09/2022] Open
Abstract
Roifman Syndrome is a rare congenital disorder characterized by growth retardation, cognitive delay, spondyloepiphyseal dysplasia and antibody deficiency. Here we utilize whole-genome sequencing of Roifman Syndrome patients to reveal compound heterozygous rare variants that disrupt highly conserved positions of the RNU4ATAC small nuclear RNA gene, a minor spliceosome component that is essential for minor intron splicing. Targeted sequencing confirms allele segregation in six cases from four unrelated families. RNU4ATAC rare variants have been recently reported to cause microcephalic osteodysplastic primordial dwarfism, type I (MOPD1), whose phenotype is distinct from Roifman Syndrome. Strikingly, all six of the Roifman Syndrome cases have one variant that overlaps MOPD1-implicated structural elements, while the other variant overlaps a highly conserved structural element not previously implicated in disease. RNA-seq analysis confirms extensive and specific defects of minor intron splicing. Available allele frequency data suggest that recessive genetic disorders caused by RNU4ATAC rare variants may be more prevalent than previously reported. Roifman Syndrome is a rare disorder whose disease manifestations include growth retardation, spondyloepiphyseal dysplasia and immunodeficiency. Here, the authors use whole-genome sequencing to discover that rare compound heterozygous variants disrupting the small nuclear RNA gene RNU4ATAC cause Roifman Syndrome.
Collapse
Affiliation(s)
- Daniele Merico
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Maian Roifman
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1Z5.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5G 1X8
| | | | - Ryan K C Yuen
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Roumiana Alexandrova
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Andrea Bates
- Division for Immunology and Allergy, Canadian Center for Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Brenda Reid
- Division for Immunology and Allergy, Canadian Center for Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Thomas Nalpathamkalam
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Zhuozhi Wang
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Bhooma Thiruvahindrapuram
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Paul Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales 2031, Australia
| | - Alyson Kakakios
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia
| | - Jane Peake
- Queensland Paediatric Immunology and Allergy Service, The Lady Cilento Children's Hospital, South Brisbane, Queensland 4101, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland 4006, Australia
| | - Stephanie Hogarth
- Queensland Paediatric Immunology and Allergy Service, The Lady Cilento Children's Hospital, South Brisbane, Queensland 4101, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland 4006, Australia
| | - David Manson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Raymond Buncic
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Sergio L Pereira
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Jo-Anne Herbrick
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4
| | - Benjamin J Blencowe
- Donnelly Centre, University of Toronto, Toronto, Ontario, Canada M5S 3E1.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Chaim M Roifman
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5G 1X8.,Division for Immunology and Allergy, Canadian Center for Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
| | - Stephen W Scherer
- The Centre for Applied Genomics (TCAG), Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada M5S 1A8.,McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada M5G 0A4.,Centre of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| |
Collapse
|
5
|
Abstract
Adult subjects with systemic capillary leak syndrome (SCLS) present with acute and recurrent episodes of vascular leak manifesting as severe hypotension, hypoalbuminemia, hemoconcentration, and generalized edema. We studied clinical disease characteristics, serum cytokine profiles, and treatment modalities in a cohort of children with documented SCLS. Six children with SCLS were recruited from the United States, Australia, Canada, and Italy. Serum cytokines from SCLS subjects and a group of 10 healthy children were analyzed. Children with SCLS (aged 5-11 years old) presented with at least 1 acute, severe episode of hypotension, hypoalbuminemia, and hemoconcentration in the absence of underlying causes for these abnormalities. In contrast to what is observed in adult SCLS, identifiable infectious triggers precipitated most episodes in these children, and none of them had a monoclonal gammopathy. We found elevated levels of chemokine (C-C motif) ligand 2 (CCL2), interleukin-8, and tumor necrosis factor α in baseline SCLS sera compared with the control group. All patients are alive and well on prophylactic therapy, with 4 patients receiving intravenous or subcutaneous immunoglobulins at regular intervals. The clinical manifestations of pediatric and adult SCLS are similar, with the notable exceptions of frequent association with infections and the lack of monoclonal gammopathy. Prophylactic medication, including high dose immunoglobulins or theophylline plus verapamil, appears to be safe and efficacious therapy for SCLS in children.
Collapse
Affiliation(s)
- Peter Hsu
- Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Zhihui Xie
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Katie Frith
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney, Australia
| | - Melanie Wong
- Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Alyson Kakakios
- Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Kelly D. Stone
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Kirk M. Druey
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and
| |
Collapse
|
6
|
Tan JWL, Campbell DE, Turner PJ, Kakakios A, Wong M, Mehr S, Joshi P. Baked egg food challenges - clinical utility of skin test to baked egg and ovomucoid in children with egg allergy. Clin Exp Allergy 2014; 43:1189-95. [PMID: 24074337 DOI: 10.1111/cea.12153] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/07/2013] [Accepted: 06/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many children with IgE-mediated egg allergy can tolerate products containing extensively heated (baked) egg. Aside from food challenge, there are no tests which reliably predict tolerance to baked egg in egg-allergic individuals. OBJECTIVES To determine if skin prick test (SPT) to baked egg (muffin) and ovomucoid can predict the outcome of baked egg challenges in egg allergic patients. METHODS In this prospective study, children with a recent history of immediate allergic reactions to egg [and corroborative positive SPT or serum-specific IgE (ssIgE) to egg] or those with SPT/ssIgE > 95% PPV for egg allergy were invited to undergo an open standardized baked egg (muffin) challenge. SPT to egg white, ovomucoid, and fresh muffin were performed immediately prior to challenge. RESULTS One hundred and forty-three egg allergic children underwent baked egg challenge and of these, 90 (63%) tolerated 1 g of egg protein in a baked muffin. Of the 53 positive challenges, eight (15%) had respiratory and/or cardiovascular symptoms. The median SPT diameters in positive challenges compared with negative challenges were baked muffin - 6.0 mm/4.0 mm and ovomucoid 7.5 mm/5.0 mm respectively. Receiver operating characteristic (ROC) curves were generated for SPT to baked egg and ovomucoid. The area under the curve was 0.68 for baked egg, and 0.67 for ovomucoid. A muffin SPT of < 2 mm had a negative predictive value of 88% and an ovomucoid SPT ≥ 11 mm had a positive predictive value of 100%. CONCLUSIONS AND CLINICAL RELEVANCE A SPT of < 2 mm to muffin had a high negative predictive value to baked egg challenge. Ovomucoid SPT ≥ 11 mm was very likely to predict a reaction to baked egg. In these children, deferring the challenge would be appropriate.
Collapse
Affiliation(s)
- J W-L Tan
- Children's Hospital at Westmead, Sydney, Australia; University of Sydney, Sydney, Australia
| | | | | | | | | | | | | |
Collapse
|
7
|
Utami KH, Hillmer AM, Aksoy I, Chew EGY, Teo ASM, Zhang Z, Lee CWH, Chen PJ, Seng CC, Ariyaratne PN, Rouam SL, Soo LS, Yousoof S, Prokudin I, Peters G, Collins F, Wilson M, Kakakios A, Haddad G, Menuet A, Perche O, Tay SKH, Sung KWK, Ruan X, Ruan Y, Liu ET, Briault S, Jamieson RV, Davila S, Cacheux V. Detection of chromosomal breakpoints in patients with developmental delay and speech disorders. PLoS One 2014; 9:e90852. [PMID: 24603971 PMCID: PMC3946304 DOI: 10.1371/journal.pone.0090852] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/04/2014] [Indexed: 01/25/2023] Open
Abstract
Delineating candidate genes at the chromosomal breakpoint regions in the apparently balanced chromosome rearrangements (ABCR) has been shown to be more effective with the emergence of next-generation sequencing (NGS) technologies. We employed a large-insert (7-11 kb) paired-end tag sequencing technology (DNA-PET) to systematically analyze genome of four patients harbouring cytogenetically defined ABCR with neurodevelopmental symptoms, including developmental delay (DD) and speech disorders. We characterized structural variants (SVs) specific to each individual, including those matching the chromosomal breakpoints. Refinement of these regions by Sanger sequencing resulted in the identification of five disrupted genes in three individuals: guanine nucleotide binding protein, q polypeptide (GNAQ), RNA-binding protein, fox-1 homolog (RBFOX3), unc-5 homolog D (C.elegans) (UNC5D), transmembrane protein 47 (TMEM47), and X-linked inhibitor of apoptosis (XIAP). Among them, XIAP is the causative gene for the immunodeficiency phenotype seen in the patient. The remaining genes displayed specific expression in the fetal brain and have known biologically relevant functions in brain development, suggesting putative candidate genes for neurodevelopmental phenotypes. This study demonstrates the application of NGS technologies in mapping individual gene disruptions in ABCR as a resource for deciphering candidate genes in human neurodevelopmental disorders (NDDs).
Collapse
Affiliation(s)
- Kagistia H. Utami
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Axel M. Hillmer
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Irene Aksoy
- Stem Cells and Developmental Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Elaine G. Y. Chew
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Audrey S. M. Teo
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Zhenshui Zhang
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Charlie W. H. Lee
- Computational and Mathematical Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Pauline J. Chen
- Computational and Mathematical Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Chan Chee Seng
- Scientific & Research Computing, Genome Institute of Singapore, Singapore, Singapore
| | - Pramila N. Ariyaratne
- Computational and Mathematical Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Sigrid L. Rouam
- Computational and Mathematical Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Lim Seong Soo
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Saira Yousoof
- Eye and Developmental Genetics Research, The Children’s Hospital at Westmead, Children’s Medical Research Institute and Save Sight Institute, Sydney, New South Wales, Australia
- Disciplines of Paediatrics and Child Health and Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ivan Prokudin
- Eye and Developmental Genetics Research, The Children’s Hospital at Westmead, Children’s Medical Research Institute and Save Sight Institute, Sydney, New South Wales, Australia
- Disciplines of Paediatrics and Child Health and Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gregory Peters
- Department of Cytogenetics, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Felicity Collins
- Department of Clinical Genetics, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Meredith Wilson
- Department of Clinical Genetics, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alyson Kakakios
- Department of Immunology, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - Arnaud Menuet
- Service de Genetique INEM UMR7355 CNRS-University, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Olivier Perche
- Service de Genetique INEM UMR7355 CNRS-University, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Stacey Kiat Hong Tay
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ken W. K. Sung
- Computational and Mathematical Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Xiaoan Ruan
- Genome Technology and Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Yijun Ruan
- Genome Technology and Biology, Genome Institute of Singapore, Singapore, Singapore
| | - Edison T. Liu
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Sylvain Briault
- Service de Genetique INEM UMR7355 CNRS-University, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Robyn V. Jamieson
- Eye and Developmental Genetics Research, The Children’s Hospital at Westmead, Children’s Medical Research Institute and Save Sight Institute, Sydney, New South Wales, Australia
| | - Sonia Davila
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Valere Cacheux
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore
- * E-mail:
| |
Collapse
|
8
|
Turner PJ, Mehr S, Joshi P, Tan J, Wong M, Kakakios A, Campbell DE. Safety of food challenges to extensively heated egg in egg-allergic children: a prospective cohort study. Pediatr Allergy Immunol 2013; 24:450-5. [PMID: 23773122 DOI: 10.1111/pai.12093] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children with IgE-mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg-allergic children who react to baked egg at open food challenge (OFC) are not well defined. METHODS Children presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009-2012. RESULTS Open food challenge to baked egg were carried out on 236 egg-allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty-six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria), including four to <100 mg extensively heated egg protein. Intramuscular adrenaline was administered to 5 of the 12 children, one of whom required a second dose due to persistent hypotension. Skin prick testing, asthma, or prior egg anaphylaxis were not predictive of challenge outcome. CONCLUSION The majority of children with IgE-mediated allergy to egg were able to tolerate 1 g of baked egg protein, but the outcome of OFC remained unpredictable, and 14% of children who failed OFC reacted with anaphylaxis. We recommend that OFC to baked egg should take place under medical supervision.
Collapse
Affiliation(s)
- Paul J Turner
- Department of Paediatric Allergy, Imperial College London, London, UK.
| | | | | | | | | | | | | |
Collapse
|
9
|
Gray PEA, Mehr S, Katelaris CH, Wainstein BK, Star A, Campbell D, Joshi P, Wong M, Frankum B, Keat K, Dunne G, Dennison B, Kakakios A, Ziegler JB. Salicylate elimination diets in children: is food restriction supported by the evidence? Med J Aust 2013; 198:600-2. [DOI: 10.5694/mja12.11255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 04/12/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Paul E A Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW
| | - Sam Mehr
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | | | - Brynn K Wainstein
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW
| | - Anita Star
- Department of Nutrition and Dietetics, Griffith University, Gold Coast, QLD
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - Preeti Joshi
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - Melanie Wong
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - Brad Frankum
- Department of Immunology and Allergy, Campbelltown Hospital, Sydney, NSW
| | - Karuna Keat
- Department of Immunology and Allergy, Campbelltown Hospital, Sydney, NSW
| | - Geraldine Dunne
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - Barbara Dennison
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - Alyson Kakakios
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, NSW
| | - John B Ziegler
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW
| |
Collapse
|
10
|
Abstract
Severe cases of atopic dermatitis (AD) may require systemic immunosuppression to achieve disease control. Unfortunately, some cases continue to be refractory to management or develop unacceptable adverse effects. There are limited reports of the use of intravenous immunoglobulin (IVIg) in the treatment of severe AD, but results are inconsistent. In a retrospective study, we report 10 children with severe AD refractory to systemic immunosuppression and maximal topical therapy who were treated using IVIg. The children received monthly IVIg for an average of 24 months. This resulted in a significant improvement in symptoms, with fewer infection-related exacerbations and hospitalizations, allowing systemic immunosuppression to be tapered. The effect was associated with a significant decrease in serum immunoglobulin E and was sustained after cessation of IVIg in 50% of cases. No significant side effects attributable to the IVIg infusions were noted. In this cohort of children with severe AD and recurrent cutaneous infections, IVIg provided an effective treatment with minimal side effects and significant benefits in school attendance and quality of life.
Collapse
Affiliation(s)
- Paul J Turner
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia.
| | | | | | | | | |
Collapse
|
11
|
Tan J, Campbell D, Turner P, Kakakios A, Wong M, Mehr S, Joshi P. Baked Egg Food Challenges - Clinical Outcomes And Determination Of Negative And Positive Predictive Values For Skin Test To Baked Egg And Ovomucoid. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Abstract
Roifman syndrome is a rare syndrome of bone dysplasia, growth retardation, retinal dystrophy and humeral immunodeficiency. Six cases have been reported to date, all of whom are male. We report a boy with clinical features of Roifman syndrome, whose older sister has skewed X-inactivation and a milder phenotype of the same disorder, supporting the hypothesis that this is an X-linked recessive condition. Both children had previously had a provisional diagnosis of Jeune dysplasia, and the boy had neonatal hip X-rays which demonstrated 'acetabular spurs' which are seen in a number of diseases thought to be caused by dysfunction of nonmotile cilia, including Jeune asphyxiating thoracic dystrophy. This finding in combination with other features such as retinal dystrophy, hepatic and renal disease suggests that the gene which is affected in Roifman syndrome may be involved with the function of nonmotile cilia and that Roifman syndrome may be the first example of a ciliopathy with associated immunodeficiency.
Collapse
Affiliation(s)
- P E A Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Australia.
| | | | | |
Collapse
|
13
|
Mehr S, Kakakios A, Shaw P, Webster R, Kemp A. Beware the lymphopenia: a case of severe combined immunodeficiency. J Paediatr Child Health 2011; 47:565-7. [PMID: 21843190 DOI: 10.1111/j.1440-1754.2010.01870.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of a 2-month-old boy with partially treated meningitis and suspected Pneumocystis carinii pneumonia. A full blood count revealed profound lymphopenia. The child was diagnosed with adenosine deaminase deficiency, a rare cause of severe combined immunodeficiency (SCID). SCID is an immunological emergency and must be considered in any lymphopaenic infant with opportunistic infection. We discuss adenosine deaminase-deficient SCID, which can involve multiple systems and in which other treatment options apart from bone marrow transplant are available.
Collapse
Affiliation(s)
- Sam Mehr
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
14
|
Abstract
We present a 6 year old boy with chronic urticaria of neonatal onset associated in childhood with features of neurological and joint inflammation. Genetic analysis confirmed the diagnosis of neonatal onset multi-inflammatory disorder (NOMID). Daily subcutaneous anti-IL-1 receptor antagonist therapy resulted in a dramatic and sustained amelioration of systemic inflammation. NOMID must be considered in any child with chronic urticaria of neonatal/infantile onset, particularly if associated with joint and/or neurological inflammation.
Collapse
Affiliation(s)
- Sam Mehr
- Departments of Allergy and Immunology, The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
15
|
Mehr S, Rego S, Kakakios A, Kilham H, Kemp A. Treatment of a case of pediatric hypereosinophilic syndrome with anti-interleukin-5. J Pediatr 2009; 155:289-91. [PMID: 19619754 DOI: 10.1016/j.jpeds.2009.01.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 12/16/2008] [Accepted: 01/22/2009] [Indexed: 11/30/2022]
Abstract
We report the use of anti-interleukin-5 (mepolizumab) during an 18-month period in a pediatric hypereosinophilic syndrome. Infusions every 3 months allowed better control of hypereosinophilic syndrome flares and maintained blood eosinopenia with significantly less steroid use compared with all other therapies (prednisolone alone, interferon alpha, or imatinib mesylate).
Collapse
Affiliation(s)
- Sam Mehr
- Department of Allergy & Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome. METHODS This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years. RESULTS Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of <36 degrees C at presentation was recorded for 24% of episodes. A platelet count of >500 x 10(9) cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age. CONCLUSIONS Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome.
Collapse
Affiliation(s)
- Sam Mehr
- Department of Allergy and Immunology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, Australia 2145.
| | | | | | | |
Collapse
|
17
|
Spelman D, Buttery J, Daley A, Isaacs D, Jennens I, Kakakios A, Lawrence R, Roberts S, Torda A, Watson DAR, Woolley I, Anderson T, Street A. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J 2008; 38:349-56. [DOI: 10.1111/j.1445-5994.2007.01579.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Abstract
Individuals with immunodeficiency, either primary or acquired, are increasingly common. These individuals have increased susceptibility to a range of infections which are uncommon in the normal host. An understanding of the individual's immune defect provides important information about the range of organisms that this individual may be susceptible to. As a corollary, identification of an 'opportunistic pathogen' may indicate the patient's type of underlying immune defect.
Collapse
Affiliation(s)
- Alison M Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, University of Sydney, LMB 4001, Westmead NSW 2145, Australia.
| | | |
Collapse
|
19
|
Affiliation(s)
- Alyson Kakakios
- Department of Immunology and Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | | |
Collapse
|
20
|
Sastry J, Kakakios A, Tugwell H, Shaw PJ. Allogeneic bone marrow transplantation with reduced intensity conditioning for chronic granulomatous disease complicated by invasive Aspergillus infection. Pediatr Blood Cancer 2006; 47:327-9. [PMID: 16628555 DOI: 10.1002/pbc.20865] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chronic granulomatous disease (CGD) is a rare disorder characterized by recurrent infections, often resulting in impaired quality of life and death. Allogeneic BMT provides a definitive cure for CGD, but carries a significant risk of mortality and morbidity. The risk is higher for those who have invasive fungal infection prior to transplant. Reduced intensity conditioning (RIC) is associated with less toxicity from the conditioning agents and may provide an alternative option for all non-malignant diseases. We report a case of successful allogeneic BMT after RIC for a case of X-linked CGD complicated by severe invasive aspergillosis (IA).
Collapse
Affiliation(s)
- Jairam Sastry
- Oncology Unit, The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
21
|
Ginn SL, Curtin JA, Kramer B, Smyth CM, Wong M, Kakakios A, McCowage GB, Watson D, Alexander SI, Latham M, Cunningham SC, Zheng M, Hobson L, Rowe PB, Fischer A, Cavazzana-Calvo M, Hacein-Bey-Abina S, Alexander IE. Treatment of an infant with X‐linked severe combined immunodeficiency (SCID‐X1) by gene therapy in Australia. Med J Aust 2005; 182:458-63. [PMID: 15865589 DOI: 10.5694/j.1326-5377.2005.tb06785.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 03/08/2005] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To report the outcome of gene therapy in an infant with X-linked severe combined immunodeficiency (SCID-X1), which typically causes a lack of T and natural killer (NK) cells. DESIGN AND SETTING Ex-vivo culture and gene transfer procedures were performed at The Children's Hospital at Westmead, Sydney, NSW, in March 2002. Follow-up to March 2005 (36 months) is available. PATIENT A 9-month-old male infant with confirmed SCID-X1 (including complete absence of T cells) with an NK+ phenotype (a less common variant of SCID-X1), and no HLA-identical sibling donor available for conventional bone marrow transplantation. PROCEDURE CD34+ haemopoietic progenitor cells were isolated from harvested bone marrow and cultured with cytokines to stimulate cellular replication. Cells were then genetically modified by exposure to a retrovirus vector encoding human gamma c (the common gamma chain of several interleukin receptors; mutations affecting the gamma c gene cause SCID-X1). Gene-modified cells (equivalent to 1.3 x 10(6) CD34+/gamma c+ cells/kg) were returned to the infant via a central line. RESULTS T cells were observed in peripheral blood 75 days after treatment, and levels increased rapidly to 0.46 x 10(9) CD3+ cells/L at 5 months. Within 2 weeks of the appearance of T cells, there was a distinct clinical improvement, with early weight gain and clearance of rotavirus from the gut. However, T-cell levels did not reach the reference range, and immune reconstitution remained incomplete. The infant failed to thrive and developed weakness, hypertonia and hyperreflexia in the legs, possibly the result of immune dysregulation. He went on to receive a bone marrow transplant from a matched unrelated donor 26 months after gene therapy. CONCLUSIONS This is the first occasion that gene therapy has been used to treat a genetic disease in Australia. Only partial immunological reconstitution was achieved, most likely because of the relatively low dose of gene-corrected CD34+ cells re-infused, although viral infection during the early phase of T-cell reconstitution and the infant's NK+ phenotype may also have exerted an effect.
Collapse
Affiliation(s)
- Samantha L Ginn
- Gene Therapy Research Unit, The Children's Hospital at Westmead and Children's Medical Research Unit, Sydney, NSW
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Whilst breastfeeding has been considered to exert a preventative effect on the development of allergic disease, several recent publications have challenged this view, particularly with respect to the long-term outcomes for asthma. There are many other beneficial effects of breastfeeding apart from the possibility of allergy prevention. The suggestion that breastfeeding may increase the development of allergic disease raises concerns about the appropriate steps to take for primary prevention of allergy. It is concluded that breastfeeding can still be recommended for the beneficial effects in reducing atopic disease in childhood in addition to the other demonstrated benefits, and that there are unresolved questions concerning the few studies that suggest the possibility of increased allergic disease in later life.
Collapse
Affiliation(s)
- A Kemp
- Department of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Westmead, New South Wales 2145, Australia.
| | | |
Collapse
|
23
|
Brotherton JML, Oates K, Nossal G, Kakakios A, Isaacs D, Roberton D. Festschrift for Professor Margaret Burgess AO. Commun Dis Intell Q Rep 2004; 28:349-55. [PMID: 15574059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In honour of the retirement of our director Margaret Burgess, National Centre for Immunisation Research and Surveillance (NCIRS) held a Festschrift on 5th to 6th February 2004. The themes of the event were Vaccines for the 21st Century and Congenital and Neonatal Infections. International guests attended the Festschrift, as well as over 180 colleagues and co-workers from across Australia. A summary of the presentations over these two fascinating days is provided herein.
Collapse
|
24
|
Affiliation(s)
- J Mílledge
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
25
|
Joshi P, Shaw A, Kakakios A, Isaacs D. Interferon-gamma levels in nasopharyngeal secretions of infants with respiratory syncytial virus and other respiratory viral infections. Clin Exp Immunol 2003; 131:143-7. [PMID: 12519398 PMCID: PMC1808612 DOI: 10.1046/j.1365-2249.2003.02039.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection, one of the most common causes of hospitalization of children in developed countries, has been implicated as a cause of asthma. We aimed to characterize the cytokine profile in nasopharyngeal aspirates (NPAs) taken from infants during upper respiratory tract infection to investigate whether RSV induced a unique immune response as compared with other viruses. Additionally, we sought to determine whether this profile was influenced by the infants' atopic status. A prospective birth cohort of babies at high risk of atopy was recruited. Ratios of a T-helper 1 (Th1) cytokine, interferon gamma (IFN-gamma) and a T-helper 2 (Th2)-like cytokine, interleukin-10 (IL-10), in NPAs were determined during episodes of respiratory tract infections in the first year. The viral aetiology of the respiratory tract infections was determined using polymerase chain reaction (PCR), culture and immunofluorescence. Atopic status was ascertained at 1 year of age using skin prick tests. Participants were recruited antenatally and subsequently followed in the community. Sixty babies with one or both parents atopic were enrolled into the study. IFN-gamma : IL-10 ratios in NPAs during upper respiratory tract infections and their correlation with viral aetiology and atopic status were the main outcome measures. The mean IFN-gamma : IL-10 ratio was significantly lower (due to lower IFN-gamma) during RSV infections than during infections with other viruses (P = 0.035). The cytokine ratio, however, did not differ between infants with or without wheeze during URTIs (P = 0.44), or between infants who were atopic or non-atopic (P = 0.49). This study suggests that RSV is associated with lower IFN-gamma production in young babies, regardless of their atopic status, compared to upper respiratory tract infections where either another virus is detected or where no viral identification is made.
Collapse
Affiliation(s)
- P Joshi
- Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
| | | | | | | |
Collapse
|
26
|
Abstract
BACKGROUND Following the emergence of penicillin and cephalosporin resistant pneumococcal meningitis in the United States, inclusion of vancomycin in empiric therapy for all suspected bacterial meningitis was recommended by the American Academy of Pediatrics. Few data are available to evaluate this policy. AIMS To examine the management and clinical course in relation to antibiotic therapy of a large unselected cohort of children with pneumococcal meningitis in a geographic area where antibiotic resistance has recently increased. METHODS Retrospective review of all cases of pneumococcal meningitis in a defined population (Sydney, Australia), 1994-99. RESULTS A total of 104 cases without predisposing illnesses were identified; timing of lumbar puncture (LP) was known in 103. Resistance to penicillin increased from 0 to 20% over the study period. Only 57 (55%) had an early LP (prior to parenteral antibiotics); 55 (96%) had organisms on Gram stain. Severe disease (intensive care admission or death) increased significantly from 57 cases with early LP (28%) to 33 with delayed LP (42%) to 13 with no LP (62%). Evidence of pneumococcal infection was available within 24 hours in 85% of those with delayed or no LP. Outcome was not related to empiric vancomycin use, which increased from 5% prior to 1998 to 48% in 1999. CONCLUSION LP is frequently delayed in pneumococcal meningitis. Based on disease severity, empiric vancomycin is most justified when LP is deferred. If an early LP is done, vancomycin can be withheld if Gram positive diplococci are not seen.
Collapse
Affiliation(s)
- P McMaster
- Department of Immunology and Infectious Diseases, The Children's Hospital at Westmead, PO Box 3515, Parramatta, NSW 2124, Australia
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
We present a 15-year-old girl who has had a persisting extensive annular erythematous eruption since birth. Otherwise, she is healthy and developmentally normal. Multiple investigations throughout the years have been normal or negative. Numerous treatments have been tried, but with little success. Both clinical and histological examination fit no known classification. It is most consistent with annular erythema of infancy but could be the first reported case of a new entity. A review of other causes of annular erythema in infancy is presented.
Collapse
Affiliation(s)
- Li-Chuen Wong
- Department of Dermatology, The Children's Hospital at Westmead, New South Wales, Australia.
| | | | | |
Collapse
|
28
|
Hanlon M, Nambiar R, Kakakios A, McIntyre P, Land M, Devine P. Pertussis antibody levels in infants immunized with an acellular pertussis component vaccine, measured using whole-cell pertussis ELISA. Immunol Cell Biol 2000; 78:254-8. [PMID: 10849113 DOI: 10.1046/j.1440-1711.2000.00910.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A commercially available whole-cell pertussis IgG ELISA was used to test the response of 137 2-month-old infants to immunization with a trivalent acellular pertussis vaccine. The pre-immunization geometric mean (GM) IgG index was 6.96 (95% confidence interval (CI) 5.88-8.04) and the postimmunization GM index was 13.16 (95% CI 12. 20-14.11), P < 0.001. Eighty percent of subjects (110/137) had a significant 1.5-fold increase of pertussis IgG index (97/137, 71%) or a postimmunization IgG index > 10 (93/137, 68%). In single antigen ELISA, 83% showed at least a fourfold increase in pertussis toxin-specific IgG (PT-IgG) and 91% showed an increase in IgG specific for filamentous haemagglutinin (FHA-IgG). Four percent had high pre- immunization antibody levels (index > 20), likely to reflect recent maternal exposure to pertussis. This correlated with a smaller increase in pertussis IgG index. A decline in pertussis IgG index postimmunization occurred in 17/24 infants (71%) whose pre-immunization IgG index was > 10. This postimmunization pertussis IgG index was not significantly different to that of infants with a low pre-immunization index. A similar trend was noted with PT-IgG and FHA-IgG results. The whole-cell ELISA can detect a response to acellular pertussis vaccination in most infants if both antibody index and degree of seroconversion are calculated and at least one criterion is satisfied.
Collapse
Affiliation(s)
- M Hanlon
- Department of Immunology and Infectious Diseases, New Children's Hospital, Westmead, New South Wales, Windsor, Queensland, Australia.
| | | | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- A J Daley
- Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children Parramatta, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
30
|
Joshi P, Kakakios A, Jayasekera J, Isaacs D. A comparison of IL-2 levels in nasopharyngeal and endotracheal aspirates of babies with respiratory syncytial viral bronchiolitis. J Allergy Clin Immunol 1998; 102:618-20. [PMID: 9802370 DOI: 10.1016/s0091-6749(98)70278-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cytokines such as IL-2 are thought to be important in the pathogenesis of respiratory tract inflammation. Cytokine levels in nasopharyngeal aspirates (NPAs) have been used as a measure of respiratory inflammation in children with viral infections, but it is unclear whether they reflect levels in the lower respiratory tract. OBJECTIVE We sought to assess the correlation between IL-2 levels in the nasopharyngeal and endotracheal secretions of children intubated with respiratory syncytial virus (RSV)-positive bronchiolitis. METHODS NPA and endotracheal aspirates were collected concurrently from intubated infants with RSV-positive bronchiolitis. IL-2 levels were assayed by ELISA, and the results were compared according to collection site. RESULTS Nine paired specimens were collected. IL-2 levels ranged from 31 pg/mL to 8040 pg/mL. No significant difference was found in the geometric mean IL-2 values from the 2 collection sites. The intraclass correlation coefficient between NPA IL-2 levels and endotracheal aspirate IL-2 levels was 0.83. CONCLUSION IL-2 levels in NPAs are comparable with those in the lower respiratory tracts of infants with RSV-positive bronchiolitis. NPA cytokine levels provide a simple and useful means of assessing respiratory tract inflammation.
Collapse
Affiliation(s)
- P Joshi
- Department of Immunology and Infectious Diseases, The Royal Alexandra Hospital for Children, Westmead, Paramatta, NSW, Australia
| | | | | | | |
Collapse
|
31
|
Abstract
Hospital-acquired infection (HAI) results in an enormous burden of excess morbidity, mortality and cost in both adults and children. Monitoring HAI is difficult, especially with limited resources, but it is vital if infection control measures are to be appropriately implemented and assessed. Cross-sectional prevalence surveys, repeated every six months, have been used effectively to monitor HAI in adults, but this technique has not been previously employed in the paediatric population. We performed prevalence surveys of HAI on a single day once every six months for five years, using a standardized questionnaire. Of the 1623 inpatients surveyed, 125 (7.7%) had HAI and 352 (21%) had community-acquired infection. In those with HAI, central-line infections, pneumonia, and wound infections predominated. A hospital stay of greater than seven days was associated with a sixfold increase in the risk of HAI. In addition, admission to a paediatric or neonatal intensive care unit, the presence of a urinary or vascular catheter, the presence of an endotracheal tube, immunosuppression and recent surgery were all associated with a significantly increased risk of HAI. In contrast to other studies, younger children were not at increased risk of HAI; admission to the neonatal unit, rather than age per se, was associated with increased risk. We conclude that repeated prevalence surveys enable simple and cost-effective assessment of HAI, facilitating appropriate infection control interventions. They should be used more widely in the paediatric setting.
Collapse
Affiliation(s)
- D Burgner
- Department of Microbiology, Royal Alexandra Hospital for Children, Parramatta NSW, Australia
| | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Kesson AM, Grimwood K, Burgess MA, Ferson MJ, Gilbert GL, Hogg G, Isaacs D, Kakakios A, McIntyre P. Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy. J Paediatr Child Health 1996; 32:211-7. [PMID: 8827537 DOI: 10.1111/j.1440-1754.1996.tb01556.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Varicella causes a mild, self-limiting childhood disease that may reactivate years later as shingles. In immunocompromised patients with altered cell mediated immunity, and rarely in healthy individuals, varicella results in a life-threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy individuals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or as treatment of the post-varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.
Collapse
Affiliation(s)
- A M Kesson
- Australasian Society for infectious Diseases, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Burgess MA, Levy M, Alperstein G, Mira M, Bek M, Isaacs D, Kakakios A, Fasher B, Hanson R, Kilham H, Malcolm M. "On the spot' vaccination: does it work? J Paediatr Child Health 1996; 32:63-7. [PMID: 8652218 DOI: 10.1111/j.1440-1754.1996.tb01545.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To trial and evaluate a system of "on the spot' vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. METHODOLOGY A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given "on the spot'. RESULTS Over an 8 week period in August-September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations "on the spot'. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination "on the spot' actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. CONCLUSIONS A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine-preventable diseases.
Collapse
Affiliation(s)
- M A Burgess
- Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Burgner D, Kakakios A. Diagnosis of mycobacterial lymphadenopathy. Arch Dis Child 1995; 73:276-7. [PMID: 7492182 PMCID: PMC1511274 DOI: 10.1136/adc.73.3.276-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
36
|
Lackmann M, Hoad R, Kakakios A, Geczy CL. Radioimmunoassay for the detection of active-site specific thrombin inhibitors in biological fluids. I. Assay characteristics and quantitation of recombinant hirudin. Thromb Res 1991; 63:595-607. [PMID: 1780804 DOI: 10.1016/0049-3848(91)90086-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A sensitive radioimmunoassay (RIA) for the quantitation of recombinant (r) hirudin in biological fluids is described. Taking advantage of the highly specific hirudin-thrombin interaction, a monoclonal antibody to human alpha-thrombin was used to capture hirudin-thrombin complexes in a competitive binding assay. Quantitation of r.hirudin in buffer, plasma or urine at concentrations ranging from 0.17 to 20 ng/ml (1.7 x 10(-3) to 2 x 10(-2) antithrombin units/ml) was achieved. In the absence of competing unlabelled r.hirudin the assay also measured alpha-thrombin (from 2 x 10(-4) to 1 x 10(-2) NIH units/ml) in citrated or defibrinated human plasma. A series of peptides corresponding to the carboxyl-terminal region of hirudin and with varying anticoagulant activities did not displace 125I-r.hirudin in the RIA described, confirming published data that these hirudin fragments bind to a site distant to the catalytic site of thrombin. The assay was used to test hirudin clearance after bolus i.v. injections of 0.1 mg r.hirudin [Val1-Val2] into human volunteers. The plasma concentrations and elimination kinetics of r.hirudin were in good agreement with published data and a close correlation between hirudin plasma concentration and prolonged clotting time was observed.
Collapse
Affiliation(s)
- M Lackmann
- Heart Research Institute, Camperdown, NSW, Australia
| | | | | | | |
Collapse
|