Serum IgG Profiling of Toddlers Reveals a Subgroup with Elevated Seropositive Antibodies to Viruses Correlating with Increased Vaccine and Autoantigen Responses.

PURPOSE: The human antibody repertoire forms in response to infections, the microbiome, vaccinations, and environmental exposures. The specificity of such antibody responses was compared among a cohort of toddlers to identify differences between seropositive versus seronegative responses. METHODS: An assessment of the serum IgM and IgG antibody reactivities in 197 toddlers of 1- and 2-years of age was performed with a microfluidic array containing 110 distinct antigens. Longitudinal profiling was done from years 1 to 2. Seropositivity to RNA and DNA viruses; bacteria; live attenuated, inactive, and subunit vaccines; and autoantigens was compared. A stratification was developed based on quantitative variations in the IgG responses. Clinical presentations and previously known genetic risk alleles for various immune system conditions were investigated in relation to IgG responses. RESULTS: IgG reactivities stratified toddlers into low, moderate, and high responder groups. The high group (17%) had elevated IgG responses to multiple RNA and DNA viruses (e.g., respiratory syncytial virus, Epstein-Barr virus, adenovirus, Coxsackievirus) and this correlated with increased responses to live attenuated viral vaccines and certain autoantigens. This high group was more likely to be associated with gestational diabetes and an older age. Genetic analyses identified polymorphisms in the IL2RB, TNFSF4, and INS genes in two high responder individuals that were associated with their elevated cytokine levels and clinical history of eczema and asthma. CONCLUSION: Serum IgG profiling of toddlers reveals correlations between the magnitude of the antibody responses towards viruses, live attenuated vaccines, and certain autoantigens. A low responder group had much weaker responses overall, including against vaccines. The serum antibody screen also identifies individuals with IgG responses to less common infections (West Nile virus, parvovirus, tuberculosis). The characterization of the antibody responses in combination with the identification of genetic risk alleles provides an opportunity to identify children with increased risk of clinical disease.

Recurrent Episodes of Encephalopathy/Encephalitis Secondary to Influenza Virus in a Pediatric Patient.

Influenza virus commonly causes acute upper respiratory tract infections in pediatrics. Rarely, influenza-associated encephalopathy/encephalitis may occur in 4 of 100,000 children annually in the United States. North American literature, however, is sparse regarding the incidence of recurrent episodes. This report characterizes the clinical manifestations and identifies genetic, virologic and/or epidemiologic factors making children susceptible for recurring episodes of influenza-associated encephalopathy/encephalitis.

Neonatal Hearing Screening: Challenges of COVID-19 Pandemic.

This is a retrospective chart review of newborns referred to audiology between June and December 2020. Newborns who failed or did not have an initial newborn hearing screening (NBHS) at an academic, tertiary care medical center, either in the nursery or in the neonatal intensive care unit (NICU) prior to discharge, were referred for a follow-up audiology appointment. Forty-three patients were included who failed or did not receive an NBHS. Of 43 patients, 15 (34.9%) did not receive an initial hearing test due to coronavirus disease 2019 (COVID-19 protocols). Of the 15, 7 (16.3% of total 43) newborns had mothers who refused COVID-19 screening, and 5/7 were lost to follow-up (11.6% of total). Another 7/15 newborns (16.3% of total) had a COVID-19-positive mother, and 1 of these 7 was lost to follow-up (2.3% of total). One of the 15 newborns (2.3% of total) had a pending maternal COVID-19 test result at discharge, and this patient was also lost to follow-up.

[Clinical and therapeutic issues in children and adolescents with liver hidatidosis at the Hipolito Unanue National Hospital]. / Características clínicas y terapéuticas en niños y adolescentes con hidatidosis hepática en el Hospital Nacional Hipólito Unanue del 2002 al 2011.

The aim of this study is to evaluate the clinical diagnosis and treatment of pediatrics patients with hepatic hydatid disease hospitalized in the pediatric ward of HNHU in the last ten years. The study is a descriptive, cross-sectional and retrospective observational of patients undergoing surgery for liver hydatidosis. We studied 42 confirmed cases of hepatic hydatidosis, the ages ranged from 1 to 17 years and most were adolescents 13 to 17 years (20 cases 47.62%), the gender distribution is equal and the source of patients is mainly from the Central Andes of Peru (24 cases 57.14%) followed by Lima city (10 cases 23.81%). The most common presenting symptom was abdåominal pain (29 cases 69.05%) followed by fever (19 cases 45.24%). Ultrasound is the most common diagnostic method and only not done in a patient carrying a prior CT scan. Serology (indirect immunofluorescence) was positive in only 19 of 27 patients who had the test (70%).Most were single hepatic cysts (22 cases 52.38%) with size from 3 to 20 cm but most commonly they were 5 to 10 cm sized. The location was predominant on the right lobe (26 cases 61.98%) followed on both lobes (10 cases 23.81%). Apart from the liver there were cysts on the lungs (18 cases 42.86%).The surgical procedure performed was radical cystectomy with or without drainage in 36 cases (85.71%). And conservative surgery in only 6 cases (14.28). The important complications were: 15 cases of fever (35.71), nosocomial respiratory infection in 9 cases (21.43%), biliary fistula in 5 cases (11.90%) and residual abscess in 3 cases (7.14%). Although morbidity was high, mortality of the cases studied was zero.

Coronavirus Disease 2019 (COVID-19) Associated Hemolytic Uremic Syndrome in a Toddler.

Coronavirus disease 2019 (COVID-19) is a heterogenous, predominantly pulmonary disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has resulted in catastrophic illness around the world. Thrombotic microangiopathy (TMA) is a triad of hemolytic anemia, thrombocytopenia, and end organ damage. This is present in severe cases of COVID-19 and in hemolytic uremic syndrome (HUS) commonly caused by Escherichia coli (E.coli) 0157:H7. We report a novel case of a toddler who presented with classic features suggestive of HUS characterized by bloody diarrhea followed by thrombocytopenia, hemolytic anemia, and acute kidney injury, in whom a polymerase chain reaction (PCR) test for SARS-CoV-2 was positive.

Successful Implementation of Single Urine Polymerase Chain Reaction Test for Evaluating Suspected Cytomegalovirus Infection in Neonates.

Overuse of laboratory investigations is viewed as medical waste. In the past, to diagnose congenital cytomegalovirus (CMV) infection, consecutive urine culture samples were obtained. With the advent of polymerase chain reaction (PCR) technology, 1 urine specimen should be enough. We conducted this quality improvement study to look at the effect of a practice change from 3 to 1 urine specimen for PCR testing. Methods: The authors instituted a single PCR urine test for CMV in their neonatal intensive care unit (NICU) in May 2021. We reviewed the data on all the urine CMV PCRs obtained on neonates for 1 year, May 1, 2020, to April 30, 2021 (Epoch 1), and compared it with the data obtained from May 1, 2021, to February 28, 2022 (Epoch 2). Results: A total of 3,612 neonates were born during the study period-1,816 infants were born during Epoch 1 and 1,796 infants during Epoch 2. A total of 97 neonates (5.3%) were evaluated for congenital CMV infection during Epoch 1 and 149 infants (8.2%) during Epoch 2. The single urine sample CMV evaluation rate during Epoch 1 was 53.6% (52 infants out of 97 infants evaluated), which increased to 98.6% in Epoch 2 (147 infants out of 149 infants), P < 0.001. The monthly average cost per infant declined from a mean value of 70.1 dollars to a mean value of 39.5 dollars. Conclusions: We increased the single specimen urine CMV PCR test from 53.6% to 98.6%. The intervention resulted in reducing waste and improving resource utilization.

Erratum to: An Outbreak of Brucellosis: An Adult and Pediatric Case Series.

[This corrects the article DOI: 10.1093/ofid/ofz384.][This corrects the article DOI: 10.1093/ofid/ofz384.].

An Outbreak of Brucellosis: An Adult and Pediatric Case Series.

Background: Brucellosis is recognized as a neglected zoonotic disease and a major public health threat. The purpose of this study was to characterize epidemiological risk factors and healthcare utilization and compare clinical aspects of disease among adult and pediatric cases in North Texas. Methods: A retrospective chart review of electronic medical records was completed at 3 large tertiary centers-Parkland Health and Hospital System, Clements University Hospital, and Children's Medical Center-between January 1, 2007 and June 1, 2017. Demographic, clinical, and laboratory variables were collected. Cases were defined as confirmed or probable. Results: Twenty-eight cases of brucellosis were identified: 26 confirmed (9 children, 17 adults) and 2 probable cases (1 child, 1 adult). Half (n = 14) were diagnosed in 2016 during an outbreak in Dallas County. Risk factors associated with infection were consumption of unpasteurized cheese (71%), recent travel (54%), close contact to a confirmed human brucellosis case (36%), and exposure to animals (11%). Median days of symptoms was 10 and 16 for children and adults, respectively. The majority (79%) of patients visited the emergency department before diagnosis and 93% were hospitalized. Fever was the most common symptom in children (80%) and adults (100%). Hepatitis (75% of children) and anemia (82% of adults) were the most common laboratory abnormalities. The most common complication in children was splenic lesions (40%), and the most common complication in adults was hepato/splenomegaly (39%). Conclusions: The diagnosis of Brucella infection requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible exposure history.

Tuberculosis pleural en niños en una zona altamente endémica: Revisión de 96 casos / Chilhood pleural tuberculosis in a region of high prevalence of tuberculosis: A review of 96 cases

Objetivo de estudio: Describir las características clínicas, radiográficas, de laboratorio y hallazgos bacteriológicos de pacientes pediátricos con derrame pleural tuberculoso. Material y Métodos: En este estudio retrospectivo se revisaron las historias clínicas de los pacientes menores de 16 años internados en el Hospital Nacional Hipólito Unanue, de enero del 2003 a diciembre del 2012, con el diagnóstico de tuberculosis pleural. Resultados: En total fueron 96 pacientes diagnosticados de derrame pleural tuberculoso. La edad mediana de los pacientes fue 11 años. El 60.42% fueron eutróficos, el 26.04% tuvieron sobrepeso u obesidad y solo 13.54% eran desnutridos. La positividad al test de tuberculina fue de 89.86%. El derrame pleural fue la única manifestación radiográfica en 36.5% y la enfermedad parenquimal estuvo asociada en 63.5% de los casos. La confirmación bacteriológica de tuberculosis se obtuvo en 13 pacientes (13.5%). El tratamiento antituberculoso por 6 meses fue efectivo en todos los casos. Conclusiones: La tuberculosis pleural está generalmente asociada a un test de tuberculina positivo y un infiltrado parenquimal pulmonar. La mayoría de los pacientes eran eutróficos o con sobrepeso u obesidad. Un curso de 6 meses de tratamiento fue efectivo.

Study objective: To describe the clinical features, radiographics, laboratory and bacteriologic findings of pediatric patients with tuberculous pleural effusion. Material and Methods: It is a retrospective study. We have collected information from medical records of inpatients < 16 years old, who were admitted at Hipolito Unanue Hospital from January 2003 to December 2012, with diagnosis of tuberculous pleuritis. Results: Ninety – six children were diagnosed with tuberculous pleural effusion. The median age was 11 years. 60.42% of the patients were eutrophic, 26.04%were overweight or obese and only 13.65%suffered of malnutrition. Positive tuberculin skin tests were seen in 89.86%. Pleural effusion was the sole radiographic manifestation in 36.5% of cases and parenchymal disease was associated in 63.5% of the patients. Bacteriologic confirmation of tuberculosis was achieved in 13 cases (13.5%). Antituberculous therapy for 6 months was effective in all cases. Conclusions: Tuberculous pleural effusion was usually associated with a positive tuberculin skin test, and lung parenquimal infiltrates. A short course of chemotherapy is effective.

Características clínicas y terapeúticas en niños y adolescentes con hidatidosis hepática en el Hospital Nacional Hipólito Unanue del 2002 al 2011 / Clinical and therapeutic issues in children and adolescents with liver hydatidosis at the Hipolito Unanue National Hospital

El objetivo del presente estudio es evaluar las características clínicas y terapéuticas de los pacientes pediátricos con hidatidosis hepática hospitalizados en el pabellón de pediatría del HNHU en los últimos 10 años. El estudio es de tipo descriptivo observacional transversal y retrospectivo de los pacientes intervenidos quirúrgicamente por hidatidosis hepática. Se estudiaron 42 casos confirmados de Hidatidosis hepática, las edades fueron de 1 a 17 años y la mayoría fueron adolescentes de 13 a 17 años (20 casos 47.62%), la distribución por sexo es igual y la procedencia de los pacientes es mayormente de la Sierra Central (24 casos 57.14%) seguida por Lima ciudad (10 casos 23.81%). El síntoma de presentación más frecuente fue dolor abdominal (29 casos 69.05%) seguido por fiebre ( 19 casos 45.24%). La ecografía es el método diagnóstico más usado y solo se dejo de hacer en un paciente que traía una tomografía previa. La serología (inmunofluorescencia indirecta) fue positiva solo en 19 pacientes de 27 que se realizó (70%). La mayoría fueron quistes hepáticos únicos (22 casos 52.38%) de tamaño entre 3 y 20 cm pero lo más común fue de 5 a 10 cm. La localización fue predominante en el lóbulo derecho (26 casos 61.98%) seguida por ambos lóbulos (10 casos 23.81%). Aparte del hígado hubo quistes en pulmón (18 casos 42.86%). Se realizo cirugía radical, quistectomia con o sin drenaje en 36 casos (85.71%). Cirugía conservadora en solo 6 casos (14.28%). Las complicaciones fueron importantes con 15 casos de fiebre (35.71%), infección respiratoria intrahospitalaria 9 casos (21.43%), fistula biliar 5 casos (11.90%) y absceso residual en 3 casos (7.14%). Si bien la morbilidad fue alta la mortalidad de los casos estudiados fue de cero.

The aim of this study is to evaluate the clinical diagnosis and treatment of pediatrics patients with hepatic hydatid disease hospitalized in the pediatric ward of HNHU in the last ten years. The study is a descriptive, cross-sectional and retrospective observational of patients undergoing surgery for liver hydatidosis. We studied 42 confirmed cases of hepatic hydatidosis, the ages ranged from 1 to 17 years and most were adolescents 13 to 17 years (20 cases 47.62%), the gender distribution is equal and the source of patients is mainly from the Central Andes of Peru (24 cases 57.14%) followed by Lima city (10 cases 23.81%). The most common presenting symptom was abdaominal pain (29 cases 69.05%) followed by fever (19 cases 45.24%). Ultrasound is the most common diagnostic method and only not done in a patient carrying a prior CT scan. Serology ( indirect immunofluorescence) was positive in only 19 of 27 patients who had the test (70%). Most were single hepatic cysts (22 cases 52.38%) with size from 3 to 20 cm but most commonly they were 5 to 10 cm sized. The location was predominant on the right lobe (26 cases 61.98%) followed on both lobes (10 cases 23.81%). Apart from the liver there were cysts on the lungs (18 cases 42.86%). The surgical procedure performed was radical cystectomy with or without drainage in 36 cases (85.71%). And conservative surgery in only 6 cases (14.28). The important complications were: 15 cases of fever (35.71), nosocomial respiratory infection in 9 cases (21.43%), biliary fistula in 5 cases (11.90%) and residual abscess in 3 cases (7.14%). Although morbidity was high, mortality of the cases studied was zero.

Complicaciones en el tratamiento quirúrgico de pacientes pediátricos conhidrocefalia operados en el Hospital Nacional Guillermo Almenara Irigoyen / Surgical complications in pediatric patients with hydrocephalus in Guillermo Almenara-Irigoyen Nacional Hospital

Objetivo: Determinar las principales complicaciones postquirúrgicas en pacientes pediátricos con hidrocefalia en el Hospital Nacional Guillermo Almenara Irigoyen. Material y método: Estudio descriptivo, de tipo serie de casos que incluyó las historias clínicas de pacientes post operados por hidrocefalia mediante la derivación ventriculoperitoneal, entre 0 y 14 años al momento de la primera intervención quirúrgica en la institución indicada. Los datos fueron recolectados en una ficha estandarizada. Se aceptó como significancia estadística p<0,05. Resultados: Se encontró complicaciones en 35,5% de los pacientes. De las complicaciones 54% fueron tempranas y 45% tardías. Las causas fueron: disfunción del sistema, infección y hematoma subdural debido a sobredrenaje, 54,5%, 27,3% y 18,2% respectivamente. De los pacientes con complicaciones: 54,5% tenían hidrocefalia adquirida y 45,5% congénita; 72,7% fueron intervenidos de emergencia y 27,3% de manera electiva. Se encontró asociación estadísticamente significativa entre la etiología de la hidrocefalia y las complicaciones registradas χ2 = 5,387 (p = 0,02). Conclusiones: Se encontró una frecuencia de 35,5% de complicaciones post quirúrgicas, siendo la disfunción del sistema la complicación más frecuente en este escenario. Los resultados indican que la hidrocefalia adquirida presenta mayor riesgo de presentar complicaciones postquirúrgicas que la congénita.

Objective: To determine the main surgical complications in pediatric patients with hydrocephalus in Guillermo Almenara Irigoyen National Hospital. Material and method: A descriptive case series reviewed the charts of pediatric patients with hydrocephalus who underwent a ventriculo-peritoneal shunt procedure. These patients were between 0 and 14 years old when they had their first surgery. Data was collected in a standardized chart. Statistical significance was established in p<0.05. Results: Approximately one third of patients (35.5%) developed complications. Fifty- four percent had early complications and 45% developed late complications. Causes for complications were: system malfunction, infection and subdural hematoma caused by overdrainage of VP shunts in 54.5%, 27.3% and 18.2%, respectively. Of all patients who developed complications, 54.5% had acquired and 45.5% had congenital hydrocephalus; 72.7% underwent emergency surgery and 27.3% underwent elective surgery. There was a statistically significant association between the origin of hydrocephalus and the development of complications, χ2 = 5.387 (p = 0.02). Conclusions: The frequency of complications after surgical therapy for hydrocephalus was 35.5%. The main cause was system malfunction. These results show that acquired hydrocephalus has a greater likelihood for developing post surgical complications compared to congenital hydrocephalus.

[Hepatotoxicity caused by antituberculosis drugs in pediatrics]. / Hepatotoxicidad por Fármacos Antituberculosos en Pediatria.

The clinical profile of hepatotoxicity induced by tuberculosis drugs varies and the re-introduction of therapy for patients who developed this condition is controversial.5 pediatric cases treated throughout a period of 10 years in the Pediatric Department of Hipolito Unanue National Hospital are presented.2 individuals showed an asymptomatic increase of transaminases, 2 individuals had hepatitis, and 1 individual had acute liver failure. Most patients were female school students. Malnutrition and therapy continuation once the hepatic damage was started were found to be the risk factors.A staged reintroduction scheme for these agents after recovery from hepatitis is proposed.

Hepatotoxicidad por fármacos antituberculosos en Pediatría / Hepatotoxicity caused by antituberculosis drugs in Pediatrics

El perfil clínico de la hepatotoxicidad inducida por fármacos antituberculosos es variable y la reintroducción de la terapia a los pacientes que la han desarrollado es controversial. Se presentan 5 casos pediátricos atendidos en un periodo de 10 años en el Servicio de Pediatría del Hospital Nacional Hipólito Unanue. 2 casos mostraron elevación asintomática de transaminasas, 2 presentaron hepatitis y 1 presentó insuficiencia hepática fulminante. La mayoría fueron escolares del sexo femenino y como factores de riesgo se encontró la desnutrición y la continuación de la terapia una vez que el daño hepático se inicia. Proponemos un esquema de reintroducción escalonada de estos agentes luego de la recuperación de la hepatitis.

The clinical profile of hepatotoxicity induced by tuberculosis drugs varies and the re-introduction of therapy for patients who developed this condition is controversial. 5 pediatric cases treated throughout a period of 10 years in the Pediatric Department of Hipolito Unanue National Hospital are presented. 2 individuals showed an asymptomatic increase of transaminases, 2 individualshad hepatitis, and 1 individual had acute liver failure. Most patients were female school students. Malnutrition and therapy continuation once the hepatic damage was started were found to be the risk factors. A staged reintroduction scheme for these agents after recovery from hepatitis is proposed.