Epidemiology, clinical characteristics and risk factors of COVID-19 among children in Saudi Arabia: a multicenter chart review study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) has affected over 100 million cases worldwide. Children accounted for 1-5% of all cases with less reported symptoms and better prognosis compared to adults. This study aimed to describe the epidemiological characteristics and outcomes of pediatric COVID-19 cases in Saudi Arabia in addition to identifying risk factors associated with disease severity. METHODS: This was a multicenter, cross-sectional retrospective study that included confirmed SARS-CoV-2 infection among pediatric patients (< 14 years) from the time of initial identification in March 2020 to the end of July 2020 in 6 centers across the country. Patients were classified based on clinical severity. Study outcomes included time to recovery, need for invasive ventilation, and mortality. Multivariate logistic regression analysis was conducted to explore factors associated with increased disease severity. RESULTS: The study enrolled 567 children with (51.5%) were males, and (44.6%) aged from 6 to 14 years old. Asymptomatic patients accounted for 38.98% of the cases: while 319 patients (56%) had mild disease, and 27 patients (4.76%) had moderate-to-severe disease. Only 10 patients (1.76%) required Pediatric Intensive Care Unit admission. The calculated case-fatality was 0.7%. After performing multivariate regression analysis, chronic lung conditions [adjusted OR = 12.73, 95% CI (2.05-79.12)] and decreased red blood cells (RBCs) count [adjusted OR = 2.43, 95% CI (1.09-5.41] were found to be significant predictors for moderate-to-severe disease (p = 0.006 and 0.030, respectively). CONCLUSION: Most COVID-19 cases in the current study had a benign course of illness and carried an excellent prognosis. Children with chronic lung conditions or low RBCs count are at higher risk to develop moderate-to-severe COVID-19 disease.

Vancomycin-Induced Fever and Neutropenia in an Immunocompetent Patient With Complicated Community-Acquired Pneumonia.

Drug-induced fever can be caused by many medications through several mechanisms. One of the most common mechanisms is an immunologic reaction mediated by drug-induced antibodies. Herein, we report the case of a rare adverse reaction with vancomycin. A six-year-old girl being treated for necrotizing pneumonia with vancomycin developed mild neutropenia, skin rash, and fever two weeks into her therapy. These resolved after stopping vancomycin, with noted reversal of neutropenia and leukopenia. Upon rechallenging the patient with vancomycin, she developed a fever in less than 24 h from the administration. Vancomycin-induced fever was made as a diagnosis of exclusion after all other possible causes were ruled out.

What is Behind Salmonella? Unusual Presentation in Two Pediatric Cases.

Salmonella infection is an international public health concern. Salmonella organisms are Gram-negative bacilli that belong to the family Enterobacteriaceae, and more than 2500 Salmonella serovars have been described. The most common clinical presentations of Salmonella infection are gastroenteritis, bacteremia, enteric fever, and chronic carrier state. Other rare extraintestinal infections include cellulitis, urinary tract infection, pneumonia, endocarditis, meningitis, brain abscess, and osteomyelitis. Salmonella species resistant to first-line treatment such as ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole are referred to as multi-drug resistant. In recent years, extensively drug-resistant (XDR) Salmonella have appeared in Pakistan; XDR strains are resistant to multiple antibiotics, including first-line antibiotics, fluoroquinolones, and third-generation cephalosporins. We report two interesting pediatric cases who presented with uncommon Salmonella infection. The first case is a child diagnosed with XDR typhoid fever in a country where the strain is not endemic. The second case is a child who presented with a Salmonella urinary tract infection who is otherwise immunocompetent and has no apparent underlying structural abnormalities of the urinary tract.

A child with complicated Mycobacterium tuberculosis.

Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide, with ever increasing resistance to commonly used antituberculous drugs. Drug-resistant TB was recognized shortly after the introduction of an effective therapy in the late 1940s, the use of streptomycin, which was the first widely used antituberculosis drug. Patients who received this drug usually had marked and rapid clinical improvement, but treatment failures were common after the first three months of therapy. Most children are infected by household contacts who have TB, particularly parents or other caretakers. Common symptoms of pulmonary TB in children include cough (chronic, without improvement for more than three weeks), fever (higher than 38 °C for more than two weeks), and weight loss or failure to thrive. Findings on a physical exam may suggest the presence of a lower respiratory infection, whereas the clinical presentation of extra pulmonary TB depends on the site of disease. The most common forms of extra pulmonary disease in children are TB of the lymph nodes and of the central nervous system. The role of inadequate treatment and poor compliance in the emergence of resistance highlights the importance of the DOT (Direct Observation Therapy) method in improving treatment outcomes and to control the spread of resistance.