RESUMO
OBJECTIVE: To examine whether ordering testing of cerebrospinal fluid (CSF) for herpes simplex virus (HSV) by polymerase chain reaction (PCR) in neonates and young infants is associated with increased hospital length of stay (LOS) or increased hospital charges. STUDY DESIGN: This retrospective cohort study enrolled infants age Assuntos
Herpes Simples/diagnóstico
, Preços Hospitalares
, Tempo de Internação
, Punção Espinal
, Líquido Cefalorraquidiano/virologia
, Serviço Hospitalar de Emergência
, Herpes Simples/líquido cefalorraquidiano
, Herpes Simples/economia
, Humanos
, Lactente
, Recém-Nascido
, Tempo de Internação/economia
, Reação em Cadeia da Polimerase/economia
, Punção Espinal/economia
RESUMO
Many children with influenza are treated with antibiotics. In this report, we describe the rate and indications for antibacterial use in children hospitalized with influenza. A total of 333 of 729 (46%) patients received >2 days of treatment with antibacterial medications, of whom 36% did not have an apparent indication for therapy.
Assuntos
Antibacterianos/uso terapêutico , Criança Hospitalizada/estatística & dados numéricos , Uso de Medicamentos , Hospitais Pediátricos/estatística & dados numéricos , Influenza Humana/tratamento farmacológico , Adolescente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Comorbidade , Feminino , Humanos , Lactente , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To determine the characteristics, incidence, and risk factors for influenza-related neurologic complications (INC). STUDY DESIGN: A retrospective cohort study of INC in children hospitalized with laboratory-confirmed influenza infection (LCI) from June 2000 to May 2004 was conducted. Systematic chart review was performed to identify clinical characteristics and outcomes. A neighborhood cohort was constructed to estimate the incidence of INC. Logistic regression was used to identify independent risk factors for INC. RESULTS: Of 842 patients with LCI, 72 patients had an INC: influenza-related encephalopathy (8), post-infectious influenza encephalopathy (2), seizures (56), and other (6). Febrile seizures were the most common type of seizures (27). No patient died from an INC. In our neighborhood cohort, the incidence of INC was 4 cases per 100,000 person-years. An age of 6 to 23 months (odds ratio [OR], 4.2; 95% CI, 1.4-12.5) or 2 to 4 years (OR, 6.3; 95% CI, 2.1-19.1) and an underlying neurologic or neuromuscular disease (OR, 5.6; 95% CI, 3.2-9.6) were independent risk factors for the development of INC. CONCLUSION: Seizures are the most common neurologic complication experienced by children hospitalized with influenza. In the United States, encephalopathy is uncommon. Young children and patients with neurologic or neuromuscular disease are at increased risk for INC.
Assuntos
Hospitalização/estatística & dados numéricos , Influenza Humana/complicações , Influenza Humana/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Distribuição por Idade , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Lactente , Influenza Humana/terapia , Masculino , Prontuários Médicos , Análise Multivariada , Doenças do Sistema Nervoso/fisiopatologia , Probabilidade , Estudos Retrospectivos , Medição de Risco , Convulsões Febris/epidemiologia , Convulsões Febris/etiologia , Convulsões Febris/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Estatísticas não ParamétricasRESUMO
We used a binomial regression model to determine the relationship between the percent of cerebrospinal fluid (CSF) mononuclear white blood cells and symptom duration in children with proven enteroviral meningitis. The odds of a CSF white blood cell being mononuclear increased by 15.7% (95% confidence interval: -3.8% to 38.0%; P = .11) for each day of symptoms. Fifty percent of patients with symptoms of 1 day or less had predominance of mononuclear cells among CSF white blood cells. These findings suggest that factors other than symptom duration influence the composition and evolution of the CSF white blood cell response to enteroviral infection.
Assuntos
Infecções por Enterovirus/patologia , Leucócitos Mononucleares/patologia , Meningite Viral/patologia , Adolescente , Contagem de Células , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , Estudos Transversais , Enterovirus/genética , Enterovirus/crescimento & desenvolvimento , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/virologia , Reação em Cadeia da Polimerase , Fatores de TempoRESUMO
Mild splenomegaly is common in patients with Epstein-Barr virus-associated infectious mononucleosis. Massive splenomegaly, however, is rare and requires further evaluation to exclude other causes. We report an adolescent girl with previously undiagnosed type 1 Gaucher disease who presented with massive splenomegaly. The diagnosis of her underlying condition was hampered by the presence of a positive heterophile antibody test for infectious mononucleosis.