Clostridium difficile infection and colonisation in children under 3 years of age: prospective comparative study.

AIMS: Despite an increasing trend in Clostridium difficile infections (CDI) and high C. difficile colonization rate especially among younger children, infants remain quite resistant to the disease. The goals of this study were to distinguish whether there exists a difference in CDI between children with or without diarrhoea, ascertain the prevalence of CDI, and assess CDI severity in children under 3 years with diarrhoea in our institution. METHODS: A prospective study was conducted from May 2015 to June 2016. Children 3 years of age or younger were enrolled and into two groups. Every faecal sample was tested using a diagnostic two-step screening algorithm including an immunochromatographic test and polymerase chain reaction. RESULTS: The study enrolled 147 children with diarrhoea and 75 control patients. The prevalence of CDI in children with diarrhoea was 2% (3/147), the prevalence of toxigenic C. difficile in the diarrhoeal group compared to the control group was 11.6 % (17/147) vs. 10.6% (8/75) (p.

Clinical and microbiological characteristics of Clostridium difficile infection in children hospitalized at the Departement of Paediatric Infectious Diseases in Brno between 2013 and 2017.

AIMS: Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients. MATERIALS AND METHODS: A retrospective study was conducted in patients (0-19 years of age) hospitalized for Clostridium difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays. RESULTS: Thirty-five patients with a median age of 10.3 years (range 1-17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome). CONCLUSIONS: The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).

Improvement of diagnostic approach to Lyme neuroborreliosis in children by using recombinant antigens in detection of intrathecally produced IgM/IgG.

BACKGROUND: The purpose of the study was to evaluate new 3rd-generation test kits, EIA Borrelia recombinant IgM and IgG (TestLine, Brno, Czech Republic), in serum and cerebrospinal fluid (CSF) of children with Lyme neuroborreliosis. METHODS: Comparison of three tests was used: the whole-cell EIA from Borrelia garinii (EIA 1) was compared with the EIA using recombinant antigens (EIA 2) and immunoblot. In total, 364 samples of serum and CSF were examined. Eighty-six paired sera and CSF samples were evaluated in the first group of children with Lyme neuroborreliosis. The second group consisted of 30 children with probable Lyme neuroborreliosis. Sixty-six samples from children with neuroinfections other than borrelial etiology were used as controls. RESULTS: In the first group of children with proven LNB, EIA 2 gave significantly more positive results for IgG in serum (P = 0.006; OR = 7.5) as in CSF (P < 0.001; OR = 4.5). There was no statistically significant difference in the IgM positivity of serum (P = 0.54; OR = 0.71). EIA 2 determined significantly (P = 0.001; OR = 0.06) less positive results of IgM in CSF in the LNB patients. IgG antibody index (AI) assessed by both methods revealed similar results (P = 0.646; OR = 1.38). Both methods are comparable, but IgM AI assessed by EIA 2 showed significantly less positive results (P < 0.001; OR = 0.04).The differences in the detection of positive IgM/IgG antibodies in serum and CSF did not reach statistical significance either in the groups of children with excluded LNB or in controls. CONCLUSIONS: EIA 2 showed better results than EIA 1 and western blot for the detection of positive IgG antibodies in serum and CSF. The difference in the calculation of AI IgG by EIA 1 and EIA 2 was not noticeable in the group of LNB patients. Comparing IgG and IgM AIs calculated from both tests, the sensitivity for EIA 2 was 68% for IgG and 26% for IgM. The specificity is 100% for both tests.

Assessment of antibodies against surface and outer membrane proteins of Anaplasma phagocytophilum in Lyme borreliosis and tick-borne encephalitis paediatric patients.

To examine evidence of positive antibodies against immunogenic proteins of Anaplasma phagocytophilum in patients with other tick-borne infections and to diagnose possible co-infections, 412 serum specimens were tested by immunoblotting using three specific Anaplasma antigens: surface proteins p44 and Asp62 and outer membrane protein A (OmpA). In total, 284 serum samples from children with Lyme borreliosis and 12 serum samples from children with tick-borne encephalitis were tested. Sera from patients with viral aseptic meningitis (n = 47) and from blood donors (n = 69) were used as controls. Among all serum specimens from patients with tick-borne infections submitted for this study, six samples (2·0%) showed positive IgM reactions and seven samples (2·4%) were IgG positive for A. phagocytophilum by immunoblot. Borderline reactivity was found in 30 samples (10·14%) for IgM and 36 samples (12·2%) for IgG. The difference between patients and blood donors was statistically significant for IgM (P = 0·006) and for IgG (P = 0·0007) antibodies. A statistically significant result was obtained for IgG (P = 0·02) but not for IgM between patients and children with aseptic meningitis. Immunoblot using three specific antigens provides novel information about the positivity of antibodies to A. phagocytophilum in children with other tick-borne infections. Taking into account clinical and laboratory findings of children despite antibody positivity, no case of human granulocytic anaplasmosis was demonstrated.

[Benign acute childhood myositis as a complication of influenza B and its differential diagnosis]. / Benigní akutní myozitidy u detí jako komplikace chripky B a jejich diferenciální diagnostika.

STUDY AIM: Analysis of the course of benign acute childhood myosistis during the influenza epidemic of 2012/2013, with a focus on the clinical specificities, laboratory findings, diagnostic and therapeutic approaches, and prognosis. METHODS: A retrospective study was conducted of 10 patients with myositis during influenza infection. The haematological and biochemistry parameters were analysed. A direct real time-PCR assay was used to detect the virus from nasopharyngeal swabs. RESULTS: Eight of 10 patients were males of an average age of 7.1 years. Muscle disorders emerged during recovery from influenza. They were characterized by a sudden onset of severe pain in the calf muscles with the consequent inability to walk in nine patients. Toe walking was reported in six children and wide-base gait in one patient. The full blood count showed leukopenia (eight cases) and thrombocytopenia (five cases). Blood biochemistry typically detected elevated muscle enzymes (creatine kinase and aspartate aminotransferase) and elevated myoglobin in all patients. Influenza B was confirmed in all study patients. They all recovered spontaneously within two to four days. CONCLUSIONS: Benign acute childhood myositis presents with the clinical picture of transient muscle disorders resulting in difficulty walking and very rarely can be complicated by rhabdomyolysis and kidney failure. It is most often associated with influenza B and affects school age children, mostly males. Good awareness of the condition facilitates the differential diagnosis and enables to rule out other more serious causes of difficulty walking. Symptomatic therapy is an adequate option and the patient recovers spontaneously within a couple of days. Early recognition of the disease avoids unnecessary diagnostic and therapeutic interventions.

Therapy of Lyme borreliosis in children.

A retrospective open study was conducted to determine the efficacy of penicillin and ceftriaxone in children with skin manifestations of Lyme borreliosis (solitary erythema migrans, multiple erythemata, borrelial lymphocytoma) and neuroborreliosis, respectively. One hundred sixty children were treated with penicillin and 41 with ceftriaxone for an average of 12 days. Serum antibodies to borreliae were determined before therapy and 2-3 and 4-6 weeks thereafter. At admission 44%/26%,8%/42%, and 40%/35% of erythema migrans, borrelial lymphocytoma and neuroborreliosis patients, respectively, were IgM/IgG positive. Four to 6 weeks after treatment the percentage of seropositives was 20%/15%,8%/61%, and 21%/44%, respectively. A 3 months follow-up was completed with 151 children. No child showed clinical evidence of illness, nor were there abnormalities in laboratory parameters.

[Experiences in CSR with rapid diagnostic tests in diagnosis of bacterial meningitis]. / Erfahrungen in der CSR mit schnelldiagnostischen Tests bei der Diagnose bakterieller Meningitiden.

On the basis of examinations of 229 children with rapid diagnostic method--latex agglutination of cerebrospinal fluid, serum and urine--this method is to compare with classic culture and it is evaluated as advantageous in the clinical practice. The etiologic agents was found out in 199 cases with the help of latex agglutination.