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We aimed to describe the frequency of treatment failure and associated risk factors for treatment failure amongst neonates with skin and soft tissue infections (SSTIs). We conducted a retrospective cohort study of neonates 0 to 28 days old with uncomplicated SSTIs presenting to the emergency department of a quaternary care children's hospital from 2009 to 2017. Data were collected via chart review. Skin and soft tissue infections included the following: cellulitis, abscess, mastitis, perirectal SSTI, carbuncle, and furuncle. Of the 202 neonates in the study, most were term, afebrile with mastitis, or perirectal SSTI. Treatment failure occurred in 8% (17/202) of neonates receiving oral antibiotics; 10 of these neonates had perirectal SSTIs and 2 had clindamycin and methicillin-resistant Staphylococcus aureus. Neonates with treatment failure had increased odds of having perirectal SSTIs (odds ratio [OR] = 4.08, 95% confidence interval [CI] = 1.46-11.31). Further studies are needed to identify strategies to prevent treatment failure in neonates with perirectal SSTIs. [ABSTRACT FROM AUTHOR]

Background An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic. Methods We performed a retrospective review of all children presenting to the Texas Children's Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests. Results Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18–21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died. Conclusions A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died. [ABSTRACT FROM AUTHOR]

Absolute resonance Raman cross sections for chlorine dioxide (OClO) dissolved in chloroform are obtained at several excitation wavelengths spanning the photochemically relevant [sup 2]B[sub 1]-[sup 2]A[sub 2] optical transition. The absolute scattering cross sections of OClO are determined by reference to the 666 cm[sup -1] transition of chloroform whose absolute scattering cross sections are reported here. The time-dependent theory for Raman and absorption are used to develop a mode-specific description of the [sup 2]A[sub 2] excited state surface. This description demonstrates that photoexcitation of OClO leads to significant structural evolution along the symmetric stretch and bend coordinates, with only limited evolution occurring along the asymmetric stretch. This description is similar to that determined for OClO dissolved in cyclohexane and water demonstrating that the excited-state structural evolution of OClO is similar in these solvents. Analysis of the OClO absolute scattering cross sections establishes that the homogeneous linewidth is 95±15 cm[sup -1] in chloroform, essentially identical to the linewidths in cyclohexane and water. To establish the origin of this linewidth, the fluorescence cross section for OClO dissolved in cyclohexane is measured and found to be consistent with an excited-state lifetime of ∼200 fs. Comparison of this lifetime to the homogeneous linewidth establishes that the homogeneous broadening is dominated by solvent-induced pure dephasing. It is proposed that the apparent solvent independence of the homogeneous linewidth reflects the mechanical response of the solvent to the photoinitiated change in solute geometry. In support of this hypothesis, the homogeneous linewidth is reproduced using the viscoelastic continuum model of nonpolar solvation. Finally, it is argued that the restricted evolution along the asymmetric-stretch coordinate is due to dielectric solvent-solute interactions consistent with the incr... [ABSTRACT FROM AUTHOR]

Analyzes the resonance Raman depolarization ratios of chlorine dioxide dissolved in cyclohexane. Measurement of the depolarization ratio of the symmetric stretch fundamental transition at several excitation wavelengths spanning the lowest-energy electronic transition; Maximum value of the depolarization ratio.

Background Trichosporonosis is an emerging and often fatal opportunistic fungal infection in immunocompromised patients, particularly those with hematologic malignancy, but data in children are lacking. Methods We report here 3 cases of invasive infection caused by Trichosporon asahii in pediatric patients with acute lymphoblastic leukemia at Texas Children’s Hospital in Houston, Texas. We also conducted a literature review and identified 16 additional reports of pediatric patients with invasive T asahii infection and an underlying malignant or nonmalignant hematologic disorder. Results Of the 19 cases of invasive T asahii infection, the most commonly reported underlying hematologic disorder was acute lymphoblastic leukenia (47%), followed by acute myelogenous leukemia (21%). Most of the patients (94%) had neutropenia, defined as an absolute neutrophil count of <500 cells/mm3. Antifungal prophylaxis information was available in 6 of the 19 cases, and micafungin use was reported in 5 cases. Treatment regimens frequently included voriconazole monotherapy (47%) or the combination of an azole antifungal with amphotericin B (35%). The mortality rate was 58%. Conclusions Recognizing that echinocandins, which are increasingly used for prophylaxis in patients with a hematologic malignancy, are not active against Trichosporon species is of critical importance. The recommended first-line therapy for trichosporonosis is voriconazole, but successful outcome depends largely on the underlying immune status of the host. [ABSTRACT FROM AUTHOR]

Background Periorbital and orbital cellulitis cause significant pediatric morbidity. Here, we define the clinical features of and characterize isolates from children with periorbital or orbital cellulitis caused by Staphylococcus aureus at Texas Children’s Hospital in Houston. Methods Patients were identified from a prospective S aureus study database from January 2002 to July 2015. Demographic and clinical data were collected retrospectively. Isolates were genotyped by pulsed-field gel electrophoresis, and Panton-Valentine leukocidin (lukSF - PV [ pvl ]) genes were detected by quantitative polymerase chain reaction. Data were analyzed with the Fisher exact or Wilcoxon rank-sum test. Results Eighty-five patients with periorbital (n = 58) or orbital (n = 27) cellulitis were identified. We found 57 (67%) methicillin-resistant S aureus (MRSA) isolates, 72 (85%) pvl -positive (pvl +) isolates, and 66 (78%) USA300 isolates. No differences in clinical characteristics were found when we compared MRSA to methicillin-susceptible (MSSA) infections or USA300 to non-USA300 infections. Patients with orbital cellulitis were hospitalized a median of 12 days (range, 2–28 days) and received antibiotics for 21 days (range, 10–32 days). Twelve (44%) patients with orbital cellulitis received steroids. Steroid treatment did not affect the length of hospitalization or duration of antibiotic treatment. Six (7%) patients with orbital cellulitis were bacteremic. Patients with periorbital cellulitis were hospitalized for a median of 3 days (range, 0–17 days) and received antibiotics for 11 days (range, 7–32 days). According to computed tomography (CT), 19 (70%) patients with orbital cellulitis and 11 (41%) with periorbital cellulitis had sinusitis. Conclusions The majority of periorbital and orbital S aureus infections at Texas Children’s Hospital were caused by MRSA, and no change was observed over time. Empirical antibiotic treatment should include coverage for MRSA. PVL might be an important virulence factor in these presentations. S aureus is associated with sinusitis and its complications. [ABSTRACT FROM AUTHOR]