Méningite à pneumocoque résistant à la pénicilline et transmission nosocomiale en milieu hospitalier pédiatrique confirmée par analyse génomique

Background.

Careful epidemiological studies and sophisticated diagnostic procedures are necessary to prove that bacterial infection is nosocomial in origin. DNA finger printing method can be useful with this aim in view.

Case reports.

A 11 month-old girl suffered from a febrile pneumonia. She developed acute meningitis 15 days later; culture of CSF grew Streptococcus pneumoniae, serotype 23 F, resistant to β-lactamines, erythromycin and cotrimoxazole. She died 24 hours later. Five days after this death, a 5 month-old infant hospitalized in the next bed developed an acute pulmonary infection due to the same strain with the same bacterial characteristics; this patient was cured with cefotaxime plus vancomycin and gentamicin. Randomly amplified polymorphic DNA analysis showed an identical profile of both strains.

Conclusion.

This is the first case of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRSP) associated with nosocomial spread between two children in adjacent beds. This case suggests that it is necessary to isolate patients with PRSP infection during hospitalization.     

High Rates of Colonization with Drug Resistant <Emphasis Type="Italic">Hemophilus Influenzae</Emphasis> Type B and <Emphasis Type="Italic">Streptococccus Pneumoniae</Emphasis> in Unvaccinated HIV Infected Children from West Bengal

Objective  

To determine nasopharyngeal colonization rates of two vaccine preventable bacterial pathogens Hemophilus influenzae type b (Hib), and Streptococcus pneumoniae (Pneumococcus), antibiotic susceptibility of isolates, factors associated with their colonization, and immunization history in a cohort of HIV infected children.     

Prevalence of <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis> among HIV Infected Children

Objectives  

To determine the seroprevalence of Mycoplasma pneumoniae infection among HIV infected children. Also, to correlate various hematological and radiological findings associated with M.pneumoniae infection.     

Epidemiological characteristics and meteorological factors of childhood <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis> pneumonia in Hangzhou

Background  

Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of pediatric respiratory infections and the relation of M. pneumoniae pneumonia (MPP) with meteorological factors remains obscure. This study aims to investigate the epidemiological characteristics of childhood MPP and observe if there is a relationship between epidemiological characteristics and meteorological factors in Hangzhou.     

A case of <Emphasis Type="Italic">Listeria</Emphasis> meningoencephalitis complicated by hydrocephalus in an immunocompetent infant

We report a very unusual case of meningoencephalitis due to Listeria monocytogenes in a 7-month-old immunocompetent boy. Cerebrospinal fluid (CSF) culture was initially negative, but was positive on the seventh day. The disease was complicated by seizures and hydrocephalus managed with temporary ventriculostomy. The infant was discharged without obvious neurological sequelae after 30 days and developed without neurological or developmental sequelae at two years of age. Listeria is difficult to isolate and is not susceptible to third-generation cephalosporins commonly used for the empirical treatment of bacterial meningitis.     

Dexamethasone and antibiotics for the empirical treatment of bacterial meningitis in Canadian children: A survey of paediatric infectious diseases specialists

PURPOSE:

With the changing epidemiology of the etiological agents causing bacterial meningitis in Canada, the purposes of this study were to determine what empirical antibiotic(s) is/are advocated, and whether dexamethasone is recommended as adjunctive therapy by paediatric infectious diseases specialists for suspected meningitis caused by Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae type b, and partially treated (PT) bacterial meningitis.

METHODS:

A questionnaire invoking the specialists’ preferred choices in treating bacterial meningitis was circulated by e-mail in March 1999 to 41 paediatric infectious diseases specialists or microbiologists (Paediatric Investigators Collaborative Network on Infections in Canada [PICNIC] members) who practised in 13 paediatric centres located in eight provinces.

RESULTS:

Thirty-two (78% response rate) replies were received by July 1999 from 11 paediatric centres in seven provinces. Dexamethasone was recommended by 11 of 32 (34%) respondents for suspected S pneumoniae, four of 32 (12%) for suspected N meningitides, 18 of 32 (56%) for suspected H influenzae type b and five of 32 (16%) for suspected PT meningitis. A trend for more frequent recommended use of dexamethasone for S pneumoniae, H influenzae type b and N meningitides meningitis was found in eastern provinces (Ontario, Quebec and Nova Scotia), as opposed to the western provinces (Manitoba, Saskatchewan, Alberta and British Columbia). The most commonly recommended first line empirical antibiotic therapy was vancomycin plus 3rd-generation cephalosporin (V+3C). This was recommended by 27 of 32 (84%) respondents for suspected S pneumoniae, seven of 32 (22%) for suspected N meningitides, six of 32 (19%) for suspected H influenzae type b and 24 of 32 (75%) for PT meningitis; the remainder recommended using a 3C empirically for each type of meningitis. The major reason cited by respondents for using V+3C for suspected S pneumoniae was the presence of high-and intermediate-level penicillin-resistant S pneumoniae in their centres. No differences were found in the choice of antibiotic(s) between practitioners in the eastern and western provinces.

CONCLUSIONS:

Although regional differences exist, the majority of paediatric infectious diseases experts no longer favour the use of dexamethasone for empirical therapy in most cases of bacterial meningitis. V+3C has become the regimen of choice in Canada for most cases of suspected bacterial meningitis.     

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.     

Bacterial meningitis: Mechanisms of disease and therapy

Bacterial meningitis continues to be a serious infectious disease with a high morbidity and mortality in young children. Early recognition and initiation of adequate treatment are the major determinants for a good outcome. Recent advances in our understanding of the host inflammatory response by cytokines may result in the use of new therapeutic strategies. Such modulation of the inflammatory response may reduce the incidence of sequelae and death. The use of steroids as adjunctive therapy in children with bacterial meningitis probably has beneficial effects although the available data are still controversial. Additionally, studies in experimental meningitis models indicate that non-steroidal anti-inflammatory drugs and monoclonal antibodies against bacterial products, cytokines and CD18 on leucocytes reduce the extent of the meningeal inflammation. Human studies to evaluate the efficacy of these immune modulators are expected to start soon. However, prevention of bacterial meningitis by conjugate vaccines againstStreptococcus pneumoniae andNeisseria meningitidis will be the most promising development in the next decade.     

Difference of clinical features in childhood <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis> pneumonia

Background  

M. pneumoniae pneumonia (MP) has been reported in 10-40% of community-acquired pneumonia cases. We aimed to evaluate the difference of clinical features in children with MP, according to their age and chest radiographic patterns.     

Risk factors for adverse outcomes of bacterial meningitis

Objective : To identify risk factors for adverse outcomes from bacterial meningitis.
Methodology : From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5–9 years following their illness.
Results : Major adverse outcomes included 8/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age ≤12 months, tertiary referral, symptoms >24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age ≤12 months, symptoms >24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities.
Conclusions : As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.     

Étude du portage rhinopharyngé de Streptococcus pneumoniae et de sa sensibilité aux antibiotiques chez les enfants en bonne santé âgés de moins de 2 ans dans la région de Marrakech (Maroc)

The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco.

Objectives

This study's objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2 years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine.

Patients and methods

From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2 years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region.

Results

S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates.

Conclusion

These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2 years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco.     

Diagnostik und Therapie der bakteriellen Meningitis

The clinical picture and course of acute bacterial meningitis are determined by the patient’s age and immune status and the bacterial species that is the causative organism. While Group B streptococci and E. coli predominate in the neonatal period, in most patients older than this the disease is caused by Neisseria menigitidis, Streptococcus pneumoniae and, now a rarity in the western world, Haemophilus influenzae. In neonates the symptoms are typically nonspecific. With advancing age the classic triad of headache, meningism and fever is more typically observed. Morphological, chemical and microbiological analysis of the cerebrospinal fluid (CSF) is of decisive importance for the diagnosis. CSF cell count, glucose and protein levels provide crucial diagnostic information. Gram staining and a CSF culture should be performed in all cases. The appropriate choice of empirical antibiotic therapy is guided by the patient’s age and medical history. Neonates are usually best treated with ampicillin and a third-generation cephalosporin. In infants aged 3 months and over singe-agent therapy with a third-generation cephalosporin is considered most suitable. Glucocorticoids have been shown to reduce the incidence of neurological sequelae. Prophylaxis by way of exposure and vaccination is also discussed.     

Serotype replacement of Streptococcus pneumoniae due to seven‐valent pneumococcal conjugate vaccine in Japan

Background

This study examined the trends for the serotypes of S. pneumoniae that have caused infections before (2010) and after (2012) the introduction of PCV‐7 in Japan.

Methods

We examined 458 strains of Streptococcus pneumoniae obtained from 22 pediatric institutions throughout Japan from January to June 2010 (immediately after the introduction of the seven‐valent pneumococcal conjugate vaccine [PCV‐7]), and 370 strains obtained from 19 institutions from January to June 2012 (after PCV‐7 became widely used). The samples were collected from children aged 0–14 years with conditions such as respiratory tract infections (upper airway inflammation, bronchitis, and pneumonia), meningitis, and sepsis.

Results

The most frequent serotype in the 2010 strains was 19F (17.3%), followed by 6B (16.8%), and 23F (15.1%). The most frequent serotype in the 2012 strains was 6C (10.0%), followed by 19F (9.7%), 15A (8.9%) and 15B (8.9%), indicating a significant change in the distribution. The serotypes contained in PCV‐7 were detected in 280 strains (61.1%) in 2010 and in 81 strains (21.9%) in 2012 (P < 0.01). The serotypes contained in PCV‐13 were detected in 356 strains (77.7%) in 2010 and in 146 strains (39.5%) in 2012 (P < 0.01). A total of 129 subjects who had not been vaccinated with PCV‐7 and 127 subjects who had been vaccinated with PCV‐7 at least once, were compared with regard to the 2012 strains. The serotypes contained in PCV‐7 were found in 21 strains (16.5%) in those who had been vaccinated and in 37 strains (28.7%) in those who had not been vaccinated (P < 0.05).

Conclusions

The increased use of PCV‐7 led to decreases in the serotypes contained in PCV‐13 and increases in the serotypes not contained in PCV‐13, suggesting serotype replacement.     

Invasive Infektion durch Streptococcus pneumoniae Serotyp 8 im Säuglingsalter

Background

Despite the (now) extended spectrum of pneumococcal vaccination by PCV13 (PCV: pneumococcal conjugate vaccine), invasive pneumococcal disease continues to occur.

Case

We report on a 4-month-old female infant who was admitted to the pediatric hospital because of high fever and decreased oral intake of 2 day’s duration prior to admission.

Diagnosis

After extensive diagnostics (blood work, catheter urinalysis, cerebrospinal fluid analysis and culture, blood culture, catheter urine culture, throat swab, stool test, sonography of the brain), a diagnosis of invasive infection by Streptococcus pneumoniae serotype 8 (meningitis, sepsis) was made. The hospital course was complicated by cerebral empyema.

Conclusion

Consideration should be given to adding more serotypes to the conjugate vaccine, especially those which are known for invasive infections, as in our case, serotype 8.     

Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection

Background  

Congenital cytomegalovirus (CMV) infection can lead to severe neurological sequelae, but a defined brain magnetic resonance (MR) pattern and MR predictors of clinical outcome are still lacking.     

Effect of hemodiafiltration therapy in a low‐birthweight infant with congenital sepsis

The clinical course of congenital neonatal sepsis due to Streptococcus pneumoniae progresses rapidly and results in multiorgan failure with high mortality. The swift progression of the disease limits the timeframe for conventional treatment, which often requires waiting for antibiotics to show efficacy. Here, we describe the case of a very low‐birthweight (VLBW) female infant with congenital sepsis due to S. pneumoniae who was treated with continuous hemodiafiltration (CHDF) and polymyxin B‐immobilized fiber column–direct hemoperfusion (PMX‐DHP). The infant was born at 30 weeks’ gestation and diagnosed with hypotension, disseminated intravascular coagulation, and pulmonary hypertension. CHDF and PMX‐DHP were initiated approximately 11 h after birth. Mean blood pressure, oxygenation, and blood interleukin‐6 began to improve after dialysis commencement, and the patient survived with mild sequelae. Combined CHDF and PMX‐DHP may be effective in treating VLBW infants with severe septic shock.     

Prolonged and secondary fever in childhood bacterial meningitis

In order to study the causes of prolonged and secondary fever in bacterial meningitis, a group of 102 infants and children with proven bacterial meningitis were studied. The causative agent wasHaemophilus influenzae in 58% of patients,Streptococcus pneumoniae in 25% andNeisseria meningitidis in 17%. Prolonged fever was observed in 12% of the patients. The established causes include, in order of frequency, subdural effusion, drug fever, otitis media, gastroenteritis and urinary tract infection. Secondary fever was noted in 18% of the patients. The causes, in order of frequency, were urinary tract infection, subdural effusion, otitis media, phlebitis, pneumonia and drug fever. Neither relapse of the meningitis nor inadequate response to antibiotic therapy was the cause for prolonged or secondary fever. Neurological sequalae were observed in 21 patients. There was no correlation between prolonged or secondary fever and neurological sequalae. We conclude that prolonged and secondary fever in patients with treated bacterial meningitis is rarely caused by the primary infection.     

Chlamydia Pneumoniae Infection Associated with Uncontrolled Asthma: A Hospital Based Cross Sectional Study

Objectives  

To evaluate the proportion of anti- Chlamydia pneumoniae (Cp) IgM positivity in patients with uncontrolled asthma and partly controlled childhood asthma and their clinical correlates.     

Outcomes following severe hand foot and mouth disease: A systematic review and meta-analysis

Background

Hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) is associated with acute neurological disease in children.This study aimed to estimate the burden of long-term sequelae and death following severe HFMD.

Fever as a sign of central nervous system infection

Over the past decade, there has been a variety of changes in the epidemiology and management of central nervous system (CNS) infection in children. With the rapid decline of invasive Haemophilus influenzae type b disease, Streptococcus pneumoniae is now the most prominent pathogen responsible for bacterial meningitis in children 1 to 23 months. The emergence of penicillin-resistant pneumococcal disease has led to the recommendation of empiric vancomycin and either ceftriaxone or cefotaxime for all children older than 1 month with probable or definite bacterial meningitis. Use of adjunctive dexamethasone therapy has proven beneficial in HIB meningitis and a beneficial effect I MS been suggested in pneumococcal meningitis. Fluid restriction as a routine to treat presumptive syndrome of inappropriate antidiuretic hormone in acute meningitis does not appear to improve outcome in hospitalized children. In addition, newly available diagnostic modalities allow more specific diagnosis and treatment of aseptic meningitis and encephalitis. This article reviews the three most common causes of CINS infection in the pediatric population which are meningitis, brain abscess, and encephalitis. Emphasis is placed on clinical features, diagnostic evaluation, and appropriate treatment of patients with suspected CNS infection. Early recognition and presumptive treatment of suspected CNS infection could limit neurological damage, exerting a positive impact on final outcome. Clinicians must he knowledgeable of emerging diseases, developing diagnostic trends, and new therapeutic options to provide quality patient care.