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Fusani L, Venturini E, Indolfi G, Scagnet M, Trabalzini F, Chiappini E, Galli L. Complicated Sinusitis in Children: Should We Increase Awareness After the Pandemic? Pediatr Infect Dis J 2024:00006454-990000000-00828. [PMID: 38621165 DOI: 10.1097/inf.0000000000004357] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Lara Fusani
- Department of Health Sciences University of Florence
| | | | - Giuseppe Indolfi
- Paediatric Unit Meyer Children's Hospital IRCCS Department of Neurofarba University of Florence
| | - Mirko Scagnet
- Department of Neurosurgery Meyer Children's Hospital IRCCS
| | | | - Elena Chiappini
- Department of Health Sciences University of Florence Infectious Disease Unit Meyer Children's Hospital IRCCS Florence, Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Infectious Disease Unit Meyer Children's Hospital IRCCS Florence, Italy
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Romani L, Roversi M, Bernardi S, Venturini E, Garazzino S, Donà D, Krzysztofiak A, Montagnani C, Funiciello E, Calò Carducci FI, Marabotto C, Castagnola E, Salvini F, Lancella L, Lo Vecchio A, Galli L, Castelli Gattinara G. Use of Remdesivir in children with COVID-19: report of an Italian multicenter study. Ital J Pediatr 2024; 50:32. [PMID: 38413992 PMCID: PMC10900665 DOI: 10.1186/s13052-024-01606-z] [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: 09/28/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study conducted in 10 Italian Hospitals to investigate the safety of RDV in children affected by COVID-19. METHODS We collected the clinical data of children with COVID-19 treated with RDV between March 2020 and February 2022 in 10 Italian hospitals. Clinical data were compared according to a duration of RDV therapy more or less than 5 days. Linear regression model was used to determine the association of significant variables from the bivariate analysis to the duration of RDV therapy. RESULTS A total of 50 patients were included, with a median age of 12.8 years. Many patients had at least one comorbidity (78%), mostly obesity. Symptoms were fever (88%), cough (74%) and dyspnea (68%). Most patients were diagnosed with pneumonia of either viral and/or bacterial etiology. Blood test showed leukopenia in 66% and increased C-reactive protein (CRP) levels in 63% of cases. Thirty-six patients received RDV for 5 days, nine patients up to 10 days. Most children who received RDV longer were admitted to the PICU (67%). Treatment with RDV was well tolerated with rare side effects: bradycardia was recorded in 6% of cases, solved in less than 24 h after discontinuation. A mild elevation of transaminases was observed in 26% of cases, however for the 8%, it was still detected before the RDV administration. Therefore, in these cases, we could not establish if it was caused by COVID-19, RDV o both. Patients who received RDV for more than 5 days waited longer for its administration after pneumonia diagnosis. The presence of comorbidities and the duration of O2 administration significantly correlated with the duration of RDV therapy at the linear regression analysis. CONCLUSION Our experience indicates that RDV against SARS-CoV-2 is safe and well-tolerated in pediatric populations at high risk of developing severe COVID-19. Our data suggest that delaying RDV therapy after diagnosis of pneumonia may be associated with a longer duration of antiviral therapy, especially in patients with comorbidities.
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Affiliation(s)
- Lorenza Romani
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- PhD Course "Immunology, Molecular Medicine and Applied Biotechnology", University of Rome Tor Vergata, Rome, Italy
| | - Stefania Bernardi
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisa Funiciello
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Caterina Marabotto
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elio Castagnola
- Hematology and Oncology, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filippo Salvini
- Pediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Lancella
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
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Venturini E, Fusani L, Lo Vecchio A, Scarano SM, Garazzino S, Pruccoli G, Donà D, Lancella L, Castelli Gattinara G, Galli L. Safety of Sotrovimab use in children with COVID-19: an Italian experience. J Chemother 2024; 36:45-48. [PMID: 37605372 DOI: 10.1080/1120009x.2023.2250138] [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: 03/08/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
Sotrovimab is a monoclonal antibody approved in adult and adolescents at high risk for COVID-19. Thirty-three children evaluated in five Italian paediatric centres received Sotrovimab infusion and were retrospectively enrolled from December 2021 to April 2022. In more than half of cases (19/33, 57.6%) Sotrovimab was prescribed off-label. Overall, the infusion was well tolerated with no significative differences in those receiving an off-label prescription. All children had a complete recovery. Data on the safety of Sotrovimab should be investigated in a larger paediatric cohort, considering the continuous selection of new SARS CoV-2 variants which may be more or less susceptible to the effects of the Sotrovimab.
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Affiliation(s)
- Elisabetta Venturini
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Lara Fusani
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Sara Maria Scarano
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | | | - Luisa Galli
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Venturini E, Bortone B, Cini G, Venanzi J, Pellegrino R, Bartolesi AM, Vaggelli G, Trapani S, Indolfi G, Bianchi L, Montagnani C, Chiappini E, Rossolini GM, Galli L. Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis? Eur J Pediatr 2024; 183:425-434. [PMID: 37924350 PMCID: PMC10858102 DOI: 10.1007/s00431-023-05277-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates. Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2-113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children ≤ 4 years of age and in those with uncomplicated TB (p=0.008).Conclusions: Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern. What is known: • The diagnosis of paediatric tuberculosis is a challenge for paediatricians • Despite their low sensitivity gastric aspirates represent the standard sample for microbiological confirmation of active pulmonary tuberculosis in children • Most international guidelines recommend performing three sequential gastric aspirates on three consecutive days What is new: • A significant increase in global sensitivity by 13.4% was found by the collection of three gastric aspirates compared to the first one • Performing a higher number of gastric aspirates increases the sensitivity of microbiological confirmation, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.
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Affiliation(s)
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Gianmaria Cini
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Jacopo Venanzi
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Viale Pieraccini, 24 - 50139 , Firenze, Florence, Italy
| | - Roberta Pellegrino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Viale Pieraccini, 24 - 50139 , Firenze, Florence, Italy
| | | | - Guendalina Vaggelli
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Sandra Trapani
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Viale Pieraccini, 24 - 50139 , Firenze, Florence, Italy
| | | | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Viale Pieraccini, 24 - 50139 , Firenze, Florence, Italy
| | - Gian Maria Rossolini
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Viale Pieraccini, 24 - 50139 , Firenze, Florence, Italy.
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5
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Pellegrino R, Timitilli E, Verga MC, Guarino A, Iacono ID, Scotese I, Tezza G, Dinardo G, Riccio S, Pellizzari S, Iavarone S, Lorenzetti G, Simeone G, Bergamini M, Donà D, Pierantoni L, Garazzino S, Esposito S, Venturini E, Gattinara GC, Lo Vecchio A, Marseglia GL, Di Mauro G, Principi N, Galli L, Chiappini E. Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives. Eur J Pediatr 2023; 182:5259-5273. [PMID: 37819417 PMCID: PMC10746578 DOI: 10.1007/s00431-023-05211-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
This study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5-7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known: • GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases. • GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New: • Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk. • The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy.
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Affiliation(s)
- Roberta Pellegrino
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | - Edoardo Timitilli
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Iride Dello Iacono
- Unit of Allergology, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Giovanna Tezza
- Department of Pediatrics, Ospedale San Maurizio, Bolzano, Italy
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Simona Riccio
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sofia Pellizzari
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Sonia Iavarone
- Department of Maternal, Infantile, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Lorenzetti
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Susanna Esposito
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Nicola Principi
- Professor Emeritus of Pediatrics, University of Milan, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy.
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Chiappini E, Bestetti M, Masi S, Paba T, Venturini E, Galli L. Discomfort relief after paracetamol administration in febrile children admitted to a third level paediatric emergency department. Front Pediatr 2023; 11:1075449. [PMID: 36969272 PMCID: PMC10034175 DOI: 10.3389/fped.2023.1075449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/05/2023] [Indexed: 03/29/2023] Open
Abstract
Background international guidelines recommend treating fever in children not at a predefined body temperature limit but based on the presence of discomfort. However few studies evaluated discomfort relief after administration of antipyretics in children. Methods Between 1st January and 30th September 2021 a single-center prospective observational study was performed in febrile children consecutively admitted to a pediatric emergency department and treated with paracetamol orally. For each child, body temperature, presence and severity of discomfort, defined using a previously published semiquantitative likert scale, were evaluated at baseline and 60 min after administration of paracetamol, and differences were analyzed. Results 172 children (males: 91/172; 52.9%; median age: 41.7 months) were included. Significant reductions in body temperature (median body temperature at T0: 38.9 °C; IQR: 38.3-39.4, median body temperature at T60: 36.9 °C; IQR: 36.4-37.5; P < 0.0001), and in the level of discomfort (proportion of children with severe discomfort at T0: 85% and at T60:14%; P < 0.0001) were observed. Severe discomfort at T60 persisted in a minority of children (24/172; 14%) and it was not related to body temperature values. Conclusions paracetamol in febrile children is associated not only with significantly reduction in body temperature but also with discomfort relief.
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Affiliation(s)
- Elena Chiappini
- Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
- Correspondence: Elena Chiappini
| | - Matilde Bestetti
- Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Stefano Masi
- Department of Health Sciences, University of Florence, Florence, Italy
- Department of Emergency Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Teresa Paba
- Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Venturini E, Giometto S, Tamborino A, Becciolini L, Bosis S, Corsello G, Del Barba P, Garazzino S, Lo Vecchio A, Pugi A, Signa S, Stera G, Trapani S, Castelli Gattinara G, Lucenteforte E, Galli L. Sensitivity of three commercial tests for SARS-CoV-2 serology in children: an Italian multicentre prospective study. Ital J Pediatr 2022; 48:192. [PMID: 36461032 PMCID: PMC9716520 DOI: 10.1186/s13052-022-01381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND US Food and Drug Administration has issued Emergency Use Authorizations for hundreds of serological assays to support Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) diagnosis. The aim of this study is to evaluate, for the first time in children, the performance of three widely utilized SARS-CoV-2 serology commercial assays, Diesse Diagnostics (IgG, IgA, IgM) and Roche Diagnostics, both Roche Nucleocapsid (N) IgG and Roche Spike (S) IgG assays. METHODS Sensitivity and 95% confidence intervals (CIs) were estimated for each of the three different serological tests and mixed and direct comparison were performed. Univariate and multivariate Poisson regression models were fitted to calculate incidence rate ratios and 95% CIs as estimate of the effects of age, gender, time on the serology title. A p-value < 0.05 indicated statistical significance. RESULTS Overall, 149 children were enrolled in the study. A low sensitivity was found for Diesse IgA, IgM and IgG. Compare to Diesse, Roche S had a higher sensitivity at 15-28 days from infection (0.94, 95%CI: 0.73-1.0) and Roche N at 28-84 days (0.78, 95%CI: 0.58-0.91). When a direct comparison of IgG tests sensitivity was feasible for patients with pairwise information, Roche S and Roche N showed a statistically significant higher sensitivity compared to Diesse in all the study periods, whereas there was no difference between the two Roche tests. CONCLUSION Roche S and Roche N serology tests seem to better perform in children. Large prospective studies are needed to better define the characteristics of those tests.
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Affiliation(s)
- Elisabetta Venturini
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Sabrina Giometto
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agnese Tamborino
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Laura Becciolini
- grid.413181.e0000 0004 1757 8562Clinical Chemistry and Microbiology Laboratory, Meyer Children’s Hospital, Florence, Italy
| | - Samantha Bosis
- grid.414818.00000 0004 1757 8749Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Paolo Del Barba
- grid.18887.3e0000000417581884Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Garazzino
- grid.7605.40000 0001 2336 6580Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- grid.4691.a0000 0001 0790 385XSection of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Pugi
- grid.413181.e0000 0004 1757 8562Clinical Trial Office, Meyer Children’s Hospital, Florence, Italy
| | - Sara Signa
- grid.419504.d0000 0004 1760 0109Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Stera
- grid.6292.f0000 0004 1757 1758Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | - Sandra Trapani
- grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
| | - Guido Castelli Gattinara
- grid.414603.4Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ersilia Lucenteforte
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisa Galli
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
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8
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Dona’ D, Montagnani C, Di Chiara C, Venturini E, Galli L, Lo Vecchio A, Denina M, Olivini N, Bruzzese E, Campana A, Giacchero R, Salvini F, Meini A, Ponzoni M, Trapani S, Rossi E, Lombardi MH, Badolato R, Pierri L, Pruccoli G, Rossin S, Colomba C, Cazzato S, Pacati I, Nicolini G, Pierantoni L, Bianchini S, Krzysztofiak A, Garazzino S, Giaquinto C, Castelli Gattinara G. COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease? Viruses 2022; 14:v14102256. [PMID: 36298812 PMCID: PMC9612333 DOI: 10.3390/v14102256] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
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Affiliation(s)
- Daniele Dona’
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3388946412
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Nicole Olivini
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Campana
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | | | - Filippo Salvini
- Department of Pediatrics, Niguarda Hospital, 20162 Milan, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
| | - Sandra Trapani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | | | - Mary Haywood Lombardi
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
| | - Ilaria Pacati
- Paediatric Unit, Ospedale Bolognini ASST Bergamo Est, 24068 Seriate, Italy
| | | | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, 40138 Bologna, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
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Naselli A, Venturini E, Oss M, Tota F, Graziani S, Collini L, Galli L, Soffiati M. Early-onset fulminant neonatal sepsis caused by Multi-Drug Resistant and ESBL producing E. coli (CTX-M gene) in a late-preterm neonate: case report and literature review. New Microbiol 2022; 45:223-226. [PMID: 35920879] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Neonatal sepsis is a systemic condition characterized by haemodynamic changes and other clinical manifestations due to a presence of pathogenic microorganisms (bacteria, viruses, or fungi) in nor- mally sterile fluid that occurs in an infant younger than 90 days old. Neonatal sepsis may be divided into two types: early-onset neonatal sepsis (EOS) and late-onset neonatal sepsis (LOS). Gram-posi- tive microorganisms are the etiological agents in 62% of EOS, and in 43% of the total the identified microorganism is GBS. Gram-negative microorganisms comprise 37% of the etiological agents of EOS, of which 29% are caused by Escherichia coli. ESBL-producing Enterobacteriaceae represent a major worldwide threat among drug-resistant bacteria in both hospital and community settings. ESBLs are often located on large plasmids that also harbour genes resistant to other antimicrobial classes, resulting in multidrug-resistant isolates. Plasmid-encoded ESBLs of the CTX-M-type are increasingly reported worldwide in Gram-negative rods and now account for most of the ESBLs found in Enterobacteriaceae. We present one case of EOS by Multi Drug Resistant (MDR) and ESBL producing E. coli (CTX-M gene) in a neonate born to a mother recently immigrated from Africa. Maternal blood culture grew the same bacteria.
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Affiliation(s)
- Aldo Naselli
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Elisabetta Venturini
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Martina Oss
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Silvia Graziani
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Lucia Collini
- Microbiology and Virology Unit, S. Chiara Hospital, Trento, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Florence, Italy
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10
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Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022; 11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.
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Affiliation(s)
- Aniello Meoli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Lorenzo Ciavola
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Sofia Rahman
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Marco Masetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Tommaso Toschetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Riccardo Morini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Giulia Dal Canto
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Nicola Petrosillo
- Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
- Correspondence: ; Tel.: +39-0521-903524
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11
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Corsi E, Bosso A, Venturini E. P395 INFECTIVE ENDOCARDITIS: A SUBTLE PRESENTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.381] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Infective endocarditis is still a serious and deadly disease. Despite improvements in its management, the diagnosis it is not always easy and thus it is still associated with high mortality and severe complications. This is especially true for patients with prosthetic valves, that have higher risk of developing infective endocarditis and more often associated with severe complications and a higher rate of mortality.
Case Description
A 75–years–old woman presented to the ED for persistent low–grade fever and mild dyspnoea. She had an aortic biologic prosthetic valve implanted the year before for severe aortic stenosis. She also complained a persistent back pain, present for about three months and irresponsive to pharmacological therapy and also physiotherapy. Getting back in time, she had been hospitalized few months before for genitourinary tract infection from multi–resistant E. faecalis, treated with antibiotic therapy and then discharged after few days. She underwent a transthoracic echocardiogram in ED that showed an apparently intraprosthetic moderate aortic regurgitation, never described in the previous cardiologic controls. In the strong suspect of endocarditis complicated by systemic embolization, she also underwent transoesophageal echocardiography, that showed dehiscence of the prosthetic valve with severe paravalvular abscess and regurgitation, without rocking motion of the prosthesis. A TC scan and then a spine MRI confirmed the presence of infectious spondylodiscitis, responsible for that persistent back pain. The patient was therefore urgently sent to cardiac surgery: a Bentall procedure (aortic valve and aortic root replacement) was performed. The patient, despite the severity of the sepsis and the cardiac endocarditis, survived the surgery and after 3 weeks of intensive care hospitalization was discharged and sent back to our Department for Cardiac Rehabilitation. Entering the ward, the patient was severely deconditioned, but after about 45 days of hospitalization she was discharged fit, with good functional capacity.
Conclusion
This case shows the subtle but serious evolution that usually controlled infections can have in patients with high risk of endocarditis, as patients with prosthetic valves. This underlines on one hand the importance of antibiotic prophylaxis in this subset of patients, on the other hand the role of multimodality imaging for diagnosis and management of infective endocarditis and its complications.
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Affiliation(s)
- E Corsi
- UO UTIC CARDIOLOGIA OSPEDALE CECINA, CECINA; UO RIABILITAZIONE CARDIOLOGICA OSPEDALE CECINA, CECINA
| | - A Bosso
- UO UTIC CARDIOLOGIA OSPEDALE CECINA, CECINA; UO RIABILITAZIONE CARDIOLOGICA OSPEDALE CECINA, CECINA
| | - E Venturini
- UO UTIC CARDIOLOGIA OSPEDALE CECINA, CECINA; UO RIABILITAZIONE CARDIOLOGICA OSPEDALE CECINA, CECINA
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12
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Canale M, Coviello K, Solarino G, Del Meglio J, Simonetti F, Venturini E, Camerini A, Maurea N, Bisceglia I, Tessa C, Casolo G. P147 RECOVERY OF CHEMOTHERAPY RELATED ACUTE HEART FAILURE BY THE COMBINED USE OF SACUBITRIL VALSARTAN AND WEARABLE CARDIOVERTER DEFIBRILLATOR. A NOVEL WINNING COMBINATION IN CARDIO–ONCOLOGY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.142] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Effective anticancer treatments have dramatically improved the outcome of cancer patients but cardiac toxicity reduces their clinical efficacy in a non–negligible percentage of patients. Sacubitril/valsartan is a new paradigm in the treatment of chronic heart failure with reduced ejection fraction due to the enhancement of natriuretic peptides’ properties when coupled with a blocking effect on the AT1 angiotensin receptors. As with other clinical conditions of heart failure with potentially reversible declines in cardiac function, the wearable cardioverter defibrillator is a valid tool for protection against sudden death until recovery occurs. We report a case series of four patients with chemotherapy–related acute cardiac failure with severely reduced cardiac function. They were successfully treated with sacubitril/valsartan while being protected from malignant arrhythmias by the use of a wearable cardioverter defibrillator until the recovery of cardiac function. Sacubitril/valsartan was confirmed to be effective in anthracycline–related cardiac toxicity and the wearable cardioverter defibrillator should be considered as a support tool even in the oncology patient.
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Affiliation(s)
- M Canale
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - K Coviello
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - G Solarino
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - J Del Meglio
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - F Simonetti
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - E Venturini
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - A Camerini
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - N Maurea
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - I Bisceglia
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - C Tessa
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
| | - G Casolo
- CARDIOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; EMATOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA OSPEDALE CIVILE, CECINA; ONCOLOGIA OSPEDALE VERSILIA, LIDO DI CAMAIORE; CARDIOLOGIA ISTITUTO NAZIONALE TUMORI, IRCCS FONDAZIONE PASCALE, NAPOLI; SERVIZI CARDIOLOGICI INTEGRATI, AZIENDA OSPEDALIERA SAN CAMILLO FORLANINI, ROMA; RADIOLOGIA, NUOVO OSPEDALE APUANO, MASSA
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Venturini E, Masini G, Giallauria F. Treatment of iron deficiency anemia after cardiac surgery. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.217] [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] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Iron deficiency anemia (IDA) after cardiac surgery (CS) increases mortality, serious adverse events and length of stay. Aim of the study was to compare the efficacy of Sucrosomal Iron (SI) on IDA and hematinic deficiencies (HD) in patients (P) after CS, compared to i.v. Ferric Carboxymaltose (FCM). SI was chosen for its peculiar intestinal absorption properties such as to overcome the hepcidin's block.
Methods
106 consecutive anemic P were tested for HD after the admission in Cardiac Rehabilitation and alternately treated with SI (56) or FCM (54). The study design included a single dose of 1000 mg of FCM at T1 (8-10 days CS) or a dose of 120 mg of SI per day from T1 to T2 (on the day of discharge 10 days after T1); since then the SI was reduced to 30 mg per day until T3 (follow-up, 10 days after T2). Measures of efficacy included changes from baseline in Hb, HD, natriuretic peptides (NP), C-reactive protein (CRP), and the 6-minute-walking-test (6MWT).
Results
The data are shown in the Table. At T1, two treatment groups did not show statistically significant differences. Hb increased significantly (p<0.001), with no differences between SI and FCM. Transferrin saturation and sideremia significantly increased, albeit more rapidly with FCM. Ferritin, elevated at baseline for inflammation due to CS, decreases to T3 with SI, while significantly increases in the FCM group. NP were reduced with both treatments, but not significantly; CRP, on the other hand, was significantly reduced over time. At 6MWT the distance increased significantly with no difference between SI and FCM.
Conclusions
SI and FCM show similar efficacy on HD, starting from Hb, in P with IDA, after CS. The quick response to treatment, comparable between SI and FCM, could support the choice of oral iron, with organizational and cost benefits. In addition, was shown a positive impact on functional capacity, assessed with the 6MWT, for the first time similar between an oral and i.v. iron. Inflammation was reduced, but only SI is able to recover Hb levels, avoiding the risk of hyperferritinemia.
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Affiliation(s)
| | - G Masini
- Civil Hospital Cecina, Cecina, Italy
| | - F Giallauria
- Federico II University Hospital, Department of Translational Medical Sciences, Division of Internal Medicine, Naples, Italy
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Esposito S, Sgarzani R, Bianchini S, Monaco S, Nicoletti L, Rigotti E, Di Pietro M, Opri R, Caminiti C, Ciccia M, Conti G, Donà D, Giuffré M, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Piacentini G, Pietrasanta C, Puntoni M, Simonini A, Venturini E, Staiano A, Principi N. Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11040506. [PMID: 35453257 PMCID: PMC9029976 DOI: 10.3390/antibiotics11040506] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
- Correspondence: ; Tel.: +39-0521-903524
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Marilia Di Pietro
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Carlo Pietrasanta
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Matteo Puntoni
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer’s Children Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
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15
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Rigotti E, Bianchini S, Nicoletti L, Monaco S, Carrara E, Opri F, Opri R, Caminiti C, Donà D, Giuffré M, Inserra A, Lancella L, Mugelli A, Piacentini G, Principi N, Tesoro S, Venturini E, Staiano A, Villani A, Sesenna E, Vicini C, Esposito S. Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11030382. [PMID: 35326845 PMCID: PMC8944694 DOI: 10.3390/antibiotics11030382] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days−18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.
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Affiliation(s)
- Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90134 Palermo, Italy;
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139 Florence, Italy;
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
- Correspondence: ; Tel.: +39-0521-903524
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16
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Chappell E, Kohns Vasconcelos M, Goodall RL, Galli L, Goetghebuer T, Noguera‐Julian A, Rodrigues LC, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro ML, Ramos JT, Warszawski J, Spolou V, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb DM, Giaquinto C, Judd A, Collins IJ. Children living with HIV in Europe: do migrants have worse treatment outcomes? HIV Med 2022; 23:186-196. [PMID: 34596323 PMCID: PMC9293243 DOI: 10.1111/hiv.13177] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe. METHODS Children aged < 18 years at the start of antiretroviral therapy (ART) in European paediatric HIV observational cohorts where ≥ 5% of children were migrants (defined as born abroad) were included. Three outcomes were considered: (i) severe immunosuppression-for-age; (ii) viraemic viral load (≥ 400 copies/mL) at 1 year after ART initiation; and (iii) AIDS/death after ART initiation. The effect of migrant status was assessed using univariable and multivariable logistic and Cox models. RESULTS Of 2620 children included across 12 European countries, 56% were migrants. At ART initiation, migrant children were older than domestic-born children (median 6.1 vs. 0.9 years, p < 0.001), with slightly higher proportions being severely immunocompromised (35% vs. 33%) and with active tuberculosis (2% vs. 1%), but a lower proportion with an AIDS diagnosis (14% vs. 19%) (all p < 0.001). At 1 year after beginning ART, a lower proportion of migrant children were viraemic (18% vs. 24%) but there was no difference in multivariable analysis (p = 0.702), and no difference in severe immunosuppression (p = 0.409). However, there was a trend towards higher risk of AIDS/death in migrant children (adjusted hazard ratio = 1.51, 95% confidence interval: 0.96-2.38, p = 0.072). CONCLUSIONS After adjusting for characteristics at ART initiation, migrant children have virological and immunological outcomes at 1 year of ART that are comparable to those who are domestic-born, possibly indicating equity in access to healthcare in Europe. However, there was some evidence of a difference in AIDS-free survival, which warrants further monitoring.
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Affiliation(s)
| | - Malte Kohns Vasconcelos
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Institute for Medical Microbiology and Hospital HygieneHeinrich Heine University DüsseldorfDüsseldorfGermany
- Paediatric Infectious Diseases Research GroupInstitute for Infection and ImmunitySt. George's, University of LondonLondonUK
| | | | - Luisa Galli
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Tessa Goetghebuer
- Department of PediatricsHôpital St PierreUniversité libre de BruxellesBruxellesBelgium
| | - Antoni Noguera‐Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases UnitDepartment of PediatricsSant Joan de Déu Hospital Research FoundationBarcelonaSpain
- Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of PediatricsUniversity of BarcelonaBarcelonaSpain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
| | - Laura C. Rodrigues
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Henriette Scherpbier
- Emma Children's Hospital/Amsterdam University Medical CentreAmsterdamThe Netherlands
| | - Colette Smit
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCLLondonUK
- Great Ormond Street Hospital for Children NHS TrustLondonUK
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Marissa Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
- Hospital General Universitario "Gregorio Marañón"MadridSpain
- Universidad ComplutenseMadridSpain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM)MadridSpain
| | - Jose T. Ramos
- Departamento de Salud Pública y Materno‐infantilUniversidad ComplutenseHospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
| | - Josiane Warszawski
- Service d'Epidémiologie et Santé PubliqueAP‐HPHôpital BicêtreLe Kremlin‐BicêtreFrance
- Unité de Recherche Clinique Paris Descartes Necker CochinAP‐HPParisFrance
| | - Vana Spolou
- First Department of PaediatricsInfectious Diseases Unit, “Agia Sophia” Childrens' HospitalAthensGreece
| | - Elena Chiappini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Elisabetta Venturini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | | | - Christian Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal HospitalInfectious Diseases and Hospital EpidemiologySt GallenSwitzerland
| | | | - Laura Marques
- Centro Hospitalar e Universitário do PortoPortoPortugal
| | - Lars Naver
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Ali Judd
- MRC Clinical Trials Unit at UCLLondonUK
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17
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Lanari M, Venturini E, Pierantoni L, Stera G, Castelli Gattinara G, Esposito SMR, Favilli S, Franzoni E, Fusco E, Lionetti P, Maffeis C, Marseglia G, Massella L, Midulla F, Zanobini A, Zecca M, Villani A, Staiano A, Galli L. Eligibility criteria for pediatric patients who may benefit from anti SARS-CoV-2 monoclonal antibody therapy administration: an Italian inter-society consensus statement. Ital J Pediatr 2022; 48:7. [PMID: 35022088 PMCID: PMC8754075 DOI: 10.1186/s13052-021-01187-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023] Open
Abstract
The fast diffusion of the SARS-CoV-2 pandemic have called for an equally rapid evolution of the therapeutic options.The Human recombinant monoclonal antibodies (mAbs) have recently been approved by the Food and Drug Administration (FDA) and by the Italian Medicines Agency (AIFA) in subjects aged ≥12 with SARS-CoV-2 infection and specific risk factors.Currently the indications are specific for the use of two different mAbs combination: Bamlanivimab+Etesevimab (produced by Eli Lilly) and Casirivimab+Imdevimab (produced by Regeneron).These drugs have shown favorable effects in adult patients in the initial phase of infection, whereas to date few data are available on their use in children.AIFA criteria derived from the existing literature which reports an increased risk of severe COVID-19 in children with comorbidities. However, the studies analyzing the determinants for progression to severe disease are mainly monocentric, with limited numbers and reporting mostly generic risk categories.Thus, the Italian Society of Pediatrics invited its affiliated Scientific Societies to produce a Consensus document based on the revision of the criteria proposed by AIFA in light of the most recent literature and experts' agreement.This Consensus tries to detail which patients actually have the risk to develop severe disease, analyzing the most common comorbidities in children, in order to detail the indications for mAbs administration and to guide the clinicians in identifying eligible patients.
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Affiliation(s)
- Marcello Lanari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Italian Association of Children's Hospital (AOPI), Rome, Italy
| | | | - Luca Pierantoni
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giacomo Stera
- Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | | | - Susanna Maria Roberta Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Favilli
- Cardiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Emilio Franzoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Eleonora Fusco
- Postgraduate School of Pediatrics, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Paolo Lionetti
- Gastroenterology Unit, NEUROFARBA Department, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Claudio Maffeis
- Pediatric Clinic B, Mother and Child Hospital, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, University of Pavia, San Matteo Foundation IRCCS Policlinico, Pavia, Italy
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Villani
- General Pediatrics Unit, Pediatric Emergency and General Pediatrics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.
- Department of Health Sciences, University of Florence, Florence, Italy.
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18
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Consonni F, Chiti N, Ricci S, Venturini E, Canessa C, Bianchi L, Lippi F, Montagnani C, Giovannini M, Chiappini E, Galli L, Azzari C, Lodi L. Unbalanced serum immunoglobulins in clinical subtypes of pediatric tuberculosis disease. Front Pediatr 2022; 10:908963. [PMID: 36016881 PMCID: PMC9395963 DOI: 10.3389/fped.2022.908963] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
Immune response to tuberculosis (TB) has been extensively studied in the past decades and classically involves cellular immunity. However, evidence suggests that humoral immunity may play a relevant role. Past studies regarding serum immunoglobulin (Ig) levels in TB are dated and only involve adult subjects. In this study, we retrospectively studied a cohort of 256 children with TB disease and analyzed 111 patients screened for total serum Ig at diagnosis. According to the severity and extent of organ involvement, subjects were divided into four groups, namely, uncomplicated pulmonary TB (UCPTB, 56.3% of patients), complicated pulmonary TB (CPTB, 22.5%), lymph node extrapulmonary TB (LN-EPTB, 7.2%), and extra-nodal extrapulmonary TB (EN-EPTB, 13.5%). Serum IgG and IgA levels were significantly higher in more severe and extended TB disease. Median IgG levels progressively increased from uncomplicated to complicated pulmonary and nodal forms, reaching their highest values in diffuse extra-pulmonary TB. In parallel, UCPTB showed significantly lower frequencies of patients presenting a substantial increase in IgG levels when compared with the other three groups. No relevant differences in IgM levels were detected. Ig screening at follow-up showed a significant reduction in IgG and IgA levels. Finally, we unveiled three cases of selective IgA and one case of selective IgM deficiencies (SIgMD), the latter with a severe clinical course. Serum IgG and IgA may be a useful clinical tool to assess the severity and monitor the treatment response in pediatric TB disease. Moreover, immunological workup in children with TB disease may unmask primary defects of humoral immunity.
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Affiliation(s)
- Filippo Consonni
- Meyer Children's Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Nicolò Chiti
- Meyer Children's Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Elisabetta Venturini
- Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Clementina Canessa
- Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Francesca Lippi
- Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Carlotta Montagnani
- Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Florence, Italy.,Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy.,Infectious Diseases Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
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19
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Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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Thee S, Basu Roy R, Blázquez-Gamero D, Falcón-Neyra L, Neth O, Noguera-Julian A, Lillo C, Galli L, Venturini E, Buonsenso D, Götzinger F, Martinez-Alier N, Velizarova S, Brinkmann F, Welch SB, Tsolia M, Santiago-Garcia B, Schilling R, Tebruegge M, Krüger R. Treatment and outcome in children with tuberculous meningitis - a multi-centre Paediatric Tuberculosis Network European Trials Group study. Clin Infect Dis 2021; 75:372-381. [PMID: 34849642 DOI: 10.1093/cid/ciab982] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Currently, data on treatment, outcome, and prognostic factors in children with tuberculous meningitis (TBM) in Europe are limited. To date, most existing data on TBM originate from adult studies, or studies conducted in low-resource settings. METHODS Multicentre, retrospective study involving 27 paediatric healthcare institutions in nine European countries via an established paediatric TB research network, before and after the 2014 revision of WHO dosing recommendations. RESULTS Of 118 children, 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2 and 11 (9.3%) grade 3. Fifty-eight (49.1%) children received a standard four-drug treatment regimen; other commonly used drugs included streptomycin, prothionamide, and amikacin. Almost half of the patients (48.3%; 56/116) were admitted to intensive care unit, with a median stay of 10 (IQR 4.5-21.0) days. Of 104 children with complete outcome data, 9.6% (10/104) died, and only 47.1% (49/104) recovered fully. Main long-term sequelae included spasticity of one or more limbs and developmental delay both in 19.2% (20/104), and seizure disorder in 17.3% (18/104). Multivariate regression analyses identified microbiological confirmation of TBM, the need for neurosurgical intervention and mechanical ventilation as risk factors for unfavourable outcome. DISCUSSION There was considerable heterogeneity in the use of TB drugs in this cohort. Despite few children presenting with advanced disease and the study being conducted in a high-resource setting, morbidity and mortality were high. Several risk factors for poor outcome were identified, which may aid prognostic predictions in children with TBM in the future.
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Affiliation(s)
- Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Centre, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robindra Basu Roy
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Lola Falcón-Neyra
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Seville (IBIS), Sevilla, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Seville (IBIS), Sevilla, Spain
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Cristina Lillo
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Department of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Florian Götzinger
- Department of Paediatrics and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Klinik Ottakring, Vienna, Austria
| | - Nuria Martinez-Alier
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Svetlana Velizarova
- Department of Pulmonary Diseases, Medical University, Hospital for Lung Diseases 'St. Sofia', Sofia, Bulgaria
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Maria Tsolia
- Second Department or Paediatrics, National and Kapodistrian University of Athens, School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Begoña Santiago-Garcia
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Red de Investigación Translacional en Infectología Pediátrica (RITIP)
| | - Ralph Schilling
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia.,Department of Infection, Immunity & Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Centre, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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21
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Tersigni C, Boiardi G, Tofani L, Venturini E, Montagnani C, Bortone B, Bianchi L, Chiappini E, Cassetta MI, Fallani S, Novelli A, Galli L. Real-life isoniazid and rifampicin plasma concentrations in children: a tool for therapeutic drug monitoring of tuberculosis. BMC Infect Dis 2021; 21:1087. [PMID: 34674665 PMCID: PMC8529739 DOI: 10.1186/s12879-021-06764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Low plasma levels of first-line antitubercular drugs can be counted among the main causes of poor response to antitubercular therapy, and therapeutic drug monitoring has been proposed as a method to promote tailored treatments for both child and adult patients. The main aim of the study was to evaluate serum concentrations of isoniazid (INH) and rifampicin (RIF) and to investigate reasons for sub-therapeutic plasma concentrations in order to fix dosages. Methods Children with TB were prospectively enrolled from January to August 2019. Two venous blood samples were collected (the first at least 15 days after the beginning of antitubercular treatment, and the second between 1 and 8 weeks later). Plasma concentrations were determined by a validated high-performance liquid chromatography method. Results In all, 45 children were included. Seventy blood samples for INH plasma concentration were collected between 120 and 240 min after drug intake. Adjusting for dose (mg/kg/day) and time of INH administration, when considering three different age groups (≤ 2 years, 2–12 years, > 12 years), a statistically significant lower INH plasma concentration was observed in younger children compared to the older age groups in the multivariate analysis (p < 0.001 and p < 0.001). A total of 68 blood samples were evaluated for RIF concentrations. Both for INH and RIF a statistically significant lower plasma concentration was also observed in adolescents (p < 0.001). Fifteen children (15/45, 33%) presented drug concentrations under the referral therapeutic range. Conclusions Based on our findings, monitoring patients’ drug plasma concentrations in children under 2 years of age and in adolescents can make treatment more patient-tailored.
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Affiliation(s)
- Chiara Tersigni
- Post Graduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Lorenzo Tofani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Iris Cassetta
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Stefania Fallani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy. .,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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22
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Venturini E, Virgillitto A, Briscese L, Cavicchioli P, Bavera M, Mussini F, Santini S, Bresci M, Laddaga C. Short and medium-term impact of a cardiac rehabilitation (CR) program in COVID-19 patients after acute care hospitalization. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2678] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
COVID-19 (C-19) infection can acutely cause organ dysfunctions, especially cardiorespiratory, even with a long recovery period, inducing a significant functional deficit. Aim of the study was to evaluate the impact of a holistic hospital intensive rehabilitation program, based on CR, on C-19 patients (P), after acute care, to improve their fitness, in order to return to their life in the best conditions.
Methods
In the period april-august 2020, 30 P (mean age 73 years, 60% male) were admitted to the rehabilitation centre at a mean distance of 31±11 days from the onset of C-19; 34% of them had undergone prolonged invasive ventilation, 34% non invasive ventilation and 32% required high flow oxygen. Comorbidities were: hypertension (77%), diabetes (13%) and chronic coronary syndrome (10%); 18 P were unable to stand, and 12 showed impaired trunk control. No P had impaired LVEF or significant valvular disease. Initially, the program focused on training for trunk and sitting control; then on exercises for straightening the upper and lower limbs. From the second week, started a CR training on the cycle ergometer 10–20 minutes a day for 6 days a week, similar protocol to that used in P with heart failure. The aerobic training was of moderate intensity, not exceeding 40–60% of the maximum heart rate, Borg scale 10–12, starting with zero load, gradually increasing by 10–15 watts and up to a minimum target of 25–30 watts. The impact of the protocol on motor functions [MRC Muscle Strenght Scale, Short Physical Performance Battery (SPPB)] on functional capacity [6 Minutes Walking Test (6MWT)] on anxiety (A) and depression (D) [Hamilton Anxiety Rating scale (HAMA) and Hamilton Depression Rating scale (HAMD)] and on basic activities of daily life [Barthel Index (BI)] were evaluated. The assessment was done on the admission (T0), at the discharge (T1, on average after 31 days) and after a follow-up of 55 days (T3).
Results
The results are shown in the table below. Only 4 P were able to perform the 6MWT at T0. The motor function improves rapidly and then reaches a plateau and its trend is reflected in the BI. Functional capacity, on the other hand, improves significantly even at a distance. A and D decreased rapidly but increased over time.
Conclusions
A rehabilitation protocol, centered on CR, induces a rapid increase in motor capacity, even in severely compromised subjects such as C-19. The improvement in fitness over time, as demonstrated by the 6MWT, probably is due to the severe muscle deconditioning, for the long stay in acute care. The long-term worsening of A and D may depend on various causes: no longer living in a “protected and safe” place, the fear of relapse, returning home and discovering new deaths and mournings. A program, CR-like, can counteract many of the negative consequences of C-19; however these P deserve an outpatient rehabilitation to maintain and consolidate the positive results over time.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- E Venturini
- Civic Hospital Cecina, Unit of Cardiac Rehabilitation, Cecina, Italy
| | - A Virgillitto
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
| | - L Briscese
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
| | - P Cavicchioli
- Civic Hospital Cecina, Unit of Cardiac Rehabilitation, Cecina, Italy
| | - M Bavera
- Civic Hospital Cecina, Unit of Cardiac Rehabilitation, Cecina, Italy
| | - F Mussini
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
| | - S Santini
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
| | - M Bresci
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
| | - C Laddaga
- Civic Hospital, U.O.C. Recupero e Rieducazione Funzionale, Cecina, Italy
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23
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Venturini E, Montagnani C, Garazzino S, Donà D, Pierantoni L, Vecchio AL, Krzysztofiak A, Nicolini G, Bianchini S, Galli L, Villani A, Gattinara GC. Treatment of children with COVID-19: update of the Italian Society of Pediatric Infectious Diseases position paper. Ital J Pediatr 2021; 47:199. [PMID: 34620212 PMCID: PMC8495664 DOI: 10.1186/s13052-021-01132-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Department for Woman and Child Health, Division of Pediatric Infectious Diseases, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrzej Krzysztofiak
- Universitarian-Hospital Department, Bambino Gesù Children Hospital - IRCCS, Rome, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Bambino Gesù Children Hospital - IRCCS, Rome, Italy
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24
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Krzysztofiak A, Chiappini E, Venturini E, Gargiullo L, Roversi M, Montagnani C, Bozzola E, Chiurchiu S, Vecchio D, Castagnola E, Tomà P, Rossolini GM, Toniolo RM, Esposito S, Cirillo M, Cardinale F, Novelli A, Beltrami G, Tagliabue C, Boero S, Deriu D, Bianchini S, Grandin A, Bosis S, Ciarcià M, Ciofi D, Tersigni C, Bortone B, Trippella G, Nicolini G, Lo Vecchio A, Giannattasio A, Musso P, Serrano E, Marchisio P, Donà D, Garazzino S, Pierantoni L, Mazzone T, Bernaschi P, Ferrari A, Gattinara GC, Galli L, Villani A. Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children. Ital J Pediatr 2021; 47:179. [PMID: 34454557 PMCID: PMC8403408 DOI: 10.1186/s13052-021-01130-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acute hematogenous osteomyelitis (AHOM) is an insidious infection of the bone that more frequently affects young males. The etiology, mainly bacterial, is often related to the patient's age, but it is frequently missed, owing to the low sensitivity of microbiological cultures. Thus, the evaluation of inflammatory biomarkers and imaging usually guide the diagnosis and follow-up of the infection. The antibiotic treatment of uncomplicated AHOM, on the other hand, heavily relies upon the clinician experience, given the current lack of national guidelines for the management of this infection. METHODS A systematic review of the studies on the empirical treatment of uncomplicated AHOM in children published in English or Italian between January 1, 2009, and March 31, 2020, indexed on Pubmed or Embase search engines, was carried out. All guidelines and studies reporting on non-bacterial or complicated or post-traumatic osteomyelitis affecting newborns or children older than 18 years or with comorbidities were excluded from the review. All other works were included in this study. RESULTS Out of 4576 articles, 53 were included in the study. Data on different topics was gathered and outlined: bone penetration of antibiotics; choice of intravenous antibiotic therapy according to the isolated or suspected pathogen; choice of oral antibiotic therapy; length of treatment and switch to oral therapy; surgical treatment. CONCLUSIONS The therapeutic management of osteomyelitis is still object of controversy. This study reports the first Italian consensus on the management of uncomplicated AHOM in children of pediatric osteomyelitis, based on expert opinions and a vast literature review.
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Affiliation(s)
- Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Chiappini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Livia Gargiullo
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlotta Montagnani
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Bozzola
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Chiurchiu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Vecchio
- Rare Disease and Medical Genetics, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elio Castagnola
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Renato Maria Toniolo
- Surgery Department, Traumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Andrea Novelli
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Silvio Boero
- Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy
| | - Daniele Deriu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Annalisa Grandin
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Martina Ciarcià
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Daniele Ciofi
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Trippella
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | | | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Paola Musso
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Serrano
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Paola Bernaschi
- Microbiology Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | | | | | - Luisa Galli
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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25
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Di Sciacca G, Di Sieno L, Farina A, Lanka P, Venturini E, Panizza P, Dalla Mora A, Pifferi A, Taroni P, Arridge SR. Enhanced diffuse optical tomographic reconstruction using concurrent ultrasound information. Philos Trans A Math Phys Eng Sci 2021; 379:20200195. [PMID: 34218668 PMCID: PMC8255947 DOI: 10.1098/rsta.2020.0195] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 05/26/2023]
Abstract
Multimodal imaging is an active branch of research as it has the potential to improve common medical imaging techniques. Diffuse optical tomography (DOT) is an example of a low resolution, functional imaging modality that typically has very low resolution due to the ill-posedness of its underlying inverse problem. Combining the functional information of DOT with a high resolution structural imaging modality has been studied widely. In particular, the combination of DOT with ultrasound (US) could serve as a useful tool for clinicians for the formulation of accurate diagnosis of breast lesions. In this paper, we propose a novel method for US-guided DOT reconstruction using a portable time-domain measurement system. B-mode US imaging is used to retrieve morphological information on the probed tissues by means of a semi-automatical segmentation procedure based on active contour fitting. A two-dimensional to three-dimensional extrapolation procedure, based on the concept of distance transform, is then applied to generate a three-dimensional edge-weighting prior for the regularization of DOT. The reconstruction procedure has been tested on experimental data obtained on specifically designed dual-modality silicon phantoms. Results show a substantial quantification improvement upon the application of the implemented technique. This article is part of the theme issue 'Synergistic tomographic image reconstruction: part 2'.
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Affiliation(s)
- G. Di Sciacca
- Department of Computer Science, University College London, London WC1E 6BT, UK
| | - L. Di Sieno
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - A. Farina
- Consiglio Nazionale delle Ricerche, Istituto di Fotonica e Nanotecnologie, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - P. Lanka
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - E. Venturini
- Breast Imaging Unit, San Raffaele Scientific Hospital, Milano, Italy
| | - P. Panizza
- Breast Imaging Unit, San Raffaele Scientific Hospital, Milano, Italy
| | - A. Dalla Mora
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - A. Pifferi
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - P. Taroni
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32 20133 Milano, Italy
| | - S. R. Arridge
- Department of Computer Science, University College London, London WC1E 6BT, UK
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26
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Montagnani C, Tersigni C, D'Arienzo S, Miftode A, Venturini E, Bortone B, Bianchi L, Chiappini E, Forni S, Gemmi F, Galli L. Resistance Patterns from Urine Cultures in Children Aged 0 to 6 Years: Implications for Empirical Antibiotic Choice. Infect Drug Resist 2021; 14:2341-2348. [PMID: 34188500 PMCID: PMC8236245 DOI: 10.2147/idr.s293279] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Urinary tract infection (UTI) is a frequent disorder of childhood, caused mainly by Gram negative Enterobacterales. The aim of this study is to evaluate etiology and antimicrobial susceptibility patterns of bacterial isolates in urine cultures of children under the age of 6 and to analyze the relationship between previous hospitalization or antibiotic prescriptions and antimicrobial resistance rates. Patients and Methods A retrospective study on positive urine cultures from 13 public laboratories in Tuscany, Italy was conducted. Data were obtained by reviewing records of the “Microbiological and Antibiotic-Resistance Surveillance System” (SMART) in Tuscany, Italy. A total of 2944 positive urine cultures were collected from 2445 children. Results Escherichia coli represented the majority of isolates (54,2%), followed by Enterococcus faecalis (12,3%), Proteus mirabilis (10,3%) and Klebsiella pneumoniae (6,6%). Isolated uropathogens showed high resistance rates to amoxicillin-clavulanate (>25%), particularly in children under one year of age or hospitalized within the 12 months before the sample collection. High susceptibility rates were reported of aminoglycosides, cephalosporins and quinolones (>90%). Previous antibiotic prescriptions by general pediatricians did not increase resistance rates. Conclusion Our results show a rate of amoxicillin-clavulanate resistance of 25%. Higher resistance rates were reported in children under one year of age and with previous hospitalization. Hence, amoxicillin-clavulanate should be used carefully in young children and those with severe symptoms.
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Affiliation(s)
- Carlotta Montagnani
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Postgraduate School of Paediatrics, University of Florence, Florence, Italy
| | | | | | | | - Barbara Bortone
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | | | - Luisa Galli
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
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27
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Venturini E, Scarso S, Prelazzi GA, Niccolai C, Bianchi L, Montagnani C, Lapini M, Chiappini E, Antonelli A, Rossolini GM, Galli L. Epidemiology and clinical features of intestinal protozoan infections detected by Real-time PCR in non-native children within an Italian tertiary care children's hospital: A cross-sectional study. Travel Med Infect Dis 2021; 43:102107. [PMID: 34116243 DOI: 10.1016/j.tmaid.2021.102107] [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: 01/21/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enteric parasite infections are underestimated due to the limited sensitivity and specificity of microscopy, which remains the diagnostic gold standard in routine clinical practice. This could be a major problem in high-income countries, where the burden of parasitic diseases is low. In recent years, Multiplex Real-Time polymerase chain reaction (RT-PCR) based methods have been implemented. Therefore, the aim of this study was to evaluate the prevalence of four enteric protozoan species detected by RT-PCR in non-native children in Italy, and to describe their clinical characteristics. METHODS Adopted and immigrant children, evaluated for migration health assessment between 2017 and 2020 in a tertiary care children's hospital in Italy, were enrolled. Molecular analysis for Giardia lamblia, Dientamoeba fragilis, Blastocystis hominis, and Entamoeba histolytica, was conducted by in-house RT-PCR. RESULTS Overall, 209 children were enrolled and 70% of them resulted positive by RT-PCR for at least one enteric parasite. B. hominis (47.8%) was the most commonly identified protozoa, followed by D. fragilis (44.5%). Co-infections with multiple pathogens were detected in 35.4% of the samples. Almost 80% of parasite-positive children were asymptomatic and the most common symptom was flatulence (60.7% of symptomatic children). Eosinophils were significantly increased in RT-PCR positive children compared to the negative ones and children with D. fragilis presented the highest eosinophils count. CONCLUSIONS The In-house Multiplex RT-PCR assay provides a valid molecular detection system for selected enteric parasites. This novel and accurate diagnostic method can help in increasing the detection rate of parasite infection, especially in high-risk population.
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Affiliation(s)
| | - Salvatore Scarso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Claudia Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Manuela Lapini
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Italy.
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28
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Rossini D, Venturini E, Barni L, Dardi O, Bonaguidi E, Cavicchioli P, Lucchesi N. Comparison between the 6-minute walking test (6MWT) and gait speed (GS) during outpatient cardiac rehabilitation. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.320] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): USL TOSCANA CENTRO USL TOSCANA NORD-OVEST
Background
6MWT is the gold standard for the functional and prognostic evaluation of patients (P) undergoing cardiac rehabilitation (CR), documenting the increase in exercise capacity induced by CR intervention. However, 6MWT requires an adequate space of at least 30 meters and a non-negligible operator time. GS has been proposed as a test of rapid execution, that can be performed even in a small space. Due to the limited experiences, the aim of the present study was to validate GS in CR in comparison with 6MWT.
Material and Methods
44 P (31 males and 13 females; age 68.2 ± 11.9 years) were enrolled consecutively in an outpatient rehabilitation program; 20 of them after cardiac surgery, 18 after acute cardiac syndrome and 6 with heart failure. After evaluating equilibrium and gait with the Tinetti scale (score ≥ 19), P performed 6MWT and GS at the beginning and at the end of the CR program. The speed at GS was calculated as the average of 3 tests. Data were expressed as mean ± SD. The results of 6MWT and GS at the initial and the final evaluation were compared with Student’s t-test for paired data (statistical significance at p <0.05). The Pearson correlation index (r) was calculated to evaluate the linearity relationship between distance traveled at 6MWT and velocity at GS; the statistical significance was tested with ANOVA. The Statistical Package SPSS (version 24) was used for statistical analysis.
Results
the meters traveled at the initial and the final 6MWT were 434 ± 100 and 491 ± 96 respectively (p <0.001). The velocity in m/sec at the initial and the final GS was 1.68 ± 0.42 and 1.80 ± 0.44 respectively (p <0.001). The correlation between meters traveled and velocity is strong at baseline (r = 0.896) and after CR (r = 0.859), with p <0.001 in both cases.
Conclusions
certainly, aerobic capacity and resistance to exercise are better described by 6MWT. However, given the strong correlation between the distance traveled at 6MWT and the speed at GS, the latter test can be proposed as a tool for a rapid, precise and repeatable functional evaluation, even in clinical settings other than CR.
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Affiliation(s)
- D Rossini
- Civic Hospital, Cardiac Rehabilitation Unit, Pescia (PT), Italy
| | - E Venturini
- Civic Hospital, Cardiac Rehabilitation Unit, Cecina (Li), Italy
| | - L Barni
- Civic Hospital, Cardiac Rehabilitation Unit, Pescia (PT), Italy
| | - O Dardi
- Civic Hospital, Cardiac Rehabilitation Unit, Pescia (PT), Italy
| | - E Bonaguidi
- Civic Hospital, Cardiac Rehabilitation Unit, Pescia (PT), Italy
| | - P Cavicchioli
- Civic Hospital, Cardiac Rehabilitation Unit, Cecina (Li), Italy
| | - N Lucchesi
- Civic Hospital, Cardiac Rehabilitation Unit, Cecina (Li), Italy
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29
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Fusani L, Tersigni C, Chiappini E, Venturini E, Galli L. Old biomarkers in tuberculosis management: are they still useful? a systematic review. Expert Rev Anti Infect Ther 2021; 19:1191-1203. [PMID: 33722116 DOI: 10.1080/14787210.2021.1898945] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The diagnosis of childhood tuberculosis (TB) can be challenging, given the lack of a gold standard test. Several new biomarkers have been studied for research purposes, but despite encouraging results, they are not used in clinical practice yet. Old biomarkers can be valuable tools in TB management. We conducted a systematic review to provide an update on their possible usefulness in TB patients.Areas covered: C-reactive protein could be useful to rule out TB, due to its high negative predictive value. Moreover, ferritin and erythrocyte sedimentation rates were found to be higher in TB patients with positive sputum smears. The lack of biomarkers decreases during an appropriate treatment course, indicating a poor response to treatment, seems to be correlated with a higher risk of death. Finally, procalcitonin and C-reactive protein seems to be useful in the differential diagnosis with pneumonia.Expert opinion: Old biomarkers are point-of-care tests, cheap and easily interpretable. These characteristics make them particularly useful, especially in TB endemic areas, to better manage patients with TB. Further studies performed in children are essential to implement the use of old biomarkers as diagnostic and prognostic tests.
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Affiliation(s)
- Lara Fusani
- Department of Health Sciences, Post Graduate School of Paediatrics, University of Florence, Florence, Italy
| | - Chiara Tersigni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Florence, Italy.,Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy.,Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
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30
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Scarcella A, Bortone B, Tersigni C, Trippella G, Bianchi L, Montagnani C, Chiappini E, Venturini E, Galli L. Early limb paralysis in infants: do not forget about congenital syphilis. Int J STD AIDS 2021; 32:768-770. [PMID: 33533292 DOI: 10.1177/0956462420987442] [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] [Indexed: 11/15/2022]
Abstract
We describe the case of a 2-month-old baby with congenital syphilis, presenting with limb paralysis. The radiological investigations showed periosteal thickenings of the limb. Despite negative maternal serology during the first trimester of pregnancy, clinical and radiological features led to the suspicion of pseudoparalysis of Parrot, which was confirmed by blood tests. Delayed diagnoses or misdiagnoses are possible when uncommon presentations of forgotten diseases occur. The needing for a second screening for syphilis in high-risk pregnant women should be evaluated.
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Affiliation(s)
- Antonio Scarcella
- University of Florence, 9300Department of Health Science, Florence, Italy.,Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Barbara Bortone
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Chiara Tersigni
- University of Florence, 9300Department of Health Science, Florence, Italy.,Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Giulia Trippella
- University of Florence, 9300Department of Health Science, Florence, Italy.,Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Leila Bianchi
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | - Elena Chiappini
- University of Florence, 9300Department of Health Science, Florence, Italy.,Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
| | | | - Luisa Galli
- University of Florence, 9300Department of Health Science, Florence, Italy.,Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy
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31
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Bassi A, Pedaci F, Oranges T, Azzari C, Galli L, Ricci S, Filippeschi C, Venturini E. The Serum Immunoglobulin E Level: Is There a Relationship With the Clinical Course of the Gianotti-Crosti Syndrome? Front Pediatr 2021; 9:643341. [PMID: 33718308 PMCID: PMC7947791 DOI: 10.3389/fped.2021.643341] [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] [Received: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Gianotti Crosti syndrome (GCS) is a self-healing condition with a spontaneous resolution in 2-6 weeks but, even if rarely, recurrent episodes have been reported. Objective: The aim of this observational study is to investigate serum Immunoglobulin E (IgE) level in children with GCS, evaluating if there is a relationship between IgE level and clinical course of the disease. Methods: Children with GCS diagnosed at a tertiary care children's university hospital between June 2018 and November 2019 were prospectively enrolled. Demographic, clinical and hematochemical data of children investigated were collected. In particular, IgE level were investigated at symptoms onset and, if available, at the following blood tests. Patients were divided in 2 groups on the bases of the clinical course: children with a chronic relapsing course and children who did not present any relapse. Results: Among 29 patients enrolled in this study, 14 (48.3%) children had a chronic relapsing course and 15 (51.7%) did not present any relapse. A statistically significant difference was present considering the length of the disease: 210 days (IQR: 161.25-255) for patients with a chronic relapsing course compared to 40 days (IQR: 30-75) for the other group (p < 0.0001). About the median IgE level in the 2 groups, a value about 10 time higher was found in children with chronic course compared to the other group (1,144 vs. 116 U/mL) with a statistically significant difference (p < 0.0001). Conclusion: Despite the study limitations, a significant correlation between higher IgE levels and chronic-relapsing course of the GCS can be assumed.
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Affiliation(s)
- Andrea Bassi
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Fausto Pedaci
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Teresa Oranges
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Cesare Filippeschi
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Elisabetta Venturini
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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32
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Garazzino S, Lo Vecchio A, Pierantoni L, Calò Carducci FI, Marchetti F, Meini A, Castagnola E, Vergine G, Donà D, Bosis S, Dodi I, Venturini E, Felici E, Giacchero R, Denina M, Pierri L, Nicolini G, Montagnani C, Krzysztofiak A, Bianchini S, Marabotto C, Tovo PA, Pruccoli G, Lanari M, Villani A, Castelli Gattinara G. Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results From an Italian Multicenter Study. Front Pediatr 2021; 9:649358. [PMID: 33796491 PMCID: PMC8007917 DOI: 10.3389/fped.2021.649358] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. Methods: The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020. Results: As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission (p < 0.01) and linearly to length of stay (p = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications (p < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission (p < 0.05). Conclusions: Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.
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Affiliation(s)
- Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Icilio Dodi
- Emergency and General Pediatric Unit, Pietro Barilla Children's Hospital, Parma, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | | | - Marco Denina
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierri
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | | | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Caterina Marabotto
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | - Pier-Angelo Tovo
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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33
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Parigi S, Venturini E, Galli L, Chiappini E. Xpert ® MTB/RIF Ultra performance in diagnosing paediatric pulmonary TB in gastric aspirates. Int J Tuberc Lung Dis 2021; 25:75-77. [PMID: 33384051 DOI: 10.5588/ijtld.20.0499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Parigi
- Department of Health Sciences, University of Florence, Anna Meyer Children´s University Hospital, Florence, Italy
| | | | - L Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children´s University Hospital, Florence, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Anna Meyer Children´s University Hospital, Florence, Italy
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34
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Montagnani C, Venturini E, L'Erario M, Tersigni C, Bortone B, Bianchi L, Menegazzo F, Indolfi G, Chiappini E, Galli L. Criteria for referral of pediatric SARS-CoV-2 infection: a real-life experience in the pandemic era. Ital J Pediatr 2020; 46:181. [PMID: 33287859 PMCID: PMC7720782 DOI: 10.1186/s13052-020-00946-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
A practical guidance on the management of children with COVID-19 to insure homogeneous criteria for referral to a higher-level facility, according to the disease severity, is pivotal in the pandemic era. A panel of experts in pediatric infectious diseases and intensive care at the tertiary-care Meyer Children’s University Hospital, Florence, Italy, issued a practical document shared with Tuscany hospitals. The rationale was to target the referral for those children at risk of requiring an intensive support, since the above mentioned hospital has the pediatric intensive care unit. Overall, 378 patients between 0 and 19 years of age were diagnosed with COVID-19 infection in the Tuscany region with 24 (6.3%) hospitalizations. Only three children were centralized to Meyer Children’s University Hospital according to reported criteria. Considering that appropriate referral criteria have been associated with reduced mortality in other conditions, our document might be useful to improve outcomes of children with COVID-19.
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Affiliation(s)
- Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Manuela L'Erario
- Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy. .,Department of Health Sciences, University of Florence, Florence, Italy.
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Morri M, Venturini E, Franchini N, Ruisi R, Culcasi A, Ruggiero A, Govoni C, Benedetti MG. Is kinesiophobia a predictor of early functional performance after total hip replacement? A prospective prognostic cohort study. BMC Musculoskelet Disord 2020; 21:724. [PMID: 33160343 PMCID: PMC7648978 DOI: 10.1186/s12891-020-03748-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Considerable attention has been paid to the role of kinesiophobia with respect to knee prosthesis but it has not yet been studied as a prognostic factor of short-term functional performance following total hip replacement. The main purpose of the present study is to examine the possible predictors of early functional performance of patients undergoing total primary hip arthroplasty, including demographics as age, sex and body mass index, preoperative functional ability, type of anaesthesia, level of haemoglobin, pain and level of kinesiophobia before surgery. Secondly, we want to describe the main characteristics of the population with the highest levels of kinesiophobia. Methods A prospective, prognostic cohort study was carried out. Patients undergoing primary hip replacement were recruited consecutively. The main outcome is the early functional performance achieved by patients after surgery and measured using the Iowa Level of Assistance (ILOA) scale on the fifth postoperative day. Preoperative kinesiophobia was measured by the Tampa Scale and the preoperative functional ability by the Western Ontario and McMaster Osteoarthritis Index (WOMAC). The multivariate analysis was performed by the General Linear Model. The analysis of the population with high levels of kinesiophobia was conducted by identifying a cut-off of 40 compared to the Tampa Scale. Results Statistical analysis was performed on 269 patients. The average ILOA score recorded was 19.5 (DS 8.3). The levels of kinesiophobia, showed an average score of 35.1 (7.8) and it was not associated with early functional performance. The independent predictive factors include age, sex and body mass index. Kinesiophobia high levels were recorded in 30% of the population and this population had a higher level of pre-operative WOMAC score. Conclusions Early functional performance after hip replacement surgery was not correlated with the level of kinesiophobia. Three significant factors that describe a population most at risk of not achieving optimal functional performance are increased age, being female and increase in body mass index. In the preoperative phase, high levels of kinesiophobia were associated with more impaired preoperative functional ability. Trial registration Current Controlled Trials NCT02786121, May 2016. Retrospectively registered.
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Affiliation(s)
- M Morri
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy.
| | - E Venturini
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - N Franchini
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - R Ruisi
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - A Culcasi
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - A Ruggiero
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - C Govoni
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Assistenza Infermieristico Tecnico e Riabilitativo, Via Pupilli 1, 40136, Bologna, IT, Italy
| | - M G Benedetti
- IRCCS Istituto Ortopedico Rizzoli, Servizio di Medicina Fisica e Riabilitativa, Bologna, Italy
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Venturini E, Montagnani C, Garazzino S, Donà D, Pierantoni L, Lo Vecchio A, Nicolini G, Bianchini S, Krzysztofiak A, Galli L, Villani A, Castelli-Gattinara G. Treatment of children with COVID-19: position paper of the Italian Society of Pediatric Infectious Disease. Ital J Pediatr 2020; 46:139. [PMID: 32972435 PMCID: PMC7512208 DOI: 10.1186/s13052-020-00900-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
A statement of consensus was formulated after reviewing available literature on pediatric treatment strategies for COVID-19 by the Steering and Scientific Committee of the Italian Society of Infectious Pediatric Diseases in connection with the Italian Society of Paediatrics.
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Affiliation(s)
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | | | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department Ospedale Bambino Gesù IRCCS, Rome, Italy
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Venturini E, Grillandini C, Bianchi L, Montagnani C, Chiappini E, Galli L. Clinical features and outcomes of lymphadenopathy in a tertiary children's hospital. J Paediatr Child Health 2020; 56:1277-1282. [PMID: 32436627 DOI: 10.1111/jpc.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/16/2019] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 02/01/2023]
Abstract
AIM The aim of the present study is to describe the clinical features and outcomes of childhood lymphadenopathy and to define factors able to predict neoplastic aetiology or may improve its prognosis. METHODS All children evaluated for lymphadenopathy in our tertiary children's hospital and who underwent their first examination between 1 January, 2015 and 31 December, 2017 were enrolled in this retrospective observational study. Data were analysed using SPSS.Statistics, 24.0. RESULTS A total of 322 children, aged between 0 and 18 years (median 4.5; interquartile range 2.5-9), were enrolled. A specific diagnosis was achieved in almost half of the cases (n = 159, 49.4%) by using one or more methods, including serological, microbiological, biomolecular or histological investigations on surgical samples. Epstein Barr virus and non-tuberculous mycobacteria were the most common etiological agents among acute/sub-acute and chronic lymphadenopathy, respectively. At the end of the study period, two-thirds (210, 65.2%) of enrolled patients were successfully treated. Malignancies and non-tuberculous mycobacteria infections had the longest time to resolution. CONCLUSIONS Our data suggest that lymphadenopathy is a benign condition in most cases. Of note in our study, 2.5% of lymphadenopathy cases were found to be due to oncologic conditions. The most frequent infective causes were Epstein Barr virus, bacteria and non-tuberculous mycobacteria infections. No haematic or ultrasonographic features were independently able to provide sufficient evidence for a conclusive diagnosis. However, utilising these findings alongside evaluation for clinical criteria can guide decision-making for physicians. Lymphadenectomy is the most appropriate process to follow in the event of chronic lymphadenopathy with undefined diagnosis.
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Affiliation(s)
- Elisabetta Venturini
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Leila Bianchi
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
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38
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Basu Roy R, Thee S, Blázquez-Gamero D, Falcón-Neyra L, Neth O, Noguera-Julian A, Lillo C, Galli L, Venturini E, Buonsenso D, Götzinger F, Martinez-Alier N, Velizarova S, Brinkmann F, Welch SB, Tsolia M, Santiago-Garcia B, Krüger R, Tebruegge M. Performance of immune-based and microbiological tests in children with tuberculosis meningitis in Europe: a multicentre Paediatric Tuberculosis Network European Trials Group (ptbnet) study. Eur Respir J 2020; 56:13993003.02004-2019. [PMID: 32299859 PMCID: PMC7330130 DOI: 10.1183/13993003.02004-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 10/11/2019] [Accepted: 03/09/2020] [Indexed: 01/31/2023]
Abstract
Introduction Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-γ release assays (IGRA) and molecular assays in children with TBM in routine clinical practice, particularly in the European setting. Methods Multicentre, retrospective study involving 27 healthcare institutions providing care for children with tuberculosis (TB) in nine European countries. Results Of 118 children included, 54 (45.8%) had definite, 38 (32.2%) probable and 26 (22.0%) possible TBM; 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2 and 11 (9.3%) grade 3. Of 108 patients who underwent cranial imaging 90 (83.3%) had at least one abnormal finding consistent with TBM. At the 5-mm cut-off the tuberculin skin test had a sensitivity of 61.9% (95% CI 51.2–71.6%) and at the 10-mm cut-off 50.0% (95% CI 40.0–60.0%). The test sensitivities of QuantiFERON-TB and T-SPOT.TB assays were 71.7% (95% CI 58.4–82.1%) and 82.5% (95% CI 58.2–94.6%), respectively (p=0.53). Indeterminate results were common, occurring in 17.0% of QuantiFERON-TB assays performed. Cerebrospinal fluid (CSF) cultures were positive in 50.0% (95% CI 40.1–59.9%) of cases, and CSF PCR in 34.8% (95% CI 22.9–43.7%). In the subgroup of children who underwent tuberculin skin test, IGRA, CSF culture and CSF PCR simultaneously, 84.4% had at least one positive test result (95% CI 67.8%–93.6%). Conclusions Existing immunological and microbiological TB tests have suboptimal sensitivity in children with TBM, with each test producing false-negative results in a substantial proportion of patients. Combining immune-based tests with CSF culture and CSF PCR results in considerably higher positive diagnostic yields, and should therefore be standard clinical practice in high-resource settings. All existing immunological and microbiological TB tests have suboptimal sensitivity in children with TBM. Combining immune-based tests with CSF culture and PCR results in far higher positive diagnostic yields, and should therefore be standard practice.http://bit.ly/2TSAArl
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Affiliation(s)
- Robindra Basu Roy
- Clinical Research Dept, London School of Hygiene and Tropical Medicine, London, UK.,Joint first authors
| | - Stephanie Thee
- Dept of Pediatric Pneumology, Immunology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Joint first authors
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Lola Falcón-Neyra
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Institut de Recerca Pediàtrica; Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Cristina Lillo
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), RITIP, Madrid, Spain
| | - Luisa Galli
- Dept of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Dept of Health Sciences, University of Florence, Florence, Italy.,Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Danilo Buonsenso
- Dept of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Florian Götzinger
- Dept of Paediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Nuria Martinez-Alier
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Svetlana Velizarova
- Dept of Pulmonary Diseases, Medical University, Hospital for Lung Diseases 'St. Sofia', Sofia, Bulgaria
| | - Folke Brinkmann
- Dept of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Maria Tsolia
- Second Dept of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Begoña Santiago-Garcia
- Dept of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Renate Krüger
- Dept of Pediatric Pneumology, Immunology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Tebruegge
- Dept of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK .,Dept of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia.,Dept of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Venturini E, Palmas G, Montagnani C, Chiappini E, Citera F, Astorino V, Trapani S, Galli L. Severe neutropenia in infants with severe acute respiratory syndrome caused by the novel coronavirus 2019 infection. J Pediatr 2020; 222:259-261. [PMID: 32444222 PMCID: PMC7236669 DOI: 10.1016/j.jpeds.2020.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Elena Chiappini
- Pediatric Infectious Disease Unit, Meyer Children University Hospital; Department of Health Sciences, University of Florence
| | | | | | | | - Luisa Galli
- Pediatric Infectious Disease Unit, Meyer Children University Hospital; Department of Health Sciences, University of Florence, Florence, Italy
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40
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Venturini E, Iannuzzo G, D’Andrea A, Pacileo M, Tarantini L, Canale M, Gentile M, Vitale G, Sarullo F, Vastarella R, Di Lorenzo A, Testa C, Parlato A, Vigorito C, Giallauria F. Oncology and Cardiac Rehabilitation: An Underrated Relationship. J Clin Med 2020; 9:E1810. [PMID: 32532011 PMCID: PMC7356735 DOI: 10.3390/jcm9061810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient's cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation.
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Affiliation(s)
- E. Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 LI Cecina, Italy
| | - G. Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - A. D’Andrea
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - M. Pacileo
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - L. Tarantini
- Division of Cardiology, Ospedale San Martino ULSS1 Dolomiti, 32100 Belluno, Italy;
| | - M.L. Canale
- Department of Cardiology, Azienda USL Toscana Nord-Ovest, Ospedale Versilia, Lido di Camaiore, 55041 LU, Italy;
| | - M. Gentile
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - G. Vitale
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - F.M. Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - R. Vastarella
- UOSD Scompenso Cardiaco e Cardiologia Riabilitativa, AORN Ospedale dei Colli-Monaldi, 80131 Naples, Italy;
| | - A. Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Testa
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - A. Parlato
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - F. Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
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Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, Bernardi S, Giacchero R, Lo Vecchio A, Marchisio P, Nicolini G, Pierantoni L, Rabbone I, Banderali G, Denina M, Venturini E, Krzysztofiak A, Badolato R, Bianchini S, Galli L, Villani A, Castelli-Gattinara G. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32400362 PMCID: PMC7219028 DOI: 10.2807/1560-7917.es.2020.25.18.2000600] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day–17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.
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Affiliation(s)
- Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Antonella Meini
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Enrico Felici
- Paediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Stefania Bernardi
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | | | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Luca Pierantoni
- Paediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Giuseppe Banderali
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | | | - Raffaele Badolato
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Sonia Bianchini
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Luisa Galli
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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- The members of the Italian SITIP-SIP SARS-CoV-2 paediatric infection study group are listed at the end of this article
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Chiappini E, Storelli F, Tersigni C, Venturini E, de Martino M, Galli L. QuantiFERON-TB Gold In-Tube test performance in a large pediatric population investigated for suspected tuberculosis infection. Paediatr Respir Rev 2019; 32:36-47. [PMID: 31155511 DOI: 10.1016/j.prrv.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/18/2018] [Revised: 01/30/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The performance of QuantiFERON-TB Gold In-Tube (QTF-IT) in children is under debate, especially in those under 5 years of age. Moreover, interpretation of discordant QFT-IT/Tuberculin-Skin-Test (TST) results remains controversial. This study aims at studying the sensitivity of QFT-IT and TST in children with active TB cases and exploring risk factors associated with discordant TST+/QFT-IT-. METHODS Children consecutively referred to one single pediatric center between 2010 and 2017 for suspected tuberculosis infection (TB) were enrolled. All children underwent clinical evaluation, TST and QFT-IT. Sensitivity of QFT-IT and TST in active TB cases and risk factors associated with discordant TST+/QFT-IT- results were assessed. Uni- and multi-variate logistic regression analyses were performed. RESULTS Overall, 4631 children (median age 5.67 years) were enrolled, and 205 active TB cases were diagnosed (83 microbiologically confirmed). A high QFT-IT sensitivity was observed in children between 2 and 4 years of age (95.0%; 95%CI: 85.4-100) and in those between 5 and 18 years (89.1%; 95%CI:79.2-99.2) with microbiologically confirmed active TB. However, sensitivity was suboptimal in children younger than 2 years (84.6%; 95%CI: 65.0-100). Independent risk factors associated with discordant TST+/QFT-IT- results in children with latent tuberculosis infection (LTBI) were previous BCG vaccination (aOR:2.18; 95%CI:1.33-3.58; p = 0.002), age <2 years vs. 5-18 years (aOR:7.54; 95%CI:2.52-22.59; p < 0.0001), age 2-4 years vs. 5-18 years (aOR:4.63; 95%CI:2.66-8.06; p < 0.0001), and investigation for screening rather than for contact with a suspected or confirmed case (aOR:3.58; 95%CI:2.30-5.59; p < 0.0001). CONCLUSION Our data suggest that QFT-IT might be used as unique assay in children over 2 years of age investigated for recent immigration/adoption screening and in cases of recent low risk TB contact. This approach could considerably reduce the number of children undergoing pharmacological treatment. Conversely, both tests are recommended in cases of strong clinical suspicion or high risk TB contact in children less than 5 years of age, in order to avoid misdiagnosis.
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Affiliation(s)
- Elena Chiappini
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Flavio Storelli
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Chiara Tersigni
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elisabetta Venturini
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Maurizio de Martino
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Luisa Galli
- Paediatric Infectious Disease Unit, Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
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Tersigni C, Venturini E, Montagnani C, Chiappini E, de Martino M, Galli L. Antimicrobial stewardship in children: more shadows than lights? Expert Rev Anti Infect Ther 2019; 17:871-876. [PMID: 31661998 DOI: 10.1080/14787210.2019.1686355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: The aim of this review is to evaluate the effectiveness of antimicrobial stewardship (AMS) programmes in the pediatric population in improving clinical outcomes, altering prescribing behavior, controlling antimicrobial resistance and measuring the cost-effectiveness.Areas covered: Medline Ovid MEDLINE(R), Embase, and Cochrane Library were searched on 30 September 2018 combining MeSH and free terms for 'antimicrobial stewardship', 'clinical outcomes', 'antimicrobial resistance', 'cost-effectiveness' and 'prescribing behavior'. Several studies have been conducted on the impact of antimicrobial stewardship programmes (ASPs) in children, which showed a positive impact on length of hospital stay and days of therapy. Together with ASP bundles, the introduction of fast microbiology and point-of-care tests showed a positive impact in terms of rapid identification of the pathogen, time to optimal antimicrobial therapy and reduction of antibiotic use, without worsening clinical outcomes. These improvements turned out to be limited over time. Conflicting results were observed regarding the impact of ASPs on antimicrobial resistance and on cost-effectiveness and cost-benefits, due to the lack of homogeneity between studies.Expert opinion: Evidence regarding the impact of ASPs in children is limited to single center studies, with different study designs, making it impossible to draw unequivocal conclusions. High quality studies are needed. More feasable approaches should be designed both for inpatients and outpatients and for critical patients.
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Affiliation(s)
- Chiara Tersigni
- Post graduate school of Paediatrics, Univerity of Florence, Florence, Italy
| | - Elisabetta Venturini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Tersigni C, Semeraro A, Caremani M, Venturini E, Defilippi C, de Martino M, Galli L. Case Report: Percutaneous Treatment of Multiple Echinococcal Cysts Presenting as Abdominal Palpable Mass. Am J Trop Med Hyg 2019; 100:143-145. [PMID: 30426922 DOI: 10.4269/ajtmh.18-0464] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the case of an adolescent Moroccan girl with abdominal pain and palpable mass in the upper right side of the abdomen. In the emergency department, an abdominal ultrasound showed hepatomegaly and eight active liver cysts, compatible with cystic echinococcosis. Serology for Echinococcus granulosus confirmed the diagnosis. Other sites of localization were excluded. Treatment involved albendazole combined with puncture, aspiration, injection, re-aspiration, performed only for the most medial cysts. Periodical follow-up with abdominal ultrasound and with abdominal magnetic resonance imaging showed a progressive involution of all cysts. The treatment with albendazole was stopped after, overall, 6 months, and monthly ultrasound scan were planned as follow-up. In case of hepatic cysts, E. granulosus should be excluded, especially in children from endemic countries. A multidisciplinary approach with pediatric infectious disease specialists, radiologists, and surgeons is fundamental for disease management.
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Affiliation(s)
- Chiara Tersigni
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alessandro Semeraro
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | | | - Elisabetta Venturini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Claudio Defilippi
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Chiappini E, Matucci T, Lisi C, Petrolini C, Venturini E, Tersigni C, de Martino M, Galli L. Use of Second-line Medications and Treatment Outcomes in Children With Tuberculosis in a Single Center From 2007 to 2018. Pediatr Infect Dis J 2019; 38:1027-1034. [PMID: 31397749 DOI: 10.1097/inf.0000000000002410] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of drug-resistant forms of tuberculosis (DR-TB) and the number of children treated with second-line drugs (SLDs) are increasing. However, limited amount of information is available regarding the use of SLDs in this population. METHODS To describe the treatment of pediatric TB with SLDs and factors associated with use of SLDs in children with and without documented DR-TB, records of pediatric TB patients referred to a center in Italy from 2007 to 2018 were reviewed retrospectively. RESULTS Of 204 children diagnosed with active TB during the study period, 42 were treated with SLDs because of confirmed or probable drug resistance (42.8%), adverse reactions to first-line drugs (7.1%), central nervous system involvement (11.9%) or unconfirmed possible drug resistance (38.1%). There were no deaths or adverse reactions to SLDs reported. Treatment was successful in 85.2% children treated with first-line drugs and 92.9% children treated with SLDs. After adjusting for calendar period, the only factor associated with DR-TB was <2 years old [odds ratio (OR): 5.24 for <2 years vs. 5-18 years; P = 0.008]. Factors associated with treatment with SLDs were TB at 2 or more sites (OR: 11.30; P < 0.001), extrapulmonary TB (OR: 8.48; P < 0.001) or adverse reactions to first-line drugs (OR: 7.48; P = 0.002). No differences were noted in age or region of origin. CONCLUSIONS A substantial proportion of TB children were treated with SLDs. The main reason for using SLDs was failure of a first-line drug regimen, suggesting possible DR-TB and underestimation of DR-TB in children. The use of SLD regimens was associated with a high success rate and good tolerability profile.
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Affiliation(s)
- Elena Chiappini
- From the Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Venturini E, Lodi L, Francolino I, Ricci S, Chiappini E, de Martino M, Galli L. CD3, CD4, CD8, CD19 and CD16/CD56 positive cells in tuberculosis infection and disease: Peculiar features in children. Int J Immunopathol Pharmacol 2019; 33:2058738419840241. [PMID: 30957643 PMCID: PMC6454648 DOI: 10.1177/2058738419840241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pathogenesis of mycobacterial infection has been extensively studied determining
the fundamental role of host immunocompetence in disease progression. Cellular
adaptive immunity, in particular CD4+ cells, has shown to be crucial in the host
defence. A role of cytotoxic lymphocytes and humoral immunity has also been
established. However, few studies have been performed in low endemic countries
on immunological correlates of tuberculosis in paediatric patients. The present
study aims to fill this gap analysing the distribution and the absolute values
of the main lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+ and CD16+/CD56+)
in the different stages of tubercular infection in human immunodeficiency
virus–negative children living in low tubercular endemic countries. Results
obtained in children with latent tuberculosis, active tuberculosis and healthy
controls were compared. Moreover, quantitative analysis of interferon-γ levels
of mitogen-induced response was carried out within the different study groups.
The aim of this analysis was to enforce the comprehension of immune
modifications subsequent to Mycobacterium tuberculosis
infection. The major finding of our study was CD3+ and CD4+ absolute and
percentage depletion in children with active tuberculosis versus healthy
controls. Moreover, severe forms of active tuberculosis showed a marked
reduction in the CD4+ percentage in the context of a systemic impairment which
affects globally the absolute count of all peripheral lymphocyte subsets tested.
A relative increase of natural killer cells was proved in infected patients,
whereas no differences in B cells among the study groups were detected.
Mitogen-induced interferon-γ levels were significantly higher in children with
latent tuberculosis when compared to active tuberculosis and healthy controls,
demonstrating effective immune activation in those patients able to control the
infection.
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Affiliation(s)
| | | | | | | | | | - Maurizio de Martino
- Maurizio de Martino, Department of Health
Sciences and Anna Meyer Children’s University Hospital, University of Florence,
viale Pieraccini 24, 50139 Florence, Italy.
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Della Bella C, Venturini E, Devente S, Piccini P, Tapinassi S, Bianchi L, Grassi A, Benagiano M, Alnwaisri HFM, Montagnani C, Chiappini E, Bitter W, D’Elios MM, de Martino M, Galli L. Role of Mycobacterium avium lysate INF-γ, IL-17, and IL-2 ELISPOT assays in diagnosing nontuberculous mycobacteria lymphadenitis in children. Eur J Clin Microbiol Infect Dis 2019; 38:1113-1122. [DOI: 10.1007/s10096-019-03506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
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Venturini E, Piccini P, Tersigni C, Chiappini E, Galli L. Systematic review shows that immunising internationally adopted children is a major challenge for primary health care. Acta Paediatr 2019; 108:411-418. [PMID: 30368909 DOI: 10.1111/apa.14625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/27/2018] [Revised: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
AIM This systematic review aimed to provide an overview of the immunisation of internationally adopted children and to discuss possible vaccination strategies. METHODS A literature search was performed covering papers published in English from 1988 to 15 June 2018 using the Ovid MEDLINE, EMBASE and Cochrane Library databases. This identified 749 studies and 41 full texts were evaluated. RESULTS Overall, 19 studies conducted between 1988 and 2016 fulfilled our inclusion criteria. These covered 7663 children aged 1.1-5.7 years adopted from Asia, Eastern Europe, Africa and South and Central America. Tetanus protective antibody levels ranged from 35 to 95%, and similar data were reported for diphtheria. A higher percentage of adoptees had protective antibody levels for polio (50-93%) and measles (62-95%). More than a third (35%) did not have protective antibody titres for hepatitis B. Only one study investigated adoptees with protective antibodies against haemophilus influenza, and it reported that this was around 66%. CONCLUSION The appropriate immunisation of internationally adopted children is a major challenge for primary health care and a number of different approaches have been suggested, with no clear conclusions. Further studies on the cost-effectiveness of different approaches should be performed to optimise screening strategies and develop recommendations.
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Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Paola Piccini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Chiara Tersigni
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Elena Chiappini
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence Anna Meyer Children's University Hospital Florence Italy
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Venturini E, Montagnani C, Boldrini A, Moroni M, Chiappini E, de Martino M, Galli L. Congenital tuberculosis after in vitro fertilization presenting with endobronchial granuloma. Pediatr Neonatol 2019; 60:105-107. [PMID: 29724565 DOI: 10.1016/j.pedneo.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/22/2017] [Revised: 10/28/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Elisabetta Venturini
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Carlotta Montagnani
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Antonio Boldrini
- U.O. Neonatology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Marco Moroni
- Neonatal Intensive Care Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
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del Vecchio A, Loria A, Venturini E, Panizza P, Signorotto P. 271. Digital breast tomosynthesis with photon counting technology: Dosimetric data from a preliminary clinical comparison study. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.281] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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