RESUMO
Despite worldwide spread of severe acute respiratory syndrome coronavirus-2, few publications have reported the potential for severe disease in the pediatric population. We report 177 infected children and young adults, including 44 hospitalized and 9 critically ill patients, with a comparison of patient characteristics between infected hospitalized and nonhospitalized cohorts, as well as critically ill and noncritically ill cohorts. Children <1 year and adolescents and young adults >15 years of age were over-represented among hospitalized patients (P = .07). Adolescents and young adults were over-represented among the critically ill cohort (P = .02).
Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitalização , Pneumonia Viral/epidemiologia , Adolescente , Distribuição por Idade , Asma/epidemiologia , COVID-19 , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Tosse/virologia , Estado Terminal , District of Columbia/epidemiologia , Dispneia/virologia , Feminino , Febre/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Pandemias , Faringite/virologia , Pneumonia Viral/diagnóstico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adulto JovemRESUMO
BACKGROUND: Critical thinking is essential for the accurate diagnosis and management of patients. It is correlated with academic success. OBJECTIVE: Our objective was to design a novel tool for interactive online learning to improve knowledge and to assess trainees' critical thinking skills using the framework of the American Philosophical Association (APA). METHODS: Residents, fellows and students participated in an online, self-directed case-based vignette activity to learn malaria diagnosis and management. Pre and post-tests with multiple choice and open-ended case-based questions assessed knowledge and critical thinking. Comparison between pre and post-test scores across subgroups were performed using paired t-tests or one-way ANOVA. RESULTS: Between 4 April 2017 to 14 July 2019, 62 of 75 (82%) eligible subjects completed both the pre and the post-test. Improved post-test scores occurred in 90% of medical students, p=0.001, 77% of residents, p<0.001, 60% of fellows, p=0.72 and 75% of trainees overall, p=<0.001. Fellows had higher pre-test scores than students or residents but there was no difference by level of training on the post-test. CONCLUSIONS: This interactive online learning activity effectively imparted medical knowledge and improved trainee responses to questions requiring critical thinking. To our knowledge, this is the first time the APA's critical thinking framework has been incorporated into interactive online learning and assessment of critical thinking skills in medical trainees. We applied this innovation specifically in global health education, but there is obvious potential to expand it to a wide variety of areas of clinical training.
Assuntos
Sucesso Acadêmico , Educação a Distância , Estudantes de Medicina , Humanos , Pensamento , EscolaridadeRESUMO
We describe the presentation, diagnosis and management of a premature newborn with Actinomyces odontolyticus bacteremia; this is the first case report of neonatal sepsis secondary to this bacteria. Maternal dental infection was the likely source of the pathogen. The outcome was favorable, with good response to antimicrobial therapy with ampicillin/amoxicillin.
Assuntos
Sepse Neonatal , Sepse , Actinomyces , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Sepse/diagnóstico , Sepse/tratamento farmacológicoRESUMO
The objective of the study was to describe the complexity of diagnosis and evaluation of Zika-exposed pregnant women/fetuses and infants in a U.S. Congenital Zika Program. Pregnant women/fetuses and/or infants referred for clinical evaluation to the Congenital Zika Program at Children's National (Washington, DC) from January 2016 to June 2018 were included. We recorded the timing of maternal Zika-virus (ZIKV) exposure and ZIKV laboratory testing results. Based on laboratory testing, cases were either confirmed, possible, or unlikely ZIKV infection. Prenatal and postnatal imaging by ultrasound and/or magnetic resonance imaging (MRI) were categorized as normal, nonspecific, or as findings of congenital Zika syndrome (CZS). Of 81 women-fetus/infant pairs evaluated, 72 (89%) had confirmed ZIKV exposure; 18% of women were symptomatic; only a minority presented for evaluation within the time frame for laboratory detection. Zika virus could only be confirmed in 29 (40%) cases, was possible in 26 (36%) cases, and was excluded in 17 (24%) cases. Five cases (7%) had prenatal ultrasound and MRI findings of CZS, but in only three was ZIKV confirmed by laboratory testing. Because of timing of exposure to presentation, ZIKV infection could not be excluded in many cases. Neuroimaging found CZS in 7% of cases, and in many patients, there were nonspecific imaging findings that warrant long-term follow-up. Overall, adherence to postnatal recommended follow-up evaluations was modest, representing a barrier to care. These challenges may be instructive to future pediatric multidisciplinary clinics for congenital infectious/noninfectious threats to pregnant women and their infants.
Assuntos
Microcefalia/diagnóstico por imagem , Programas Nacionais de Saúde , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico , Técnicas de Laboratório Clínico , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética/estatística & dados numéricos , Microcefalia/virologia , Neuroimagem/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Ultrassonografia/estatística & dados numéricos , Estados Unidos/epidemiologia , Zika virus/patogenicidade , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/transmissãoRESUMO
Human parechovirus-3 (HPeV-3) is an emerging pathogen that has been described as a cause of neonatal sepsis. Human parechoviruses are a family of viruses closely related to enteroviruses; however, enteroviral PCR will not detect HPeVs. We present clinical details of neonatal meningoencephalitis and hepatitis-coagulopathy syndrome caused by HPeV-3 infection.
Assuntos
Meningoencefalite/diagnóstico , Parechovirus/isolamento & purificação , Infecções por Picornaviridae/diagnóstico , Sepse/diagnóstico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Líquido Cefalorraquidiano/virologia , Humanos , Recém-Nascido , Masculino , Meningoencefalite/tratamento farmacológico , Meningoencefalite/virologia , Parechovirus/genética , Parechovirus/patogenicidade , Infecções por Picornaviridae/tratamento farmacológico , Infecções por Picornaviridae/virologia , Reação em Cadeia da Polimerase , Sepse/tratamento farmacológico , Sepse/virologiaRESUMO
We report here the isolation of Mucor velutinosus from multiple blood cultures performed on samples from Broviac catheters and culture of a Broviac insertion-site wound sample from a 6-year-old boy with a history of intestinal failure secondary to chronic intestinal pseudo-obstruction, parenteral nutrition, and jejunostomy tube dependence. Examination of a slide from the culture revealed the presence of wide nonseptate hyphae with sporangiophores, columella, and chlamydospores. The fungal isolate was sent to the National Institutes of Health for further evaluation and was identified as Mucor velutinosus by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and genomic sequencing. The patient was treated successfully with intravenous amphotericin B and prompt removal of his central line. To the best of our knowledge, this is the first case of M velutinosus bloodstream infection in a child without cancer.
Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/microbiologia , Fungemia/diagnóstico , Mucor/isolamento & purificação , Mucormicose/diagnóstico , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Criança , Fungemia/tratamento farmacológico , Humanos , Imunocompetência , Pseudo-Obstrução Intestinal/terapia , Jejunostomia/instrumentação , Masculino , Mucormicose/tratamento farmacológico , Nutrição Parenteral/instrumentaçãoAssuntos
Betacoronavirus , Cardiopatias/virologia , Insuficiência de Múltiplos Órgãos/virologia , Trombocitopenia/virologia , Adolescente , COVID-19 , Infecções por Coronavirus/complicações , Cardiopatias/terapia , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/terapia , Pandemias , Fenótipo , Pneumonia Viral/complicações , SARS-CoV-2 , Trombocitopenia/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Gram-positive infections caused by susceptible and resistant strains of Staphylococcus aureus, coagulase-negative staphylococci and enterococci are increasing problems in neonates. Linezolid, a new oxazolidinone, is active against these pathogens and has recently been approved by the Food and Drug Administration for treating Gram-positive infections in pediatric patients. OBJECTIVE: To compare the clinical efficacy and safety of intravenous and oral linezolid with vancomycin (10 to 15 mg/kg every 6 to 24 h) in neonates (age 0 to 90 days). METHODS: Hospitalized infants with known or suspected hospital-acquired pneumonia, complicated skin or skin structure infections, bacteremia or other infections (e.g. pyelonephritis, abdominal abscess) were eligible. Test-of-cure clinical response was evaluated at follow-up. RESULTS: Sixty-three neonates, randomized 2:1 to linezolid (n = 43) or vancomycin (n = 20) were included in the intent-to-treat group. Clinical cure rates at follow-up in the intent-to-treat group were higher, but not significantly different, for linezolid vs. vancomycin (78% vs. 61%; P = 0.196). Corresponding cure rates in clinically evaluable patients were 84% vs. 77% (P = 0.553) for linezolid and vancomycin, respectively. Pathogen eradication rates were as follows in the linezolid and vancomycin groups, respectively: S. aureus (67% vs. 60%; P = 0.850); coagulase-negative staphylococci (88% vs. 100%; P = 0.379); and enterococci (71% vs. 0%; P = 0.168). Results for hematology and chemistry assays were similar between treatment groups. Fewer linezolid-treated neonates had drug-related adverse events than vancomycin-treated neonates (12% vs. 32%; P = 0.058). CONCLUSIONS: Linezolid is well-tolerated and as effective as vancomycin in the treatment of resistant Gram-positive infections in neonates.
Assuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/farmacologia , Vancomicina/farmacologia , Acetamidas/administração & dosagem , Acetamidas/efeitos adversos , Administração Oral , Antibacterianos/efeitos adversos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Infusões Intravenosas , Linezolida , Masculino , Oxazolidinonas/administração & dosagem , Oxazolidinonas/efeitos adversos , Resultado do Tratamento , Vancomicina/efeitos adversosRESUMO
BACKGROUND: Nosocomial infections, particularly hospital-acquired pneumonia (HAP) and bacteremia, are an increasing concern in pediatric hospitals and pediatric intensive care units. Gram-positive pathogens are a leading cause of these infections in children. Linezolid is well-tolerated and as effective as vancomycin in the treatment of these infections in adults. OBJECTIVE: To evaluate the clinical effectiveness and safety of iv/oral linezolid and iv vancomycin in children with resistant Gram-positive HAP or bacteremia. METHODS: Hospitalized children <12 years of age were randomized 2:1 to linezolid or vancomycin. Patients received linezolid 10 mg/kg iv every 8 h with the option to change treatment to oral linezolid suspension 10 mg/kg every 8 h or iv vancomycin 10 to 15 mg/kg every 6 to 24 h. Clinical response was evaluated at follow-up. Results from an analysis of patients with HAP or bacteremia are presented. RESULTS: Thirty-nine patients (linezolid, 23; vancomycin, 16) with HAP and 113 patients with bacteremia (linezolid, 81; vancomycin, 32) were included in the intent-to-treat group. Clinical cure rates for clinically evaluable patients with HAP did not differ between treatment groups (linezolid, 90.0% and vancomycin, 100%; P = 0.305). No significant difference was seen in clinical cure rates in the clinically evaluable population between the linezolid and vancomycin groups for patients with catheter-related bacteremia (84.8 and 80.0%, respectively; P = 0.716) or patients with bacteremia of unknown source (79.2 and 69.2%, respectively; P = 0.501). In this subset fewer linezolid-treated patients had drug-related adverse events than did vancomycin-treated patients (19.4% vs. 28.3%; P = 0.230). Similar percentages of patients with laboratory abnormalities, including selected hematologic parameters, were seen in both treatment groups. CONCLUSIONS: Intravenous/oral linezolid was well-tolerated and as effective as vancomycin in treating children with resistant Gram-positive HAP or bacteremia.
Assuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Bacteriemia/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/farmacologia , Pneumonia Bacteriana/tratamento farmacológico , Vancomicina/farmacologia , Acetamidas/administração & dosagem , Acetamidas/efeitos adversos , Administração Oral , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas , Linezolida , Masculino , Oxazolidinonas/administração & dosagem , Oxazolidinonas/efeitos adversos , Resultado do TratamentoAssuntos
Edema/microbiologia , Febre/microbiologia , Lábio/patologia , Mucosite/microbiologia , Úlceras Orais/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Adolescente , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Humanos , Masculino , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/patologia , Recidiva , Sulbactam/uso terapêuticoAssuntos
Infecções por Ascaridida/complicações , Infecções por Ascaridida/diagnóstico , Letargia/complicações , Letargia/diagnóstico , Espasticidade Muscular/complicações , Espasticidade Muscular/diagnóstico , Diagnóstico Diferencial , Humanos , Lactente , Letargia/diagnóstico por imagem , Masculino , Espasticidade Muscular/diagnóstico por imagemAssuntos
Aspergilose/diagnóstico , Doença Granulomatosa Crônica/complicações , Pneumonia/etiologia , Pneumonia/fisiopatologia , Aspergillus/citologia , Doença Granulomatosa Crônica/diagnóstico , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Pneumonia/diagnóstico por imagem , Pneumonia/patologia , RadiografiaRESUMO
Adenovirus infection is a serious and often fatal complication in hematopoietic stem cell transplant patients. There are currently no FDA-approved therapies for adenovirus infection, with only anecdotal, off-label uses described for a variety of anti-viral agents or immune therapies. We report the first case of successful eradication of disseminated adenovirus infection by the novel antiviral agent CMX001 in a severely immunocompromised pediatric stem cell transplant recipient following failure to respond to intravenous cidofovir. Complete clinical and virologic response was documented; virologic and pharmacokinetic data are reported. CMX001 is a promising new oral antiviral agent under development for the prophylaxis and treatment of severe infections caused by double-stranded DNA viruses including adenovirus in immunocompromised patients.
Assuntos
Infecções por Adenovirus Humanos/tratamento farmacológico , Antivirais/uso terapêutico , Citosina/análogos & derivados , Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido , Organofosfonatos/uso terapêutico , Infecções por Adenovirus Humanos/complicações , Criança , Citosina/uso terapêutico , Feminino , Humanos , Reação em Cadeia da PolimeraseAssuntos
Infecções por Bordetella/diagnóstico , Bordetella bronchiseptica/isolamento & purificação , Meningites Bacterianas/diagnóstico , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adolescente , Animais , Antibacterianos , Infecções por Bordetella/tratamento farmacológico , Gatos , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Neurofibromatose 2/complicações , Neurofibromatose 2/diagnóstico , Neuroma Acústico/complicações , Neuroma Acústico/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Medição de Risco , Resultado do TratamentoAssuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Infecções por Bactérias Gram-Positivas/diagnóstico , Propionibacterium acnes/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Derivações do Líquido Cefalorraquidiano/instrumentação , Criança , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Penicilinas/uso terapêutico , Complicações Pós-Operatórias , Reoperação , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/instrumentaçãoAssuntos
Parechovirus/isolamento & purificação , Parechovirus/patogenicidade , Infecções por Picornaviridae/epidemiologia , Infecções por Picornaviridae/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/tratamento farmacológicoRESUMO
Antimicrobial resistance is increasing among bacterial pathogens. In particular, organisms producing extended spectrum beta-lactamase enzymes (ESBLs) and AmpC chromosomal beta-lactamase enzymes are resistant to third generation cephalosporins and pose a formidable challenge in the management of seriously ill patients. Carbapenems are a class of broad-spectrum antibiotics with stability against ESBL and AmpC chromosomal beta-lactamases. They are well tolerated by patients. This review will examine the pharmacokinetic and pharmacodynamic properties of two carbapenems imipenem and meropenem and discuss their clinical use in children. References are limited to the English language and extend back to 1980. Sources include computerized databases such as MEDLINE searched using PubMed, and bibliographies of recent articles and books. Approximately 50% of the articles initially reviewed are included in the bibliography. Carbapenems are efficacious in the treatment of a variety of bacterial infections including meningitis, pneumonia, intraabdominal infections, bone, joint and urinary tract infections. The broad spectrum activity and comparatively low toxicity of carbapenems make them valuable therapeutic agents in the treatment of seriously ill patients with bacterial infections. These agents should be used judiciously in order to minimize the risk for development of carbapenem-resistant pathogens.