Faculty Bibliography

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections in infants and young children, accounting for more than 100,000 hospitalizations per year in the USA. The majority of hospitalizations occur in infants less than 1 year of age. Worldwide, RSV is associated with an annual mortality rate of 160,000-600,000 deaths. Premature infants, and infants with congenital heart disease, neuromuscular disease, structural airway abnormalities and immunodeficiencies are at increased risk for severe RSV disease. Despite the magnitude of RSV disease, treatment remains primarily supportive. Trials of bronchodilators, corticosteroids and montelukast have not demonstrated conclusive clinical benefit. The antiviral drug ribavirin has demonstrated only marginal clinical benefit and is not routinely indicated in treatment of RSV disease. Palivizumab is beneficial in prophylaxis for infants at high-risk for severe RSV infection although optimal indications based on cost-effectiveness considerations have not been defined. Future directions in treatment and prevention of RSV infections likely include the second-generation monoclonal antibody motavizumab, more potent antiviral compounds and more unique anti-inflammatory agents. Vaccination against RSV is in development but not eminent.

OBJECTIVE:This study aimed to review cases of Lemierre's and Lemierre's-like syndromes in paediatric patients, to examine a possible association with Epstein-Barr virus as a predisposing factor, and to assess the impact of this virus on the severity of illness. METHODS:We performed a retrospective analysis of data from the in-patient database at Winthrop University Hospital, from January 2001 to October 2007. We reviewed clinical and laboratory findings as well as the outcome of infection in patients aged 21 years or less with a diagnosis of Lemierre's syndrome. An additional case of Lemierre's-like syndrome was also included. The illness severity and duration of in-patient management of those testing positive for heterophile antibody were then compared with the same parameters in patients who tested negative. RESULTS:Of the five patients diagnosed with Lemierre's syndrome, two had concomitant acute infection with Epstein-Barr virus. Additionally, a 19-year-old adolescent was admitted during this period with acute infectious mononucleosis, Fusobacterium necrophorum sepsis, sinusitis, frontal lobe abscess and ophthalmic vein thrombosis. The clinical presentation of all patients included fever, sore throat, and ear or neck pain. The duration of symptoms ranged from two days to three weeks prior to admission. The patients with acute Epstein-Barr virus infection had been diagnosed with infectious mononucleosis prior to admission, and tested positive for heterophile antibody. These patients subsequently underwent more extensive in-patient treatment, including intensive care management and ventilator support. The patients who tested negative for heterophile antibody experienced a milder course of illness, with a shorter duration of in-patient management. CONCLUSION/CONCLUSIONS:Two patients diagnosed with Lemierre's syndrome, and a third with Fusobacterium necrophorum sepsis, had coexisting acute Epstein-Barr virus infection. Patients who tested positive for heterophile antibody experienced a more severe course of illness. These observations suggest a possible association between Epstein-Barr virus infection and the severity of concomitant Lemierre's syndrome.

OBJECTIVES/OBJECTIVE:The 2009 outbreak of novel influenza A H1N1 reached a pandemic status on June 11, 2009. Early detection is a key factor for management and infection-control practices. Recent studies have suggested a difference in performance of rapid influenza kits for influenza A H1N1. Our goal was to evaluate the performance of the QuickVue influenza A+B test (Quidel Corp., San Diego, CA) in an emergency department setting and determine the most current epidemiologic trends in our community. METHODS:Results from 1137 samples for influenza A collected between April 8, 2009 and June 30, 2009 were retrospectively reviewed. Results of QuickVue influenza A+B test were compared with R-Mix viral culture and DFA results. Age distribution and hospitalization rates by age group were analyzed to further delineate the epidemiology of influenza A in a suburban hospital. RESULTS:The sensitivity of the rapid test was 77%, the specificity was 85%, the positive predictive value was 74%, and the negative predictive value was 87%. We found a similar age distribution for positive influenza tests and admissions when compared with the national Centers for Disease Control and Prevention data. CONCLUSIONS:The QuickVue influenza A+B test is a sensitive assay for the novel H1N1 strain of influenza. In our hospital, the group with highest risk of hospital admission was patients aged < 25 years.

In the spring of 2009, our institution found itself at the epicentre of the "herald wave" of the swine influenza (H1N1) pandemic in New York. We were inundated with hundreds of patients exhibiting influenza-like illnesses (ILIs), presenting for rapid influenza A testing. During this pandemic, an infant with newly diagnosed acute lymphatic leukaemia (ALL) was admitted for induction chemotherapy. After being in hospital for a week, she developed high fever and shortness of breath, although her chest X-ray was clear. She was admitted to the paediatric intensive care unit (PICU) for mechanical ventilation. As we were in the midst of the pandemic, diagnosis of H1N1 pneumonia was considered and reverse transcription-polymerase chain reaction for H1N1 was positive. Contact investigation revealed that none of her family members/visitors had been in recent/close contact with anyone with ILI/H1N1. The investigation also revealed that paediatric healthcare staff, in contact with H1N1 patients, had rotated into PICU to care for the patient. Although no specific individual could be identified, it seems likely that H1N1 was transmitted to the patient by a healthcare worker who worked both in the paediatric ward and the PICU. This is the first known case of nosocomial paediatric transmission of H1N1 pneumonia.