Comparison of SARS-CoV-2 viral load in asymptomatic and symptomatic children attended in a referral public pediatric hospital in Argentina / Comparación de la carga viral de SARS-CoV-2 en niños asintomáticos y sintomáticos atendidos en un hospital pediátrico público de referencia en Argentina

Abstract At present, different reports have shown that children reach similar SARS-CoV-2 viral load (VL) levels compared to adults; however, the impact of VL on children remains ambiguous when asymptomatic versus symptomatic cases are compared. Thus, the aim of this study was to assess VL at the time of diagnosis in asymptomatic and symptomatic SARS-CoV-2 infected children. VL analysis was retrospectively carried out from nasopharyngeal swabs on 82 SARS-CoV-2 infected children, from March to October 2020. Of the 82 children, 31 were asymptomatic. Symptomatic patients had significantly higher VL values compared to asymptomatic ones (median = 7.41 vs4.35 log10 copies/ml, respectively). Notwithstanding, 8 out of 31 asymptomatic children had high VL levels, overlapping levels observed above the first quartile in the symptomatic group. Analysis of different age groups revealed that median VL values were higher in the symptomatic groups, although there was only a significant difference in children younger than 5 years of age. On the other hand, there was no significant difference between the VL values from the 82 SARS-CoV-2 infected children according to age, sex, underlying disease, symptoms or severity of COVID-19 related disease. This study emphasizes the importance of VL analysis in SARS-CoV-2 infected children, who could contribute to viral spread in the community. This concern could be extended to healthcare workers, who are in contact with children.

Resumen Diferentes informes han demostrado que los ninos alcanzan niveles de carga viral (CV) de SARS-CoV-2 similares a los de los adultos, pero el impacto de la CV en los niños continua siendo incierto cuando se compara entre aquellos que son asintomáticos y sintomáticos. El objetivo de este estudio fue evaluar la CV al momento del diagnóstico en ninos asintomáticos y sintomáticos infectados por SARS-CoV-2. El análisis de CV se realizó retrospectivamente a partir de muestras de hisopados nasofaríngeos de 82 niños infectados por SARS-CoV-2 entre marzo y octubre de 2020. De ellos, 31 eran asintomáticos. Encontramos que el grupo sintomático tenía valores de CV significativamente más altos en comparación con el grupo asintomático (mediana = 7,41 vs. 4,35 log10 copias/ml, respectivamente). No obstante, 8 de los 31 ninos asintomáticos presentaron valores de CV elevados, equivalentes a los observados por encima del primer cuartil del grupo sintomático. El análisis por grupos de edad reveló que la mediana de CV fue más alta en los niños sintomáticos, aunque esta diferencia fue significativa solamente en los menores de 5 anos. A su vez, los valores de CV obtenidos a partir de los 82 niños infectados por SARS-CoV-2 no mostraron diferencias significativas según el grupo etario, el sexo, la enfermedad de base, los síntomas y la gravedad de la COVID-19. Este estudio enfatiza la necesidad del análisis de la CV en ninos infectados por SARS-CoV-2, quienes podrían contribuir a la propagación del virus en la comunidad. Esta preocupación podría extenderse a los trabajadores de la salud que están en contacto con los ninños.

Comparison of SARS-CoV-2 viral load in asymptomatic and symptomatic children attended in a referral public pediatric hospital in Argentina.

At present, different reports have shown that children reach similar SARS-CoV-2 viral load (VL) levels compared to adults; however, the impact of VL on children remains ambiguous when asymptomatic versus symptomatic cases are compared. Thus, the aim of this study was to assess VL at the time of diagnosis in asymptomatic and symptomatic SARS-CoV-2 infected children. VL analysis was retrospectively carried out from nasopharyngeal swabs on 82 SARS-CoV-2 infected children, from March to October 2020. Of the 82 children, 31 were asymptomatic. Symptomatic patients had significantly higher VL values compared to asymptomatic ones (median=7.41 vs 4.35log10 copies/ml, respectively). Notwithstanding, 8 out of 31 asymptomatic children had high VL levels, overlapping levels observed above the first quartile in the symptomatic group. Analysis of different age groups revealed that median VL values were higher in the symptomatic groups, although there was only a significant difference in children younger than 5 years of age. On the other hand, there was no significant difference between the VL values from the 82 SARS-CoV-2 infected children according to age, sex, underlying disease, symptoms or severity of COVID-19 related disease. This study emphasizes the importance of VL analysis in SARS-CoV-2 infected children, who could contribute to viral spread in the community. This concern could be extended to healthcare workers, who are in contact with children.

[Epidemiological characteristics according to the progress of SARS-CoV-2 pandemic in a highly complex pediatric hospital in Argentina: a descriptive study]. / Características epidemiológicas según el avance de la pandemia SARS-CoV-2 en un hospital pediátrico de alta complejidad en Argentina: estudio descriptivo.

BACKGROUND: The knowledge of the clinical and evolutionary characteristics of children with SARS-CoV-2 is continuously updated. The true impact of the disease in the pediatric population is still unknown. AIM: To describe the clinical characteristics, the use of resources and the evolution of children with COVID-19 in the Garrahan Pediatric Hospital, Buenos Aires, Argentina, in the first 20 weeks from the identification of the first case. METHODS: Descriptive, analytical, retrospective study. The epidemiological, clinical, evolutionary characteristics and the use of hospital resources of patients < 18 years with confirmed COVID-19 are described. In addition, these characteristics were compared according to whether they occurred in the first 10 epidemiological weeks from the first case of COVID-19 in the hospital or in the following ten weeks. RESULTS: n: 280. The median age was 83 months (IQR 33-144). 209 patients (74.6%) were hospitalized. The median days of hospitalization was 8 days (IQR 3-13). According to the WHO severity classification, there were 184 mild cases (65.7%), 3 moderate (1.1%), 16 severe (5.7%) and 20 critical patients (7.1%). The main reasons for admission to the ICU were not related to SARS-CoV-2 infection. When comparing the characteristics of the patients in the two periods, in the first period there was a higher frequency of underlying comorbidities, immunosuppressive treatment, the consultation was later and the patients had more requirements for ICU admission. Two children (0.7%) died in relation to the infection, both with severe comorbidities and severe bacterial coinfections. CONCLUSION: In this study, patients with underlying disease predominated. The mild form of the disease was the most frequent presentation. At the beginning of the pandemic, there were more patients under immunosuppressive treatment, the consultation was later and the hospitalization was more frequent, prolonged and with more serious clinical pictures.

Características epidemiológicas según el avance de la pandemia SARS-CoV-2 en un hospital pediátrico de alta complejidad en Argentina: estudio descriptivo / Epidemiological characteristics according to the progress of SARS-CoV-2 pandemic in a highly complex pediatric hospital in Argentina: a descriptive study

INTRODUCCIÓN: El conocimiento de las características clínicas y evolutivas de los niños con SARS-CoV-2 está siendo continuamente actualizado. El verdadero impacto de la enfermedad en la población pediátrica es todavía desconocido. OBJETIVO: Describir las características clínicas, el uso de recursos y la evolución de niños con COVID-19 en el Hospital de Pediatría Garrahan, Buenos Aires, Argentina, en las primeras 20 semanas desde la identificación del primer caso. PACIENTES Y MÉTODOS: Estudio descriptivo analítico, retrospectivo. Se describen las características epidemiológicas, clínicas, evolutivas y el uso de recursos hospitalarios de pacientes < 18 años con COVID-19 confirmado. Además, se compararon dichas características según se presentaran en las primeras 10 semanas epidemiológicas desde el primer caso de COVID-19 en el hospital o en las 10 siguientes. RESULTADOS: n: 280. La mediana de edad fue 83 meses (RIC 33-144). Fueron hospitalizados 209 pacientes (74,6 %). La mediana de días de internación fue de 8 días (RIC 3-13). Según la clasificación de gravedad de la OMS, fueron casos leves 184 (65,7%), moderados 3 (1,1%), graves 16 (5,7%) y 20 pacientes críticos (7,1%). Los principales motivos de ingreso a UCI no se relacionaron con la infección por SARS-CoV-2. Al comparar las características de los pacientes en los dos períodos, en el primer período hubo más frecuencia de comorbilidades subyacentes, tratamiento inmunosupresor, la consulta fue más tardía y los pacientes tuvieron más requerimientos de internación en UCI. Fallecieron en relación con la infección dos niños (0,7%), ambos con comorbilidades graves y coinfecciones bacterianas graves. CONCLUSIÓN: En este estudio predominaron los pacientes con enfermedad de base. La forma leve de la enfermedad fue la presentación más frecuente. Al inicio de la pandemia, hubo más pacientes bajo tratamiento inmunosupresor, la consulta fue más tardía y la internación fue más frecuente, prolongada y con cuadros clínicos más graves.

BACKGROUND: The knowledge of the clinical and evolutionary characteristics of children with SARS-CoV-2 is continuously updated. The true impact of the disease in the pediatric population is still unknown. AIM: To describe the clinical characteristics, the use of resources and the evolution of children with COVID-19 in the Garrahan Pediatric Hospital, Buenos Aires, Argentina, in the first 20 weeks from the identification of the first case. METHODS: Descriptive, analytical, retrospective study. The epidemiological, clinical, evolutionary characteristics and the use of hospital resources of patients < 18 years with confirmed COVID-19 are described. In addition, these characteristics were compared according to whether they occurred in the first 10 epidemiological weeks from the first case of COVID-19 in the hospital or in the following ten weeks. RESULTS: n: 280. The median age was 83 months (IQR 33-144). 209 patients (74.6%) were hospitalized. The median days of hospitalization was 8 days (IQR 3-13). According to the WHO severity classification, there were 184 mild cases (65.7%), 3 moderate (1.1%), 16 severe (5.7%) and 20 critical patients (7.1%). The main reasons for admission to the ICU were not related to SARS-CoV-2 infection. When comparing the characteristics of the patients in the two periods, in the first period there was a higher frequency of underlying comorbidities, immunosuppressive treatment, the consultation was later and the patients had more requirements for ICU admission. Two children (0.7%) died in relation to the infection, both with severe comorbidities and severe bacterial coinfections. CONCLUSION: In this study, patients with underlying disease predominated. The mild form of the disease was the most frequent presentation. At the beginning of the pandemic, there were more patients under immunosuppressive treatment, the consultation was later and the hospitalization was more frequent, prolonged and with more serious clinical pictures.

Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2: A Retrospective Cohort Study From Argentina.

OBJECTIVE: To evaluate the differential characteristics of SARS-COV-2 associated inflammatory multisystem syndrome (MIS-C) in children. METHODS: A retrospective cohort study was conducted.  The definition of MIS- C was based on WHO criteria. Temporally related COVID-19 patients were included as controls. RESULTS: 25 patients with MIS-C and 75 controls were included. Multivariate multiple logistic regression model of variables that showed to be significant in univariate analysis revealed that age ≥2 years (OR 24.7; 95% CI 1.03 -592.4; P=0.048), lymphopenia (OR 9.03, 95%CI 2.05-39.7; P=0.004), and platelet count <150x109/L (OR 11.7; 95% CI 1.88-75.22; P=0.009) were significantly associated with MIS-C. Presence of underlying disease seemed to reduce the risk of MIS-C (OR 0.06; 95% CI 0.01-0.3). CONCLUSIONS: MIS-C was more common in patients older than 2 years and in those with lymphopenia or thrombocytopenia. Underlying disease appears to reduce the risk of MIS-C.

Corrigendum to: Bullous dermatosis suspected in an eight-month-old child in Guinea-Bissau: a case report.

[This corrects the article DOI: 10.1093/omcr/omz004.].

Bullous dermatosis suspected in an 8-month-old child in Guinea-Bissau.

An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with severe blistering dermatosis. He was treated with broad spectrum antibiotics and dressings, without improvement. After 2 weeks, linear IgA bullous dermatosis was suspected. Owing to lack of dapsone, the child was treated with prednisolone and improved. To avoid corticosteroids side effects, 2 months after starting prednisolone we switched to colchicine, but the boy's condition worsened for reasons of poor adherence, requiring intravenous corticosteroids and antibiotics. After complete resolution of the skin lesions, we continued with colchicine monotherapy, then changed to dapsone after 3 months. The child did not show any further signs of dermatosis, but his follow-up ended abruptly, because he did not return to the hospital. IgA bullous dermatosis is a challenging diagnosis in settings where pathological studies cannot be conducted. Multidisciplinary treatment is required and colchicine is a good option if dapsone is not available.

Síndrome de Bickerstaff: Caso clínico / Bickerstaff syndrome: Case report

El síndrome de Guillain-Barré se define como una polirradiculoneuropatía aguda, de inicio súbito y cuyo origen es, en la mayor parte de los casos, autoinmune. Se manifiesta como un cuadro de parálisis motora fláccida, de tipo ascendente, acompañada de arreflexia, con alteraciones sensitivas o sin ellas. Es la causa más frecuente de parálisis fláccida aguda en niños previamente sanos. Presenta distintas variantes que forman parte de un mismo espectro. Una de ellas es el síndrome de Bickerstaff, caracterizado por ataxia, oftalmoplejía externa asociada a encefalopatía o hiperreflexia. Es importante el diagnóstico precoz a fin de poder instaurar rápidamente medidas de sostén y tratamiento que beneficiarán a aquellos pacientes que progresan hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 4 años de edad, previamente sano, que presenta cuadro compatible con síndrome de Bickerstaff.

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.

Síndrome de Bickerstaff: Caso clínico / Bickerstaff syndrome: Case report

El síndrome de Guillain-Barré se define como una polirradiculoneuropatía aguda, de inicio súbito y cuyo origen es, en la mayor parte de los casos, autoinmune. Se manifiesta como un cuadro de parálisis motora fláccida, de tipo ascendente, acompañada de arreflexia, con alteraciones sensitivas o sin ellas. Es la causa más frecuente de parálisis fláccida aguda en niños previamente sanos. Presenta distintas variantes que forman parte de un mismo espectro. Una de ellas es el síndrome de Bickerstaff, caracterizado por ataxia, oftalmoplejía externa asociada a encefalopatía o hiperreflexia. Es importante el diagnóstico precoz a fin de poder instaurar rápidamente medidas de sostén y tratamiento que beneficiarán a aquellos pacientes que progresan hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 4 años de edad, previamente sano, que presenta cuadro compatible con síndrome de Bickerstaff.(AU)

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.(AU)

[Bickerstaff syndrome: Case report]. / Síndrome de Bickerstaff: Caso clínico.

Guillain-Barré syndrome is defined as an acute polyradiculoneuropathy, with sudden onset and its origin being mostly autoimmune. It is characterized by flaccid paralysis, symmetrical and ascending, together with areflexia, with or without sensory disturbances. It is the primary cause of acute flaccid paralysis in previously healthy children. Guillain-Barré syndrome presents different variants as part of the same spectrum. One of this is the Bickerstaff syndrome, characterized by ataxia, encephalopathy, hyperreflexia and external ophthalmoplegia. Early diagnosis is important with the view to establishing an early treatment that will be beneficial for those patients that progress to a more serious illness. We report the case of a 4-year-old boy who was previously healthy, and then presented symptoms that are compatible with Bickerstaff syndrome.

Piomiositis bilateral de muslo por Staphylococcus aureus meticilino resistente proveniente de la comunidad / Bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus

La piomiositis es una infección bacteriana aguda del músculo esquelético que resulta en abscesos localizados, únicos o múltiples. El agente etiológico más frecuente es el Staphylococcus aureus, principal patógeno emergente de infecciones invasivas del músculo esquelético en pacientes pediátricos previamente sanos. Es importante el alto índice de sospecha, ya que el diagnóstico precoz y el tratamiento empírico eficaz permiten evitar la progresión hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 8 años de edad, previamente sano, con piomiositis de muslo bilateral por Staphylococcus aureus meticilino resistente de la comunidad.

Primary pyomyositis is an acute bacterial infection of skeletal muscle leading to single or multiple abscess formation. The etiologic agent most frequently identified is Staphylococcus aureus, principal emerging pathogen of invasive musculoskeletal infections in otherwise healthy children. It is important to maintain a high level of suspicion, since early diagnosis and effective empirical treatment may prevent progression to a more severe disease. We present a case of bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus in an otherwise healthy eight-year-old child.

Piomiositis bilateral de muslo por Staphylococcus aureus meticilino resistente proveniente de la comunidad / Bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus

La piomiositis es una infección bacteriana aguda del músculo esquelético que resulta en abscesos localizados, únicos o múltiples. El agente etiológico más frecuente es el Staphylococcus aureus, principal patógeno emergente de infecciones invasivas del músculo esquelético en pacientes pediátricos previamente sanos. Es importante el alto índice de sospecha, ya que el diagnóstico precoz y el tratamiento empírico eficaz permiten evitar la progresión hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 8 años de edad, previamente sano, con piomiositis de muslo bilateral por Staphylococcus aureus meticilino resistente de la comunidad.(AU)

Primary pyomyositis is an acute bacterial infection of skeletal muscle leading to single or multiple abscess formation. The etiologic agent most frequently identified is Staphylococcus aureus, principal emerging pathogen of invasive musculoskeletal infections in otherwise healthy children. It is important to maintain a high level of suspicion, since early diagnosis and effective empirical treatment may prevent progression to a more severe disease. We present a case of bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus in an otherwise healthy eight-year-old child.(AU)

[Bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus]. / Piomiositis bilateral de muslo por Staphylococcus aureus meticilino resistente proveniente de la comunidad.

Primary pyomyositis is an acute bacterial infection of skeletal muscle leading to single or multiple abscess formation. The etiologic agent most frequently identified is Staphylococcus aureus, principal emerging pathogen of invasive musculoskeletal infections in otherwise healthy children. It is important to maintain a high level of suspicion, since early diagnosis and effective empirical treatment may prevent progression to a more severe disease. We present a case of bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus in an otherwise healthy eight-year-old child.

Piomiositis bilateral de muslo por Staphylococcus aureus meticilino resistente proveniente de la comunidad. / [Bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus].

Primary pyomyositis is an acute bacterial infection of skeletal muscle leading to single or multiple abscess formation. The etiologic agent most frequently identified is Staphylococcus aureus, principal emerging pathogen of invasive musculoskeletal infections in otherwise healthy children. It is important to maintain a high level of suspicion, since early diagnosis and effective empirical treatment may prevent progression to a more severe disease. We present a case of bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus in an otherwise healthy eight-year-old child.