M abscessus infection was associated with significant medical morbidity and treatment complications. Unique manifestations included extranodal mandibular or maxillary osteomyelitis and pulmonary nodules. Challenges in the identification of case-children resulted from an extended incubation period and various clinical manifestations. Clinicians should consider the association between M abscessus infection and pulpotomy in children who present with subacute cervical lymphadenitis. The use of treated/sterile water during pulpotomy might prevent further outbreaks.
Objective: The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.Study Design: We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.Result: Primary health-care workers identified 1-to 20-day-old neonates with hyperbilirubinemia X15 mg per 100 ml (260 mmol l À1 ) with 83.3% sensitivity and 50.5% specificity; neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia X15 mg per 100 ml (260 mmol l À1 ) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers' and physicians' assessments showed fair interobserver agreement (k statistic 0.29).Conclusion: Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world.
School-based TB education, screening, testing using IGRAs and administration of 3HP treatment is feasible to improve the identification and treatment of adolescent students at risk for TB.
The usual route of acquisition for intrauterine herpes simplex virus (HSV) infection is transplacental. We evaluated a premature infant with in utero acquisition of HSV resulting from ascending infection. Histopathologic evidence of chronic chorioamnionitis and positive staining with immunohistochemistry for HSV in the placenta and umbilical cord established the diagnosis. The clinical presentation was also of interest in that the infant was initially healthy appearing.
Identifying and treating children with tuberculosis (TB) infection in both low and high-TB burden settings will decrease the incidence of TB disease worldwide. Areas covered: This review covers each of the available TB infection treatment options for children based on effectiveness, safety, tolerability and treatment completion rates. Six to 9 months of daily administered isoniazid is no longer the treatment of choice for many children with TB infection. Shorter, rifamycin based, TB infection treatment regimens are effective, safe and easier for children to complete. Fluroquinolone-based regimens are recommended for the treatment of children infected by a source case with drug-resistant TB. Directly observed therapy (DOT) programs improve childhood TB infection treatment completion rates. Expert commentary: As shorter, rifamycin-based, TB infection treatment regimens offer superior treatment success rate in both adults and children; the widespread use of these regimens has huge potential to decrease the burden of TB disease worldwide. The implementation of these programs will involve improving patient access to the medications, decreasing their cost to the patient, and the use of novel electronic methods to document patient treatment completion.
The goal of diagnosing and treating latent tuberculosis infection (LTBI) in children is to prevent future cases of tuberculosis (TB) disease. In low-prevalence countries, LTBI screening, testing, and treatment are risk based. Testing is limited by lack of a reference standard; both available methods-the tuberculin skin test (TST) and interferon gamma release assays (IGRAs)-have significant limitations. The antigens used in IGRAs are not found in BCG-Mycobacterium bovis or most nontuberculous mycobacteria, making these tests more specific for Mycobacterium tuberculosis infection than the TST. The two methods have similar sensitivity, and neither performs well in immunosuppressed children. Children with LTBI are given treatment because it decreases their risk of developing TB disease, and the rate of significant adverse events is low. The most commonly used treatment regimen of 6-9 months of isoniazid is limited in effectiveness by poor adherence. New treatment regimens, using 4 months of rifampin, 3 months of isoniazid and rifampin, or 12 weekly doses of isoniazid and rifapentine, are safe and have significantly higher completion rates.
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