Inborn Errors of Immunity in Children With Invasive Pneumococcal Disease: A Multicenter Prospective Study

Mechanical Circulatory Support for Septic Shock in Children and Adults: Different But Similar

Although extracorporeal membrane oxygenation (ECMO) for circulatory support in patients with severe septic shock commenced in newborn infants and children in the late 1980s, ECMO has remained a controversial treatment for adults with refractory septic shock (RSS). This is fundamentally because of differences in the predominant hemodynamic response to sepsis. In newborn infants and very young children ventricular failure, low cardiac output syndrome (LCOS) is the major hemodynamic response whereas adolescents and adults mainly have vasoplegic shock. ECMO is a very effective treatment for cardiogenic shock even shock caused by sepsis, with a survival that has varied from 40% to 70%; vasoplegic shock, however, requires vasopressors rather than ECMO, and hence survival of these patients with ECMO was poor (< 20%). However, since the early 2000s, sepsis- induced cardiomyopathy (SCM) with ventricular failure (identical to LCOS in children) has been increasingly described in adults, and the occurrence of cardiogenic shock caused by septic shock is treatable with ECMO. In the last 6 years, increasing publications of series of adults with RSS and cardiogenic shock receiving ECMO and ∼70+% surviving has led to increased use of VA ECMO for RSS.

Surveillance of Pediatric Invasive Bacterial Diseases in the Veneto Region: Epidemiological Trends and Outcomes over 17 Years (2007-2023)

Introduction: Invasive bacterial diseases (IBDs) such as meningitis and sepsis are significant public health concerns, particularly in pediatric populations. This study analyzes the incidence, outcomes, and bacterial serotype distribution of pediatric IBDs in the Veneto Region over 17 years. Methods: An observational study was conducted using data (2007-2023) from the surveillance system of the Veneto Region, including microbiologically confirmed cases in individuals < 18 years. Differences by age groups and trends were statistically assessed. Results: A total of 535 pediatric IBD cases were reported, with Streptococcus pneumoniae (54.6%), Neisseria meningitidis (19.6%), and Streptococcus agalactiae (13.5%) being the most common pathogens. Haemophilus influenzae infections were more commonly represented in infants under 1 year (41.5%), whereas S. pneumoniae and N. meningitidis were more frequent in the 1-4-year age group (40.8% and 37.1%, respectively). Sepsis was the most common clinical presentation (57.2%), followed by meningitis (36.3%). Serotype analysis revealed that S. pneumoniae serotype 3 was the most prevalent, while serogroup B dominated N. meningitidis cases. Temporal trends generally showed a decline in cases until 2019, a drop during the COVID-19 pandemic, and a subsequent resurgence in 2022-2023. Conclusions: Our research underscores the value of evidence-based epidemiology through robust surveillance systems in tracking IBD trends and serotype shifts, essential for guiding vaccination strategies and public health interventions. These insights highlight the effectiveness of vaccination programs and the necessity of ongoing monitoring to inform public health policies. Improved data integration and completeness are recommended to enhance surveillance accuracy.

Severe Invasive Pneumococcal Disease Caused by Serotype 19A in Children Under Five Years in Tāmaki Makaurau Auckland, Aotearoa New Zealand

BACKGROUND

Increases in childhood invasive pneumococcal disease (IPD) have been reported in several countries following the easing of COVID-19 pandemic mitigations. In Aotearoa New Zealand (AoNZ), a surge in IPD is occurring in young children concurrent with changes in pneumococcal vaccines and declining immunization coverage. We sought to examine epidemiologic and clinical features of IPD among children under 5 years in a large urban region of AoNZ in the 3 years post-COVID-19.

METHODS

Demographic, clinical and laboratory data were collated from children under 5 years with Streptococcus pneumoniae identified from normally sterile sites between January 1, 2021, and December 31, 2023, in Tāmaki Makaurau Auckland, AoNZ.

RESULTS

We identified 93 episodes of IPD (annual incidence of 18-40 cases per 100,000 population per year). Serotype was identified in 68 episodes and 46 (68%) were serotype 19A. Incidence was higher in Pacific children compared with non-Māori, non-Pacific children (incidence rate ratio: 2.3; 95% confidence interval: 1.4-3.7). Bacteremia occurred in 65 (70%) episodes, empyema in 47 (51%), meningitis in 11 (12%) and hemolytic uremic syndrome in 7 (7.5%). All cases of hemolytic uremic syndrome and empyema were only among children with serotype 19A. Two children died, both had serotype 19A, and 13/91 survivors (14%) experienced serious sequelae.

CONCLUSIONS

The use of the pneumococcal conjugate vaccine with lower valency and easing of COVID-19 containment measures each may have contributed to an increase in IPD in AoNZ. Serotype 19A is associated with empyema and causes severe disease in young children. Urgent efforts are required to improve PCV13 coverage in AoNZ.

Clinical and immunological features of specific antibody deficiency in a pediatric hospital in Colombia

Introduction. Specific antibody deficiency is an innate error of humoral immunity characterized by normal levels of immunoglobulin isotypes, recurrent infections, and a reduced reaction to polysaccharide antigens in vaccines. Objective. To describe the clinical and immunological characteristics of patients with specific antibody deficiency attending a pediatric hospital in Bogotá between May 2021 and September 2023. Materials and methods. We reviewed the medical records of 16 patients with specific antibody deficiency. Results. The median age at diagnosis was six and a half years. Nine were male, and 7 had a history of prematurity. Eleven patients had adequate nutritional status, and 7 had standard height. The most frequent recurrent infection was pneumonia, affecting 12 patients; more than half of them experienced some associated complications. The most common phenotype was moderate, and 15 of the individuals received immunoglobulin as definitive treatment. Conclusion. Specific antibody deficiency is a frequently underdiagnosed functional alteration of the immune system. It should be suspected in patients experiencing recurrent otitis media and pneumonia or in cases complicated by septic shock, pleural effusion, or necrotizing pneumonia.