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Abstract Background The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition. Methods A retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period. Results There were 233 cases of proven enteroviral (EV) meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children ≥ 5 years of age, while rash, diarrhea and cough were more common in children < 5 years of age. Pleocytosis was absent in 22.3% of children < 30 days of age with proven EV meningitis. Enterovirus was isolated in cerebrospinal fluid (CSF) from 154 of 389 patients (39.6%) who had viral culture performed, and a nucleic acid amplification test for enterovirus was positive in CSF from 81 of 149 patients (54.3%). Imaging of the head by computerized tomography or magnetic resonance imaging was completed in 96 cases (19.7%) and 24 had abnormal findings that were possibly related to meningitis while none had changes that were definitely related to meningitis. There was minimal morbidity and there were no deaths. Conclusion The clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants < 30 days of age. Enterovirus is the predominant isolate, but no etiologic agent is identified in the majority of cases of aseptic meningitis in Canadian children.

Although the overall risk of a hospital-acquired illness with respiratory syncytial virus (RSV) appears to be low, nosocomial disease (NRSV) in medically frail children may result in longer hospital stays and increased mortality. Of 1,516 hospitalized children with RSV disease, only 6% demonstrated illness at least 72 hours after admission, indicating nosocomial, rather than community-acquired, disease. All children were isolated or grouped together, although procedures varied. Children at risk for severe disease were more likely to acquire NRSV infection associated with prolonged hospitalization and a sharp increase in mortality rates., Objective. To determine nosocomial transmission of respiratory syncytial virus (RSV) in Canadian pediatric hospitals, outcomes associated with nosocomial disease, and infection control practices. Design. A prospective cohort study in the 1992 to 1994 winter respiratory seasons. Setting. Nine Canadian pediatric university-affiliated hospitals. Participants. Hospitalized children with symptoms of lower respiratory tract infection (at least one of cough, wheezing, dyspnea, tachypnea, and apnea) and RSV antigen identified in a nasopharyngeal aspirate. Results. Of 1516 children, 91 (6%) had nosocomial RSV (NRSV), defined as symptoms of lower respiratory tract infection and RSV antigen beginning [is greater than] 72 hours after admission. The nosocomial ratio (NRSV/[community-acquired RSV (CARSVJ)] + NRSV) varied by site from 2.8% to 13%. The median length of stay attributable to RSV for community-acquired illness was 5 days, but 10 days for nosocomial illness. Four children with NRSV (4.4%) died within 2 weeks of infection, compared with 6 (0.42%) with CARSV (relative risk = 10.4, 95% confidence interval: 3.0, 36.4). All sites isolated RSV-positive patients in single rooms or cohorted them. In a multivariate model, no particular isolation policy was associated with decreased nosocomial ratio, but gowning to enter the room was associated with increased risk of RSV transmission (incidence rate ratio 2.81; confidence interval: 1.65, 4.77). Conclusions. RSV transmission risk in Canadian pediatric hospitals is generally low. Although use of barrier methods varies, all sites cohort or isolate RSV-positive patients in single rooms. Children with risk factors for severe disease who acquire infection nosocomially have prolonged stays and excess mortality. Pediatrics 1997;100: 943-946; respiratory syncytial virus, nosocomial infections., ABBREVIATIONS. RSV, respiratory syncytial virus; LRTI, lower respiratory tract infection; NRSV, nosocomial RSV; CARSV, community-acquired RSV; OR, odds ratio. Raspiratory syncytial virus (RSV) is the most common cause of bronchiolitis [...]

OBJECTIVES. Influenza is a common childhood infection that may result in hospitalization. Our objectives were to (1) determine characteristics of children hospitalized for influenza and disease manifestations and (2) obtain baseline data before implementation of new recommendations for routine immunization of young children and their caretakers against influenza. METHODS. All of the children hospitalized with laboratory-confirmed influenza at 9 Canadian tertiary care hospitals during the 2003-2004 influenza season were identified from virology laboratory reports, and their charts were reviewed. RESULTS. There were 505 children admitted because of influenza. Fifty-seven percent were 14 days before the onset of illness. CONCLUSIONS. Healthy young children and children with chronic conditions are at risk for serious illness with influenza. Ongoing surveillance is needed to evaluate the impact of changing immunization recommendations on the burden of influenza illness in children. KEY WORDS. influenza, vaccine, pediatrics., Dorothy L. Moore, PhD, MD, Wendy Vaudry, MD, David W. Scheifele, MD, Scott A. Halperin, MD, Pierre Dery, MD, Elizabeth Ford-Jones, MD, Haider M. Arishi, MD, Barbara J. Law, MD, [...]

OBJECTIVE. Antibiotics are not recommended for the treatment of wheezing in children with asthma, but little is known about their use. This study was undertaken to evaluate trends and determinants of antibiotic use in children with wheezing during the fiscal years 1995 through 2001. METHODS. Using the population-based health care and prescription databases in Manitoba, Canada, this descriptive study examined time trends in antibiotic prescription use for wheezing episodes in a population of children with asthma. The likelihood of receiving an antibiotic prescription according to child and physician characteristics also was determined. Annual population-based rates of antibiotic prescriptions for wheezing episodes were modeled by age and antibiotic class, using general estimating equations. The odds ratio for receiving an antibiotic prescription according to child demographics and physician factors was determined from hierarchical linear modeling. RESULTS. The antibiotic prescription rate for wheezing decreased by 28% from 708 prescriptions per 1000 children with asthma in 1995 to 511 prescriptions in 2001. Fifteen-fold increases in use were observed for broader spectrum macrolides in preschool children. Twenty-three percent of physician visits for wheezing resulted in an immediate antibiotic prescription, but this percentage increased to 64% for antibiotics that were received within 7 days of the episode. General practitioners prescribed antibiotics more often than did pediatricians. Physicians who were not trained in Canada or the United States were 40% more likely to prescribe antibiotics than their counterparts. CONCLUSIONS. Antibiotic use for wheezing in children declined in the 1990s, but the increased use of broader spectrum macrolides has implications for antibiotic resistance. A link between antibiotic prescribing and physician specialty and location of training identifies opportunities for intervention. KEYWORDS. antibiotics, children, asthma, macrolides, trends, physician factors., URL: [...]

Abstract. Characteristics of Nocardia infection, which occurred in ten Oklahoma children between 1975 and 1980, are described. Fatal N asteroides infection occurred in three immunocompromised patients. Pneumonia was the presenting feature in each; one patient had disseminated disease. The first reported case of shunt-associated N asteroides ventriculitis occurred in a 2-month-old girl, who was successfully treated with oral trimethoprim-sulfamethoxazole. N brasiliensis was isolated from six immunologically competent children, five of whom had localized, uncomplicated, cutaneous infections. The sixth child developed osteomyelitis following a compound skull fracture. Based on this experience and a review of the literature, N asteroides infections are associated with immunocompromised hosts, and usually are seen as pneumonia with occasional dissemination to other sites. In contrast, N brasiliensis infections are more common than previously thought and usually occur in otherwise normal children as acute posttraumatic pyoderma. Pediatrics 70:560-565, 1982; Actinomycetales infections, Nocardia infections, Nocardia asteroides, Nocardia brasiliensis, pyoderma. [ABSTRACT FROM AUTHOR]

Presents information on a case study which described the role of the early use of metronidazole with rapid sterilization of the cerebrospinal fluid in the recovery of a newborn with Bacteroides fragilis meningitis. Overview of the case; Discussion on anaerobic infections; Bacterial action of metronidazole against anaerobes.