Non-polio enterovirus aseptic meningitis in infants up to three months of age, the bacterial mask of viral disease: A retrospective cohort study.

BACKGROUND: Non-polio enterovirus aseptic meningitis (NPE-AM) is a self-limiting illness that can mimic serious bacterial infection (SBI) in infants during their first months of life. OBJECTIVES: To compare the clinical features of febrile infants diagnosed with NPE-AM with those of infants who had SBI or non-bacterial infection (NBI). STUDY DESIGN: A systematic series of febrile infants < 3-months-old hospitalized between 2010 and 2019 with febrile illness in a tertiary hospital. Clinical and laboratory data were compared between the three groups. RESULTS: Overall 1278 infants were included; 207 (16.2%) had NPE-AM, 210 (16.4%) SBI and 861 (67.4%) NBI. The median age was 34 (IQR: 21.5-51.7) days. NPE-AM was documented in 25% of infants < 29 days and 9.9% of infants aged 29-90 days. Infants with NPE-AM or SBI had fever >39°C more frequently, 24.2% and 17.1% compared with 10% in infants with NBI (p < 0.001). Fever duration ≥ 2 days was reported in 3.4% of infants with NPE-AM vs 18.6% in SBI and 26.3% in NBI (p < 0001); rash occurred in 37.7% in NPE-AM compared to 4.6% in NBI and 5.7% in SBI (p < 0.001). The mean white blood count, C-reactive protein and absolute neutrophil count were significantly lower in infants with NPE-AM compared to infants with the SBI (p < 0.001) and similar to the means in infants with NBI (p = 0.848, 0.098 and 0.764 respectively). A high proportion of bloody tap 346/784 (53.1%) was detected. Infants with NPE-AM were more likely to be treated with antibiotics than infants with NBIs (88.9% vs 50.7%, p < 0.001), similarly to infants with SBIs (p = 0.571). CONCLUSIONS: The clinical presentation of infants with NPE-AM that could mimic bacterial infection and the high rate of bloody taps may lead to more hospital admissions and antibiotic prescriptions. Rapid molecular testing for detection of NPE may be of additional value in the evaluation of febrile infants.

Six-Year Surveillance of Acquired Bloodstream Infection in a Pediatric Intensive Care Unit in Israel.

OBJECTIVES: We studied profile of the bloodstream infections (BSI) in the pediatric intensive care unit (PICU) and identified predictors of mortality. METHODS: The study collected data from hospital records for children younger than 18-years who developed BSI during their PICU stay between 2014 and 2019. RESULTS: In 114 patients, 136 PICU-acquired BSIs with 152 pathogens were documented. The incidence of BSI was 47.12/1,000 PICU admissions and 7.95/1000 PICU hospital days. Gram-negative rods accounted for 75% of isolates, Gram-positive cocci accounted for 21.7% of isolates, and fungi accounted for 3.3% of isolated pathogens. ICU mortality was observed in 25 (21.9%) patients with a BSI compared to 94 (3.1%) patients without a BSI (P<0.001). Hemodynamic instability (P=0.014, OR 4.10, CI 1.33-12.66), higher blood urea nitrogen (BUN) (P=0.044), and lower albumin levels (P=0.029) were associated with increased risk of ICU mortality. CONCLUSION: BSI in the PICU is associated with increased mortality. Early identification and management of risk factors independently associated with poor clinical outcomes in these patients should be aimed to ensure improved survival.

Predictors of unfavorable outcome in children hospitalized with influenza and differences in clinical presentation among serotypes.

BACKGROUND: Apart from age and underlying disease, predictors of adverse outcome in children hospitalized with influenza are poorly understood. OBJECTIVES: Our goal is to determine clinical and laboratory predictors that help identify children at increased risk for an unfavorable course and identify differences in clinical presentation between serotypes. STUDY DESIGN: A retrospective, observational cohort study conducted at the Rambam Healthcare Campus in Haifa. We analyzed data from electronic records of children < 18 years with influenza A or B infection hospitalized between 2009 and 2020. Multivariate regression analyses were used to identify predictors of unfavorable outcome, defined as mortality, ICU admission, intubation, prolonged length of stay, or bacterial coinfection. RESULTS: A total of 1077 children were included, of whom 54% were male. The median age was 2.5 years. Influenza A was detected in 797 (74%) and influenza B in 286 (26%) of the cases. Children with influenza A were younger (OR 2.51, 95%CI 1.90-3.33), more likely to have oxygen desaturation <90% (OR 2.44, 95%CI 1.23-4.83) and an elevated CRP>5 mg/dL on admission (OR 2.67, 95% CI 1.63-4.37). In multivariate analyses, oxygen desaturation <90% and CRP > 5 mg/dL at admission had an 11.1 and 4-fold increased risk of unfavorable outcome, respectively, in addition to a 3.1 and 1.6-fold increased risk in the presence of underlying condition or influenza A serotype infection, respectively. CONCLUSIONS: Data available on admission can help identify children hospitalized with influenza who are at increased risk for complications and unfavorable outcome, encouraging aggressive treatment and care.