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1.
Pediatr Infect Dis J ; 38(11): e295-e300, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31626041

RESUMO

BACKGROUND: Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany. METHODS: Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria. RESULTS: Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated. CONCLUSIONS: ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.

2.
Emerg Infect Dis ; 25(7): 1384-1388, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211683

RESUMO

In 2018, a cluster of pediatric human parechovirus (HPeV) infections in 2 neighboring German hospitals was detected. Viral protein 1 sequence analysis demonstrated co-circulation of different HPeV-3 sublineages and of HPeV-1 and -5 strains, thereby excluding a nosocomial outbreak. Our findings underline the need for HPeV diagnostics and sequence analysis for outbreak investigations.

3.
Pediatr Infect Dis J ; 2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-29846301

RESUMO

Group B Streptococcus (GBS) is a leading cause of morbidity and mortality in newborns worldwide. From 2000-2008, national guidelines in Germany recommended intrapartum antibiotic prophylaxis for pregnant women displaying risk factors (e.g. perinatal anogenital GBS colonization, rupture of the membranes ≥ 18 hours before birth), for the vertical transmission of GBS to their children.In 2008, these guidelines were revised in order to advocate universal, culture-based screening for GBS colonization among all pregnant women between 35 and 37 weeks of gestation. For the period 2009-2010, our prospective active surveillance study assessed the incidence of invasive GBS infections in infants aged 0-90 days in Germany. We did this by means of a capture-recapture analysis of two separate, independent systems (pediatric reporting vs. laboratory reporting). We compared our results with those from a previous study by employing an equivalent design (2001-2003). We detected a 32% reduction in GBS incidence, from 0.47 per 1,000 live births (n=679) in 2001-2003, to 0.34 per 1,000 live births (n=450) in 2009-2010. This decline primarily is tied to a reduced number of GBS cases in children under one week of age. In 2009-2010, the ratio of EOD to LOD reversed from 1.52 (206:136), as determined in 2001-2003, to 0.75 (92:122). This study is the first to assess changes in the incidence of invasive GBS in Germany after the implementation of the guidelines for intrapartum prophylaxis for pregnant women colonized with GBS.

4.
Klin Padiatr ; 230(3): 115-121, 2018 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29589346

RESUMO

Immunocompromised children and adolescents receiving treatment for cancer have a considerably increased risk for infection. Neutropenia is the most important single risk factor for infectious complications, and fever in neutropenia is considered as an emergency. Whereas guidelines for the management of fever in neutropenic adults have been established for decades, specific pediatric guidelines have not been developed until recently. As children differ in many aspects from adults such as in the underlying malignancy or in the availability and dosing of antimicrobial compounds, guidelines for pediatric patients are important. This article reviews similarities and differences between the recently published German interdisciplinary guideline of the German Societies of Pediatric Infectious Diseases and Pediatric Oncology and Hematology and a guideline developed by a panel of international experts for the management of fever in neutropenia in children and adolescents.

5.
Artigo em Inglês | MEDLINE | ID: mdl-29579259

RESUMO

Background: This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide. Methods: Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012. Results: Overall, 17693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day. Conclusions: A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

6.
Neuropediatrics ; 49(3): 213-216, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29523004

RESUMO

Despite the availability of modern antibiotics, pneumococcal meningitis in both children and adults remains a severe disease-one known to frequently cause grave complications and residual disability. Although the appearance of arterial vasospasms in bacterial meningitis systematically has been investigated and reported on for adult patients, such research is lacking when it comes to infants. We report on a 4-week-old infant who, 6 days after onset of pneumococcal meningitis, suffered severe neurological deterioration with treatment-resistant seizures and coma. Generalized cortical and subcortical edema developed in conjunction with diminished cerebral blood flow, as depicted in magnetic resonance angiography and serial Doppler-sonographic examinations. The ischemia resulted in extensive cystic encephalomalacia. We propose that the degree of variation in cerebral blood flow in the acute phase was the result of an extensive arterial vasculopathy involving vasospasms. Awareness of this complication and prospective serial Doppler-sonographic examinations may improve our understanding of the connection between brain edema and vasculopathy. At present, however, no effective treatment appears available.

7.
Pediatr Infect Dis J ; 37(9): 850-855, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29406464

RESUMO

BACKGROUND: Diverse scores on high-risk Kawasaki disease (KD) patients have proven a good prognostic validity in the Japanese population. However, data on non-Japanese have been inconclusive. Do the Kobayashi, Egami and Sano scores or application of up-to-date statistical methods (Random Forest) predict response to standard intravenous immunoglobulin (IVIG) therapy and the risk of persistent coronary artery aneurysm (CAA) in patients with KD in a mainly Caucasian population in Germany? METHODS: Data on 442 children (German population-based survey, 2013 and 2014) were used to assess the prognostic validity of the Kobayashi, Egami and Sano scores for being refractory to IVIG treatment and for predicting the risk of persistent CAA. Additionally, an up-to-date statistical approach (Random Forest) was applied to identify a potentially more valid score. RESULTS: A total of 301 children were eligible for assessment of their response to IVIG treatment. Among those, 177 children were followed-up for 1 year to identify persistent CAA. Although all scores were significantly associated with being refractory to IVIG (relative risk range between 2.32 and 3.73), the prognostic properties were low (likelihood ratio positive: 1.83-4.57; sensitivity in the range of 0.28-0.53). None of the scores was a significant predictor of CAA 1 year after acute illness. Application of statistical analysis such as Random Forest did not yield a more valid score. CONCLUSIONS: None of the available scores appears to be appropriate for identifying high-risk Caucasian children with KD who might need intensified therapy.

8.
Pediatr Rheumatol Online J ; 16(1): 7, 2018 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-29357887

RESUMO

BACKGROUND: Systemic juvenile idiopathic arthritis (SJIA) is an autoinflammatory disease associated with chronic arthritis. Early diagnosis and effective therapy of SJIA is desirable, so that complications are avoided. The PRO-KIND initiative of the German Society for Pediatric Rheumatology (GKJR) aims to define consensus-based strategies to harmonize diagnostic and therapeutic approaches in Germany. METHODS: We analyzed data on patients diagnosed with SJIA from 3 national registries in Germany. Subsequently, via online surveys and teleconferences among pediatric rheumatologists with a special expertise in the treatment of SJIA, we identified current diagnostic and treatment approaches in Germany. Those were harmonized via the formulation of statements and, supported by findings from a literature search. Finally, an in-person consensus conference using nominal group technique was held to further modify and consent the statements. RESULTS: Up to 50% of patients diagnosed with SJIA in Germany do not fulfill the International League of Associations for Rheumatology (ILAR) classification criteria, mostly due to the absence of chronic arthritis. Our findings suggest that chronic arthritis is not obligatory for the diagnosis and treatment of SJIA, allowing a diagnosis of probable SJIA. Malignant, infectious and hereditary autoinflammatory diseases should be considered before rendering a diagnosis of probable SJIA. There is substantial variability in the initial treatment of SJIA. Based on registry data, most patients initially receive systemic glucocorticoids, however, increasingly substituted or accompanied by biological agents, i.e. interleukin (IL)-1 and IL-6 blockade (up to 27.2% of patients). We identified preferred initial therapies for probable and definitive SJIA, including step-up patterns and treatment targets for the short-term (resolution of fever, decrease in C-reactive protein by 50% within 7 days), the mid-term (improvement in physician global and active joint count by at least 50% or a JADAS-10 score of maximally 5.4 within 4 weeks) and the long-term (glucocorticoid-free clinically inactive disease within 6 to 12 months), and an explicit treat-to-target strategy. CONCLUSIONS: We developed consensus-based strategies regarding the diagnosis and treatment of probable or definitive SJIA in Germany.


Assuntos
Artrite Juvenil/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Fatores Biológicos/uso terapêutico , Criança , Pré-Escolar , Consenso , Bases de Dados Factuais , Alemanha , Glucocorticoides/uso terapêutico , Humanos , Sistema de Registros
9.
Pediatr Infect Dis J ; 37(3): 272-274, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29135825
10.
Emerg Infect Dis ; 23(2): 343-344, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28098549

RESUMO

Diffuse unilateral subacute neuroretinitis is an ocular infectious disease caused by several distinct nematodes. Definite identification of the involved nematodes is rarely achieved. We report on the molecular-based genetic identification of an Ancylostoma ceylanicum hookworm implicated in a case of diffuse unilateral subacute neuroretinitis in a child.


Assuntos
Ancylostoma , Ancilostomíase/diagnóstico , Ancilostomíase/parasitologia , Retinite/diagnóstico , Retinite/parasitologia , Ancylostoma/genética , Ancylostoma/imunologia , Ancilostomíase/imunologia , Animais , Anticorpos Anti-Helmínticos/imunologia , Criança , DNA de Helmintos , Ensaio de Imunoadsorção Enzimática , Genes de Helmintos , Humanos , Masculino , Oftalmoscópios , Reação em Cadeia da Polimerase , Retinite/imunologia
11.
Arthritis Rheumatol ; 68(12): 3023-3034, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27332999

RESUMO

OBJECTIVE: To investigate the clinical presentation and medical treatment of patients with systemic juvenile idiopathic arthritis (JIA) during the first year of illness. Our study focused on 3-year outcomes in a subsample of patients who were followed up longitudinally. METHODS: From 2000 to 2013, 597 patients with systemic JIA and a disease duration of ≤12 months were recorded in the National Pediatric Rheumatologic Database. Among those patients, 3-year outcome data were available for 133. These data included the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS-10) and the physician's global assessment score (on a numerical rating scale), as well as assessment of joint involvement, growth retardation, and patient-reported outcomes. RESULTS: The median clinical JADAS-10 declined significantly, from 7 in 2000 to 2 in 2013, while the proportion of patients with inactive disease increased from 19% in 2000 to 41% in 2013. The rate of treatment with systemic glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) remained stable from 2000 to 2013. By 2013, the proportion of patients with systemic JIA who were treated with biologic DMARDs had increased to 20%. At 3-year follow-up, 72% of patients with systemic JIA had inactive disease, and 77% had no functional limitations. Growth retardation was associated with persistently high disease activity and continuing treatment with systemic glucocorticoids. At the 3-year follow-up, one-third of patients were still being treated with systemic glucocorticoids. CONCLUSION: The proportion of patients with inactive disease has increased over the past decade. Possible explanations may include improved access to specialized care, additional treatment options, and earlier or faster step-up treatment. However, challenges in the management of systemic JIA remain, as ∼30% of patients continue to present with ongoing active disease.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Glucocorticoides/uso terapêutico , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Adolescente , Artrite Juvenil/complicações , Artrite Juvenil/fisiopatologia , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Feminino , Alemanha , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Estudos Longitudinais , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Pediatr Infect Dis J ; 35(2): 129-34, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26465100

RESUMO

BACKGROUND: National estimates of Kawasaki disease (KD) incidence often do not include incomplete cases (diagnosed based on only laboratory or echocardiographic criteria), and/or they rely on retrospective case reports and data registries where underreporting is known to be a problem. METHODS: We conducted a prospective nationwide KD surveillance study in children younger than 5 years through the hospital-based German Pediatric Surveillance Unit (ESPED). We accounted for underreporting through applying capture-recapture methodology in 2 federal states using hospital discharge records with KD International Statistical Classification of Diseases and Related Health Problems 10th revision code (ie, M30.3). KD diagnosis (complete and incomplete) was established according to the American Heart Association criteria, 2004. RESULTS: Incidence of KD, corrected for underreporting, was 7.2 of 100,000 in children younger than 5 years in Germany. Underreporting to ESPED was estimated at 37%-44%. Overall, 315 validated KD cases were reported. Of the 64 (20%) incomplete cases, 58% (37/64) were detected through echocardiographic findings and 42% (27/64) through laboratory criteria alone. Incomplete cases were younger than complete cases (1.2 vs. 2.0 years, P = 0.0001) and had more coronary aneurysms (43% vs. 11%, P = 0.0001). CONCLUSIONS: A substantial number of incomplete KD cases were diagnosed based on the laboratory and echocardiographic criteria only. This was particularly the case in relation to infants younger than 1 year-an age group known to have an increased risk of developing coronary aneurysms. In addition, we found a high rate of underreporting to national Pediatric Surveillance Units. We suggest that improved surveillance and development of better diagnostic tests remain a high priority.


Assuntos
Síndrome de Linfonodos Mucocutâneos/epidemiologia , Pré-Escolar , Monitoramento Epidemiológico , Feminino , Alemanha/epidemiologia , Humanos , Lactente , Masculino , Estudos Prospectivos
15.
Eur J Pediatr ; 174(6): 827-35, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25922140

RESUMO

UNLABELLED: Implementation of guidelines for group B streptococcal (GBS) prepartum screening (PS) rarely has been prospectively evaluated. To assess PS at 35-37 weeks of gestation and compare its predictive value to that of an intrapartum screening (IS) within 7 days of delivery, a surveillance cohort study was conducted at a tertiary care center in Freiburg, Germany, during 2011-2012. Study participants included 937 pregnant women who had intrapartum cultures taken for vaginal and rectal GBS colonization. Colonization status was compared to PS, and intrapartum antibiotic prophylaxis (IAP) rates calculated. The neonates were tested for GBS transmission via cultures from their throats and external ear canals. While 67.5% (633/937) of study participants had a PS, only 22.7% (144/633) underwent a fully guideline-compatible PS. However, maternal GBS colonization rates were similar when comparing PS (18.5% [117/633]) versus IS (17.0% [133/784]). The positive predictive value of a positive PS result for GBS positivity at delivery was 77.2 %. Women with a positive PS received IAP in 89.3% of cases (75/84). The capsular serotype distribution pattern of colonizing GBS strains has not changed in comparison to our 2003-2004 study--one with a similar study design. CONCLUSIONS: Improved strategies for adoption of prepartum GBS screening are needed. WHAT IS KNOWN: • The prediction of prepartum GBS screening for intrapartum colonization status has not been well studied. • Longitudinal studies of GBS screening are needed for screening program evaluations and vaccine development. What is New: • The rate of GBS screening has improved over 10 years, and intrapartum GBS colonization prediction was accurate. • Serotype distribution was stable and suggests the potential long-term efficacy of GBS vaccines.


Assuntos
Streptococcus agalactiae/isolamento & purificação , Adolescente , Adulto , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Estudos de Coortes , Parto Obstétrico , Feminino , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Troca Materno-Fetal , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Gravidez , Reto/microbiologia , Vagina/microbiologia , Adulto Jovem
17.
Pediatrics ; 133(5): e1388-91, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24709927

RESUMO

Group B Streptococcus (GBS) remains the leading cause of neonatal sepsis and meningitis in industrialized countries. Whereas the use of intrapartum antibiotic prophylaxis has led to a significant decline in early-onset sepsis, the incidence of late-onset sepsis has remained unchanged. Whether late-onset sepsis usually originates from established mucocutaneous GBS colonization of the infant or whether it results from an acute exogenous GBS infection remains controversial. Here we report on twins who both twice developed GBS sepsis in a strikingly parallel fashion, with both instances originating from a single hypervirulent GBS clone. Factored together, the presentation as cervical soft tissue infection in both cases, the synchronicity of the episodes, and the detection of GBS DNA in breast milk all strongly suggest an enteral mode of transmission with a short incubation period.


Assuntos
Doenças do Prematuro/diagnóstico , Pescoço , Sepse/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae , Nutrição Enteral , Humanos , Doenças do Prematuro/microbiologia , Leite Humano/microbiologia , Recidiva , Sepse/microbiologia , Sepse/transmissão , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/transmissão , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus agalactiae/patogenicidade , Gêmeos Dizigóticos , Virulência
19.
Int J Pediatr Otorhinolaryngol ; 77(9): 1585-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23845534

RESUMO

Since the widespread availability and use of antibiotics the prevalence of Lemierre syndrome (L.S.) has decreased. It is a well-described entity, consisting of postanginal septicaemia with thrombophlebitis of the internal jugular vein with metastatic infection, most commonly in the lungs. The most common causative agent is a gram-negative, non-spore-forming obligate anaerobic bacterium, Fusobacterium necrophorum (F.n.). We describe the unusual clinical features of a 12-year-old boy with Lemierre syndrome with isolated hypoglossal nerve palsy - the latter symptom is an extremely rare manifestation of this disease.


Assuntos
Infecções por Fusobacterium/diagnóstico , Doenças do Nervo Hipoglosso/etiologia , Síndrome de Lemierre/diagnóstico , Antibacterianos/uso terapêutico , Criança , Estado Terminal/terapia , Seguimentos , Infecções por Fusobacterium/tratamento farmacológico , Fusobacterium necrophorum/efeitos dos fármacos , Fusobacterium necrophorum/isolamento & purificação , Humanos , Doenças do Nervo Hipoglosso/diagnóstico por imagem , Doenças do Nervo Hipoglosso/terapia , Unidades de Terapia Intensiva , Síndrome de Lemierre/tratamento farmacológico , Masculino , Doenças Raras , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Pediatr Pulmonol ; 48(12): 1246-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23139028

RESUMO

While pleuropulmonary involvement in systemic lupus erythematosus (SLE) is a common occurrence, shrinking lung syndrome (SLS) is a rare complication of SLE, particularly in children. We report on a teenager girl with a primary SLE diagnosis, which was based upon clinical, imaging, lung-function and histological findings ascertained to be compatible with SLS. Following a pneumonia, the patient developed inflammatory residues in the lower lobes, an event that probably caused diaphragmatic immobility and subsequently led to SLS. Treatment response to steroids, cyclophosphamide and hydroxychloroquine in this case was excellent, and efficacy was more profound than previously has been reported in the literature with respect to pediatric patients. This case report argues that prognosis of SLS in SLE is likely to be favorable when the diagnosis is made early and the disease is treated appropriately.


Assuntos
Diafragma/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico , Atelectasia Pulmonar/diagnóstico por imagem , Dor no Peito/etiologia , Criança , Ciclofosfamida/uso terapêutico , Diafragma/fisiopatologia , Dispneia/etiologia , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Pleurisia/etiologia , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/fisiopatologia , Radiografia , Síndrome , Resultado do Tratamento
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