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van Kalleveen MW, Plötz FB, de Meij TGJ. Microbiota in Children With Dientamoeba fragilis: A Player to Take Into Account? J Pediatr Gastroenterol Nutr 2022; 74:e40. [PMID: 34338236 DOI: 10.1097/mpg.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Michael W van Kalleveen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden
- Department of Paediatrics, Tergooi Hospital, Blaricum
| | - Frans B Plötz
- Department of Paediatrics, Tergooi Hospital, Blaricum
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Emma's Children's Hospital, Amsterdam
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital Amsterdam UMC, Amsterdam, The Netherlands
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van Kalleveen MW, van Bergen M, Benninga MA, Savelkoul PHM, Plötz FB, de Meij TGJ. Diagnostic and Therapeutic Considerations Towards Dientamoeba fragilis in Children: A Survey Amongst General Practitioners and Pediatricians in the Netherlands. J Pediatr Gastroenterol Nutr 2021; 73:e121-e125. [PMID: 34520404 DOI: 10.1097/mpg.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT This survey was undertaken to obtain insight in the attitude of Dutch physicians towards pathogenicity, diagnostic- and therapeutic approach towards Dientamoeba fragilis in children. Physicians were invited by e-mail for a questionnaire. A total of 211 of 450 physicians (46.9%) completed the questionnaire, including 67 general practitioners (GPs) and 144 pediatricians. Of all respondents, 175 of 211 (82.9%) considered D fragilis a "potential pathogen", when other causes of gastro-intestinal complaints are ruled out. Only 16 of 211 (7.6%) performed diagnostic tests regularly. Diagnostic tests were performed by 162 of 211 (77%) of respondents in children with diarrhea and abdominal pain in consideration of duration of symptoms. Fecal polymerase chain reaction (PCR) was diagnostic modality of preference. Eighty-nine of 142 (62.7%) prescribed metronidazole as antibiotic of first choice. This study shows heterogeneity in clinical practice amongst Dutch physicians regarding diagnostic- and therapeutic approach of D fragilis in children. Different attitude towards pathogenicity and inconsistent guidelines could be causative factors.
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Affiliation(s)
- Michael W van Kalleveen
- Department of Pediatrics, Tergooi Hospital, Blaricum
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden
| | - Merel van Bergen
- Department of Pediatric Gastroenterology, Emma Children's Hospital Amsterdam UMC, Amsterdam
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital Amsterdam UMC, Amsterdam
| | - Paul H M Savelkoul
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location VUmc, Amsterdam
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital Amsterdam UMC, Amsterdam
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van Kalleveen MW, Dykstra TC, de Meij TGJ, Plötz FB. Guideline adherence and clinical relevance of laboratory investigations during follow-up in paediatric coeliac disease: A Dutch single-centre cohort study. Acta Paediatr 2021; 110:2641-2647. [PMID: 34081815 DOI: 10.1111/apa.15967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 01/21/2023]
Abstract
AIM Dutch national guidelines on follow-up of paediatric celiac disease (CD) are available. The primary aim was to evaluate guideline adherence by paediatricians during follow-up. The secondary aim was to determine the clinical relevance and diagnostic yield of routine laboratory tests suggested by these guidelines. METHODS A retrospective, single-centre, cohort study was performed in paediatric CD patients who visited Tergooi Hospital, the Netherlands, between January 2017 and December 2019, with follow-up of at least twelve months after diagnosis. We analysed guideline adherence, number of outpatient visits and all laboratory data. RESULTS We included 91 CD children with a median follow-up of 4.0 years (range 1-16 years) and 162 follow-up visits. Strict adherence amongst paediatricians during follow-up was 8.0% (13/162 cases). A total of 1570 laboratory tests were performed of which 45.4% (713/1570) was in strict compliance with the Dutch national guidelines. Clinically relevant deviations were observed in 5.3% of requested laboratory tests. CONCLUSION Strict guideless adherence amongst paediatricians in follow-up of paediatric CD was low and the clinical relevance of the suggested routine laboratory tests is limited. This underlines the increasing notion that evidence-based guidelines on follow-up of CD are warranted.
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Affiliation(s)
- Michael W. van Kalleveen
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Gastroenterology and Hepatology Leiden University Medical Centre Leiden The Netherlands
| | - Tim C. Dykstra
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
| | - Tim G. J. de Meij
- Department of Paediatric Gastroenterology Amsterdam UMC Amsterdam The Netherlands
| | - Frans B. Plötz
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Paediatrics Amsterdam UMC Emma Children’s Hospital University of Amsterdam Amsterdam The Netherlands
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van Kalleveen MW, Budding AE, Benninga MA, Savelkoul PHM, van Gool T, van Maldeghem I, Dorigo-Zetsma JW, Bart A, Plötz FB, de Meij TGJ. Intestinal Microbiota in Children With Symptomatic Dientamoeba fragilis Infection: A Case-control Study. Pediatr Infect Dis J 2021; 40:279-283. [PMID: 33181781 DOI: 10.1097/inf.0000000000002975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dientamoeba fragilis in children has been associated with gastrointestinal symptoms, like abdominal pain and diarrhea. The mechanism underlying these symptoms in children with D. fragilis remains unclear. We hypothesized that concomitant microbial alterations, which have been described in other parasitic infections, may be associated with gastrointestinal symptoms in D. fragilis. METHODS In this case-control study performed in 2 centers, 19 children referred to a pediatrician because of gastrointestinal symptoms and with a positive fecal PCR for D. fragilis were included as cases. We included 19 healthy children as controls and matched for age and gender, selected from an existing cohort of 63 children. A PCR for D. fragilis was performed on fecal samples of the 19 controls to assess D. fragilis carriership in this asymptomatic group. Microbiota was analyzed with the IS-pro technique, and the intestinal microbiota composition and diversity were compared between the 2 groups. RESULTS Microbiota of children with D. fragilis and gastrointestinal symptoms did not significantly differ in terms of composition and diversity compared with controls, both on phylum and species level. In the asymptomatic controls, a positive fecal PCR for D. fragilis was found in 16 of 19 (84.2%). CONCLUSION Intestinal microbiota does not seem to play a key role in the presence of clinical symptoms in children with D. fragilis. The pathogenicity of D. fragilis and pathophysiologic pathways underlying the development of gastrointestinal symptoms remains yet to be clarified.
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Affiliation(s)
- Michael W van Kalleveen
- From the Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
- Department of Gastroenterology, Noordwest Hospital, Alkmaar, The Netherlands
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology & Infection Control
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Iris van Maldeghem
- From the Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - J W Dorigo-Zetsma
- Department of Medical Microbiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Aldert Bart
- Department of Medical Microbiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
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van Kalleveen MW, van Gool T, Klarenbeek N, Benninga MA, Savelkoul PHM, de Meij T, Plötz FB. Dientamoeba fragilis in children: a systematic review on diagnostic considerations and efficacy of treatment. Expert Rev Gastroenterol Hepatol 2020; 14:231-242. [PMID: 32155096 DOI: 10.1080/17474124.2020.1739520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The presence of D. fragilis in feces is characterized by an asymptomatic carrier ship to a spectrum of gastrointestinal symptoms. However, a causal relationship remains to be elucidated. In this systematic review, we aimed to evaluate the relationship between the eradication of D. fragilis and symptoms to establish the strength of evidence that D. fragilis in symptomatic children warrants antibiotic treatment.Areas covered: This systematic review covers a challenge in daily clinical practice. Is it necessary to test for D. fragilis in children with gastrointestinal symptoms and does a positive fecal PCR test warrant treatment?Expert opinion: Testing for D. fragilis seems justified in a selection of children with persistent unexplained chronic abdominal pain and diarrhea. Treatment of D. fragilis should be withhold until other causes like celiac disease have been excluded. Both microscopic and Real Time-PCR methods (or a combination of the two) can be used for diagnosis. Paromomycin or clioquinol are antibiotics of choice based on their small spectrum of activity, fewer side effects, and better eradication rates than metronidazole. Future randomized studies, with strict inclusion criteria, appropriate diagnostic testing, and doses of antibiotics based on bodyweight are warranted.
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Affiliation(s)
- Michael W van Kalleveen
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Gastroenterology, Noordwest Hospital, Alkmaar, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nikki Klarenbeek
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Section Clinical Parasitology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tim de Meij
- Department of Pediatric Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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van Kalleveen MW, Noordhuis EJ, Lasham C, Plötz FB. Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain. Pediatr Gastroenterol Hepatol Nutr 2019; 22:225-232. [PMID: 31110955 PMCID: PMC6506428 DOI: 10.5223/pghn.2019.22.3.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. METHODS The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. RESULTS A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35-0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. CONCLUSION We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
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Affiliation(s)
| | | | - Carole Lasham
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
| | - Frans B. Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
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van Kalleveen MW, de Meij T, Plötz FB. [Coeliac disease in children: a changing clinical spectrum]. Ned Tijdschr Geneeskd 2019; 163:D3059. [PMID: 30945827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over the past decades the clinical spectrum of paediatric coeliac disease has profoundly changed, from a classical presentation with distended abdomen, diarrhoea and failure to thrive to more atypical symptoms. These days, children commonly present with symptoms such as recurrent abdominal pain, fatigue, iron deficiency anaemia and constipation. Age at diagnosis has also increased over the past few years. In the past 20 years the incidence of the disease in the Netherlands has increased from 12.3 to 21.1 per 100,000 inhabitants, reaching a stable level in the past 5 years. In approximately 10% of children, serological test results are negative on first examination but become positive after repeated testing in the years that follow, emphasising the need for alertness when first tests are negative and symptoms persist. We underscore the guidelines' advice to apply a low threshold in testing for coeliac disease in children with atypical symptoms.
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Affiliation(s)
| | - Tim de Meij
- Amsterdam UMC, locatie VUmc, afd. Kinder-maag-darm-leverziekten
| | - Frans B Plötz
- Tergooi ziekenhuis, afd. Kindergeneeskunde, Blaricum
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van Kalleveen MW, Walraven M, Hendriks MP. Pazopanib-related tumor lysis syndrome in metastatic clear cell renal cell carcinoma: a case report. Invest New Drugs 2018; 36:513-516. [PMID: 29464464 DOI: 10.1007/s10637-018-0576-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/14/2018] [Indexed: 01/22/2023]
Abstract
Introduction Tumor lysis syndrome (TLS) is a life-threatening emergency caused by rapid cell death as a result of anti-tumor therapy. In the era of targeted therapy it has increasingly been observed in solid malignancies such as hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC). Case We describe the case of a 58-year old man with the medical history of a memorial sloan kettering cancer centre (MSKCC) poor prognosis metastasized clear cell renal cell carcinoma (mRCC) who developed TLS within six days after initiating therapy with the tyrosine kinase inhibitor (TKI) pazopanib. Discussion The pharmacokinetics and pharmacodynamics of pazopanib are complex and characterized by a non-linear and time-dependent bioavailability. Pazopanib is almost completely bound to serum albumin (>99.9%). In this presented case, a low serum albumin (26 g/L) might have led to a higher free fraction of pazopanib, which could have resulted in more toxicity. Also, pazopanib is metabolised by the CYP3A4 isoform of the cytochrome P450 group. Low quantities of this enzyme may lead to an impaired and prolonged breakdown of the drug. Conclusion As far as we know this is the first report on pazopanib induced TLS. We advise further research in order to identify the exact mechanism behind TKI-induced TLS and the patients at risk of developing TLS.
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Affiliation(s)
- Michael W van Kalleveen
- Department of Internal Medicine, Medical Oncology, Northwest Clinics Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands.
| | - Maudy Walraven
- Department of Internal Medicine, Medical Oncology, Northwest Clinics Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Medical Oncology, Northwest Clinics Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands
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