Pediatrics, Perinatology and Child HealthInfectious DiseasesMedicine (miscellaneous)
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The Journal of the Pediatric Infectious Diseases Society (JPIDS), the official journal of the Pediatric Infectious Diseases Society, is dedicated to perinatal, childhood, and adolescent infectious diseases. The journal is a high-quality source of original research articles, clinical trial reports, guidelines, and topical reviews, with particular attention to the interests and needs of the global pediatric infectious diseases communities. The journal's first and current (2017) Impact Factor is 2.456.
Kathleen Chiotos, Molly Hayes, David W. Kimberlin, Sarah Bruyn Jones, Scott H. James, Swetha Pinninti, April Yarbrough, Mark J. Abzug, Taiju Miyagami, Vijaya L. Soma, Daniel E. Dulek, Surabhi B Vora, Alpana Waghmare, Joshua Wolf, Rosemary Olivero, Steven P Grapentine, Rachel L Wattier, Laura L. Bio, Shane J. Cross, Nicholas O. Dillman, Kevin J. Downes, Carlos R. Oliveira, Kathryn Timberlake, Jennifer L. Young, Rachel C. Orscheln, Pranita D. Tamma, Hayden T. Schwenk, Philip Zachariah, Margaret Aldrich, David L. Goldman, Helen Groves, Nipunie Rajapakse, Gabriella S Lamb, Alison C. Tribble, Adam L. Hersh, Emily A. Thorell, Mark R. Denison, Adam J. Ratner, Jason G. Newland, Mari Nakamura
AbstractBackgroundAlthough coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance is needed regarding use of these agents in children.MethodsA panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of the best available evidence and expert opinion.ResultsGiven the typically mild course of COVID-19 in children, supportive care alone is suggested for most cases. For children with severe illness, defined as a supplemental oxygen requirement without need for noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically ill children requiring invasive or noninvasive mechanical ventilation or ECMO. A duration of 5 days is appropriate for most patients. The panel recommends against the use of hydroxychloroquine or lopinavir-ritonavir (or other protease inhibitors) for COVID-19 in children.ConclusionsAntiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.
Daniel E. Dulek, Robert C. Fuhlbrigge, Alison C. Tribble, James A. Connelly, Michele Loi, Hassan El Chebib, Shanmuganathan Chandrakasan, W Otto, Caroline Diorio, Garrett Keim, Kelly Walkovich, Preeti Jaggi, Jennifer E Girotto, April Yarbrough, Edward M. Behrens, Randy Q. Cron, Hamid Bassiri
AbstractBackgroundImmune-mediated lung injury and systemic hyperinflammation are characteristic of severe and critical coronavirus disease 2019 (COVID-19) in adults. Although the majority of severe acute respiratory syndrome coronavirus 2 infections in pediatric populations result in minimal or mild COVID-19 in the acute phase of infection, a small subset of children develop severe and even critical disease in this phase with concomitant inflammation that may benefit from immunomodulation. Therefore, guidance is needed regarding immunomodulatory therapies in the setting of acute pediatric COVID-19. This document does not provide guidance regarding the recently emergent multisystem inflammatory syndrome in children (MIS-C).MethodsA multidisciplinary panel of pediatric subspecialty physicians and pharmacists with expertise in infectious diseases, rheumatology, hematology/oncology, and critical care medicine was convened. Guidance statements were developed based on best available evidence and expert opinion.ResultsThe panel devised a framework for considering the use of immunomodulatory therapy based on an assessment of clinical disease severity and degree of multiorgan involvement combined with evidence of hyperinflammation. Additionally, the known rationale for consideration of each immunomodulatory approach and the associated risks and benefits was summarized.ConclusionsImmunomodulatory therapy is not recommended for the majority of pediatric patients, who typically develop mild or moderate COVID-19. For children with severe or critical illness, the use of immunomodulatory agents may be beneficial. The risks and benefits of such therapies are variable and should be evaluated on a case-by-case basis with input from appropriate specialty services. When available, the panel strongly favors immunomodulatory agent use within the context of clinical trials. The framework presented herein offers an approach to decision-making regarding immunomodulatory therapy for severe or critical pediatric COVID-19 and is informed by currently available data, while awaiting results of placebo-controlled randomized clinical trials.
Museveni Justine, Anita Yeconia, Ingi Nicodemu, Domitila Augustino, Jean Gratz, Estomih Mduma, Scott K. Heysell, Sokoine Kivuyo, Sayoki Mfinanga, Charles A. Peloquin, Theodore Zagurski, Gibson Kibiki, Blandina T. Mmbaga, Eric R. Houpt, Tania A. Thomas
AbstractBackgroundDosing recommendations for treating childhood tuberculosis (TB) were revised by the World Health Organization, yet so far, pharmacokinetic studies that have evaluated these changes are relatively limited. We evaluated plasma drug concentrations of rifampicin (RIF), isoniazid (INH), pyrazinamide (PZA), and ethambutol (EMB) among children undergoing TB treatment in Tanzania when these dosing recommendations were being implemented.MethodsAt the end of intensive-phase TB therapy, blood was obtained 2 hours after witnessed medication administration to estimate the peak drug concentration (C2h), measured using high-performance liquid chromatography or liquid chromatography–tandem mass spectrometry methods. Differences in median drug concentrations were compared on the basis of the weight-based dosing strategy using the Mann–Whitney U test. Risk factors for low drug concentrations were analyzed using multivariate regression analysis.ResultsWe enrolled 51 human immunodeficiency virus–negative children (median age, 5.3 years [range, 0.75–14 years]). The median C2hs were below the target range for each TB drug studied. Compared with children who received the “old” dosages, those who received the “revised” WHO dosages had a higher median C2h for RIF (P = .049) and PZA (P = .015) but not for INH (P = .624) or EMB (P = .143); however, these revised dosages did not result in the target range for RIF, INH, and EMB being achieved. A low starting dose was associated with a low C2h for RIF (P = .005) and PZA (P = .005). Malnutrition was associated with a low C2h for RIF (P = .001) and INH (P = .001).ConclusionsAmong this cohort of human immunodeficiency virus–negative Tanzanian children, use of the revised dosing strategy for treating childhood TB did not result in the target drug concentration for RIF, INH, or EMB being reached.
Maria Deza Leon, Ajla Redzepi, Eric McGrath, Nahed Abdel‐Haq, Ahmed Shawaqfeh, Usha Sethuraman, Bradley Tilford, Teena Chopra, Harbir Arora, Jocelyn Y. Ang, Basim I. Asmar
Peter Lang, Thomas Eichholz, Tamam Bakchoul, Monika Streiter, Maurice Petrasch, Hans Bösmüller, Reinhild Klein, Armin Rabsteyn, Annemarie Lang, Constantin Adams, Karin Klingel, Michaela Geßner, Peter Rosenberger, Peter Ruef, Rupert Handgretinger
AbstractThe pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection is a severe complication of coronavirus disease 2019. Since impaired coagulation and thrombosis/endotheliitis are suspected pathomechanisms, we treated 2 patients with defibrotide, a profibrinolytic, antithrombotic, antiinflammatory oligonucleotide. Symptoms resolved during treatment. Moreover, coagulation parameters indicating hypofibrinolysis and complement activation normalized.The pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection is a severe complication of coronavirus disease 2019. Since impaired coagulation and thrombosis/endotheliitis are suspected pathomechanisms, 2 patients received defibrotide, a profibrinolytic, antithrombotic, antiinflammatory oligonucleotide. Symptoms resolved and hypofibrinolysis/complement activation normalized during treatment.
Kathleen Chiotos, Hamid Bassiri, Edward M. Behrens, Allison M. Blatz, Joyce C. Chang, Caroline Diorio, Julie C. Fitzgerald, Alexis A. Topjian, Audrey R. Odom John
AbstractWe present a series of 6 critically ill children with multisystem inflammatory syndrome in children. Key findings of this syndrome include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.
Maher Ben Khalifa, Fairouz Zakaria, Yasser Ragab, Ahmed Saad, Ahmed K. Bamaga, Yasser Emad, Johannes J. Rasker
AbstractCoronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Physicians in China reported what is believed to be the first adult case of a SARS-CoV-2 infection associated with acute Guillain-Barré syndrome (GBS), followed by 5 adult Italian patients and another case in the United States. In the current report, we present one of the first descriptions of an association of GBS and SARS-CoV-2 infection in a child. In our facility, an 11-year-old boy presented with typical features of GBS and, after 5 days, a morbilliform skin rash over the palms of both hands. Three weeks before the start of the neurological symptoms, the boy had experienced an episode of mild febrile illness with mild respiratory manifestations and a persistent cough. The diagnosis of SARS-CoV-2 infection was confirmed by oropharyngeal swab on reverse-transcription polymerase chain reaction assay. The disease course of our patient strongly suggests a possible relationship between the development of GBS and SARS-CoV-2 infection. The case is discussed in view of previous case reports regarding the association of GBS and COVID-19.
Lei Yao, Yang Song, Yan Cui, Junfeng Zhou, Shuxia Zhong, Dongyang Zhao, Shanshan Li
AbstractBackgroundPediatric patients make a substantial contribution to the epidemiologic profile of sporotrichosis in Jilin Province, a region of China in which the disease is strongly endemic. However, the exact epidemiologic and clinical manifestations of childhood sporotrichosis in China are unclear.MethodsThe medical records of 704 pediatric patients aged <15 years with sporotrichosis diagnosed by fungus culture at the Department of Dermatology at the First Hospital of Jilin University in a 7-year period (January 2010 to December 2016) were reviewed retrospectively. The patients were from rural areas of Jilin Province, located in northeast China.ResultsAmong the 704 pediatric patients, the male/female ratio was 1.41:1, and the highest incidence of sporotrichosis (63%) occurred in those aged 0 to 6 years; 561 patients (80%) contracted sporotrichosis in a colder month. Overall, 655 (93%) patients had lesions in the facial region, whereas 602 (86%) patients had fixed cutaneous sporotrichosis. The incidence of the fixed cutaneous form in the 0- to 6-year age group was significantly higher than that in the 7- to 14-year age group (P = .009). Patients were treated with 10% potassium iodide solution, itraconazole, or terbinafine.ConclusionsThe characteristics of pediatric sporotrichosis in Jilin Provence include the following: (1) a more frequent occurrence in the colder months; (2) the facial region is affected predominantly, in most cases manifesting in the fixed cutaneous form; and (3) significantly more cases occur in younger children than in older ones. Decaying cornstalks used as fire materials might be the source of infection in this population; however, additional research is needed to explore the exact mechanism of infection.
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