Daniel J. Adams

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Objective To characterize the medication and other exposures associated with pediatric community‐associated Clostridium difficile infections (CA‐CDIs). Study design We performed a case‐control study using billing records from the US military health system database. CA‐CDI cases included children 1‐18 years of age with an outpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for Clostridium difficile infection (CDI) from 2001 to 2013. Each case was matched to 3 controls without CDI by age and sex. Children hospitalized at any time before their CDI were excluded. Outpatient pharmacy records were used to identify medication exposures in the preceding 12 weeks. In addition, we evaluated recent outpatient healthcare exposure, exposure to a sibling younger than 1 year of age, or to a family member with CDI. Results A total of 1331 children with CA‐CDI were identified and 3993 controls were matched successfully. Recent exposure to fluoroquinolones, clindamycin (OR 73.00; 95% CI 13.85‐384.68), third‐generation cephalosporins (OR 16.32; 95% CI 9.11‐29.26), proton pump inhibitors (OR 8.17; 95% CI 2.35‐28.38), and to multiple classes of antibiotics, each was associated strongly the subsequent diagnosis of CA‐CDI. Recent exposure to outpatient healthcare clinics (OR 1.35; 95% CI 1.31‐1.39) or to a family member with CDI also was associated with CA‐CDI. Conclusions CA‐CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

Otitis Media and Related Complications among Children with Autism Spectrum Disorders.

Acute otitis media (AOM) symptoms can be masked by communication deficits, common to children with autism spectrum disorders (ASD). We sought to evaluate the association between ASD and otitis media. Using ICD-9-CM diagnostic codes, we performed a retrospective case-cohort study comparing AOM, and otitis-related diagnoses among children with and without ASD. Children with ASD had a significantly increased rate of AOM, otitis media with effusion, otorrhea, and PE tube placement. Children with ASD were more than twice as likely to develop mastoiditis, and to undergo mastoidectomy and tympanoplasty. Children with ASD are more likely to have middle ear infections and otitis-related complications, highlighting the importance of routine middle ear examinations and close attention to hearing impairment in this population.

West Nile Encephalitis in a previously healthy child: Evaluation for CCR5 Chemokine receptor mutation

Neuroinvasive disease seldom follows infection with West Nile virus, but is particularly rare in children. Most reported cases of West Nile virus encephalitis have occurred in older adults or the immunocompromised. Although individuals who are homozygous for a 32 base pair deletion in the chemokine receptor CCR5 have been shown to be resistant to infection with HIV-1, they have been reported to have in increased risk of developing severe disease following West Nile virus infection. Analysis of the presence of the CCR5 deletion has not been previously examined in children with West Nile neuroinvasive disease. We present a case of West Nile encephalitis in a previously healthy young child whom we evaluated for the presence of the CCR5Δ32 mutation.

Recurrent Nocardia Sepsis in a Patient With Sickle Cell Anemia Receiving Continuous Deferoxamine

Nocardia species are ubiquitous soil-borne organisms that most commonly cause invasive disease in patients with defective cell-mediated immunity. We report a case of recurrent Nocardia sepsis in a patient with sickle cell disease and chronic iron overload, who was undergoing high-dose infusions of deferoxamine through a central venous catheter.