Human ; Research ; Publishing ; Publications

BACKGROUND

Differentiating bacterial from aseptic meningitis in children is critical for optimal treatment. While symptoms overlap, bacterial meningitis demands immediate antibiotics. Traditionally, CSF culture has been the gold standard for diagnosis, but its yield has declined with widespread vaccination. Consequently, some children with negative cultures may still have bacterial meningitis. The Bacterial Meningitis Score (BMS), a validated clinical prediction rule, offers a valuable tool, particularly in resource-limited settings, to better identify high-risk children and guide more effective treatment strategies.

To evaluate the clinical utility and diagnostic accuracy of the BMS in identifying pediatric patients at high risk for bacterial meningitis.

This retrospective cross-sectional study included 75 pediatric patients (aged 29 days to 18 years) with suspected meningitis seen at the Emergency Room of the Pediatrics Department in Mariano Marcos Memorial Hospital and Medical Center from March to November 2023. Eligible patients underwent lumbar puncture for CSF analysis. The BMS, a five-variable clinical tool including CSF Gram stain, CSF absolute neutrophil count, CSF protein, peripheral absolute neutrophil count, and seizure, were used to classify patients as very low risk (BMS=0) or not very low risk (BMS ≥1).

The diagnostic performance of the Bacterial Meningitis Score (BMS) across different cut-off thresholds is as follows: At a cutoff of ≥1, sensitivity is 100%, specificity is 36.80%, positive predictive value (PPV) is 33.3% (95% CI: 22% – 46%), negative predictive value (NPV) is 100% (95% CI: 84.5% – 100%), positive likelihood ratio (LR+) is 1.58 (95% CI: 1.29 – 1.93), negative likelihood ratio (LR–) is 0 (95% CI: 0 – NaN), and Youden’s index is 0.36. For a cut-off of ≥2, sensitivity is 88.90%, specificity is 78.90%, PPV is 57% (95% CI: 39% – 73%), NPV is 95% (95% CI: 85% – 98%), LR+ is 4.21 (95% CI: 2.48 – 7.16), LR– is 0.14 (95% CI: 0.03 – 0.52), and Youden’s index is 0.67. At a cut-off of ≥3, sensitivity drops to 61.10%, specificity increases to 98.20%, PPV rises to 91% (95% CI: 64% – 98%), NPV is 88%(95% CI: 78% – 94%), LR+ is 33.94 (95% CI: 4.82 – 251.61), LR– is 0.39 (95% CI: 0.22 – 0.70), and Youden’s index is 0.59. Finally, at a cut-off of ≥4, sensitivity is markedly low at 5.56%, specificity is perfect at 100%, PPV is 100% (95% CI: 20% – 100%), NPV is 77% (95% CI: 66% – 85%), LR+ is not applicable, LR– is 0.94 (95% CI: 0.84 – 1.05), and Youden’s index is 0.056. The optimal cutoff based on Youden’s index (0.67) was BMS ≥2, providing a more balanced trade-off between sensitivity (88.90%) and specificity (78.90%).

The BMS is a highly sensitive initial screen for bacterial meningitis in children, but its low specificity at the ≥1 cutoff necessitates a more judicious approach. Employing a ≥2 cutoff (Youden index 0.67) significantly improves diagnostic accuracy, optimizing resource utilization and enabling targeted interventions. While definitive diagnosis requires confirmatory testing, the BMS strategically guides initial triage, particularly crucial in resource-constrained environments.

INTRODUCTION

Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are two related conditions that primarily affect pediatric patients. The overlap in clinical symptoms, physical findings, and laboratory results between MIS-C and KD complicates diagnosis and treatment, as children with MIS-C may fulfill the criteria for KD. Early recognition of distinguishing clinical, laboratory, and echocardiographic findings is crucial for timely diagnosis and appropriate treatment, which can mitigate the risk of severe cardiovascular, gastrointestinal, and neurological complications.

This study aims to compare the clinical profile, laboratory profile, 2-D echocardiographic findings, treatment, and outcome ofchildren with KD vs MIS-C at a tertiary hospital in the Philippines.

A retrospective, analytic cohort study was done to differentiate the clinical profiles, laboratory profile, treatments, and outcomesof pediatric patients aged less than 19 years old, admitted with a diagnosis of KD, from January 2016 to December 2019 (pre-COVID-19 pandemic), and MIS-C cases admitted from January 2020 to December 2023, in a private, urban, tertiary hospital. Descriptive statistics (frequency and proportion, mean and standard deviation, median and inter-quartile range) were used to summarize the general and clinical characteristics of the participants. Independent T-test, Mann-Whitney U test and Fisher’s Exact/Chi-square test were used to determine the difference of mean, median and frequency of laboratory parameters among groups.

The study included 87 patients, with 60 categorized in the KD group (13 diagnosed with complete KD and 47 with incomplete KD) and 27 in the MIS-C group. MIS-C patients were more likely to be older (p = 0.023), present with GI symptoms such as vomiting (48.2% in MIS-C vs. 12.8% in KD) and abdominal pain (40.7% vs. 6.4%), respiratory symptoms such as shortness of breath (29.6% vs 0%) and wheezing (14.8% vs 0%), have lower WBC (6.30 in MIS-C vs. 13.07 in complete KD and 10.18 in incomplete KD, p < 0.001), ANC (5,940 in MIS-C vs. 13,660 in complete KD and 10,432 in incomplete KD, p = 0.002), and platelet count (280 in MIS-C vs. 368 incomplete KD and 364 in incomplete KD, p = 0.13), and experience more complications such as myocarditis (14.81% vs. 0%), hypotension (18.52% vs. 0%), shock (14.81% vs. 0%), and pneumonia (40.74% vs. 17.02% for incomplete KD and 7.69% for complete KD). In contrast, key features of KD, including conjunctival injection (100% in KD vs. 25.9% in MIS-C), rash (100% vs 59.3%), oral changes (92.3% vs. 22.2%), and cervical lymphadenopathy (92.3% vs. 29.6%), elevated laboratory results of CRP (12.89 in MIS-C vs. 46.53 incomplete KD and 111.15 in incomplete KD, p < 0.001), ESR (41.91 in MIS-C vs. 61.73 in complete KD and 82.49 in incomplete KD, p= 0.003), and AST/ALT ratios (0.42 in MIS-C vs. 1.88 in complete KD and 0.62 in incomplete KD, p = 0.034) were more frequently observed in KD patients. Combination therapy involving intravenous immunoglobulin (IVIG), methylprednisolone, and acetylsalicylic acid (ASA) was more common in MIS-C patients than in KD patients (48.15% in MIS-C vs. 7.69% for complete KD and 2.13% forincomplete KD), who mainly received IVIG and ASA alone (84.62% in complete KD and 93.62% in incomplete KD vs 3.7% in MIS-C).

This study highlights key clinical and laboratory differences between MIS-C and KD in a private tertiary hospital setting. MIS-C patients were generally older, exhibited more GI and respiratory symptoms, and had a higher risk of serious complications. In contrast, KD cases more often presented with classic mucocutaneous signs and elevated inflammatory markers. These findings underscore the importance of early differentiation, as MIS-C often requires more intensive management. The study also identifies practical diagnostic indicators including CBC parameters such as WBC, ANC, and platelet count that may aid clinicians, particularly in resource-limited settings. Further multicenter research involving both public and private hospitals is needed to validate and enhance the diagnostic criteria.

INTRODUCTION

Multisystem Inflammatory Syndrome in Children (MIS-C) is a delayed hyperinflammatory condition affecting multiple organ systems. Prominent symptoms include fever, skin rashes, and gastrointestinal symptoms, manifesting prior to critical signs such as cardiac involvement, hypotension, and shock.

To determine if certain demographic, clinical, and laboratory markers are predictive of poor outcomes in patients diagnosed with MIS-C.

This is a retrospective, cross-sectional study (2020-2023) of children who met the 2020 CDC MIS-C criteria. Data on demographics, comorbidities, clinical course, outcomes, laboratory results and 2D Echocardiogram findings were obtained and analyzed.

There were 28 patients with MIS-C, with a median age of 4.5 years. The majority of patients were male (64%). The percentage of neutrophils showed a significant association with hypotension/shock (OR 1.16). White blood cell count (WBC) and ferritin were significantly associated with ICU admission (OR 3.5 and 2.9, respectively). Pericardial effusion was observed in 71.4% while myocarditis was present in 67.9% of patients. The most notable risk factor was HIV infection, which was significantly associated with a more than 50-fold increase in the odds of developing ARDS and 165-fold increase in the odds of mortality; there was only one mortality, and only one patient with documented HIV infection.

The outcome was good in non-immunocompromised patients and the only recorded mortality was a patient not previously known to have HIV. We identified statistically significant factors that were associated with adverse outcome measures, with the limitation of a small sample, such as HIV infection and risk for ARDS and mortality; elevated neutrophil percentage and risk for hypotension/shock; elevated WBC and ferritin and risk for ICU admission; and saw a high prevalence of pericardial effusion and myocarditis in these patients, highlighting the critical role of hyperinflammation and cardiac involvement in disease progression and outcome.

BACKGROUND

Human immunodeficiency virus infection and acquired immunodeficiency syndrome are significant public health concerns and social issues. Key players in efforts to stop HIV/AIDS as a public threat are healthcare personnel. Research has shown that negative attitudes of healthcare workers towards HIV can negatively influence their practices and these are associated with their level of knowledge about the disease.

This study aims to investigate the baseline knowledge, attitudes, and practices of healthcare workers towards HIV/AIDS and to determine the association between profession and level of knowledge, attitudes and practices among healthcare workers in a tertiary pediatric government hospital.

This study utilized an analytical cross-sectional research design. Data were collected through a written questionnaire administered to 213 healthcare personnel, who were selected via stratified random sampling from January to April 2024. Knowledge, attitude, and practice (KAP) scores were evaluated using Bloom’s cut-off points. Scores below 60% were classified as low level of knowledge, negative attitude, and poor practice. Scores from 60-79% were classified as moderate level of knowledge, neutral attitude and fair practice. Lastly, scores between 80-100% were classified as high level of knowledge, positive attitude and good practice. Descriptive and inferential statistics, specifically Fisher’s test were used whenever appropriate.

Among 213 study participants, 140 (65.73%) demonstrated a high level of knowledge towards HIV/AIDS among doctors, nurses, medical technologists, and radiologic technologists. There were 161 (75.59%) who exhibited positive attitude towards HIV/AIDS and worked as pharmacists, physical therapists, and dentists. About 154 (72.30%) reported having fair practices on HIV/AIDS.

The healthcare workers in our study have a high level of knowledge, positive attitude, and fair practices towards HIV/AIDS with significant differences between professions. There is a significant association between professions with the level of knowledge, attitudes, and practices towards HIV. Doctors, nurses, medical technologists, and radiologic technologists have higher level of knowledge on HIV/AIDS. Positive attitude was higher among pharmacists, physical therapists, and dentists. Lastly, good practices were highest among midwives.

BACKGROUND

The impact of the COVID-19 pandemic on respiratory virus activity in children has been studied globally, but no published study in the Philippines has provided viral profiling and epidemiological data on children during and after the pandemic’s peak.

To identify respiratory pathogens detected using a multiplex RT-PCR assay (BioFire® Respiratory 2.1 Panel) among pediatric patients with respiratory symptoms admitted to St. Luke’s Medical Center–Global City during (March 2020–February 2022) and after (March 2022–March 2023) the peak of the COVID-19 pandemic; to compare the prevalence of these pathogens between the two periods; and to assess the clinico-demographic characteristics, diagnostic test results, and clinical outcomes of patients with single-pathogen infections versus co-infections.

A single-center, cross-sectional study was conducted through a retrospective chart review of pediatric patients with respiratory symptoms tested using a multiplex RT-PCR assay (BioFire® Respiratory 2.1 Panel) at St. Luke’s Medical Center–Global City from March 2020 to March 2023.

Of 739 children, 92.02% were positive for at least one respiratory pathogen, mostly viruses. Rhinovirus/enterovirus (50.59%), RSV (19.71%), and COVID-19 (12.50%) were the most common. COVID-19 and Influenza A were more prevalent during the peak, while rhinovirus/enterovirus and adenovirus were higher post-peak. Most patients were male, aged 1–5 years, and cough (89.99%) was the most common symptom. Normal leukocyte, CRP, and procalcitonin levels were observed in 70.09%, 47.31%, and 68.25%, respectively. No significant differences were noted in diagnostic test results based on pathogen detection. Antibiotics were given to 53.31% of patients, and 99.86% were discharged. The average length of stay was 3.69 days.

The prevalence of respiratory pathogens among children admitted to our institution during and after the peak of the COVID-19 pandemic predominantly consisted of viruses, showing statistically significant differences. Rhinovirus/enterovirus and RSV were the leading respiratory pathogens in both periods. The peak group showed a higher prevalence of COVID-19 and Influenza A whereas the post-peak group exhibited a higher prevalence of rhinovirus/enterovirus and adenovirus. Single viral infections were more prevalent compared to co-infections

BACKGROUND

Rabies causes 59,000 deaths globally each year, with 391 and 368 cases reported in the Philippines in 2022 and 2023, respectively. In Davao City, 4 human rabies deaths were recorded in 2023. Though fatal, rabies is preventable through vaccination. The COVID-19 pandemic disrupted rabies eradication and immunization efforts. This study investigated its effect on the compliance with post-exposure rabies prophylaxis (PEP) and the reasons for non-compliance.

To compare the compliance with PEP and reasons for non-compliance among pediatric patients with animal bites before and during the COVID-19 pandemic.

This single-center retrospective cross-sectional study in a private tertiary hospital in Davao City reviewed 1,277 animal bite cases between March 16, 2017 and March 16, 2023. Data was gathered through chart reviews with follow-up through phone interviews. Compliance rates and reasons for non-compliance to PEP were determined.

There were 1,224 cases of animal bites included in the study, 599 cases before the pandemic, and 625 during the pandemic. Thirty six percent of cases were aged 3-6 years old, with equal sex distribution. The highest cases were from the downtown area of the city (69% pre-pandemic and 53% during the pandemic); dogs were the primary biting animals. Bites in the upper extremities were common before the pandemic, while bites in the head and neck region increased during the pandemic. Most exposures were bites from vaccinated pets (65% pre-pandemic and 84% during the pandemic) and classified as Category III (52% pre-pandemic and 55% during the pandemic). Despite the pandemic, compliance with PEP among the animal bite cases remained to be high, 93.8% pre-pandemic and 93.1% during the pandemic. Non-compliance with PEP was influenced by psychological factors (fear of hospitals and vaccination and acquiring infection during hospital visit and socioeconomic factors (cost, distance and loss of wages).

The most significant factors for non-compliance with PEP during the pandemic were fear of hospitals and acquiring illnesses while in the hospital, while compliance was linked to parent’s higher socio-economic status and awareness.

Human ; Environment ; Work ; Philippines

BACKGROUND

Rabies remains to be a neglected tropical disease in the Philippines, with the country reporting a higher number of cases compared to its counterparts in Asia.

To describe the demographics, animal bite characteristics, and post-exposure prophylaxis of animal bite patients coming in for care at the Research Institute for Tropical Medicine (RITM), a large government referral center for infectious diseases, and animal bites.

Electronic patient records from January 1, 2018 to December 31, 2019 were obtained from the National Rabies Information System (NaRIS) database of the Department of Health, and summarized using applicable descriptive statistics.

A total of 14,614 patients were included over the two-year study period, and more than third of the patients were children below 15 years old, while more than half were adult males. Lower extremities were the most frequently affected area, while with children, more than a third of exposures were in the head and neck areas. Intradermal route was mostly used for the post-exposure prophylaxis, while WHO prequalified vaccines were utilized in more than 90% of the patients. Only 55.7% of patients completed the prophylaxis regimen at RITM.

These findings reflect the significant exposure of children from animal bites, and the non-compliance of patients to the prescribed post-exposure prophylaxis.

OBJECTIVE

To determine the prevalence of rectal colonization with carbapenem-resistant organisms (CRO) among PGH neonatal intensive care unit (NICU) patients.

A prospective single-center observational study conducted over a 1-month period included all NICU 3 and cohort area patients admitted on April 24, 2024. Rectal swabs were collected for multidrug-resistant organism (MDRO) screening and repeated weekly for 1 month while admitted. Swabs were inoculated on chromogenic media, and isolates were identified and tested for antimicrobial sensitivity by disk diffusion. Clinical characteristics and outcomes were collected for 30 days from initial MDRO screening. Descriptive statistics were used to summarize the data.

The point prevalence of CRO colonization was 37% (14 of 38) at initial screening. There were 14 incident colonizations, hence the 4-week period prevalence of CRO colonization was 72.5% (29 of 40). The patients were mostly very preterm, very low birth weight neonates, majority were tested within the first 2 weeks of life, and half were exposed to meropenem at initial screening. Nosocomial infection developed in 29% and 64%, and 30-day mortality rate was 8% and 21% among initially non-CRO-colonized and CRO-colonized patients respectively. Despite high CRO colonization, no culture-proven CRO infection was observed. Surveillance screening documented persistent CRO colonization in 37%, but no decolonization. Escherichia coli, Klebsiella spp. and Serratia spp. were the most common colonizers.

The high prevalence of rectal CRO colonization in the NICU emphasizes the burden of antimicrobial resistance, but despite the high CRO colonization, no CRO infection was documented from the limited sample and study period.