Jocelyn Y. Ang

A Randomized Placebo-Controlled Trial of Massage Therapy on the Immune System of Preterm Infants

OBJECTIVES: The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers. METHODS: A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated. RESULTS: The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 consecutive days of study intervention compared with control (13.79 vs 10 lytic units, respectively; P = .04). Infants in the massage group were heavier at end of study and had greater daily weight gain compared with those in the control group; other immunologic parameters, number of infections, and length of stay were not different between the 2 groups. CONCLUSIONS: In this study, MT administered to stable preterm infants was associated with higher NK cytotoxicity and more daily weight gain. MT may improve the overall outcome of these infants. Larger studies are needed.

Use of complementary and alternative medicine by parents of children with HIV infection and asthma and well children.

Objective: Although the use of complementary and alternative medicine (CAM) in children is increasing, little is known about its use in children with human immunodeficiency virus (HIV) infection. This study investigated the use of CAM by parents of children with HIV infection (H), children with asthma (A), and well children (W). Our hypothesis was that parents of the H group are more likely to use CAM than parents of the W or A group because of the nature and severity of the illness. Materials and Methods: Parents of 152 subjects [H (n = 46), A (n = 53), and W (n = 53)] were interviewed on the use of CAM for their children, types of CAM, reasons for use/nonuse, methods of payment, and perceived benefits for their children. Results: Compared with parents of the W and A groups, parents of the H group were less likely to be employed, were less likely to have private insurance, were less likely to have a high school or college education, and were more likely to be black. Interestingly, 38% of the W parents used CAM in their children compared with 22% in the H group and 25% in the A group. More than 80% of all three groups paid out of pocket for their use of CAM in their children. Within these groups, H parents were more likely to want CAM as part of their child’s medical care (H = 91% vs W = 75% and A = 67%, P = 0.02) and were more likely to believe that CAM was expensive (H = 78% vs W = 57% and A = 60%, P < 0.01). Conclusions: Our study revealed a relatively high rate of CAM usage by parents of all three study groups. Although parents of children with HIV infection were more likely to want CAM as part of their children’s medical care, their rate of CAM usage was not higher than that in well children. This may be related to their socioeconomic factors. A larger and more diverse study population may provide more information on factors contributing to CAM usage in chronically ill and well children.

Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream Infections

Background. Central line–associated bloodstream infection (CLABSI) is a known complication of central line use. Salvage of infected central lines with ethanol lock therapy (ELT) with systemic antimicrobials may be an alternative treatment option in children. Methods. Retrospective review was performed in children with CLASBI who underwent short-dwell ELT (70% ethanol, 4- to 25-hour dwell times ≤3 days) with systemic antimicrobials from January 1, 2007 to July 15, 2009. Results. A total of 59 patients, aged 2 months to 19 years (mean ± SD = 6.3 ± 6.1 years) with 80 episodes of CLABSI were included. The CLABSI eradication rate was 86% (69/80 episodes; 95% confidence interval [CI] 78%, 94%), significantly greater than 50% (Z = 2.35, P < .05), the estimated clearance rate of CLABSI eradication using systemic antimicrobials alone. Overall central line retention was 78% (60/77 episodes, 95% CI 69%, 87%). ELT was well tolerated. Conclusions. These findings suggest the potential benefit of short-dwell ELT combined with systemic antimicrobials in CLABSI treatment. Randomized controlled trials are needed.

Detection of Oseltamivir Resistance during Treatment of 2009 H1N1 Influenza Virus Infection in Immunocompromised Patients: Utility of Cycle Threshold Values of Qualitative Real-Time Reverse Transcriptase PCR

ABSTRACT Two immunocompromised patients with 2009 H1N1 influenza pneumonia had viral shedding for over 5 weeks despite therapy with oseltamivir. Declining or persistently low cycle threshold values noted on serial qualitative real-time reverse transcriptase PCR (rRT-PCR) of respiratory specimens implied increasing viral load and probable drug resistance. Oseltamivir resistance was later confirmed by pyrosequencing.

Staphylococcal acalculous cholecystitis in a child

Acute acalculous cholecystitis is inflammation of the gallbladder in the absence of gallstones. It usually occurs in critically ill patients and is rare in the pediatric age group. We describe a 12-year-old boy who presented with fever, jaundice, and abdominal pain and was found to have acute acalculous cholecystitis, sacroiliitis, and pelvic osteomyelitis associated with bacteremia as a result of Staphylococcus aureus. Antibiotic therapy without surgical intervention was effective. A high index of suspicion is required to make an early diagnosis and institute appropriate treatment for children with this condition. Although cholecystectomy has been considered the standard therapy, medical treatment alone can be successful.

Traveler's diarrhea: updates for pediatricians.

Children who travel are at risk of developing the same illnesses that affect adult travelers. Treatment, etiology and actual risk of TD in children are not well defined. Prevention and self-treatment of TD should be discussed in great detail during pre-travel counseling. This includes information and instructions on various preventive measures as well as when to use medications and the potential adverse effects associated with these medications. A TD that is mild can be managed effectively by appropriate use of oral rehydration solutions. Families should be advised to carry ORS packets and start treatment in children as soon as the diarrhea begins. Self treatment with antibiotics such as azithromycin may be considered in children if diarrhea is moderate to severe. Caregivers should contact local health authorities if there is no improvement especially after self treatment with antibiotics.

Multidrug-resistant viridans streptococcus (MDRVS) osteomyelitis of the mandible successfully treated with moxifloxacin

Multidrug-resistant viridans group streptococcus (MDRVS) strains have emerged as important pathogens. Treatment of MDRVS infections is problematic. The use of fluoroquinolones for treatment of MDRVS osteomyelitis has not been established. We present the first case of MDRVS osteomyelitis of the mandible successfully treated with sequential intravenous then oral moxifloxacin, and review the literature on the subject.

Multidrug-Resistant Pseudomonas aeruginosa Infection in a Child with Cystic Fibrosis.

ABSTRACT We describe a pediatric cystic fibrosis patient who developed a pulmonary exacerbation due to two multidrug-resistant (MDR) Pseudomonas aeruginosa isolates. In addition to these MDR organisms, the case was further complicated by β-lactam allergy. Despite the MDR phenotype, both isolates were susceptible to an antimicrobial combination.

The use of linezolid in the treatment of paediatric patients with infections caused by enterococci including strains resistant to vancomycin

A CT scan performed after 20 days demonstrated resolution of pulmonary lesions. The 6 month follow-up was negative. Candida pneumonia is an extremely rare disease, associated with high mortality rates. A pulmonary infection caused by Candida spp. may exist in two forms: a very rare primary pneumonia due to aspiration of oropharyngeal material; and a relatively more common secondary pneumonia due to haema-togenous seeding from a distant site of infection. The predominant origins of septic pulmonary embolism due to Candida spp. are right-sided fungal endocarditis, CVC infection, central venous thrombophlebitis and drug addiction. 2 The presence of Candida in respiratory specimens may be due to contamination and there are no specific clinical and radiological pictures. The clinical syndrome is usually dominated by signs and symptoms of systemic inflammatory syndrome, 3 while the radiographic features include a miliary nodular pattern, with feeding-vessel sign, ground-glass opacity, small nodules or multiple larger nodules with ill-defined borders randomly distributed in bilateral lungs. This pattern was prevalent in the two patients presented here. Other less common CT findings include airspace consolidation, pleural effusion, cavitation and thickening of the bronchial walls. 4 Conclusive diagnosis requires demonstration of the organism in lung tissues. Our two cases were not confirmed by biopsy but certain points strongly favoured the diagnosis: (i) the patients were immunocompromised; (ii) Candida spp. were repeatedly isolated from bronchial samples; (iii) tracheal and bronchial specimen cultures and blood cultures were negative for pyogenic organisms; (iv) PAC cultures were positive for Candida spp; (v) patients failed to respond to ordinary antibiotics; and (vi) there was a good clinical as well as radiological response to antifungal therapy. To date, this is the first report of pulmonary candidiasis treated with anidulafungin therapy. Recently, Crandon et al. 5 studied the bronchopulmonary penetration of intravenous vori-conazole and anidulafungin given in combination in healthy adults, and found good anidulafungin concentrations in alveolar macrophages and optimal lung distribution. Another study found the combination of anidulafungin and voriconazole synergistic at a dosage of 5 mg/kg/day in neutropenic rabbits with experimental invasive pulmonary aspergillosis. 6 These data seem to support the clinical use of this drug alone or in combination with voriconazole for the treatment of Candida lung infections. In conclusion, we have described two cases of bilateral septic pulmonary candidiasis successfully treated with anidulafungin therapy. This report suggests a potential role for anidulafungin in the treatment of pulmonary fungal infections. Funding M. F. …

Nasopharyngeal Carriage of Streptococcus Pneumoniae in Very Low-Birth-Weight Infants After Administration of Heptavalent Pneumococcal Conjugate Vaccine

The effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (NP) carriage in very low birth weight (VLBW) infants has not been studied. Our primary objective was to characterize NP carriage of S. pneumoniae in a group of VLBW infants (401-1500 grams) before administration of first PCV-7 (PRE) and at 4-6 weeks after a 3-dose PCV-7 primary series (POST). We also investigated the correlation between vaccine induced pneumococcal IgG antibody level and pneumococcal NP carriage POST PCV-7.