To compare cell adhesion molecules levels in cerebrospinal fluid (CSF) between Zika virus (ZIKV)‐exposed neonates with/without microcephaly (cases) and controls, 16 neonates (cases), 8 (50%) with and ...8 (50%) without microcephaly, who underwent lumbar puncture (LP) during the ZIKV epidemic (2015–2016) were included. All mothers reported ZIKV clinical symptoms during gestation, all neonates presented with congenital infection findings, and other congenital infections were ruled out. Fourteen control neonates underwent LP in the same laboratory (2017–2018). Five cell adhesion proteins were measured in the CSF using mass spectrometry. Neurexin‐1 (3.50 2.00–4.00 vs. 7.5 5.00–10.25, P = 0.001), neurexin‐3 (0.00 0.00–0.00 vs. 3.00 1.50–4.00, P = 0.001) and neural cell adhesion molecule 2 (NCAM2) (0.00 0.00–0.75 vs. 1.00 1.00–2.00, P = 0.001) were significantly lower in microcephalic and non‐microcephalic cases than in controls. When these two sub‐groups of prenatally ZIKA‐exposed children were compared to controls separately, the same results were found. When cases with and without microcephaly were compared, no difference was found. Neurexin‐3 (18.8% vs. 78.6%, P = 0.001) and NCAM2 (25.0% vs. 85.7%, P = 0.001) were less frequently found among the cases. A positive correlation was found between cephalic perimeter and levels of these two proteins. Neurexin‐2 and neurexin‐2b presented no significant differences. Levels of three cell adhesion proteins were significantly lower in CSF of neonates exposed to ZIKV before birth than in controls, irrespective of presence of congenital microcephaly. Moreover, the smaller the cephalic perimeter, the lower CSF cell adhesion protein levels. These findings suggest that low CSF levels of neurexin‐1, neurexin‐3 and NCAM2 may reflect the effects of ZIKV on foetal brain development.
Neurexin‐1, Neurexin‐3, Neural cell adhesion molecule 2 (NCAM2) levels are significantly lower in the cerebrospinal fluid of neonates exposed to Zika virus before birth. The smaller the cephalic perimeter, the lower the Neurexin‐3 and NCAM2 levels. Such findings may reflect the effects of Zika virus on foetal brain development.
Aim
To assess whether there was a difference in the frequency of symptoms and signs among children with community‐acquired pneumonia (CAP) with viral or bacterial infection.
Methods
A prospective ...cross‐sectional study was conducted in Salvador, Brazil. Children less than 5‐years‐old hospitalized with CAP were recruited. Viral or only bacterial infection was diagnosed by an investigation of 11 viruses and 8 bacteria. Bacterial infection was diagnosed by blood culture, detection of pneumococcal DNA in acute buffy coat, and serological tests. Viral infection was diagnosed by detection of respiratory virus in nasopharyngeal aspirate and serological tests. Viral infection comprised only viral or mixed viral‐bacterial infection subgroups.
Results
One hundred and eighty‐eight patients had a probable etiology established as only viral (51.6%), mixed viral‐bacterial (30.9%), and only bacterial infection (17.5%). Asthma was registered for 21.4%. Report of wheezing (47.4% vs 21.2%; P = 0.006), rhonchi (38.0% vs 15.2%;
P = 0.01), and wheezing detected on physical examination (51.0% vs 9.1%;
P < 0.001) were the differences found. Among children with asthma, detected wheezing was the only different finding when children with viral infection were compared with those with only bacterial infection (75.0% vs 0%;
P = 0.008). By multivariable analysis, viral infection (AdjOR 95% CI: 9.6; 95%CI: 2.7‐34.0), asthma (AdjOR 95% CI: 4.6; 95%CI: 1.9‐11.0), and age (AdjOR 95% CI: 0.95; 95%CI: 0.92‐0.97) were independently associated with wheezing on physical examination. The positive predictive value of detected wheezing for viral infection was 96.3% (95% CI: 90.4‐99.1%).
Conclusion
Wheezing detected on physical examination is an independent predictor of viral infection.
Aim
To compare the systemic cytokines/chemokines levels over time during the evolution of children hospitalized with community‐acquired pneumonia (CAP) with and without pneumococcal infection.
...Methods
Children less than 5‐years‐old hospitalized with CAP were prospectively investigated in Salvador, Brazil. Clinical data and biological samples were collected to investigate 20 etiological agents and to determine serum cytokines/chemokines levels on admission and 2 to 4 weeks later. Cases with pneumococcal infection received this diagnosis irrespective of also having other etiologies.
Results
A total of 277 patients were enrolled, however, serum sample was unavailable for cytokine measurement upon admission (n = 61) or upon follow‐up visit (n = 36), etiology was undetected (n = 50) and one patient did not attend the follow‐up visit. Therefore, this study group comprised of 129 cases with established etiology. The median (interquartile range) age and sampling interval was 18 (9‐27) months and 18 (16‐21) days, respectively. Established etiology was viral (52.0%), viral‐bacterial (30.2%), and bacterial (17.8%). Pneumococcal infection was found in 31 (24.0%) patients. Overall, median interleukin‐6 (IL‐6; 10.6 4.7‐30.6 vs 21.0 20.2‐21.7; P = .03), IL‐10 (3.5 3.1‐4.5 vs 20.1 19.8‐20.4; P < .001), and CCL2 (19.3 12.4‐23.2 vs 94.0 67.2‐117.8; P < .001) were significantly higher in convalescent serum samples, whereas median CXCL10 (83.6 36.4‐182.9 vs 14.6 0‐116.6; P < .001) was lower. Acute vs convalescent levels evolution of IL‐10, CCL2, and CXCL10 did not differ among patients with or without pneumococcal infection. However, IL‐6 decreased (27.8 12.3‐48.6 vs 20.8 20.2‐22.6; P = .1) in patients with pneumococcal infection and increased (9.0 4.2‐22.6 vs 21.0 20.2‐21.7; P = .001) in patients without it.
Conclusion
The marked increase of IL‐6 serum levels during the acute phase makes it a potential biomarker of pneumococcal infection among children with CAP.
Not every neonate with congenital Zika virus (ZIKV) infection (CZI) is born with microcephaly. We compared inflammation mediators in CSF (cerebrospinal fluid obtained from lumbar puncture) between ...ZIKV-exposed neonates with/without microcephaly (cases) and controls. In Brazil, in the same laboratory, we identified 14 ZIKV-exposed neonates during the ZIKV epidemic (2015-2016), 7(50%) with and 7(50%) without microcephaly, without any other congenital infection, and 14 neonates (2017-2018) eligible to be controls and to match cases. 29 inflammation mediators were measured using Luminex immunoassay and multidimensional analyses were employed. Neonates with ZIKV-associated microcephaly presented substantially higher degree of inflammatory perturbation, associated with uncoupled inflammatory response and decreased correlations between concentrations of inflammatory biomarkers. The groups of microcephalic and non-microcephalic ZIKV-exposed neonates were distinguished from the control group (area under curve AUC = 1; P < 0.0001). Between controls and those non-microcephalic exposed to ZIKV, IL-1β, IL-3, IL-4, IL-7 and EOTAXIN were the top CSF markers. By comparing the microcephalic cases with controls, the top discriminant scores were for IL-1β, IL-3, EOTAXIN and IL-12p70. The degree of inflammatory imbalance may be associated with microcephaly in CZI and it may aid additional investigations in experimental pre-clinical models testing immune modulators in preventing extensive damage of the Central Nervous System.
To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature.
A comprehensive search was ...conducted in PubMed, by using the expressions: “community-acquired pneumonia” AND “child” AND “etiology” OR “diagnosis” OR “severity” OR “antibiotic”. All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading.
In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25ng/dL was 92% (77–98%) and 93% (90–99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients.
Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.
Fornecer informações de ponta para o manejo de crianças menores de cinco anos com pneumonia adquirida na comunidade, com base nas evidências mais recentes publicadas na literatura.
Uma pesquisa abrangente foi feita no PubMed, com as expressões: “community-acquired pneumonia” + “child” + “etiology” ou “diagnosis” ou “severity” ou “antibiotic”. Todos os artigos encontrados tiveram o título e o resumo lidos e os artigos que relatavam as evidências mais recentes sobre cada assunto foram identificados e recuperados para leitura completa.
Na era das vacinas bacterianas conjugadas amplamente usadas e do uso difundido de técnicas de amplificação de ácidos nucléicos, os vírus respiratórios foram identificados como os agentes causadores mais frequentes de pneumonia adquirida na comunidade em pacientes com menos de cinco anos. A hipoxemia (saturação de oxigênio ≤ 96%) e o aumento do esforço respiratório são os sinais mais associados à pneumonia adquirida na comunidade. A sibilância detectada ao exame físico prediz de forma independente a infecção viral e o valor preditivo negativo (intervalo de confiança de 95%) da radiografia de tórax normal e a procalcitonina sérica <0,25ng/dL foi de 92% (77–98%) e 93% (90–99%), respectivamente. Incapacidade de beber e se alimentar, vomitar todo o alimento, convulsões, retração torácica subcostal, cianose central, letargia, aleteo nasal, estridor e saturação de oxigênio <90% são preditores de óbito e podem ser usados como indicadores de hospitalização. Derrames pleurais moderados/grandes e infiltrados multilobulares são preditores de doença grave. A amoxicilina administrada por via oral é a opção de primeira linha para tratar pacientes ambulatoriais e a ampicilina ou penicilina cristalina G ou amoxicilina (administrada inicialmente por via intravenosa) são as opções de primeira linha para tratar pacientes hospitalizados.
Aspectos distintos da pneumonia adquirida na comunidade durante a infância mudaram durante as últimas três décadas.
Objective
To evaluate the impact of meningococcal C conjugate (MCC) vaccine in Brazil.
Methods
Ecological study assessing all invasive meningococcal disease (IMD) and meningococcal C disease (MenC) ...cases reported in all age groups, from 2001 to 2019. MCC was implemented in 2010. Data were collected on the DATASUS platform. Joinpoint regression was performed to assess the annual percent change (APC) of the incidence rate.
Results
Invasive meningococcal disease incidence decreased in all Brazilian regions from 2001 onwards, without apparent additional reduction attributable to MCC vaccine in the North, Northeast and South. The higher and statistically significant APC reduction in all age groups, in the North and South, and in children <5 years, in the Northeast, occurred between 2001 and 2011 (−15.4%), 2004 and 2012 (−14.4%), and 2001 and 2013 (−10.3%), respectively, before MCC vaccine implementation. Annual incidence of MenC in children under 5 years significantly fell in the North (−6.8%; 2011–2018), Southeast (−40.6%; 2010–2015) and Midwest (−48.6%; 2010–2014), which may be attributable to MCC implementation.
Conclusion
Invasive meningococcal disease and MenC behaved differently after MCC vaccine implementation in Brazil during this 18‐year time‐series analysis. This suggests that the control of IMD should be based on multiple public health care measures and considered on a regional basis.
This study evaluates the early effects of COVID-19 vaccine implementation in the number of cases and deaths due to COVID-19 among those aged < 80 years or ≥ 80 years in the state of Bahia, Brazil. ...For that, we used data from the Bahia state Secretary of Health platform of cases and deaths due to COVID-19 in all age groups, between March 2020 and May 2021, when 82% of COVID-19 vaccines were CoronaVac. Overall, there were 1,012,200 cases and 21,241 deaths due to COVID-19, of which, respectively, 2.3% and 25.3% occurred in patients aged ≥ 80 years. The median proportion of deaths in those ≥ 80 years decreased from 29.8% (27.8%–30.4%) in the pre- to 18.8% (15.6%–18.8%) in the post-vaccine periods (p = 0.04). Significant reduction in the median proportion of deaths from COVID-19 among those aged ≥ 80 years after COVID-19 vaccine implementation was found, which suggests CoronaVac effectiveness against death from COVID-19 in the elderly.
Community-acquired pneumonia (CAP) is the leading cause of mortality among children under 5 years worldwide. However, the choices of chemical therapy for the empirical treatment of CAP are frequently ...debated.
The authors provide an update on the chemical management recommendations for childhood CAP. The authors have performed a MEDLINE literature search, using the keywords 'guidelines,' 'community-acquired pneumonia,' AND 'children.' Articles published in English, providing consensual recommendations on management of children >2 months and <5 years with CAP but without HIV infection, were included. Furthermore, the authors discuss the latest evidence guiding the rational use of antibiotics in young children with CAP.
For the chemical management of CAP, the first-line antibiotic options are amoxicillin (50 mg/kg/day, every 12 h) among ambulatory patients and aqueous penicillin G (200,000 IU/kg/day, every 6 h) or ampicillin (200 mg/kg/day, every 6 h) for hospitalized children. Ceftriaxone can be considered in the treatment of very severe cases. Oxacillin or macrolide may be added in specific situations, if Staphylococcus aureus or atypical bacteria, respectively, are potential etiological agents, although not deemed common. Penicillins remain the first-line choice of antibiotic for the treatment of CAP in young children.
Objective
The frequency and seasonality of viruses in tropical regions are scarcely reported. We estimated the frequency of seven respiratory viruses and assessed seasonality of respiratory syncytial ...virus (RSV) and influenza viruses in a tropical city.
Methods
Children (age ≤ 18 years) with acute respiratory infection were investigated in Salvador, Brazil, between July 2014 and June 2017. Respiratory viruses were searched by direct immunofluorescence and real‐time polymerase chain reaction for detection of RSV, influenza A virus, influenza B virus, adenovirus (ADV) and parainfluenza viruses (PIV) 1, 2 and 3. Seasonal distribution was evaluated by Prais–Winsten regression. Due to similar distribution, influenza A and influenza B viruses were grouped to analyse seasonality.
Results
The study group comprised 387 cases whose median (IQR) age was 26.4 (10.5–50.1) months. Respiratory viruses were detected in 106 (27.4%) cases. RSV (n = 76; 19.6%), influenza A virus (n = 11; 2.8%), influenza B virus (n = 7; 1.8%), ADV (n = 5; 1.3%), PIV 1 (n = 5; 1.3%), PIV 3 (n = 3; 0.8%) and PIV 2 (n = 1; 0.3%) were identified. Monthly count of RSV cases demonstrated seasonal distribution (b3 = 0.626; P = 0.003). More than half (42/76 55.3%) of all RSV cases were detected from April to June. Monthly count of influenza cases also showed seasonal distribution (b3 = −0.264; P = 0.032). Influenza cases peaked from November to January with 44.4% (8/18) of all influenza cases.
Conclusions
RSV was the most frequently detected virus. RSV and influenza viruses showed seasonal distribution. These data may be useful to plan the best time to carry out prophylaxis and to increase the number of hospital beds.
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