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Laya BF, Concepcion NDP, Garcia-Peña P, Naidoo J, Kritsaneepaiboon S, Lee EY. Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:15-40. [PMID: 34836562 DOI: 10.1016/j.rcl.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower respiratory tract infection (LRTI) remains a major cause of morbidity and mortality in children. Various organisms cause LRTI, including viruses, bacteria, fungi, and parasites, among others. Infections caused by 2 or more organisms also occur, sometimes enhancing the severity of the infection. Medical imaging helps confirm a diagnosis but also plays a role in the evaluation of acute and chronic sequelae. Medical imaging tests help evaluate underlying pathology in pediatric patients with recurrent or long-standing symptoms as well as the immunocompromised.
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Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines.
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
| | - Pilar Garcia-Peña
- Autonomous University of Barcelona (AUB), University Hospital Materno-Infantil Vall d'Hebron, Pso. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jaishree Naidoo
- Paeds Diagnostic Imaging and Envisionit Deep AI, 2nd Floor, One-on Jameson Building, 1 Jameson Avenue, Melrose Estate, Johannesburg, 2196, South Africa
| | - Supika Kritsaneepaiboon
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Road, Hat Yai, 90110, Thailand
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Bozzola E, Spina G, Valeriani M, Papetti L, Ursitti F, Agostiniani R, Mascolo C, Ruggiero M, Di Camillo C, Quondamcarlo A, Matera L, Vecchio D, Memo L, Villani A. Management of pediatric post-infectious neurological syndromes. Ital J Pediatr 2021; 47:17. [PMID: 33494818 PMCID: PMC7836589 DOI: 10.1186/s13052-021-00968-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition. AIM OF THE STUDY To elaborate a diagnostic guide for PINS. MATERIALS AND METHODS We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children's Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words "Post-Infectious Neurological Syndromes" were used. RESULTS A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment. DISCUSSION We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging. CONCLUSIONS We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.
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Affiliation(s)
| | | | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | | | | | | | | | | | - Luigi Memo
- Italian Pediatric Society, Florence, Italy
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Le Roux P, Millardet E, Duquenoy A, Labbé F, Vandendriessche A. Pleuropneumonia resulting from varicella and COVID-19 co-infection in a 10-month-old infant. Arch Pediatr 2020; 27:509-510. [PMID: 32933816 PMCID: PMC7836533 DOI: 10.1016/j.arcped.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/23/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022]
Abstract
COVID-19 is a new disease leading to respiratory complications in adults. Children appear to have more modest symptoms than adults. Varicella is often described as a benign disease in the pediatric population. However, patients with varicella and COVID-19 co-infection can develop a more serious respiratory infection. We report the case of an infant who had a co-infection with both viruses that led to pleuropneumonia. The main question in the present case concerns the link between COVID-19 and varicella infection, and the possible modulation in immune response due to the two virus infections.
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Affiliation(s)
- Pascal Le Roux
- Department of Pediatrics, Le Havre Hospital, 76600 Le Havre, France.
| | | | - Anne Duquenoy
- Department of Pediatrics, Le Havre Hospital, 76600 Le Havre, France
| | - Franck Labbé
- Department of Medical Microbiology, Le Havre Hospital, 76600 Le Havre, France
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Bozzola E, Carsetti R, Piano Mortari E, Masci M, Spina G, Villani A. The link between varicella and immune system: which children will develop acute cerebellitis? Ital J Pediatr 2020; 46:75. [PMID: 32471468 PMCID: PMC7260733 DOI: 10.1186/s13052-020-00840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/21/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Varicella may complicate with cerebellitis in previously healthy children, requiring hospitalization. Aim of our study was to define whether children who experienced varicella cerebellitis have a normal immune system. Methods Patients over 3 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for cerebellitis in varicella were asked to participate to the follow-up study. The immune status was evaluated clinically and by laboratory investigations. Results Twenty-five patients were included in the study. At follow up, at least one immunological alteration was detected in 80% of patients. To avoid bias due to possible effects of the recent disease, we separately analyzed patients who had the follow-up control at least 1 year (Group 1) or between 1 month and 1 year (Group 2) after the hospitalization for acute varicella cerebellitis. The results were similar in both groups with immunological alterations detected in 84,6 and 75% of the patients, respectively. Conclusions Our preliminary results indicate that sub-clinical immunological defects may correlate to cerebellitis in varicella.
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Affiliation(s)
- Elena Bozzola
- Pediatric and Infectious Diseases Unit, University/hospital Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Rita Carsetti
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Eva Piano Mortari
- B cell Physiopathology Unit, Immunology Research Area, Bambino Gesù Children Hospital, Rome, Italy
| | - Marco Masci
- Pediatric and Infectious Diseases Unit, University/hospital Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Spina
- Pediatric and Infectious Diseases Unit, University/hospital Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Diseases Unit, University/hospital Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Liu CH, Yeh YC, Huang WT, Chie WC, Chan KA. Assessment of pre-specified adverse events following varicella vaccine: A population-based self-controlled risk interval study. Vaccine 2020; 38:2495-2502. [PMID: 32046891 DOI: 10.1016/j.vaccine.2020.01.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/20/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinical trials and spontaneous reporting systems have revealed rare but biologically plausible adverse events following varicella immunization. Few post-marketing controlled studies have been conducted to assess the relationship between the varicella vaccine and these outcomes. OBJECTIVES To evaluate the risk of pneumonia, idiopathic thrombocytopenic purpura (ITP), meningitis, encephalitis and ischemic stroke following varicella immunization. MATERIALS AND METHODS This nationwide observational study was based on Taiwan National Health Insurance data and National Immunization Information System from 2004 through 2014. Primary analysis included children aged 12-35 months who received the single varicella vaccine on the date of administration. The self-controlled risk interval design compared the incidence of pre-specified outcomes during a risk interval of 1-42 days post-vaccination and a control interval of 43-84 days. The outcomes of interest were defined as admitted pneumonia, ITP, meningitis, encephalitis, and ischemic stroke, as well as fracture as a negative control. Conditional Poisson regression was used to assess the incidence rate ratio (aIRR) with adjustments for age and seasonal effects. RESULTS Among 1,194,189 children, who receiving the varicella vaccine, there was no observed increase in the risk for ITP (aIRR 1.00; 95% CI, 0.76-1.33), meningitis (aIRR 1.21; 95% CI, 0.49-2.95), encephalitis (aIRR 1.00; 95% CI, 0.62-1.60), or ischemic stroke (aIRR 1.24; 95% CI, 0.31-4.95). A clustering feature with pneumonia occurred during days 36-42 post-vaccination (aIRR 1.10; 95% CI, 1.02-1.18). An increase in the risk for ITP was observed in children receiving the varicella and MMR vaccines concomitantly (aIRR 1.70; 95% CI, 1.19-2.43), but not among those receiving the varicella vaccine only. CONCLUSIONS We detected a small risk of incidental pneumonia associated with varicella vaccine in the 6th week after immunization. There was no increase in the risk of other pre-specified adverse events.
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Affiliation(s)
- Chia-Hung Liu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ting Huang
- Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
| | - Wei-Chu Chie
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
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Hagemann C, Krämer A, Grote V, Liese JG, Streng A. Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany). Infect Dis Ther 2019; 8:597-611. [PMID: 31674000 PMCID: PMC6856245 DOI: 10.1007/s40121-019-00273-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV. METHODS Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005-2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression. RESULTS Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1-8.3] in 2005 to 1.5 (95% CI: 0.8-2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0-6.6) in 2005 to 0.5 (95% CI: 0.1-0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%. DISCUSSION Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV. CONCLUSION Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract.
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Affiliation(s)
- Christine Hagemann
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Alexander Krämer
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Veit Grote
- Dr. von Haunersches Children's Hospital, University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
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