Increased Serum Levels of Anti-Mumps and Rubella Viruses Antibodies in Children with Kawasaki Disease

Serum IgM and IgG antibodies against mumps virus and rubella virus were quantitated serially by enzyme-linked immunosorbent assays in 15 children with Kawasaki disease. IgM antibody against mumps virus and IgG antibody against rubella virus were increased significantly in children with Kawasaki disease who had no previous history of mumps virus or rubella virus infection. Booster-like effect in IgG antibody levels against mumps virus was observed in children with Kawasaki disease who had a previous history of exposure to mumps virus. Since none of the patients manifested clinical symptoms of mumps or rubella, the increased antibody levels against mumps and rubella may represent a part of the nonspecific increase in serum immunoglobulins in children with Kawasaki disease.     

Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus.

Hospital acquired infections with respiratory syncytial virus are a major problem. The virus is spread predominantly by infected nasal secretions and we investigated whether we could reduce its incidence by cohorting babies on each ward into designated areas and encouraging staff and parents to wash their hands. We examined the incidence of hospital acquired infection due to respiratory syncytial virus in all children less than 2 years old and in those with congenital heart disease. In 1986-7, before any intervention, 18 (4.2%) of 425 hospitalised children less than 2 years old developed hospital acquired infection due to respiratory syncytial virus. In 1987-8, after intervention, five (0.6%) of 840 children developed hospital acquired infection but there were fewer ward admissions with community acquired infections due to the virus. In 1988-9, when there were more community acquired infections than 1986-7, six (1.1%) of 552 children developed hospital acquired infection. In 1986-7, eight (34.8%) of 23 children less than 2 years old with congenital heart disease developed hospital acquired infection due to respiratory syncytial virus; all eight were among 11 children with congenital heart disease hospitalised for more than 14 days. In 1987-8, one (3.3%) of 30 children with congenital heart disease developed hospital acquired infection due to respiratory syncytial virus and in 1988-9 there was one (2.1%) case out of 47 children with congenital heart disease. Handwashing and cohorting significantly reduce the incidence of nosocomial respiratory syncytial virus infection.     

Co-morbidity of Kawasaki Disease

Despite more than four decades of investigation, the etiology of Kawasaki disease remains obscure, and none of the proposed etiologic theories for the disease have achieved independent confirmation. Clinical and epidemiologic features support an infectious cause, but the etiology remains unclear. The authors present a case of Kawasaki disease associated with Epstein-Barr virus and Mycoplasma pneumoniae infection in a 3.5-y-old boy. He received two doses of intravenous immunoglobulin due to prolonged course of Kawasaki disease but later had complicated autoimmune haemolytic anaemia. His prolonged fever subsided after azithromycin administration. Epstein-Barr virus infection was confirmed by molecular microbiological pathology of cervical lymph node and serological tests. The serological tests for Mycoplasma pneumoniae also revealed a positive result. Thus, it is concluded that Mycoplasma pneumoniae and Epstein-Barr virus infections may occur simultaneously in a child with Kawasaki disease. In addition, autoimmune hemolytic anaemia may be noted in Kawasaki disease patients after high-dose IVIG administration. To the authors' knowledge, this is the first report of Kawasaki disease with Epstein-Barr virus and Mycoplasma pneumoniae in the English-language literature.     

Herpes Simplex Virus Infection in the Newborn

Fourteen cases of neonatal herpes simplex virus infection in 10 boys and 4 girls are described. The disease was disseminated in 9 cases. In 5 cases skin symptoms predominated, and 1 had only central nervous system symptoms. Two had a vesicular eruption when born. Six of the children with disseminated disease died.EEG recordings were made on 7 patients: 5 had clinical symptoms compatible with encephalitis, and in these the EEG showed periodic complexes, consisting of triangular or sharp waves, a pattern described in adult cases of herpetic encephalitis.The diagnosis was made by virus isolation and antibody titration. Herpes virus type 2 was the causative agent in all 8 cases where the type was determined. In 5 patients herpes virus antigen was demonstrated using immunofluorescence either in vesicles or throat swabs, in the early phase of the disease.Two children with generalized disease were treated with intravenous iododeoxyuridine (IDU). The first died, but the other, treated early in his disease, recovered completely.The clinical picture, complemented by the immunofluorescent technique for virus detection and repeated EEG recordings, should lead to the early diagnosis of herpetic encephalitis in the newborn, and warrant the use of systemic IDU treatment.     

Aetiology of Kawasaki disease.

Thirteen serum samples from nine children with Kawasaki disease and 23 control samples gave negative results on screening for antibodies to hog cholera virus, border disease of sheep, bovine diarrhoea virus, and equine arteritis virus. The sera from two children with Kawasaki disease were cytotoxic; a possible link with cytotoxin from Propionibacterium acnes is considered.     

Viral infections in hospitalized children affected by acute lower respiratory tract disease

OBJECTIVE: To evaluate the frequency of the main respiratory viruses in hospitalized children affected by acute lower respiratory tract disease at a university hospital. METHODS: This is a prospective trial that included two cohorts of hospitalized children in the period from April to July 1996. The groups were selected according to the presence of lower respiratory tract disease on admission: Group A- with acute disease (history of less than 7 days) and B- without present or recent respiratory disease. The parameters for defining lower respiratory tract disease included physical and/or radiological pulmonary changes. Clinical and radiological criteria were established for the classification of lower respiratory tract diseases in group A. Nasopharyngeal swab was collected from all children on admission for viral detection by cellular cultures and direct immunofluorescence. RESULTS: 201 cases were selected, 126 in group A and 75 in group B. Viruses were identified in 71 children from groupA(56.4%) and only in 3 from group B (4.0%). The predominant agent in group A was respiratory syncytial virus, identified in 66 cases; adenovirus (4) and influenza (1) were detected in other patients. In group B two patients with respiratory syncytial virus and one with adenovirus were identified. The patients from group A affected by respiratory syncytial virus were younger (median age 3 months versus 13 months) and more wheezy on physical examination (78.7%) than the other patients of the group (33.3%). This virus was associated to most of the bronchiolitis cases (84%) and to half of the pneumonia cases (46.4%). CONCLUSION: The authors found a significant presence of viruses in the majority of children hospitalized with acute lower respiratory tract disease. The respiratory syncytial virus was the predominant agent identified. These results are similar to others previously reported both in developed and some developing countries. The authors emphasize that the present study evaluated only partially the possibility of simultaneous infection by other pathogens and that the present protocol was conducted during the season with the highest incidence of respiratory syncytial virus.     

Neonatal herpes infection: diagnosis,treatment and prevention

Approximately 2000 neonates contract infection due to herpes simplex virus each year in the United States. Although herpes simplex virus type 2 is responsible for most neonatal infections, approximately 30% of infections are caused by herpes simplex virus type 1. Infections are categorized by extent of disease into skin/eye/mouth, central nervous system and disseminated disease categories. Each disease category is responsible for roughly one third of neonatal infections. Mortality is highest in disseminated disease. Morbidity is highest for survivors of central nervous system infection. Treatment with high dose parenteral acyclovir (60 mg/kg/day) for 14–21 days improves outcome. Since most neonatal infections are acquired from contact with infected maternal genital tract secretions, potential preventative strategies include: Caesarean delivery, serologic screening of pregnant women, prophylactic acyclovir and vaccination. The two strategies currently accepted by most obstetricians are Caesarean delivery for women with active lesions or prodromal symptoms and prophylactic acyclovir for women with gestational herpes.     

Clinical and epidemiologic characteristics of viral infections in a neonatal intensive care unit during a 12-year period

BACKGROUND: The incidence of viral infections in patients treated in the neonatal intensive care unit (NICU) is not well-known. We summarized the data of all patients with laboratory-confirmed viral infections admitted at the NICU of our hospital during the period of 1992-2003. OBJECTIVES: To determine the incidence of viral infections among infants hospitalized in a NICU, the associated clinical manifestations and their outcome. METHODS: Retrospective analysis of epidemiologic, virologic and clinical data from infants with proven viral infection. The diagnosis viral infection was confirmed by positive viral culture and/or polymerase chain reaction from clinical samples. RESULTS: Viral infection was confirmed in 51 of 5396 infants (1%) admitted to the NICU; 20 (39%) had an enterovirus and parechovirus (EV/PEV) infection, 15 (29%) a respiratory syncytial virus (RSV) infection, 5 (10%) a rotavirus infection, 3 (6%) a cytomegalovirus (CMV) infection, 2 (4%) an adenovirus infection, 2 (4%) a parainfluenza virus infection, 2 (4%) a herpes simplex virus infection, 1 (2%) a rhinovirus infection and 1 (2%) a rubella virus infection. Three of the infants presented at birth with symptomatic rubella virus, CMV or herpes simplex virus infection. RSV infection developed mostly in hospitalized infants (60%), and 93% of infections occurred during the winter (November-March). The clinical presentations of EV/PEV disease were sepsis-like illness, prolonged seizures in term infants and gastrointestinal disease in preterm infants. RSV, parainfluenza virus, rhinovirus and CMV caused respiratory disease, predominantly in preterm infants. Gastrointestinal disease was seen only in preterm infants with adenovirus, rotavirus or EV/PEV infection. Mortality and serious sequelae were high in patients infected with EV/PEV (10 and 15%, respectively). CONCLUSIONS: The incidence of viral infection in the NICU was 1%. Enteroviral infections were the most frequently diagnosed infections, occurred often in term infants born at home and presented with sepsis-like illness or seizures. Preterm infants hospitalized from birth mainly developed gastrointestinal disease caused by rotavirus and adenovirus infection or respiratory disease caused by RSV, parainfluenza and CMV infection. Enteroviruses were responsible for the highest mortality and development of serious sequelae.     

Adenovirus, adeno-associated virus and Kawasaki disease

Clinical similarities and shared seasonality suggested a relationship between adenovirus infection and Kawasaki disease. We performed adenovirus serology and quantitative polymerase chain reaction for both adenovirus and adeno-associated virus in patients with acute Kawasaki disease. No evidence was found to suggest a link between either virus and Kawasaki disease.     

IMPAIRED INTERFERON RESPONSE OF CHILDREN WITH CONGENITAL CYTOMEGALOVIRUS DISEASE

Abstract. Emödi, G. and Just, M. (Department of Microbiology and Immunology of the University Childrens Hospital, Basel Switzerland). Impaired interferon response of children with congenital cytomegalovirus disease. Acta Paediat Scand, 63: 183, 1974.–The reason for the observation, that only 1 child out of 30 newborns with congenital cytomegalovirus infection has clinical signs of congenital disease, is not known. The possibility of a defect in interferon mechanism responsible for development of congenital disease. was tested. Six infants with typical symptoms of congenital cytomegalovirus disease were compared with infants excreting virus without symptoms related to congenital infection and with healthy adults with and without virus excretion. From patients and controls lymphocytes were separated and stimulated by in vitro virus infection for interferon production capacity. A significantly reduced interferon response was found in the children with symptoms of congenital cytomegalovirus disease, compared with the different control groups. The possibility that the impaired interferon response is a genetically fixed defect leading to generalization of cytomegalovirus infection is discussed.     

Cholestasis as a presenting feature of acute Epstein-Barr virus infection

Biochemical evidence of hepatic involvement in Epstein-Barr virus disease is common but clinical features of cholestasis are rare in children. We present three children with cholestasis as a presenting feature of Epstein-Barr virus disease.     

Functional-metabolic activity of the mononuclear phagocyte system of the blood, liver, spleen and skin in children with hepatitis B

A total of 102 children aged 5 to 14 years with virus hepatitis B were examined for the status of the mononuclear phagocytic system in accordance with the absolute monocyte count in the circulating blood, esterase and acid phosphatase activity in the monocytes, for function of organ macrophages of the liver and spleen using dynamic scintigraphy with TC-colloid and for macrophages of the skin by the "skin window" method. The rise of the absolute count and lowering of the functional and metabolic activity of blood monocytes were directly proportional to the gravity of virus hepatitis B. The changes persisted for a long time, namely up to 1.5 to 3 months since the disease onset. There was a progressive drop of the functional activity of Kupffer cells in the liver with a maximum decrease seen within 4 to 6 weeks since the disease onset, followed by returning to normal in cyclic disease and preservation of the changes in lingering and chronic virus hepatitis B. Spleen macrophages play an active compensatory role, maintaining normal "purifying" function of the mononuclear phagocytic system. That compensatory response tension appeared high in lingering and especially in chronic virus hepatitis and may serve as a criterion for process chronicity. The changes in the mononuclear phagocytic system observed in cyclic course of mild and medium-gravity virus hepatitis B may be regarded as normal adaptive reaction and do not require any drug correction. The latter one may only be indicated in patients with grave, lingering or chronic disease patterns associated with break down or depletion of the adaptive mechanisms of the system in question.     

Laboratory characteristics of suspected herpes zoster in vaccinated children

Varicella vaccination of children has decreased varicella disease incidence, but introduced the occurrence of herpes zoster (HZ) from vaccine-type virus. We identified 14 vaccinated children with suspected HZ and confirmed varicella virus by polymerase chain reaction in 6 cases. Two cases were due to vaccine-type virus. Serum varicella IgM and IgG were not useful for diagnosis of HZ among vaccinated children.     

Nationwide survey of palivizumab for respiratory syncytial virus prevention in Japanese children with congenital heart disease

A questionnaire study was performed to determine the current status of palivizumab prophylaxis against respiratory syncytial virus infection in Japanese children with congenital heart disease <2 years of age. Palivizumab prophylaxis decreased the respiratory syncytial virus hospitalization rate by 42.8%.     

Effect of maternal CD4 cell count, acquired immunodeficiency syndrome, and viral load on disease progression in infants with perinatally acquired human immunodeficiency virus type 1 infection

Among a cohort of 152 infants perinatally infected with human immunodeficiency virus type 1, and their mothers, we correlated infant outcome with maternal CD4 ⁺ lymphocyte count and the presence of maternal acquired immunodeficiency syndrome near delivery. In a subset of 50 mother-infant pairs, we also correlated infant outcome with maternal quantitative viral burden as measured by the nucleic acid sequence based amplification system. We found that low maternal CD4 ⁺ cell count and high viral burden were associated with decreased time to category C disease or death in infants infected with human immunodeficiency virus type 1. In a multivariate analysis, high maternal viral load and maternal acquired immunodeficiency syndrome were independently associated with shorter time to category C disease or death in infants with human immunodeficiency virus type 1 infection. High viral load in pregnant women, independent of the presence of advanced maternal disease, appears to increase the risk of rapidly progressive disease in their infected offspring. (J Pediatr 1997;130:830-7)     

JC virus associated meningoencephalitis in an immunocompetent girl.

JC virus is most commonly acquired during childhood, and no clinical illness has been associated with primary infection, which is assumed to be asymptomatic. The only disease associated with JC virus to date is progressive multifocal leucoencephalopathy (PML), which is usually caused by viral reactivation in immunocompromised adults. A chronic meningoencephalitis associated with an active JC virus infection in an immunocompetent 13 year old girl is described.     

Pediatrics and herpes simplex virus vaccines

This review explores the development of prophylactic genital herpes vaccines and their potential impact on perinatal and oral-facial disease. Vaccine strategies have included the use of whole killed virus, viral subunits, attenuated live virus, viral vectors, and bare DNA. To date, the recombinant subunit vaccine, truncated HSV-2 gD and alum/MPL, has been the most efficacious. The vaccine is 73 to 74 percent effective in preventing genital disease in herpes simplex virus seronegative women but is not effective in men or seropositive women. Models predict a significant impact on genital herpes if it limits viral shedding. Reductions in perinatal and oral-facial disease are likely to occur as well. Once an efficacious herpes vaccine is available, its effectiveness will depend ultimately on vaccine acceptance by professional organizations, healthcare professionals, and parents. Further research is required to improve on and fully understand the implications of prophylactic herpes simplex vaccines.     

Role of parainfluenza virus-specific IgE in pathogenesis of croup and wheezing subsequent to infection

In order to determine the role of parainfluenza virus-specific IgE antibody production and release of histamine in the pathogenesis of lower respiratory disease caused by parainfluenza virus infection, we studied 84 infants and children at the time of parainfluenza virus infection. Parainfluenza virus-IgE antibody was detected in samples of nasopharyngeal secretions by means of an enzyme-linked immunosorbent assay, and histamine content of nasopharyngeal secretions was determined by a fluorometric technique. Virus-specific IgE responses appeared earlier and were of greater magnitude in patients with croup, wheezing, and croup with wheezing caused by parainfluenza virus infection than in patients with parainfluenza virus-induced upper respiratory illness. Histamine was detectable in nasopharyngeal secretions of patients with parainfluenza virus-related croup significantly more often than in patients with upper respiratory illness caused by parainfluenza virus. These observations suggest a role for immunologic mechanisms in the pathogenesis of severe forms of respiratory illness caused by parainfluenza virus infection.     

Herpes zoster by reactivated vaccine varicella zoster virus in a healthy child

Varicella can be prevented by vaccination using the live-attenuated Oka vaccine strain of varicella zoster virus (VZV). Only mild breakthrough disease has been reported in seronegative vaccinees when exposed to the wild-type virus. The latent varicella vaccine virus has rarely caused herpes zoster in childhood and adolescence. We report a healthy 2-year-old girl who developed an impressive herpes zoster infection 16 months after vaccination, localised in three cervical dermatoma. As causative virus, VZV vaccine strain was identified by polymerase chain reaction and analysis of restriction fragment length polymorphisms of the amplified products. CONCLUSION: vaccine varicella zoster virus can occasionally reactivate in healthy children and present as herpes zoster. Virus characterisation is necessary to identify the strain and provide information on the incidence of occurrence.     

Hepatitis B and A markers in children with thalassaemia and sickle-cell disease in Riyadh

Sera from 40 children with beta-thalassaemia major, 54 children with sickle-cell disease and 120 matched controls were examined by radio-immunoassay for hepatitis B and A markers. The overall prevalence of hepatitis B virus markers was highest in children with thalassaemia followed by children with sickle-cell disease and lowest in the control group. The hepatitis A marker showed a reversed pattern, being lowest in the thalassaemic group. The high incidence of hepatitis B infection was presumably due to frequent blood transfusions, frequent exposure to hospital environment and the high carrier rate in the community. Frequent blood transfusions, however, seem to protect against hepatitis A virus infection.