Benjamin Estrada

Prednisolone Plus Albuterol Versus Albuterol Alone in Mild to Moderate Bronchiolitis

To evaluate combination therapy of mild to moderate bronchiolitis with bronchiodilators and corticosteroids, we treated 51 young children with first-time wheezing and symptoms of respiratory tract infection with albuterol plus either prednisolone or placebo for 5 days. Disease severity was scored on days 0, 2, 3, and 6. On day 2, prednisolone resulted in significantly lower scores (2.7 ±1.4 vs. 4.0 ±1.5 in all patients evaluated, p<0.05) than placebo, whereas there was no detectable difference on day 6, suggesting that addition of prednisolone to albuterol transiently accelerates recovery from bronchiolitis. The clinical significance of this effect needs to be evaluated in further studies.

A Double-Blind Taste Comparison of Pediatric Antibiotic Suspensions

This study examined the palatability of 22 antimicrobial suspensions by using five independent categories for scoring: appearance, smell, texture, taste, and aftertaste. The likely overall influence on patient compliance was also evaluated. Drugs were compared within their respective classes. The only antibiotics judged to be so unpalatable as to potentiallyjeopardize compliance were dicloxacillin, oxacillin, erythromycin/sulfisoxazole, and cefpodoxime. Among the penicillins, amoxicillin and ampicillin were preferred. Azithromycin was slightly superior to erythromycin and clarithromycin within the macrolide class. Many cephalosporins were ranked quite high, the best being loracarbef, cefadroxyl, cefprozil, and cefixime.

Activation of cytokines and NF-kappa B in corneal epithelial cells infected by respiratory syncytial virus: potential relevance in ocular inflammation and respiratory infection

BackgroundRespiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection, claiming millions of lives annually. The virus infects various cells of the respiratory tract as well as resident inflammatory cells such as macrophages. Infection activates a variety of cellular factors such as cytokines and the pro-inflammatory transcription factor, NF-kappa B, all of which are important players in the respiratory disease. However, the exact natural route of RSV infection and its etiology remain relatively unknown. In this paper, we test the hypothesis that human corneal epithelial cells, which constitute the outermost layer of the cornea, can be infected with RSV, and that the infection leads to the activation of proinflammatory macromolecules.ResultsCorneal swabs obtained from pediatric patients with acute respiratory disease were found to contain RSV at a high frequency (43 positive out of 72 samples, i.e., 60%). Primary corneal epithelial cells in tissue culture supported robust infection and productive growth of RSV. Infection resulted in the activation of TNF-α, IL-6 and sixteen chemokines as well as NF-κB. Three proinflammatory CXC chemokines (MIG, I-TAC, IP-10) underwent the greatest activation.ConclusionsThe ocular epithelium is readily infected by RSV. The pro-inflammatory cytokines are likely to play critical roles in the etiology of inflammation and conjunctivitis commonly seen in pediatric patients with respiratory infections. RSV-eye interactions have important implications in RSV transmission, immunopathology of RSV disease, and in the management of conjunctivitis.

Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole and Hyperbaric Oxygen Therapy

Mucormycosis is a rare, but invasive infection caused by ubiquitous molds. Amphotericin B and surgery have been known to help improve the outcome. Sporadic case reports support the use of posaconazole in adults. We report a toddler with acute lymphoblastic leukemia who acquired rhino-orbital mucormycosis caused by Rhizopus species at the end of induction chemotherapy. She was successfully treated with multiple surgical debridements, amphotericin B, posaconazole and hyperbaric oxygen therapy. In conclusion, mucormycosis is a serious infection that requires aggressive surgical and medical therapy. To the best of our knowledge the use of posaconazole combined with hyperbaric oxygen therapy has not been reported in a toddler with leukemia and invasive Rhizopus sp. infection. This approach was found to be safe and effective in our patient.

Neonatal Candida parapsilosis meningitis and empyema related to epidural migration of a central venous catheter

Candida parapsilosis is an extremely rare cause of meningitis. We report the case of a neonate born at 26+4 weeks of gestation who was admitted to the neonatal intensive care unit at our institution due to respiratory immaturity. During the course of a 3-month hospitalization, the neonate developed fever and lethargy. A lumbar puncture revealed milky-white, turbid cerebrospinal fluid which contained many nucleated cells, mostly neutrophils. Microscopic examination of the cerebrospinal fluid revealed marked acute inflammation and fungal yeast forms, and cultures of the cerebrospinal fluid and peripheral blood yielded C. parapsilosis. Imaging studies subsequently revealed a subdural empyema related to epidural migration of a central venous catheter (CVL). The neonate received extended therapy with amphotericin B and fluconazole. He responded favorably to therapy and was discharged 3 months after birth. This case underscores the clinical importance of the recognition and treatment of a potentially lethal fungal pathogen of the central nervous system and the need for awareness of complications resulting from CVL malposition.

Severe Human Metapneumovirus Infection in Hospitalized Children

Human metapneumovirus is a recently discovered pathogen that causes upper and lower respiratory tract disease in children. This study describes the course of illness in hospitalized children with this infection. During a 6-month period, 11 children were diagnosed with human metapneumovirus infection by reverse transcription-polymerase chain reaction. Oxygen supplementation was required for 82% of patients. Severe disease developed in 45%, and mechanical ventilation was required. An apparent life-threatening event was the indication for hospitalization of 27% of patients infected with human metapneumovirus. Children with underlying asthma or neuromuscular disease had a prolonged hospitalization.

Methicillin-resistant Staphylococcus aureus hepatic abscess in a patient with sickle-cell disease.

We report a case of a 16‐year‐old female patient with sickle‐cell disease with a liver abscess secondary to methicillin‐resistant Staphylococcus aureus (MRSA). She had initially presented with jaundice and abdominal pain and subsequently underwent endoscopic retrograde cholangio‐pancreaticography followed by laparoscopic cholecystectomy for removal of gallstones. However, post‐cholecystectomy she presented with generalized abdominal pain and computed tomography scan of the abdomen revealed a liver abscess. A pigtail catheter was inserted into the abscess and culture of the aspirate yielded MRSA (susceptibility pattern of the organism was compatible with community‐acquired MRSA). She was treated with intravenous clindamycin for 6 weeks with complete resolution of the abscess.

Eastern equine encephalitis virus infection and hemophagocytic lymphohistiocytosis in a 5-month-old infant.

Eastern equine encephalitis virus infection is a rare sporadic central nervous system infection transmitted by a mosquito vector. Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease associated with the inability of an overactive immune system to effectively respond to infections. Many viruses are known to trigger primary, as well as secondary, HLH. We report a pediatric case of eastern equine encephalitis virus-associated HLH which caused severe neurologic injury and death.

Fusobacterium necrophorum Mediastinal Abscess Presenting as an Anterior Chest Wall Mass in a Child: A Case Report

F usobacterium infections in children are quite rare. Infections caused by Fusobacterium sp. have been associated with Lemier re’s syndrome, which is also known as necrobacillosis and postanginal sepsis. Lemierre’s syndrome, which is mainly observed in adolescents and adults, is a suppurative orophar yngeal infection that is associated with Fusobacterium necrophorum bacteremia and thrombophlebitis of the internal jugular vein and subsequent metastatic foci of infection.1 We report a case of an anterior mediastinal abscess due to Fusobacterium necrophorum in a child. Patient Report

Antimicrobial prophylaxis in pediatric critical care

Patients admitted to the pediatric intensive care unit are at increased risk of developing infections that may exacerbate their already labile conditions. Different strategies are used to prevent infection in patients and their contacts in this setting. They include the implementation of infection control policies and the use of immunotherapy and prophylactic antimicrobials. The following is a review of the different chemotherapeutic approaches established or suggested to prevent infection in these highly susceptible hosts. The conditions in which these interventions may be used consist of surgical wound infections, solid organ transplantation, cardiac disease suitable for endocarditis prophylaxis, and pathogen-or host-specific situations in which prophylaxis may be required. Chemoprophylactic strategies used to prevent infection in contacts, including hospital personnel, in situations in which the offending organism is highly transmissible or virulent also are described.