Procalcitonin: A Key Marker in Children with Urinary Tract Infection

Urinary tract infections (UTIs) are the most common source of bacterial infections among young febrile children. Accurate diagnosis of acute pyelonephritis (APN) and vesicoureteral reflux (VUR) is important because of their association with renal scarring, leading in the cases to long-term complications. However, the gold standard examinations for both are either DMSA scan (for APN and scar) or cystography (for VUR) and present limitations (feasibility, pain, cost, etc.). Procalcitonin, a reliable marker of bacterial infections, was demonstrated to be a good predictor of both renal parenchymal involvement in the acute phase and late renal scars. Furthermore, it was also found to be associated with high-grade VUR and was the key tool of a clinical decision rule to predict high-grade VUR in children with a first UTI. Therefore, procalcitonin may certainly be found playing a role in the complex and still debated picture of which examination should be performed after UTI in children

Performance characteristics of a rapid immunochromatographic assay for detection of pandemic influenza A (H1N1) virus in children

Rapid tests for diagnosis of influenza are valuable assets in the management of influenza in pediatric patients. However, test performance fluctuates with virus subtypes. We assessed the test characteristics of Influenzatop®, a rapid immunochromatographic influenza A and B test, in detecting pandemic 2009 influenza A (H1N1) in children up to 18years of age, using reverse transcriptase polymerase chain reaction (RT-PCR) as the gold standard. Three hundred and one pediatric outpatients with influenza-like illness were included into the study. Overall sensitivity of Influenzatop® was 64% (95% confidence interval (CI) 56-71%) but increased to 92% (95% CI, 80-97%) when performed between 24 and 48h after onset of symptoms. Positive Influenzatop® results among RT-PCR-positive patients were associated with higher viral load. No significant variation in test performance could be detected when analyzed by age and high versus low prevalence period. Overall test specificity was 99% (95% CI, 95-100%); positive and negative predictive values were 98% (95% CI, 93-99%) and 70% (95% CI, 63-76%), respectively. Conclusion: Influenzatop® rapid influenza test is a sound tool in the diagnosis of H1N1 in pediatric patients when employed 24-48h after onset of symptom

Performance characteristics of a rapid immunochromatographic assay for detection of pandemic influenza A (H1N1) virus in children.

UNLABELLED Rapid tests for diagnosis of influenza are valuable assets in the management of influenza in pediatric patients. However, test performance fluctuates with virus subtypes. We assessed the test characteristics of Influenzatop®, a rapid immunochromatographic influenza A and B test, in detecting pandemic 2009 influenza A (H1N1) in children up to 18 years of age, using reverse transcriptase polymerase chain reaction (RT-PCR) as the gold standard. Three hundred and one pediatric outpatients with influenza-like illness were included into the study. Overall sensitivity of Influenzatop® was 64% (95% confidence interval (CI) 56-71%) but increased to 92% (95% CI, 80-97%) when performed between 24 and 48 h after onset of symptoms. Positive Influenzatop® results among RT-PCR-positive patients were associated with higher viral load. No significant variation in test performance could be detected when analyzed by age and high versus low prevalence period. Overall test specificity was 99% (95% CI, 95-100%); positive and negative predictive values were 98% (95% CI, 93-99%) and 70% (95% CI, 63-76%), respectively. CONCLUSION Influenzatop® rapid influenza test is a sound tool in the diagnosis of H1N1 in pediatric patients when employed 24-48 h after onset of symptoms

Disease burden of rotavirus gastroenteritis in children up to 5years of age in two Swiss cantons: paediatrician- and hospital-based surveillance

Rotavirus gastroenteritis (RV GE) is a leading cause of diarrhoea in young children. The purpose of this epidemiological surveillance was to measure the disease burden of RV GE among children <5years of age in two regions of Switzerland, Geneva and Lucerne. One hospital and four paediatricians participated per region. The surveillance lasted from December 2006 to June 2007. The population denominator for calculation of the RV GE incidence rate was the average of the overall study population <5years of age under surveillance during the surveillance period. At the study sites, 513 children with GE were presented. Stool sample was collected and examined in 341 cases, of which 130 were RV positive (38.1%). Informed consent to participate in the study was obtained for 113 RV positive subjects. The overall RV GE incidence rate was 0.97% in Lucerne [lower incidence interval (LCI), 0.71%; upper incidence interval (UCI), 1.2%] compared with 0.65 and in Geneva (LCI, 0.50%; UCI, 0.81%). Disease severity assessments using the Vescari score showed that the RV GE episodes were more severe in Lucerne than in Geneva (14.05 ± 3.05 vs 12.85 ± 2.87), which was confirmed by a higher hospitalisation rate in Lucerne at the study visit (82.9% vs 23.6%). More children had fever in Geneva than in Lucerne (42.9% vs 26.8%), and more children were hospitalised during the follow-up period in Geneva than in Lucerne (14.5% vs 2.5%). Genotyping of RV positive stool samples revealed that both G1 and P8 were the most prevalent types in both regions. There was a statistically significant difference in the distribution frequency of G1 between the two regions (p = 0.039). Assessment of health economic data confirmed the economic burden of RV GE episodes. In conclusion, RV GE episodes are a health burden as well as an economic burden also for the children in a developed country such as Switzerlan

Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?

The aim of this study was to evaluate the clinical, therapeutic, laboratory, and radiological differences between respiratory syncytial virus (RSV) and non-RSV bronchiolitis in order to assess if the prior knowledge of viral etiology changed management decisions and would be able to predict outcomes. Medical charts of children <1year admitted to the emergency department with bronchiolitis during two RSV seasons (2010-2012) were reviewed. We analyzed 221 episodes of bronchiolitis. The percentage of exams performed (95% confidence interval (CI) 0.74-2.52), abnormal laboratory and radiological findings (95% CI 0.53-16.89) did not differ between groups. RSV bronchiolitis had a more severe clinical course. However, virologic testing for RSV had low specificity in identifying at-risk patients for hospitalization, longer hospital length of stay, and need of oxygen therapy and nasogastric tube (44, 40, 42, and 35%, respectively), and while statistically significant, the positive likelihood ratios were only slightly greater than 1. Conclusion: Although RSV bronchiolitis has a more severe clinical course, virologic testing does not help in management decisions, and at an individual level, as a performance test, it seems insufficient to precisely predict outcomes

Congenital Transmission of Chagas Disease in Latin American Immigrants in Switzerland

International migration has changed the epidemiologic patterns of Chagas disease. Recently, 2 cases of Chagas disease transmitted from Latin American women to their newborns were diagnosed in Geneva, Switzerland. A retrospective study to detect Chagas disease showed a prevalence of 9.7% among 72 Latin American women tested during pregnancy in Switzerland

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunizatio

Artificial 64-Residue HIV-1 Enhancer-Binding Peptide Is a Potent Inhibitor of Viral Replication in HIV-1-Infected Cells

An artificial HIV-1 enhancer-binding peptide was extended by nine consecutive arginine residues at the C-terminus and by the nuclear localization signal of SV40 large T antigen at the N-terminus. The resulting synthetic 64-residue peptide was found to bind to the two enhancers of the HIV-1 long terminal repeat, cross the plasma membrane and the nuclear envelope of human cells, and suppress the HIV-1 enhancer-controlled expression of a green fluorescent protein reporter gene. Moreover, HIV-1 replication is inhibited by this peptide in HIV-1-infected CEM-GFP cells as revealed by HIV-1 p24 ELISA and real-time RT-PCR of HIV-1 RNA. Rapid uptake of this intracellular stable and inhibitory peptide into the cells implies that this peptide may have the potential to attenuate HIV-1 replication in vivo

A Multicenter, Cross-Sectional Study on the Prevalence and Risk Factors for Nasal Colonization with Staphylococcus aureus in Patients Admitted to Children's Hospitals in Switzerland

The rate of nasal carriage of Staphylococcus aureus and associated risk factors were determined in a cross-sectional study involving Swiss children's hospitals. S. aureus was isolated in 562 of 1363 cases. In a stepwise multivariate analysis, the variables age, duration of antibiotic use, and hospitalization of a household member were independently associated with carriage of S. aureu