Paediatric enteric fever in Brussels: a case series over 16 years.

Enteric fever (EF) is a major public health problem and a witness of the global health disparities. It is caused by Salmonella enterica serovar Typhi (Salmonella ser. Typhi) and Salmonella enterica serovar Paratyphi A, B, C (Salmonella ser. Paratyphi) and is estimated to infect 12-26 million persons yearly. Paediatric data on enteric fever in Europe are scarce. A case series of EF was analysed to describe the clinical presentation, laboratory characteristics and diagnostic challenges identified in a paediatric population in Brussels. We performed a retrospective study of all lab-confirmed cases of enteric fever in children aged 0-15 years at two Brussels teaching hospitals, between January 2005 and December 2020. We reviewed age, gender, travel history, consultations before diagnosis, hospitalisation duration, clinical symptoms and laboratory findings. There were 34 positive isolates of S. typhi and S. paratyphi: 31 patients had positive blood culture, 1 patient had positive bone aspirate and 2 patients had positive stool culture (one was excluded for missing data). There were 20 girls (60%). Median age was 3.5 years (range 5 months to 14 years). Travel to EF endemic areas was present in 55% of patients. Diagnosis was delayed in 80% of children. Eosinopenia was present in 93% of the cohort. The patients had not received any preventive travel education or vaccination.  Conlusion: Enteric fever poses diagnostic challenges to clinicians. Eosinopenia in a febrile patient coming from the tropics should raise suspicion of EF. Travellers to endemic areas should be better educated about EF risks, and typhoid fever vaccination must be promoted. What is Known: • Enteric fever is a global public health problem and includes typhoid and paratyphoid fever. • Typhoid fever is vaccine preventable disease. Paratyphoid fever is not vaccine preventable. What is New: • Enteric fever diagnosis is very challenging in non-endemic settings, and a large proportion of patients may develop serious complications if they receive delayed management. Occurrence of small family clusters is possible and mandates education and monitoring of the families of enteric fever affected children. • We report that the widest majority of our enteric fever affected patients (69%) had aneosinophilia (zero eosinophil count), and almost all patients (93%) had eosinopaenia (less than 50 eosinophil count) during their bacteriaemic phase.

Imported Malaria in Children: A Study Over an 11-Year Period in Brussels.

BACKGROUND: Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. METHODS: This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. RESULTS: A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. CONCLUSIONS: Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.