Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study

Background: Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe. Methods: The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures. Findings: 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4–93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0–80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8–100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis. Interpretation: Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients

Seasonal variation in the copepod community structure from a tropical Amazon estuary, Northern Brazil

The main purpose of this study was to investigate the seasonal variation of copepod community structure during the months of July, September and November 2003 (dry season) and January, March and May 2004 (rainy season) in the Curuçá estuary, northern Brazil. Samples were collected during neap tides via gentle 200µm mesh net tows from a small powerboat. Measurements of surface water conductivity were accomplished in situ using an electronic conductivimeter and salinity was later obtained through the transformation of the conductivity values. Salinity varied seasonally from 7.2 ± 0.1 to 39.2 ± 1.8 (mean ± standard deviation) and was influenced mainly by differences in the amount of rainfall between the studied sampling seasons. In total, 30 Copepoda taxa were identified and Acartia tonsa comprised the most representative species throughout the entire studied period followed by Acartia lilljeborgii, Subeucalanus pileatus and Paracalanus quasimodo. In the present study, the density values, ecological indexes and copepod species dominance presented a clear seasonal pattern, showing that the studied area may be considered seasonally heterogeneous in relation to the investigated parameters.<br>O presente estudo teve como objetivo principal avaliar a variação sazonal na estrutura da comunidade dos copépodos durante os meses de julho, setembro e novembro de 2003 (período seco) e janeiro, março e maio de 2004 (período chuvoso) no estuário do Curuçá, Norte do Brasil. As amostras foram coletadas nas marés de quadratura com auxílio de uma rede deplâncton com 200µm de abertura de malha, rebocada por meio de uma pequena embarcação a motor. As medidas de condutividade da água foram realizadas in situ utilizando-se um condutivímetro eletrônico e a salinidade foi posteriormente obtida através da transformação dos valores de condutividade. Os valores de salinidade variaram sazonalmente de 7, 2 ± 0, 1a 39, 2 ± 1, 8 (média ± desvio padrão), tendo sido principalmente influenciados pelas diferenças nas taxas de precipitação entre os períodos de amostragem estudados. Foram identificados no total 30 táxons, com Acartia tonsa constituindo a espécie mais representativa durante todo o período de estudo,seguida por Acartia lilljeborgii, Subeucalanus pileatus e Paracalanus quasimodo. Durante este trabalho, os valores de densidade, índices ecológicos e dominância das espécies de copépodos apresentaram um padrão sazonal claro, mostrando que a área estudada pode ser considerada sazonalmente heterogênea em relação a estes parâmetros investigados