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Joye R, Cousin VL, Malaspinas I, Mwizerwa L, Bouhabib M, Nalecz T, Sologashvili T, Beghetti M, L’Huillier AG, Wacker J. Infective Endocarditis Due to Kingella kingae. Microorganisms 2024; 12:164. [PMID: 38257992 PMCID: PMC10819173 DOI: 10.3390/microorganisms12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Infective endocarditis due to Kingella kingae is a rare but serious invasive infection that occurs mostly in children. Recent advances in nucleic acid amplification testing as well as in cardiac imaging have enabled more accurate diagnosis. A good understanding of the epidemiology and virulence factors remains crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, pathophysiological insights, complications, and therapy regarding Kingella kingae endocarditis in children and adults. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Vladimir L. Cousin
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Iliona Malaspinas
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Leonce Mwizerwa
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Maya Bouhabib
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Tomasz Nalecz
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Tornike Sologashvili
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Arnaud G. L’Huillier
- Pediatric Infectious Disease Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
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Thiriard A, Meyer B, Eberhardt CS, Loevy N, Grazioli S, Adouan W, Fontannaz P, Marechal F, L’Huillier AG, Siegrist CA, Georges D, Putignano A, Marchant A, Didierlaurent AM, Blanchard-Rohner G. Antibody response in children with multisystem inflammatory syndrome related to COVID-19 (MIS-C) compared to children with uncomplicated COVID-19. Front Immunol 2023; 14:1107156. [PMID: 37006315 PMCID: PMC10050384 DOI: 10.3389/fimmu.2023.1107156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesTo comprehensively analyze the quality of the antibody response between children with Multisystem inflammatory syndrome (MIS-C) and age-matched controls at one month after SARS-CoV-2 exposure, and infected in the same time-period.MethodsSerum from 20 MIS-C children at admission, and 14 control children were analyzed. Antigen specific antibody isotypes and subclasses directed against various antigens of SARS-CoV-2 as well as against human common coronavirus (HCoVs) and commensal or pathogenic microorganisms were assessed by a bead-based multiplexed serological assay and by ELISA. The functionality of these antibodies was also assessed using a plaque reduction neutralization test, a RBD-specific avidity assay, a complement deposition assay and an antibody-dependent neutrophil phagocytosis (ADNP) assay.ResultsChildren with MIS-C developed a stronger IgA antibody response in comparison to children with uncomplicated COVID-19, while IgG and IgM responses are largely similar in both groups. We found a typical class-switched antibody profile with high level of IgG and IgA titers and a measurable low IgM due to relatively recent SARS-CoV-2 infection (one month). SARS-CoV-2-specific IgG antibodies of MIS-C children had higher functional properties (higher neutralization activity, avidity and complement binding) as compared to children with uncomplicated COVID-19. There was no difference in the response to common endemic coronaviruses between both groups. However, MIS-C children had a moderate increase against mucosal commensal and pathogenic strains, reflecting a potential association between a disruption of the mucosal barrier with the disease.ConclusionEven if it is still unclear why some children develop a MIS-C, we show here that MIS-C children produce higher titers of IgA antibodies, and IgG antibodies with higher functionality, which could reflect the local gastro-intestinal mucosal inflammation potentially induced by a sustained SARS-CoV-2 gut infection leading to continuous release of SARS-CoV-2 antigens.
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Affiliation(s)
- Anaïs Thiriard
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Christiane S. Eberhardt
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Natasha Loevy
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Wafae Adouan
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Paola Fontannaz
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Fabienne Marechal
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Daphnée Georges
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Enzymology and Protein Folding, Centre for Protein Engineering, InBioS, University of Liège, Liège, Belgium
| | - Antonella Putignano
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud M. Didierlaurent
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Pediatric Immunology and Vaccinology Unit, Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- *Correspondence: Geraldine Blanchard-Rohner,
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Galetto-Lacour A, Cordey S, Papis S, Mardegan C, Luterbacher F, Combescure C, Lacroix L, Gervaix A, Kaiser L, Posfay-Barbe KM, L’Huillier AG. Viremia as a predictor of absence of serious bacterial infection in children with fever without source. Eur J Pediatr 2023; 182:941-947. [PMID: 36399200 PMCID: PMC9672567 DOI: 10.1007/s00431-022-04690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
UNLABELLED Most children with fever without source (FWS) require diagnostic laboratory tests to exclude a serious bacterial infection (SBI), often followed by admission and empirical antibiotics. As febrile children with a viral infection are less likely to have a SBI, identifying patients with systemic viral infection could contribute to exclude SBI. We evaluated whether the presence of virus in the blood could be used as a biomarker to rule out SBI. Children < 3 years old with FWS were prospectively enrolled and had real-time (reverse-transcription) PCR performed on the blood for adenovirus, enterovirus, parechovirus, and HHV6. 20/135 patients had SBI, and in 47/135, at least one virus was detected in the blood. Viremia had a higher sensitivity and negative predictive value (90% and 96%) to rule out SBI compared to CRP (65% and 93%) and PCT (55% and 90%). The odds ratio (OR) for the presence of SBI among non-viremic patients was 5.8 (p = 0.0225), compared to 5.5 for CRP ≥ 40 mg/l (p = 0.0009) and 3.7 for PCT ≥ 0.5 ng/mL (0.0093). This remained significant after adjusting for CRP and PCT (OR 5.6 and 5.9, respectively; p = 0.03 for both). Area under the ROC curve for CRP and PCT were 0.754 and 0.779, respectively, but increased to 0.803 and 0.832, respectively, when combined with viremia. CONCLUSION The presence of viremia had a better performance than commonly used biomarkers to rule-out SBI and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. Larger studies should evaluate the role of point-of-care testing of viruses by (revere-transcription) PCR in the plasma in management algorithms of children with FWS. WHAT IS KNOWN • Most children with FWS have a viral infection, but up to 15% have a SBI; most require laboratory tests, and many admission and empirical antibiotics. • Children with a viral infection are less likely to have a SBI. WHAT IS NEW • Children with a systemic viral infection are less likely to have an SBI. • Viremia is a better predictor of absence of SBI than commonly used biomarkers and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS.
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Affiliation(s)
- Annick Galetto-Lacour
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Samuel Cordey
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sebastien Papis
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Chiara Mardegan
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fanny Luterbacher
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- grid.150338.c0000 0001 0721 9812Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurence Lacroix
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alain Gervaix
- grid.150338.c0000 0001 0721 9812Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Kaiser
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- grid.150338.c0000 0001 0721 9812Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Lorthe E, Bellon M, Michielin G, Berthelot J, Zaballa ME, Pennacchio F, Bekliz M, Laubscher F, Arefi F, Perez-Saez J, Azman AS, L’Huillier AG, Posfay-Barbe KM, Kaiser L, Guessous I, Maerkl SJ, Eckerle I, Stringhini S. Epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak (Alpha variant) in a primary school: A prospective longitudinal study. PLoS One 2022; 17:e0272663. [PMID: 35976947 PMCID: PMC9385020 DOI: 10.1371/journal.pone.0272663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To report a prospective epidemiological, virological and serological investigation of a SARS-CoV-2 outbreak in a primary school. Methods As part of a longitudinal, prospective, school-based surveillance study, this investigation involved repeated testing of 73 pupils, 9 teachers, 13 non-teaching staff and 26 household members of participants who tested positive, with rapid antigen tests and/or RT-PCR (Day 0–2 and Day 5–7), serologies on dried capillary blood samples (Day 0–2 and Day 30), contact tracing interviews and SARS-CoV-2 whole genome sequencing. Results We identified 20 children (aged 4 to 6 years from 4 school classes), 2 teachers and a total of 4 household members who were infected by the Alpha variant during this outbreak. Infection attack rates were between 11.8 and 62.0% among pupils from the 4 school classes, 22.2% among teachers and 0% among non-teaching staff. Secondary attack rate among household members was 15.4%. Symptoms were reported by 63% of infected children, 100% of teachers and 50% of household members. All analysed sequences but one showed 100% identity. Serological tests detected 8 seroconversions unidentified by SARS-CoV-2 virological tests. Conclusions This study confirmed child-to-child and child-to-adult SARS-CoV-2 transmission and introduction into households. Effective measures to limit transmission in schools have the potential to reduce the overall community circulation.
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Affiliation(s)
- Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Mathilde Bellon
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Grégoire Michielin
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julie Berthelot
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - María-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Francesco Pennacchio
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Meriem Bekliz
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florian Laubscher
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Fatemeh Arefi
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Javier Perez-Saez
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew S. Azman
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
- Department of Pediatrics, Gynecology & Obstetrics, Pediatric Infectious Disease Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Department of Pediatrics, Gynecology & Obstetrics, Pediatric Infectious Disease Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Kaiser
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sebastian J. Maerkl
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Isabella Eckerle
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Laboratory of Virology, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
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L’Huillier AG, Ardura MI, Chaudhuri A, Danziger‐Isakov L, Dulek D, Green M, Michaels MG, Posfay‐Barbe KM, Vàsquez L, Benden C. COVID-19 vaccination in pediatric solid organ transplant recipients-Current state and future directions. Pediatr Transplant 2021; 25:e14031. [PMID: 34076928 PMCID: PMC8236924 DOI: 10.1111/petr.14031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Population-level COVID-19 immunization will play a key role in slowing down the SARS-CoV-2 pandemic on a global scale and protect the most at-risk individuals. Thanks to a formidable universal effort, several SARS-CoV-2 vaccines have been marketed less than a year since the first documented COVID-19 case, with promising safety, efficacy, and immunogenicity results in adults. As children were not included in the initial trials, no vaccine is currently approved for individuals <16 years of age. Similarly, immunosuppressed individuals, such as solid organ transplant recipients, were excluded from initial vaccine trials, limiting the understanding of vaccine immunogenicity and safety in this at-risk population. Thus, data regarding COVID-19 vaccination in pediatric solid organ transplantation recipients are currently lacking. METHODS Members of the International Pediatric Transplant Association review the current general status of COVID-19 vaccines focusing on pediatric-specific issues. RESULTS This review provides an overview of COVID-19 vaccines in pediatric SOT recipients and highlights the current paucity of data in both pediatric and transplant settings in terms of safety, immunogenicity, and clinical efficacy. CONCLUSIONS Vaccine trials including children and transplant recipients are underway and will be necessary to characterize COVID-19 vaccine safety, immunogenicity, and efficacy, which will determine potential future research directions.
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Affiliation(s)
- Arnaud G. L’Huillier
- Faculty of MedicineChildren’s Hospital of GenevaGeneva University HospitalsGenevaSwitzerland
| | - Monica I. Ardura
- Nationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
| | | | | | - Daniel Dulek
- Vanderbilt University Medical CenterNashvilleTNUSA
| | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M. Posfay‐Barbe
- Faculty of MedicineChildren’s Hospital of GenevaGeneva University HospitalsGenevaSwitzerland
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L’Huillier AG, Lacour M, Sadiku D, Gadiri MA, De Siebenthal L, Schibler M, Eckerle I, Pinösch S, Kaiser L, Gervaix A, Glangetas A, Galetto-Lacour A, Lacroix L. Diagnostic Accuracy of SARS-CoV-2 Rapid Antigen Detection Testing in Symptomatic and Asymptomatic Children in the Clinical Setting. J Clin Microbiol 2021; 59:e0099121. [PMID: 34190574 PMCID: PMC8373030 DOI: 10.1128/jcm.00991-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022] Open
Abstract
Antigen-based rapid diagnostic tests (RDTs) are used in children despite the lack of data. We evaluated the diagnostic performance of the Panbio-COVID-19 Ag Rapid Test Device (P-RDT) in children. Symptomatic and asymptomatic participants 0 to 16 years old had two nasopharyngeal swabs (NPS) for both reverse transcription-PCR (RT-PCR) and P-RDT. A total of 822 participants completed the study, of which 533 (64.9%) were symptomatic. Among the 119 (14.5%) RT-PCR-positive patients, the P-RDT sensitivity was 0.66 (95% confidence interval [CI] 0.57 to 0.74). Mean viral load (VL) was higher among P-RDT-positive patients than negative ones (P < 0.001). Sensitivity was 0.91 in specimens with VL of >1.0E6 IU/ml (95% CI 0.83 to 0.99) and decreased to 0.75 (95% CI 0.66 to 0.83) for specimens >1.0E3 IU/ml. Among symptomatic participants, the P-RDT displayed a sensitivity of 0.73 (95% CI 0.64 to 0.82), which peaked at 1.00 at 2 days post-onset of symptoms (DPOS) (95% CI 1.00 to 1.00), then decreased to 0.56 (95% CI 0.23 to 0.88) at 5 DPOS. There was a trend toward lower P-RDT sensitivity in symptomatic children <12 years (0.62 [95% CI 0.45 to 0.78]) versus ≥12 years (0.80 [95% CI 0.69 to 0.91]; P = 0.09). In asymptomatic participants, the P-RDT displayed a sensitivity of 0.43 (95% CI 0.26 to 0.61). Specificity was 1.00 in symptomatic and asymptomatic children (95% CI 0.99 to 1.00). The overall 73% and 43% sensitivities of P-RDT in symptomatic and asymptomatic children, respectively, was below the 80% cutoff recommended by the World Health Organization. We observed a correlation between VL and P-RDT sensitivity, as well as variation of sensitivity according to DPOS, a major determinant of VL. These data highlight the limitations of RDTs in children, with the potential exception in early symptomatic children ≥12yrs.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | | | | | - Manuel Schibler
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Isabella Eckerle
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Selina Pinösch
- Division of General Pediatrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alain Gervaix
- Pediatric Emergency Department, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alban Glangetas
- Pediatric Emergency Department, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Pediatric Emergency Department, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurence Lacroix
- Pediatric Emergency Department, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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Pigny F, Wagner N, Rohr M, Mamin A, Cherpillod P, Posfay-Barbe KM, Kaiser L, Eckerle I, L’Huillier AG. Viral co-infections among SARS-CoV-2-infected children and infected adult household contacts. Eur J Pediatr 2021; 180:1991-1995. [PMID: 33502627 PMCID: PMC7838463 DOI: 10.1007/s00431-021-03947-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 11/24/2022]
Abstract
We evaluated the rates of viral respiratory co-infections among SARS-CoV-2-infected children. Twelve percent of SARS-CoV-2-infected children had viral co-infection with one or more common respiratory viruses. This was significantly more frequent than among their SARS-CoV-2-infected adult household contacts (0%; p=0.028). Compared to the same period the previous year, common respiratory viruses were less frequently detected (12% vs 73%, p<0.001).Conclusion: Despite partial lockdown with school and daycare closure, and consequently similar exposure to common viruses between children and adults, SARS-CoV-2-infected children had more frequent viral respiratory co-infections than their SARS-CoV-2-infected adult household contacts. Circulation of common respiratory viruses was less frequent during the SARS-CoV-2 outbreak when compared to the same period last year, showing the impact of partial lockdown on the circulation of common viruses. What is Known: • Viral respiratory co-infections are frequent in children. • SARS-CoV-2 can be identified alongside other respiratory viruses, but data comparing children and adults are lacking. What is New: • Children infected with SARS-CoV-2 are more likely to have viral respiratory co-infections than their SARS-CoV-2-infected adult household contacts, which is surprising in the context of partial lockdown with schools and daycare closed. • When compared to data collected during the same period last year, our study also showed that partial lockdown reduced circulation of common respiratory viruses.
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Affiliation(s)
- Fiona Pigny
- Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Noémie Wagner
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Marie Rohr
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Aline Mamin
- Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Pascal Cherpillod
- Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Centre for Emerging Viral Diseases & Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Isabella Eckerle
- Laboratory of Virology & Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
| | - Arnaud G. L’Huillier
- Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland ,Pediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva, Switzerland
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Grazioli S, Tavaglione F, Torriani G, Wagner N, Rohr M, L’Huillier AG, Leclercq C, Perrin A, Bordessoule A, Beghetti M, Pachlopnik J, Vavassori S, Perreau M, Eberhardt C, Didierlaurent A, Kaiser L, Eckerle I, Roux-Lombard P, Blanchard-Rohner G. Immunological Assessment of Pediatric Multisystem Inflammatory Syndrome Related to Coronavirus Disease 2019. J Pediatric Infect Dis Soc 2020; 10:706-713. [PMID: 33180935 PMCID: PMC7717282 DOI: 10.1093/jpids/piaa142] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recently, cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) have been reported worldwide. Negative polymerase chain reaction (RT-PCR) testing associated with positive serology in most of the cases suggests a postinfectious syndrome. Because the pathophysiology of this syndrome is still poorly understood, extensive virological and immunological investigations are needed. METHODS We report a series of 4 pediatric patients admitted to Geneva University Hospitals with persistent fever and laboratory evidence of inflammation meeting the published definition of MIS-C related to COVID-19, to whom an extensive virological and immunological workup was performed. RESULTS RT-PCRs on multiple anatomical compartments were negative, whereas anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin A (IgA) and immunoglobulin G (IgG) were strongly positive by enzyme-linked immunosorbent assay and immunofluorescence. Both pseudoneutralization and full virus neutralization assays showed the presence of neutralizing antibodies in all children, confirming a recent infection with SARS-CoV-2. The analyses of cytokine profiles revealed an elevation in all cytokines, as reported in adults with severe COVID-19. Although differing in clinical presentation, some features of MIS-C show phenotypic overlap with hemophagocytic lymphohistiocytosis (HLH). In contrast to patients with primary HLH, our patients showed normal perforin expression and natural killer (NK) cell degranulation. The levels of soluble interleukin (IL)-2 receptor (sIL-2R) correlated with the severity of disease, reflecting recent T-cell activation. CONCLUSION Our findings suggest that MIS-C related to COVID-19 is caused by a postinfectious inflammatory syndrome associated with an elevation in all cytokines, and markers of recent T-cell activation (sIL-2R) occurring despite a strong and specific humoral response to SARS-CoV-2. Further functional and genetic analyses are essential to better understand the mechanisms of host-pathogen interactions.
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Affiliation(s)
- Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fedora Tavaglione
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Giulia Torriani
- Geneva Centre for Emerging Viral Diseases, Geneva Switzerland
| | - Noemie Wagner
- Pediatric infectious diseases unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie Rohr
- Pediatric infectious diseases unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G L’Huillier
- Geneva Centre for Emerging Viral Diseases, Geneva Switzerland,Pediatric infectious diseases unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Charlotte Leclercq
- Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Anne Perrin
- Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alice Bordessoule
- Division of Neonatal and Pediatric Intensive Care, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | - Matthieu Perreau
- Division of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Switzerland
| | | | | | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva Switzerland
| | | | - Pascale Roux-Lombard
- Laboratory of Immunology and Allergology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Children’s Hospital of Geneva, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland,Center of Vaccinology, Geneva University Hospitals, Switzerland,Corresponding Author: Geraldine Blanchard Rohner, Children’s Hospital of Geneva, 6, rue Willy-Donzé, 1211 Genève 14, Switzerland,
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10
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Tschopp J, L’Huillier AG, Mombelli M, Mueller NJ, Khanna N, Garzoni C, Meloni D, Papadimitriou-Olivgeris M, Neofytos D, Hirsch HH, Schuurmans MM, Müller T, Berney T, Steiger J, Pascual M, Manuel O, van Delden C. First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study. Am J Transplant 2020; 20:2876-2882. [PMID: 32412159 PMCID: PMC7272999 DOI: 10.1111/ajt.16062] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/25/2023]
Abstract
Immunocompromised patients may be at increased risk for complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, comprehensive data of SARS-CoV-2 infection in solid organ transplant (SOT) recipients are still lacking. We performed a multicenter nationwide observational study within the Swiss Transplant Cohort Study (STCS) to describe the epidemiology, clinical presentation, treatment and outcomes of the first microbiologically documented SARS-CoV-2 infection among SOT recipients. Overall, 21 patients were included with a median age of 56 years (10 kidney, 5 liver, 1 pancreas, 1 lung, 1 heart and 3 combined transplantations). The most common presenting symptoms were fever (76%), dry cough (57%), nausea (33%), and diarrhea (33%). Ninety-five percent and 24% of patients required hospital and ICU admission, respectively, and 19% were intubated. After a median of 33 days of follow-up, 16 patients were discharged, 3 were still hospitalized and 2 patients died. These data suggest that clinical manifestations of SARS-CoV-2 infection in middle-aged SOT recipients appear to be similar to the general population without an apparent higher rate of complications. These results need to be confirmed in larger cohorts.
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Affiliation(s)
- Jonathan Tschopp
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud G. L’Huillier
- Pediatric Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Matteo Mombelli
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas J. Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zürich, Switzerland
| | - Nina Khanna
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Christian Garzoni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Dario Meloni
- Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
| | | | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Hans H. Hirsch
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland,Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | | | - Thomas Müller
- Nephrology clinic, University Hospital Zurich, Zürich, Switzerland
| | - Thierry Berney
- Service of Transplantation, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland
| | - Jürg Steiger
- Department for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva and Faculty of Medicine, Genève, Switzerland,Correspondence Christian van Delden
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L’Huillier AG, Kumar D, Bahinskaya I, Ferreira VH, Humar A. 1532. Increased Risk of Bacterial, Fungal and Other Viral Infections During CMV Infection: Decreased Cytokine Production in Response to Toll-Like Receptor Ligands. Open Forum Infect Dis 2018. [PMCID: PMC6254807 DOI: 10.1093/ofid/ofy210.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arnaud G L’Huillier
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Ilona Bahinskaya
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Victor H Ferreira
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Atul Humar
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
- Transplantation, University of Toronto, Toronto, ON, Canada
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12
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L’Huillier AG, Mardegan C, Cordey S, Luterbacher F, Papis S, Hugon F, Kaiser L, Gervaix A, Posfay-Barbe K, Galetto-Lacour A. 2569. High Incidence of Enterovirus, HHV6, Parechovirus and Adenovirus Blood Viremia in Children 0 to 3 Years Old Presenting With Fever Without Source. Open Forum Infect Dis 2018. [PMCID: PMC6252676 DOI: 10.1093/ofid/ofy209.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Fever without source (FWS) is defined as a fever in which an extensive history and clinical examination fail to identify a cause. Although the vast majority of children with FWS have a self-limited viral infection, up to 10–25% have a serious bacterial infection (SBI). Therefore, many children require invasive diagnostic tests, hospital admission, and empirical administration of broad-spectrum antibiotics. The aim of this study was to assess the respective role of Human enterovirus (HEV), human parechovirus (HPeV), adenovirus (ADV) and herpesvirus type 6 (HHV6) viremia in children <3 years old presenting with FWS. Methods Prospective monocentric diagnostic study. Between November 2015 to December 2017, children <3 year olds with FWS had, in addition to the standardized institutional work-up for FWS, plasma tested by real-time (reverse-transcription) polymerase chain reaction (PCR) for ADV, HHV6, HEV, and HPeV. Specimens with cycle threshold values <40 were considered positive. Quantification was performed on positive specimens for HEV, ADV, and HHV6 specimens when volume permitted. Results One hundred thirty-five patients had plasma PCR for ADV, HHV6, HEV, and HPeV. Male:female ratio was 1.45:1 and median age was 2.4 months (interquartile range 1.3–9.7). Among those, 47/135 (34.8%) had at least 1 virus detected in the plasma. More specifically, HEV was detected in 19 patients (14.1%), HHV6 in 15 (11.1%), HPeV in 8 (5.9%), and ADV in 7 (5.2%). Co-infection with 2 viruses was detected in 2 patients (ADV/HEV and ADV/HPeV). No patient with positive plasma PCR had a positive blood or CSF culture. Two patients with positive plasma PCR fulfilled American Academy of Pediatrics criteria for urinary tract infection. The first was HEV+ in plasma and CSF, midstream urine was positive for leukocytes and grew E. coli 106 CFU/mL, whereas the second was HHV6+ in plasma and catheter urine was positive leukocytes/nitrites and grew P. mirabilis 105 CFU/mL. Conclusion This epidemiological study highlights the frequent detection of active enteroviral, adenoviral, and HHV6 infections in plasma of children with FWS. Virus–virus and virus–bacteria co-infections are rare. Further studies are needed to establish causality between FWS and viremia. Disclosures A. G. L’Huillier, Gertrude Von Meissner foundation: Investigator, Research grant. Ernst and Lucie Schmidheiny foundation: Investigator, Research grant. Research and Development Grant, Geneva University Hospitals: Investigator, Research grant. L. Kaiser, Swiss National Funds: Investigator, Research grant. A. Galetto-Lacour, Gertrude Von Meissner foundation: Investigator, Research grant. Ernst and Lucie Schmidheiny foundation: Investigator, Research grant. Research and Development Grant, Geneva University Hospitals: Investigator, Research grant.
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Affiliation(s)
- Arnaud G L’Huillier
- Pediatric Infectious Diseases Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Chiara Mardegan
- Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Samuel Cordey
- Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Luterbacher
- Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sebastien Papis
- Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Florence Hugon
- Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Klara Posfay-Barbe
- Pediatric Infectious Diseases Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
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13
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14
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L’Huillier AG, Eshaghi A, Racey CS, Ogbulafor K, Lombos E, Higgins RR, Alexander DC, Kristjanson E, Maregmen J, Gubbay JB, Mazzulli T. Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada. Virol J 2018; 15:98. [PMID: 29866178 PMCID: PMC5987625 DOI: 10.1186/s12985-018-0996-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In September 2009, a mumps outbreak originated in New York and spread to Northeastern USA and Canada. This study compares the performance of different diagnostic testing methods used in Ontario and describes molecular characteristics of the outbreak strain. METHODS Between September 2009 and February 2010, specimens from suspect cases were submitted to Public Health Ontario Laboratory for mumps serology, culture and/or real-time reverse-transcriptase PCR (rRT-PCR) testing. rRT-PCR-positive specimens underwent genotyping at Canada's National Microbiology Laboratory. Whole genome sequencing was performed on four outbreak and three sporadic viral culture isolates. RESULTS Six hundred ninety-eight patients had IgM serology testing, of which 255 (37%) had culture and rRT-PCR. Among those, 35/698 (5%) were IgM positive, 39/255 (15%) culture positive and 47/255 (18%) rRT-PCR-positive. Buccal swabs had the highest rRT-PCR positivity (21%). The outbreak isolates were identical to that in the New York outbreak occurring at the same time. Nucleotide and amino acid identity with the Jeryl Lynn vaccine strain ranged from 85.0-94.5% and 82.4-99.4%, depending on the gene and coding sequences. Homology of the HN protein, the main immunogenic mumps virus protein, was found to be 94.5 and 95.3%, when compared to Jeryl Lynn vaccine major and minor components, respectively. CONCLUSIONS Despite higher sensitivity than serology, rRT-PCR testing is underutilized. Further work is needed to better understand the suboptimal match of the HN gene between the outbreak strain and the Jeryl Lynn vaccine strain.
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Affiliation(s)
- Arnaud G. L’Huillier
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Alireza Eshaghi
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - C. Sarai Racey
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Katherene Ogbulafor
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Ernesto Lombos
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Rachel R. Higgins
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - David C. Alexander
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Cadham Provincial Laboratory, Winnipeg, Manitoba R3C 3Y1 Canada
| | - Erik Kristjanson
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jocelyn Maregmen
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jonathan B. Gubbay
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Tony Mazzulli
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5 Canada
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L’Huillier AG, Bogoch II. Aspergilloma. CMAJ 2018; 190:E334. [DOI: 10.1503/cmaj.171483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Cordey S, Vu DL, Schibler M, L’Huillier AG, Brito F, Docquier M, Posfay-Barbe KM, Petty TJ, Turin L, Zdobnov EM, Kaiser L. Astrovirus MLB2, a New Gastroenteric Virus Associated with Meningitis and Disseminated Infection. Emerg Infect Dis 2016; 22:846-53. [PMID: 27088842 PMCID: PMC4861523 DOI: 10.3201/eid2205.151807] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This virus is an unrecognized cause of central nervous system infection, particularly among immunocompromised patients. Next-generation sequencing has identified novel astroviruses for which a pathogenic role is not clearly defined. We identified astrovirus MLB2 infection in an immunocompetent case-patient and an immunocompromised patient who experienced diverse clinical manifestations, notably, meningitis and disseminated infection. The initial case-patient was identified by next-generation sequencing, which revealed astrovirus MLB2 RNA in cerebrospinal fluid, plasma, urine, and anal swab specimens. We then used specific real-time reverse transcription PCR to screen 943 fecal and 424 cerebrospinal fluid samples from hospitalized patients and identified a second case of meningitis, with positive results for the agent in the patient’s feces and plasma. This screening revealed 5 additional positive fecal samples: 1 from an infant with acute diarrhea and 4 from children who had received transplants. Our findings demonstrate that astrovirus MLB2, which is highly prevalent in feces, can disseminate outside the digestive tract and is an unrecognized cause of central nervous system infection.
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Cordey S, Vu DL, Schibler M, L’Huillier AG, Brito F, Docquier M, Posfay-Barbe KM, Petty TJ, Turin L, Zdobnov EM, Kaiser L. Astrovirus MLB2, a New Gastroenteric Virus Associated with Meningitis and Disseminated Infection. Emerg Infect Dis 2016. [DOI: 10.3201/eid2205.150807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
ABSTRACT: Live-attenuated viral vaccines (LAV) have been used safely for several decades in healthy individuals to protect against diseases with great success. In immunocompromised hosts their use is usually not recommended. We explore the use of currently available LAV, such as live-attenuated influenza, varicella–zoster virus, measles, mumps and rubella, oral polio, rotavirus, yellow fever virus vaccines, especially in patients with cancer, solid organ or hematopoietic stem cell transplant, HIV, and with acquired or congenital immunodeficiencies. Although evidence-based recommendations cannot currently be made, it is possible that LAV will be recommended in specific, well-defined situations in these immunocompromised patients in the future.
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Affiliation(s)
- Arnaud G L’Huillier
- Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva & University of Geneva Medical School, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva & University of Geneva Medical School, Geneva, Switzerland
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