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Background: Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected. Methods: We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. Results: Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whomwas treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G. Conclusions: Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy. [ABSTRACT FROM AUTHOR]

In this retrospective multicenter series of 154 children with cerebrospinal fluid shunt infections, the median (interquartile range) duration of antibiotic therapy was 18 (14-26) days. The time to shunt replacement was 14 (10-19) days. Management appeared to potentially differ according to the targeted pathogen and site. [ABSTRACT FROM AUTHOR]

Background Pneumonia causes significant morbidity and mortality in children worldwide, especially in resource-poor settings. Accurate identification of bacterial etiology leads to timely antibiotic initiation, minimizing overuse, and development of resistance. Host biomarkers may improve diagnostic sensitivity and specificity. We assessed the ability of biomarkers to correctly identify bacterial pneumonia in children who present with respiratory distress. Methods A librarian-directed search was conducted of MEDLINE, EMBASE, CENTRAL, Global Health, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to May 2020 with no language restriction. Included studies compared a diagnostic biomarker in children with bacterial pneumonia to those with nonbacterial respiratory distress. Results There were 31 observational studies of 23 different biomarkers. C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were the biomarkers with sufficient data for meta-analysis. Meta-analysis revealed that CRP and PCT best differentiated bacterial from viral pneumonia with CRP summary AUROC (area under the receiver operating characteristic curve) 0.71 (0.69-0.73), Youden index 53 mg/L, sensitivity 0.70 (0.68-0.78), and specificity 0.64 (0.58-0.68) and PCT summary AUROC 0.70 (0.67-0.74), Youden index 0.59 ng/mL, sensitivity 0.69 (0.65-0.77), and specificity 0.64 (0.60-0.68). WBC and ESR did not perform as well. Nineteen other inflammatory and immunologic biomarkers were identified including CRP/mean platelet value, neutrophil/leukocyte ratio, interleukin 6, and interferon-alpha, with sensitivities from 60% to 85% and specificities from 76% to 83%. Conclusion CRP and PCT performed better than WBC and ESR but had suboptimal sensitivity. Some less well-studied novel biomarkers appear to have promise particularly in combination. [ABSTRACT FROM AUTHOR]

Immunization rates in Canada are suboptimal. Strategies such as making immunization mandatory for child care or school entry and financial incentives are used in other countries. Additional strategies that could work in the Canadian context include requiring accurate immunization records at school entry, implementing immunization registries at the provincial/territorial level, educating parents and schoolaged children about vaccine-preventable diseases and making it more convenient for parents to ensure their children are fully immunized. [ABSTRACT FROM AUTHOR]

La méningococcie invasive (MI) est une maladie grave qui est souvent à l'origine d'un sepsis fulminant ou d'une méningite. Au Canada, elle est surtout attribuable aux sérogroupes B et C. Des programmes de vaccination systématique contre le méningocoque du sérogroupe C sont prévus à l'âge de 12 mois, et dans certaines régions sociosanitaires, le calendrier comprend l'administration de doses supplémentaires aux enfants plus jeunes. Les adolescents reçoivent systématiquement une dose de rappel du vaccin contre le sérogroupe C ou d'un vaccin quadrivalent (sérogroupes A, C, W et Y). L'utilisation systématique des vaccins contre le sérogroupe B n'est pas recommandée tant qu'on n'aura pas recueilli de données supplémentaires sur l'efficacité des vaccins sur le marché et la durée de la protection qu'ils confèrent. Cependant, les enfants d'au moins deux mois qui courent un risque accru de MI devraient être vaccinés contre les sérogroupes B et C dans les plus brefs délais. [ABSTRACT FROM AUTHOR]

Invasive meningococcal disease (IMD) is serious, often resulting in fulminant sepsis or meningitis. IMD in Canada is primarily attributable to serogroups B and C. There are routine programs for serogroup C vaccine at 12 months of age, with some jurisdictions routinely providing additional earlier doses. Adolescents routinely receive a booster dose of serogroup C vaccine or of a quadrivalent (serogroups A, C, W and Y) vaccine. Serogroup B vaccines are not recommended for routine use pending further data on the efficacy and duration of protection from the available vaccine. However, children at increased risk for IMD should start immunization for serogroups B and C as soon as possible, assuming that they are at least 2 months of age. [ABSTRACT FROM AUTHOR]

L'effet tératogène du virus Zika (VZIK) a récemment été confirmé. Il faut envisager le diagnostic de syndrome associé à l'infection congénitale à VZIK chez les enfants qui présentent une microcéphalie inexpliquée, des calcifications intracrâniennes, une ventriculomégalie ou des anomalies structurelles majeures du système nerveux central. La prise en charge est en constante évolution, mais des suggestions sont proposées pour les enfants chez qui les constatations évoquent une infection congénitale et ceux nés d'une mère susceptible d'avoir été exposée au virus pendant sa grossesse. [ABSTRACT FROM AUTHOR]

Zika virus (ZIKV) was recently recognized to be teratogenic. The diagnosis of congenital ZIKV syndrome should be considered in children with unexplained microcephaly, intracranial calcifications, ventriculomegaly or major structural central nervous system abnormalities. Management is evolving but suggestions are provided for children with findings compatible with congenital infection and for those born to women with potential exposure during pregnancy. [ABSTRACT FROM AUTHOR]

The article discusses cost-effectiveness point of view, Rajasinghamet al conclude that the preferred regimen for treatment of Clostridiodes difficile infection (CDI) is fidaxomicin for nonsevere CDI.

Although immunization has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. Symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease. Optimally, the diagnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness severity are critical when deciding whether to admit a patient to hospital. Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia .If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). Routine chest radiographs at the end of therapy are not recommended unless clinically indicated. [ABSTRACT FROM AUTHOR]

The incidence and spectrum of severity of RSV infections in SOT or HSCT recipients is not known. From September 2010 through August 2013, pediatricians were surveyed monthly by the CPSP for SOT or HSCT recipients with RSV infection within two yr post-transplant. There were 24 completed case report forms that fit the inclusion criteria (10 HSCT and 14 SOT recipients). Six of 24 cases (25%) remained outpatients, and 11 (46%) were managed on an inpatient ward, while seven (29%) required intensive care of which five required mechanical ventilation and two died of RSV infection. Ten of 23 cases (43%) were nosocomial with these data not recorded for one case. Many transplant recipients recover uneventfully from RSV infection in the first two yr post-transplant. However, severe disease and death also occur. Larger studies are required to establish risk factors for poor outcomes. Prevention of nosocomial RSV should be a priority in transplant recipients. [ABSTRACT FROM AUTHOR]

A systematic review was conducted of the epidemiology, clinical and laboratory features, and outcome of hepatitis E virus infection in children.A systematic review was conducted, seeking all literature relevant to the epidemiology, clinical and laboratory features, and outcome of hepatitis E virus (HEV) infection in children. Transmission is thought to be primarily from fecal–oral transmission, with the role of transmission from animal reservoirs not being clear in children. Worldwide, seroprevalence is <10% up to 10 years of age, with the exception of 1 of 5 studies from India and the sole study from Egypt. Seroprevalence increases with age, but it is not clear if it is increasing over time. The clinical presentation of HEV infection has broad similarities to hepatitis A virus (HAV) infection, with most cases being subclinical. However, HEV differs from HAV in that infectivity is lower, perinatal transmission can result in neonatal morbidity and even mortality, and a chronic carrier state exists, accounting for chronic hepatitis in some pediatric solid organ transplant recipients. [ABSTRACT FROM AUTHOR]

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should he ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy. [ABSTRACT FROM AUTHOR]

Most invasive meningococcal disease in Canada is now caused by serogroup B organisms. A vaccine directed against this serogroup (4CMenB) is newly licensed in Canada. A decision will need to be made by all provinces and territories regarding whether a routine infant immunization program is warranted. This decision will need to take into account factors such as uncertain estimates for the effectiveness of the vaccine, the high incidence of fever from the vaccine and the burden of introducing more injections into the current immunization schedule, and consider them against the potentially preventable mortality and morbidity that result from a rare but very serious disease. [ABSTRACT FROM AUTHOR]

Background The outcome of patients with hepatitis C virus ( HCV) infection acquired during childhood in the absence of antiviral therapy is not clear. Aims The purpose of this study was to review the outcome of untreated HCV acquired in childhood. Only population-based studies were included, as referred cases would be predicted to have more severe disease. Methods A systematic review of the literature was completed up to October 2010 to identify studies where a population was screened for HCV infection that was presumably acquired during childhood. Demographical and clinical data were collected on infected patients who had not been treated with an antiviral. Primary outcome was development of a severe adverse outcome (cirrhosis, hepatoma, need for a liver transplant or liver-related death). Results There were 25 studies reporting a total of 733 infected patients. Liver biopsy results were provided for 180 patients (25%), revealing cirrhosis in eight (1.0% of the total and 4.0% of those who had a biopsy). None of the other patients developed a severe adverse outcome. As a result of the small number of patients with a severe adverse outcome, risk factors for HCV progression could not be identified. Conclusion Although HCV can lead to liver transplantation and death during childhood, the vast majority of patients with disease acquired during childhood have slowly progressive disease. There is no clear indication for antiviral therapy in the majority of children with HCV infection. [ABSTRACT FROM AUTHOR]

Recent studies have described an increase in the incidence of complicated pneumonia in children, primarily caused by Streptococcus pneumoniae. The objective of this study was to determine if the incidence of complicated pneumonias in total and due to different pneumococcal serotypes has changed following the introduction of routine immunization with heptavalent pneumococcal conjugate vaccine (PCV7). A retrospective review of patients admitted to the Stollery Children's Hospital in Edmonton, Alberta with complicated pneumonia between July 1, 1997 and June 30, 2007 (5 years before and after the introduction of PCV7) was completed. There were 34 children in the pre- and 68 in the post-PCV7 era (14.31 and 19.91 per 10,000 discharges, respectively, p = 0.114). Patient characteristics were not significantly different, and pneumococcus was the most common organism isolated (pre: 21% (7/34); post: 26% (18/68), p = 0.515). In patients where serotype data was available, non-vaccine pneumococcal serotypes accounted for 67% (12/18) cases in the post-PVC7 era versus 14% (1/7) in the pre-PCV7 era (p = 0.031). The incidence of non-vaccine serotypes was 0.42 and 3.51 per 10,000 discharges in the pre- and post-PCV7 eras, respectively (p = 0.020). There has been a non-significant trend towards an increase in the incidence of complicated pneumonia following the introduction of PCV7. S. pneumoniae remains the predominant organism identified with non-vaccine serotypes now accounting for almost all cases. Although it is not clear if this increase is attributable to the use of PCV7, expanding pneumococcal serotype coverage has the potential to prevent complicated pneumonia. [ABSTRACT FROM AUTHOR]

Background. Nasopharyngeal (NP) specimens are commonly used for the detection of respiratory viruses, but throat and saliva specimens are easier to obtain. The objective of this study was to compare the viral yield of direct fluorescent antigen detection of NP specimens and nucleic acid amplification tests (NAT) of direct fluorescent antigen-negative NP specimens with the viral yield of NAT of throat swab and saliva specimens. Methods. NP, throat swab, and saliva specimens were obtained from children and adolescents aged ⩽17 years. Direct fluorescent antigen testing of the NP specimen for respiratory syncytial virus, influenza A and B viruses, and parainfluenza virus was performed. If no virus was detected, NAT was performed for these 4 viruses, adenovirus, and human metapneumovirus. If a virus was detected by either method, NAT for the same virus was performed for the corresponding throat swab and saliva specimens. Results. A virus was detected in 105 of the 137 NP specimens. The same virus was detectable by NAT in 87 (83%) of 105 throat swab specimens and 77 (74%) of 104 saliva specimens. The likelihood of viral detection among throat swab and saliva swab specimens was higher when the NP specimen tested positive by direct fluorescent antigen testing, compared with NAT alone, and when the specimens were obtained within 3 days after symptom onset, compared with later in the illness. Conclusions. Throat swab and saliva specimens are inferior to NP specimens for the detection of respiratory viruses but might be acceptable for screening in a setting where it is impractical to obtain an NP specimen. [ABSTRACT FROM AUTHOR]

An influenza A virus (H3N2) of probable swine origin, designated A/Canada/1158/2006, was isolated from a 7-month-old hospitalized child who lived on a communal farm in Canada. The child recovered uneventfully. A serosurvey that used a hemagglutination-inhibition assay for A/Canada/1158/2006 was conducted on 54 of the 90 members of the farm. Seropositivity was demonstrated in the index patient, 4 of 7 household members, and 4 of 46 nonhousehold members; none had a history of hospital admission for respiratory illness in the preceding year. Serologic evidence for this strain of swine influenza was also found in 1 of 10 pigs (12 weeks-6 months of age) on the farm. Human infection with swine influenza virus is underrecognized in Canada, and because viral strains could adapt or reassort into a form that results in efficient human-to-human transmission, routine surveillance of swine workers should be considered as part of pandemic influenza preparedness. [ABSTRACT FROM AUTHOR]

Summary: Herpes simplex virus (HSV) is a rare cause of laryngotracheitis (LT) with only 22 previously reported and confirmed pediatric cases in the literature. It is often associated with immune deficiency states and presents with a severe acute upper airway obstruction commonly requiring intensive care management and artificial ventilation. We present two cases of atypical laryngotracheitis in which HSV was found to be the causative pathogen subsequent to laryngoscopy and microbiologic investigations. While the first case was a previously well 8-month-old girl, the second was a 22-month-old immunosuppressed boy. One-third of the total confirmed cases in the English literature required intensive care management eliciting the setting as a pointer to the diagnosis. Laryngoscopy is a readily available tool for rapid diagnosis and controlled securing of the airway. This step may avoid controversial and potential counter-productive use of systemic steroids in these cases. [Copyright &y& Elsevier]

Background: The clinical, laboratory, and radiological features of malignancy can overlap with those of infection. The purpose of this study was to determine the findings in children who were initially thought to have an infectious disease but ultimately proved to have a malignancy. Methods: The database of patients diagnosed with a malignancy in the Northern Alberta Children's Cancer Program (NACCP) January 1, 1993 to December 31, 2003 was merged with the database of inpatients referred to the infectious diseases service at the Stollery Children's Hospital and charts were reviewed on all patients referred to the infectious diseases consult service prior to the diagnosis of malignancy. Results: An infectious diseases consultation for diagnosis was requested in 21 of 561 patients prior to the confirmation of malignancy, and 3 of these 21 patients had both infection and malignancy (leukemia (N = 13), lymphoma (N = 3), rhabdomyosarcoma (N = 1), Langerhan's cell histiocytosis (N = 1), fibrous histicocytosis (N = 1), ependymoma (N = 1), and neuroblastoma (N = 1). The most common reason for infectious diseases consultation was suspected muskuloskeletal infection (N = 9). A palpable or radiographically enlarged spleen was noted in 11 patients (52%). All but 2 patients had abnormal hematologic parameters while an elevated lactate dehydrogenase (LDH) occurred in 10 patients (48%). Delay of diagnosis because of investigation or therapy for an infectious disease occurred in only 2 patients. Conclusion: It is not common for treatment of pediatric malignancies to be delayed because infection is thought to be the primary diagnosis. However, pediatric infectious diseases physicians should consider malignancy in the differential diagnosis when they see patients with fever and bone pain, unexplained splenomegaly or abnormal complete blood cell counts. Other clues may include hepatomegaly or elevated LDH. [ABSTRACT FROM AUTHOR]

Background: Most cases of echinococcal disease (ED) acquired in Canada are thought to be due to the sylvatic form of Echinococcus granulosus, which may be more benign than ED due to either Echinococcus multilocularis or the pastoral form of E. granulosus. There are limited descriptions of the clinical course and outcome of Canadian patients with ED in the modern era. Methods: A retrospective chart review was performed of patients hospitalized with echinococcal disease (ED) from 1991 to 2001 in Edmonton, Alberta. Results: Forty-two cases of ED were identified of which 19 were definite, 3 probable, and 20 possible. Further analysis was limited to the 22 definite and probable cases, of which 77% were female and 41% aboriginal, with an age range of 5 to 87 years. Nine patients (40%) had pulmonary involvement and 11 (50%) hepatic involvement. One patient had an intracardiac mass presenting as a cerebrovascular event and one had a splenic cyst. Seven of the 22 patients had combined surgical resection and medical treatment, six had surgical resection of the cyst alone, four had cyst aspiration, one had medical treatment alone and four had no specific treatment. There was no mortality attributable to ED but three patients died of unrelated illnesses. Conclusion: Echinococcal disease in northern Alberta has a marked diversity of clinical presentations, and generally has a good prognosis despite a wide variety of therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: An association between Henoch-Schonlein purpura (HSP) and seropositivity for Bartonella henselae (BH) has been described. The objective of this study was to see if such an association exists in northern Alberta. Methods: Immunofluorescent antibody testing utilizing an antigen prepared from B. henselae was undertaken on sera from six children with current HSP, 22 children with remote HSP, and 28 controls that were matched for age. Blood from the six children with current HSP was analysed by polymerase chain reaction (PCR) assay with primers derived from the citrate synthase (gltA) gene for the detection of Bartonella DNA. Results: The seropositivity rate for BH was 61% in cases versus 21% in controls (p < 0.03). The PCR assay was negative in all six current cases. Conclusion: There is an increased seropositivity rate for BH in children with HSP. However, it is not clear if infection with B. henselae or a related Bartonella species can result in HSP, or if the increased seropositivity is from non- specific or cross-reacting antibodies. [ABSTRACT FROM AUTHOR]

Background: It is now common for parents to measure tympanic temperatures in children. The objective of this study was to assess the diagnostic accuracy of these measurements. Methods: Parents and then nurses measured the temperature of 60 children with a tympanic thermometer designed for home use (home thermometer). The reference standard was a temperature measured by a nurse with a model of tympanic thermometer commonly used in hospitals (hospital thermometer). A difference of ≥ 0.5 ଌ was considered clinically significant. A fever was defined as a temperature ≥ 38.5 ଌ. Results: The mean absolute difference between the readings done by the parent and the nurse with the home thermometer was 0.44 ≥ 0.61 ଌ, and 33% of the readings differed by ≥ 0.5 ଌ. The mean absolute difference between the readings done by the parent with the home thermometer and the nurse with the hospital thermometer was 0.51 ≥ 0.63 ଌ, and 72 % of the readings differed by ≥ 0.5 ଌ. Using the home thermometer, parents detected fever with a sensitivity of 76% (95% CI 50-93%), a specificity of 95% (95% CI 84-99%), a positive predictive value of 87% (95% CI 60-98%), and a negative predictive value of 91% (95% CI 79-98 %). In comparing the readings the nurse obtained from the two different tympanic thermometers, the mean absolute difference was 0.24 ± 0.22 ଌ. Nurses detected fever with a sensitivity of 94% (95 % CI 71-100 %), a specificity of 88% (95% CI 75-96 %), a positive predictive value of 76% (95% CI 53-92%), and a negative predictive value of 97% ( 5%CI 87-100 %) using the home thermometer. The intraclass correlation coefficient for the three sets of readings was 0.80, and the consistency of readings was not affected by the body temperature.Conclusions: The readings done by parents with a tympanic thermometer designed for home use differed a clinically significant amount from the reference standard (readings done by nurses with a model of tympanic thermometer commonly used in hospitals) the majority of the time, and parents failed to detect fever about one-quarter of the time. Tympanic readings reported by parents should be interpreted with great caution. [ABSTRACT FROM AUTHOR]

The case of a 9-year-old girl with acute encephalopathy with evidence of influenza B virus infection and bilateral basal ganglia lesions is reported. The literature on acute necrotizing encephalopathy is reviewed, and other causes of bilateral basal ganglia lesions are discussed. [Copyright &y& Elsevier]

Physicians often must select antibiotics for patients who are reported to have an antibiotic allergy. For penicillins, the sensitivity of penicillin skin testing for predicting serious allergic reactions is excellent. For other β-lactam antibiotics, penicillin skin testing is useful for excluding the possibility of sensitivity to the β-lactam ring. For other antibiotics, the patient history remains the most useful tool for determining whether a serious reaction is likely to occur with further drug exposure. The cross-reactivity between penicillins and second- or third-generation cephalosporins (excluding cefamandole) is probably no higher than is the cross-reactivity between penicillins and other classes of antibiotics. When a patient has a suspected immunoglobulin E-mediated antibiotic allergy, desensitization therapy should be considered, if the efficacy of alternate antibiotics is in doubt. For the treatment of serious infections, it is usually possible to safely administer the antibiotic of choice despite a history of possible antibiotic allergy, [ABSTRACT FROM AUTHOR]

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made. [ABSTRACT FROM AUTHOR]

SummaryCorrespondence on: The cost-effectiveness of palivizumab for respiratory syncytial virus prophylaxis in premature infants with a gestational age of 32–35 weeks: a Canadian-based analysis [Lanctôt KL et al., Curr Med Res Opin 2009; 24: 3223-37; doi:10.1185/03007990802484234] [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses the lessons learned by the journal "Paediatrics & Child Health" (PCH) since its operation, its mission, and changes made to the layout and design.

Presents a medical case of a 10-year-old boy with sinus arrest and atrioventricular block secondary to erythromycin-induced carbamazepine toxicity. Description of the patient's condition and the medical treatment given; Discussion on the physiologic effect of carbamazepine.

Nontyphoidal Salmonella (NTS) infections are primarily transmitted by contaminated food or water or contact with carrier animals (particularly reptiles), and present with diarrhea. Antibiotics do not decrease the severity or duration of diarrhea and may increase the incidence of NTS carriage, so they should only be used with suspected or proven bacteremia or invasive infection. Typhoid/paratyphoid fever manifests as bacteremia within 60 days of travel to resource-poor countries and presents with fever and variable abdominal complaints. Therefore, blood cultures are indicated for unexplained fever and a relevant travel history. When blood cultures are positive or when a child is unwell pending blood culture results, ceftriaxone is indicated. A switch to oral antibiotics (usually azithromycin) is often possible after blood cultures have cleared and the child is improved. [ABSTRACT FROM AUTHOR]

Les infections à Salmonella non typhiques (SNT) sont surtout transmises par des aliments ou de l'eau contaminés ou par contact avec des animaux porteurs (notamment des reptiles) et se manifestent par de la diarrhée. Les antibiotiques ne limitent ni la gravité ni la durée de la diarrhée et peuvent accroître l'incidence de portage de SNT. Ils ne doivent donc être utilisés qu'en cas de bactériémie ou d'infection invasive présumée ou démontrée. La fièvre typhoïde ou paratyphoïde se révèle par une bactériémie dans les 60 jours suivant un voyage vers des pays pauvres en ressources, accompagnée de fièvre et de divers troubles abdominaux. Ainsi, des hémocultures sont indiquées en cas de fièvre inexpliquée et d'histoire de voyage pertinente. Lorsque les hémocultures sont positives ou qu'on n'en a pas encore obtenu les résultats et que l'enfant est malade, la ceftriaxone est indiquée. Il est souvent possible de passer à des antibiotiques par voie orale (généralement de l'azithromycine) après que les hémocultures sont devenues négatives et que l'état de l'enfant s'est amélioré. [ABSTRACT FROM AUTHOR]

Background: There are no narrative or systematic reviews of hearing loss in patients with congenital syphilis. Objectives: The aim of this study was to perform a scoping review to determine what is known about the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis. Eligibility criteria: PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), Proquest Dissertations and Theses Global, and SCOPUS were searched from inception to March 31, 2023. Articles were included if patients with hearing loss were screened for CS, ii) patients with CS were screened for hearing loss, iii) they were case reports or case series that describe the characteristics of hearing loss, or iv) an intervention for hearing loss attributed to CS was studied. Sources of evidence: Thirty-six articles met the inclusion criteria. Results: Five studies reported an incidence of CS in 0.3% to 8% of children with hearing loss, but all had a high risk of bias. Seven reported that 0 to 19% of children with CS had hearing loss, but the only one with a control group showed comparable rates in cases and controls. There were 18 case reports/ case series (one of which also reported screening children with hearing loss for CS), reporting that the onset of hearing loss was usually first recognized during adolescence or adulthood. The 7 intervention studies were all uncontrolled and published in 1983 or earlier and reported variable results following treatment with penicillin, prednisone, and/or ACTH. Conclusions: The current literature is not informative with regard to the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Preventing hospitalizations for respiratory syncytial virus infection" in the August/September 2015 issue is presented.

A growing antivaccine movement in Canada and elsewhere is hearing more about an unproven homeopathic therapy, 'nosodes', as an alternative to routine vaccines. The present statement defines nosodes and describes limitations for their use in children. There is scant evidence in the medical literature for either the efficacy or safety of nosodes, which have not been well studied for the prevention of any infectious disease in humans. Recommendations to change the labelling on these products to reflect such limitations are made. [ABSTRACT FROM AUTHOR]

An editorial is presented on practical aspects of diagnosis or treatment of diseases in children and youth. Topics discussed include developments have practical implications for clinicians; diagnostic dilemma or dramatic illustrations of a condition; and quality improvement initiatives with outcome data or novel solutions to patient safety issues.

Abstract: A 9-week-old infant presented with respiratory distress. The presumptive diagnosis of Chlamydia trachomatis pneumonia was ultimately made in a novel manner by a positive nucleic acid amplification test on a urine sample. [Copyright &y& Elsevier]

• Cell-mediated immunity assays help resolve CMV status when passive antibodies exist. • Flow cytometry detected CMV-specific CD4+Tcells useful to assign CMV status pre-SOT. • CD27-CD28-CD4 + T cell analysis lacks specificity in assignment of CMV status pre-SOT. • CMV DNA is rarely detected in blood/urine of CMV-seropositive adults awaiting SOT. Background/objectives: Determination of Cytomegalovirus (CMV) status in solid organ transplant (SOT) candidates is essential to stratify risk of post-transplant CMV disease. Passive transfusion-acquired antibodies can make serologic determination of CMV status unreliable. We evaluated 3 assays, not affected by passive antibodies (PA), in assignment of CMV status: quantification of CMV-specific CD4 + T-cells (CMV-TC) and exhausted CD27-CD28- CD4 + T-cells, and detection of CMV DNA with Nucleic Acid Amplification Testing (NAAT). Study design: We enrolled 50 adults awaiting SOT and 50 immunocompetent age-matched controls, and collected a throat swab, urine, saliva and blood sample on each. Using flow cytometry CD4 + T-cells were phenotypically analyzed for expression of CD27 and CD28 and CMV-specific CD4 + T-cells were identified by CD69 expression and intracellular IFN-γ quantification after stimulation with CMV-antigen lysate. CMV NAAT was performed on all specimens using real-time PCR. CMV serology (CMV IgG) was determined by enzyme immunoassay. Subjects were considered to have potential PA if they received blood products within 2 months of collection. Results: The CMV-TC assay discriminated between CMV-seropositive and seronegative SOT candidates without PA well (sensitivity 79%, specificity 93%) while the CD27-CD28-CD4 + T-cell assay had good sensitivity (86%) but specificity of 74%. Detection of CMV DNA was uncommon in CMV-seropositive SOT candidates (2/21). Conclusions: Given its high specificity, the CMV-TC assay is valuable in confirming true-positive CMV status in seropositive SOT candidates with PA, while use of CD27-CD28-CD4 + T-cell analysis is limited by moderate specificity. Detection of CMV DNA is of limited value in assignment of CMV status in adults. [ABSTRACT FROM AUTHOR]

Canadian clinical practice guidelines currently recommend risk-based screening for HCV in pregnant individuals. However, no provinces or territories have ever compared the effectiveness of risk-based vs. universal screening for the prenatal diagnosis of HCV. We aimed to evaluate and compare HCV screening programs after implementing a universal population-level pilot program among prenatal patients in Alberta, Canada. The Alberta Prenatal Screening Program for Select Communicable Diseases was amended to include universal HCV antibody screening. Cohorts of pregnant individuals screened for HCV through risk-based or universal programs were generated over 1-year periods. HCV screening rates and prevalence were analyzed and compared between cohorts to evaluate the effectiveness of screening methods. Social and demographic risk factors for HCV-positive individuals were compared between screening cohorts to identify which populations may be overlooked with risk-based guidelines. HCV antibody screening rates were 11.9% and 99.9% among pregnant individuals in the risk-based and universal cohorts, respectively. HCV prevalence among the cohorts was 0.07% and 0.11% (difference = 0.04%, p = 0.032), with an average of 21 additional HCV-positive pregnant individuals identified annually with universal screening. HCV-positive pregnant patients diagnosed through universal screening were more likely to engage in high-risk sexual behaviours/sex work compared to those diagnosed through risk-based screening (47.6% vs. 12.5%, respectively p = 0.035), suggesting that these high-risk cases are being missed by risk-based screening. Universal HCV screening diagnoses significantly higher numbers of pregnant individuals infected with HCV compared to risk-based screening. Universal HCV screening or amending risk-based guidelines to incorporate more proxy variables for risk factors should be considered to improve prenatal HCV screening guidelines in Canada and help achieve HCV elimination in the next decade. HCV is a bloodborne pathogen that can cause severe liver disease and be vertically transmitted from a mother to her baby during pregnancy. Pregnant individuals in Alberta are currently only tested for HCV if they disclose engaging in activities that put them at risk of acquiring the infection (risk-based screening). Using a population-wide universal prenatal HCV screening program, our work shows that testing based on patient disclosed risk alone leads to the significant underdiagnosis of HCV in pregnant individuals and suggests individuals engaging in sex work or risky sexual behaviours are being overlooked by the current risk-based program. Our outcomes represent the first province-wide study to evaluate and compare prenatal HCV risk-based and universal screening programs in Canada and provide evidence to support the update of prenatal HCV screening policies across the country and in similar jurisdictions. [Display omitted] • Risk-based screening leads to significant underdiagnosis of prenatal HCV. • Universal screening captures more individuals engaging in high-risk sex behaviours. • Significantly more new HCV cases are identified with universal screening. • The prenatal prevalence of HCV is similar to that of HBV and double that of HIV. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia" by N. J. Gadsby and colleagues.

The article features Doctor Noni McDonald from the Department of Paediatrics at the University of Alberta in Edmonton, Alberta. Topics include MacDonald being the inaugural editor of the "Paediatrics & Child Health" (PCH) journal of the Canadian Paediatric Society 20 years ago. Also mentioned are PCH achieving the major milestone of being indexed in PubMed as well as McDonald being part of the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO).

A photo quiz concerning the infectious diseases of the infants is presented.

Presents a research letter to the 'Canadian Medical Association Journal' on the prevention of perinatal transmission of HIV infection in Alberta, Canada. Methods; Results; Suggestion that there should be public health programs aimed at reducing the burden of HIV and hepatitis C illnesses among Aboriginal women of reproductive age.

A letter to the editor is presented in response to the article related to meningococcal serogroup B vaccine.