Abstract
Background
Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections (ARIs) in hospitalized children. Although prematurity and underlying medical conditions are ...known risk factors, most of these children are healthy, and factors including RSV load and subgroups may contribute to severity. Therefore, we aimed to evaluate the role of RSV in ARI severity and determine factors associated with increased RSV-ARI severity in young children.
Methods
Children aged <5 years with fever and/or ARI symptoms were recruited from the emergency department (ED) or inpatient settings at Vanderbilt Children’s Hospital. Nasal and/or throat swabs were tested using quantitative reverse-transcription polymerase chain reaction for common respiratory viruses, including RSV. A severity score was calculated for RSV-positive children.
Results
From November 2015 through July 2016, 898 participants were enrolled, and 681 (76%) had at least 1 virus detected, with 191 (28%) testing positive for RSV. RSV-positive children were more likely to be hospitalized, require intensive care unit admission, and receive oxygen compared with children positive for other viruses. Higher viral load, White race, younger age, and higher severity score were independently associated with hospitalization in RSV-positive children. No differences in disease severity were noted between RSV A and RSV B.
Conclusions
RSV was associated with increased ARI severity in young children enrolled from the ED and inpatient settings, but no differences in disease severity were noted between RSV A and RSV B. These findings emphasize the need for antiviral therapy and/or preventive measures such as vaccines against RSV in young children.
Respiratory syncytial virus (RSV) is associated with increased severity compared to other viruses in young children. Differences in RSV A and RSV B clinical presentation, but not severity, were noted. A severity score at presentation predicted intensive care unit admission.
ABSTRACT
The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the ...global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.
The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population have been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs in pediatric healthcare, and the challenges of pediatric ASP as seen by the authors.
ABSTRACT
Introduction
Haemophilus influenzae (Hi) is subdivided into typeable (a–f) and non‐typeable groups. Hi serotype b (Hib) has historically been one of the important pathogens responsible for ...invasive infection. However, after widespread Hib vaccination, the emergence of other Hi serotypes, specifically Hi serotype a (Hia), was noted during the last few decades, mostly in children younger than 5 years of age.
Case presentation
We present two cases of severe intracranial infections with detected Hia in patients > 5 years of age within a short time frame and within the same geographic area.
Conclusion
Epidemiological studies and surveillance on Hia‐related illnesses in all age groups worldwide are needed to better understand the clinical and epidemiological characteristics of Hia. This can establish a platform to develop a candidate vaccine against Hia that might protect children of all ages.
Report of Haemophilus influenzae serotype A intracranial infections in older children.
Parainfluenza virus (PIV) is a leading cause of acute respiratory illness (ARI) in children. However, few studies have characterized the clinical features and outcomes associated with PIV infections ...among young children in the Middle East.
We conducted hospital-based surveillance for ARI among children < 2 years of age in a large referral hospital in Amman, Jordan. We systematically collected clinical data and respiratory specimens for pathogen detection using reverse transcription polymerase chain reaction. We compared clinical features of PIV-associated ARI among individual serotypes 1, 2, 3, and 4 and among PIV infections compared with other viral ARI and ARI with no virus detected. We also compared the odds of supplemental oxygen use using logistic regression.
PIV was detected in 221/3168 (7.0%) children hospitalized with ARI. PIV-3 was the most commonly detected serotype (125/221; 57%). Individual clinical features of PIV infections varied little by individual serotype, although admission diagnosis of 'croup' was only associated with PIV-1 and PIV-2. Children with PIV-associated ARI had lower frequency of cough (71% vs 83%; p < 0.001) and wheezing (53% vs 60% p < 0.001) than children with ARI associated with other viruses. We did not find a significant difference in supplemental oxygen use between children with PIV-associated infections (adjusted odds ratio aOR 1.12, 95% CI 0.66-1.89, p = 0.68) and infections in which no virus was detected.
PIV is frequently associated with ARI requiring hospitalization in young Jordanian children. Substantial overlap in clinical features may preclude distinguishing PIV infections from other viral infections at presentation.
Rhinovirus (RV) is one of the most common etiologic agents of acute respiratory infection (ARI), which is a leading cause of morbidity and mortality in young children. The clinical significance of RV ...co-detection with other respiratory viruses, including respiratory syncytial virus (RSV), remains unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI-associated RV-only detection and those with RV co-detection-with an emphasis on RV/RSV co-detection.
We conducted a prospective viral surveillance study (11/2015-7/2016) in Nashville, Tennessee. Children < 18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of < 14 days duration were eligible if they resided in one of nine counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1-4, and influenza A-C using reverse transcription quantitative polymerase chain reaction assays. We compared the clinical characteristics and outcomes of children with RV-only detection and those with RV co-detection using Pearson's χ
test for categorical variables and the two-sample t-test with unequal variances for continuous variables.
Of 1250 children, 904 (72.3%) were virus-positive. RV was the most common virus (n = 406; 44.9%), followed by RSV (n = 207; 19.3%). Of 406 children with RV, 289 (71.2%) had RV-only detection, and 117 (28.8%) had RV co-detection. The most common virus co-detected with RV was RSV (n = 43; 36.8%). Children with RV co-detection were less likely than those with RV-only detection to be diagnosed with asthma or reactive airway disease both in the ED and in-hospital. We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and those with RV co-detection.
We found no evidence that RV co-detection was associated with poorer outcomes. However, the clinical significance of RV co-detection is heterogeneous and varies by virus pair and age group. Future studies of RV co-detection should incorporate analyses of RV/non-RV pairs and include age as a key covariate of RV contribution to clinical manifestations and infection outcomes.
Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection (ARI) in young children worldwide. Multiple factors affect RSV disease severity, and data regarding differences ...between RSV subtypes severity are controversial. This study aimed to evaluate the clinical characteristics, seasonality and severity of RSV subtypes in children.
As part of a prospective ARI surveillance study conducted from March 2010 to March 2013 in Amman, Jordan, children less than 2 years with fever and/or respiratory symptoms were enrolled. Demographic and clinical characteristics were collected through parental interviews and medical chart review. The treating physician collected severity score data at admission. Nasal and throat swabs were collected and tested. Multivariable regression models were used to compare the odds of increased disease severity across a priori selected predictors of interest.
Overall, 1397/3168 (44%) children were RSV positive, with a mean age of 5.3 months (±4.8 SD), 59.7% were male, 6.4% had an underlying medical condition (UMC), 63.6% were RSV-A positive, 25.2% were RSV-B positive, 0.6% were positive for both, and 10.6% could not be typed. Both RSV subtypes peaked in January-March of each year. RSV A-positive children were more likely to present with decreased appetite but less likely to have viral co-detection than RSV B-positive children. Independent factors associated with RSV disease severity included cycle threshold value, vitamin D level, age, UMC, prematurity and severity score, but not RSV subtypes.
RSV subtypes co-circulated and had similar severity profiles; future preventive and treatment measures should target both subtypes.
The most common clinical manifestation of adenovirus (AdV) infection is acute respiratory illness (ARI). Specific AdV species associated with ARI hospitalizations are not well defined in the Middle ...East.
A viral surveillance study was conducted among children <2 years hospitalized in Amman, Jordan, from March 2010 to March 2013. Nasal and throat respiratory specimens were obtained from enrolled children and tested for viruses using a real-time reverse-transcription quantitative polymerase chain reaction. AdV-positive specimens were typed by partial hexon gene sequencing. Demographic and clinical features were compared between AdV detected as single pathogen versus co-detected with other respiratory viruses, and between AdV-B and AdV-C species.
AdV was detected in 475/3168 (15%) children hospitalized with ARI; of these, 216 (45%) specimens were successfully typed with AdV-C as the most common species detected (140/216; 65%). Children with AdV-single detection (88/475; 19%) had a higher frequency of fever (71% vs. 56%; P=0.015), diarrhea (18% vs. 11%; p=0.048), and/or seizures/abnormal movements (14% vs. 5%; p=0.003). Children with AdV co-detected with other viruses more likely required oxygen support adjusted odds ratio (aOR) 1.91 (95% CI: 1.08, 3.39), P = 0.027 than those with AdV-single detection. Children with AdV-C had higher odds of co-detections with other viruses compared with those with AdV-B aOR 4.00 (95% CI: 1.91, 8.44), P < 0.001.
Clinical differences were identified between AdV-single and AdV co-detected with other viruses, and between AdV-B and AdV-C. Larger studies with AdV typing are needed to determine additional epidemiological and clinical differences between specific AdV species and types.
•This is a retrospective study of children with ARI whose HAdV-positive respiratory specimens were typed by specific qPCR assay.•The most common HAdV species detected were HAdV-B and HAdV-C•Patients ...with HAdV-C had higher odds of being admitted compared to those with HAdV-B.•No sufficient evidence of an association between HAdV species and co-detection with other respiratory viruses were found.
Human adenovirus (HAdV) species B, C, and E are commonly associated with acute respiratory illnesses (ARI). We sought to determine the association between HAdV species and ARI severity in children over one respiratory season at Monroe Carell Jr. Children's Hospital at Vanderbilt.
We conducted a retrospective cohort study of children with HAdV from a provider-ordered BioFire® FilmArray Respiratory Pathogen Panel 2.0 (RPP) from 05/2018−06/2019. Type-specific PCR assays for HAdV-B3, B7, B11, B14, B16, B21, HAdV-C1, C2, C5, C6, and HAdV-E4 were performed. Demographics, clinical characteristics, and outcome data were compared between HAdV species.
Of 4514 respiratory specimens collected, 2644 (59 %) had at least one pathogen detected by RPP, and 384 (15 %) were HAdV-positive; 342 (89 %) were available for research testing with 306 (89 %) specimens from unique symptomatic individuals; 237 (77 %) were positive for the following species: 104 (44 %) HAdV-B, 114 (48 %) HAdV-C, 9 (4%) HAdV-E, and 10 (4%) with co-detection between species. The majority with identified HAdV species were seen in the ED (62 %), and approximately one-third were hospitalized. Patients with HAdV-C were more likely to be younger, hospitalized, and have a higher frequency of seizures compared to HAdV-B.
HAdV-C and HAdV-B were the most common species detected, with differences in clinical characteristics and outcomes noted. Additional studies with larger sample sizes focusing on a high-risk pediatric population are necessary to determine if differences in illness severity across individual HAdV types exist to guide further type-specific HAdV vaccine development.
Rhinovirus (RV)‐specific surveillance studies in the Middle East are limited. Therefore, we aimed to study the clinical characteristics, outcomes, and seasonality of RV‐associated acute respiratory ...infection among hospitalized young children in Jordan. We conducted a prospective viral surveillance study and enrolled children <2 years old admitted to a large public hospital in Amman, Jordan (2010–2013). Demographic and clinical data were collected by structured interviews and chart ions. Nasal and/or throat swabs were collected and tested for a panel of respiratory viruses, and RV genotyping and speciation was performed. At least one virus was detected in 2641/3168 children (83.4%). RV was the second most common virus detected (n = 1238; 46.9%) and was codetected with another respiratory virus in 730 cases (59.0%). Children with RV codetection were more likely than those with RV‐only detection to have respiratory distress but had similar outcomes. RV‐A accounted for about half of RV‐positive cases (54.7%), while children with RV‐C had a higher frequency of wheezing and reactive airway disease. RV was detected year‐round and peaked during winter. In conclusion, though children with RV codetection had worse clinical findings, neither codetection nor species affected most clinical outcomes.
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