The Pediatric infectious disease journal
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Pediatr. Infect. Dis. J. · Dec 2008
Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count.
Cerebrospinal fluid (CSF) findings are often used to diagnose meningitis in neonates given antibiotics before the lumbar puncture is performed. Traumatic lumbar punctures are common and complicate interpretation of CSF white blood cell counts. The purpose of this study is to evaluate the diagnostic utility of adjusting CSF white blood cell counts based on CSF and peripheral red blood cell counts. ⋯ Adjustment of CSF white blood cell counts to account for increased red cells does not improve diagnostic utility. Adjustment can result in loss of sensitivity with marginal gain in specificity. Adjustment of WBC counts in the setting of a traumatic lumbar puncture does not aid in the diagnosis of bacterial and fungal meningitis in neonates.
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Pediatr. Infect. Dis. J. · Nov 2008
Human bocavirus infection in children with respiratory tract disease.
Human bocavirus (HBoV) is a ubiquitous, newly described member of the Parvoviridae family frequently detected in the respiratory tract of children, but only few reports provide data proving the link between HBoV and respiratory tract disease (RTD). ⋯ The difference observed in HBoV prevalence between children with RTD and controls provides support for a role of this virus in RTD. The frequent associations of HBoV with other respiratory viruses might be explained by the persistence of HBoV in the respiratory tract. The significance of HBoV viral load in nasopharyngeal secretions as a marker of pathogenicity merits further investigation.
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Pediatr. Infect. Dis. J. · Oct 2008
Vaccines against pandemic influenza: what can be done before the next pandemic?
We currently do not know which specific influenza subtype or isolate will cause the next influenza pandemic. However, 4 influenza virus hemagglutinin subtypes (H2, H5, H7, and H9) are considered the most likely candidates. Avian influenza viruses of the H5N1 subtype have received the most attention to this point, as their ability to spread within the human population remains the only barrier to emergence of a pandemic strain. ⋯ The use of adjuvants to improve presentation of antigen and stimulate the immune system offers promise for enhanced immunity. Currently approved adjuvants, MF59 and Alum, can be readily incorporated into pandemic vaccines, while novel adjuvants are moving toward approval, but may still be years away from routine use. Thus, a prepandemic vaccine strategy that involves the stockpiling of both potential antigens and proven adjuvants may represent the best approach to deal with this looming threat.
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Antivirals are effective in prophylaxis and therapy for influenza and are likely to be active against a new pandemic variant. They can be divided into the M2 inhibitors, adamantane and rimantadine, and the neuraminidase inhibitors (NAIs), zanamivir and oseltamivir. The former are limited in activity to type A viruses, whereas the latter are also active against type B viruses. ⋯ Resistance does emerge, but not at the same frequency as with the M2 inhibitors. Resistant viruses also appear less fit and thus less able to spread. However, as use increases, resistance needs to be carefully monitored.
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Human metapneumovirus (hMPV) was first identified in 2001 in Dutch children with bronchiolitis. The virus is an RNA virus in the Pneumovirinae subfamily and is most closely related to respiratory syncytial virus. hMPV has been shown to have worldwide circulation with nearly universal infection by age 5. Similar to influenza and respiratory syncytial virus, activity is greatest during the winter in temperate climates. ⋯ In addition, 6-12% of exacerbations of chronic obstructive pulmonary disease have been associated with hMPV and underlying lung disease is common in patients hospitalized with hMPV. Lastly, hMPV has been linked with severe idiopathic pneumonia in recipients of hematopoietic stem cell transplants. Although the true spectrum of adult hMPV remains to be defined, it is clear that hMPV can result in severe illness the frail elderly and adults with underlying diseases.