Our objective was to analyze, in formula-fed infants, correlates of HIV mother-to-child transmission, including cytomegalovirus (CMV) infection. HIV-infected infants were matched with HIV-uninfected by maternal HIV RNA in a case-control design. Infant CMV infection was determined by CMV-IgG at 18 months and timed by earlier CMV-IgM or -DNA. Correlations were assessed using logistic regression. In utero HIV infection was independently associated with congenital CMV infection (P=0.01), intrapartum HIV infection with congenital-plus-intrapartum/neonatal CMV infection (P=0.01), and overall HIV with overall CMV infection (P=0.001), as well as prematurity (P=0.004). Congenital and acquired CMV infections are strong independent correlates of mother-to-child HIV transmission.

BackgroundThe study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices.MethodsRetrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement), and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression.ResultsA total of 526 patients were classified into nonsevere (n = 357), severe (n = 100), and deceased (n = 69). The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45–0.74, P < 0.001), increased pulse rate (OR = 1.03, 95% CI = 1.01–1.05, P < 0.001), presence of crepitation (OR = 3.25, 95% CI = 1.52–6.96, P = 0.001), increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95–0.98, P = 0.001), increased aspartate aminotransferase (every 10 IU/L) (OR = 1.04, 95% CI = 1.02–1.06, P < 0.001), increased serum albumin (OR = 0.47, 95% CI = 0.27–0.80, P = 0.001), increased serum creatinine (OR = 1.83, 95% CI = 1.50–2.24, P < 0.001), and increased levels of positive urine albumin (OR = 1.43, 95% CI = 1.17–1.75, P < 0.001).ConclusionPatients suspicious of scrub typhus with low body temperature, rapid pulse rate, presence of crepitation, low percentage of lymphocyte, low serum albumin, elevated aspartate aminotransferase, elevated serum creatinine, and positive urine albumin should be monitored closely for severity progression.

PurposeTo develop a simple risk-scoring system to forecast scrub typhus severity.Patients and methodsSeven years’ retrospective data of patients diagnosed with scrub typhus from two university-affiliated hospitals in the north of Thailand were analyzed. Patients were categorized into three severity groups: nonsevere, severe, and dead. Predictors for severity were analyzed under multivariable ordinal continuation ratio logistic regression. Significant coefficients were transformed into item score and summed to total scores.ResultsPredictors of scrub typhus severity were age >15 years, (odds ratio [OR] =4.09), pulse rate >100/minute (OR 3.19), crepitation (OR 2.97), serum aspartate aminotransferase >160 IU/L (OR 2.89), serum albumin ≤3.0 g/dL (OR 4.69), and serum creatinine >1.4 mg/dL (OR 8.19). The scores which ranged from 0 to 16, classified patients into three risk levels: non-severe (score ≤5, n=278, 52.8%), severe (score 6–9, n=143, 27.2%), and fatal (score ≥10, n=105, 20.0%). Exact severity classification was obtained in 68.3% of cases. Underestimations of 5.9% and overestimations of 25.8% were clinically acceptable.ConclusionThe derived scrub typhus severity score classified patients into their severity levels with high levels of prediction, with clinically acceptable under- and overestimations. This classification may assist clinicians in patient prognostication, investigation, and management. The scoring algorithm should be validated by independent data before adoption into routine clinical practice.

ObjectiveThe aim of the study reported here was to validate the risk-scoring algorithm for prognostication of scrub typhus severity.MethodsThe risk-scoring algorithm for prognostication of scrub typhus severity developed earlier from two general hospitals in Thailand was validated using an independent dataset of scrub typhus patients in one of the hospitals from a few years later. The predictive performances of the two datasets were compared by analysis of the area under the receiver-operating characteristic curve (AuROC). Classification of patients into non-severe, severe, and fatal cases was also compared.ResultsThe proportions of non-severe, severe, and fatal patients by operational definition were similar between the development and validation datasets. Patient, clinical, and laboratory profiles were also similar. Scores were similar in both datasets, both in terms of discriminating non-severe from severe and fatal patients (AuROC =88.74% versus 91.48%, P=0.324), and in discriminating fatal from severe and non-severe patients (AuROC =88.66% versus 91.22%, P=0.407). Over- and under-estimations were similar and were clinically acceptable.ConclusionThe previously developed risk-scoring algorithm for prognostication of scrub typhus severity performed similarly with the validation data and the first dataset. The scoring algorithm may help in the prognostication of patients according to their severity in routine clinical practice. Clinicians may use this scoring system to help make decisions about more intensive investigations and appropriate treatments.

Background: Viral pneumonia is a common complication of influenza like illness including COVID-19. Virus is the most common cause of pneumonia in children. While there are important cues in history, the laboratory examination that can help differentiate viral and bacterial causes. There are limited clinical manifestations to differentiate viral and co-infection bacterial and viral pneumonia. Objective: To determine basic clinical manifestations and laboratory performed at bedside as predictors to differentiate viral and co-infection bacterial and viral pneumonia. Materials and Methods: A retrospective study was conducted in pediatric patients with radiographic evidence of severe pneumonia and admitted in Nakornping Hospital, Chiang Mai, Thailand between October 2017 and April 2020. Multiplex real time polymerase chain reactions (PCRs) (RP-24-26) were used to identify the cause of the pneumonia. Demographic data and basic clinical predictors such as age, comorbidity, symptoms, and physical findings, and basic laboratory such as complete blood count were collected. Patients were divided into three groups, no infection detected, viral infection, and bacterial and viral co-infection. Polytomous logistic regression was performed to investigate predictors for type of infection. Area under the receiver operating characteristic curve (AuROC) and 95% confidence interval (CI) were further determined for a final model to differentiate type of infection. Results: Two hundred eight cases participated in this study and included 122 males (58.7%). The etiology of pneumonia identified by RP-24-26, pathogen was detected among 166 cases (79.8%). A virus was detected in 141 cases (67.8%), co-infection was detected in 25 cases (12%), and no infection was detected in 42 cases (20.2%). The statistically significant predictor for viral pneumonia was cough, with an adjusted relative risk ratio (RRR) of 4.42 (1.41 to 13.82). The statistically significant predictors for co-infection were age 13 to 24 months and lymphocytes at 40.0% or greater with adj. RRR 14.28 (1.47 to 138.52), and 4.60 (1.24 to 17.04), respectively. Pneumonia patients with cough were 4.42 times more to have viral cause. Those with lymphocytes of 40.0% or greater were 4.60 times more to be co-infected with both virus and bacteria, especially in the age group 13 to 24 months compared with 1 to 12 months. The age group13 to 24 months, cough, and lymphocytes at 40.0% or greater were 74% (95% CI 0.66 to 0.82) correctly predicted to viral pneumonia. Conclusion: Coughing is a predominant symptom for childhood pneumonia caused by virus. In addition, pneumonia patients age 13 to 24 months who have lymphocyte of more than 40% should start and continue antibiotics until complete course. Keywords: Childhood pneumonia, Respiratory panel 24, Respiratory panel 26, Co-infection bacterial pneumonia, Predictor