Emergence and dominance of #E coli ST131 CTX-M-27 in a community #paediatric cohort study: independent host factors and #bacterial genetic determinants (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Emergence and dominance of E. coli ST131 CTX-M-27 in a community paediatric cohort study: independent host factors and bacterial genetic determinants

André Birgy, Corinne Levy, Marie-Hélène Nicolas-Chanoine, Aurélie Cointe, Claire A. Hobson, Mélanie Magnan, Stéphane Bechet, Philippe Bidet, Robert Cohen, Stéphane Bonacorsi

DOI: 10.1128/AAC.00382-19



The recent emergence and diffusion in the community of Escherichia coli isolates belonging to the multidrug-resistant and CTX-M-27-producing ST131 C1-M27 cluster, makes this cluster potentially as epidemic as the worldwide E coli ST131 subclade C2 composed of multidrug resistant isolates producing CTX-M-15. Thirty-five extended-spectrum beta-lactamase (ESBL) producing ST131 isolates were identified in a cohort of 1,885 French children over a 5 year-period. They were sequenced to characterize the ST131 E. coli isolates producing CTX-M-27 recently emerging in France. ST131 isolates producing CTX-M-27 (n=17), and particularly those belonging to the C1-M27 cluster (n=14), carried many resistance-encoding genes and predominantly a F1:A2:B20 plasmid type. In multivariate analysis, having been hospitalized since birth (OR=10.9; 95%CI=2.4;48.8; p=0.002) and being cared for in a day-care center (OR=9.4;95%; CI=1.5;59.0; p=0.017) were independent risk factors for ST131 CTX-M-27 fecal carriage compared with ESBL-producing non-ST131 isolates. No independent risk factor was found when comparing CTX-M-15 (n=11) and CTX-M-1/14 (n=7)-producing ST131 isolates with ESBL-producing non-ST131 isolates or with non-ESBL-producing isolates. Several factors may contribute to the increase in fecal carriage of CTX-M-27-producing E. coli isolates: resistance to multiple antibiotics, capacity of the CTX-M-27 enzyme to hydrolyze both cefotaxime and ceftazidime, carriage of a peculiar F-type plasmid, and/or capacity to colonize children who have been hospitalized since birth or who attend day-care centers.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Pediatrics; Cefotaxime; Ceftazidime.



#Neurological manifestations of #pediatric #arboviral #infections in the #Americas (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 8 May 2019 / In Press, Accepted Manuscript

Neurological manifestations of pediatric arboviral infections in the Americas

Aline Almeida Bentes a,c,d, Erna Geessien Kroon b,d, Roberta Maiade Castro Romanelli a,d

{a} Faculdade de Medicina, Departamento de Pediatria, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190- Santa Efigênia, CEP 30130-100, Belo Horizonte, MG, Brazil; {b} Laboratório de Vírus, Departamento de Microbiologia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; {c} Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil; {d} Faculty of Medicine of José do Rosário Vellano Univesity, Brazil

Received 8 February 2019, Revised 21 April 2019, Accepted 23 April 2019, Available online 8 May 2019. DOI: https://doi.org/10.1016/j.jcv.2019.04.006



  • The neurological complications caused by DENV are based on three possible neuropathogenic mechanisms: invasion of the central (CNS) and peripheral (PNS) nervous systems; metabolic and vascular disorders and immune-mediated with different manifestations and sequelae.
  • Neurological manifestations of Zika acquired in children were remarkable and included hemiparesis, myelitis, Guillain-Barre syndrome, cortical infarction and behavioral changes.
  • The most common neurological manifestations found in children with Chikungunya infection were seizures, encephalitis, meningism and behavioral changes. Of these children, 5.6% died and 8.5% developed neuronal sequelae.



Dengue, Zika, Chikungunya and yellow fever viruses are arboviruses transmitted by the mosquito Aedes aegypti. These viruses exhibit marked neurotropism but have rarely been studied. Here, we conduct an integrative review of the neurological manifestations caused by these arboviruses in the pediatric population. Data on patients under 18 years of age were extracted from literature databases. The most frequently reported neurological manifestations were encephalitis, meningitis, seizures, hypotonia, paresis, and behavioral changes. This review highlights the importance of accurately diagnosing these arboviral infections in children and adolescents with neurological manifestations.

Keywords: neurological manifestations – Dengue virus – Zika virus – Chikungunya virus – Yellow fever virus

© 2019 Elsevier B.V. All rights reserved.

Keywords: Arbovirus; Neurology; Zika virus; Chikungunya fever; Dengue Fever; Pediatrics; Encephalitis; Meningitis.


Rapid #detection and #clinical #spectrum of the novel #influenza #H1N1 strain in a #diabetic #pediatric population (J Med Virol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Med Virol. 2019 May 3. doi: 10.1002/jmv.25497. [Epub ahead of print]

Rapid detection and clinical spectrum of the novel influenza H1N1 strain in a diabetic pediatric population.

Ammar RA1, Montasser K2, Ezz H1, Albishi LA3, Ghareeb A4.

Author information: 1 Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2 Clinical Pathology Department, Faculty of Medicine, Helwan University, Cairo, Egypt. 3 Pediatric Medicine Department, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia. 4 Microbiology Department, Faculty of Science, Cairo University, Cairo, Egypt.




H1N1 infection in diabetic patients is of special concern and serious interest, since the virus can place individuals, especially children, at great possible risk of subsequently developing type 1 diabetes. This work aims to describe the demographic characteristics, clinical features and severity of illness of children with type 1 diabetes mellitus (DM), compare the incidence of pandemic H1N1 virus in children, with that of the general pediatric population with influenza-like symptoms, and identify the complications of H1N1 virus infection associated with glycemic control.


The present study included 45 children and adolescents with type 1 diabetes, who were subject to clinical and laboratory investigations. Another thirty healthy adolescents and children with a mean age of (10.43± 4.38) years were included as a control group. H1N1 reverse transcriptase quantitative PCR (RT-Q PCR) was tested for H1N1 virus detection.


Diabetic patients positive for (H1N1) showed significantly higher random blood sugar levels than diabetic patients negative for (H1N1). Moreover, the H1N1- positive patients had significantly higher hemoglobin (Hb) g/dl, platelet counts, total leucocyte counts (TLCs) and CRP levels. Newly diagnosed patients who tested positive for (H1N1) and DKA had significantly higher random blood sugar levels and TLCs than patients who presented with hyperglycemia.


RT-PCR is a rapid and specific method for influenza A (H1N1) virus diagnosis. Additionally, early administration of oseltamivir no later than 48 hours after infection is highly recommended in either diabetic or DKA patients suspected of having H1N1.

This article is protected by copyright. All rights reserved.

KEYWORDS: 2009 H1N1; DKA; Diabetes mellitus; Influenza A; Oseltamivir; RT-PCR

PMID: 31054173 DOI: 10.1002/jmv.25497

Keywords: Seasonal Influenza; H1N1pdm09; Diabetes; Egypt; Pediatrics.


Multi- #recombinant #Enterovirus A71 Subgenogroup C1 Isolates Associated with #Neurologic Disease, #France, 2016–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 6—June 2019 / Dispatch

Multirecombinant Enterovirus A71 Subgenogroup C1 Isolates Associated with Neurologic Disease, France, 2016–2017

Stéphanie Tomba Ngangas, Alexander Lukashev, Gwendoline Jugie, Olga Ivanova, Jean-Michel Mansuy, Catherine Mengelle, Jacques Izopet, Anne-Sophie L’honneur, Flore Rozenberg, David Leyssene, Denise Hecquet, Stéphanie Marque-Juillet, David Boutolleau, Sonia Burrel, Hélène Peigue-Lafeuille, Christine Archimbaud, Kimberley Benschop, Cécile Henquell, Audrey Mirand, and Jean-Luc Bailly

Author affiliations: Université Clermont Auvergne, Clermont-Ferrand, France (S. Tomba Ngangas, G. Jugie, H. Peigue-Lafeuille, C. Archimbaud, C. Henquell, A. Mirand, J.-L. Bailly); Sechenov University, Moscow, Russia (A. Lukashev); Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products, Moscow (O. Ivanova); Centre Hospitalier Universitaire de Toulouse, Toulouse, France (J.-M. Mansuy, C. Mengelle, J. Izopet); Assistance Publique-Hôspitaux de Paris Cochin, Paris, France (A.-S. L’honneur, F. Rozenberg); Centre Hospitalier de la Côte Basque, Bayonne, France (D. Leyssene); Centre Hospitalier Universitaire Amiens, Amiens, France (D. Hecquet); Centre Hospitalier de Versailles, Le Chesnay, France (S. Marque-Juillet); Assistance Publique-Hôspitaux de Paris Pitié-Salpêtrière-Charles Foix, Paris (D. Boutolleau, S. Burrel); CHU Clermont-Ferrand, Clermont-Ferrand (H. Peigue-Lafeuille, C. Archimbaud, C. Henquell, A. Mirand, J.-L. Bailly); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (K. Benschop)



In 2016, an upsurge of neurologic disease associated with infection with multirecombinant enterovirus A71 subgenogroup C1 lineage viruses was reported in France. These viruses emerged in the 2000s; 1 recombinant is widespread. This virus lineage has the potential to be associated with a long-term risk for severe disease among children.

Keywords: EV-A71; Encephalitis; Neurology; Pediatrics; France.


Use of #ECMO and associated #outcomes in #children hospitalized for #sepsis in the #USA: A large population-based study (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study

Katharine Robb , Aditya Badheka  , Tong Wang, Sankeerth Rampa, Veerasathpurush Allareddy, Veerajalandhar Allareddy

Published: April 26, 2019 / DOI: https://doi.org/10.1371/journal.pone.0215730




The American College of Critical Care Medicine recommends that children with persistent fluid, catecholamine, and hormone-resistant septic shock be considered for extracorporeal membrane oxygenation (ECMO) support. Current national estimates of ECMO use in hospitalized children with sepsis are unknown. We sought to examine the use of ECMO in these children and to examine the overall outcomes such as in-hospital mortality, length of stay (LOS), and hospitalization charges (HC).


A retrospective analysis of the National Inpatient Sample, which approximates a 20% stratified sample of all discharges from United States community hospitals, was performed. All children (≤ 17 years) who were hospitalized for sepsis between 2012 and 2014 were included. The associations between ECMO and outcomes were examined by multivariable linear and logistic regression models.


A total of 62,310 children were included in the study. The mean age was 4.2 years. ECMO was provided to 415 of the children (0.67% of the cohort with sepsis). Comparative outcomes of sepsis in children who received ECMO versus those who did not included in-hospital mortality rate (41% vs 2.8%), mean HC ($749,370 vs $90,568) and mean LOS (28.8 vs 9.1 days). After adjusting for confounding factors, children receiving ECMO had higher odds of mortality (OR 11.15, 95% CI 6.57–18.92, p < 0.001), longer LOS (6.6 days longer, p = 0.0004), and higher HC ($510,523 higher, p < 0.0001).


Use of ECMO in children with sepsis is associated with considerable resource utilization but has 59% survival to discharge. Further studies are needed to examine the post discharge and neurocognitive outcomes in survivors.


Citation: Robb K, Badheka A, Wang T, Rampa S, Allareddy V, Allareddy V (2019) Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. PLoS ONE 14(4): e0215730. https://doi.org/10.1371/journal.pone.0215730

Editor: Andrea Ballotta, IRCCS Policlinico S.Donato, ITALY

Received: July 19, 2018; Accepted: April 8, 2019; Published: April 26, 2019

Copyright: © 2019 Robb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data user agreement (with AHRQ-HCUP) precludes us from releasing any data. This is standard for all publications originating from NIS (HCUP datasets). Authors should not release data. However, the authors are allowed to disclose the pathway to access of all data. The NIS releases for data years 1988 through 2016 are available for purchase online through the Online HCUP Central Distributor. All HCUP data users, including data purchasers and collaborators, must complete the online HCUP Data Use Agreement Training Tool, and must read and sign the Data Use Agreement for Nationwide Databases (PDF file, 86 KB; HTML). Questions about purchasing databases can be directed to the HCUP Central Distributor: Email: HCUPDistributor@AHRQ.gov Telephone: (866) 556-4287 (toll free) Fax: (866) 792-5313 (toll free).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: ECMO, extracorporeal membrane oxygenation; LOS, length of stay; NIS, National (Nationwide) Inpatient Sample; ACCM, American College of Critical Care Medicine; AHRQ, Agency for Healthcare Research and Quality; HCUP, Healthcare Cost and Utilization Project

Keywords: ECMO; Sepsis; Pediatrics; USA.


#Picornavirus #etiology of acute #infections among hospitalized #infants (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 25 April 2019 / In Press, Accepted Manuscript

Picornavirus etiology of acute infections among hospitalized infants

Glen R.Abedi a, Kevin Messacar b, William Luong c, W. Allan Nix a, Shannon Rogers a, Krista Queen a, Suxiang Tong a, M. Steven Oberste a, James Watt c, Gretchen Rothrock c, Samuel Dominguez b, Susan I. Gerber a, John T. Watson a

{a} Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, United States; {b}
Colorado Emerging Infections Program, Denver, Colo., United States; {c} California Emerging Infections Program, Richmond, Calif., United States

Received 4 December 2018, Revised 17 April 2019, Accepted 23 April 2019, Available online 25 April 2019. DOI: https://doi.org/10.1016/j.jcv.2019.04.005



  • Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.
  • Of 319 patients aged <1 year, CSF specimens from 13 (4.1%) were positive for EV and from 11 (3.4%) for PeV.
  • Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.
  • Clinicians should consider EV and PeV infections in infants presenting with febrile illness.




Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.


We describe EV and PeV infections among children from 2 US study sites aged <1 year and hospitalized with acute infections. For EV- and PeV-negative case-patients, we explored other viral etiologies.


Participants were aged <1 year, hospitalized during 2016, and had cerebrospinal fluid (CSF) collected for routine diagnostic testing. Demographic and clinical data were abstracted from medical charts, and residual specimens were sent to CDC for confirmatory testing and typing.


Of 472 eligible case-patients, CSF specimen was available for 319 (67.6%). Among those, 13 (4.1%) were positive for EV and 11 (3.4%) for PeV. Most case-patients (86.8%, n = 277) were aged <2 months, as were all EV- or PeV-positive case-patients. None of the positive case-patients had underlying conditions, and the chief complaint for 91.7% (n = 22) was fever. Twelve positive case-patients were admitted to intensive care (ICU) and had brief hospital stays (median 2 days). Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.


A range of EVs and PeVs were associated with acute febrile illnesses leading to hospitalization in children aged <2 months. Approximately half of EV and PeV case-patients were admitted to ICU, but length of hospital stay was brief and illnesses were generally self-limiting. Clinicians should consider EV and PeV infections in infants presenting with febrile illness.

Keywords: enterovirus – parechovirus – infants – fever – sepsis – encephalitis – meningitis

{☆} The conclusions, findings, and opinions expressed by the authors do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

© 2019 Published by Elsevier B.V.

Keywords: Enterovirus; Picornavirus; Parechovirus; Encephalitis; Meningitis; Sepsis; Pediatrics.


#Children Born to #Mothers with #Rash During #Zika Virus #Epidemic in #Brazil: First 18 Months of Life (J Trop Pediatr., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Trop Pediatr. 2019 Apr 21. pii: fmz019. doi: 10.1093/tropej/fmz019. [Epub ahead of print]

Children Born to Mothers with Rash During Zika Virus Epidemic in Brazil: First 18 Months of Life.

Vianna RAO1, Lovero KL2, Oliveira SA1, Fernandes AR1, Santos TCSD1, Lima LCSS1, Carvalho FR1, Quintans MDS1, Bueno AC1, Torbey AFM1, Souza ALAAG1, Farias AOP1, Camacho LAB3, Riley LW4, Cardoso CAA1.

Author information: 1 Faculdade de Medicina, Universidade Federal Fluminense, RJ 24.033-900, Brazil. 2 Department of Psychiatry, University of Columbia, New York 10032, USA. 3 Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ 21.041-210, Brazil. 4 Division of Infectious Diseases and Vaccinology, University of California, Berkeley 94720, USA.




To better understand the clinical spectrum and course of congenital Zika syndrome (CZS) during the first 18 months of life of children whose mothers had rash during pregnancy.


This longitudinal observational study evaluated the clinical progress from birth until 18 months of life of children of mothers who developed rash during or up to 3 months before gestation. Maternal rash occurred from November 2015 to May 2017. The study subjects were divided into three groups: children whose mothers tested positive by RT-qPCR for Zika virus (ZIKV) (Group 1), children whose mothers tested negative by RT-qPCR for ZIKV (Group 2), and children whose mothers did not undergo any testing for ZIKV (Group 3) but tested negative for other congenital infections.


Between April 2016 and July 2018, we studied 108 children: 43 in Group 1, 26 in Group 2 and 39 in Group 3. The majority of children were admitted into the study within 6 months of life. CZS was diagnosed in 26 children, equally distributed in Groups 1 and 3. Of 18 children with microcephaly, 6 were in Group 1 (1 postnatal) and 12 were in Group 3 (5 postnatal). Maternal rash frequency was 10 times higher during the first trimester than in the other trimesters (OR: 10.35; CI 95%: 3.52-30.41). CZS was diagnosed during the follow-up period in 14 (54%) cases. Developmental delays and motor abnormalities occurred in all children and persisted up to 18 months. Epilepsy occurred in 18 (69%) of the cases.


Infants born of mothers exposed to ZIKV during pregnancy showed progression of developmental, motor and neurologic abnormalities even if they were born asymptomatic. Continued postnatal monitoring of such newborns is necessary to preclude disability-associated complications.

© The Author(s) [2019]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

KEYWORDS: Congenital Zika syndrome; RT-PCR; Zika virus; microcephaly

PMID: 31006031 DOI: 10.1093/tropej/fmz019

Keywords: Zika Virus; Zika Congenital Infection; Zika Congenital Syndrome; Microcephaly; Pregnancy; Brazil.