Coping with MRSA Fernando, A.M.R.; McQueen, Susan; Sharland, Mike
Current paediatrics,
10/2005, Letnik:
15, Številka:
5
Journal Article
The proportion of
Staphylococcus aureus that is methicillin resistant has been rising in children. Active steps need to be taken to ensure that the problem of methicillin-resistant
S. aureus (MRSA) ...does not escalate. The clinical disease pattern ranges from long-term colonisation with MRSA to death, and can be affected by genes such as the Panton–Valentine-leukocidin gene. Antibiotic management varies from oral treatment with agents such as clindamycin to parenteral treatment. Newer antibiotics, such as linezolid, are being used and can be beneficial when vancomycin resistance is present. The judicious use of antibiotics is essential if multi-resistant strains of MRSA are not to become more prevalent. The availability of newer antibiotics, such as linezolid, provide challenges in avoiding overprescription (which can result in wider resistance) and should be used in conjunction with specialist microbiology or infectious diseases advice. Basic measures such as good handwashing technique and a clean hospital environment cannot be overemphasised.
An 11-y-old girl diagnosed with HIV-1, presented with prolonged pyrexia and a non-reactive tuberculin skin test. An INF-γ assay (ELISpot) was positive and led to administration of tuberculosis ...treatment. Positive cultures for Mycobacterium tuberculosis followed 6 weeks later. INF-γ assays should be considered as first line investigations in HIV-1 infected subjects when TB is a diagnostic possibility.
The molecular genetic relationship between esophageal adenocarcinoma (EAC) and its precursor lesion, Barrett's esophagus, is poorly understood. Using whole-genome sequencing on 23 paired Barrett's ...esophagus and EAC samples, together with one in-depth Barrett's esophagus case study sampled over time and space, we have provided the following new insights: (i) Barrett's esophagus is polyclonal and highly mutated even in the absence of dysplasia; (ii) when cancer develops, copy number increases and heterogeneity persists such that the spectrum of mutations often shows surprisingly little overlap between EAC and adjacent Barrett's esophagus; and (iii) despite differences in specific coding mutations, the mutational context suggests a common causative insult underlying these two conditions. From a clinical perspective, the histopathological assessment of dysplasia appears to be a poor reflection of the molecular disarray within the Barrett's epithelium, and a molecular Cytosponge technique overcomes sampling bias and has the capacity to reflect the entire clonal architecture.
Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a ...UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.
Abstract
Background
Recent studies have shown a decrease in CD4 count during adolescence in young people with perinatally acquired human immunodeficiency virus (HIV, PHIV).
Methods
Young people with ...PHIV in the United Kingdom, followed in the Collaborative HIV Paediatric Study who started antiretroviral therapy (ART) from 2000 onward were included. Changes in CD4 count over time from age 10 to 20 years were analyzed using mixed-effects models, and were compared to published CD4 data for the gerneral population. Potential predictors were examined and included demographics, age at ART start, nadir CD4 z score (age-adjusted) in childhood, and time-updated viral load.
Results
Of 1258 young people with PHIV included, 669 (53%) were female, median age at ART initiation was 8.3 years, and the median nadir CD4 z score was −4.0. Mean CD4 count was higher in young people with PHIV who started ART before age 10 years and had a nadir CD4 z score ≥−4; these young people with PHIV had a decline in CD4 count after age 10 that was comparable to that of the general population. Mean CD4 count was lower in young people with PHIV who had started ART before age 10 and had a nadir CD4 z score <−4; for this group, the decline in CD4 count after age 10 was steeper over time.
Conclusions
In children, in addition to starting ART at an early age, optimizing ART to maintain a higher CD4 z score during childhood may be important to maximizing immune reconstitution later in life.
Young people with human immunodeficiency virus who started antiretroviral therapy before age 10 years and had a nadir CD4 z score <-4 in childhood, had a decline in CD4 count after age 10 steeper than that of the general population.
Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/evolution-of-cd4-t-cell-count-with-age-in-a-cohort-of-young-people-growing-up-with-perinatally-acquired-hiv-e628fcfc-4e7a-4d1f-b878-ebf12b31f134
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