Erik Normann

Chlamydia pneumoniae in children with acute respiratory tract infections

Children seeking medical attention for acute respiratory tract infections were investigated for evidence of Chlamydia pneumoniae infection. Blood samples were obtained from 367 children. Nasopharyngeal or throat swabs for PCR analysis (polymerase chain reaction) were taken from 360 children. Serology was found to be useful for diagnosis of infection only in children aged 5 y. Using PCR, a prevalence of 8 and 10% of C pneumoniae was found in male and female children aged < 2 y; 17 and 19%, respectively, in the age group 2‐4 y and 32 and 21%, respectively, in the age group 5–16 y. We conclude that Chlamydia pneumoniae is a common finding in young children with respiratory tract infections. Younger children were more often found to have a moderate disease, but may have been ill for a long period.

Intestinal microbial profiles in extremely preterm infants with and without necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) represents one of the gravest complications in premature infants. The suggested role of intestinal microbiota in the development of NEC needs to be elucidated.

Chlamydia pneumoniae in children attending day-care centers in Gävle, Sweden

BACKGROUND The epidemiology of Chlamydia pneumoniae in healthy children has not been established. METHODS This investigation used polymerase chain reaction (PCR) to study the epidemiology of C. pneumoniae in presumed healthy children. Four hundred fifty-three children and 142 personnel at 9 day-care centers were investigated for carriage of C. pneumoniae. Children found to be positive by PCR were also investigated with serology, and their family members were tested with PCR. RESULTS One hundred and three (22.7%) children had a positive PCR, as had 33 (23.2%) personnel. Fourteen percent of the children younger than 3 years had a positive PCR test compared with 26% of the older children (P < 0.01). No correlation was found between respiratory symptoms and carriage of C. pneumoniae. Mothers were more often positive in the PCR test as compared with fathers (relative risk, 2.59; 95% confidence interval, 1.16 to 5.78). Antibodies to C. pneumoniae were found in 27 of 97 PCR-positive children; only 2 of whom were younger than 3 years. CONCLUSION C. pneumoniae can be commonly found in young children attending day care. Most of the youngest children did not develop specific antibodies. Children may have subclinical infections with C. pneumoniae. The organism seems to be easily communicable among individuals living in close proximity.

DEMONSTRATION OF CHLAMYDIA PNEUMONIAE IN CARDIOVASCULAR TISSUES FROM CHILDREN WITH KAWASAKI DISEASE

demonstration of chlamydia pneumoniae in cardiovascular tissues children with kawasaki disease

Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex

Background: The proposed association between Chlamydia pneumoniae (Cpn) infection and wheezing needs further clarification. Methods: Serum samples obtained from 1581 children aged 4 years in a population based cohort were tested for antibodies to Cpn and IgE antibodies to common allergens. Data on environmental factors and disease were collected prospectively from birth. Results: The occurrence of IgG antibodies to Cpn at 4 years of age was associated with reported wheezing at different ages; however, these findings were most often not significant. In girls, the occurrence of anti-Cpn IgG was associated with wheezing at the ages of 1, 2, and 4 years (odds ratios (ORs) 3.41 (95% confidence interval (CI) 1.46 to 7.96), 2.13 (95% CI 1.02 to 4.44), and 2.01 (95% CI 1.14 to 3.54), respectively), and even higher ORs were observed for each age category when only high level antibody responses to Cpn were analysed. At the time of blood sampling the association between anti-Cpn IgG and wheezing was restricted to girls without atopic sensitisation (OR 2.39 (95% CI 1.25 to 4.57). No associations with wheezing were detected in boys, in whom IgE sensitisation was inversely associated with the presence of anti-Cpn IgG (OR 0.49 (95% CI 0.26 to 0.90). Conclusions: This study suggests an association between evidence of earlier Cpn infection and a history of wheezing in young girls. Infection with Cpn may be an important risk factor for wheezing and possibly for non-atopic asthma, predominantly in girls.

Chlamydia pneumoniae in children undergoing adenoidectomy

Chlamydia pneumoniae is a common respiratory pathogen which is often found in paediatric populations. Little is known about the true colonization rate and the localization of the bacteria in the respiratory tract. In this study, immunohistochemistry was used to examine adenoids from 69 children undergoing elective adenoidectomy. Throat swabs for polymerase chain reaction (PCR) and blood samples for serology were also obtained. Chlamydia pneumoniae was demonstrated in the adenoids by immunohistochemistry in 68 of the children. Five children (7%) had a positive C. pneumoniae PCR test from throat swabs and 14 children (20%) had detectable antibodies by the microimmunofluorescence technique.

Parents' presence and parent–infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries

Little is known about the amount of physical parent–infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.

Parents experiences of discharge readiness from a Swedish neonatal intensive care unit

The aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home.

Serum pentraxin 3 concentrations in neonates

Dear Editor, C-reactive protein (CRP) is one of the most commonly used diagnostic biomarkers in the clinical setting for diagnosing and monitoring of inflammatory and infectious diseases. However, in neonates several questions remain, regarding the interpretation of an increased serum CRP concentration during the first days of life in otherwise healthy newborns, especially in preterms (1). Pentraxins are endogenous substances that neutralize or eliminate a variety of pathogenic agents in concert with the complement system and macrophages. These complex biological responses to tissue injury, necrosis, infections, or immune-related diseases are part of the natural innate defence system (2). The pentraxin family consists of proteins with cyclic multimeric structures. The well-known acute-phase protein CRP belongs to the short members of the family, while pentraxin 3 (PTX3) belongs to the long counterparts. PTX3 is released from macrophages and endothelial cells among a great variety of other cell types in which the protein is synthesized and stored. On stimuli from primary inflammatory signal proteins, as interleukin-1 (IL-1), tumour necrosis factor-alpha (TNF-α), and microbial lipopolysaccharides (LPS) as well as toll-receptor-mediated signals, PTX3 will be synthesized, and the serum concentration will increase up to 100-fold in 6–8 hours. Interleukin-6 (IL-6) is a weak inducer for PTX3 (3,4). PTX3 synthesis is thus produced close to the site of inflammation and is not dependent on cytokine production or liver function. All subjects in our study were recruited from the Department of Womens and Childrens Health, Uppsala University Hospital, Uppsala, Sweden. Three groups were included: umbilical venous cord blood collected from term healthy newborns (n = 36), venous blood from term healthy newborns at 3–7 days of age at phenylketonuria (PKU) testing (n = 11), and venous blood from very preterm (VPT) newborns at the neonatal supportive care unit (n = 40). The median gestational age and postnatal age were 26 weeks (range 23–31, IQR 4) and 27 days (range 4–103, IQR 26), respectively. The median birth weight was 954 g (range 422–2244, IQR 400). The study was approved by the local Ethical Review Board of Uppsala University. Serum PTX3 was determined by a commercial sandwich ELISA kit (DY1826, R&D Systems, Minneapolis, MN, USA), as described elsewhere (5). Serum concentrations of PTX3 in term healthy newborns were lower than in term healthy newborns at 3–7 days of age and VPT newborns at the supportive care unit (P < 0.0001) (Figure 1). VPT newborns showed a lower serum concentration of PTX3 than term healthy newborns at 3–7 days of age (P < 0.0001) (Figure 1). To our knowledge, no studies have presented such data before. Previous studies on serum amyloid A and high-sensitivity (hs) CRP reported gestational age-related differences, with higher concentrations in VPT compared with full-term healthy babies, during the neonatal period (6-8). A similar pattern seems to apply to PTX3. Because PTX3 may be a faster acute-phase protein that is not liver-dependent, it is probable that it is superior to traditional biomarkers for mirroring rapid inflammatory courses. Compelling indications are present that a high serum concentration of PTX3 predicts shock, poor outcome, and organ failure in meningococcal disease and severe sepsis, respectively, in children and adults (9,10). Figure 1. Serum concentrations in term healthy newborns (n = 36), term healthy newborns at 3-7 days of age (n = 11), and very preterm newborns (n = 40). A Kruskal–Wallis test was used for continuous three-group comparisons. Data were computed by Statistica ... The serum concentration of PTX3 in the cohort should be interpreted with care because a part of the sample was likely to have its origin from infants treated with antibiotics or with inflammatory reactions. It is important to remember that there is an extremely rapid foetal development up to the expected day of delivery. This means that there will be differences between a prematurely born child with a gestation age of 30 weeks from a child with a gestation age of 36 weeks. The cause of the prematurity may also involve inflammatory reactions which will further increase the variability in PTX3 values in samples from prematurely born babies. Nevertheless, the prematurely born cohort, despite the existence of possible factors that may influence the serum PTX3 concentration, could be representative for this group of newborn infants. In summary, serum PTX3 may be a promising acute-phase protein for interpretation of affected newborns with symptoms and signs of sepsis. Serum PTX3 is measurable in both term and preterm babies in similarity with other acute-phase proteins. Considering the promising results from studies in adult patients with sepsis, PTX3 might represent a helpful tool in diagnosis of sepsis in the neonate as well. The predictive value of PTX3 may thus be higher compared with conventionally used acute-phase proteins. However, regarding serum PTX3 concentrations in infants with infection we propose a prospective study on neonatal sepsis with well-defined established criteria.

Decreased serum insulin-like growth factor I during puberty in children with insulin dependent diabetes mellitus (IDDM).

Previous reports concerning insulin-like growth factor-I (IGF-I) in diabetics are conflicting. This study describes IGF-I in children with insulin-dependent diabetes mellitus (IDDM) and healthy controls in relation to pubertal development. Sixty-six children participated (34 girls and 32 boys) of which 33 had IDDM. The mean age in the study population was 14.3 years, (range 7.1 to 19.7). Serum IGF-I was significantly decreased in diabetics. Diabetic girls had a mean IGF-I of 28.3 (14.4; = SD) nmol/l compared with 42.8 (15.0) nmol/l in controls. In diabetic boys the result was 30.0 (16.0) nmol/l compared with 44.1 (23.4) in controls. Growth hormone was measured in only one fasting morning serum sample from each individual. There was no difference between girls, but diabetic boys had higher mean serum concentration of growth hormone than controls (3.5 (4.8) vs. 1.8 (1.5) micrograms/l respectively). Diabetic girls had delayed menarche, corresponding to a slightly delayed bone maturation.