ABSTRACT
Human parechovirus (HPeV) is an emerging pathogen for infants. Improved diagnostics are needed due to the non-specific clinical presentation. Real-time reverse transcription polymerase chain reaction (RT-PCR) on blood samples may be an adjunct to diagnosis. A retrospective cohort of HPeV-affected infants was used to assess sensitivity and specificity of a HPeV RT-PCR on blood and cerebrospinal fluid (CSF). As a secondary analysis, the Ct value of the PCR results was compared to clinical correlates of severity. Between 2017 and 2018 blood samples were obtained from 97 infants of whom 44 had HPeV clinical and laboratory proven infection. Eighty-three concurrent CSF samples were available. Sensitivity was 93.3% [95% CI 82-99] for blood HPeV RT-PCR and 85% [95% CI 73.9-96.1] for CSF HPeV RT-PCR. Blood HPeV RT-PCR Ct values < 25 cycles were associated with age < 28 days and < 3 days of symptoms. No statistical associations were identified between potential clinical markers of severity and Ct value. HPeV RT-PCR on blood is a valuable adjunct to diagnostic testing for acute HPeV-related illness in infants. Results can be expected to be robust until at least day 5 of symptoms, with optimal sampling occurring close to onset of symptoms.
Subject(s)
Molecular Typing/methods , Parechovirus/genetics , Picornaviridae Infections/diagnosis , Polymerase Chain Reaction/methods , RNA, Viral/blood , Humans , Infant , Infant, Newborn , Picornaviridae Infections/virology , RNA, Viral/cerebrospinal fluid , Sensitivity and SpecificityABSTRACT
The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.
Subject(s)
Clostridioides difficile , Clostridium Infections/epidemiology , Clostridium Infections/therapy , Disease Management , Practice Guidelines as Topic/standards , Societies, Medical/standards , Adult , Australasia/epidemiology , Australia/epidemiology , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Communicable Diseases/diagnosis , Communicable Diseases/epidemiology , Communicable Diseases/therapy , Humans , New Zealand/epidemiology , Societies, Medical/trendsABSTRACT
Antibiotics are an important part of neonatal care, but we must be careful that a short-sighted approach to their use does not magnify the problems they are designed to prevent. Prevention of infections by good infection control practices and minimizing risk factors for sepsis is just as important as appropriate antibiotic use. Attempts to eradicate colonizing organisms of low virulence may result in their replacement by more problematic organisms, so over-vigorous use of antibiotics to try to prevent infections is not always wise.
