Hot Topics in Infection and Immunity in Children VI (eBook)

Preface 6
Acknowledgments 7
Contents 8
Contributors 10
Infections in the Immunocompromised 13
1 Introduction 13
2 Types of Immunodeficiency and Infection 13
3 Site of Infection 14
4 Respiratory Tract 15
4.1 Pneumocystis jiroveci Pneumonia (PCP) 16
4.2 Viruses 17
5 Gut 18
5.1 Viruses 18
5.2 Cryptosporidium 19
5.3 Giardia 19
6 Disseminated Infection 19
6.1 Adenovirus 20
6.2 Cytomegalovirus 21
6.3 Epstein Barr Virus 21
6.4 Human Herpes Virus 6 22
6.5 Varicella Zoster Virus 22
7 Fungal Infections 22
7.1 Candidiasis 23
7.2 Aspergillosis 24
8 Central Venous Catheter Infections 24
9 Febrile Neutropenia 25
10 Conclusions 27
References 28
Host Biomarkers and Paediatric Infectious Diseases: From Molecular Profiles to Clinical Application 31
1 Introduction 31
2 Molecular Profiling: Current Techniques 32
2.1 Genomics 32
2.2 Transcriptomics 33
2.3 Proteomics 33
3 Clinical Applications in Pediatric Infectious Diseases 34
3.1 What Has Been Studied up to now? 34
3.2 Current and Potential Clinical Applications of ''''omic'' Technologies 37
3.3 Future Perspectives for Biomarker Development 39
4 Conclusions 40
References 41
The Epidemiology and Management of Non Typhoidal Salmonella Infections 44
1 Introduction 44
2 Seasonality of NTS infections 49
3 Malaria, Anemia and NTS infection 50
4 Malnutrition and NTS Infection 50
5 HIV and NTS infection 51
6 NTS Recurrence and Relapse 51
7 Treatment of NTS Infections 51
References 52
Where Does Campylobacter Come From? A Molecular Odyssey 58
1 Introduction 58
2 Campylobacter Typing and Population Structure 59
3 Epidemiology of Human Infection 60
4 Host Association Studies of Chickens, Geese and Starlings 61
5 Genetics of Host Association and Speciation 63
6 Conclusion Impact of Molecular Epidemiology on Control of Human Infection 64
References 65
Why Are Some Babies Still Being Infected with HIV in the UK? 68
1 Introduction 68
2 Risk Factors for Transmission 68
3 British HIV Association Guidelines 2008 70
4 Transmission in the Era of HAART 71
5 Clinical Scenario Emergency Management of a New Diagnosis of Maternal HIV at Delivery 75
5.1 What Should be Done Before the Baby Is Born? 75
5.2 Which Antiretrovirals Should be Started for the Baby? 75
5.3 What Should be Done if the Mother is in Premature Labour? 77
5.4 How Should the Infant be Tested for HIV? 77
5.5 When Should Cotrimoxazole Prophylaxis be Started? 77
5.6 What Is the Appropriate Management of a Mother Diagnosed with HIV Antenatally Who Has R efused Any Interventions? 78
6 Conclusions 78
References 79
The Use and Abuse of Antibiotics and the Developmentof Antibiotic Resistance 83
1 Introduction 83
2 Antibiotic Resistance Is Inevitable 83
3 Antibiotic Overuse and Misuse Is a Major Problem 84
4 Antibiotic Use (and Abuse) Drives the Development of Resistance 85
5 The Role of Antibiotic Use and Overuse in Facilitating the Emergence and Spread of Antibiotic-Resistant Pathogens Is Complex 86
6 The Role of Antibiotic Use and Overuse in Facilitating the Emergence and Spread of Specific Antibiotic-Resistant Gram-Positive Pathogens in Pediatrics Pneumococci, Staphylococci and Enterococci 86
6.1 Penicillin and Cephalosporin-Resistant Streptococcus pneumoniae 86
6.2 Community-Associated, Methicillin-Resistant Staphylococcus aureus (CA-MRSA) 87
6.3 Vancomycin-Resistant Enterococci ( VRE ) 88
7 Promoting Rational and Judicious Antibiotic Use Is This a Pipe Dream?
8 Summary, Conclusions, and Recommendations 89
References 90
Vaccination Against Varicella: Whats the Point? 93
1 Introduction 93
References 96
What Can We Learn from the Retina in Severe Malaria? 98
1 Introduction 98
2 Malarial Retinopathy The Components 98
3 How to See Malarial Retinopathy 100
4 The Prognostic Value of Retinopathy 102
5 Malarial Retinopathy in Clinical Practice and Research 102
6 Retinal Angiography in CM 103
7 Pathogenesis of Retinal Findings and Potential Relevance to the Pathogenesis of Cerebral Disease 103
8 Summary 105
References 106
Epidemiology and Prevention of Neonatal Candidiasis: Fluconazole for All Neonates? 107
1 Scope of the Problem 107
2 Risk Factors for ICI 107
3 Incidence of ICI 109
4 ICI Variation Among NICUs 109
5 Candida Species and ICI 110
6 Neurodevelopmental Impairment 110
7 Mortality 111
8 Costs of ICI 112
9 Prompt and Empiric Treatment of ICI 112
10 Prophylaxis 112
10.1 Fluconazole 112
10.2 Combined Outcome of ICI or Mortality 116
10.3 Meta-Analysis and Cochrane Review 116
10.4 Resistance and Safety 117
10.5 Side Effects of Fluconazole Prophylaxis 118
10.6 Cost-Benefit Ratio 119
11 Nystatin 119
12 Fluconazole or Nystatin? 120
12.1 Class 1 Evidence for the Use of Fluconazole Prophylaxis 120
13 Deciding Who is High-Risk 120
14 Who Should Receive Antifungal Prophylaxis? 120
15 Dosage and Schedule 122
16 Summary 122
References 123
Current Status of Treatment of Hepatitis B in Children 128
1 Introduction 128
2 Diagnosis and Natural History 129
3 Management of Chronic HBV Infection 129
4 Antiviral Therapy 130
5 Aim of Treatment 130
6 Indications for Treatment 131
6.1 Interferon 131
6.2 Lamivudine 132
6.3 Adefovir Dipivoxil 132
6.4 Combination Therapy 133
6.5 Liver Transplantation 133
7 Future Therapy for HBV in Children 133
8 Choice of Therapy for HBV 133
References 134
Treatment of Neonatal Fungal Infections 136
1 Introduction 128
2 Epidemiology 129
2.1 Candida Species 137
3 Invasive Candidiasis 130
4 End Organ Assessment 130
5 Treatment 131
5.1 Amphotericin B deoxycholate 131
5.2 Lipid Preparations of Amphotericin B 132
5.3 5-Fluorocytosine (Flucytosine, 5-FC). 132
5.4 The Azoles 133
5.5 The Echinocandins 133
References 134
Malaria in Pregnancy and the Newborn 146
1 The Global Burden of Malaria 128
2 The Burden of Malaria in Pregnancy 129
3 Malaria Species in Pregnancy 129
4 Clinical Malaria in Pregnancy 130
5 Timing of Infection 130
6 Susceptibility to Malaria in Pregnancy 131
7 Gravidity and Age Influence Parasite Prevalence in Pregnancy 148
8 Modelling Placental Malaria In Vitro 150
9 Placental Inflammation, Monocyte Infiltrates, and Pregnancy Outcomes 151
10 Treating Malaria in Pregnancy 152
11 Intermittent Preventive Treatment in Pregnancy 153
12 Malaria in the Newborn: Congenital Malaria 133
13 Malaria Antibody in Neonates 133
14 Malaria in the First Year of Life 155
15 Future Prospects 155
References 134
Adenovirus Infection in the Immunocompromised Host 160
1 Classification, Structure, and Molecular Pathogenesis 128
2 Terminology and Definitions Related to Adenovirus Infection and Disease 129
3 Epidemiology, Clinical Features, and Natural History in the General Population 129
4 Epidemiology, Clinical Features, and Natural History in the Immununocompromised 130
5 Risk Factors for Adenovirus Infection in the Transplant Setting 130
6 Diagnostic Methods in Adenovirus Infection 131
7 Prognosis of Adenovirus Infection in the Immunocompromised 148
8 Control of Adenovirus Infection and Immune Recovery 150
9 Indications for Treatment of Adenovirus Infection 151
10 Treatment of Adenovirus Infection 152
10.1 Immunological Interventions 133
10.2 Antiviral Drugs 171
10.2.1 Ganciclovir 171
10.2.2 Vidarabine 171
10.2.3 Zalcitabine 172
10.2.4 Ribavirin 172
10.2.5 Cidofovir 173
11 Future Prospects 173
References 134
Strategies for Global Prevention of Hepatitis B Virus Infection 182
1 Hepatitis B Virus Infection 128
1.1 Aetiological Agent 182
1.2 Clinical Spectrum 137
1.3 Epidemiology and Transmission 184
1.4 Prevention Strategies 185
1.5 Vaccine 186
1.6 Immunization Strategies 131
1.7 Global I Impact 132
2 Conclusions 151
References 134
Subject Index 196