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Mycoplasma hominis (M hominis) is a rare cause of neonatal bacterial meningitis. Treatment can be challenging because of M hominis' intrinsic antibiotic resistance and the difficulty in accessing antimicrobial susceptibility testing. In this report, we describe an extremely preterm male infant with seizures who had a subsequent diagnosis of M hominis meningitis. Because of severity of illness, doxycycline (4 mg/kg IV every 24 hours) and moxifloxacin (5 mg/kg IV every 24 hours) were started empirically. Repeat cerebrospinal fluid cultures were negative and showed decreasing pleiocytosis. Given the concentration-dependent killing of moxifloxacin and concern for endovascular infection from a concomitant cerebral venous sinus thrombosis, serum concentrations of moxifloxacin were obtained to estimate pharmacokinetic and pharmacodynamic parameters. These were compared to the targets described in other case reports of M hominis meningitis. The maximum serum concentration (Cmax) was 2.5 mg/L, volume of distribution was 2.2 L/kg, clearance was 0.18 L/kg/hr, terminal half-life was 8.6 hours, and area-under-the-concentration-time curve (AUC) was 28.1 mg•hr/L. Using the range of minimum inhibitory concentrations (MICs) reported in the literature, the estimated Cmax/MIC for this patient was 21 to 158 (target Cmax/MIC: >10) and AUC/MIC was 234 to 1757 (target AUC/MIC: ≥100). Doxycycline and moxifloxacin were continued for 6 weeks. No adverse events to moxifloxacin or doxycycline were observed in the NICU. This report describes the successful treatment of M hominis neonatal meningitis and adds to the knowledge of pharmacokinetic and pharmacodynamic parameters of moxifloxacin in neonates. Additional data will help to confirm the role for routine therapeutic drug monitoring of moxifloxacin in neonates.

Background Influenza virus infection is an important cause of under-five mortality. Maternal vaccination protects children younger than 3 months of age from influenza infection. However, it is unknown to what extent paediatric influenza-related mortality may be prevented by a maternal vaccine since global age-stratified mortality data are lacking. Methods We invited clinicians and researchers to share clinical and demographic characteristics from children younger than 5 years who died with laboratory-confirmed influenza infection between January 1, 1995 and March 31, 2020. We evaluated the potential impact of maternal vaccination by estimating the number of children younger than 3 months with in-hospital influenza-related death using published global mortality estimates. Findings We included 314 children from 31 countries. Comorbidities were present in 166 (53%) children and 41 (13%) children were born prematurely. Median age at death was 8·6 (IQR 4·5–16·6), 11·5 (IQR 4·3–24·0), and 15·5 (IQR 7·4–27·0) months for children from low- and lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs), respectively. The proportion of children younger than 3 months at time of death was 17% in LMICs, 12% in UMICs, and 7% in HICs. We estimated that 3339 annual influenza-related in-hospital deaths occur in the first 3 months of life globally. Interpretation In our study, less than 20% of children is younger than 3 months at time of influenza-related death. Although maternal influenza vaccination may impact maternal and infant influenza disease burden, additional immunisation strategies are needed to prevent global influenza-related childhood mortality. The missing data, global coverage, and data quality in this study should be taken into consideration for further interpretation of the results. Funding Bill & Melinda Gates Foundation.

The focus of this review is on human adenovirus (HAdV) infections in immunocompetent children. HAdV infections are ubiquitous among children under 5 years of age. To date, over 100 different HAdV genotypes have been identified using genomic and bioinformatic analyses. While the vast majority of infections are mild or asymptomatic, severe, life-threatening manifestations including respiratory failure, meningoencephalitis, myocarditis, and disseminated disease can occur in otherwise healthy infants and children. Neonates are at highest risk of severe or disseminated infection, especially within the first 2 weeks of life. Microbiologic diagnosis of HAdV infection is helpful in cases of severe or disseminated disease or in outbreak settings. Molecular detection is the preferred diagnostic method. Evidence for antiviral therapy is limited, but may be warranted in immunocompetent children with severe disease. Hand hygiene, droplet/contact measures, and use of disinfectants are the mainstay for infection prevention in institutional settings. While a live, oral vaccine for types 4 and 7 is available, its use is restricted to military personnel. HAdV infections in immunocompetent children encompass a wide spectrum of clinical disease. Further research is required in understanding host and viral factors that predispose immunocompetent children to severe infection and to determine what treatments are most effective in those with severe disease.

Highlights • Third-generation cephalosporins are common first line agents to empirically treat typhoid fever. • An outbreak of extensively-drug resistant (XDR) typhoid has emerged in Pakistan that is resistant to ceftriaxone. • This is the first Canadian case of XDR typhoid in a child who travelled to Pakistan and was successfully treated with 2 weeks of meropenem. • Clinicians should consider adapting their empiric management of typhoid for travellers returning from XDR regions., We report on a three year-old male who contracted enteric fever during a visit to the Sindh province of Pakistan in the summer of 2018. He was diagnosed after returning to Canada and blood cultures isolated Salmonella enterica serovar Typhi which harbored extensive drug-resistance (XDR) to all first-line antibiotics including ceftriaxone. Empiric ceftriaxone was switched to meropenem and he was successfully treated with a two-week course. An outbreak of XDR typhoid is currently emerging from Pakistan and several outbreak-related cases have been identified in the U.K and U.S. Whole genome sequencing confirmed that our child was infected with the XDR outbreak-strain. Current empiric antimicrobial choices will result in treatment failure if an XDR strain is encountered, therefore clinicians must adapt their empiric approach for those returning from high risk regions. This is the first XDR typhoid case in Canada and the first pediatric case to be diagnosed and treated outside of Pakistan. Clinicians must be vigilant of future cases.

In this study, 108 eyes of 62 patients had photorefractive keratectomy (PRK) with a 193 nm excimer laser to correct myopia. The eyes were assigned to one of three groups: low, moderate, or high myopia. Six months after PRK, 88.9% of eyes in the low myopia group, 90.0% in the moderate myopia group, and 23.8% in the high myopia group achieved an uncorrected visual acuity of 20/40 or better. In the low myopia group, 88.9% were within ±1 diopter (D) of attempted correction, as were 70.0% in the moderate group and 18.8% in the high myopia group. There were no significant complications. We conclude that excimer laser PRK appears to be a safe and relatively accurate procedure to correct low to moderate myopia but not high myopia because of regression over time.