West-Nile virus encephalitis in an immunocompetent pediatric patient: successful recovery

Background

West Nile virus (WNV) is a mosquito-borne RNA virus belonging to the Flaviviridae family. Symptomatic infection happens in only about 20% of the cases, while WNV neuroinvasive disease (WNND) is rare and accounts for less than 1%. There is insufficient information about natural history and clinical course in children, because underdiagnosis is common, and reports are scarce. On the other hand, Europe has seen a dramatic increase of WNV infections in the last decades, and the Po valley itself, in Northern Italy, has become an endemic region since 2013.

Case presentation

We hereby report a case of West-Nile virus neuroinvasive disease in a 12-year-old boy. This is one of the very few cases diagnosed in the Italian pediatric population. The clinical presentation was compatible with acute encephalitis. Diagnosis was made by detection of specific IgM in both serum and cerebrospinal fluid. He finally was discharged with complete recovery, and no neurologic sequelae after a 12-months follow up period.

Conclusions

Given its non-specific clinical presentation, the diffusion of WNV constitutes a crucial and emerging concern. Even though rare, neuroinvasive WNV infection should always be suspected in pediatric patients, living or traveling in endemic areas, presenting with meningitis, encephalitis or acute flaccid paralysis during the WNV transmission season.

     

West Nile virus infection: a pediatric perspective

West Nile virus (WNV) infection recently became a major public health concern in the western hemisphere. This article describes recent information regarding previously unrecognized mechanisms of WNV transmission and reviews clinical manifestations of WNV infection, diagnostic tests, and prevention strategies from a pediatric perspective. WNV is transmitted to humans primarily through the bite of infected mosquitoes, but during the epidemic that spread across North America in 2002, transmission of WNV through blood transfusions and organ transplantation was described for the first time. Individual case reports indicate that WNV can be transmitted also in utero and probably through breast milk. Although most WNV infections are asymptomatic, the virus causes a broad range of manifestations from uncomplicated febrile illness to meningitis, neuropathies, paralysis, and encephalitis. Severe manifestations of WNV infection are far more common in adults than in children, but 105 cases of neuroinvasive WNV disease were reported among children in the United States in 2002. The distribution of the virus in North America continues to spread. WNV infection can be diagnosed by detecting WNV-specific antibody in cerebrospinal fluid or serum, or by detecting the virus or viral nucleic acid in cerebrospinal fluid, blood, or tissues. Cornerstones of prevention include personal protection against mosquitoes, including wearing insect repellent, reducing populations of vector mosquitoes, and screening the blood supply for WNV-contaminated blood donations.     

Invasive pneumococcal infection in children, 1981-92: A hospital-based study

Objective: To document the pattern and sequelae of invasive pneumococcal infection in hospitalized children.
Methodology Retrospective review of Streptococcus pneumoniae (Sp) isolates from normally sterile sites from 1981 to 1992 at three paediatric centres in Sydney for demographic data, spectrum of disease, predisposing conditions, mortality, and sequelae from meningitis.
Results: Four hundred and thirty-one episodes in 417 patients were identified. Foci of infection were: meningitis, 34%; pneumonia, 29%; bacteraemia without apparent focus, 30%; and other foci, 7%. Sixty-one per cent of all cases and 64% of cases with meningitis were less than 2 years old. Predisposing conditions were present in 37%, were significantly more common in patients over age 2 years and were more common with foci other than meningitis. Overall mortality was 6.6% whereas the mortality for those with meningitis was 8%. Neurological sequelae were identified in 34% of previously normal children, and severe hearing loss occurred in 11.5%.
Conclusions The high morbidity and mortality from invasive pneumococcal infection in children justifies further evaluation of preventive strategies.     

West Nile virus infection in the pediatric population

In 2004, Los Angeles County confirmed 11 cases of symptomatic West Nile virus (WNV) infections in children younger than 18 years of age. Eight had WNV fever, 2 had meningitis and 1 had encephalitis. Fever, rash, nausea and vomiting were the most prominent symptoms at presentation; median duration of illness was 7 days. Clinicians should be aware of the risk of WNV illness, confirm this diagnosis and report suspected WNV cases to their local health department.     

Staphylococcus aureus Bacteraemia in Children below the Age of One Year

ABSTRACT. The bacteriology, epidemiology, infection types and mortality were reviewed in 407 cases of Staphylococcus aureus bacteraemia in the period 1967–1984 in children less than one year old. The number of bacteraemia cases in this age group increased in the seventies, but only 4% of the bacteraemias seemed to be due to epidemic spreading. Neonates might be at higher risk for 5. aureus bacteraemia than older children less than one year old, and nearly all infections in the neonatal period were hospital-acquired. The mortality was 24%, and did not correlate with type of infection, but in neonates it correlated with low birthweight.     

Staphylococcus aureus bacteraemia in children below the age of one year. A review of 407 cases

The bacteriology, epidemiology, infection types and mortality were reviewed in 407 cases of Staphylococcus aureus bacteraemia in the period 1967-1984 in children less than one year old. The number of bacteraemia cases in this age group increased in the seventies, but only 4% of the bacteraemias seemed to be due to epidemic spreading. Neonates might be at higher risk for S. aureus bacteraemia than older children less than one year old, and nearly all infections in the neonatal period were hospital-acquired. The mortality was 24%, and did not correlate with type of infection, but in neonates it correlated with low birthweight.     

West Nile virus infection in a teenage boy with acute lymphocytic leukemia in remission

West Nile Virus (WNV) infection is an important cause of encephalitis. Although the medical literature contains examples of WNV encephalitis in susceptible, mainly elderly, immunocompromised hosts, few case reports have described pediatric cases. The authors describe an adolescent with acute lymphocytic leukemia and WNV encephalitis. Surveillance studies indicate an increase in WNV activity. Physicians need to be aware of WNV activity in their community and consider WNV as a potential source of infection.     

Pediatric submersions: prehospital predictors of outcome.

This retrospective cohort study was conducted to test prehospital prognostic indicators in pediatric submersion victims. The authors studied all less than 20 years old victims submerged in the non-icy waters of King County, WA who were treated by Seattle or King County Emergency Medical Services between 1985 and 1989 and were hospitalized or died. Seventy-seven victims were identified from emergency medical services incident logs, hospital discharge records, and medical examiner's registries. Outcome predictors were correlated with the victim's condition at hospital discharge. Of 29 victims in cardiac arrest, 13 had return of spontaneous circulation following field resuscitation. Of these, 6 (21%) survived, with mild (n = 2) and severe (n = 4) neurologic impairment at hospital discharge. The best outcome predictors were obtained in the field. These were, for death or severe neurologic impairment, submersion durations > 10 minutes (6/6) and resuscitation durations > 25 minutes (17/17), and for good outcome, sinus rhythm (37/37), reactive pupils (43/43), and neurologic responsiveness (40/40) at the scene. Field-determined factors were reproducibly good outcome predictors. Aggressive emergency medical services may save the lives of pediatric victims in cardiac arrest following short submersion durations. The data support pronouncing dead in the field those pediatric victims of non-icy submersions who do not respond to advanced life support within 25 minutes.     

Clinical and epidemiologic features of invasive group A streptococcal infections in children

BACKGROUND: Invasive group A streptococcal infection (IGASI) is a disease of public health importance. The clinical epidemiology of IGASI in children has not been studied extensively in Florida, USA. The objective of this study was to describe the clinical and epidemiologic features of children hospitalized for IGASI in Florida, USA, during a 4-year period. METHODS: Data from a previous retrospective cohort study of IGASI were analyzed. The study subjects were children and adults who had been hospitalized throughout Florida for IGASI between 1996 and 2000 and reported to the Florida Department of Health. A total of 25 patients who were 0 to 17 years of age were identified and included in the current pediatric case series. RESULTS: The median age at the time of admission was 4 years (range, 0.05-17 years). A total of 14 cases (56%) were boys. In total, 18 of the pediatric patients had group A streptococcal bacteremia and three children were diagnosed with group A streptococcal necrotizing fasciitis. Various antibiotic regimens were used. A total of 33% (7/21) of the patients received clindamycin during their hospital stay. Data on mortality were available for 23 pediatric IGASI cases and 205 adult IGASI cases. The mortality rate was 4.4% in children as compared to 19.5% in adults (Fisher's two-sided P = 0.087). CONCLUSIONS: The low case-fatality in children was consistent with other pediatric series of IGASI.     

Indications et modalités de prescription du Synagis®

Palivizumab is a recombinant humanized monoclonal antibody against the F glycoprotein of respiratory syncytial virus (RSV). It has been licensed since 1999 in France for the prevention of serious lower respiratory-tract infection caused by RSV requiring hospitalization in children born at 35 weeks gestation or less and who are less than 6 months old at the onset of RSV season, or in children less than 2 years old who have received treatment for bronchopulmonary dysplasia within the last 6 months. Since 2003, it has been also licensed for children less than 2 years with hemodynamically significant heart disease. Its high cost leads french and foreign pediatric Societies to restrain its indications for children with the highest risk of severe illness.     

Hemorrhagic stroke associated with pulmonary edema and catastrophic cardiac failure

Cerebral arteriovenous fistula (AVF) is a vascular malformation that is rare in the pediatric population. Older children with cerebral AVF tend to present with neurologic problems related to intracranial venous hypertension or intracranial hemorrhage. Cardiac and pulmonary complications following acute neurologic injury such as subarachnoid hemorrhage are common in adults, but are rarely reported in children. However, complications have been reported in cases of enterovirus 71 rhombencephalitis in infants and children and can cause high morbidity and mortality. Here, we report a 14-year-old boy who presented with cardiac failure associated with pulmonary edema following cerebral hemorrhagic stroke due to AVF. After aggressive investigation and management, we intervened before significant hypoxia and hypotension developed, potentially reducing the risk of long-term adverse neurologic consequences in this patient.     

The first report of West Nile virus infection in a child from Turkey

Seroprevalence data indicate that West Nile virus (WNV) activity is present in Turkey; however, no pediatric cases of WNV infection have been reported to date. WNV is an emerging flavivirus in Turkey, and in September2010, the Turkish Ministry of Health reported the first seven cases of laboratory-confirmed WNV infection from five different cities in the western part of the country. This is the first report of a child from central Anatolia, indicating the existence of the virus in other regions of the country.     

Risk factors for mortality in children with candidemia

We performed a retrospective cohort study of hospitalized children with positive blood cultures for Candida species. Independent risk factors for mortality by multivariable analysis were location in the pediatric intensive care unit at the time of infection (hazard ratio, 6.3; 95% confidence interval, 1.6-24.3) and the presence of an arterial catheter (hazard ratio, 2.4; 95% confidence interval, 1.1-5.8). Our findings help identify a group of pediatric patients that should be targeted for future interventions to prevent and treat candidemia.     

Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting

Few large studies have evaluated risk factors for mortality among children hospitalized for pneumonia and this may contribute to suboptimal case management efficiency. To identify useful screening criteria for mortality among children hospitalized for pneumonia in a developing country setting, we conducted a population-based hospital cohort study among children less than 2 years of age admitted for pneumonia during 1999-2001 at one of three major hospitals on Lombok Island, Indonesia. Of 4351 children admitted for pneumonia, 12 per cent died before discharge. Case fatality proportions were seasonal, with peaks occurring immediately after peaks in the proportion of cases positive for respiratory syncytial virus. Children with an oxygen saturation < or = 85 per cent or age younger than 4 months were 5.6 times more likely to die than children with none of these predictive factors (95 per cent CI, 4.5-7.1); 83 per cent of children who died had one of these two risk factors. For children < 4 months old, mortality increased at an oxygen saturation < 88 per cent compared with < 80 per cent for older children. Laboratory, physical examination, and radiological findings were not associated with or did not contribute substantially to mortality prediction. Among children hospitalized for pneumonia, age less than 4 months and hypoxia were identified with those at high risk of death. Age influences cut-off levels for hypoxia.     

Spectrum of clinical manifestations of West Nile virus infection in children

Reports of clinical manifestations of West Nile virus (WNV) infections in children have been relatively rare. Four cases of WNV infection in children are described: the first report of prolonged encephalitis and fulminant hepatitis caused by WNV, and 3 other presentations of WNV, including the first report of ocular involvement in a child.     

Neurologic sequelae of open-heart surgery in children. An 'irritating question'

As pediatric cardiac surgical techniques have improved in recent years, mortality rates have dropped and attention has turned to residual morbidity, especially neurologic sequelae. Although the majority of children undergoing open-heart surgery for correction of congenital heart defects apparently emerge with no adverse consequences, a small percentage suffer permanent neurologic injury (seizures, motor disorders). Another small and not well-defined population may be left with disorders of higher cortical function, such as mental retardation or learning disabilities. A survey of six major pediatric cardiac surgery units in North America was undertaken in 1988-1989 to ascertain current approaches to the detection and management of neurologic sequelae of pediatric open-heart surgery. All units reported seeing a small but definite incidence of postoperative neurologic symptoms, including alterations of consciousness, seizures, and localized abnormalities such as hemiparesis or delayed choreoathetoid syndromes. Postoperative neuroimaging procedures have shown a disturbing incidence of hypoxic-ischemic encephalopathy, unsuspected cerebral atrophy, and subdural hematomas. Pathogenesis may include factors related to preoperative brain anomalies and/or hypoxic insults, altered cerebral blood flow and metabolism during hypothermic cardiopulmonary bypass with or without total circulatory arrest, embolization, and low cardiac output states postoperatively. Further studies are needed to examine the mechanisms of injury and to develop techniques to minimize the occurrence of these sequelae, as they may be associated with life-long neurologic disability and reduced quality of life.     

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema

OBJECTIVE: To investigate the relation between outcomes of children with diabetic ketoacidosis (DKA)-related cerebral edema and baseline clinical features and therapeutic interventions for treatment of cerebral edema. STUDY DESIGN: All children 相似文献   

Diverse manifestations of acute sickle cell hepatopathy in pediatric patients with sickle cell disease: A case series

The hepatic complications of sickle cell disease (SCD) are associated with increased morbidity and mortality in adults; children usually survive but may suffer significant sequelae. Few diagnostic tools differentiate the various hepatic manifestations of SCD. Why patients exhibit one hepatic pathology versus another is unclear. We report four pediatric patients with hemoglobin SS disease with diverse manifestations of acute hepatic involvement including acute sickle hepatic crisis, hepatic sequestration, sickle cell intrahepatic cholestasis, and a non‐SCD cause of hepatopathy in a patient with viral hepatitis. These complications require a systematic approach to extensive evaluation and coordinated multidisciplinary care.     

Children after renal transplantation hospitalized for fever: Is empirical antibiotic treatment always justified?

Infections are a major cause of morbidity and mortality after renal transplantation. However, data focusing on children are scarce. The objective of this study was to investigate the frequency and predictors of bacterial infection in pediatric renal transplant recipients in a specific setting of hospitalization due to fever. Clinical and laboratory data were retrospectively collected for all pediatric renal transplant recipients hospitalized for fever in a national renal transplantation center from 2004 to 2012. One hundred and sixty‐eight hospital admissions for fever of 52 children were analyzed. A bacterial etiology was diagnosed in 85 admissions (50.6%); 49 cases (57.6%) were documented microbiologically and 36 (42.4%) clinically. Risk factors and markers of bacterial infection included older age, presence of a central venous catheter, sonographic findings, and elevated inflammatory indices. C‐reactive protein level was a more sensitive marker than white blood cell count and absolute neutrophil count. In patients without identified risk factors, no bacterial infections were diagnosed. Pediatric renal transplant recipients hospitalized for fever are at high risk of bacterial infections and usually require empirical antibiotic treatment at admission. However, there is a minority of low‐risk patients in whom clinicians may consider withholding antibiotic treatment with close follow‐up.