Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

Can probiotic administration during pregnancy and the first year of life effectively reduce the risk of infections and allergic diseases in childhood?

Infections and allergic disorders are common pediatric diseases. It has been reported that probiotics, which are live microorganisms, confer health benefits to hosts when administered in appropriate amounts. Probiotics have been widely used in the treatment of pediatric infections and allergic disorders through modulating the microbial environment of host. However, it is still not clear whether probiotic administration during pregnancy and/or the first year of life is an efficient approach for the prevention of infections and allergic diseases in childhood. The present study aims to address this question through reviewing previous publications on this topic. Analysis of previous studies suggests that probiotic administration during pregnancy and/or the first year of life could reduce the prevalence of infectious diseases in infancy. The effects of probiotic administration during pregnancy and/or the first year of life on the prevention of allergic disorders are still not clear. In addition, the available studies differ in probiotic species, number of probiotics, dosage of probiotics, inclusion and exclusion criteria, outcomes, and diagnostic and follow-up methods. These differences highlight further studies for better understanding the effects of probiotic administration on the prevention of infections and allergic diseases in childhood.

Impact of rhinovirus nasopharyngeal viral load and viremia on severity of respiratory infections in children.

There are few and partially discordant data regarding nasopharyngeal rhinovirus (RV) load and viremia, and none of the published studies evaluated the two variables together. The aim of this study was to provide new information concerning the clinical relevance of determining nasopharyngeal viral load and viremia when characterising RV infection. Nasopharyngeal swabs were obtained from 251 children upon their admission to hospital because of fever and signs and symptoms of acute respiratory infection in order to identify the virus and determine its nasopharyngeal load, and a venous blood sample was taken in order to evaluate viremia. Fifty children (19.9 %) had RV-positive nasopharyngeal swabs, six (12 %) of whom also had RV viremia: RV-C in four cases (66.6 %), and RV-A and RV-B in one case each. The RV nasopharyngeal load was significantly higher in the children with RV viremia (p < 0.001), who also had a higher respiratory rate (p = 0.02), white blood cell counts (p = 0.008) and C-reactive protein levels (p = 0.006), lower blood O2 saturation levels (P = 0.005), and more often required O2 therapy (p = 0.009). The presence of RV viremia is associated with a significantly higher nasopharyngeal viral load and more severe disease, which suggests that a high nasopharyngeal viral load is a prerequisite for viremia, and that viremia is associated with considerable clinical involvement.

Evaluation of "chemical isolation" in 1,168 leprosy patients' homes.

"Chemical isolation" (treatment of open cases as a measure of control for transmission between contacts) is evaluated by a retrospective study of 7,232 household contacts of 1,168 leprosy patient homes. Contacts comparable in age and type of exposure were arranged in subgroups according to whether they were born before (Group A) or born after (Group B) beginning treatment of the index cases had begun. Additionally, the whole group of contacts, both of open (LL & BB) and closed (TT & I) cases were evaluated. Among comparable contacts of LL and BB cases, the infection rate in the contacts before initiation of treatment is higher than in that of contacts after initiation of treatment. The protection afforded by the treatment to the exposed group (Group B) is on the order of 66%. The morbidity occurring in the group born after the initiation of index case treatment apparently results from partial persistence of infectiousness of the case under treatment.