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A modified Vesikari severity score (MVSS) is a useful research tool for assessing severity of acute gastroenteritis. We present a MVSS for studies in which a follow-up assessment of symptoms cannot be obtained. The MVSS significantly correlated with other markers of severity, including illness duration and work and school absenteeism.The New Vaccine Surveillance Network uses a modified Vesikari severity score (MVSS) that captures severity without follow-up contact. This MVSS significantly correlated with other markers of severity and may be a useful tool to measure the severity of acute gastroenteritis.

Giving antibiotics to pregnant women who have risk factors for group B streptococcal infection can prevent the infection in over 80%, according to a study of 316 women. It is best to give the antibiotics at least two hours before delivery for greatest effectiveness.

At nine US hospitals that enrolled children hospitalized with acute respiratory illness (ARI) during 2015-2016 through 2017-2018 influenza seasons, 50% of children with ARI received clinician-initiated testing for influenza and 35% of cases went undiagnosed due to lack of clinician-initiated testing. Marked heterogeneity in testing practice was observed across sites.

Parental report was reliable and concordant with influenza vaccination history from documented records in hospitalized children with acute respiratory illness at 7 pediatric hospitals. Influenza vaccine effectiveness estimates did not differ substantially using either source of vaccination history.

In a US surveillance network from 2015 to 2016, full influenza vaccination led to a 56% reduction in the likelihood of children being hospitalized with laboratory-confirmed influenza, highlighting the benefit of influenza vaccination in preventing severe outcomes in fully vaccinated children.

Rotavirus is a leading cause of acute gastroenteritis (AGE) in children and is highly transmissible. In this study, we assessed the presence of AGE in household contacts (HHCs) of pediatric patients with laboratory-confirmed rotavirus.

The epidemiology of antibiotic-resistant Enterobacteriaceae intestinal carriage in healthy US children has not been well characterized.

ABSTRACTThe purpose of this study was to describe the population structure of group B streptococci (GBS) isolated from infected and colonized neonates during a prospective active-surveillance study of early-onset disease in six centers in the United States from July 1995 to June 1999 and to examine its relationship to bovine strains of GBS. The phylogenetic lineage of each GBS isolate was determined by multilocus sequence typing, and isolates were clustered into clonal complexes (CCs) using the eBURST software program. A total of 899 neonatal GBS isolates were studied, of which 129 were associated with invasive disease. Serotype Ia, Ib, and V isolates were highly clonal, with 92% to 96% of serotype Ia, Ib, and V isolates being confined to single clonal clusters. In contrast, serotype II and III isolates were each comprised of two major clones, with 39% of serotype II and 41% of serotype III isolates in CC 17 and 41% of serotype II and 54% of serotype III isolates in CC 19. Further analysis demonstrates that the CC 17 serotype II and III GBS are closely related to a previously described “ancestral” lineage of bovine GBS. While 120 (93%) of invasive GBS were confined to the same lineages that colonized neonates, 9 (7%) of the invasive GBS isolates were from rare lineages that comprised only 2.7% of colonizing lineages. These results are consistent with those for other geographic regions that demonstrate the highly clonal nature of GBS infecting and colonizing human neonates.

ABSTRACTThis study compares the phylogenetic lineages of invasive serotype III group B streptococci (GBS) to those of colonizing strains in order to determine lineages associated with invasive disease. Isolates from 29 infants with early-onset disease (EOD) and from 196 colonized infants, collected in a prospective, multicenter study, were assigned a sequence type (ST) by multilocus sequence typing. Overall, 54.5% of the isolates were in the ST-19 complex, and 40.4% were in the ST-17 complex. Invasive strains were more likely to be in the ST-17 complex than were colonizing strains (59% versus 38%, P= 0.03). After we adjusted for potential confounders, the ST-17 complex was more likely to be associated with EOD than were other lineages (odds ratio = 2.51, 95% confidence interval = 1.02 to 6.20). These data support the hypothesis that ST-17 complex GBS are more virulent than other serotype III GBS.

As the most common cause of severe diarrhea among children, rotavirus has a significant economic impact. Previous studies focused on the direct medical costs of rotavirus infections; however, nonmedical costs account for the majority of the financial burden from this disease. Herein, we report the results from the largest prospective study in the United States determining the nonmedical costs of severe rotavirus infections.

Gram-positive infections caused by susceptible and resistant strains of Staphylococcus aureus,coagulase-negative staphylococci and enterococci are increasing problems in neonates. Linezolid, a new oxazolidinone, is active against these pathogens and has recently been approved by the Food and Drug Administration for treating Gram-positive infections in pediatric patients.

Wereport four fatal cases of amebic encephalitis in children caused by the free-living pathogenic ameba Balamuthia mandrillaris.

Although rotaviruses (RVs) are the most common cause of severe gastroenteritis in children, there is a lack of information detailing the spectrum of clinical manifestations of RV disease resulting in hospitalization.

To determine the safety, tolerance, pharmacokinetics and efficacy of linezolid, a new oxazolidinone antibiotic in the treatment of community-acquired pneumonia in hospitalized children.

Pediatric skin and skin structure infections are often polymicrobial and require empiric therapy effective against pathogens that may be resistant to many antimicrobial agents. The present study tested the efficacy and safety of a parenteral beta-lactam/beta-lactamase inhibitor combination, ampicillin/sulbactam, and a beta-lactamase-stable cephalosporin, cefuroxime, in serious pediatric skin and skin structure infections requiring hospitalization and parenteral antimicrobial therapy.

• The traditional treatment of African sleeping sickness (trypanosomiasis) with central nervous system involvement Is an organic arsenical compound, melarsoprol, which is associated with severe and even life-threatening side effects. A polyamine biosynthesis inhibitor, eflornithine (chemical name, DL-α-difluoromethylornithine, supplied as monohydrochloride monohydrate), was used to treat a 3½-year-old child with newly diagnosed severe trypanosomiasis that had been acquired more than two years previously in Zaire or the Congo. Treatment consisted of 300 to 400 mg/kg/d of eflornithine by continuous Intravenous infusion for 25 days followed by 300 mg/kg/d of eflornithine by mouth divided in four equal doses daily for 17 days. The child's recovery was dramatic, with eradication of blood and cerebrospinal fluid parasites in the first week. Cerebrospinal fluid pleocytosis resolved completely. Her generalized adenopathy and fever gradually resolved. Severe ataxia, Inability to walk or to change posture on her own, marked language regression, and lethargy all improved during and after her therapy. The drug was well tolerated; the only noted adverse effect was transient thrombocytopenia during the fourth week of therapy. Eflornithine was a safe and effective agent for treatment of trypanosomiasis with central nervous system involvement in this child.(AJDC 1988;142:224-228)

• An outbreak of hepatitis A involving 15 nurses, two premature infants, and the mother of one infant occurred in an intensive care nursery. The infants became infected after receiving blood transfusions from a donor who shortly thereafter experienced symptoms compatible with hepatitis A and was later found to have serologic evidence of acute hepatitis A. Hepatitis was not suspected clinically in the infants but was documented serologically. One of the infants had an ileostomy with liquid intestinal drainage. Her mother and most, if not all, of the nurses acquired hepatitis from this infant. All 15 nurses had contact with this infant, whereas only four nurses had contact with the second infant. The amount of contact nurses had with this infant clearly was related to their risk of infection. Nurses not actually assigned to this infant but who reported some contact had a significantly lower attack rate than those assigned to the infant. Among assigned nurses, those assigned to more than one shift had 4.7 times the risk of acquiring hepatitis than those assigned to one shift only. No specific nursing techniques or personal habits were documented as being significant risk factors in the infected group of nurses.(AJDC 1986;140:23-27)

The California group of arboviruses are now recognized as a significant cause of encephalitis in children. Fifty children with California encephalitis were seen at Columbus Children's Hospital between 1966 and 1970. The illness characteristically began abruptly with fever, lethargy, vomiting, and progressive encephalitic findings during the first two to four days and with recovery in seven to ten days. Focal neurologic findings were present in 20% and electroencephalograms revealed asymmetrical delta-wave activity in 40% of the children during the acute phase of the illness.

Three female siblings aged 6, 4, and 2 years with the clinical syndrome of chronic granulomatous disease had frequent hospital admissions for serious bacterial infections, including pneumonia, liver abscesses, pyoderma, keratoconjunctivitis, draining adenitis, septicemia, and anemia. All three children were immunologically competent. Liver biopsy specimens in two of the three showed "chronic granulomatous reaction." Polymorphonuclear leukocytes from the patients showed impaired bactericidal ability when incubated with Staphylococcus aureus. Their leukocytes showed decreased ability to reduce nitroblue tetrazolium (NBT) dye compared with normal cells. The X-linked mode of transmission found in males with fatal chronic granulomatous disease is unlikely in these cases even if the Lyon hypothesis is considered. An autosomal locus acting either as homozygous recessive or dominant with variable expression would explain the occurrence of this disorder in females.

Fifty-one children with mumps meningoencephalitis were studied. The disease occurred throughout the year, with higher frequency in boys. The disease was of short duration and was generally benign. Parotitis accompanied meningoencephalitis in 47% of the patients. Appropriate serologic studies and/or recovery of virus from cerebrospinal fluid, saliva, urine, or washings of throat swabs are essential for the diagnosis of mumps meningoencephalitis in the absence of parotitis. All children recovered uneventfully and follow-up examinations of 33 children 4 to 40 months after the onset of meningoencephalitis showed no neurological sequelae or hearing loss. Serum amylase concentration was found to be elevated in the presence of parotitis and generally normal in primary mumps meningoencephalitis.

Generalized infections or encephalitis due to herpesvirus are being recognized with increasing frequency. Recognition of these infections is facilitated by a high index of suspicion, by careful history of contacts with herpesvirus infection during the perinatal period, and by familiarity with clinical syndromes compataible with such infections. Diagnosis is confirmed by isolation of virus from blood or tissues; however, isolation of herpesvirus from other specimens may be helpful. The prognosis in patients with generalized herpesvirus infections or encephalitis is so dismal that early confirmation of diagnosis is indicated. Biopsy specimens should be studied by direct viral isolation procedures, fluorescent antibody techniques, and microscopic examination for characteristic intranuclear inclusions. Therapeutic trials with idoxuridine (IDU) and supportive measures deserve further study.

Growth of Malassezia furfurin the intravascular catheter used for administration of lipid emulsion resulted in occlusion of deep intravascular Silastic® catheters in 12 infants in 2 intensive care nurseries. At the time of occlusion visible growth was noted in the clear catheter which was connected to the Silastic® intravascular line. Five infants showed clinical signs suggestive of sepsis. The yield of M. furfurfrom blood cultures and catheter tips was low even when oil enrichment was used. The highest yield of M. furfurwas found in the connecting catheter (11 of 11). The source from and the route by which M. furfurentered the catheter remain unclear. The potential portals of entry include the proximal and distal ends of the connecting catheter as well as the colonized skin of the infants and caretakers.

Forty-seven infants and children with a variety of infections including bacteremia, ethmoiditis, and periorbital cellulitis, soft tissue infection, pneumonia, and lymphadenitis were treated with intravenous cefamandole. The infections were due to Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae. The clinical response was prompt, and, with the exception of two cases who developed skin rash, significant side effects were not noted. In vitro cefamandole was very effective in inhibiting the growth of H. influenzae, including ampicillin-resistant isolates.

Recent reports have described an increase in the incidence of Haemophilus influenzae infection.1.2 Ampicillin-resistant strains of H influenzae have recently been reported from many states.3 This is the report of a 6-month-old infant in whom, within a 28-day period, periorbital cellulitis and bacteremia followed by meningitis developed, both infections having been caused by H influenzae. The organism isolated from the first infection was sensitive to and the second resistant to ampicillin sodium.Report of a Case.—A previously well 6-month-old male infant was admitted to Columbus Children's Hospital with left periorbital edema, erythema, and a temperature of 40 C. Blood culture yielded H influenzae type b, sensitive to both ampicillin sodium and chloramphenicol.The infant was initially treated with ampicillin sodium (200 mg/kg/day) and methicillin sodium (200 mg/kg/day) administered intravenously for six days, at which time he was placed on a regimen of oral ampicillin (100 mg/kg/day),

• Two newborn siblings, one with meningitis and one with sepsis due to Listeria monocytogenes, were born to a healthy, 33-year-old woman. She had had a spontaneous abortion prior to the birth of these infants. In spite of negative cultures, persistence of this bacterium in the mother's genital tract and perinatal acquisition of infection is suspected.(Am J Dis Child 131:398-399, 1977)

MUMPS meningoencephalitis is usually a benign self-limiting disease; its clinical features are fever, headache, nausea, vomiting, and meningeal signs. The clinical course is of short duration, and death or major neurological complications are rare.The patient with mumps meningoencephalitis described in this report is unusual because of the persistence of an elevated cerebrospinal fluid (CSF) protein level and pleocytosis.Report of a CaseAn 11-year-old boy was admitted to Columbus (Ohio) Children's Hospital on Aug 6, 1973. Five days prior to admission, earache, fever, vomiting, and ataxia had developed. The following day, his temperature rose to 40 C (104 F). His physician gave him an injection of penicillin, and ampicillin in a dosage of 500 mg orally every six hours was prescribed. In spite of antibiotic therapy, his illness progressed and he was admitted to the hospital because of confusion and visual hallucinations. At the time of admission, his temperature

Cefamandole nafate was effective in the treatment of a variety of infections caused by Staphylococcus aureus, Streptococcus pyogenes group A, Streptococcus pneumoniae, and Haemophilus iniiuenzae in infants and children. The infections included periorbital cellulitis and ethmoiditis, bacteremia, cellulitis, pneumonia, and lymphadenitis. In vitro, cefamandole was effective in inhibiting the growth of H. influenzae isolated from blood or cerebrospinal fluid of patients with meningitis or sepsis. In two patients rash developed and cefamandole was discontinued. Other significant adverse effects were not noted.