Paediatric TB care in the United Kingdom.

BACKGROUND: Care of patients with paediatric TB is delivered in a variety of settings by different clinicians in the United Kingdom. Paediatric practices vary in size. Guidelines on managing children with TB differ in recommendations. These factors contribute to variations in practice.OBJECTIVE: To describe practice among UK professionals caring for children exposed to or infected with TB, and their investigation and treatment.METHODS: From 81 NHS (National Health Service) clinical services, 114 individuals responded to a web-based questionnaire.RESULTS: We describe variation in several areas of practice, with important differences between smaller and larger centres. Most respondents go beyond National Institute for Health & Care Excellence guidance and screen child contacts of extrapulmonary TB. Most respondents would presume pulmonary TB exposed children aged under 2 years to be infected. They would not rely on immunological investigations to rule out infection. There was wide variety in approaches to microbiological diagnosis, and in the use of laboratory investigations to monitor treatment. Many respondents felt unclear on how to manage newborns exposed to TB, or children exposed to multidrug-resistant TB.CONCLUSION: These findings support the case for further developing regional networks providing evidence and consensus-based care for children with TB.

Paediatric antimicrobial stewardship programmes in the UK's regional children's hospitals.

A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.

Clinical practice update of antifungal prophylaxis in immunocompromised children.

Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.

Enfermedades emergentes: eosinofilia en el niño migrante / Emerging diseases: eosinophilia in migrant children

La eosinofilia es uno de los hallazgos analíticos más frecuentes en los protocolos de cribado del niño migrante; de ahí la necesidad de implantar algoritmos diagnósticos. Aunque ha quedado demostrada la importante asociación entre eosinofilia y parasitación por helmintos en pacientes procedentes de áreas endémicas, el diagnóstico diferencial es más amplio y requiere un estudio estructurado y unificado. El objetivo de esta revisión es ilustrar con casos clínicos concretos una realidad cada vez más patente en nuestro medio como es la patología emergente y, a su vez, proponer un protocolo de cribado específico de eosinofilia en la edad pediátrica, sobre todo en estos pacientes con antecedentes epidemiológicos de movilidad geográfica. Este tipo de actuaciones permitirán la detección precoz y el tratamiento específico de las enfermedades asintomáticas u oligosintomáticas, que en muchas ocasiones no son percibidas por estas familias como un problema de salud (AU)

Eosinophilia is one of the most frequent analytical findings in paediatrics screenings focused on migrant children. On this basis, it is necessary to propose a specific diagnosis protocol for those patients. Although it has been proved there is a significant association between eosinophilia and parasitic infection by helminths in patients from endemic areas, the differential diagnosis is wider and requires a unified and structured approach. The objective of this report is to use specific case reports to illustrate the emerging diseases as a growing phenomenon, as well as to propose a specific pediatrics screening protocol for eosinophilia, especially for patients with a geographical mobility background. These diagnoses will lead to an early detection and specific treatment of asymptomatic or mildly symptomatic children, because those conditions are not often perceived as a health problem by these families (AU)