Human ; Quarantine

Objective: This paper looked into the outcome of currently used antibiotic regimens for neonatal sepsis in a tertiary hospital. Methods: This retrospective study reviewed all cases of culture positive neonatal sepsis delivered in a tertiary hospital between January 1, 2000 to December 31, 2015. Demographic profile, stratification as to early-onset and late-onset sepsis, clinical manifestations, culture and antimicrobial susceptibility results, and outcomes were analyzed. Results: There were 28 cases of culture positive neonatal sepsis reported during the study period, and prematurity and low birth weight were the major risk factors identified. Of these, 8 were early-onset sepsis and 20 were late-onset sepsis cases. Respiratory symptoms were the most common presenting manifestations. Sepsis isolates were evenly distributed between gram-negative bacilli and gram-positive cocci with no ESBL E. coli or Klebsiella pneumoniae identified. The institution’s current empiric antibiotic regimen of cefuroxime and amikacin for early-onset neonatal sepsis was shifted to another drug in 57% of cases. Piperacillintazobactam or carbapenem was given for late-onset sepsis. The addition of vancomycin for late-onset sepsis was done where Staphylococcus was considered. Sepsis due to gram-negative bacilli had a high mortality rate. Conclusion Our institution’s empiric antibiotic regimen which consists of cefuroxime and amikacin for early onset sepsis is effective in 43% of cases. A carbapenem or piperacillin-tazobactam, even without amikacin, proved to be effective for late-onset sepsis. Vancomycin, should be considered for late-onset sepsis, if staphyloccoccal disease is suspected.
Neonatal Sepsis ; Anti-Bacterial Agents ; Infant, Newborn ; Infant, Low Birth Weight

Introduction: Fever of unknown origin (FUO) is a problem commonly encountered by infectious disease specialists, and even general pediatricians, in spite of the improvement in diagnostic modalities. There is no local study on childhood FUO from a private hospital. Thus, there is a need to determine the etiology of FUO seen in private practice, which may be different from those encountered in government or teaching hospitals. Objectives: The purpose of this study is to identify the etiologies of childhood FUO from two private, urban, tertiary hospitals, as evaluated by a single pediatric infectious disease physician; and to discuss epidemiologic, clinical and diagnostic clues for the most common etiologies. Methods: Childhood FUO cases were compiled from 1993 to 2020. Each consecutive, inpatient, admission or referral of a patient, 18 years or younger, was logged into a personal computer, and the discharge diagnosis for the FUO was recorded. Clinical, epidemiologic, diagnostic and therapeutic data, relevant to the FUO diagnosis were likewise recorded. FUO was defined as daily fever of 380C for ten consecutive days, or more, with no etiology identified after being admitted for seven days. Results: Of 171 cases of childhood FUO, the etiology was an infection in 68%, collagen-vascular disease in 13%, miscellaneous cause in 8%, malignancy in 6%, and no diagnosis in 5%. The most common infections were Epstein Barr Virus (EBV) mononucleosis, tuberculosis, enteric fever, sinusitis, pneumonia and incomplete Kawasaki disease. The most common collagen vascular diseases were juvenile idiopathic arthritis and systemic lupus erythematosus. Hemophagocytic lymphohistiocytosis was the most common miscellaneous cause. Lymphoma was the most common malignancy. Conclusion This study found EBV mononucleosis, sinusitis, pneumonia, incomplete Kawasaki disease, lymphoma, HLH and Kikuchi-Fujimoto disease to be FUO etiologies not reported previously in other local reports.
Child ; Fever ; Inpatients

Objectives: This study aimed to establish the accuracy of TB PCR versus TB culture and rifampicin resistance detection by PCR versus conventional susceptibility testing of body fluids in diagnosing tuberculosis in pediatric patients 3 months to 18 years with suspected tuberculous disease at a tertiary care center. Methods: This is a retrospective analytical study of patients seen between January 1, 2012 to May 31, 2017, with clinical and radiographic features suggestive of tuberculosis, who had diagnostic testing of body fluids for TB PCR and TB culture. Results: Among 159 patients suspected of TB, 46 (28%) tested positive by PCR, of which one was rifampicin-resistant. The sensitivity, specificity, positive predictive value and negative predictive values of TB PCR, using TB culture as the gold standard were 90%, 91.6%, 78.3%, and 96.5% respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of TB PCR for detecting rifampicin resistance, using TB culture and sensitivity as the gold standard, were 33%, 100%, 100%, and 95%, respectively. Overall, the accuracy of TB PCR in detecting TB disease is 91.2% and the accuracy of TB PCR in detecting rifampicin resistance is 95%. Conclusion Findings in our study suggest that TB PCR play an important role in TB disease diagnosis, but clinical and radiological assessment continue to be essential in the diagnosis of childhood tuberculosis. The accuracy of TB PCR in detecting TB disease in children is 91.2% and the accuracy of TB PCR in detecting Rifampicin resistance is 95%.
Tuberculosis ; Pediatrics

Background: Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome that is associated with a variety of underlying conditions leading to the same characteristic hyperinflammatory phenotype. Objectives: To describe the clinical profile of patients diagnosed with HLH admitted between January 1, 2010 to September 30, 2019 in a tertiary care hospital. Methods: Retrospective descriptive study of pediatric patients diagnosed with HLH in a tertiary care hospital. Results: Eleven subjects were included in the study. Age distribution showed a bimodal pattern: < 5 years old (5, 46%) and 10-15 years old (4, 36%). Male to female ratio is 4.5:1. All patients presented with fever (100%) followed by hepatomegaly (5, 45%) and splenomegaly (4, 36%) on physical examination. All eleven subjects fulfilled the following criteria for HLH such as fever, splenomegaly, and hyperferritinemia. Six out of eleven showed hypofibrinogemia (55%) and hypertriglyceridemia (55%). Among the eleven with two cell cytopenia, five presented with anemia (46%), six with neutropenia (55%), while all of them had thrombocytopenia (100%). Other laboratory findings noted were elevated ALT (5, 46%), CRP (4, 36%), AST (3, 27%), alkaline phosphatase (3, 27%), and hyponatremia (3, 27%). EBV and dengue (3, 27%) were the most common etiologies. Pneumonia (3, 27%) was the most common complication, followed by sepsis (2, 18%). All but one patient were responsive to either dexamethasone (7, 64%) and or IVIG (5, 45%) and chemotherapy (1, 9%). The antibiotic most commonly used was piperacillin tazobactam (3, 27%). The median hospital stay was 17 days. There was one mortality (9%). Conclusion HLH should be considered in children presenting with prolonged fever, hepatomegaly, and or splenomegaly, with hyperferritinemia, thrombocytopenia, anemia and neutropenia.
Lymphohistiocytosis, Hemophagocytic

Background: Bacteremia is a major cause of prolonged hospital stay and mortality in neonates and its early diagnosis remains a challenge to pediatricians. Red cell distribution width (RDW) is a component of a complete blood count test which is accessible and inexpensive and has been reported to be a possible diagnostic marker for neonatal bacteremia. This study determined the association of RDW with neonatal bacteremia in term and preterm neonates. Methodology: This is a retrospective case-control study of 26 bacteremic neonates as cases and 104 non-bacteremic neonates, either symptomatic or with risk factors for bacteremia, as controls. Included newborns were seen between January 1, 2010 to September 30, 2021. Laboratory data obtained were CBC, C-reactive protein and blood culture. Results: RDW values between bacteremic and non-bacteremic neonates were not significantly different. There was an association between RDW and neonatal bacteremia at an RDW level of > 16.1, where the likelihood of bacteremia was three times higher compared with lower RDW values. Significantly lower levels of hemoglobin, hematocrit, RBC count, WBC count, platelet count, MCH and MCHC, and a higher CRP level were seen among bacteremic neonates compared to those who were not. The median RDW for both term and preterm neonates was close to 16, with a narrow inter-quartile range at 1 and 2 for controls and cases, respectively. The range (minimum to maximum) of RDW values of bacteremic preterm neonates was more variable than those of term neonates. Using RDW to detect bacteremia, it had an equivocal discriminatory power or AUC of 0.6056. We found insufficient evidence to demonstrate a correlation between RDW and other CBC parameters, except for MCHC. For MCHC, the results suggest a very weak and indirect correlation. Conclusion RDW was not significantly different between bacteremic and non-bacteremic neonates, but there was a suggested association between RDW and bacteremia at an RDW level of > 16.1, at which level there was a 3-fold risk for bacteremia.
Erythrocyte Indices ; Case-Control Studies

Background: MIS-C is an infrequent, but serious complication encountered after acquiring COVID-19 illness in children. There is a lack of local data on MIS-C in the Philippines. Objective: To identify demographic data, co-morbidities, clinical manifestations, laboratory results, 2D-echocardiography findings, acute co-illnesses and complications, treatment, and outcome of children with MIS-C, seen in two, private, urban, tertiary hospitals. Methodology: This is a retrospective, descriptive study of all consecutive MIS-C cases, using the 2020 US CDC definition, seen between July 2020 to January 2023, by a single infectious disease physician. Demographic, epidemiologic, clinical, and physical examination findings; results of laboratory, 2-DE, and radiologic tests; co-illnesses and complications; and therapeutic and outcome data, were entered in a case report form for each patient. Results: Thirty-six patients were seen. MIS-C cases had a median age of 6 years, presented with fever in 97%, while one-half had abdominal pain, vomiting, diarrhea and/or rash. CRP, D-dimer, ferritin, LDH and procalcitonin were generally elevated, and thrombocytopenia was seen in 39%. The most common 2-DE abnormalities were pericardial effusion (50%), coronary artery dilatation or aneurysm (39%) and mitral regurgitation (36%); the 2-DE was normal in 22%. The main complications were pneumonia (31%), myocarditis (28%) and hypotension (14%); 8% had ARDS. Treatment was with corticosteroids (89%) and IVIG (84%). Most (94%) recovered, and the hospital stay was five days, or less, in 86%. The two mortalities were a severely wasted adolescent with previously undiagnosed HIV infection; and an adolescent on chemotherapy for AML, who was also being treated for disseminated TB. Conclusions There is a need to create a greater awareness of MIS-C as, like Kawasaki disease, it has the potential to be an important cause of acquired heart disease among children.

Introduction: Community-acquired pneumonia remains to be an important cause of morbidity and mortality among the pediatric age group with Streptococcus pneumoniae and Haemophilus influenzae typ B being the predominant bacteria identified. Conjugate vaccines against these organisms are available however, the prevalence of pneumonia in our country continues to be high. Objectives: The aim of this research is to determine the HiBCV and PCV 7 immunization status of children 5 years and below who were hospitalized due to pneumonia compared to controls. This study also aims to describe the clinical outcome of pneumonia among children who were vaccinated with HiBCV and/or PCV7 compared to those without vaccination. Methods: This retrospective case-control study was conducted in Makati Medical Center from January 1, 2009 to August 31, 2010. Cases were children five years old and below discharged with the final diagnosis of pneumonia. Controls were patients five years and below discharged without pneumonia during the same study period. Medical records were reviewed for information on age, gender, clinical findings upon admission, laboratory results, vaccination status, interventions and outcomes. Conclusion: The findings indicated that clinical and radiologically-confirmed pneumonia still occurred among children with complete vaccination with HiBCV and PCV7. Although not statistically significant, those without vaccination had higher odds of having pneumonia.
Human ; Male ; Female ; Child Preschool ; Infant ; HAEMOPHILUS INFLUENZAE TYPE B ; VACCINES, CONJUGATE ; HEPTAVALENT PNEUMOCOCCAL CONJUGATE VACCINE ; IMMUNIZATION ; PNEUMONIA

Introduction: The scarce local data on the etiology of childhood pneumonia admitted in a hospital has come from a few urban and rural government hospitals. There is no data from private hospitals. Knowing the most likely etiology of pneumonia is of outmost importance as this has implications on the diagnostic modalities requested and the institution of therapy. Objectives: The purpose of this study is to identify clinical and microbiologic diagnoses of clinically- and radiographically-confirmed pediatric pneumonia cases admitted in a private hospital. Secondarily, a discussion of specific etiologies is made. Methodology: Each consecutive, inpatient, pneumonia referral/admission in either one of two private, urban, tertiary hospitals, of a child 18 years and below from 1993 to 2021 was logged into a computer daily by a single pediatric infectious disease specialist. Clinical, epidemiologic, diagnostic and therapeutic data were recorded. All pneumonia cases, except those seen in newborns before their discharge from the nursery, were included. Results: Of the 496 cases, there was a clinical and/or microbiologic etiology in 43% of cases. The bacteremia rate was 6.3%. The most common identifiable etiologies were Mycoplasma pneumoniae (11.9%), Mycobacterium tuberculosis (5.2%), and Staphylococcus aureus (4.2%), while bronchiolitis (5.5%) and measles (4.8%) were the most common clinical diagnoses. There were several cases of ventilator-associated pneumonia and Pneumocystis jirovecii pneumonia. Conclusions Mycoplasma pneumoniae, tuberculosis, Staphylococcus aureus and Pneumocystis jirovecii are important pneumonia etiologies that have not been widely considered locally. The data presented here mirrors the practice of one pediatric infectious disease doctor in two hospitals where diagnostic and treatment options are readily available and utilized.
Child ; Inpatients ; Hospitals, Private ; Communicable Diseases ; Pneumonia

Introduction: Kawasaki disease (KD) is the leading cause of acquired heart disease in childhood, but its diagnosis remains challenging since a significant number of cases do not meet the diagnostic criteria (Incomplete KD). This may delay the diagnosis and initiation of treatment, and increase the risk of morbidity from coronary artery complications. Objectives: This study compared the clinical profile and treatment outcomes of children with complete and incomplete KD. Methods: This is a cross-sectional, retrospective study of pediatric patients diagnosed with KD and admitted in a tertiary hospital from January 1, 2010 to December 31, 2020. Demographics, clinical manifestations, laboratories, 2D echocardiography (2DE) findings and treatment outcomes were obtained by review of medical records and analyzed using descriptive statistics. Results: Among 135 patients studied, 71% were classified as Incomplete Kawasaki Disease. Majority (89%) were children more than 1 year old and predominantly male (55%). Five classic features, other than fever, were more frequent in complete KD – bilateral bulbar conjunctivitis, mucosal changes in the lip and oral cavity, polymorphous exanthem, changes in extremities, and cervical lymphadenopathy. Fever (100%), conjunctivitis (100%), rashes (97%) and oral changes (90%) were the most common findings in complete KD, while fever (100%), rashes (56%), conjunctivitis (46%) and oral changes (35%) were noted in incomplete KD. Higher CRP (167 mg/L vs. 100 mg/L) and lower albumin levels (30 g/L vs. 38 g/L) were seen in complete KD. Coronary artery dilatation (56% vs. 48%) was frequently detected in both complete and incomplete KD. Majority (96%) of cases received only one dose of IVIG and 4% needed additional treatment with methylprednisone. Conclusion The five principal features of KD other than fever, elevated CRP and lower albumin levels were significantly more common in complete cases. No significant differences in the demographics and 2DE findings of children with complete and incomplete KD were observed.
Mucocutaneous Lymph Node Syndrome