The Pediatric Infectious Disease Journal

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ISSN / EISSN : 0891-3668 / 1532-0987
Total articles ≅ 16,391
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Melanie M. Dubois, Meredith B. Brooks, Amyn A. Malik, Sara Siddiqui, Junaid F. Ahmed, Maria Jaswal, Farhana Amanullah, , Hamidah Hussain
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003584

Abstract:
Background: Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan. Methods: In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years. Results: A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB. Conclusions: This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.
, Irmeli Roine, Luis Bernardino, Kirsi Jahnukainen, Heikki Peltola
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003581

Abstract:
Sickle-cell disease (SCD) was found in 10% of children with bacterial meningitis (BM) in Luanda, 5-fold more than in the general population. BM children with SCD versus BM children without SCD had higher inflammatory markers, more often had pneumococcal meningitis (71% vs. 39%), and either died (39% vs. 22%) or had a longer hospital stay (15 vs. 11 days).
Miki Goldenfeld, Carmit Cohen, Mayan Gilboa, Itai M. Pessach, Bella Mehnick, Ilana Tal, Lilac Meltzer, Sharon Amit, Tal Gonen, Arnon Afek, et al.
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003569

Abstract:
Background: Since the beginning of the Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, school closure as a mitigating measure was at the center of a public and professional debate. While the negative effects of school closure cannot be ignored, accumulating data suggested that it is necessary for reducing community transmission. Our study presents an optional strategy for safe school opening during a pandemic, implemented in selected Israeli high schools by a special task force constructed by the Sheba Medical Center (SMC). Methods: The study took place between November 2020 and April 2021. Three schools from different areas of Israel were enrolled. The participants were asked to undergo bi-weekly SARS-CoV-2 rapid diagnostic antigen tests (Ag-RDT). Those who tested positive were requested to self-isolate, whereas their school contacts were tested daily by Ag-RDT. Participants with a previously documented SARS-CoV-2 infection or who were found to be SARS-CoV-2 seropositive upon enrollment were exempted from screening. Results: Of a total of 361 participants who enrolled in the study, 12.3% were found to be seropositive. Fourteen SARS-CoV-2 cases were detected (3.5%), 12 of them in one single school located in an endemic area for SARS-CoV-2. The 14 cases resulted in 84 days of COVID-19-related absence from school, comparing with 1775 potential days of COVID-19-related absence under a strategy implementing self-isolation instead of testing. Conclusions: Safe continuation of academic routine during the pandemic is possible when using rapid Ag-RDT as a screening tool, while allowing swab collection by trained students and teachers.
, Jallouli Leila, Gargouri Rania, Chabchoub Imen, Abid Leila, Aloulou Hajer, Kamoun Thouraya
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003577

Abstract:
Guillain-Barré syndrome has been associated with acute severe acute respiratory syndrome coronavirus 2 infection in children. Here, we report a 4-year-old boy who developed Guillain-Barré syndrome in the course of multisystem inflammatory syndrome related to COVID-19.
, María Del Valle Juarez, María Florencia Lucion, María Natalia Pejito, Sofia Alexay, Ana Sofia Orqueda, Lucia Romero Bollon, Alicia Mistchenko
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003564

Abstract:
Background: Initially, the impact of SARS-CoV-2 infection on children was unknown. Standard COVID-19 diagnosis is confirmed using real-time qPCR. Cycle threshold (Ct) values of RT-qPCR are inversely proportional to viral load and the test indirectly quantifies viral RNA copy numbers. The objective of this study was to determine the correlation between epidemiology, clinical characteristics, severity of confirmed COVID-19 cases, and Ct values. Methods: An observational, analytical, cross-sectional study. All children with COVID-19 under 18 years old admitted to the Ricardo Gutiérrez Children’s Hospital between March 1, 2020, and February 28, 2021, were included. SARS-CoV-2 infection was confirmed using RT-qPCR. Results: Median age of patients was 7 years. Ct values were estimated in 419 cases, median Ct value was 23.5 [interquartile range (IQR): 18.9–30.9]. Levels were significantly lower in symptomatic than asymptomatic patients (Ct: 22.1; IQR: 18.4–22.1), in children <2 years of age (Ct: 20.6; IQR: 17.3–27.3) and when sample collection was 2 years, Ct values were significantly lower in symptomatic (Ct: 22.6; IQR: 18.7–29.3) than asymptomatic (Ct: 31.2; IQR: 24.5–33.3) patients. Conclusions: Children younger than 2 years with COVID-19 have lower values of Ct—as a proxy for higher viral load—than older children. Symptomatic children over 2 years of age had lower Ct values compared with asymptomatic children.
, Shalom Ben-Shimol, Amir Sharf, David Greenberg, Noga Givon-Lavi
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003570

Abstract:
Background: The proportion of remote clinic visits was expected to increase among children during the COVID-19 pandemic which might result in antibiotic overuse. Methods: In southern Israel, 2 ethnic groups, Jewish and Bedouin, live side-by-side. Computerized data on visits for children <18 years were examined from clinics with ≥50 insured children, active both pre-COVID-19 and during the COVID-19 pandemic. Visits were divided into in-person and remote. Monthly infectious diagnoses and dispensed antibiotic prescription rates were calculated by age (<5, 5–17 years) and ethnic groups. Mean monthly rates of 2 parallel seasons (pre-COVID-19 and COVID-19 periods) were compared. Results: Overall 2,120,253 outpatient clinic visits were recorded. Remote clinic visit rates (per 1000 children) increased from 97.04 and 33.86 in the pre-COVID-19 to 179.75 and 50.05 in the COVID-19 period in Jewish and Bedouin children, respectively (P < 0.01) along with a reduction of in-person visit rates in both populations. Comparing pre-COVID-19 and COVID-19 periods, the rates of overall infectious diagnoses in remote visits increased. Nevertheless, dispensed antibiotic prescription rates in remote visits (per 1000 visits) remained unchanged (9.84 vs. 8.67, P = 0.70, in the Jewish population and 14.32 vs. 14.17, P = 1.00, in the Bedouin population in the pre-COVID-19 and COVID-19 periods, respectively) with a similar distribution of antibiotic categories. Conclusions: COVID-19 pandemic resulted in an expansion of remote visits of children <18 years with an increase in infectious diagnoses. However, remote dispensed antibiotic prescription rates remained unchanged. These dynamics were more accentuated in Jewish children, characterized by higher socio-economic conditions, compared to Bedouin children.
, Roger L. Zemek, Ken Tang, Richard Malley, Amy C. Plint, Anne Pham-Huy, Jennifer Dawson, Candice McGahern, Martin Pelchat, Corey Arnold, et al.
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003573

Abstract:
This substudy of a prospective case-ascertained household transmission study investigated severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction–positive individuals without antibody development and factors associated with nonseroconversion. Approximately 1 of 8 individuals with coronavirus disease 2019 did not seroconvert. Children, particularly the youngest, were approximately half as likely to seroconvert compared with adults. Apart from the absence of fever/chills, individual symptoms did not strongly predict nonseroconversion.
Shoko Ozeki, Makoto Oshiro, Daichi Fukumi, Tomoya Takeuchi, Sayaka Mii, Yuichi Nishikado
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003568

Abstract:
Background: Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis, and in temperate climates, late fall and winter epidemics of bronchiolitis are usually linked to RSV. In recent years in Japan, the RSV infection epidemic has occurred earlier, even during the hot season. This study aimed to evaluate the seasonal variation of RSV-associated hospitalizations over the past decade and the relationship between season and disease severity. Methods: This was a retrospective single-center study. Hospitalized children were studied between 2011 and 2019. RSV was detected using rapid antigen detection tests. Clinical information was obtained from medical records, and patients were classified by 4 seasons of admission and analyzed for changes over time. Results: Among 3750 children, 945 (25.2%) were RSV-positive. The seasonal proportion of hospitalized children who are RSV-positive showed a peak shift towards summer, with a turning point in 2016. Comparing 2011–2012 and 2018–2019, incidence increased from 6.8% to 46.3% during summer, whereas during fall decreased from 50.0% to 20.7% and decreased from 28.4% to 20.7% during winter (P < 0.05). A similar trend was observed in the number of children requiring oxygenation in the earlier period; however, after the transition, there was no significant difference between seasons. Conclusions: Our findings showed that the RSV epidemic shifted to peak during summer until 2016. There was an association between seasonality and severity, such that many younger children were hospitalized during the autumn and winter and required more oxygen; however, after 2016, this difference was no longer observed.
Fabio Savorgnan, , Alexander Alali, Axel Moreira, Ananth Annapragada, Craig G. Rusin, Saul Flores, Rohit S. Loomba, Alvaro Moreira
Pediatric Infectious Disease Journal, Volume 41; https://doi.org/10.1097/inf.0000000000003511

Abstract:
Social constructs are known risk factors for multisystem inflammatory syndrome in children. A review of 206 patients demonstrated that children who were non-Hispanic Black, over the age of 12 years or living in a disadvantaged neighborhood associated with severe multisystem inflammatory syndrome in children (intensive care unit admission, intubation and/or vasopressor use).
Nobuaki Michihata, , Akira Honda, Itsuhiro Oka, Tetsushi Yoshikawa, Kazuyoshi Saito, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
Pediatric Infectious Disease Journal; https://doi.org/10.1097/inf.0000000000003571

Abstract:
Purpose: Atlantoaxial rotatory fixation (AARF) is a rare complication of acute Kawasaki disease (KD). Early diagnosis and intervention are important for AARF because delayed diagnoses may incur neurological sequelae. However, previous studies on AARF associated with KD are limited, and its clinical characteristics and course are unknown. This study aimed to examine the clinical features and treatment course of KD with AARF using a Japanese national inpatient database. Methods: Using the Diagnosis Procedure Combination database, we identified KD patients who received intravenous immunoglobulin (IVIG) treatment between July 2010 and March 2020. The clinical characteristics of KD patients with AARF and their risk factors were evaluated using multivariable logistic regression analysis. We also examined the relationship between AARF, the proportion of coronary artery abnormalities (CAAs), IVIG resistance, length of stay and medical costs. Results: We identified 71,913 patients with KD, 166 of whom had AARF. The AARF group had older age, heavier bodyweight and atypical KD. In multivariable analysis, AARF was associated with older age [odds ratio (OR): 1.24; 95% confidence interval (CI): 1.19–1.29], lower body mass index (OR: 0.89; 95% CI: 0.82–0.96) and atypical KD (OR: 1.95; 95% CI: 1.12–3.40). AARF was not associated with CAAs (OR: 0.73; 95% CI, 0.23–2.32) and IVIG resistance (OR: 1.05; 95% CI, 0.74–1.49). However, AARF was associated with higher medical costs (difference, US$1064; 95% CI: 346–1781) and longer hospital stay (difference, 3.1 days; 95% CI: 1.7–4.4). Conclusion: AARF in patients with acute KD should be considered if cervical symptoms present in older patients with atypical KD.
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