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      Severe acute malnutrition and infection

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          Abstract

          Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice.

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          Most cited references194

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          Maternal and child undernutrition: global and regional exposures and health consequences.

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            International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.

            Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Consensus conference. This document describes the issues surrounding consensus on four major questions addressed at the meeting: a) How should the pediatric age groups affected by sepsis be delineated? b) What are the specific definitions of pediatric SIRS, infection, sepsis, severe sepsis, and septic shock? c) What are the specific definitions of pediatric organ failure and the validity of pediatric organ failure scores? d) What are the appropriate study populations and study end points required to successfully conduct clinical trials in pediatric sepsis? Five subgroups first met separately and then together to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiological data, and coagulation variables. All conference participants approved the final draft of the proceedings of the meeting. Conference attendees modified the current criteria used to define SIRS and sepsis in adults to incorporate pediatric physiologic variables appropriate for the following subcategories of children: newborn, neonate, infant, child, and adolescent. In addition, the SIRS definition was modified so that either criteria for fever or white blood count had to be met. We also defined various organ dysfunction categories, severe sepsis, and septic shock specifically for children. Although no firm conclusion was made regarding a single appropriate study end point, a novel nonmortality end point, organ failure-free days, was considered optimal for pediatric clinical trials given the relatively low incidence of mortality in pediatric sepsis compared with adult populations. We modified the adult SIRS criteria for children. In addition, we revised definitions of severe sepsis and septic shock for the pediatric population. Our goal is for these first-generation pediatric definitions and criteria to facilitate the performance of successful clinical studies in children with sepsis.
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              Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm.

              The three main soil-transmitted helminth infections, ascariasis, trichuriasis, and hookworm, are common clinical disorders in man. The gastrointestinal tract of a child living in poverty in a less developed country is likely to be parasitised with at least one, and in many cases all three soil-transmitted helminths, with resultant impairments in physical, intellectual, and cognitive development. The benzimidazole anthelmintics, mebendazole and albendazole, are commonly used to remove these infections. The use of these drugs is not limited to treatment of symptomatic soil-transmitted helminth infections, but also for large-scale prevention of morbidity in children living in endemic areas. As a result of data showing improvements in child health and education after deworming, and the burden of disease attributed to soil-transmitted helminths, the worldwide community is awakening to the importance of these infections. Concerns about the sustainability of periodic deworming with benzimidazole anthelmintics and the emergence of resistance have prompted efforts to develop and test new control tools.
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                Author and article information

                Journal
                Ann Trop Paediatr
                Ann Trop Paediatr
                PCH
                Annals of Tropical Paediatrics
                Maney Publishing (Suite 1C, Joseph's Well, Hanover Walk, Leeds LS3 1AB, UK )
                0272-4936
                1465-3281
                2014
                : 34
                : Suppl 1
                : 1-29
                Affiliations
                [1 ]KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya
                [2 ]Department of Paediatrics and Wellcome Centre for Clinical Tropical Medicine, Imperial College, London, UK
                [3 ]Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, UK
                Author notes
                Correspondence to: J. A. Berkley KEMRI-Wellcome Trust Research Programme PO Box 230 Kilifi, 80108 Kenya. Email: jberkley@ 123456kemri-wellcome.org
                Article
                201410
                10.1179/2046904714Z.000000000218
                4266374
                25475887
                c552279c-58f1-457c-ac1f-94a76c750799
                © W. S. Maney & Son Ltd 2014

                MORE OpenChoice articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial License 3.0

                History
                Categories
                Original Article

                Pediatrics
                malnutrition,children,infection,antibiotics,pneumonia,sepsis,diarrhoea,hiv,tuberculosis,measles,urinary tract infection,malaria

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