Epidemiological, molecular, and clinical features of enterovirus respiratory infections in French children between 1999 and 2005

Enteroviruses (EVs) can induce nonspecific respiratory tract infections in children, but their epidemiological, virological, and clinical features remain to be assessed. In the present study, we analyzed 252 EV-related infection cases (median age of subjects, 5.1 years) diagnosed among 11,509 consecutive children visiting emergency departments within a 7-year period in the north of France. EV strains were isolated from nasopharyngeal samples by viral cell culture, identified by seroneutralization assay, and genetically compared by partial amplification and sequencing of the VP1 gene. The respiratory syndromes (79 [31%] of 252 EV infections) appeared as the second most common EV-induced pediatric pathology after meningitis (111 [44%] of 252 cases) (44 versus 31%, P < 10⁻³), contributing to lower respiratory tract infection (LRTI) in 43 (54%) of 79 EV respiratory infection cases. Bronchiolitis was the most common EV-induced LRTI (34 [43%] of 79 cases, P < 10⁻³) occurring more often in infants aged 1 to 12 months (P = 0.0002), with spring-fall seasonality. Viruses ECHO 11, 6, and 13 were the more frequently identified respiratory strains (24, 13, and 11%, respectively). The VP1 gene phylogenetic analysis showed the concomitant or successive circulation of genetically distinct EV respiratory strains (species A or B) during the same month or annual epidemic period. Our findings indicated that respiratory tract infections accounted for the 30% of EV-induced pediatric pathologies, contributing to LRTIs in 54% of these cases. Moreover, the concomitant or successive circulation of genetically distinct EV strains indicated the possibility of pediatric repeated respiratory infections within the same epidemic season.     

Epidemiological,clinical, and molecular features of norovirus infections in western India

The study was conducted to investigate the molecular epidemiology of noroviruses (NoVs) from western India. A total of 830 fecal specimens were collected during July 2005–June 2007 from children, ≤7 years of age suffering from acute gastroenteritis in Pune, Nagpur, and Aurangabad cities. All the specimens were subjected to RT‐PCR, sequencing and phylogenetic analysis for detection and characterization of Genogroup I (GI) and GII NoVs. NoV positivity varied between 6.3% and 12.6% in different cities with the predominance of GII (96.6%). NoV infections were very common in the patients ≤2 years of age. A majority (55%) of the patients suffered from severe disease, however, vomiting was not experienced in 35%. Coinfections with rotaviruses were found in 10% cases. Summer month seasonality supported NoV infections in western India. The phylogenetic analysis of partial RNA polymerase and VP1 (capsid) genes identified 2 GI (GI. 2 and GI.6) and 5 GII (GII.4, GII.6, GII.7, GII.8, and GII.14) genetic clusters with possible occurrence of “2007 new‐variant” of GII.4. Six different combinations of RdRp and capsid genes (GII.b/GII.3, GII.b/GII.4, GII.d/GII.3, GII.b/GII.18, GII.1/GII.12 and GII.3/GII.13) were also identified. GII.4 (52%) prevailed in 2005–2006 while the predominance of probable recombinant NoV strains (58%) was noted in 2006–2007 with the contribution of GII.b/GII.3 at 79% level. GII.b/GII.18 type identified in 37% infections in 2005–2006 was completely replaced by GII.b/GII.3 type in 2006–2007. This is the first report that highlights the norovirus epidemiology and strain diversity demonstrating possible circulation of new variants in patients with acute gastroenteritis from western India. J. Med. Virol. 81:922–932, 2009. © 2009 Wiley‐Liss, Inc.     

Epidemiological and clinical study of viral respiratory tract infections in children from Italy

Impact of recently discovered viruses on epidemiology of acute respiratory tract infections (ARTI) is still unclear. We studied the impact of recently discovered human metapneumovirus (hMPV), human bocavirus (HBoV), and new coronaviruses (HCoV‐NL63 and HKU1) on the global epidemiology of ARTI. From October 2006 to April 2007, 237 pediatric patients affected by ARTI were enrolled in our study. Specimens were tested for respiratory viruses by polymerase chain reaction. One hundred twenty‐four out of 237 samples (52.3%) were positive for one or more viruses. Picornaviruses were the most prevalent viruses (n = 61, 43.6%), followed by respiratory syncytial virus (n = 34, 24.3%) and Adenovirus (n = 25, 17.9%); hMPV (n = 9, 6.4%) was the fourth most common virus detected. HBoV and HCoV showed a low prevalence (respectively 2.9% and 2.1%). RSV was the prevalent agent of LRTI (38%). Viruses were identified in more than 50% of the studied ARTI, providing useful information on clinical features and epidemiology of specific agents affecting children in cold months. Although routine surveillance of respiratory viruses does not seem cost‐effective, continuous monitoring of ARTI etiology could be a useful tool for planning resources for the development of new vaccines and antiviral agents. J. Med. Virol. 81:750–756, 2009 © 2009 Wiley‐Liss, Inc.     

手足口病住院患儿流行病学和临床特征分析

目的探讨手足口病住院患儿入院时流行病学和临床特征。方法回顾性总结2008年5—8月份手足口病高发季节我院收治的239例住院患儿病例资料。结果住院〉5天患儿年龄偏小（P=0．025）,3岁以下儿童构成比较高（P=0．012）;入院时体温、心率和呼吸频率均偏高（P=0．015;P=0．031或P=0．013）,最高体温I〉38℃的患儿构成比较高（P=0．023）。与年龄〉3岁患儿比较,年龄≤3岁患儿并发急性支气管炎、支气管肺炎的发生率较高（P=0．011或P=0．008）,出现心肌损害及神经系统损害表现发生率也均较高（P=0．036或P=0．017）,且出现2种以上并发症状比例更高（P=0．003）。结论应密切观察低龄儿童的病情变化,及时控制低龄患儿并发症的发生和进展。     

Hunter' syndrome. Ultrastructural features in young children

Ultrastructural abnormalities in two stepbrothers with Hunter's syndrome, ages 1 and 4 years, were found in cortical neurons, neurons of the myenteric plexus, and skin. Inclusions containing little or no electron-dense material were noted in most tissues, and lamellar figures were restricted to cortical neurons and neurons of the myenteric plexus. These changes correlate with those described in tissues obtained at post mortem.     

24例狂犬病流行病学及临床特点分析

目的 回顾性研究北京地坛医院2008年11月至2010年12月,收治的24例狂犬病例,分析研究狂犬病的流行病学及临床特点,以提高诊治水平,加强狂犬病防治能力.结果 本组病例壮年人群发病多,男性多,农村地区病例多,夏秋季节发病多,潜伏期随暴露部位距头部的距离而延长.36.8％的患者在暴露后处理了伤口,15.8％的患者注射...     

Epidemiological and clinical features of travel-associated cryptosporidiosis

Data concerning the clinical and epidemiological features of travel-associated cryptosporidiosis are lacking. In order to investigate the impact of this disease on travellers' health, a retrospective study was conducted at the Institute of Tropical Medicine, Berlin. In total, 57 cryptosporidial infections were identified between 2000 and 2004, resulting in a prevalence of 2.9% in patients with travel-associated diarrhoea. Travel to south-central Asia, especially India, was associated with a higher prevalence of infection than was travel to other destinations. Clinically, the disease resembled giardiasis, but fever and arthralgias seemed to occur more frequently.     

RSV molecular characterization and specific antibody response in young children with acute lower respiratory infection.

The presence of respiratory syncytial virus (RSV) in nasopharyngeal aspirates (NPA) were studied in 254 hospitalized Argentinean children with acute lower respiratory infection tract (ALRI). The specific humoral immune response and partial sequences of the G protein gene were studied in a subset of 22 children with RSV confirmed infection. The RSV IgM detection and the RSV IgG titration were made by immunofluorescence assay (IFA) in pairs of sera. The partial RSV G gene sequences were obtained by an RT-PCR amplification directly from de NPAs. RSV was present in 44.5% of the children. The RSV IgM was detected in 22.7 and 68.8% of the first and second sera, respectively. The IgG geometric mean titers of the acute and convalescent sera were 8 and 589. The RSV IgG titration was able to define 86.4% of the RSV confirmed cases. The percentage of coincidence between RSV IgM detection in the second sera and diagnosis by RSV IgG titration was 72.7% and no significant differences were observed. The nucleotide sequence of one group A and three group B viruses were identified. The first one was related with circulating viruses in Madrid, Montevideo and Mozambique during 1992, 1989 and 1999, respectively. The three sequences identified as group B viruses were closely related with circulating viruses in 1998 from South Africa and Canada during 1999 and 2000. The data obtained in our study provide the first approach at the molecular level (nucleotide) of the RSV circulating strains in Argentina and the lack of genotype patterns previously determined make necessary a continuous molecular surveillance in order to contribute to the understanding of the behavior of this virus in our community.     

Epidemiological analysis of serologically determined rotavirus and enterotoxigenic Escherichia coli infections in Ecuadorian children.

The statistical association of rotavirus- and enterotoxigenic Escherichia coli-specific serum antibody with demographic and hygienic factors was tested in Ecuadorian children enrolled in a cross-sectional survey. In 7- to 10-month-old children, enterotoxigenic E. coli-specific antibody was associated (P less than 0.05) with poor drinking water quality, lack of a sewage system, and feeding of supplementary food. In 7- to 14-month-old children, rotavirus-specific antibody was associated only with family size but notably not with hygienic factors.     

Etiology,clinical features,management, and outcomes of skin and soft tissue infections in hospitalized children: A 10-year review

PurposeThis study aimed to describe the etiology, clinical features, hospital course, and outcomes of hospitalized children with skin and soft tissue infections (SSTIs) and to test if clinical and laboratory variables at admission could differentiate between community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and community-acquired methicillin-sensitive S. aureus (CA-MSSA).MethodsWe reviewed the clinical, laboratory, treatment, and outcome data for children hospitalized with SSTIs, aged 0–18 years at MacKay Children's Hospital between 2010 and 2019. Multivariable logistic regression was used to identify independent predictors of CA-MRSA and CA-MSSA SSTIs.ResultsA total of 1631 patients were enrolled. Erysipelas/cellulitis (73.8%) was the most common pediatric SSTI type, followed by acute lymphadenitis (13.6%) and abscess/furuncle/carbuncle (8.6%). Among the 639 culture-positive isolates (purulent SSTIs), 142 (22.2%) were CA-MSSA and 363 (56.8%) were CA-MRSA. The age group 0–1 month (OR, 6.52; 95% CI 1.09–38.92; P = 0.04) and local lymph node reaction (OR, 2.47; 95% CI 1.004–6.08; P = 0.049) were independent factors for differentiating children with CA-MSSA from those with CA-MRSA SSTIs. MRSA isolates in our cohort were highly susceptible to glycopeptides (100%), linezolid (100%), daptomycin (100%), and sulfamethoxazole/trimethoprim (98.6%) but were significantly less susceptible to clindamycin compared with MSSA (34.2% vs. 78.2%, P < 0.001).ConclusionS. aureus is the leading pathogen of culture-proven SSTIs in hospitalized children with MRSA accounting for more than half. Determining the optimal empirical antibiotics in CA-SSTIs may rely on the patient's age, disease severity, and local epidemiologic data.     

急性呼吸道感染住院患儿RSV和ADV与病情严重程度相关性研究

目的 通过对呼吸道合胞病毒(RSV)及腺病毒(ADV)临床检测阳性率来评价儿童急性呼吸道感染病情严重程度的相关性分析.方法 将82例患急性呼吸道感染的儿童(感染组)及30例健康儿童(健康组)作为观察对象,比较两组RSV和ADV阳性率;同时根据感染严重程度,将感染组患儿分为28例的非肺炎组、33例的普通肺炎组及21例的重症肺炎组,对比三组间RSV和ADV阳性率.此外,对感染组患儿中RSV和ADV阳性率与感染严重程度、血常规白细胞计数(WBC)、中性粒细胞百分比(N％)及淋巴细胞百分比(L％)的相关性.结果 感染组RSV和ADV阳性率明显高于健康组(P ＜0.05),而不同严重程度感染组中,以重症肺炎组RSV和ADV阳性率最高(P＜0.05),同时感染组中,RSV和ADV阳性率与患者的感染严重程度存在显著的直线相关性,但与WBC、N％及L％无直线相关性.结论 RSV和ADV阳性率可作为评价急性呼吸道感染患儿病情严重程度的指标.     

Radiographic, clinical, and prognostic features of complicated and uncomplicated community-acquired lobar pneumonia in children.

BACKGROUND AND PURPOSE: The incidence of community-acquired lobar pneumonia in conjunction with either necrosis or empyema in children has rapidly increased in recent years. This study aimed to evaluate the radiographic, clinical, and predicted factors of complicated and uncomplicated lobar pneumonia in children. METHODS: This retrospective study included 131 patients younger than 18 years of age with community-acquired lobar pneumonia treated between January 2002 and March 2005. Multiple logistic regression analysis was performed to demonstrate the risk factors of complicated lobar pneumonia. RESULTS: The proportion of children with lobar pneumonia in children increased dramatically from 7% in 2002 to 19% in 2004. Analysis revealed the presence of elevated C-reactive protein level (>12 mg/dL) [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.61-7.66], persistent fever for more than 1 week before admission (OR, 1.14; 95% CI, 1.04-1.26), and multilobar (> or =2 lobes) confluent lung opacity on chest radiographs (OR, 2.83; 95% CI, 1.27-6.33) were independent predictors of the occurrence of complicated lobar pneumonia. A progressive increase in the number of penicillin-non-susceptible Streptococcus pneumoniae isolates was found during the study period. Prolonged fever was a common clinical feature of hospitalized children with lobar pneumonia. Failure of consolidative pneumonia to respond to appropriate antibiotic treatment within 4.4 days was associated with the development of necrosis or empyema. CONCLUSIONS: Complicated and uncomplicated lobar pneumonia are difficult to distinguish based on clinical symptoms at the time of admission. The presence of the above risk factors can help in the early diagnosis of complicated lobar pneumonia.     

Epidemiological and clinical characteristics of children with acute respiratory viral infections in the Philippines: a prospective cohort study

ObjectivesViral acute respiratory infection (ARI) remains a major global health problem, especially among children in low- and middle-income countries. The study was conducted to reveal aetiological significance of respiratory viruses among both non-hospitalized and hospitalized children.MethodsA cohort study of children with ARI at the household, primary healthcare facility, and hospital levels was conducted alongside a hospital-based study including non-cohort children from 2014 to 2016 in the Philippines. The ARI cases were recorded at households and healthcare facilities, and a clinical investigation was performed. Nasopharyngeal swabs were collected from the symptomatic children and tested for respiratory viruses via polymerase chain reaction. Then, the association between healthcare facility utilization and viral detection was investigated.ResultsOverall, 18,514 ARI cases were enrolled in the cohort study, and samples were collected from 4735 of these cases. The hospital-based study detected 648 ARI cases, all of which were sampled. Rhinovirus (22.2%; 1052/4735) was most frequently detected followed by respiratory syncytial virus (12.0%; 566/4735). Enterovirus (adjusted odds ratio, 1.8; 95% confidence interval, 1.1–2.8), human metapneumovirus (2.1, 1.4–3.2), rhinovirus (2.1, 1.8–2.6), and respiratory syncytial virus (1.6, 1.2–1.9) were significantly more prevalent in the ARI cases at healthcare facilities than in those in households. Of all ARI cases, 0.6% required hospitalization while 1.8% were hospitalized among the respiratory syncytial virus-positive cases (3.8, 3.0–4.9).ConclusionsWe determined the prevalence of respiratory viruses among children with ARIs at the household, primary healthcare facility, and hospital levels and the association with clinical characteristics. In particular, we discovered a significant disease burden and impact of respiratory syncytial virus infections as well as a considerable aetiological implication of rhinovirus infections.     

Kikuchi-Fujimoto disease in children: clinical features and disease course.

Kikuchi-Fujimoto disease (KFD) is a rare cause of cervical lymphadenitis which mostly affects Asian women but is sometimes observed in the pediatric population. This study analyzed the clinical manifestations and disease course in children with KFD. Retrospective chart review and telephone interview were used to collect data for 13 children (8 boys and 5 girls) with a diagnosis of KFD from January 1988 to January 2003. Involvement of the posterior cervical lymph nodes was found in 12 patients, leukopenia in 9, and all patients had C-reactive protein less than 5 mg/dL. A high antinuclear antibody titer was associated with a more protracted and complicated course. Five of the 13 patients had new symptoms compatible with an autoimmune process during follow-up, with neurological symptoms the most common. In conclusion, the risk of evolution into an autoimmune syndrome in pediatric KFD patients is high, and careful long-term observation is mandatory.     

Epidemiological features of invasive Kingella kingae infections and respiratory carriage of the organism

The age, sex, and seasonal distributions of invasive Kingella kingae infections in southern Israel were examined and compared to the epidemiology of respiratory carriage of the organism. Medical records of all patients diagnosed between 1988 and 2002 were reviewed, and 2,044 oropharyngeal specimens were cultured on selective media during two periods (February to May and October to December) in 2001. Invasive infections significantly affected children (73 of 74 patients [98.6%] were younger than 4 years), 50 patients (67.8%) were males (P = 0.045), and 55 episodes (74.3%) occurred between July and December (P = 0.004). Carriage was higher in the 0- to 3-year-old group and decreased with increasing age (P for trend = 0.0008). Carriage rates were similar in both sexes and did not significantly differ between the February-to-May and October-to-December periods. The highest rate of carriage of K. kingae coincided with the age (less than 4 years) at which invasive infections were especially frequent. The peculiar sex and seasonal distributions of invasive disease, however, cannot be readily explained by the epidemiology of respiratory carriage. Viral infections and other yet-to-be-defined cofactors may play a role in the causation of invasive K. kingae infections.