Yersinia enterocolitica infection mimicking surgical conditions

Yersinia enteritis may present with alarming gastrointestinal manifestations. The aim of this study was to review the cases of children admitted to a general hospital with a preliminary diagnosis of surgical nature and subsequently proven to be infected by Yersinia enterocolitica. All cases of children aged less than 14 years with stool cultures positive for Y. enterocolitica during the 12-year period January 1993 through December 2004 were analyzed. Y. enterocolitica was isolated from the stools of 71 children with gastrointestinal manifestations; 27 children were treated as outpatients and 44 were hospitalized. Six were admitted to the Pediatric Surgery Department (13.6% of the total hospitalizations and 8.4% of all Y. enterocolitica cases). Four of the Pediatric Surgery patients presented with abdominal pain and right lower quadrant tenderness. The preliminary diagnosis of appendicitis was excluded during hospitalization and none of them underwent appendectomy. The other two children were admitted for vomiting initially attributed to a preceding head injury and for diarrhea and a perianal abscess. Two children were given antibiotics and all had an excellent outcome. Y. enterocolitica enteritis manifestations can infrequently mimic appendicitis or other surgical conditions but should remain in the differential diagnosis of children presenting with an acute abdomen.     

Streptococcus pneumoniae invasive disease in the neonatal period: An increasing problem?

Abstract A series of 11 cases of invasive infection withStreptococcus pneumoniae, occurring over an 11-year period, is reported. Eight of the 11 cases occurred during the final 2 years of the study suggesting that the incidence of infection may be increasing. Infection carries a high mortality (3/11). Morbidity includes meningitis, convulsions and respiratory failure. In one caseS. pneumoniae meningitis occurred in both mother and newborn. Most mothers and newborn. Most mothers who carried the organism were asymptomatic at the time of delivery.Conclusion S. pneumoniae should be specifically sought in swabs taken from the pregnant mother and newborn and if isolated, even in the absence of symptoms, antibiotic therapy against the organism should be strongly considered.     

Staphylococcus aureus epidemic in a neonatal nursery: a strategy of infection control

The risk of nosocomial infection due to Staphylococcus aureus in fullterm newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection control techniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21, 2000) and the measures undertaken to bring the epidemic under control. These measures included: separating neonates already present in the nursery on August 23, 2000 from ones newly arriving by creating two different cohorts, one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus- infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns, gloves, and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions, microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can, in retrospect, be assessed to have been very effective.     

Plesiomonas shigelloides sepsis and meningoencephalitis in a neonate

A newborn infant is described who presented with septicaemia and meningoencephalitis caused byPlesiomonas shigelloides, a Gram-negative rod belonging to the family Vibrionaceae. The patient in this case, the first to be documented in Europe, developed multilocular lysis of the brain despite immediate treatment with antibiotics active in vitro. A cranial CT revealed garland-like calcifications and a large amount of medullary necrosis was seen on MRI.     

Tolerance,pharmacokinetics and efficacy of once daily amikacin for treatment of Pseudomonas aeruginosa pulmonary exacerbations in cystic fibrosis patients

Twenty cystic fibrosis patients aged 1.8–22 years (mean ±SD: 9.6 ± 4.8 years) withPseudomonas aeruginosa pulmonary exacerbations were treated with amikacin (AM) (35 mg/kg/day in one daily 30 min infusion) associated with either ceftazidime (200 mg/kg/day in 3 i.v. injections) (n = 19) or imipenem (n = 1) at the same dose. Glomerular and tubular functions (creatinine clearance, 24-h proteinuria, ₂ microglobulinuria, lysozymuria) and audiometry remained within normal ranges from day 0 to day 14. A peak concentration of AM of 83 ± 19 mg/l and a trough concentration of 0.8 ±0.5 mg/l were observed in blood while AM levels in sputum were above the minimal inhibitory concentration 50 from 30 min to 16 h. No serum accumulation of AM was observed during the treatment. From day 0 to day 14, the following changes were observed: weight/height ratio: 96%–100% (P < 0.001); daily energy intake: 111%–128% of RDA (P < 0.001); prealbumin: 195–290 mg/l (P < 0.001); forced vital capacity (FVC): 66%–81% (P < 0.01); forced expiratory volume in 1 s: 60%–75% (P < 0.01); forced expiratory flow between 25% and 75% of FVC: 42%–56% (P < 0.01); nocturnal SaO₂ also improved significantly; cardiac rate decreased from 89 ±18/min to 76 ± 16/min (P < 0.001); respiratory rate decreased from 31 ±15/min to 26 ± 10/min (P < 0.05); inflammatory parameters (white blood cells, polymorphonuclear cells, erythrocyte sedimentation rate) also improved.     

Concomitant cytomegalovirus infection and congenital toxoplasmosis in a newborn

We report what we believe to be the first case of simultaneous infection by Toxoplasma gondii and cytomegalovirus in a newbornAbbreviations CMV cytomegalovirus - CSF cerebrospinal fluid     

Fatal ureaplasmal pneumonia and sepsis in a newborn infant

Ureaplasma urealyticum was isolated in pure culture from blood tracheal aspirate and lung tissue in a newborn infant, who died of a severe pneumonia within 48h after birth. The clinical course was characterized by persistent pulmonary hypertension of the newborn (PPHN). Post-mortem examination revealed extensive hyaline membrane formation combined with signs of inflammation in both lungs. The clinical and histopathological picture resembled that of early onset group B haemolytic streptococcal pneumonia/sepsis.     

Early onset neonatal sepsis with Campylobacter jejuni: A case report

Perinatal infections with bacteria belonging to the genus campylobacter are being increasingly recognized. We present a case of early onset neonatal sepsis withCampylobacter jejuni (previouslyC. Fetus ss. jejuni orVibrio jejuni). The infant was born prematurely at 31 weeks of gestation and presented with respiratory distress and frequent apnoea from birth. The chest X-ray film demonstrated reticulogranular pattern consistent with hyaline membrane disease. The infant was successfully treated with ampicillin and gentamicin.C. jejuni infection should be considered in the differential diagnosis of early onset sepsis in the neonate and can mimic the radiological picture of hyaline membrane disease.     

Early onset systemicCandida infection in extremely preterm neonates

Classically, systemicCandida infections in preterm neonates occur at a mean age of 1 month. Over an 18-month period in a Regional Neonatal Intensive Care Unit we encountered seven cases of severeCandida infection, all in babies below 26 weeks gestation and weighing less than 0.75 kg. The median age of onset was 7 days (range 0–17), with thrombocytopenia, coagulopathy, hypotension, oedema, and skin breakdown being prominent features.     

Late-onset sepsis due to Salmonella Typhi in a preterm infant in a French neonatal unit

We report a case of late-onset sepsis caused by Salmonella Typhi in a one-month old preterm infant hospitalised in our neonatal unit. An investigation of the index case was undertaken to identify the source of contamination. The patient made a complete recovery.     

Early onset mixed Morganella and Klebsiella sepsis in a neonate

A premature baby girl was delivered vaginally to a mother who had an otherwise normal pregnancy, and spontaneous premature onset of labour. She had early onset neonatal sepsis with pneumonia. The baby's blood culture as well as the amniotic membrane culture grewMorganella andKlebsiella. She recovered on appropriate antibiotics. This is only the second reported case of early onset neonatal sepsis due toMorganella. The literature is reviewed.     

Diminished cord blood lymphocytel-selectin expression in neonatal bacterial infection

l-Selectin, a leukocyte surface glycoprotein involved in white blood cell extravasation, is rapidly down-regulated after leukocyte activation. We prospectively determined lymphocytel-selectin expression in freshly obtained cord blood samples of 98 neonates (gestational age 25–42 weeks). In eight infants with bacterial infection, the mean percentage ofl-selectin^high lymphocytes was 32.5% (SD 20.1%), compared to 60.1% (SD 18.7%) in the control group (P<0.01). A percentage ofl-selectin^high lymphocytes of less than 42% had a sensitivity of 75% and a specificity of 82% in identifying infected newborns. Cord blood lymphocytel-selectin expression was independent of gestational age, birth weight, umbilical artery pH, hematocrit, white blood cell count, absolute neutrophil count, C-reactive protein level, or maternal fever before delivery while there was a weak correlation with the newborn's immature/total ratio and platelet count. To our knowledge, this is the first report demonstrating downregulation of human lymphocytel-selectin expression following activation of the immune system in vivo.     

小儿社区获得性铜绿假单胞菌脓毒症临床分析

目的 探讨儿童社区获得性铜绿假单胞菌脓毒症的临床特点.方法 回顾性分析复旦大学儿科医院重症监护中心2003年5月至2007年5月收治的12例铜绿假单胞菌脓毒症的发病情况.结果 12例儿童发病前均系健康儿童;突发起病,以毒血症状(12例)、高热(12例)、感染性休克(6例)、重症肺炎(12例)、特异性皮疹(6例)为主要特征,疾病进展迅速,很快发生1～6个脏器功能的衰竭;血清或渗出物培养阳性率高.药敏显示,社区获得性感染中铜绿假单胞菌对绝大部分抗革兰阴性杆菌抗生素敏感,对复方磺胺甲噁唑均耐药;12例中6例死亡.结论 铜绿假单胞菌脓毒症在儿童社区获得性感染中占有一定比例,发病有一定的特征,病情进展迅速,易导致多脏器损害.早期发现,早期干预是治疗的关键.     

Specific decrease of anti-pseudomonal IgA after anti-pseudomonal therapy in cystic fibrosis

In patients with cystic fibrosis (CF) and chronic colonisation withPseudomonas aeruginosa, specific anti-pseudomonal IgG and IgA, as well as serum immunoreactive protein C, WBC and differential count, ESR, pulmonary function and chest radiograph score were determined before and after a 2 week intravenous course of anti-pseudomonal antibiotics in 32 cases of acute exacerbation of pulmonary infection. Specific anti-pseudomonal IgA but not specific anti-pseudomonal IgG decreased significantly after treatment. Log of anti-pseudomonal IgA but not log anti-pseudomonal IgG correlated well with disease severity as assessed by the Brasfield chest radiograph score (r 0.57), forced expiratory volume in 1 s (r 0.6) as well as C-reactive protein (r 0.62).     

Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants

We report a nosocomial outbreak with group B streptococci (GBS) in a level two neonatal intensive care unit (NICU) at Sachs’ Children and Youth Hospital, Stockholm, Sweden, in 2014. There were five very preterm infants with severe late‐onset septicaemia, and 10 further infants were colonised. Pulsed‐field gel electrophoresis and multilocus sequence typing genetic characterisation showed that one GBS strain was the cause: serotype Ia, sequence type 23, clonal complex 23. The NICU environment cultures revealed GBS reservoirs on surfaces near sick and colonised patients. We identified workflows and guidelines that could increase the risks of nosocomial infections. Conclusion: This nosocomial GBS outbreak among preterm infants demonstrates that GBS can be harboured in the NICU environment.     

Acute symptomatic neonatal seizures in preterm neonates: etiologies and treatments

Acute symptomatic neonatal seizures in preterm newborns are a relevant clinical challenge due to the presence of many knowledge gaps. Etiology-wise, acute symptomatic seizures have an age-specific epidemiology, with intraventricular hemorrhage and its complications representing the first cause in extremely and very preterm neonates, whereas other etiologies have similar occurrence rates as in full-term infants. Specific treatment strategies for the premature neonates are not yet available. Studies suggest a similarly low response rate with even more unfavorable prognosis than in full-term infants. Pharmacodynamic and pharmacokinetic changes are likely under way during the preterm period, with the potential to affect both effectiveness and safety of antiepileptic drugs in these patients. However, due to the lack of clear evidence to guide prioritization of second-line drugs, off-label medications are frequently indicated by review papers and flow-charts, and are prescribed in clinical practice. We therefore conclude by exploring potential future lines of research.     

Genital mycoplasmas in preterm infants: Prevalence and clinical significance

The genital mycoplasmas:Ureaplasma urealyticum andMycoplasma hominis have recently assumed an increasing importance as neonatal pathogens. The aim of the present survey was to determine the prevalence of infections with these organisms in preterm infants in two neonatal intensive care units in Israel. Among 99 preterm infants, 24 (24%) harboured mycoplasmas in their throats shortly after birth.U. urealyticum was the most common organism.M. hominis was isolated only from 3 infants. Six out of 27 (22%) mechanically ventilated infants secretedU. urealyticum in their lower airways. The rate of colonization was inversely correlated with gestational age; 80% of infants younger than 28 weeks gestation were found to be colonized as opposed to 17.9% at 28–36 weeks of gestation. No mycoplasmas were isolated in blood cultures drawn from 146 infants and CSF cultures obtained from 47 preterm infants. Neonatal mortality, respiratory complications and intraventricular haemorrhage grade 3–4 were significantly increased in colonized infants. However, above gestational age of 27 weeks, colonization with mycoplasmas was not associated with a worse prognosis. We conclude that colonization withU. urealyticum is common in Israeli preterm infants, correlates inversely with gestational age and has no detrimental effect on neonatal morbidity and mortality of infants older than 27 wks of gestation.