RESUMO
Group A Streptococcus causes a variety of clinical manifestations, including pharyngitis and skin and soft tissue infections as well as more invasive disease. There are also multiple nonsuppurative complications of group A Streptococcus infection, including acute rheumatic fever and poststreptococcal glomerulonephritis. Pediatricians should be able to diagnose and treat the various presentations of the infection.
Assuntos
Glomerulonefrite , Faringite , Febre Reumática , Infecções Estreptocócicas , Humanos , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Febre Reumática/complicações , Febre Reumática/diagnóstico , Febre Reumática/terapia , Streptococcus pyogenes , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Faringite/diagnóstico , Faringite/etiologiaRESUMO
The COVID-19 vaccine is now approved for individuals greater than 5 years of age, but vaccination rates remain lower than expected in the pediatric age group. Misinformation and widespread reporting of vaccine-related myocarditis are contributing to vaccine hesitancy. When compared to severe cardiac complications that are associated with COVID-19, vaccine-related myocarditis has a milder presentation, is easily treated, and has a good prognosis. Acute COVID-19 has been associated with higher rates of myocarditis and myocardial injury. Multisystem inflammatory syndrome in children occurs weeks after initial infection with SARS-CoV-2 and can be associated with severe cardiovascular complications and death. Cardiac complications associated with acute COVID-19 and MIS-C are more severe and occur more frequently than myocarditis after mRNA COVID-19 vaccination. Furthermore, some of the academic and social disruptions caused by the pandemic expect to be eased by widespread vaccination. For all these reasons, COVID-19 vaccination is strongly recommended for all eligible age groups.
Assuntos
Vacinas contra COVID-19 , COVID-19 , COVID-19/complicações , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Criança , Humanos , RNA Mensageiro , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Vacinação/efeitos adversosRESUMO
OBJECTIVE: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity. STUDY DESIGN: We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut. RESULTS: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.
Assuntos
COVID-19/epidemiologia , Hospitalização , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Biomarcadores/análise , Proteína C-Reativa/análise , COVID-19/sangue , Criança , Pré-Escolar , Connecticut/epidemiologia , Feminino , Humanos , Hipóxia/epidemiologia , Lactente , Unidades de Terapia Intensiva , Contagem de Linfócitos , Masculino , Análise Multivariada , New Jersey/epidemiologia , New York/epidemiologia , Obesidade Infantil/epidemiologia , Pró-Calcitonina/sangue , Estudos Prospectivos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Troponina/sangue , Adulto JovemAssuntos
Dor no Peito , Fadiga , Masculino , Humanos , Adolescente , Dor no Peito/etiologia , Fadiga/etiologia , Redução de PesoRESUMO
Objective of this article is to describe differences in the demographic and clinical characteristics, severity of illness, and outcomes in pediatric patients with different SARS-CoV-2 variants. We conducted a retrospective study of pediatric patients admitted with COVID-19 during the 3 large waves of infection within a health network in New Jersey. We included demographic characteristics, clinical features, and outcomes and compared the data with respect to the different variants. Of 351 total patients included in this study, 74 were admitted during wave 1, 94 during wave 2, and 181 during wave 3. The median age of patients decreased from wave 1 (11.5 years) to wave 3 (3 years) (P = .0034). 87.7% of the patients were unvaccinated. The overall incidence of admissions due to pneumonia related to COVID-19 decreased in wave 3. COVID-19 bronchiolitis or croup admissions occurred mostly in wave 3. There was no significant difference in the number of patients requiring intensive care in any particular wave. Length of stay decreased across the waves (P < .0001). Treatments required did not vary between the waves except for a decrease in antibiotic use with each subsequent wave (P < .0001). The impact of COVID-19 on the pediatric population differs from the adult population, and the overall number of hospitalized children has mirrored the peak in cases observed during each infection wave. Our study illustrates the changes in clinical presentation and severity observed with the different coronavirus variants.
Assuntos
COVID-19 , Criança Hospitalizada , Adulto , Humanos , Criança , Lactente , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/terapia , Estudos Retrospectivos , Atenção à SaúdeRESUMO
A large proportion of children have been affected by COVID-19; we evaluated the association between comorbidities and hospitalization/ICU (intensive care unit) admission among 4097 children under age 21 years with symptomatic COVID-19 (not just polymerase chain reaction [PCR]-positive or multisystem inflammatory syndrome in children associated with COVID-19 [MIS-C]) from 2 large health systems from March 2020 to September 2021. Significant comorbidities and demographic factors identified by univariable analysis were included in a multivariable logistic regression compared with children ages 6 to 11 without comorbidities. In all, 475 children (11.6%) were hospitalized, of whom 25.5% required ICU admission. Children under 1 year had high hospitalization risk, but low risk of ICU admission. Presence of at least 1 comorbidity was associated with hospitalization and ICU admission (odds ratio [OR] > 4). Asthma, obesity, chronic kidney disease, sickle cell disease, bone marrow transplantation, and neurologic disorders were associated with hospitalization (adjusted odds ratio [AOR] > 2). Malignancy, intellectual disability, and prematurity were associated with ICU admission (AOR > 4). Comorbidities are significantly associated with hospitalization/ICU admission among children with COVID-19.
Assuntos
COVID-19 , Humanos , Criança , Adulto Jovem , Adulto , COVID-19/epidemiologia , SARS-CoV-2 , Fatores de Risco , Hospitalização , Comorbidade , Unidades de Terapia Intensiva , Hospitais , Estudos RetrospectivosRESUMO
An adolescent boy with newly diagnosed T-cell acute lymphoblastic leukaemia developed right eye and facial pain, and a 1 cm × 2 cm area of black eschar over his hard palate. Initial differential diagnosis included rhinocerebral mucormycosis and aspergillosis, and he was started on liposomal amphotericin B. Later, he underwent nine surgical debridements of his sinus cavities, resection of a third of his palate and right orbital exenteration. While histological specimens exhibited features of both Aspergillus and Mucor, a PCR assay detected Penicillium chrysogenum He was successfully treated with amphotericin B and Posaconazole. P. chrysogenum has been reported in a rare case of endocarditis, a case of post-traumatic endophthalmitis, disseminated infection in a child with Henoch-Schonlein syndrome, and one fatal adult case of invasive rhinosinusitis. While infection from Penicillium species is rare, it should be considered as a cause of invasive rhinosinusitis in cases of unclear histopathology.
Assuntos
Leucemia , Mucormicose , Penicillium chrysogenum , Sinusite , Masculino , Adulto , Criança , Humanos , Adolescente , Antifúngicos/uso terapêutico , Mucormicose/complicações , Mucormicose/diagnóstico , Sinusite/complicações , Leucemia/complicaçõesRESUMO
OBJECTIVES: Understanding the risk factors, predictors, and clinical presentation of coronavirus disease 2019 (COVID-19) in pediatric patients with severe disease. METHODS: We conducted a retrospective chart review of pediatric patients admitted between March 1, 2020, and May 31, 2020, to a large health network in New Jersey with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction, rapid testing, or serum immunoglobulin G testing; we included demographic characteristics, clinical features, and outcomes. RESULTS: A total of 81 patients ≤21 years old were admitted with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction and/or serum immunoglobulin testing. Sixty-seven patients (82.7%) were admitted for management of acute COVID-19 infection, whereas 14 (17.3%) were admitted for management of multisystem inflammatory syndrome in children (MIS-C). Of the 81 hospitalized patients, 28 (34.6%) required intensive care. A majority of patients (42 [51.9%]) admitted for both acute COVID-19 infection and MIS-C were Hispanic. Underlying chronic health conditions were not present in most patients. Obesity (mean BMI of 41.1) was noted in the patients with MIS-C requiring ICU care, although not statistically significant. Absolute lymphopenia and elevated levels of inflammatory markers were statistically significant in the patients with MIS-C treated in the ICU. CONCLUSIONS: This study adds to the growing literature of potential risk factors for severe disease in pediatric patients due to COVID-19 infection and MIS-C. Patients of Hispanic ethnicity represented the majority of patients with both acute COVID-19 infection and MIS-C, despite only representing 10% to 20% of the population our hospitals serve. Infants and patients with chronic health conditions were not at increased risk for severe disease. Absolute lymphopenia and elevated levels of inflammatory markers were associated with more severe disease.
Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Masculino , New Jersey , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
This is a retrospective chart review of 20 patients treated with a consensus-driven treatment algorithm in multisystem inflammatory syndrome in children patients across a wide clinical spectrum. Their treatments and clinical status are described as well as their favorable return to functional baseline by 30 days post presentation.
Assuntos
COVID-19/terapia , Protocolos Clínicos , Síndrome de Resposta Inflamatória Sistêmica/terapia , Adolescente , Corticosteroides/uso terapêutico , Algoritmos , COVID-19/diagnóstico por imagem , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Resultado do Tratamento , Tratamento Farmacológico da COVID-19RESUMO
This is a case of an 11-year-old female who was admitted with respiratory failure, requiring intubation while testing positive for SARS-CoV-2. During her recovery, she had new onset fevers and uptrending inflammatory markers. After an evaluation of infectious causes, the diagnosis of MIS-C was made approximately 1 month after her initial symptoms.
Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Síndrome do Desconforto Respiratório/virologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Betacoronavirus/isolamento & purificação , COVID-19 , Criança , Infecções por Coronavirus/terapia , Feminino , Febre/virologia , Humanos , Pandemias , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/virologia , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapiaRESUMO
Aerococcus urinae has been found to cause urinary tract infection in elderly patients and has been reported as a rare cause of infective endocarditis associated with significant morbidity and death in adults. However, information regarding its occurrence in children is lacking. We report here the case of a pediatric patient with subacute A urinae infective endocarditis with mycotic aneurysms.
Assuntos
Aerococcus/isolamento & purificação , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Endocardite Bacteriana Subaguda/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Criança , Angiografia por Tomografia Computadorizada , Endocardite Bacteriana Subaguda/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Penicilina G/uso terapêutico , Artéria Pulmonar/microbiologia , Artéria Pulmonar/cirurgia , Toracotomia , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the impact of MALDI-TOF MS coupled with antimicrobial stewardship on clinical outcomes for pediatric inpatients with bloodstream infections. METHODS: Outcomes of pediatric inpatients were compared before and after MALDI-TOF MS implementation. Outcomes measured included time until organism identification and susceptibility, duration of antibiotics, patient length of stay (LOS), mortality and hospital costs. RESULTS: 210 and 135 patient events were compared pre- and post-intervention. Average time to organism identification decreased from 41 to 11â¯hours (Pâ¯=â¯<0.0001). Time to i) susceptibilities decreased from 50.8 to 37.7â¯hours (Pâ¯=â¯<0.0001), ii) de-escalation of antibiotics decreased from 58 to 23â¯hours (Pâ¯=â¯<0.0001), iii) discontinuation of unnecessary antibiotics decreased from 49 to 20â¯hours (Pâ¯=â¯<0.0001). Infection-related LOS decreased from 10.5 to 8.37â¯days (Pâ¯=â¯0.006). No significant differences were seen for other outcomes. CONCLUSIONS: MALDI-TOF MS identification of bacteria from blood culture broth improves time to appropriate antibiotic treatment for pediatric inpatients.
Assuntos
Hemocultura , Infecções/epidemiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Adolescente , Fatores Etários , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , Hemocultura/métodos , Criança , Pré-Escolar , Comorbidade , Gerenciamento Clínico , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Recém-Nascido , Infecções/diagnóstico , Infecções/tratamento farmacológico , Infecções/microbiologia , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Avaliação de Resultados em Cuidados de Saúde , Encaminhamento e Consulta , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/microbiologiaRESUMO
We present a paediatric case of group G streptococcal bacteraemia and vertebral osteomyelitis. The patient is a 14-year-old girl with Gaucher disease type 1 who presented with severe thoracolumbar pain. She was treated with a 4-week course of antibiotics for presumed osteomyelitis with clinical improvement.
Assuntos
Antibacterianos/uso terapêutico , Osteomielite/microbiologia , Doenças da Coluna Vertebral/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Adolescente , Feminino , Humanos , Vértebras Lombares , Imageamento por Ressonância Magnética , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/tratamento farmacológico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Vértebras TorácicasRESUMO
INTRODUCTION: Species of the genus Kocuria are Gram-positive cocci of the family Micrococcacceae that are ubiquitous in the environment and part of the normal skin and oral flora in humans. A paucity of cases have been reported of Kocuria as human pathogens and there are currently no evidence-based guidelines for managing these uncommon infections. CASE PRESENTATION: We present two paediatric cases of central line infections with species of the genus Kocuria that required line removal despite antimicrobial therapy. CONCLUSION: Species of the genus Kocuria are uncommon human pathogens that have rarely been reported to cause opportunistic infections in both adult and paediatric populations. The cases presented here add to the growing body of literature documenting the pathogenicity of these organisms and the possible need for line removal to achieve clinical cure in central line-associated bacteraemia caused by species of the genus Kocuria.