The prevalence and predictors of pulmonary lesions in paediatric patients with coronavirus disease 2019 - a brief report.

Purpose: There are currently only scarce data available describing imaging manifestations in children with COVID-19. The aim of this study was to analyse pulmonary lesions on chest radiography (CXR) in paediatric patients infected with SARS-CoV-2 and to compare the CXR results with clinical and laboratory data. Material and methods: In this prospective single-centre study we included 118 consecutive paediatric patients with COVID-19. CXR was performed in 107 patients. Clinical and laboratory evaluations were performed on the same day as CXR, immediately (0 to 2 days) after the COVID-19 diagnosis had been established. Results: Pulmonary lesions were found in 24/107 (23%) children, including 14/24 (58%) with bilateral abnormalities. Compared to patients with normal CXR, children presenting with pulmonary lesions were significantly younger (7.0 ± 4.5 vs. 9.5 ± 4.5 years, p = 0.03) and more commonly presented with an elevated D-dimer level (6/24, 25% vs. 5/81, 7%; p = 0.008). Almost half (46%) of the children with pulmonary lesions were asymptomatic, and 11/60 (18%) of all asymptomatic patients presented with abnormal CXR. Conclusions: Pulmonary lesions in the course of COVID-19 are more common in younger children and those presenting with an elevated D-dimer level. A significant proportion of asymptomatic COVID-19 patients develop CXR abnormalities.

COVID-19 infections in infants.

The study aimed to analyse the clinical course of COVID-19 in 300 infants, selected from 1283 children diagnosed with COVID-19 between March and December 2020, registered in the SARSTerPED multicenter database. Most of the infants were registered in October and November 2020. 44% of the group were girls, and 56% were boys. At diagnosis, the most common symptoms were fever in 77% of the children, cough in 40%, catarrh in 37%. Pneumonia associated with COVID-19 was diagnosed in 23% of the children, and gastrointestinal symptoms in 31.3%. In 52% of the infants, elevated levels of D-dimers were observed, and in 40%, elevated levels of IL-6 serum concentration were observed. During the second wave of the pandemic, 6 times more infants were hospitalized, and the children were statistically significantly younger compared to the patients during the first wave (3 months vs 8 months, p < 0.0001 respectively). During the second wave, the infants were hospitalized for longer. COVID-19 in infants usually manifests as a mild gastrointestinal or respiratory infection, but pneumonia is also observed with falls in oxygen saturation, requiring oxygen therapy. Gastrointestinal symptoms are common in infants infected with SARS-CoV-2, and infant appetite disorders may lead to hospitalization. The clinical course of the disease differed significantly between the first and second wave of the pandemic. It seems that infants may play a role in the transmission of SARS-COV-2 infections in households, despite mild or asymptomatic courses; eating disorders in infants should be an indication for COVID-19 testing.

Analysis of Preventable Risk Factors for Toxoplasma gondii Infection in Pregnant Women: Case-Control Study.

BACKGROUND: Toxoplasma gondii (TG) is a parasitic protozoon that may cause miscarriages or birth defects if the infection occurs during pregnancy. The study's aim was to evaluate the risk factors associated with TG infection in pregnant women. MATERIALS: Medical charts for all 273 pregnant women with suspected TG infection consecutively admitted to the Hospital of Warsaw between 2019 and 2020 were retrospectively analyzed. The presumptive TG diagnosis was verified by a serologic assessment of IgM and IgG titers, and IgG affinity tests. RESULTS: The median age was 32 years (range: 19-42 years). The diagnosis of primary TG infection was confirmed in 74/273 (27.1%) women. In 114/273 (41.8%) there was evidence of past infection. In 71/273 (26%) women, an infection was excluded. In 172/273 (62%) women the recommended testing for other infectious diseases putting fetus development at risk was performed correctly. Logistic regression model analysis revealed that living in rural areas and eating raw meat were independent factors associated with increased risk of TG infection during pregnancy (OR 2.89, 95% CI: 1.42-5.9, p = 0.004; and OR 2.07, 95% CI: 1.03-4.18, p = 0.04, respectively). CONCLUSIONS: The independent risk factors for TG infection during pregnancy include living in rural areas and eating raw meat. The physician's educational role here is crucial for the efficient prevention of congenital toxoplasmosis.

Urticaria multiforme in a child with SARS-CoV-2 infection.

We present a case of a 10-month-old boy with urticaria multiforme in the course of coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributes to skin lesions in both children and adults. The main cutaneous manifestations of this infection include pseudochilblains, urticaria and maculopapular eruptions. Urticaria multiforme is a common yet underrecognized exanthem in children that is precipitated by viral infections among other causes.

Effective Treatment of Chronic Hepatitis C Virus Infection With Ledipasvir/Sofosbuvir in 2 Teenagers With HIV Coinfection: A Brief Report.

ABSTRACT: We present the efficacy and safety of 12 weeks of therapy with a fixed dose of ledipasvir/sofosbuvir in 2 teenagers with HIV/hepatitis C virus coinfection. Patient 1 presented with compensated cirrhosis, whereas patient 2 had evidence of previous hepatitis B virus infection. Both patients achieved a sustained virologic response 12 weeks after the end of treatment. No serious adverse effects were reported.

Comparison of clinical severity and epidemiological spectrum between coronavirus disease 2019 and influenza in children.

Data on the novel coronavirus disease 2019 (COVID-19) in children are limited, and studies from Europe are scarce. We analyzed the clinical severity and epidemiologic aspects of COVID-19 in consecutive children aged 0-18 years, referred with a suspicion of COVID-19 between February 1, and April 15, 2020. RT-PCR on a nasopharyngeal swab was used to confirm COVID-19. 319 children met the criteria of a suspected case. COVID-19 was diagnosed in 15/319 (4.7%) patients (8 male; mean age 10.5 years). All of them had household contact with an infected relative. Five (33.3%) patients were asymptomatic. In 9/15 (60.0%) children, the course of the disease was mild, and in 1/15 (6.7%), it was moderate, with the following symptoms: fever (46.7%), cough (40%), diarrhea (20%), vomiting (13.3%), rhinitis (6.7%), and shortness of breath (6.7%). In the COVID-19-negative patients, other infections were confirmed, including influenza in 32/319 (10%). The clinical course of COVID-19 and influenza differed significantly based on the clinical presentation. In conclusion, the clinical course of COVID-19 in children is usually mild or asymptomatic. In children suspected of having COVID-19, other infections should not be overlooked. The main risk factor for COVID-19 in children is household contact with an infected relative.

Prevalence and predictors of liver disease in HIV-infected children and adolescents.

Liver disease in HIV-infected patients may result from the infection itself, antiretroviral treatment or comorbidities. In this study, we analysed liver disease in 79 HIV-infected children and adolescents aged 14.0 ± 5.1 years. All the patients were receiving combination antiretroviral therapy (cART), with a mean duration of 11.5 ± 4.7 years. Six patients (8%) had detectable HIV viral load, and 8/79 (10%) of the participants were coinfected with hepatitis B or C virus (HCV, 6/8 or HBV, 2/8). Liver disease was defined as an elevation of any of the following parameters: alanine or aspartate aminotransferase (ALT and AST), total bilirubin, and gamma glutamyl transferase (GGTP). For the noninvasive evaluation of liver fibrosis, the AST-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) were calculated. Liver disease was diagnosed in 20/79 (25%) of the patients, including 13/71 (18%) of participants without coinfection and 7/8 (88%) with coinfection (p < 0.0001). All of the liver markers except bilirubin were significantly higher in the coinfected group. APRI scores indicated significant fibrosis in 5/8 (63%) of patients with coinfection. HBV or HCV coinfection and detectable HIV viral load were independently positively associated with APRI (p = 0.0001, and p = 0.0001) and FIB-4 (p = 0.001, and p = 0.002, respectively). In conclusion, liver disease in HIV-infected children and adolescents results mainly from HBV or HCV coinfection. Effective antiretroviral treatment is protective against hepatic abnormalities.

Immunisation practices in centres caring for children with perinatally acquired HIV: A call for harmonisation.

BACKGROUND: Current national immunisation schedules differ between countries in terms of vaccine formulation, timing of vaccinations and immunisation programme funding and co-ordination. As a result, some HIV infected paediatric population may be left susceptible to vaccine preventable infections. Vaccines used in healthy population should be subjected to high quality ethical research and be explicitly validated for use in children with special vaccination needs such as those infected with HIV. This survey was completed to assess current vaccination practices and attitudes toward vaccination among pediatricians who care for vertically HIV infected children. METHODS: An online questionnaire was completed by 46 experts in paediatric HIV-infection from the Paediatric European Network for Treatment of AIDS (PENTA). Data were collected between November 2013 and March 2014. RESULTS: 46units looking after 2465 patients completed the questionnaire. The majority of units (67%) reported that common childhood immunisation were administered by the family doctor or local health services rather than in the HIV specialist centre. Vaccination histories were mostly incomplete and difficult to obtain for 40% of the studied population. Concerns were reported regarding the use of live attenuated vaccines, such as varicella and rotavirus, and these were less frequently recommended (61% and 28% of the units respectively). Monitoring of vaccine responses was employed in a minority of centres (41%). A range of different assays were used resulting in diverse units of measurement and proposed correlates of protection. CONCLUSION: Vaccination practices for perinatally HIV-infected children vary a great deal between countries. Efforts should be made to improve communication and documentation of vaccinations in healthcare settings and to harmonise recommendations relating to additional vaccines for HIV infected children and the use of laboratory assays to guide immunisation. This will ultimately improve coverage and vaccine induced immunity in this vulnerable patient group.

[Evaluation of antibody response to HPV vaccination in HIV infected girls]. / Ocena skutecznosci szczepienia przeciwko HPV dziewczat zakazonych HIV na podstawie badania obecnosci przeciwcial poszczepiennych.

BACKGROUND: HIV-infected women have an increased prevalence of HPV infections and high risk of cervical cancer. HPV vaccines seem to be a successive method of prevention in immunocompetent women. AIM: To evaluate HPV vaccination effectiveness based on the presence of HPV antibodies in HIV infected girls and to establish factors, which influence vaccination effectiveness. PATIENTS AND METHODS: Post vaccination antibodies were evaluated in 17 HIV -infected girls who received 3 doses of quadrivalent (types 6/11/16/18) HPV vaccine at the mean age of 11,5 years (range 9-17 yr). HPV antibodies were checked 1 month to 2 years (mean 18 months) after the third vaccine dose by ELISA HPV IgG assay (Dia.Pro Diagnostic Bioprobes). All patients have been receiving combined antiretroviral treatment (cART). Analyzed factors included: age at HIV diagnosis, age at the first vaccine dose, Centers for Disease Control and Prevention (CDC) classification at diagnosis, at vaccination and at evaluation. RESULTS: HPV antibodies were present in all 17 (100%) patients. HIV-infection was diagnosed at the mean age of 3,5 years (range 1 month--10.5 years). Nadir clinical CDC category: 7/17 patients (41%)--A, 5/17 (29,5%)--B, 5/29 (29.5%)--C. Nadir CDC count pointed moderate immunosuppression in 8/17 (47%) children and severe in 9/17 (53%). At vaccination 15/17 girls had CDC classification N1/A1, 2/17 (11.7%) were classified N2. At evaluation all girls had CDC classification N1 or A1. CONCLUSIONS. HPV vaccination in HIV infected girls resulted in successful antibody response. Immune recovery due to cART resulted in a good vaccine response, even in children with prior severe immunodeficiency.

[Hepatitis B vaccination effectiveness based on anti-HBs antibodies presence in children vertically infected with HIV]. / Ocena skutecznosci szczepien przeciwko wzw typu B na podstawie obecnosci przeciwcial poszczepiennych anty-HBs u dzieci zakazonych wertykalnie HIV.

AIM: To evaluate hepatitis B vaccination effectiveness. PATIENTS AND METHODS: 49 vertically HIV-infected children were enrolled. Anti-HBs antibodies were evaluated at HIV diagnosis, at evaluation (year 2004) and after primary vaccination. The following factors were analyzed: age, time since the last vaccine dose, clinical and immunological CDC category, HIV viral load, age at the beginning of ART. RESULTS: At HIV diagnosis 14% of children had anti-HBs antibody level > or = 100 mLU/ml. At evaluation 76% of patients had anti-HBs antibody level > or = 100 mIU/ml. Children, who were diagnosed before their first birthday, were more likely to have protective antibody level (p < 0.01). Percentage of lymphocyte T CD4+ count (p < 0.01) and time since last vaccination (p < 0.01) were found to be important factors of vaccination response. Primary vaccination was effective in 86% of children. CONCLUSIONS: Factors which influenced vaccination effectiveness included early HIV diagnosis, percentage of lymphocyte T CD4+ at evaluation and time since last vaccination. The effectiveness of primary vaccination was high.

[Measles vaccination in HIV infected children]. / Skutecznosc szczepien przeciwko odrze u dzieci z wertykalnym zakazeniem HIV.

INTRODUCTION: vaccination is one of very important aspects in medical care of HIV infected children. AIM: to evaluate measles vaccination effectiveness based on post-vaccination antibodies in HIV infected children. PATIENTS AND METHODS: 45 -- vertically HIV infected children were observed between 2001-2004 in the Department of Children's Infectious Diseases, Medical University of Warsaw. Post vaccination measles antibodies were evaluated at the beginning of study and during the follow-up. Effectiveness of primary vaccination and revaccination was evaluated The analysed factors included: age, time since the last vaccine dose, age at HIV diagnosis, clinical and immunological condition, HIV viral load, age of the child at the beginning of antiretroviral treatment. RESULTS: post vaccination measles antibodies were detected in 47% patients. Children, who were diagnosed before vaccination, were more likely to have measles antibodies (p<0,02). Age at the beginning of antiretroviral treatment (p<0,005) and time since last vaccination (p<0,01) were found to be important factors of measles antibody response. Primary vaccination was effective in 77% of the treated children, revaccination in 46%. CONCLUSIONS: factors which influenced measles vaccination effectiveness included age at the beginning of antiretroviral treatment and the time since last vaccination. The effectiveness of primary vaccination in treated children was high but lower compared to healthy children. Revaccination response is lower.

[20-years experiences of HIV infected children's care]. / 20-letnie doswiadczenie w opiece nad dziecmi zakazonymi HIV.

OBJECTIVE: The aim was to present the 20-years experiences of medical care of children borne to HIV(+) mothers and HIV infected children. METHODS: Between 1987 and 2006 year 305 children borne to HIV(+) mother were investigated. The risk of vertical transmission was estimated. We analyzed routs of HIV transmission, the reasons of HIV diagnosis, HIV staging at diagnosis, HBV and HCV coinfection, ART treatment and its efficacy. MAIN OBSERVATIONS AND RESULTS: HIV infection was confirmed: 75 cases of vertical HIV infection and 8 children infected in other ways. 260 children were borne after 1994 year (the date of introducing recommendation of the use of ART to reduce perinatal transmission of HIV). 158 of them received prophylaxis of vertical HIV infection. The risk of HIV vertical in children receiving prophylaxis was 5% comparing to 45.6% risk in children without prophylaxis regimens. 66 children receive ART regimen. The efficacy of treatment was: viral 85%, immunological: 89% and clinical: 85% improvement. CONCLUSIONS: HIV testing should be offered to every women in the child-bearing age. Current prophylaxis, which suppress maternal VL HIV below detection level, decrease the risk of vertical HIV transmission to 0-1%. The child born to HIV(+) mother requires early diagnostics of HIV, HBV, HCV infections. Because of rapid progression of the disease, the HIV infected child should be diagnosed and treated since the first year of life. Properly treated children reach to mature age.

[HIV infection in children in Poland - clinical advancement at time of diagnosis]. / Zakazenie HIV u dzieci w polsce - zaawansowanie kliniczne choroby w momencie rozpoznania.

UNLABELLED: At the end of 2006, there were about 130 children with confirmed HIV infection in Poland, 90% of them being infected vertically. AIM: to present the causes, the diagnostic procedure of HIV infection and the assessment of clinical staging at diagnosis of vertical infection in a child. MATERIALS AND METHODS: between 1987-2006 there were 86 HIV infected children (45 male, 41 female) treated in our Department. 78 children had been infected vertically, 8 by other route. Reasons for HIV testing in children and clinical staging at diagnosis were analysed in vertically infected children. The patients were divided into two groups: I - diagnosed because of clinical signs and symptoms, II - because of knowledge of HIV positive status in family members. RESULTS: there were 22/79 children in group I and 56/79 in group II. Vertical HIV infection diagnosis was confirmed at the age from 1 month to 11 years, the mean age was: 26 months - in group I, 25 months - in group II. During the first year of life HIV infection was diagnosed in 36 children (33% of them having AIDS, 36% severe immunodeficiency), at the age of 12-35 months in 22 children (23% of them having AIDS, 32% severe immunodeficiency) and above 35 months in 20 children (15% of them having AIDS, 35% severe immunodeficiency), respectively. Children diagnosed because of clinical manifestations were more likely to have AIDS (p<0.01) and severe immunodeficiency (p<0.07). CONCLUSIONS: early diagnosis in children relies on the knowledge on the mother's HIV infection positive status. In Poland vertical HIV infection diagnosis is established late (mean: above 2 years), often at the advanced stage of the disease.

[Effectiveness of vaccination against hepatitis B in HIV infected children]. / Ocena skutecznosci szczepien przeciwko wzw B u dzieci zakazonych HIV.

OBJECTIVE: The aim of the study was to evaluate hepatitis B vaccination effectiveness in HIV infected children. METHODS: 45 children vertically infected with HIV who received hepatitis B vaccination were evaluated. Anti-HBs antibodies were assayed to established vaccination efficiency and were repeated every 6-12 months. No-responders received the next vaccination schedule with doubled dose. Children with antibody levels < 100 IU/ml were boostered. All the children have been receiving HAART. MAIN OBSERVATIONS AND RESULTS: 35/45 (77,8%) children had anti-HBs antibodies > 100 IU/ml, including 20 with anti-HBs antibodies > or = 1000 IU/ml (32 children without immunodeficiency, 2 with moderate and 1 with severe immunodeficiency). Anti-HBs level 8-100 IU/ml was observed in 6/46 (13,3%) children (5 children without immunodeficiency and 1 with severe immunodeficiency). 4/46 (8.9%) children had no anti-HBs antibodies (2 children without immunodeficiency, 1 with moderate and 1 with severe immunodeficiency). CONCLUSIONS: In HIV infected children anti-HBs antibodies should be assayed to establish hepatitis B vaccination efficiency and repeated every 6-12 months.