Syphilis in pregnancy and infant outcomes in Manitoba.

Background: Infectious syphilis has been increasing in incidence in Manitoba since 2012, especially in heterosexual women of childbearing age resulting in an increasing number of infants with in utero exposure and who are at risk for congenital syphilis (CS). We aimed to evaluate the impact of syphilis in pregnancy on infants and to describe our experience with CS. Methodology: This retrospective 2012 to 2018 cohort study reviewed women with syphilis in pregnancy and short-term infant outcomes. We grouped mother-infant pairs into high risk and low risk for CS and compared their management and outcomes. We also describe our cases of confirmed and possible CS. Results: Seventy-nine mothers and 80 infants met inclusion criteria. Thirty mother-infant pairs were classified as high risk for CS. Nine of their infants were diagnosed with confirmed CS and four with possible CS. All confirmed CS cases were asymptomatic at birth but two were not recognized to have CS until they later presented with symptoms. One of these infants had negative serologies (treponemal and non-treponemal) at birth, but at 3 months old had reactive serologies. Two months of age was the earliest clearance of maternal treponemal antibodies amongst low-risk infants compared to 6 months in high-risk infants. Most infants who did not have confirmed CS had non-reactive non-treponemal tests by 6 months old. Interpretation: Our study shows that symptoms and paired maternal-infant non-treponemal titres at birth are not sensitive for diagnosing CS. Serologies can be falsely negative with recent infection. Regardless of investigations or clinical findings, 10 days of intravenous penicillin G should be considered for all high-risk infants.

Comparaison de l'infectivité du coronavirus du syndrome respiratoire aigu sévère 2 chez les enfants et les adultes.

CONTEXTE: Le rôle des enfants dans la propagation et la transmission communautaire du coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) est encore mal compris. Nous visons à quantifier l'infectivité du SRAS-CoV-2 d'échantillons nasopharyngés provenant d'enfants comparativement à ceux provenant d'adultes. MÉTHODES: Nous avons obtenu des écouvillons nasopharyngés de cas adultes et pédiatriques de la maladie à coronavirus 2019 (COVID-19) ainsi que de leurs contacts qui ont obtenu un résultat positif à la présence du SRAS-CoV-2 lors d'un test de dépistage au Manitoba entre les mois de mars et décembre 2020. Nous avons comparé la croissance virale en culture cellulaire, les valeurs de cycle seuil de test d'amplification en chaîne par polymérase couplé à une transcription inverse (RT-PCR) de l'enveloppe (E) du gène du SRAS-CoV-2 et de la dose infectieuse pour 50 % de la culture tissulaire (DICT50/mL) entre les adultes et les enfants. RÉSULTATS: Parmi les 305 échantillons positifs à la présence du SRAS-CoV-2 validés par RT-PCR, 97 échantillons provenaient d'enfants de 10 ans et moins, 78 échantillons d'enfants de 11­17 ans et 130 échantillons d'adultes (≥ 18 ans). On a observé une croissance virale en culture dans 31 % des échantillons, dont 18 (19 %) échantillons d'enfants de 10 ans et moins, 18 (23 %) d'enfants de 11­17 ans et 57 (44 %) d'adultes (enfants c. adultes, rapport de cotes 0,45; intervalle de confiance [IC] à 95 % 0,28­0,72). Le cycle seuil était de 25,1 (IC à 95 % 17,7­31,3) chez les enfants de 10 ans et moins, 22,2 (IC à 95 % 18,3­29,0) chez les enfants de 11­17 ans et 18,7 (IC à 95 % 17,9­30,4) chez les adultes (p < 0,001). La DICT50/mL médiane était considérablement plus faible chez les enfants de 11­17 ans (316, écart interquartile [EI] 178­2125) que chez les adultes (5620, EI 1171­17 800, p < 0,001). Le cycle seuil était un indicateur exact d'une culture positive chez les enfants et les adultes (aire sous la courbe de la fonction d'efficacité du récepteur, 0,87, IC à 95 % 0,81­0,93 c. 0,89, IC à 95 % 0,83­0,96, p = 0,6). INTERPRÉTATION: Comparés aux adultes, les enfants qui ont obtenu un résultat positif à un test de dépistage du SRAS-CoV-2 à l'aide d'un écouvillon nasopharyngé étaient moins susceptibles de présenter une croissance du virus en culture et obtenaient un cycle seuil plus élevé et une concentration virale moins élevée, indiquant que les enfants ne sont pas les principaux vecteurs de la transmission du SRAS-CoV-2.

Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults.

BACKGROUND: The role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. We aimed to quantify the infectivity of SARS-CoV-2 in nasopharyngeal samples from children compared with adults. METHODS: We obtained nasopharyngeal swabs from adult and pediatric cases of coronavirus disease 2019 (COVID-19) and from their contacts who tested positive for SARS-CoV-2 in Manitoba between March and December 2020. We compared viral growth in cell culture, cycle threshold values from the reverse transcription polymerase chain reaction (RT-PCR) of the SARS-CoV-2 envelope (E) gene and the 50% tissue culture infective dose (TCID50/mL) between adults and children. RESULTS: Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged 10 years or younger, 78 were from children aged 11-17 years and 130 were from adults (≥ 18 yr). Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children 10 years or younger, 18 (23%) from children aged 11-17 years and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28-0.72). The cycle threshold was 25.1 (95% CI 17.7-31.3) in children 10 years or younger, 22.2 (95% CI 18.3-29.0) in children aged 11-17 years and 18.7 (95% CI 17.9-30.4) in adults (p < 0.001). The median TCID50/mL was significantly lower in children aged 11-17 years (316, interquartile range [IQR] 178-2125) than adults (5620, IQR 1171 to 17 800, p < 0.001). Cycle threshold was an accurate predictor of positive culture in both children and adults (area under the receiver-operator curve, 0.87, 95% CI 0.81-0.93 v. 0.89, 95% CI 0.83-0.96, p = 0.6). INTERPRETATION: Compared with adults, children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow virus in culture, and had higher cycle thresholds and lower viral concentrations, suggesting that children are not the main drivers of SARS-CoV-2 transmission.

Successful Treatment of High-Level Aminoglycoside-Resistant Enterococcus faecalis Bacteremia in a Preterm Infant with Ampicillin and Cefotaxime.

Enterococcal bloodstream infections are usually treated with single-agent antibiotics. In persistent infections, synergistic combination therapy is often required with a beta-lactam and an aminoglycoside antibiotic. High-level aminoglycoside-resistant (HLAR) enterococci are increasingly prevalent and preclude the use of this combination. The use of ampicillin with a third-generation cephalosporin to treat endovascular HLAR Enterococcus infections is becoming more established in the adult population; however, the literature on treatment of such infections in children remains scarce. We report a preterm neonate with persistent HLAR Enterococcus faecalis bacteremia from day of life 9 to 17 despite treatment with ampicillin and vancomycin. On day of life 17, antibiotic treatment was switched to ampicillin and cefotaxime, with subsequent clearance of blood cultures on day of life 20. To our knowledge, this is the first report illustrating the use of ampicillin and cefotaxime for an HLAR E. faecalis infection in a neonate.