Rapid Influenza Testing in Infants and Children Younger than 6 Years in Primary Care: Impact on Antibiotic Treatment and Use of Health Services.

Influenza is often misdiagnosed in children because of the low sensitivity of clinical diagnosis because of nonspecific signs and symptoms. This can be overcome by using digital immunoassays or rapid molecular diagnostic tests with adequate sensitivity and specificity. When using these tests at the patient care site, antibiotic consumption and number of healthcare consultations were reduced.

Diagnòstic ràpid de grip en lactants i infants menors de 6 anys a l'atenció primària / Diagnóstico rápido de gripe en lactantes y niños menores de 6 años en atención primaria / Rapid diagnosis of influenza in infants and children younger than 6 years of age in primary care

Fonament: La taxa d'incidència de la grip en l'edat pediàtrica és la més elevada de la població, i el diagnòstic és difícil els primers anys de vida perquè té una simptomatologia inespecífica. Els tests de diagnòstic ràpid (TDR) de grip podrien millorar el maneig dels pacients en atenció primària. Objectiu: Estudiar si el diagnòstic de grip amb un TDR objectiu en lactants i infants menors de 6 anys disminueix el consum d'antibiòtics i el nombre de consultes successives. Mètode: Estudi longitudinal prospectiu descriptiu realitzat durant la temporada epidèmica 2016-2017 en quatre centres d'atenció primària de Barcelona, a lactants i infants fins als 6 anys. Amb una mostra de frotis nasofaringi es van fer dos tipus de TDR i al cap de 10 dies s'efectuava un seguiment telefònic demanant l'evolució de la simptomatologia, l'antibioteràpia rebuda, les consultes fetes i el contagi familiar produït. Resultats: Es van diagnosticar 55 casos de grip A, amb una edat mitjana de 33 mesos. La durada de la febre abans del diagnòstic va ser de 2,1 dies i de 3,2 dies després del diagnòstic, amb una temperatura mitjana de 38,9ºC. La simptomatologia més freqüent va ser la respiratòria, amb una durada mitjana després del diagnòstic de 6-7 dies. Van rebre antibioteràpia dos pacients, es van efectuar 18 reconsultes i es va objectivar un contagi de 50 persones en 29 famílies. Conclusions: La baixa prescripció antibiòtica i de consultes successives semblen confirmar que fer el diagnòstic en la consulta mateix és útil per aconseguir aquest objectiu

Fundamento: La tasa de incidencia de gripe en edad pediátrica es la más elevada de la población y su diagnóstico es difícil en los primeros años de vida por su sintomatología inespecífica. Los tests de diagnóstico rápido (TDR) de gripe podrían mejorar el manejo de los pacientes en atención primaria. Objetivo: Estudiar si el diagnóstico de gripe con un TDR en lactantes y niños menores de 6 años disminuye el consumo de antibióticos y el número de consultas sucesivas. Método: Se realizó un estudio longitudinal prospectivo descriptivo durante la temporada epidémica de 2016-2017 en cuatro centros de atención primaria de Barcelona, a lactantes y niños hasta los 6 años. Con una muestra de frotis nasofaríngeo se realizaron dos tipos de TDR y a los 10 días se efectuaba el seguimiento telefónico, preguntando por la evolución de la sintomatología, la antibioterapia recibida, las consultas realizadas y el contagio familiar producido. Resultados: Se diagnosticaron 55 casos de gripe A, con una edad media de 33 meses. La duración media de la fiebre antes del diagnóstico fue de 2,1 días y de 3,2 días después del diagnóstico, con una temperatura media de 38,9ºC. La sintomatología más frecuente fue la respiratoria, con una duración media tras el diagnóstico de 6-7 días. Recibieron antibioterapia dos pacientes, se efectuaron 18 reconsultas y se objetivó un contagio de 50 pacientes en 29 familias. Conclusiones: La baja prescripción antibiótica y del número de consultas sucesivas parecen confirmar que realizar el diagnóstico en la propia consulta es útil para conseguir este objetivo

Background: The incidence of influenza in children is the highest among all age groups, and its diagnosis may be difficult in the first years of life due to the non-specific symptoms. Rapid diagnostic tests (RDT) of influenza could improve the management of patients in the primary care setting. Objective: To investigate if the diagnosis of influenza using RDT in infants and children under 6 years resulted in a decrease in the prescription of antibiotics and in the number of follow-up medical visits. Method: We conducted a descriptive prospective longitudinal study during the 2016-2017 epidemic season in four primary care centers of Barcelona, with infants and children up to 6 years of age. Two types of RDT using a nasopharyngeal swab sample were performed, with a follow-up telephone call 10 days later to inquire about symptoms, antibiotic treatment received, additional medical visits, and family contagion noted. Results: A total of 55 cases of influenza A were diagnosed, at a median age of 33 months. The median duration of fever before and after the diagnosis was 2.1 and 3.2 days, respectively, with a median temperature of 38.9ºC. The most frequent symptomatology was respiratory, with a median duration after diagnosis of 6-7 days. Two patients received antibiotic therapy, 18 additional medical visits were carried out, and 50 individuals were reported to be infected among 29 families. Conclusions: The low antibiotic prescription and number of following medical visits seem to confirm that a rapid diagnosis performed during the initial consultation is useful for achieving those goals

Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era.

OBJECTIVE: To prospectively identify the bacterial aetiology and antimicrobial susceptibility of problematic (recurrent and treatment failure) acute otitis media in Spanish children several years after the introduction of 7-valent pneumococcal conjugate vaccine. METHODS: Tympanocentesis or careful sampling of spontaneous otorrhoea was performed on children aged 3 to <36 months with recurrent acute otitis media, acute otitis media treatment failure or unresolved acute otitis media. RESULTS: 105 acute otitis media episodes (77 sampled by tympanocentesis, 28 otorrhoea samples) were evaluated: 46 recurrent, 35 treatment failures, 24 unresolved acute otitis media. 74 episodes (70.4%) had at least one bacterium identified on culture: Streptococcus pneumoniae was identified in 21 episodes, Haemophilus influenzae (all non-typeable) in 44, Streptococcus pyogenes in 2, Moraxella catarrhalis in 2. No statistically significant difference in bacterial aetiology by episode type was detected. Non-typeable H. influenzae was the most commonly isolated pathogen in all acute otitis media types and in all age sub-groups. Forty percent of S. pneumoniae isolates were multi-drug resistant. Pneumococcal serotype 19A was the most frequently identified serotype (7/21 episodes). Multi-drug resistance was found in 56% of 19A isolates. Of non-typeable H. influenzae isolates, 15% were ampicillin resistant and 13% were amoxicillin/clavulanate resistant. S. pneumoniae and non-typeable H. influenzae DNA were each detected in 57% of samples culture negative for these pathogens, including 12 co-infections. CONCLUSION: Combining culture and polymerase chain reaction results, H. influenzae and S. pneumoniae may be implicated in 70% and 43% of clinically problematic bacterial acute otitis media episodes, respectively. The impact of new vaccines to prevent both S. pneumoniae and non-typeable H. influenzae acute otitis media may be substantial in this population and is worth investigating.

Long-term (5-year) antibody persistence following two- and three-dose regimens of a combined hepatitis A and B vaccine in children aged 1-11 years.

This study compared the long-term persistence of anti-hepatitis A (anti-HAV) and B (anti-HBs) antibodies, 5 years after vaccination of subjects aged 1-11 years with a combined hepatitis A and B vaccine either in a two-dose (0, 6 months, Adult formulation) or a three-dose (0, 1, 6 months, Paediatric formulation) schedule. At the end of the 5 years, all subjects (100%) in both groups continued to have anti-HAV antibodies > or =15mIU/mL, while 94-97% of subjects in both groups had anti-HBs antibody concentrations > or =10mIU/mL. Subjects with anti-HBs antibody concentration < or =10mIU/mL were administered a challenge dose of hepatitis B vaccine. All subjects mounted a vigorous immune response to the challenge indicating the presence of immunological memory to HBV.

Control of serotonergic neurons in the dorsal raphe nucleus by the lateral hypothalamus.

Anatomical evidence indicates the presence of projections from the lateral hypothalamus to serotonergic (5-hydroxytryptamine, 5-HT) neurons of the dorsal raphe nucleus (DR). Using dual probe microdialysis and extracellular recordings in the DR, we show that the application of GABAergic agents in the lateral hypothalamus modulates the activity of 5-HT neurons in the DR. GABA and bicuculline or baclofen, applied in the lateral hypothalamus significantly reduced and increased, respectively, the 5-HT output in the DR. Likewise, the intrahypothalamic application of GABA and bicuculline reduced (14/20 neurons) and increased (8/12 neurons), respectively, the firing rate of 5-HT neurons in the DR. A smaller percentage of neurons, however, were excited by GABA (3/20) and inhibited by bicuculline (1/12). Application of tetrodotoxin in the lateral hypothalamus suppressed the local 5-HT output and reduced that in the DR. The 5-HT output in the DR increased transiently soon after darkness. The hypothalamic application of GABA attenuated and that of bicuculline potentiated this spontaneous change with an efficacy similar to that seen in light conditions. These results indicate that the lateral hypothalamus is involved in the control of 5-HT activity in the DR, possibly through excitatory (major) and inhibitory (minor) inputs.

Control of the serotonergic system by the medial prefrontal cortex: potential role in the etiology of PTSD and depressive disorders.

The prefrontal cortex is involved in an array of higher brain functions that are altered in psychiatric disorders. Serotonergic neurons of the midbrain rapbe nuclei innervate the prefrontal cortex and are the cellular target for drugs used to treat mood disorders such as the selective serotonin (5-HT) reuptake inhibitors. Anatomical evidence supports the existence of projections from the medial prefrontal cortex (mPFC) to the dorsal raphe nucleus (DR). We report on a functional control of the activity of DR 5-HT neurons by projection neurons in the mPFC. The stimulation of the mPFC elicits two types of responses in DR 5-HT neurons, orthodromic excitations and inhibitions. Excitations are mediated by AMPA/KA and NMDA receptors whereas inhibitions are mediated by GABA(A) and 5-HT(1A) receptors. The activation of a subgroup of 5-HT neurons increases 5-HT release which subsequently activates 5-HT(1A) autoreceptors on other 5-HT neurons. GABA(A)-mediated inhibitions involve GABAergic elements in the DR or adjacent areas. Pyramidal neurons of the mPFC co-express postsynaptic 5-HT(1A) (inhibitory) and 5-HT(2A) (excitatory) receptors. Consistent with the above observations, the selective activation of both receptors in mPFC reduced and increased, respectively, the firing activity of DR 5-HT neurons and the 5-HT release in mPFC. Overall, these data indicate that the activity of the 5-HT system is strongly controlled by the mPFC. Thus, the abnormal prefrontal function in post-traumatic stress disorder and depressive patients may induce a disregulation of 5-HT neurons projecting to other brain areas that can underlie the existing symptomatology in these psychiatric disorders.