Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases.</p> <p>Methods</p> <p>In the early 1970s a Meningitis Registry (MR) was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974–1984), B (1985–1994) and C (1995–2005).</p> <p>Results</p> <p>Of the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3%) were classified as "probable" and 1,331 (53.7%) as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR) was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for <it>Neisseria meningitidis</it>, 1.3/100,000 for <it>Streptococcus pneumoniae</it>, 2.5/100,000 for <it>Haemophilus influenzae </it>type b (Hib) before vaccination and 0.4/100,000 for Hib after vaccination. <it>Neisseria meningitis </it>constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to <it>Streptococcus pneumoniae </it>was stable. The long-term epidemiological pattern of <it>Neisseria meningitidis </it>appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR) from all causes was 3.8%, while higher CFR were estimated for <it>Streptococcus pneumoniae </it>(7.5%, RR=2.1, 95% CI 1.2–3.7) and <it>Neisseria meningitidis </it>(4.8%, RR=1.7, 95% CI 1.1–2.5) compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015), and was estimated to be higher in period C.</p> <p>Conclusion</p> <p>By using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.</p

Aseptic Meningitis in Children: Analysis of 506 Cases

BACKGROUND: Non-polio human enteroviruses are the leading cause of aseptic meningitis in children. The role of enterovirus PCR for diagnosis and management of aseptic meningitis has not been fully explored. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective study was conducted to determine the epidemiological, clinical, and laboratory characteristics of aseptic meningitis and to evaluate the role of enterovirus PCR for the diagnosis and management of this clinical entity. The medical records of children who had as discharge diagnosis aseptic or viral meningitis were reviewed. A total of 506 children, median age 5 years, were identified. The annual incidence rate was estimated to be 17/100,000 children less than 14 years of age. Most of the cases occurred during summer (38%) and autumn (24%). The dominant clinical symptoms were fever (98%), headache (94%) and vomiting (67%). Neck stiffness was noted in 60%, and irritation in 46% of the patients. The median number of CSF cell count was 201/mm(3) with polymorphonuclear predominance (>50%) in 58.3% of the cases. Enterovirus RNA was detected in CSF in 47 of 96 (48.9%) children tested. Children with positive enterovirus PCR had shorter hospitalization stay as compared to children who had negative PCR or to children who were not tested (P = 0.01). There were no serious complications or deaths. CONCLUSIONS: Enteroviruses accounted for approximately one half of cases of aseptic meningitis. PCR may reduce the length of hospitalization and plays important role in the diagnosis and management of children with aseptic meningitis

Limited cross-border infections in patients newly diagnosed with HIV in Europe

Matti Ristola ja Jussi Sutinen kuuluvat työryhmään SPREAD ProgrammePeer reviewe

Oxidation of aqueous ethanol to acetic acid over heterogeneous catalysts

The heterogeneously catalysed oxidation of bioethanol is an environmentally friendly route to manufacture acetic acid as a bio-based platform chemical for industrial applications. However, its implementation as an economically feasible process is still hampered by the lack of understanding for the catalytic mechanism, as well as an efficiently performing catalytic system. Despite promising yields, the current state-of-the-art gold-based catalysts still suffer from high selectivity to carbon dioxide, fast sintering of the gold particles, and high cost due to the price of gold. Due to the complexity of the three-phase reaction, studies have focused on tedious batch reactor experiments, which did not allow for reliable kinetic studies and fast screening of catalytic systems. This thesis presents a set of studies aiming at designing a trickle-flow reactor setup for kinetic studies and fast screening, studying the reaction mechanism over gold-based catalysts, designing new supported gold catalysts, and searching for the next generation of ethanol oxidation catalysts to challenge the state-of-the-art gold-based systems. We designed a trickle-flow reactor system, which was found reliable and more efficient for catalytic and kinetic testing and introduced the possibility for in-situ and operando mechanistic experiments. It also revealed enhancement in the catalytic performance of Au/TiO2, which was associated with less sintering of the gold particles. The study underlines the necessity to use flow systems already at the research level, in order to benchmark and identify potential catalysts as well as to enhance understanding of the involved reactions. The design of the trickle-flow reactor enabled for fast continuous testing, similar to that in the gas-phase system, allowing for a direct comparison between the gas- and the liquid-phase reactions. In the literature-proposed reaction paths, the ethanol oxidative dehydrogenation to acetaldehyde and the oxygen insertion to acetic acid are the two essential catalytic steps. The experimental results in this thesis suggest that acetaldehyde autoxidises non-catalytically to acetic acid, likely driven by radicals. These results led to a shift in the design principles for ethanol oxidation catalysts. The emphasis lies on the design of a catalytic system capable to catalyse the dehydrogenation and suppress the parallel over-oxidation to carbon dioxide. Herein, new supports for gold nanoparticles were developed to reduce the carbon dioxideformation. The most promising support system is titania on silica, which combines the high surface area of silica with the stabilising effect of titania on the gold particles. Characterisation of the catalyst showed that titanium is present in the form of a thin titania layer on silica, on which gold nanoparticles are preferably formed. Hence, gold does not require the bulk properties of titania but can be stabilised and better dispersed on the higher surface area of silica. Furthermore, the catalyst can be used in X-ray absorption spectroscopy analysis to study the interaction of gold and titania more clearly avoiding the diluting effect of bulk titania on the measurement. Consequently, a mechanistic study using a series of in-situ techniques, such as Xray absorption and infrared spectroscopy on the silica and titania-silica supported gold nanoparticles was performed. The study demonstrated the direct involvement of the support on the overall reaction as the adsorption site of both ethanol and acetaldehyde. It was determined that over Au/Ti@SiO2, and possibly over Au/TiO2, the mechanism follows a classic dehydrogenation in the absence of oxygen. That is, gold facilities the α hydrogen-carbon bond cleavage and the formation of molecular hydrogen. In the presence of oxygen, hydrogen removal may be facilitated by the formation of water instead of molecular hydrogen, which is thermodynamically more favourable. The search for an alternative system to gold has led to the discovery of a catalytic system, which exhibits exceptionally high selectivity to acetic acid. The catalytic system is very stable and more cost-effective due to its lower market price compared to gold. Overall this thesis extends our understanding of the ethanol oxidation reaction mechanism and provides basic design principles for the development of novel gold- and next-generation systems. In particular, the latter have the potential to be developed into commercial systems to enable the manufacturing of bio-based acetic acid at an industrial scale

Oral lesions in children with perinatally acquired human immunodeficiency virus infection

Fifteen vertically HIV-infected children aged between 2 and 12 years were followed up for 1 year, weekly to monthly, to study the incidence of oral lesions. At the time of first examination, oral candidiasis (OC) was observed in nine children. Seven children presented with the erythematous type only and two with pseudomembranous oral candidiasis. Four cases of cheilitis were seen in association with the erythematous forms of oral candidiasis. One erythematous candidiasis progressed to pseudomembranous form. A second case of erythematous OC, after multiple recurrences in the form of erythematous OC, recurred as pseudomembranous OC. Another case of erythematous OC and one of pseudomembranous OC presented after multiple recurrences as a persistent, adherent pseudomembranous OC. An orofacial herpes-zoster infection, a hairy leukoplakia and a necrotic lingual ulcer were observed as second lesions and in association with oral candidiasis in three children. Erythematous oral candidiasis was the most frequent oral HIV-related lesion, was observed in different stages of HIV-infection, and in some cases progressed to pseudomembranous candidiasis. A different, selectively resistant, Candida clone was isolated in three cases of recurrent candidiasis

Vesiculopapular rash as a single presentation in intrauterine coxsackie virus infection

In neonates with a rash, a high degree of clinical suspicion should be maintained for coxsackie virus congenital infection. Reverse transcriptase polymerase chain reaction allows its rapid and accurate diagnosis