Rebecca Wallihan

Nationwide Children's Hospital, Columbus, Ohio, United States

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Publications (7)14.3 Total impact

  • Rebecca Wallihan, Octavio Ramilo
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    ABSTRACT: Pneumonia is a commonly encountered illness and the leading cause of death in children under 5 years of age. Our current management strategies remain less than optimal in part because we do not have adequate tools to determine etiology, classify patients and predict their outcomes. Studies in the last decade have demonstrated that viruses are commonly detected in children with pneumonia, but on many occasions this is not sufficient to establish a clear etiologic diagnosis since bacterial coinfection cannot be excluded. Gene expression profile analysis provides a comprehensive assessment of the host response to infection. Preliminary data suggest that transcriptional profile analysis and measurement of Molecular Distance to Health (MDTH) scores allows more precise patient classification than current diagnostic techniques and laboratory markers. Application of this tool to the evaluation of children with pneumonia may enhance our clinical decision making process and ultimately improve patient outcomes.
    Journal of Infection 09/2014; DOI:10.1016/j.jinf.2014.07.021 · 4.02 Impact Factor
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    ABSTRACT: Bordetella parapertussis is widely recognized as a cause of a pertussis-like respiratory illness in children, but reports of invasive infection are rare. We review the literature and describe the clinical presentation and treatment of 2 children with B. parapertussis bacteremia, as well as the techniques used to isolate the organism.
    The Pediatric Infectious Disease Journal 07/2013; 32(7):796-798. DOI:10.1097/INF.0b013e31828d2ca4 · 3.14 Impact Factor
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    ABSTRACT: Background: Mp is a common cause of LRTI in school- aged children. The true incidence of disease is uncertain because sensitive and specific laboratory tests for Mp are not widely available. The availability of PCR in our hospital laboratory for rapid detection of Mp in respiratory specimens has aided diagnosis and management. During 2011, we experienced a significant increase in Mp cases in both inpatients and outpatients. The goals of this study were to define the time course, age distribution, and clinical characteristics of inpatients affected during this outbreak. Methods: Laboratory records were searched to identify all patients testing positive for Mp by PCR from nasopharyngeal or throat swab samples from 4/25/2011 to 1/9/2012. Medical records of inpatients were reviewed to identify clinical and laboratory characteristics and clinical outcomes. Results: There were 441 patient positive samples for Mp (24%) of 1830 tested. Among these, 129 (29% of positives) were hospitalized and 17 (13% of inpatients) admitted to PICU. Diagnoses included 126 LRTIs, two Stevens - Johnson syndrome, and one case of encephalitis. Inpatient ages ranged from 0.5-18 yrs (mean 7.5); 43 were <5 yrs (33%) and 2 were <1yr (2%). PCR cycle time to positivity (Cts) for all patients ranged from 21.2-39.8. There was no difference in mean Cts between outpatients, ward, and PICU patients or between patients >5 and <5 yrs. Viral co-infection was detected in 25/114 (22%) patients tested for both Mp and respiratory viruses. Compared to patients >5yrs, patients <5yrs were more likely to have viral co-infection (p = 0.02). For inpatients <5 yrs tested for both Mp and viruses, 35% (14/43) had viral co-infection. There was no difference in length of stay or PICU admission among patients <5 yrs vs. >5 yrs or among patients with or without viral co-infection; however, patients with viral co-infection required O2 more frequently that those without (56% vs 41%, p=0.05). Conclusion: This outbreak of Mp infection was associated with a large number of LRTIs in patients < 5 yrs. The presence of a viral co-infection was common, especially in younger patients, and viral co-infections were associated with increased O2 requirement.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • Rebecca Wallihan, Asuncion Mejias, Mario Marcon
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    ABSTRACT: Background: Although respiratory viruses are frequently identified in children with community-acquired pneumonia (CAP), the clinical utility of specific viral diagnostics has not been fully explored in this population. Our objectives were to 1) determine the frequency of respiratory virus detection and 2) evaluate the impact of viral detection on antibiotic usage in children hospitalized with CAP. Methods: Prospective, observational study of patients 2 months to 18 years hospitalized with CAP at NCH from February 1, 2011, to January 31, 2012. Nasopharyngeal (NP) swabs were collected within 24 hours of hospitalization and two multiplex polymerase chain reaction (PCR) assays for respiratory viruses [xTAG respiratory viral panel IVD (RVP) & xTAG RVP FAST RUO, Luminex, Austin, TX] were performed. In this initial phase of the study, the RVP results were not available for clinical decision-making but viral culture, direct fluorescent antibody testing, and select lab-developed PCRs for respiratory viruses could be ordered at the discretion of the attending physician based on current routine practice. Demographic, clinical, laboratory, and outcome data were collected via chart review. Results: Of 143 patients with an NP sample analyzed by RVP, a total of 122 respiratory viruses were detected in 97 (67%) patients, with multiple viruses in 20 (14%) children. There were 65 (53%) viruses detected during standard of care testing and an additional 57 (47%) viruses detected by RVP. The viruses most frequently detected were rhinovirus (n=55; 38%), human metapneumovirus (n=18; 13%), parainfluenza (n=16; 11%), and respiratory syncytial virus (n=13; 9%). In children without confirmed bacterial infection, clinicians were more likely to withhold or discontinue antibiotics if a positive viral result was known during routine care compared with children with viruses only discovered during research testing (OR 10.0; 95% CI: 2.1-47; p=0.0007). Conclusion: When tested in a comprehensive and standardized fashion using RVP, respiratory viruses were detected in the majority of children hospitalized with CAP. Physicians were more likely to withhold or discontinue antibiotics in patients with a known positive viral test result. Routine implementation of viral testing may lead to decreased antibiotic usage in this population.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: The use of herpes simplex virus (HSV) polymerase chain reaction for diagnosis of HSV disease involving the central nervous system has not translated into widespread use for the detection of DNAemia. We report our 6-year experience using blood polymerase chain reaction testing for HSV infection in neonates and older children with HSV disease.
    The Journal of pediatrics 05/2012; 161(2):357-61. DOI:10.1016/j.jpeds.2012.04.009 · 4.02 Impact Factor
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    ABSTRACT: Background: Studies have described an association between influenza virus and bacteria in the pathogenesis of lower respiratory tract (LRT) infections. However, the clinical impact of other respiratory viruses in children with complicated pneumonia has not been well characterized. Our objectives were to determine the frequency of viral detection in children with complicated pneumonia and to describe and compare the clinical characteristics and outcomes of those with and without respiratory viruses detected. Methods: Retrospective review of patients < 21 years of age hospitalized at NCH from January 1, 2006, to April 30, 2011, with complicated pneumonia (defined as parapneumonic effusion or empyema requiring a drainage procedure) who had one or more laboratory tests performed for respiratory viruses. Cases were defined as patients in whom a viral pathogen was identified, and controls were patients who tested negative for viruses. Each case was matched with two controls for age, sex, race, and bacterial pathogen (S.pneumoniae, S. pyogenes, S. aureus, or none). Demographic, clinical, laboratory, and outcome data were compared between the groups. Results: Of 222 patients hospitalized with complicated pneumonia during the study period, respiratory virus testing was performed in 95 (43%). A viral pathogen was identified in 26 patients: 12% of all patients and 27% of those with viral testing. Viruses detected included 10 influenza virus, 8 respiratory syncytial virus, 4 parainfluenza virus, 3 human metapneumovirus, and 1 adenovirus. Compared with controls, cases had significantly longer length of stay (13 vs 8.5 days; p<0.01) and days of fever (8 vs 5 days; p<0.01). They were also more likely to have necrotizing pneumonia (OR 4.7; 95% CI: 1.5-14; p<0.01) and require ICU admission (OR 3.4; 95% CI: 1.1-10; p<0.05) or surgical decortication (OR 6.4; 95% CI: 1.5-28; p=0.01). Conclusion: Viral detection was common in children hospitalized with complicated pneumonia and such patients showed increased disease severity. These findings lend further evidence to the hypothesis of viral-bacterial synergism in LRT disease. Routine implementation of viral testing in this clinical setting may improve patient outcomes when specific antiviral therapies are available.
    Infectious Diseases Society of America 2011 Annual Meeting; 10/2011
  • Rebecca Wallihan, Katalin Koranyi, Michael Brady
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    ABSTRACT: Current Centers for Disease Control and Prevention (CDC) recommendations suggest all pregnant women have human immunodeficiency virus (HIV) antibody testing early in pregnancy. For women with specific identified risks for HIV-1 infection, the CDC recommends repeat testing in the third trimester. We report 3 cases of infants perinatally infected with HIV-1 whose mothers tested negative for HIV-1 during the first trimester of pregnancy. Because they were not considered to be "high risk" for HIV-1 infection, they did not have a third trimester HIV test. These cases suggest that repeat HIV antibody testing may be necessary to avoid cases of perinatal transmission that might be prevented with antiretroviral treatment during pregnancy.
    The Pediatric Infectious Disease Journal 11/2009; 29(3):274-5. DOI:10.1097/INF.0b013e3181bdbd88 · 3.14 Impact Factor