Assuntos
Doenças Autoimunes do Sistema Nervoso/tratamento farmacológico , Azetidinas/uso terapêutico , Inibidores de Janus Quinases/uso terapêutico , Malformações do Sistema Nervoso/tratamento farmacológico , Sulfonamidas/uso terapêutico , Adolescente , Idade de Início , Azetidinas/efeitos adversos , Biomarcadores , Criança , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Expressão Gênica/efeitos dos fármacos , Humanos , Lactente , Interferons/genética , Interferons/metabolismo , Inibidores de Janus Quinases/efeitos adversos , Análise dos Mínimos Quadrados , Masculino , Purinas , Pirazóis , Sulfonamidas/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: To test the hypothesis that predisposition to childhood herpes simplex virus (HSV) type 1 encephalitis (HSE) may be determined in part by human genetic factors. STUDY DESIGN: A genetic epidemiologic survey of childhood HSE (onset at age 3 months to 15 years) over a 20-year period (1985-2004) was conducted throughout France (comprising 29 university hospital neuropediatric centers). A total of 85 children fulfilled the diagnostic criteria for inclusion. Family and personal histories were obtained by face-to-face interview for 51 patients. RESULTS: No familial cases of HSE were identified in our survey; however, a high proportion (20%) of the children interviewed had a relevant family history: parental consanguinity (12% of patients), early-onset herpetic keratitis in a first-degree relative (6%), or both (2%). The narrow window of high susceptibility to HSE before age 3 years (62% of patients) further indicates that predisposition to HSE is tightly age-dependent. CONCLUSIONS: This survey suggests that childhood HSE, although sporadic, may result from Mendelian predisposition (from autosomal recessive susceptibility in particular), at least in some children. There likely is incomplete penetrance, however, which may reflect, at least in part, the impact of age at the time of HSV-1 infection.
Assuntos
Encefalite por Herpes Simples/genética , Encefalite por Herpes Simples/virologia , Variação Genética , Receptor 3 Toll-Like/genética , Aciclovir/uso terapêutico , Adolescente , Fatores Etários , Idade de Início , Antivirais/uso terapêutico , Criança , Pré-Escolar , Encefalite por Herpes Simples/tratamento farmacológico , Feminino , Predisposição Genética para Doença , Variação Genética/genética , Humanos , Lactente , Masculino , Fatores de Risco , Simplexvirus , Adulto JovemRESUMO
Bocavirus was found in 11.6% of hospitalized children and 13% of ambulatory patients with exacerbations of asthma, and respiratory syncytial virus was found in 13.5% and 17.7%, respectively. In addition, influenza A virus was detected in 2.6% of hospitalized children and 14.1% (P<.001) of ambulatory-treated patients. Thus, the influenza burden in asthma may be underestimated.
Assuntos
Asma/complicações , Influenza Humana/complicações , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Empirical antibiotic use is prescribed in managing children with pneumonia worldwide. We assessed the usefulness of procalcitonin (PCT) and interferon-alpha (IFN-alpha) in differentiating viral from bacterial pneumonia. Among 159 hospitalized children, pneumonia was diagnosed based on clinical complaints plus pulmonary infiltrate. Aetiology was investigated for 9 viruses and 4 atypical and 3 typical bacteria. PCT and IFN-alpha were measured in the serum sample collected on admission. Eight patients had bacteraemic infections, 38 had non-bacteraemic typical infections, and 19 patients had atypical bacterial infections. Viral and unknown aetiology was established in 57 (36%) and 34 (21%) cases, respectively. Three patients with bacterial infection without collected blood culture were excluded. IFN-alpha (IU/ml) was detectable in 20 (13%) cases. The difference among median PCT values of the bacteraemic (4.22; 1.56-7.56), non-bacteraemic typical bacterial (1.47; 0.24-4.07), atypical bacterial (0.18; 0.06-1.03) and only viral (0.65; 0.11-2.22) subgroups was significant (p = 0.02). PCT was > or =2 ng/ml in 52 (33%) cases. The presence of IFN-alpha was associated with PCT <2 ng/ml (90% vs. 64%, p = 0.02). The negative predictive value (95% confidence interval) of PCT > or =2 ng/ml was 95% (89-100%), 89% (78-100%), 93% (85-100%) for differentiation of bacteraemic from viral, atypical bacterial and non-bacteraemic typical bacterial infection, respectively, and 58% (49-68%) for differentiation between bacterial and viral infection. PCT may be useful in identifying bacteraemia among children hospitalized with community-acquired pneumonia. IFN-alpha was uncommonly detected.
Assuntos
Bacteriemia/diagnóstico , Calcitonina/sangue , Pneumonia Bacteriana/diagnóstico , Pneumonia Viral/diagnóstico , Precursores de Proteínas/sangue , Bacteriemia/sangue , Peptídeo Relacionado com Gene de Calcitonina , Pré-Escolar , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Interferon-alfa/sangue , Masculino , Pneumonia Bacteriana/sangue , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/sangue , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Estatísticas não ParamétricasRESUMO
Real-time polymerase chain reaction for human bocavirus (HBoV) was performed in nasopharyngeal aspirate specimens from 166 children over 2 years of age hospitalized for severe asthma exacerbation. Whereas HBoV was detected in 21 of these children (13%), it was found in only 1 of 50 ambulatory children with stable asthma (2%), suggesting a major role of HBoV in acute exacerbations in asthmatic children.
Assuntos
Asma/virologia , Bocavirus/isolamento & purificação , Nasofaringe/virologia , Infecções por Parvoviridae/epidemiologia , Adolescente , Bocavirus/genética , Criança , Pré-Escolar , DNA Viral/isolamento & purificação , Feminino , Hospitalização , Humanos , Masculino , Reação em Cadeia da Polimerase , Estudos Prospectivos , Estações do Ano , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED). STUDY DESIGN: All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. RESULTS: Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively. CONCLUSION: PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.