RESUMO
Mother-to-child transmission accounts for the majority of new HIV infections among children worldwide. Post-natal prophylaxis, in addition to other preventive measures, have been very successful in reducing transmission to babies born to mothers living with HIV infection to <2%. Single-drug prophylaxis with zidovudine is the mainstay regimen for infants in low-risk transmission settings. The optimal regimen for newborns of women with anti-retroviral (ARV)-resistant HIV is unknown. We report a baby born to a young mother living with highly resistant perinatally-acquired HIV at a tertiary care centre in Sydney, Australia, in 2018. Furthermore, the challenges with giving postnatal ARV prophylaxis to her baby, in light of the lack of dosing and safety data for many antiretroviral agents for neonates, is discussed. The baby received a combination of lamivudine and raltegravir for a total of six weeks and he was not breast-fed. He had negative HIV proviral DNA polymerase chain reaction at six weeks and three months and a negative HIV serology at 18 months of age.
RESUMO
Respiratory syncytial virus (RSV), or human orthopneumovirus, is a major cause of acute lower respiratory infection (ALRI), particularly in young children, causing significant morbidity and mortality. We used pathogen genomics to characterize the population structure and genetic signatures of RSV isolates circulating in children in New South Wales between 2016 and 2018 and to understand the evolutionary dynamics of these strains in the context of publicly available RSV genomes from the region and globally. Whole-genome phylogenetic analysis demonstrated the co-circulation of a few major RSV clades in the paediatric population from Sydney. The whole-genome-based genotypes A23 (RSV-A ON1-like genotype) and B6 (RSV-B BA9-like genotype) were the predominant RSV-A and RSV-B genotypes circulating during the study period, respectively. These genotypes were characterized with high levels of diversity of predicted N- and O-linked glycosylation patterns in both the G and F glycoproteins. Interestingly, a novel 72-nucleotide triplication in the sequence that corresponds to the C-terminal region of the G gene was identified in four of the A23 genotype sequenced in this study. Consistently, the population dynamics analysis demonstrated a continuous increase in the effective population size of A23 and B6 genotypes globally. Further investigations including functional mapping of mutations and identifying the impact of sequence changes on virus fitness are highly required. This study highlights the potential impact of an integrated approach that uses WG-based phylogeny and studying selective pressure events in understanding the emergence and dissemination of RSV genotypes.
Assuntos
Genômica , Infecções Respiratórias , Criança , Humanos , Pré-Escolar , Filogenia , Vírus Sinciciais Respiratórios , Genótipo , AustráliaRESUMO
BACKGROUND: COVID-19 disease in kidney transplant (KT) recipients is associated with increased morbidity, mortality, and hospitalization rates. Unfortunately, KT recipients also have a reduced response to SARS-CoV-2 immunization. The primary aim of this study was to assess immunologic response to SARS-CoV-2 mRNA vaccines in pediatric kidney transplant recipients 12-18 years of age. Secondary aims were to assess response rates following a third immunization and determine factors that influence immunization response. METHODS: Pediatric KT recipients in a single tertiary center received SARS-CoV-2 mRNA vaccination as per local protocol. SARS-CoV-2 immunoglobulin (IgG) was measured following second and/or third vaccination. Demographics including patient factors (age, gender, and underlying disease), transplant factors (time and type of transplant), and immunosuppression (induction, maintenance, and immunomodulatory therapies such as IVIG) were collected from the medical records. RESULTS: Of 20 participants, 10 (50%) responded following a two-dose vaccine schedule, which increased to 15 (75%) after three doses. Maintenance immunosuppression affected immunologic response, with azathioprine demonstrating a higher rate of response to vaccine compared to mycophenolate (100% vs. 38%, p = 0.04). Increasing prednisolone dose had a negative impact on immunologic response (0.01 mg/kg/day increase: OR 1.60 95% CI 1.01 to 2.57). Tacrolimus dose and trough levels, age, time post-transplant, underlying disease, and other immunosuppression did not impact immunologic response. CONCLUSIONS: Pediatric KT recipients had similar response rates following SARS-CoV-2 immunization as adult KT recipients. Immunologic response improved following a third immunization. Choice of antimetabolite and prednisolone dosing influenced the rate of response. A higher resolution version of the Graphical abstract is available as Supplementary Information.
Assuntos
COVID-19 , Transplante de Rim , Adulto , Humanos , Criança , SARS-CoV-2 , Transplante de Rim/efeitos adversos , COVID-19/prevenção & controle , Vacinação , Transplantados , Imunossupressores/efeitos adversos , RNA Mensageiro , Anticorpos AntiviraisRESUMO
The detection of a new and unexpected Japanese encephalitis virus (JEV) outbreak in March 2022 in Australia, where JEV is not endemic, demanded the rapid development of a robust diagnostic framework to facilitate the testing of suspected patients across the state of New South Wales (NSW). This nascent but comprehensive JEV diagnostic service encompassed serological, molecular and metagenomics testing within a centralised reference laboratory. Over the first three months of the outbreak (4 March 2022 to 31 May 2022), 1,061 prospective samples were received from 878 NSW residents for JEV testing. Twelve confirmed cases of Japanese encephalitis (JE) were identified, including ten cases diagnosed by serology alone, one case by metagenomic next generation sequencing and real-time polymerase chain reaction (RT-PCR) of brain tissue and serology, and one case by RT-PCR of cerebrospinal fluid, providing an incidence of JE over this period of 0.15/100,000 persons in NSW. As encephalitis manifests in <1% of cases of JEV infection, the population-wide prevalence of JEV infection is likely to be substantially higher. Close collaboration with referring laboratories and clinicians was pivotal to establishing successful JEV case ascertainment for this new outbreak. Sustained and coordinated animal, human and environmental surveillance within a OneHealth framework is critical to monitor the evolution of the current outbreak, understand its origins and optimise preparedness for future JEV and arbovirus outbreaks.
Assuntos
Vírus da Encefalite Japonesa (Espécie) , Encefalite Japonesa , Animais , Austrália , Surtos de Doenças , Vírus da Encefalite Japonesa (Espécie)/genética , Encefalite Japonesa/diagnóstico , Encefalite Japonesa/epidemiologia , Genótipo , Humanos , New South Wales/epidemiologia , Estudos ProspectivosRESUMO
Paediatric spondylodiscitis (SD) (discitis) is a rare bacterial infection involving the inter-vertebral disc space and adjacent vertebrae. The non-specific manifestations of SD can lead to delayed diagnosis, which may ultimately result in spinal deformities and even devastating neurological complications. The main purpose of this review is to discuss the epidemiology, clinical, laboratory and radiological features, management and outcome of paediatric SD to help paediatricians recognise and treat this important condition.
Assuntos
Infecções Bacterianas , Discite , Infecções Bacterianas/diagnóstico , Criança , Discite/diagnóstico por imagem , Discite/terapia , Humanos , Imageamento por Ressonância Magnética , RadiografiaRESUMO
The incidence of enterovirus D68 (EV-D68) in New South Wales, Australia, is unknown. As part of a state-wide surveillance program, enterovirus positive diagnostic specimens were assessed from patients presenting to hospitals with respiratory and meningitis syndromes from August 2018 to November 2019. Diagnostic enterovirus positive samples were collected from 339 patients and re-extracted followed by targeted PCR across the whole EV-D68 genome (7.4 kb). Obtained amplicons (n=208) were sequenced using Illumina sequencing technology and the phylogenetic relationships analysed relative to EV-D68 Fermon strain. We identified EV-D68 in 31 patients, both children (n=27) and adults (n=4). Phylogenetically, the majority (n=30) were from subclade B3, the same as that causing outbreaks of EV-D68 across the USA and Europe during 2018. These data strengthen the importance of having an active enterovirus surveillance network.
Assuntos
Enterovirus Humano D , Infecções por Enterovirus , Infecções Respiratórias , Adulto , Criança , Surtos de Doenças , Enterovirus Humano D/genética , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Humanos , Lactente , New South Wales/epidemiologia , Filogenia , Infecções Respiratórias/epidemiologiaRESUMO
Encephalitis is most often caused by a variety of infectious agents identified through diagnostic tests utilizing cerebrospinal fluid. We investigated the clinical characteristics and potential aetiological agents of unexplained encephalitis through metagenomic sequencing of residual clinical samples from multiple tissue types and independent clinical review. Forty-three specimens were collected from 18 encephalitis cases with no cause identified by the Australian Childhood Encephalitis study. Samples were subjected to total RNA sequencing ('metatranscriptomics') to determine the presence and abundance of potential pathogens, and to describe the possible aetiologies of unexplained encephalitis. Using this protocol, we identified five RNA and two DNA viruses associated with human infection from both non-sterile and sterile sites, which were confirmed by PCR. These comprised two human rhinoviruses, two human seasonal coronaviruses, two polyomaviruses and one picobirnavirus. Human rhinovirus and seasonal coronaviruses may be responsible for five of the encephalitis cases. Immune-mediated encephalitis was considered likely in six cases and metatranscriptomics did not identify a possible pathogen in these cases. The aetiology remained unknown in nine cases. Our study emphasizes the importance of respiratory viruses in the aetiology of unexplained child encephalitis and suggests that non-central-nervous-system sampling in encephalitis clinical guidelines and protocols could improve the diagnostic yield.
Assuntos
Encefalite , Vírus , Austrália , Criança , Encefalite/diagnóstico , Encefalite/etiologia , Humanos , Metagenômica , Reação em Cadeia da PolimeraseRESUMO
COVID-19 public health measures altered respiratory syncytial virus (RSV) epidemiology. We examined age-stratified trends in RSV-related disease in Australian children in 2020 compared with previous years.
Assuntos
COVID-19/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Adolescente , Distribuição por Idade , Austrália/epidemiologia , Bronquiolite Viral/epidemiologia , Bronquite/epidemiologia , Criança , Pré-Escolar , Conjuntos de Dados como Assunto , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Estações do AnoAssuntos
Linfadenite , Mycobacterium tuberculosis , Cardiopatia Reumática , Tuberculose dos Linfonodos , Criança , Humanos , Linfonodos , Linfadenite/diagnóstico , Linfadenite/etiologia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnóstico , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/diagnósticoRESUMO
Cytomegalovirus (CMV) is a human herpes virus that causes significant morbidity and mortality in immunosuppressed children. CMV primary infection causes a clinically mild disease in healthy children, usually in early childhood; the virus then utilises several mechanisms to establish host latency, which allows for periodic reactivation, particularly when the host is immunocompromised. It is this reactivation that is responsible for the significant morbidity and mortality in immunocompromised children. We review CMV infection in the primary immunodeficient host, including early identification of these infants by newborn screening to allow for CMV infection prevention strategies. Furthermore, clinical CMV is discussed in the context of children treated with secondary immunodeficiency, particularly paediatric cancer patients and children undergoing haematopoietic stem cell transplant (HSCT). Treatments for CMV are highlighted and include CMV immunotherapy.
Assuntos
Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/terapia , Doenças da Imunodeficiência Primária/virologia , Adolescente , Antivirais/uso terapêutico , Criança , Pré-Escolar , Citomegalovirus/patogenicidade , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Hospedeiro Imunocomprometido/imunologia , Lactente , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Doenças da Imunodeficiência Primária/imunologia , Transplante HomólogoRESUMO
OBJECTIVES: The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS: Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS: A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS: This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
Assuntos
Artrite Infecciosa , Kingella kingae , Infecções por Neisseriaceae , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Kingella kingae/genética , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/epidemiologia , Reação em Cadeia da Polimerase , Estudos RetrospectivosAssuntos
Trombose do Corpo Cavernoso/diagnóstico , Trombose do Corpo Cavernoso/cirurgia , Fusobacterium necrophorum/isolamento & purificação , Celulite Orbitária/diagnóstico , Celulite Orbitária/cirurgia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/patologia , Criança , Exoftalmia/etiologia , Febre/etiologia , Fusobacterium necrophorum/efeitos dos fármacos , Hemodinâmica , Humanos , Masculino , Neuroimagem , Celulite Orbitária/tratamento farmacológico , Celulite Orbitária/patologia , Penicilinas/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Criança , Hospitais Pediátricos , Humanos , SARS-CoV-2Assuntos
Betacoronavirus/isolamento & purificação , Saúde da Criança/tendências , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Hospitalização , Pandemias , Pneumonia Viral , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Respiratórias , Austrália/epidemiologia , COVID-19 , Criança , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Saúde Pública/tendências , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia , SARS-CoV-2RESUMO
Nontuberculous mycobacteria (NTM) are commonly found in soil and water and can cause nosocomial infections by contaminating equipment and disinfectants solution used in hospitals. NTM port-site infection after laparoscopic surgery is increasingly observed, but its clinical features, management, and prevention have not been reviewed adequately. We performed a comprehensive literature review of reports that described the clinical manifestation and management of NTM port-site infections following laparoscopic surgery. The perceived increase in NTM port-site infections is likely multifactorial, influenced by greater awareness, better diagnostics, changes in medical practice, increased prevalence of immunosuppression, and potential pathogen spread. Widespread resistance to common disinfectants is a major concern. Patients with NTM port-site infections typically present 1-3 months after the laparoscopic intervention with chronic local and minimal systemic symptoms. Surgical excision plays an important role in localized or refractory cases. Medical treatment should be guided by species identification and in vitro drug-susceptibility testing (DST) of the infecting NTM strain, with a combination of second-line antituberculosis agents, given for a prolonged duration. NTM port site infection is best prevented by meticulous skin preparation and infection control, using only sterilized supplies for laparoscopic surgery.