infectious complications

This study aimed to define risk factors associated with suppurative complications, short-term sequelae, and death in pediatric patients with bacterial meningitis.

A retrospective cohort study was conducted on children with bacterial meningitis, aged 0 months to 18 years, who were admitted to the Hospital Infantil João Paulo II, reference in infectious diseases, from 2005 to 2018.

In 178 cases, meningococcal meningitis was the most prevalent disease form (51%), followed by pneumococcal meningitis (31%) andHaemophilus influenzae type Bmeningitis (10%). Themain clinical findings at admission were fever (93.1%), vomiting (67.9%), drowsiness (47.8%), headache (36.5%), irritability (28.3%), and seizures (26.4%). Suppurative complications were recorded in 19% of the patients. The prevalence of neurological sequelae during hospital discharge was 12.4%. Hearing (41%; n = 9) and cognitive (9%) impairments were prominent among the diagnosed sequelae. Incidences of epileptic crises, vestibular disorders, or hydrocephalus were noted in one case each (4.5%), and 12.4% of the patients died.

Streptococcus pneumoniae and H. influenzae type B were associated with the diagnosis of sequelae during hospital discharge, seizures were considered a risk factor for suppurative complications, and gastrointestinal symptoms or signs of clinical severity were associated with death.

To choose the ideal ureteral access sheath (UAS) size for an unstented ureter in flexible ureteroscopic lithotripsy (FURL).

A retrospective study was conducted in patients treated with FURL for renal calculi from 2005 to 2020. The patients were divided into two groups: smaller (10/12 Fr) vs. larger (12/14 Fr) calibre UAS. The outcomes were the insertion success rate, systemic inflammatory response syndrome (SIRS) complication rate after the operation, ureteral wall injury, operative time, and stone-free rate.

Of the 1573 patients enrolled, 10/12 Fr UAS was used in 957 patients (Group A), and 12/14 Fr UAS was used in the remaining patients (Group B). The insertion success rate was significantly better in Group A (91.2% vs. 86.9%, P = .006), with no significant difference between the groups regarding the stone-free rate, postoperative pain, operative time or hospital stay. The severity of visible ureteral lesions with 10/12 Fr UAS was significantly lower than that with larger UASs (80.1% vs 85.2%, P < .001). Despite the lack of a significant difference in the incidence of SIRS between the two groups, the incidence of SIRS in the 10/12 Fr group showed a sharp increase with stones > 2 cm (17.0% vs. 8.5%, P = 0.037).

The use of 10/12 Fr UAS was beneficial with respect to insertion success rate, avoiding ureteral wall injury and not increasing postoperative infectious complications in FURL. We recommend the use of a smaller calibre (10/12 Fr) UAS in patients with renal calculi < 2 cm.

  CVID is a common primary immunodeficiency disease defined by a failure in B cell differentiation and impaired immunoglobulin production. Subsequently CVID patients are remarkably susceptible to recurrent and multiple infections with bacterial, viral or fungal agents. In the present study, we aimed to provide an update report on different infectious complications of patients with CVID in Iran.

Demographic, clinical and immunologic data as well as history of infections with related microbial pathogens were obtained from records of patients diagnosed with CVID and followed up at Children’s Medical Center. Based on presence of meningitis, osteomyelitis and sepsis, 2 groups of severe infections and non-severe infections were defined for further investigations.

Among the enrolled 301 CVID patients, 15 (5%) had severe and 286 (95%) had non-severe infections. Respiratory followed by gastrointestinal tract problems (83.1 and 71.4%, respectively) were the most common involved organs. Among the infectious complications, lower and upper respiratory tract infection, followed by mucocutaneous and gastrointestinal tract were the most frequent (76.1, 64.8, 21.6 and 19.6%, respectively). Candida followed by Giardia lamblia were the most common detected pathogens, respectively in those with opportunistic infections and infectious diarrhea.

Recurrent infections of various parts of body are the most prevalent manifestation among patients with CVID playing an important role in the morbidity and even mortality in those with prolonged and untreated infections. Recurrent infections initiating early in childhood should be paid attention and trigger further immunological work up for a possible underlying immunodeficiency especially in families with consanguineous marriage and/or a positive family history of primary immunodeficiency.

Te objective of the present study was to determine the association between chemotherapy and infectious complications in patients diagnosed with Hematologic malignancies (HMs).
Te study included 463 patients diagnosed with HMs multiple myeloma (MM), Hodgkin’s lymphoma (HL), non?HL (NHL), acute myeloid leukemia (AML), acute lymphocytic leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia, between January 2014 and June 2015. Te patients were followed for 1 year after inclusion, to record the infectious complications. Te collected data included age, sex, type of chemotherapy
regimen, and several blood tests at admission. All patients received prophylactic treatment with antibiotics and antifungal agents. For each infection, we recorded the microbiological diagnosis and the day of occurrence since HMs diagnosis.
In patients with MM, we found that the treatment with growth factors (hazard ratio [HR] 2.2; confdence interval [CI] 95%: 1–4.6; P = 0.03) was associated with a higher chance of infectious complications. In patients with non?Hodgkin lymhoma (LNH), the following drugs were associated with a higher infectious incidence: cytarabine (HR: 2.3; CI 95%: 1–5; P = 0.03), methotrexate (HR: 2.1; CI 95%: 1.8–4; P = 0.01), dexamethasone (HR: 1.7; CI 95%: 0.9–3; P = 0.06), growth factors (HR: 1.7; CI 95%: 0.9–3.2; P = 0.001), and etoposide (HR: 2.5; CI 95%: 1.5–4.2; P = 0.002). Cytarabine (induction) (HR: 2; CI 95%: 1.1–3.7; P = 0.01), cytarabine (consolidation) (HR: 2.1; CI 95%: 1.3–3.5; P = 0.01), and growth factors (HR: 2.1; CI 95%: 1.3–3.5; P = 0.002) were often on the therapeutic plan of patients with AML, which developed infections.
Regarding the chemotherapy regimen, the highest incidences of infectious complications were observed for growth factors and cytarabine.