Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments d...Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.展开更多
Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immu...Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response.This makes it difficult to detect HBV infection.For this reason,it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunop-rophylaxis at birth should have HBsAb testing when they are 9-15 months old.展开更多
AIM:To present our experience with tuberculous peritonitis treated in our hospital from 2002-2007. METHODS: We reviewed the medical records of 9 children with tuberculous peritonitis. RESULTS: Nine patients (5 boys, 4...AIM:To present our experience with tuberculous peritonitis treated in our hospital from 2002-2007. METHODS: We reviewed the medical records of 9 children with tuberculous peritonitis. RESULTS: Nine patients (5 boys, 4 girls) of mean age 14.2 years were diagnosed with peritoneal tuberculosis. All patients presented with abdominal distention. Abdominal pain was seen in 55.5% and fever in 44.4% of the patients. Four cases had coexisting pleural effusion and two had pulmonary tuberculosis with parenchymal consolidation. Ultrasonography found ascites with septation in 7 patients. Two patients had only ascites without septation. Ascitic fluid analysis of 8 patients yielded serum-ascite albumin gradients of less than 1.1 gr/dL. Laparoscopy and laparotomy showed that whitish tuberculi were the most common appearance. Adhesions were also seen in three cases. The diagnosis of peritoneal tuberculosis was confirmed histo-pathologically in 7 patients and microbiologically in two. Two patients had been diagnosed by ascitic fluid diagnostic features and a positive response to antituberculous treatment. All patients completed the antituberculous therapy without any complications. CONCLUSION: Tuberculous peritonitis has to be clinically suspected in all patients with slowly progressive abdominal distension, particularly when it is accompanied by fever and pain. Laparoscopy and peritoneal biopsy are still the most reliable, quick and safe methods for the diagnosis of tuberculous peritonitis.展开更多
Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CC...Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.展开更多
BACKGROUND Environmental enteric dysfunction(EED)is a subclinical condition caused by fecal-oral contamination leading to enteric inflammation and dysbiosis.Bile acids serve to facilitate lipid digestion and absorptio...BACKGROUND Environmental enteric dysfunction(EED)is a subclinical condition caused by fecal-oral contamination leading to enteric inflammation and dysbiosis.Bile acids serve to facilitate lipid digestion and absorption,regulate metabolic pathways associated with childhood growth and inflammation,and may be affected by EED.AIM To investigate bile acid metabolism in Bangladeshi children with EED and its association with growth impairment.METHODS We conducted a cross-sectional study of 100 Bangladeshi infants(aged 6-9 months)and quantified serum and fecal bile acids using LC-MS/MS.We compared profiles to a control group of 6 American children(6-12 months)and 80 older Bangladeshi children(aged 2 years).RESULTS Bangladeshi infants had higher levels of plasma unconjugated primary(65.23%vs 44.25%,P=0.003)and sulfated primary bile acids(12.98%vs<0.001%,P=0.01),with lower primary conjugated bile acids(0.69%vs 2.74%,P≤0.001)compared to American children.Stool unconjugated primary bile acids were inversely associated with weight-for-age[regression coefficient(β)=-0.01,P=0.01]and height-for-age Z scores(β=-0.01,P=0.03).Conjugated secondary bile acids were inversely associated with small intestine bacterial overgrowth(β=-1096.68,P=0.05).Fecal myeloperoxidase was associated with sulfated secondary bile acids(β=-0.40,P=0.04).Compared to 2-year-old children,the Bangladeshi infant’s serum had higher levels of unconjugated primary bile acids(65.23%vs 9.20%,P≤0.001)and lower levels of primary conjugated bile acids(0.69%vs 80.38%,P≤0.001).CONCLUSION Our data suggests an age-dependent defect in conjugation of primary bile acids in Bangladeshi children with compensatory hydrophilic shunting.Additionally,bile acid profiles are associated with intestinal overgrowth.展开更多
Background In children, surveys on Staphylococcus aureus have focused on specific infections, situations or strains but no study has so far given an overview on S. aureus isolation without any selection. Here, we desc...Background In children, surveys on Staphylococcus aureus have focused on specific infections, situations or strains but no study has so far given an overview on S. aureus isolation without any selection. Here, we describe the overall bacteriologi-cal and clinical characteristics of S. aureus isolation in children, with a special focus on isolates harbouringtst,sea, and/or luk-PV genes, respectively, encoding the three clinically relevant toxins: toxic shock syndrome toxin-1, enterotoxin A and Panton–Valentine leukocidin. Methods Data associated with S. aureus isolation were reviewed: isolation site, infection status,tst,sea andluk-PV genes, antimicrobial susceptibility pattern,agr typing. Results Three hundred and seventy-seven isolates retrieved from 328 children during S. aureus infection (55.2%) or colo-nisation (44.8%) were included.tst,sea and luk-PV genes were amplified in 14.3, 9.5 and 5.8% of the isolates, respectively. These isolates were significantly more frequently retrieved during infection (69.1%) than colonisation but differences were observed according to isolation site. Methicillin-resistance was found in 7.2% of the isolates, 78% of which harboured ≥ 1 of the targeted toxin-encoding genes. Conclusions This first comprehensive study of S. aureus in children showed S. aureus to be mainly retrieved during infection and a high rate of colonisation, not limited to the nasopharynx. Predominant infections were skin and soft tissue infections wheretst was most frequently detected.luk-PV was most commonly detected during bone and joint infections. Isolates harbouring targeted toxin-encoding genes were significantly associated with infections but a quarter of children were asymp-tomatic carriers representing a reservoir for dissemination of isolates with virulence potency.展开更多
Objective:To describe clinical and epidemiological characteristics,antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections(HCAIs)caused by Staphylococcus(S.)aureus in children...Objective:To describe clinical and epidemiological characteristics,antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections(HCAIs)caused by Staphylococcus(S.)aureus in children.Methods:We conducted a retrospective,single-centre study of pediatric HCAIs caused by S.aureus from a tertiary care hospital in Turkey between February 2014 and December 2019.The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S.aureus(MSSA and MRSA)isolates was evaluated.Results:A total of 310 pediatric patients were examined.Overall,225(72.6%)isolates were MSSA and 85(27.4%)were MRSA.All S.aureus isolates were susceptible to teicoplanin,vancomycin,linezolid,tigecycline,mupirocin,and daptomycin.Penicillin resistance rates were high(89.0%),while fosfomycin,gentamicin,and clindamycin resistance rates were low(1.3%,1.0%,and 2.3%,respectively).Except susceptibility to fosfomycin,which was significantly lower in 2014 compared to 2018 and 2019,no significant difference was found in the antimicrobial susceptibility of S.aureus isolates between the years.Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs.The mortality rate of HCAIs caused by S.aureus was 6.5%(20 patients).Malignancy was an independent risk factor associated with mortality in the multivariate analysis(OR 5.446,95%CI 1.573-18.849).Conclusions:Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S.aureus.The mortality rate was 6.5%,the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children.These findings could help improve the management of HCAIs caused by S.aureus in children.展开更多
Background: Tuberculosis remains a public health problem worldwide, and tuberculosis in pregnancy in particular can have effects on both mother and infant. Findings: We report a case of a 22- year-old female presentin...Background: Tuberculosis remains a public health problem worldwide, and tuberculosis in pregnancy in particular can have effects on both mother and infant. Findings: We report a case of a 22- year-old female presenting in preterm labor at 32 weeks gestation. Her pregnancy had been complicated by hearing loss and weight loss, and at the time of delivery, she was diagnosed with tuberculous otitis media and disseminated tuberculosis. Tuberculous otitis media is a rare form of tuberculosis disease, and in this case, had consequences for mother and infant. Conclusions: Importance of suspicion for tuberculosis disease in patients presenting with atypical symptoms but epidemiologic history is emphasized.展开更多
Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 lev...Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case s ubjects had candidemia diagnosed more than 48 hours after hospitalization. Contr ol subjects (3 per case) were matched by study site, birth weight, study year, a nd date of enrollment. Potential risk factors included medical devices, medicati ons, gastrointestinal (GI) pathology (congenital anomalies or necrotizing entero colitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-f ive cases of candidemia occurred during the study period and accounted for 15%o f BSIs. C. albicans caused 62%of infections (28/45); C. parapsilosis, 31%(14/4 5). Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95%confidence interval [CI] = 1.02 to 1.10), previous bacterial BS Is (OR = 8.02; 95%CI = 2.76 to 23.30) and GI pathology (OR = 4.57; 95%CI = 1.6 2 to 12.92)were significantly associated with candidemia. In all, 26/45 cases (5 8%) of candidemia occurred in infants who would not have qualified for fluconaz ole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed pre vious risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.展开更多
The endosomal Toll-like receptors （TLRs） TLR3, TLR7, TLR8 and TLR9 are important in sensing foreign nucleic acids encountered by phagocytes. Because TLR8 was initially thought to be non-functional in mice, less is k...The endosomal Toll-like receptors （TLRs） TLR3, TLR7, TLR8 and TLR9 are important in sensing foreign nucleic acids encountered by phagocytes. Because TLR8 was initially thought to be non-functional in mice, less is known about TLR8 than the genetically and functionally related TLR7. Originally associated with the recognition of single-stranded RNA of viral origin, there is now evidence that human TLR8 is also able to sense bacterial RNA released within phagosomal vacuoles, inducing the production of both nuclear factor （NF）-κB-dependent cytokines and type I interferons （IFNs）, such as IFN-β. The functions of TLR8 extend beyond the recognition of foreign pathogens and include cross-talk with other endosomal TLRs, a process that may also have a role in the generation of autoimmunity.展开更多
An analytical and experimental study of nanofilm aluminum (Al) for ultra-high dynamic range surface plasmon resonance (SPR) biosensor is presented in this article. A thin film of 16 nm Al is proposed for metallic sens...An analytical and experimental study of nanofilm aluminum (Al) for ultra-high dynamic range surface plasmon resonance (SPR) biosensor is presented in this article. A thin film of 16 nm Al is proposed for metallic sensing layer for SPR .s*ensoi For the protective layer, a 10 nm of gold (Au) layer was configured on top of Al as a protection layer. This ultra-high dynamic range of SPR biosensor reached the bulk refractive index sample limit up to 1.45 RIU. For the analytical study, with the assumption of anisotropic refractive indices experiment, the dynamic range showed a refractive index value of around 1.58 RIU. The refractive index value limit achieved by the proposed sensing design is potentially implemented in various applications, such as in chemical detection and environ- mental monitoring study with high refractive index solution sample. The experimental results are presented as a proof-of-concept of the proposed idea.展开更多
Immunogenic antigens for vaccination are often created through the production of recombinant proteins using Escherichia coli.1 As a side product,aggregates called inclusion bodies(IBs)are formed,containing largely mis...Immunogenic antigens for vaccination are often created through the production of recombinant proteins using Escherichia coli.1 As a side product,aggregates called inclusion bodies(IBs)are formed,containing largely misfolded forms of the overexpressed recombinant protein.2 The effect of IBs on the immune system and whether they can be used as effective vaccine products remain unknown.The non-native conformation of proteins upon accumulation in IBs abrogates their use as vaccines aimed at generating high-affinity antibodies.3 However,IBs exhibit unique properties,including mechanical and thermal stability due to their intrinsic particulate nature,biocompatibility,high antigenic content,low toxicity and relative resistance to proteases.These characteristics make IBs attractive as an antigenic vaccine formulation for T cell responses to linear epitopes.Whether IBs can trigger adaptive cellular responses initiated via uptake by dendritic cells for presentation to T cells is unknown.展开更多
Background:Previously rare A2ML1 variants were identified to confer otitis media susceptibility in an indigenous Filipino community and in otitis-prone US children.The goal of this study is to describe differences in ...Background:Previously rare A2ML1 variants were identified to confer otitis media susceptibility in an indigenous Filipino community and in otitis-prone US children.The goal of this study is to describe differences in the middle ear microbiome between carriers and non-carriers of an A2ML1 duplication variant that increases risk for chronic otitis media among indigenous Filipinos with poor health care access.Methods:Ear swabs were obtained from 16 indigenous Filipino individuals with chronic otitis media,of whom 11 carry the A2ML1 duplication variant.Ear swabs were submitted for 16S rRNA gene sequencing.Results:Genotype-based differences in microbial richness,structure,and composition were identified,but were not statistically significant.Taxonomic analysis revealed that the relative abundance of the phyla Fusobacteria and Bacteroidetes,and genus Fusobacterium were nominally increased in carriers compared to non-carriers,but were non-significant after correction for multiple testing.We also detected rare bacteria including Oligella that was reported only once in the middle ear.Conclusions:These findings suggest that A2ML1-related otitis media susceptibility may be mediated by changes in the middle ear microbiome.Knowledge of middle ear microbial profiles according to genetic background can be potentially useful for therapeutic and prophylactic interventions for otitis media and can guide public health interventions towards decreasing otitis media prevalence within the indigenous Filipino community.展开更多
文摘Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.
文摘Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response.This makes it difficult to detect HBV infection.For this reason,it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunop-rophylaxis at birth should have HBsAb testing when they are 9-15 months old.
文摘AIM:To present our experience with tuberculous peritonitis treated in our hospital from 2002-2007. METHODS: We reviewed the medical records of 9 children with tuberculous peritonitis. RESULTS: Nine patients (5 boys, 4 girls) of mean age 14.2 years were diagnosed with peritoneal tuberculosis. All patients presented with abdominal distention. Abdominal pain was seen in 55.5% and fever in 44.4% of the patients. Four cases had coexisting pleural effusion and two had pulmonary tuberculosis with parenchymal consolidation. Ultrasonography found ascites with septation in 7 patients. Two patients had only ascites without septation. Ascitic fluid analysis of 8 patients yielded serum-ascite albumin gradients of less than 1.1 gr/dL. Laparoscopy and laparotomy showed that whitish tuberculi were the most common appearance. Adhesions were also seen in three cases. The diagnosis of peritoneal tuberculosis was confirmed histo-pathologically in 7 patients and microbiologically in two. Two patients had been diagnosed by ascitic fluid diagnostic features and a positive response to antituberculous treatment. All patients completed the antituberculous therapy without any complications. CONCLUSION: Tuberculous peritonitis has to be clinically suspected in all patients with slowly progressive abdominal distension, particularly when it is accompanied by fever and pain. Laparoscopy and peritoneal biopsy are still the most reliable, quick and safe methods for the diagnosis of tuberculous peritonitis.
文摘Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.
基金Supported by Children’s Hospital Foundation at VCU,No.1K23HD097282(to Donowitz JR)National Institutes of Health,No.5R01AI043596(to Donowitz JR)+6 种基金Bill and Melinda Gates Foundation,No.OPP1017093VA Merit Award,No.1I01BX005730VA ShEEP Grants,No.1 IS1 BX004777-01National Institutes of Health Grant,No.2R56DK115377-05A1PIDS Summer Research Scholars AwardVCU SOM Dean’s Summer Research Fellowshipand Research Career Scientist Award from the Department of Veterans Affairs,No.IK6BX004477.
文摘BACKGROUND Environmental enteric dysfunction(EED)is a subclinical condition caused by fecal-oral contamination leading to enteric inflammation and dysbiosis.Bile acids serve to facilitate lipid digestion and absorption,regulate metabolic pathways associated with childhood growth and inflammation,and may be affected by EED.AIM To investigate bile acid metabolism in Bangladeshi children with EED and its association with growth impairment.METHODS We conducted a cross-sectional study of 100 Bangladeshi infants(aged 6-9 months)and quantified serum and fecal bile acids using LC-MS/MS.We compared profiles to a control group of 6 American children(6-12 months)and 80 older Bangladeshi children(aged 2 years).RESULTS Bangladeshi infants had higher levels of plasma unconjugated primary(65.23%vs 44.25%,P=0.003)and sulfated primary bile acids(12.98%vs<0.001%,P=0.01),with lower primary conjugated bile acids(0.69%vs 2.74%,P≤0.001)compared to American children.Stool unconjugated primary bile acids were inversely associated with weight-for-age[regression coefficient(β)=-0.01,P=0.01]and height-for-age Z scores(β=-0.01,P=0.03).Conjugated secondary bile acids were inversely associated with small intestine bacterial overgrowth(β=-1096.68,P=0.05).Fecal myeloperoxidase was associated with sulfated secondary bile acids(β=-0.40,P=0.04).Compared to 2-year-old children,the Bangladeshi infant’s serum had higher levels of unconjugated primary bile acids(65.23%vs 9.20%,P≤0.001)and lower levels of primary conjugated bile acids(0.69%vs 80.38%,P≤0.001).CONCLUSION Our data suggests an age-dependent defect in conjugation of primary bile acids in Bangladeshi children with compensatory hydrophilic shunting.Additionally,bile acid profiles are associated with intestinal overgrowth.
文摘Background In children, surveys on Staphylococcus aureus have focused on specific infections, situations or strains but no study has so far given an overview on S. aureus isolation without any selection. Here, we describe the overall bacteriologi-cal and clinical characteristics of S. aureus isolation in children, with a special focus on isolates harbouringtst,sea, and/or luk-PV genes, respectively, encoding the three clinically relevant toxins: toxic shock syndrome toxin-1, enterotoxin A and Panton–Valentine leukocidin. Methods Data associated with S. aureus isolation were reviewed: isolation site, infection status,tst,sea andluk-PV genes, antimicrobial susceptibility pattern,agr typing. Results Three hundred and seventy-seven isolates retrieved from 328 children during S. aureus infection (55.2%) or colo-nisation (44.8%) were included.tst,sea and luk-PV genes were amplified in 14.3, 9.5 and 5.8% of the isolates, respectively. These isolates were significantly more frequently retrieved during infection (69.1%) than colonisation but differences were observed according to isolation site. Methicillin-resistance was found in 7.2% of the isolates, 78% of which harboured ≥ 1 of the targeted toxin-encoding genes. Conclusions This first comprehensive study of S. aureus in children showed S. aureus to be mainly retrieved during infection and a high rate of colonisation, not limited to the nasopharynx. Predominant infections were skin and soft tissue infections wheretst was most frequently detected.luk-PV was most commonly detected during bone and joint infections. Isolates harbouring targeted toxin-encoding genes were significantly associated with infections but a quarter of children were asymp-tomatic carriers representing a reservoir for dissemination of isolates with virulence potency.
文摘Objective:To describe clinical and epidemiological characteristics,antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections(HCAIs)caused by Staphylococcus(S.)aureus in children.Methods:We conducted a retrospective,single-centre study of pediatric HCAIs caused by S.aureus from a tertiary care hospital in Turkey between February 2014 and December 2019.The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S.aureus(MSSA and MRSA)isolates was evaluated.Results:A total of 310 pediatric patients were examined.Overall,225(72.6%)isolates were MSSA and 85(27.4%)were MRSA.All S.aureus isolates were susceptible to teicoplanin,vancomycin,linezolid,tigecycline,mupirocin,and daptomycin.Penicillin resistance rates were high(89.0%),while fosfomycin,gentamicin,and clindamycin resistance rates were low(1.3%,1.0%,and 2.3%,respectively).Except susceptibility to fosfomycin,which was significantly lower in 2014 compared to 2018 and 2019,no significant difference was found in the antimicrobial susceptibility of S.aureus isolates between the years.Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs.The mortality rate of HCAIs caused by S.aureus was 6.5%(20 patients).Malignancy was an independent risk factor associated with mortality in the multivariate analysis(OR 5.446,95%CI 1.573-18.849).Conclusions:Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S.aureus.The mortality rate was 6.5%,the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children.These findings could help improve the management of HCAIs caused by S.aureus in children.
文摘Background: Tuberculosis remains a public health problem worldwide, and tuberculosis in pregnancy in particular can have effects on both mother and infant. Findings: We report a case of a 22- year-old female presenting in preterm labor at 32 weeks gestation. Her pregnancy had been complicated by hearing loss and weight loss, and at the time of delivery, she was diagnosed with tuberculous otitis media and disseminated tuberculosis. Tuberculous otitis media is a rare form of tuberculosis disease, and in this case, had consequences for mother and infant. Conclusions: Importance of suspicion for tuberculosis disease in patients presenting with atypical symptoms but epidemiologic history is emphasized.
文摘Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case s ubjects had candidemia diagnosed more than 48 hours after hospitalization. Contr ol subjects (3 per case) were matched by study site, birth weight, study year, a nd date of enrollment. Potential risk factors included medical devices, medicati ons, gastrointestinal (GI) pathology (congenital anomalies or necrotizing entero colitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-f ive cases of candidemia occurred during the study period and accounted for 15%o f BSIs. C. albicans caused 62%of infections (28/45); C. parapsilosis, 31%(14/4 5). Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95%confidence interval [CI] = 1.02 to 1.10), previous bacterial BS Is (OR = 8.02; 95%CI = 2.76 to 23.30) and GI pathology (OR = 4.57; 95%CI = 1.6 2 to 12.92)were significantly associated with candidemia. In all, 26/45 cases (5 8%) of candidemia occurred in infants who would not have qualified for fluconaz ole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed pre vious risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.
文摘The endosomal Toll-like receptors （TLRs） TLR3, TLR7, TLR8 and TLR9 are important in sensing foreign nucleic acids encountered by phagocytes. Because TLR8 was initially thought to be non-functional in mice, less is known about TLR8 than the genetically and functionally related TLR7. Originally associated with the recognition of single-stranded RNA of viral origin, there is now evidence that human TLR8 is also able to sense bacterial RNA released within phagosomal vacuoles, inducing the production of both nuclear factor （NF）-κB-dependent cytokines and type I interferons （IFNs）, such as IFN-β. The functions of TLR8 extend beyond the recognition of foreign pathogens and include cross-talk with other endosomal TLRs, a process that may also have a role in the generation of autoimmunity.
基金This research was funded in part by Ministry of Science and Technology(MOST)(Taiwan,China)under the contract number ofMOST 107-2218-E-182-008 and MOST 106-2221-E-182-041,also Chang Gung Memorial Hospital Grant with the contract number of CMRPDG0151.The authors thank the Indonesian Institute of Sciences and Chang Gung University for supporting this research.B.A.P.wholeheartedly thanks Chang Gung University,Taiwan,China for the visiting scholar invitation under the grant number BMRP741.
文摘An analytical and experimental study of nanofilm aluminum (Al) for ultra-high dynamic range surface plasmon resonance (SPR) biosensor is presented in this article. A thin film of 16 nm Al is proposed for metallic sensing layer for SPR .s*ensoi For the protective layer, a 10 nm of gold (Au) layer was configured on top of Al as a protection layer. This ultra-high dynamic range of SPR biosensor reached the bulk refractive index sample limit up to 1.45 RIU. For the analytical study, with the assumption of anisotropic refractive indices experiment, the dynamic range showed a refractive index value of around 1.58 RIU. The refractive index value limit achieved by the proposed sensing design is potentially implemented in various applications, such as in chemical detection and environ- mental monitoring study with high refractive index solution sample. The experimental results are presented as a proof-of-concept of the proposed idea.
基金supported by the European Research Council(ERC-339977-Glycotreat)supported by grants from the Dutch Cancer Society(VU2013-5940 and VU2016-10449).
文摘Immunogenic antigens for vaccination are often created through the production of recombinant proteins using Escherichia coli.1 As a side product,aggregates called inclusion bodies(IBs)are formed,containing largely misfolded forms of the overexpressed recombinant protein.2 The effect of IBs on the immune system and whether they can be used as effective vaccine products remain unknown.The non-native conformation of proteins upon accumulation in IBs abrogates their use as vaccines aimed at generating high-affinity antibodies.3 However,IBs exhibit unique properties,including mechanical and thermal stability due to their intrinsic particulate nature,biocompatibility,high antigenic content,low toxicity and relative resistance to proteases.These characteristics make IBs attractive as an antigenic vaccine formulation for T cell responses to linear epitopes.Whether IBs can trigger adaptive cellular responses initiated via uptake by dendritic cells for presentation to T cells is unknown.
基金supported by:the National Organization for Hearing Research Foundation,the Hearing Health Foundation,and Action On Hearing Loss(to R.L.P.S.C.)the University of the Philippines Manila–National Institutes of Health(to G.T.A.)+1 种基金the Albert and Margaret Alkek Foundation(to J.F.P.)the United States National Institutes of Health-National Institute on Deafness and Other Communication Disorders grants K18 DC013564(to T.C.),R01 DC011651 and R01 DC003594(to S.M.L.)and R01 DC015004(to R.L.P.S.C.).
文摘Background:Previously rare A2ML1 variants were identified to confer otitis media susceptibility in an indigenous Filipino community and in otitis-prone US children.The goal of this study is to describe differences in the middle ear microbiome between carriers and non-carriers of an A2ML1 duplication variant that increases risk for chronic otitis media among indigenous Filipinos with poor health care access.Methods:Ear swabs were obtained from 16 indigenous Filipino individuals with chronic otitis media,of whom 11 carry the A2ML1 duplication variant.Ear swabs were submitted for 16S rRNA gene sequencing.Results:Genotype-based differences in microbial richness,structure,and composition were identified,but were not statistically significant.Taxonomic analysis revealed that the relative abundance of the phyla Fusobacteria and Bacteroidetes,and genus Fusobacterium were nominally increased in carriers compared to non-carriers,but were non-significant after correction for multiple testing.We also detected rare bacteria including Oligella that was reported only once in the middle ear.Conclusions:These findings suggest that A2ML1-related otitis media susceptibility may be mediated by changes in the middle ear microbiome.Knowledge of middle ear microbial profiles according to genetic background can be potentially useful for therapeutic and prophylactic interventions for otitis media and can guide public health interventions towards decreasing otitis media prevalence within the indigenous Filipino community.
