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Background Infections are responsible for morbidity and mortality in children on hemodialysis (HD). Procalcitonin (PCT) is rarely used in this population, even though it is an efficient biomarker of infection and sepsis. Our aim was to study PCT baseline level in uninfected children with stage 5 chronic kidney disease (CKD 5) on HD, and determine how to use it in this population. Methods Prospective observational study including 40 uninfected children on classical HD or hemodiafiltration (HDF) in three pediatric HD centers in the Paris region. PCT was monitored before and after three consecutive sessions within 1 week. Results Median pre-dialysis PCT was 0.60 ng/mL [0.36-1.15], median post-dialysis PCT was 0.23 ng/mL [0.10-0.47], PCT reduction rate was 59.8% [37.5-75.8]. Seventy percent of pre-dialysis PCT were Conclusion PCT levels in pediatric HD patients without infection are higher than normal, but this increase is relatively moderate compared to massive increases of PCT in children with bacterial infections on HD. If PCT is measured after dialysis sessions, the specific technique-dependent reduction rates should be taken into consideration. Moderately increased PCT levels around 2 ng/ml should be interpreted with caution; however, higher PCT serum levels can be used to motivate rapid start of antibiotic treatment in pediatric HD patients. Graphical abstract, Author(s): Antoine Mouche [sup.1] , Cyrielle Parmentier [sup.1] [sup.2] , Claire Herbez Rea [sup.1] [sup.2] , Thérèsa Kwon [sup.3] , Olivia Boyer [sup.4] , Jean Daniel Delbet [sup.1] , Tim [...]

Introduction E-cigarette or vaping product use associated lung injury (EVALI) has been an important health risk in both children and adults. The pathophysiology of EVALI is not well understood. However, it is speculated that certain substances such as Vitamin E Acetate (VEA), particularly in marijuana containing vape cartridges may result in lung injury and lead to respiratory dysfunction. EVALI is often seen in the absence of infections, but it has been found to be associated with both fungal and bacterial infections. Like EVALI, nontuberculous mycobacteria (NTM) pulmonary disease is also on the rise, but is primarily reported in immunocompromised individuals. Here, we present three immunocompetent individuals wherein pulmonary NTM infection co-occurred with vaping. Methods Medical information including patient history, laboratory, and radiograph reports were abstracted from electronic medical records from participating institutions located in the Bronx, NY, Philadelphia, PA, and Lexington, KY. Results All three cases were otherwise immunocompetent individuals with a significant history of vaping either nicotine and/or marijuana containing products. The pathogens isolated include Mycobacterium avium complex, M. xenopi, and M. gordonae. All three patients were treated for NTM. Conclusion There is little reported on the association between vaping and NTM. It is possible that vaping may have rendered these individuals to be more susceptible to NTM colonization and infection. The possible mechanisms of vaping lung injury and pulmonary NTM are discussed., Author(s): Laura Chen [sup.1], Raanan Arens [sup.2], Ambika G. Chidambaram [sup.3], Sarah Capponi [sup.3], Loor Alshawa [sup.4], Tiffany A. Claeys [sup.5], Don Jr. Hayes [sup.6], Richard T. Robinson [sup.5] Author [...]

Purpose Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. Methods Narrative review. Results We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. Conclusion We provide state-of the art review of available knowledge of critically ill SOT patients with infections., Author(s): Jean-François Timsit [sup.1] [sup.2], Romain Sonneville [sup.3] [sup.4], Andre C. Kalil [sup.5], Matteo Bassetti [sup.6], Ricard Ferrer [sup.7], Samir Jaber [sup.8], Fanny Lanternier [sup.9] [sup.10], Charles-Edouard Luyt [sup.11] [sup.12], [...]

Background: Private wells are an important source of drinking water in Kewaunee County, Wisconsin. Due to the region's fractured dolomite aquifer, these wells are vulnerable to contamination by human and zoonotic gastrointestinal pathogens originating from land- applied cattle manure and private septic systems. OBJECTIVE: We determined the magnitude of the health burden associated with contamination of private wells in Kewaunee County by feces-borne gastrointestinal pathogens. Methods: This study used data from a year-long countywide pathogen occurrence study as inputs into a quantitative microbial risk assessment (QMRA) to predict the total cases of acute gastrointestinal illness (AGI) caused by private well contamination in the county. Microbial source tracking was used to associate predicted cases of illness with bovine, human, or unknown fecal sources. Results: Results suggest that private well contamination could be responsible for as many as 301 AGI cases per year in Kewaunee County, and that 230 and 12 cases per year were associated with a bovine and human fecal source, respectively. Furthermore, Cryptosporidium parvum was predicted to cause 190 cases per year, the most out of all 8 pathogens included in the QMRA. Discussion: This study has important implications for land use and water resource management in Kewaunee County and informs the public health impacts of consuming drinking water produced in other similarly vulnerable hydrogeological settings. https://doi.org/10.1289/EHP7815, Introduction Kewaunee County is a rural county located in northeast Wisconsin (USA), just south of the Door County peninsula and southeast of Green Bay. The principal source of drinking water [...]

In February 2017, a 40-year-old man in France who was under immunoglobulin replacement therapy for X-linked agammaglobulinemia experienced a migrating nonitchy papular eruption. Skin biopsy revealed nonspecific lymphocytic dermatitis. One [...]

Hepatitis E is an infection of public health concern, leading to an estimated global disease burden of 3.4 million acute cases, 70,000 deaths, and 3,000 stillbirths per year (1). Large [...]

In the United States, meningococcal disease, a nationally reportable bacterial disease caused by Neisseria meningitidis, has a case-fatality rate of 10%-15% (7). Clusters of serogroup C meningococcal disease have been [...]