Background Polymerase chain reaction (PCR) assays increase the rate of viral detection in clinical specimens, compared with conventional virologic methods. Studies suggest that PCR may detect virus nucleic acid (NA) that persists in the respiratory tract. Methods We analyzed virologic data from children having frequent upper respiratory infections (URI) who were followed in a longitudinal study. Nasopharyngeal secretions (NPS) were collected at URI onset and when acute otitis media (AOM) was diagnosed; virus studies were performed using conventional diagnostics and PCR. Repeated presence of adenovirus by PCR was further studied by sequencing and phylogenetic analysis. Results Of 581 URI episodes in 76 children, 510 viruses were detected. Of the viruses detected by PCR, 15% were those detected previously; repeated positives occurred most frequently with adenovirus. Sequencing results were available in 13 children with repeated adenovirus detection; four patterns of infection were identified (16 instances): 1) adenovirus of the same serotype and strain detected continuously (n=8 instances), 2) adenovirus of different serotypes detected during sequential URI episodes (n=3), 3) adenovirus of the same serotype but different strains detected during sequential URI episodes (n=3) and 4) adenovirus of the same serotype and strain detected intermittently (n=2). Conclusions Among children with frequent URIs, repeated positive PCR results for adenovirus NA may represent a new serotype/strain, or persistence of viral NA. Results must be interpreted with caution; clinical correlation and presence of other viruses are important. Further longitudinal studies of children during and after infection are required for better understanding of the clinical significance of positive PCR tests for adenovirus NA in the respiratory tract .

Background-Acute otitis media (AOM) often occurs as a complication of upper respiratory tract infection (URI).

We report twin neonates who were born prematurely at 32 weeks of gestation to a mother with human immunodeficiency virus infection. One of the twins developed complete heart block and dilated cardiomyopathy related to lopinavir/ritonavir therapy, a boosted protease-inhibitor agent, while the other twin developed mild bradycardia. We recommend caution in the use of lopinavir/ritonavir in the immediate neonatal period.

Evaluation of: O’Brien MA, Prosser LA, Paradise JL et al.: New vaccines against otitis media: projected benefits and cost-effectiveness. Pediatrics 123(6), 1452–1463 (2009). Vaccines have the potential to impact on otitis media, a leading cause of childhood morbidity. O ‘Brien et al. created a computerized model to project the potential health and economic benefits of bacterial vaccines targeted against Streptococcus pneumoniae, nontypeable Hemophilus influenzae and Moraxella catarrhalis against otitis media. They concluded that reasonably priced bacterial vaccines could achieve cost-effectiveness and potentially prevent millions of episodes of acute otitis media annually.

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