COVID-19: enfermedad nueva, manifestaciones nuevas / COVID-19: New disease, new manifestations

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Apnea neonatal como manifestación inicial de infección por SARS-CoV-2 / Neonatal apnea as initial manifestation of SARS-CoV-2 infection

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A Case Series of Parechovirus Encephalopathy: Apnea and Autonomic Dysregulation in Critically Ill Infants.

This article aims to describe a rare cause of severe encephalitis in 2 cases of infants with signs of intracranial hypertension and severe autonomic dysregulation. The authors conclude that human parechoviruses are becoming a more recognized cause of encephalitis because of the increasing use of rapid detection methods. With early recognition of this clinical entity, improved care can be administered.

Paediatric apnoeas are not related to a specific respiratory virus, and parental reports predict hospitalisation.

AIM: The aim of this study was to determine the frequency of apnoeas in previously healthy young infants with acute respiratory tract infection (ARI) and correlate their occurrence with isolated micro-organisms, clinical findings, disease severity and outcome. METHODS: We performed reverse transcriptase real-time polymerase chain reaction (RT-PCR) on the nasal wash specimens of a prospective cohort study of 582 children with ARI. Clinical data on a subgroup of 241 infants under three months of age, with and without apnoeas, were compared. RESULTS: Our study found that 19 (7.9%) of the 241 infants under three months old had a history of apnoeas: eight had a respiratory syncytial virus (RSV), five had a different virus than RSV and seven RT-PCR results were negative. Infants with apnoeas were more likely to have cyanosis, had longer hospital stays and required extra oxygen for a longer period. Most patients with parental reported apnoeas also experienced apnoeas during hospitalisation. CONCLUSION: This study observed apnoeas irrespective of the isolated micro-organism, and we hypothesise that they were related to the pathophysiology of the respiratory infection and not to the micro-organism itself. Parental reported apnoeas were a major warning sign and predicted that apnoeas would occur in hospital.

Apnea induced by respiratory syncytial virus infection is not associated with viral invasion of the central nervous system.

We aimed to study whether direct central nervous system invasion is responsible for the neurologic manifestations seen in hospitalized infants with respiratory syncytial virus (RSV) infection. Cerebrospinal fluid from infants with RSV infection was tested for the detection of the following respiratory RNA viruses: RSV, influenza A and B, pandemic influenza H1N1, Parainfluenza-3, human metapneumovirus, adenovirus, parechovirus and enterovirus. All children tested negative for the presence of viral material in the cerebrospinal fluid. Our results support the notion that the mechanism of RSV-induced neurologic manifestations, including apnea, is not direct central nervous system invasion.

Frequency of apnea and respiratory viruses in infants with bronchiolitis.

The frequency of apnea in infants <12 months of age admitted with acute bronchiolitis was 5.16% (95% confidence interval: 3.94-6.72). Most commonly detected viruses in the 51 apneic infants were respiratory syncytial virus (33.3%), rhinovirus (13.7%) and viral coinfections (23.5%). Young age and prematurity were the main risk factors for apnea independent of the respiratory syncytial virus status. Non-respiratory syncytial virus infants had a higher rate of prematurity.

Hyperferritinemia in neonatal and infantile human parechovirus-3 infection in comparison with other infectious diseases.

Human parechovirus-3 (HPeV-3) has been associated with severe clinical manifestations in neonates and infants in the form of sepsis or hemophagocytic lymphohistiocytosis (HLH)-like illness. To clarify the clinical features of HPeV-3 infection, we compared clinical signs and laboratory findings among enteroviruses (EVs), HPeV-3, and other infections. Participants were 26 febrile infants in whom EVs (n = 20) or HPeV-3 (n = 6) were isolated from throat swab or fecal specimens. Clinical and laboratory data were compared among EVs, HPeV-3, respiratory syncytial virus (RSV) infection (n = 15), and bacterial meningitis (n = 8) groups. Apnea was frequently seen in the HPeV-3 group although there were no significant differences in other clinical symptoms. Leukocyte count was significantly lower in the HPeV-3 group than in the EV and RSV group. Platelet count was significantly lower in the HPeV-3 group than in the RSV group. Serum ferritin levels in the HPeV-3 group (mean, 2437 ng/ml) and EV group (mean, 552 ng/ml) were significantly higher than in the RSV group (mean 237 ng/ml; P = 0.008 and P = 0.002, respectively). The frequency of patients with clearly high ferritin levels ≥1000 ng/ml was comparatively higher in the HPeV-3 group (4/6) than the EV group (3/20) (P = 0.03). In the HPeV-3 group, ferritin levels were high on Days 4-5. Elevated ferritin levels, decreased leukocyte and platelet counts could offer diagnostic clues to HPeV-3 infection in infant. These laboratory findings might be associated with aberrant immune response to HPeV-3, which could contribute to the development of sepsis or HLH-like illness in neonates.

Apnea with RSV infection in three infants receiving palivizumab.

The present report describes three infants receiving palivizumab prophylaxis who presented with apnea associated with respiratory syncytial virus (RSV) infection. All three were found to be RSV positive but had mild bronchiolitis courses. Even though palivizumab has been shown to be an effective prophylaxis in preventing RSV bronchiolitis hospitalizations, its effect on apnea is unknown. The cases presented raise the concern that apnea associated with RSV must still be considered in infants who receive proper prophylaxis with palivizumab. Also, if palivizumab is found to be ineffective in preventing apnea, clinical management of these patients could be altered.

Prevalence of respiratory syncytial virus-associated lower respiratory infection and apnea in infants presenting to the emergency department.

The prevalence of respiratory syncytial virus in children presenting to US emergency departments with lower respiratory tract infection or apnea (N = 4172) was evaluated outside the traditional respiratory syncytial virus season (September to October and April to May) relative to January to February. The Mid-Atlantic and Southeast demonstrated positivity rates in September to October comparable with rates observed during January to February.

Distribution of respiratory syncytial virus subtypes A and B among infants presenting to the emergency department with lower respiratory tract infection or apnea.

BACKGROUND: Respiratory syncytial virus (RSV), a leading viral respiratory pathogen worldwide, has 2 major subtypes, A and B. OBJECTIVE: To describe the temporal and geographic distribution and parameters of disease severity associated with RSV A and B in the United States. METHODS: A US multicenter active surveillance study was conducted in emergency departments (EDs) during 2 RSV seasons. Infants <1 year of age presenting to the ED with symptoms of lower respiratory tract infection or apnea were enrolled. RSV subtypes were detected in nasal swabs by reverse transcriptase polymerase chain reaction. RESULTS: Of 4248 patients enrolled, 4172 patients were evaluable; 32.4% of patients were positive for any RSV subtype in season 1 and 29.9% in season 2. RSV A and B were detected in each region studied. More patients presented to the ED with RSV A than with RSV B (853 [20.4%] versus 453 [10.9%], respectively); RSV A-positive patients were more likely to be admitted to the hospital or intensive care unit (47.7%, versus RSV B, 35.8%; P < 0.0001); hospitalized RSV A-positive patients were less likely to be prescribed antibiotics (32.4%, versus RSV B, 47.8%; P < 0.001). CONCLUSIONS: This is the largest epidemiologic study in EDs reporting trends in RSV subtypes. RSV subtypes A and B were documented in both seasons across all US regions studied and detected in September to May. The results of this study support suggestions from smaller studies that RSV A may be more virulent than RSV B; however, more quantitative assessments of disease severity are needed.

[Influenza A H1N1 in neonatal intensive care unit: analysis and lessons]. / Grippe A H1N1 en unité de néonatologie : analyse et enseignements.

Since WHO announced the flu-like pandemic H1N1v in autumn 2009, data on clinical presentation and treatment of H1N1v infection in preterm infants with oseltamivir remain scarce. We cared for four infected preterm infants and ordered prophylactic treatment with oseltamivir in 13 additional contact preterm infants. A number of lessons can be drawn from this experience. The first two cases in twins were revealed by an increase in the number of apnea and one infant required mechanical ventilation. Cough was the major symptom in the two other infected infants. No digestive intolerance was observed among the 17 preterm infants during oseltamivir treatment. Polymerase chain reaction (PCR) quickly determined whether an infant was infected, making it helpful in deciding on initial containment. PCR remained positive, whereas culture became negative. Therefore, culture appeared to be more relevant in deciding on the end of containment. Follow-up of the four infected infants showed their ability to develop immunity against H1N1v.

Influenza A/H1N1 virus in very low-birth-weight premature infant: case report.

Influenza is an uncommon illness among premature infants in developed modern neonatal intensive care units (NICUs), but if infants do manifest symptoms of this significant illness, they commonly present with an abrupt onset, with temperature instability and upper respiratory tract involvement and, commonly, clinical features similar to bacterial sepsis. Additionally, frequent manifestations include bronchiolitis and pneumonia. Influenza infection in premature infants is likely a result of reduced levels of passively transferred protective maternal antibodies. Timely supportive therapy, antiviral agents, and isolation of affected infants to prevent spread of infection may be sufficient protective measures in the NICU. We report a case of a 50-day-old very low-birth-weight premature infant with novel A/H1N1 influenza virus (swine flu). There were no obvious epidemiological conditions in the NICU among patients and staff. The unique presenting symptom was apnea, which required respiratory support by nasal intermittent positive pressure ventilation. Due to the current pandemic, neonatologists should be aware of possible infection of neonates with novel A/H1N1 influenza virus.

Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization.

OBJECTIVE: To determine the population-based inpatient disease burden of parainfluenza virus in children <5 years of age. STUDY DESIGN: The New Vaccine Surveillance Network (NVSN) enrolled children <5 years of age who were hospitalized with febrile or acute respiratory illnesses. Surveillance hospitals admitted >95% of all hospitalized children from each county. Combined nasal turbinate/throat swabs were tested for parainfluenza virus (PIV), respiratory syncytial virus, and influenza virus with culture and reverse-transcription-polymerase chain reaction. Both parental interviews and medical chart reviews were conducted. Age-specific population-based hospitalization rates were calculated. RESULTS: From October 2000 through September 2004, 2798 children were enrolled. A total of 191 PIVs were identified from 189 children (6.8% of enrolled: 73 PIV type 1, 23 PIV type 2, and 95 PIV type 3), compared with 521 respiratory syncytial viruses and 159 influenza viruses. Mean PIV hospitalization rates were 3.01, 1.73, 1.53, 0.39, and 1.02 per 1000 children per year for ages 0 to 5 months, 6 to 11 months, 12 to 23 months, 24 to 59 months, and 0 to 59 months, respectively. CONCLUSIONS: PIV accounted for 6.8% of all hospitalizations for fever, acute respiratory illnesses, or both in children <5 years of age. The pediatric PIV inpatient burden is substantial and highlights the need to find an effective vaccine candidate.

Chronological and clinical characteristics of apnea associated with respiratory syncytial virus infection: a retrospective case series.

OBJECTIVE: Infants with respiratory syncytial virus (RSV) infection are at risk for developing apnea. The authors compared patients with RSV infection who develop apnea with those who do not, to help ambulatory physicians risk stratify their patients with RSV infection. METHODS: Entry criteria were age less than 1 year, RSV infection, and presentation to the authors' pediatric emergency departments. Random and weighted sampling techniques were used to identify the study group and provide the control sample. Charts were abstracted for 34 clinical variables. RESULTS: The study group consisted of 42 patients with apnea, and the control group consisted of 198 patients without apnea. Logistic regression analysis identified 2 independent variables associated with apnea: young age and presentation with apnea. Most patients with apnea were less than 2 months of age and were ill for less than 5 days. CONCLUSIONS: Age and duration of illness may help clinicians determine which previously healthy infants are at risk for apnea.

[Apnea as a presenting symptom in human metapneumovirus infection]. / Apnea como forma de presentación de una infección por metapneumovirus humano.

Human metapneumovirus (hMPV), a recently described pathogen of lower respiratory tract infections (LRTI), has been detected in 5,4% of Chilean infants hospitalized for LRTI whom are negative for adenovirus, respiratory syncytial virus, influenza and parainfluenza viruses. hMPV may cause bronchiolitis or pneumonia in hospitalized patients, and ocassionally require admission to intensive care units and mechanical ventilation. The infection has been associated with apnea, especially in preterm infants. Nosocomial dissemination has also been described. We present the case of a one-month-of age premature infant with apnea, and infection caused by hMPV of probable nosocomial aquisition. Clinical features of hMPV infection are reviewed and its association with apnea and nosocomial transmission is discussed. hMPV should be included in the routine diagnosis of respiratory viruses in infants with apnea and should be considered among the respiratory pathogens associated with nosocomial transmission.

Apnea como forma de presentación de una infección por metapneumovirus humano / Apnea as a presenting symptom in human metapneumovirus infection

Metapneumovirus humano (MPVh), agente de infección respiratoria aguda baja (IRAB) recientemente descrito, ha sido detectado en 5,4 por ciento de lactantes chilenos hospitalizados por IRAB, con estudio negativo para virus respiratorio sincicial, adenovirus, parain-fluenza e influenza. Puede determinar bronquiolitis o neumonía en hospitalizados, en ocasiones llega a requerir conexión a ventilación mecánica y tratamiento en una unidad de cuidados intensivos. En algunos casos se presenta como apnea, situación que es más frecuente en prematuros. Está descrita su transmisión nosocomial. Presentamos el caso de un lactante de un mes de edad, con apnea, antecedente de prematurez e infección por MPVh y una probable adquisición intrahospitalaria. Se revisan las características clínicas de la infección por este agente y se discute la asociación con apnea e infección nosocomial. El MPVh debiera ser incluido en el estudio etiológico de lactantes que presentan apnea con estudio viral convencional negativo y como agente respiratorio de infección nosocomial

Human metapneumovirus (hMPV), a recently described pathogen of lower respiratory tract infections (LRTI), has been detected in 5,4 percent of Chilean infants hospitalized for LRTI whom are negative for adenovirus, respiratory syncytial virus, influenza and parainfluenza viruses. hMPV may cause bronchiolitis or pneumonia in hospitalized patients, and ocassionally require admission to intensive care units and mechanical ventilation. The infection has been associated with apnea, especially in preterm infants. Nosocomial dissemination has also been described. We present the case of a one-month-of age premature infant with apnea, and infection caused by hMPV of probable nosocomial aquisition. Clinical features of hMPV infection are reviewed and its association with apnea and nosocomial transmission is discussed. hMPV should be included in the routine diagnosis of respiratory viruses in infants with apnea and should be considered among the respiratory pathogens associated with nosocomial transmission

Lethal enterovirus-induced myocarditis and pancreatitis in a 4-month-old boy.

After inconspicuous pregnancy and birth, a 16-year-old mother presented her male baby 5 days later with severe diarrhoea and vomiting. During the following weeks, the child temporarily showed hypotension, hypothermia and increased body temperature, bradyarrythmia with apnoea, continuing diarrhoea, sometimes vomiting and developed signs of pancreatic insufficiency. Due to increasing loss of weight and obviously severe dystrophia, parenteral nutrition had to be initiated. All clinical investigations revealed no underlying disease. Numerous biopsies, mainly from the gastrointestinal tract were taken, but no relevant pathological findings were disclosed. The baby was found lifeless by his mother, 4 months after birth. According to the death certificate, the physicians regarded the lethal outcome as a case of sudden infant death syndrome (SIDS). Histological and immunohistochemical investigations of organ samples revealed signs of myocarditis, pancreatitis and focal pneumonia. Molecularpathological techniques were used to detect enterovirus RNA from tissue samples from the myocardium, liver and pancreas. Enteroviral myocarditis with concomitant pancreatitis was determined as cause of death.