Is Posaconazole Really Effective in Adolescent patients as a Prophylactic Agent: Experience of a Tertiary Care Center.

BACKGROUND: Invasive fungal infections (IFIs) are a leading cause of morbidity and death in immunocompromised patients. Data on efficacy and pharmacokinetics of posaconazole in pediatric patients are rare (1 to 5). Herein, we retrospectively analyzed adolescent patients who had received posaconazole as antifungal prophylaxis. METHODS: We retrospectively analyzed patients who received posaconazole as primary or secondary antifungal prophylaxis. RESULTS: A total of 34 adolescent patients, 19 men (55.9%) and 15 women (44.1%) with a mean age of 15.8±2.1 years were included. Twenty-five of 34 (73.5%) patients were on primary and nine of 34 (26.5%) patients were on secondary antifungal prophylaxis. Diagnosis of the patients receiving posaconazole as primary antifungal prophylaxis were acute myeloid leukemia (n=12, 48%), hematopoietic stem cell transplantation (n=7, 28%), acute lymphoblastic leukemia (n=5, 20%), and Fanconi aplastic anemia (n=1, 4%). Five patients (55.6%) with hematopoietic stem cell transplantation, 1 patient with acute myeloid leukemia (11.1%), 1 patient with Fanconi aplastic anemia (11.1%), and 2 (22.2%) patients with chronic granulomatous disease received posaconazole as secondary antifungal prophylaxis. Twelve of 25 (48%) patients receiving posaconazole as primary antifungal prophylaxis were complicated by IFI; 4 of them were proven, 6 probable, and 2 with possible IFI. Three of 9 patients (33.3%) receiving posaconazole as secondary antifungal prophylaxis was complicated by IFI (P=0.29), 2 of them were probable and 1 was possible IFI. Five of 25 patients (20%) receiving posaconazole as primary prophylaxis died because of IFI. CONCLUSION: Improvement of antifungal prophylaxis in patients with high risk of invasive infections seems clearly necessary, and analyzing serum posaconazole levels and individualizing dosing may be 1 approach to improve outcomes.

Bacteriemia por Stenotrophomonas maltophilia en niños: análisis de 10 años / Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.

Stenotrophomonas maltophilia is a multidrug-resistant, Gram-negative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0­18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophiliaisolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0­7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization

Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis. / Bacteriemia por Stenotrophomonas maltophilia en niños: análisis de 10 años.

Stenotrophomonas maltophilia is a multidrug-resistant, Gramnegative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0-18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophilia isolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0-7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization.

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.

Myocarditis associated with influenza infection in five children.

BACKGROUND: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caused by a variety of bacterial and viral infections. Influenza is one of the most common relevant viruses that cause myocarditis. OBJECTIVES: We attempted to share our experiences about clinical and laboratory findings, cardiac evaluation, and treatment of children with influenza myocarditis. METHODS: This retrospective study was performed by the Department of Pediatric Infectious Diseases at the Faculty of Medicine, Hacettepe University in Turkey. The medical records of patients diagnosed with myocarditis associated with an influenza infection between January 2014 and January 2017 were systematically reviewed. RESULTS: Vaccination seems likely to be an important protection strategy for both influenza infections and complications.

Clinical and microbiological characteristics of Pantoea agglomerans infection in children.

Pantoea agglomerans is an environmental Gram-negative bacterium that rarely is responsible for the infections in humans but it is often a causative factor of a number of occupational diseases. This study evaluated the clinical and microbiological characteristics and pathogenicity of P. agglomerans in children. We retrospectively reviewed microbiological test results for all children (1 month old to 18 years old) who were admitted to our pediatric hospital between January 2000 to June 2015 and had positive clinical specimen cultures for P. agglomerans. Isolates were identified using conventional tests and the BBL Crystal E/NF ID or MALDI-TOF MS systems. Antibiotic susceptibilities were evaluated using the Kirby-Bauer disc diffusion method. We identified fifteen positive cultures from 14 patients with confirmed infections. The positive specimens included pus, urine, tracheal aspirate, blood, and central venous line samples that yielded P. agglomerans. The median patient age was 8.8 years (range: 1.5 months to 16.5 years), and all patients had underlying comorbidities. Five patients had medical devices, and two devices were removed. The most common P. agglomerans infections involved wound infections (35.7%), pneumonia (21.4%), and urinary tract infections (21.4%). Three patients had concomitant infections (Enterococcus faecium, Pseudomonas aeruginosa, and Aspergillus fumigatus). Five patients had anemia. Three patients (21.4%) died, and all three had carbapenem-resistant P. agglomerans that was detected after the first week of hospitalization; two cases involved pneumonia, which was ineffectively treated. P. agglomerans infections may be life-threatening, especially in young patients with pneumonia. Hospital-acquired P. agglomerans may have different pathogenicity and clinical features, compared to community-acquired P. agglomerans, although further studies are needed to understand the drug-resistance patterns in this bacterium.

Infección mortal por Clostridium perfringens con hemólisis tras quimioterapia en un adolescente / A fatal Clostridium perfringens infection with hemolysis after chemotherapy in an adolescent

La gangrena gaseosa, o mionecrosis clostridial, es una de las enfermedades infecciosas más graves, y se caracteriza por la rápida y progresiva destrucción de los tejidos blandos profundos y la producción de gas dentro de los tejidos. Presentamos un caso de gangrena gaseosa espontánea mortal causada por Clostridium perfringens en un paciente con leucemia linfocítica aguda durante la fase de quimioterapia de inducción de la remisión.

Gas gangrene, clostridial myonecrosis, is one of the most serious infectious diseases, characterized by rapidly progressive destruction of deep soft tissues and production of gas within the tissues. We presented a case of fatal spontaneous gas gangrene due to Clostridium perfringens in a patient with acute lymphoblastic leukemia during remission induction chemotherapy phase.

A fatal Clostridium perfringens infection with hemolysis after chemotherapy in an adolescent. / Infección mortal por Clostridium perfringens con hemólisis tras quimioterapia en un adolescente.

Gas gangrene, clostridial myonecrosis, is one of the most serious infectious diseases, characterized by rapidly progressive destruction of deep soft tissues and production of gas within the tissues. We presented a case of fatal spontaneous gas gangrene due to Clostridium perfringens in a patient with acute lymphoblastic leukemia during remission induction chemotherapy phase.

La gangrena gaseosa, o mionecrosis clostridial, es una de las enfermedades infecciosas más graves, y se caracteriza por la rápida y progresiva destrucción de los tejidos blandos profundos y la producción de gas dentro de los tejidos. Presentamos un caso de gangrena gaseosa espontánea mortal causada por Clostridium perfringens en un paciente con leucemia linfocítica aguda durante la fase de quimioterapia de inducción de la remisión.

Vancomycin-resistant Enterococcus bacteremia in a child with acute myeloid leukemia: successful treatment with daptomycin. / Bacteriemia por Enterococcus resistente a la vancomicina en un niño con leucemia mieloide aguda: tratamiento satisfactorio con daptomicina.

Multiple-drug-resistant enterococcal infections canbe a serious problem in pediatric patients particularly concomitance with severe underlying diseases and lead to significant morbidity and mortality. The treatment options in children are limited compared with adults. We report a 3-year old-boy with acute myeloid leukemia (AML)-M7 and vancomycin-resistant enterococcus bacteremia successfully treated with daptomycin. Daptomycin may be an alternative therapy for VRE infections in children; more studies are needed for extended usage.

Las infecciones enterocócicas multirresistentes pueden ser un problema serio en los pacientes pediátricos y causarles complicaciones importantes o la muerte, en particular, en los casos de enfermedades subyacentes graves concomitantes. Las opciones de tratamiento en los niños son limitadas en comparación con las de los adultos. En este artículo, presentamos el caso de un niño de 3 años con leucemia mieloide aguda (LMA)-M7 y bacteriemia por Enterococcus resistente a la vancomicina, que se trató satisfactoriamente con daptomicina. La daptomicina puede ser un tratamiento alternativo para las infecciones por Enterococcus resistente a la vancomicina (ERV) en los niños. Se necesitan más estudios para ampliar su uso.

Bacteriemia causada por Rothia mucilaginosa después de neumonía en un paciente con trasplante de células progenitoras hematopoyéticas / Bacteremia caused by Rothia mucilaginosa after pneumonia, in a patient with hematopoietic stem cell transplantation

La Rothia mucilaginosa forma parte de la flora normal y no suele causar una enfermedad invasiva. Los pacientes inmunodeprimidos tienen mayor riesgo de infección grave. En este artículo, presentamos el caso de un paciente con neuroblastoma recidivante hospitalizado por neumonía. Después de la mejoría clínica, los síntomas respiratorios del paciente empeoraron de nuevo. En el hemocultivo, se aisló la bacteria Rothia mucilaginosa. El empeoramiento de los síntomas respiratorios puede explicarse por la diseminación hematopoyética de la bacteria. Se le administró tratamiento con meropenem y vancomicina durante 14 días, cuyos resultados fueron satisfactorios. Se sabe que esta bacteria poco frecuente tiene una alta tasa de mortalidad si no se trata de forma adecuada, y debe considerarse especialmente en los pacientes inmunodeprimidos con neoplasias malignas.

Rothia muciloginosa is a member of normal flora and rarely causes invasive disease. Immunosupressed patients have increased risk for severe infection. Here, we report a male patient with relapsed neuroblastoma hospitalized for pneumonia. After clinical improvement, patient's respiratory symptoms worsened again. Rothia muciloginosa was isolated from blood culture. The worsening of respiratory symptoms can be explained by hematogenous spread of bacteria. He was successfully treated with meropenem and vancomycin for 14 days. This rarely seen bacterium is known to have high mortality rates unless treated appropriately and should be considered especially in patients with malignancy due to their immunsupressed situation.

Bacteremia caused by Rothia mucilaginosa after pneumonia, in a patient with hematopoietic stem cell transplantation. / Bacteriemia causada por Rothia mucilaginosa después de neumonía en un paciente con trasplante de células progenitoras hematopoyéticas.

Rothia muciloginosa is a member of normal flora and rarely causes invasive disease. Immunosupressed patients have increased risk for severe infection. Here, we report a male patient with relapsed neuroblastoma hospitalized for pneumonia. After clinical improvement, patient's respiratory symptoms worsened again. Rothia muciloginosa was isolated from blood culture. The worsening of respiratory symptoms can be explained by hematogenous spread of bacteria. He was successfully treated with meropenem and vancomycin for 14 days. This rarely seen bacterium is known to have high mortality rates unless treated appropriately and should be considered especially in patients with malignancy due to their immunsupressed situation.

La Rothia mucilaginosa forma parte de la flora normal y no suele causar una enfermedad invasiva. Los pacientes inmunodeprimidos tienen mayor riesgo de infección grave. En este artículo, presentamos el caso de un paciente con neuroblastoma recidivante hospitalizado por neumonía. Después de la mejoría clínica, los síntomas respiratorios del paciente empeoraron de nuevo. En el hemocultivo, se aisló la bacteria Rothia mucilaginosa. El empeoramiento de los síntomas respiratorios puede explicarse por la diseminación hematopoyética de la bacteria. Se le administró tratamiento con meropenem y vancomicina durante 14 días, cuyos resultados fueron satisfactorios. Se sabe que esta bacteria poco frecuente tiene una alta tasa de mortalidad si no se trata de forma adecuada, y debe considerarse especialmente en los pacientes inmunodeprimidos con neoplasias malignas.

Sarcoidosis del adulto de inicio en la infancia: a proposito de un caso / Pediatric-onset adult type sarcoidosis: A case report

La sarcoidosis, un trastorno multiorgánico de etiología desconocida que afecta varios órganos, es poco frecuente en los niños. Se desconocen la incidencia y la prevalencia reales de la sarcoidosis infantil. Al igual que en los adultos, muchos niños con sarcoidosis tal vez no presentan síntomas y la enfermedad cursa sin diagnosticarse. Es fundamental realizar una evaluación completa y sistemática del paciente para establecer el diagnóstico de sarcoidosis en los niños. Se describe el caso de una nina de 12 años con uveítis y hepatoesplenomegalia de dos años de evolución. Mediante una tomografía computarizada del tórax, se hallaron nódulos pulmonares periféricos dispersos y linfadenopatía hiliar bilateral. La aspiración de médula ósea y la biopsia de hígado no fueron diagnósticas. La biopsia de pulmón mostró granulomas de células epitelioides no necrosantes. A la paciente se le diagnosticó sarcoidosis en virtud del hallazgo de inflamación granulomatosa y de la exclusión de entidades confusoras.

Sarcoidosis, a multisystem disorder of unknown etiology that involves multiple organs, is rare in children. The true incidence and prevalence of childhood sarcoidosis is unknown. As in adults, many children with sarcoidosis may be asymptomatic; the disease may remain undiagnosed. A complete and systematic evaluation of the patient is essential for the sarcoidosis diagnosis in children. Here, we describe a case of 12-year-old female who presented with 2 years history of uveitis and hepatosplenomegaly. A chest computerized tomography revealed scattered peripheral pulmonary nodules and bilateral hiliar lymphadenopathy. Bone marrow aspiration and liver biopsy were not diagnostic. A lung biopsy showed non-necrotizing epithelioid cell granulomas. She was diagnosed with sarcoidosis according to demonstration of granulomatous inflammation and the exclusion of confusable entities

[Pediatric-onset adult type sarcoidosis: A case report]. / Sarcoidosis del adulto de inicio en la infancia: a proposito de un caso.

Sarcoidosis, a multisystem disorder of unknown etiology that involves multiple organs, is rare in children. The true incidence and prevalence of childhood sarcoidosis is unknown. As in adults, many children with sarcoidosis may be asymptomatic; the disease may remain undiagnosed. A complete and systematic evaluation of the patient is essential for the sarcoidosis diagnosis in children. Here, we describe a case of 12-year-old female who presented with 2 years history of uveitis and hepatosplenomegaly. A chest computerized tomography revealed scattered peripheral pulmonary nodules and bilateral hiliar lymphadenopathy. Bone marrow aspiration and liver biopsy were not diagnostic. A lung biopsy showed non-necrotizing epithelioid cell granulomas. She was diagnosed with sarcoidosis according to demonstration of granulomatous inflammation and the exclusion of confusable entities

La sarcoidosis, un trastorno multiorgánico de etiología desconocida que afecta varios órganos, es poco frecuente en los niños. Se desconocen la incidencia y la prevalencia reales de la sarcoidosis infantil. Al igual que en los adultos, muchos niños con sarcoidosis tal vez no presentan síntomas y la enfermedad cursa sin diagnosticarse. Es fundamental realizar una evaluación completa y sistemática del paciente para establecer el diagnóstico de sarcoidosis en los niños. Se describe el caso de una niña de 12 años con uveítis y hepatoesplenomegalia de dos años de evolución. Mediante una tomografía computarizada del tórax, se hallaron nódulos pulmonares periféricos dispersos y linfadenopatía hiliar bilateral. La aspiración de médula ósea y la biopsia de hígado no fueron diagnósticas. La biopsia de pulmón mostró granulomas de células epitelioides no necrosantes. A la paciente se le diagnosticó sarcoidosis en virtud del hallazgo de inflamación granulomatosa y de la exclusión de entidades confusoras.