Publications by authors named "Joan L Robinson"

129 Publications

Prevalence of Serious Bacterial Infections in Children with Sickle Cell Disease at King Abdulaziz Hospital, Al Ahsa.

Mediterr J Hematol Infect Dis 2021 1;13(1):e2021002. Epub 2021 Jan 1.

Department of Pediatrics, University of Alberta, Edmonton, Canada.

Objective: The main aim was to report the prevalence and severity of serious bacterial infections (SBI) in children with sickle cell disease at King Abdulaziz Hospital (KAH), Al Ahsa, Saudi Arabia, to aid in determining whether outpatient management of such cases is appropriate.

Methods: We conducted a retrospective chart review of febrile children less than 14 years of age admitted with sickle cell disease 2005 through 2015.

Results: During 320 admissions, 25 children had SBIs (8%) including pneumonia (n=11), osteomyelitis (n=8), bacteremia (n=3, all with species) and UTI (n=3). All recovered uneventfully.

Conclusion: It appears that in the current era, less than 10% of febrile children with sickle cell disease in our center are diagnosed with an SBI. Over 11 years, there were no sequelae or deaths from SBI. Given these excellent outcomes, outpatient ceftriaxone should be considered for febrile well-appearing children with sickle cell disease if they have no apparent source and parents are judged to be reliable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4084/MJHID.2021.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813273PMC
January 2021

Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of the current landscape of invasive meningococcal disease in children.

Can Commun Dis Rep 2020 Oct 1;46(10):339-343. Epub 2020 Oct 1.

Department of Paediatrics, Western University, London, ON.

Background: Immunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.

Objectives: The purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.

Methods: Data were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.

Results: There were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.

Conclusion: IMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14745/ccdr.v46i10a05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723307PMC
October 2020

Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study.

BMJ Open 2020 12 10;10(12):e043403. Epub 2020 Dec 10.

Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Introduction: Early empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada.

Methods And Analysis: Our study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology.

Ethics And Dissemination: Ethics for the study has been granted by the University of British Columbia Children's & Women's Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications.

Trial Registration Number: NCT04388293.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-043403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733165PMC
December 2020

Treatment strategies for cerebrospinal shunt infections: a systematic review of observational studies.

BMJ Open 2020 12 10;10(12):e038978. Epub 2020 Dec 10.

Pediatrics and Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada.

Objective: A systematic review was conducted of studies comparing time to cerebrospinal fluid (CSF) sterilisation or rate of recurrence with different treatment strategies for CSF shunt infections.

Methods: A librarian-directed search was conducted of Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid Medline Daily and Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL Plus with Full Text via EBSCOhost, Scopus Advanced Search, and Web of Science Core Collection from 1990 to May 2019. Studies of any design that compared outcomes in groups of any age with different management strategies were included. Studies that compared complete versus incomplete shunt removal were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale.

Results: The search identified 2208 records, of which 8 met the inclusion criteria. All were cohort studies of moderate quality. Four studies compared the duration of antibiotics; none demonstrates that a longer course prevented recurrences. Two studies analysed addition of rifampin, with one showing a decrease in recurrences while the other had a small sample size. No studies analysed the addition of intraventricular antibiotics, but one showed equally good results with once versus twice daily administration. One study reported no difference in recurrences with placement of antibiotic-impregnated catheters. Recurrence rates did not differ with shunt replacement minimum of 7 days vs less than 7 days after CSF became sterile. There were no recurrences in either group when shunt replacement was performed after sterile CSF cultures were obtained at 24 vs 48 hours after antibiotics were discontinued. A new shunt entry site did not decrease recurrences.

Discussion: The main limitations are the lack of high-quality studies, the small sample sizes and the heterogeneity which precluded meta-analysis. Addition of rifampin for staphylococcal infections may decrease relapse but requires further study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-038978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733168PMC
December 2020

Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age.

PLoS One 2020 28;15(8):e0238056. Epub 2020 Aug 28.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Background: There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis.

Objective: To evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort.

Methods: This cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians.

Results: Forty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%.

Conclusion: In this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238056PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454955PMC
October 2020

Risk of Repeated Admissions for Respiratory Syncytial Virus in a Cohort of >10 000 Hospitalized Children.

J Pediatric Infect Dis Soc 2020 Jul 24. Epub 2020 Jul 24.

Department of Pediatrics, University of Alberta, Edmonton, Canada.

Background: The objective was to describe respiratory syncytial virus (RSV) hospitalizations in Alberta, Canada over a 13-year period with an emphasis on the incidence and risk factors for repeat hospitalizations attributable to new RSV infections.

Methods: This was a retrospective database analysis. The Alberta Health Services Discharge Abstract Database was searched for patients <5 years of age admitted to any hospital with a primary diagnosis of RSV from July 1, 2004 through June 30, 2017. Clinical characteristics were compared for children with repeat RSV admission during the same RSV season (but >30 days apart so presumably due to separate infections) compared with all other children with RSV admissions.

Results: During the study period, 10 212 children had 10 967 RSV admissions. The RSV hospitalization rate was 1.6%. A total of 666 children (6.5%) were readmitted for RSV at least once during the study period, of whom 433 (4.2%) were readmitted within 30 days of the initial hospital discharge. There were 36 children (0.35%) with 2 RSV admissions >30 days apart during the same RSV season. When compared to all other children with RSV admissions, they were more likely to have congenital heart disease or to have been diagnosed with RSV pneumonia (vs bronchiolitis or upper respiratory tract infection) during their initial hospitalization.

Conclusions: The RSV hospitalization rate in children <5 years of age was 1.6%. Repeat RSV infections requiring readmission during the same RSV season occurred following only 0.35% of RSV hospitalizations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jpids/piaa077DOI Listing
July 2020

Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators' Collaborative Network on Infections in Canada (PICNIC) study.

BMC Pediatr 2020 05 26;20(1):252. Epub 2020 May 26.

Department of Pediatrics, University of Alberta, 4-590 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.

Background: The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome.

Methods: In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014.

Results: Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002).

Conclusions: Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12887-020-02151-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249448PMC
May 2020

Demographic, clinical, and virological characteristics of patients with a laboratory-confirmed diagnosis of influenza during three consecutive seasons, 2015/2016-2017/18, in the Islamic Republic of Iran.

J Clin Virol 2020 03 16;124:104281. Epub 2020 Jan 16.

University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Background: There are minimal data on the differences in demographics, clinical presentations and outcomes for patients with different types and sub-types of influenza in the Middle East.

Objectives: To use population-based data from Iran to investigate factors associated with unfavorable disease outcome.

Study Design: Clinical data were compiled from the Iranian Ministry of Health for patients of all ages who fulfilled the severe acute respiratory infections (SARI) definition according to World Health Organization criteriatested for any reason and found to have and had laboratory proven influenza September 21, 2015 through March 20, 2018. Pulmonary, cardiac, renal, hematologic and neurologic complications were recorded. Results were compared by type, age, gender and health status. Multivariate analysis was used to analyze risk factors for complications and death.

Results: Of 11,080 enrolled patients, 10,046 (90.7 %) were inpatients, 2254 (20.4 %) were children, 8403 (75.8 %) had influenza A, 2599 (23.5 %) had influenza B, and 78 (0.7 %) had unidentified types. Fever was less common in older patients (OR 0.99; 95 % CI 0.98-0.99, p < 0.001 and in those with comorbidity (OR 0.87; 95 % CI 0.77-0.97, p = 0.013). Although the rate of complications was lower with A(H1N1) pdm09 influenza than with A(H3N2) infection (12.8 % versus 15.6 %, p = 0.001), the mortality rate was higher (7.0 % versus 3.0 %, p < 0.001). Complications occurred more often during late versus early influenza season (OR 1.22; 95 % CI 1.08-1.37, p = 0.002). Patients with type B influenza (OR 0.85; 95 % CI 0.74-0.98, p = 0.025), or who presented with sore throat (OR 0.74; 95 % CI 0.65-0.84, p < 0.001) were less likely to develop complications. The risk of developing complications was increased in patients who had chronic heart disease (OR 1.51; 95 % CI 1.29-1.76, p < 0.001), chronic pulmonary disease (OR 1.62; 95 % CI 1.37-1.91, p < 0.001), diabetes (OR 1.24; 95 % CI 1.03-1.50, p = 022), or epilepsy (OR 1.55; 95 % CI 1.17-2.05). Older age and male gender increased the risk of death but not of complications.

Conclusions: The clinical features, complications and outcomes of influenza vary by age and by viral type and sub-type. Comorbidites appear to be more important than age in predicting complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcv.2020.104281DOI Listing
March 2020

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018.

Pediatr Transplant 2019 11 9;23(7):e13571. Epub 2019 Sep 9.

Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Growing evidence suggests receipt of live-attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2-day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post-SOT. For consideration of VV and MMR post-transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post-SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell-depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in-depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of "low-level" immune suppression as defined in the document.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/petr.13571DOI Listing
November 2019

CMV-specific T-cells and CD27-CD28-CD4+ T-cells for assignment of cytomegalovirus (CMV) status in adults awaiting organ transplant.

J Clin Virol 2019 06 25;115:37-42. Epub 2019 Mar 25.

Department of Medicine, University of Alberta, Edmonton T6G 2B7, Canada.

Background/objectives: Determination of Cytomegalovirus (CMV) status in solid organ transplant (SOT) candidates is essential to stratify risk of post-transplant CMV disease. Passive transfusion-acquired antibodies can make serologic determination of CMV status unreliable. We evaluated 3 assays, not affected by passive antibodies (PA), in assignment of CMV status: quantification of CMV-specific CD4 + T-cells (CMV-TC) and exhausted CD27-CD28- CD4 + T-cells, and detection of CMV DNA with Nucleic Acid Amplification Testing (NAAT).

Study Design: We enrolled 50 adults awaiting SOT and 50 immunocompetent age-matched controls, and collected a throat swab, urine, saliva and blood sample on each. Using flow cytometry CD4 + T-cells were phenotypically analyzed for expression of CD27 and CD28 and CMV-specific CD4 + T-cells were identified by CD69 expression and intracellular IFN-γ quantification after stimulation with CMV-antigen lysate. CMV NAAT was performed on all specimens using real-time PCR. CMV serology (CMV IgG) was determined by enzyme immunoassay. Subjects were considered to have potential PA if they received blood products within 2 months of collection.

Results: The CMV-TC assay discriminated between CMV-seropositive and seronegative SOT candidates without PA well (sensitivity 79%, specificity 93%) while the CD27-CD28-CD4 + T-cell assay had good sensitivity (86%) but specificity of 74%. Detection of CMV DNA was uncommon in CMV-seropositive SOT candidates (2/21).

Conclusions: Given its high specificity, the CMV-TC assay is valuable in confirming true-positive CMV status in seropositive SOT candidates with PA, while use of CD27-CD28-CD4 + T-cell analysis is limited by moderate specificity. Detection of CMV DNA is of limited value in assignment of CMV status in adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcv.2019.03.014DOI Listing
June 2019

Surveys of parents and clinicians concerning the minimally important difference of probiotic therapy for prevention of paediatric antibiotic-associated diarrhoea.

BMJ Open 2019 04 2;9(4):e024651. Epub 2019 Apr 2.

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Objectives: To establish the minimally important difference (MID) that would prompt parents and clinicians to use probiotics for prevention of paediatric antibiotic-associated diarrhoea (AAD) and to obtain parent and clinician opinion about the most important outcomes in clinical trials of AAD.

Methods: In this survey, parents of children presenting to the emergency department of a Canadian tertiary care children's hospital and paediatricians working in that hospital were approached. A range of potential MIDs were presented and participants selected one that they would require to use probiotics for AAD prevention. In addition, participants were asked to rate a list of outcomes they would consider to be important in clinical trials of AAD.

Results: In total, 127 parents and 45 paediatricians participated. About 51% (64/125) of parents and 51% (21/41) of clinicians responding to the MID question reported they would use probiotics if it reduced the risk of AAD by 39% (ie, reduce the risk of AAD from 19% to 12%). The most important outcomes to parents, in descending order, were need for hospitalisation, prevention of dehydration, disruption of normal daily activities, diarrhoea duration and physician revisit. Paediatricians considered need for hospitalisation along with physician revisit as the most important outcomes. They rated prevention of dehydration, diarrhoea duration and stool frequency as important outcomes as well.

Conclusion: There is good agreement between parents and clinicians regarding how effective probiotics would need to be in preventing AAD in order to warrant use. This information, along with outcomes perceived to be most important, will help in the design of future clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-024651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500342PMC
April 2019

Salmonella infections in Canadian children.

Authors:
Joan L Robinson

Paediatr Child Health 2019 Feb 15;24(1):50-51. Epub 2019 Feb 15.

Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario.

Nontyphoidal Salmonella (NTS) infections are primarily transmitted by contaminated food or water or contact with carrier animals (particularly reptiles), and present with diarrhea. Antibiotics do not decrease the severity or duration of diarrhea and may increase the incidence of NTS carriage, so they should only be used with suspected or proven bacteremia or invasive infection. Typhoid/paratyphoid fever manifests as bacteremia within 60 days of travel to resource-poor countries and presents with fever and variable abdominal complaints. Therefore, blood cultures are indicated for unexplained fever and a relevant travel history. When blood cultures are positive or when a child is unwell pending blood culture results, ceftriaxone is indicated. A switch to oral antibiotics (usually azithromycin) is often possible after blood cultures have cleared and the child is improved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxy199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376300PMC
February 2019

Potential strategies to improve childhood immunization rates in Canada.

Authors:
Joan L Robinson

Paediatr Child Health 2018 08 18;23(5):353-356. Epub 2018 Jul 18.

Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario.

Immunization rates in Canada are suboptimal. Strategies such as making immunization mandatory for child care or school entry and financial incentives are used in other countries. Additional strategies that could work in the Canadian context include requiring accurate immunization records at school entry, implementing immunization registries at the provincial/territorial level, educating parents and school-aged children about vaccine-preventable diseases and making it more convenient for parents to ensure their children are fully immunized.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxy052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054155PMC
August 2018

Congenital Brucellosis: A Systematic Review of the Literature.

Vector Borne Zoonotic Dis 2018 08 29;18(8):393-403. Epub 2018 Jun 29.

4 Department of Pediatrics, Stollery Children's Hospital and University of Alberta , Edmonton, Canada .

Background: Knowledge of the spectrum of presentations and the outcome of congenital brucellosis should expedite diagnosis and improve prognostication.

Methods: A systematic review of literature of cases of congenital brucellosis was performed on October 10, 2017 (registered as PROSPERO CRD42017072061).

Results: A case seen by the authors was added to the review, yielding 44 reported cases of which 22 (50%) were from Turkey, Saudi Arabia, or Kuwait. For cases with the gestational age reported, 23 of 37 (62%) were preterm. The species was Brucella melitensis in 35 cases, Brucella abortus in 3 cases and not documented in 6 cases. The diagnosis was based on a positive blood culture from the first day of life in 20 cases (45%). Presentation was usually typical for a bacteremic infant of that GA, but two infants were asymptomatic at diagnosis. There were two recurrences and seven deaths (six in preterm infants), but the role of Brucella infection in the deaths was not clear.

Conclusion: Brucellosis remains a concern in endemic countries, adversely affecting pregnancy and very rarely causing neonatal infection. Prematurity appeared to be the prime cause of death in neonates with congenital brucellosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/vbz.2018.2280DOI Listing
August 2018

Consequences of brucellosis infection during pregnancy: A systematic review of the literature.

Int J Infect Dis 2018 Aug 6;73:18-26. Epub 2018 Jun 6.

Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Background: The aim was to establish the incidence of adverse outcomes with brucellosis infection during pregnancy.

Methods: Ovid Medline (1946-), Ovid Embase (1974-), and Web of Science (Clarivate Analytics) (1900-), the World Health Organization website and Google were searched September 27, 2017 for (i) outcomes with brucellosis diagnosed during pregnancy and (ii) studies with retrospective diagnosis of maternal brucellosis following adverse pregnancy outcomes.

Results: Sixty studies met inclusion criteria. In 65 pregnancies from 28 case reports and 9 small case series (<10 women), there were 20 spontaneous abortions (SAs) (31%), 2 intra-uterine fetal deaths (IUFDs) (3%) and 11 cases of congenital brucellosis (17%). In 14 larger case series there were 181 SAs in 679 pregnancies (27%), 19 IUFDs in 458 pregnancies (4%), and 44 preterm infants (12%) plus 6 infants with congenital brucellosis (2%) in 362 pregnancies. SA, IUFD and preterm delivery incidence were increased with meta-analysis of the 5 case series with controls. Nine studies described brucellosis seroprevalence with adverse pregnancy outcomes with no increased seroprevalence in the two studies with controls.

Conclusions: Brucellosis almost certainly causes SA with increasing evidence that it also leads to IUFD and prematurity. Congenital brucellosis occurs in approximately 2% of infants exposed in-utero.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijid.2018.05.023DOI Listing
August 2018

Assigning Cytomegalovirus Status in Children Awaiting Organ Transplant: Viral Shedding, CMV-Specific T Cells, and CD27-CD28-CD4+ T Cells.

J Infect Dis 2018 09;218(8):1205-1209

Department of Pediatrics, University of Alberta, Edmonton, Canada.

Passive antibodies, maternal or transfusion-acquired, make serologic determination of pretransplant cytomegalovirus (CMV) status unreliable. We evaluated 3 assays unaffected by passive antibodies, in assignment of CMV infection status in children awaiting solid organ transplant and in controls: (1) CMV nucleic acid amplification testing (NAAT), (2) quantification of CMV-specific CD4+ T cells, and (3) quantification of CD27-CD28-CD4+ T cells. Our results highlight that CMV NAAT, from urine and oropharynx, is useful in confirming positive CMV status. Detection of CMV-specific CD4+ T cells was sensitive and specific in children >18 months but was less sensitive in children <12 months. CD27-CD28-CD4+ T cells are not likely useful in CMV risk stratification in children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/infdis/jiy309DOI Listing
September 2018

Role of the Father in Human Papillomavirus Transmission to Infants.

Authors:
Joan L Robinson

Pediatr Infect Dis J 2018 06;37(6):617-618

Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000001939DOI Listing
June 2018

Probiotics for Modification of the Incidence or Severity of Respiratory Tract Infections.

Authors:
Joan L Robinson

Pediatr Infect Dis J 2018 07;37(7):722-724

From the Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000002000DOI Listing
July 2018

Zika virus: What does a physician caring for children in Canada need to know?

Authors:
Joan L Robinson

Paediatr Child Health 2017 Mar 30;22(1):48-55. Epub 2017 Mar 30.

Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario.

Zika virus (ZIKV) was recently recognized to be teratogenic. The diagnosis of congenital ZIKV syndrome should be considered in children with unexplained microcephaly, intracranial calcifications, ventriculomegaly or major structural central nervous system abnormalities. Management is evolving but suggestions are provided for children with findings compatible with congenital infection and for those born to women with potential exposure during pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxx012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804958PMC
March 2017

Update on invasive meningococcal vaccination for Canadian children and youth.

Authors:
Joan L Robinson

Paediatr Child Health 2018 02 15;23(1):e1-e4. Epub 2018 Feb 15.

Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario.

Invasive meningococcal disease (IMD) is serious, often resulting in fulminant sepsis or meningitis. IMD in Canada is primarily attributable to serogroups B and C. There are routine programs for serogroup C vaccine at 12 months of age, with some jurisdictions routinely providing additional earlier doses. Adolescents routinely receive a booster dose of serogroup C vaccine or of a quadrivalent (serogroups A, C, W and Y) vaccine. Serogroup B vaccines are not recommended for routine use pending further data on the efficacy and duration of protection from the available vaccine. However, children at increased risk for IMD should start immunization for serogroups B and C as soon as possible, assuming that they are at least 2 months of age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxx162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814812PMC
February 2018

Medical publishing in 2018.

Authors:
Joan L Robinson

Paediatr Child Health 2018 Feb 15;23(1):1-2. Epub 2018 Feb 15.

Stollery Children's Hospital and University of Alberta, Edmonton, Alberta.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxx196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815065PMC
February 2018

The dawn of a new era for .

Authors:
Joan L Robinson

Paediatr Child Health 2017 Mar 30;22(1). Epub 2017 Mar 30.

University of Alberta and Stollery Children's Hospital, Edmonton, Alberta.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/pch/pxx001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804763PMC
March 2017

Does Dientamoeba fragilis cause diarrhea? A systematic review.

Parasitol Res 2018 Apr 5;117(4):971-980. Epub 2018 Feb 5.

University of Alberta, Edmonton, AB, Canada.

It remains controversial whether Dientamoeba fragilis is a commensal parasite or a pathogen. The objective of this systematic review was to establish the strength of the evidence that Dientamoeba fragilis would cause diarrhea. A search was performed for studies that reported either the association between D. fragilis detection in stools and diarrhea or diarrhea outcomes with D. fragilis therapy or challenge. Data from seven studies of specific populations reported that 22% had D. fragilis in stools of which only 23% had diarrhea. Eleven studies of stool samples submitted to laboratories reported that 4.3% of individuals had D. fragilis of which 54% had diarrhea. Twelve studies reported that D. fragilis was detected from 1.6% of individuals with diarrhea and 9.6% of diarrheal stools. Five studies analyzed the prevalence of D. fragilis in individuals with and without diarrhea; the two with a statistically significant difference between groups had discordant results. The only cohort study with an appropriate control group reported diarrhea in a higher proportion of children with D. fragilis than in controls. No D. fragilis treatment studies included diarrhea as an outcome. There were only two challenge studies involving one person each. In conclusion, the evidence that D. fragilis would cause diarrhea or that treatment would hasten diarrhea resolution is inconclusive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00436-018-5771-4DOI Listing
April 2018

Early Childhood Neurodevelopmental Outcomes in Infants Exposed to Infectious Syphilis In Utero.

Pediatr Infect Dis J 2018 06;37(6):576-579

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Background: There are minimal neurodevelopmental follow-up data for infants exposed to syphilis in utero.

Methods: This is an inception cohort study of infants exposed to syphilis in utero. We reviewed women with reactive syphilis serology in pregnancy or at delivery in Edmonton (Canada), 2002 through 2010 and describe the neurodevelopmental outcomes of children with and without congenital syphilis.

Results: There were 39 births to women with reactive syphilis serology, 9 of whom had late latent syphilis (n = 4), stillbirths (n = 2) or early neonatal deaths (n = 3), leaving 30 survivors of which 11 with and 7 without congenital syphilis had neurodevelopmental assessment. Those with congenital syphilis were all born to women with inadequate syphilis treatment before delivery. Neurodevelopmental impairment was documented in 3 of 11 (27%) infants with congenital syphilis and one of 7 (14%) without congenital syphilis with speech language delays in 4 of 11 (36%) with congenital syphilis and 3 of 7 (42%) without congenital syphilis.

Conclusions: Infants born to mothers with reactive syphilis serology during pregnancy are at high risk for neurodevelopmental impairment, whether or not they have congenital syphilis, so should all be offered neurodevelopmental assessments and early referral for services as required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000001842DOI Listing
June 2018

Practices regarding human Papillomavirus counseling and vaccination in head and neck cancer: a Canadian physician questionnaire.

J Otolaryngol Head Neck Surg 2017 Oct 26;46(1):61. Epub 2017 Oct 26.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4.34, Walter Mackenzie Center 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada.

Background: Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect against HPV-related head and neck cancer (HNC) in addition to HPV-related cervical and anogenital disease. While the association between HPV infection and cervical cancer is widely understood, its relation to HNC is less well known. The purpose of this study was to better understand HPV counseling practices for infection and vaccination in relation to HNC of primary care physicians (PCPs), Obstetricians/Gynecologists (OBGYNs), and Otolaryngology - Head and Neck Surgeons (OHNSs) in Canada.

Methods: A Canada-wide electronic questionnaire regarding counseling practices on HPV infection, transmission, and vaccination was designed and distributed to PCPs, OBGYNs, and OHNSs across Canada through electronic and paper-based methods. Basic Descriptive statistics were used to analyze responses.

Results: In total, 337 physicians responded (239 family physicians, 51 OHNSs, 30 OBGYNs, and 17 pediatricians). Three out of four PCPs reported routine counseling of their patients regarding HPV infection, transmission, and vaccination. Among this group, 68% reported "never" or "rarely" counseling patients that HPV can cause HNC. The most commonly reported reason that PCPs cited for not counseling was a lack of knowledge. The majority of OHNSs (81%) and OBGYNs (97%) counseled patients regarding HPV infection, transmission, and vaccination. However, very few OHNSs (10%) regularly counseled patients with HPV-related HNC about HPV-related anogenital cancer. Similarly, very few OBGYNs (18%) regularly counseled patients with HPV related cervical/anogenital cancer about HPV related HNC.

Conclusions: The rate of counseling on HPV infection, transmission, and vaccination in relation to HNC among PCPs is low. The most common reason is a lack of knowledge. Specialists rarely counsel patients with confirmed HPV-related cancer about other HPV-related malignancies. More research is needed on the relationship between different HPV-related cancers in order to better inform counseling practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40463-017-0237-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658991PMC
October 2017

Probiotics for Modification of the Incidence or Severity of Respiratory Tract Infections.

Authors:
Joan L Robinson

Pediatr Infect Dis J 2017 Nov;36(11):1093-1095

From the University of Alberta and Stollery Children's Hospital, Edmonton, Alberta.

There is increasing interest in probiotics for therapy and prevention of infectious diseases. There are no published trials of probiotics as therapy for respiratory tract infections (RTIs) in children or adults. There is low quality, inconsistent evidence for the efficacy of probiotics for prevention of RTIs or ventilator-associated pneumonia or for modification of the severity of RTIs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000001714DOI Listing
November 2017

The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants.

Pediatrics 2017 Jul 9;140(1). Epub 2017 Jun 9.

Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada

Objectives: The pathogens that cause bacterial meningitis in infants and their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in early infancy.

Methods: This was a cohort study of infants <90 days of age with bacterial meningitis at 7 pediatric tertiary care hospitals across Canada in 2013 and 2014.

Results: There were 113 patients diagnosed with proven meningitis ( = 63) or suspected meningitis ( = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogens were ( = 37; 33%) and GBS ( = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin ( and type B). Six of 60 infants presenting a diagnosis of meningitis from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice ( [ = 3], , , and ). Sequelae were documented in 84 infants (74%), including 8 deaths (7%).

Conclusions: and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2017-0476DOI Listing
July 2017

The Epidemiology of Childhood Salmonella Infections in Alberta, Canada.

Foodborne Pathog Dis 2017 06 17;14(6):364-369. Epub 2017 Mar 17.

1 Department of Pediatrics, University of Alberta , Edmonton, Canada .

Objectives: The objectives were to describe the incidence, demographics, laboratory findings, and suspected sources of childhood Salmonella infections in Alberta, Canada, with a focus on preventable cases.

Methods: Data from Notifiable Disease Reports for children with nontyphoidal salmonellosis (NTS) or typhoid/paratyphoid fever from 2007 through 2015 were analyzed.

Results: NTS was detected from 2285 children. Bacteremia was documented in 55 cases (2.4%), whereas a single infant had NTS meningitis. The suspected source was food (N = 577; 25.3%) followed by animal or animal manure contact (N = 426; 18.6%), of which a reptile was the suspected source in 264 cases (11.5%). There were 44 outbreaks with none sharing the same food source. Ninety-five children were diagnosed with typhoid/paratyphoid fever, of which 48 cases (51%) were typhoid cases in unimmunized children 2 years or older.

Conclusions: There are still ∼275 pediatric cases of Salmonella infection in Alberta annually, the bulk of which are preventable.

Application: Public education about reptile exposure, food safety, and pretravel immunizations could potentially prevent many cases of Salmonella infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/fpd.2016.2259DOI Listing
June 2017

Letter to the Editor - Re: Canadian Pediatrics Society position statement on newborn circumcision: a risk-benefit analysis revisited.

Can J Urol 2017 02;24(1):8684-8687

Canadian Pediatric Society, University of Alberta, Edmonton, Alberta, Canada.

EDITORIAL.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2017

Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome.

Clin Infect Dis 2017 Apr;64(7):921-927

Hospital for Sick Children, University of Toronto, Ontario.

Background: Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days).

Methods: All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined.

Results: Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007).

Conclusions: ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/cix001DOI Listing
April 2017