Volume 55, Issue 6, 15 September 2012

This is the first report on Shiga toxin–producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) in children due to E. coli O104:H4 and the largest outbreak ever reported in detail in children. STEC-HUS due to E. coli O104:H4 is comparable to typical HUS in previous pediatric series.

Enterococcal bloodstream infections are associated with an increased risk of mortality during the first year after hematopoietic stem cell transplantation, especially in patients with vancomycin-resistant enterococci (VRE) strains. Colonization with VRE and delayed engraftment are significant risk factors for VRE bacteremia.

The impact of the treatment of asymptomatic bacteriuria on the recurrence rate among young women affected by recurrent urinary tract infection is evaluated.

The USA300 clone of methicillin-resistant Staphylococcus aureus causes concurrent epidemics of skin and soft tissue infections (SSTIs) and bloodstream infections (BSIs). Because USA300 SSTIs serve as a source for BSIs, strategies to control the USA300 SSTI epidemic may lessen the severity of the USA300 BSI epidemic.

Neurological disease, with or without lung infection, is common in sporadic Cryptococcus gattii infection (85%; raised intracranial pressure [42%]; hydrocephalus [30%]; neurological deficits [27%]). Immunocompromised patients had increased mortality risk. Cerebrospinal fluid cryptococcal antigen titers ≥256 predicted death and/or neurological sequelae in central nervous system infection.

The Clinical and Laboratory Standards Institute recently elected to lower the susceptibility breakpoint of piperacillin against Pseudomonas aeruginosa based largely on pharmacokinetic-pharmacodynamic modeling. We conducted a retrospective study to determine if lowering susceptibility breakpoints predicts improved clinical outcomes in children.

Antimicrobial resistance was associated with higher charges, length of stay, and death rates. The difference in estimates after accounting for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial-resistant infections.

This study evaluated the impact of age and pneumococcal vaccination on the density of pneumococcal nasopharyngeal carriage. Among colonized individuals, density decreased with increasing age. Time-trends analysis revealed that pneumococcal vaccination appeared to lower the density of nasopharyngeal carriage.

The new Japanese encephalitis vaccine (JE-VC, Ixiaro) has replaced mouse brain–derived vaccines (JE-MB) associated with serious safety concerns. A single dose of JE-VC effectively boosted immunity in JE-MB–primed travelers. Current recommendations for booster vaccination should be reevaluated.

Targeted information about disease- and vaccine-risk is necessary but insufficient to change how providers make vaccine administration decisions. Providers need additional education to enable them to apply evidence, overcome cognitive decision-making errors and involve patients in vaccine decisions.

Toxoplasmosis is a leading foodborne illness. Undercooked meat and soil contaminated with cat feces are the major sources of infection. Reduction of Toxoplasma gondii in meat, proper food preparation practices, and reduction of environmental contamination can help prevent toxoplasmosis.

Carbapenem-resistant Enterobacteriaceae (CRE) are widespread and of global concern. CRE data in children are sparse though incidence may be increasing owing to efficient bacterial spread and mobile genetic resistance elements. This review summarizes available data on CRE in the pediatric population.

Human immunodeficiency virus (HIV)–associated diarrhea remains common despite the use of highly active antiretroviral therapy (HAART) and may be caused by noninfectious mechanisms, such as HAART-related adverse events and HIV enteropathy. Newer therapies targeting these noninfectious causes of diarrhea are needed.

ACTG A5199 compared the neuropsychological effects of 3 antiretroviral regimens in 860 human immunodeficiency virus–positive participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe. Treatment with either of the World Health Organization–recommended first-line regimens improved neurological and neuropsychological functioning.

Among 414 infants born to human immunodeficiency virus–infected women, congenital cytomegalovirus (CMV) rates did not change from the pre–highly active antiretroviral therapy (HAART) era (1988–1996) to the post-HAART era (1997–2002). Rates of perinatal/early postnatal CMV decreased, however (from 17.9% to 8.9%), as did the occurrence of CMV-related clinical symptoms.

Since the Libreville outbreak in 2007, Chikungunya virus and dengue virus serotype 2 have continued to spread throughout Gabon. We prospectively studied 4287 acute febrile cases, of which 1943 were virologically confirmed, and we documented coinfections in human and mosquito.

We assessed morbidity due to Opisthorchis viverrini and Schistosoma mekongi infections in 243 individuals in Lao People's Democratic Republic. Morbidity was associated with O. viverrini infection intensity. Coinfection with S. mekongi resulted in excess risk of liver fibrosis and left liver lobe enlargement. The high public health impact of opisthorchiasis warrants control.