Pediatric Infectious Disease Journal最新文献

Objective: To elucidate the clinical characteristics and risk factors associated with liver injury in children with severe Mycoplasma pneumoniae pneumonia (SMPP).

Methods and materials: This 2-center retrospective study analyzed 1321 children with SMPP from Nanjing Medical University Affiliated Children's Hospital (January-December 2023), divided into liver injury (alanine aminotransferase > 80 IU/L) and nonliver injury groups. Medical records were used to compare clinical features and prognoses. External validation used data from 640 patients at Nanjing Lishui People's Hospital.

Results: Of the 1321 patients, 55 had liver injury. These patients were typically older, had more severe pulmonary manifestations (eg, pulmonary consolidation, atelectasis and pleural effusion), and higher levels of white blood cell count, neutrophil percentage, neutrophil-to-lymphocyte ratio, lactate dehydrogenase (LDH), D-dimer, alanine aminotransferase, and aspartate aminotransferase. They also had longer hospital stays, higher costs and greater need for intensive care and oxygen support, along with higher risks of pulmonary embolism, necrotizing pneumonia and refractory Mycoplasma pneumoniae pneumonia. Multivariate logistic regression identified elevated LDH (odds ratio =1.040, 95% confidence interval: 1.027-1.055, P < 0.001) and D-dimer (odds ratio = 2.149, 95% confidence interval: 1.648-2.802, P < 0.001) as independent risk factors. The combined prediction model showed an area under the curve of 0.811. External validation confirmed the reliability of LDH and D-dimer as predictive biomarkers.

Conclusions: SMPP with liver injury shows distinct clinical features. Affected children are often older and exhibit severe pulmonary symptoms. These patients face prolonged hospitalization, higher medical costs and increased need for intensive care and oxygen support. They are also at greater risk of adverse outcomes such as pulmonary embolism, necrotizing pneumonia and refractory M. pneumoniae pneumonia. External validation confirms LDH and D-dimer as reliable predictive biomarkers.

Background: Rabies is a uniformly fatal but vaccine-preventable disease. In India, the standard 4-session intradermal rabies post-exposure prophylaxis is currently administered. The World Health Organization has recommended a shortened 3-session regimen. Pediatric and adolescent-specific data for this abbreviated protocol remain sparse.

Objectives: To evaluate the immunogenicity of the 3-session intradermal rabies post-exposure prophylaxis regimen among children and adolescents under 18 years of age in India and to assess its adequacy for potential policy adoption.

Methods: A descriptive cross-sectional study was conducted at the Animal Bite Clinic of a tertiary teaching hospital in New Delhi, India. Eighty-two children and adolescents presenting for the 4th rabies vaccine dose were enrolled. Blood samples were collected before administration of the fourth dose, and IgG anti-rabies virus glycoprotein antibody values were estimated using indirect enzyme-linked immunosorbent assay. Values ≥0.5 EU/mL were considered seroprotective. Participants were followed up for 1 year for any development of rabies.

Results: Of the 82 participants, 79 (96.3%) had seroprotective values. The geometric mean value was 2.67 EU/mL. Three participants (3.7%) had values <0.5 EU/mL. Follow-up assessment post-4th dose confirmed seroconversion in 2 of them. The use and type of rabies immunoglobulin had no significant effect on seroconversion. No participants developed rabies over a 1-year follow-up.

Conclusions: Although seroconversion was achieved in 96.3% of participants after 3 sessions, the 3.7% with nonprotective values raise concerns. Given the fatal nature of rabies and infrastructural variability in Indian healthcare, continuation of the 4-session regimen is recommended until broader validation is conducted in a representative pediatric population via multicentric studies.

Infectious myositis in children is typically linked to influenza viruses and involves the lower limb muscles. We report the first pediatric case of bilateral temporal myositis associated with adenovirus infection in a 3-year-old child. Diagnosis was supported by ultrasound evidence of temporalis muscle inflammation. Symptoms resolved with supportive care, and 1-month follow-up confirmed full recovery without recurrence or complications.

Background: Maternal antibodies are critical for infant protection. We analyzed the dynamics of placental transferred antibodies generated after SARS-CoV-2 maternal infection and/or vaccination.

Methods: Prospective, multicenter, observational study of SARS-CoV-2-infected and/or vaccinated pregnant people and their infants. We collected maternal and cord blood samples at delivery and neonatal/infant samples at delivery, 1, 2, 6 and 12 months of age. Receptor Binding Domain (RBD) and Spike immunoglobulin G antibody titers were measured by Enzyme Linked Immunosorbent Assay (ELISA). Serum maternal cytokines were measured at delivery using the Olink platform. We analyzed differences in antibody transfer according to infection versus vaccination, adjusted for trimester of gestation.

Results: We collected blood samples from 193 pregnant people (infected = 96, vaccinated = 60 and infected and vaccinated = 37) and 154 infants (n = 76, n = 47 and n = 31, respectively). At birth, RBD median (interquartile range) log 10 ng/mL antibody titers of infants from vaccinated-only [4.28 (3.48-4.80)] and from infected-and-vaccinated mothers [4.61 (4.27-4.93)] were higher than from infected-only mothers [2.20 (0.10-3.30); P < 0.001]. Differences persisted through 6 months of age. Median (interquartile range) transplacental antibody transfer ratio was higher in vaccinated-only [2.94 (1.34-3.74)] versus infected-only pregnant people [1.19 (0.33-2.52); P < 0.01]. Spike antibodies showed similar results. Linear regression analysis showed that mean RBD and Spike antibodies transfer ratios were higher in infants from vaccinated-only versus infected-only mothers, adjusted for trimester of infection or vaccination. Maternal concentrations of CXCL10, CXCL11, IL-18 and IFNg at delivery were inversely correlated with placental antibody transfer.

Conclusions: Antibodies generated by maternal vaccination were transplacentally transferred more efficiently and persisted longer in infants than those generated by SARS-CoV-2 infection alone.

Background: Viral lower respiratory tract infections (LRTIs) are a leading cause of mortality among children. Bacterial coinfections in viral LRTI are associated with severe clinical outcomes. Identifying lower airway bacterial involvement in viral LRTI is challenging. Our objective was to define the concordance of bacterial detection between paired upper nasopharyngeal (NP) swabs and lower endotracheal airway samples (ETAs) in children with severe viral LRTI.

Methods: Convenience sample of children <5 years intubated with LRTI. Children were enrolled within 48 hours of ICU admission, and NP/ETAs were obtained for the detection of Moraxella catarrhalis , Streptococcus pneumoniae , Haemophilus influenzae and Staphylococcus aureus. Concordance was assessed via intraclass correlation coefficient (ICC), according to the respiratory virus and age. Clinical outcomes were also assessed.

Results: From 2017 to 2021, we enrolled 76 children [median age: 2.1 (1.2-4.3) months]. The most common respiratory virus was respiratory syncytial virus (RSV) (73.7%). Overall concordance for bacterial detection was high for M. catarrhalis , H. influenzae , and S. pneumoniae (ICC ≥0.75) but low for S. aureus (ICC 0.36). Detection rates varied by viral pathogen, with M. catarrhalis and S. pneumoniae showing the highest agreement in children with RSV. Agreement was higher in infants <6 months. Prolonged intubation was observed in children with RSV and NP codetection of S. pneumoniae or H. influenzae .

Conclusions: Concordance was high for M. catarrhalis , H. influenzae , and S. pneumoniae, but not for S. aureus, and was influenced by the viral etiology and age. These findings suggest the applicability of NP swabs as surrogates for lower airway cultures for specific bacterial-virus combinations in children with severe LRTI.

Background: Necrotizing pneumonia (NP) represents a severe and potentially life-threatening complication of community-acquired pneumonia in children, characterized by progressive lung parenchymal necrosis, cavity formation and significant respiratory compromise. Despite advances in pediatric critical care, NP continue to pose substantial challenges in terms of early recognition, optimal management strategies and prediction of intensive care requirements.

Objectives: This multicenter observational study aimed to comprehensively analyze the clinical characteristics, microbiological patterns, radiological features and management strategies of pediatric NP requiring intensive care admission, with particular focus on identifying predictive factors for disease severity and resource utilization.

Methods: We conducted a retrospective analysis of all children admitted with radiologically confirmed NP to Italian pediatric intensive care units (PICUs) between January 2018 and December 2022. Comprehensive data collection included demographics, clinical presentation, laboratory findings, microbiological results, radiological patterns, therapeutic interventions, complications and outcomes. Statistical analysis was performed to identify associations between clinical variables and outcomes.

Results: Among 76 children (median age 45 months, interquartile range: 19-84), Streptococcus pneumoniae was identified in 38 patients (52.8%), followed by Staphylococcus aureus in 18 (23.7%), including 12 Panton-Valentine leukocidin-positive strains (16.7%). Mechanical ventilation was required in 44 patients (57.9%), chest drainage in 58 (76.3%) and video-assisted thoracoscopic surgery in 11 (14.5%). Comorbidities were present in 23 patients (30.3%). Mean PICU stay was 8.9 ± 8.8 days with zero mortality. Independent predictors of prolonged PICU stay included age <24 months [odds ratio (OR) 2.8, 95% confidence interval (CI): 1.2-6.5], comorbidities (OR 3.2, 95% CI: 1.4-7.3) and bilateral involvement (OR 3.8, 95% CI: 1.5-9.6).

Conclusions: Pediatric NP remains a challenging clinical entity requiring multidisciplinary management and significant intensive care resources. Early recognition of severity predictors, prompt microbiological diagnosis and individualized therapeutic approaches are essential for optimizing outcomes. Our findings support the need for standardized protocols and further prospective studies to refine management strategies for this severe condition.

Clinical trial registration: Not applicable (observational study).

Background: This study aimed to evaluate and compare the clinical, laboratory and radiologic characteristics, as well as treatment approaches, in pediatric patients diagnosed with preseptal and orbital cellulitis.

Methods: This descriptive, retrospective, cross-sectional study included pediatric patients treated at a tertiary care center between January 2019 and December 2023. Demographic, clinical, etiologic, laboratory and radiologic data were analyzed.

Results: Among 244 patients, 233 (95.5%) had preseptal cellulitis and 11 (4.5%) had orbital cellulitis. There were no significant differences in age and gender between the groups ( P = 0.465 and P = 0.274, respectively). Fever (81.8%), proptosis (54.5%), pain with eye movements (54.5%) and diplopia (18.2%) were significantly more frequent in orbital cellulitis ( P < 0.05). Sinusitis was detected in all patients with orbital cellulitis ( P = 0.001), while conjunctivitis was the leading etiologic factor in preseptal cases (28.3%). Leukocyte and C-reactive protein levels were significantly higher in orbital cellulitis patients ( P = 0.001). All patients underwent computed tomography; subperiosteal abscess was identified in 5 (2%), orbital abscess in 1 (0.4%) and epidural abscess in 1 (0.4%) patient. Surgery was required in 54.5% of orbital cellulitis cases. No permanent complications were observed in either group.

Conclusions: Preseptal cellulitis is more common and typically follows a milder clinical course. In contrast, orbital cellulitis, although rare, presents with more severe symptoms and elevated inflammatory markers. Radiologic imaging plays a key role in the diagnostic process, complementing clinical assessment. The consistent association of sinusitis with orbital cellulitis highlights the importance of early recognition and treatment of sinus infections to prevent serious complications.