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Tu WC, Jeacopello I, Blom A, Alfaro E, Shinkawa VAM, Hatchett DB, Sanchez JC, McManamen AM, Su X, Berthier E, Thongpang S, Wald ER, DeMuri GP, Theberge AB. Capture of Group A Streptococcus by Open-Microfluidic CandyCollect Device in Pediatric Patients. medRxiv 2024:2023.12.14.23299923. [PMID: 38168197 PMCID: PMC10760271 DOI: 10.1101/2023.12.14.23299923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Importance Obtaining high-quality samples to diagnose streptococcal pharyngitis in pediatric patients is challenging due to discomfort associated with traditional pharyngeal swabs. This may cause reluctance to go to the clinic, inaccurate diagnosis, or inappropriate treatment for children with sore throat. Objective Determine the efficacy of using CandyCollect, a lollipop-inspired open-microfluidic pathogen collection device, to capture Group A Streptococcus (GAS) and compare user preference for CandyCollect, conventional pharyngeal swabs, or mouth swabs among children with pharyngitis and their caregivers. Design Participants of this cohort study were recruited over a 7-month period in 2022 - 2023. Setting This study was conducted at an ambulatory care clinic that serves pediatric patients in the Madison, Wisconsin, metropolitan area. Participants Study participants were diagnosed with GAS pharyngitis using a traditional pharyngeal swab via rapid antigen detection test (RADT); those testing positive were approached or reached out to about participation in the study. A total of 74 caregiver/children dyads were contacted about the study: 23 declined to participate; 21 were not eligible; and 30 willing and eligible participants were admitted into the study. A caregiver provided verbal consent and parental permission, and all children provided verbal assent. Immediately after the standard of care visit in which the throat swab was obtained, a research nurse guided participants through collecting oral samples: CandyCollect device and mouth swab (ESwab TM ). CandyCollect and mouth swab samples were analyzed for GAS by quantitative polymerase chain reaction (qPCR) at the University of Washington. Exposure Detection of salivary GAS using qPCR analysis of samples obtained from CandyCollect devices and mouth swabs. Main Outcomes and Measures The proportion of pediatric patients with GAS pharyngitis, as determined by a positive pharyngeal swab tested via a RADT, who were also positive using a CandyCollect and mouth swab analyzed by qPCR. Results All child participants (30/30) were positive for GAS by qPCR on both the mouth swab and CandyCollect. Caregivers ranked CandyCollect as a good sampling method overall (27/30), and all caregivers (30/30) would recommend the CandyCollect for children 5 years and older. Twenty-three of 30 children "really like" the taste and 24/30 would prefer to use the CandyCollect if a future test was needed. All caregivers (30/30) and most children (28/30) would be willing to use the CandyCollect device at home. Conclusion and relevance All participants tested positive for GAS on all three collection methods (pharyngeal swab, mouth swab, and CandyCollect). While both caregivers and children like the CandyCollect device, some caregivers would prefer a shorter collection time. Future work includes additional studies with larger cohorts presenting with pharyngitis of unknown etiology and shortening collection time, while maintaining the attractive form of the device. Trial Registration Registry name: ClinicalTrials.gov ClinicalTrials.gov Identifier: NCT05175196 Weblink: https://classic.clinicaltrials.gov/ct2/show/NCT05175196. Key Points Question: In pediatric patients with Group A Streptococcus pharyngitis, how do test results and user experience compare across three sampling methods-CandyCollect devices, mouth swabs, and pharyngeal swabs?Findings: In this cohort study of 30 children, aged 5-14 years, saliva samples were collected with CandyCollect devices and mouth swabs and analyzed via qPCR. The results show CandyCollect, a pathogen collection tool preferred by children, had 100% concordance with the results from pharyngeal swabs positive with a rapid antigen detection test performed as part of their clinical care.Meaning: With further development and testing, the CandyCollect device may potentially become an alternative sampling tool for the diagnosis of streptococcal pharyngitis.
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Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, American Family Children's Hospital, Madison, Wisconsin
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Wald ER, Eickhoff J, Flood GE, Heinz MV, Liu D, Agrawal A, Morse RP, Raney VM, Veerapandiyan A, Madan JC. Estimate of the incidence of PANDAS and PANS in 3 primary care populations. Front Pediatr 2023; 11:1170379. [PMID: 37808558 PMCID: PMC10551157 DOI: 10.3389/fped.2023.1170379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/23/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute-Onset Neuropsychiatric syndrome (PANS) are presumed autoimmune complications of infection or other instigating events. To determine the incidence of these disorders, we performed a retrospective review for the years 2017-2019 at three academic medical centers. Methods We identified the population of children receiving well-child care at each institution. Potential cases of PANS and PANDAS were identified by including children age 3-12 years at the time they received one of five new diagnoses: avoidant/restrictive food intake disorder, other specified eating disorder, separation anxiety disorder of childhood, obsessive-compulsive disorder, or other specified disorders involving an immune mechanism, not elsewhere classified. Tic disorders was not used as a diagnostic code to identify cases. Data were abstracted; cases were classified as PANDAS or PANS if standard definitions were met. Results The combined study population consisted of 95,498 individuals. The majority were non-Hispanic Caucasian (85%), 48% were female and the mean age was 7.1 (SD 3.1) years. Of 357 potential cases, there were 13 actual cases [mean age was 6.0 (SD 1.8) years, 46% female and 100% non-Hispanic Caucasian]. The estimated annual incidence of PANDAS/PANS was 1/11,765 for children between 3 and 12 years with some variation between different geographic areas. Conclusion Our results indicate that PANDAS/PANS is a rare disorder with substantial heterogeneity across geography and time. A prospective investigation of the same question is warranted.
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Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Grace E. Flood
- Medical Director Clinical Analytics and Reporting, University of Wisconsin, Madison, WI, United States
| | - Michael V. Heinz
- Department of Pediatrics, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Daniel Liu
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Alisha Agrawal
- Department of Pediatrics, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Richard P. Morse
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Veronica M. Raney
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Aravindhan Veerapandiyan
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Juliette C. Madan
- Department of Pediatrics, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Psychiatry, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Bochkov YA, Devries M, Tetreault K, Gangnon R, Lee S, Bacharier LB, Busse WW, Camargo CA, Choi T, Cohen R, De R, DeMuri GP, Fitzpatrick AM, Gergen PJ, Grindle K, Gruchalla R, Hartert T, Hasegawa K, Khurana Hershey GK, Holt P, Homil K, Jartti T, Kattan M, Kercsmar C, Kim H, Laing IA, Le Souëf PN, Liu AH, Mauger DT, Pappas T, Patel SJ, Phipatanakul W, Pongracic J, Seroogy C, Sly PD, Tisler C, Wald ER, Wood R, Lemanske RF, Jackson DJ, Gern JE. Rhinoviruses A and C elicit long-lasting antibody responses with limited cross-neutralization. J Med Virol 2023; 95:e29058. [PMID: 37638498 PMCID: PMC10484091 DOI: 10.1002/jmv.29058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Rhinoviruses (RVs) can cause severe wheezing illnesses in young children and patients with asthma. Vaccine development has been hampered by the multitude of RV types with little information about cross-neutralization. We previously showed that neutralizing antibody (nAb) responses to RV-C are detected twofold to threefold more often than those to RV-A throughout childhood. Based on those findings, we hypothesized that RV-C infections are more likely to induce either cross-neutralizing or longer-lasting antibody responses compared with RV-A infections. We pooled RV diagnostic data from multiple studies of children with respiratory illnesses and compared the expected versus observed frequencies of sequential infections with RV-A or RV-C types using log-linear regression models. We tested longitudinally collected plasma samples from children to compare the duration of RV-A versus RV-C nAb responses. Our models identified limited reciprocal cross-neutralizing relationships for RV-A (A12-A75, A12-A78, A20-A78, and A75-A78) and only one for RV-C (C2-C40). Serologic analysis using reference mouse sera and banked human plasma samples confirmed that C40 infections induced nAb responses with modest heterotypic activity against RV-C2. Mixed-effects regression modeling of longitudinal human plasma samples collected from ages 2 to 18 years demonstrated that RV-A and RV-C illnesses induced nAb responses of similar duration. These results indicate that both RV-A and RV-C nAb responses have only modest cross-reactivity that is limited to genetically similar types. Contrary to our initial hypothesis, RV-C species may include even fewer cross-neutralizing types than RV-A, whereas the duration of nAb responses during childhood is similar between the two species. The modest heterotypic responses suggest that RV vaccines must have a broad representation of prevalent types.
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Affiliation(s)
| | - Mark Devries
- University of Wisconsin-Madison, Madison, WI, United States
| | | | - Ronald Gangnon
- University of Wisconsin-Madison, Madison, WI, United States
| | - Sujin Lee
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Carlos A. Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Timothy Choi
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robyn Cohen
- Boston University, Boston, MA, United States
| | - Ramyani De
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter J. Gergen
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, United States
| | | | | | - Tina Hartert
- Vanderbilt University, Nashville, TN, United States
| | - Kohei Hasegawa
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Kiara Homil
- University of Turku and Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- University of Turku and Turku University Hospital, Turku, Finland
- PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Meyer Kattan
- Columbia University, New York, NY, United States
| | | | - Haejin Kim
- Henry Ford Health Systems, Detroit, MI, United States
| | | | | | - Andrew H. Liu
- Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Tressa Pappas
- University of Wisconsin-Madison, Madison, WI, United States
| | | | | | | | | | - Peter D. Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | | | - Ellen R. Wald
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robert Wood
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | - James E. Gern
- University of Wisconsin-Madison, Madison, WI, United States
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Shaikh N, Hoberman A, Shope TR, Jeong JH, Kurs-Lasky M, Martin JM, Bhatnagar S, Muniz GB, Block SL, Andrasko M, Lee MC, Rajakumar K, Wald ER. Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial. JAMA 2023; 330:349-358. [PMID: 37490085 PMCID: PMC10370259 DOI: 10.1001/jama.2023.10854] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 07/26/2023]
Abstract
Importance The large overlap between symptoms of acute sinusitis and viral upper respiratory tract infection suggests that certain subgroups of children being diagnosed with acute sinusitis, and subsequently treated with antibiotics, derive little benefit from antibiotic use. Objective To assess if antibiotic therapy could be appropriately withheld in prespecified subgroups. Design, Setting, and Participants Randomized clinical trial including 515 children aged 2 to 11 years diagnosed with acute sinusitis based on clinical criteria. The trial was conducted between February 2016 and April 2022 at primary care offices affiliated with 6 US institutions and was designed to evaluate whether symptom burden differed in subgroups defined by nasopharyngeal Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis on bacterial culture and by the presence of colored nasal discharge. Interventions Oral amoxicillin (90 mg/kg/d) and clavulanate (6.4 mg/kg/d) (n = 254) or placebo (n = 256) for 10 days. Main Outcomes and Measures The primary outcome was symptom burden based on daily symptom scores on a validated scale (range, 0-40) during the 10 days after diagnosis. Secondary outcomes included treatment failure, adverse events including clinically significant diarrhea, and resource use by families. Results Most of the 510 included children were aged 2 to 5 years (64%), male (54%), White (52%), and not Hispanic (89%). The mean symptom scores were significantly lower in children in the amoxicillin and clavulanate group (9.04 [95% CI, 8.71 to 9.37]) compared with those in the placebo group (10.60 [95% CI, 10.27 to 10.93]) (between-group difference, -1.69 [95% CI, -2.07 to -1.31]). The length of time to symptom resolution was significantly lower for children in the antibiotic group (7.0 days) than in the placebo group (9.0 days) (P = .003). Children without nasopharyngeal pathogens detected did not benefit from antibiotic treatment as much as those with pathogens detected; the between-group difference in mean symptom scores was -0.88 (95% CI, -1.63 to -0.12) in those without pathogens detected compared with -1.95 (95% CI, -2.40 to -1.51) in those with pathogens detected. Efficacy did not differ significantly according to whether colored nasal discharge was present (the between-group difference was -1.62 [95% CI, -2.09 to -1.16] for colored nasal discharge vs -1.70 [95% CI, -2.38 to -1.03] for clear nasal discharge; P = .52 for the interaction between treatment group and the presence of colored nasal discharge). Conclusions In children with acute sinusitis, antibiotic treatment had minimal benefit for those without nasopharyngeal bacterial pathogens on presentation, and its effects did not depend on the color of nasal discharge. Testing for specific bacteria on presentation may represent a strategy to reduce antibiotic use in this condition. Trial Registration ClinicalTrials.gov Identifier: NCT02554383.
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Affiliation(s)
- Nader Shaikh
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy R. Shope
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jong-Hyeon Jeong
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Marcia Kurs-Lasky
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith M. Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonika Bhatnagar
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gysella B. Muniz
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Melissa Andrasko
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew C. Lee
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen R. Wald
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison
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Tu WC, McManamen AM, Su X, Jeacopello I, Takezawa MG, Hieber DL, Hassan GW, Lee UN, Anana EV, Locknane MP, Stephenson MW, Shinkawa VAM, Wald ER, DeMuri GP, Adams KN, Berthier E, Thongpang S, Theberge AB. At-Home Saliva Sampling in Healthy Adults Using CandyCollect, a Lollipop-Inspired Device. Anal Chem 2023; 95:10211-10220. [PMID: 37364037 DOI: 10.1021/acs.analchem.3c00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Respiratory infections are common in children, and there is a need for user-friendly collection methods. Here, we performed the first human subjects study using the CandyCollect device, a lollipop-inspired saliva collection device .We showed that the CandyCollect device can be used to collect salivary bacteria from healthy adults using Streptococcus mutans and Staphylococcus aureus as proof-of-concept commensal bacteria. We enrolled healthy adults in a nationwide (USA) remote study in which participants were sent study packages containing CandyCollect devices and traditional commercially available oral swabs and spit tubes. Participants sampled themselves at home, completed usability and user preference surveys, and mailed the samples back to our laboratory for analysis by qPCR. Our results showed that for participants in which a given bacterium (S. mutans or S. aureus) was detected in one or both of the commercially available methods (oral swab and/or spit tubes), CandyCollect devices had a 100% concordance with the positive result (n = 14 participants). Furthermore, the CandyCollect device was ranked the highest preference sampling method among the three sampling methods by 26 participants surveyed (combining survey results across two enrollment groups). We also showed that the CandyCollect device has a shelf life of up to 1 year at room temperature, a storage period that is convenient for clinics or patients to keep the CandyCollect device and use it any time. Taken together, we have demonstrated that the CandyCollect is a user-friendly saliva collection tool that has the potential to be incorporated into diagnostic assays in clinic visits and telemedicine.
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Affiliation(s)
- Wan-Chen Tu
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Anika M McManamen
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Xiaojing Su
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ingrid Jeacopello
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Meg G Takezawa
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Damielle L Hieber
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Grant W Hassan
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ulri N Lee
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Eden V Anana
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Mason P Locknane
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Molly W Stephenson
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Victoria A M Shinkawa
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, United States
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, United States
| | - Karen N Adams
- Institute of Translational Health Sciences, School of Medicine, University of Washington, Seattle, Washington 98109, United States
| | - Erwin Berthier
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
| | - Sanitta Thongpang
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom 73170, Thailand
| | - Ashleigh B Theberge
- Department of Chemistry, University of Washington, Seattle, Washington 98195, United States
- Department of Urology, School of Medicine, University of Washington, Seattle, Washington 98195, United States
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Tu WC, McManamen AM, Su X, Jeacopello I, Takezawa MG, Hieber DL, Hassan GW, Lee UN, Anana EV, Locknane MP, Stephenson MW, Shinkawa VAM, Wald ER, DeMuri GP, Adams K, Berthier E, Thongpang S, Theberge AB. At-home saliva sampling in healthy adults using CandyCollect, a lollipop-inspired device. bioRxiv 2023:2023.01.14.524039. [PMID: 36711895 PMCID: PMC9882111 DOI: 10.1101/2023.01.14.524039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Respiratory infections are common in children, and there is a need for user-friendly collection methods. Here, we performed the first human subjects study using the CandyCollect device, a lollipop inspired saliva collection device. 1 We showed the CandyCollect device can be used to collect salivary bacteria from healthy adults using Streptococcus mutans and Staphylococcus aureus as proof-of-concept commensal bacteria. We enrolled healthy adults in a nationwide (USA) remote study in which participants were sent study packages containing CandyCollect devices and traditional commercially available oral swabs and spit tubes. Participants sampled themselves at home, completed usability and user preference surveys, and mailed the samples back to our laboratory for analysis by qPCR. Our results showed that for participants in which a given bacterium ( S. mutans or S. aureus ) was detected in one or both of the commercially available methods (oral swab and/or spit tubes), CandyCollect devices had a 100% concordance with the positive result (n=14 participants). Furthermore, the CandyCollect device was ranked the highest preference sampling method among the three sampling methods by 26 participants surveyed (combining survey results across two enrollment groups). We also showed that the CandyCollect device has a shelf life of up to 1 year at room temperature, a storage period that is convenient for clinics or patients to keep the CandyCollect device and use it any time. Taken together, we have demonstrated that the CandyCollect is a user-friendly saliva collection tool that has the potential to be incorporated into diagnostic assays in clinic visits and telemedicine. For Table of Contents Only
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Schmit KM, DeMuri GP, Eickhoff JC, Bochkov Y, Gern JE, Wald ER. Genotypic Diversity of Childhood Rhinovirus Infections. J Pediatric Infect Dis Soc 2023; 12:239-241. [PMID: 37013688 PMCID: PMC10146928 DOI: 10.1093/jpids/piad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 04/05/2023]
Abstract
Our objective was to describe the distribution of rhinovirus (RV) by species and type in both symptomatic and asymptomatic children in a prospective study over multiple years. A large and diverse distribution of RV types was seen among children with and without symptoms. RV-A and RV-C were predominant at all visits.
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Affiliation(s)
- Kathryn M Schmit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yury Bochkov
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Wald ER. Antimicrobial Stewardship and the American Academy of Pediatrics 2013 Acute Otitis Media Guideline: Interpretation? Misinterpretation? A Call to Action. J Pediatric Infect Dis Soc 2023; 12:6-7. [PMID: 36461706 DOI: 10.1093/jpids/piac122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, Alfred Dorrance Daniels Professor on Diseases of Children, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Lee UN, Su X, Hieber DL, Tu WC, McManamen AM, Takezawa MG, Hassan GW, Chan TC, Adams KN, Wald ER, DeMuri GP, Berthier E, Theberge AB, Thongpang S. CandyCollect: at-home saliva sampling for capture of respiratory pathogens. Lab Chip 2022; 22:3555-3564. [PMID: 35983761 PMCID: PMC9931141 DOI: 10.1039/d1lc01132d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Streptococcus pyogenes is a major human-specific bacterial pathogen and a common cause of a wide range of symptoms from mild infection such as pharyngitis (commonly called strep throat) to life-threatening invasive infection and post-infectious sequelae. Traditional methods for diagnosis include collecting a sample using a pharyngeal swab, which can cause discomfort and even discourage adults and children from seeking proper testing and treatment in the clinic. Saliva samples are an alternative to pharyngeal swabs. To improve the testing experience for strep throat, we developed a novel lollipop-inspired sampling platform (called CandyCollect) to capture bacteria in saliva. The device can be used in clinics or in the home and shipped back to a lab for analysis, integrating with telemedicine. CandyCollect is designed to capture bacteria on an oxygen plasma treated polystyrene surface embedded with flavoring substances to enhance the experience for children and inform the required time to complete the sampling process. In addition, the open channel structure prevents the tongue from scraping and removing the captured bacteria. The flavoring substances did not affect bacterial capture and the device has a shelf life of at least 2 months (with experiments ongoing to extend the shelf life). We performed a usability study with 17 participants who provided feedback on the device design and the dissolving time of the candy. This technology and advanced processing techniques, including polymerase chain reaction (PCR), will enable user-friendly and effective diagnosis of streptococcal pharyngitis.
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Affiliation(s)
- Ulri N Lee
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Xiaojing Su
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Damielle L Hieber
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Wan-Chen Tu
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Anika M McManamen
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Meg G Takezawa
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Grant W Hassan
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Tung Ching Chan
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Karen N Adams
- Institute of Translational Health Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erwin Berthier
- Department of Chemistry, University of Washington, Seattle, WA, USA.
| | - Ashleigh B Theberge
- Department of Chemistry, University of Washington, Seattle, WA, USA.
- Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sanitta Thongpang
- Department of Chemistry, University of Washington, Seattle, WA, USA.
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakorn Pathom, Thailand
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Barton HJ, Werner NE, Morgen M, DeMuri GP, Kelly MM, Wald ER, Warner G, Katz B, Coller RJ. Task Analysis of In-Home SARS-CoV-2 Rapid Antigen Testing by Families. Pediatrics 2022; 150:188098. [PMID: 35610754 PMCID: PMC9677708 DOI: 10.1542/peds.2022-056681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | | | | | | | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin-Madison
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin-Madison
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Kelly MM, DeMuri GP, Barton HJ, Nacht CL, Butteris SM, Katz B, Burns R, Koval S, Ehlenbach ML, Stanley J, Wald ER, Warner G, Wilson LF, Myrah GE, Parker DE, Coller RJ. Priorities for Safer In-Person School for Children With Medical Complexity During COVID-19. Pediatrics 2022; 149:184886. [PMID: 35199167 PMCID: PMC9647557 DOI: 10.1542/peds.2021-054434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method. METHODS We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when…" Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities. RESULTS From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school. CONCLUSIONS Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.
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Affiliation(s)
- Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,Address correspondence to Michelle M. Kelly, MD, MS Department of Pediatrics, University of Wisconsin, H4/419 CSC, 600 Highland Ave., Madison, WI 53792. E-mail:
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L. Nacht
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rebecca Burns
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Shawn Koval
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julia Stanley
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Gary E. Myrah
- Wisconsin Council of Administrators and Special Services, Wisconsin
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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13
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McCauley KE, DeMuri G, Lynch K, Fadrosh DW, Santee C, Nagalingam NN, Wald ER, Lynch SV. Moraxella-dominated pediatric nasopharyngeal microbiota associate with upper respiratory infection and sinusitis. PLoS One 2021; 16:e0261179. [PMID: 34962959 PMCID: PMC8714118 DOI: 10.1371/journal.pone.0261179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/27/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distinct bacterial upper airway microbiota structures have been described in pediatric populations, and relate to risk of respiratory viral infection and, exacerbations of asthma. We hypothesized that distinct nasopharyngeal (NP) microbiota structures exist in pediatric populations, relate to environmental exposures and modify risk of acute sinusitis or upper respiratory infection (URI) in children. METHODS Bacterial 16S rRNA profiles from nasopharyngeal swabs (n = 354) collected longitudinally over a one-year period from 58 children, aged four to seven years, were analyzed and correlated with environmental variables, URI, and sinusitis outcomes. RESULTS Variance in nasopharyngeal microbiota composition significantly related to clinical outcomes, participant characteristics and environmental exposures including dominant bacterial genus, season, daycare attendance and tobacco exposure. Four distinct nasopharyngeal microbiota structures (Cluster I-IV) were evident and differed with respect to URI and sinusitis outcomes. These clusters were characteristically either dominated by Moraxella with sparse underlying taxa (Cluster I), comprised of a non-dominated, diverse microbiota (Cluster II), dominated by Alloiococcus/Corynebacterium (Cluster III), or by Haemophilus (Cluster IV). Cluster I was associated with increased risk of URI and sinusitis (RR = 1.18, p = 0.046; RR = 1.25, p = 0.009, respectively) in the population studied. CONCLUSION In a pediatric population, URI and sinusitis associate with the presence of Moraxella-dominated NP microbiota.
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Affiliation(s)
- Kathryn E. McCauley
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Gregory DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Kole Lynch
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Douglas W. Fadrosh
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Clark Santee
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Nabeetha N. Nagalingam
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Susan V. Lynch
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
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14
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Schmit KM, Brown RL, Hayer S, Checovich M, Gern JE, Wald ER, Barrett B. Wisconsin Upper Respiratory Symptom Survey for Kids: Validation of an Illness-specific Quality of Life Instrument. Pediatr Res 2021; 90:1207-1214. [PMID: 33627821 PMCID: PMC8996437 DOI: 10.1038/s41390-021-01395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/06/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute respiratory infections (ARIs) are the most common illness seen in the pediatric ambulatory setting. Research in this area is hampered by the lack of validated ARI measures. The aim of this study was to assess the reliability and validity of the Wisconsin Upper Respiratory Symptom Survey for Kids (WURSS-K), a 15-item instrument, which measures illness-specific symptoms and impact on quality of life during an ARI. METHODS WURSS-K was administered to two populations: (1) children aged 4-10 years recruited from the local community and (2) 9- and 10-year-old children from an ongoing study, the Urban Environment and Childhood Asthma. RESULTS Overall, 163 children with 249 ARI episodes completed WURSS-K. WURSS-K was analyzed using multiple models to evaluate reliability and validity for a two-factor structure (symptom and functionality) and a single global structure. These models provided evidence of reliability and validity with omega of 0.72 and 0.91 for symptoms and functionality along with the single structure with omega of 0.90. CONCLUSIONS WURSS-K shows strong psychometric properties for validity and reliability as either a single global factor or a two-factor structure. This instrument will be useful in both therapeutic trials and observational studies among children with ARI in ambulatory settings. IMPACT WURSS-K is a valid and reliable illness-specific quality of life instrument that evaluates the impacts of ARIs on children. WURSS-K is designed for children 4-10 years of age, for whom there is a lack of validated assessment tools. This now validated instrument will be useful for future observational studies and therapeutic trials among children with ARIs in ambulatory settings.
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Affiliation(s)
- Kathryn M. Schmit
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI,Corresponding author: Kathryn M. Schmit, MD, Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, 600 Highland Ave, Mail code 4108, Madison, WI, 53792, Phone 1(608)265-1425, Fax 1(608)265-2207,
| | - Roger L. Brown
- Research Design & Statistics Unit, University of Wisconsin-Madison School of Nursing, Madison, WI
| | | | | | - James E. Gern
- Department of Pediatrics, Division of Allergy and Immunology, University of Wisconsin-Madison, Madison, WI
| | - Ellen R. Wald
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI
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15
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Wald ER, Eickhoff JC. Impact of Steroids as Adjuvant Therapy in Acute Bacterial Infections of Childhood. Pediatrics 2021; 148:e2021053062. [PMID: 34697220 DOI: 10.1542/peds.2021-053062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ellen R Wald
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jens C Eickhoff
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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16
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Affiliation(s)
- Ellen R Wald
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
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17
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Abstract
This review highlights the clinical and epidemiologic characteristics of coronavirus disease 2019 (COVID-19) in children and neonates and contrasts these features with other common respiratory viruses. Although the majority of infections in children are mild, there are many important, as yet, unanswered questions (specifically, the attack rate in children and the role of children as vectors of infection) that will have a major impact on disease in adults. There are no distinctive clinical characteristics that will allow the infectious disease consultant to make the diagnosis without laboratory testing. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to be less common, with lower morbidity and mortality than respiratory syncytial virus or influenza, and causes less-severe disease in children with cancer than these more common viruses. The range of severity of infection during pregnancy is comparable to infection in nonpregnant cohorts. Intrauterine infection has been documented but is uncommon. A theme of less-severe disease in individuals with modulated immune systems is emerging.
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Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kathryn M Schmit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Daniele Y Gusland
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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18
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Choi T, Devries M, Bacharier LB, Busse W, Camargo CA, Cohen R, Demuri GP, Evans MD, Fitzpatrick AM, Gergen PJ, Grindle K, Gruchalla R, Hartert T, Hasegawa K, Khurana Hershey GK, Holt P, Homil K, Jartti T, Kattan M, Kercsmar C, Kim H, Laing IA, LeBeau P, Lee KE, Le Souëf PN, Liu A, Mauger DT, Ober C, Pappas T, Patel SJ, Phipatanakul W, Pongracic J, Seroogy C, Sly PD, Tisler C, Wald ER, Wood R, Gangnon R, Jackson DJ, Lemanske RF, Gern JE, Bochkov YA. Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection. Am J Respir Crit Care Med 2021; 203:822-830. [PMID: 33357024 PMCID: PMC8017585 DOI: 10.1164/rccm.202010-3753oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/23/2020] [Indexed: 01/10/2023] Open
Abstract
Rationale: Rhinovirus (RV) C can cause asymptomatic infection and respiratory illnesses ranging from the common cold to severe wheezing.Objectives: To identify how age and other individual-level factors are associated with susceptibility to RV-C illnesses.Methods: Longitudinal data from the COAST (Childhood Origins of Asthma) birth cohort study were analyzed to determine relationships between age and RV-C infections. Neutralizing antibodies specific for RV-A and RV-C (three types each) were determined using a novel PCR-based assay. Data were pooled from 14 study cohorts in the United States, Finland, and Australia, and mixed-effects logistic regression was used to identify factors related to the proportion of RV-C versus RV-A detection.Measurements and Main Results: In COAST, RV-A and RV-C infections were similarly common in infancy, whereas RV-C was detected much less often than RV-A during both respiratory illnesses and scheduled surveillance visits (P < 0.001, χ2) in older children. The prevalence of neutralizing antibodies to RV-A or RV-C types was low (5-27%) at the age of 2 years, but by the age of 16 years, RV-C seropositivity was more prevalent (78% vs. 18% for RV-A; P < 0.0001). In the pooled analysis, the RV-C to RV-A detection ratio during illnesses was significantly related to age (P < 0.0001), CDHR3 genotype (P < 0.05), and wheezing illnesses (P < 0.05). Furthermore, certain RV types (e.g., C2, C11, A78, and A12) were consistently more virulent and prevalent over time.Conclusions: Knowledge of prevalent RV types, antibody responses, and populations at risk based on age and genetics may guide the development of vaccines or other novel therapies against this important respiratory pathogen.
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Affiliation(s)
- Timothy Choi
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Mark Devries
- University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | | | | | | | | | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Peter J Gergen
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, Maryland
| | | | | | | | | | | | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Tuomas Jartti
- University of Turku, Turku, Finland
- Universities of Oulu, Oulu, Finland
| | | | | | - Haejin Kim
- Henry Ford Health Systems, Detroit, Michigan
| | - Ingrid A Laing
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Peter N Le Souëf
- University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Liu
- University of Colorado, Denver, Colorado
| | | | | | | | | | | | | | | | - Peter D Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia; and
| | | | - Ellen R Wald
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Wood
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - James E Gern
- University of Wisconsin-Madison, Madison, Wisconsin
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DeMuri GP, Lehtoranta LM, Eickhoff JC, Lehtinen MJ, Wald ER. Ex vivo peripheral blood mononuclear cell response to R848 in children after supplementation with the probiotic Lactobacillus acidophilus NCFM/ Bifidobacterium lactis Bi-07. Benef Microbes 2021; 12:85-93. [PMID: 33550937 DOI: 10.3920/bm2020.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Several studies have demonstrated a decrease in upper respiratory infection (URI) frequency and severity in subjects taking probiotic supplements. We hypothesised beneficial effects of probiotics on viral URI in children are due to modulation of inflammatory innate immune responses. We tested this hypothesis, providing children with a probiotic combination of Lactobacillus acidophilus/Bidfidobacterium animalis ssp. lactis Bi-07 (NCFM/Bi-07) and measuring levels of cytokines in response to stimulation of peripheral blood mononuclear cells (PBMCs) to toll-like receptor (TLR) 7/8 agonist resiquimod (R848). In this open label study, 21 (2 dropouts) children received probiotic containing 5×109 cfu each of NCFM/(Bi-07) daily for 30 days. Whole blood was taken from each subject at study entry and 30 days for culture of PBMCs. PBMCs stimulated with resiquimod (R848) or unstimulated were incubated and a panel of immune markers was measured. There was a significant decrease in the net (stimulated-null) level of myeloid progenitor inhibitory factor 1 (MPIF-1) (mean decrease 0.1 ng/ml, 95% confidence interval 0.01-0.24, P=0.032) following probiotic supplementation. The change in immune marker levels after supplementation, when analysed together with respect to expected inflammatory/anti-inflammatory effects, was increased for interleukin (IL)-10 and decreased for MPIF-1, IL-8, interferon gamma induced protein 10, macrophage inflammatory protein 3 alpha (MIP-3α) and E-selectin (P=0.01). Adverse events were mild. In conclusion, supplementation with this probiotic combination was safe and resulted in significant modulation of PBMC limited immune response to TLR7/8 agonist R848 and in levels of MPIF-1 and MIP-3α. The anti-inflammatory effect may be one mechanism by which probiotics modulate the immune system however further study is needed.
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Affiliation(s)
- G P DeMuri
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
| | - L M Lehtoranta
- DuPont Nutrition and Biosciences, Danisco Sweeteners Oy, Sokeritehtaantie 20, Kantvik 02460, Finland
| | - J C Eickhoff
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
| | - M J Lehtinen
- DuPont Nutrition and Biosciences, Danisco Sweeteners Oy, Sokeritehtaantie 20, Kantvik 02460, Finland
| | - E R Wald
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53972, USA
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20
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DeMuri GP, Eickhoff JC, Gern JC, Wald ER. Clinical and Virological Characteristics of Acute Sinusitis in Children. Clin Infect Dis 2020; 69:1764-1770. [PMID: 30649261 PMCID: PMC7108184 DOI: 10.1093/cid/ciz023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/11/2019] [Indexed: 11/14/2022] Open
Abstract
Background Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain uncomplicated and those that precede an episode of sinusitis. We hypothesize that certain viruses are more likely to lead to acute sinusitis, and we compare viruses identified at the time of diagnosis of sinusitis with those identified early in the URI. Methods Children aged 48–96 months were followed longitudinally for 1 year. Nasal samples were obtained at surveillance visits, on Day 3–4 of the URI, and on Day 10, when sinusitis was diagnosed. Molecular diagnostic testing was performed on nasal washes for common respiratory viruses and pathogenic bacteria. A standardized score was used to quantify symptom severity. Results We evaluated 519 URIs, and 37 illnesses in 31 patients met the criteria for sinusitis. Respiratory syncytial virus was detected more frequently in URI visits that led to sinusitis, compared to in uncomplicated URIs (10.8% vs 3.4%; P = .05). New viruses were detected in 29% of sinusitis episodes, and their pattern was different than those patterns observed at surveillance. The median number of URIs per subject per year was 1 (range 0–9) in uncomplicated URI subjects and 3 (range 1–9) in sinusitis subjects (P < .001). Conclusions Children who developed sinusitis experienced more frequent URIs, compared to children whose URIs remained uncomplicated. When nasal samples were obtained on the day of diagnosis of acute sinusitis, nearly 30% of children had a new virus identified, suggesting that some children deemed to have sinusitis were experiencing sequential viral infections.
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Affiliation(s)
- Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - James C Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
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21
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Abstract
Rapid turnaround real-time polymerase chain reaction (PCR) has recently become available as a point-of-care test for group A Streptococcus (GAS) in children presenting with pharyngitis. Our aim in this pilot study was to determine if GAS can be detected in the saliva of children with sore throat using swabs inoculated by children sucking on them as they would a lollipop. Twenty children with positive rapid antigen detection tests for GAS from pharyngeal swabs were enrolled. Pharyngeal and lollipop samples underwent PCR testing using the cobas Liat system. All 20 pharyngeal swabs were positive; 19 of 20 lollipop samples were positive. The increased sensitivity of the new PCR kits for GAS may permit use of less invasive and more comfortable sampling techniques for diagnosis.
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22
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DeMuri GP, Gern JE, Eickhoff JC, Lynch SV, Wald ER. Dynamics of Bacterial Colonization With Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis During Symptomatic and Asymptomatic Viral Upper Respiratory Tract Infection. Clin Infect Dis 2019; 66:1045-1053. [PMID: 29121208 PMCID: PMC6019034 DOI: 10.1093/cid/cix941] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background Virus is detected in about 80% of upper respiratory tract infections (URTIs) in children and is also detectable in the nasopharynx of 30% of asymptomatic children. The effect of asymptomatic viral infection on the dynamics of bacterial density and colonization of the nasopharynx has not been reported. The current study was performed to assess the presence and density of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the nasopharynx of 4–7-year-old children during URTI and when well. Methods Nasal samples were obtained during 4 surveillance periods when children were asymptomatic and whenever they had symptoms of URTI. Respiratory viruses and bacterial pathogens were identified and quantified using polymerase chain reaction. Results The proportion of children colonized with all 3 bacteria was higher during visits for acute URTI than during asymptomatic surveillance visits. Mean bacterial densities were significantly higher at all visits for all 3 pathogens when a virus was detected. The differences between the means were 1.0, 0.4, and 0.7 log10 colony-forming unit equivalents per milliliter for S. pneumoniae, H. influenzae, and M. catarrhalis, respectively, compared with visits in which virus was not detected. The percentage of children colonized and density were also higher at asymptomatic visits in which virus was detected than at visits in which virus was not detected. Conclusion The density and frequency of colonization with S. pneumoniae, H. influenzae, and M. catarrhalis in nasal wash samples increase during periods of both symptomatic and asymptomatic viral infection. Increases in bacterial colonization observed during asymptomatic viral infection were nearly the same magnitude as when children were symptomatic.
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Affiliation(s)
- Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Susan V Lynch
- Department of Medicine, University of California, San Francisco
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
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DeMuri GP, Wald ER. 2179. Detection of Group A Streptococcus in the Saliva of Children Presenting With Pharyngitis Using the cobas®LIAT® PCR System. Open Forum Infect Dis 2019. [PMCID: PMC6809875 DOI: 10.1093/ofid/ofz360.1859] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background CLIA waived polymerase chain reaction (PCR) has recently become available as a point of care test for Group A Streptococci (GAS) in individuals presenting with pharyngitis, enabling rapid and accurate diagnosis. However, swabbing the pharynx results in discomfort and is often dreaded by young children which may result in poor quality sampling. Objective In order to assess the viability of saliva as a sample specimen for GAS, this study compared saliva samples with pharynx swabs of children with sore throat, using swabs inoculated by children sucking on them as they would a lollipop in the context of newly available very sensitive techniques. Methods We enrolled children ages 5–15 years presenting with sore throat and known to have a positive rapid streptococcal antigen detection test (RADT) performed on a posterior pharyngeal swab, at the discretion of the primary care provider. The RADT used was the SureVue® (Fisher Scientific) system. A second swab was obtained by having the child suck on the swab in the anterior mouth for 30 seconds and a third swab was obtained from the posterior pharynx. PCR was performed on these two additional swabs using the cobas®LIAT® (Roche) system according to the manufacturer’s instructions. Results Seventeen children were enrolled in the study between January and April 2019. The mean age of enrollment was 9.6 years (range 6–15). By design all children were known to have a positive RADT for GAS. The LIAT posterior pharynx swab was positive in all 17 subjects. In addition, the LIAT saliva swab was positive in all 17 subjects. Conclusion In this small pilot study, there was 100% concordance between the RADT for GAS and both the posterior pharyngeal and saliva swab using the cobas®LIAT® PCR system. Performing saliva swabs will result in less discomfort and distress to children who are tested for GAS. Further study is needed to determine the sensitivity and specificity of saliva swabs for the detection of GAS in children presenting with acute pharyngitis. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Gregory P DeMuri
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Ellen R Wald
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Shaikh N, Wald ER, Jeong JH, Kurs-Lasky M, Nash D, Pichichero ME, Kearney DH, Haralam MA, Bowen A, Flom LL, Hoberman A. Development and Modification of an Outcome Measure to Follow Symptoms of Children with Sinusitis. J Pediatr 2019; 207:103-108.e1. [PMID: 30545562 PMCID: PMC6440829 DOI: 10.1016/j.jpeds.2018.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/19/2018] [Revised: 10/09/2018] [Accepted: 11/06/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To develop a parent-reported Pediatric Rhinosinusitis Symptom Scale (PRSS) that could be used to monitor symptoms of young children with acute sinusitis in response to therapy. STUDY DESIGN We developed an 8-item symptom severity scale and evaluated its internal reliability, construct validity, and responsiveness in children 2-12 years of age with acute sinusitis. Parents of 258 children with acute sinusitis completed the PRSS at the time of diagnosis, as a diary at home, and at the follow-up visit at days 10-12. Based on psychometric results and additional parent feedback, we revised the scale. We evaluated the revised version in 185 children with acute sinusitis. RESULTS Correlations between the scale and reference measures on the day of enrollment were in the expected direction and of the expected magnitude. PRSS scores at the time of presentation correlated with radiographic findings (P < .001), functional status (P < .001), and parental assessment of overall symptom severity (P < .001). Responsiveness (standardized response mean) and test-retest reliability of the revised scale were good (2.17 and 0.75, respectively). CONCLUSIONS We have developed an outcome measure to track the symptoms of acute sinusitis. Data presented here support the use of the PRSS as a measure of change in symptom burden in clinical trials of children with acute sinusitis.
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Affiliation(s)
- Nader Shaikh
- Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Ellen R. Wald
- University of Wisconsin School of Medicine and Public Health
| | | | - Marcia Kurs-Lasky
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics
| | - David Nash
- University of Pittsburgh School of Medicine, Division of Allergy and Immunology
| | | | - Diana H. Kearney
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics
| | - Mary Ann Haralam
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics
| | - A’Delbert Bowen
- Children’s Hospital of Pittsburgh, Division of Pediatric Radiology
| | - Lynda L. Flom
- Children’s Hospital of Pittsburgh, Division of Pediatric Radiology
| | - Alejandro Hoberman
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics
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Abstract
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
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Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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Abstract
This prospective, randomized, controlled trial for parents of overweight and obese 3- to 7-year-olds was performed to assess the feasibility of a program promoting healthy eating and lifestyle by targeting parents as agents of change. The intervention was composed of 6-in-person group sessions and a customized website over 12 months. The control group received customary care. The primary outcome was feasibility of the intervention to promote healthy behavior change measured by attendance. The secondary outcome was effectiveness assessed by attaining reduced body mass index (BMI) z scores, healthy behavior changes and increased parent self-efficacy. Seventy-three child-parent dyads were enrolled; 14 parents never attended any sessions. Participation in follow-up assessments did not meet the hypothesized level. Ultimate BMI z scores did not differ between control and intervention groups. Parenting skills did not improve in the intervention group. This intervention to achieve healthy lifestyle changes in children via their parents as "change agents" was unsuccessful.
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Affiliation(s)
- Ellen R Wald
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda J Ewing
- 2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jens C Eickhoff
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Affiliation(s)
- Kenneth B Roberts
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Ellen R Wald
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Abstract
The purpose of this study was to ( a) determine the frequency of diagnostic errors in pediatric cancer, ( b) categorize errors, and ( c) underscore themes associated with misdiagnosis. This is a retrospective cohort study at a tertiary children's hospital of 265 patients with new oncologic diagnoses. The diagnostic error rate was 28%. Compared with those with no diagnostic error, those in whom there was an error were more likely to have ( a) more visits before diagnosis ( P < .001), ( b) not been seen in an acute care setting ( P = .03), ( c) inappropriate treatment ( P < .001), and ( d) misinterpreted laboratory studies or imaging ( P < .001). Themes in diagnostic errors were lack of appropriate evaluation for persistent symptoms (47%), failure to recognize signs and symptoms suggestive of malignancy (45%), and misinterpretation of tests (8%). Clinicians should consider diagnostic evaluation for multiple visits for the same complaint or a constellation of signs and symptoms suggestive of malignancy.
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Affiliation(s)
| | - Keith Hanson
- 2 University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Webber S, Cooper G, DeMuri G, Wald ER. Pneumococcal Meningitis in the PCV13 Era: A Cluster of Cases With Increased Morbidity and Mortality. Clin Pediatr (Phila) 2016; 55:1252-1255. [PMID: 26902305 DOI: 10.1177/0009922816629761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Webber
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Gena Cooper
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Gregory DeMuri
- University of Wisconsin Hospital and Clinics, Madison, WI, USA University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ellen R Wald
- University of Wisconsin Hospital and Clinics, Madison, WI, USA University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
BACKGROUND AND OBJECTIVES Adherence to the American Academy of Pediatrics safe sleep practice (SSP) recommendations among hospitalized infants is unknown, but is assumed to be low. This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children's hospital general care unit between October 2013 and December 2014. METHODS After development of a hospital policy and redesign of room setup processes, a multidisciplinary team developed intervention strategies based on root cause analysis and implemented changes using iterative Plan-Do-Study-Act cycles. Nurse knowledge was assessed before and after education. SSPs were measured continuously with room audits during sleeping episodes. Statistical process control and run charts identified improvements and sustainability in hospital SSPs. Caregiver home practices after discharge were assessed via structured questionnaires before and after intervention. RESULTS Nursing knowledge of SSPs increased significantly for each item (P ≤ .001) except avoidance of bed sharing. Audits were completed for 316 sleep episodes. Simultaneous adherence to all SSP recommendations improved significantly from 0% to 26.9% after intervention. Significant improvements were noted in individual practices, including maintaining a flat, empty crib, with an appropriately bundled infant. The largest gains were noted in the proportion of empty cribs (from 3.4% to 60.3% after intervention, P < .001). Improvements in caregiver home practices after discharge were not statistically significant. CONCLUSIONS Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.
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Affiliation(s)
- Kristin A Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Windy Smith
- American Family Children's Hospital, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
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Santee CA, Nagalingam NA, Faruqi AA, DeMuri GP, Gern JE, Wald ER, Lynch SV. Nasopharyngeal microbiota composition of children is related to the frequency of upper respiratory infection and acute sinusitis. Microbiome 2016; 4:34. [PMID: 27364497 PMCID: PMC4929776 DOI: 10.1186/s40168-016-0179-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/13/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Upper respiratory infections (URI) and their complications are a major healthcare burden for pediatric populations. Although the microbiology of the nasopharynx is an important determinant of the complications of URI, little is known of the nasopharyngeal (NP) microbiota of children, the factors that affect its composition, and its precise relationship with URI. RESULTS Healthy children (n = 47) aged 49-84 months from a prospective cohort study based in Wisconsin, USA, were examined. Demographic and clinical data and NP swab samples were obtained from participants upon entry to the study. All NP samples were profiled for bacterial microbiota using a phylogenetic microarray, and these data were related to demographic characteristics and upper respiratory health outcomes. The composition of the NP bacterial community of children was significantly related prior to the history of acute sinusitis (R (2) = 0.070, P < 0.009). History of acute sinusitis was associated with significant depletion in relative abundance of taxa including Faecalibacterium prausnitzii and Akkermansia spp. and enrichment of Moraxella nonliquefaciens. Enrichment of M. nonliquefaciens was also a characteristic of baseline NP samples of children who subsequently developed acute sinusitis over the 1-year study period. Time to develop URI was significantly positively correlated with NP diversity, and children who experienced more frequent URIs exhibited significantly diminished NP microbiota diversity (P ≤ 0.05). CONCLUSIONS These preliminary data suggest that previous history of acute sinusitis influences the composition of the NP microbiota, characterized by a depletion in relative abundance of specific taxa. Diminished diversity was associated with more frequent URIs.
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Affiliation(s)
- Clark A Santee
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Nabeetha A Nagalingam
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
- Present address: Janssen Prevention Center, 2 Royal College Street, London, NW1 0TU, UK
| | - Ali A Faruqi
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gregory P DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA.
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Wampole AJ, Anderson HM, Wald ER. A Case of Postinfectious Protein S Deficiency Masquerading as Henoch-Schönlein Purpura. Clin Pediatr (Phila) 2016; 55:488-91. [PMID: 26063758 DOI: 10.1177/0009922815590116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anthony J Wampole
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Halie M Anderson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ellen R Wald
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER. Clinical Features, Virus Identification, and Sinusitis as a Complication of Upper Respiratory Tract Illness in Children Ages 4-7 Years. J Pediatr 2016; 171:133-9.e1. [PMID: 26787374 PMCID: PMC4808614 DOI: 10.1016/j.jpeds.2015.12.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/06/2015] [Accepted: 12/11/2015] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To determine the rate of sinusitis complicating upper respiratory tract illnesses (URIs) in children. We prospectively identified the clinical, virologic, and epidemiologic characteristics of URIs in a population of 4- to 7-year-old children followed for 1 year. STUDY DESIGN This was an observational cohort study in 2 primary care pediatric practices in Madison, Wisconsin. Nasal samples were obtained during 4 asymptomatic surveillance visits and during symptomatic URIs. A polymerase chain reaction-based assay for 9 respiratory viruses was performed on nasal samples. A diagnosis of sinusitis was based on published criteria. RESULTS Two hundred thirty-six children ages 48-96 months were enrolled. A total of 327 URIs were characterized. The mean number of URIs per child was 1.3 (range 0-9) per year. Viruses were detected in 81% of URIs; rhinovirus (RV) was most common. Seventy-two percent of URIs were resolved clinically by the 10th day. RV-A and RV-C were detected more frequently at URI visits; RV-B was detected at the same rate for both asymptomatic surveillance visits and URI visits. Sinusitis was diagnosed in 8.8% of symptomatic URIs. Viruses were detected frequently (33%) in samples from asymptomatic children. CONCLUSIONS Sinusitis occurred in 8.8% of symptomatic URIs in our study. The virus most frequently detected with URIs in children was RV; RV-A and RV-C detection but not RV-B detection were associated with illness. Viruses, especially RV, are detected frequently in asymptomatic children. Most URIs have improved or resolved by the 10th day after onset. Children experienced a mean of 1.3 URIs per year, which was lower than expected.
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Key Words
- adv, adenovirus
- cov, coronavirus
- ev, enterovirus
- flu, influenza virus
- gee, generalized estimating equation
- hbov, human bocavirus
- hmpv, human metapneumovirus
- piv, parainfluenza virus
- rsv, respiratory syncytial virus
- rv, rhinovirus
- uri, upper respiratory tract illness
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Affiliation(s)
- Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stacey C. Moyer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mary J. Lindstrom
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Susan V. Lynch
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Shaikh N, Hoberman A, Keren R, Ivanova A, Gotman N, Chesney RW, Carpenter MA, Moxey-Mims M, Wald ER. Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children. J Pediatr 2016; 171:116-21. [PMID: 26794472 PMCID: PMC4808618 DOI: 10.1016/j.jpeds.2015.12.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials. STUDY DESIGN Children, 2-71 months of age (n = 769) enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux or Careful Urinary Tract Infection Evaluation studies were included. We used logistic regression models to test the associations between demographic and clinical characteristics and resistance to narrow-spectrum antimicrobials. RESULTS Of the included patients, 91% were female and 76% had vesicoureteral reflux. The risk of resistance to narrow-spectrum antibiotics in uncircumcised males was approximately 3 times that of females (OR 3.1; 95% CI 1.4-6.7); in children with bladder bowel dysfunction, the risk was 2 times that of children with normal function (OR 2.2; 95% CI 1.2-4.1). Children who had received 1 course of antibiotics during the past 6 months also had higher odds of harboring resistant organisms (OR 1.6; 95% CI 1.1-2.3). Hispanic children had higher odds of harboring pathogens resistant to some narrow-spectrum antimicrobials. CONCLUSIONS Uncircumcised males, Hispanic children, children with bladder bowel dysfunction, and children who received 1 course of antibiotics in the past 6 months were more likely to have a urinary tract infection caused by pathogens resistant to 1 or more narrow-spectrum antimicrobials.
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Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, Grammer LC, Kennedy DW, Cohen NA, Kaliner MA, Wald ER, Karagianis A, Slavin RG. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 2015; 113:347-85. [PMID: 25256029 DOI: 10.1016/j.anai.2014.07.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
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Abstract
Despite the common nature of group A streptococcal (GAS) infections, the carrier state of this organism is not well understood. In this article, we review the historical and recent research on the definition, epidemiology, and pathogenesis of the GAS carrier state. In addition, we outline trials of antimicrobial agents in the eradication of the carrier state and discuss indications for providing treatment to patients in the clinical setting.
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Affiliation(s)
- Gregory P DeMuri
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Ellen R Wald
- University of Wisconsin School of Medicine and Public Health, Madison
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Abstract
BACKGROUND The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. OBJECTIVES To determine the efficacy of decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. SEARCH METHODS We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each study for inclusion. MAIN RESULTS Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. AUTHORS' CONCLUSIONS There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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Affiliation(s)
- Nader Shaikh
- Children's Hospital of PittsburghGeneral Academic Pediatrics3414 Fifth Ave, Suite 301PittsburghPAUSA15213
| | - Ellen R Wald
- University of Wisconsin School of Medicine and Public HealthDepartment of PediatricsH4/458 CSC, 600 Highland AvenueMadisonWIUSA53792
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Shaikh N, Hoberman A, Colborn DK, Kearney DH, Jeong JH, Kurs-Lasky M, Barbadora KA, Bowen A, Flom LL, Wald ER. Are nasopharyngeal cultures useful in diagnosis of acute bacterial sinusitis in children? Clin Pediatr (Phila) 2013; 52:1118-21. [PMID: 24137025 DOI: 10.1177/0009922813506257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 12/31/2022]
Abstract
The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs). Nasopharyngeal swabs were collected from 204 children meeting a priori clinical criteria for acute sinusitis. All children had sinus X-rays at the time of diagnosis. To determine if negative nasopharyngeal culture results could reliably identify the subgroup of children with normal radiographs, we calculated negative predictive values and negative likelihood ratios. Absence of pathogens in the nasopharynx was not helpful in identifying this low-risk subgroup.
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Affiliation(s)
- Nader Shaikh
- 1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.
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Affiliation(s)
- Gregory DeMuri
- Associate Professor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Casselbrant ML, Kaleida PH, Rockette HE, Paradise JL, Wald ER, Lasky MK, Bluestone CD. In reference toWhat is the Role of Tympanostomy Tubes in the Treatment of Recurrent Acute Otitis Media? Laryngoscope 2013; 123:E127. [DOI: 10.1002/lary.24142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - Phillip H. Kaleida
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Howard E. Rockette
- Department of Biostatistics; Graduate School of Public Health, University of Pittsburgh; Pittsburgh Pennsylvania
| | - Jack L. Paradise
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Ellen R. Wald
- Department of Pediatrics; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin U.S.A
| | - Marcia Kurs Lasky
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Charles D. Bluestone
- Department of Pediatric Otolaryngology; University of Pittsburgh; Pittsburgh Pennsylvania
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Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013; 132:e262-80. [PMID: 23796742 DOI: 10.1542/peds.2013-1071] [Citation(s) in RCA: 286] [Impact Index Per Article: 26.0] [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: 11/24/2022] Open
Abstract
OBJECTIVE To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS Analysis of the medical literature published since the last version of the guideline (2001). RESULTS The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever[temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the firstline treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening(progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management.If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.
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Affiliation(s)
- Gregory P DeMuri
- Division of Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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Abstract
BACKGROUND The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. OBJECTIVES To systematically review the efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis. We considered the following four interventions: 1) decongestants versus placebo or no medication, 2) antihistamines versus placebo or no medication, 3) decongestant and antihistamine combination versus placebo or no medication, 4) nasal irrigation versus no irrigation. The primary outcomes of the review were symptom resolution (improvement in symptom score from enrolment to day five and overall symptom burden (as measured by average symptom scores while on therapy). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 1), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to January week 3, 2012) and EMBASE (1950 to January 2012). SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs which evaluated children less than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each study for inclusion. MAIN RESULTS Of the 526 studies found through the electronic searches and handsearching, none met all the inclusion criteria. AUTHORS' CONCLUSIONS There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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Affiliation(s)
- Nader Shaikh
- General Academic Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA.
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DeMuri G, Wald ER. Acute rhinosinusitis treatment. JAMA 2012; 307:2368-9; author reply 2369-70. [PMID: 22692159 DOI: 10.1001/jama.2012.4391] [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: 11/14/2022]
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Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJC, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis370] [Citation(s) in RCA: 367] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
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Affiliation(s)
- Anthony W. Chow
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C
| | - Jan L. Brozek
- Department of Clinical Epidemiology and Biostatistics
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellie J. C. Goldstein
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles
- R. M. Alden Research Laboratory, Santa Monica, California
| | - Lauri A. Hicks
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George A. Pankey
- Department of Infectious Disease Research, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mitchel Seleznick
- Division of General Internal Medicine, University of South Florida College of Medicine, Tampa
| | - Gregory Volturo
- Department of Emergency Medicine, University of Massachusetts, Worcester
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Thomas M. File
- Department of Infectious Diseases, Northeast Ohio Medical University, Rootstown
- Summa Health System, Akron, Ohio
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Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJC, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72-e112. [PMID: 22438350 DOI: 10.1093/cid/cir1043] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
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Affiliation(s)
- Anthony W Chow
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Abstract
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the etiologic agents of acute bacterial sinusitis (ABS). Staphylococcus aureus has been an uncommon cause of ABS despite its frequent occupancy within the anterior nares. A quantitative culture of a maxillary sinus aspirate is the gold standard for determining etiology of ABS. Cultures of the middle meatus cannot be used as a surrogate for a maxillary sinus aspirate in children with ABS, although they may be used in adults if interpretation is confined to usual sinus pathogens. Recent studies highlighting S. aureus as a major pathogen in ABS should be interpreted cautiously. Most isolates in recent pediatric studies were derived from cultures of the middle meatus. The range of reported results for the incidence of S. aureus as a cause of ABS in adults is similar to the results reported for staphylococcal colonization of the middle meatus in healthy adults.
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Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792, USA.
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Abstract
The objective of this prospective, cohort study was to assess an intervention for obese children (9-12 years of age) and their families delivered in primary care. A family-based, behavioral weight management program consisted of 11 sessions. The treatment consisted of a calorie goal, self-monitoring of daily food intake, physical activity and sedentary behavior, and other behavior change skills. A total of 78 children and families entered treatment; 23 children served as quasi-controls. The mean weight loss at 15 weeks among 55 children (71%) who completed the program was 2.4 lbs (SD = 5.24, range of -16.7 to +8.4 lbs) compared with a mean weight gain of 3.45 lbs (SD = 4.31, range of -5.0 to +12.0 lbs) among 23 control children. The mean change in body mass index z score from baseline to month 24 was -0.17 ± 0.32 (P < .001). Primary care is an appropriate place to identify and treat children with obesity.
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Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is an important pathogen in children and adults; however, current treatment options are primarily supportive. Palivizumab, the only approved specific monoclonal antibody for RSV is used prophylactically to reduce morbidity in a select population of high-risk children. AREAS COVERED The development and current use of palivizumab; the potential role of palivizumab as preventive therapy in patients with cystic fibrosis, asthma and compromised immune systems; and explores the limited research in which palivizumab has been used for treatment of RSV. The modified recommendations for the use of palivizumab espoused by the American Academy of Pediatrics and research on the cost-effectiveness of this product are presented. In addition, the authors discuss the development of enhanced monoclonal antibodies including motavizumab, which was recently denied FDA approval for preventative therapy. The authors explore the historical and current efforts to develop a vaccine targeting RSV. The current status of antiviral drug development is also reviewed. The literature search included RSV-Ig, palivizumab, and emerging drugs and vaccines for the treatment of RSV as keywords and titles from 1997 to 2011. EXPERT OPINION Although there are potential drugs and vaccines in development to prevent or reduce the effects of RSV infection, palivizumab remains the only licensed product to reduce the severity of disease in high-risk pediatric patients.
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Affiliation(s)
- Kristin A Shadman
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, 600 Highland Avenue, Box 4108, Madison, WI 53792, USA.
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