Al Youha, Sarah, Alowaish, Osama, Ibrahim, Islam K., Alghounaim, Mohammad, Abu-Sheasha, Ghada A., Fakhra, Zainab, Al Hendi, Sarah, AlQabandi, Yousif, Almazeedi, Sulaiman, Al Asoomi, Fatima, and Al-Sabah, Salman
In Journal of Infection and Public Health September 2021 14(9):1226-1232
Alfraij, Abdulla, Bin Alamir, Abdulrahman A., Al-Otaibi, Abdulnasir M., Alsharrah, Danah, Aldaithan, Abdulrahman, Kamel, Ahmed M., Almutairi, Muna, Alshammari, Salman, Almazyad, Mohammed, Macarambon, Jara Mia, and Alghounaim, Mohammad
In Journal of Infection and Public Health February 2021 14(2):193-200
Pertussis is a common respiratory infection caused by the bacterium Bordetella pertussis. Although most cases occur in developing countries, it is considered endemic globally. The World Health Organization estimates there are 20-40 million cases of pertussis annually. Pertussis vaccines played a pivotal role in reducing the burden of pertussis disease as well as infant morbidity and mortality. Although the two forms of pertussis vaccine are effective, each has its advantages and drawbacks. This review aims to review the current knowledge on pertussis vaccines, emphasizing vaccine effectiveness in different populations within a community. Clinical trials have shown favorable vaccine efficacy with acellular pertussis (aP)vaccine. However, observational and population-level studies showed that introducing at least a single dose of whole-cell pertussis (wP) vaccine within the routine immunization schedule is associated with better disease protection and a longer duration of immunity. On the other hand, wP vaccine is more reactogenic and associated with higher adverse events. Therefore, the selection of vaccine should be weighed against the effectiveness, reactogenicity, and cost-effectiveness. Due to its safety profile, aP vaccine can be offered to wider population groups. Booster adolescent and pregnant immunization programs have been implemented globally to control outbreaks and protect vulnerable infants. Due to the variable effectiveness performance of both vaccines, different countries adopted distinctive immunization programs. Determining the right vaccination approach depends on financial consideration, immunization program infrastructure, adverse event monitoring, and pertussis surveillance in the community. [ABSTRACT FROM AUTHOR]
Downie, Mallory L., Alghounaim, Mohammad, Davidge, Kristen M., Yau, Yvonne, Walsh, Thomas J., Pope, Elena, Somers, Gino R., Waters, Valerie, and Robinson, Lisa A.
VIRAL shedding, LEUKOCYTE count, COVID-19, SARS-CoV-2, and REGRESSION analysis
Abstract
Objectives: We aimed to describe the clinical characteristics of SARS-CoV-2 infection and estimate viral shedding duration in respiratory specimens. Methods: A retrospective cohort study was performed from February 25 to March 25, 2020. In Kuwait, all suspected coronavirus disease 2019 (COVID-19) cases, contacts of cases, and returning travelers were systematically tested for SARS-CoV-2 by RT-PCR. All infected persons, regardless of symptoms, were hospitalized and serially tested until they had two negative results. Descriptive statistics and regression analyses were performed. Results: Two hundred seven cases of SARS-CoV-2 infection were included in this study. About half of the cases were asymptomatic and 1.9% died. The median time to negative RT-PCR was 22 days. Increasing age, ARDS, and low peripheral white blood cell count were associated with prolonged PCR positivity. Conclusion: Predictors for prolonged RT-PCR positivity included increasing age, ARDS, and low white blood cell count. The findings of this study may aid in better understanding of the epidemiology of SARS-CoV-2 infection and molecular testing dynamics. [ABSTRACT FROM AUTHOR]
Infectious Diseases, Microbiology (medical), General Medicine, Enterovirus, medicine.disease_cause, medicine, business.industry, business, Internal medicine, medicine.medical_specialty, Medical microbiology, Meningitis, medicine.disease, Retrospective cohort study, Antibiotic therapy, Pleocytosis, Cerebrospinal fluid, and Enterovirus meningitis
Abstract
To estimate the impact of implementing in-hospital enterovirus (EV) polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with same-day turn-around-time (TAT) on length-of-stay (LOS), antibiotic use and on cost per patient with suspected EV meningitis, compared with testing at an outside reference laboratory. A model-based analysis using a retrospective cohort of all hospitalized children with CSF EV PCR testing done between November 2013 and 2017. The primary outcome measured was the potential date of discharge if the EV PCR result had been available on the same day. Patients with positive EV PCR were considered for potential earlier discharge once clinically stable with no reason for hospitalization other than intravenous antibiotics. Descriptive statistics and cost-sensitivity analyses were performed. CSF EV PCR testing was done on 153 patients, of which 44 (29%) had a positive result. Median test TAT was 5.3 days (IQR 3.9-7.6). Median hospital LOS was 5 days (IQR 3-12). Most (86%) patients received intravenous antibiotics with mean duration of 5.72 ± 6.51 days. No patients with positive EV PCR had a serious bacterial infection. We found that same-day test TAT would reduce LOS and duration of intravenous antibiotics by 0.50 days (95%CI 0.33-0.68) and 0.67 days (95%CI 0.42-0.91), respectively. Same-day test TAT was associated with a cost reduction of 342.83CAD (95%CI 178.14-517.00) per patient with suspected EV meningitis. Compared with sending specimens to a reference laboratory, performing CSF EV PCR in-hospital with same-day TAT was associated with decreased LOS, antibiotic therapy, and cost per patient.
MENINGOCOCCAL infections, EMPYEMA, INTENSIVE care units, INFECTION, C-reactive protein, and MENINGITIS
Abstract
Background: Immunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.Objectives: The purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.Methods: Data were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.Results: There were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.Conclusion: IMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis. [ABSTRACT FROM AUTHOR]
Downie, Mallory L., Alghounaim, Mohammad, Davidge, Kristen M., Yau, Yvonne, Walsh, Thomas J., Pope, Elena, Somers, Gino R., Waters, Valerie, and Robinson, Lisa A.
Subjects
Transplantation, Pediatrics, Perinatology, and Child Health, Renal transplant, Mucormycosis, medicine.disease, medicine, Surgical excision, Cutaneous mucormycosis, Full recovery, Kidney transplantation, business.industry, business, Surgery, medicine.medical_specialty, Antifungal, and medicine.drug_class
Abstract
Mucormycosis is a rare and potentially life-threatening infection, typically affecting immunocompromised hosts. We report a case of an adolescent boy who developed primary isolated cutaneous mucormycosis in the early period following kidney transplantation. Surgical excision was performed using intraoperative fungal staining to obtain clear margins, followed by topical and systemic antifungal therapy. A skin graft was then applied to the excised area with good healing, and the patient made a full recovery.
Infection Control & Hospital Epidemiology; September 2016, Vol. 37 Issue: 9 p1087-1093, 7p
Abstract
BACKGROUNDPolymerase chain reaction (PCR) assays based on the detection of the toxin B gene are replacing enzyme-linked immunosorbent assay (ELISA)–based toxin production detection or cell cytotoxicity assay in most laboratories.OBJECTIVETo determine the proportion of pediatric patients diagnosed withClostridium difficileinfection by PCR who would have also been diagnosed by ELISA and to compare the clinical characteristics of PCR+/ELISA+ vs PCR+/ELISA− patients.METHODSUsing the microbiology laboratory information system, stool samples positive for C. difficileby PCR between October 2010 and July 2014 were identified. Using frozen stool specimens, an ELISA for toxin A and B was performed. A retrospective medical chart review was conducted to obtain demographic and clinical data. Duplicate samples were excluded.RESULTSA total of 136 PCR-positive samples underwent ELISA testing: 54 (40%) were positive for toxin A or B. The mean (SD) age of the entire cohort was 8.5 (6.2) years. There was no difference in age, gender, clinical manifestation, previous medical problems, and management between patients positive or negative by ELISA. However, patients positive by ELISA were more likely to have had a recent exposure to antibiotics (67.9% vs 50%; crude odds ratio, 2.1 [95% CI, 1.03–4.28]).CONCLUSIONIn our pediatric population, 60% of patients with C. difficilediagnosed by PCR had no toxin detectable by ELISA. ELISA-negative patients were less likely to have received an antibiotic recently compared with ELISA-positive patients. These results highlight the need to standardize laboratory criteria for the diagnosis of C. difficileinfections in children.Infect Control Hosp Epidemiol2016;37:1087–1093