Human metapneumovirus infections in hospitalized children

We evaluated the percentage of hospitalizations for acute respiratory tract infections in children < or =3 years of age attributable to human metapneumovirus (HMPV) and other respiratory viruses in a prospective study during winter and spring 2002. We used real-time polymerase chain assays and other conventional diagnostic methods to detect HMPV, human respiratory syncytial virus (HRSV), and influenza viruses in nasopharyngeal aspirates of children. HMPV was detected in 12 (6%) of the 208 children hospitalized for acute respiratory tract infections, HRSV in 118 (57%), and influenza A in 49 (24%). Bronchiolitis was diagnosed in 8 (68%) and pneumonitis in 2 (17%) of HMPV-infected children; of those with HRSV infection, bronchiolitiss was diagnosed in 99 (84%) and pneumonitis in 30 (25%). None of the HMPV-infected children was admitted to an intensive-care unit, whereas 15% of those with HRSV or influenza A infections were admitted. HMPV is an important cause of illness in young children with a similar, although less severe, clinical presentation to that of HRSV.     

Human metapneumovirus and severity of respiratory syncytial virus disease

We screened 23 children with severe respiratory syncytial virus (RSV) disease and 23 children with mild RSV disease for human metapneumovirus (HMPV). Although HMPV was circulating in Connecticut, none of the 46 RSV-infected patients tested positive for HMPV. In our study population, HMPV did not contribute to the severity of RSV disease.     

Household and socioeconomic factors associated with childhood febrile illnesses and treatment seeking behaviour in an area of epidemic malaria in rural Ethiopia

To assess household and socioeconomic factors associated with childhood febrile illnesses and treatment seeking behaviour, a study was conducted in Adami Tulu district in Ethiopia during the peak malaria transmission season in 2003. All mothers/caretakers of children <5 years of age were interviewed regarding their household characteristics, history of febrile illness (malaria) among children and actions taken 2 weeks prior to the survey. Of 3873 children, 21% had experienced fever in the past 2 weeks. Household ownership of a mosquito net (odds ratio (OR)=0.4, 95% CI 0.3-0.7) and prior spraying of the house with aerosols (OR=0.7, 95% CI 0.5-0.9) or DDT (OR=0.8, 95% CI 0.6-0.9) were associated with lower risk of febrile illnesses, whilst sharing the house with livestock increased the risk (OR=1.3, 95% CI 1.1-1.6). Treatment was sought for 87% of febrile children, with public facilities, private clinics and community health workers accessed fairly equally (26-27%). Home management was uncommon (6.4%). More febrile children from households in the middle (37.1%) and highest (44.6%) wealth categories sought treatment within 24h compared with the lowest category (18.3%). Widescale use of vector control measures such as mosquito nets and insecticide spraying of houses can effectively reduce the incidence of febrile illnesses among children.     

血钠水平预测小儿单纯热性惊厥再发的实用价值

目的 探讨单纯性热性惊厥及惊厥再发与血钠浓度的关系;支持或否决血钠生化分析在热性惊厥及惊厥再发的临床价值。方法 从2004年2月到2005年8月观察、分析了160例年龄在6月龄～5岁急诊惊厥患儿的血钠水平,其中单次抽搐的单纯性热性惊厥130例,多次抽搐（再发）的单纯性热性惊厥30例,所有患儿均在静脉输液前抽出外周静脉血送血钠生化分析。结果 再发单纯性热性惊厥组比单发单纯性热性惊厥组血钠平均值低,两组间血钠值的比较,统计显示：t=3．6167,P＜0．01,差异有统计学意义。结论 支持国内外大多数学者的观点,即低血钠可能是同一次热性疾病中、24h内惊厥再发的诱因之一,临床上血钠浓度检测应作为热性惊厥病人的常规检查项目。     

Human metapneumovirus and respiratory syncytial virus, Brazil

We describe the epidemiologic and clinical characteristics of 111 children attending clinics and hospitals in Aracaju, northeast Brazil, with acute respiratory infections attributable to human metapneumovirus (HMPV), respiratory syncytial virus (RSV), or both in May and June 2002. Fifty-three (48%) children were infected with RSV alone, 19 (17%) with HMPV alone, and 8 (7%) had RSV/HMPV co-infections.     

Human metapneumovirus, Peru

We retrospectively studied 420 pharyngeal swab specimens collected from Peruvian and Argentinean patients with influenzalike illness in 2002 and 2003 for evidence of human metapneumovirus (HMPV). Twelve specimens (2.3%) were positive by multiple assays. Six specimens yielded HMPV isolates. Four of the 6 isolates were of the uncommon B1 genotype.     

Telephone management of febrile young children in a family practice setting

To examine which factors are related to the telephone disposition of febrile children in a university family practice setting, telephone encounter records of a cohort of febrile young children were analyzed. No relationship was found between telephone disposition and a child's sex, age, or temperature, the latter two being well-known risk factors for occult and serious illness in febrile young children. There was a significant relationship between telephone disposition and telephone diagnosis. The lack of association between telephone disposition and either age or temperature of a child should be impetus for staff education concerning the telephone management of febrile children in this family practice.     

Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection,China, 2017–2019

We detected human metapneumovirus (HMPV) in 72 (7.1%) of 1,021 patients hospitalized with severe acute respiratory infection in Luohe, China, during 2017–2019. We detected HMPV most frequently in young children and less often in adults. HMPV genotype A2c variants 111 nt and 180 nt duplications predominated, demonstrating their continuing geographic spread.     

Prevalence and predictors of urinary tract infection and severe malaria among febrile children attending Makongoro health centre in Mwanza city,North-Western Tanzania

Background

In malaria endemic areas, fever has been used as an entry point for presumptive treatment of malaria. At present, the decrease in malaria transmission in Africa implies an increase in febrile illnesses related to other causes among underfives. Moreover, it is estimated that more than half of the children presenting with fever to public clinics in Africa do not have a malaria infection. Thus, for a better management of all febrile illnesses among under-fives, it becomes relevant to understand the underlying aetiology of the illness. The present study was conducted to determine the relative prevalence and predictors of P. falciparum malaria, urinary tract infections and bacteremia among under-fives presenting with a febrile illness at the Makongoro Primary Health Centre, North-Western Tanzania.

Methods

From February to June 2011, a cross-sectional analytical survey was conducted among febrile children less than five years of age. Demographic and clinical data were collected using a standardized pre-tested questionnaire. Blood and urine culture was done, followed by the identification of isolates using in-house biochemical methods. Susceptibility patterns to commonly used antibiotics were investigated using the disc diffusion method. Giemsa stained thin and thick blood smears were examined for any malaria parasites stages.

Results

A total of 231 febrile under-fives were enrolled in the study. Of all the children, 20.3% (47/231, 95%CI, 15.10-25.48), 9.5% (22/231, 95%CI, 5.72-13.28) and 7.4% (17/231, 95%CI, 4.00-10.8) had urinary tract infections, P. falciparum malaria and bacteremia respectively. In general, 11.5% (10/87, 95%CI, 8.10-14.90) of the children had two infections and only one child had all three infections. Predictors of urinary tract infections (UTI) were dysuria (OR = 12.51, 95% CI, 4.28-36.57, P < 0.001) and body temperature (40-41 C) (OR = 12.54, 95% CI, 4.28-36.73, P < 0.001). Predictors of P. falciparum severe malaria were pallor (OR = 4.66 95%CI, 1.21-17.8, P = 0.025) and convulsion (OR = 102, 95% CI, 10-996, P = 0.001). Escherichia coli were the common gram negative isolates from urine (72.3%, 95% CI, 66.50-78.10) and blood (40%, 95%CI, and 33.70-46.30). Escherichia coli from urine were 100% resistant to ampicillin, 97% resistant to co-trimoxazole, 85% resistant to augmentin and 32.4% resistant to gentamicin; and they were 100%, 91.2% and 73.5% sensitive to meropenem, ciprofloxacin and ceftriaxone respectively.

Conclusion

Urinary tract infection caused by multi drug resistant Escherichia coli was the common cause of febrile illness in our setting. Improvement of malaria diagnosis and its differential diagnosis from other causes of febrile illnesses may provide effective management of febrile illnesses among children in Tanzania     

Virus-like particle vaccine induces cross-protection against human metapneumovirus infections in mice

Human metapneumovirus (HMPV) is a paramyxovirus that causes acute respiratory-tract infections in children and adults worldwide. A safe and effective vaccine could decrease the burden of disease associated with this novel pathogen. We engineered HMPV viral-like particles (HMPV-VLPs) derived from retroviral core particles that mimic the properties of the viral surface of two HMPV viruses of either lineage A or B. These VLPs functionally display F and G HMPV surface glycoproteins. When injected in mice, HMPV-VLPs induce strong humoral immune response against both homologous and heterologous strains. Moreover, the induced neutralizing antibodies prevented mortality upon subsequent infection of the lungs with both homologous and heterologous viruses. Upon challenge, viral titers in the lungs of immunized animals were significantly reduced as compared to those of control animals. In conclusion, a HMPV-VLP vaccine that induces cross-protective immunity in mice is a promising approach to prevent HMPV infections.     

Measles in a partially immunized community.

During the investigation of a measles outbreak in a rural community, a spectrum of illness was observed which ranged in severity from a brief febrile illness to one characteristic of typical measles. Unimmunized children were more apt to develop measles (p less than 0.001) than were immunized children. However, a proportion of both the immunized and unimmunized children developed a milder, "measles-associated," illness. Employing a logistic model, it was demonstrated that the probability of developing either measles or "measles-associated" illness decreased with increasing age at immunization but was not affected by the interval since immunization.     

Serological evidence of arboviral infection and self-reported febrile illness among U.S. troops deployed to Al Asad, Iraq

Understanding the epidemiology of current health threats to deployed U.S. troops is important for medical assessment and planning. As part of a 2004 study among U.S. military personnel deployed to Al Asad Air Base, in the western Anbar Province of Iraq, over 500 subjects were enrolled, provided a blood specimen, and completed a questionnaire regarding history of febrile illness during this deployment (average approximately 4 months in country). This mid-deployment serum was compared to pre-deployment samples (collected approximately 3 months prior to deployment) and evaluated for seroconversion to a select panel of regional arboviral pathogens. At least one episode of febrile illness was reported in 84/504 (17%) of the troops surveyed. Seroconversion was documented in nine (2%) of deployed forces tested, with no association to febrile illness. Self-reported febrile illness was uncommon although often debilitating, and the risk of illness due to arbovirus infections was relatively low.     

Severity of illness and the use of paracetamol in febrile preschool children; a case simulation study of parents' assessments

OBJECTIVE: Misconceptions and exaggerated fear of fever may divert parents' attention from more predictive symptoms of childhood illness, such as appetite and level of activity. This study aims at exploring how specific predefined characteristics of febrile preschool children affected parents' assessment of the severity of the condition and the perceived need for treatment with paracetamol. METHODS: Parents judged 24 constructed cases of febrile children with different levels of fever, appetite and activity, occurring at different times of the day. For each case they decided whether the child was moderately or severely ill, and whether or not they would prefer to administer paracetamol. Parents' decision-making was examined by discriminant analyses. RESULTS: Of 466 invited parents, 267 supplied information about their families and 205 accepted to participate in judging constructed cases of febrile children. A total of 159 parents responded to all cases. When evaluating the severity of the illness, 119 parents (75%) responded to one or more of the four cues describing illness. Only one of four cues was used by 80 parents (67%), and 86 (72%) parents emphasized fever. When deciding to give paracetamol, one or more of four cues was used by 102 parents (64%), while 72 parents (71%) used only one cue, and 92 parents (90%) emphasized fever. CONCLUSIONS: Parents focus on fever when they evaluate febrile illness and decide whether or not to give paracetamol. Educating parents to focus on their child's level of appetite or activity may improve management, especially when judgement is based on only one or two cues.     

Prevalence of febrile seizures in Dutch schoolchildren

During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to 4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch school-children may well be compared with prevalence rates found in the United States and Great Britain.     

Prevalence of febrile seizures in Dutch schoolchildren

Summary. During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch schoolchildren may well be compared with prevalence rates found in the United States and Great Britain.     

Fever episodes in a holoendemic malaria area of Tanzania: parasitological and clinical findings and diagnostic aspects related to malaria.

All episodes of acute illness, in children aged 0-9 years, were registered during 3 years in a health clinic in a village of about 500 inhabitants in a malaria holoendemic area on the Tanzanian coast. Of 668 clinical episodes, 395 were diagnosed as malaria. There was no death. Only 5% of the children with malaria episodes came to the clinic after more than 3 d of symptoms. All 11 severe anaemias occurred among these children. Fever was reported in 98%, vomiting in 15%, and diarrhoea in 8% of the malaria episodes. Intermittent fever was reported in 98% of the malaria patients with more than one day of fever, compared to 4% of those with other febrile illnesses. Parasite densities > or = 10,000/microliters were found in 48% of the malaria episodes. Densities > or = 400/microliters were found in 96% of the malaria episodes and in only 8% of the other febrile illnesses. The 16 malaria episodes (4%) with densities below that level were all in children under one year of age. The ability of the rural medical aid or the doctor to differentiate malaria episodes from other febrile illnesses without microscopical examination was limited. Although very few malaria episodes were missed, substantial over-diagnosis resulted in specificity values of only 13% and 52% for their respective malaria diagnoses. It is concluded that intermittent fever was strongly associated with malaria, but a high accuracy of malaria diagnosis in febrile children requires microscopical examination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Respiratory tract reinfections by the new human Metapneumovirus in an immunocompromised child

The human Metapneumovirus (HMPV), a new member of the Paramyxoviridae family, has been recently associated with respiratory tract infections in young children. We report the case of a young, immunocompromised child who had severe lower respiratory tract infections during two consecutive winter seasons caused by genetically distinct HMPV strains.