THE EDITORS’ PERSPECTIVES uchler et al have done a service to the pediatric community in their assiduous and Recognition of J aggressive approach to the bacteriologic conﬁrmation of etiologic agents of Kingella kingae as a osteoarticular infections (OAIs). Using culture and molecular techniques, their work is a weighted modern compendium of relevant pathogens. They also carefully catego- major cause of rized cases and causes by age and a constellation of markers of the host’s inﬂamma- osteoarticular tory responses, which will improve clinical decision making. Remarkably, Kingella kingae represented 88% of etiologically identiﬁed cases in the age group of 6 through 47 months, infections in young and Staphylococcus aureus 78% of cases in those 48 months and older. They also docu- children mented that a patient with Kingella OAI compared with S. aureus OAIismorelikely to be afebrile or only modestly febrile, have elevated sedimentation rate and platelet — Sarah S. Long,MD count, but only a modestly elevated C-reactive protein level. The authors are cautious about generalizability of their documented Kingella preva- lence to other regions and continents. They needn’t be overly cautious. As we in the US have picked up on speciﬁc molecular testing of blood and bone and joint speci- mens in the relevant age group, Kingella kingae is conﬁrmed not infrequently. The ﬁnding of Staphylococcus aureus as the predominant organism in school-age children seems generalizable. However, the virtual absence of methicillin-resistant S. aureus (MRSA) in the Geneva case series over 14 years is “special.” Across multiple studies in the US since the 1990s, staphylococcal infections have increased, and community-acquired MRSA is responsible for approximately one-half of staphylococcal OAIs. A ﬁnal, interesting speculation of the authors is that the ﬁnding of 21% of clinical cases of OAI without proven etiology despite aggressive pursuit suggests that other fas- tidious microorganism(s) may yet be discovered. Borrelia burgdorferi certainly is long ago discovered and is on the list for culture-negative pyogenic arthritis in regions of endemicity. Additionally, some culture-negative cases undoubtedly occur as autoinﬂammatory or autoimmune conditions. Article page 190 ▶ o predict the clinical course, severity, and outcome of disease, organ-speciﬁc pro- In search of T teins have been examined as candidate plasma biomarkers of injury. To date, the biomarkers for HIE sensitivity and speciﬁcity of such biomarkers for routine clinical use have been low. Yet the pursuit of biomarkers to characterize brain injury in critically ill children has — Paul G. Fisher,MD continued. In this volume of The Journal, Massaro et al report a secondary analysis evaluating plasma brain speciﬁc proteins and cytokines as biomarkers of brain injury in 50 new- borns with hypoxic-ischemic encephalopathy extracted from a phase II multi-center randomized trial evaluating erythropoietin for neuroprotection. Some elevated plasma brain-speciﬁc proteins and cytokine levels in the ﬁrst 24 hours of life were associated with worse brain injury on subsequent brain MRI, but by day 5 only tau and BDNF proteins were found to relate to neurodevelopmental outcomes. The authors suggest that further prospective studies with more frequent sampling are warranted, but maybe we should instead pause here and consider whether mass sampling of multiple plasma proteins and other blood components will lead us to selecting optimal therapies or pre- dicting outcomes. Perhaps we need to consider other non-plasma biomarkers and even innovative technologies to predict better the clinical course and ﬁnal outcome in chil- dren with critical illness. Article page 67 ▶ March 2018
The Journal of Pediatrics – Elsevier
Published: Mar 1, 2018
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