Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain.

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).  Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.

Household Severe Acute Respiratory Syndrome Coronavirus 2 Transmission and Children: A Network Prospective Study.

BACKGROUND: The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics. METHODS: A prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection. RESULTS: The study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR. CONCLUSIONS: Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.

Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old.

Fever without source (FWS) in infants is a frequent cause of consultation at the emergency department, and the emergence of SARS-CoV-2 could affect the approach to those infants. The aim of this study is to define the clinical characteristics and rates of bacterial coinfections of infants < 90 days with FWS as the first manifestation of SARS-CoV-2 infection. This is a cross-sectional study of infants under 90 days of age with FWS and positive SARS-CoV2 PCR in nasopharyngeal swab/aspirate, attended at the emergency departments of 49 Spanish hospitals (EPICO-AEP cohort) from March 1 to June 26, 2020. Three hundred and thirty-three children with COVID-19 were included in EPICO-AEP. A total of 67/336 (20%) were infants less than 90 days old, and 27/67(40%) presented with FWS. Blood cultures were performed in 24/27(89%) and were negative in all but one (4%) who presented a Streptococcus mitis bacteremia. Urine culture was performed in 26/27(97%) children and was negative in all, except in two (7%) patients. Lumbar puncture was performed in 6/27(22%) cases, with no growth of bacteria. Two children had bacterial coinfections: 1 had UTI and bacteremia, and 1 had UTI. C-reactive was protein over 20 mg/L in two children (one with bacterial coinfection), and procalcitonin was normal in all. One child was admitted to the pediatric intensive care unit because of apnea episodes. No patients died.Conclusion: FWS was frequent in infants under 90 days of age with SARS-CoV-2 infection. Standardized markers to rule out bacterial infections remain useful in this population, and the outcome is generally good. What is Known: • Fever without source (FWS) in infants is a common cause of consultation at the emergency department, and young infants have a higher risk of serious bacterial infections (SBI). • The emergence of the new coronavirus SARS-CoV-2 could affect the approach to young infants with FWS in the emergency department. management of those children is a challenge because information about bacterial coinfection and prognosis is scarce. What is New: • SARS-CoV-2 infection should be ruled out in young infants (< 90 days of age) with FWS in areas with community transmission. • Bacterial coinfection rarely coexists in those infants. • Inflammatory markers were not increased in children without bacterial coinfection. • Outcome is good in most patients.

Diagnostic Accuracy of QuantiFERON-TB Gold Plus Assays in Children and Adolescents with Tuberculosis Disease.

In 2016, a new interferon-gamma release assay, QuantiFERON-TB Gold Plus, was introduced. We conducted a cross-sectional multicenter study, involving 158 children and adolescents with tuberculosis disease. The overall sensitivity of the assay was 82.9% (IQR 77.0%-88.8%), indicating that in children this test does not have higher sensitivity than previous generation interferon-gamma release assays.

Prevalence, Clinical Characteristics and Risk Factors of Post-COVID-19 Condition in a Multicenter Pediatric Primary and Hospital Care Cohort.

The prevalence of post-COVID-19 condition is not well defined. We describe a cohort of 244 children diagnosed with COVID-19 and followed up for 6 months, in which 4.9% of patients had persistent symptoms at 12 weeks. Anosmia was the most frequent symptom. Being female and having more than 3 symptoms in acute infection were associated with an increased risk of post-COVID.

QuantiFERON-TB Gold Plus Assay Specificity in Children and Adolescents With Suspected Tuberculosis-A Multicenter Cross-sectional Study in Spain.

In this cross-sectional study of 284 children and adolescents with clinically or radiologically suspected tuberculosis in a low-endemic country, the QuantiFERON-TB Gold Plus assay specificity, sensitivity, positive predictive value and negative predictive value were 91.5%, 87.3%, 86.4%, and 91.2%, respectively. The specificity was higher than that observed in tuberculin skin tests performed simultaneously, but similar to previous-generation interferon-gamma release assays.

Pneumopatía raquítica: el retorno de una entidad clínica del pasado / Rickets pneumopathy: the return of a clinical entity of the past

Introducción. El raquitismo era una enfermedad poco frecuente en los países desarrollados; no obstante, debido a los cambios culturales y los episodios migratorios, vuelve a ser una patología emergente. La neumopatía raquítica se basa en el compromiso de la función respiratoria por una parrilla costal flexible y débil secundaria a una mineralización deficiente de los huesos en crecimiento. Se añade una mayor susceptibilidad a las infecciones y cambios del parénquima pulmonar. Caso clínico. Se presenta el caso de una lactante de 7 meses de padres subsaharianos que consulta por fiebre y dificultad respiratoria. En la inspección destaca un tórax delgado y acampanado, con una depresión transversal en la unión tóraco-abdominal (surco de Harrison), y se palpa craneotabes, por lo que se realiza un estudio que muestra: parathormona y fosfatasa alcalina elevadas, vitamina 25-(OH)-D3 baja, calcio, fósforo y función renal normales. La radiografía de muñeca izquierda muestra ensanchamiento de metáfisis y edad ósea retrasada. Comentarios. Hay descritos casos con presentaciones atípicas, como convulsiones hipocalcémicas, tetania o fractura patológicas, pero hay que remontarse a publicaciones de hace cuatro décadas para encontrar en la literatura artículos sobre patología respiratoria asociada a raquitismo. Cabe resaltar la importancia de la detección precoz de los síntomas y signos en la población de riesgo para disminuir la incidencia de raquitismo mediante una profilaxis adecuada (AU)

Introduction. Rickets is an extremely rare disease in high-income countries; however, cultural changes and migratory phenomena have led to a resurgence of this condition. Patients with rickets pneumopathy have impaired respiratory function resulting from dysfunctional rib cage due to insufficient bone mineralization during growth. In addition, patients have an increased susceptibility to infections and alterations in the lung parenchyma. Case Report. A 7-month-old infant born to Sub-Saharan parents presented with fever and respiratory distress. Physical examination revealed a bell-shaped, narrow thorax, with a horizontal groove along the lower border of the chest (Harrison groove) and palpable craniotabes. Additional evaluation showed elevated levels of parathyroid hormone and alkaline phosphatase, vitamin 25-(OH)-D3 deficiency, and normal calcium, phosphorus, and renal function. Wrist X-ray revealed widening of the metaphysis and delayed bone age. Comments. Several atypical presentations of rickets have been reported, such as hypocalcemic seizures, tetany, or pathological fractures, and yet rickets-associated respiratory diseases have seldom been reported in the last four decades. Early detection of symptoms and signs in populations at risk is paramount to reduce the incidence and severity of rickets and to provide adequate prevention and treatment (AU)

Intoxicació accidental per ferro a l’edat pediàtrica. Revisió d’un cas / No disponible

Introducció. La ingesta accidental de ferro representauna de les primeres causes de mort per intoxicació en infants menors de 6 anys en països com els Estats Units, amb una taxa de mortalitat entre els casos d'intoxicació greu superior al 10%, i una incidència mitjana de 3.000 casos l'any en el període comprès entre 1986 i 1997, any en què la US Food and Drug Administration (FDA) va publicar noves normes d'empaquetament monodosi per a aquests productes. Tot i així, és una intoxicació poc freqüent al nostre medi, cosa que fa important aprofundir en el coneixement d'aquesta intoxicació potencialment letal per assegurar un maneig correcte que permeti reduir-ne la morbimortalitat.Observació clínica. Presentem el cas d'una nena de 21mesos amb sospita d'intoxicació aguda per ferro, desprésd'ingerir 73 comprimits d'una presentació de parafarmàcia(dosi tòxica ingerida de ferro element: 21 mg/kg). Es va fer un rentat gàstric, i la pacient es va mantenir asimptomàtica durant les 12 hores d'observació.Comentaris. Només els valors de siderèmia obtingutsentre les quatre i sis hores postingesta es correlacionenamb el grau de toxicitat. En absència de valors de siderèmia és necessari calcular la dosi tòxica ingerida per kg de pes, per valorar la gravetat de la intoxicació i iniciar mesures destinades a evitar l'absorció del ferro: rentat gàstric, irrigació intestinal i tractament quelant amb deferoxamina. És important evitar l'alta precoç d'aquests pacients, ja que la toxicitat sistèmica no apareix fins les 12-24 hores postingesta

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