Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City.

Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18 years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.

Staphylococcus schleiferi: An Uncommon Pathogen in an Immunocompetent Adolescent with Chronic Osteomyelitis.

Staphylococcus schleiferi represents an uncommon pathogen in human infections. As a veterinary pathogen, S. schleiferi causes canine ear and skin infections. Chronic osteomyelitis is a progressive process characterized by bone destruction and the formation of sequestrum. It may be a sequela of untreated or undertreated acute osteomyelitis or septic arthritis. Descriptions detailing the pathogenicity and virulence of S. schleiferi osteomyelitis were limited to a few case reports. Among the three reported cases of S. schleiferi osteomyelitis, immunosuppression, malignancy, and recent surgical procedures were comorbidities. Compared to those who are immunosuppressed, immunocompetent individuals are generally not susceptible to uncommon microorganisms. Early detection of osteomyelitis, aggressive appropriate prolonged antimicrobial treatment and a multidisciplinary approach contribute to optimal recovery. We report the first case of S. schleiferi chronic osteomyelitis in an immunocompetent adolescent.