Journal of the Pediatric Infectious Diseases Society
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Multicenter Interim Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2 Abstract Background Although 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. Methods A 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. Results Given 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. Conclusions Antiviral 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.
Journal of the Pediatric Infectious Diseases Society - Tập 10 Số 1 - Trang 34-48 - 2021
Multidisciplinary Guidance Regarding the Use of Immunomodulatory Therapies for Acute Coronavirus Disease 2019 in Pediatric Patients Abstract Background Immune-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). Methods A 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. Results The 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. Conclusions Immunomodulatory 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 6 - Trang 716-737 - 2020
Pharmacokinetics of First-Line Drugs Among Children With Tuberculosis in Rural Tanzania Abstract Background Dosing 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. Methods At 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. Results We 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). Conclusions Among 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 1 - Trang 14-20 - 2020
COVID-19–Associated Pediatric Multisystem Inflammatory Syndrome
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 3 - Trang 407-408 - 2020
Defibrotide for the Treatment of Pediatric Inflammatory Multisystem Syndrome Temporally Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2 Pediatric Patients Abstract 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, 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 5 - Trang 622-625 - 2020
Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series Abstract
We 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 3 - Trang 393-398 - 2020
Guillain-Barré Syndrome Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Detection and Coronavirus Disease 2019 in a Child Abstract
Coronavirus 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 4 - Trang 510-513 - 2020
Pediatric Sporotrichosis in Jilin Province of China (2010–2016): a Retrospective Study of 704 Cases Abstract
Background
Pediatric 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.
Methods
The 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.
Results
Among 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.
Conclusions
The 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.
Journal of the Pediatric Infectious Diseases Society - Tập 9 Số 3 - Trang 342-348 - 2020
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