Rapid Flu Test Trims Further Tests, Tx
Rapid viral testing for influenza as part of the routine care plan for febrile infants reduced antibiotic use, emergency department visits, and the use of additional tests, based on data from a prospective study of 206 infants during the course of two flu seasons.
Nonspecific fevers without obvious signs of infection send many infants to the pediatric emergency department, and rapid flu testing in these settings can help triage patients more effectively and reduce unnecessary tests and treatment, wrote Dr. Javier Benito-Fernandez of the pediatric emergency department in Hospital de Cruces, Barakaldo, Spain, and colleagues.
Overall, 84 of 206 (41%) infants aged 0–36 months tested positive based on commercially available rapid flu tests. The influenza-positive infants were significantly less likely than influenza-negative infants to undergo blood tests (33% vs. 100%), urinalysis (81% vs. 100%), chest radiographs (14% vs. 32%), and lumbar punctures for cerebrospinal fluid analysis (2% vs. 21%). In addition, none of the influenza-positive infants received antibiotics at the time of diagnosis, compared with 39% of the influenza-negative infants (Pediatr. Infect. Dis. J. 2006;25:1153–7).
Only two influenza-positive infants (2%) required hospital stays for observation, compared with 20 influenza-negative infants (16%) admitted for diagnoses including pneumonia, meningitis, urinary tract infection, and bacteremia. All influenza-positive patients had a favorable clinical course, the investigators said.
New Coronavirus Subtypes on Rise
Two recently discovered coronavirus subtypes, NL63 and HKU1, accounted for a majority of the 66 coronaviruses identified in a review of 1,043 samples from children with acute respiratory illness.
Overall, coronavirus subtypes HKU1, OC43, NL63, and 229E were identified in 28, 19, 11, and 8 specimens, respectively, reported Jane Kuypers, Ph.D., of the University of Washington, Seattle, and her colleagues (Pediatrics 2007;119:e70–6 [doi:10.1542/peds.2006–1406]).
The researchers collected specimens from patients aged 0–19 years who presented to a children's hospital with upper respiratory illness from October 2003 through September 2004. The acute clinical features experienced by the children were not significantly different based on the virus type.
A coronavirus was the only respiratory viral pathogen identified in 32 (57%) of the 56 children for whom complete clinical data were available, including 14 patients with HKU1, 11 with OC43, 5 with NL63, and 2 with 229E. Of these, children infected only with a coronavirus were significantly more likely to have underlying medical conditions, compared with children who were infected with more than one respiratory virus.
Three children (one each infected with HKU1, OC43, and 229E) were treated in the intensive care unit, and two of them needed ventilators. In addition, six immunocompromised children had coronavirus as the sole pathogen, including five children with acute lymphocytic leukemia and one renal transplant patient. Three of the children with leukemia and the transplant patient required hospital stays ranging from 2 to 12 days.
The findings diverge from previous coronavirus research by showing that the viruses were present year-round; specimens from at least one virus were collected during each month, although the monthly specimen total peaked at 218 in December 2003.
Levofloxacin Succeeds vs. AOM
Treatment with oral levofloxacin is safe and effective against bacteria in the middle-ear fluid of children with recurrent or persistent acute otitis media, based on data from children aged 6 months to 5 years.
The open-label study, sponsored by Johnson and Johnson Pharmaceutical Research and Development, included 204 children with confirmed acute otitis media who received at least one 10-mg/kg dose of the study medication (Pediatr. Infect. Dis. J. 2006;25:1102–9). The full course of therapy was 10 mg/kg of levofloxacin twice daily for 10 days.
A total of 105 pathogens were recovered from the middle-ear fluid of 89 bacteriologically evaluable children using tympanocentesis. Haemophilus influenzae, the most common pathogen, was identified in 54 children, either alone or along with Streptococcus pneumoniae or Moraxella catarrhalis.
All of the H. influenzae and S. pneumoniae isolates were susceptible to levofloxacin, and the eradication rates for these pathogens were 100% and 84%, respectively. The eradication rate for M. catarrhalis was 100%, wrote Dr. Adriano Arguedas of the Universidad de Ciencias Médicas, in San José, Costa Rica, and colleagues. No cartilage damage was reported in any patients.