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Effects of storage process on the bacterial growth-inhibiting activity of expressed human breast milk on common neonatal pathogens, staphylococcus aureus, Escherichia coli And Klebsiella pneumoniae

Jennifer Lou L. Lorico ; Ma. Lucila Perez

Pediatric Infectious Disease Society of the Philippines Journal.2012;13(1):2-7.

Storage of human breast milk is unavoidable especially among working mothers who need to report back to work soon after delivery. The aim of this study was to describe the effects of storage process on the bacterial growth-inhibiting activity of expressed human breast milk on common neonatal pathogens. Methods: This was an experimental study performed at the Ospital ng Makati on the breast milk of mothers who were without infection prior to delivery, did not take any medications, and spontaneously delivered their babies full term. Fifteen mothers expressed breast milk within the first seven days up to one month, postpartum. Each milk sample was stored and tested with the following time series: immediately after expression; thawed after being frozen for 24; and thawed after being frozen for 72 hours. Each of the broth medium containing Staphylococcus aureus, Escherichia coli or Klebsiella pneumonia was added to 1 ml of expressed breast milk. Tenfold dilutions were made. Each dilution was plated at zero and four hours and colony-forming units (CFU) were counted after 24 hours incubation. Same procedure was performed on a negative control. Results: The number of CFU for the three tested organisms (had lower nominal counts with the breast milk solution when compared to control solutions both at zero-hour and four-hour test samples. Breast milk exhibited bacteriostatic properties against most pathogens except for Escherichia coli after being frozen for 24 hours. For the breast milk that was frozen for 72 hours, most tests did not show significant lower counts when compared to control solutions, except still for Staphylococcus aureus and Escherichia coli both at 0 hour. Conclusion: Breast milk has bacterial inhibiting property against common neonatal pathogens. Bacteriostatic property of breast milk started to diminish after being frozen for 72 hours, but still exerted its inhibiting property.
Human ; Animal ; Female ; Adult ; Young Adult ; MILK, HUMAN ; STAPHYLOCOCCUS AUREUS ; ESCHERICHIA COLI ; KLEBSIELLA PNEUMONIAE

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Novel influenza AH1N1 infection among pediatric patients admitted in a local tertiary hospital

Sharon B. Gawigawen

Pediatric Infectious Disease Society of the Philippines Journal.2012;13(1):29-36.

Introduction: The influenza virus is a single stranded RNA virus which has the potential to cause periodic global pandemics. The first major Influenza A global pandemic devastated the 20th century with the Spanish flu in 1918; it had more than 2.5% case fatality rate. In the 21st century, the Influenza A pandemic was first detected in Mexico in March 2009 and from then, there had been a rapid increase in the number of reported cases and deaths reported which created panic. Objectives: This study aims to determine the profile of pediatric patients with confirmed Novel Influenza AH1N1 at a Local Tertiary Hospital from June 2009 to December 2009. Methods: This study is retrospective chart review of patients aged 0-19 years old, confirmed to have influenza A H1N1 and were admitted at Baguio General Hospital. Their demographic profile, signs and symptoms, laboratory examinations, treatment and outcome were recorded in a uniform case repot form. Results: Of the 235 pediatric cases of influenza-like illness seen, 31(13%) were admitted. Fifteen (48.3%) of the admitted patients were positive for the novel influenza AH1N1. Majority of the cases were from the five-to-nine age group (34%), while three (20%) were from the age group, two years old and below. The presenting signs or symptoms were fever (100%), cough (80%), colds (47%) and sore throat (34%). Most common underlying conditions noted were bronchial asthma in six (40%) of the cases. Complete blood count revealed anemia in 40%, leukopenia in 26.67%, and lymphocytosis in 26.67% cases. Using chest radiograph, pneumonia was seen in 40% (6/15) of patients. Two (13.3%) revealed no growth in their blood cultures while one had Klebsiella pneumonia and another one grew Candida non-albicans. All received Oseltamivir upon admission and was completed for five days. Antibiotics were given to those with bacterial co-infection. The mean duration of hospital stay was eight days: 13 (86%) patients were discharged in improved condition; while, two (13.3%) died due to respiratory failure. Conclusion: There was an equal distribution of both sexes in the study. Incidence was highest among five years old and below. The pediatric influenza AH1N1 infection presented with mild acute respiratory tract infection. Most cases were uncomplicated although majority of them had underlying medical conditions putting them at risk for complications. Oseltamivir was the mainstay of treatment in conjunction with antimicrobials for those who had bacterial co-infections. Most of the patients improved with a case fatality rate of 13.3%.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; INFLUENZA, HUMAN ; RESPIRATORY TRACT INFECTIONS

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Prevalence of viral pathogens among pediatric patients admitted for pneumonia in a local tertiary hospital

Charlene Mae B. Perez

Pediatric Infectious Disease Society of the Philippines Journal.2012;13(1):8-14.

In the Cordillera Administrative Region, pneumonia has been the second most common cause of morbidity. In Baguio General Hospital and Medical Center (BGHMC) pneumonia has been the number one cause of morbidity and one of the top three causes of mortality among pediatric patients since 2002; these were all treated as bacterial pneumonia. However, the epidemiology of viral pneumonia has not yet been studied. OBJECTIVES: The goal of this study was to determine the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010. METHODS: A chart review was performed to provide data on (1) all patients' ages 0 to 18 years old admitted in the institution for pneumonia; (2) those enrolled in the SARI epidemiological surveillance from May 2009 to April 2010; (3) only patients admitted on Sundays or Wednesdays; and (4) those swabbed within 24 hours of admission (This is the schedule agreed upon by the involved groups on the oropharyngeal and nasopharyngeal swabbing at the institution for the SARI surveillance which is done during Mondays and Thursdays); (5) those who recently have not taken any antiviral medications; and (6) those who were not subjected to oropharyngeal or nasopharyngeal swabs prior to admission. the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010 (indicate aseline characteristics such as age, sex, clinical symptoms, and co-morbid diseases, course and length of hospital stay; and outcome data was gathered. RESULTS: A total of 982 pediatric patients were admitted for pneumonia. Of the three-hundred-seventy-seven patients tested for viral isolates, 28.1% were positive and most of the cases with viral isolates were in October. In all ages, Respiratory Syncytial Virus (RSV) was the most prevalent (87.74%). Subjects who were less than one year old showed a higher detection rate of virus. There were more patients from the viral isolate negative group who presented with signs of respiratory distress. Most of the patients of both groups were discharged after one-to-three hospital days. CONCLUSION: RSV was the most common virus isolated. Children less than one year old had the highest detection rate of a virus.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; PNEUMONIA, VIRAL ; RESPIRATORY TRACT INFECTIONS ; PREVALENCE

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Clinical profile and outcome of children with parapneumonic effusion

Grace Devota Gomez-Go ; Ma. Liza Gonzales ; Anna Ong-Lim

Pediatric Infectious Disease Society of the Philippines Journal.2012;13(1):15-28.

Parapneumonic effusions frequently occur as complications of pneumonia. Data from developing countries is limited. The purpose of this paper is to review the epidemiological and clinical profile of parapneumonic effusions among children admitted in a tertiary government hospital. Methodology: Medical records of 72 children diagnosed with parapneumonic effusions from 2005-to-2009 were obtained. Demography, clinical presentations, diagnostics, treatment modalities, outcomes, etiology and antibiotic susceptibilities were analyzed using descriptive statistics. Comparison of purulent effusion and empyema was done using parametric or non-parametric statistics, accordingly. Results: There were 106 children discharged with a diagnosis of parapneumonic effusion. Of the 96 medical records available, 72 patients fulfilled the criteria for parapneumonic effusions. Only 53 patients submitted pleural fluid for analysis: 29 cases were empyema, while 24 cases were purulent effusion; mean age was 9.66 years. Fever (90.28%), cough (69.44%), and dyspnea (66.67%) were the most common clinical presentations. Forty-four patients underwent thoracentesis while 37 children had closed-tube thoracostomy. Methicillin-resistant Staphylococcus aureus(MRSA) was the most commonly isolated organism from the pleural fluid cultures (9.26%) and blood cultures (6.25%). Patients with purulent effusion were treated with a combination of antibiotics and anti-TB meds (75%).Majority of patients with empyema were treated with antibiotics alone (79.31%). Earlier improvement and shorter hospital stay were observed among patients with purulent effusion. Conclusion: Parapneumonic effusions occurred in 6.80% of hospitalized children with pneumonia; 54.72% of which were empyema and 45.28% were purulent effusion. MRSA was the most commonly isolated organism. Chest imaging, pleural fluid analysis and cultures, and blood cultures were important diagnostic procedures. The mainstays of treatment were medical, surgical or both, depending on the severity of effusion. Prompt diagnosis and management could account for favorable clinical outcomes.
Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; PNEUMONIA ; EMPYEMA ; PLEURAL EFFUSION

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Efficacy of zinc as adjunct in the treatment of pneumonia in children less than five years: A meta-analysis

Kathlynne Anne Caling Abat ; Jacinto Blas V. Mantaring III

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):2-9.

Background: Zinc supplementation has been shown to lower mortality and morbidity due to diarrhea and pneumonia. Because of the positive effect of zinc in the prevention of pneumonia, several studies have been conducted to investigate its effect as an adjunct therapy for pneumonia. For this reason, a systematic, quantitative review of available studies is needed to determine the overall effect of zinc as an adjunct in the treatment of pneumonia in children less than five years old. Objectives: To assess from literature the effect of zinc, when given with antibiotics, in reducing mortality, treatment failure, length of hospital stay, and duration of symptoms of pneumonia in children less than five years old. Design: Meta-analysis of randomized, placebo-controlled intervention trials. Methods: Studies for inclusion were identified by PubMed search, journal handsearch, and other methods. The authors independently assessed study quality and extracted data. Statistical Analysis: Revman Version 4.2 was used to analyze the data gathered. The summary relative risks (RRs) and 95% CI for each outcome variable were estimated using a fixed-effects model. Chi-square and I2 were computed to assess for heterogeneity of results. Results: A total of three acceptable studies were included in the meta-analysis. The summary RRs showed that zinc had no overall treatment effect on mortality from pneumonia (RR 0.69, CI 0.08, 5.70) and treatment failure (RR 1.05, CI 0.74, 1.49). These results were statistically insignificant with p-values of 0.73 and 0.77, respectively. Chi2 and I2 tests showed significant heterogeneity of results for treatment failure (Chi2 = 5.06, I2 = 60.5%). The same tests did not show significant heterogeneity of results for mortality (Chi2 = 0.43, I2 = 0%). In one study, the use of zinc reduced the duration of severe pneumonia with mean difference of four (4.2-4.9) versus five (4.5-5.5) days leading to shorter hospitalization [5 (4.8-5.5) versus six (5.1-6.1) days]. In another study, the zinc group's recovery rate from very ill status was 2.6 times (p = 0.004) more, and the resolution of fever was 3.1 times (p = 0.003) more than those in the placebo group. However, these results could not be combined due to lack of data on standard deviation. Conclusion: There is not enough evidence to conclude that zinc is effective in reducing mortality, treatment failure and duration of symptoms of pneumonia. A large population, multi-center, randomized, placebo-controlled trial should be conducted to obtain statistically significant evidence.
Human ; ZINC ; PNEUMONIA

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Clinical and laboratory profile of urinary tract infection among children at the outpatient clinic of a tertiary hospital

April Gamier Bay ; Francisco Anacleto, Jr.

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):10-16.

Introduction: Urinary tract infection (UTI) is a common reason for outpatient consults. It is almost always in the Top Ten consults at the sick-child clinic of a tertiary hospital. However, a study concerning the incidence and clinical and laboratory profiles of UTI in the Philippines has yet to be documented. Objectives: To determine the incidence rate and clinical and laboratory profiles of UTI among patients who consulted at the pediatric outpatient clinic of a tertiary hospital. Methods: All patients 0 to 12 years, who were UTI suspects and consulted at the Sick-Child Clinic of a tertiary hospital from January to December 2006 were included in the study. Patients who had recurrent UTI or history of previous UTI and those with co-morbidities such as anatomic and/or functional problems involving the urinary tract were excluded. Chart review was done and the following were noted: demographics and clinical and laboratory characteristics. Results: Four hundred twenty three patients were included in the study. The incidence rate was 30 per 1000 persons (95% CI). 54% percent were female. The majority of the patients were between 7 to 12 years of age. The most common presenting symptoms were fever, abdominal pain, vomiting, and dysuria. Only 25 patients had urine culture done and only 8 had positive results, mostly with E. coli. The most common antibiotics used were Cotrimoxazole, Cefuroxime, and Amoxicillin. Conclusion: The incidence rate is higher compared to other studies done in general practice. The presenting signs and symptoms were however similar. Important to note is the high incidence of patients who did not follow up. It is also noted that the gold standard for the diagnosis of UTI, which is the urine culture is very seldom requested. This may lead to the over- or maybe under-diagnosis of UTI and its eventual mismanagement. Therefore, it is recommended that the approach to the diagnosis and management of UTI in children should be reviewed.
Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Infant Newborn ; URINARY TRACT INFECTIONS ; INCIDENCE ; DIAGNOSIS

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Profile of pediatric patients with dengue fever/dengue hemorrhagic fever over a five-year period (2000-2004)

Jonathan G. Lim ; Salvacion R. Gatchalian ; Ma. Rosario Z. Capeding

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):26-34.

Objectives: This study was conducted to determine the clinico-demographic profile of pediatric patients who were admitted for dengue infection at the Research Institute for Tropical Medicine (RITM) from 2000 to 2004. Methods: This is a retrospective, descriptive study. Charts of patients who were less than 19 years of age and were admitted at the RITM due to confirmed dengue (using paired dengue HI titer results) were reviewed. Conclusion: The clinico-demographic profile of patients involved in the study was very similar to that of other studies done, both locally and abroad. By using Spearman's correlation of ranks, the study showed that there was no significant relationship between the severity of dengue infection based on the World Health Organization (WHO) Grade and whether it was a primary or secondary infection with r=.018, p-value=.025.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; DENGUE ; DENGUE HEMORRHAGIC FEVER

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The antihelminthic efficacy of pineapple fruit mebendazole on soil transmitted helminthiases: A randomized controlled trial

Charina A. Manabo ; Melchor Victor G. Frias

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):35-43.

Objectives: The study was performed in order compare the antihelminthic efficacy of pineapple fruit versus mebendazole in schoolchildren. Design: The study performed was a single, blinded randomized control trial. Subjects: Ninety subjects aged 5 to 13 years old and positive for soil-transmitted helminthiases were included in the study. Methods: Eligible participants were subjected to Kato-Katz for diagnosis and quantitative ova count. Those positive for soil-transmitted helminthes were randomized to Group A (pineapple) and Group B (mebendazole). After 7 days of treatment, stool samples were subjected to another Kato Katz for quantitative ova analysis. Seven hundred fifty ml of puree made from one pineapple, with approximate weight of 750g, was given in divided amounts within 24 hours (250 ml 3x a day) for group A. Results: Majority (77.78%) were infected with Ascaris lumbricoides. Pineapple exhibited a significant improvement in egg reduction rate (RR) with a p-value of < 0.001 at 95% CI. This showed 83.5 % egg per gram (epg) of feces reduction and a cure rate of 68.9%. Mebendazole also revealed a significant egg reduction with p-value of < 0.001 at 95% CI. It also showed a remarkable egg per gram reduction rate of 92.25% and cure rate of 88.9%. There were no adverse events reported. Conclusion: Mebendazole, as an antihelminthic, is a better choice; but pineapple fruit may be beneficial as it had a high egg reduction rate and an acceptable cure rate.
Human ; Animal ; Male ; Female ; Adolescent ; Child ; Child Preschool ; ANANAS ; ASCARIASIS ; TRICHURIS ; PLANTS ; FRUIT ; PARASITIC DISEASES ; TREATMENT OUTCOME

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Risk factors for candidemia in the neonatal intensive care unit of the Philippines General Hospital from October 2003 to August 2006: A case-control study

Novette Regina M. Morales-Lagunzad ; Jacinto Blas V. Mantaring

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):44-50.

Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS

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Terror in the air: Meningococcal disease outbreak in the Philippines

Xenia Cathrine T. Jaramillo Fabay

Pediatric Infectious Disease Society of the Philippines Journal.2010;11(1):17-25.

Introduction: Meningococcal disease is caused by Neisseria meningitidis that can present as fever or respiratory infection developing into a fulminant course. In February 2005, WHO experts confirmed that the Cordillera Administrative Region of the Philippines experienced an outbreak of Serogroup A Meningococcal Disease where there was an unusually large proportion of meningococcemia cases. Objectives: This study aims to describe the clinical profile of pediatric patients discharged from a tertiary hospital with a diagnosis of meningococcal disease and to identify the etiologic agent. Methodology: This is a retrospective descriptive study involving chart review of patients 0-18 years of age discharged from October 2004 to October 2006 with a diagnosis of either meningococcemia, meningococcal meningitis or both. Results: There were 217 discharges with this diagnosis. Of these, 100 (46.08%) belonged to the 0-18 years of age, 47% of who were male, 64% were Baguio residents, 28% were 0-1 year old, 19% were between 2-5 years old and 26% were 15-18 years old. 100% had a history of fever and 90% had rashes. 51% had a discharge diagnosis of Meningococcemia. 32% died due to septic shock, DIC. The etiologic agent was identified as Neisseria meningitidis. Conclusion: Of the study population, 53% were female. Children 0-5 years of age were most affected (47%). 100% had a history of fever. 32% died of septic shock. 62% were confirmed by laboratory. The culprit of this epidemic was a hypervirulent strain of Neisseria meningitidis Serogroup A Subtype A 1.9 sensitive to Penicillin.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; MENINGOCOCCAL INFECTIONS ; NEISSERIA MENINGITIDIS ; MENINGITIS, MENINGOCOCCAL

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