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Aim Methods Results Conclusion This prospective pilot study evaluated urinary interferon‐γ‐induced protein‐10 (IP‐10)/creatinine and tumour necrosis factor‐related apoptosis‐inducing ligand (TRAIL)/creatinine ratios as non‐invasive biomarkers for distinguishing bacterial from viral infections and assessing disease severity in febrile children.The study involved 85 febrile children and 29 healthy controls, measuring urinary IP‐10/creatinine and TRAIL/creatinine ratios to determine their diagnostic utility.Both ratios were significantly elevated in infected patients compared to controls. The IP‐10/creatinine ratio effectively assessed disease severity in the overall cohort and subgroups (AUC: 0.7324, 0.7192, 0.7277; p < 0.05). Serum C‐reactive protein showed limited discriminatory ability in viral infections (AUC = 0.5385, p = 0.7257). Differentiation between bacterial and viral infections using IP‐10/creatinine approached significance (p = 0.082). No significant differences in biomarker levels were observed across pathogens.The urinary IP‐10/creatinine ratio shows promise as a biomarker for assessing paediatric infection severity, particularly when traditional markers are less effective. Larger studies are needed to validate these results and improve its discriminatory accuracy in clinical practice. [ABSTRACT FROM AUTHOR]

Streptococcus pyogenes (streptocoque bêta-hémolytique du groupe A, SGA) est un pathogène strictement humain, de répartition mondiale. Le SGA est responsable d'un large éventail de manifestations cliniques allant des infections non invasives, les plus nombreuses, aux infections invasives, plus rares mais pouvant être fatales, tels la fasciite nécrosante et le syndrome de choc toxique streptococcique (SCTS). Dans la population pédiatrique, les infections à SGA se manifestent principalement par des angines. Les infections invasives, moins fréquentes que chez l'adulte, surviennent fréquemment sous la forme d'érysipèles, de pleuro-pneumopathies pouvant compliquer des infections virales respiratoires et d'ostéomyélites ou ostéoarthrites. Une recrudescence des infections à SGA a été décrite depuis les années 1980, survenant sous forme de bouffées épidémiques, la dernière datant de l'automne 2022, à la faveur de différents clones. La diversité des manifestations cliniques est associée à de nombreux facteurs de virulence parmi lesquels la protéine M, les streptolysines et les toxines superantigéniques. La protéine M, codée par le gène emm , est immunogène et présente une grande diversité antigénique. Parmi les plus de 200 génotypes emm décrits, les génotypes emm1 et emm3 sont plus fréquemment associés aux formes les plus sévères. En outre, le SGA possède jusqu'à 11 gènes distincts codant des toxines superantigéniques pouvant être responsables d'une stimulation immunitaire massive conduisant au SCTS. Le SGA est constamment sensible aux bêta-lactamines, considérées comme le traitement de choix des infections à SGA. La surveillance continue des infections à SGA reste essentielle afin d'ajuster les mesures thérapeutiques et prophylactiques et d'évaluer l'impact potentiel des futurs vaccins. Streptococcus pyogenes (or group A Streptococcus , GAS) is a human-specific pathogen, with a worldwide distribution, responsible for a wide range of diseases, ranging from superficial to life-threatening invasive infections, including necrotizing fasciitis and streptococcal toxic shock syndrome (STSS). In the paediatric population, GAS infections mainly occur as pharyngitis whereas invasive infections are less frequent than in adults and frequently manifesting as erysipelas, pleural and pulmonary infections that may complicate respiratory viral infections, and osteomyelitis or osteoarthritis. A resurgence of GAS infections has been described since the 1980s, emerging as outbreaks, most recently in autumn 2022, as a result of different clones. The diversity of clinical manifestations is associated with numerous virulence factors, including the M protein, streptolysins and superantigenic toxins. The M protein, encoded by the emm gene, is immunogenic and has a wide antigenic diversity. Among the over 200 emm genotypes described, emm1 and emm3 are more frequently associated with the most severe cases. GAS encodes up to 11 distinct genes encoding superantigenic toxins that may be responsible for massive immune stimulation leading to STSS. GAS is always susceptible to beta-lactam antibiotics, considered to be the gold standard to treat GAS infections. Ongoing monitoring of GAS infections remains essential in order to adjust therapeutic and prophylactic measures and to assess the potential impact of future vaccines. [ABSTRACT FROM AUTHOR]

Background: Enterovirus D68 (EV-D68) primarily causes respiratory infection, occasionally manifesting with neurological symptoms. Outbreak reports have been published from various countries including Norway, but a longitudinal study on EV-D68 prevalence in Northern Europe is lacking. Methods: Respiratory samples from children ≤14 years received at Oslo University Hospital in the years 2012-2022 were examined for EV-D68. Samples from 2012-2015 were retrospectively screened using a semi-specific RT-PCR, with positive samples confirmed by an EV-D68 specific RT-PCR. Samples from 2016-2022 underwent routine diagnostics with the EV-D68 specific RT-PCR. Results: Among the 22,911 samples tested, EV-D68 was detected in 338 samples (324 patients). Most EV-D68 cases occurred in August to December. The highest detection rate was recorded in 2014, 2016 and 2022 (6.0%, 7.8% and 6.6% of samples from August-December). Lower frequencies were observed in 2018 and 2019 (1.0% and 2.4%), and in the years before the 2014 outbreak (2012: 1.3%, 2013: 0.8%). Few cases were identified in 2020-2021. Children aged 0-1 years accounted for 40%, and 0-4 years for 78%, of the EV-D68 positive patients. Most of the patients with EV-D68 (83%) were hospitalised. Discussion: Also in Norway, EV-D68 has caused outbreaks with significant disease burden, especially among the youngest children. The detection rate varies, with a trend towards biennial outbreaks, except for low numbers in 2018 and during the COVID-19 restrictions (2020-2021). Due to its potential for severe respiratory illness and significant neurological complications, conducting EVD68 testing is essential both for diagnosing clinically suspected cases, and for monitoring the disease burden. [ABSTRACT FROM AUTHOR]

BackgroundEnterovirus D68 (EV-D68) primarily causes respiratory infection, occasionally manifesting with neurological symptoms. Outbreak reports have been published from various countries including Norway, but a longitudinal study on EV-D68 prevalence in Northern Europe is lacking.MethodsRespiratory samples from children ≤14 years received at Oslo University Hospital in the years 2012-2022 were examined for EV-D68. Samples from 2012-2015 were retrospectively screened using a semi-specific RT-PCR, with positive samples confirmed by an EV-D68 specific RT-PCR. Samples from 2016-2022 underwent routine diagnostics with the EV-D68 specific RT-PCR.ResultsAmong the 22,911 samples tested, EV-D68 was detected in 338 samples (324 patients). Most EV-D68 cases occurred in August to December. The highest detection rate was recorded in 2014, 2016 and 2022 (6.0%, 7.8% and 6.6% of samples from August-December). Lower frequencies were observed in 2018 and 2019 (1.0% and 2.4%), and in the years before the 2014 outbreak (2012: 1.3%, 2013: 0.8%). Few cases were identified in 2020-2021. Children aged 0-1 years accounted for 40%, and 0-4 years for 78%, of the EV-D68 positive patients. Most of the patients with EV-D68 (83%) were hospitalised.DiscussionAlso in Norway, EV-D68 has caused outbreaks with significant disease burden, especially among the youngest children. The detection rate varies, with a trend towards biennial outbreaks, except for low numbers in 2018 and during the COVID-19 restrictions (2020-2021). Due to its potential for severe respiratory illness and significant neurological complications, conducting EV-D68 testing is essential both for diagnosing clinically suspected cases, and for monitoring the disease burden.

Background. Nowadays, population generally has high contamination with herpes virus infections. Infection commonly is asymptomatic, and the virus persists in the human body over a lifetime. Excessive diagnosis of herpes virus infections as well as overestimation of their role in the genesis of various diseases in immunocompetent people are common in Russian pediatrics.Objective. The aim of the study is to assess the frequency and efficacy of serological testing in the suspected correlation of herpes virus infections and infectious and somatic diseases in a multidisciplinary hospital.Methods. The study included patients hospitalized in the multidisciplinary hospital in Moscow, who were assigned serological examination for herpes viruses. The laboratory study was carried out by enzyme-linked immunosorbent assay with the revealing the markers of herpes simplex virus type 1 and 2, Epstein-Barr virus, and cytomegalovirus. The results of the examination were analyzed according to the nosology and their role in diagnosis and management.Results. The identification of herpes virus infections’ markers was performed for 996 patients undergoing medical treatment in 17 different hospital departments within 2 months. Most commonly the examination was prescribed in infectious disease, pediatric, and hematological departments and covered more than 140 different nosologies. Acute respiratory infection, reactive arthritis, thrombocytopenia, infectious mononucleosis, acute tonsillitis, gastrointestinal pathology, acute bronchitis, and pneumonia were the most common nosologies. Positive markers of acute infection were revealed in 1.71% of cases for HSV-1/HSV-2, in 4.89% — for EBV, in 3.81% — for CMV. Moreover, positive results of serological examination were mostly noted in the cases of infectious diseases: infectious mononucleosis, tonsillitis, or acute respiratory infections. Tests were assigned for all three infections at the same time in most cases.Conclusion. Widespread examination for herpes virus infections is the typical variant of overdiagnosis and it is usually less informative. Generally positive markers are observed in typical course of herpes virus infections when clinical picture is enough for diagnosis verification.

Objectives: Rhinoviruses (RV) represent the most common aetiological agent of all acute respiratory tract infections across all age groups and a significant burden of disease among children. Recent studies have shown that RV-A and RV-C species are associated with increased disease severity. In order to better understand the potential associations between RV species and clinical features among paediatric cases, this study aimed to integrate genetic and epidemiological data using Bayesian phylogenetic methods. Methods: Potential associations between RV species and subtypes, and clinical disease severity using a matched dataset of 52 RV isolates sampled from children (< 18 years) in Sydney, Australia, between 2006 and 2009 were uncovered using epidemiological and phylogenetic methods. Results: It was found that RV-C was significantly more likely to be isolated from paediatric cases aged < 2 years compared with RV-A, although no significant differences in recorded symptoms were observed. Significant phylogenetic-trait associations between age and the VP4/VP2 capsid protein phylogeny suggest that age-specific variations in infectivity among subtypes may may be possible. Conclusion: This study adds to the growing body of epidemiological evidence concerning RV. Improving surveillance and testing for RV, including routine whole genome sequencing, may improve understanding of the varied disease outcomes of RV species and subtypes. Future studies could aim to identify specific genetic markers associated with age-specific infectivity of RV, which could inform treatment practices and public health surveillance of RV.

الملخص: أهداف البحث: تتزايد التهابات المسالك البولية في الأطفال بسرعة في جميع أنحاء العالم، وعادة ما تكون ناجمة عن البكتيريا المقاومة للأدوية. هذه الدراسة تحدد انتشار التهاب المسالك البولية في الأطفال، وتقيم نمط البكتيريا المقاومة للأدوية من قبل سلالات معزولة من الإشريكية والكلبسيلة عن التهابات المسالك البولية في مرضى الأطفال. طرق البحث: تم عزل السلالات البكتيرية الممرضة للجهاز البولي من المرضى الأطفال بالتهابات المسالك البولية التي تم إدخالها في معهد صحة الطفل بلاهور، باكستان. تم تحديد السلالات من جنس الإشريكية والكلبسيلة، من خلال التوصيف الكيميائي الحيوي، وتعرضت لمقاييس الحساسية للمضادات الحيوية لتحديد البكتيريا المقاومة للأدوية ضد ٢١ من الأدوية المضادة للميكروبات. النتائج: خلال ستة أشهر، تم عزل ما مجموعه ٦٣ من الإشريكية و٣٧ من سلالات الكلبسيلة من ١٣٠ طفلا مصابين بالتهابات المسالك البولية. وأظهرت مقاييس حساسية المضادات الحيوية أن الإشريكية والكلبسيلة لها مقاومة عالية ضد كوأموكسيكلاف، وسيفروكسيم، وسيفيكسيم، وسيفوتاكسيم، وسيفتازيديم، وسيفترياكسون، وسيبروفلوكساسين، وحمض ناليديكسيك، ونورفلوكساسين، وحمض بيبيديمك، وكوتريموكسيزول. ومع ذلك، فقد وجد أن للعقاقير المضادة للميكروبات بما في ذلك بوليميكسين-ب، وكبريتات الكوليستين، والكلورامفينيكول، ونيتروفوارانتون، وفوسفومايسين فاعلية كبرى للتحكم بالسلالات الممرضة للجهاز البولي من القولونية الإشريكيشية والكلبسيلة الرئوية. وتم تحديد السلالات الخمس التي تعاني من أعلى مقاومة ضد المضادات الحيوية المختبرة على أنها سلالات من الإشريكية القولونية والكلبسيلة الرئوية. الاستنتاجات: أظهرت دراستنا أن الإشريكية القولونية والكلبسيلة الرئوية كانت البكتيريا المهيمنة لمقاومة للأدوية من التهابات المسالك البولية المكتسبة من المجتمع في مجموعتنا. وتم الوصول إلى أن هذه البكتيريا الممرضة للجهاز البولي غير مستجيبة للعقارات المستخدمة بشكل روتيني من المضادات الحيوية مثل بيتا اللاكتام، والبيريدوبيريميدين، والكينولون، والفلوروكينولون. قد تكون هذه النتائج مفيدة للأطباء لتعزيز العلاج التجريبي لالتهابات المسالك البولية في الأطفال. Abstract: Objectives: Urinary tract infections (UTIs) in children are rapidly increasing worldwide and are commonly caused by extensively drug-resistant bacteria. This study determines the prevalence of UTIs in paediatric patients and evaluates the pattern of extensively drug-resistance in Escherichia coli and Klebsiella pneumoniae strains isolated from paediatric UTI patients. Methods: Uropathogenic bacterial strains were isolated from paediatric patients with UTIs admitted to the Institute of Child Health, Lahore, Pakistan. Strains of both E. coli and K. pneumoniae were identified using biochemical characterisation and subjected to antibiotic susceptibility assays for 21 common antimicrobial drugs in order to determine their extensively drug-resistant profile. Results: We isolated 63 E. coli and 37 K. pneumoniae strains from 130 paediatric patients with UTIs over a period of six months. The antibiotic susceptibility assays showed that both the E. coli and K. pneumoniae strains exhibited a high degree of resistance against co-amoxiclav, cefuroxime, cefixime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, nalidixic acid, norfloxacin, pepedemic acid, and co-trimoxazole. However, several of the antimicrobial agents, including polymyxin B, colistin sulphate, chloramphenicol, nitrofurantoin, and fosfomycin, were found to retain their antimicrobial activities against both pathogens. The five highest antibiotic resistant strains were identified as E. coli strains ZK9, ZK40, and ZK60 and K. pneumoniae ZK32 and ZK89 using 16S rRNA gene sequencing. Conclusion: Our study demonstrates that E. coli and K. pneumonia are the dominant extensively drug-resistant uropathogenic bacteria in community-acquired UTIs in our cohort. These uropathogens were found to be resistant to the majority of the routinely-used classes of β-lactams, pyridopyrimidines, quinolones, and fluoroquinolone antibiotics, and these findings may be useful for clinicians in their treatment of paediatric UTIs.

• A clinically matched dataset of rhinovirus (RV) isolates from children in Sydney, Australia • There were significantly more RV-C isolates from paediatric cases aged < 2 years • There were phylogenetic-trait associations between young age and VP4/VP2 capsid protein • There are possible age-specific variations in infectivity among subtypes Rhinoviruses (RV) represent the most common aetiological agent of all acute respiratory tract infections across all age groups and a significant burden of disease among children. Recent studies have shown that RV-A and RV-C species are associated with increased disease severity. In order to better understand the potential associations between RV species and clinical features among paediatric cases, this study aimed to integrate genetic and epidemiological data using Bayesian phylogenetic methods. Potential associations between RV species and subtypes, and clinical disease severity using a matched dataset of 52 RV isolates sampled from children (< 18 years) in Sydney, Australia, between 2006 and 2009 were uncovered using epidemiological and phylogenetic methods. It was found that RV-C was significantly more likely to be isolated from paediatric cases aged < 2 years compared with RV-A, although no significant differences in recorded symptoms were observed. Significant phylogenetic-trait associations between age and the VP4/VP2 capsid protein phylogeny suggest that age-specific variations in infectivity among subtypes may may be possible. This study adds to the growing body of epidemiological evidence concerning RV. Improving surveillance and testing for RV, including routine whole genome sequencing, may improve understanding of the varied disease outcomes of RV species and subtypes. Future studies could aim to identify specific genetic markers associated with age-specific infectivity of RV, which could inform treatment practices and public health surveillance of RV. [ABSTRACT FROM AUTHOR]

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Stay-at-home orders, physical distancing, face masks and other non-pharmaceutical interventions (NPIs) do not only impact COVID-19, but also the dynamics of various other infectious diseases. Bronchiolitis is a clinically diagnosed viral infection of the lower respiratory tract, and causes a yearly seasonal wave of admissions in paediatric wards worldwide. We counted 92,5% less bronchiolitis hospitalisations in Antwerp before the expected end of the peak this year (of which only 1 RSV positive), as compared to the last 3 years. Furthermore, there was a >99% reduction in the number of registered RSV cases in Belgium. Conslusion: The 2020 winter bronchiolitis peak is hitherto nonexistent, but we fear a 'delayed' spring/summer bronchiolitis peak when most NPIs will be relaxed and pre-pandemic life restarts. What is known? • Bronchiolitis causes a yearly seasonal wave of admissions in paediatric departments worldwide. • Non-pharmaceutical interventions (NPIs) do not only impact COVID-19, but also the dynamics of various other infectious diseases. What is new? • The 2020 winter bronchiolitis peak is hitherto nonexistent. • A 'delayed' spring or summer bronchiolitis peak could happen when most NPIs will be relaxed and pre-pandemic life restarts. [ABSTRACT FROM AUTHOR]

Tick-borne encephalitis (TBE) is a serious viral neuroinfection affecting humans in large areas of Europe and Asia. TBE can occur at any age, but only a few reports of TBE in infants younger than 1 year have been published. Here, we report a case of severe TBE in an 8.5-month-old boy presenting with seizures at the beginning of the neurological phase.

Francesco Di Pierro,1 Maria Colombo,2 Alberto Zanvit,3 Amilcare S Rottoli,4 1Scientific Department, Velleja Research, Milan, 2Pediatric Department, University of Parma, Parma, 3Stomatology Institute, 4Pediatric Department, Uboldo Hospital, Cernusco S/N, Milan, Italy Background: Streptococcus salivarius K12 (BLIS K12®) is a probiotic strain producing the bacteriocins salivaricin A2 and salivaricin B, both of which strongly antagonize the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans. It successfully colonizes and exhibits persistence in the oral cavity and is endowed with an excellent safety profile. Previous observations of a small group of children indicated that the use of BLIS K12 could also reduce the occurrence of viral pharyngitis. The present study focused on a further evaluation of the role of BLIS K12 in the control of pediatric streptococcal disease and moreover whether its use could also help provide protection against various nonstreptococcal infections. Methods: In total, 48 children with a recent history of recurrent pharyngeal streptococcal disease were enrolled in the treated group. The control group comprised 76 children known to have had a very low recent occurrence of oral streptococcal disease. The treated children were given BLIS K12 daily for 90 days. The number of episodes of streptococcal pharyngotonsillitis, tracheitis, viral pharyngitis, rhinitis, flu, laryngitis, acute otitis media, enteritis, and stomatitis was recorded during probiotic treatment and for a follow-up period of 9 months, and this was compared with the episodes of the control group over the corresponding period. Results: Compared with the pretreatment time period, 2013, a 90% reduction of streptococcal pharyngeal disease was observed in 2014; compared with untreated children, a statistically significant reduction of all of the other disease conditions assessed, other than stomatitis, was detected in the probiotic-treated children. Conclusion: In agreement with previous findings, in the present study, it was found that the daily use of BLIS K12 has been associated with a concurrent and persisting reduction in the occurrence of pharyngeal, recurrent, streptococcal disease. Moreover, the benefits to children may also extend to a reduction of nonstreptococcal diseases, including tracheitis, viral pharyngitis, rhinitis, flu, laryngitis, acute otitis media, and enteritis. Keywords: Streptococcus salivarius K12, pediatric infections, pharyngotonsillitis, rhinitis, flu, tracheitis, laryngitis, stomatitis, enteritis, otitis

Aim This French study assessed a quick, noninvasive, immuno-chromatographic, Helicobacter pylori ( H. pylori) stool antigen test for detecting infections in children. Methods We enrolled 158 children, with a median age of 8.5 years (range eight months to 17 years), with digestive symptoms suggesting upper gastrointestinal tract disease. Upper digestive endoscopy was performed with gastric biopsy specimens for histology, a rapid urease test, culture test and quantitative real-time polymerase chain reaction. The H. pylori stool antigen test was performed twice for each child and the results were compared to the reference method. Results The reference methods showed that 23 (14.6%) of the 158 children tested were H. pylori positive. The H. pylori stool antigen test showed 91.3% sensitivity, with a 95% confidence interval (95% CI) of 86.9-95.6 and 97% specificity (95% CI 94.3-99.6), 30.84 positive likelihood ratio and 0.09 negative likelihood ratio. The test accuracy was 96.2% (95% CI 93.2-99.1). The two blinded independent observers produced identical H. pylori stool antigen test results and the Kappa coefficient for the H. pylori stool antigen test was one. Conclusion The H. pylori stool antigen test was found to be a consistent, reliable, quick and specific test for detecting the H. pylori infection in children. [ABSTRACT FROM AUTHOR]

Since autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1 UK sublineage (26/55) and more diverse emm 12 isolates (12/55).

Introduction: Escherichia coli O157: H7 are recognized as important aetiological agents of diarrhea in children, particularly in developed countries. Aim: The aim of the study was to determine the rates of detection of E. coli O157: H7strains among children in Ahvaz, Iran. Materials and Methods: From June 2010 to December 2010, 137 diarrheal stool samples of children were collected. E.coli was identified by standard microbiological techniques. O157 or O157:H7 subtypes discerned by serological tests. Results: Of the 137 E. coli isolates, enteropathogens were found in 53 (38.7%) of the patients as follow: Shigella spp. (75.5%), EPEC (enteropathogenic E. coli) (16.9%), Campylobacter spp. (3.8%) and Salmonella spp. (3.8%). None of the isolated E. coli was O157:H7 serotype. Conclusion: This shows that non-O157:H7 E. coli are the major cause of paediatric infections in this region of Iran.

OBJECTIVE: Streptococcus salivarius K12 (BLIS K12) is a probiotic strain strongly antagonistic to the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans. Shown to colonize the oral cavity and to be safe for human use, BLIS K12 has previously been reported to reduce pharyngo-tonsillitis episodes in children or adults known to have experienced recurrent streptococcal infection. The present study was focussed upon evaluating the role of BLIS K12 in the control of streptococcal disease and acute otitis media in children attending the first year of kindergarten. PATIENTS AND METHODS: By randomization, 222 enrolled children attending the first year of kindergarten were divided into a treated group (N = 111) receiving for 6 months a daily treatment with BLIS K12 (Bactoblis®) and a control group (N = 111) who were monitored as untreated controls. During the 6 months of treatment and 3 months of follow-up, the children were evaluated for treatment tolerance, and for episodes of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media. RESULTS: During the 6-month trial (N = 111 per group) the incidence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media was approximately 16%, 9% and 44% respectively in the treated group and 48%, 4% and 80% in the control group. During the 3- months follow-up (N = 29 per group) the corresponding rates of infection were 15%, 0% and 12% in the treated group and 26%, 6% and 36% in the controls. No apparent side effects were detected in the treated group either during treatment or follow-up. All of the enrolled children completed the study. CONCLUSIONS: The daily administration of BLIS K12 to children attending their first year of kindergarten was associated with a significant reduction in episodes of streptococcal pharyngitis and acute otitis media. No protection against scarlet fever was detected. [ABSTRACT FROM AUTHOR]

Summary: Clostridium difficile is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. The clinical significance of C. difficile in children, however, is less certain. In this article we discuss colonisation and infection and describe C. difficile in childhood in terms of risk factors, epidemiology and management. [ABSTRACT FROM AUTHOR]

Fifty-three children who attended the emergency department with community-associated (CA) Staphylococcus aureus skin and soft tissue infections (SSTIs) were enrolled in the study. Seven cases of infection (13.2%) were due to methicillin-resistant S. aureus (MRSA). Twelve of 46 available isolates (26.1%) were Panton–Valentine leukocidin (PVL)-positive. PVL-positive S. aureus SSTIs were more frequently associated with abscesses and cellulitis (75% vs. 38%, p 0.028), and more commonly required incision and drainage (75% vs. 21%, p 0.001). Most PVL-positive CA-MRSA isolates belonged to a single multilocus sequence type (ST8). In contrast, PVL-positive methicillin-susceptible S. aureus isolates belonged to four different sequence types (ST8, ST30, ST80, ST120). [ABSTRACT FROM AUTHOR]

Introduction: Escherichia coli O157: H7 are recognized as important aetiological agents of diarrhea in children, particularly in developed countries. Aim: The aim of the study was to determine the rates of detection of E. coli O157: H7strains among children in Ahvaz, Iran. Materials and Methods: From June 2010 to December 2010, 137 diarrheal stool samples of children were collected. E.coli was identified by standard microbiological techniques. O157 or O157:H7 subtypes discerned by serological tests. Results: Of the 137 E. coli isolates, enteropathogens were found in 53 (38.7%) of the patients as follow: Shigella spp. (75.5%), EPEC (enteropathogenic E. coli) (16.9%), Campylobacter spp. (3.8%) and Salmonella spp. (3.8%). None of the isolated E. coli was O157:H7 serotype. Conclusion: This shows that non-O157:H7 E. coli are the major cause of paediatric infections in this region of Iran. [ABSTRACT FROM AUTHOR]

Acute respiratory tract infections (ARTIs) are a leading cause of morbidity and mortality in children worldwide, but the aetiology of many ARTIs is still unknown. In 2001, researchers in The Netherlands reported the discovery of a previously unidentified pathogen called human metapneumovirus (hMPV). Since its initial description, hMPV has been associated with ARTI in Europe (Italy, France, Spain, the UK, Germany, Denmark, Finland and Norway), America (the USA, Canada, Argentina and Brazil), Asia (India, Japan, China and Singapore), Australia and South Africa in individuals of all ages. The incidence of infection varies from 1.5% to 25%, indicating that hMPV is a ubiquitous virus with a worldwide distribution. hMPV seems to play an important role as a cause of paediatric upper and lower respiratory tract infection, with similar, but not identical, epidemiological and clinical features to those of respiratory syncytial virus and influenza virus. Moreover, the socio-economic impact of hMPV-infected children on their families seems to be considerable, which suggests that, like influenza virus, hMPV infection may be a substantial public health problem for the community. It may be associated with significant morbidity and mortality in pre-term infants and children with underlying clinical conditions, although more adequately controlled studies are needed to confirm its importance in such patients. Many fundamental questions concerning the pathogenesis of hMPV disease and the host's specific immune response remain to be answered. Further studies are also required to properly define hMPV diagnosis, treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

Tick-borne encephalitis (TBE) is a serious viral neuroinfection affecting humans in large areas of Europe and Asia. TBE can occur at any age, but only a few reports of TBE in infants younger than 1 year have been published. Here, we report a case of severe TBE in an 8.5-month-old boy presenting with seizures at the beginning of the neurological phase. [ABSTRACT FROM AUTHOR]

The pharmacokinetics of cefonicid was studied in 17 children requiring antibiotic treatment for respiratory or urinary tract infections. After informed consent had been obtained from the parents, a single dose of cefonicid 50 mg/kg/body weight was given by intramuscular injection. The mean peak serum concentration of 212.63 µg/ml was reached at 1.00 h, as absorption occurred at a very fast rate with a mean constant of 3.24 h. Mean values for half-life, apparent volume of distribution (V), total body clearance (CL), and renal clearance (CL) were 3.24 h, 0.21 l·kg, 16.67 ml·min and 13.60 ml·min respectively. There was an inverse relationship between age and V, whereas CL and CL were positively correlated with age. Cefonicid concentrations in urine were many times higher than the MICs of susceptible strains of bacteria. The study demonstrated that i.m. cefonicid 50 mg·kg gave serum concentrations well within the therapeutic range for susceptible bacteria, and that its pharmacokinetic properties allow single daily doses to be used to treat infections in children. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of meningitis due to Haemophilus influenzae serotype d strain in an infant. As far as we know, this is the first report of a serotype d strain, responsible for childhood invasive disease in Europe, demonstrating an emerging of H. influenzae non-b serotype, in the post-vaccination era. [ABSTRACT FROM AUTHOR]

Paediatric invasive fungal infections have significantly increased over the past few decades, in particular among the immunocompromised population. Candida and Aspergillus spp. are still the most commonly isolated organisms. Image-based assessment of fungal infections can indeed be challenging especially in oncological patients where the differential diagnosis relative to other infections and neoplastic lesions cannot be often obvious. Therefore, the knowledge of the main radiological features associated with fungal infections is crucial to achieve an early correct diagnosis and address the most appropriate therapeutic approach. Thus, our aim was to review the main radiological features of paediatric fungal infections with particular focus on positron emission tomography/magnetic resonance imaging (PET/MRI), referring to the experience of our tertiary level hospital., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

A letter to the editor is presented in response to the article "Successful use of fidaxomicin in recurrent Clostridium difficile infection in a child" by Stephanie Smeltzer et al. in the March 5, 2013 issue.

Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 μm were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-μm filters in all tap faucets and showers., (Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and paediatric intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general paediatric wards, respiratory and gastrointestinal infections predominate, reflecting the occurrence in the community. The surveillance of nosocomial infections identifies priorities for infection control activities and permits evaluation of interventions.The prevention of transmission between patients and to personnel requires that certain measures be taken with all patients, and that additional precautions be taken with some infections, based on the route of transmission. The prevention of transmission from personnel involves ensuring that personnel are appropriately immunized and counselled about working with infections. The prevention of nosocomial infection also involves control of visitors, appropriate management of invasive procedures and devices, sterilization and disinfection of equipment, provision of a clean environment and adequate staffing. Severely immunocompromised children require extra protection, including ventilation systems that reduce the risk of exposure to filamentous fungi. Infection control in paediatrics is an evolving field that must adapt to changes in the paediatric patient population and in health care technology.