Kneiffiella palmae: A non-Aspergillus fungal infection isolated from a pulmonary nodule in a child with chronic granulomatous disease.

We report the first known human case of Kneiffiella palmae in the medical literature. K. palmae was isolated from a pulmonary nodule in a 7-year-old male with chronic granulomatous disease. The mold was identified as K. palmae at a national reference laboratory, where 17 other human respiratory samples tested positive for K. palmae from 2013 to 2021. Optimal antimicrobial treatment is unknown, but azoles and amphotericin B demonstrated in vitro activity against each tested isolate.

Invasive pneumococcal infections in children following transplantation in the pneumococcal conjugate vaccine era.

BACKGROUND: Pediatric recipients of hematopoietic stem cell and solid organ transplants are at increased risk of invasive pneumococcal infections (IPI). Data on IPI in this population are scarce. To our knowledge, this is the first study describing the epidemiology of IPI among pediatric transplant recipients in the pneumococcal conjugate vaccine (PCV) era. METHODS: We identified transplant recipients with IPI at 8 children's hospitals in the U.S. from our surveillance database (2000-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Categorical variables were analyzed by Fisher's exact test and continuous variables with nonparametric tests. Indirect cohort study design was used to calculate vaccine effectiveness. RESULTS: We identified 65 episodes of IPI in transplant recipients. Recurrent IPI was observed in 10% of transplant recipients. The IPI crude incidence rate in solid organ transplant recipients was higher than in the general population. Most IPI episodes occurred >6 months after transplantation. Bacteremia and pneumonia were the most common presentations. Meningitis was unusual. No case fatalities were observed. Serotype 19A was the most common serotype (n=10), followed by 6C (n=7). In 2010-2014, 37% of IPI was caused by PCV13 serotypes. Four cases of vaccine breakthrough were identified. Most isolates were susceptible to penicillin and ceftriaxone. Pneumococcal conjugate and polysaccharide immunization rates were low. CONCLUSION: Pediatric transplant recipients remain at increased risk of IPI in the vaccine era. Most cases presented as a late post-transplant infection. The interval between transplantation and IPI may allow adequate time for pneumococcal immunization.

Impact of the 13-valent pneumococcal conjugate vaccine on chronic sinusitis associated with Streptococcus pneumoniae in children.

BACKGROUND: The widespread use of the 7-valent pneumococcal conjugate vaccine has been associated with epidemiologic changes of mucosal and invasive pneumococcal disease. No study describes the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on chronic sinusitis in children. We describe changes in epidemiology of Streptococcus pneumoniae chronic sinusitis after the introduction of PCV13 at Texas Children's Hospital. METHODS: We identified patients <18 years with positive sinus culture for S. pneumoniae who underwent endoscopic sinus surgery because of chronic sinusitis from August 2008 to December 2013 at Texas Children's Hospital. Isolates were serotyped by the capsular swelling method. Demographic and clinical information was collected retrospectively. The χ test and Fisher's exact test were used to analyze dichotomous variables. RESULTS: We identified 91 cases of chronic sinusitis with positive sinus culture for S. pneumoniae. Sixty-one (67%) isolates were non-PCV13 serotypes. PCV13 cases decreased 31% in the post-PCV13 period (P = 0.003). Serotype 19A decreased 27% in the post-PCV13 period (P = 0.007), but accounted for all the isolates with penicillin minimal inhibitory concentration ≥ 4 µg/mL and ceftriaxone minimal inhibitory concentration ≥ 2 µg/mL. Serotypes 19A (38%) and 15C (17%) were the most common in the pre- and post-PCV13 periods, respectively. The most common organism co-isolated was Haemophilus influenzae (52%). Isolation of Prevotella spp. increased in the post-PCV13 period (P = 0.02). CONCLUSIONS: S. pneumoniae continues to represent an important pathogen in chronic sinusitis in children <5 years of age. After the introduction of PCV13, S. pneumoniae isolation declined in children with chronic sinusitis at Texas Children's Hospital. We also observed a substantial reduction of PCV13 serotypes, predominantly serotype 19A.

Physicians’ responsibility for antibiotic use in infants from periurban Lima, Peru / Responsabilidad del médico en el uso de antibióticos en niños menores de 1 año de zonas periurbanas de Lima, Perú

Objetivo. Describir el uso de antibióticos en niños de 2 a 12 meses de edad en entornos donde estos medicamentos se pueden obtener sin prescripción. Métodos. Se analizaron los datos de un estudio de cohorte efectuado entre septiembre del 2006 y diciembre del 2007 en 1 023 niños menores de 2 meses de la zonaperiurbana de Lima, Perú, cuyo seguimiento se realizó hasta el año de edad. Resultados. De los 1 023 niños, 770 (75,3%) tomaron 2 085 tandas de tratamiento antibiótico. Se registraron dos tandas por niño por año (rango 0–12). Las tasas más elevadas de uso de antibióticos se encontraron en los niños de 3 a 6 meses (37,2%). Los niños recibieron antibióticos para 8,2% de los resfriados comunes, 58,6% de las faringitis, 66,0% de las bronquitis, 40,7% de las diarreas, 22,8% de las dermatitis y 12,0% de las obstruccionesbronquiales. La prescripción de un médico fue la razón más frecuente para el uso de antibióticos (90,8%). Se comprobó el uso de medicamentos sin prescripción en 6,9% de los niños, y en 63,9% de ellos este fue precedido por una prescripción médica. Conclusiones. En el entorno estudiado, los niños menores de 1 año a menudo estánexpuestos a los antibióticos. El abuso de los antibióticos es frecuente ante enfermedades como faringitis, bronquitis, obstrucción bronquial y diarrea, pero por lo general es inadecuado (83,1% de las tandas de tratamiento antibiótico) según las etiologías más comunes en este grupo etario. Las intervenciones dirigidas a mejorar el uso de los antibióticos deben concentrarse en los médicos, ya que la prescripción médica fue la razón más común para el uso de antibióticos.

Objective. To describe the use of antibiotics in Peruvian children under 1 year in a setting where they are available without a prescription. Methods. Data were analyzed from a cohort study between September 2006 and December 2007 of 1 023 children < 2 months old in periurban Lima, Peru, followed until they were 1 year old. Results. Seven hundred seventy of 1 023 (75.3%) children took 2 085 courses of antibiotics. There were two courses per child per year (range 0–12). Higher rates of antibiotic usewere found in children 3–6 months old (37.2%). Antibiotics were given to children for 8.2% of common colds, 58.6% of all pharyngitis, 66.0% of bronchitis, 40.7% of diarrheas, 22.8%of dermatitis, and 12.0% of bronchial obstructions. A physician’s prescription was the most common reason for antibiotic use (90.8%). Medication use without a prescription was found in 6.9% of children, and in 63.9% of them it was preceded by a physician’s prescription. Conclusions. Infants are often exposed to antibiotics in this setting. Overuse of antibiotics is common for diagnoses such as pharyngitis, bronchitis, bronchial obstruction, and diarrhea but is typically inappropriate (83.1% of courses) based on the most common etiologies for this age group. Interventions to improve the use of antibiotics should focus on physicians, since a physician’s prescription was the most common reason for antibiotic use.

Brucellar uveitis: intraocular fluids and biopsy studies.

BACKGROUND: Ocular brucellosis is usually diagnosed by clinical criteria and serological tests. Little is known with regard to the ocular immunology of brucellosis and the use of intraocular diagnostic tests. We report retrospectively the laboratory findings of patients with ocular involvement associated with brucellosis. MATERIALS AND METHODS: Patients with uveitis with no evident etiologic diagnosis were evaluated at the Instituto de Medicina Tropical "Alexander von Humboldt" of the Universidad Peruana Cayetano Heredia and the Hospital Nacional Cayetano Heredia. Patients were tested for brucellosis, tuberculosis, syphilis, toxoplasmosis, toxocariasis, and human T-cell lymphotropic virus-1. Blood and intraocular fluid samples were examined. Patients with a diagnosis of brucellar uveitis were selected as cases and patients with a diagnosis of uveitis of other etiology were included as controls. The Goldmann-Witmer coefficient was determined. RESULTS: Twelve patients with clinical and laboratory findings suggestive of brucellar uveitis were considered as cases. Seven patients with uveitis of other etiology were selected as controls. Four (33.3%) patients with ocular brucellosis had negative ocular agglutinations and eight (66.7%) had positive agglutinations. No control cases had positive agglutinations for Brucella melitensis. The sensitivity of the test was 66.7% and the specificity 100%. Only one patient had a positive culture for B. melitensis in subretinal fluid. The Goldmann-Witmer coefficient was calculated in six cases of brucellosis uveitis and five uveitis controls. It was highly positive in three patients with ocular brucellosis. Tissue samples showed lymphoplasmacytic infiltrates. CONCLUSIONS: Intraocular serological tests could be used to support the diagnosis of ocular brucellosis.