Current Pediatric Reviews - Volume 5, Issue 4, 2009

Epstein-Barr virus (EBV), one of the eight known human herpesviruses, generally infects subclinically. However, in certain circumstances, EBV causes overt diseases such as infectious mononucleosis (IM), usually a selflimiting disorder, by its primary infection. Additionally, it associates the development of various human malignancies including EBV genome-positive Burkitt's lymphoma (BL) and undifferentiated nasopharyngeal carcinoma (NPC). More recently, EBV infection has been thought to be etiologically linked to the occurrence of lymphoproliferative disease (LPD) in immunologically compromised individuals either with hereditary or secondary condition, and the other lifethreatening diseases such as hemophagocytic lymphohistiocytosis (HLH) and chronic active EBV infection (CAEBV). This review mainly introduces, focuses and discusses on the recent advances of EBV infection regarding its pathogenetic mechanism(s), diagnosis and treatment.

Bronchiectasis remains common in indigenous populations as reported from Alaska, Australia and New Zealand. Each of these countries has published incidence and prevalence estimates, suggested aetiologies, clinical course and associated factors which may contribute to the burden of disease. The purpose of this collaborative review is to summarise literature on bronchiectasis in indigenous peoples, discuss similarities and differences between these groups and countries, and compare these findings to recent reports on non-indigenous populations. Difficulties in applying best management practice are highlighted, including the difficult and confusing terminology, and suggestions made to address the unmet healthcare needs in order to reduce future respiratory morbidity and mortality in these populations.

The global burden of disease associated with Varicella-Zoster Virus (VZV), the aetiological agent of chickenpox and shingles, can no longer be considered insignificant. This review provides a comprehensive insight in to the epidemiology of VZV in different settings. High childhood incidence rates are seen in temperate climates and substantial evidence is presented regarding the morbidity associated with primary infection both in children and high risk groups. The increased adult prevalence of disease in warmer countries is associated with significantly higher rates of complications and death. The disparities in age specific incidence of chickenpox maybe associated with decreased viral transmission in warmer temperatures, in rural settings and in high humidity. However, these factors were not always consistent especially in Australia and South American countries. This suggests the possible role of other undefined host and viral factors. Universal childhood vaccination has resulted in a dramatic decrease in incidence, hospitalisations and deaths associated with VZV in the USA. A two dose schedule is now recommended following evidence of increased incidence of breakthrough disease in vaccine recipients over time. In addition a vaccine to prevent zoster has recently been recommended for use in the elderly to address the significant burden posed by this illness on health resources in temperate countries.

Children undergoing treatment for malignancy have excellent survival rates which now approach 75%. In most cases, children who die following treatment for cancer do so of their disease, but despite huge improvements in supportive care, one in six of the deaths within 5 years of diagnosis are due to the complications of therapy. One such life-threatening complication remains infection, frequently presenting as the occurrence of fever with neutropenia. This paper explores the issues around prevention of febrile neutropenia and risk stratification of new episodes, reviews recent advances in the field of febrile neutropenia and highlights current research which may directly improve patient care.

Extremely low frequency electromagnetic radiation (ELF-EMR) is an omnipresent component of electricity, with a frequency of 3-30Hz, and wavelengths 3,450-5,996km long. We reviewed the scientific literature regarding pediatric health effects resulting from chronic exposure to ELF-EMR and compared these with the international safety standards. Articles published between 1980-2007 were identified using Medline, Cancerlite, Science Citation Index, and EMBASE. For the general population, the International Commission on Non-Ionizing Radiation Protection considers chronic exposure to magnetic fields lower than 100μT to be safe. However, even 0.3-0.4μT has been associated with an increased risk of acute lymphoblastic leukemia (ALL) in children. Although there is no experimental model to test the effects of ELF-EMR on organic systems, the Precautionary Principle is fundamental to the protection of children who are exposed to residential radiation doses higher than 0.3μT.