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Turkova A, Chan MK, Kityo C, Kekitiinwa AR, Musoke P, Violari A, Variava E, Archary M, Cressey TR, Chalermpantmetagul S, Sawasdichai K, Ounchanum P, Kanjanavanit S, Srirojana S, Srirompotong U, Welch S, Bamford A, Epalza C, Fortuny C, Colbers A, Nastouli E, Walker S, Carr D, Conway M, Spyer MJ, Parkar N, White I, Nardone A, Thomason MJ, Ferrand RA, Giaquinto C, Ford D. D3/Penta 21 clinical trial design: A randomised non-inferiority trial with nested drug licensing substudy to assess dolutegravir and lamivudine fixed dose formulations for the maintenance of virological suppression in children with HIV-1 infection, aged 2 to 15 years. Contemp Clin Trials 2024; 142:107540. [PMID: 38636725 DOI: 10.1016/j.cct.2024.107540] [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: 01/04/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There is increasing interest in utilising two-drug regimens for HIV treatment with the goal of reducing toxicity and improve acceptability. The D3 trial evaluates the efficacy and safety of DTG/3TC in children and adolescents and includes a nested pharmacokinetics(PK) substudy for paediatric drug licensing. METHODS D3 is an ongoing open-label, phase III, 96-week non-inferiority randomised controlled trial(RCT) conducted in South Africa, Spain, Thailand, Uganda and the United Kingdom. D3 has enrolled 386 children aged 2- < 15 years, virologically suppressed for ≥6 months, with no prior treatment failure. Participants were randomised 1:1 to receive DTG/3TC or DTG plus two nucleoside reverse transcriptase inhibitors(NRTIs), stratified by region, age (2- < 6, 6- < 12, 12- < 15 years) and DTG use at enrolment (participants permitted to start DTG at enrolment). The primary outcome is confirmed HIV-1 RNA viral rebound ≥50 copies/mL by 96-weeks. The trial employs the Smooth Away From Expected(SAFE) non-inferiority frontier, which specifies the non-inferiority margin and significance level based on the observed event risk in the control arm. The nested PK substudy evaluates WHO weight-band-aligned dosing in the DTG/3TC arm. DISCUSSION D3 is the first comparative trial evaluating DTG/3TC in children and adolescents. Implications of integrating a PK substudy and supplying data for prompt regulatory submission, were carefully considered to ensure the integrity of the ongoing trial. The trial uses an innovative non-inferiority frontier for the primary analysis to allow for a lower-than-expected confirmed viral rebound risk in the control arm, while ensuring interpretability of results and maintaining the planned sample size in an already funded trial. TRIAL REGISTRATION International Standard Randomised Clinical Trial Number Register: ISRCTN17157458. European Clinical Trials Database: 2020-001426-57. CLINICALTRIALS gov: NCT04337450.
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Affiliation(s)
- Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, UK.
| | - Man K Chan
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Children Health, King Edward VIII Hospital, Enhancing Care Foundation, University of KwaZulu-Natal, Durban, South Africa
| | - Tim R Cressey
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suwalai Chalermpantmetagul
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Steven Welch
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cristina Epalza
- Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - Clàudia Fortuny
- Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Department of Surgery and Medico-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Medical InnovationHealth Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eleni Nastouli
- University College London Great Ormond Street Institute of Child Health, London, UK; University College London Hospitals NHS Trust, Advanced Pathogen Diagnostics Unit, London, UK
| | - Simon Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Dan Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| | | | - Moira J Spyer
- Medical Research Council Clinical Trials Unit at University College London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nazia Parkar
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Iona White
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Carlo Giaquinto
- Fondazione Penta ETS, Padova, Italy; University of Padova, Department of Women and Child Health, Padova, Italy
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, UK
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2
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Sáez-Llorens X, Norero X, Mussi-Pinhata MM, Luciani K, de la Cueva IS, Díez-Domingo J, Lopez-Medina E, Epalza C, Brzostek J, Szymański H, Boucher FD, Cetin BS, De Leon T, Dinleyici EC, Gabriel MÁM, Ince T, Macias-Parra M, Langley JM, Martinón-Torres F, Rämet M, Kuchar E, Pinto J, Puthanakit T, Baquero-Artigao F, Gattinara GC, Arribas JMM, Ramos Amador JT, Szenborn L, Tapiero B, Anderson EJ, Campbell JD, Faust SN, Nikic V, Zhou Y, Pu W, Friel D, Dieussaert I, Lopez AG, McPhee R, Stoszek SK, Vanhoutte N. Safety and Immunogenicity of a ChAd155-Vectored Respiratory Syncytial Virus Vaccine in Infants 6-7 Months of age: A Phase 1/2 Randomized Trial. J Infect Dis 2024; 229:95-107. [PMID: 37477875 PMCID: PMC10786261 DOI: 10.1093/infdis/jiad271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections in infants. This phase 1/2, observer-blind, randomized, controlled study assessed the safety and immunogenicity of an investigational chimpanzee-derived adenoviral vector RSV vaccine (ChAd155-RSV, expressing RSV F, N, and M2-1) in infants. METHODS Healthy 6- to 7-month-olds were 1:1:1-randomized to receive 1 low ChAd155-RSV dose (1.5 × 1010 viral particles) followed by placebo (RSV_1D); 2 high ChAd155-RSV doses (5 × 1010 viral particles) (RSV_2D); or active comparator vaccines/placebo (comparator) on days 1 and 31. Follow-up lasted approximately 2 years. RESULTS Two hundred one infants were vaccinated (RSV_1D: 65; RSV_2D: 71; comparator: 65); 159 were RSV-seronaive at baseline. Most solicited and unsolicited adverse events after ChAd155-RSV occurred at similar or lower rates than after active comparators. In infants who developed RSV infection, there was no evidence of vaccine-associated enhanced respiratory disease (VAERD). RSV-A neutralizing titers and RSV F-binding antibody concentrations were higher post-ChAd155-RSV than postcomparator at days 31, 61, and end of RSV season 1 (mean follow-up, 7 months). High-dose ChAd155-RSV induced stronger responses than low-dose, with further increases post-dose 2. CONCLUSIONS ChAd155-RSV administered to 6- to 7-month-olds had a reactogenicity/safety profile like other childhood vaccines, showed no evidence of VAERD, and induced a humoral immune response. Clinical Trials Registration. NCT03636906.
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Affiliation(s)
- Xavier Sáez-Llorens
- Department of Infectious Diseases, Hospital del Niño Dr. José Renán Esquivel
- Vaccine Research Department, Centro de Vacunación Internacional
- Sistema Nacional de Investigación
- Secretaria Nacional de Ciencia y Tecnologia, Panama City, Panama
| | - Ximena Norero
- Department of Infectious Diseases, Hospital del Niño Dr. José Renán Esquivel
- Vaccine Research Department, Centro de Vacunación Internacional
| | - Marisa Márcia Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Kathia Luciani
- Department of Infectious Diseases, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Panama City, Panama
| | | | - Javier Díez-Domingo
- FISABIO Fundación para el Fomento Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Valencia, Spain
| | - Eduardo Lopez-Medina
- Centro de Estudios en Infectología Pediátrica, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Research and Clinical Trials Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Jerzy Brzostek
- Oddział Dziecięcy, Zespół Opieki Zdrowotnej w Dębicy, Dębica
| | - Henryk Szymański
- Department of Pediatrics, St Hedwig of Silesia Hospital, Trzebnica, Poland
| | - François D Boucher
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada
| | - Benhur S Cetin
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tirza De Leon
- Department of Vaccines, Cevaxin Sede David, Chiriquí, Panama
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Miguel Ángel Marín Gabriel
- Departamento de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - Tolga Ince
- Department of Social Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela
- Vaccines, Infections and Pediatrics Research Group, Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela
- Centro de Investigación Biomédica en Red of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Mika Rämet
- Vaccine Research Center, Tampere University, Tampere, Finland
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Jorge Pinto
- Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Fernando Baquero-Artigao
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario Infantil La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, ISCIII, Madrid, Spain
| | - Guido Castelli Gattinara
- Centro Vaccinazioni, Dipartimento Pediatrico Universitario Ospedaliero, Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Lazio, Rome, Italy
| | | | - Jose Tomas Ramos Amador
- Department of Pediatrics, Universidad Complutense–Instituto de Investigación Sanitaria del Hospital Clínico San Carlos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Leszek Szenborn
- Department of Pediatrics and Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bruce Tapiero
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Canada
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - James D Campbell
- Center for Vaccine Development and Global Health, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Saul N Faust
- National Institute for Health and Care Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | | | | | - Wenji Pu
- GSK, Biostatistics, Rockville, Maryland
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Epalza C, Valadés-Alcaraz A, González-Alba JM, Beltrán-Pavez C, Gutiérrez-López M, Rubio-Garrido M, Fortuny C, Frick MA, Muñoz Medina L, Moreno S, Sanz J, Rojo P, Navarro ML, Holguín Á. Transmitted Drug Resistance and HIV Diversity Among Adolescents Newly Diagnosed With HIV in Spain. Pediatr Infect Dis J 2024; 43:40-48. [PMID: 37922511 DOI: 10.1097/inf.0000000000004138] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Virologic characterization of newly HIV-diagnosed adolescents could help to improve their specific needs. The objective was to describe the transmitted drug resistance mutations (TDR) and its transmission by clusters in this population in Spain. METHODS TDR to retrotranscriptase and protease inhibitors included in the WHO TDR list 2009 implemented in the Calibrated Population Resistance tool v8.0 (Stanford) were studied in HIV pol sequences from all HIV-diagnosed adolescents (12-19-year-old) enrolled during 2004-2019 period in the Spanish pediatric and adult (CoRISpe-CoRIS) cohorts. The found TDR were compared with the provided by the Stanford algorithm v9.0 2021. HIV-1 variants and transmission clusters were also studied. RESULTS Among 410 HIV-1 adolescents diagnosed, 141 (34.4%) had available ART-naive sequences. They were mostly male (81.6%), Spanish (55.3%) and with behavioral risk (92.2%), mainly male-to-male sexual contact (63.1%). TDR prevalence was significantly higher by Stanford versus WHO list (18.4% vs. 7.1%; P = 0.004). The most prevalent TDR by the WHO list was K103N (3.6%) and by Stanford E138A (6.6%), both at retrotranscriptase. E138A, related to rilpivirine/etravirine resistance, was absent in the WHO list. One in 4 adolescents carried HIV-1 non-B variants. We described 5 transmission clusters, and 2 carried TDR mutations. CONCLUSIONS Our data suggest a high TDR prevalence in adolescents with a new HIV diagnosis in Spain, similar to adults, 2 active TDR transmission clusters, and the need for the WHO TDR list update. These findings could have implications for the options of the recently available rilpivirine-related long-acting treatment and in first-line regimen election.
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Affiliation(s)
- Cristina Epalza
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Pediatric Research and Clinical Trials Unit (UPIC) , Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Ana Valadés-Alcaraz
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - José María González-Alba
- Microbiology Department, Hospital Universitario Central de Asturias and Grupo de Investigación Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Carolina Beltrán-Pavez
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Miguel Gutiérrez-López
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Marina Rubio-Garrido
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
| | - Clàudia Fortuny
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Servicio de Pediatría, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Leopoldo Muñoz Medina
- Unidad de Enfermedades Infecciosas, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, IRYCIS, Universidad Alcalá de Henares, Madrid, Spain
| | - José Sanz
- Servicio de Medicina Interna/Enfermedades Infecciosas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Pablo Rojo
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Pediatric Research and Clinical Trials Unit (UPIC) , Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - María Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CoRISpe, Universidad Complutense de Madrid, Madrid, Spain
| | - África Holguín
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Universitario Ramón y Cajal-IRYCIS and CoRISpe, Madrid
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Berzosa A, Guillen S, Epalza C, Escosa L, Navarro ML, Prieto LM, Sainz T, de Ory SJ, Montes M, Abad R, Vázquez JA, García IS, Ramos-Amador JT. Immunogenicity of the Conjugate Meningococcal ACWY-TT Vaccine in Children and Adolescents Living with HIV. Microorganisms 2023; 12:30. [PMID: 38257857 PMCID: PMC10818554 DOI: 10.3390/microorganisms12010030] [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: 11/20/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Children and adolescents living with HIV (CALHIV) are at high risk of meningococcal infections and may present lower immune responses to vaccines. The objectives of this study were to assess the immunogenicity of the quadrivalent Men ACWY-TT vaccine (Nimenrix®) in CALHIV after a two-dose schedule and to describe possible HIV-related factors that may affect the immunogenic response. METHODS A multicenter prospective study was designed, including CALHIV followed in five hospitals in Madrid, between 2019 and 2021. Two doses of the Men ACWY-TT vaccine were administered. Serum bactericidal antibody (SBA) assays using rabbit complement (rSBA) against serogroups C, W, and Y were used to determine seroprotection and vaccine response (the proportion achieving a putative protective titer of ≥eight or a ≥four-fold rise in titer from baseline). Serum was collected at baseline, and at 3 and 12 months after vaccination. RESULTS There were 29 CALHIV included, 76% of whom were perinatally infected. All were receiving TAR and presented a good immunovirological and clinical status overall. At baseline, 45% of CALHIV had seroprotective titers to at least one serogroup, with individual seroprotection rates of 24%, 28%, and 32% against C, W, and Y, respectively. After a two-dose schedule, vaccine response was 83% for each serogroup, eliciting a vaccine response to all serogroups in 69% of them. One year after vaccination, 75% of CALHIV maintained seroprotective titers against the C serogroup, and 96% against W and Y. None of the HIV-related characteristics analyzed could predict vaccine response or antibody duration. CONCLUSIONS CALHIV who received effective TAR and presented a good immuno-virological situation achieved an appropriate vaccine response after two doses of the Men ACWY-TT vaccine, and antibody-mediated protection against serogroups C, W, and Y was maintained in more than 70% of the patients one year after vaccination.
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Affiliation(s)
- Arantxa Berzosa
- Pediatric Infectious Diseases Unit, Department of Paediatrics, Clínico San Carlos Hospital, 28040 Madrid, Spain
- Health Research Institute of the Clínico San Carlos Hospital (IdISSC), 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
| | - Sara Guillen
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital de Getafe, 28905 Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (C.E.); (L.M.P.)
| | - Luis Escosa
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Infectious and Tropical Diseases, Pediatrics, La Paz University Hospital, 28046 Madrid, Spain
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
| | - Maria Luisa Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics and IISGM, Gregorio Marañón Hospital, 28007 Madrid, Spain
- Department of Pediatrics, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Luis M. Prieto
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (C.E.); (L.M.P.)
| | - Talía Sainz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Infectious and Tropical Diseases, Pediatrics, La Paz University Hospital, 28046 Madrid, Spain
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
- Department of Pediatrics, Universidad Autonoma de Madrid (UAM), 28029 Madrid, Spain
| | | | - Marina Montes
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Raquel Abad
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Julio A. Vázquez
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Irene Serrano García
- Health Research Institute of the Clínico San Carlos Hospital (IdISSC), 28040 Madrid, Spain;
| | - José Tomás Ramos-Amador
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Universidad Autonoma de Madrid (UAM), 28029 Madrid, Spain
- Pediatric Infectious Diseases Unit, Head of Department of Pediatrics, Clínico San Carlos Hospital, 28040 Madrid, Spain
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5
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Villaverde S, Caro JM, Domínguez-Rodríguez S, Orellana MÁ, Rojo P, Epalza C, Blázquez-Gamero D. PACTA-Ped: Antimicrobial stewardship programme in a tertiary care hospital in Spain. An Pediatr (Barc) 2023; 99:312-320. [PMID: 37891136 DOI: 10.1016/j.anpede.2023.09.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/12/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Fighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. METHODS We conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children's hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014-2015, period 1 [P1]). The sample consisted of paediatric inpatients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. RESULTS A total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended "no change" to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from є150 356/year during P1 to є98 478/year in P2. CONCLUSION Our ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.
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Affiliation(s)
- Serena Villaverde
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.
| | - José Manuel Caro
- Department of Pharmacy, Hospital Universitario 12 de Octubre, Madrid, Spain; Antimicrobial Stewardship Programme, Hospital 12 de Octubre, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - María Ángeles Orellana
- Antimicrobial Stewardship Programme, Hospital 12 de Octubre, Madrid, Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Antimicrobial Stewardship Programme, Hospital 12 de Octubre, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
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6
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Gaschignard J, Koehl B, Rees DC, Rincón-López E, Vanderfaeillie A, Pascault A, Allali S, Cela E, Odièvre MH, Hau I, Oliveira M, Guillaumat C, Brousse V, de Montalembert M, Navarro Gómez ML, Beldjoudi N, Bardon-Cancho EJ, Epalza C. Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014-2019. Pediatrics 2023; 152:e2022061061. [PMID: 37767606 DOI: 10.1542/peds.2022-061061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited. METHODS Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen. RESULTS We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases). CONCLUSIONS In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.
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Affiliation(s)
- Jean Gaschignard
- Department of Pediatrics, Groupe Hospitalier Nord Essonne, Longjumeau, France
- IAME, INSERM 1137, Hôpital Bichat, Paris, France
| | - Bérengère Koehl
- Departments of Sickle Cell Disease, Hôpital Robert Debré
- Université de Paris-Cité, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - David C Rees
- Red Cell Haematology Laboratory, School of Cancer and Pharmaceutical Sciences, King's College London and King's College Hospital, London, United Kingdom
| | - Elena Rincón-López
- Departments of Pediatrics
- Biomedical Research Networking Center on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alice Pascault
- Departments of Sickle Cell Disease, Hôpital Robert Debré
| | - Slimane Allali
- General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Université Paris Cité
- Université de Paris-Cité, Paris, France
| | - Elena Cela
- Pediatric Hematology and Oncology Unit, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Isabelle Hau
- Department of Pediatrics, Centre Hospitalier Intercommunal, Créteil, France
| | - Marisa Oliveira
- Pediatric Hematology Unit, Hospital D. Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cécile Guillaumat
- Department of Pediatrics, Centre Hospitalier Sud Francilien, Corbeil-Essonne, France
| | - Valentine Brousse
- Departments of Sickle Cell Disease, Hôpital Robert Debré
- Université de Paris-Cité, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - Mariane de Montalembert
- General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Université Paris Cité
- Université de Paris-Cité, Paris, France
| | - Maria Luisa Navarro Gómez
- Departments of Pediatrics
- Biomedical Research Networking Center on Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Naima Beldjoudi
- Epidemiology and Clinical Research Department, GH Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Eduardo Jesus Bardon-Cancho
- Pediatric Hematology and Oncology Unit, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
- Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
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7
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Carrasco Colom J, Manzanares Á, Álvaro Gómez A, Serrano Escribano I, Esquivel E, Pérez-Rivilla A, Moral-Pumarega MT, Aguirre Pascual E, De Vergas J, Reda Del Barrio S, Moraleda C, Epalza C, Fernández-Cooke E, Prieto L, Villaverde S, Zamora B, Herraiz I, Galindo A, Folgueira MD, Delgado R, Blázquez-Gamero D. Clinical outcomes and antibody transfer in a cohort of infants with in utero or perinatal exposure to SARS-CoV-2 (Coronascope Study). Eur J Pediatr 2023; 182:4647-4654. [PMID: 37561198 DOI: 10.1007/s00431-023-05147-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
We aimed to describe the outcomes, focusing on the hearing and neurological development, of infants born to mothers with COVID-19 during pregnancy and to evaluate the persistence of maternal antibodies in the first months of life. An observational, prospective study at a tertiary hospital in Madrid (Spain) on infants born to mothers with COVID-19 during pregnancy between March and September 2020 was conducted. A follow-up visit at 1-3 months of age with a physical and neurological examination, cranial ultrasound (cUS), SARS-CoV-2 RT-PCR on nasopharyngeal swab, and SARS-CoV-2 serology were performed. Hearing was evaluated at birth through the automated auditory brainstem response and at six months of age through the auditory steady-state response. A neurodevelopmental examination using the Bayley-III scale was performed at 12 months of age. Of 95 infants studied, neurological examination was normal in all of them at the follow-up visit, as was the cUS in 81/85 (95%) infants, with only mild abnormalities in four of them. Serology was positive in 47/95 (50%) infants, which was not associated with symptoms or severity of maternal infection. No hearing loss was detected, and neurodevelopment was normal in 96% of the infants (median Z score: 0). CONCLUSION In this cohort, the majority of infants born to mothers with COVID-19 during pregnancy were healthy infants with a normal cUS, no hearing loss, and normal neurodevelopment in the first year of life. Only half of the infants had a positive serological result during the follow-up. WHAT IS KNOWN • Hearing loss and neurodevelopmental delay in infants born to mothers with COVID-19 during pregnancy has been suggested, although data is inconsistent. Maternal antibody transfer seems to be high, with a rapid decrease during the first weeks of life. WHAT IS NEW • Most infants born to mothers with COVID-19 during pregnancy had normal hearing screening, cranial ultrasound, and neurodevelopmental status at 12 months of life. Antibodies against SARS-CoV-2 were only detected in 50% of the infants at two months of life.
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Affiliation(s)
- Jaime Carrasco Colom
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Ángela Manzanares
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain.
| | | | | | - Estrella Esquivel
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Alfredo Pérez-Rivilla
- Microbiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Maria Teresa Moral-Pumarega
- Neonatology Department, Hospital Universitario 12 de Octubre, RICORS Network, ISCIII, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Joaquín De Vergas
- Pediatric Otorhinolaryngology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Reda Del Barrio
- Pediatric Otorhinolaryngology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Elisa Fernández-Cooke
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Luis Prieto
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Serena Villaverde
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
| | - Berta Zamora
- Neuropsychology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ignacio Herraiz
- Universidad Complutense de Madrid, Madrid, Spain
- Fetal Medicine Unit, Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Chronic Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS Network), Instituto de Salud Carlos III, RD21/0012/0024, Madrid, Spain
| | - Alberto Galindo
- Universidad Complutense de Madrid, Madrid, Spain
- Fetal Medicine Unit, Obstetrics and Gynecology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Primary Care Interventions to Prevent Chronic Maternal and Child Diseases of Perinatal and Developmental Origin (RICORS Network), Instituto de Salud Carlos III, RD21/0012/0024, Madrid, Spain
| | - María Dolores Folgueira
- Microbiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Rafael Delgado
- Microbiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Hospital, RECLIP, 12 de Octubre (imas12), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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8
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Aguilera-Alonso D, Escosa-García L, Epalza C, Bravo-Queipo-de-Llano B, Camil Olteanu F, Cendejas-Bueno E, Orellana MÁ, Cercenado E, Saavedra-Lozano J. Antibiotic resistance in bloodstream isolates from high-complexity paediatric units in Madrid, Spain: 2013-2021. J Hosp Infect 2023; 139:33-43. [PMID: 37331378 DOI: 10.1016/j.jhin.2023.05.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) has become a significant challenge in high-complexity healthcare settings. AIM To evaluate the prevalence of AMR in bloodstream isolates from high-complexity paediatric units in Spain over a nine-year period. METHODS A retrospective observational multicentre study was conducted in three tertiary hospitals, analysing bloodstream isolates from patients aged <18 years admitted to the paediatric intensive care, neonatology, and oncology-haematology units between 2013 and 2021. Demographics, antimicrobial susceptibility, and resistance mechanisms were analysed in two periods (2013-2017 and 2017-2021). FINDINGS In all, 1255 isolates were included. AMR was more prevalent in older patients and those admitted to the oncology-haematology unit. Multidrug resistance was observed in 9.9% of Gram-negative bacteria (GNB); 20.0% of P. aeruginosa vs 8.6% of Entero-bacterales (P < 0.001), with an increase in Enterobacterales from 6.2% to 11.0% between the first and the second period (P = 0.021). Difficult-to-treat resistance was observed in 2.7% of GNB; 7.4% of P. aeruginosa vs 1.6% of Enterobacterales (P < 0.001), with an increasing trend in Enterobacterales from 0.8% to 2.5% (P = 0.076). Carbapenem resistance among Enterobacterales increased from 3.5% to 7.2% (P = 0.029), with 3.3% producing carbapenemases (67.9% VIM). Meticillin resistance was observed in 11.0% of S. aureus and vancomycin resistance in 1.4% of Enterococcus spp., with both rates remaining stable throughout the study period. CONCLUSION This study reveals a high prevalence of AMR in high-complexity paediatric units. Enterobacterales showed a concerning increasing trend in resistant strains, with higher rates among older patients and those admitted to oncology-haematology units.
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Affiliation(s)
- D Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - L Escosa-García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain; Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - C Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - B Bravo-Queipo-de-Llano
- Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain
| | - F Camil Olteanu
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Paediatrics, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Cendejas-Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Microbiology, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - M Á Orellana
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - E Cercenado
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - J Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
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9
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Jackson HR, Miglietta L, Habgood-Coote D, D’Souza G, Shah P, Nichols S, Vito O, Powell O, Davidson MS, Shimizu C, Agyeman PKA, Beudeker CR, Brengel-Pesce K, Carrol ED, Carter MJ, De T, Eleftheriou I, Emonts M, Epalza C, Georgiou P, De Groot R, Fidler K, Fink C, van Keulen D, Kuijpers T, Moll H, Papatheodorou I, Paulus S, Pokorn M, Pollard AJ, Rivero-Calle I, Rojo P, Secka F, Schlapbach LJ, Tremoulet AH, Tsolia M, Usuf E, Van Der Flier M, Von Both U, Vermont C, Yeung S, Zavadska D, Zenz W, Coin LJM, Cunnington A, Burns JC, Wright V, Martinon-Torres F, Herberg JA, Rodriguez-Manzano J, Kaforou M, Levin M. Diagnosis of Multisystem Inflammatory Syndrome in Children by a Whole-Blood Transcriptional Signature. J Pediatric Infect Dis Soc 2023; 12:322-331. [PMID: 37255317 PMCID: PMC10312302 DOI: 10.1093/jpids/piad035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/30/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND To identify a diagnostic blood transcriptomic signature that distinguishes multisystem inflammatory syndrome in children (MIS-C) from Kawasaki disease (KD), bacterial infections, and viral infections. METHODS Children presenting with MIS-C to participating hospitals in the United Kingdom and the European Union between April 2020 and April 2021 were prospectively recruited. Whole-blood RNA Sequencing was performed, contrasting the transcriptomes of children with MIS-C (n = 38) to those from children with KD (n = 136), definite bacterial (DB; n = 188) and viral infections (DV; n = 138). Genes significantly differentially expressed (SDE) between MIS-C and comparator groups were identified. Feature selection was used to identify genes that optimally distinguish MIS-C from other diseases, which were subsequently translated into RT-qPCR assays and evaluated in an independent validation set comprising MIS-C (n = 37), KD (n = 19), DB (n = 56), DV (n = 43), and COVID-19 (n = 39). RESULTS In the discovery set, 5696 genes were SDE between MIS-C and combined comparator disease groups. Five genes were identified as potential MIS-C diagnostic biomarkers (HSPBAP1, VPS37C, TGFB1, MX2, and TRBV11-2), achieving an AUC of 96.8% (95% CI: 94.6%-98.9%) in the discovery set, and were translated into RT-qPCR assays. The RT-qPCR 5-gene signature achieved an AUC of 93.2% (95% CI: 88.3%-97.7%) in the independent validation set when distinguishing MIS-C from KD, DB, and DV. CONCLUSIONS MIS-C can be distinguished from KD, DB, and DV groups using a 5-gene blood RNA expression signature. The small number of genes in the signature and good performance in both discovery and validation sets should enable the development of a diagnostic test for MIS-C.
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Affiliation(s)
- Heather R Jackson
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Luca Miglietta
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - Dominic Habgood-Coote
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Giselle D’Souza
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Priyen Shah
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Samuel Nichols
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Ortensia Vito
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Oliver Powell
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Maisey Salina Davidson
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Chisato Shimizu
- Department of Pediatrics, Rady Children’s Hospital and University of California San Diego, La Jolla, California, USA
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Coco R Beudeker
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Karen Brengel-Pesce
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Lyon Sud Hospital, Pierre-Bénite, France
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Michael J Carter
- Paediatric Intensive Care, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Tisham De
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children’s Hospital, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Doce de Octubre, Madrid, Spain
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK
| | - Ronald De Groot
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Katy Fidler
- Academic Department of Paediatrics, Royal Alexandra Children’s Hospital, University Hospitals Sussex, Brighton, UK
| | - Colin Fink
- Micropathology Ltd., University of Warwick, Warwick, UK
| | | | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Sanquin Research, Department of Blood Cell Research, and Landsteiner Laboratory, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Henriette Moll
- Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Irene Papatheodorou
- Gene Expression Team, European Molecular Biology Laboratory, EMBL-European Bioinformatics Institute (EMBL-EBI), Hinxton, Cambridge, UK
| | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Marko Pokorn
- Division of Pediatrics, University Medical Centre Ljubljana and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Irene Rivero-Calle
- Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain
- Genetics–Vaccines–Infectious Diseases and Pediatrics Research Group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
- Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, Galicia, Spain
- GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Doce de Octubre, Madrid, Spain
| | - Fatou Secka
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children’s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Adriana H Tremoulet
- Department of Pediatrics, Rady Children’s Hospital and University of California San Diego, La Jolla, California, USA
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Effua Usuf
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Michiel Van Der Flier
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ulrich Von Both
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- Department of Pediatrics, Children’s Clinical University Hospital, Rīga, Latvia
| | - Werner Zenz
- Department of General Paediatrics, University Clinic of Paediatrics and Adolescent Medicine, Medical University Graz, Austria
| | - Lachlan J M Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Aubrey Cunnington
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Jane C Burns
- Department of Pediatrics, Rady Children’s Hospital and University of California San Diego, La Jolla, California, USA
| | - Victoria Wright
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Federico Martinon-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain
- Genetics–Vaccines–Infectious Diseases and Pediatrics Research Group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
- Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, Galicia, Spain
- GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Jethro A Herberg
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | | | - Myrsini Kaforou
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
| | - Michael Levin
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, SW7 2AZ, UK
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10
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Díez-Domingo J, Sáez-Llorens X, Rodriguez-Weber MA, Epalza C, Chatterjee A, Chiu CH, Lin CY, Berry AA, Martinón-Torres F, Baquero-Artigao F, Langley JM, Ramos Amador JT, Domachowske JB, Huang LM, Chiu NC, Esposito S, Moris P, Lien-Anh Nguyen T, Nikic V, Woo W, Zhou Y, Dieussaert I, Leach A, Gonzalez Lopez A, Vanhoutte N. Safety and Immunogenicity of a ChAd155-Vectored Respiratory Syncytial Virus (RSV) Vaccine in Healthy RSV-Seropositive Children 12-23 Months of Age. J Infect Dis 2023; 227:1293-1302. [PMID: 36484484 PMCID: PMC10226655 DOI: 10.1093/infdis/jiac481] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Safe and effective respiratory syncytial virus (RSV) vaccines remain elusive. This was a phase I/II trial (NCT02927873) of ChAd155-RSV, an investigational chimpanzee adenovirus-RSV vaccine expressing 3 proteins (fusion, nucleoprotein, and M2-1), administered to 12-23-month-old RSV-seropositive children followed up for 2 years after vaccination. METHODS Children were randomized to receive 2 doses of ChAd155-RSV or placebo (at a 1:1 ratio) (days 1 and 31). Doses escalated from 0.5 × 1010 (low dose [LD]) to 1.5 × 1010 (medium dose [MD]) to 5 × 1010 (high dose [HD]) viral particles after safety assessment. Study end points included anti-RSV-A neutralizing antibody (Nab) titers through year 1 and safety through year 2. RESULTS Eighty-two participants were vaccinated, including 11, 14, and 18 in the RSV-LD, RSV-MD, and RSV-HD groups, respectively, and 39 in the placebo groups. Solicited adverse events were similar across groups, except for fever (more frequent with RSV-HD). Most fevers were mild (≤38.5°C). No vaccine-related serious adverse events or RSV-related hospitalizations were reported. There was a dose-dependent increase in RSV-A Nab titers in all groups after dose 1, without further increase after dose 2. RSV-A Nab titers remained higher than prevaccination levels at year 1. CONCLUSIONS Three ChAd155-RSV dosages were found to be well tolerated. A dose-dependent immune response was observed after dose 1, with no observed booster effect after dose 2. Further investigation of ChAd155-RSV in RSV-seronegative children is warranted. CLINICAL TRIALS REGISTRATION NCT02927873.
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Affiliation(s)
| | - Xavier Sáez-Llorens
- Department of Infectious Diseases, Hospital del Niño Dr José Renán Esquivel and Cevaxin Clinical Research Center, Panama City, Panama
- National Investigation System, Senacyt, Panama City, Panama
| | | | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
- Research and Clinical Trials Unit, Madrid, Spain
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
- RITIP (Traslational Research Network in Pediatric Infectious Diseases), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University Taoyuan, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
| | - Andrea A Berry
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Genetics, Vaccines, Infectious Diseases and Pediatrics Research Group, Spain, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Galicia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Baquero-Artigao
- Hospital Universitario Infantil La Paz, Department of Infectious Diseases and Tropical Pediatrics, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Joanne M Langley
- Canadian Center for Vaccinology, Iwk Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | - José T Ramos Amador
- Departamento De Salud Pública Y Materno-infantil, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Joseph B Domachowske
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Susanna Esposito
- Pietro Barilla Children's Hospital, University of Parma, Pediatric Clinic, Parma, Italy
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11
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Tagarro A, Domínguez-Rodríguez S, Mesa JM, Epalza C, Grasa C, Iglesias-Bouzas MI, Fernández-Cooke E, Calvo C, Villaverde S, Torres-Fernández D, Méndez-Echevarria A, Leoz I, Fernández-Pascual M, Saavedra-Lozano J, Soto B, Aguilera-Alonso D, Rivière JG, Fumadó V, Martínez-Campos L, Vivanco A, Pilar-Orive FJ, Alcalá P, Ruiz B, López-Machín A, Oltra M, Moraleda C. Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies. Eur J Pediatr 2023; 182:461-466. [PMID: 36282324 PMCID: PMC9595092 DOI: 10.1007/s00431-022-04649-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023]
Abstract
Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG. Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.
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Affiliation(s)
- Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
- RITIP (Translational Research Network On Paediatric Infectious Diseases), Madrid, Spain.
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Juan Miguel Mesa
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain
- Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Grasa
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elisa Fernández-Cooke
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Cristina Calvo
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Serena Villaverde
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - David Torres-Fernández
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Ana Méndez-Echevarria
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Inés Leoz
- Paediatrics Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Paediatrics Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - David Aguilera-Alonso
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacques G Rivière
- Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Leticia Martínez-Campos
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - Ana Vivanco
- Paediatrics Intensive Care Unit, Hospital Central de Asturias, Asturias, Spain
| | | | - Pedro Alcalá
- Paediatrics Department, Hospital General de Alicante, Alicante, Spain
| | - Beatriz Ruiz
- Paediatrics Department, Hospital Reina Sofía, Córdoba, Spain
| | | | - Manuel Oltra
- Paediatrics Department, Hospital La Fe, Valencia, Spain
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
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12
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Epalza C, Domínguez-Rodríguez S, Cervantes E, Jiménez de Ory S, Frick MA, Fortuny C, Soler-Palacín P, Prieto-Tato L, Sainz T, Carreras-Abad C, Montero Alonso M, de Zárraga Fernández MA, Ocampo A, Rojo P, Navarro ML. Factors associated with late presentation for HIV care in adolescents in Spain. HIV Med 2022; 23:1195-1201. [PMID: 36178091 DOI: 10.1111/hiv.13407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Late presenters (LP) for HIV care are associated with higher morbidity and mortality rates. Our aim was to describe the characteristics associated with LP among adolescents in Spain. Identification of particular features may help in the design of strategies for improvement. METHODS Late-presenting adolescents diagnosed at 12-19 years of age and enrolled in the Spanish paediatric and adult HIV/AIDS cohorts (CoRIS-CoRISpe) from 2004 to 2019 were selected. LP were defined as those presenting with CD4 count <350 cells/mm3 or an AIDS-defining event in the 6 months following HIV diagnosis. Confirmed low CD4 count in the next 3 months and before antiretroviral treatment initiation defined confirmed LP (cLP). RESULTS Of 410 adolescents newly diagnosed with HIV, 303 (73.9%) had available data for assessing late presentation. Of these, 34.7% were LP and 23.7% were cLP. The median CD4 count for cLP was 235 cells/mm3 (interquartile range 122-285). In a multivariable analysis, adolescents at the highest risk of late presentation were early adolescents (age 12-14 years; odds ratio [OR] 6.50; 95% confidence interval [CI] 2.61-18.2), middle adolescents (age 15-17 years; OR 1.85; 95% CI 0.92-3.59), and adolescents born abroad (OR 1.71; 95% CI 0.97-3.00), particularly those of African origin (OR 3.08; 95% CI 1.38-6.79). CONCLUSIONS One-quarter of adolescents presented late for HIV care in Spain. Early adolescents, middle adolescents, and those born abroad presented a sevenfold, twofold, and twofold higher risk of being cLP, respectively. Enhancing the awareness of HIV risk and the access to care, especially for younger and foreign adolescents, could help reduce late presentation and tackle the adolescent HIV epidemic.
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Affiliation(s)
- Cristina Epalza
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Eloisa Cervantes
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Santiago Jiménez de Ory
- Grupo de Enfermedades Infecciosas en la Población Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón Madrid, Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Clàudia Fortuny
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain.Departament de Pediatria, Universitat de Barcelona Facultat de Medicina, Barcelona, Spain
| | - Pere Soler-Palacín
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Luis Prieto-Tato
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Talía Sainz
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Department of Pediatrics. Hospital Universitario La Paz - IdiPAZ Research Institute. Universidad Autónoma de Madrid, Spain
| | - Clara Carreras-Abad
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Montero Alonso
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | | | - Antonio Ocampo
- Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Maria Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). UCM, Madrid, Spain
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13
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del Valle R, Ballesteros Á, Calvo C, Sainz T, Mendez A, Grasa C, Molina PR, Mellado MJ, Sanz‐Santaeufemia FJ, Herrero B, Calleja L, Soriano‐Arandes A, Melendo S, Rincón‐López E, Hernánz A, Epalza C, García‐Baeza C, Rupérez‐García E, Berzosa A, Ocaña A, Villarroya‐Villalba A, Barrios A, Otheo E, Galán JC, Rodríguez MJ, Mesa JM, Domínguez‐Rodríguez S, Moraleda C, Tagarro A. Comparison of pneumonia features in children caused by SARS-CoV-2 and other viral respiratory pathogens. Pediatr Pulmonol 2022; 57:2374-2382. [PMID: 35754093 PMCID: PMC9349806 DOI: 10.1002/ppul.26042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/01/2022] [Accepted: 06/23/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pneumonia is a frequent manifestation of coronavirus disease 2019 (COVID-19) in hospitalized children. METHODS The study involved 80 hospitals in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical and radiological characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from ValsDance (retrospective) cohort. RESULTS In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP were included. Main clinical features of SARS-CoV-2-associated CAP were cough, fever, or dyspnea. Lymphopenia was found in 43% patients and 15% required admission to the pediatric intensive care unit (PICU). Chest X-ray revealed condensation (42%) and other infiltrates (58%). Compared with CAP from other viral pathogens, COVID-19 patients were older, with lower C-reactive protein (CRP) levels, less wheezing, and greater need of mechanical ventilation (MV). There were no differences in the use of continuous positive airway pressure (CPAP) or HVF, or PICU admission between groups. CONCLUSION SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap and differentiating the etiology may be difficult. The overall prognosis is good.
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Affiliation(s)
- Rut del Valle
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Talía Sainz
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Research Center, Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos III, Madrid, SpainMadridSpain
| | - Ana Mendez
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Paula R. Molina
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - María J. Mellado
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz)RITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | | | - Blanca Herrero
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Lourdes Calleja
- Pediatrics DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Antoni Soriano‐Arandes
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of PediatricsHospital Universitario Vall d'HebronBarcelonaSpain
| | - Elena Rincón‐López
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
| | - Alicia Hernánz
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario Gregorio MarañónMadridSpain
- Research CenterGregorio Marañón Research Institute (IiSGM)MadridSpain
| | - Cristina Epalza
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | - Carmen García‐Baeza
- Pediatric Infectious Diseases Unit, Department of PediatricsHospital Universitario 12 de OctubreMadridSpain
| | | | - Arantxa Berzosa
- Pediatrics DepartmentHospital Universitario Clínico San CarlosMadridSpain
| | - Angustias Ocaña
- Pediatric Intensive Care Unit DepartmentHospital La MoralejaMadridSpain
| | - Alvaro Villarroya‐Villalba
- Pediatric Infectious Diseases Unit, Pediatrics DepartmentHospital Universitari i Politècnic La FeValenciaSpain
| | - Ana Barrios
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Enrique Otheo
- Pediatrics Department, Hospital Universitario Ramón y CajalUniversidad de Alcalá MadridMadridSpain
| | - Juan C. Galán
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Mario José Rodríguez
- Microbiology Department, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS)MadridSpain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Juan M. Mesa
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
| | - Sara Domínguez‐Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Cinta Moraleda
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
| | - Alfredo Tagarro
- Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
- Pediatric Research and Clinical Trials Unit (UPIC), Pediatrics Department, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Fundación de Investigación Biomédica Hospital 12 de OctubreRITIP (Translational Research Network in Paediatric Infectious Diseases)MadridSpain
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14
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Grasa Lozano CD, Baro-Fernández M, Rubio-San-Simón A, Blázquez-Gamero D, López-Roa P, Liébana C, Guerra-García P, Moraleda C, Epalza C. Tuberculosis screening after detection of a case in a paediatric haemato-oncology unit in a low prevalence country. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:423-427. [PMID: 36195406 DOI: 10.1016/j.eimce.2020.12.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/17/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. METHODS After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. RESULTS After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. CONCLUSIONS The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.
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Affiliation(s)
- Carlos Daniel Grasa Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain; Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.
| | - María Baro-Fernández
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Alba Rubio-San-Simón
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
| | - Paula López-Roa
- Microbiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Constanza Liébana
- Paediatric Radiology Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Pilar Guerra-García
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cinta Moraleda
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
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15
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Torres-Fernandez D, Jiménez de Ory S, Fortuny C, Sainz T, Falcón D, Bernal E, Jiménez MC, Vilasaró MN, Epalza C, Navarro M, Ramos JT, Holguín Á, Prieto L. Integrase inhibitors in children and adolescents: clinical use and resistance. J Antimicrob Chemother 2022; 77:2784-2792. [PMID: 35971971 DOI: 10.1093/jac/dkac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although integrase inhibitor (INI)-based regimens are now the first-line choice for all people living with HIV, experience among children and adolescents is still scarce. We describe the characteristics and outcomes of a paediatric/adolescent cohort on INI-based ART. METHODS Retrospective analysis of HIV-infected patients below 18 years of age who started an INI-based regimen from 2007 to 2019, enrolled in the Spanish National Adult (CoRIS) and Paediatric (CoRISpe) cohorts. Resistance mutations were identified by the Stanford HIV Drug Resistance Database. RESULTS Overall, 318 INI-based regimens were implemented in 288 patients [53.8% female; median age at start of 14.3 years (IQR 12.0-16.3)]. Most were born in Spain (69.1%), vertically infected (87.7%) and treatment-experienced (92.7%). The most frequently prescribed INI was dolutegravir (134; 42.1%), followed by raltegravir (110; 34.6%) and elvitegravir (73; 23.0%). The median exposure was 2.0 years (IQR 1.1-3.0). The main reasons to start an INI-based therapy were treatment simplification (54.4%) and virological failure (34.3%). In total, 103 (32.4%) patients interrupted their regimen: 14.5% for simplification and 8.5% due to virological failure. Most subjects who received dolutegravir (85.8%) and elvitegravir (83.6%) did not interrupt their regimen and maintained undetectable viral load. There were only five virological failures with dolutegravir and three with elvitegravir. There were no interruptions related to adverse events. Seven patients with virological failure presented major resistance mutations to INIs; none of them were on dolutegravir. CONCLUSIONS INI-based regimens were effective and safe for HIV treatment in children and adolescents. Dolutegravir and elvitegravir presented an excellent profile, and most patients achieved and maintained viral suppression.
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Affiliation(s)
- David Torres-Fernandez
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Santiago Jiménez de Ory
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Talía Sainz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Hospital Universitario La Paz and La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain.,Universidad Autonoma de Madrid (UAM), Madrid, Spain
| | - Dolores Falcón
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Marisa Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Paediatric Infectious Diseases Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - José Tomás Ramos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Hospital Clínico San Carlos, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - África Holguín
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Prieto
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
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16
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Epalza C, Prieto-Tato L, Pino R, Escartín-Paredes P, Leoz I, Grasa C, Vivanco-Allende A, Rivière JG, Carrasco-Colom J, Villate O, Fumadó V, Hermoso-Ibañez C, Herrero B, Aguilera-Alonso D, Tagarro A, Moraleda C. Safety and Acceptance of COVID-19 Vaccination After Multisystem Inflammatory Syndrome in Children (MIS-C) in Spain. J Pediatric Infect Dis Soc 2022; 11:471-473. [PMID: 35904132 PMCID: PMC9384566 DOI: 10.1093/jpids/piac076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this cohort of 42 adolescents with a previous multisystem inflammatory syndrome (MIS-C) diagnosis, 32 (76.2%) were vaccinated with COVID-19 vaccines, with a low incidence of relevant adverse events. More importantly, no new MIS-C or myocarditis occurred after a median of 10 weeks (range 5.3-19.7) post-vaccination.
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Affiliation(s)
- Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Luis Prieto-Tato
- Corresponding Author: Luis Prieto-Tato, PhD, Hospital Universitario 12 de Octubre, Servicio de Pediatría, Avenida de Córdoba s/n, 28041 Madrid, Spain. E-mail:
| | - Rosa Pino
- Department of Pediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Paula Escartín-Paredes
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inés Leoz
- Pediatric Intensive Care Unit, Pediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), CIBER en Enfermedades Infecciosas (CIBERINFEC) (ISCIII), Madrid, Spain
| | - Ana Vivanco-Allende
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jacques G Rivière
- Infection in Immunocompromised Pediatric Patients Research Group, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Barcelona, Spain,Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Jaume Carrasco-Colom
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Universitario Son Espases, Palma (Illes Balears), Spain
| | - Olatz Villate
- Pediatric Oncology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Concepción Hermoso-Ibañez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Blanca Herrero
- Pediatric Hemato-Oncology Unit, Pediatric Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - David Aguilera-Alonso
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC) (ISCIII), Madrid, Spain
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17
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Aguilera-Alonso D, Epalza C, Sanz-Santaeufemia FJ, Grasa C, Villanueva-Medina S, Melendo Pérez S, Cervantes Hernández E, Urretavizcaya-Martínez M, Pino R, Gómez M, Orive J, González Zárate A, Vidal Lana P, González Montero R, Ruiz González S, Calvo C, Iglesias-Bouzas MI, Caro-Teller JM, Domínguez-Rodríguez S, Ballesteros Á, Mesa J, Cobos-Carrascosa E, Tagarro A, Moraleda C. Antibiotic Prescribing in Children Hospitalized With COVID-19 and Multisystem Inflammatory Syndrome in Spain: Prevalence, Trends, and Associated Factors. J Pediatric Infect Dis Soc 2022; 11:225-228. [PMID: 35188190 PMCID: PMC8903467 DOI: 10.1093/jpids/piac003] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain.
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Affiliation(s)
- David Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Unidad de Investigación Maternoinfantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Corresponding Author: Cristina Epalza, MD, Hospital Universitario 12 de Octubre, Servicio de Pediatría, Avenida de Córdoba s/n, 28041 Madrid, Madrid, Spain. E-mail:
| | | | - Carlos Grasa
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Sara Villanueva-Medina
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Melendo Pérez
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall dʹHebron, Vall dʹHebron Research Institute, Barcelona, Spain
| | | | | | - Rosa Pino
- Pediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Marisa Navarro Gómez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Unidad de Investigación Maternoinfantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Pilar Orive
- Pediatric Critical Care Service, Hospital Universitario Cruces, Barakaldo, Spain,Pediatric Critical Care Group, BioCruces Health Research Institute, Barakaldo, Spain
| | - Ana González Zárate
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Paula Vidal Lana
- Department of Pediatrics, Hospital Lozano Blesa, Zaragoza, Spain
| | | | - Sara Ruiz González
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Cristina Calvo
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | | | | | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Juan Mesa
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Elena Cobos-Carrascosa
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Alfredo Tagarro
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
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18
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Tagarro A, Sanz-Santaeufemia FJ, Grasa C, Cobos E, Yebra J, Alonso-Cadenas JA, Baquero-Artigao F, Mesa-Guzmán JM, Pérez-Seoane B, Calvo C, Herreros ML, Epalza C, Melendo S, Dominguez-Rodriguez S, Vidal P, Pacheco M, Ballesteros A, Bernardino M, Villanueva-Medina S, Rodríguez-Molino P, Miragaya Castro S, Rivière J, Garcés R, Santiago B, Fumadó V, Urretavizcaya-Martínez M, García-García ML, Penín M, Cava F, Sáez E, Iglesias-Bouzas MI, Herrero B, Reinoso TDJ, Moraleda C. Dynamics of Reverse Transcription-Polymerase Chain Reaction and Serologic Test Results in Children with SARS-CoV-2 Infection. J Pediatr 2022; 241:126-132.e3. [PMID: 34571020 PMCID: PMC8463102 DOI: 10.1016/j.jpeds.2021.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. STUDY DESIGN The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (<14 and ≥14 days after diagnosis) phase. RESULTS In total, 324 patients were included in the study. The median time to RT-PCR negativity was 17 days (IQR, 8-29 days), and 35% of patients remained positive more than 4 weeks after the first RT-PCR test. The probability of RT-PCR negativity did not differ across groups defined by sex, disease severity, immunosuppressive drugs, or clinical phenotype. Globally, 24% of children failed to seroconvert after infection. Seroconversion was associated with hospitalization, persistence of RT-PCR positivity, and days of fever. CONCLUSIONS Time to RT-PCR negativity was long, regardless of the severity of symptoms or other patient features. This finding should be considered when interpreting RT-PCR results in a child with symptoms, especially those with mild symptoms. Seroprevalence and postimmunization studies should consider that 11 in 4 infected children fail to seroconvert.
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Affiliation(s)
- Alfredo Tagarro
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Pediatrics Research Group, Europea University of Madrid, Madrid, Spain,Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | | | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Elena Cobos
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Julia Yebra
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Juan Miguel Mesa-Guzmán
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Beatriz Pérez-Seoane
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - María Luisa Herreros
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Epalza
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Sara Dominguez-Rodriguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Paula Vidal
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Mónica Pacheco
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alvaro Ballesteros
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - María Bernardino
- Pediatrics Research Group, Europea University of Madrid, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Jacques Rivière
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Rosa Garcés
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Begoña Santiago
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | | | | | - María Penín
- Pediatrics Departament, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Fernando Cava
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Elena Sáez
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Blanca Herrero
- Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Teresa de Jesús Reinoso
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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19
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Otheo E, Rodríguez M, Moraleda C, Domínguez-Rodríguez S, Martín MD, Herreros ML, Vázquez C, Folgueira MD, Pérez-Rivilla A, Jensen J, López A, Berzosa A, Sanz de Santaeufemia FJ, Jiménez AB, Sainz T, Llorente M, Santos M, Garrote E, Muñoz C, Sánchez P, Illán M, Coca A, Barrios A, Pacheco M, Arquero C, Gutiérrez L, Epalza C, Rojo P, Serna-Pascual M, Mota I, Moreno S, Galán JC, Tagarro A. Viruses and Mycoplasma pneumoniae are the main etiological agents of community-acquired pneumonia in hospitalized pediatric patients in Spain. Pediatr Pulmonol 2022; 57:253-263. [PMID: 34633153 DOI: 10.1002/ppul.25721] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN Observational, multicenter, and prospective study. PATIENT SELECTION This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.
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Affiliation(s)
- Enrique Otheo
- Department of Pediatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Mario Rodríguez
- Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cinta Moraleda
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - María D Martín
- Department of Microbiology, Laboratorio BR Salud, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - María L Herreros
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Carmen Vázquez
- Department of Pediatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - María D Folgueira
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Alfredo Pérez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Julia Jensen
- Department of Pediatrics, Hospital Infanta Cristina , Parla, Madrid, Spain
| | - Agustín López
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Arantxa Berzosa
- Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Ana B Jiménez
- Department of Pediatrics, Fundación Jiménez Díaz, Madrid, Spain
| | - Talía Sainz
- RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Marta Llorente
- Department of Pediatrics, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Mar Santos
- RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Elisa Garrote
- Department of Pediatrics, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Cristina Muñoz
- Department of Pediatrics, Hospital General de Villalba, Villalba, Madrid, Spain
| | - Paula Sánchez
- Pediatric Infectious Diseases, Immunology and Rheumatology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Marta Illán
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Coca
- Pediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Barrios
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Mónica Pacheco
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Carmen Arquero
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Lourdes Gutiérrez
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Cristina Epalza
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Pablo Rojo
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain
| | - Miquel Serna-Pascual
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Inmaculada Mota
- Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan C Galán
- Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alfredo Tagarro
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain.,RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain.,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.,Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
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20
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Andina‐Martinez D, Alonso‐Cadenas JA, Cobos‐Carrascosa E, Bodegas I, Oltra‐Benavent M, Plazaola A, Epalza C, Jimenez‐García R, Moraleda C, Tagarro A. SARS-CoV-2 acute bronchiolitis in hospitalized children: Neither frequent nor more severe. Pediatr Pulmonol 2022; 57:57-65. [PMID: 34664782 PMCID: PMC8661835 DOI: 10.1002/ppul.25731] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Endemic coronaviruses have been found in acute bronchiolitis, mainly as a coinfecting virus. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for respiratory illness in hospitalized children. The characteristics of patients with bronchiolitis have not been extensively described. METHODS Cross-sectional study of patients with bronchiolitis and SARS-CoV-2 infection enrolled in a prospective multicenter cohort of children hospitalized with COVID-19 in Spain from March 1, 2020 to February 28, 2021. RESULTS Twelve of 666 children infected with SARS-CoV-2 who required hospital admission met the diagnostic criteria for bronchiolitis (1.8%). Median age was 1.9 months (range: 0.4-10.1). Six cases had household contact with a confirmed or probable COVID-19 case. Main complaints were cough (11 patients), rhinorrhea (10), difficulty breathing (8), and fever (8). Eleven cases were classified as mild or moderate and one as severe. Laboratory tests performed in seven patients did not evidence anemia, lymphopenia, or high C-reactive protein levels. Chest X-rays were performed in six children, and one case showed remarkable findings. Coinfection with metapneumovirus was detected in the patient with the most severe course; Bordetella pertussis was detected in another patient. Seven patients required oxygen therapy. Albuterol was administered in four patients. One patient was admitted to the pediatric intensive care unit. Median length of admission was 4 days (range: 3-14). No patient died or showed any sequelae at discharge. Two patients developed recurrent bronchospasms. CONCLUSION SARS-CoV-2 infection does not seem to be a main trigger of severe bronchiolitis, and children with this condition should be managed according to clinical practice guidelines.
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Affiliation(s)
| | | | - Elena Cobos‐Carrascosa
- Research Institute Hospital 12 de Octubre in Madrid (i+12)Foundation for Biomedical Research of the 12 de Octubre HospitalMadridSpain
| | - Inmaculada Bodegas
- Department of PediatricsQuiron Salud Madrid University HospitalMadridSpain
| | | | - Ane Plazaola
- Paediatric DepartmentHospital Infanta SofíaMadridSpain
| | - Cristina Epalza
- Research Institute Hospital 12 de Octubre in Madrid (i+12)Foundation for Biomedical Research of the 12 de Octubre HospitalMadridSpain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad ComplutensePediatric Research and Clinical Trials Unit (UPIC)MadridSpain
| | | | - Cinta Moraleda
- Research Institute Hospital 12 de Octubre in Madrid (i+12)Foundation for Biomedical Research of the 12 de Octubre HospitalMadridSpain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad ComplutensePediatric Research and Clinical Trials Unit (UPIC)MadridSpain
| | - Alfredo Tagarro
- Research Institute Hospital 12 de Octubre in Madrid (i+12)Foundation for Biomedical Research of the 12 de Octubre HospitalMadridSpain
- Hospital Universitario Infanta SofíaUniversidad Europea de MadridMadridSpain
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21
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Tagarro A, Cobos-Carrascosa E, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Hernanz A, Navarro ML, Pino R, Epalza C, Batista R, Rizo J, Iglesias-Bouzas MI, Rodríguez-Molino P, Villanueva-Medina S, Carrasco-Colom J, Alonso-Cadenas JA, Mellado MJ, Herrero B, Melendo S, De La Torre M, Calleja L, Calvo C, Urretavizcaya-Martínez M, Astigarraga I, Menasalvas A, Penin M, Neth O, Berzosa A, De Ceano-Vivas M, Vidal P, Romero I, González R, García ML, Mesa JM, Ballesteros Á, Bernardino M, Moraleda C. Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children. Eur J Pediatr 2022; 181:1105-1115. [PMID: 34738173 PMCID: PMC8568563 DOI: 10.1007/s00431-021-04306-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022]
Abstract
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
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Affiliation(s)
- Alfredo Tagarro
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain. .,Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain. .,Pediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Elena Cobos-Carrascosa
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - Serena Villaverde
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | | | - Carlos Grasa
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Alicia Hernanz
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Pino
- grid.411160.30000 0001 0663 8628Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rosa Batista
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Jana Rizo
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - María-Isabel Iglesias-Bouzas
- grid.411107.20000 0004 1767 5442Paediatric Intensive Care Unit, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Paula Rodríguez-Molino
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Sara Villanueva-Medina
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jaime Carrasco-Colom
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María-José Mellado
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Blanca Herrero
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Susana Melendo
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Mercedes De La Torre
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Lourdes Calleja
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Cristina Calvo
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Itziar Astigarraga
- Department of Pediatrics, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, OsakidetzaBarakaldo, Spain
| | - Ana Menasalvas
- grid.411372.20000 0001 0534 3000Paediatrics Department, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | - María Penin
- grid.411336.20000 0004 1765 5855Paediatrics Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Olaf Neth
- grid.411109.c0000 0000 9542 1158Paediatrics Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arantxa Berzosa
- grid.411068.a0000 0001 0671 5785Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María De Ceano-Vivas
- grid.81821.320000 0000 8970 9163Emergency Pediatrics Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Paula Vidal
- grid.411050.10000 0004 1767 4212Paediatrics Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Isabel Romero
- Paediatrics Department, Hospitales HM, Madrid, Spain
| | - Raúl González
- Paediatrics Department, Hospital Universitario Sant Joan, Comunidad Valenciana, AlacantAlicante, Spain
| | - María Luz García
- grid.411361.00000 0001 0635 4617Paediatrics Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Juan-Miguel Mesa
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Álvaro Ballesteros
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - María Bernardino
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
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22
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Torres-Fernandez D, Prieto Tato LM, Perez-Ayala A, Moraleda C, Fernandez Cooke E, Blazquez-Gamero D, Rojo P, Perez Rivilla A, Epalza C. Etiology and outcome of febrile children coming from the tropics. Enferm Infecc Microbiol Clin (Engl Ed) 2021; 39:498-502. [PMID: 34865711 DOI: 10.1016/j.eimce.2020.08.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.
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Affiliation(s)
- David Torres-Fernandez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain.
| | - Luis Manuel Prieto Tato
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Ana Perez-Ayala
- Instituto de Investigación 12 de Octubre (imas12), Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Elisa Fernandez Cooke
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Daniel Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Alfredo Perez Rivilla
- Instituto de Investigación 12 de Octubre (imas12), Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
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23
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Carrasco I, Tarancon-Diez L, Vázquez-Alejo E, Jiménez de Ory S, Sainz T, Apilanez M, Epalza C, Guillén S, Tomás Ramos J, Díez C, Bernardino JI, Iribarren JA, Zamora A, Muñoz-Fernández MÁ, Navarro ML. Innate and adaptive abnormalities in youth with vertically acquired HIV through a multicentre cohort in Spain. J Int AIDS Soc 2021; 24:e25804. [PMID: 34672108 PMCID: PMC8528666 DOI: 10.1002/jia2.25804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/09/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Immune abnormalities have been described among youth with vertically acquired HIV (YWVH) despite antiretroviral treatment (ART). The CD4/CD8 ratio could be a useful prognostic marker. We assess immune activation and senescence in a cohort of YWVH in comparison to youth without vertically acquired HIV. Methods YWVH under suppressive ART were included and compared to a group of HIV‐negative donors (HD) matched by age and sex, from September 2019 to September 2020. Subset distribution and expression of activation, maturation, senescence and exhaustion markers on T and NK cells were studied on peripheral blood mononuclear cells by multiparametric flow cytometry. Results Thirty‐two YWVH (median age: 24.4 years (interquartile range: 22.5 to 28.3 years)) were included. Among YWVH, CD4‐ and CD8‐T cells showed high levels of activation (HLA‐DR/CD38), IL‐7 receptor expression (CD127) and exhaustion (TIM‐3). Regarding NK cells, YWVH showed increased levels of activation and exhaustion markers compared to HD. Strong inverted correlations were observed between T‐cell activation (HLA‐DR/CD38), senescence (CD57) and exhaustion (TIGIT, PD‐1) levels with the CD4/CD8 ratio among YWVH. HLA‐DR, CD69, NKG2D and NKG2A expression levels on NK cells also correlated with the CD4/CD8 ratio. Age at ART initiation was directly associated with higher frequency of CD16high NK‐cell subsets, exhaustion T‐cell levels (CD57, TIM3) and NK cells activation levels. Conclusions Immunological changes associated with vertically acquired HIV, characterized by increased activation and exhaustion levels in innate and adaptive immune components, are only partially restored by ART. The CD4/CD8 ratio can be a useful marker of disease progression for routine clinical practice.
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Affiliation(s)
- Itzíar Carrasco
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Tarancon-Diez
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - Elena Vázquez-Alejo
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - Santiago Jiménez de Ory
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
| | - Talía Sainz
- Department of Paediatrics, La Paz Research Institute (IdiPAZ) and University Hospital, Madrid, Spain
| | - Miren Apilanez
- Department of Paediatrics, Donostia University Hospital, País Vasco, Spain
| | - Cristina Epalza
- Department of Paediatrics, 12 de Octubre University Hospital, Madrid, Spain
| | - Sara Guillén
- Department of Paediatrics, Getafe University Hospital, Madrid, Spain
| | - José Tomás Ramos
- Department of Paediatrics, Clínico San Carlos University Hospital, Madrid, Spain
| | - Cristina Díez
- Department Infectious Diseases, Gregorio Marañón Research Institute and University Hospital, Madrid, Spain
| | - Jose Ignacio Bernardino
- Department of Infectious Diseases, La Paz Research Institute (IdiPAZ) and University Hospital, Madrid, Spain
| | | | - Angielys Zamora
- Biochemistry Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - María Luisa Navarro
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
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24
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de Ceano-Vivas M, García ML, Velázquez A, Martín del Valle F, Menasalvas A, Cilla A, Epalza C, Romero MP, Cabrerizo M, Calvo C. Neurodevelopmental Outcomes of Infants Younger Than 90 Days Old Following Enterovirus and Parechovirus Infections of the Central Nervous System. Front Pediatr 2021; 9:719119. [PMID: 34650940 PMCID: PMC8505960 DOI: 10.3389/fped.2021.719119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of central nervous system (CNS) infection in young infants. They have been implicated in neurodevelopmental delay, however limited data are available. The aim of this study is to describe the clinical outcome of young infants and to assess and compare the medium-term neurodevelopment following CNS infections caused by EV and HPeV. A multicentre observational ambispective study was conducted between May 2013 and March 2018. Children under 3 months of age with EV or HPeV CNS infection excluding encephalitis were included. Infants were contacted 1 year after the acute infection and their neurological development was evaluated using the Ages and Stages Questionnaire-3 (ASQ-3). If any area assessed was abnormal during the first round of tests, a second round was completed 6 to 12 months later. Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) were positive for EV and 15 (31.3%) for HPeV. At first assessment 14 out of 29 EV (48.3%) and 3 out of 15 HPeV (20%) positive cases presented some developmental concern in the ASQ-3 test. EV-positive infants showed mild and moderate alteration in all domains analyzed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (31 vs. 0%, p = 0.016). At second assessment 4 out of 13 EV-positive patients (30.8%) showed mild to moderate concerns in communication and gross motor function domains and 3 out of 13 (23.1%) showed significant concern in fine motor function. Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months almost half of the EV-infected infants (48.3%) and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3 test. We recommend monitor the neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation of psychomotor development if necessary.
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Affiliation(s)
| | - M. Luz García
- Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain
| | - Ana Velázquez
- Department of Pediatrics, La Paz University Hospital, Madrid, Spain
| | | | - Ana Menasalvas
- Department of Pediatrics, Virgen de la Arixaca University Hospital, Murcia, Spain
| | - Amaia Cilla
- Department of Pediatrics, Burgos University Hospital, Burgos, Spain
| | - Cristina Epalza
- Department of Pediatrics, 12 de Octubre University Hospital, Madrid, Spain
| | - M. Pilar Romero
- Department of Microbiology, La Paz University Hospital, Madrid, Spain
| | - María Cabrerizo
- National Centre for Microbiology, Instituto de Salud Carlos III, CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, La Paz University Hospital and La Paz Research Institute (IdiPaz), Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (Red de Investigación Traslacional en Infectología Pediátrica), Madrid, Spain
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25
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Domínguez-Rodríguez S, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Saavedra-Lozano J, Fumadó V, Epalza C, Serna-Pascual M, Alonso-Cadenas JA, Rodríguez-Molino P, Pujol-Morro J, Aguilera-Alonso D, Simó S, Villanueva-Medina S, Iglesias-Bouzas MI, Mellado MJ, Herrero B, Melendo S, De la Torre M, Del Rosal T, Soler-Palacin P, Calvo C, Urretavizcaya-Martínez M, Pareja M, Ara-Montojo F, Ruiz Del Prado Y, Gallego N, Illán Ramos M, Cobos E, Tagarro A, Moraleda C. A Bayesian Model to Predict COVID-19 Severity in Children. Pediatr Infect Dis J 2021; 40:e287-e293. [PMID: 34250967 DOI: 10.1097/inf.0000000000003204] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to identify risk factors causing critical disease in hospitalized children with COVID-19 and to build a predictive model to anticipate the probability of need for critical care. METHODS We conducted a multicenter, prospective study of children with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care. We used a multivariable Bayesian model to estimate the probability of needing critical care. RESULTS The study enrolled 350 children from March 12, 2020, to July 1, 2020: 292 (83.4%) and 214 (73.7%) were considered to have relevant COVID-19, of whom 24.2% required critical care. Four major clinical syndromes of decreasing severity were identified: multi-inflammatory syndrome (MIS-C) (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome (19.6%). Main risk factors were high C-reactive protein and creatinine concentration, lymphopenia, low platelets, anemia, tachycardia, age, neutrophilia, leukocytosis, and low oxygen saturation. These risk factors increased the risk of critical disease depending on the syndrome: the more severe the syndrome, the more risk the factors conferred. Based on our findings, we developed an online risk prediction tool (https://rserver.h12o.es/pediatria/EPICOAPP/, username: user, password: 0000). CONCLUSIONS Risk factors for severe COVID-19 include inflammation, cytopenia, age, comorbidities, and organ dysfunction. The more severe the syndrome, the more the risk factor increases the risk of critical illness. Risk of severe disease can be predicted with a Bayesian model.
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Affiliation(s)
- Sara Domínguez-Rodríguez
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Serena Villaverde
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Carlos Grasa
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Miquel Serna-Pascual
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Joan Pujol-Morro
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Silvia Simó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Sara Villanueva-Medina
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | | | | | - Susana Melendo
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | - Teresa Del Rosal
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | | | - Marta Pareja
- Paediatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fátima Ara-Montojo
- Paediatrics Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | | | - Nerea Gallego
- Paediatrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Illán Ramos
- Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Elena Cobos
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Alfredo Tagarro
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
- Paediatrics Department, Hospital Universitario Infanta Sofía, Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
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26
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Kohns Vasconcelos M, Loens K, Sigfrid L, Iosifidis E, Epalza C, Donà D, Matheeussen V, Papachristou S, Roilides E, Gijon M, Rojo P, Minotti C, Da Dalt L, Islam S, Jarvis J, Syggelou A, Tsolia M, Nyirenda Nyang'wa M, Keers S, Renk H, Gemmel AL, D'Amore C, Ciofi Degli Atti M, Rodríguez-Tenreiro Sánchez C, Martinón-Torres F, Burokienė S, Goetghebuer T, Spoulou V, Riordan A, Calvo C, Gkentzi D, Hufnagel M, Openshaw PJ, de Jong MD, Koopmans M, Goossens H, Ieven M, Fraaij PLA, Giaquinto C, Bielicki JA, Horby P, Sharland M. Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study. BMJ Open Respir Res 2021; 8:8/1/e000887. [PMID: 34326154 PMCID: PMC8323363 DOI: 10.1136/bmjresp-2021-000887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Both pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation. Methods 349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets. Results RSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses. Conclusion RSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.
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Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK .,Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katherine Loens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Savvas Papachristou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Manuel Gijon
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Chiara Minotti
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Samsul Islam
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Jessica Jarvis
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aggeliki Syggelou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maggie Nyirenda Nyang'wa
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Sophie Keers
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Anna-Lena Gemmel
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sigita Burokienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Tessa Goetghebuer
- Department of Paediatrics, St-Pierre Hospital Brussels, Brussels, Belgium
| | - Vana Spoulou
- 1st Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, Agia Sophia Children's Hospital of Athens, Athens, Greece
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
| | - Cristina Calvo
- Paediatrics and Infectious Diseases Department, La Paz University Hospital, Madrid, Spain
| | - Despoina Gkentzi
- Department of Paediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Peter J Openshaw
- National Heart and Lung Division, Faculty of Medicine, Imperial College London, London, UK
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, ErasmusMC, Rotterdam, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
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27
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Moraleda C, Serna-Pascual M, Soriano-Arandes A, Simó S, Epalza C, Santos M, Grasa C, Rodríguez M, Soto B, Gallego N, Ruiz Y, Urretavizcaya-Martínez M, Pareja M, Sanz-Santaeufemia FJ, Fumadó V, Lanaspa M, Jordan I, Prieto L, Belda S, Toral-Vázquez B, Rincón E, Gil-Villanueva N, Méndez-Echevarría A, Castillo-Serrano A, Rivière JG, Soler-Palacín P, Rojo P, Tagarro A. Multi-inflammatory Syndrome in Children Related to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Spain. Clin Infect Dis 2021; 72:e397-e401. [PMID: 32710613 PMCID: PMC7454331 DOI: 10.1093/cid/ciaa1042] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Some clusters of children with a multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. We describe the epidemiological and clinical features of children with MIS-C in Spain. MIS-C is a potentially severe condition that presents in children with recent SARS-CoV-2 infection.
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Affiliation(s)
- Cinta Moraleda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12); Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain, RITIP (Traslational Research Network in Pediatric Infectious Diseases)
| | - Miquel Serna-Pascual
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12); Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain, RITIP (Traslational Research Network in Pediatric Infectious Diseases)
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Silvia Simó
- Infectious and Imported Diseases Unit, Department of Pediatrics, Sant Joan de Déu Universitary Hospital Research Foundation, Barcelona, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mar Santos
- Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Grasa
- Pediatrics and Infectious Disease Unit, Pediatrics Department, Hospital Universitario La Paz. Fundación IdiPaz, Madrid, Spain, Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Maria Rodríguez
- Pediatrics Department. Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Beatriz Soto
- Pediatrics Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Nerea Gallego
- Pediatrics Department, Hospital Universitario Son Espases. Palma de Mallorca, Illes Baleares, Spain
| | - Yolanda Ruiz
- Pediatrics Department, Hospital Universitario San Pedro, Logroño, La Rioja, Spain
| | | | - Marta Pareja
- Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | | | - Victoria Fumadó
- Infectious and Imported Diseases Unit, Department of Pediatrics, Sant Joan de Déu Universitary Hospital Research Foundation, Barcelona, Spain
| | - Miguel Lanaspa
- Infectious and Imported Diseases Unit, Department of Pediatrics, Sant Joan de Déu Universitary Hospital Research Foundation, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Sant Joan de Deu Universitary Hospital, CIBERES, Barcelona, Spain
| | - Luis Prieto
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sylvia Belda
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, School of Medicine, Complutense University of Madrid, Mother-Child Health and Development Network (Red SAMID) of Carlos III Health Institute, Madrid, Spain
| | - Belén Toral-Vázquez
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Rincón
- Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ana Méndez-Echevarría
- Pediatrics and Infectious Disease Unit, Pediatrics Department, Hospital Universitario La Paz. Fundación IdiPaz, Madrid, Spain, Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Ana Castillo-Serrano
- Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12); Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain, RITIP (Traslational Research Network in Pediatric Infectious Diseases)
| | - Alfredo Tagarro
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12); Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain, RITIP (Traslational Research Network in Pediatric Infectious Diseases).,Pediatrics Department, Hospital Universitario Infanta Sofía, Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
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Martinón-Torres F, Rusch S, Huntjens D, Remmerie B, Vingerhoets J, McFadyen K, Ferrero F, Baraldi E, Rojo P, Epalza C, Stevens M. Pharmacokinetics, Safety, and Antiviral Effects of Multiple Doses of the Respiratory Syncytial Virus (RSV) Fusion Protein Inhibitor, JNJ-53718678, in Infants Hospitalized With RSV Infection: A Randomized Phase 1b Study. Clin Infect Dis 2021; 71:e594-e603. [PMID: 32201897 PMCID: PMC7744997 DOI: 10.1093/cid/ciaa283] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/12/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background This phase 1b study evaluated the pharmacokinetics, safety, and antiviral effects of the respiratory syncytial virus (RSV)–specific fusion inhibitor JNJ-53718678 (JNJ-8678) in hospitalized RSV-infected patients aged > 1 to ≤24 months. Methods Patients categorized by age (cohort 1: ≥6 to ≤24 months; cohort 2: ≥3 to < 6 months; cohort 3: > 1 to < 3 months) were randomized to oral JNJ-8678 or placebo once daily for 7 days. Dose increases followed data review committee recommendations (cohort 1: 2/6/8/9 mg/kg; cohort 2: 1.5/4.5/6 mg/kg; cohort 3: 1/3/5 mg/kg). Cohort 1 included a 9 mg/kg dose, as target exposures were not reached at lower doses. Sparse pharmacokinetic samples were assessed using population pharmacokinetics modeling. Safety was assessed by adverse events (AEs), laboratory tests, and electrocardiograms. To assess antiviral effects, RSV RNA viral load from nasal swabs was quantified over time using reverse-transcription quantitative polymerase chain reaction. Results Patients received JNJ-8678 (n = 37) or placebo (n = 7). Pharmacokinetic parameters were similar at the highest doses for cohorts 1–3 (area under the plasma concentration–time curve from time of administration up to 24 hours postdosing at day 7: 35 840, 34 980, and 39 627 ng × hour/mL, respectively). Two grade 3 AEs were reported (both bronchiolitis; 1 JNJ-8678, 1 placebo), reported as serious AEs; all other AEs were grade 1 or 2. Two additional serious AEs were reported (rhinitis [JNJ-8678]; pneumonia [placebo]). No deaths, grade 4 AEs, or AEs leading to discontinuation were reported. Median RSV viral load change from baseline in JNJ-8678 vs placebo by day 3 was −1.98 vs −0.32 log10 copies/mL. Conclusions In RSV-infected infants, JNJ-8678 was well tolerated. Target exposures were reached and antiviral activity was observed. Clinical Trials Registration NCT02593851.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, La Coruña, Spain
- Correspondence: F. Martinón-Torres, Head of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, A Choupana, 15706 Santiago de Compostela, Spain ()
| | - Sarah Rusch
- Quantitative Sciences, Janssen Research and Development, Beerse, Belgium
| | - Dymphy Huntjens
- Quantitative Sciences, Janssen Research and Development, Beerse, Belgium
| | - Bart Remmerie
- Quantitative Sciences, Janssen Research and Development, Beerse, Belgium
| | - Johan Vingerhoets
- Clinical Virology, Janssen Research and Development, Beerse, Belgium
| | - Katie McFadyen
- Global Clinical Development Operations Infectious Diseases, Janssen Research and Development, Washington, District of Columbia, USA
| | - Fernando Ferrero
- Hospital General de Niños “Pedro de Elizalde,” Buenos Aires, Argentina
| | - Eugenio Baraldi
- Women’s and Children’s Health Department, University Hospital of Padova, Padova, Italy
| | - Pablo Rojo
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre, Translational Research Network in Pediatric Infectology, Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre, Translational Research Network in Pediatric Infectology, Madrid, Spain
| | - Marita Stevens
- Global Clinical Development Infectious Diseases, Janssen Research and Development, Beerse, Belgium
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Olivas-Mazón R, Blázquez-Gamero D, Alberti-Masgrau N, López-Roa P, Delgado-Muñoz MD, Epalza C. Diagnosis of nontuberculous mycobacterial lymphadenitis: the role of fine-needle aspiration. Eur J Pediatr 2021; 180:1279-1286. [PMID: 33205252 DOI: 10.1007/s00431-020-03875-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
Nontuberculous mycobacterial lymphadenitis often presents a diagnostic challenge. This study aimed to evaluate the role of fine-needle aspiration cytology in the diagnosis of nontuberculous mycobacterial lymphadenitis in children. We conducted a retrospective review of fine-needle aspiration cytology performed in patients < 17 year-old with subacute lymphadenitis from 2003 to 2016 in a tertiary hospital in Spain. Confirmed nontuberculous mycobacterial lymphadenitis (isolation of nontuberculous mycobacterial in culture from fine-needle aspiration cytology or biopsy samples) and probable nontuberculous mycobacterial lymphadenitis ("granulomatous inflammation" in cytopathologic examinations from fine-needle aspiration cytology or biopsy and clinical-epidemiological history compatible with nontuberculous mycobacterial) were selected. Forty-one patients with nontuberculous mycobacterial lymphadenitis were included: 14 confirmed and 27 probable. Fine-needle aspiration cytology was done in all of them. For 34 patients with excised lymphadenopathy, cytopathology from fine-needle aspiration cytology was concordant with biopsy in 100% cases. Culture results were available from 78.0% (32/41) of patients with fine-needle aspiration cytology and from 85.3% (29/34) with excisional biopsy. Among 22 patients with microbiological results from fine-needle aspiration cytology and biopsy, fine-needle aspiration cytology allowed advanced results in concordance with biopsy or with positive isolation not found in biopsy in 90.1% (20/22) of patients. Sensitivity of nontuberculous mycobacterial cultures obtained by fine-needle aspiration cytology compared to biopsy was 45.5% vs. 36.4% (p = 0.07). Two patients with previous skin alterations presented fistulas after fine-needle aspiration cytology (4.9%); no other complications were described.Conclusion: Fine-needle aspiration cytology provides quick cytopathologic information and is an accurate and safe technique for the diagnosis of nontuberculous mycobacterial lymphadenitis, especially in cases with challenging work-up. What is Known: • Nontuberculous mycobacterial (NTM) infection is an important cause of subacute lymphadenitis in children. • Fine-needle aspiration cytology (FNAC) is an available technique for the diagnosis of lymphadenitis of unknown etiology. What is New: • FNAC is an accurate and safe technique for the diagnosis of NTM lymphadenitis in children. • FNAC can provide reliable samples for cytopathological studies and even a better sensitivity for microbiological culture than excisional biopsy in the study of suspected NTM lymphadenitis.
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Affiliation(s)
- Raquel Olivas-Mazón
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain.
- Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.
| | | | - Paula López-Roa
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain
- Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain
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Grasa Lozano CD, Baro-Fernández M, Rubio-San-Simón A, Blázquez-Gamero D, López-Roa P, Liébana C, Guerra-García P, Moraleda C, Epalza C. Tuberculosis screening after detection of a case in a paediatric haemato-oncology unit in a low prevalence country. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00022-7. [PMID: 33627247 DOI: 10.1016/j.eimc.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/15/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected. METHODS After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up. RESULTS After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients. CONCLUSIONS The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.
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Affiliation(s)
- Carlos Daniel Grasa Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain; Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.
| | - María Baro-Fernández
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Alba Rubio-San-Simón
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
| | - Paula López-Roa
- Microbiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Constanza Liébana
- Paediatric Radiology Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Pilar Guerra-García
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cinta Moraleda
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Spain
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Blázquez-Gamero D, Epalza C, Cadenas JAA, Gero LC, Calvo C, Rodríguez-Molino P, Méndez M, Santos MDM, Fumadó V, Guzmán MF, Soriano-Arandes A, Jiménez AB, Penin M, Cobo-Vazquez E, Pareja M, Lobato Z, Serna M, Delgado R, Moraleda C, Tagarro A. Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old. Eur J Pediatr 2021; 180:2099-2106. [PMID: 33606120 PMCID: PMC7893843 DOI: 10.1007/s00431-021-03973-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
Fever without source (FWS) in infants is a frequent cause of consultation at the emergency department, and the emergence of SARS-CoV-2 could affect the approach to those infants. The aim of this study is to define the clinical characteristics and rates of bacterial coinfections of infants < 90 days with FWS as the first manifestation of SARS-CoV-2 infection. This is a cross-sectional study of infants under 90 days of age with FWS and positive SARS-CoV2 PCR in nasopharyngeal swab/aspirate, attended at the emergency departments of 49 Spanish hospitals (EPICO-AEP cohort) from March 1 to June 26, 2020. Three hundred and thirty-three children with COVID-19 were included in EPICO-AEP. A total of 67/336 (20%) were infants less than 90 days old, and 27/67(40%) presented with FWS. Blood cultures were performed in 24/27(89%) and were negative in all but one (4%) who presented a Streptococcus mitis bacteremia. Urine culture was performed in 26/27(97%) children and was negative in all, except in two (7%) patients. Lumbar puncture was performed in 6/27(22%) cases, with no growth of bacteria. Two children had bacterial coinfections: 1 had UTI and bacteremia, and 1 had UTI. C-reactive was protein over 20 mg/L in two children (one with bacterial coinfection), and procalcitonin was normal in all. One child was admitted to the pediatric intensive care unit because of apnea episodes. No patients died.Conclusion: FWS was frequent in infants under 90 days of age with SARS-CoV-2 infection. Standardized markers to rule out bacterial infections remain useful in this population, and the outcome is generally good. What is Known: • Fever without source (FWS) in infants is a common cause of consultation at the emergency department, and young infants have a higher risk of serious bacterial infections (SBI). • The emergence of the new coronavirus SARS-CoV-2 could affect the approach to young infants with FWS in the emergency department. management of those children is a challenge because information about bacterial coinfection and prognosis is scarce. What is New: • SARS-CoV-2 infection should be ruled out in young infants (< 90 days of age) with FWS in areas with community transmission. • Bacterial coinfection rarely coexists in those infants. • Inflammatory markers were not increased in children without bacterial coinfection. • Outcome is good in most patients.
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Affiliation(s)
- Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain. .,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain.
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain ,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | | | | | - Cristina Calvo
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Pediatric and Infectious Diseases Department, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Paula Rodríguez-Molino
- Pediatric and Infectious Diseases Department, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - María Méndez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol de Badalona, Badalona, Spain
| | - Maria del Mar Santos
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Antoni Soriano-Arandes
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Barcelona Hospital Campus, Barcelona, Spain
| | - Ana B. Jiménez
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Penin
- Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | | | - Marta Pareja
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Zulema Lobato
- Althaia, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Miquel Serna
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Pediatric Research and Clinical Trials Unit. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Rafael Delgado
- Microbiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Diseases Unit, Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain ,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Pediatric Research and Clinical Trials Unit. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alfredo Tagarro
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain ,Pediatric Research and Clinical Trials Unit. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain ,Pediatrics Department. Hospital Universitario Infanta Sofía. Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
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Torres-Fernandez D, Prieto Tato LM, Perez-Ayala A, Moraleda C, Fernandez Cooke E, Blazquez-Gamero D, Rojo P, Perez Rivilla A, Epalza C. Etiology and outcome of febrile children coming from the tropics. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30269-X. [PMID: 33008681 DOI: 10.1016/j.eimc.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/28/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.
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Affiliation(s)
- David Torres-Fernandez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain.
| | - Luis Manuel Prieto Tato
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Ana Perez-Ayala
- Instituto de Investigación 12 de Octubre (imas12), Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Elisa Fernandez Cooke
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Daniel Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Alfredo Perez Rivilla
- Instituto de Investigación 12 de Octubre (imas12), Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
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Kohns Vasconcelos M, Epalza C, Renk H, Tagarro A, Bielicki JA. Harmonisation preserves research resources. Lancet Infect Dis 2020; 21:e71. [PMID: 32717206 PMCID: PMC7380932 DOI: 10.1016/s1473-3099(20)30585-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain; Paediatric Research and Clinical Trials Unit, Instituto de Investigación Sanitaria Hospital 12 de Octubre and Translational Research Network in Paediatric Infectious Diseases, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Alfredo Tagarro
- Paediatrics Department, Hospital Universitario Infanta Sofía, Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland; Fondazione Penta Onlus, Padova, Italy
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Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, Calvo C. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr 2020; 175:2764394. [PMID: 32267485 PMCID: PMC7142799 DOI: 10.1001/jamapediatrics.2020.1346] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Alfredo Tagarro
- Hospital Universitario Infanta Sofía. Universidad Europea de Madrid. Madrid, Spain
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Cristina Epalza
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
- Hospital Universitario 12 de Octubre, Pediatric Infectious Disease Unit, Madrid, Spain
| | - Mar Santos
- Hospital Universitario Gregorio Marañón, Pediatric Infectious Diseases Unit, Madrid, Spain
| | | | - Enrique Otheo
- Hospital Universitario Ramon y Cajal, Pediatrics Department, Madrid, Spain
| | - Cinta Moraleda
- Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
- Hospital Universitario 12 de Octubre, Pediatric Infectious Disease Unit, Madrid, Spain
| | - Cristina Calvo
- Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz; Fundación IdiPaz, Madrid, España; European Network of Excellence for Pediatric Clinical Research; Red de Investigación Traslacional en Infectología Pediátrica
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Calvo C, Tagarro A, Otheo E, Epalza C. Epidemiological update on SARS-CoV-2 infection in Spain. Comments on the management of infection in pediatrics. Anales de Pediatría (English Edition) 2020; 92:239-240. [PMID: 32363216 PMCID: PMC7194876 DOI: 10.1016/j.anpede.2020.03.001] [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] [Received: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cristina Calvo
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
- Corresponding author.
| | - Alfredo Tagarro
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
- Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Fundación Hospital Universitario 12 de Octubre. Universidad Europea de Madrid, Madrid, Spain
| | - Enrique Otheo
- Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid Spain
| | - Cristina Epalza
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
- Unidad de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
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Calvo C, Tagarro A, Otheo E, Epalza C. [Epidemiological update on SARS-CoV-2 infection in Spain. Comments on the management of infection in pediatrics]. An Pediatr (Barc) 2020; 92:239-240. [PMID: 32241653 PMCID: PMC7195269 DOI: 10.1016/j.anpedi.2020.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Cristina Calvo
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, España; TEDDY Network - European Network of Excellence for Pediatric Clinical Research, Pavía, Italia; Red de Investigación Traslacional en Infectología Pediátrica (RITIP); Fundación Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España.
| | - Alfredo Tagarro
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP); Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Fundación Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España
| | - Enrique Otheo
- Fundación Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España; Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Cristina Epalza
- TEDDY Network - European Network of Excellence for Pediatric Clinical Research, Pavía, Italia; Fundación Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España; Unidad de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (Imas12), Madrid, España
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Epalza C, Hallin M, Busson L, Debulpaep S, De Backer P, Vandenberg O, Levy J. Role of Viral Molecular Panels in Diagnosing the Etiology of Fever in Infants Younger Than 3 Months. Clin Pediatr (Phila) 2020; 59:45-52. [PMID: 31709801 PMCID: PMC7206330 DOI: 10.1177/0009922819884582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As infants with proven viral infection present lower risk of bacterial infection, we evaluated how molecular methods detecting viruses on respiratory secretions could contribute to etiological diagnostic of these febrile episodes. From November 2010 to May 2011, we enrolled all febrile infants <90 days presenting to emergency room. Standard workup included viral rapid antigenic test and viral culture on nasopharyngeal aspirate. Samples negative by rapid testing were tested by molecular methods. From 208 febrile episodes (198 infants) with standard techniques, rate of documented microbiological etiology was 13% at emergency department, 47% during hospitalization, and 64% with viral cultures. Molecular methods increased microbiologically documented etiology rate by 12%, to 76%. Contribution of molecular methods was the highest in infants without clinical source of infection, increasing documentation by 18%, from 50% to 68%. Making viral molecular results rapidly available could help identifying a higher proportion of infants at low risk of serious bacterial infection.
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Affiliation(s)
- Cristina Epalza
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium,Cristina Epalza, Pediatric Department, Saint Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Marie Hallin
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Laurent Busson
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sara Debulpaep
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Paulette De Backer
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Olivier Vandenberg
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jack Levy
- Saint Pierre University Hospital, Bruxelles, Belgium,Université Libre de Bruxelles, Bruxelles, Belgium
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Martín-Cazaña M, Grau S, Epalza C, Brañas P, Flores M, Olmedilla M, Blázquez-Gamero D. Successful ceftolozane-tazobactam rescue therapy in a child with endocarditis caused by multidrug-resistant Pseudomonas aeruginosa. J Paediatr Child Health 2019; 55:985-987. [PMID: 30737855 DOI: 10.1111/jpc.14388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Santiago Grau
- Pharmacy Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Epalza
- Department of Pediatrics, Complutense University of Madrid, Madrid, Spain
| | - Patricia Brañas
- Department of Pediatrics, Complutense University of Madrid, Madrid, Spain
| | - Marta Flores
- Department of Pediatrics, Complutense University of Madrid, Madrid, Spain
| | - Marta Olmedilla
- Department of Pediatrics, Complutense University of Madrid, Madrid, Spain
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Francisco-González L, Rubio-San-Simón A, González-Tomé MI, Manzanares Á, Epalza C, Santos MDM, Gastañaga T, Merino P, Ramos-Amador JT. Congenital transmission of Chagas disease in a non-endemic area, is an early diagnosis possible? PLoS One 2019; 14:e0218491. [PMID: 31291269 PMCID: PMC6619651 DOI: 10.1371/journal.pone.0218491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is an emergent disease in Europe, due to immigration. The aims of this study are to describe the epidemiological characteristics of a cohort of Chagas infected pregnant women in Spain, to assess the vertical transmission (VT) rate and evaluate the usefulness of the PCR in the diagnosis of congenital infection in the first months of life. METHODS A descriptive, retrospective study including Chagas seropositive pregnant women who were attended at three tertiary hospitals in Madrid, from January 2012 to September 2016. Infants were examined by PCR at birth and 1 month later and serologically studied at 9 months or later. Children were considered infected when the parasite was detected by PCR at any age or when serology remained positive without decline over the age of 9 months. RESULTS We included 122 seropositive-infected pregnant women, 81% were from Bolivia and only 8.2% had been treated before. 125 newborns were studied and finally 109 were included (12.8% lost the follow-up before performing the last serology). The VT rate was 2.75% (95% CI: 0,57-8,8%). Infected infants had positive PCR at birth and 1 month later. All of them were treated successfully with benznidazole (PCR and serology became negative later on). All non-infected children presented negative PCR. The mean age at which uninfected patients had negative serology was 10.5 months. CONCLUSIONS The VT rate is in keeping with literature and confirms the need to carry out a screening in pregnant women coming from endemic areas. PCR seems to be a useful tool to provide early diagnosis of congenital CD.
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Affiliation(s)
- Laura Francisco-González
- Department of Pediatrics, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | | | | | | | - Cristina Epalza
- Department of Pediatrics, Hospital Doce de Octubre, Madrid, Spain
| | | | - Teresa Gastañaga
- Department of Obstetrics and Gynaecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Paloma Merino
- Department of Microbiology, Hospital Clínico San Carlos, Madrid, Spain
| | - José Tomás Ramos-Amador
- Department of Pediatrics, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain
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Martinon-Torres F, Rusch S, Huntjens D, Remmerie B, Vingerhoets J, McFadyen K, Ferrero F, Baraldi E, Conejo PR, Epalza C, Stevens M. 1958. Antiviral Effects, Pharmacokinetics (PK), and Safety of the Respiratory Syncytial Virus (RSV) Fusion Protein Inhibitor, JNJ-53718678 (JNJ-8678), in RSV-infected Infants With Bronchiolitis, in the Phase 1b Study 53718678RSV1005. Open Forum Infect Dis 2018. [PMCID: PMC6252897 DOI: 10.1093/ofid/ofy210.1614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background JNJ-8678 is a RSV-specific fusion inhibitor and a potential new treatment for respiratory infections caused by RSV. Data from a Phase 1b study of PK, safety and antiviral effects in hospitalized RSV-infected infants are presented. Methods 37 and 7 patients, respectively, were randomized to JNJ-8678 (ascending doses, Table) or placebo (PBO) treatment once daily for 7 days. PK assessments were based on sparse sampling using a population PK model in adults scaled for pediatrics, accounting for allometric principles and maturation of drug clearance pathways. Safety was evaluated by AE reporting, lab and ECG assessments. Antiviral activity was assessed by measuring viral load (VL) using a quantitative RT-PCR assay for RSV RNA from nasal swabs. Results Sparse PK data are described by an integrated PK model (table) and indicated PK parameters for different dose levels were similar across age groups. Treatment with JNJ-8678 appeared to reduce VL more rapidly than PBO (figure). Median change in VL from baseline (BL) in JNJ-8678-treated patients (combined dose groups) vs. PBO was −1.98 vs. −0.32 log10 copies/mL at Day 3. Mean differences in change from BL (90% CI) of JNJ-8678 (combined dose groups) vs. PBO on Days 2 and 3 were estimated −1.33 (−2.26; −0.39) and −1.62 (−2.55; −0.69) log10 copies/mL, respectively (general linear model, adjusted for BL VL; P ≤ 0.05). There was a clear separation between JNJ-8678 and PBO, but no evident exposure–response relationship. JNJ-8678 was generally well tolerated with no new safety signals compared with adults and no dose relationship with AEs or lab abnormalities were observed. Conclusion This dataset in RSV-infected infants showed a clear trend for an early antiviral effect of JNJ-8678, which was similar across dose groups. JNJ-8678 treatment was generally well tolerated. ![]()
Disclosures F. Martinon-Torres, Pfizer: Consultant, Consulting fee. SPMSD: Consultant, Consulting fee. GSK: Consultant, Consulting fee. S. Rusch, Janssen: Employee and Shareholder, Salary. D. Huntjens, Janssen: Employee and Shareholder, Salary. B. Remmerie, Janssen: Employee and Shareholder, Salary. J. Vingerhoets, Janssen: Employee and Shareholder, Salary. K. McFadyen, Janssen: Employee and Shareholder, Salary. E. Baraldi, Abbvie: Lectures, Speaker honorarium. Chiesi Farmaceutici: Consultant, Consulting fee. Novartis: Consultant, Consulting fee. Janssen: Consultant, Consulting fee. M. Stevens, Janssen: Employee and Shareholder, Salary.
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Affiliation(s)
| | - Sarah Rusch
- Janssen Research and Development, Beerse, Belgium
| | | | | | - Johan Vingerhoets
- Janssen Research and Development Infectious Diseases, Beerse, Belgium
| | - Katie McFadyen
- Global Clinical Development Operations Infectious Diseases, Janssen Research and Development, Raritan, New Jersey
| | - Fernando Ferrero
- Hospital General de Niños “Pedro de Elizalde,,” Buenos Aires, Argentina
| | - Eugenio Baraldi
- Women’s and Children’s Health Department, University of Padova, Padova, Italy
| | - Pablo Rojo Conejo
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Marita Stevens
- Global Clinical Development Infectious Diseases, Janssen Research and Development, Beerse, Belgium
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Epalza C, Úbeda A, Ruiz M, Casallo M, Moreno J, Cid C, Arroyo O. Quality of life in preterm with congenital heart disease. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.699] [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: 10/28/2022]
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Goetghebuer T, Adler C, Epalza C, Levy J. High incidence of group B streptococcal infection in infants born to HIV-infected mothers. Emerg Infect Dis 2012; 18:539-40. [PMID: 22377165 PMCID: PMC3309597 DOI: 10.3201/eid1803.111630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Epalza C, Goetghebuer T, Hainaut M, Prayez F, Barlow P, Dediste A, Marchant A, Levy J. High incidence of invasive group B streptococcal infections in HIV-exposed uninfected infants. Pediatrics 2010; 126:e631-8. [PMID: 20732944 DOI: 10.1542/peds.2010-0183] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The occurrence of an unusual number of group B streptococcal (GBS) infections in HIV-exposed uninfected (HEU) infants who were followed in our center prompted this study. The objective of this study was to describe and compare the incidence and clinical presentation of GBS infections in infants who were born to HIV-infected and -uninfected mothers. METHODS All cases of invasive GBS infections in infants who were born between 2001 and 2008 were identified from the database of HEU infants and from the microbiology laboratory records. The medical charts of all infants with GBS infection were reviewed. RESULTS GBS invasive infections were described for 5 (1.55%) infants who were born to 322 HIV-infected mothers who delivered in our center. The incidence of GBS infections during the same period was 16 (0.08%) of 20 158 infants who were born to HIV-uninfected mothers. One HEU infant presented a recurrent infection 28 days after completion of treatment for the first episode. Late-onset infection was more frequent in HEU infants (5 of 6 vs 2 of 16 episodes in the control population). The diseases were also more severe in HEU infants with 5 of 6 sepsis or sepsis shock in HEU infants versus 10 of 16 in control subjects, and most HEU infants had leukopenia at onset of infection. CONCLUSIONS The incidence of GBS infection was significantly higher in HEU infants than in infants who were born to HIV-uninfected mothers. These episodes of GBS sepsis in HEU infants were mostly of late onset and more severe than in the control population, suggesting an increased susceptibility of HEU infants to GBS infection.
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Affiliation(s)
- Cristina Epalza
- Pediatric Department, St Pierre University Hospital, and Institute for Medical Immunology, Free University of Brussels, 322 rue Haute, 1000 Brussels, Belgium
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Epalza C, Goetghebuer T, Hainaut M, Barlow P, Dediste A, Melin P, Levy J. High incidence of invasive group B streptococcal infections in uninfected infants born to HIV-1-infected mothers. Retrovirology 2009. [DOI: 10.1186/1742-4690-6-s1-o22] [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: 11/10/2022] Open
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