- [Recurrent infections of the upper aerodigestive tract in patients with primary immunodeficiency]. [Journal Article]
- HNOHNO 2019 May 22
- CONCLUSIONS: The prevalence of ENT infections in patients with a primary immunodeficiency is increased compared to the normal population. For the ENT specialist, these findings underline the necessity of including primary immunodeficiency in the differential diagnosis and initiating targeted diagnostic methods where indicated. Interdisciplinary collaboration with rheumatologists and immunologists is highly recommended, particularly for pediatric patients.
- Health outcomes and services in children with sickle cell trait, sickle cell anemia, and normal hemoglobin. [Journal Article]
- BABlood Adv 2019 May 28; 3(10):1574-1580
- The health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA),…
The health effects of sickle cell trait among children are unknown. We compared select health outcomes and health services utilization among children with sickle cell trait, sickle cell anemia (SCA), and normal hemoglobin. Newborn screening records were used to identify children with sickle cell trait and SCA born in Michigan (1997-2014) who were enrolled in Michigan Medicaid for ≥1 year from 2012 to 2014. Each select health outcome (acute otitis media, acute respiratory infections, fever, invasive pneumococcal disease, pneumonia and influenza, renal complications, spleen problems, stroke) was defined as ≥1 claim with a diagnosis code for the respective outcome within a study year. Health services utilization was summarized as counts of emergency department, inpatient, and outpatient encounters. The relationship between hemoglobin status and each health outcome or utilization was assessed by logistic or negative binomial regression with generalized estimating equations. The study population consisted of 18 257 children with sickle cell trait, 368 with SCA, and 74 523 with normal hemoglobin (227 188 total person-years). Compared with those with normal hemoglobin, children with sickle cell trait had lower odds of acute otitis media (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.84-0.91), acute respiratory infections (OR, 0.94; 95% CI, 0.92-0.97), pneumonia and influenza (OR, 0.93; 95% CI, 0.87-0.99), and outpatient visits (incidence rate ratio, 0.95; 95% CI, 0.93-0.97). Children with SCA had higher or nonsignificant odds of all outcomes and types of health services utilization. These results indicate that children with sickle cell trait may not be at additional health risk for these outcomes. However, additional case-control studies may be necessary to identify rare events.
- Detecting middle ear fluid using smartphones. [Journal Article]
- STSci Transl Med 2019 May 15; 11(492)
- The presence of middle ear fluid is a key diagnostic marker for two of the most common pediatric ear diseases: acute otitis media and otitis media with effusion. We present an accessible solution tha…
The presence of middle ear fluid is a key diagnostic marker for two of the most common pediatric ear diseases: acute otitis media and otitis media with effusion. We present an accessible solution that uses speakers and microphones within existing smartphones to detect middle ear fluid by assessing eardrum mobility. We conducted a clinical study on 98 patient ears at a pediatric surgical center. Using leave-one-out cross-validation to estimate performance on unseen data, we obtained an area under the curve (AUC) of 0.898 for the smartphone-based machine learning algorithm. In comparison, commercial acoustic reflectometry, which requires custom hardware, achieved an AUC of 0.776. Furthermore, we achieved 85% sensitivity and 82% specificity, comparable to published performance measures for tympanometry and pneumatic otoscopy. Similar results were obtained when testing across multiple smartphone platforms. Parents of pediatric patients (n = 25 ears) demonstrated similar performance to trained clinicians when using the smartphone-based system. These results demonstrate the potential for a smartphone to be a low-barrier and effective screening tool for detecting the presence of middle ear fluid.
- Education, decision support, feedback and a minor reward: a novel antimicrobial Stewardship intervention in a Swedish paediatric emergency setting. [Journal Article]
- IDInfect Dis (Lond) 2019 May 15; :1-11
- CONCLUSIONS: This relatively easily implementable ASP intervention showed a significant effect on correctly refraining from the use of antibiotics. Previous interventions in Scandinavia either failed to accomplish this or have been more logistically difficult. The combination of education, decision support, email-based feedback and a minor reward, offers an alternative. Future research will be needed to assess whether the result is sustainable, as well as to identify additional barriers to the judicious use of antibiotics not addressed in this study.
- Role of Biofilms in Children with Chronic Adenoiditis and Middle Ear Disease. [Review]
- JCJ Clin Med 2019 May 13; 8(5)
- Chronic adenoiditis occurs frequently in children, and it is complicated by the subsequent development of recurrent or chronic middle ear diseases, such as recurrent acute otitis media, persistent ot…
Chronic adenoiditis occurs frequently in children, and it is complicated by the subsequent development of recurrent or chronic middle ear diseases, such as recurrent acute otitis media, persistent otitis media with effusion and chronic otitis media, which may predispose a child to long-term functional sequalae and auditory impairment. Children with chronic adenoidal disease who fail to respond to traditional antibiotic therapy are usually candidates for surgery under general anaesthesia. It has been suggested that the ineffectiveness of antibiotic therapy in children with chronic adenoiditis is partially related to nasopharyngeal bacterial biofilms, which play a role in the development of chronic nasopharyngeal inflammation due to chronic adenoiditis, which is possibly associated with chronic or recurrent middle ear disease. This paper reviews the current evidence concerning the involvement of bacterial biofilms in the development of chronic adenoiditis and related middle ear infections in children.
- Design and characterization of PE-PilA, a candidate fusion antigen for non-typeable Haemophilus influenzae vaccine. [Journal Article]
- IIInfect Immun 2019 May 13
- Non-typeable Haemophilus influenzae (NTHi) is a pathogen known for being a frequent cause of acute otitis media in children and respiratory tract infections in adults with chronic obstructive pulmona…
Non-typeable Haemophilus influenzae (NTHi) is a pathogen known for being a frequent cause of acute otitis media in children and respiratory tract infections in adults with chronic obstructive pulmonary disease. In the present study, a vaccine antigen has been developed based on the fusion of two known NTHi adhesive proteins, Protein E (PE) and pilin subunit (PilA). The quality of the combined antigen was investigated through functional, biophysical and structural analyses. It was shown that PE and PilA individual structures are not modified in the PE-PilA fusion and that PE-PilA assembles as a dimer in solution, reflecting PE dimerization. PE-PilA was found to bind vitronectin in ELISA, as isolated PE does. Disulfide bridges were conserved and homogeneous, which was determined by peptide mapping and Top-down analysis on PE, PilA and PE-PilA molecules. Finally, the PE-PilA crystal showed a PE entity with a 3D-structure similar to that of recently published isolated PE, while the structure of the PilA entity was similar to that of a 3D-model elaborated from two other type 4 pilin subunits.Taken together, our observations suggest that the two tethered proteins behave independently within the chimeric molecule and display structures similar to the respective isolated antigens, which are important characteristics for eliciting an optimal antibody-mediated immunity. PE and PilA can thus be further developed as a single fusion protein in a vaccine perspective, in the knowledge that tethering the two antigens does not perceptibly compromise the structural attributes offered by the individual antigens.
- A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. [Journal Article]
- IJInt J Pediatr Otorhinolaryngol 2019 May 06; 123:102-109
- CONCLUSIONS: We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.
- Subversion of host immune responses by otopathogens during otitis media. [Review]
- JLJ Leukoc Biol 2019 May 10
- Otitis media (OM) is one of the most common ear diseases affecting humans. Children are at greater risk and suffer most frequently from OM, which can cause serious deterioration in the quality of lif…
Otitis media (OM) is one of the most common ear diseases affecting humans. Children are at greater risk and suffer most frequently from OM, which can cause serious deterioration in the quality of life. OM is generally classified into two main types: acute and chronic OM (AOM and COM). AOM is characterized by tympanic membrane swelling or otorrhea and is accompanied by signs or symptoms of ear infection. In COM, there is a tympanic membrane perforation and purulent discharge. The most common pathogens that cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis whereas Pseudomonas aeruginosa and Staphylococcus aureus are commonly associated with COM. Innate and adaptive immune responses provide protection against OM. However, pathogens employ a wide arsenal of weapons to evade potent immune responses and these mechanisms likely contribute to AOM and COM. Immunologic evasion is multifactorial, and involves damage to host mucociliary tract, genetic polymorphisms within otopathogens, the number and variety of different otopathogens in the nasopharynx as well as the interaction between the host's innate and adaptive immune responses. Otopathogens utilize host mucin production, phase variation, biofilm production, glycans, as well as neutrophil and eosinophilic extracellular traps to induce OM. The objective of this review article is to discuss our current understanding about the mechanisms through which otopathogens escape host immunity to induce OM. A better knowledge about the molecular mechanisms leading to subversion of host immune responses will provide novel clues to develop effective treatment modalities for OM.
- The effect of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on H. influenzae in healthy carriers and middle ear infections in Iceland. [Journal Article]
- JCJ Clin Microbiol 2019 May 08
- Vaccinations with the PHiD-CV pneumococcal vaccine started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine, and can po…
Vaccinations with the PHiD-CV pneumococcal vaccine started in Iceland in 2011. Protein D (PD) from H. influenzae, which is coded for by the hpd gene, is used as a conjugate in the vaccine, and can possibly provide protection against PD positive H. influenzae. We aimed to evaluate the effect of the PHiD-CV vaccination on H. influenzae in children, both in carriage and in acute otitis media (AOM).H. influenzae was isolated from nasopharyngeal swabs, collected from healthy children attending 15 day care centers in 2009 and 2012-2017, and from middle ear (ME) samples from children with AOM, collected from 2012-2017. All isolates were identified using PCR for the hpd and fucK genes.Of 3,600 samples collected from healthy children, 2,465 samples were culture-positive for H. influenzae (68.5% carriage rate) and of these, 151 (6.1%) contained hpd negative isolates. Of 2,847 ME samples collected, 889 (31.2%) were culture positive for H. influenzae and of these, 71 (8.0%) were hpd negative. In spite of the same practice throughout the study, the annual number of ME samples reduced from 660 in 2012 to 330 in 2017. The proportion of hpd negative isolates in unvaccinated vs. vaccinated children was 5.6% and 7.0%, respectively, in healthy carriers, and 5.4% and 7.8%, respectively, in ME samples. The proportion of hpd negative isolates increased with time in ME samples, but not in healthy carriers.The number of ME samples from children with AOM decreased. The PHiD-CV had no effect on the proportion of the hpd gene in H. influenzae from carriage but there was an increase in hpd negative H. influenzae in otitis media. The proportion of hpd negative isolates remained similar in vaccinated and unvaccinated children.
New Search Next
- Otitis Externa. [Journal Article]
- DADtsch Arztebl Int 2019 Mar 29; 116(13):224-234
- CONCLUSIONS: With correct assessment of the different types of otitis externa, rapidly effective targeted treatment can be initi- ated, so that complications will be avoided and fewer cases will progress to chronic disease.