Characterization of Extended Spectrum Beta-lactamase and Carbapenamase Producing Enterobacteriaceae Causing Urinary Tract Infection among Children in Kenya: A Cross-Sectional Study

Introduction: Enterobacteriaceae causing urinary tract infections (UTI) have developed resistance to the commonly used antibiotics due to emergence of Extended Spectrum Beta-Lactamases (ESBLs) and Carbapenamase producing Enterobactericeae which are a public health problem worldwide. This study aims to determine the prevalence and characterize ESBLs and carbapenamase producing Enterobactericeae. Method: A cross-sectional study was carried out in Gertrude’s Children’s Hospital, Nairobi. 238 urine samples were collected from patients with urinary symptoms attending the outpatient department within the period 2020-2021. The urine were examined macroscopically and microscopically. Identification and antimicrobial susceptibility testing were done using VITEK® 2 Compact system (BioMérieux). Double disc synergy test and modified hodge tests were done as confirmatory tests for ESBLs and Carbapenamase phenotypes respectively. Polymerase Chain Reaction was used for the detection of blaCTX-M, blaTEM, blaSHV, blaKPC and blaOXA-48 genes. Results: From the 238 children sampled the prevalence of UTI caused by Enterobactericeae was 22.3%. The Enterobacteriaceae species isolated were Escherichia coli (84.9%), Klebsiella pneumoniae (5.66%), Proteus mirabillis (5.66%), Enterobacter aerogenes (1.89%) and Morganella morganii (1.89%). The isolated species were resistant to ampicillin. Meropenem had the highest susceptibility. Only E. coli species had the ESBLs (26.4%) and carbapenamase (1.9%) phenotypes. 100% had BlaCTX-M while 50% had blaTEM resistant gene. There was a significant association (p Conclusion: Ampicillin resistance resulted to use of alternative drugs and Meropenem was the drug of choice where increased resistance to the recommended drugs was noted. Further research on resistant genes is recommended.

Factors Associated with Acute Respiratory Infections in Children Aged 0 - 5 Years in the Yénawa District of Cotonou (Benin) in 2023

Introduction: Acute respiratory infections remain one of the main causes of mortality in children aged 0 to 5. This work aimed to study the associated factors with the occurrence of acute respiratory infections in children 0 to 5 years old in Yénawa, Cotonou in 2023. Subjects and Method: It was an analytical cross-sectional study of children aged 0 - 5 years and their mothers in Yénawa, selected by four-degree random sampling. The sampling size, calculated using the Schwartz formula, was 126 children and 126 mothers. The dependent variable was the occurrence of acute respiratory infections. The independent variables were classified into four groups: socio-demographic and economic characteristics, behavioral factors, child-related factors, and environmental factors. Data collected by observation and questionnaire survey were analyzed using STATA version 15 software. Associated factors were investigated by bivariate analysis and multiple logistic regression, at the 5% significance level. Results: A total of 126 children aged 0 - 5 years and 126 mothers were surveyed, aged 23.5 (11 - 36) months and 30 (18 - 48) years respectively. The prevalence of acute respiratory infections was 74.60% (CI95% = 66.89 to 82.30). The associated factors were the mother’s age between 18 and 28 (OR = 10.77;CI95% = 1.89 to 61.27;p = 0.007), the use of charcoal/wood for cooking (OR = 7.36;IC = 1.99 to 27.10;p = 0.003)), children's poor personal hygiene (OR = 8.87;IC = 2.92 to 26.97;p 0.001)), and cohabitation with domestic animals (OR = 7.27;IC = 1.67 to 31.71;p = 0.015). Conclusion: Communicating with mothers about the factors identified will help reduce the prevalence of acute respiratory infections in children aged 0 to 5.

Healthcare-associated Staphylococcus aureus infections in children in Turkey:A six-year retrospective,single-center study

Objective:To describe clinical and epidemiological characteristics,antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections(HCAIs)caused by Staphylococcus(S.)aureus in children.Methods:We conducted a retrospective,single-centre study of pediatric HCAIs caused by S.aureus from a tertiary care hospital in Turkey between February 2014 and December 2019.The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S.aureus(MSSA and MRSA)isolates was evaluated.Results:A total of 310 pediatric patients were examined.Overall,225(72.6%)isolates were MSSA and 85(27.4%)were MRSA.All S.aureus isolates were susceptible to teicoplanin,vancomycin,linezolid,tigecycline,mupirocin,and daptomycin.Penicillin resistance rates were high(89.0%),while fosfomycin,gentamicin,and clindamycin resistance rates were low(1.3%,1.0%,and 2.3%,respectively).Except susceptibility to fosfomycin,which was significantly lower in 2014 compared to 2018 and 2019,no significant difference was found in the antimicrobial susceptibility of S.aureus isolates between the years.Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs.The mortality rate of HCAIs caused by S.aureus was 6.5%(20 patients).Malignancy was an independent risk factor associated with mortality in the multivariate analysis(OR 5.446,95%CI 1.573-18.849).Conclusions:Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S.aureus.The mortality rate was 6.5%,the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children.These findings could help improve the management of HCAIs caused by S.aureus in children.

Prevalence, Pattern and Risk Factors of Soil Transmitted Helminth Infections amongst Children in a Tertiary Institution in South East, Nigeria

Introduction: Soil-transmitted helminthic infection (STHI) is a common public health challenge of children in the most deprived communities in low income countries. In the long-term, STHI can cause developmental and growth disorders leading to future learning defect. Objective: Our aim was to determine the prevalence and pattern of soil-transmitted helminthic infection among children attending a tertiary hospital in Imo State, Nigeria. Patients and Method: The study involved a cross-sectional survey of 268 children, aged 7 months to 18 years seen in a tertiary health facility in Nigeria;from August to December 2022. Data were collected using a structured questionnaire and stool samples were analyzed for intestinal helminths using the Kato-Katz method. Results: The prevalence of soil-transmitted helminthic infection (STHI) was 38.4%. Of all STHIs, Ascaris lumbricoides was the commonest geohelminth observed, 81 (62.1%). Multiple infections were noted in 25 (62.4%) of the specimen. The prevalence of soil-transmitted helminthic infection amongst subjects’ 5 - 9 years was high and least in children older than 15 years. This difference was not statistically significant (p = 0.3407). Statistically significant relationship was detected between STHI and low socioeconomic class. Conclusion: The high prevalence rate of soil-transmitted helminthic infection amongst the subjects is disturbing. This high rate justifies strengthening a structured and routine deworming amongst children in order to improve outcome.

Research Progress of Combined Detection of WBC, CRP and SAA in Early Diagnosis of Respiratory Tract Infection in Children

Objective: To investigate the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. Methods: Collect the literature reports on the early diagnosis of respiratory tract infection in children by the combined detection of WBC, CRP and SAA in recent years, and follow up the relevant literature reports from the selection of “new three routine” laboratory items for rapid diagnosis in pediatric outpatient department and the application of the combined detection of WBC, CRP and SAA in the early diagnosis of respiratory tract infection in children. Results: Many literature studies found that the combined detection of WBC, CRP and SAA has important clinical significance in the early diagnosis of respiratory tract infection in children. Conclusion: Through reviewing the relevant literature, we can understand the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. To provide more accurate and reliable laboratory data for the early diagnosis and treatment of respiratory tract infection in children in the future.

Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000

AIM: To review gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy. To look at gut microflora features in oncology children.METHODS: We selected studies published after year 2000, excluding trials on transplanted pediatric patients. We searched English language publications in MEDLINE using the keywords: "gastrointestinal infection AND antineoplastic chemotherapy AND children", "gastrointestinal infection AND oncology AND children", "liver infection AND antineoplastic chemotherapy AND children", "liver abscess AND chemotherapy AND child", "neutropenic enterocolitis AND chemotherapy AND children", "thyphlitis AND chemotherapy AND children", "infectious diarrhea AND children AND oncology", "abdominal pain AND infection AND children AND oncology", "perianal sepsis AND children AND oncology", "colonic pseudo-obstruction A N D o n c o l o g y A N D c h i l d A N D c h e m o t h e r a p y ", "microflora AND children AND malignancy", "microbiota AND children AND malignancy", "fungal flora AND children AND malignancy". We also analysed evidence from several articles and book references.RESULTS: Gastrointestinal and liver infections represent a major cause of morbidity and mortality in children undergoing antineoplastic chemotherapy. Antineoplastic drugs cause immunosuppression in addition to direct toxicity, predisposing to infections, although the specific risk is variable according to disease and host features. Common pathogens potentially induce severe diseases whereas opportunistic microorganisms may attack vulnerable hosts. Clinical manifestations can be subtle and not specific. In addition, several conditions are rare and diagnostic process and treatments are not standardized. Diagnosis may be challenging, however early diagnosis is needed for quick and appropriate interventions. Interestingly, the source of infectionin those children can be exogenous or endogenous. Indeed, mucosal damage may allow the penetrance of endogenous microbes towards the bowel wall and their translocation into the bloodstream. However, only limited knowledge of intestinal dysbiosis in oncology children is available. CONCLUSION: The diagnostic work-up requires a multimodal approach and should be implemented(also by further studies on new biomarkers) for a prompt and individualized therapy.

Seroepidemiology of Helicobacter pylori infection among asymptomatic Chinese children

INTRODUCTIONIncreasing data has demonstrated that Helicobacterpylori(H.pylori),a spiral gram negativebacterium,colonized in human stomach,can causetype B gastritis,is strongly associated withgastric and duodenal ulceration,and has beenimplicated in the causation of gastric carcinomaand mucosa-associated lymphoid tissue(MALT)lymphomas.It has been reported that there

What's new in hepatitis C virus infections in children?

The number of hepatitis C virus(HCV) infection cases is relatively low in children. This low number may be connected with the lack of screening tests and the asymptomatic course of infection. Currently,mother-toinfant transmission is the most common cause of HCV infection amongst children in developed countries. It is important to introduce routine screening tests for HCV in pregnant women. The risk of vertical transmission of HCV is estimated at approximately 5%(3%-10%). Currently,we do not have HCV transmission prevention methods. Some factors could potentially be eliminated by elective caesarean section. Currently,the method of prevention of perinatal HCV infection is the early identification and effective treatment of infections in young women in the preconception period. We describe genetic tests(IL-28 B single nucleotide polymorphisms) to identify children with an increased chance of spontaneous clearance or sustained virologic response achievement and vitamin D level as a potential predictor of treatment response in children. It is also important to develop non-invasive tests that can predict liver fibrosis. The existence of differences in the mechanisms leading to liver injury between children and adults creates new perspectives of action to reduce liver disease progression in children in the early years of life.

Burden of respiratory syncytial virus infection in young children

Respiratory syncytial virus(RSV) is the most frequent and important cause of lower respiratory tract infection in infants and children. It is a seasonal virus, with peak rates of infection occurring annually in the cold season in temperate climates, and in the rainy season, as temperatures fall, in tropical climates. High risk groups for severe RSV disease include infants below six mo of age, premature infants with or without chronic lung disease, infants with hemodynamically significant congenital heart disease, infants with immunodeficiency or cystic fibrosis, and infants with neuromuscular diseases. Mortality rates associated with RSV infection are generally low in previous healthy infants(below 1%), but increase significantly in children with underlying chronic conditions and comorbidities. Following early RSV lower respiratory tract infection, some patients experience recurrent episodes of wheezing mimicking early childhood asthma with persistence of lung function abnormalities until adolescence. There is currently no RSV vaccine available, but promising candidate vaccines are in development. Palivizumab, a monoclonal RSV antibody that is the only tool for immunoprophylaxis in high-riskinfants, lowers the burden of RSV infection in certain carefully selected patient groups.

Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India

BACKGROUND Respiratory syncytial virus(RSV) is a leading cause of lower respiratory infections among children.AIM To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.METHODS Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections(ALRI), admitted between August 2011-August 2013, were included.Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.RESULTS Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9%(130/383) had evidence of viral infection, and RSV was detected in 24.5%(94/383). Co-infections with RSV and other respiratory viruses(influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5%(21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season.Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.CONCLUSION Our study provides evidence of a high proportion of RSV and other virusassociated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.

Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infections(VPIs)can effectively minimize this infection burden.However,data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.AIM To evaluate the immunization status,VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital(Bangkok,Thailand)were retrospectively reviewed.Immunization status was evaluated via their vaccination books.Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated,and divided into VPIs and non-VPIs.Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded.Severity of infection,length of hospital stay,ventilator support,intensive care unit requirement,and mortality were assessed.RESULTS Seventy-seven children with a mean age of 3.29±4.17 years were included in the study,of whom 41(53.2%)were female.The mean follow-up duration was 3.68±1.45 years.Fortyeight children(62.3%)had vaccination records.There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization(52.0%)and accelerated vaccine from Infectious Diseases Society of America(89.5%)(P<0.001).Post-liver transplant,47.9%of the children did not catch up with ageappropriate immunizations.There were 237 infections requiring hospitalization during the 5 years of follow-up.There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations.The risk of serious infection was high in the first year after receiving a liver transplant,and two children died.Respiratory and gastrointestinal systems were common sites of infection.The most common pathogens that caused VPIs were rotavirus,influenza virus,and varicella-zoster virus.CONCLUSION Incomplete immunization was common pre-and post-transplant,and nearly all children required hospitalization for non-VPIs or VPIs within 5 years posttransplant.Infection severity was high in the first year post-transplant.

Prevalence and predictors of urinary tract infections among children with cerebral palsy in Makurdi, Nigeria

Background: Children with cerebral palsy (CP) are prone to urinary tract infection (UTI), a common cause of childhood morbidity and mortality. However, there has been no report regarding the prevalence of UTI among this group of children inNigeria. Objectives: The study aims at determining the prevalence and the possible predictors of UTI in children with CP compared to age and sex matched children without CP. Methods: A prospective cross-sectional study was carried out among consecutive children with CP at the Neurologic Clinic in the Paediatric Department of the Federal Medical Centre, Makurdi, Nigeria, from December 2011 to May 2013. Results: The age range of the studied population was between 2 and 15 years with a mean age of 8.63 ± 3.83 years including 30 males and 22 females. UTI was confirmed in 20 (38.5%) children with cerebral palsy compared to 2 children (3.8%) without CP (p value 0.000). Among children with CP, Escherichia coli was the commonest organism isolated in 9 (9/20, 45.0%), Streptococcus faecalis in 4 (20.0%), Staphylococcus aureus in 3 (15%), while both Proteus spp., and Klebsiella spp., were isolated in 2 children (10.0%) each. Escherichia coli was also found in the 2 children without CP. All the organisms were resistant to co-trimoxazole, nalidixic acid, nitrofuratoin and amoxiclav, while they were 100% sensitive to ceftriazone and the quinolones. In a univariate regression, analysis only moderate to severe gross motor dysfunction predicted the risk of UTI (OR = 54.81, 95%CI, 2.27 - 1324.00, p value 0.014). Conclusion: Efforts should be put in place to aid mobility among children with CP in order to reduce risk of UT.

Clinical Diagnosis and Treatment Characteristics of Acute Respiratory Infections in Children and New Developments in Laboratory Testing

Acute respiratory tract infection (ARTI) in children is the most common infectious disease in childhood, and its pathogens include viruses, bacteria and fungi, mycoplasma, chlamydia and rickettsia. In recent years, with the continuous development of pathogen detection methods, the diagnosis and treatment of acute respiratory infections has received more and more clinical attention. The clinical diagnosis and treatment characteristics of acute respiratory infections in children and the research of clinical laboratory detection methods have also been continuously developed. The author collected references to review the clinical features and new developments in laboratory testing of acute respiratory tract infection in children.

Efficacy of different antibiotics in treatment of children with respiratory mycoplasma infection

BACKGROUND Respiratory infections in children are common pediatric diseases caused by pathogens that invade the respiratory system.Children are considerably susceptible to Mycoplasma pneumoniae infection.There has been widespread clinical attention on treatment strategies for this disease.AIM To analyze the clinical efficacy of different antibiotics in treating pediatric respiratory mycoplasma infections.METHODS We included 106 children with a confirmed diagnosis of respiratory mycoplasma infection who were admitted to our hospital from April 2017 to July 2019 and grouped them using a random number table.Among them,53 children each received clarithromycin or erythromycin.The clinical efficacy of both drugs was evaluated and compared.We performed the multiplex polymerase chain reaction(MP-PCR)test and determined the MP-PCR negative rate in children after the end of the treatment course.We compared the incidence of toxic and side effects,including nausea,diarrhea,and abdominal pain;further,we recorded the length of hospitalization,antipyretic time,and drug costs.Additionally,we evaluated and compared the compliance of the children during treatment.RESULTS The erythromycin group showed a significantly higher total effective rate of clinical treatment than the clarithromycin group.MP-PCR test results showed that the clarithromycin group had a significantly higher MP-PCR negative rate than the erythromycin group.Moreover,children in the clarithromycin group had shorter fever time,shorter hospital stays,and lower drug costs than those in the erythromycin group.The clarithromycin group had a significantly higher overall drug adherence rate than the erythromycin group.The incidence of toxic and side effects was significantly lower in the clarithromycin group than in the erythromycin group(P<0.05).CONCLUSION Our findings indicate that clarithromycin has various advantages over erythromycin,including higher application safety,stronger mycoplasma clearance,and higher medication compliance in children;therefore,it can be actively promoted.

Norovirus Infection and Histo-blood Group Antigens in Children Hospitalized with Diarrhea in Lulong and Chenzhou in China

Norovirus （NOV） is a pathogen that commonly causes viral diarrhea in children. Studies indicate that NoV recognizes human histo-blood group antigens （HBGAs） as cell attachment factors. In order to explore the correlation between of NoV infection and HBGAs, a cross-sectional study was conducted in children less than five years old who were hospitalized with diarrhea in two areas of China between November 2014 and February 2015. Of the paired stool and saliva samples taken from 424 children,

Characteristics of Children Referred for Drainage of Sub-cutaneous Soft Tissue Infections

Purpose: Severe skin and soft tissue infections in children are a common cause of hospital admission. Surgical drainage is often required for definitive therapy. Our aim was to review common characteristics of children requiring surgical incision and drainage (I&D) for subcutaneous abscesses. Methods: IRB approval was obtained for a retrospective chart review of children requiring I&D of subcutaneous abscesses between July 2006 and June 2011. Data points included patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay. Results: Surgical I&D were performed on 1042 children, and 781 patients (75%) were admitted to the surgical service. The average age was 3.4 years. 605 patients (58%) were female. 637 abscesses (61%) were located in the groin/buttock/perineum area. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 70% of the culture specimens. The average length of stay was 2.8 days. The rate of recidivism was 10.9%. Conclusions: Soft tissue infections requiring hospital admission and I&D are common in the pediatric population. The vast majority of these are due to MRSA infections. Infections requiring drainage most frequently occurred in the diaper area of girls less than 3 years old. A significant number of children have recurrent skin infections and represent an important patient subpopulation.

Upper respiratory tract infections in children: A normal stage or high parental concern?

Background: Families function less efficiently when one of the children suffers from illness. Upper respiratory tract infections (URTI) are common among children. Though the child may have no critical or serious health problem, the parents may frequently get worried and visit the general practitioner or pediatrician. Do children with URTI who visit the doctor frequently pass through a normal stage in childhood or are their parents more concerned than usual? Methods: A questionnaire was filled out for 76 children between 1 and 4 years of age. Two groups were created: a URTI group and a control group. Results: The URTI group suffered from these infections for 19.4 days a month, compared with 5.9 days in the control group. In addition, they also suffered from fever for a longer duration and used more antibiotics. The parents of these children were found to be more concerned, caused by a fear of a serious disease. They often keep their child at home and make their child consume more medicines. Conclusions: Parents of children with recurrent infections are found to be more concerned and a hypothesis of high parental concern and child's illness is discussed. Minimizing parental concern can therefore be a possible preventive treatment.

Vitamin D₃Variation between Children and Adults with Reference to Renal Stones, Environment and Urinary Tract Infections

Purpose: A better understanding of urinary tract infection (UTI) and the role of host, bacterial and environmental factors have improved the ability to identify the patients at risk and prevent or minimize sequelae. Kidney stones may be a complicated subject and its etiology is related to diet, increase urinary solutes and colloids in hot weather. Hypercalcaemia produced by taking large doses of vitamin D, creates high blood pressure and calcium deposits that can produce renal and bludder stones in all age groups including children. The objective of the present study was to estimate the serum level of vitamin D among patients particularly children taking treatable vitamin D. Correlation between vitamin D renal stones and UTI was also assessed. Methods: The number of patients studied was 150 collected during 2010 and 2011 in University teaching hospital. Forty two of them were children. The patients under study should have renal stone confirmed by ultrasound examination. Urine, blood and stone samples were taken for relevant laboratory investigations including identification of bacteriuria and its causative agents. Serum ions and vitamin D were also estimated. Type of renal stone collected was chemically identified. Results: One hundred and fifty patients with urolithiasis were included in the present study whose ages ranged from 8 months to 69 years and the ratio of males to females was 1.7:1. The frequency of patients revealed UTI was 52% and 78% of the infected patients were suffered from Gram-negative bacteria particularly Escherichia coli. Renal stones of mixed chemical composition were almost 72% and 78.2% of the stones were infection type. The mean of serum calcium was 2.157 mmol/L. The serum means of vitamin D among children and adults were 50.9 and 31.4 nmol/L respectively and the peak of this vitamin was recorded during summer. Conclusion: The frequency of UTI among urolithiasis patients was greater than that of non-urolithiasis. Enterobacteriaceae was the dominant family causing UTI particularly among females. Urolithiasis was more prevalent in males (62%). Recurrence of urolithiasis was high (39%) which indicated insufficient treatment of the underlying causes. Serum ions concentrations among children and adults were variables. Vitamin D values in children were higher than those estimated among adults and the peak of its overall concentration mean was found during summer (39.7 nmol/L). There was a strong relation between vitamin D level and the incidence of urolithiasis particularly among children with dietary problems.

Human bocavirus infection in children hospitalized with lower respiratory tract infections:Does viral load affect disease course?

Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.

Cytomegalovirus infection in liver-transplanted children

Cytomegalovirus (CMV) infection is a common complication of liver transplantationin children. The CMV serostatus of recipients and donors is theprimary risk factor, and prophylaxis or pre-emptive strategies are recommendedfor high-risk patients. Graft rejection, coinfection and Epstein-Bar virusreactivation, which can lead to post-transplant lymphoproliferative disease, areindirect effects of CMV infection. Assessment of CMV infection viral load shouldbe routinely performed upon clinical suspicion. However, tissue-invasive CMVdisease is not associated with CMV viraemia and requires confirmation by tissuepathology. Oral valganciclovir and intravenous ganciclovir are equivalenttreatments, and the duration of treatment depends on factors including CMV viralload, tissue pathology, and clinical response. Risk stratification by donor andrecipient status prior to transplantation and post-transplantation antiviralprophylaxis or pre-emptive therapy are recommended. Adult guidelines havebeen established but additional study of the effectiveness of the preventiveguidelines in children is needed. This review summarizes the burden, risk factors,clinical manifestations, laboratory evaluation, treatment, and prevention of CMVinfection in children after liver transplantation.