Tetanus

Cherry, James D.; Harrison, Rick

doi:10.1016/b978-1-4160-4044-6.50165-5

Cited by 6 publications

(14 citation statements)

References 80 publications

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“…LTBI is defined by a positive tuberculin test (TST) result and/or a positive interferon-gamma release assay (IGRA) result, a normal chest radiograph, and the absence of signs or symptoms of TB disease. 1 10 In accordance with Korean TB guidelines for LTBI screening, pediatric patients aged ≤ 18 years with a history of close contact with TB are advised to undergo a two-step TST protocol. The second TST should be conducted 8–12 weeks after the last exposure to TB.…”

Section: Methodsmentioning

confidence: 99%

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Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Kim,

Bae,

Choi

et al. 2024

J Korean Med Sci

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Background The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data. Methods We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician’s specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion. Results Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018–2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20–2.66; P < 0.001). Additionally, management in a primary hospital, a hospital’s location in a non-metropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion. Conclusion Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.

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Section: Methodsmentioning

confidence: 99%

“…When the host’s immune function weakens, LTBI can progress to active TB disease. 1 Hence, treating LTBI effectively prevents new TB cases. Pediatric patients are at higher risk of transitioning from LTBI to active TB disease, frequently presenting with severe forms of TB like TB meningitis and miliary TB.…”

Section: Introductionmentioning

confidence: 99%

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Kim,

Bae,

Choi

et al. 2024

J Korean Med Sci

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“…While the replicating virus is often shed in saliva, the latent form can be found in mononuclear cells. Most cases of HHV-6 infection in transplant recipients are presumed to occur because of reactivation of latent virus rather than newly acquired infection through community transmission ( 21 , 33 , 34 , 100 , 101 ).…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

“…Clinical manifestations of HSV disease in transplant recipients include mucocutaneous vesicles, hepatitis, infection of the adrenal glands, ocular disease (keratitis, endotheliitis, uveitis, retinitis), pneumonitis, and meningoencephalitis. HSV CNS disease may present as ataxia, cranial nerve palsies including anosmia, temporal lobe seizures (apraxia, lip smacking), olfactory hallucinations, behavioral abnormalities, and psychiatric changes ( 101 ). While HSV results in sporadic cases of fatal meningoencephalitis in immunocompetent patients, institution of prophylactic measures against HSV make these viral etiologies less likely to cause meningoencephalitis in transplant recipients ( 120 ).…”

Section: Causative Viral Pathogensmentioning

confidence: 99%

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

Thomas,

Ouellette

2024

Front. Pediatr.

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Neurologic complications, both infectious and non-infectious, are frequent among hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. Up to 46% of HCT and 50% of SOT recipients experience a neurological complication, including cerebrovascular accidents, drug toxicities, as well as infections. Defects in innate, adaptive, and humoral immune function among transplant recipients predispose to opportunistic infections, including central nervous system (CNS) disease. CNS infections remain uncommon overall amongst HCT and SOT recipients, compromising approximately 1% of total cases among adult patients. Given the relatively lower number of pediatric transplant recipients, the incidence of CNS disease amongst in this population remains unknown. Although infections comprise a small percentage of the neurological complications that occur post-transplant, the associated morbidity and mortality in an immunosuppressed state makes it imperative to promptly evaluate and aggressively treat a pediatric transplant patient with suspicion for viral meningoencephalitis. This manuscript guides the reader through a broad infectious and non-infectious diagnostic differential in a transplant recipient presenting with altered mentation and fever and thereafter, elaborates on diagnostics and management of viral meningoencephalitis. Hypothetical SOT and HCT patient cases have also been constructed to illustrate the diagnostic and management process in select viral etiologies. Given the unique risk for various opportunistic viral infections resulting in CNS disease among transplant recipients, the manuscript will provide a contemporary review of the epidemiology, risk factors, diagnosis, and management of viral meningoencephalitis in these patients

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“…Recurrence or relapse of CNS infection is a well-recognized entity of neonatal E coli meningitis with increased risk associated with the K1 virulence factor and signs of complicated infection (abnormalities on brain imaging: ventriculitis, abscess or clinical signs of CNS infection: seizures or altered mental status). Therefore, repeat LP to document sterility prior to the end of antibiotics has been a longstanding recommendation [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

New and old lessons from a devastating case of neonatal E coli meningitis

Saleh,

Kamau,

Rathe

2024

BMC Pediatr

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Background Neonatal Escherichia coli (E coli) meningitis results in significant morbidity and mortality. We present a case of a premature infant with extensive central nervous system (CNS) injury from recurrent E coli infection and the non-traditional methods necessary to identify and clear the infection. Case Presentation The infant was transferred to our institution’s pediatric intensive care unit (PICU) after recurrence of E coli CNS infection requiring neurosurgical intervention. He had been treated for early onset sepsis (EOS) with ampicillin and gentamicin for 10 days followed by rapid development of ampicillin-resistant E coli septic shock and meningitis after discontinuation of antibiotics. Sterility of the CNS was not confirmed at the end of 21 days of cefepime therapy and was subsequently followed by recurrent ampicillin-resistant E coli septic shock and CNS infection. Despite 6 weeks of appropriate therapy with sterility of CSF by traditional methods, he suffered from intractable seizures with worsening hydrocephalus. Transferred to our institution, he underwent endoscopic 3rd ventriculostomy with cyst fenestration revealing purulent fluid and significant pleocytosis. An additional 3 weeks of systemic and intraventricular antibiotics with cefepime and tobramycin were given but a significant CNS neutrophil-predominant pleocytosis persisted (average of $$\sim$$ 21,000 cells/mm3). Repeated gram stains, cultures, polymerase chain reaction (PCR) testing, and metagenomic next generation sequencing (NGS) testing of CSF were negative for pathogens but acridine orange stain (AO) revealed numerous intact rod-shaped bacteria. After the addition of ciprofloxacin, sterility and resolution of CSF pleocytosis was finally achieved. Conclusion Neonatal E coli meningitis is a well-known entity but unlike other bacterial infections, it has not proven amenable to shorter, more narrow-spectrum antibiotic courses or limiting invasive procedures such as lumbar punctures. Further, microbiologic techniques to determine CSF sterility suffer from poorly understood limitations leading to premature discontinuation of antibiotics risking further neurologic damage in vulnerable hosts.

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Tetanus

Cited by 6 publications

References 80 publications

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

New and old lessons from a devastating case of neonatal E coli meningitis

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