Diagnostic Markers for Early Sepsis Diagnosis in Children With Systemic Inflammatory Response Syndrome
Sepsis caused by infection remains a major cause of mortality among children. One of the main reasons for high sepsis mortality rates is the inability to obtain early diagnosis. Sensitive and specific biomarkers are greatly needed in rapid diagnosis of sepsis. The main aim of study was to investigate the ability of high-mobility group box-1 protein (HMGB1), lipopolysaccharide-binding protein (LBP), Interleukin-6 (IL-6), procalcitonin (PCT) and C reactive protein (CRP) to differentiate sepsis patients. Eighty-four children with Systemic Inflammatory Response Syndrome (SIRS) were included in the prospective study. Sepsis was recognised in 23% (n = 19) of them. LBP, IL-6, CRP and PCT levels were significantly higher among the sepsis group (P < 0.05). HMGB1 levels in the sepsis patients did not significantly differ from SIRS patients. In ROC analysis in sepsis patients, identification markers LBP, IL6 and CRP performed quite similarly (P < 0.001), with the best result being for IL6. Our data suggest that in early sepsis diagnosis in children, LBP, IL-6, PCT and CRP are probably the superior diagnostic markers, with the best performance by IL6. LBP and IL-6 are superior markers for sepsis patients' disease process monitoring. HMGB1 does not have a diagnostic value for sepsis patient identification.
Meat consumption during the first year of life is especially important to provide necessary iron requirements. The aim of the study was to assess meat and meat product consumption of Latvian infants during their first year of life, in relation to different factors. Data were collected by interview method using two types of questionnaires: food frequency questionnaires and food diary. The study included a representative sample of infants and toddlers from all regions of Latvia with a target sample of 560 participants. The study included 266 infants: 127 girls, 139 boys, aged from 0 to 12 month. Data were summarised using the Excel software and analysed using the SPSS software. For data analysis two age groups were created: 0–5.9 months and 6–12 months. Consumption was analysed by two parameters: frequency and amount per feeding. Meat products were defined as offal products, sausages, and meat in baby food. Meat was mainly consumed after 6 months of age and by 73% of infants (n = 107). Meat from baby food was consumed only after 6 months and by 23% (n = 34). Sausages and offal products were consumed after 6 months of age. Sausages were consumed by 18% (n = 28) and offal products by 11% (n = 16) of infants. Meat consumption for the majority of infants was introduced after 6 months and was in accordance with recommendations.
The aim of this study was to investigate parental perception of febrile illness in their children, the most commonly applied management practices, as well as the expectations from clinicians when coping with fever in children. The study included parents of patients admitted to the Emergency and Observation Department of Children’s Clinical University Hospital in Rīga, Latvia. Data were collected via semi-structured interviews. All interviews were transcribed, and the transcripts analysed by inductive thematic analysis. Thirty-four parental interviews were analysed. Six themes emerged from the study, which were: signs causing concern; beliefs regarding fever; assessment and monitoring of fever; fever management practices; help-seeking behaviour; and expectations from the healthcare personnel. Many parents believed that fever could potentially cause injuries to the nervous system, kidneys, the brain, other internal organs, and even cause death. The perceived threat of fever resulted in frequent temperature measurements and administration of antipyretics. Meeting the emotional and information needs of the parents were considered as equally important to meeting the child’s medical needs. The study found that fever phobia exists among parents. Parental misconceptions of fever lead to overly zealous management practices. Parental education initiatives must be organised in order to improve parental knowledge of fever and its management in children.
In developed and developing countries, most cases of acute gastroenteritis in children are caused by viruses, and rotaviruses are known as the leading cause. The aim of our study was to estimate the main circulating serotypes of rotavirus before the introduction of routine immunisation in Latvia, and to search for their possible correlation with clinical symptoms and circulating genotypes. A cross-sectional study was carried out among children who had been hospitalised in the Children’s Clinical University Hospital from April 2013 to December 2015. Genotyping was done for 462 stool samples. Among G/P combinations, the most predominant genotypes were G4P (61.3%), G9P (12.4%) and G2P (10.0%) in children of age < 5 years, G4P (45.5%), G2P (18.2%), G9P, G3P, and G1P (9.1%) in children of age > 5 years. There was a statistically significant correlation (p < 0.05) between clinical signs (vomiting, dehydration, chronic diseases) and G1P and G8P genotypes. Infants infected with genotype G4P had a statistically significant negative correlation with severity of acute gastroenteritis episodes (p < 0.05). We detected nine different rotavirus G genotypes, and two different P genotypes. G4P, G9P, and G2P were predominant. We observed correlation between the dominant genotypes and clinical manifestations of rotavirus infection.
The world has seen a rise of type 2 diabetes mellitus in children during the last 20 years. It is proposed that this increase is due to unhealthy eating habits, increasing obesity, especially among teenagers, and better diagnostics. The main risks associated with diabetes are microvascular and macrovascular complications, which can lead to early disability and premature death. The aim of our study was to identify children with type 2 diabetes mellitus or impaired glucose tolerance and investigate associated comorbidities at the time of diagnosis in the Children’s Clinical University Hospital in Latvia. A retrospective analysis was performed of all children with type 2 diabetes mellitus or glucose tolerance impairment from 2002 till 2013, who were treated in Children’s Endocrinology Centre. According to inclusion criteria, 57 patients were selected of whom 24 (42%) had type 2 diabetes mellitus and 33 (58%) had impaired glucose tolerance. Body mass index was analysed according to percentile and all patients were found to have excess weight. In children with type 2 diabetes mellitus, all patients had body mass index over the 99th percentile. Arterial hypertension was found in 66.7% and dyslipidemia in 54.2% type 2 diabetes mellitus patients. From all type 2 diabetes mellitus patients, 71% (n = 17) were girls and they had statistically significantly higher total cholesterol (p = 0.02) and low-density lipoprotein (p = 0.003) levels. Considering, that girls with type 2 diabetes mellitus have high cardiovascular risk in adulthood, it is very important not only to achieve normal glucose levels early, but also to treat comorbidities, to reduce further microvascular and macrovascular complication risk.
Lower respiratory tract infection (LRTI) is the major cause of morbidity and mortality of children in the world. In addition to respiratory syncytial virus, influenza virus types A and B, parainfluenza types 1, 2 and 3, and adenoviruses, several new respiratory viruses associated with LRTI were discovered in the 21st century. These are metapneumovirus, coronaviruses NL63 and HKU1, parainfluenza virus type four and human bocavirus one (HBoV1). HBoV1 was discovered in 2005 and is considered as the fourth most prevalent respiratory virus worldwide. However, the high frequency of co-infections detected together with HBoV1 raises doubt about whether HBoV1 is a true pathogen or just a bystander. This is the first study aimed to determine the presence of HBoV1 and 18 other respiratory viruses in nasopharyngeal aspirates (NPA) of children with LRTI in Latvia. Using multiplex real-time polymerase chain reaction method, the HBoV1 genomic sequence was detected in 60.0% of NPA samples, showing that HBoV1 prevalence is high among children with LRTI in Latvia. HBoV1 mono-infection was revealed in 6.67%. The most common co-infections associated with HBoV1 were rhinovirus, adenovirus, respiratory syncytial virus A and B, metapneumovirus, and enterovirus.
Since its discovery in 2005, human bocavirus 1 (HBoV1) has globally been one of the most common respiratory viruses. It is currently accepted that HBoV1 is a pathogen, causing upper and lower respiratory tract infections (LRTIs) in children. However, due to the prolonged HBoV1 DNA shedding from the upper airways and the subsequent high rate of co-detections with other respiratory viruses, the interpretation of positive polymerase chain reaction results is challenging. The aim of this study was to identify acute HBoV1 infections by the presence of HBoV1-specific IgM and IgG measured by competition enzyme immunoassay, to elucidate the induction of Th1/Th2 cytokines, and to describe the clinical characteristics associated with acute HBoV1 infection in hospitalised children less than five years of age with LRTI. HBoV1 IgM was detected in 19/102 (18.6%) and IgG in 66/102 (64.7%) patients. HBoV1 IgM was most frequently found in patients aged 13 to 24 months. Pneumonia and acute wheezing were the most common clinical diagnoses among HBoV1 IgM positive patients. The seroprevalence of HBoV1-specific IgG increased with age, reaching 85% by the age of five years. INF-γ, IL-4, IL-5, and IL-10 were observed to be higher in patients with acute HBoV1 infection.
Human bocavirus 1 (HBoV1) is a parvovirus recently found to be a possible aetiologic agent of acute respiratory disease in children. We conducted the first clinical and molecular study on this virus in Latvia (LV) and Lithuania (LT). The aim of the study was to determine the occurrence of HBoV1 in respiratory tract samples taken from hospitalised children with acute respiratory tract infections in LV and LT. In total 186 children with age one to 50 months, and who fulfilled criteria of acute respiratory tract infection, including lower respiratory tract infections, with or without fever, were included in this study. A nasopharyngeal aspirate was obtained from each patient on admission. DNA was isolated and polimerase chain reaction (PCR) performed targeting the HBoV1 NS1sequence. HBoV1 positive samples were sequenced and phylogenetic analysis was performed. HBoV1 sequence was detected in 42 (32%) of 130 LV and in 8 (14%) of 56 LT samples. In LV the majority of patients with HBoV1 infection were observed in February while in LT in October. The phylogenetic tree for HBoV1 indicated that isolates of HBoV1 cluster closely and include almost all of the isolates in this study. HBoV1 is common in Latvia and Lithuania and might be a significant pathogen that contributes to acute respiratory tract infections in children.