ORCID Profile
0000-0003-3174-9834
Current Organisations
Gold Coast University Hospital
,
Griffith University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Engineering Systems Design | Environmental and Occupational Health and Safety | Atmospheric Aerosols | Public Health and Health Services |
ANZSRC Socio-Economic Objective (SEO)
Commercial Building Management and Services | Environmental Health | Environmentally Sustainable Transport not elsewhere classified
Related Links
Publications
Respiratory Viruses in Neonates
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Extended excretion of rotavirus after severe diarrhoea in young children
Publisher: Elsevier BV
Date: 06-1998
DOI: 10.1016/S0140-6736(97)11257-0
Abstract: The burden of Hypertension (HT) [P1][YT2] in Indonesian postmenopausal women has increased over the past years. Obesity is the most prevalent risk of HT among postmenopausal women. This study evaluates the relationship of fluctuating BMI with BP in postmenopausal women in Bogor, Indonesia. This longitudinal study acquired secondary data from a previous study of the "Cohort Study of NCD' Risk Factors" along with a two-year follow-up. Data were analyzed from a total of 888 postmenopausal women aged ≥ 25 years[P3][wr4]. BMI and BP fluctuations were calculated from baseline BMI at the first visit (T1) until the observation period (T7). The significance of panel analysis at p value < 0.05.[P5][wr6]. The fixed-effect model showed a significant correlation between BMI changes with the changes in SBP and DBP and fluctuating BMI with SBP. After adjustment for physical activity, 1 kg of weight gain will increase SBP and DBP in normotensive, controlled, and uncontrolled hypertensive in iduals. After adjusting for smoking, BMI reduction by 1% would lower the SBP as much as 2-3 mmHg compared to a stable BMI. Fluctuating BMI was a predictor in decreasing BP in postmenopausal women, so it could be used to control HT.
Another vaccine, another step forward?
Publisher: Wiley
Date: 11-2005
PATIENTS WITH ENTERIC ADENOVIRUS GASTROENTERITIS ADMITTED TO AN AUSTRALIAN PEDIATRIC TEACHING HOSPITAL FROM 1981 TO 1992
Publisher: American Society for Microbiology
Date: 1995
DOI: 10.1128/JCM.33.1.131-136.1995
Abstract: During the period 1981 to 1992, 4,473 fecal specimens collected from children hospitalized with acute gastroenteritis at the Royal Children's Hospital, Melbourne, Australia, were examined by electron microscopy. A monoclonal antibody enzyme immunoassay for enteric adenovirus (EAd) types 40 (Ad40) and 41 (Ad41) was used when adenoviruses were visualized. Fecal s les were positive for adenovirus by both electron microscopy and enzyme immunoassay in 138 patients (3.1%). Ad40 was identified in 19 children (14%), and Ad41 was identified in 119 children (86%). These EAd were identified during each of the 12 years surveyed. EAd were present year-round, but the annual number of hospitalizations was not constant. Yearly prevalence varied from 0.7% (1981) to 6.5% (1985). This was associated with monthly fluctuations in Ad41 activity, with overall peak monthly prevalence in May (late autumn). By contrast, Ad40 numbers remained low and constant year-round. The frequency of Ad41 relative to Ad40 increased from 25% in 1981 to exceed 75% after 1983. Children admitted with EAd infection were more likely to have diarrhea for more than 5 days (P 0.001) but less likely to be febrile or dehydrated (P 0.05) than children with rotavirus infection. EAd are responsible for enteric symptoms of only a fraction of hospitalized children with infectious diarrhea but result in a more-protracted illness than rotavirus. Their relationship to persistent diarrhea requires further investigation.
Evaluation of end-point titration, single dilution and capture enzyme immunoassays for measurement of antirotaviral IgA and IgM in infantile secretions and serum
Publisher: Elsevier BV
Date: 10-1989
DOI: 10.1016/0166-0934(89)90074-8
Abstract: In order to facilitate measurement of antirotaviral IgA in large collections of faeces and secretions, adaptations of enzyme immunoassay methods for estimating antirotaviral IgA and IgM in duodenal fluid, saliva, faeces and serum were studied. To quantitate specific IgA, a single dilution of each s le was assayed. Results were expressed as antirotaviral IgA units derived from a standard curve. Units were calculated by log-logit analysis on computer. There was strong correlation between antirotaviral IgA units and end-point titres in 257 faecal s les (correlation coefficient r = 0.92) and in 182 duodenal fluids and salivary s les (correlation coefficient r = 0.74). The assay was validated using acute and convalescent faeces from children with or without rotavirus infection. Immune conversions in IgA were detected in 33 (75%) of the children by units and 34 (77%) by titres. None of nine children with gastroenteritis due to other infectious agents showed immune conversions to rotavirus. A monoclonal capture IgM assay showed similar end-point titres and numbers of immune conversions when compared with a direct assay for antirotaviral IgM in serum and secretions. Use of the capture method eliminated false-positive reactions with the cell control. The assay for antirotaviral IgA units in secretions is simple, rapid, reproducible and reliable, and has proven of value in longitudinal epidemiological studies of rotavirus coproIgA profiles. Both the capture IgM technique and the single dilution IgA method permit analysis of large numbers of specimens and are appropriate for examination of immune responses to natural rotavirus infection or during vaccine trials.
Further clinical trials on macrolides for bronchiolitis in infants are unnecessary.
Publisher: Elsevier BV
Date: 10-2015
Tuberculosis in New Zealand, 1992-2001: a resurgence.
Publisher: BMJ
Date: 11-2005
A comparison of two informative SNP-based strategies for typing Pseudomonas aeruginosa isolates from patients with cystic fibrosis
Publisher: Springer Science and Business Media LLC
Date: 05-06-2014
Bronchiectasis in children: diagnosis and treatment
Publisher: Elsevier BV
Date: 09-2018
Amoxicillin–clavulanate versus azithromycin for respiratory exacerbations in children with bronchiectasis (BEST-2): a multicentre, double-blind, non-inferiority, randomised controlled trial
Publisher: Elsevier BV
Date: 10-2018
Prospective evaluation of respiratory exacerbations in children with cystic fibrosis from newborn screening to 5 years of age
Publisher: BMJ
Date: 23-01-2013
Multi-centre research in Australia: Analysis of a recent National Health and Medical Research Council-funded project
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1440-1843.2009.01595.X
Abstract: Human research ethics committees provide essential review of research projects to ensure the ethical conduct of human research. Several recent reports have highlighted a complex process for successful application for human research ethics committee approval, particularly for multi-centre studies. Limited resources are available for the execution of human clinical research in Australia and around the world. This report overviews the process of ethics approval for a National Health and Medical Research Council-funded multi-centre study in Australia, focussing on the time and resource implications of such applications in 2007 and 2008. Applications were submitted to 16 hospital and two university human research ethics committees. The total time to gain final approval from each committee ranged between 13 and 77 days (median = 46 days) the entire process took 16 months to complete and the research officer's time was estimated to cost $A34 143. Obstacles to timely human research ethics committee approval are reviewed, including recent, planned and potential initiatives that could improve the ethics approval of multi-centre research.
Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial
Publisher: BMJ
Date: 03-2017
Molecular Detection of Human Bacterial Pathogens
Publisher: CRC Press
Date: 18-04-2011
DOI: 10.1201/B10848
Bacteria and viruses in the nasopharynx immediately prior to onset of acute lower respiratory infections in Indigenous Australian children
Publisher: Springer Science and Business Media LLC
Date: 29-06-2018
Dexamethasone treatment for bacterial meningitis
Publisher: Wiley
Date: 12-1990
Risk Factors for Chronic Cough in Young Children: A Cohort Study
Publisher: Frontiers Media SA
Date: 12-08-2020
The clinical, immunological and microbiological impact of the 10-valent pneumococcal-Protein D conjugate vaccine in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: A multi-centre, double-blind, randomised controlled trial.
Publisher: Informa UK Limited
Date: 26-06-2018
Acellular pertussis vaccine effectiveness for children during the 2009–2010 pertussis epidemic in Queensland
Publisher: AMPCo
Date: 04-2014
DOI: 10.5694/MJA13.11069
Abstract: OBJECTIVES To assess the effectiveness of three, four and five doses of acellular pertussis vaccine against pertussis notification for children aged 1 - < 4 years and 5 - < 12 years, and the effectiveness of three doses of acellular pertussis vaccine against pertussis hospitalisation for children aged 1 - < 4 years. A population-based retrospective study of children aged 1 - < 12 years residing in Queensland, Australia, during 2009 and 2010. Routinely collected notification, hospitalisation, testing and vaccination data were used to describe notification rates and testing patterns and to assess vaccine effectiveness (VE) by the screening method. VE against pertussis notification for children aged 1 - < 4 years and 5 - < 12 years, by birth year, and VE against pertussis hospitalisation for children aged 1 - < 4 years. 1961 notifications and 29 hospitalisations were included in the VE calculations. VE point estimates against pertussis notification and hospitalisation in children aged 1 - < 4 years were similar in 2009 and 2010, and ranged between 83.5% and 89.4%. VE point estimates against notification among children aged 5 - < 12 years were between 71.2% and 87.7% in 2009, and between 34.7% and 70.3% in 2010. The numbers of pertussis tests performed for children, particularly polymerase chain reaction (PCR) tests, increased between 2009 and 2010. Acellular pertussis vaccine provided good protection within the first years of priming, but this waned as age increased. Changes in pertussis testing behaviour, because of increases in PCR use and awareness, may have contributed to increased pertussis notification rates and lower estimates of VE against notification owing to identification of milder disease.
Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2x2 partial factorial, randomised controlled trial
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJRESP-2022-001236
Abstract: Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance. We are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance. Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians. ACTRN12619000564156.
The role of mobile phones as a possible pathway for pathogen movement, a cross-sectional microbial analysis
Publisher: Elsevier BV
Date: 09-2021
Macro‐AST: A benign cause of persistently elevated aspartate aminotransferase
Publisher: Wiley
Date: 05-10-2004
World Bronchiectasis Day: It is time for global action to promote equity of care
Publisher: Wiley
Date: 12-05-2023
DOI: 10.1002/PPUL.26467
Flexible bronchoscopy in managing a child with pulmonary hydatid disease
Publisher: Wiley
Date: 19-03-2012
DOI: 10.1002/PPUL.22545
Abstract: Few articles have described the airway management of parenchymal lung hydatid cysts complicated by endobronchial or airway involvement, and none have described the use of flexible bronchoscopy (FB) therapeutically in children. We present a child with a ruptured pulmonary hydatid cyst who underwent repeated FB for removal of cystic material from an obstructed right upper lobe segmental bronchus. This child did not require thoracic surgery and made a full clinical recovery, demonstrating that in selected cases FB may offer curative treatment.
Management of bronchiectasis and chronic suppurative lung disease in Indigenous children and adults from rural and remote Australian communities
Publisher: AMPCo
Date: 10-2008
DOI: 10.5694/J.1326-5377.2008.TB02085.X
Abstract: 1) Consensus recommendations for managing bronchiectasis in Indigenous children and adults living in rural and remote regions were developed during a multidisciplinary workshop and were based on available systematic reviews. 2) Successful diagnosis, management and prevention of bronchiectasis in Indigenous Australians requires access to comprehensive health care services, as well as improved housing, education and employment and reduced poverty levels. 3) Diagnosis of bronchiectasis requires a chest high-resolution computed tomography scan. Children who have bronchiectasis symptoms but non-diagnostic scans are described as having chronic suppurative lung disease (CSLD), rather than bronchiectasis. Untreated CSLD may progress to bronchiectasis. 4) Chronic wet cough (> 4 weeks) or recurrent wet cough (> 2 episodes/year) are important but often under-reported symptoms. Bronchiectasis is suspected when chronic cough is excessively prolonged (> 12 weeks) or if a chest radiographic abnormality persists despite appropriate therapy. 5) Intensive treatment aims to improve symptom control and quality of life while preserving lung function and reducing acute exacerbation frequency. 6) Antibiotics should be prescribed for acute infective episodes according to culture results of respiratory secretions, local susceptibility patterns and clinical severity. Patients not responding promptly to oral antibiotics should be hospitalised for more intensive treatment. 7) Ongoing care requires regular primary health care and specialist review, including monitoring for complications and comorbidities. Corticosteroids, bronchodilators and mucoactive agents may be used in in idual cases, but routine use is not recommended. Physiotherapy and exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and immunisations maintained.
Bronchoscopy contributes to the clinical management of indigenous children newly diagnosed with bronchiectasis
Publisher: Wiley
Date: 19-03-2012
DOI: 10.1002/PPUL.22544
Abstract: Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice. To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis. We examined FB and BAL data collected prospectively in 56 children aged 0.8-9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >10(4) colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics. Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%). Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.
Epidemiology of respiratory syncytial virus in a community birth cohort of infants in the first 2 years of life
Publisher: Springer Science and Business Media LLC
Date: 25-02-2021
Should rotavirus vaccines be included in the national immunization program of a small developed country?
Publisher: Informa UK Limited
Date: 10-2009
DOI: 10.1586/ERP.09.46
Childhood Pneumonia Screener: a concept
Publisher: Springer Science and Business Media LLC
Date: 12-2015
DOI: 10.1007/BF03371463
International consensus statement on quality standards for managing children/adolescents with bronchiectasis from the ERS CRC Child-BEAR-Net
Publisher: European Respiratory Society (ERS)
Date: 06-2022
Time course of transient cortical scintigraphic defects associated with acute pyelonephritis
Publisher: Springer Science and Business Media LLC
Date: 12-2002
DOI: 10.1007/S00247-002-0784-6
Abstract: Acute pyelonephritis is distinguished from renal scarring using repeat cortical scintigraphy. The defects of acute pyelonephritis resolve, while those of scars persist. To determine the duration of reversible cortical defects following acute pyelonephritis and the time interval required to differentiate infection from scars. An observational prospective study of 193 children (386 kidneys) aged less than 5 years following their first proven urinary tract infection (UTI). Renal cortical scintigraphic defects were detected in 112 (29%) kidneys within 15 days of diagnosis. Of these, 95 underwent repeat renal cortical scans 2 years after the UTI, including 50 with additional scans performed within 2-6 months of infection. Of the 50 kidneys undergoing a second renal cortical scan within 2-6 months of the first UTI, 22 (44%) had persistent defects. A third scan was performed on 17 (77%) kidneys after 2 years, by which time defects had resolved in another 8 (47%) kidneys. The predictive value of defects detected within 2-6 months of UTI representing scars is 53% (95% CI 28, 77). Overall, nine (18%) kidneys with initial renal cortical abnormalities had permanent defects. In the 45 kidneys undergoing a second cortical scan more than 6 months after the UTI, 11 (24%) had persistent defects. None of the 95 kidneys undergoing serial scans developed new or larger defects. Renal scars may not be reliably diagnosed by cortical scintigraphy performed within 6 months of UTI because the inflammatory lesions may not have fully resolved.
Detection of Streptococcus pyogenes M1UK in Australia and characterization of the mutation driving enhanced expression of superantigen SpeA
Publisher: Springer Science and Business Media LLC
Date: 24-02-2023
DOI: 10.1038/S41467-023-36717-4
Abstract: A new variant of Streptococcus pyogenes serotype M1 (designated ‘M1 UK ’) has been reported in the United Kingdom, linked with seasonal scarlet fever surges, marked increase in invasive infections, and exhibiting enhanced expression of the superantigen SpeA. The progenitor S. pyogenes ‘M1 global ’ and M1 UK clones can be differentiated by 27 SNPs and 4 indels, yet the mechanism for speA upregulation is unknown. Here we investigate the previously unappreciated expansion of M1 UK in Australia, now isolated from the majority of serious infections caused by serotype M1 S. pyogenes . M1 UK sub-lineages circulating in Australia also contain a novel toxin repertoire associated with epidemic scarlet fever causing S. pyogenes in Asia. A single SNP in the 5’ transcriptional leader sequence of the transfer-messenger RNA gene ssrA drives enhanced SpeA superantigen expression as a result of ssrA terminator read-through in the M1 UK lineage. This represents a previously unappreciated mechanism of toxin expression and urges enhanced international surveillance.
Mycoplasma pneumoniae infection complicated by pneumomediastinum and severe mucositis
Publisher: Wiley
Date: 05-2007
DOI: 10.1111/J.1440-1754.2007.01088.X
Abstract: We report an 8-year-old boy with Mycoplasma pneumoniae respiratory infection complicated by pneumomediastinum and severe oral and conjunctival mucositis. M. pneumoniae-associated mucositis is distinct from the Stevens-Johnson syndrome. There are no skin lesions and it improves promptly with antibiotics. Spontaneous pneumomediastinum usually only requires rest, analgesia and management of the underlying condition.
Cost‐effectiveness of palivizumab in New Zealand
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1440-1754.2002.00790.X
Abstract: To establish the preterm infant hospitalization risks from respiratory syncytial virus (RSV) in New Zealand and the net cost per hospitalization averted by palivizumab. The 437 infants born < 32 weeks' gestation in 1997 and treated at five major neonatal units were identified. Subsequent admissions during the next 2 years for bronchiolitis, pneumonia and croup were tracked, and information collected on RSV tests performed. Data on the length of stay and hospital costs were used to calculate the potential net cost per hospitalization averted associated with the use of palivizumab and the number needed to treat (NNT) to prevent one hospitalization. Estimated RSV readmission risk before 1 year corrected age in infants < 32 weeks' gestation discharged home on oxygen, and those " 28 weeks' gestation, or between 29 and 31 weeks' gestation with or without chronic lung disease was 42%, 23%, 19%, 10% and 8%, respectively. The NNT with palivizumab to prevent one hospitalization ranged from six to 26 across subgroups. Mean (range) net cost per hospitalization averted was 60,000 New Zealand dollars ($28,000-$166,700). In no subgroup would prophylaxis result in net cost saving. Prophylaxis for all NZ infants " 28 weeks' gestation would cost approximately $1,090,000 net and prevent 29 hospitalizations annually, being equivalent to $37,000 net per hospitalization averted, with eight infants treated to prevent one hospitalization. Alternative assumptions about cost and efficacy failed to alter these findings. If value is placed on preventing morbidity, the priority groups for palivizumab prophylaxis are preterm infants discharged home on oxygen, followed by preterm infants of 28 weeks' gestation or less.
Value of serology in predicting Pseudomonas aeruginosa infection in young children with cystic fibrosis
Publisher: BMJ
Date: 10-2010
Abstract: Early detection of Pseudomonas aeruginosa is essential for successful eradication. The accuracy of serum antibodies against specific and multiple P aeruginosa antigens at predicting lower airway infection in young children with cystic fibrosis (CF) was investigated. A commercial P aeruginosa multiple antigen (MAg) ELISA and an in-house exotoxin A (ExoA) ELISA were compared in two populations: a discovery population of 76 children (0.1-7.1 years) undergoing annual bronchoalveolar lavage (BAL)-based microbiological surveillance and a test population of 55 children (0.1-5.6 years) participating in the Australasian CF Bronchoalveolar Lavage Trial. In the discovery population, P aeruginosa was cultured from BAL fluid (≥10(5) colony-forming units (cfu)/ml) in 15/76 (19.7%) children (median age 1.88 years). Positive MAg and ExoA serological results were found in 38 (50.0%) and 30 (39.5%) children, respectively. Positive (PPV) and negative (NPV) predictive values for serology at diagnosing P aeruginosa infection (≥10(5) cfu/ml) were 0.14 and 0.99 respectively (MAg assay) and 0.11 and 0.98 (ExoA assay). In the test population, P aeruginosa was cultured from BAL fluid (≥10(5) cfu/ml) in 16/55 (29.1%) children (median age 1.86 years) and from oropharyngeal swabs in 32/36 (88.9%). Positive MAg and ExoA serology was detected in 19 (34.5%) and 33 (60.0%) children, respectively. The PPV and NPV of serology were 0.26 and 0.94 respectively (MAg assay) and 0.19 and 0.98 (ExoA assay) and were marginally higher for oropharyngeal cultures. Measuring serum antibody responses against P aeruginosa is of limited value for detecting early P aeruginosa infection in young children with CF.
Bacterial colonization dynamics associated with respiratory syncytial virus during early childhood
Publisher: Wiley
Date: 16-03-2020
DOI: 10.1002/PPUL.24715
Rotavirus vaccines: Opportunities and challenges
Publisher: Informa UK Limited
Date: 02-2009
DOI: 10.4161/HV.5.2.6924
Abstract: Each year rotavirus gastroenteritis episodes in young children cause more than 500,000 deaths and 2.4 million hospital admissions worldwide. Vaccine development became a priority when improved personal hygiene and living standards failed to significantly reduce this disease burden. Rotavirus vaccines were developed mimicking natural immunity by protecting against severe gastroenteritis in young children, which would otherwise lead to health-care attendance, hospitalization or even death. Licensed rotavirus vaccines appear safe and are well-tolerated. In high and middle-income countries they provide 80-100% protection against severe disease and 70-80% protection against rotavirus gastroenteritis of any severity, depending upon the population studied. However, rotavirus vaccines remain to be fully evaluated in low-income countries where reduced immunogenicity of oral vaccines, greater strain ersity and difficulties reaching target populations might decrease immunization program performance. Nevertheless, if these challenges are met, rotavirus vaccines should help reduce the 5% of all childhood deaths attributable to rotavirus gastroenteritis.
Community-associated Methicillin-resistant Staphylococcus aureus Causing Orbital Cellulitis in Australian Children
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2011
Detection of a Widespread Clone of Pseudomonas aeruginosa in a Pediatric Cystic Fibrosis Clinic
Publisher: American Thoracic Society
Date: 10-2002
Investigation of congenital infection - The TORCH screen is not a legitimate test
Publisher: Wiley
Date: 09-1993
Detection of epidemic scarlet fever group A Streptococcus in Australia
Publisher: Oxford University Press (OUP)
Date: 05-02-2019
DOI: 10.1093/CID/CIZ099
Abstract: Sentinel hospital surveillance was instituted in Australia to detect the presence of pandemic group A Streptococcus strains causing scarlet fever. Genomic and phylogenetic analyses indicated the presence of an Australian GAS emm12 scarlet fever isolate related to United Kingdom outbreak strains. National surveillance to monitor this pandemic is recommended.
Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children
Publisher: Wiley
Date: 16-10-2018
DOI: 10.1002/PPUL.24174
Abstract: Alaska Native (AN) children from the Yukon Kuskokwim (YK) Delta region have high rates of chronic suppurative lung disease (CSLD), including bronchiectasis. We characterized the clinical progress of an AN adolescent cohort with CSLD/bronchiectasis, and estimated bronchiectasis prevalence trends in this region. The original cohort comprised 41 AN children (originally aged 0.5-8 years) with CSLD/bronchiectasis, recruited between 2005 and 2008, with follow-up in 2015-2016. Clinical assessments, lung function, radiography, medical chart review, and spirometry were obtained. We also conducted data queries of bronchiectasis diagnoses in YK in iduals born between 1990 and 2010 to estimate prevalence. Thirty-four (83%) of the original cohort aged 7.3-17.6 years were reviewed, of whom 14 (41%) had high-resolution computed tomography (HRCT)-confirmed bronchiectasis, eight (24%) had no evidence of bronchiectasis on HRCT scans, while 12 (35%) had not undergone HRCT scans. Annual lower respiratory tract infection (LRTI) frequency decreased with age, although 27 (79%) still had respiratory symptoms, including all with HRCT-confirmed bronchiectasis, who were also more likely than those without confirmed bronchiectasis to have recent wheeze (80 vs 25%, P = 0.005), auscultatory crackles (60 vs 0%, P < 0.001), and lower mean forced expiratory volume in 1-second/forced vital capacity ratio (73 vs 79%, P = 0.03). The bronchiectasis prevalence for YK AN people born during 2000-2009 was 7 per 1000 births, which was lower than previously reported. Despite reduced LRTI frequency, most AN children with CSLD/bronchiectasis had symptoms/signs of underlying lung disease as they entered adolescence. Close clinical follow-up remains essential for managing these patients as they transition to adulthood.
Antibiotics for bronchiectasis exacerbations in children: rationale and study protocol for a randomised placebo-controlled trial
Publisher: Springer Science and Business Media LLC
Date: 31-08-2012
Risk factors in the development of early renal cortical defects in children with urinary tract infection
Publisher: American Roentgen Ray Society
Date: 06-1994
DOI: 10.2214/AJR.162.6.8192006
Abstract: Defects seen on early cortical scintigrams of the renal cortex in children with urinary tract infection may represent acute inflammatory change or established scar. The purpose of this study was to determine the relationship between these defects and age, sex, the presence and grade of vesicoureteral reflux, and infective organism in a cohort of children examined after their first proved urinary tract infection. We prospectively examined 193 consecutive patients less than 5 years old who were seen at the ambulatory pediatric department during a 3-year period and had a first proved urinary tract infection. Children with obstructed or solitary kidneys were excluded. All patients were imaged with scintigraphy of the renal cortex and radiographic voiding cystourethrography within 15 days of diagnosis. The association of age, sex, the presence and grade of vesicoureteral reflux, and infective organism with a defect (acute pyelonephritis or a renal scar) seen on a cortical renal scan was studied. The prevalence of cortical defects was greater in the kidneys of patients less than 2 years old (96/290, 33%) than in older children (16/96, 17%) and greater in those with vesicoureteral reflux (41/92, 45%) than in those without it (71/294, 24%). Vesicoureteral reflux was absent in 63% (71/112) of kidneys with a cortical defect. No association with sex or infective organism was established. As well as having a greater prevalence of cortical defects, 145 (75%) of the 193 urinary tract infections included in the study were in children less than 2 years old. The kidneys of these younger patients also had a greater severity and prevalence of vesicoureteral reflux (74/290, 26%) than did those of older children (18/96, 19%). Early cortical defects are associated with an age less than 2 years and vesicoureteral reflux. However, the association of early defects with the presence and grade of vesicoureteral reflux is confounded by the declining prevalence and severity of reflux with age. A significant proportion of cortical defects occur in the absence of vesicoureteral reflux, and the contribution of reflux to scar formation might be less than previously considered.
Bronchoalveolar lavage or oropharyngeal cultures to identify lower respiratory pathogens in infants with cystic fibrosis
Publisher: Wiley
Date: 05-1996
DOI: 10.1002/(SICI)1099-0496(199605)21:5<267::AID-PPUL1>3.0.CO;2-K
Persistence of oral polio vaccine virus after its removal from the immunisation schedule in New Zealand
Publisher: Elsevier BV
Date: 07-2005
ERS statement on protracted bacterial bronchitis in children
Publisher: European Respiratory Society (ERS)
Date: 08-2017
DOI: 10.1183/13993003.02139-2016
Abstract: This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.
An Echovirus Type 33 Winter Outbreak in New Zealand
Publisher: Oxford University Press (OUP)
Date: 09-2003
DOI: 10.1086/376915
Abstract: Echovirus type 33 (E33) is a relatively uncommon enterovirus. An E33 outbreak during the winter of 2000 in New Zealand led to 75 virologically-confirmed cases of E33 infection (2.6 cases per 100,000 in iduals). Sixty-six (88%) of the 75 patients were aged <30 years, with the highest rates of infection recorded in Maori and Pacific ethnic groups. Overall, 47 (84%) of 56 patients whose cases were analyzed had either aseptic meningitis or encephalitis. Central nervous system involvement was more common after infancy (43 of 45 non-infant patients vs. 4 of 11 infants [relative risk, 2.6 95% CI, 1.5-4.3]). Two infants died, including a neonate with fulminant hepatitis. Independent of symptom duration, neutrophil-predominant pleocytosis was detected in 17 (41%) of 41 cerebrospinal fluid specimens. Virus isolates could not be definitively typed by antibody neutralization testing but were identified as E33 by partial sequencing of the VP-1 capsid gene. The isolates were closely related to strains from Australia and Oman. Molecular typing, together with a serotype-specific E33 PCR, improved the speed and effectiveness of the outbreak investigation.
Balancing the medical and social needs of children during the
COVID
‐19 pandemic
Publisher: Wiley
Date: 15-08-2022
DOI: 10.5694/MJA2.51685
Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 14-08-2012
An infant with fever and convulsions
Publisher: Springer Science and Business Media LLC
Date: 06-1996
DOI: 10.1007/BF01955194
Abstract: Wind turbines have been recognised as an alternative and clean-energy source with a low environmental impact. The selection of sites for wind-farm often creates serious conservation concerns on bio ersity. Wind turbines have become a serious threat to migratory birds as they collide with the turbine blades in some regions across the globe, while the impact on terrestrial mammals is relatively less explored. In this context, we assessed the responses of birds and mammals to the wind turbines in central Karnataka, India from January 2016 to May 2018 using carcass searches to quantify animal collisions (i.e., birds and bats), fixed radius point count for bird population parameters, and an occupancy framework for assessing the factor that determines the spatial occurrence of terrestrial mammals. The mean annual animal fatality rate per wind turbine was 0.26/year. Species richness, abundance, and unique species of birds were relatively higher in control sites over wind turbine sites. Species and functional compositions of birds in control sites were different from wind turbine sites, explaining the varied patterns of bird assemblages of different feeding guilds. Blackbuck, Chinkara, Golden Jackal, and Jungle Cat were less likely to occupy sites with a high number of wind turbines. The study indicates that certain bird and mammal species avoided wind turbine-dominated sites, affecting their distribution pattern. This is of concern to the management of the forested areas with wind turbines. We raised conservation issues and mitigating measures to overcome the negative effects of wind turbines on animals.
Factors in childhood associated with lung function decline to adolescence in cystic fibrosis
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JCF.2022.03.008
Abstract: Despite improvements in general health and life expectancy in people with cystic fibrosis (CF), lung function decline continues unabated during adolescence and early adult life. We examined factors present at age 5-years that predicted lung function decline from childhood to adolescence in a longitudinal study of Australasian children with CF followed from 1999 to 2017. Lung function trajectories were calculated for 119 children with CF from childhood (median 5.0 [25%-75%=5.0-5.1]) years) to early adolescence (median 12.5 [25%-75%=11.4-13.8] years). Lung function fell progressively, with mean (standard deviation) annual change -0.105 (0.049) for forced vital capacity (FVC) Z-score (p<0.001), -0.135 (0.048) for forced expiratory volume in 1-second (FEV Action in the first 5-years of life to prevent and/or treat respiratory exacerbations and counteract neutrophilic inflammation in the lower airways may reduce lung function decline in children with CF, and these should be targets of future research.
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines
Publisher: AMPCo
Date: 2015
DOI: 10.5694/MJA14.00287
Elevated exoenzyme expression by Pseudomonas aeruginosa is correlated with exacerbations of lung disease in cystic fibrosis.
Publisher: Wiley
Date: 03-1993
Abstract: Two studies were conducted to determine whether Pseudomonas aeruginosa exoenzyme expression was increased during pulmonary exacerbations of cystic fibrosis (CF) and if it was reduced by antibiotic therapy. The first study was retrospective comparing in vitro exoenzyme levels expressed by P. aeruginosa sputum isolates from seriously ill, hospitalized patients with CF to those from P. aeruginosa strains isolated from CF clinic patients who were in relatively better health. Exoenzyme values were significantly greater in P. aeruginosa strains isolated from ill, hospitalized patients than in clinic patients (P = 0.0001). In the prospective study, in vitro exoenzyme levels were measured from sputum P. aeruginosa isolates of 9 hospitalized patients with CF. Exoenzyme values were greatest in nonmucoid strains on admission (P < 0.0025), and P. aeruginosa exoenzyme expression decreased significantly during hospitalization (P < 0.0025). Deterioration in CF lung disease was accompanied by increased P. aeruginosa exoenzyme production, especially by nonmucoid strains. Antibiotic treatment during hospitalization resulted in mean improvement of % predicted forced expiratory volume in 1 sec (FEV1) from 39 to 53% (P = 0.002). Thus, antibiotics may improve pulmonary function in patients with CF by decreasing P. aeruginosa exoenzyme expression.
Clinical update: rotavirus gastroenteritis and its prevention
Publisher: Elsevier BV
Date: 11-2007
Human Bocavirus in Infants, New Zealand
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2007
Temporal association tracts and the breakdown of episodic memory in mild cognitive impairment
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-11-2012
ROLE OF COPROANTIBODY IN CLINICAL-PROTECTION OF CHILDREN DURING REINFECTION WITH ROTAVIRUS
Publisher: American Society for Microbiology
Date: 07-1992
DOI: 10.1128/JCM.30.7.1678-1684.1992
Abstract: Rotavirus is the major cause of severe, dehydrating infantile gastroenteritis. Infection is limited to the gut, but the relative roles of serum and secretory copro-immunoglobulin A (IgA) in protection are unclear. Specific copro-IgA is predictive of duodenal antirotaviral IgA and correlates with virus-neutralizing coproantibody. Copro-IgA conversion is a more sensitive marker of rotavirus reinfection than seroconversion. We measured rotavirus reinfections by copro-IgA conversion prospectively in 35 children recruited at a time of severe rotavirus illness. The children were followed up longitudinally for 14 to 31 months to determine whether high coproantibody levels correlated with clinical protection against rotavirus disease. Ninety-four percent of the children experienced reinfection, and 38% developed persistent elevations in specific copro-IgA termed plateaus. Plateau children had a higher mean annual rate of rotavirus infection and a lower ratio of symptomatic to total number of rotavirus reinfections than did nonplateau children. The annual rates of rotavirus infection and disease were significantly higher outside the plateau than inside it in children experiencing antirotavirus copro-IgA plateaus. Frequent rotavirus infection of children appears to stimulate production of a specific copro-IgA plateau which correlates with protection against an excess of infection and symptomatic disease.
ANALYSIS OF HOMOTYPIC AND HETEROTYPIC SERUM IMMUNE-RESPONSES TO ROTAVIRUS PROTEINS FOLLOWING PRIMARY ROTAVIRUS INFECTION BY USING THE RADIOIMMUNOPRECIPITATION TECHNIQUE
Publisher: American Society for Microbiology
Date: 02-1993
DOI: 10.1128/JCM.31.2.377-385.1993
Abstract: Three sequential serum s les collected from each of 20 young children with a naturally acquired primary rotavirus infection were assayed by the radioimmunoprecipitation technique for immunoglobulin G antibodies to rotavirus structural and nonstructural proteins of the four major human rotavirus serotypes G1, P1A G2, P1B G3, P2 and G4, P2. Fourteen children were infected with a serotype G1 rotavirus strain and six children were infected with a serotype G4 rotavirus strain. Sera were collected from each child in the acute and convalescent periods postinfection and also approximately 4 months later. Serum immune responses to rotavirus core antigens VP2 and VP3, to the major inner capsid antigen VP6, to nonstructural proteins NS35, NS28, and NS26, and to the outer capsid neutralization antigen VP4 of all test strains were detected in the majority of patients. These responses do not appear to be influenced by the G type or P type of the rotavirus strain used in the reactions. Homologous responses to the main neutralization antigen VP7 were detected in 93% of patients with serotype G1 infections and 50% of patients with serotype G4 infections. Heterologous VP7 responses were less frequently detected and were restricted to G1, G3, and G4 serotype rotavirus strains. No responses to VP7 of the serotype G2 rotavirus strain were detected in any patients. Heterotypic immune responses to the neutralization antigens, at least following serotype G1 and G4 infections, therefore appear to consist primarily of responses to VP4 rather than to VP7.
Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study
Publisher: Oxford University Press (OUP)
Date: 13-08-2019
DOI: 10.1093/CID/CIZ761
Abstract: Hospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study. Australian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated. PeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128–160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0–11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age & months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%). In contrast with hospital-based studies, this study showed that erse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children. Parechovirus can cause severe illnesses in children. However, studies focus mainly on hospitalized populations. True disease burden in the community remains largely unknown. From our community-based cohort, we found erse parechovirus genotypes in the community, causing mild or subclinical infections in children. NCT01304914.
Randomized placebo-controlled trial on azithromycin to reduce the morbidity of bronchiolitis in Indigenous Australian infants: rationale and protocol.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2011
Timing of First Respiratory Virus Detections in Infants: A Community-Based Birth Cohort Study
Publisher: Oxford University Press (OUP)
Date: 17-11-2017
Respiratory virus detection during the COVID‐19 pandemic in Queensland, Australia
Publisher: Elsevier BV
Date: 02-2022
Parainfluenza Virus Infection in an Australian Community-based Birth Cohort
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-07-2020
Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines
Publisher: Wiley
Date: 14-07-2016
DOI: 10.1111/AJO.12378
Abstract: Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in New Zealand five years after the publication of national risk-based GBS prevention guidelines. Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48 h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life. There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per 1000 live births. Ten years after a similar survey and five years after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines
Publisher: Wiley
Date: 02-2015
DOI: 10.5694/MJAC14.00287
Geographical differences in the proportion of human group A rotavirus strains within New Zealand during one epidemic season
Publisher: Wiley
Date: 05-2010
DOI: 10.1002/JMV.21739
Abstract: The prospect of future rotavirus vaccine programs means it is important to understand rotavirus strain ersity within New Zealand, especially if this was to influence vaccine effectiveness. The G-genotype of 359 group A rotavirus strains isolated from 416 stool s les collected from June 2005 to May 2006 (inclusive) from children less than 5 years of age in multiple centers throughout New Zealand was determined. G1 was the dominant circulating strain (55.8%) followed by G4 (21.4%), G3 (3.4%), G9 (3.4%) G2 (1.0%), and mixed infection (1.0%). Two less common strains, G6 and G8, were identified for the first time in New Zealand. P genotypes were determined for a random 10% of s les containing the common G-type strains, and all s les with an unusual G-type. All s les able to be tested contained P[8] bearing strains, except for G1P[4], G2P[4], and G8P[14] strains. Importantly, significant differences in strain frequency were found between s les collected from the North and South Islands of New Zealand. G1 was the most commonly identified strain in the North Island (81.9%) whereas G4 predominated in the South Island (39.6%). Of note, no significant differences in the relative frequency of rotavirus strains were observed between s les collected from children treated in hospital compared to s les collected from children seen by their primary healthcare provider in the community. Regional strain variation highlights the importance of ensuring multi-center surveillance to help monitor program effectiveness when rotavirus vaccines are introduced into New Zealand's national childhood immunization schedule.
Acute and Persistent Diarrhea
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.PCL.2009.09.004
Abstract: Socially disadvantaged Indigenous infants and children living in western industrialized countries experience high rates of infectious diarrhea, no more so than Aboriginal children from remote and rural regions of Northern Australia. Diarrheal disease, poor nutrition, and intestinal enteropathy reflect household crowding, inadequate water and poor sanitation and hygiene. Acute episodes of watery diarrhea are often best managed by oral glucose-electrolyte solutions with continuation of breastfeeding and early reintroduction of feeding. Selective use of lactose-free milk formula, short-term zinc supplementation and antibiotics may be necessary for ill children with poor nutrition, persistent symptoms, or dysentery. Education, high standards of environmental hygiene, breastfeeding, and immunization with newly licensed rotavirus vaccines are all needed to reduce the unacceptably high burden of diarrheal disease encountered in young children from Indigenous communities.
Patient and economic impact of implementing a paediatric sepsis pathway in emergency departments in Queensland, Australia
Publisher: Springer Science and Business Media LLC
Date: 16-06-2022
DOI: 10.1038/S41598-022-14226-6
Abstract: We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (− 20.8 h [− 36.1, − 8.0]) but not intensive care (–9.4 h [− 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [− 5.0%, 11.4%]), non-intensive (− 4.5 h [− 19.0, 9.8]) and intensive (+ 7.7 h, [− 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [− $857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs.
Antibiotic perturbation of mixed-strain Pseudomonas aeruginosa infection in patients with cystic fibrosis
Publisher: Springer Science and Business Media LLC
Date: 02-11-2017
Combination of salbutamol inhalational powder and tablets in asthma
Publisher: BMJ
Date: 04-1983
DOI: 10.1136/ADC.58.4.283
Abstract: A double-blind cross-over trial was conducted to assess the effects of salbutamol administered by inhalation of dry powder, by tablet, and combined tablet and inhalational powder in a s le of 18 severely asthmatic children. The combined treatment had a rapid onset of effect and sustained action. The onset of action of the tablet treatment was less rapid but sustained, whereas the inhalational powder treatment had rapid onset but fairly short action. The response characteristics of the combined treatment were shown to be an additive function of its tablet and inhaled components. Children on the combined or tablet treatment showed a significant, but slight, increase in pulse rate. Few other side effects were observed.
Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies
Publisher: MDPI AG
Date: 07-12-2021
DOI: 10.3390/JCM10245735
Abstract: We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age -years ( -months: aRR = 4.31, 95% CI 1.42–13.10 12- months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1% no PBB = 50.2%, p 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.
Budget Impact and Cost-Effectiveness of Including a Pentavalent Rotavirus Vaccine in the New Zealand Childhood Immunization Schedule
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1111/J.1524-4733.2009.00534.X
Abstract: To estimate: 1) rotavirus disease burden in New Zealand children aged under 5 years, and 2) health benefits, budget impact, and cost-effectiveness of incorporating a pentavalent rotavirus vaccine (PRV) into the national immunization schedule. A static equilibrium model was developed to evaluate health benefits and budget impact of vaccinating five successive birth cohorts with PRV at $50 per dose and 85% coverage (three doses). Cost-effectiveness was estimated from the societal perspective in year 5 of the program, with future health benefits discounted at 3.5% per annum. By the age of 5 years, one in five children will have sought medical advice for rotavirus gastroenteritis and one in 43 will have been hospitalized. In 2009, we estimate 1506 hospitalizations (476 per 100,000 95% confidence interval 451, 502), 3086 Emergency Department (ED) presentations not requiring hospitalization, plus 10,120 cases of rotavirus gastroenteritis managed solely in primary care. The annual societal cost is $7.07 million, including 41% from hospitalization and 25% from caregiver income loss. Health benefits will increase and the cost of illness will decline by 78% in year 5 as successive birth cohorts are immunized. In the fifth year, 1191 hospitalizations, 2442 ED treated cases, 9762 primary care consultations, and 0.8 deaths will be averted. It requires six vaccinated children to avoid one primary care consultation, 49 to avert one hospitalization, and 73,357 to prevent one death. The incremental cost is $2.99 million and the break-even price per vaccine dose is $32.39 at 2006 prices. The cost is $2509 to avert one hospitalization and $305 to prevent one case seeking health-care assistance. The cost per life-year gained in year 5 is $143,097 and the cost per quality-adjusted life-year (QALY) gained is $46,092 (US$26,774). The cost per QALY is sensitive to incidence rates, vaccine price and efficacy, loss of quality of life by the child, case fatality, and caregiver income loss. From a societal perspective, addition of PRV to the New Zealand childhood immunization schedule would confer important clinical gains at a modest cost per QALY gained.
Antibiotics in childhood pneumonia: how long is long enough?
Publisher: Springer Science and Business Media LLC
Date: 11-05-2016
Upper airway viruses and bacteria and clinical outcomes in children with cough
Publisher: Wiley
Date: 26-07-2016
DOI: 10.1002/PPUL.23527
Human rotavirus vaccines: too early for the strain to tell
Publisher: Elsevier BV
Date: 04-2008
Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline
Publisher: European Respiratory Society (ERS)
Date: 09-2021
DOI: 10.1183/20734735.0105-2021
Abstract: Bronchiectasis, characterised by chronic wet roductive cough with recurrent respiratory exacerbations and abnormal bronchial dilatation on computed tomography scans, remains an increasingly recognised but often neglected chronic pulmonary disorder in children and adolescents. An early diagnosis combined with optimal management offers the prospect, at least in some patients, of curing a condition previously considered irreversible. However, unlike in adults, until now no international paediatric guidelines existed. The recently published European Respiratory Society clinical practice guidelines for the management of children and adolescents with bronchiectasis attempts to address this clinical information gap. The guidelines were formulated by panel members comprised of experts from several relevant health fields, the European Lung Foundation and parents of children with bronchiectasis. Systematic reviews and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach guided the nature and strength of recommendations. The recommendations are grouped into clinically relevant topics: diagnosis, evaluating for underlying causes, defining exacerbations, management, systematic care, monitoring, reversibility and prevention. The guidelines seek to achieve: 1) optimal lung growth, 2) preserved lung function, 3) enhanced quality of life, 4) minimal exacerbations, 5) few or no complications, and 6) if possible, reversal of lung injury for each child/adolescent with bronchiectasis. This review presents ex le cases that highlight the recommendations of the clinical practice guidelines. This article is intended for those involved in caring for children/adolescents with bronchiectasis. It aims to inform: Clinicians of the European Respiratory Society recommendations for the diagnosis and management of children/adolescents with bronchiectasis. Adolescents and parents of children/adolescents with bronchiectasis of these recommendations, so as to assist discussions with healthcare teams and help facilitate access to appropriate care.
Multivalent Rotavirus Vaccine and Wild-type Rotavirus Strain Shedding in Australian Infants: A Birth Cohort Study
Publisher: Oxford University Press (OUP)
Date: 15-11-2017
DOI: 10.1093/CID/CIX1022
Abstract: Rotavirus vaccines have reduced moderate-to-severe gastroenteritis episodes in infants and young children. Nevertheless, knowledge gaps exist concerning rotavirus vaccine shedding and vaccine impact upon mild and asymptomatic wild-type infections. Our primary objective was to investigate vaccine shedding in Australian infants where the multivalent human-bovine reassortant rotavirus vaccine, RotaTeq, was part of the routine vaccination schedule. The Observational Research in Childhood Infectious Diseases (ORChID) birth cohort study was conducted in Brisbane, Australia, from September 2010 to October 2014. Newborn infants were enrolled progressively and followed until their second birthday. Parents recorded daily symptoms and mailed weekly stool swab s les from their infants to the laboratory where reverse-transcription polymerase chain reaction testing was performed, and rotavirus-positive s les underwent genotyping to distinguish between vaccine and wild-type strains. Rotavirus was detected in 1068 of 11139 (9.6%) stool swabs from 158 infants, and 994 (93.1%) were genotyped. RotaTeq vaccine strains accounted for 951 of 994 (95.7%) typed rotavirus-positive swabs. Proportions of infants shedding RotaTeq after the first, second, and third vaccine doses were 87.0%, 57.4%, and 47.3%, respectively, and median (interquartile range) shedding duration after vaccine doses 1-3 was 3 (1-8), 1.5 (1-3), and 1 (1-2), weeks, respectively. In contrast, the incidence rate of wild-type rotavirus episodes was 10.3 (95% confidence interval, 6.8-15.6) per 100 child-years of observation. RotaTeq vaccine virus was detected in stool s les from 47%-87% of infants after each vaccine dose. Genotyping is an essential tool for differentiating between rotavirus vaccine and wild-type strains and monitoring vaccine impact in children. NCT01304914.
Airway microbiology and host defences in paediatric non-CF bronchiectasis
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.PRRV.2010.10.009
Abstract: Bronchiectasis in children without cystic fibrosis is most common in socioeconomically disadvantaged communities. Recurrent pneumonia in early childhood and defective pulmonary defences are important risk factors. These help establish a 'vicious cycle' of impaired mucociliary clearance, infection, airway inflammation and progressive lung injury. Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Pseudomonas aeruginosa are the main infecting pathogens. H. influenzae predominates across all ages, while P. aeruginosa is found in older children with advanced disease. It is uncertain whether viruses and upper airway commensal bacteria play an important aetiological role. Overall, the microbiological data are limited however and there are difficulties obtaining reliable respiratory specimens from young children. Bronchiectasis is a complex disorder resulting from susceptibility to pulmonary infection and poorly regulated respiratory innate and adaptive immunity. Airway inflammatory responses are excessive and persist, even once infection is cleared. Improved specimen collection, molecular techniques and biomarkers are needed to enhance management.
Oral antibiotics vs placebo for exacerbations of paediatric bronchiectasis
Publisher: European Respiratory Society
Date: 28-09-2019
Cord‐blood respiratory syncytial virus antibodies and respiratory health in first 5 years of life
Publisher: Wiley
Date: 29-09-2021
DOI: 10.1002/PPUL.25688
Abstract: To determine the potential longer‐term effects of maternal antenatal respiratory syncytial virus (RSV) vaccination, we examined the association between cord‐blood RSV‐neutralizing antibodies (RSV‐NA) and RSV infections in the first 2 years of life, RSV‐NA at 3 years, and respiratory health to age 5 years. Two community‐based Australian birth cohorts were combined. For children with at least one atopic parent, paired serum RSV‐NA levels were compared in cord blood and at age 3 years. Weekly nasal swabs were collected in one cohort and during acute respiratory infections (ARI) in the other. Wheeze history up to age 5 years and physician‐diagnosed asthma at 5 years was collected by parent report. In 264 children, each log 10 increase of cord‐blood RSV‐NA level was associated with 37% decreased risk (adjusted incidence‐rate‐ratio [aIRR] 0.63 95% confidence interval [CI]: 0.40–1.01) of RSV‐ARI and 49% decreased risk (aIRR 0.51 95% CI: 0.25–1.02) of RSV acute lower respiratory infections (ALRI) at 12–24 months of age. However, higher cord‐blood RSV‐NA was associated with increased risk of all‐cause ALRI (aIRR 1.29 95% CI: 0.99–1.69), wheeze‐associated ALRI (aIRR 1.75 95% CI: 1.08–2.82), and severe ALRI (aIRR 2.76 95% CI: 1.63–4.70) at age 6– months. Cord‐blood RSV‐NA was not associated with RSV‐ARI in the first 6‐months, RSV‐NA levels at 3 years, or wheeze or asthma at 5 years. Higher levels of cord‐blood RSV‐NA did not protect against RSV infections during the first 6‐months‐of‐life, time‐to‐first RSV‐ARI, or wheeze or asthma in the first 5 years of life. Additional strategies to control RSV‐related illness in childhood are needed.
Vitamin A and E deficiency and lung disease in infants with cystic fibrosis
Publisher: Wiley
Date: 25-11-2005
DOI: 10.1111/J.1440-1754.2005.00755.X
Abstract: Vitamin A and E deficiency is common in cystic fibrosis (CF). These vitamins have immunomodulating properties and we determined whether decreased serum vitamin A and E levels in young infants are associated with early CF lung disease and lower airway inflammation. A post-hoc analysis was undertaken on previous data collected prospectively in 39 newly diagnosed infants identified by a newborn CF screening programme. Assessment of CF genotype, nutrition, pancreatic status, serum retinol and alpha-tocopherol levels was performed at diagnosis. Pulmonary status was determined clinically, by Brasfield chest radiographic scores and analysis of bacterial counts and inflammatory indices in bronchial lavage (BL) fluid. These assessments were repeated 12 months later. At diagnosis, 20 out of 39 (51%) CF infants had low serum retinol (mean (SD) 0.7 (0.3) micromol/L) and 9/38 (24%) had low alpha-tocopherol (mean (SD) 13.4 (8.4) micromol/L) levels. Dietary energy intake was related to serum retinol concentrations at diagnosis (r(2) = 0.27 P = 0.001). At 1 year, serum retinol and alpha-tocopherol levels had normalized following vitamin A and E supplementation. Respiratory symptoms, radiographic scores and BL inflammatory indices systematically deteriorated during infancy, reaching significance for free neutrophil elastase activity (9 out of 29 vs 21 out of 33 P = 0.01) and IL-8 levels (79 vs 416 P = 0.046) in BL fluid. No association was seen between serum vitamin levels at diagnosis and airway inflammatory indices at either diagnosis or 12 months later. We found in this CF birth cohort no evidence to implicate vitamin A or E deficiency in the development of lung disease or airway inflammation during infancy.
Chronic recurrent multifocal osteomyelitis: Effectiveness of cyclic intravenous pamidronate therapy in pain relief and spinal involvement
Publisher: Elsevier BV
Date: 06-2007
Nasal swab bacteriology by PCR during the first 24‐months of life: A prospective birth cohort study
Publisher: Wiley
Date: 04-01-2019
DOI: 10.1002/PPUL.24231
Spread of rotavirus within families: A community based study
Publisher: BMJ
Date: 27-08-1983
Abstract: The spread of rotavirus infection was studied over four weeks in a s le of 28 families exposed to a child with rotavirus infection. The results showed a high incidence of intrafamilial infection, with 46% of members of these families developing rotavirus infections compared with none in another series of 18 families. Children in the families with an index case were more frequently affected than adults: 75% of the children developed rotavirus infection but only 33% of the adults. Children tended to suffer the infection in a more severe form. Intrafamily contact is clearly important in transmitting rotavirus infection, and preventive measures should aim at reducing the likelihood of such cross infection.
Pediatric bronchiectasis: No longer an orphan disease
Publisher: Wiley
Date: 03-02-2016
DOI: 10.1002/PPUL.23380
Abstract: Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.
Ciprofloxacin-associated Peripheral Neuropathy in a Child
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-01-2021
Respiratory Bacterial Pathogens in the Nasopharynx and Lower Airways of Australian Indigenous Children with Bronchiectasis
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.JPEDS.2010.06.002
Abstract: To test the hypothesis that bacterial density, strain ersity, and concordance of pathogens between upper and lower airways are higher in children with bronchiectasis than in those with non-bronchiectatic conditions. Nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluid were cultured from 45 Indigenous children with bronchiectasis and 30 non-Indigenous children with non-bronchiectatic respiratory symptoms. Lower airway infection was defined as >10(4) colony-forming units of respiratory bacteria/mL of BAL fluid. Concordance was determined by phenotype or genotype. NP carriage of Streptococcus pneumoniae, nontypable Haemophilus influenzae (NTHi), and Moraxella catarrhalis, and lower airway infection by NTHi (47% vs 3%), were detected significantly more often in the children with bronchiectasis than in those without this condition. BAL specimens from the infected Indigenous children also showed greater strain ersity (71% vs 0%). Strain concordance in NP and BAL cultures was high in both infected subgroups. The high density and ersity of respiratory bacteria, along with strain concordance between upper and lower airways, found in Indigenous children with bronchiectasis suggest a possible pathogenic role of recurrent aspiration of NP secretions.
The point prevalence of respiratory syncytial virus in hospital and community-based studies in children from Northern Australia: studies in a ‘high-risk’ population
Publisher: European Respiratory Society
Date: 28-09-2019
Pharmacodynamics of once- versus twice-daily dosing of nebulized amikacin in an in vitro Hollow-Fiber Infection Model against 3 clinical isolates of Pseudomonas aeruginosa
Publisher: Elsevier BV
Date: 06-2021
Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.JCF.2014.12.007
Abstract: We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources. Of 168 CF children aged ≤5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy. Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably. CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.
Effect of bronchoalveolar lavage-directed therapy on Pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis: A randomized trial
Publisher: American Medical Association (AMA)
Date: 13-07-2011
Abstract: Early pulmonary infection in children with cystic fibrosis leads to increased morbidity and mortality. Despite wide use of oropharyngeal cultures to identify pulmonary infection, concerns remain over their diagnostic accuracy. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking. To determine if BAL-directed therapy for pulmonary exacerbations during the first 5 years of life provides better outcomes than current standard practice relying on clinical features and oropharyngeal cultures. The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) randomized controlled trial, recruiting infants diagnosed with cystic fibrosis through newborn screening programs in 8 Australasian cystic fibrosis centers. Recruitment occurred between June 1, 1999, and April 30, 2005, with the study ending on December 31, 2009. BAL-directed (n = 84) or standard (n = 86) therapy until age 5 years. The BAL-directed therapy group underwent BAL before age 6 months when well, when hospitalized for pulmonary exacerbations, if Pseudomonas aeruginosa was detected in oropharyngeal specimens, and after P. aeruginosa eradication therapy. Treatment was prescribed according to BAL or oropharyngeal culture results. Primary outcomes at age 5 years were prevalence of P. aeruginosa on BAL cultures and total cystic fibrosis computed tomography (CF-CT) score (as a percentage of the maximum score) on high-resolution chest CT scan. Of 267 infants diagnosed with cystic fibrosis following newborn screening, 170 were enrolled and randomized, and 157 completed the study. At age 5 years, 8 of 79 children (10%) in the BAL-directed therapy group and 9 of 76 (12%) in the standard therapy group had P. aeruginosa in final BAL cultures (risk difference, -1.7% [95% confidence interval, -11.6% to 8.1%] P = .73). Mean total CF-CT scores for the BAL-directed therapy and standard therapy groups were 3.0% and 2.8%, respectively (mean difference, 0.19% [95% confidence interval, -0.94% to 1.33%] P = .74). Among infants diagnosed with cystic fibrosis, BAL-directed therapy did not result in a lower prevalence of P. aeruginosa infection or lower total CF-CT score when compared with standard therapy at age 5 years. anzctr.org.au Identifier: ACTRN12605000665639.
Acquisition of human polyomaviruses in the first 18 months of life.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2015
Pseudomonas aeruginosa eradication therapy and risk of acquiring Aspergillus in young children with cystic fibrosis.
Publisher: BMJ
Date: 15-06-2019
DOI: 10.1136/THORAXJNL-2018-211548
Abstract: While Aspergillus detection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown. To determine the risk and explanatory factors of acquiring Aspergillus in children with CF by age 5 years. Cross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detecting Aspergillus at age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiring Aspergillus and Pseudomonas aeruginosa from birth until age 5 years. Cross-sectional analysis found that the number of P. aeruginosa eradication courses increased the odds of detecting Aspergillus at age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the first P. aeruginosa positive culture was 2.38 (1.32–3.79) years and 3.69 (1.68–4.74) years for the first Aspergillus positive culture. The risk of P. aeruginosa and Aspergillus events changes with time after the first year of study entry. It also decreases for P. aeruginosa after completing P. aeruginosa eradication (HR 0.15, 95% CI 0.00 to 0.79), but increases for Aspergillus events (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event. In young children with CF, completing P. aeruginosa eradication therapy and previous Aspergillus events are associated with increased risk of acquiring Aspergillus .
European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis
Publisher: European Respiratory Society (ERS)
Date: 04-02-2021
DOI: 10.1183/13993003.02990-2020
Abstract: There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality of life for the child/adolescent and their parents, recurrent exacerbations, and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines. The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised methodology that included a systematic review of the literature and application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to define the quality of the evidence and level of recommendations. A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. 14 key clinical questions (seven PICO (Patient, Intervention, Comparison, Outcome) and seven narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent atient advisory group. This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids and bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment, and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
Environmentally Persistent Free Radicals: Linking Air Pollution and Poor Respiratory Health?
Publisher: American Thoracic Society
Date: 15-10-2019
Endemic Non–SARS-CoV-2 Human Coronaviruses in a Community-Based Australian Birth Cohort
Publisher: American Academy of Pediatrics (AAP)
Date: 11-2020
Abstract: The coronavirus (CoV) disease 2019 pandemic has drawn attention to the CoV virus family. However, in community settings, there is limited information on these viruses in healthy children. We explored the epidemiology of the 4 endemic (non–severe acute respiratory syndrome CoV 2) human coronaviruses (HCoVs) by species, including acute illness episodes, risk factors, and health care burden in Australian children in the first 2 years of life. The Observational Research in Childhood Infectious Diseases community-based cohort was a prospective study of acute respiratory illnesses in children from birth until their second birthday. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HCoVs, by real-time polymerase chain reaction assays. Overall, 158 children participating in Observational Research in Childhood Infectious Diseases provided 11 126 weekly swabs, of which 168 were HCoV-positive involving 130 incident episodes. HCoV-NL63 and HCoV-OC43 were most commonly detected, accounting for two-thirds of episodes. Whereas 30 children had different HCoVs detected on different occasions, 7 were reinfected with the same species. HCoV incidence in the first 2 years of life was 0.76 episodes per child-year (95% confidence interval [CI] 0.63 to 0.91), being greatest in the second year (1.06 95% CI 0.84 to 1.33) and during winter (1.32 95% CI 1.02 to 1.71). Fifty percent of HCoV episodes were symptomatic, and 24.2% led to health care contact. In children, HCoV infections are common, recurrent, and frequently asymptomatic. In future studies, researchers should determine transmission pathways and immune mechanisms.
Association of rhinovirus and potentially pathogenic bacterial detections in the first 3 months of life with subsequent wheezing in childhood
Publisher: Wiley
Date: 06-09-2023
DOI: 10.1002/PPUL.26667
Management of tuberculosis in children
Publisher: Wiley
Date: 12-2000
DOI: 10.1046/J.1440-1754.2000.00565.X
Abstract: This paper provides specific guidelines on the management of tuberculosis infection and disease, covering general principles, recommended drug regimens and discuss the evidence to support these. It also covers use of corticosteroids, intermittent therapy, directly observed therapy and an approach to the management of a patient with drug-resistant tuberculosis.
Study Protocol for Preventing Early-Onset Pneumonia in Young Children Through Maternal Immunisation: A Multi-Centre Randomised Controlled Trial (PneuMatters)
Publisher: Frontiers Media SA
Date: 17-01-2022
Abstract: Background: Preventing and/or reducing acute lower respiratory infections (ALRIs) in young children will lead to substantial short and long-term clinical benefits. While immunisation with pneumococcal conjugate vaccines (PCV) reduces paediatric ALRIs, its efficacy for reducing infant ALRIs following maternal immunisation has not been studied. Compared to other PCVs, the 10-valent pneumococcal- Haemophilus influenzae Protein D conjugate vaccine (PHiD-CV) is unique as it includes target antigens from two common lower airway pathogens, pneumococcal capsular polysaccharides and protein D, which is a conserved H. influenzae outer membrane lipoprotein. Aims: The primary aim of this randomised controlled trial (RCT) is to determine whether vaccinating pregnant women with PHiD-CV (compared to controls) reduces ALRIs in their infants' first year of life. Our secondary aims are to evaluate the impact of maternal PHiD-CV vaccination on different ALRI definitions and, in a subgroup, the infants' nasopharyngeal carriage of pneumococci and H. influenzae , and their immune responses to pneumococcal vaccine type serotypes and protein D. Methods: We are undertaking a parallel, multicentre, superiority RCT (1:1 allocation) at four sites across two countries (Australia, Malaysia). Healthy pregnant Australian First Nation or Malaysian women aged 17–40 years with singleton pregnancies between 27 +6 and 34 +6 weeks gestation are randomly assigned to receive either a single dose of PHiD-CV or usual care. Treatment allocation is concealed. Study outcome assessors are blinded to treatment arms. Our primary outcome is the rate of medically attended ALRIs by 12-months of age. Blood and nasopharyngeal swabs are collected from infants at birth, and at ages 6- and 12-months (in a subset). Our planned s le size ( n = 292) provides 88% power (includes 10% anticipated loss to follow-up). Discussion: Results from this RCT potentially leads to prevention of early and recurrent ALRIs and thus preservation of lung health during the infant's vulnerable period when lung growth is maximum. The multicentre nature of our study increases the generalisability of its future findings and is complemented by assessing the microbiological and immunological outcomes in a subset of infants. Clinical Trial Registration: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374381 , identifier: ACTRN12618000150246.
Infants hospitalised with pertussis: Estimating the true disease burden
Publisher: Wiley
Date: 06-08-2007
DOI: 10.1111/J.1440-1754.2007.01154.X
Abstract: New Zealand (NZ) has a large pertussis disease burden compared with other developed countries. Accurate ascertainment of disease burden is fundamental to controlling pertussis and informing immunisation policy. Disease burden estimates are primarily from passive surveillance, which underestimates disease incidence. The aim of this study is to use active surveillance to determine pertussis disease burden in infants hospitalised in NZ. Using the NZ Paediatric Surveillance Unit, active surveillance from 08/2004 to 07/2005 for infants <12 months old, hospitalised with pertussis. 110 infants identified (196 per 100,000), including six with complications, eight intensive care admissions and one death. The hospitalisation rate (per 100,000) varied with ethnicity, being higher for Maori (296) and Pacific (358) compared with European/other (117). Twenty-four per cent were too young to be immunised. Of infants 6 weeks and older 46% had received no immunisations. Despite being more likely to be immunised Pacific infants had a higher hospitalisation rate owing to a larger proportion acquiring pertussis prior to age 6 weeks. Cyanosis and apnoea were frequent symptoms in young infants. Under-identification, estimated using capture-recapture analysis, was modest for both active surveillance (16%) and passive notification (19%). Infant pertussis hospitalisation rates are three to six times greater than rates in the USA, England and Australia. Underestimation of disease burden by passive notification in hospitalised infants is modest, suggesting a high degree of clinical awareness by paediatricians in NZ. New immunisation strategies are needed to protect infants from a younger age.
Health-related quality-of-life in children with cystic fibrosis aged 5-years and associations with health outcomes
Publisher: Elsevier BV
Date: 05-2020
Aspergillus and progression of lung disease in children with cystic fibrosis.
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/THORAXJNL-2018-211550
Abstract: The impact of Aspergillus on lung disease in young children with cystic fibrosis is uncertain. To determine if positive respiratory cultures of Aspergillus species are associated with: (1) increased structural lung injury at age 5 years (2) accelerated lung function decline between ages 5 years and 14 years and (3) to identify explanatory variables. A cross-sectional analysis of association between Aspergillus positive bronchoalveolar lavage (BAL) cultures and chest high-resolution CT (HRCT) scan findings at age 5 years in subjects from the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) study was performed. A non-linear mixed-effects disease progression model was developed using FEV 1 % predicted measurements at age 5 years from the ACFBAL study and at ages 6–14 years for these subjects from the Australian Cystic Fibrosis Data Registry. Positive Aspergillus BAL cultures at age 5 years were significantly associated with increased HRCT scores for air trapping (OR 5.53, 95% CI 2.35 to 10.82). However, positive Aspergillus cultures were not associated with either FEV 1 % predicted at age 5 years or FEV 1 % predicted by age following adjustment for body mass index z-score and hospitalisation secondary to pulmonary exacerbations. Lung function demonstrated a non-linear decline in this population. In children with cystic fibrosis, positive Aspergillus BAL cultures at age 5 years were associated contemporaneously with air trapping but not bronchiectasis. However, no association was observed between positive Aspergillus BAL cultures on FEV 1 % predicted at age 5 years or with lung function decline between ages 5 years and 14 years.
Invasive Haemophilus influenzae Infections after 3 Decades of Hib Protein Conjugate Vaccine Use
Publisher: American Society for Microbiology
Date: 16-06-2021
DOI: 10.1128/CMR.00028-21
Abstract: Haemophilus influenzae serotype b (Hib) was previously the most common cause of bacterial meningitis and an important etiologic agent of pneumonia in children aged years. Its major virulence factor is the polyribosyl ribitol phosphate (PRP) polysaccharide capsule.
The respiratory specimen collection trial (respect): A randomized controlled trial to compare quality and timeliness of respiratory sample collection in the home by parents and healthcare workers from children aged <2 years
Publisher: Oxford University Press (OUP)
Date: 18-01-2020
DOI: 10.1093/JPIDS/PIY136
Abstract: Most acute respiratory infection (ARI) research focuses on severe disease and overlooks the burden of community-managed illness. For community-based studies, home-based specimen collection by parents could be a resource-saving alternative to collection by healthcare workers (HCWs). In this study, we compared parent and HCW groups for their likelihood to collect specimens and the timeliness and quality of such collection. In this unblinded randomized controlled trial, parents from Brisbane, Australia, were taught to identify new ARI episodes in their children aged & years. When their child had a new ARI, parents either collected a nasal swab from the child (P group) or contacted an HCW who visited to obtain a nasopharyngeal swab (HCW group). We compared the likelihood and timeliness of specimen collection and respiratory pathogen detection. A nested diagnostic study compared paired specimen collections from children in the HCW group. Included were 76 incident ARI episodes from 31 children and 102 episodes from 33 children in the P and HCW groups, respectively. The proportions of ARIs for which a specimen was collected were similar (P group, 69.7% HCW group, 72.5% P = .77), and pathogens were detected in 93.8% and 77.5% of the specimens, respectively (P = .03). The period between ARI onset and specimen collection was shorter in the P group than in the HCW group (mean difference, 1.9 days [95% confidence interval, 0.7–3.0 days] P & .001). For the 69 paired specimens, viral loads were lower in the parent-collected swabs (mean cycle threshold difference, 4.5 [95% confidence interval, 3.1–5.9] P & .001). Parents and HCWs obtained s les in similar proportions of ARI episodes, but the parents collected the s les fewer days after ARI onset and with a resulting higher likelihood of pathogen identification. This method can be used in population-based epidemiological studies of ARI as a resource-saving alternative. ClinicalTrials.gov identifier NCT00966069.
Intussusception and rotavirus associated hospitalisation in New Zealand
Publisher: BMJ
Date: 07-06-2005
Three-Weekly Doses of Azithromycin for Indigenous Infants Hospitalized with Bronchiolitis: A Multicentre, Randomized, Placebo-Controlled Trial
Publisher: Frontiers Media SA
Date: 21-04-2015
Prevention of neonatal group B streptococcus disease in the 21st century
Publisher: Wiley
Date: 13-12-2011
DOI: 10.1111/J.1440-1754.2011.02203.X
Abstract: There have been significant reductions in early-onset neonatal group B streptococcus (GBS) disease following implementation of maternal intrapartum antibiotic prophylaxis (IAP) policies. Nevertheless, GBS remains a leading cause of neonatal sepsis in Australia and New Zealand resulting in considerable morbidity and mortality, particularly among preterm infants. In the United States, the universal screening-based approach for identifying women for IAP results in apparently lower rates of early-onset neonatal GBS infection than risk-based assessment. In addition, IAP has altered the profile of newborn infants who develop early-onset disease. Many affected infants lack the typical intrapartum risk factors for GBS infection, are born to mothers with a negative GBS screen or represent missed opportunities for prevention. Clinicians should remain alert for signs of sepsis in any newborn infant. We provide an update of GBS preventative management strategies in the perinatal period taking into account recent United States, Australian and New Zealand guidelines.
Streptococcus pneumoniae and chronic endobronchial infections in childhood
Publisher: Wiley
Date: 18-09-2017
DOI: 10.1002/PPUL.23828
Abstract: Streptococcus pneumoniae (pneumococcus) is the main cause of bacterial pneumonia worldwide and has been studied extensively in this context. However, its role in chronic endobronchial infections and accompanying lower airway neutrophilic infiltration has received little attention. Severe and recurrent pneumonia are risk factors for chronic suppurative lung disease (CSLD) and bronchiectasis the latter causes considerable morbidity and, in some populations, premature death in children and adults. Protracted bacterial bronchitis (PBB) is another chronic endobronchial infection associated with substantial morbidity. In some children, PBB may progress to bronchiectasis. Although nontypeable Haemophilus influenzae is the main pathogen in PBB, CSLD and bronchiectasis, pneumococci are isolated commonly from the lower airways of children with these diagnoses. Here we review what is known currently about pneumococci in PBB, CSLD and bronchiectasis, including the importance of pneumococcal nasopharyngeal colonization and how persistence in the lower airways may contribute to the pathogenesis of these chronic pulmonary disorders. Antibiotic treatments, particularly long-term azithromycin therapy, are discussed together with antibiotic resistance and the impact of pneumococcal conjugate vaccines. Important areas requiring further investigation are identified, including immune responses associated with pneumococcal lower airway infection, alone and in combination with other respiratory pathogens, and microarray serotyping to improve detection of carriage and infection by multiple serotypes. Genome wide association studies of pneumococci from the upper and lower airways will help identify virulence and resistance determinants, including potential therapeutic targets and vaccine antigens to treat and prevent endobronchial infections. Much work is needed, but the benefits will be substantial.
Inhibition of Pseudomonas aeruginosa exoenzyme expression by subinhibitory antibiotic concentrations
Publisher: American Society for Microbiology
Date: 1989
DOI: 10.1128/AAC.33.1.41
Abstract: We examined the effects of subinhibitory concentrations of ciprofloxacin, tobramycin, and ceftazidime on Pseudomonas aeruginosa exoenzyme expression in vitro and in vivo. Exotoxin A, exoenzyme S, phospholipase C, elastase, and total protease activities were suppressed by antibiotics at concentrations as low as 1/20 of the MIC over a 24-h period in broth. Continuous 10-day exposure of P. aeruginosa DG1 broth cultures to antibiotic levels equal to 1/10 of the MIC reduced exoenzyme S activity in all treatment groups. Elastase activity was reduced only by ciprofloxacin and tobramycin treatment. This suppressive effect of the antibiotics persisted throughout the 10 days and was not influenced by the increase in MIC of ciprofloxacin detected during the course of the experiment. Rats chronically infected with P. aeruginosa were treated with subinhibitory doses of antibiotics and compared with untreated controls. Bacterial numbers in lung homogenates from each of the four study groups were identical. However, the lungs from antibiotic-treated rats had significantly less histological damage than those from control rats (P less than 0.001). The protective effect was greatest for ciprofloxacin and tobramycin. Further, P. aeruginosa isolates from ciprofloxacin- and tobramycin-treated rats demonstrated significantly less exoenzyme S and elastase activity than isolates from untreated rats (P less than 0.001). Isolates from ceftazidime-treated lungs expressed less exoenzyme S activity (P less than 0.001) but an equivalent amount of elastase activity as isolates from controls. The suppression of P. aeruginosa exoenzymes may arrest progressive lung injury during chronic P. aeruginosa lung infections.
Pentavalent Rotavirus Vaccine and Prevention of Gastroenteritis Hospitalizations in Australia
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2010
Abstract: A publicly funded, universal infant pentavalent rotavirus vaccine (RV5) program was implemented in Queensland, Australia, in mid-2007. We sought to assess vaccine effectiveness (VE) of 3 doses of RV5 at preventing rotavirus and nonrotavirus acute gastroenteritis (AGE) hospitalizations in the first birth cohort and impact on hospitalizations in all age groups. Hospitalization rates for rotavirus and nonrotavirus AGE in all age groups before and after RV5 introduction were compared. Population vaccine coverage, hospitalization data, and in idual vaccination status were obtained from routinely collected, publicly funded state- and nationally based data sets. Data linkage was performed to calculate 3-dose VE for preventing hospitalization in the eligible age group. RV5 coverage in the first eligible birth cohort was 89.6% for at least 1 dose and 73.1% for 3 doses. Three-dose VE for preventing nonrotavirus AGE hospitalization was 62.3% to 63.9% (any rimary diagnosis) and 89.3% to 93.9% (any rimary diagnosis) for rotavirus hospitalizations. After program implementation, there were immediate and sustained reductions in rotavirus hospitalizations for those who were younger than 20 years and nonrotavirus AGE-coded hospitalizations for those who were younger than 5 years. RV5 is highly effective at preventing rotavirus hospitalizations in a developed country setting, confirming efficacy figures from the pivotal clinical trial. Additional direct and indirect effects are substantial and include reductions in nonrotavirus AGE hospitalizations in vaccinated age groups and rotavirus and nonrotavirus AGE hospitalization rates in older age groups.
Twelve year outcomes following bacterial meningitis: Further evidence for persisting effects
Publisher: BMJ
Date: 08-2000
DOI: 10.1136/ADC.83.2.111
Abstract: To determine whether intellectual and cognitive impairments observed seven years following early childhood bacterial meningitis persist into adolescence. Blinded neuropsychological, auditory, and behaviour assessments were conducted in 109 (69%) subjects from an original cohort of 158 children, seven and 12 years after their meningitis, and in 96 controls. Meningitis subjects remained at greater risk than controls for any disability (odds ratio OR 4.7, confidence interval 2.2 to 9.6). Those with acute neurological complications had more sequelae than children with uncomplicated meningitis or controls (47% v 30% v 11.5% respectively p < 0.001). Differences in intellectual, academic, and high level cognitive function between subjects and controls were maintained at the seven and 12 year assessments. In contrast, lower order skills improved, while behaviour scores deteriorated significantly (p = 0.033). Many of the deficits identified at the seven year follow up persist 12 years after an episode of bacterial meningitis.
Acute Flaccid Paralysis from Echovirus Type 33 Infection
Publisher: American Society for Microbiology
Date: 05-2003
DOI: 10.1128/JCM.41.5.2230-2232.2003
Abstract: During a community echovirus type 33 outbreak, the virus was detected in the feces and cerebrospinal fluid of a 3-year-old boy with right arm weakness that followed a mild nonspecific febrile illness. This is the first time an association between echovirus type 33 infection and acute flaccid paralysis has been reported.
Rapid single-nucleotide polymorphism-based identification of clonal Pseudomonas aeruginosa isolates from patients with cystic fibrosis by the use of real-time PCR and high-resolution melting curve ana
Publisher: Elsevier BV
Date: 09-2011
Strict exclusion criteria do not apply for healthy respiratory impedance reference ranges in pre-school aged children
Publisher: European Respiratory Society
Date: 09-2017
Toward making inroads in reducing the disparity of lung health in Australian Indigenous and New Zealand Māori children
Publisher: Frontiers Media SA
Date: 13-02-2015
Does a 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine prevent respiratory exacerbations in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: protocol for a randomised controlled trial.
Publisher: Springer Science and Business Media LLC
Date: 2013
Abolition of Pseudomonas aeruginosa AUST‐01 from an Australian CF center: Do other strains remain?
Publisher: Wiley
Date: 11-02-2019
DOI: 10.1002/PPUL.24258
Health-resource use and quality of life in children with bronchiectasis: A multi-center pilot cohort study
Publisher: Springer Science and Business Media LLC
Date: 13-08-2019
Response to “Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain” Eur J Pediatr (2018) 177:181–192
Publisher: Springer Science and Business Media LLC
Date: 14-06-2018
Effectiveness of a chronic cough management algorithm at the transitional stage from acute to chronic cough in children: a multicenter, nested, single-blind, randomised controlled trial
Publisher: Elsevier BV
Date: 12-2019
Improving the Diagnosis, Management, and Outcomes of Children with Pneumonia: Where are the Gaps?
Publisher: Frontiers Media SA
Date: 2013
Emergence and impact of oprD mutations in Pseudomonas aeruginosa strains in cystic fibrosis
Publisher: Elsevier BV
Date: 2022
Lower airway inflammation in infants and young children with cystic fibrosis
Publisher: American Thoracic Society
Date: 10-1997
DOI: 10.1164/AJRCCM.156.4.96-11058
Abstract: Airway inflammation is an important component of cystic fibrosis (CF) lung disease. To determine whether this begins early in the illness, before the onset of infection, we examined bronchoalveolar lavage (BAL) fluid from 46 newly diagnosed infants with CF under the age of 6 mo identified by a neonatal screening program. These infants were ided into three groups: 10 had not experienced respiratory symptoms or received antibiotics and pathogens were absent in their BAL fluid 18 had clear evidence of lower respiratory viral or bacterial (> or = 10(5) CFU/ml) infection and the remaining 18 had either respiratory symptoms, taken antibiotics, or had < 10(5) CFU/ml of respiratory pathogens. Their BAL cytology, interleukin-8, and elastolytic activity were compared with those from 13 control subjects. In a longitudinal study to assess if inflammation develops or persists in the absence of infection, the results of 56 paired annual BAL specimens from 44 CF infants were grouped according to whether they showed absence, development, clearance, or persistence of infection. In newly diagnosed infants with CF, those without infection had BAL profiles comparable with control subjects while those with a lower respiratory infection had evidence of airway inflammation. In older children, the development and persistence of infection was accompanied by increased inflammatory markers, whereas these were decreased in the absence, or with the clearance, of infection. We conclude that airway inflammation follows respiratory infection and, in young children, improves when pathogens are eradicated from the airways.
Clonal complex Pseudomonas aeruginosa in horses
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.VETMIC.2010.11.030
Abstract: Pseudomonas aeruginosa is associated with infectious endometritis in horses. Although infectious endometritis is often considered a venereal infection, there is relatively limited genotypic-based evidence to support this mode of transmission. The study sought to determine the relatedness between genital P. aeruginosa isolates collected from a limited geographical region using molecular strain typing. Enterobacterial repetitive intergenic consensus PCR typing was performed on 93 isolates collected between 2005 and 2009 from 2058 thoroughbred horses (including 18 stallions) at 66 studs. While P. aeruginosa was not detected in the stallions, 53/93 (57%) mares harbouring P. aeruginosa had clonally related strains, which included a single dominant genotype detected in 42 (45%) mares from 13 different studs. These novel findings suggest that most equine genital P. aeruginosa infections in this region may have been acquired from mechanisms other than direct horse to horse transmission. Instead, other potential acquisition pathways, as well as strain specific adaptation to the equine genital tract, should be investigated.
Vaccination against respiratoryPseudomonas aeruginosainfection
Publisher: Informa UK Limited
Date: 11-2014
DOI: 10.4161/HV.34296
Contemporary Concise Review 2018: Bronchiectasis
Publisher: Wiley
Date: 11-02-2019
DOI: 10.1111/RESP.13502
Lower airway microbiology and cellularity in children with newly diagnosed non-CF bronchiectasis
Publisher: Wiley
Date: 07-09-2011
DOI: 10.1002/PPUL.21550
Abstract: Infection and inflammation are important in the pathogenesis of bronchiectasis. However, there are few published data describing the lower airway microbiology and cellularity in children. Children with non-cystic fibrosis (CF) bronchiectasis who underwent bronchoalveolar lavage (BAL) within 4 weeks of diagnosis were identified by a retrospective patient-record review. The effects of infection (≥10(5) colony-forming units of respiratory bacteria/ml or detectable Pseudomonas aeruginosa mycobacteria, fungi, mycoplasma, or respiratory viruses) on airway cellularity and the impact of age, gender, indigenous status, immune function, radiographic involvement and antibiotic usage on infection risk were evaluated. Of 113 children [median age 63 months (IQR 32-95)] with newly diagnosed bronchiectasis, 77 (68%) had positive BAL cultures for respiratory bacterial pathogens. Haemophilus influenzae was most commonly detected, being present in 53 (47%) BAL specimens. P. aeruginosa was found in just 7 (6%) children, five of whom had an underlying disorder, while mycobacterial and fungal species were not detected. Respiratory viruses were identified in 14 (12%) children and Mycoplasma pneumoniae in two others. Overall, 56 (49.5%) children fulfilled our definition of a lower airway infection and of these, 35 (63%) had more than one pathogen present. Compared to children without infection, children with infection had higher total cell counts (610 vs. 280 × 10(6) /L), neutrophil counts (351 vs. 70 × 10(6) /L), and neutrophil percentages (69% vs. 34%). Age at diagnosis was most strongly associated with infection. BAL microbiology of children with newly diagnosed bronchiectasis is dominated by H. influenzae. In the absence of CF, isolation of P. aeruginosa may suggest a serious co-morbidity in this group. Airway neutrophilia is common, especially with higher bacterial loads.
Helicobacter pylori and recurrent abdominal pain in children
Publisher: No publisher found
Date: 1996
DOI: 10.1097/00005176-199602000-00004
Abstract: Recurrent abdominal pain is one of the most common presentations to pediatricians yet an organic etiology can be found in only 10% of cases. Because infection with Helicobacter pylori in adults and children results in gastritis, a causative role for the organism has been postulated. To investigate this theory, we conducted a prospective case-control study in children with recurrent abdominal pain using serum H. pylori IgG antibodies measured by an enzyme immunoabsorbent assay. Age, sex, ethnicity, and socioeconomic status were adjusted in the statistical model. Five subjects (5.1%) and 14 controls (14.3%) had raised serum IgG antibodies to H. pylori (adjusted OR, 0.21 95% confidence interval, 0.05, 0.85). The negative association between H. pylori and recurrent abdominal pain indicates that this organism is unlikely to have an important etiologic role in this disorder.
Impact of the Epithelial Lining Fluid Milieu on Amikacin Pharmacodynamics Against Pseudomonas aeruginosa
Publisher: Springer Science and Business Media LLC
Date: 02-04-2021
Pathogenesis of nontypeable Haemophilus influenzae infections in chronic suppurative lung disease
Publisher: Wiley
Date: 03-05-2023
DOI: 10.1002/PPUL.26446
Abstract: The respiratory tract antimicrobial defense system is a multilayered defense mechanism that relies upon mucociliary clearance and components of both the innate and adaptive immune systems to protect the lungs from inhaled or aspirated microorganisms. One of these potential pathogens, nontypeable Haemophilus influenzae ( NTHi ), adopts several, multifaceted redundant strategies to successfully colonize the lower airways and establish a persistent infection. NTHi can impair mucociliary clearance, express multiple multifunctional adhesins for various cell types within the respiratory tract and evade host defenses by surviving within and between cells, forming biofilms, increasing antigenic drift, secreting proteases and antioxidants, and by host‐pathogen cross‐talk, impair macrophage and neutrophil function. NTHi is recognized as an important pathogen in several chronic lower respiratory disorders, such as protracted bacterial bronchitis, bronchiectasis, cystic fibrosis, and primary ciliary dyskinesia. The persistence of NTHi in human airways, including its capacity to form biofilms, results in chronic infection and inflammation, which can ultimately injure airway wall structures. The complex nature of the molecular pathogenetic mechanisms employed by NTHi is incompletely understood but improved understanding of its pathobiology will be important for developing effective therapies and vaccines, especially given the marked genetic heterogeneity of NTHi and its possession of phase‐variable genes. Currently, no vaccine candidates are ready for large phase III clinical trials.
Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis
Publisher: Wiley
Date: 08-02-2013
DOI: 10.1002/PPUL.22763
Abstract: Indigenous children in developed countries are at increased risk of chronic suppurative lung disease (CSLD), including bronchiectasis. We evaluated sociodemographic and medical factors in indigenous children with CSLD/bronchiectasis from Australia, United States (US), and New Zealand (NZ). Indigenous children aged 0.5-8 years with CSLD/bronchiectasis were enrolled from specialist clinics in Australia (n = 97), Alaska (n = 41), and NZ (n = 42) during 2004-2009, and followed for 1-5 years. Research staff administered standardized parent interviews, reviewed medical histories and performed physical examinations at enrollment. Study children in all three countries had poor housing and sociodemographic circumstances at enrollment. Except for increased household crowding, most poverty indices in study participants were similar to those reported for their respective local indigenous populations. However, compared to their local indigenous populations, study children were more often born prematurely and had both an increased frequency and earlier onset of acute lower respiratory infections (ALRIs). Most (95%) study participants had prior ALRI hospitalizations and 77% reported a chronic cough in the past year. Significant differences (wheeze, ear disease and plumbed water) between countries were present. Indigenous children with CSLD/bronchiectasis from three developed countries experience significant disparities in poverty indices in common with their respective indigenous population however, household crowding, prematurity and early ALRIs were more common in study children than their local indigenous population. Addressing equity, especially by preventing prematurity and ALRIs, should reduce risk of CSLD/bronchiectasis in indigenous children.
Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom
Publisher: Elsevier BV
Date: 06-2016
Detection of Expiratory Flow Limitation by Forced Oscillations during Noninvasive Ventilation
Publisher: American Thoracic Society
Date: 15-10-2019
Community-level burden of acute diarrhoeal illness in the first 2 years of life in Brisbane, Australia: A birth cohort study
Publisher: Wiley
Date: 03-09-2020
DOI: 10.1111/JPC.15160
Pharmacodynamic Evaluation of Plasma and Epithelial Lining Fluid Exposures of Amikacin against Pseudomonas aeruginosa in a Dynamic In Vitro Hollow-Fiber Infection Model
Publisher: American Society for Microbiology
Date: 20-08-2020
DOI: 10.1128/AAC.00879-20
Abstract: Given that aminoglycosides, such as amikacin, may be used for multidrug-resistant Pseudomonas aeruginosa infections, optimization of therapy is paramount for improved treatment outcomes. This study aims to investigate the pharmacodynamics of different simulated intravenous amikacin doses on susceptible P. aeruginosa to inform ventilator-associated pneumonia (VAP) and sepsis treatment choices. A hollow-fiber infection model with two P. aeruginosa isolates (MICs of 2 and 8 mg/liter) with an initial inoculum of ∼10 8 CFU/ml was used to test different amikacin dosing regimens.
Human bocavirus-1 infections in Australian children aged < 2 years: a birth cohort study
Publisher: Springer Science and Business Media LLC
Date: 25-11-2022
Effects of Segregation on an Epidemic Pseudomonas aeruginosa Strain in a Cystic Fibrosis Clinic
Publisher: American Thoracic Society
Date: 05-2005
Costs of Bronchoalveolar Lavage-Directed Therapy in the First 5 Years of Life for Children with Cystic Fibrosis
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.JPEDS.2014.05.031
Abstract: To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules. Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902, 95% CI AUD-27 782 to 31 586, P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288 95% CI AUD-35 252 to 16 676, P = .48). BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings.
Streptococcus anginosus group infections in hospitalised children and young people.
Publisher: Wiley
Date: 12-2022
DOI: 10.1111/JPC.15840
Abstract: The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre. Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed. Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years. SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.
Defining healthy' in preschool-aged children for forced oscillation technique reference equations
Publisher: Wiley
Date: 05-10-2018
DOI: 10.1111/RESP.13186
Abstract: Selecting 'healthy' preschool-aged children for reference ranges may not be straightforward. Relaxing inclusion criteria for normative data does not affect spirometry z-scores. We therefore investigated the effect of similarly relaxing inclusion criteria in preschoolers on reference ranges for respiratory impedance (Zrs) using a modified forced oscillation technique (FOT). The International Study of Asthma and Allergies in Childhood questionnaire classified 585 children into a healthy and five mutually exclusive groups. Zrs was measured between 4 and 26 Hz and resistance (R) and compliance (C) obtained by model fitting. Prediction models were determined using mixed effect models and z-scores compared between healthy children and the five groups. Zrs data were obtained for 494 participants (4.30 ± 0.7 years) on 587 occasions. Comparison of the Zrs z-scores between the healthy children and the health groups found significant differences in children with asthma, current wheeze and respiratory symptoms, but not in children born preterm or with early-life wheeze. Adding these two groups to the healthy dataset had no significant effect on the distribution of z-scores and increased the size of the dataset by 22.3%. Our data suggest that preschool-aged children born preterm or with early-life wheeze can be included in FOT reference equations, while those with asthma, current wheeze and respiratory symptoms within 4 weeks of testing should be excluded. This more inclusive approach results in more robust FOT reference ranges.
Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.IJANTIMICAG.2012.05.018
Abstract: Indigenous Australian children have increased rates of bronchiectasis. Despite a lack of high-level evidence on effectiveness and antibiotic resistance, these children often receive long-term antibiotics. In this study, we determined the impact of recent macrolide (primarily azithromycin) and β-lactam antibiotic use on nasopharyngeal colonisation, lower airway infection (>10(4) CFU/mL of bronchoalveolar lavage fluid culture) and antibiotic resistance in non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae and Moraxella catarrhalis isolates from 104 Indigenous children with radiographically confirmed bronchiectasis. Recent antibiotic use was associated with significantly reduced nasopharyngeal carriage, especially of S. pneumoniae in 39 children who received macrolides [odds ratio (OR)=0.22, 95% confidence interval (CI) 0.08-0.63] and 26 children who received β-lactams (OR=0.07, 95% CI 0.01-0.32), but had no significant effect on lower airway infection involving any of the three pathogens. Children given macrolides were significantly more likely to carry (OR=4.58, 95% CI 1.14-21.7) and be infected by (OR=8.13, 95% CI 1.47-81.3) azithromycin-resistant S. pneumoniae. Children who received β-lactam antibiotics may be more likely to have lower airway infection with β-lactamase-positive icillin-resistant NTHi (OR=4.40, 95% CI 0.85-23.9). The risk of lower airway infection by antibiotic-resistant pathogens in children receiving antibiotics is of concern. Clinical trials to determine the overall benefit of long-term antibiotic therapy are underway.
Pulmonary oxidative stress response in young children with cystic fibrosis
Publisher: BMJ
Date: 06-1997
DOI: 10.1136/THX.52.6.557
Abstract: It has been suggested that oxidative stress contributes to lung injury in cystic fibrosis. There is, however, no direct evidence of increased pulmonary oxidative stress in cystic fibrosis nor of the effects of inflammation on the major pulmonary antioxidant, glutathione. A study was undertaken to measure these parameters in infants and young children in the presence or absence of pulmonary inflammation. Thirty two infants and young children with cystic fibrosis of mean (SD) age 21.4 (15.3) months (range 2-54) and seven non-cystic fibrosis control subjects of mean (SD) age 21.0 (21.2) months (range 2-54) were studied using bronchoalveolar lavage (BAL). On the basis of the BAL findings the cystic fibrosis group was ided into those with (CF-I) and those without pulmonary inflammation (CF-NI). Levels of lipid hydroperoxide, total glutathione, and gamma-glutamyl transpeptidase (gamma-GT) were then measured in the BAL fluid. The concentrations of lipid hydroperoxide and gamma-GT in the epithelial lining fluid were significantly increased in the CF-I group compared with the control and CF-NI groups, each of which had similar values for these parameters (ratio of geometric means for CF-I group versus control for lipid hydroperoxide 5.4 (95% confidence interval (CI) 1.8 to 15.8) and for gamma-GT 5.2 (95% CI 1.4 to 19.4)). The glutathione concentration tended to be lower in the CF-I subjects but the difference did not reach statistical significance. These results demonstrate that the airways in patients with cystic fibrosis are exposed to increased oxidative stress which appears to be a consequence of pulmonary inflammation rather than part of the primary cystic fibrosis defect. The increase in gamma-GT in the CF-I group suggests a mechanism by which extracellular glutathione could be utilised by airway epithelial cells.
Cognitive and Executive Function 12 Years after Childhood Bacterial Meningitis
Publisher: Oxford University Press (OUP)
Date: 03-2004
Abstract: This study investigated long-term neurobehavioral outcome from childhood bacterial meningitis, with particular focus on the influence of acute neurologic complications and age at illness. This prospective, longitudinal study compared survivors of childhood bacterial meningitis (n = 109) with grade- and gender-matched controls (n = 96) selected from the target children's schools 12 years post-illness, in order to identify residual deficits in intellectual, academic, and executive ability. Results showed that at 12 years post-illness, children with a history of meningitis were at greater risk of impairment in each of these domains. However, development was shown to keep pace with that exhibited by healthy controls, suggesting no deterioration in function with time since illness. While prediagnosis symptom duration and acute neurologic complications were not predictors of 12-year outcome, meningitis before 12 months of age was significantly related to poorer performance on tasks requiring language and executive skills. These findings suggest that while the overall impact of meningitis may be relatively general and mild, younger age at illness is predictive of neurobehavioral outcome. There was no evidence of progressive deterioration postmeningitis, with comparison of results from 7 to 12 years post-illness demonstrating significant "catch-up" in aspects of executive function.
Early onset neonatal meningitis in Australia and New Zealand, 1992-2002.
Publisher: BMJ
Date: 07-2005
European Respiratory Society statement for defining respiratory exacerbations in children and adolescents with bronchiectasis for clinical trials
Publisher: European Respiratory Society (ERS)
Date: 21-06-2022
DOI: 10.1183/13993003.00300-2022
Abstract: Bronchiectasis is being diagnosed increasingly in children and adolescents. Recurrent respiratory exacerbations are common in children and adolescents with this chronic pulmonary disorder. Respiratory exacerbations are associated with an impaired quality of life, poorer long-term clinical outcomes, and substantial costs to the family and health systems. The 2021 European Respiratory Society (ERS) clinical practice guideline for the management of children and adolescents with bronchiectasis provided a definition of acute respiratory exacerbations for clinical use but to date there is no comparable universal definition for clinical research. Given the importance of exacerbations in the field, this ERS Task Force sought to obtain robust definitions of respiratory exacerbations for clinical research. The panel was a multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, methodology, patient advocacy, and parents of children and adolescents with bronchiectasis. We used a standardised process that included a systematic literature review, parent survey, and a Delphi approach involving 299 physicians (54 countries) caring for children and adolescents with bronchiectasis. Consensus was obtained for all four statements drafted by the panel as the disagreement rate was very low (range 3.6–7.2%). The panel unanimously endorsed the four consensus definitions for 1a) non-severe exacerbation and 1b) severe exacerbation as an outcome measure, 2) non-severe exacerbation for studies initiating treatment, and 3) resolution of a non-severe exacerbation for clinical trials involving children and adolescents with bronchiectasis. This ERS Task Force proposes using these internationally derived, consensus-based definitions of respiratory exacerbations for future clinical paediatric bronchiectasis research.
Clinical and research priorities for children and young people with bronchiectasis: an international roadmap
Publisher: European Respiratory Society (ERS)
Date: 03-06-2021
DOI: 10.1183/23120541.00122-2021
Abstract: The global burden of children and young people (CYP) with bronchiectasis is being recognised increasingly. They experience a poor quality of life and recurrent respiratory exacerbations requiring additional treatment, including hospitalisation. However, there are no published data on patient-driven clinical needs and/or research priorities for paediatric bronchiectasis. Parent atient-driven views are required to understand the clinical needs and research priorities to inform changes that benefit CYP with bronchiectasis and reduce their disease burden. The European Lung Foundation and the European Respiratory Society Task Force for paediatric bronchiectasis created an international roadmap of clinical and research priorities to guide, and as an extension of, the clinical practice guideline. This roadmap was based on two global web-based surveys. The first survey (10 languages) was completed by 225 respondents (parents of CYP with bronchiectasis and adults with bronchiectasis diagnosed in childhood) from 21 countries. The parent atient survey encompassed both clinical and research priorities. The second survey, completed by 258 health practitioners from 54 countries, was limited to research priorities. The two highest clinical needs expressed by parents atients were: having an action management plan for flare-ups/exacerbations and access to physiotherapists. The two highest health practitioners’ research priorities related to eradication of airway pathogens and optimal airway clearance techniques. Based on both surveys, the top 10 research priorities were derived, and unanimous consensus statements were formulated from these priorities. This document addresses parents' atients' clinical and research priorities from both the parents' atients' and clinicians' perspectives and will help guide research and clinical efforts to improve the lives of people with bronchiectasis.
Risk factors for respiratory syncytial virus bronchiolitis hospital admission in New Zealand
Publisher: Cambridge University Press (CUP)
Date: 04-01-2008
DOI: 10.1017/S0950268807000180
Abstract: This study assessed risk factors for respiratory syncytial virus (RSV) hospitalization and disease severity in Wellington, New Zealand. During the southern hemisphere winter months of 2003–2005, 230 infants aged months hospitalized with bronchiolitis were recruited. RSV was identified in 141 (61%) infants. Comparison with data from all live hospital births from the same region (2003–2005) revealed three independent risk factors for RSV hospitalization: birth between February and July [adjusted risk ratio (aRR) 1·62, 95% confidence interval (CI) 1·15–2·29], gestation weeks (aRR 2·29, 95% CI 1·48–3·56) and Māori ethnicity (aRR 3·64, 95% CI 2·27–5·85) or Pacific ethnicity (aRR 3·60, 95% CI 2·14–6·06). The high risk for Māori and Pacific infants was only partially accounted for by other known risk factors. This work highlights the importance of RSV disease in indigenous and minority populations, and identifies the need for further research to develop public health measures that can reduce health disparities.
High-throughput single-nucleotide polymorphism-based typing of shared Pseudomonas aeruginosa strains in cystic fibrosis patients using the Sequenom iPLEX platform
Publisher: Microbiology Society
Date: 05-2013
Abstract: Shared strains of Pseudomonas aeruginosa are now well recognized in people with cystic fibrosis (CF), and suitable P. aeruginosa laboratory typing tools are pivotal to understanding their clinical significance and guiding infection control policies in CF clinics. We therefore compared a single-nucleotide polymorphism (SNP)-based typing method using Sequenom iPLEX matrix-assisted laser desorption ionization with time-of-flight mass spectrometry (MALDI-TOF MS) with typing methods used routinely by our laboratory. We analysed 617 P. aeruginosa isolates that included 561 isolates from CF patients collected between 2001 and 2009 in two Brisbane CF clinics and typed previously by enterobacterial repetitive intergenic consensus (ERIC)-PCR, as well as 56 isolates from non-CF patients analysed previously by multilocus sequence typing (MLST). The isolates were tested using a P. aeruginosa Sequenom iPLEX MALDI-TOF (PA iPLEX) method comprising two multiplex reactions, a 13-plex and an 8-plex, to characterize 20 SNPs from the P. aeruginosa housekeeping genes acsA , aroE , guaA , mutL , nuoD , ppsA and trpE . These 20 SNPs were employed previously in a real-time format involving 20 separate assays in our laboratory. The SNP analysis revealed 121 different SNP profiles for the 561 CF isolates. Overall, there was at least 96 % agreement between the ERIC-PCR and SNP analyses for all predominant shared strains among patients attending our CF clinics: AUST-01, AUST-02 and AUST-06. For the less frequently encountered shared strain AUST-07, 6/25 (24 %) ERIC-PCR profiles were misidentified initially as AUST-02 or as unique, illustrating the difficulty of gel-based analyses. SNP results for the 56 non-CF isolates were consistent with previous MLST data. Thus, the PA iPLEX format provides an attractive high-throughput alternative to ERIC-PCR for large-scale investigations of shared P. aeruginosa strains.
Number and order of whole cell pertussis vaccines in infancy and disease protection
Publisher: American Medical Association (AMA)
Date: 08-2012
Late-onset infections of infants in neonatal units
Publisher: Wiley
Date: 04-1996
DOI: 10.1111/J.1440-1754.1996.TB00914.X
Abstract: To examine regional variations in the incidence of late-onset neonatal infections in Australian and New Zealand neonatal units. A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late-onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993. Data were available on 24535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were early-onset 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1OOOg, but 0.6% over 2000g. Coagulase negative staphylococci were the commonest cause of late-onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late-onset sepsis. The mortality from late-onset sepsis was 7.7%. Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.
Over-diagnosis of rotavirus infection in infants due to detection of vaccine virus
Publisher: Oxford University Press (OUP)
Date: 18-12-2020
DOI: 10.1093/CID/CIZ1196
Abstract: An accurate rotavirus diagnosis is important for clinical management and monitoring active disease and vaccine effectiveness. Between 2016–2018, rotavirus-positive results in our laboratory were from vaccine virus shedding in 71/152 (46.7%) infants with a request for rotavirus testing. Routine infant diagnostic testing should ideally distinguish vaccine from wild-type viruses.
Novel Neutrophil-Derived Proteins in Bronchoalveolar Lavage Fluid Indicate an Exaggerated Inflammatory Response in Pediatric Cystic Fibrosis Patients
Publisher: Oxford University Press (OUP)
Date: 10-2007
DOI: 10.1373/CLINCHEM.2007.087650
Abstract: Background: Airway inflammation in cystic fibrosis (CF) is exaggerated and characterized by neutrophil-mediated tissue destruction, but its genesis and mechanisms remain poorly understood. To further define the pulmonary inflammatory response, we conducted a proteome-based screen of bronchoalveolar lavage fluid (BALF) collected from young children with and without CF experiencing endobronchial infection. Methods: We collected BALF s les from 45 children younger than 5 years and grouped them according to the presence of respiratory pathogens: ≥1 × 105 colony-forming units (CFU)/mL BALF (18 and 12 s les with and without CF, respectively) and & × 105 CFU/mL (23 and 15 s les). BALF proteins were analyzed with SELDI-TOF mass spectrometry (MS) and H4 ProteinChips®. Proteins were identified and characterized using trypsin digestion, tandem MS, Fourier transform ion cyclotron resonance MS, immunoblotting, and ELISA. Results: The SELDI-TOF MS BALF profiles contained 53 unique, reliably detected proteins. Peak intensities of 24 proteins differed significantly between the CF and non-CF s les. They included the neutrophil proteins, α-defensin 1 and 2, S100A8, S100A9, and S100A12, as well as novel forms of S100A8 and S100A12 with equivalent C-terminal deletions. Peak intensities of these neutrophil proteins and immunoreactive concentrations of selected ex les were significantly higher in CF than non-CF s les. Conclusions: Small neutrophil-derived BALF proteins, including novel C-terminal truncated forms of S100A proteins, are easily detected with SELDI-TOF MS. Concentrations of these molecules are abnormally high in early CF lung disease. The data provide new insights into CF lung disease and identify novel proteins strongly associated with CF airway inflammation.
Respiratory exacerbations in indigenous children from two countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis
Publisher: Elsevier BV
Date: 09-2014
Early-onset group B streptococcus prevention protocols in New Zealand public hospitals
Publisher: Wiley
Date: 08-2002
DOI: 10.1111/J.0004-8666.2002.00363.X
Abstract: Determine group B streptococcus (GBS) prevention protocols. Questionnaire survey of 19 hospitals accounting for 73% of New Zealand births. Prevention policies were reported by 16 (84%) hospitals (bacteriological-screening n = 4, risk-factor determination n = 8, both strategies n = 4). Only five out of 12 (42%) centres using risk-assessment administered antibiotics for all high-risk criteria. Inadequate specimen collection and culture methods meant no hospital maximised culture-based strategies. Nevertheless, hospitals with prevention policies had lower early-onset GBS disease rates (0.46 versus 1.44 per 1,000 births OR 0.32 (95% CI 0.12, 0.98)). Prevention strategies can be further improved by hospitals fully implementing nationally agreed guidelines.
HPeV3 Diversity, Recombination and Clinical Impact Across 7-years: an Australian Story
Publisher: Oxford University Press (OUP)
Date: 22-07-2022
Abstract: A novel human parechovirus 3 Australian recombinant (HPeV3-AR) strain emerged in 2013 and coincided with biennial outbreaks of sepsis-like illnesses in infants. We evaluated the molecular evolution of the HPeV3-AR strain and its association with severe HPeV infections. HPeV3-positive s les collected from hospitalized infants aged 5–252 days in 2 Australian states (2013–2020) and from a community-based birth cohort (2010–2014) were sequenced. Coding regions were used to conduct phylogenetic and evolutionary analyses. A recombinant-specific polymerase chain reaction was designed and utilized to screen all clinical and community HPeV3-positive s les. Complete coding regions of 54 cases were obtained, which showed the HPeV3-AR strain progressively evolving, particularly in the 3′ end of the nonstructural genes. The HPeV3-AR strain was not detected in the community birth cohort until the initial outbreak in late 2013. High-throughput screening showed that most (& %) hospitalized HPeV3 cases involved the AR strain in the first 3 clinical outbreaks, with declining prevalence in the 2019–2020 season. The AR strain was not statistically associated with increased clinical severity among hospitalized infants. HPeV3-AR was the dominant strain during the study period. Increased hospital admissions may have been from a temporary fitness advantage and/or increased virulence.
Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis
Publisher: Elsevier BV
Date: 05-2001
Abstract: To determine the clinical consequences of acquiring Pseudomonas aeruginosa infection during early childhood in children with cystic fibrosis (CF). Prospective, observational cohort study of 56 children with CF identified by newborn screening during 1990-92. Each child underwent an annual bronchial lavage during the first 2 to 3 years of life. Clinical outcome was determined at 7 years of age. P aeruginosa infection was diagnosed in 24 (43%) cohort subjects. Four children died before 7 years of age, all of whom had been infected with a multi-resistant, mucoid strain of P aeruginosa (P =.04). In survivors, P aeruginosa infection was associated with significantly increased morbidity as measured by lower National Institutes of Health scores, greater variability in lung function, increased time in the hospital, and higher rates of recombinant human deoxyribonuclease therapy (P <.01). In this young CF cohort, best forced expiratory volume in 1 second was an insensitive measure of increased morbidity. Acquisition of P aeruginosa was common by 7 years of age in this CF birth cohort and was associated with increased morbidity and mortality. An improved disease severity score would improve the evaluation and study of early CF lung disease.
Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis
Publisher: BMJ
Date: 17-04-2014
Comparison between children treated at home and those requiring hospital admission for rotavirus and other enteric pathogens associated with acute diarrhea in Melbourne, Australia
Publisher: American Society for Microbiology
Date: 09-1986
DOI: 10.1128/JCM.24.3.395-399.1986
Abstract: The etiology of acute diarrhea in children less than 42 months of age attending one pediatric hospital in Melbourne, Australia, was studied during a 7-month period encompassing the winter of 1984. Pathogens identified in 157 children treated as outpatients with mild disease were compared with those in 232 children hospitalized with severe disease. The pathogens (and frequencies among outpatients and inpatients, respectively) detected were rotaviruses (32.5 and 50.9%), enteric adenoviruses (8.9 and 7.4%), C ylobacter jejuni (7.2 and 1.3%), and Salmonella sp. (4.0 and 1.7%). Electropherotypes of rotavirus strains from outpatients and inpatients were compared. Two strains predominated during the 7 months of this study and were observed with equal frequency from outpatients and inpatients. Rotaviruses of the same electropherotype caused a wide spectrum of disease, with symptoms ranging from mild to severe, life-threatening diarrhea. The similarity of etiological agents identified from children with mild and severe forms of acute diarrhea suggests that the etiology of community enteric illness can be reasonably inferred from the etiology of inpatient disease in children in the same geographic area. During the winter epidemic period, the severity of symptoms associated with rotavirus infection in young children is likely to be determined by the inherent susceptibility of the host rather than by genetic differences in the strains of infecting rotaviruses.
Probiotics for preventing acute otitis media in children (Review)
Publisher: Wiley
Date: 18-06-2019
Asthma COPD overlap versus COPD alone in Australian primary care
Publisher: Wiley
Date: 03-2019
DOI: 10.1111/RESP.13491
β-lactam antibiotic versus combined β-lactam antibiotics and single daily dosing regimens of aminoglycosides for treating serious infections: A meta-analysis
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.IJANTIMICAG.2019.10.020
Abstract: Combining aminoglycosides with β-lactam antibiotics for treating serious infections has not been associated with reduced mortality in previous meta-analyses. However, the multiple daily aminoglycoside dosing regimen principally used in most of the included studies is inconsistent with current practice. To determine if a combination of an aminoglycoside administered as a single daily dose and a β-lactam antibiotic reduces all-cause mortality in patients compared with β-lactam antibiotic monotherapy. A systematic review and meta-analysis of clinical studies was performed (Prospero registration number #68506). Studies were included if they compared β-lactam antibiotic monotherapy with combined β-lactam and single daily dose aminoglycoside therapy for treating serious infections. Studies investigating multiple daily dosing aminoglycoside regimens, infective endocarditis and febrile neutropaenia were excluded. Study quality was assessed using the PEDro and Newcastle-Ottawa scoring systems. The end points for outcome analyses were 30-day all-cause mortality, clinical cure and nephrotoxicity. Four randomised controlled trials and five retrospective cohort studies were analysed. Compared with β-lactam antibiotic monotherapy, single daily aminoglycoside dosing in combination with β-lactam antibiotics was not associated with reduced mortality compared with β-lactam antibiotic monotherapy (n = 3686, OR 0.82, 95% CI 0.63-1.08, P = 0.10, I The existing evidence suggests no added survival benefit from a single daily dosing regimen of an aminoglycoside when combined with β-lactam antibiotics.
Subinhibitory antibiotics reduce pseudomonas aeruginosa tissue injury in the rat lung model
Publisher: Oxford University Press (OUP)
Date: 1989
DOI: 10.1093/JAC/24.6.937
Abstract: Using the agar-bead rat lung model, we evaluated the effects of subinhibitory antibiotic treatment upon Pseudomonas aeruginosa exoenzyme expression and lung injury in vivo. One hundred and twenty-eight animals were separated into two groups of 64 animals. One group was inoculated with P. aeruginosa DG1, and the other with P. aeruginosa 3740. Each of these two groups was ided into four subgroups of 16 animals on the basis of ten-day antibiotic treatment with ciprofloxacin, tobramycin and ceftazidime or untreated controls. P. aeruginosa DG1 is non-mucoid and expresses significant yields of exoenzyme S and elastase. P. aeruginosa 3740 is a mucoid organism isolated from the sputum of a cystic fibrosis patient, and demonstrates modest elastase activity only (10% of DG1 levels). Lung bacterial counts were similar in treatment and control groups. Lungs from antibiotic-treated rats demonstrated fewer histological changes than those from untreated animals (P less than 0.001). DG1 lung isolates from antibiotic-treated animals yielded less elastase and exoenzyme S compared with isolates from untreated animals (P less than 0.001). No detectable decrease in elastase or mucoid phenotype was observed in 3740 lung isolates from antibiotic treated animals. Thus, antibiotic protection against lung injury by P. aeruginosa may involve modulation of virulence factors.
PBB: Definition, mechanisms, and treatment
Publisher: Elsevier BV
Date: 10-2015
Early airway infection, inflammation, and lung function in cystic fibrosis
Publisher: BMJ
Date: 10-2002
DOI: 10.1136/ADC.87.4.306
Abstract: To determine the relation between lower airway infection and inflammation, respiratory symptoms, and lung function in infants and young children with cystic fibrosis (CF). A prospective study of children with CF aged younger than 3 years, diagnosed by a newborn screening programme. All were clinically stable and had testing as outpatients. Subjects underwent bronchial lavage (BL) and lung function testing by the raised volume rapid thoracoabdominal compression technique under general anaesthesia. BL fluid was cultured and analysed for neutrophil count, interleukin 8, and neutrophil elastase. Lung function was assessed by forced expiratory volume in 0.5, 0.75, and 1 second. Thirty six children with CF were tested on 54 occasions. Lower airway infection shown by BL was associated with a 10% reduction in FEV(0.5) compared with subjects without infection. No relation was identified between airway inflammation and lung function. Daily moist cough within the week before testing was reported on 20/54 occasions, but in only seven (35%) was infection detected. Independent of either infection status or airway inflammation, those with daily cough had lower lung function than those without respiratory symptoms at the time of BL (mean adjusted FEV(0.5) 195 ml and 236 ml respectively). In young children with CF, both respiratory symptoms and airway infection have independent, additive effects on lung function, unrelated to airway inflammation. Further studies are needed to understand the mechanisms of airway obstruction in these young patients.
Early‐onset neonatal group B streptococcal infections in New Zealand 1998−1999
Publisher: Wiley
Date: 06-2002
DOI: 10.1046/J.1440-1754.2002.00783.X
Abstract: To determine in New Zealand infants the attack rates, risk factors, preventive policies, strain serotype and antibiotic susceptibilities of early-onset neonatal group B streptococcus (GBS) infection. A 2-year prospective active surveillance study was conducted in New Zealand's 19 neonatal units. Cases had to present within 48 h of delivery, be unwell, possess abnormal haematological indices and have GBS isolated from sterile sites. Of the 112 402 infants born in New Zealand during 1998-1999, 56 had early-onset GBS infection, an attack rate of 0.5 per 1000 live births (95% confidence interval [CI] 0.38, 0.65). Seven had meningitis and there was one death (case fatality rate of 1.8% upper 95% CI 9.5%). Univariate analysis identified young maternal age, parity, preterm labour, prolonged membrane rupture, maternal fever and assisted delivery as risk factors. Preventive policies for GBS were reported by 14 (74%) obstetric centres associated with neonatal units. Of the 56 cases, five (9%) were born to mothers receiving intrapartum antibiotics, 32 (57%) had mothers with risk factors but were not treated with antibiotics, and 19 (34%) were born to mothers without identifiable risk factors for GBS prevention. Serotypes Ia and III predominated, while two isolates were resistant to erythromycin and/or clindamycin. Rates of early-onset GBS infection are similar to other countries following the introduction of prevention policies. Further reductions are possible with full implementation of these guidelines. Meanwhile, emergence of antibiotic resistance complicates the management of women with penicillin allergy. Vaccine development therefore remains a priority.
Energy metabolism in infants with cystic fibrosis
Publisher: Elsevier BV
Date: 05-2002
Abstract: To determine whether a defect in energy metabolism exists in infants with cystic fibrosis (CF). Unselected, newly-diagnosed subjects with CF (n = 46) and 24 healthy infants aged <20 weeks had measurements of resting energy expenditure (REE), total energy expenditure (TEE) (n = 25), and body composition. Metabolizable energy intake (MEI) was calculated. Genotype, energy intake, and pancreatic status was determined in all subjects with CF, and 24 underwent bronchial lavage. At diagnosis, infants with CF detected by newborn screening had significant anthropometric deficits (mean [SD] z-weight = 0.5 [1.0], z-length = 0.7 [1.3]) associated with pancreatic insufficiency. Their REE, TEE, or MEI (absolute measurements, per unit body weight or fat-free mass) were not increased. No relationship between REE, TEE, or MEI and Delta F(508) genotype, and no proportional differences in in idual components of MEI between subjects with CF and controls, or between subjects with CF who were homozygotes or compound heterozygotes for Delta F(508) were observed. REE and TEE were not correlated with bronchial infection or inflammation. Growth impairment during the first weeks of life in infants with CF is associated with pancreatic insufficiency. However, there is no evidence for a defect of energy metabolism related to Delta F(508), and in infants with CF, minimal lung disease is unaccompanied by increased energy expenditure.
Comparison of Three Molecular Techniques for Typing Pseudomonas aeruginosa Isolates in Sputum Samples from Patients with Cystic Fibrosis
Publisher: American Society for Microbiology
Date: 2011
DOI: 10.1128/JCM.01421-10
Abstract: Monitoring the emergence and transmission of Pseudomonas aeruginosa strains among cystic fibrosis (CF) patients is important for infection control in CF centers internationally. A recently developed multilocus sequence typing (MLST) scheme is used for epidemiologic analyses of P. aeruginosa outbreaks however, little is known about its suitability for isolates from CF patients compared with that of pulsed-field gel electrophoresis (PFGE) and enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). As part of a prevalence study of P. aeruginosa strains in Australian CF clinics, we compared the discriminatory power and concordance of ERIC-PCR, PFGE, and MLST among 93 CF sputum and 11 control P. aeruginosa isolates. PFGE and MLST analyses were also performed on 30 paired isolates collected 85 to 354 days apart from 30 patients attending two CF centers separated by 3,600 kilometers in order to detect within-host evolution. Each of the three methods displayed high levels of concordance and discrimination however, overall lower discrimination was seen with ERIC-PCR than with MLST and PFGE. Analysis of the 50 ERIC-PCR types yielded 54 PFGE types, which were related by ≤6 band differences, and 59 sequence types, which were classified into 7 BURST groups and 42 singletons. MLST also proved useful for detecting novel and known strains and for inferring relatedness among unique PFGE types. However, 47% of the paired isolates produced PFGE patterns that within 1 year differed by one to five bands, whereas with MLST all paired isolates remained identical. MLST thus represents a categorical analysis tool with resolving power similar to that of PFGE for typing P. aeruginosa . Its focus on highly conserved housekeeping genes is particularly suited for long-term clinical monitoring and detecting novel strains.
Defining chronic Pseudomonas aeruginosa infection in cystic fibrosis
Publisher: Elsevier BV
Date: 05-2018
Emergence of Echovirus Type 13 as a Prominent Enterovirus
Publisher: Oxford University Press (OUP)
Date: 2004
DOI: 10.1086/380462
Abstract: In 2001, increased activity of the rarely detected enterovirus echovirus type 13 (E13) was observed in the United States. This article describes the epidemiologic, clinical, and genetic characteristics of E13 activity in the United States in 2001, compared with E13 activity abroad in 2000-2002. In the United States, E13 accounted for 376 (24%) of the 1584 enterovirus isolates reported in 2001 (29% of the reported isolates had a known serotype), compared with 74 isolates reported during 1970-2000. Five states reported aseptic meningitis outbreaks associated with E13, for a total of 521 cases. All characterized E13 isolates from the United States, Europe, Asia, and Oceania recovered in 2000-2002 were at least 95% identical to each other in VP1 capsid gene sequence, but they were genetically distinct from E13 isolates recovered before 2000. Continued surveillance of enteroviruses is important to alert physicians and public health officials to changes in disease trends and to improve efficiencies of clinical intervention.
Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis
Publisher: Wiley
Date: 11-1999
DOI: 10.1002/(SICI)1099-0496(199911)28:5<321::AID-PPUL3>3.0.CO;2-V
Abstract: The objective of this study was to assess the diagnostic accuracy of oropharyngeal (OP) cultures relative to simultaneous bronchoalveolar lavage (BAL) cultures in very young children with CF, and to examine the effects of bacterial density, age, and study cohort on diagnostic accuracy. Respiratory culture data were analyzed from three independent, prospective studies involving simultaneous collection of 286 OP and BAL cultures from 141 children with CF <5 years of age. For predicting any growth of Pseudomonas aeruginosa (Pa) from the lower airway in subjects /=10(3) or >/=10(5) cfu/mL. Specificity for Pa declined significantly with increasing age. In children with CF <5 years of age, the specificity and negative predictive value of OP cultures for Pa are high, while the sensitivity and positive predictive value are poor. Thus, in this age range, a negative throat culture is helpful in "ruling out" lower airway infection with Pa. However, a positive culture does not reliably "rule in" the presence of Pa in the lower respiratory tract. These findings may have implications for study design and interpretation as well as clinical management of young children with CF.
Safety of bronchoalveolar lavage in young children with cystic fibrosis
Publisher: Wiley
Date: 10-2008
DOI: 10.1002/PPUL.20885
Abstract: Our aim was to determine the safety of BAL in young children <6 years with CF. As part of a multi-center study of BAL-directed therapy, children with CF or=38.5 degrees C and 10 (3%) had clinically significant episodes (five intraoperative hemoglobin desaturations to <90% requiring intervention, one tachyarrhythmia, two needing post-operative supplemental oxygen, one hospitalization for stridor). Two contaminated bronchoscopes were detected. 180 minor adverse events were recorded in 174 (52%) BAL procedures (137 altered cough, 41 fever or=38.5 degrees C. Adverse events are common with BAL in young CF children, but are usually transient and well tolerated. Parents should be counseled that signs of a pre-existing lower respiratory infection are associated with increased risk of post-BAL fever.
Efficacy of oral amoxicillin–clavulanate or azithromycin for non-severe respiratory exacerbations in children with bronchiectasis (BEST-1): a multicentre, three-arm, double-blind, randomised placebo-controlled trial
Publisher: Elsevier BV
Date: 09-2019
Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy
Publisher: Wiley
Date: 06-1996
DOI: 10.1111/J.1440-1754.1996.TB01556.X
Abstract: Varicella causes a mild, self-limiting childhood disease that may reactivate years later as shingles. In immunocompromised patients with altered cell mediated immunity, and rarely in healthy in iduals, varicella results in a life-threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy in iduals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or as treatment of the post-varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.
Systemic bacterial and fungal infections in infants in Australian neonatal units
Publisher: AMPCo
Date: 02-1995
DOI: 10.5694/J.1326-5377.1995.TB126024.X
Abstract: To examine the pattern and incidence of sepsis occurring in neonatal units in Australia. A one-year prospective study of babies with systemic sepsis within 48 hours of birth (early-onset sepsis) or after this time (late-onset sepsis) in seven Australian neonatal units. Systemic sepsis was defined as clinical sepsis, plus either positive bacterial or fungal culture of blood and/or cerebrospinal fluid, or group B streptococcal antigen detected in the urine. There were 241 episodes of sepsis, affecting 234 babies. One quarter (61) were early-onset, a rate of 2.2 per 1000 live births. Group B streptococcus (GBS) was the commonest cause of early-onset sepsis, with a rate of 1.3 per 1000 live births. The incidence of early-onset GBS sepsis was lower at a hospital which screened for maternal carriage and used intrapartum antibiotic prophylaxis for all carriers. The rate of late-onset sepsis was 4.4 per 1000 live births and coagulase-negative staphylococci were the commonest cause. Meningitis occurred in 23% of babies with early-onset and in 10% with late-onset sepsis. The mortality from early-onset sepsis was 15%, and from late-onset sepsis was 9%. There were no major regional variations, other than for GBS. The incidence of and mortality from neonatal sepsis is comparable to other countries, and shows no major regional variation. The use of intrapartum antibiotics may reduce the incidence of neonatal GBS sepsis. There are no previous comparable data on neonatal infections in Australia.
Interference between rhinovirus and other RNA respiratory viruses in the first 2-years of life: A longitudinal community-based birth cohort study
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.JCV.2022.105249
Abstract: Cross-sectional studies report negative associations between rhinovirus and other RNA respiratory viruses. However, longitudinal studies with frequent, serial s ling are needed to identify the directionality of this relationship and its nature. To investigate the association between rhinovirus and other RNA respiratory viruses detected 1-week apart. The Observational Research in Childhood Infectious Diseases cohort study was conducted in Brisbane, Australia (2010-2014). Parents collected nasal swabs weekly from birth until age 2-years. Swabs were analysed by real-time polymerase chain reaction. The association between new rhinovirus detections and five other RNA viruses (influenza, respiratory syncytial virus, parainfluenza viruses, seasonal human coronaviruses, and human metapneumovirus) in paired swabs 1-week apart were investigated. Overall, 157 children provided 8,101 swabs, from which 4,672 paired swabs 1-week apart were analysed. New rhinovirus detections were negatively associated with new pooled RNA respiratory virus detections 1-week later (adjusted odds ratio (aOR) 0.48 95% confidence interval (CI): 0.13-0.83), as were pooled RNA virus detections with new rhinovirus detections the following week (aOR 0.34 95%CI: 0.09-0.60). At the in idual species level, rhinovirus had the strongest negative association with new seasonal human coronavirus detections in the subsequent week (aOR 0.34 95%CI: 0.120.95) and respiratory syncytial virus had the strongest negative association with rhinovirus 1-week later (aOR 0.21 95%CI: 0.050.88). A strong, negative bidirectional association was observed between rhinovirus and other RNA viruses in a longitudinal study of a community-based cohort of young Australian children. This suggests within-host interference between RNA respiratory viruses.
Correction to: Potentially Pathogenic Organisms in Stools and Their Association With Acute Diarrheal Illness in Children Aged <2 Years
Publisher: Oxford University Press (OUP)
Date: 14-07-2022
Children's Bronchiectasis Education Advocacy and Research Network (Child-BEAR-Net): an ERS Clinical Research Collaboration on improving outcomes of children and adolescents with bronchiectasis
Publisher: European Respiratory Society (ERS)
Date: 10-2021
Interference Between Enteric Viruses and Live-Attenuated Rotavirus Vaccine Virus in a Healthy Australian Birth Cohort
Publisher: Oxford University Press (OUP)
Date: 04-04-2023
Abstract: Rotavirus vaccines have reduced effectiveness in high-mortality settings. Interference between enteric viruses and live-attenuated oral vaccine strains may be a factor. In a birth cohort of healthy Australian infants, parents collected weekly stool s les. Three hundred eighty-one paired swabs collected within 10-days of RotaTeq vaccination from 140 infants were tested for 10 enteric viruses and RotaTeq strains. Collectively, both ribonucleic acid and deoxyribonucleic acid viruses were negatively associated with RotaTeq shedding (adjusted odds ratio = 0.29, 95% confidence interval = 0.14–0.58 and adjusted odds ratio = 0.30, 95% confidence interval = 0.11–0.78, respectively). Enteric viruses may interfere with RotaTeq replication in the gut and thus RotaTeq stool shedding.
Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo
Publisher: Springer Science and Business Media LLC
Date: 12-09-2015
DOI: 10.1007/S10096-015-2480-0
Abstract: Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3-6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 % versus 92 %). Adherence ≥70 % (versus <70 %) in the Australian azithromycin group was associated with lower carriage of any pathogen [odds ratio (OR) 0.19, 95 % confidence interval (CI) 0.07-0.53] and fewer macrolide-resistant pathogens (OR 0.34, 95 % CI 0.14-0.81). Post-intervention (median 6 months), macrolide resistance in S. pneumoniae declined significantly in the azithromycin group, from 79 % (11/14) to 7 % (1/14) of positive swabs, but S. aureus strains remained 100 % macrolide resistant. Azithromycin treatment, the Australian remote setting, and adherence <70 % were significant independent determinants of macrolide resistance in children with bronchiectasis. Adherence to treatment may limit macrolide resistance by suppressing carriage.
Protracted bacterial bronchitis: The last decade and the road ahead
Publisher: Wiley
Date: 04-12-2016
DOI: 10.1002/PPUL.23351
Observational Research in Childhood Infectious Diseases (ORChID): a dynamic birth cohort study.
Publisher: BMJ
Date: 2012
Bronchoalveolar Lavage–Directed Therapy in Children With Cystic Fibrosis and <emph type=ital>Pseudomonas aeruginosa</emph> Infection—Reply
Publisher: American Medical Association (AMA)
Date: 26-10-2011
P seudomonas aeruginosa antibiotic resistance in A ustralian cystic fibrosis centres
Publisher: Wiley
Date: 28-12-2015
DOI: 10.1111/RESP.12714
Abstract: In cystic fibrosis (CF), chronic Pseudomonas aeruginosa infection is associated with increased morbidity, antibiotic treatments and mortality. By linking Australian CF registry data with a national microbiological data set, we examined the association between where treatment was delivered, its intensity and P. aeruginosa antibiotic resistance. Sputa were collected from paediatric and adult CF patients attending 18 Australian CF centres. P. aeruginosa antibiotic susceptibilities determined by local laboratories were correlated with clinical characteristics, treatment intensity and infection with strains commonly shared among Australian CF patients. Between-centre differences in treatment and antibiotic resistance were also compared. Large variations in antibiotic usage, maintenance treatment practices and multi-antibiotic resistant P. aeruginosa (MARPA) prevalence exist between Australian CF centres, although the overall proportions of MARPA isolates were similar in paediatric and adult centres (31% vs 35%, P = 0.29). Among paediatric centres, MARPA correlated with intravenous antibiotic usage and the Australian state where treatment was delivered, while azithromycin, reduced lung function and treating state predicted intravenous antibiotic usage. In adult centres, body mass index (BMI) and treating state were associated with MARPA, while intravenous antibiotic use was predicted by gender, BMI, dornase-alpha, azithromycin, lung function and treating state. In adults, P. aeruginosa strains AUST-01 and AUST-02 independently predicted intravenous antibiotic usage. Increased treatment intensity in paediatric centres and the Australian state where treatment was received are both associated with greater risk of MARPA, but not worse clinical outcomes.
Shared Pseudomonas aeruginosa genotypes are common in Australian cystic fibrosis centres
Publisher: European Respiratory Society (ERS)
Date: 09-08-2013
DOI: 10.1183/09031936.00060512
Abstract: Recent molecular-typing studies suggest cross-infection as one of the potential acquisition pathways for Pseudomonas aeruginosa in patients with cystic fibrosis (CF). In Australia, there is only limited evidence of unrelated patients sharing indistinguishable P. aeruginosa strains. We therefore examined the point-prevalence, distribution, ersity and clinical impact of P. aeruginosa strains in Australian CF patients nationally. 983 patients attending 18 Australian CF centres provided 2887 sputum P. aeruginosa isolates for genotyping by enterobacterial repetitive intergenic consensus-PCR assays with confirmation by multilocus sequence typing. Demographic and clinical details were recorded for each participant. Overall, 610 (62%) patients harboured at least one of 38 shared genotypes. Most shared strains were in small patient clusters from a limited number of centres. However, the two predominant genotypes, AUST-01 and AUST-02, were widely dispersed, being detected in 220 (22%) and 173 (18%) patients attending 17 and 16 centres, respectively. AUST-01 was associated with significantly greater treatment requirements than unique P. aeruginosa strains. Multiple clusters of shared P. aeruginosa strains are common in Australian CF centres. At least one of the predominant and widespread genotypes is associated with increased healthcare utilisation. Longitudinal studies are now needed to determine the infection control implications of these findings.
Bronchiectasis: the arrival of better evidence
Publisher: Elsevier BV
Date: 2014
Nasal swab samples and real-time polymerase chain reaction assays in community-based, longitudinal studies of respiratory viruses: the importance of sample integrity and quality control
Publisher: Springer Science and Business Media LLC
Date: 09-01-2014
Distinct patterns of evolution between respiratory syncytial virus subgroups A and B From New Zealand isolates collected over thirty-seven years
Publisher: Wiley
Date: 2006
DOI: 10.1002/JMV.20702
Abstract: Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract infections in infants and children worldwide. In New Zealand, infants with RSV disease are hospitalized at a higher rate than other industrialized countries, without a proportionate increase in known risk factors. The molecular epidemiology of RSV in New Zealand has never been described. Therefore, we analyzed viral attachment glycoprotein (G) gene sequences from 106 RSV subgroup A isolates collected in New Zealand between 1967 and 2003, and 38 subgroup B viruses collected between 1984 and 2004. Subgroup A and B sequences were aligned separately, and compared to sequences of viruses isolated from other countries during a similar period. Genotyping and clustering analyses showed RSV in New Zealand is similar and temporally related to viruses found in other countries. By quantifying temporal clustering, we found subgroup B viruses clustered more strongly than subgroup A viruses. RSV B sequences displayed more variability in stop codon usage and predicted protein length, and had a higher degree of predicted O-glycosylation site changes than RSV A. The mutation rate calculated for the RSV B G gene was significantly higher than for RSV A. Together, these data reveal that RSV subgroups exhibit different patterns of evolution, with subgroup B viruses evolving faster than A.
Childhood bacterial meningitis: Impact of age at illness and acute medical complications on long term outcome
Publisher: Cambridge University Press (CUP)
Date: 03-1997
DOI: 10.1017/S1355617797001471
Abstract: This study compared postmeningitic children ( N = 130) with grade and sex matched controls ( N = 130) selected from target children's schools on measures of intellectual, linguistic, learning, and reading skills. Results showed that children with a history of meningitis are at greater risk for impairment in these areas, with experience of the disease prior to 12 months of age being an important risk factor. Within the postmeningitic s le presence of medical complications was associated with poorer verbal abilities. Finally, a significant relationship was identified between depressed language skills and later educational difficulty, with these findings interpreted with respect to both developmental and neuropsychological principles. ( JINS , 1997, 3 , 147–158.)
Do combined upper airway cultures identify lower airway infections in children with chronic cough?
Publisher: Wiley
Date: 21-04-2019
DOI: 10.1002/PPUL.24336
Abstract: Obtaining lower airway specimens is important for guiding therapy in chronic lung infection but is difficult in young children unable to expectorate. While culture-based studies have assessed the diagnostic accuracy of nasopharyngeal or oropharyngeal specimens for identifying lower airway infection, none have used both together. We compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs with bronchoalveolar lavage (BAL) cultures as the "gold standard" to better inform the diagnosis of lower airway infection in children with chronic wet cough. Nasopharyngeal and oropharyngeal swabs and BAL fluid specimens were collected concurrently from consecutive children undergoing flexible bronchoscopy for chronic cough and cultured for bacterial pathogens. In cultures from 309 children (median age, 2.3 years) with chronic endobronchial suppuration, all main pathogens detected (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) were more prevalent in nasopharyngeal than oropharyngeal swabs (37%, 34%, and 23% vs 21%, 6.2%, and 3.2%, respectively). Positive and negative predictive values for lower airway infection by any of these three pathogens were 63% (95% confidence interval [95% CI] 55, 70) and 85% (95% CI, 78, 91) for nasopharyngeal swabs, 65% (95% CI, 54, 75), and 66% (95% CI, 59, 72) for oropharyngeal swabs, and 61% (95% CI, 54,68), and 88% (95% CI, 81, 93) for both swabs, respectively. Neither nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predicted lower airway infection in children with chronic wet cough. Although upper airway specimens may be useful for bacterial carriage studies and monitoring antimicrobial resistance, their clinical utility in pediatric chronic lung disorders of endobronchial suppuration is limited.
The lower airway microbiota in early cystic fibrosis lung disease: a longitudinal analysis
Publisher: BMJ
Date: 09-03-2017
DOI: 10.1136/THORAXJNL-2016-209279
Abstract: In infants and young children with cystic fibrosis, lower airway infection and inflammation are associated with adverse respiratory outcomes. However, the role of lower airway microbiota in the pathogenesis of early cystic fibrosis lung disease remains uncertain. To assess the development of the lower airway microbiota over time in infants and young children with cystic fibrosis, and to explore its association with airway inflammation and pulmonary function at age 6 years. Serial, semi-annual bronchoscopies and bronchoalveolar lavage (BAL) procedures were performed in infants newly diagnosed with cystic fibrosis following newborn screening. Quantitative microbiological cultures and inflammatory marker (interleukin 8 and neutrophil elastase) measurements were undertaken contemporaneously. 16S ribosomal RNA gene sequencing was conducted on stored BAL s les. Spirometry results recorded at 6 years of age were extracted from medical records. Ninety-five BAL s les provided 16S ribosomal RNA gene data. These were collected from 48 subjects aged 1.2-78.3 months, including longitudinal s les from 27 subjects and 13 before age 6 months. The lower airway microbiota varied, but ersity decreased with advancing age. Detection of recognised cystic fibrosis bacterial pathogens was associated with reduced microbial ersity and greater lower airway inflammation. There was no association between the lower airway microbiota and pulmonary function at age 6 years. In infants with cystic fibrosis, the lower airway microbiota is dynamic. Dominance of the microbiota by recognised cystic fibrosis bacterial pathogens is associated with increased lower airway inflammation, however early microbial ersity is not associated with pulmonary function at 6 years of age.
Palivizumab prophylaxis of respiratory syncytial virus infection in high-risk infants.
Publisher: Wiley
Date: 13-11-2002
DOI: 10.1046/J.1440-1754.2002.00057.X
Abstract: Palivizumab prophylaxis significantly reduces hospitalization for respiratory syncytial virus (RSV) disease in preterm infants. However, palivizumab is very expensive. Data from a New Zealand cost-effectiveness analysis were considered by representatives of the Infectious Diseases and Immunisation, Fetus and Newborn, and Respiratory Committees of the Paediatric Society of New Zealand. Prophylaxis in all high-risk groups was associated with net cost. The consensus panel recommends that the priority for palivizumab be given to babies discharged on home oxygen with chronic lung disease, followed by babies born at 28 weeks or less gestation.
Intrapulmonary pharmacokinetics of antibiotics used to treat nosocomial pneumonia caused by Gram-negative bacilli: A systematic review
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJANTIMICAG.2018.11.011
Abstract: Knowledge of antibiotic concentrations achievable in the epithelial lining fluid (ELF) will help guide antibiotic dosing for treating patients with Gram-negative bacillary ventilator-associated pneumonia (VAP). To compare: (1) the ELF:serum penetration ratio of antibiotics in patients with pneumonia, including VAP, with that in healthy study participants and (2) the ELF and/or tracheal aspirate antibiotic concentrations following intravenous and nebuliser delivery. Web of Science, EMBASE and PubMed databases were searched and a systematic review undertaken. Fifty-two studies were identified. ELF penetration ratios for aminoglycosides and most β-lactam antibiotics administered intravenously were between 0.12 and 0.57, whereas intravenous colistin may be undetectable in the ELF. In contrast, estimated mean fluoroquinolone ELF penetration ratios of up to 1.31 were achieved. Importantly, ELF penetration ratios appear reduced in critically ill patients with pneumonia compared with in healthy volunteers receiving intravenous ceftazidime, levofloxacin and fosfomycin thus, dose adjustment is likely to be required in critically ill patients. In contrast to the systemic administration route, nebulisation of antibiotics achieves high ELF concentrations. Nebulised 400 mg twice-daily amikacin resulted in a median peak ELF steady-state concentration of 976.01 mg/L (interquartile range 410.3-2563.1 mg/L). Similarly, nebulised 1 million international units of colistin resulted in a peak ELF concentration of 6.73 mg/L (interquartile range 4.80-10.10 mg/L). Further pharmacokinetic studies investigating the mechanisms for ELF penetration in infected patients and healthy controls are needed to guide antibiotic dosing in VAP and to determine the potential benefits of nebulised therapy.
A decade on: Follow‐up findings of indigenous children with bronchiectasis
Publisher: Wiley
Date: 25-02-2020
DOI: 10.1002/PPUL.24696
Medication and healthcare use, parent knowledge and cough in children: A cohort study.
Publisher: Wiley
Date: 26-04-2021
DOI: 10.1002/PPUL.25424
Abstract: Cough is an important contributor to the health burden of children and their families. There are limited data describing healthcare utilization and medication use over the course of a cough illness beyond the initial presentation. Our primary objective was to describe medication and healthcare use in children with a respiratory illness with cough as a symptom over the course of the illness. A cohort study of children aged less than 15‐years presenting to three primary healthcare centers and three emergency departments with a cough illness between July 7, 2015 and October 6, 2018. Children with immunosuppression, known chronic lung diseases (except asthma) and those requiring hospitalization at screening were excluded. The primary outcomes were cough‐related frequency and type of healthcare seeking and medication use up to 28 days following enrolment. Data for 465 children were analyzed median age 2.2‐years (interquartile range = 1.1–5.3). Cough at Day 28 persisted in 117 children (25.2%). Overall, 436 (94%) children received medications in the week before and/or 4 weeks following enrolment. Half with upper respiratory tract infections were prescribed antibiotics. Among children with no diagnosis of asthma, reactive airways disease or croup ( n = 404), 16.8% were given steroids. Fifty‐eight percent of children sought healthcare at least once before their baseline presentation (median = 1, range = 0–20) and 49.7% had at least one further presentation in the following 28 days. High healthcare utilization, inappropriate medication use, and suboptimal parent knowledge regarding cough suggests targeted education is needed to improve management and reduce cough burden.
Reduced risk of pertussis in whole-cell compared to acellular vaccine recipients is not confounded by age or receipt of booster-doses
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.VACCINE.2015.08.021
Abstract: Several observational studies provide evidence that acellular pertussis vaccines (aP) are less protective against pertussis disease than highly effective whole-cell pertussis vaccines (wP), however, concerns have been raised that some of these findings may be confounded by age. By undertaking age-stratified and restricted analyses on a cohort of Australian children primed with either aP-only, wP-only or mixed pertussis vaccine schedules, we demonstrate that compared to aP the association of wP with increased protection from pertussis is not confounded by age, nor by aP booster-dose receipt.
Antimicrobial treatment of non-cystic fibrosis bronchiectasis
Publisher: Informa UK Limited
Date: 26-08-2014
DOI: 10.1586/14787210.2014.952282
Abstract: Bronchiectasis unrelated to cystic fibrosis is characterized by chronic wet or productive cough, recurrent exacerbations and irreversible bronchial dilatation. After antibiotics and vaccines became available and living standards in affluent countries improved, its resulting reduced prevalence meant bronchiectasis was considered an 'orphan disease'. This perception has changed recently with increasing use of CT scans to diagnose bronchiectasis, including in those with severe chronic obstructive pulmonary disease or 'difficult to control' asthma, and adds to its already known importance in non-affluent countries and disadvantaged Indigenous communities. Following years of neglect, there is renewed interest in identifying the pathogenetic mechanisms of bronchiectasis, including the role of infection, and conducting clinical trials. This is providing much needed evidence to guide antimicrobial therapy, which has relied previously upon extrapolating treatments used in cystic fibrosis and chronic obstructive pulmonary disease. While many knowledge gaps and management challenges remain, the future is improving for patients with bronchiectasis.
Fatal granulomatous amoebic encephalitis caused by Balamuthia mandrillaris
Publisher: AMPCo
Date: 07-1997
DOI: 10.5694/J.1326-5377.1997.TB138785.X
Abstract: Granulomatous amoebic encephalitis caused by Balamuthia mandrillaris is rare (63 human) cases reported worldwide) and fatal. We report a case in a five-year-old boy who had previously been well. For 18 months, he had had a slowly progressive, granulomatous mid facial lesion, but despite extensive investigation definitive diagnosis was made only with the acute onset of neurological signs in the last two weeks of life, when a brain biopsy specimen revealed amoebic trophozoites and cysts. Infection with B. mandrillaris should be considered in the differential diagnosis of chronic skin lesions with non-specific granulomatous histopathology and negative microbiological test results.
Is there an association between tracheomalacia and bronchiectasis in children?
Publisher: European Respiratory Society
Date: 05-09-2021
The burden of community-managed acute respiratory infections in the first 2-years of life
Publisher: Wiley
Date: 26-05-2016
DOI: 10.1002/PPUL.23480
Abstract: Contemporary information on acute respiratory infections (ARIs) in children is based on hospital cohorts, primary healthcare presentations, and high-risk birth cohort studies. We describe the burden and determinants of symptomatic episodes of ARIs in unselected healthy infants in the first 2-years of life. One hundred and fifty-four infants from subtropical Brisbane, Australia participated in a longitudinal, community-based birth cohort study. A daily tick-box diary captured pre-defined respiratory symptoms. Parents also completed a burden diary, recording family physician and hospital visits, and antibiotic use. Participants contributed 88,032 child-days (78.2% of expected), of which 17,316 (19.7%) days were symptomatic during 1,651 ARI episodes: incidence rate 0.56 ARIs per child-month (95%CI: 0.54, 0.59). Runny nose (14,220 days 6.0-days median duration) and dry cough (6,880 days 4.0-days median duration) were reported most frequently. Overall, 955 burden diaries recorded 455 family physician visits (1-8 visits per ARI) and 48 hospital presentations, including six hospital admissions. Antibiotics were prescribed on 209 occasions (21.9% of ARI episodes where burden diary submitted). Increasing age, non-summer seasons, and attendance at childcare were associated with an increased risk of ARI. ARIs are a common cause of morbidity in the first 2-years of life, with children experiencing 13 discrete ARI episodes and almost 5-months of respiratory symptoms. Most ARIs are managed in the community by parents and family physicians. Antibiotic prescribing remains common for ARIs in young children. Secular societal changes, including greater use of childcare in early childhood, may have maintained the high ARI incidence in this age-group. Pediatr Pulmonol. 2016 :1336-1346. © 2016 Wiley Periodicals, Inc.
The Initial Timing and Burden of Viral Gastrointestinal Infections in Australian Infants: A Birth Cohort Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-09-2022
DOI: 10.1097/MPG.0000000000003309
Abstract: The timing and nature of initial infections by potentially vaccine-preventable gastrointestinal viruses (group-F adenoviruses, classic human astrovirus, norovirus I/II, and sapovirus I/II/IV/V) was investigated in a community-based birth cohort. Weekly stool s les were collected from 158 children aged years in an Australian subtropical city. Median age at initial infection was lowest for norovirus II (13.8 months) followed by sapovirus (14.3 months) and classic human astrovirus (17.6 months), and was months for the remaining viruses. Norovirus II and sapovirus were most often associated with acute gastroenteritis symptoms (57% and 44%, respectively). Overall, healthcare was sought for 45% of symptomatic initial infections, which varied between 17% for norovirus I to 55% for norovirus II. Age at initial infection was lower when participants were exposed to other children. Norovirus II and sapovirus were the most important pathogens in this cohort, providing further evidence for them being priority targets for vaccine development.
A cross-sectional survey of influenza A infection, and management practices in small rural backyard poultry flocks in two regions of New Zealand
Publisher: Informa UK Limited
Date: 04-2010
DOI: 10.1080/00480169.2010.65086
Abstract: To obtain baseline data on the management of small non-commercial backyard poultry flocks, in two rural regions of New Zealand, to investigate potential transmission pathways for avian influenza (AI), and to investigate the presence of AI in these flocks. During August-October 2006 a questionnaire was sent to 105 farms in the Bay of Plenty and Wairarapa with poultry flocks comprising fewer than 50 chickens, located near wetlands where AI virus had been detected previously in wild ducks. Information was collected on the number and species of poultry reared, opportunities for interaction between wild birds and poultry, farm biosecurity measures, and health status of poultry. Between September and November 2006, blood and tracheal/cloacal swabs were collected from poultry on a subset of 12 high-risk farms in each location. Influenza A-specific antibodies in sera were assayed using ELISA, and positive sera were further tested for the presence of H5 and H7 subtype-specific antibodies, using haemagglutination inhibition (HI) assay. The presence of influenza A virus in swabs was detected using real-time reverse transcriptase-PCR (RRT-PCR). Returned questionnaires were received from 54 farms. Overall, 80% had only chickens, 13% chickens and ducks, and 7% had chickens and other galliform species. Nearly all (96%) kept backyard chickens for personal consumption of eggs, with a small proportion (19%) preparing birds for the table. On surveyed farms wild waterfowl were seen on pastures (70%) and/or farm waterways (46%). Waterfowl were recorded as visiting areas where domestic birds were kept on 31% of farms. Bird litter and manure were composted (94%) or buried (6%) on-farm, as were most (82%) dead birds. During the targeted cross-sectional survey of 24 farms clinical disease was not recorded in any poultry flock. Of 309 chicken sera tested, 11 (3.6%) from five farms across both regions tested positive for influenza A antibodies. In contrast, 16/54 (30%) duck sera from three farms in the Wairarapa were positive. Avian influenza H5 and H7 subtype-specific antibodies were excluded in ELISA positive sera using HI testing, and influenza A virus was not detected using RRT-PCR. The study confirmed that small backyard poultry flocks located near waterfowl habitats were exposed to non-notifiable low-pathogenic AI viruses. Findings indicate a number of potential risk pathways for the transmission of AI viruses between wild birds and non-commercial poultry, and hence the need for continued surveillance for AI in backyard flocks and wild birds in New Zealand.
Impact and effectiveness of childhood varicella vaccine program in Queensland, Australia
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.VACCINE.2017.05.013
Abstract: In November 2005, Australia introduced a publicly funded single dose of varicella vaccine for children aged 18-months. We describe the impact of this program on varicella hospitalisations in Queensland and provide the first assessment of single-dose varicella vaccine effectiveness in Australia since the program commenced. Age-standardised varicella hospitalisation rates were calculated for 2000-2014 and pre- and post-public funding period rates compared. Case-control studies were conducted to investigate the association between vaccine receipt and both varicella hospitalisations and uncomplicated varicella emergency department presentations. Cases were matched to controls from a population-based register by date of birth and state of residence. Vaccine effectiveness was calculated as (1-odds ratio)×100%. Compared to the pre-funded period (2000-2003), age-standardised varicella hospitalisation rates declined by more than 70% in 2011-2014 with varicella principal diagnosis rates declining from 5.7 to 1.6 per 100,000 population per year. Varicella vaccine effectiveness at preventing hospitalisation with a principal diagnosis of varicella among children aged 19-months to 6-years was 81.9% (95% confidence interval: 61.8-91.4%), while for emergency department presentations among children aged 19-months to 8-years it was 57.9% (95% confidence interval: 48.5-65.5%). In Australia, the single-dose varicella vaccination program has substantially reduced varicella morbidity. The single-dose varicella vaccine schedule is moderately-to-highly effective against hospitalisation, but appears less effective against emergency department presentations.
Bronchiectasis in Indigenous children in remote Australian communities
Publisher: Wiley
Date: 08-2002
DOI: 10.5694/J.1326-5377.2002.TB04733.X
Abstract: The rates of bronchiectasis for Indigenous children from remote Australian communities are unacceptably high, with one study showing 14.7/1000 Aboriginal children. Children with bronchiectasis need to be identified early for optimisation of medical treatment. Under-reporting of cough is common. Bronchiectasis should be suspected in children with recurrent bronchitis or pneumonia, and when, despite appropriate therapy, pulmonary infiltrates or atelectasis persist 12 weeks beyond the index illness. During acute infective episodes, oral antibiotics and chest physiotherapy to clear the airways should produce prompt resolution otherwise, hospitalisation is necessary. Management follows the cystic fibrosis model of regular review, encouragement of physical activity, optimising nutrition, maintenance of immunisation and avoidance of environmental toxicants, including passive smoke exposure. Successful management and prevention of bronchiectasis will require improvements in housing, nutrition, and education, as well as access to comprehensive healthcare services, with coordination between primary and hospital-based healthcare providers.
The NICE-GUT trial protocol: a randomised, placebo controlled trial of oral nitazoxanide for the empiric treatment of acute gastroenteritis among Australian Aboriginal children
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-019632
Abstract: Diarrhoeal disease is the second leading cause of death in children under 5 years globally, killing 525 000 annually. Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children suffer a high burden of disease. Randomised trials in other populations suggest nitazoxanide accelerates recovery for children with Giardia , amoebiasis, Cryptosporidium, Rotavirus and Norovirus gastroenteritis, as well as in cases where no enteropathogens are found. This double blind, 1:1 randomised, placebo controlled trial is investigating the impact of oral nitazoxanide on acute gastroenteritis in hospitalised Australian Aboriginal children aged 3 months to years. Dosing is based on age-based dosing. The primary endpoint is the time to resolution of ‘significant illness’ defined as the time from randomisation to the time of clinical assessment as medically ready for discharge, or to the time of actual discharge from hospital, whichever occurs first. Secondary endpoints include duration of hospitalisation, symptom severity during the period of significant illness and following treatment, duration of rehydration and drug safety. Patients will be followed for medically significant events for 60 days. Analysis is based on Bayesian inference. Subgroup analysis will occur by pathogen type (bacteria, virus or parasite), rotavirus vaccination status, age and illness severity. Ethics approval has been granted by the Central Australian Human Research Ethics Committee (HREC-14–221) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC2014-2172). Study investigators will ensure that the trial is conducted in accordance with the principles of the Declaration of Helsinki. In idual participant consent will be obtained. Results will be disseminated via peer-reviewed publication. ACTRN12614000381684.
Prevalence of Helicobacter pylori infection in asymptomatic children
Publisher: Wiley
Date: 12-1995
DOI: 10.1111/J.1440-1754.1995.TB00879.X
Abstract: To determine the prevalence of Helicobacter pylori infection in a s le of asymptomatic Australian children. A prospective observational study, during a 3 month period, of consecutive children aged 0 to 14 years undergoing minor elective surgical procedures in a Day Surgical Unit at a Melbourne paediatric hospital. Subjects without gastrointestinal symptoms or a family history of peptic ulcers had sociodemographic data recorded and serum collected. Serum anti-H. pylori immunoglobulin G antibodies were measured by an enzyme immunoabsorbent assay previously validated in children from the same population. H. pylori antibodies were present in 21/147 (14.3%) children aged 3 months to 14 years. Prevalence was not influenced by age or sex, but was greatest in children whose parents migrated from developing nations and lowest in children with Caucasian Australian or Western European parents (25.8 vs 5.9% P < 0.001). An inverse relationship between social class and infection was also observed (P = 0.02). Multivariate analysis demonstrated the father's ethnic background as the only significant independent risk factor for H. pylori infection (P = 0.002). Although seroprevalence of H. pylori appears to be lower in Australian children than in developing countries there are some ethnic groups at substantially greater risk for the acquisition of H. pylori infection and its complications.
Histo-blood group antigens and rotavirus vaccine virus shedding in Australian infants
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.PATHOL.2022.04.006
Abstract: Rotavirus vaccine performance varies between high and low income countries. One possible explanation is inherited histo-blood group antigens (HBGAs) the expression of which differs between populations. HBGAs are polymorphic glycans on mucosal surfaces. Their presence indicates the secretor phenotype, while their absence identifies a non-secretor status. HBGAs can act as rotavirus receptors and might influence live-attenuated rotavirus vaccine virus replication and shedding. Studies in low and middle income countries of the human rotavirus vaccine Rotarix (RV1), suggest HBGA secretor phenotype is important for vaccine immunogenicity. We investigated in a high income country the association between HBGA phenotype (secretor and Lewis) and the bovine-human reassortment vaccine RotaTeq (RV5) vaccine shedding in the stools of infants following each vaccine dose. Eighty-two infants from an Australian birth cohort provided saliva and weekly stool s les after RV5 vaccination doses. Lewis and secretor HBGA phenotyping was identified from saliva s les and confirmed by genotyping. Vaccine virus strains were detected by real-time polymerase chain reaction assays. No significant association between secretor status and vaccine virus shedding was identified. The proportion of infants who shed rotavirus following the first RV5 dose for secretor and non-secretor infants was 57/64 (89%) and 17/18 (94%), respectively, decreasing to 24/64 (33%) and 9/18 (50%) after the second dose and 26/64 (42%) and 8/18 (44%) following the third vaccine dose, respectively. Similarly, no significant differences were observed in vaccine virus shedding by Lewis, or combined Lewis and secretor status, after each vaccine dose. We found HBGAs were not associated with RV5 vaccine virus shedding in Australian infants.
Interlobar differences in bronchoalveolar lavage fluid from children with cystic fibrosis
Publisher: European Respiratory Society (ERS)
Date: 02-2001
DOI: 10.1183/09031936.01.17202810
Abstract: Bronchoalveolar lavage (BAL) performed in specialist centres has improved the understanding of infant cystic fibrosis (CF) lung disease. As most researchers s le from a single lobe, it was determined whether BAL results could be generalized to other lung segments. Thirty-three CF children, aged 1.5–57 months, underwent in random order sequential BAL of their right middle and lingula lobes. Specimens from each lobe had separate quantitative bacteriology, cytology and cytokine analysis. Bacterial counts ≥1×10 5 colony forming units (cfu)·mL −1 were observed in nine (27%) subjects, including six involving only the right middle lobe. These six children had similar inflammatory indices in their right middle and lingula lobes, and interleukin (IL)-8 concentrations in the latter were significantly higher than that observed within the lingula lobes of the 24 CF children with bacterial counts ×10 5 cfu·mL −1 . Lingula neutrophil and IL-8 levels correlated best with right middle lobe bacteria numbers. This observational study in cystic fibrosis children suggests that while inflammation is detected in both lungs, bacterial distribution may be more inhomogeneous. Bronchoalveolar lavage microbiological findings from a single lobe may therefore, not be generalized to other lung segments. When performing bronchoalveolar lavage in cystic fibrosis children, it is important to s le from multiple sites.
Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment
Publisher: Elsevier BV
Date: 07-2023
Vesicoureteral reflux: An accurate predictor of acute pyelonephritis in childhood urinary tract infection?
Publisher: Radiological Society of North America (RSNA)
Date: 02-1994
DOI: 10.1148/RADIOLOGY.190.2.8284391
Abstract: To determine the association between vesicoureteral reflux (VUR) and the presence of acute pyelonephritis in children with urinary tract infections. The authors studied 150 consecutive patients less than 5 years of age with their first proved urinary tract infection. All patients underwent renal cortical scintigraphy (with technetium-99m dimercaptosuccinic acid or Tc-99m gluconate) and voiding cystourethrography (VCUG) to identify the presence of cortical defects and VUR, respectively. Of 300 kidneys, 88 (29.3%) had a cortical defect at scintigraphy. Fifty-four of the 88 patients (61%) did not have VUR demonstrated at VCUG. Conversely, 72 of the 300 kidneys (24%) had VUR of these, 38 (53%) had no cortical defect. The sensitivity of VCUG in helping predict a defect was 38.6%, and the specificity was 82.1%. VUR (as shown by VCUG) and renal cortical scintigraphic defects frequently occur independently of each other. Renal cortical scintigraphy may be a more accurate predictor of patients at risk for scarring.
Defining lower airway bacterial infection in children with chronic endobronchial disorders
Publisher: Wiley
Date: 19-12-2018
DOI: 10.1002/PPUL.23931
Clostridium sordellii infection and toxin neutralization
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-1990
Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand
Publisher: Wiley
Date: 02-03-2023
DOI: 10.1111/RESP.14479
Abstract: This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi‐disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early this requires awareness of bronchiectasis symptoms and its co‐existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed‐tomography scan, using age‐appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop in idualized management plans that include a multi‐disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality‐of‐life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. In idualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14‐day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. In idualize therapy for long‐term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6‐monthly monitoring for complications and co‐morbidities. Undertake optimal care of under‐served peoples, and despite its challenges, delivering best‐practice treatment remains the overriding aim.
Pharmacist-led smoking cessation intervention in Australian primary care targeting smokers at risk of developing COPD
Publisher: Wiley
Date: 03-2018
DOI: 10.1111/RESP.13267
Early-onset group B streptococcal disease in a risk factor-based prevention setting: A 15-year population-based study
Publisher: Wiley
Date: 11-09-2019
DOI: 10.1111/AJO.12891
Abstract: Intrapartum chemoprophylaxis reduces early-onset group B streptococcal disease (EOGBSD) in newborns. Some guidelines advise that intrapartum antibiotics should be offered following universal antenatal screening for GBS carriage and others recommend intrapartum antibiotics based on clinical risk factors alone. Since 1999, Queensland guidelines have recommended a risk factor-based approach. We examined trends in EOGBSD rates over time in Queensland in the setting of these guidelines and whether management of cases reflected the recommendations. A state-wide retrospective search of pathology databases, allowing near-complete, population-based case identification, was conducted to detect live-born infants from January 2000 to December 2014 with GBS cultured from blood or cerebrospinal fluid within seven days of age. A nested audit of EOGBSD cases comparing two epochs, 2000-2010 and 2011-2014, was performed to determine patient characteristics and guideline adherence for each case. Mean incidence of EOGBSD in Queensland from 2000 to 2014 was 0.33 per 1000 live births (SD± 0.08) with no changing trend over time. The case-mortality rate in the 2011-2014 epoch was 1.2% compared to 11.9% in 2000-2004 (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.002-0.67). The proportion of EOGBSD cases who were preterm infants decreased from 29.8% to 13.3% (OR 0.36, 95% CI 0.14-0.84). Of cases with risk factors in the 2011-2014 epoch, 46% received intrapartum antibiotics compared to 25% in 2000-2004 (OR 2.49, 95% CI 0.86-7.58, P = 0.09). EOGBSD incidence rate in Queensland remained low during 2000-2014. However, both the 2011-2014 case-mortality rate and the proportion of preterm cases significantly decreased. Missed opportunities for intrapartum chemoprophylaxis remain.
Cost of hospitalization for bronchiectasis exacerbation in children
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/RESP.13828
Effect of Definitions of Acute Gastroenteritis Episodes Using Symptom Diaries in Paediatric Cohorts: A Systematic Review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
DOI: 10.1097/MPG.0000000000002584
Abstract: Estimates of acute gastroenteritis (AGE) burden are difficult to compare between studies because of inconsistent definitions describing this illness. AGE definitions used in prospective, community-based childhood cohort studies were identified by searching databases for studies that collected daily observations of AGE symptoms. Disease definitions and refractory periods were extracted. Data from the Australian community-based Observational Research in Childhood Infectious Diseases birth cohort were used to calculate AGE incidence and duration using identified AGE definitions, and the World Health Organization definition for diarrhoea. Eight distinct AGE definitions were identified. All included loose stools and 7 included vomiting as symptoms. The refractory period separating episodes ranged from 1 to 21 days. When applied to the Observational Research in Childhood Infectious Diseases dataset, AGE incidence ranged from 0.8 to 2.6 episodes per child-year-at-risk, a 3-fold relative difference. Direct comparisons of rates from different cohorts can only be undertaken if a standard definition for AGE is adopted.
A new dawn: inhaled antibiotics for patients with bronchiectasis
Publisher: Elsevier BV
Date: 03-2019
Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): A multicentre, double-blind, randomised controlled trial
Publisher: Elsevier BV
Date: 10-2013
Absence of an Important Vaccine and Diagnostic Target in Carriage- and Disease-Related Nontypeable Haemophilus influenzae.
Publisher: American Society for Microbiology
Date: 27-11-2014
DOI: 10.1128/CVI.00632-13
Abstract: Nontypeable Haemophilus influenzae (NTHi)-associated disease is a major health problem globally. Whole-genome sequence analysis identified the absence of hpd genes encoding Haemophilus protein D in 3 of 16 phylogenetically distinct NTHi isolates. This novel finding is of potential clinical significance, as protein D and hpd represent important NTHi vaccine antigen and diagnostic targets, respectively.
The social network of cystic fibrosis centre care and shared Pseudomonas aeruginosa strain infection: A cross-sectional analysis
Publisher: Elsevier BV
Date: 08-2015
Risk factors for adverse outcomes of bacterial meningitis
Publisher: Wiley
Date: 10-1996
DOI: 10.1111/J.1440-1754.1996.TB00949.X
Abstract: To identify risk factors for adverse outcomes from bacterial meningitis. From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5-9 years following their illness. Major adverse outcomes included B/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age 24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age 24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities. As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.
Necrotizing pneumonia: an emerging problem in children?
Publisher: Springer Science and Business Media LLC
Date: 25-07-2017
The point prevalence of respiratory syncytial virus in hospital and community-based studies in children from Northern Australia: studies in a ‘high-risk’ population
Publisher: Rural and Remote Health
Date: 24-11-2019
DOI: 10.22605/RRH5267
Streptococcal pharyngitis in a paediatric emergency department
Publisher: Wiley
Date: 10-1996
DOI: 10.5694/J.1326-5377.1996.TB138577.X
Abstract: To determine the prevalence and clinical features of beta-haemolytic streptococcal infection in children with acute pharyngitis and thereby to define those requiring antibiotic therapy. Prospective 2:1 case--control study. Emergency Medicine Department of the Royal Children's Hospital, Melbourne, between May 1994 and May 1995. Cases (n = 271) were the first 10 self-referred children in each week with pharyngitis and no antibiotic use in the previous week. Controls (n = 135) were age-matched children without infection. Presence of groups A, C or G beta-haemolytic streptococci in oropharyngeal cultures demographic and clinical characteristics. Group A beta-haemolytic streptococci (GABHS) were isolated from significantly more case than control children (cases, 57/271 [21%] controls, 9/135 [7%] odds ratio [OR], 3.7 P or = 4 years, tender cervical lymph nodes, pharyngotonsillitis, absent coryza and scarlatiniform rash were significantly associated with GABHS (P < 0.02). GABHS was uncommon in children aged or = 4 years with a rash (86%). However, most cases lacked a rash, and for children > or = 4 years likelihood of GABHS varied from 10%-65%, depending on other clinical features. In children aged or = 4 years, the likelihood of GABHS being the cause of acute pharyngitis increases with presence of scarlatiniform rash, pharyngotonsillitis and tender cervical nodes.
Saksenaeae subcutaneous abscess in an immunocompetent child
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Long-term effects of pneumonia in young children
Publisher: Springer Science and Business Media LLC
Date: 27-10-2015
The airway microbiota in early cystic fibrosis lung disease
Publisher: Wiley
Date: 16-08-2017
DOI: 10.1002/PPUL.23782
Abstract: Infection plays a critical role in the pathogenesis of cystic fibrosis (CF) lung disease. Over the past two decades, the application of molecular and extended culture-based techniques to microbial analysis has changed our understanding of the lungs in both health and disease. CF lung disease is a polymicrobial disorder, with obligate and facultative anaerobes recovered alongside traditional pathogens in varying proportions, with some differences observed to correlate with disease stage. While healthy lungs are not sterile, differences between the lower airway microbiota of in iduals with CF and disease-controls are already apparent in childhood. Understanding the evolution of the CF airway microbiota, and its relationship with clinical treatments and outcome at each disease stage, will improve our understanding of the pathogenesis of CF lung disease and potentially inform clinical management. This review summarizes current knowledge of the early development of the respiratory microbiota in healthy children and then discusses what is known about the airway microbiota in in iduals with CF, including how it evolves over time and where future research priorities lie.
The pathogenesis of Pseudomonas aeruginosa lung infections in cystic fibrosis
Publisher: Wiley
Date: 02-1992
DOI: 10.1111/J.1440-1754.1992.TB02609.X
Abstract: We investigated whether interferon-gamma (IFN-gamma), interferon-alpha (IFN-alpha) and glucocorticoids affected the adhesion of T cells to human umbilical endothelial cells or human synovial cells. About 30% of peripheral blood T cells could bind to unstimulated endothelial cells, but only a few T cells could bind to unstimulated synovial cells. When both endothelial cells and synovial cells were cultured with recombinant IFN-gamma (rIFN-gamma), the percentage of T cell binding to both types of cells increased in a dose-dependent manner. rIFN-alpha and dexamethasone blocked the T cell binding to unstimulated endothelial cells. Furthermore, rIFN-alpha and dexamethasone suppressed T cell binding to both endothelial cells and synovial cells stimulated by IFN-gamma, and also inhibited intercellular adhesion molecule-1 (ICAM-1) expression on both endothelial cells and synovial cells stimulated by IFN-gamma. These results suggest that IFN-alpha and glucocorticoids may inhibit T cell binding to endothelial cells or synovial cells by modulating adhesion molecule expression on these cells.
Population transcript accumulation of Pseudomonas aeruginosa exotoxin A, elastase and alginate in bronchoalveolar lavage fluid from infants with cystic fibrosis
Publisher: Springer Science and Business Media LLC
Date: 04-1999
Position Paper: Chemoprophylaxis for Haemophilus and meningococcal infections
Publisher: Wiley
Date: 02-1994
Long-term Azithromycin in Children With Bronchiectasis Unrelated to Cystic Fibrosis
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.CHEST.2022.08.2216
Abstract: Following evidence from randomized controlled trials, patients with bronchiectasis unrelated to cystic fibrosis receive long-term azithromycin to reduce acute respiratory exacerbations. However, the period when azithromycin is effective and which patients are likely to most benefit remain unknown. (i) What is the period after its commencement when azithromycin is most effective? and (ii) Which factors may modify azithromycin effects? A secondary analysis was conducted of our previous randomized controlled trial involving 89 indigenous children with bronchiectasis unrelated to cystic fibrosis. Semi-parametric Poisson regression identified the azithromycin efficacy period. Multivariable Poisson regression identified factors that modify azithromycin effect. Azithromycin was associated with fewer exacerbations per child-week during weeks 4 through 96, with the most effective period observed between weeks 17 and 62. Eleven factors were associated with different azithromycin effects four were significant at the P < .05 level. Compared with their counterparts, higher reduction in exacerbations was observed in children with nasopharyngeal carriage of bacterial pathogens (incidence rate ratio [IRR] = 0.81 [95% CI, 0.57-1.14] vs 0.29 [0.20-0.44] P < .001) New Zealand children (IRR = 0.73 [0.51-1.03] vs 0.39 [0.28-0.55] P = .012) and those with higher weight-for-height z scores (interaction IRR = 0.82 [0.67-0.99] P = .044). Compared with their counterparts, lower reduction was observed in those born preterm (IRR = 0.41 [0.30-0.55] vs 0.74 [0.49-1.10] P = .012). Regular azithromycin is best used for at least 17 weeks and up to 62 weeks, as these periods provide maximum benefit for indigenous children with bronchiectasis unrelated to cystic fibrosis. Several factors modified azithromycin benefits however, these traits need confirmation in larger studies before being adopted into clinical practice. Australian New Zealand Clinical Trials Registry ACTRN12610000383066.
Early markers of cystic fibrosis structural lung disease: follow-up of the ACFBAL cohort
Publisher: European Respiratory Society (ERS)
Date: 16-01-2020
DOI: 10.1183/13993003.01694-2019
Abstract: Little is known about early predictors of later cystic fibrosis (CF) structural lung disease. This study examined early predictors of progressive structural lung abnormalities in children who completed the Australasian CF Bronchoalveolar Lavage (ACFBAL) clinical trial at age 5-years and participated in an observational follow-up study (CF-FAB). Eight Australian and New Zealand CF centres participated in CF-FAB and provided follow-up chest computed-tomography (CT) scans for children who had completed the ACFBAL study with baseline scans at age 5-years. CT scans were annotated using PRAGMA-CF scoring. Ordinal regression analysis and linear regression were used to investigate associations between PRAGMA-CF (Perth–Rotterdam Annotated Grid Morphometric Analysis for CF) outcomes at follow-up and variables measured during the ACFBAL study. 99 out of 157 ACFBAL children (mean± sd age 13±1.5 years) participated in the CF-FAB study. The probability of bronchiectasis at follow-up increased with airway disease severity on the baseline CT scan. In multiple regression (retaining factors at p .05) the extent of bronchiectasis at follow-up was associated with baseline atelectasis (OR 7.2, 95% CI 2.4–22 p≤ 0.001), bronchoalveolar lavage (BAL) log 2 interleukin (IL)-8 (OR 1.2, 95% CI 1.05–1.5 p=0.010) and body mass index z-score (OR 0.49, 95% CI 0.24–1.00 p=0.05) at age 5 years. Percentage trapped air at follow-up was associated with BAL log 2 IL-8 (coefficient 1.3, 95% CI 0.57–2.1 p .001) at age 5 years. The extent of airway disease, atelectasis, airway inflammation and poor nutritional status in early childhood are risk factors for progressive structural lung disease in adolescence.
Rotavirus vaccines must perform in low-income countries too
Publisher: Elsevier BV
Date: 11-2007
Active surveillance of serious adverse drug reactions in New Zealand children: Table 1
Publisher: BMJ
Date: 06-05-2012
Impact and risk analysis for the Namoi subregion Product 3-4 for the Namoi subregion from the Northern Inland Catchments Bioregional Assessment
Publisher: CSIRO
Date: 2018
Association of childhood tracheomalacia with bronchiectasis: a case–control study
Publisher: BMJ
Date: 14-10-2021
DOI: 10.1136/ARCHDISCHILD-2021-322578
Abstract: Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis. Single-centre, case–control study. 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT. The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement ( % expiratory reduction in the cross-sectional luminal area). Cases were younger (median age=2.6 years, IQR 1.5–4.1) than controls (7.8 years, IQR 3.4–12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (OR adj )=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (OR adj =24.4, 95% CI 3.4 to infinity). Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic ( weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.
Rotavirus hospitalisation in New Zealand children under 3 years of age
Publisher: Wiley
Date: 30-03-2006
DOI: 10.1111/J.1440-1754.2006.00829.X
Abstract: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool s les tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003-009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4% P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100,000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons.
Central nervous system tuberculosis after resolution of miliary tuberculosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1998
DOI: 10.1097/00006454-199806000-00019
Abstract: In the multicenter, non-randomized, exploratory
Detection of viruses in weekly stool specimens collected during the first 2 years of life: A pilot study of five healthy Australian infants in the rotavirus vaccine era
Publisher: Wiley
Date: 09-11-2016
DOI: 10.1002/JMV.24716
Adaptive resistance to tobramycin in Pseudomonas aeruginosa lung infection in cystic fibrosis
Publisher: Oxford University Press (OUP)
Date: 1996
Abstract: Aminoglycoside antibiotics have been shown to induce adaptive resistance in Pseudomonas aeruginosa in vitro and in a mouse model of infection, but adaptive resistance has not been described in human infections. Seven patients with cystic fibrosis were treated with inhaled tobramycin to determine whether adaptive resistance occurred in P. aeruginosa in their sputum. In three patients who had not recently taken antibiotics, 80 mg tobramycin was administered by nebuliser and resulting peak sputum tobramycin concentrations were 90-240 mg/L (elimination half-life 1.9-2.1 h). Adaptive resistance was detected in P. aeruginosa 1-4 h after the dose of tobramycin. Moderate resistance was present at 24 h and full susceptibility returned between 24 and 48 h. In four other patients on long-term twice-daily inhaled aminoglycoside treatment, adaptive resistance was present before, and 4 h after, 80 mg of tobramycin administered by nebuliser. The presence and time course of adaptive resistance in humans may have implications for improving aminoglycoside dosing regimens.
COMPARISON OF ROTAVIRUS IMMUNOGLOBULIN-A COPROCONVERSION WITH OTHER INDEXES OF ROTAVIRUS INFECTION IN A LONGITUDINAL-STUDY IN CHILDHOOD
Publisher: American Society for Microbiology
Date: 06-1990
DOI: 10.1128/JCM.28.6.1367-1374.1990
Abstract: In order to determine the sensitivity and reliability of antirotaviral fecal immunoglobulin A (IgA) as an indicator of rotavirus reinfection, the antibody responses to rotavirus of 44 infants with severe rotavirus gastroenteritis recruited on admission to a hospital were studied. Feces were collected daily during hospitalization and weekly thereafter, and sera were obtained every 4 months, for 6 to 32 months (median, 17 months). Antirotaviral IgG, IgA, and IgM were measured by enzyme immunoassay in all s les. Rotavirus antigen, rotavirus-neutralizing antibody, and total IgA were measured in feces. The results showed that use of an IgA index (ratio of specific IgA to total IgA) was unnecessary to identify copro-IgA conversion to rotavirus. The other markers of rotavirus infection tested showed a high level of predictive accuracy of coproconversion in rotavirus-neutralizing antibody. Copro-IgM, serum IgM, and virus in feces were insensitive measures of neutralizing antibody coproconversion. Seroconversion in IgG or IgA was detected in 46% of neutralizing coproconversions. The most sensitive marker, present in 92% of neutralizing coproconversions, was antirotaviral fecal IgA conversion. This correlation of fecal IgA with fecal neutralizing antibody suggests that coproconversions in IgA represent true elevations in antirotaviral IgA with neutralizing capacity. A coproconversion in IgA appears to indicate genuine rotavirus infection. Copro-IgA conversions in feces collected weekly are likely to be more sensitive markers of rotavirus reinfection than are seroconversion and virus detection combined in epidemiological studies of acute diarrhea in children and in rotavirus vaccine trials.
Low rates of Pseudomonas aeruginosa misidentification in isolates from cystic fibrosis patients
Publisher: American Society for Microbiology
Date: 05-2009
DOI: 10.1128/JCM.00014-09
Abstract: Pseudomonas aeruginosa is an important cause of pulmonary infection in cystic fibrosis (CF). Its correct identification ensures effective patient management and infection control strategies. However, little is known about how often CF sputum isolates are falsely identified as P. aeruginosa . We used P. aeruginosa -specific duplex real-time PCR assays to determine if 2,267 P. aeruginosa sputum isolates from 561 CF patients were correctly identified by 17 Australian clinical microbiology laboratories. Misidentified isolates underwent further phenotypic tests, lified rRNA gene restriction analysis, and partial 16S rRNA gene sequence analysis. Participating laboratories were surveyed on how they identified P. aeruginosa from CF sputum. Overall, 2,214 (97.7%) isolates from 531 (94.7%) CF patients were correctly identified as P. aeruginosa . Further testing with the API 20NE kit correctly identified only 34 (59%) of the misidentified isolates. Twelve (40%) patients had previously grown the misidentified species in their sputum. Achromobacter xylosoxidans ( n = 21), Stenotrophomonas maltophilia ( n = 15), and Inquilinus limosus ( n = 4) were the species most commonly misidentified as P. aeruginosa . Overall, there were very low rates of P. aeruginosa misidentification among isolates from a broad cross section of Australian CF patients. Additional improvements are possible by undertaking a culture history review, noting colonial morphology, and performing stringent oxidase, DNase, and colistin susceptibility testing for all presumptive P. aeruginosa isolates. Isolates exhibiting atypical phenotypic features should be evaluated further by additional phenotypic or genotypic identification techniques.
Virulence factor expression patterns in Pseudomonas aeruginosa strains from infants with cystic fibrosis
Publisher: Springer Science and Business Media LLC
Date: 07-07-2013
DOI: 10.1007/S10096-013-1916-7
Abstract: Pseudomonas aeruginosa is the leading cause of morbidity and mortality in cystic fibrosis (CF). This study examines the role of organism-specific factors in the pathogenesis of very early P. aeruginosa infection in the CF airway. A total of 168 longitudinally collected P. aeruginosa isolates from children diagnosed with CF following newborn screening were genotyped by pulsed-field gel electrophoresis (PFGE) and phenotyped for 13 virulence factors. Ninety-two strains were identified. Associations between virulence factors and gender, exacerbation, persistence, timing of infection and infection site were assessed using multivariate regression analysis. Persistent strains showed significantly lower pyoverdine, rhamnolipid, haemolysin, total protease, and swimming and twitching motility than strains eradicated by aggressive antibiotic treatments. Initial strains had higher levels of virulence factors, and significantly higher phospholipase C, than subsequent genotypically different strains at initial isolation. Strains from males had significantly lower pyoverdine and swimming motility than females. Colony size was significantly smaller in strains isolated during exacerbation than those isolated during non-exacerbation periods. All virulence factors were higher and swimming motility significantly higher in strains from bronchoalveolar lavage (BAL) and oropharyngeal sites than BAL alone. Using unadjusted regression modelling, age at initial infection and age at isolation of a strain showed U-shaped profiles for most virulence factors. Among subsequent strains, longer time since initial infection meant lower levels of most virulence factors. This study provides new insight into virulence factors underpinning impaired airway clearance seen in CF infants, despite aggressive antibiotic therapy. This information will be important in the development of new strategies to reduce the impact of P. aeruginosa in CF.
Differences in the lower airway microbiota of infants with and without cystic fibrosis
Publisher: Elsevier BV
Date: 09-2019
Comparison of DNA Extraction Methods for Microbial Community Profiling with an Application to Pediatric Bronchoalveolar Lavage Samples
Publisher: Public Library of Science (PLoS)
Date: 13-04-2012
COMPARISON OF SERUM AND MUCOSAL ANTIBODY-RESPONSES FOLLOWING SEVERE ACUTE ROTAVIRUS GASTROENTERITIS IN YOUNG-CHILDREN
Publisher: American Society for Microbiology
Date: 04-1988
DOI: 10.1128/JCM.26.4.732-738.1988
Abstract: The development of mucosal immunity is presumed to be the most important marker of rotavirus infection. The practical difficulties of obtaining small-bowel secretions stimulated this study of the antibody response to acute rotavirus infection at other sites. Forty-four infants admitted to the hospital with rotavirus gastroenteritis had serum, saliva, and feces collected at the acute phase (median, 5.5 days), during convalescence (median, 33.5 days), and 4 months later (median, 12.2 weeks). A subgroup of 19 children also had duodenal juice collected in parallel. Rotavirus-specific immunoglobulin G (IgG), IgA, secretory immunoglobulin, and IgM were measured and compared in all s les. The results showed that the estimation of antirotavirus serum IgM, serum IgG, duodenal juice IgA, and duodenal juice IgM by an enzyme immunoassay indicated an immune response to severe primary rotavirus infection in all children. Four months later, the levels of serum IgG and IgA served as the most sensitive markers of the preceding rotavirus infection. The predictive accuracies of immune responses at different sites in relation to a positive IgA immune response in the duodenum were calculated. Fecal IgA predicted duodenal IgA rotavirus antibodies with accuracies of 86% at 1 month and 92% at 4 months. The high sensitivity of serum IgM and IgG in detecting rotavirus infection and the high predictive accuracy of fecal IgA as an indicator of duodenal IgA abrogates the need for duodenal intubation to detect (or monitor) an immune response to rotavirus infection. This finding has important practical implications for epidemiological studies of acute diarrhea in children and in rotavirus vaccine trials.
Prevention of Neonatal Group B Streptococcal Sepsis: Is Routine Antenatal Screening Appropriate
Publisher: Wiley
Date: 05-1995
DOI: 10.1111/J.1479-828X.1995.TB01853.X
Abstract: Four strategies for prevention of early onset neonatal group B streptococcal (GBS) sepsis were considered: A: routine antenatal screening for GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antibiotic prophylaxis for all carriers B: screening as above and prophylaxis only for carriers with risk factors for sepsis C: prophylaxis for all women with risk factors D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for each option were: the proportion of women given prophylaxis the risk of anaphylaxis cases of neonatal GBS sepsis and deaths prevented costs of screening, prophylaxis and of acute care of remaining cases. Published local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evaluated. Any of the proposed strategies can prevent a significant proportion of cases of neonatal GBS sepsis and a strategy for prevention of neonatal group B streptococcal sepsis should be part of routine obstetric practice. Strategy C is simple, effective, inexpensive and avoids unnecessary antibiotic use it is recommended particularly when antenatal care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cases, but at greater cost which could be justified only if protocols can be properly implemented and monitored.
Paediatric and adult bronchiectasis: Vaccination in prevention and management
Publisher: Wiley
Date: 26-11-2018
DOI: 10.1111/RESP.13446
Abstract: Bronchiectasis has received increased attention recently, including an emphasis on preventing infective exacerbations that are associated with disease progression and lung function decline. While there are several bacteria and viruses associated with bronchiectasis, licensed vaccines are only currently available for Streptococcus pneumoniae, Haemophilus influenzae (H. influenzae protein D as a conjugate in a pneumococcal vaccine), Mycobacterium tuberculosis, Bordetella pertussis and influenza virus. The evidence for the efficacy and effectiveness of these vaccines in both preventing and managing bronchiectasis in children and adults is limited with the focus of most research being on other chronic lung disorders, such as chronic obstructive pulmonary diseases, asthma and cystic fibrosis. We review the existing evidence for these vaccines in bronchiectasis and highlight the existing gaps in knowledge. High-quality experimental and non-experimental studies using current state-of-the-art microbiological methods and validated, standardised case definitions are needed across the depth and breadth of the vaccine development pathway.
Association between vaccination status, symptom identification and healthcare use: Implications for test negative design observational studies
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.VACCINE.2022.02.049
Abstract: To test the internal validity of the test-negative design (TND) by investigating associations between maternal influenza vaccination, and new virus detection episodes (VDEs), acute respiratory illness, and healthcare visits in their children. Eighty-five children from a birth cohort provided daily symptoms, weekly nasal swabs, and healthcare use data until age 2-years. Effect estimates are summarised as incidence rate ratios (IRR). There was no association between maternal vaccination and VDEs in children (IRR = 1.1 95 %CI = 0.9-1.2). Influenza-vaccinated mothers were more likely than unvaccinated mothers to both report, and seek healthcare for, acute lower respiratory illness in their children, IRR = 2.4 95 %CI = 1.2-4.8 and IRR = 2.2 95 %CI = 1.1-4.3, respectively. A key assumption of the TND, that healthcare seeking behaviour for conditions of the same severity is not associated with vaccine receipt, did not hold. Further studies of the performance of the TND in different populations are required to confirm its validity.
Variation in erythromycin and clindamycin resistance patterns between New Zealand and Australian group B streptococcus isolates.
Publisher: Wiley
Date: 16-03-2011
Azithromycin Prescribing by Respiratory Pediatricians in Australia and New Zealand for Chronic Wet Cough: A Questionnaire-Based Survey
Publisher: Frontiers Media SA
Date: 02-09-2020
Bronchiectasis exacerbation study on azithromycin and amoxycillin-clavulanate for respiratory exacerbations in children (BEST-2): study protocol for a randomized controlled trial.
Publisher: Springer Science and Business Media LLC
Date: 2013
Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into australia's national childhood vaccine schedule
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
Inclusion of a pentavalent rotavirus vaccine in the New Zealand childhood immunisation schedule
Publisher: Elsevier BV
Date: 05-2007
Bacteraemia in febrile children presenting to a paediatric emergency department
Publisher: AMPCo
Date: 05-1999
DOI: 10.5694/J.1326-5377.1999.TB127847.X
Abstract: To determine the prevalence of bacteraemia in young febrile children presenting to a paediatric emergency department. Prospective observational case study. Emergency Department of the Royal Children's Hospital, Melbourne, between May 1996 and May 1997. Patients aged 3-36 months presenting to the Emergency Department with temperature > or = 39 degrees C and without specific viral illnesses (varicella, croup or herpes gingivostomatitis). Bacteraemia (defined as presence of pathogenic bacteria in a blood culture), white blood cell count (WCC), McCarthy score, and final diagnosis based on clinical features and investigations. Bacteraemia was identified in 18 of 534 patients (3.4%). Pathogens isolated were Streptococcus pneumoniae (15), Neisseria meningitidis (2) and Klebsiella pneumoniae (1). Increased WCC counts (P < 0.001) and brief duration of fever (P or = 20 x 10(9)/L) had or = 39 degrees C without a clinical focus have a viral infection. However, 3%-4% have occult bacteraemia. Neither clinical features nor high WCC counts reliably identify these patients. As empiric antibiotics may contribute to increasing antibiotic resistance and have not been shown to prevent the rare complication of meningitis, we believe that close contact and regular review of these patients is preferable to empiric antibiotic therapy.
Epidemiology of Norovirus in the First 2 Years of Life in an Australian Community-based Birth Cohort
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-10-2022
Quantitative PCR confirms culture as the gold standard for detection of lower airway infection by nontypeable Haemophilus influenzae in Australian Indigenous children with bronchiectasis
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.MIMET.2012.12.013
Abstract: Correlation was observed between quantitative PCR and semi-quantitative culture for definition of Haemophilus influenzae infection in bronchoalveolar lavage specimens from 81 children with bronchiectasis. However, qPCR data correlated less well with airway neutrophilia, and supports continued use of culture as the gold standard for defining H. influenzae lower airway infection.
Sapovirus Infections in an Australian Community-Based Healthy Birth Cohort During the First 2 Years of Life
Publisher: Oxford University Press (OUP)
Date: 31-10-2022
DOI: 10.1093/CID/CIAC861
Abstract: Sapovirus is an important cause of acute gastroenteritis (AGE) in young children. However, knowledge gaps remain in community settings. We investigated the epidemiology, disease characteristics, and healthcare use associated with sapovirus infections in Australian children during their first 2 years of life. Children in the Brisbane-based Observational Research in Childhood Infectious Diseases birth cohort provided daily gastrointestinal symptoms (vomiting/loose stools), weekly stool swabs, and healthcare data until age 2 years. Swabs were batch-tested for sapovirus using real-time polymerase chain reaction assays. Incidence rates and estimates of associations were calculated. Overall, 158 children returned 11 124 swabs. There were 192 sapovirus infection episodes. The incidence rate in the first 2 years of life was 0.89 infections per child-year (95% confidence interval [CI], .76–1.05), and the symptomatic incidence rate was 0.26 episodes per child-year (95% CI, .17–.37). Age ≥6 months, the fall season, and childcare attendance increased disease incidence significantly. Fifty-four of the 180 (30%) infections with linked symptom diaries were symptomatic, with 72% recording vomiting and 48% diarrhea. Prior infection reduced risk of further infections (adjusted hazard ratio, 0.70 [95% CI, .54–.81]) in the study period. Viral loads were higher and viral shedding duration was longer in symptomatic than asymptomatic children. Twenty-three (43%) symptomatic episodes required healthcare, including 6 emergency department presentations and 2 hospitalizations. Sapovirus infections are common in Australian children aged 6–23 months. Efforts to reduce childhood AGE after the global rollout of rotavirus vaccines should include sapovirus where estimates of its incidence in communities will be crucial.
The likelihood of preventing respiratory exacerbations in children and adolescents with either chronic suppurative lung disease or bronchiectasis
Publisher: Frontiers Media SA
Date: 24-03-2017
Genotypic Diversity within a Single Pseudomonas aeruginosa Strain Commonly Shared by Australian Patients with Cystic Fibrosis
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
RESISTANCE TO CIPROFLOXACIN OF RESPIRATORY PATHOGENS IN PATIENTS WITH CYSTIC-FIBROSIS
Publisher: AMPCo
Date: 05-1992
DOI: 10.5694/J.1326-5377.1992.TB121473.X
Abstract: To determine the incidence of resistance to ciprofloxacin in respiratory pathogens isolated from patients with cystic fibrosis (CF) compared with that of isolates from patients without CF. The hypothesis was that repeated exposure of these respiratory pathogens to ciprofloxacin would reduce their sensitivity. Isolates of Pseudomonas aeruginosa and Staphylococcus aureus were obtained prospectively from sputa of patients with CF, as part of their routine care. The sensitivities of these isolates to ciprofloxacin were determined by standard agar dilution techniques. The study was carried out in patients who attended the outpatient clinic or were treated as inpatients of a tertiary referral hospital. Sputa were obtained from 71 patients with CF (age range, 2-31 years) and isolates of P. aeruginosa and S. aureus were compared with those from 54 hospital patients who did not have CF. Sensitivities to ciprofloxacin, expressed as the minimal concentrations required to inhibit growth of the organisms (MIC), were used to make comparisons between different isolates and the same isolates within patients at different times. A higher incidence of ciprofloxacin resistance was displayed by isolates of P. aeruginosa from CF patients who had been previously prescribed ciprofloxacin (MIC50 of 2.0 mg/L and 4.0 mg/L for mucoid and non-mucoid strains respectively). The MIC of in idual organisms tended to rise after a course of ciprofloxacin had been given to their host. A much lower incidence of resistance was displayed by isolates of P. aeruginosa from patients without CF (MIC50, 0.25 mg/L). Similarly, S. aureus isolates from patients with CF exhibited greater resistance to ciprofloxacin (MIC50, 32 mg/L) than isolates from other patients (MIC50, 0.75 mg/L). The resistance of P. aeruginosa appears to be related to ciprofloxacin exposure, so further development of resistance may be diminished by restricting the frequency of ciprofloxacin administration to in idual patients.
Surfactant Composition in Infants and Young Children with Cystic Fibrosis
Publisher: American Thoracic Society
Date: 07-1997
DOI: 10.1164/AJRCCM.156.1.9609090
Abstract: We tested the hypothesis that the composition of bronchial surfactant is normal in infants with cystic fibrosis (CF) in the absence of active lung disease but that it is altered by lower respiratory tract infection and inflammation. We examined the total phospholipid (PL), disaturated phospholipid (DSP), surfactant protein-A (SP-A), surfactant protein B (SP-B), and surface activity in bronchoalveolar lavage fluid from 27 subjects with CF whose mean age was 22.7 (SD 14.5) mo. Six infants with stridor served as non-CF controls. Twelve of the subjects with CF (CF-I group) had evidence of active pulmonary infection or inflammation which was absent in the remaining 15 subjects (CF-NI group). We found no differences in the surfactant composition or activity between controls and the CF-NI group. In contrast, the DSP/PL ratio was lower in the CF-I subjects than in both the CF-NI subjects (p = 0.05) and controls (p < 0.01) suggesting a disturbance of surfactant function. SP-A concentrations were higher in the CF-I group compared to the other two groups (p < 0.05). These results suggest that the bronchial surfactant of infants with CF is altered following lower airway infection and inflammation and is not a primary abnormality associated with this disorder.
Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a north American outbreak
Publisher: Oxford University Press (OUP)
Date: 07-08-2012
DOI: 10.1093/CID/CIS672
Classical Kawasaki disease in a neonate
Publisher: BMJ
Date: 03-2002
DOI: 10.1136/FN.86.2.F135
Abstract: A case is reported of classical Kawasaki disease in an infant younger than 2 weeks of age. Echocardiography detected a coronary artery aneurysm on the fifth day of the illness. Administration of intravenous gamma globulin resulted in rapid improvement. Kawasaki disease is rare in neonates, but it may follow a rapid and severe course.
Renal tuberculosis in an Australian‐born child
Publisher: Wiley
Date: 06-1998
DOI: 10.1046/J.1440-1754.1998.00219.X
Abstract: This report describes a case of renal tuberculosis, complicated by hypertension and ureteric obstruction, in a previously well Australian born child. Despite antituberculous chemotherapy and ureteric stenting, there was a progressive loss of renal function in the right kidney until surgical nephrectomy allowed full recovery. A high level of clinical suspicion is necessary for a diagnosis of genitourinary tuberculosis. Ureteric cicatrisation and obstruction occasionally may occur with healing, and therefore serial renal tract imaging during treatment is necessary to detect this complication.
Serum aspartate aminotransferase levels after rotavirus gastroenteritis
Publisher: Elsevier BV
Date: 04-1988
DOI: 10.1016/S0022-3476(88)80179-3
Abstract: We report a case of small bowel ischemia secondary to sickle cell disease. Acute bowel ischemia is an uncommon presentation of patients with sickle cell disease. Historically, only a handful of cases have been reported. We also provide a summary of the literature relevant to sickle cell patients with acute bowel ischemia.
Mucosal and systemic antibody responses to potentialPseudomonas aeruginosavaccine protein antigens in young children with cystic fibrosis following colonization and infection
Publisher: Informa UK Limited
Date: 18-03-2013
DOI: 10.4161/HV.23226
Severe viral respiratory infections in infants with cystic fibrosis
Publisher: Wiley
Date: 12-1998
DOI: 10.1002/(SICI)1099-0496(199812)26:6<371::AID-PPUL1>3.0.CO;2-N
Abstract: Limited data in children with cystic fibrosis (CF) suggest that respiratory viral infections during infancy result in substantial morbidity. Eighty of 101 (79%) infants with CF diagnosed by neonatal screening during 1991-1996 were recruited into a prospective, multiple-birth cohort study. We aimed to perform an initial, then annual bronchoalveolar lavage (BAL) for bacterial and viral culture, cytology, IL-8, and elastolytic activity over the following 2 years. When possible, BAL was also performed during any hospitalization for a pulmonary exacerbation, and additional specimens for viral culture were collected by nasopharyngeal aspiration. Thirteen infants undergoing bronchoscopy for congenital stridor served as disease controls. During infancy, 31 children (39%) were hospitalized for respiratory disease and 20 (65%) cases had an etiologic agent identified. Respiratory viruses were detected in 16/31 (52%) cases, including four with simultaneous bacterial infection. Another four were infected with Staphylococcus aureus. Respiratory syncytial virus predominated and was found in seven infants. In the absence of bacteria, those with viral infections had acute onset of respiratory distress, were not treated with antibiotics, and had an uncomplicated hospital course. Compared to noninfected CF subjects and controls, infected infants had elevated BAL inflammatory indices (P < 0.01). Eleven of 31 (35%) hospitalized infants followed for 12-60 months acquired Pseudomonas aeruginosa, compared with only three of 49 (6%) subjects not hospitalized for respiratory symptoms during infancy (risk ratio 5.8, CI 1.9, 24). We conclude that respiratory viruses are important causes of hospitalization in CF infants. While viral infections were self-limited, they were accompanied by airway inflammatory changes, and admission to hospital was associated with early acquisition of Pseudomonas aeruginosa and persistent respiratory symptoms.
Mycobacterium chelonae soft‐tissue infection in an immunocompetent child
Publisher: Wiley
Date: 29-12-2022
DOI: 10.1111/JPC.16310
Global Review of the Age Distribution of Rotavirus Disease in Children Aged <5 Years Before the Introduction of Rotavirus Vaccination
Publisher: Oxford University Press (OUP)
Date: 28-01-2019
DOI: 10.1093/CID/CIZ060
Abstract: We sought datasets with granular age distributions of rotavirus-positive disease presentations among children years of age, before the introduction of rotavirus vaccines. We identified 117 datasets and fit parametric age distributions to each country dataset and mortality stratum. We calculated the median age and the cumulative proportion of rotavirus gastroenteritis events expected to occur at ages between birth and 5.0 years. The median age of rotavirus-positive hospital admissions was 38 weeks (interquartile range [IQR], 25–58 weeks) in countries with very high child mortality and 65 weeks (IQR, 40–107 weeks) in countries with very low or low child mortality. In countries with very high child mortality, 69% of rotavirus-positive admissions in children years of age were in the first year of life, with 3% by 10 weeks, 8% by 15 weeks, and 27% by 26 weeks. This information is critical for assessing the potential benefits of alternative rotavirus vaccination schedules in different countries and for monitoring program impact.
Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?
Publisher: Wiley
Date: 2003
DOI: 10.1046/J.1440-1754.2003.00069.X
Abstract: To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement. Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random s le of these admissions were reviewed. Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001). Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.
Pseudomonas aeruginosa transmission is infrequent in New Zealand cystic fibrosis clinics
Publisher: European Respiratory Society (ERS)
Date: 12-2008
DOI: 10.1183/09031936.00099508
Abstract: Pseudomonas aeruginosa is an important pathogen in cystic fibrosis (CF). Although most patients harbour unique P. aeruginosa isolates, some clinics report patients sharing common strains. The overall importance of person-to-person transmission in P. aeruginosa acquisition and whether routine patient segregation is necessary remains uncertain. The present authors therefore investigated the extent of P. aeruginosa transmission in New Zealand CF clinics. New Zealand's seven major CF centres were assessed, combining epidemiological data with computer-assisted SalI DNA fingerprinting of 496 isolates from 102 patients. One cluster of related isolates was significantly more prevalent in the largest clinic than expected by chance. The seven patients with isolates belonging to this cluster had more contact with each other than the remaining patients attending this centre. No other convincing evidence of transmission was found in any of the other smaller clinics. Three P. aeruginosa strains believed to be transmissible between patients in Australian and British CF clinics are present in New Zealand, but there was no definite evidence they had spread. Pseudomonas aeruginosa transmission is currently infrequent in New Zealand cystic fibrosis clinics. This situation could change rapidly and ongoing surveillance is required. The current results confirm that computer-assisted SalI DNA fingerprinting is ideally suited for such surveillance.
Multi-centre ethics and research governance review can impede non-interventional clinical research
Publisher: Wiley
Date: 06-2019
DOI: 10.1111/IMJ.14158
Abstract: The inter-jurisdictional National Mutual Acceptance (NMA) scheme for Human Research Ethics Committee (HREC) approvals of human research is designed to reduce the reported delays and costs of ethical review. Introduction of the NMA set forth an uncoupling of the ethics and governance review processes, permitting a single ethical review for multiple sites, while continuing separate governance review for each centre covering financial and operational aspects of the research project. To compare the time required to gain ethics and governance approvals in Australia for a non-interventional investigator-led study from December 2015 to approval times for an earlier pre-NMA study utilising a similar study design and study sites and evaluate the effect that the NMA has had on total approval time for non-interventional multi-centre projects. We recorded the time taken to obtain ethics and governance approval at 16 sites for our nationwide low-risk non-interventional study looking at the prevalence and aetiology of non-tuberculous mycobacterial infection in people with cystic fibrosis in Australia. Applications were submitted to three hospitals and one university HREC to conduct our study at 16 hospital sites, HREC approval took from 16 to 79 days (median 28). Subsequent site-specific governance approval at 15 hospital sites took 23-225 days (median 83). The entire process of gaining ethical and governance approval to conduct the study at 16 sites took 24 months at an estimated cost of AU$56000 (US$ 42 000). Lengthy governance approval processes negate benefits gained from centralised ethics review under the NMA.
Probiotics for preventing acute otitis media in children
Publisher: Wiley
Date: 31-01-2018
Type 3 secretion system effector genotype and secretion phenotype of longitudinally collected Pseudomonas aeruginosa isolates from young children diagnosed with cystic fibrosis following newborn scree
Publisher: Elsevier BV
Date: 03-2013
Sonographic measurement of renal enlargement in children with acute pyelonephritis and time needed for resolution: Implications for renal growth assessment
Publisher: American Roentgen Ray Society
Date: 08-1995
DOI: 10.2214/AJR.165.2.7618567
Abstract: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.
Quality standards for managing children and adolescents with bronchiectasis: an international consensus
Publisher: European Respiratory Society (ERS)
Date: 09-2022
DOI: 10.1183/20734735.0144-2022
Abstract: The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients’ survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.
Longitudinal Nasopharyngeal Carriage and Antibiotic Resistance of Respiratory Bacteria in Indigenous Australian and Alaska Native Children with Bronchiectasis
Publisher: Public Library of Science (PLoS)
Date: 05-08-2013
Febrile Seizures in the Era of Rotavirus Vaccine
Publisher: Oxford University Press (OUP)
Date: 13-10-2016
DOI: 10.1093/JPIDS/PIU097
Abstract: A protective association between rotavirus vaccination and childhood seizures in the year after vaccination was recently reported from the United States. In the state of Queensland, Australia, the authors found that rotavirus vaccine was 35.8% and 38.0% effective at preventing emergency department presentation and subsequent hospitalization, respectively, for febrile seizures among children up to two years following vaccination.
HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: Protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-026411
Abstract: Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode. This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two- ided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are ‘clinical cure’ at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria. The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research Auckland: Starship Children’s and KidsFirst Hospitals East Malaysia: Likas Hospital and Sarawak General Hospital Kuala Lumpur: University of Malaya Research Ethics Committee and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication. ACTRN12616000046404.
Extended Versus Standard Antibiotic Course Duration in Children <5 Years of Age Hospitalized With Community-acquired Pneumonia in High-risk Settings: Four-week Outcomes of a Multicenter, Double-blind, Parallel, Superiority Randomized Controlled Trial.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-06-2022
Lower Airway Inflammation in Infants with Cystic Fibrosis Detected by Newborn Screening
Publisher: Wiley
Date: 2005
DOI: 10.1002/PPUL.20294
Abstract: Controversy exists over whether the lower airway inflammation that characterizes cystic fibrosis (CF) is initiated primarily by the genetic defect. To determine if inflammation precedes infection, we examined bronchoalveolar lavage (BAL) fluid cytology, cytokines (interleukin (IL)-1beta, IL-4, IL-5, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha), and free neutrophil elastase activity from 70 CF (aged 1.5-71 months) children detected by newborn screening and 19 (aged 2.0-48 months) controls with chronic stridor. CF subjects were selected and categorized as pristine (13 aged /= 10(5) colony-forming units/ml of pathogenic bacteria in BAL), and uninfected (15 aged > 6 months, asymptomatic, not taking antibiotics at bronchoscopy, and free of pathogens in their BAL). To further resolve if inflammation develops without infection, inflammatory mediators in paired annual BAL s les from 38 CF subjects were measured, and results were grouped according to whether BAL showed persistence (n = 6), acquisition (n = 8), clearance (n = 13), or absence (n = 11) of infection. While pristine, uninfected, and control subjects had similar BAL profiles, infected patients showed elevated inflammatory indices, including increased IL-10 (P < 0.001). Pristine subjects had the fewest signs of inflammation. Analysis of BAL pairs found differences between the four infection groups for changes in neutrophil percentages, IL-8 (P < 0.001), and free neutrophil elastase (P = 0.009). Infection was associated with elevated inflammatory mediators in BAL fluid. In contrast, minimal or reduced signs of inflammation accompanied absence of eradication of infection from BAL fluid. We conclude that in CF, infection initiates and sustains airway inflammation.
Clinical utilization of genomics data produced by the international Pseudomonas aeruginosa consortium
Publisher: Frontiers Media SA
Date: 29-09-2015
Culture and PCR detection of Haemophilus influenzae and Haemophilus haemolyticus in Australian indigenous children with bronchiectasis
Publisher: American Society for Microbiology
Date: 07-2012
DOI: 10.1128/JCM.00566-12
Abstract: A PCR for protein D (hpd#3) was used to differentiate nontypeable Haemophilus influenzae (NTHI) from Haemophilus haemolyticus . While 90% of nasopharyngeal specimens and 100% of lower-airway specimens from 84 Indigenous Australian children with bronchiectasis had phenotypic NTHI isolates confirmed as H. influenzae , only 39% of oropharyngeal specimens with phenotypic NTHI had H. influenzae . The nasopharynx is therefore the preferred site for NTHI colonization studies, and NTHI is confirmed as an important lower-airway pathogen.
Rotavirus Infections and Vaccines
Publisher: Springer Science and Business Media LLC
Date: 08-2010
DOI: 10.2165/11537200-000000000-00000
Abstract: Rotaviruses are the most common cause of severe gastroenteritis in children. By 5 years of age virtually every child worldwide will have experienced at least one rotavirus infection. This leads to an enormous disease burden, where every minute a child dies because of rotavirus infection and another four are hospitalized, at an annual societal cost in 2007 of $US2 billion. Most of the annual 527 000 deaths are in malnourished infants living in rural regions of low and middle income countries. In contrast, most measurable costs arise from medical expenses and lost parental wages in high income countries. Vaccines are the only public health prevention strategy likely to control rotavirus disease. They were developed to mimic the immunity following natural rotavirus infection that confers protection against severe gastroenteritis and consequently reduces the risk of primary healthcare utilization, hospitalization and death. The two currently licensed vaccines--one a single human strain rotavirus vaccine, the other a multiple strain human-bovine pentavalent reassortant rotavirus vaccine--are administered to infants in a two- or three-dose course, respectively, with the first dose given at 6-14 weeks of age. In various settings they are safe, immunogenic and efficacious against many different rotavirus genotypes. In high and middle income countries, rotavirus vaccines confer 85-100% protection against severe disease, while in low income regions of Africa and Asia, protection is less, at 46-77%. Despite this reduced efficacy in low income countries, the high burden of diarrheal disease in these regions means that proportionately more severe cases are prevented by vaccination than elsewhere. Post-licensure effectiveness studies show that rotavirus vaccines not only reduce rotavirus activity in infancy but they also decrease rates of rotavirus diarrhea in older and unimmunized children. A successful rotavirus vaccination program will rely upon sustained vaccine efficacy against erse and evolving rotavirus strains and efficient vaccine delivery systems. The potential introduction of rotavirus vaccines into the world's poorest countries with the greatest rates of rotavirus-related mortality is expected to be very cost effective, while rotavirus vaccines should also be cost effective by international standards when incorporated into developed countries immunization schedules. Nonetheless, cost effectiveness in each country still depends largely on the local rotavirus mortality rate and the price of the vaccine in relation to the per capita gross domestic product.
Legacy of bacterial meningitis in infancy - Many children continue to suffer functionally important deficits
Publisher: BMJ
Date: 08-09-2001
Characterization of the Phase-Variable Autotransporter Lav Reveals a Role in Host Cell Adherence and Biofilm Formation in Nontypeable Haemophilus influenzae
Publisher: American Society for Microbiology
Date: 21-04-2022
DOI: 10.1128/IAI.00565-21
Abstract: Lav is an autotransporter protein found in pathogenic Haemophilus and Neisseria species. Lav in nontypeable Haemophilus influenzae (NTHi) is phase-variable: the gene reversibly switches ON-OFF via changes in length of a locus-located GCAA (n) simple DNA sequence repeat tract. The expression status of lav was examined in carriage and invasive collections of NTHi, where it was predominantly not expressed (OFF). Phenotypic study showed lav expression (ON) results in increased adherence to human lung cells and denser biofilm formation.
Does failed chronic wet cough response to antibiotics predict bronchiectasis?
Publisher: BMJ
Date: 12-02-2014
DOI: 10.1136/ARCHDISCHILD-2013-304793
Abstract: To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis. All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression. Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10-199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86 95% CI 1.20 to 28.5). Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.
An Analysis of Miscible Displacement and Numerical Modelling of Glyphosate Transport in Three Different Agricultural Soils
Publisher: MDPI AG
Date: 30-09-2023
Total bacterial load, inflammation, and structural lung disease in paediatric cystic fibrosis
Publisher: Elsevier BV
Date: 11-2020
Successful treatment of cepacia syndrome
Publisher: Elsevier BV
Date: 07-2009
Staphylococcus aureus infections in Australasian neonatal nurseries
Publisher: BMJ
Date: 07-2004
The Burden of Childhood Pneumonia in the Developed World
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland
Publisher: AMPCo
Date: 08-2009
DOI: 10.5694/J.1326-5377.2009.TB02727.X
Abstract: To assess the impact of introducing a publicly funded infant rotavirus vaccination program on disease notifications and on laboratory testing and results. Retrospective analysis of routinely collected data (rotavirus notifications [2006-2008] and laboratory rotavirus testing data from Queensland Health laboratories [2000-2008]) to monitor rotavirus trends before and after the introduction of a publicly funded infant rotavirus vaccination program in Queensland in July 2007. Age group-specific rotavirus notification trends number of rotavirus tests performed and the proportion positive. In the less than 2 years age group, rotavirus notifications declined by 53% (2007) and 65% (2008) the number of laboratory tests performed declined by 3% (2007) and 15% (2008) and the proportion of tests positive declined by 45% (2007) and 43% (2008) compared with data collected before introduction of the vaccination program. An indirect effect of infant vaccination was seen: notifications and the proportion of tests positive for rotavirus declined in older age groups as well. The publicly funded rotavirus vaccination program in Queensland is having an early impact, direct and indirect, on rotavirus disease as assessed using routinely collected data. Further observational studies are required to assess vaccine effectiveness. Parents and immunisation providers should ensure that all Australian children receive the recommended rotavirus vaccine doses in the required timeframe.
Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2001
DOI: 10.1097/00006454-200103000-00004
Abstract: To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily (OD) gentamicin dosing in children with severe urinary tract infections (UTI). An open, randomized, controlled trial comparing OD with three times daily (TD) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI. Daily doses (milligrams per kg per day) of gentamicin in both groups were 7.5 ( 10 years old). There were 179 children enrolled (90 OD, 89 TD). Baseline clinical characteristics and pathogens were similar, except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group. Median gentamicin treatment durations were 3.0 (OD) and 2.7 (TD) days. Mean peak gentamicin concentrations were 17.3 (OD) vs. 6.4 (TD) mg/l 99% of peak concentrations were >7 mg/l in the OD group whereas 16% of peak concentrations were or = 2 mg/l, whereas in the TD group only 0.7% were > or = 2 mg/l. Age or prior elevated peak concentrations did not predict high trough concentrations. Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination. There were no clinical or bacteriologic failures. The two disease-related complications were confined to the OD group. No nephro- or ototoxicity was identified. With age-appropriate dosing and measurement of serum trough concentrations before the second dose, OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years.
Meteorological factors and respiratory syncytial virus seasonality in subtropical Australia
Publisher: Cambridge University Press (CUP)
Date: 21-03-2018
DOI: 10.1017/S0950268818000614
Abstract: Evidence is emerging regarding the influence of meteorological factors on seasonal respiratory syncytial virus outbreaks. Data however, are limited for subtropical regions, especially in the southern hemisphere. We examined whether meteorological data (daily minimum and maximum temperatures, rainfall, relative humidity, dew point, daily global solar exposure) and tourist numbers were associated with the incidence of RSV in children aged years for the Gold Coast region of South-East Queensland, Australia (latitude 28.0°S). RSV cases between 1 July 2007 and 30 June 2016 were identified from the Pathology Queensland Gold Coast Laboratory database. Time-series methods were used to identify seasonal patterns. RSV activity peaked in mid-to-late autumn (April–May), tapering in winter (June–August). While most meteorological variables measured were associated with RSV incidence, rainfall ( ρ = 0.40, 95% confidence interval (CI) 0.32–0.48) and humidity ( ρ = 0.38, 95% CI 0.29–0.46) 8 weeks earlier had the nearest temporal relationship. Tourist numbers were not correlated with RSV activity. Identifying meteorological conditions associated with seasonal RSV epidemics can improve understanding of virus transmission and assist planning for their impact upon the health sector, including timing of passive RSV immunoprophylaxis for high-risk infants and future public health interventions, such as maternal immunisation with RSV vaccines.
LOWER RESPIRATORY-INFECTION AND INFLAMMATION IN INFANTS WITH NEWLY-DIAGNOSED CYSTIC-FIBROSIS
Publisher: BMJ
Date: 17-06-1995
Persistent renal cortical scintigram defects in children 2 years after urinary tract infection
Publisher: Springer Science and Business Media LLC
Date: 22-04-2004
DOI: 10.1007/S00247-004-1182-Z
Abstract: Renal cortical scintigraphic studies challenge the role of vesicoureteric reflux in renal scar development, emphasizing instead the part played by acute pyelonephritis. To determine the prevalence of renal cortical defects in a child cohort 2 years after the child's first diagnosed urinary tract infection and to analyze the relationship of these defects with acute illness variables, primary vesicoureteric reflux and recurrent infections. In a prospective cohort study, 193 children younger than 5 years with their first proven urinary tract infection underwent renal sonography, voiding cystourethrogram, and renal cortical scintigraphy within 15 days of diagnosis. Two years later, 150 of the 193 children, or 77.7%, had a further renal cortical scintigram, including 75, or 86.2%, of the 87 children who had acute scintigraphic defects. The relationship of cortical defects to age, gender, pre-treatment symptom duration, hospitalization, presence and grade of vesicoureteric reflux, and recurrent urinary tract infections was evaluated. Overall, 20 of the 150 (13.3% 95% confidence interval (CI) 8.3, 19.8) children had persistent defects 2 years after infection. This included 20 of 75 (26.7% 95% CI 17.1, 38.1) with initially abnormal scintigrams. No new defects were detected. Although acute defects were more common in the young, those with persistent defects were older (median ages 16.4 vs. 6.8 months, P=0.004) than those with transient abnormalities. After adjustment for age, persistent defects were no longer associated with gender and were not predicted by acute illness variables, primary vesicoureteric reflux or recurrent infections. Renal cortical scintigraphic defects persisted in approximately one-quarter of young children after their first proven urinary tract infection. The associated clinical features, however, failed to predict scar formation. It is possible that some of the scintigraphic defects preceded the infection by arising from either previously undiagnosed acute pyelonephritis or from underlying congenital dysplasia. The etiology of scars may be best addressed by determining whether prevention of urinary tract infections from birth avoids post-natal scar acquisition or extension.
Antibiotics for Childhood Pneumonia — Do We Really Know How Long to Treat?
Publisher: Massachusetts Medical Society
Date: 02-07-2020
DOI: 10.1056/NEJME2016328
Analysis of invasive nontypeable Haemophilus influenzae isolates reveals selection for the expression state of particular phase-variable lipooligosaccharide biosynthetic genes
Publisher: American Society for Microbiology
Date: 05-2019
DOI: 10.1128/IAI.00093-19
Abstract: Nontypeable Haemophilus influenzae (NTHi) is a major human pathogen, responsible for several acute and chronic infections of the respiratory tract. The incidence of invasive infections caused by NTHi is increasing worldwide.
Comparison of Test Specificities of Commercial Antigen-Based Assays and In-House PCR Methods for Detection of Rotavirus in Stool Specimens
Publisher: American Society for Microbiology
Date: 2015
DOI: 10.1128/JCM.02251-14
Abstract: Seven commercial rotavirus antigen assays were compared with in-house PCR methods for detecting rotavirus in stool specimens. The assay sensitivities were 80% to 100%, while the specificities were 54.3% for one commercial immunochromatographic (ICT) method and 99.4% to 100% for other assays. Thus, except for one commercial ICT, all the assays were generally reliable for rotavirus detection.
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. A position statement from the Thoracic Society of Australia and New Zealand and the Australian
Publisher: AMPCo
Date: 09-2010
DOI: 10.5694/J.1326-5377.2010.TB03949.X
Abstract: Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules. In idualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely.
Viruses causing lower respiratory symptoms in young children: findings from the ORChID birth cohort
Publisher: BMJ
Date: 15-12-2017
DOI: 10.1136/THORAXJNL-2017-210233
Abstract: Viral acute respiratory infections (ARIs) cause substantial child morbidity. Sensitive molecular-based assays aid virus detection, but the clinical significance of positive tests remains uncertain as some viruses may be found in both acutely ill and healthy children. We describe disease-pathogen associations of respiratory viruses and quantify virus-specific attributable risk of ARIs in healthy children during the first 2 years of life. One hundred fifty-eight term newborn babies in Brisbane, Australia, were recruited progressively into a longitudinal, community-based, birth cohort study conducted between September 2010 and October 2014. A daily tick-box diary captured predefined respiratory symptoms from birth until their second birthday. Weekly parent-collected nasal swabs were batch-tested for 17 respiratory viruses by PCR assays, allowing calculation of virus-specific attributable fractions in the exposed (AFE) to determine the proportion of virus-positive children whose ARI symptoms could be attributed to that particular virus. Of 8100 nasal swabs analysed, 2646 (32.7%) were virus-positive (275 virus codetections, 3.4%), with human rhinoviruses accounting for 2058/2646 (77.8%) positive swabs. Viruses were detected in 1154/1530 (75.4%) ARI episodes and in 984/4308 (22.8%) swabs from asymptomatic periods. Respiratory syncytial virus (AFE: 68% (95% CI 45% to 82%)) and human metapneumovirus (AFE: 69% (95% CI 43% to 83%)) were strongly associated with higher risk of lower respiratory symptoms. The strong association of respiratory syncytial virus and human metapneumovirus with ARIs and lower respiratory symptoms in young children managed within the community indicates successful development of vaccines against these two viruses should provide substantial health benefits.
Vaccines for children and adults with chronic lung disease: efficacy against acute exacerbations
Publisher: Informa UK Limited
Date: 02-12-2013
DOI: 10.1586/17476348.2014.852960
Abstract: Acute exacerbations of chronic lung disease are usually associated with viral and bacterial pathogens. They contribute to declining lung function, poor quality of life and exert an excess burden on in iduals, families, communities and the healthcare sector. Hence, preventing exacerbations is important in clinical management. Several vaccines providing protection against respiratory pathogens (Streptococcus pneumoniae, Bordetella pertussis and influenza) that can trigger exacerbations are available, but evidence to support their effectiveness in preventing exacerbations of chronic lung disease is limited. Candidate vaccines in pre-clinical or clinical development phases include those targeting Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, respiratory syncytial virus and human rhinoviruses. However, it is likely to be several years before vaccines against these pathogens are available for children and adults with chronic lung diseases. For vaccination to play an important role in managing chronic lung disease efforts need to be directed at understanding how various pathogens cause exacerbations and alter long-term lung function.
Unraveling rotaviruses, oral vaccines and intussusception
Publisher: Wiley
Date: 09-2005
A retrospective performance evaluation of an adenovirus real‐time PCR assay
Publisher: Wiley
Date: 14-11-2013
DOI: 10.1002/JMV.23844
Abstract: Human adenoviruses (AdVs) cause a wide range of diseases. To date, there are at least 60 known human AdV types and, as these exhibit high levels of genetic variation this could impact potentially upon their detection by polymerase chain reaction (PCR)-based technology. Here, the sensitivity of a pan-AdV real-time PCR assay (AdV-PCR) used widely for testing clinical s les was determined retrospectively. An in silico analysis was performed initially using the 370 AdV sequences available on the Genbank database. To investigate for potential false-negative results, two additional AdV-PCR assays were used to re-evaluate 779 respiratory s les submitted for virus testing and 1,012 nasal swab s les collected as part of an ongoing community-based study. The results were then compared to those obtained by AdV-PCR. In silico analysis showed the presence of mismatches in the AdV-PCR primers and probe for most AdV sequences available on Genbank. Notably, 215 of the 370 (58%) sequences had at least three mismatches with the AdV-PCR forward primer. Of the 779 clinical s les, 88 were identified as AdV-positive, of which 84 were positive by the AdV-PCR. The four s les providing false-negative results in the AdV-PCR had high cycle threshold values in the other methods suggesting that s ling at low load, rather than sequence variation, was responsible for the negative results. No false-negative AdV-PCR results were observed for the community-based study s les. Reassuringly, the results show that despite the high level of sequence variation in the AdV-PCR assay oligonucleotide targets, the assay remains suitable for routine detection of human AdV strains.
Late antenatal carriage of group B Streptococcus by New Zealand women
Publisher: Wiley
Date: 04-2002
DOI: 10.1111/J.0004-8666.2002.00182.X
Abstract: To determine in New Zealand women the prevalence of group B Streptococcus (GBS) carriage late in pregnancy and to identify GBS colonisation risk factors, antibiotic susceptibility and serotype distribution. Prospective, observational study. Community and hospital antenatal clinics in Wellington and Auckland during 1998-1999. Convenience s le of 240 women between 35-37 weeks gestation. Sociodemographic data, obstetric details and anogenital swabs were collected from each subject. Swabs were inoculated into selective media. GBS isolates underwent serotyping and antibiotic susceptibility testing. Two hundred and forty women (9% Maori, 11% Pacific) aged 15-41 years were recruited. Fifty-two (22% 95% CI 17, 27) were colonised by GBS. Carriage was independently associated with younger age (59% < or = 30 years adjusted OR 3.25 95% CI 1.53, 6.95) and least social deprivation (57% NZ Dep 96 score +/- 3 adjusted OR 1.22 95% CI 1.06,1.39). All GBS isolates were penicillin-susceptible, but resistance to clindamycin (15%) and erythromycin (7.5%) was detected and associated with serotype V strains. Predominant serotypes were: III (29%), Ia (21%), Ib (20%) and V (20%). Approximately 20% of New Zealand women carry GBS late in pregnancy, with young age a major risk factor. Increased risk in the socially advantaged, development of resistance to erythromycin and clindamycin, and emergence of new GBS serotypes are findings with important implications for prevention strategies requiring further confirmation.
Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection—A Global Retrospective Cohort Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
Salbutamol: Tablets, inhalational powder, or nebuliser?
Publisher: BMJ
Date: 10-01-1981
Abstract: A study was carried out to ascertain the most effective method of giving salbutamol. Seventeen children with severe asthma received active salbutamol (4 mg via a nebuliser, 400 micrograms as an inhalational powder, or a 4 mg tablet) together with complementary placebos on a double-blind, triple-dummy randomly allocated basis. The bronchodilatation effect was assessed by measuring the peak expiratory flow rate. The bronchodilatation effect was greatest when patients received nebulised salbutamol (p less than 0.05) but lasted longest when they received the tablet (p less than 0.0001) the onset of the effect was rapid with all forms of administration. These results indicate that nebulised salbutamol gives the best relief in severe asthma in less severe cases, however, a regimen combining the inhalational powder and tablets is sufficient and more convenient.
Paediatric chronic suppurative lung disease: clinical characteristics and outcomes
Publisher: Springer Science and Business Media LLC
Date: 11-06-2016
DOI: 10.1007/S00431-016-2743-5
Abstract: We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13-52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks IQR 4-6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8-14). All were cough-free at follow-up. The children's BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent. What is known on this topic? • Chronic wet cough not resolving with appropriate antibiotics increases the likelihood of bronchiectasis. • Children with chronic suppurative lung disease (CSLD) have clinical features of bronchiectasis, but lack the radiographic evidence for this diagnosis. • Children with CSLD have airway neutrophilia and predominantly Haemophilus influenzae in lower airway cultures, similar to children with protracted bacterial bronchitis and bronchiectasis. • Chronic wet cough in CSLD, unresponsive to oral antibiotics, resolves with intravenous antibiotics and airway clearance therapy.
Oral nystatin prophylaxis and neonatal fungal infections.
Publisher: BMJ
Date: 25-03-2009
Abstract: The value of antifungal prophylaxis depends partly on the incidence of neonatal fungal infection. We compared the incidence of fungal infection in babies in neonatal units which do and do not give antifungal prophylaxis using oral nystatin. Prospective, multi-centre surveillance study from 1993 to 2006 of invasive fungal infection, defined as positive blood or cerebrospinal fluid culture, in babies <1500 g birth weight in neonatal units in Australia and New Zealand. There were 118 episodes of invasive fungal infection in 14 778 babies <1500 g, an incidence of 0.80% (95% confidence interval (CI) 0.66 to 0.94%). All infections were due to Candida species, mostly C. albicans (74, 62.7%) and C. parapsilosis (39, 33.1%). The mortality was 16.5%. The incidence was 0.54% (0.38 to 0.70%) for babies <1500 g in units using selective or universal oral nystatin prophylaxis and 1.23% (0.84 to 1.62%) in units using no prophylaxis (p<0.001). The incidence of infection in babies <1000 g was 1.78% (106/5948) (95% CI 1.44 to 2.12%). The incidence was 1.23% (0.92 to 1.54%) for babies <1000 g in units using nystatin prophylaxis and 2.67% (1.97 to 3.37%) in units using no prophylaxis (p<0.001). The incidence of neonatal fungal infection was low in Australia and New Zealand, even without antifungal prophylaxis. Antifungal prophylaxis with oral nystatin was associated with a significantly lower incidence of fungal infection compared with no prophylaxis.
Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: recent epidemiology
Publisher: Informa UK Limited
Date: 05-08-2014
DOI: 10.1586/14760584.2014.944167
Abstract: The recent epidemics of pertussis (whooping cough) in parts of the USA and Australia have led to the largest numbers of annual cases reported in over half a century. These epidemics demonstrated a new pattern, with particularly high rates of disease among pre-adolescents and early adolescents. These high rates of pertussis coincided with the first cohorts vaccinated with purely acellular pertussis vaccine, which replaced whole-cell pertussis (wP) vaccine in the later 1990s in the USA and Australia. Studies undertaken during these epidemics provide new evidence of more rapid waning of acellular pertussis-containing vaccines and longer-term protection from effective wP-containing vaccines. There is evidence that receiving wP as at least the first dose of pertussis-containing vaccine provides greater and more long-lived protection, irrespective of the nature of subsequent doses. This evidence will be reviewed together with the immunobiology associated with both vaccines, and the implications for pertussis control discussed.
Early-onset group B streptococcal infections in Aboriginal and non-Aboriginal infants
Publisher: AMPCo
Date: 09-1995
DOI: 10.5694/J.1326-5377.1995.TB124596.X
Abstract: To survey early-onset neonatal infections in Australian and New Zealand neonatal units and to compare the incidence of group B streptococcal (GBS) sepsis among Aboriginal and non-Aboriginal babies. Second year of an ongoing longitudinal, prospective study. Nine Australian units and one New Zealand unit with level 3 neonatal care and one Australian unit with level 2 care, between October 1992 and September 1993 inclusive. Episodes of early-onset sepsis (within 48 hours of birth), causative organisms, mortality, birthweight and gestational age. Babies in the neonatal units with early-onset systemic sepsis, either born in attached maternity hospitals or referred. In the Australian units there were 100 episodes of early-onset sepsis (incidence among babies born in attached maternity hospitals of 2.9 per 1000 live births). GBS was the commonest infecting agent (70% of cases) and caused all 12 cases of early-onset meningitis. The mortality from early-onset sepsis was 10%. The incidence of GBS sepsis was 1.7 per 1000 live births in non-Aboriginal babies and 5.2 per 1000 in Aboriginal babies (odds ratio, 3.1 95% confidence interval, 1.4-6.6). Early-onset GBS sepsis is more than three times as common in Aboriginal babies delivered in hospital than in non-Aboriginal babies. Four of seven Australian maternity hospitals surveyed had no firm policy for reducing the incidence of early-onset GBS sepsis. All should urgently consider such a policy.
QUALITY OF DRINKING-WATER AND ITS RELATION TO GASTROINTESTINAL DISEASE IN CHILDREN.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
AMINOTRANSFERASE ACTIVITY IN CELIAC-DISEASE
Publisher: Elsevier BV
Date: 12-1993
Pseudomonas aeruginosa Exhibits Frequent Recombination, but Only a Limited Association between Genotype and Ecological Setting
Publisher: Public Library of Science (PLoS)
Date: 06-09-2012
Antibiotic management of pneumococcal infections in an era of increased resistance
Publisher: Wiley
Date: 08-1997
DOI: 10.1111/J.1440-1754.1997.TB01602.X
Abstract: Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin-resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
Nocardia brasiliensis Infection Mimicking Juvenile Idiopathic Arthritis in a 4-Year-Old Girl
Publisher: American Academy of Pediatrics (AAP)
Date: 11-2013
Abstract: Nocardia are ubiquitous environmental saprophytes that cause pneumonia and disseminated disease in immunocompromised patients. They can also cause localized cutaneous and soft tissue infections in healthy people after direct percutaneous inoculation. Nocardia arthritis is rare in both forms of the disease. Here we present the first published case of a child with septic arthritis caused by N brasiliensis. Importantly, this otherwise well 4-year-old girl had no known history of trauma but presented with transient cutaneous lesions and a 6-week history of arthritis involving the right fourth digit proximal interphalangeal joint without accompanying fever or raised systemic inflammatory markers. She received a diagnosis of juvenile idiopathic arthritis and underwent antiinflammatory and immunosuppressant therapy. After 2 months she developed frank septic arthritis, which necessitated a surgical joint washout, from which an intraoperative swab grew N brasiliensis. The patient received 6 months of high-dose trimethoprim–sulfamethoxazole and remains well more than 4 years after treatment. This unusual case highlights the importance of considering an indolent infection from slow-growing organisms, including Nocardia, when diagnosing the oligoarthritis subtype of juvenile idiopathic arthritis. This is especially relevant when a single joint is involved and response to antiinflammatory therapy is suboptimal because antiinflammatory agents may mask evolving signs of infection.
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Linkage Projects - Grant ID: LP200301123
Start Date: 2023
End Date: 06-2026
Amount: $898,013.00
Funder: Australian Research Council
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