Paediatric sepsis

By Luregn Schlapbach. Published in Infectious Diseases. October 2019.   

 

Sepsis remains among the leading causes of childhood mortality worldwide. This review serves to highlight key areas of knowledge gain and ongoing controversies pertinent to sepsis in children. Recent findings Several recent publications describe the epidemiology of paediatric sepsis, demonstrating the impact on child health in terms of mortality and morbidity, and the shortcomings of current paediatric sepsis definitions. Although emerging data support the importance of organ dysfunction as a hallmark of paediatric sepsis, the understanding of host susceptibility to sepsis and to sepsis severity remains very limited. Next-generation sequencing and host transcriptomics have the potential to provide new insights into the pathogenesis of sepsis and may enable personalized medicine approaches. Despite good observational data indicating benefit of sepsis recognition and treatment bundles, the evidence for the individual bundle components remains scarce, implying an urgent need for large trials. Recent studies have demonstrated distinct epidemiological patterns pertinent to age groups, healthcare settings, and comorbidities in the era post meningococcal epidemics. Although sepsis quality improvement initiatives have led to substantial outcome improvements, there is urgency for innovative trials to reduce uncertainty around the optimal approach for the recognition and treatment of sepsis in children.

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Identifying residual hotspots and mapping lower respiratory infection morbidity and mortality in African children from 2000 to 2017

By Robert C. Reiner, Catherine A. Welgan, Daniel C. Casey, Christopher E. Troeger, Mathew M. Baumann, QuynhAnh P. Nguyen, Scott J. Swartz, Brigette F. Blacker, Aniruddha Deshpande, Jonathan F. Mosser, Aaron E. Osgood-Zimmerman, Lucas Earl, Laurie B. Marczak, Sandra B. Munro, Molly K. Miller-Petrie, Grant Rodgers Kemp, Joseph Frostad, Kirsten E. Wiens, Paulina A. Lindstedt, David M. Pigott, Laura Dwyer-Lindgren, Jennifer M. Ross, Roy Burstein, Nicholas Graetz, Puja C. Rao, Ibrahim A. Khalil, Nicole Davis Weaver, Sarah E. Ray, Ian Davis, Tamer Farag, Oliver J. Brady, Moritz U. G. Kraemer, David L. Smith, Samir Bhatt, Daniel J. Weiss, Peter W. Gething, Nicholas J. Kassebaum, Ali H. Mokdad, Christopher J. L. Murray & Simon I. Hay. Published in Nature Microbiology. September 30, 2019.  

Lower respiratory infections (LRIs) are the leading cause of death in children under the age of 5, despite the existence of vaccines against many of their aetiologies. Furthermore, more than half of these deaths occur in Africa. Geospatial models can provide highly detailed estimates of trends subnationally, at the level where implementation of health policies has the greatest impact. We used Bayesian geostatistical modelling to estimate LRI incidence, prevalence and mortality in children under 5 subnationally in Africa for 2000–2017, using surveys covering 1.46 million children and 9,215,000 cases of LRI. Our model reveals large within-country variation in both health burden and its change over time. While reductions in childhood morbidity and mortality due to LRI were estimated for almost every country, we expose a cluster of residual high risk across seven countries, which averages 5.5 LRI deaths per 1,000 children per year. The preventable nature of the vast majority of LRI deaths mandates focused health system efforts in specific locations with the highest burden.

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Levels and trends in child mortality 2019

Above photo, credit to UNICEF, WHO, World Bank Group and United Nations

 

The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) produces estimates of child and young adolescent mortality annually, reconciling the differences across data sources and taking into account the systematic biases associated with the various types of data on child and adolescent mortality. This report presents UN IGME’s latest estimates – through 2018 – of neonatal, infant and under-five mortality as well as mortality among children aged 5–14 years. It assesses progress in the reduction of child and young adolescent mortality at the country, regional and global levels, and provides an overview of the methods used to estimate the mortality indicators above.

 

Please view the full report here. 

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Low Admission Plasma Gelsolin Concentrations Identify Community-acquired Pneumonia Patients at High Risk for Severe Outcomes

By Wesley H Self, Richard G Wunderink, Mark J DiNubile, Thomas P Stossel, Susan L Levinson, Derek J Williams, Evan J Anderson, Anna M Bramley, Seema Jain, Kathryn M Edwards, Carlos G Grijalva

Clinical Infectious Diseases. October 1, 2019.

 

Plasma gelsolin (pGSN) is an abundant circulating protein that neutralizes actin exposed by damaged cells, modulates inflammatory responses, and enhances alveolar macrophage antimicrobial activity. We investigated whether adults with low pGSN at hospital admission for community-acquired pneumonia (CAP) were at high risk for severe outcomes.

Admission pGSN concentrations in 455 adults hospitalized with CAP were measured using enzyme-linked immunosorbent assay. Patients were grouped into the following 4 hierarchical, mutually exclusive categories based on maximum clinical severity experienced during their hospitalization: general floor care without intensive care unit (ICU) admission, invasive respiratory or vasopressor support (IRVS), or death; ICU care without IRVS or death; IRVS without death; or death. Admission pGSN concentrations were compared across these discrete outcome categories. Additionally, outcomes among patients in the lowest quartile of pGSN concentration were compared to those in the upper 3 quartiles.

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Interaction With Nontypeable Haemophilus influenzae Alters Progression of Streptococcus pneumoniae From Colonization to Disease in a Site-Specific Manner

By Joseph A Lewnard, Noga Givon-Lavi, Ron Dagan

The Journal of Infectious Diseases. October 15, 2019.

 

Pneumococci and nontypeable Haemophilus influenzae (NTHi) often cocolonize children. The impact of species interactions on disease risk across the upper respiratory mucosa is not known.

We analyzed data from 4104 acute conjunctivitis (AC) cases, 11 767 otitis media (OM) cases, and 1587 nasopharyngeal specimens collected from Israeli children before pneumococcal conjugate vaccine introduction. We compared pneumococcal serotype distributions with NTHi present and absent, and compared single-species and mixed-species rates of serotype-specific progression from colonization to AC and OM.

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