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Neudecker D, Fritisch N, Sutter T, Lu L, Lu P, Tebruegge M, Santiago-Garcia B, Ritz N. Evaluation of serological assays for the diagnosis of childhood tuberculosis disease: a study protocol. BMC Infect Dis 2024; 24:481. [PMID: 38730343 PMCID: PMC11084122 DOI: 10.1186/s12879-024-09359-0] [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] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) poses a major public health challenge, particularly in children. A substantial proportion of children with TB disease remain undetected and unconfirmed. Therefore, there is an urgent need for a highly sensitive point-of-care test. This study aims to assess the performance of serological assays based on various antigen targets and antibody properties in distinguishing children (0-18 years) with TB disease (1) from healthy TB-exposed children, (2) children with non-TB lower respiratory tract infections, and (3) from children with TB infection. METHODS The study will use biobanked plasma samples collected from three prospective multicentric diagnostic observational studies: the Childhood TB in Switzerland (CITRUS) study, the Pediatric TB Research Network in Spain (pTBred), and the Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infections in children and adolescents (ProPAED) study. Included are children diagnosed with TB disease or infection, healthy TB-exposed children, and sick children with non-TB lower respiratory tract infection. Serological multiplex assays will be performed to identify M. tuberculosis antigen-specific antibody features, including isotypes, subclasses, Fc receptor (FcR) binding, and IgG glycosylation. DISCUSSION The findings from this study will help to design serological assays for diagnosing TB disease in children. Importantly, those assays could easily be developed as low-cost point-of-care tests, thereby offering a potential solution for resource-constrained settings. CLINICALTRIALS GOV IDENTIFIER NCT03044509.
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Affiliation(s)
- Daniela Neudecker
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland
| | - Nora Fritisch
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland
- University of Basel Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Sutter
- Department of Computer Science, Medical Data Science, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Lenette Lu
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Pei Lu
- Division of Geographic Medicine and Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marc Tebruegge
- Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Australia
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Paediatrics & National Reference Centre for Paediatric TB, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Begoña Santiago-Garcia
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
- Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland.
- Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Australia.
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland.
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Hasan N, Nourse C, Schaaf HS, Bekker A, Loveday M, Alcântara Gabardo BM, Coulter C, Chabala C, Kabra S, Moore E, Maleche-Obimbo E, Salazar-Austin N, Ritz N, Starke JR, Steenhoff AP, Triasih R, Welch SB, Marais BJ. Management of the infant born to a mother with tuberculosis: a systematic review and consensus practice guideline. Lancet Child Adolesc Health 2024; 8:369-378. [PMID: 38522446 DOI: 10.1016/s2352-4642(23)00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 03/26/2024]
Abstract
Infants born to mothers with tuberculosis disease are at increased risk of developing tuberculosis disease themselves. We reviewed published studies and guidelines on the management of these infants to inform the development of a consensus practice guideline. We searched MEDLINE, CINAHL, and Cochrane Library from database inception to Dec 1, 2022, for original studies reporting the management and outcome of infants born to mothers with tuberculosis. Of the 521 published papers identified, only three met inclusion criteria and no evidence-based conclusions could be drawn from these studies, given their narrow scope, variable aims, descriptive nature, inconsistent data collection, and high attrition rates. We also assessed a collection of national and international guidelines to inform a consensus practice guideline developed by an international panel of experts from different epidemiological contexts. The 16 guidelines reviewed had consistent features to inform the expert consultation process. Two management algorithms were developed-one for infants born to mothers considered potentially infectious at the time of delivery and another for mothers not considered infectious at the time of delivery-with different guidance for high and low tuberculosis incidence settings. This systematic review and consensus practice guideline should facilitate more consistent clinical management, support the collection of better data, and encourage the development of more studies to improve evidence-based care.
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Affiliation(s)
- Nadia Hasan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; General Paediatrics, The Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Infection Prevention and Management Service, The Queensland Children's Hospital, Brisbane, QLD, Australia
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Adrie Bekker
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Marian Loveday
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Betina M Alcântara Gabardo
- Child and Adolescent Unit, Clinical Hospital Complex, Federal University of Paraná, Curitiba, Brazil; Brazilian Tuberculosis Research Network, Rio de Janeiro, Brazil
| | - Christopher Coulter
- Queensland Mycobacterium Reference Laboratory, WHO Collaborating Centre for Tuberculosis Bacteriology, Pathology Queensland and Communicable Diseases Branch, Queensland Health, Brisbane, QLD, Australia
| | - Chishala Chabala
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sushil Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Eilish Moore
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | | | - Nicole Salazar-Austin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Ritz
- Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland; Department of Pediatrics and Pediatric Infectious Diseases, Children's Hospital of Central Switzerland, Lucerne, Switzerland; Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Andrew P Steenhoff
- Global Health Center and Division of Infectious Diseases, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA; Department of Paediatric and Adolescent Medicine, University of Botswana, Gaborone, Botswana
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Steven B Welch
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ben J Marais
- WHO Collaborating Centre for Tuberculosis, Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia.
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Rodríguez-Molino P, Tebruegge M, Noguera-Julian A, Neth O, Fidler K, Brinkmann F, Sainz T, Ivaskeviciene I, Ritz N, Brito MJ, Milheiro Silva T, Chechenieva V, Serdiuk M, Lancella L, Russo C, Soler-García A, Navarro ML, Krueger R, Feiterna-Sperling C, Starshinova A, Hiteva A, Hoffmann A, Kalibatas P, Lo Vecchio A, Scarano SM, Bustillo M, Blázquez Gamero D, Espiau M, Buonsenso D, Falcón L, Turnbull L, Colino E, Rueda S, Buxbaum C, Carazo B, Alvarez C, Dapena M, Piqueras A, Velizarova S, Ozere I, Götzinger F, Pareja M, Garrote Llanos MI, Soto B, Rodríguez Martín S, Korta JJ, Pérez-Gorricho B, Herranz M, Hernández-Bartolomé Á, Díaz-Almirón M, Kohns Vasconcelos M, Ferreras-Antolín L, Santiago-García B. Tuberculosis disease in immunocompromised children and adolescents: a pTBnet multi-centre case-control study. Clin Infect Dis 2024:ciae158. [PMID: 38568992 DOI: 10.1093/cid/ciae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In high-resource settings the survival of immunocompromised (IC) children has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools and outcome of IC children with TB in Europe. METHODS Multicentre, matched case-control study within the Paediatric Tuberculosis Network European Trials Group (ptbnet), capturing TB cases <18 years diagnosed 2000-2020. RESULTS 417 TB cases were included, comprising 139 children with IC (HIV, inborn errors of immunity, drug-induced immunosuppression and other immunocompromising conditions) and 278 non-IC children as controls. Non-respiratory TB was more frequent among cases than controls (32.4% vs. 21.2%; p = 0.013). IC patients had an increased likelihood of presenting with severe disease (57.6% vs. 38.5%; p < 0.001; OR [95% CI]: 2.073 [1.37-3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs. 6.0%; p < 0.001) and QuantiFERON-TB Gold assay (30.0% vs. 7.3%; p < 0.001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs. 49.3%; p = 0.083). Although the mortality in IC children was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs. 6.1%; p = 0.004). CONCLUSIONS IC children with TB disease in Europe have increased rates of non-respiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in IC patients, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain. La Paz Research Institute (IdiPAZ), Madrid, Spain. Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Tebruegge
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Great Ormond Street Institute of Child Health, Department of Infection, Immunity & Inflammation, University College London, London, United Kingdom
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica (RITIP) Seville, Spain
| | - Katy Fidler
- Paediatric Infectious Diseases Department, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Folke Brinkmann
- Department of Pediatric Pneumology, Allergology and CF Center, University Children's Hospital Bochum, Bochum, Germany
| | - Talia Sainz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain. La Paz Research Institute (IdiPAZ), Madrid, Spain. Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inga Ivaskeviciene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Nicole Ritz
- Department of Paediatrics & Paediatric Infectious Diseases, Children's Hospital of Central Switzerland, Lucerne, Switzerland. Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research University of Basel, Basel, Switzerland
| | - Maria Joao Brito
- Infectious diseases Unit, Pediatrics department. Hospital Dona Estefânia. Centro Hospitalar e Universitário Lisboa Central. Lisboa. Portugal
| | - Tiago Milheiro Silva
- Infectious diseases Unit, Pediatrics department. Hospital Dona Estefânia. Centro Hospitalar e Universitário Lisboa Central. Lisboa. Portugal
| | - Vira Chechenieva
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
- Centre for Treatment Children with HIV/AIDS, National Specialised Children's Hospital "OKHMATDYT", Kyiv, Ukraine
- Pediatric TB Department, National institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine, Kyiv, Ukraine
| | - Maryna Serdiuk
- Centre for Treatment Children with HIV/AIDS, National Specialised Children's Hospital "OKHMATDYT", Kyiv, Ukraine
| | - Laura Lancella
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cristina Russo
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Aleix Soler-García
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Maria Luisa Navarro
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Renate Krueger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Cornelia Feiterna-Sperling
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Starshinova
- St. Petersburg Research Institute of Phthisiopulmonology, Russia
| | - Antonina Hiteva
- St. Petersburg Research Institute of Phthisiopulmonology, Russia
| | - Anna Hoffmann
- Department of Pediatric Pneumology, Allergology and CF Center, University Children's Hospital Bochum, Bochum, Germany
| | - Paulius Kalibatas
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrea Lo Vecchio
- Pediatric Infectious Disease Unit, University Hospital Policlinico "Federico II" and Department of Translational Medical Sciences - Section of Pediatrics, University of Naples "Federico II", Italy
| | - Sara Maria Scarano
- Pediatric Infectious Disease Unit, University Hospital Policlinico "Federico II" and Department of Translational Medical Sciences - Section of Pediatrics, University of Naples "Federico II", Italy
| | - Matilde Bustillo
- Pediatrics Infectious Diseases Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Daniel Blázquez Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - María Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lola Falcón
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica (RITIP) Seville, Spain
| | | | - Elena Colino
- Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria
| | - Santiago Rueda
- Department of Pediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Charlotte Buxbaum
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Begoña Carazo
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario Regional de Málaga, Málaga, Spain
| | - Cristina Alvarez
- Pediatrics Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Marta Dapena
- Pediatric Infectious Diseases Unit, Hospital General de Castellón, Castellón, Spain
| | - Anabel Piqueras
- Pediatrics Department, Hospital Universitario La Fe, Valencia, Spain
| | - Svetlana Velizarova
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Iveta Ozere
- Centre of Tuberculosis and Lung Diseases of Riga Eastern Clinical University Hospital, Latvia
| | - Florian Götzinger
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - Marta Pareja
- Pediatrics Department, Albacete University Hospital, Albacete, Spain
| | | | - Beatriz Soto
- Pediatrics Department, Getafe University Hospital, Getafe, Spain
| | - Sonia Rodríguez Martín
- Pediatrics Department, Príncipe de Asturias University Hospital, Alcalá de Henares, Spain. Medicine Department, Faculty of Medicine, University of Alcalá, Spain
| | - Jose Javier Korta
- Pediatrics Department, Donostia University Hospital, San Sebastián, Spain
| | - Beatriz Pérez-Gorricho
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mercedes Herranz
- Pediatrics Department, Navarra University Hospital, Navarra, Spain
| | - Ángel Hernández-Bartolomé
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
| | | | - Malte Kohns Vasconcelos
- Institute for Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Ferreras-Antolín
- Paediatric Infectious Diseases and Immunodeficiencies Unit. St. George's University Hospital, NHS Foundation Trust. London, United Kingdom
| | - Begoña Santiago-García
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Wurm J, Uka A, Bernet V, Buettcher M, Giannoni E, Kottanattu L, Schöbi N, Zemmouri A, Ritz N, Zimmermann P. The changing clinical presentation of COVID-19 in children during the course of the pandemic. Acta Paediatr 2024; 113:771-777. [PMID: 38102898 DOI: 10.1111/apa.17061] [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: 06/22/2023] [Revised: 10/21/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
AIM To investigate the evolution of clinical symptoms of COVID-19 in children throughout the pandemic. METHODS In this national prospective surveillance study, symptoms in children hospitalised with COVID-19 were collected from all paediatric hospitals in Switzerland between March 2020 and March 2023. Data was analysed across four time periods, according to the predominantly circulating SARS-CoV-2 variant: T1 (wild-type), T2 (Alpha), T3 (Delta) and T4 (Omicron), as well as by age group. RESULTS The study included 1323 children. The proportion of children admitted to an intensive care unit remained stable throughout the pandemic. However, the pattern and frequency of clinical manifestations changed over time. Respiratory symptoms were less prevalent during T1 (wild-type), fever during T2 (Alpha) and rash during T4 (Omicron). In contrast, fever and neurological symptoms were more prevalent during T4 (Omicron). Newly described symptoms during T4 (Omicron) included conjunctivitis, laryngotracheitis and seizures. Fever was more prevalent among neonates and infants whereas respiratory symptoms were more common among infants. Gastrointestinal symptoms were more frequent among toddlers, while both toddlers and school-aged children presented with neurological symptoms more often than other age groups. CONCLUSION Continuous surveillance is required to detect changes in manifestations and there by be prepared for the optimal management of complications in children with COVID-19.
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Affiliation(s)
- Juliane Wurm
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Department of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
| | - Anita Uka
- Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Vera Bernet
- Department of Neonatology, Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Michael Buettcher
- Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
- Faculty of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, Basel, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, USI, Lugano, Switzerland
| | - Nina Schöbi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Inselspital, Bern University Hospital, University of Berne, Berne, Switzerland
| | | | - Nicole Ritz
- Department of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Wurm J, Uka A, Buettcher M, Kottanattu L, Schöbi N, Trück J, Villiger R, Ritz N, Zimmermann P. Clinical and Laboratory Biomarkers as Predictors of Severity in Pediatric Inflammatory Multisystem Syndrome-temporally Associated With SARS-CoV-2: Data From a Prospective Nationwide Surveillance Study in Switzerland. Pediatr Infect Dis J 2024:00006454-990000000-00798. [PMID: 38506504 DOI: 10.1097/inf.0000000000004332] [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: 03/21/2024]
Abstract
BACKGROUND PIMS-TS (pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2) is a rare but serious condition in children following SARS-CoV-2 infection, characterized by a range of clinical symptoms with varying severity. Understanding risk factors for severe PIMS-TS is crucial for appropriate and timely intervention. OBJECTIVE To identify factors associated with increased PIMS-TS severity in children. METHODS In this nationwide prospective observational study, epidemiological and clinical data was collected from children <18 years of age with suspected or confirmed PIMS-TS from all 29 pediatric hospitals in Switzerland. Children were categorized into 3 groups according to admission to intensive care unit (ICU): non-ICU, ICU-moderate and ICU-severe, defined as requirement of invasive ventilation and/or inotropic support. RESULTS A total of 204 children were included; 99 (49%) were categorized as non-ICU, 50 (25%) as ICU-moderate and 55 (27%) as ICU-severe. In ICU-severe cases, respiratory and neurological symptoms were more frequent compared with non-ICU cases: 72% versus 47%, P < 0.001 and 66% versus 41%, P = 0.001, respectively. Compared with the non-ICU group, children in the ICU-severe group had lower lymphocyte counts, higher neutrophil-lymphocyte ratios, lower platelet counts, as well as higher C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin T and creatinine levels at admission. Lymphopenia and elevated troponin T levels at admission were associated with an increased risk of being in the ICU-severe group. CONCLUSION The severity of PIMS-TS may be predicted using clinical symptoms and laboratory biomarkers, which help clinicians in decision-making and management of patients.
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Affiliation(s)
- Juliane Wurm
- From the Department of Paediatrics, Fribourg Hospital, Fribourg
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
| | - Anita Uka
- Department Women-Mother-Child, Lausanne University Hospital, Lausanne
| | - Michael Buettcher
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Lucerne
- Department of Paediatrics, Paediatric Pharmacology and Pharmacometrics Research Unit at University Children's Hospital Basel, Basel
| | - Lisa Kottanattu
- Department of Paediatrics, Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona
| | - Nina Schöbi
- Division of Pediatric Infectious Diseases, Inselspital, Department of Pediatrics, Bern University Hospital, University of Bern, Bern
| | - Johannes Trück
- Division of Allergy and Immunology, University Children's Hospital Zurich and Children's Research Center, University of Zurich (UZH), Zurich
| | | | - Nicole Ritz
- Department of Health Science and Medicine, Children's Hospital of Central Switzerland, University Lucerne, Lucerne
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Lucerne
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
| | - Petra Zimmermann
- From the Department of Paediatrics, Fribourg Hospital, Fribourg
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Vaezipour N, Evers K, Schmid H, Ritz N, Goischke A. Is shorter antibiotic treatment duration increasing the risk of relapse in paediatric acute focal bacterial nephritis? Arch Dis Child 2024; 109:248-250. [PMID: 37949642 DOI: 10.1136/archdischild-2023-326054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Nina Vaezipour
- Department of Paediatric Infectious Diseases and Vaccinology, University Childrens Hospital Basel, Basel, Switzerland
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
| | - Katrina Evers
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
| | - Hanna Schmid
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
- Department of Paediatrics and Paediatric Infectious Diseases, Childrens Hospital Lucerne and Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, The Royal Childrens Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Goischke
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
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Bahadori A, Ritz N, Zimmermann P. Diagnosis and treatment of Lyme disease in children. Arch Dis Child Educ Pract Ed 2023; 108:422-428. [PMID: 37726149 DOI: 10.1136/archdischild-2023-325398] [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: 01/29/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
Lyme disease is a zoonotic infection caused by the spirochete Borrelia burgdorferi sensu lato which is transmitted to humans mainly by tick bites. The global incidence of Lyme disease is rising, and children are more frequently affected. The disease can manifest in various organs causing non-specific symptoms. The lack of sensitive and specific diagnostic tests makes the management of Lyme disease challenging. This article offers up-to-date clinical algorithms for the management of children with suspected or diagnosed Lyme disease.
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Affiliation(s)
- Atessa Bahadori
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva, Geneva, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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Fritschi N, Vaezipour N, Buettcher M, Portevin D, Naranbhai V, Ritz N. Ratios from full blood count as markers for TB diagnosis, treatment, prognosis: a systematic review. Int J Tuberc Lung Dis 2023; 27:822-832. [PMID: 37880883 DOI: 10.5588/ijtld.22.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: The monocyte-to-lymphocyte (MLR) and neutrophil-to-lymphocyte (NLR) ratio are calculated from routine full blood counts. The aim of this study was to systematically review MLR and NLR as biomarkers for diagnosis, treatment response monitoring and prognostic biomarker for TB infection or disease.METHODS: A systematic literature search was conducted in Medline, Embase and the Cochrane Library on 12 January 2022. The following search terms were used: tuberculosis AND (monocyte OR neutrophils), AND lymphocytes AND (diagnostic OR prognostic OR treatment).RESULTS: A total of 2,314 studies were identified, of which 41, covering 11,952 individuals, were included in the final analysis. Studies enrolled a median of 154 individuals (IQR 108-301). Increased MLR and NLR were associated with TB disease when compared to healthy controls and individuals with TB infection. MLR was shown to be prognostic for progression to TB disease and to decrease in response to TB treatment. The cut-offs determined in the studies were highly variable for MLR and NLR, making it impractical to conduct a meta-analysis of sensitivity and specificity.CONCLUSION: Higher MLR and NLR are associated with TB disease and could be used as easy-to-obtain, low-cost additional diagnostic biomarkers. Further studies investigating these biomarkers are needed.
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Affiliation(s)
- N Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel, Basel, Department of Clinical Research, University of Basel, Basel, University Children's Hospital Basel, Basel
| | - N Vaezipour
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel, Basel, Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel
| | - M Buettcher
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, University of Basel, Basel
| | - D Portevin
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, University of Basel, Basel, Switzerland
| | - V Naranbhai
- Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, Dana-Farber Cancer Institute, Boston, MA, USA, Center for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - N Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel, Basel, Department of Clinical Research, University of Basel, Basel, Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
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9
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Gasser N, Fritschi N, Egger JM, Ritz N, Schoch OD, Zellweger JP. Tuberculosis Case Detection and Guideline Adherence among Child Contacts in Switzerland: A Retrospective Observational Study. Respiration 2023; 102:934-943. [PMID: 37899038 PMCID: PMC10664337 DOI: 10.1159/000534362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Children exposed to a tuberculosis (TB) index case are at risk of TB infection and disease. OBJECTIVES The aim of this study was to describe the proportion of child contacts who developed TB infection or disease after exposure and to assess the diagnostic pathways and adherence to current guidelines. METHODS Retrospective observational study including children ≤16 years of age who had contact to a TB index case between January 2019 and July 2021. Analysis was stratified by age groups 0-4, 5-11, and 12-16 years. RESULTS Of 401 TB-exposed children, data were available for 380 (95%). Of those, 7 (2%) were diagnosed with TB disease and 35 (9%) with TB infection. We identified several deviations in the management compared to recommendations in national Swiss guidelines: In the children aged 0-4 years, only 82% were examined with an immunodiagnostic test or a chest radiography within 2 weeks after last contact. Recommended prophylactic treatment was prescribed in 66% of the children only. In the children aged 5-11 years, 64% were tested with an immunodiagnostic test in a first examination and 75% in a second examination, 2 weeks and 2 months after last contact, respectively. CONCLUSIONS Contact investigations of children exposed to a TB index case identified a significant proportion of children with TB infection and disease in a low TB incidence setting. We observed significant deviations from the guidelines in the contact investigations suggesting the need for improved implementation.
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Affiliation(s)
- Nathalie Gasser
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
| | | | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children’s Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- University of Basel Children’s Hospital Basel, Basel, Switzerland
- Department of Pediatrics and Pediatric Infectious Diseases, Children’s Hospital Lucerne and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Otto D. Schoch
- TB Competence Center, Swiss Lung Association, Bern, Switzerland
- Department of Pneumology and Sleep Medicine, St. Gallen Hospital, St. Gallen, Switzerland
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10
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Uka A, Bressieux-Degueldre S, Buettcher M, Kottanattu L, Plebani M, Niederer-Loher A, Schöbi N, Hofer M, Tomasini J, Trück J, Villiger R, Wagner N, Wuetz D, Ritz N, Zimmermann P. Cardiac involvement in children with paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): data from a prospective nationwide surveillance study. Swiss Med Wkly 2023; 153:40092. [PMID: 37852002 DOI: 10.57187/smw.2023.40092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) may occur 4 to 8 weeks after SARS-CoV-2 infection. The acute presentation of PIMS-TS has been well described, but data on longer-term outcomes, particularly cardiac, is scarce. METHODS This prospective nationwide surveillance study included children and adolescents less than 18 years of age who were hospitalised with PIMS-TS in Switzerland between March 2020 and March 2022. Data was collected from all 29 paediatric hospitals through the Swiss Paediatric Surveillance Unit (SPSU) during hospitalisation and approximately six weeks after discharge. The data was analysed after categorising the participants into three groups based on their admission status to the intensive care unit (ICU) (non-ICU, ICU-moderate) and the requirement for invasive ventilatory and/or inotropic support (ICU-severe). RESULTS Overall, 204 children were included of whom 194 (95.1%) had follow-up data recorded. Median age was 9.0 years (interquartile range [IQR] 6.0-11.5) and 142 (69.6%) were male. In total, 105/204 (51.5%) required ICU admission, of whom 55/105 (52.4%) received inotropic support and 14/105 (13.3%) mechanical ventilation (ICU-severe group). Echocardiography was performed in 201/204 (98.5%) children; 132 (64.7%) had a cardiac abnormality including left ventricular systolic dysfunction (73 [36.3%]), a coronary artery abnormality (45 [22.4%]), pericardial effusion (50 [24.9%]) and mitral valve regurgitation (60 [29.9%]). Left ventricular systolic dysfunction was present at admission in 62/201 (30.8%) children and appeared during hospitalisation in 11 (5.5%) children. A coronary artery abnormality was detected at admission in 29/201 (14.2%) children and developed during hospitalisation or at follow-up in 13 (6.5%) and 3 (1.5%) children, respectively. None of the children had left ventricular systolic dysfunction at follow-up, but a coronary abnormality and pericardial effusion were found in 12 (6.6%) and 3 (1.7%) children, respectively. School absenteeism at the time of follow-up was more frequent in children who had been admitted to the ICU (2.5% in the non-ICU group compared to 10.4% and 17.6% in the ICU-moderate and ICU-severe group, respectively) (p = 0.011). CONCLUSION Cardiac complications in children presenting with PIMS-TS are common and may worsen during the hospitalisation. Irrespective of initial severity, resolution of left ventricular systolic dysfunction is observed, often occurring rapidly during the hospitalisation. Most of the coronary artery abnormalities regress; however, some are still present at follow-up, emphasising the need for prolonged cardiac evaluation after PIMS-TS.
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Affiliation(s)
- Anita Uka
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Sabrina Bressieux-Degueldre
- Paediatric Cardiology Unit, Department Women-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Centre, University Children's Hospital Basel, Basel, Switzerland
| | - Lisa Kottanattu
- Clinic of pediatrics, Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Margerita Plebani
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anita Niederer-Loher
- Divison of Infectious Diseases and Hospital Hygiene, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, and University Hospitals of Geneva, Geneva, Switzerland
| | - Julie Tomasini
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Johannes Trück
- Division of Immunology and Children's Research Center, University Children's Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Reto Villiger
- Department of Paediatrics, Hospital Center of Biel, Biel, Switzerland
| | - Noémie Wagner
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Daniela Wuetz
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ritz
- Paediatric Infectious Diseases, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Australia
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, The University of Melbourne, Australia
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
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11
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Zhu Y, Almeida FJ, Baillie JK, Bowen AC, Britton PN, Brizuela ME, Buonsenso D, Burgner D, Chew KY, Chokephaibulkit K, Cohen C, Cormier SA, Crawford N, Curtis N, Farias CGA, Gilks CF, von Gottberg A, Hamer D, Jarovsky D, Jassat W, Jesus AR, Kemp LS, Khumcha B, McCallum G, Miller JE, Morello R, Munro APS, Openshaw PJM, Padmanabhan S, Phongsamart W, Reubenson G, Ritz N, Rodrigues F, Rungmaitree S, Russell F, Sáfadi MAP, Saner C, Semple MG, Prado da Silva DGB, de Sousa LMM, Diogo Moço Souza M, Spann K, Walaza S, Wolter N, Xia Y, Yeoh DK, Zar HJ, Zimmermann P, Short KR. International Pediatric COVID-19 Severity Over the Course of the Pandemic. JAMA Pediatr 2023; 177:1073-1084. [PMID: 37603343 PMCID: PMC10442787 DOI: 10.1001/jamapediatrics.2023.3117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/21/2023] [Indexed: 08/22/2023]
Abstract
Importance Multiple SARS-CoV-2 variants have emerged over the COVID-19 pandemic. The implications for COVID-19 severity in children worldwide are unclear. Objective To determine whether the dominant circulating SARS-CoV-2 variants of concern (VOCs) were associated with differences in COVID-19 severity among hospitalized children. Design, Setting, and Participants Clinical data from hospitalized children and adolescents (younger than 18 years) who were SARS-CoV-2 positive were obtained from 9 countries (Australia, Brazil, Italy, Portugal, South Africa, Switzerland, Thailand, UK, and the US) during 3 different time frames. Time frames 1 (T1), 2 (T2), and 3 (T3) were defined to represent periods of dominance by the ancestral virus, pre-Omicron VOCs, and Omicron, respectively. Age groups for analysis were younger than 6 months, 6 months to younger than 5 years, and 5 to younger than 18 years. Children with an incidental positive test result for SARS-CoV-2 were excluded. Exposures SARS-CoV-2 hospitalization during the stipulated time frame. Main Outcomes and Measures The severity of disease was assessed by admission to intensive care unit (ICU), the need for ventilatory support, or oxygen therapy. Results Among 31 785 hospitalized children and adolescents, the median age was 4 (IQR 1-12) years and 16 639 were male (52.3%). In children younger than 5 years, across successive SARS-CoV-2 waves, there was a reduction in ICU admission (T3 vs T1: risk ratio [RR], 0.56; 95% CI, 0.42-0.75 [younger than 6 months]; RR, 0.61, 95% CI; 0.47-0.79 [6 months to younger than 5 years]), but not ventilatory support or oxygen therapy. In contrast, ICU admission (T3 vs T1: RR, 0.39, 95% CI, 0.32-0.48), ventilatory support (T3 vs T1: RR, 0.37; 95% CI, 0.27-0.51), and oxygen therapy (T3 vs T1: RR, 0.47; 95% CI, 0.32-0.70) decreased across SARS-CoV-2 waves in children 5 years to younger than 18 years old. The results were consistent when data were restricted to unvaccinated children. Conclusions and Relevance This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19.
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Affiliation(s)
- Yanshan Zhu
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Flávia Jacqueline Almeida
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Hospital Infantil Sabará, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - J Kenneth Baillie
- Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, United Kingdom
- MRC Human Genetics Unit, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, the Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School and Sydney Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - David Burgner
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Keng Yih Chew
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephania A Cormier
- Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Nigel Crawford
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nigel Curtis
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Camila G A Farias
- Hospital Infantil Sabará, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diana Hamer
- Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Daniel Jarovsky
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Hospital Infantil Sabará, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Waasila Jassat
- Division of the National Health Laboratory Services, National Institute of Communicable Diseases, Johannesburg, South Africa
| | - Ana Rita Jesus
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lisa S Kemp
- Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Benjawan Khumcha
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Georgina McCallum
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jessica E Miller
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alasdair P S Munro
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust: London, London, United Kingdom
| | - Srivatsan Padmanabhan
- Elson S. Floyd College of Medicine, Washington State University, Tacoma, Washington
- St Joseph Medical Center, Tacoma, Washington
| | - Wanatpreeya Phongsamart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gary Reubenson
- Empilweni Service & Research Unit, Rahima Moosa Mother & Child Hospital, Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Ritz
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Pediatrics and Pediatric Infectious Diseases, Children's Hospital Lucerne and Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Fernanda Rodrigues
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Fiona Russell
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Marco A P Sáfadi
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Hospital Infantil Sabará, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Christoph Saner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, University Hospital Inselspital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Malcolm G Semple
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, University of Liverpool, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | | | | | - Kirsten Spann
- Centre for Immunology and Infection Control, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yao Xia
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daniel K Yeoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, SA- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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12
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Mack I, Kohns Vasconcelos M, Ritz N, Zimmermann P. A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis. Acta Paediatr 2023; 112:1644-1647. [PMID: 37424283 DOI: 10.1111/apa.16841] [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] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Ines Mack
- Department of Paediatrics, University Children's Hospital, Regensburg, Germany
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Nicole Ritz
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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13
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Kissling M, Fritschi N, Baumann P, Buettcher M, Bonhoeffer J, Naranbhai V, Ritz N. Monocyte, Lymphocyte and Neutrophil Ratios - Easy-to-Use Biomarkers for the Diagnosis of Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:520-527. [PMID: 36977187 DOI: 10.1097/inf.0000000000003901] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/30/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte-ratio (NLR), neutrophil-to-monocyte-plus-lymphocyte-ratio (NMLR) and monocyte-to-lymphocyte-ratio (MLR) may have diagnostic potential for tuberculosis (TB). METHODS Data of two prospective multicenter studies in Switzerland were used, which included children <18 years with TB exposure, infection or disease or with febrile non-TB lower-respiratory-tract infection (nTB-LRTI). RESULTS Of the 389 children included 25 (6.4%) had TB disease, 12 (3.1%) TB infection, 28 (7.2%) were healthy TB exposed and 324 (83.3%) nTB-LRTI. Median (IQR) NLR was highest with 2.0 (1.2, 2.2) in children with TB disease compared to TB exposed [0.8 (0.6, 1.3); P = 0.002] and nTB-LRTI [0.3 (0.1, 1.0); P < 0.001]. Median (IQR) NMLR was highest with 1.4 (1.2, 1.7) in children with TB disease compared to healthy exposed [0.7 (0.6, 1.1); P = 0.003] and children with nTB-LRTI [0.2 (0.1, 0.6); P < 0.001). Receiver operating characteristic curves to detect TB disease compared to nTB-LRTI for NLR and NMLR had an area under the curve of 0.82 and 0.86, the sensitivity of 88% and 88%, and specificity of 71% and 76%, respectively. CONCLUSION NLR and NMLR are promising, easy-to-obtain diagnostic biomarkers to differentiate children with TB disease from other lower respiratory tract infections. These results require validation in a larger study and in settings with high and low TB endemicity.
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Affiliation(s)
- Mirjam Kissling
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
| | - Nora Fritschi
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
- University Children's Hospital Basel, Switzerland
| | - Philipp Baumann
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Vivek Naranbhai
- Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Center for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Nicole Ritz
- From the Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University of Basel, Switzerland
- University Children's Hospital Basel, Switzerland
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne Switzerland
- Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Australia
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14
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Buonsenso D, Noguera-Julian A, Moroni R, Hernández-Bartolomé A, Fritschi N, Lancella L, Cursi L, Soler-Garcia A, Krüger R, Feiterna-Sperling C, Sali M, Lo Vecchio A, Scarano S, Hernanz Lobo A, Espiau M, Soriano-Arandes A, Cetin BS, Brinkmann F, Ozere I, Baquero-Artigao F, Tsolia M, Milheiro Silva T, Bustillo-Alonso M, Martín Nalda A, Mancini M, Starshinova A, Ritz N, Velizarova S, Ferreras-Antolín L, Götzinger F, Bilogortseva O, Chechenyeva V, Tebruegge M, Santiago-García B. Performance of QuantiFERON-TB Gold Plus assays in paediatric tuberculosis: a multicentre PTBNET study. Thorax 2023; 78:288-296. [PMID: 36283826 DOI: 10.1136/thorax-2022-218929] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/03/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
RATIONALE In 2016, a new interferon-gamma release assay (IGRA) was introduced, QuantiFERON-TB Gold Plus (QFT-Plus), claimed to have improved sensitivity in active tuberculosis (TB). OBJECTIVES This study aimed to determine the performance of QFT-Plus, compared with previous generation IGRAs and the tuberculin skin test (TST), in children with TB in Europe. METHODS Multicentre, ambispective cohort study within the Paediatric Tuberculosis Network European Trials Group (ptbnet), a dedicated paediatric TB research network comprising >300 members, capturing TB cases <18 years-of-age diagnosed between January 2009 and December 2019. MEASUREMENTS AND MAIN RESULTS 1001 TB cases from 16 countries were included (mean age (IQR) 5.6 (2.4-12.1) years). QFT-Plus was performed in 358, QFT Gold in-Tube (QFT-GIT) in 600, T-SPOT.TB in 58 and TST in 636 cases. The overall test sensitivities were: QFT-Plus 83.8% (95% CI 80.2% to 87.8%), QFT-GIT 85.5% (95% CI 82.7% to 88.3%), T-SPOT.TB 77.6% (95% CI 66.9% to 88.3%) and TST (cut-off ≥10 mm) 83.3% (95% CI 83.3% to 86.2%). There was a trend for tests to have lower sensitivity in patients with miliary and/or central nervous system (CNS) TB (73.1%, 70.9%, 63.6% and 43.5%, respectively), and in immunocompromised patients (75.0%, 59.6%, 45.5% and 59.1%, respectively). CONCLUSIONS The results indicate that the latest generation IGRA assay, QFT-Plus, does not perform better than previous generation IGRAs or the TST in children with TB disease. Overall, tests performed worse in CNS and miliary TB, and in immunocompromised children. None of the tests evaluated had sufficiently high sensitivity to be used as a rule-out test in children with suspected TB.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Milano, Italy.,Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Rossana Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angel Hernández-Bartolomé
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Laura Lancella
- Paediatric Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Cursi
- Paediatric Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Aleix Soler-Garcia
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Cornelia Feiterna-Sperling
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Michela Sali
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Milano, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Sara Scarano
- Department of Translational Medical Sciences, Pediatric Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Alicia Hernanz Lobo
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Benhur Sirvan Cetin
- Department of Pediatric Infectious Diseases, Erciyes University, Kayseri, Turkey
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Children's Hospital, Ruhr-University, Bochum, Germany
| | | | - Fernando Baquero-Artigao
- Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain.,Hospital Infantil La Paz, Madrid, Spain.,CIBERINFEC, ISCIII, Madrid, Spain
| | - Maria Tsolia
- Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | | | | | - Andrea Martín Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Margherita Mancini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Anna Starshinova
- St. Petersburg Scientific Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital Lucerne Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | | | - Laura Ferreras-Antolín
- Paediatric Infectious Diseases Unit, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Florian Götzinger
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Klinik Ottakring, Vienna, Austria
| | - Olga Bilogortseva
- Ukraine. Department of Children Phthisiology, National Institution of Phthisiology and Pulmonology of National Academy of Medical sciences of Ukraine, Kiev, Ukraine.,Infectious diseases Centre «Clinic for treatment of children with HIV/AIDS» National Specialized Children's Hospital 'OKHMATDYT', Kiev, Ukraine
| | - Vira Chechenyeva
- Ukraine. Department of Children Phthisiology, National Institution of Phthisiology and Pulmonology of National Academy of Medical sciences of Ukraine, Kiev, Ukraine.,Infectious diseases Centre «Clinic for treatment of children with HIV/AIDS» National Specialized Children's Hospital 'OKHMATDYT', Kiev, Ukraine
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Begoña Santiago-García
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
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15
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Hauser M, Kabuya JBB, Mantus M, Kamavu LK, Sichivula JL, Matende WM, Fritschi N, Shields T, Curriero F, Kvit A, Chongwe G, Moss WJ, Ritz N, Ippolito MM. Malaria in Refugee Children Resettled to a Holoendemic Area of Sub-Saharan Africa. Clin Infect Dis 2023; 76:e1104-e1113. [PMID: 35640824 PMCID: PMC10169438 DOI: 10.1093/cid/ciac417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. METHODS The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. RESULTS Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P < .001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk. CONCLUSIONS Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.
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Affiliation(s)
- Manuela Hauser
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jean-Bertin B Kabuya
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Molly Mantus
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luc K Kamavu
- Office of Hospital Administration, Saint Paul's General Hospital, Nchelenge, Zambia
| | - James L Sichivula
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wycliffe M Matende
- United Nations High Commissioner for Refugees, Country Representation Office, Lusaka, Zambia
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anton Kvit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gershom Chongwe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, Australia.,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Matthew M Ippolito
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Bergeron A, Mikulska M, De Greef J, Bondeelle L, Franquet T, Herrmann JL, Lange C, Spriet I, Akova M, Donnelly JP, Maertens J, Maschmeyer G, Rovira M, Goletti D, de la Camara R, Maertens J, De Greef J, Slavin M, Spriet I, Hubacek P, Bergeron A, Cordonnier C, Kanerva J, Herbrecht R, Herrmann JL, Lanternier F, Bondeelle L, Robin C, Einsele H, Lehrnbecher T, Groll A, Maschmeyer G, Lange C, von Lilienfeld-Toal M, Pana D, Roilides E, Kassa C, Averbuch D, Engelhard D, Cesaro S, Mikulska M, Pagano L, Castagnola E, Compagno F, Goletti D, Mesini A, Donnelly PJ, Styczynski J, Botelho de Sousa A, Aljurf M, de la Camara R, Navarro D, Rovira M, Franquet T, Garcia-Vidal C, Ljungman P, Paukssen K, Ammann R, Lamoth F, Hirsch H, Ritz N, Akova M, Ceesay M, Warris A, Chemaly R. Mycobacterial infections in adults with haematological malignancies and haematopoietic stem cell transplants: guidelines from the 8th European Conference on Infections in Leukaemia. Lancet Infect Dis 2022; 22:e359-e369. [PMID: 35636446 DOI: 10.1016/s1473-3099(22)00227-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Mycobacterial infections, both tuberculosis and nontuberculous, are more common in patients with haematological malignancies and haematopoietic stem cell transplant recipients than in the general population-although these infections remain rare. Mycobacterial infections pose both diagnostic and therapeutic challenges. The management of mycobacterial infections is particularly complicated for patients in haematology because of the many drug-drug interactions between antimycobacterial drugs and haematological and immunosuppressive treatments. The management of mycobacterial infections must also consider the effect of delaying haematological management. We surveyed the management practices for latent tuberculosis infection (LTBI) in haematology centres in Europe. We then conducted a meticulous review of the literature on the epidemiology, diagnosis, and management of LTBI, tuberculosis, and nontuberculous mycobacterial infections among patients in haematology, and we formulated clinical guidelines according to standardised European Conference on Infections in Leukaemia (ECIL) methods. In this Review, we summarise the available literature and the recommendations of ECIL 8 for managing mycobacterial infections in patients with haematological malignancies.
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Affiliation(s)
- Anne Bergeron
- Division of Pulmonology, Geneva University Hospitals, Geneva, Switzerland; University of Paris, ECSTRRA Team, Inserm, Paris, France.
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; San Martino Polyclinic Hospital, Genoa, Italy
| | - Julien De Greef
- Division of Internal Medicine and Infectious Diseases, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Louise Bondeelle
- Division of Pulmonology, Saint Louis Hospital, APHP, University of Paris, Paris, France
| | - Tomas Franquet
- Department of Radiology, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Jean-Louis Herrmann
- Microbiology Department, Raymond Poincaré Hospital, GHU Paris-Saclay, Paris, France; Division of Infection and Inflammation, Paris-Saclay University, UVSQ, Inserm, Paris, France
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), TTU Tuberculosis, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Murat Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey
| | | | - Johan Maertens
- Department of Haematology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Georg Maschmeyer
- Department of Haematology, Oncology, and Palliative Care, Ernst von Bergmann Clinic, Potsdam, Germany
| | - Montserrat Rovira
- BMT Unit, Haematology Department, Hospital Clinic, IDIBAPS and Josep Carreras Foundation, Barcelona, Spain
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
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17
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Muigg V, Cuénod A, Purushothaman S, Siegemund M, Wittwer M, Pflüger V, Schmidt KM, Weisser M, Ritz N, Widmer A, Goldenberger D, Hinic V, Roloff T, Søgaard KK, Egli A, Seth-Smith HM. Diagnostic challenges within the Bacillus cereus-group: finding the beast without teeth. New Microbes New Infect 2022; 49-50:101040. [DOI: 10.1016/j.nmni.2022.101040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
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18
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Spielberger B, Pfeil J, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Hufnagel M. Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine. Monatsschr Kinderheilkd 2022; 170:1103-1112. [PMID: 36188233 PMCID: PMC9510227 DOI: 10.1007/s00112-022-01607-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Hintergrund Bis Anfang Juni 2022 sind ca. 300.000 Kinder und Jugendliche aus der Ukraine im deutschen Ausländerzentralregister registriert worden. Die vorliegenden Handlungsempfehlungen sollen die Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge aus der Ukraine unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) koordinierte Leitlinie der Stufe 1 verfasst und an die Situation Flucht aus der Ukraine angepasst. Die Empfehlungen wurden durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge, angepasst an die Situation Flucht aus der Ukraine, ausgesprochen. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbilds sowie Untersuchungen auf Tuberkulose, Hepatitis B und C sowie eine Human-Immunodeficiency-Virus(HIV)-Infektion empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und Indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen nicht nur aus der Ukraine ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
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Affiliation(s)
- B. Spielberger
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - J. Pfeil
- Praxis für Kinder- und Jugendmedizin, Schwaigern, Deutschland
| | - K. Assaad
- Gesundheitsamt Rhein-Neckar-Kreis, Heidelberg, Deutschland
| | - U. von Both
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, München, Deutschland
| | - A. Janda
- Universitätsklinik für Kinder- und Jugendmedizin, Ulm, Deutschland
| | - C. Kitz
- Praxis für Kinder- und Jugendmedizin, Veitshöchheim, Deutschland
| | - R. Kobbe
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M. Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J. Lindert
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - N. Ritz
- Kinderspital, Luzerner Kantonsspital, Luzern, Schweiz
| | - S. Trapp
- Praxis für Kinder- und Jugendmedizin, Bremen, Deutschland
| | - M. Hufnagel
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
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19
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Ritz N, Hochstätter R, Mikalauskas S, Talakić E, Seles M, Schöll W, Trutnovsky G, Laky R, Tamussino K, Fluhr H, Wölfler M. Interdisziplinäres Vorgehen bei tief infiltrierender Darmendometriose: OP-Techniken und deren Outcome. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750227] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- N Ritz
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - R Hochstätter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - S Mikalauskas
- Universitätsklinik für Chirurgie, Medizinische Universität Graz
| | - E Talakić
- Universitätsklinik für Radiologie, Medizinische Universität Graz
| | - M Seles
- Universitätsklinik für Urologie; Medizinische Universität Graz
| | - W Schöll
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - G Trutnovsky
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - R Laky
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - K Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - H Fluhr
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - M Wölfler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
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Feigl S, Schöll W, Hochstätter R, Neumayer M, Ritz N, Trutnovsky G, Laky R, Tamussino K, Fluhr H, Wölfler M. Stellenwert der Sonographie und der #ENZIAN-Klassifikation für die präoperative Beratung und Therapieplanung bei Endometriose und Adenomyosis uteri – ein Fallbericht. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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21
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Pfeil J, Bialek R, Heininger U, Liese J, Simon A, Stich A, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Fressle R, Hufnagel M. Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017). Monatsschr Kinderheilkd 2022; 170:632-647. [PMID: 35645410 PMCID: PMC9130691 DOI: 10.1007/s00112-022-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Hintergrund Mit etwa 190.000 Asylanträgen im Jahr 2021 ist Deutschland das wichtigste Aufnahmeland von Asylsuchenden in Europa. Die vorliegenden Handlungsempfehlungen sollen eine Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als AWMF-Leitlinie Stufe 1 verfasst. Entsprechend wurden die Empfehlungen durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen ausgesprochen, für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbildes sowie Untersuchungen auf Tuberkulose und Hepatitis B empfohlen. Je nach Herkunft und Alter werden weitere gezielte Untersuchungen z. B. auf Hepatitis C, HIV oder Schistosomiasis empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
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Jaeger FN, Berger C, Buettcher M, Depallens S, Heininger U, Heller Y, Kohns Vasconcelos M, Leforestier B, Pellaud N, Relly C, Trück J, von Overbeck Ottino S, Wagner N, Ritz N. Paediatric refugees from Ukraine: guidance for health care providers. Swiss Med Wkly 2022; 152:w30200. [PMID: 35633650 DOI: 10.4414/smw.2022.w30200] [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: 01/12/2023] Open
Abstract
BACKGROUND With the invasion of Ukraine by the Russian Army in February 2022, refugees, the majority of whom are women and children, started fleeing the war to neighbouring countries. Even before the current escalation, the conflict in the eastern part of Ukraine has led to the internal displacement of more than 200,000 children, and many others have experienced attacks, e.g. on schools. This inevitably leads to limitations in health care delivery. During transit, overcrowding, poor shelter and vulnerability may further put refugees at increased risk for infectious diseases. This consensus document aims to provide information and guidance regarding health issues that paediatricians and general practitioners may face when caring for Ukrainian children. METHODS Members of the Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland developed this recommendation between March and April 2022 in a modified Delphi process. RESULTS A total of 50 recommendations were agreed on with a ≥80% consensus. These include the following topics: i) general aspects, including interpreter services, urgent health needs, personal history and general check-ups; ii) mental health, including how to search for signs of psychological distress without going into traumatic details; iii) vaccinations, including recommendations for evaluation and catch-up; iv) screening for tuberculosis, human immunodeficiency virus, and hepatitis B and C; and v) providing age-appropriate preventive and health service information. CONCLUSION This document provides current evidence and guidance when caring for paediatric refugees from Ukraine. The recommendations focus on Switzerland but may well be used in other countries. These are based on current evidence and may need to be adapted to individual situations and once further evidence becomes available.
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Affiliation(s)
- Fabienne N Jaeger
- Migrant Health Reference Group of Paediatrics Switzerland.,Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland.,Hausarztpraxis Muttenz, Muttenz, Switzerland
| | - Christoph Berger
- Paediatric Infectious Disease Group Switzerland (PIGS).,University Children's Hospital Zürich, Zürich, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Disease Group Switzerland (PIGS).,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Sarah Depallens
- Migrant Health Reference Group of Paediatrics Switzerland.,Department of Paediatrics, Children's Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ulrich Heininger
- Paediatric Infectious Disease Group Switzerland (PIGS).,Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Yvon Heller
- Migrant Health Reference Group of Paediatrics Switzerland
| | - Malte Kohns Vasconcelos
- Paediatric Infectious Disease Group Switzerland (PIGS).,Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Bodil Leforestier
- Migrant Health Reference Group of Paediatrics Switzerland.,Kinderarztpraxis Rorschach, Rorschach, Switzerland
| | - Nicole Pellaud
- Migrant Health Reference Group of Paediatrics Switzerland
| | - Christa Relly
- Paediatric Infectious Disease Group Switzerland (PIGS).,University Children's Hospital Zürich, Zürich, Switzerland
| | - Johannes Trück
- Paediatric Infectious Disease Group Switzerland (PIGS).,University Children's Hospital Zürich, Zürich, Switzerland
| | | | - Noémie Wagner
- Migrant Health Reference Group of Paediatrics Switzerland.,Paediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nicole Ritz
- Migrant Health Reference Group of Paediatrics Switzerland.,Paediatric Infectious Disease Group Switzerland (PIGS).,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel, Switzerland.,Department of Clinical Research, University of Basel, Switzerland
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23
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Baumann P, Fuchs A, Gotta V, Ritz N, Baer G, Bonhoeffer JM, Buettcher M, Heininger U, Szinnai G, Bonhoeffer J. The kinetic profiles of copeptin and mid regional proadrenomedullin (MR-proADM) in pediatric lower respiratory tract infections. PLoS One 2022; 17:e0264305. [PMID: 35271609 PMCID: PMC8912143 DOI: 10.1371/journal.pone.0264305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers. Methods This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling. Results Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001). Conclusion Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.
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Affiliation(s)
- Philipp Baumann
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
- * E-mail:
| | - Aline Fuchs
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Verena Gotta
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gurli Baer
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
| | - Jessica M. Bonhoeffer
- Department of Paediatrics, University of Basel Children’s Hospital, Basel, Switzerland
| | | | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
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Vaezipour N, Fritschi N, Brasier N, Bélard S, Domínguez J, Tebruegge M, Portevin D, Ritz N. Towards Accurate Point-of-Care Tests for Tuberculosis in Children. Pathogens 2022; 11:pathogens11030327. [PMID: 35335651 PMCID: PMC8949489 DOI: 10.3390/pathogens11030327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022] Open
Abstract
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate and accessible point-of-care tests (POCTs) are needed to detect TB disease in children and, in turn, reduce TB-related morbidity and mortality in this vulnerable population. In recent years, several POCTs for TB have been developed. These include new tools to improve the detection of TB in respiratory and gastric samples, such as molecular detection of Mycobacterium tuberculosis using loop-mediated isothermal amplification (LAMP) and portable polymerase chain reaction (PCR)-based GeneXpert. In addition, the urine-based detection of lipoarabinomannan (LAM), as well as imaging modalities through point-of-care ultrasonography (POCUS), are currently the POCTs in use. Further to this, artificial intelligence-based interpretation of ultrasound imaging and radiography is now integrated into computer-aided detection products. In the future, portable radiography may become more widely available, and robotics-supported ultrasound imaging is currently being trialed. Finally, novel blood-based tests evaluating the immune response using “omic-“techniques are underway. This approach, including transcriptomics, metabolomic, proteomics, lipidomics and genomics, is still distant from being translated into POCT formats, but the digital development may rapidly enhance innovation in this field. Despite these significant advances, TB-POCT development and implementation remains challenged by the lack of standard ways to access non-sputum-based samples, the need to differentiate TB infection from disease and to gain acceptance for novel testing strategies specific to the conditions and settings of use.
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Affiliation(s)
- Nina Vaezipour
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Infectious Disease and Vaccinology Unit, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
| | - Noé Brasier
- Department of Health Sciences and Technology, Institute for Translational Medicine, ETH Zurich, 8093 Zurich, Switzerland;
- Department of Digitalization & ICT, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabine Bélard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - José Domínguez
- Institute for Health Science Research Germans Trias i Pujol. CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WCN1 1EH, UK;
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Damien Portevin
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
- Correspondence: ; Tel.: +41-61-704-1212
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25
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Starke JR, Erkens C, Ritz N, Kitai I. Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings. Pathogens 2022; 11:pathogens11020158. [PMID: 35215101 PMCID: PMC8877840 DOI: 10.3390/pathogens11020158] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/22/2023] Open
Abstract
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.
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Affiliation(s)
- Jeffrey R. Starke
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-832-824-4330
| | - Connie Erkens
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands;
| | - Nicole Ritz
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children’s Hospital, University of Basel, 4031 Basel, Switzerland
| | - Ian Kitai
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada;
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Pittet LF, Fritschi N, Tebruegge M, Dutta B, Donath S, Messina NL, Casalaz D, Hanekom WA, Britton WJ, Robins-Browne R, Curtis N, Ritz N. Bacille Calmette-Guérin Skin Reaction Predicts Enhanced Mycobacteria-Specific T Cell Responses in Infants. Am J Respir Crit Care Med 2022; 205:830-841. [DOI: 10.1164/rccm.202108-1892oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laure F Pittet
- The Royal Children's Hospital Melbourne, 6453, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | | | - Marc Tebruegge
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
- University College London, 4919, London, United Kingdom of Great Britain and Northern Ireland
- Evelina London Children's Hospital, 443490, London, United Kingdom of Great Britain and Northern Ireland
| | - Binita Dutta
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
| | - Susan Donath
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Nicole L Messina
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Dan Casalaz
- Mercy Hospital for Women, 37244, Heidelberg, Victoria, Australia
| | | | - Warwick J. Britton
- Centenary Institute, 6022, TB Researtch Program, Sydney, New South Wales, Australia
| | - Roy Robins-Browne
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, 534133, Melbourne, Victoria, Australia
| | - Nigel Curtis
- The Royal Children's Hospital Melbourne, 6453, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, 34361, Parkville, Victoria, Australia
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | - Nicole Ritz
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
- University of Basel, 27209, Basel, Switzerland
- University Children’s Hospital Basel, 30280, Basel, Switzerland
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27
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Uka A, Buettcher M, Bernhard‑Stirnemann S, Fougère Y, Moussaoui D, Kottanattu L, Wagner N, Zimmermann P, Ritz N. Correction to: Factors associated with hospital and intensive care admission in paediatric SARS‑CoV‑2 infection: a prospective nationwide observational cohort study. Eur J Pediatr 2022; 181:1257. [PMID: 35032201 PMCID: PMC8760592 DOI: 10.1007/s00431-021-04359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland ,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children’s Hospital Lucerne, Luzern, Switzerland
| | | | - Yves Fougère
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women‑Mother‑Child, Lausanne University, Hospital, Lausanne, Switzerland
| | - Dehlia Moussaoui
- Department of PaediatricsGynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Lisa Kottanattu
- Ente Ospedaliero Cantonale, Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Noémie Wagner
- Department of PaediatricsGynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland ,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland ,Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Australia
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland. .,Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, Australia. .,University Children's Hospital Basel UKBB, Spitalstrasse 33, CH‑4031, Basel, Switzerland.
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Affiliation(s)
- Sebastiano A. G. Lava
- grid.8515.90000 0001 0423 4662Paediatric Cardiology Unit, Department of Paediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniele de Luca
- grid.50550.350000 0001 2175 4109Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Gregorio P. Milani
- grid.414818.00000 0004 1757 8749Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Piet Leroy
- grid.412966.e0000 0004 0480 1382Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nicole Ritz
- grid.413354.40000 0000 8587 8621Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland ,grid.6612.30000 0004 1937 0642Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children’s Hospital, University of Basel, Basel, Switzerland
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands. .,KU Leuven Department of Development and Regeneration, Leuven, Belgium. .,KU Leuven Child & Youth Institute, Leuven, Belgium.
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Brüningk SC, Klatt J, Stange M, Mari A, Brunner M, Roloff TC, Seth-Smith HMB, Schweitzer M, Leuzinger K, Søgaard KK, Albertos Torres D, Gensch A, Schlotterbeck AK, Nickel CH, Ritz N, Heininger U, Bielicki J, Rentsch K, Fuchs S, Bingisser R, Siegemund M, Pargger H, Ciardo D, Dubuis O, Buser A, Tschudin-Sutter S, Battegay M, Schneider-Sliwa R, Borgwardt KM, Hirsch HH, Egli A. OUP accepted manuscript. Virus Evol 2022; 8:veac002. [PMID: 35310621 PMCID: PMC8927799 DOI: 10.1093/ve/veac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/07/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Transmission chains within small urban areas (accommodating ∼30 per cent of the European population) greatly contribute to case burden and economic impact during the ongoing coronavirus pandemic and should be a focus for preventive measures to achieve containment. Here, at very high spatio-temporal resolution, we analysed determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in a European urban area, Basel-City (Switzerland). We combined detailed epidemiological, intra-city mobility and socio-economic data sets with whole-genome sequencing during the first SARS-CoV-2 wave. For this, we succeeded in sequencing 44 per cent of all reported cases from Basel-City and performed phylogenetic clustering and compartmental modelling based on the dominating viral variant (B.1-C15324T; 60 per cent of cases) to identify drivers and patterns of transmission. Based on these results we simulated vaccination scenarios and corresponding healthcare system burden (intensive care unit (ICU) occupancy). Transmissions were driven by socio-economically weaker and highly mobile population groups with mostly cryptic transmissions which lacked genetic and identifiable epidemiological links. Amongst more senior population transmission was clustered. Simulated vaccination scenarios assuming 60–90 per cent transmission reduction and 70–90 per cent reduction of severe cases showed that prioritising mobile, socio-economically weaker populations for vaccination would effectively reduce case numbers. However, long-term ICU occupation would also be effectively reduced if senior population groups were prioritised, provided there were no changes in testing and prevention strategies. Reducing SARS-CoV-2 transmission through vaccination strongly depends on the efficacy of the deployed vaccine. A combined strategy of protecting risk groups by extensive testing coupled with vaccination of the drivers of transmission (i.e. highly mobile groups) would be most effective at reducing the spread of SARS-CoV-2 within an urban area.
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Uka A, Buettcher M, Bernhard-Stirnemann S, Fougère Y, Moussaoui D, Kottanattu L, Wagner N, Zimmermann P, Ritz N. Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study. Eur J Pediatr 2022; 181:1245-1255. [PMID: 34845526 PMCID: PMC8628837 DOI: 10.1007/s00431-021-04276-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.
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Affiliation(s)
- Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children’s Hospital Lucerne, Luzern, Switzerland
| | | | - Yves Fougère
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Dehlia Moussaoui
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Lisa Kottanattu
- Ente Ospedaliero Cantonale, Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Noémie Wagner
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Australia
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Melbourne, Australia
- University Children’s Hospital Basel UKBB, Spitalstrasse 33, CH-4031 Basel, Switzerland
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Evers KS, Wellmann S, Donner BC, Ritz N. Apparent life-threatening events and brief resolved unexplained events: management of children at a Swiss tertiary care center. Swiss Med Wkly 2021; 151:w30026. [PMID: 34694101 DOI: 10.4414/smw.2021.w30026] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS OF THE STUDY Apparent life threatening events (ALTEs) are highly stressful situations for the caregiver and commonly result in presentation of the child to an emergency department. As the events are usually brief and resolve in a short period of time, the entity is now called a brief resolved unexplained event (BRUE). Updated recommendations have been published in recent years on the management of BRUE, including a risk stratification to identify those at lower risk for subsequent events or severe underlying disorders. The aim of this study was to describe the epidemiology of ALTE and BRUE at our hospital and detail clinical practice of management in this population in a tertiary care children's hospital in Switzerland. METHODS We retrospectively analysed all cases of children with an ALTE or BRUE admitted to the University Children's Hospital Basel between September 2009 and April 2018, identified using ICD-10GM coding. Electronic health records were used to extract data on diagnostic procedures, duration of admission and outcome. Infants with a lower-risk BRUE (defined as age >60 days and <1year, born at ≥32 weeks gestational age and postconceptional age ≥45 weeks, first BRUE episode with a duration of <1 minute and no cardiopulmonary resuscitation by trained medical provider required) were compared with those with a higher-risk BRUE/ALTE (not fulfilling all the criteria for lower-risk BRUE). RESULTS A total of 65 patients with a median age of 42 days (interquartile range 20-67) were identified, of whom 15% were classified as having a lower-risk BRUE. A blood sample was analysed in 97% of patients, cranial ultrasound was performed in 63%, an electrocardiogram in 78% and polysomnography in 26%. The results remained normal in almost all patients and none had a further event recorded during admission. In one patient only QTc prolongation was detected as a potential serious underlying disease. CONCLUSIONS Our data show that admission for more than 24 hours and extensive investigations for infants admitted for an ALTE/BRUE rarely led to identification of specific underlying causes. According to current recommendations, 15% of the admitted patients could be categorised as having a lower-risk BRUE and therefore hospital admissions and investigations can safely be reduced. We propose an adaptation of the current Swiss recommendations for ALTE/BRUE to optimise clinical management of children presenting with a BRUE.
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Affiliation(s)
- Katrina S Evers
- University of Basel Children's Hospital (UKBB), Division of Paediatric Nephrology, Basel, Switzerland
| | - Sven Wellmann
- University of Basel Children's Hospital (UKBB), Division of Neonatology, Basel, Switzerland.,University Children's Hospital Regensburg (KUNO), University of Regensburg, Division of Neonatology, Regensburg, Germany
| | - Birgit C Donner
- University of Basel Children's Hospital (UKBB), Division of Paediatric Cardiology, Basel, Switzerland
| | - Nicole Ritz
- University of Basel Children's Hospital (UKBB), Infectious Diseases Unit and Paediatric Pharmacology, Basel, Switzerland
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von Hammerstein AL, Aebi C, Barbey F, Berger C, Buettcher M, Casaulta C, Egli A, Gebauer M, Guerra B, Kahlert C, Kellner E, Kottanattu L, Opota O, Mann C, Meyer Sauteur P, Plebani M, Ritz N, Testi C, von Niederhäusern V, Wagner N, Zimmermann P, Zucol F, Agyeman PKA, Trück J. Interseasonal RSV infections in Switzerland - rapid establishment of a clinician-led national reporting system (RSV EpiCH). Swiss Med Wkly 2021; 151:w30057. [PMID: 34499459 DOI: 10.4414/smw.2021.w30057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In anticipation of an interseasonal respiratory syncytial virus (RSV) epidemic, a clinician-led reporting system was rapidly established to capture RSV infections in Swiss hospitals, starting in January 2021. Here, we present details of the reporting system and first results to June 2021. An unusual epidemiology was observed with an interseasonal surge of RSV infections associated with COVID-19-related non-pharmacological interventions. These data allowed real-time adjustment of RSV prophylaxis guidelines and consequently underscore the need for and continuation of systematic nationwide RSV surveillance.
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Affiliation(s)
- Alix L von Hammerstein
- Divisions of Immunology and Infectious Diseases, University Children's Hospital Zurich, University of Zurich (UZH), Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Christoph Berger
- Divisions of Immunology and Infectious Diseases, University Children's Hospital Zurich, University of Zurich (UZH), Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Lucerne Children's Hospital, Lucerne Cantonal Hospital, Switzerland
| | - Carmen Casaulta
- Paediatric Respiratory Medicine, Kantonsspital Graubunden, Chur, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Switzerland.,Applied Microbiology Research, University of Basel, Switzerland
| | | | | | | | - Eva Kellner
- Klinik für Kinder und Jugendliche, Stadtspital Zürich, Switzerland
| | - Lisa Kottanattu
- Istituto Pediatrico della Svizzera Italiana, Ente Ospedaliero Cantonale, Switzerland
| | - Onya Opota
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | | | - Patrick Meyer Sauteur
- Divisions of Immunology and Infectious Diseases, University Children's Hospital Zurich, University of Zurich (UZH), Switzerland
| | - Margherita Plebani
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicole Ritz
- Infectious Disease, University Children's Hospital Basel and University of Basel, Switzerland
| | - Chiara Testi
- Pédiatrie, Réseau hospitalier neuchâtelois, Switzerland
| | - Valentin von Niederhäusern
- Divisions of Immunology and Infectious Diseases, University Children's Hospital Zurich, University of Zurich (UZH), Switzerland
| | - Noemie Wagner
- Unité d'infectiologie pédiatrique, Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, Genève, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland and Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johannes Trück
- Divisions of Immunology and Infectious Diseases, University Children's Hospital Zurich, University of Zurich (UZH), Switzerland
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Fritschi N, Wind A, Hammer J, Ritz N. Subclinical tuberculosis in children: diagnostic strategies for identification reported in a 6-year national prospective surveillance study. Clin Infect Dis 2021; 74:678-684. [PMID: 34410343 DOI: 10.1093/cid/ciab708] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subclinical tuberculosis (TB) is well recognized and defined as a disease state with absent or non-recognized symptoms. The study identifies factors associated with subclinical TB and diagnostic strategies in a low-burden, high-resource country. METHODS Data was collected between December 2013 to November 2019 through the Swiss Pediatric Surveillance Unit (SPSU). Children with culture/molecular confirmed TB, or who were treated with ≥3 anti-mycobacterial drugs, were included. RESULTS A total of 138 (80%) children with TB disease were included in the final analysis, of which 43 (31%) were subclinical. The median age of children with subclinical compared to symptomatic TB was 3.7(IQR 2.2 to 7) and 9.7(IQR 2.7 to 14.3) years, respectively (p=0.003). The cause of investigation for TB was recorded in 31/43 (72.1%) of children with subclinical TB, and included contact exposure in 25 (80.6%). In children with subclinical TB, diagnosis was made by a combination of the following abnormal/confirming results: culture/molecular + immunodiagnostic + chest radiography in 12 (27.9%), immunodiagnostic + chest radiography in 19 (44.2%), culture/molecular + chest radiography in 2 (4.7%), culture + immunodiagnostic in 1 (2.3%), chest radiography only in 8 (18.6%) and immunodiagnostic only in 1 (2.3%) case. CONCLUSION A notable proportion of children with TB had subclinical disease. This highlights the importance of non-symptom-based TB case finding in exposed children and refugees from high-TB-prevalence settings. TB screening in these asymptomatic children should therefore include a combination of immunodiagnostic testing and imaging followed by culture and molecular testing.
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Affiliation(s)
- Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel
| | - Ante Wind
- Unity Health Care, Washington DC, USA
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Australia
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Fritschi N, Schmidt AJ, Hammer J, Ritz N. Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study. Respiration 2021; 100:1050-1059. [PMID: 34325426 DOI: 10.1159/000517029] [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] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Europe, surveillance and monitoring of pediatric tuberculosis (TB) remains important, particularly in the light of migration in recent years. The aim of the study was to evaluate incidence rates of childhood TB and detailed diagnostic pathways and treatment. METHODS Data were collected through the Swiss Pediatric Surveillance Unit (SPSU) from December 2013 to November 2019. Monthly -notifications are obtained from the 33 pediatric hospitals in the SPSU, and a detailed questionnaire was sent out upon notification. Inclusion criteria were children and adolescents aged up to 15 years with culture- or molecular-confirmed TB disease or for whom a treatment with ≥3 antimycobacterial drugs had been initiated. Data were compared with age-matched notification data from the Swiss Federal Office of Public Health (FOPH). RESULTS Of the 172 cases notified to SPSU, a detailed questionnaire was returned for 161 (93%) children, of which 139 met the inclusion criteria. Reasons for exclusion were age >15 years, double reporting, and not fulfilling the criteria for TB disease. During the same time period, 172 pediatric TB cases were reported to the FOPH, resulting in an incidence of 2.1 per 100,000, ranging from 1.4 to 2.8 per year, without a clear trend over time. In the 64 (46.0%) foreign-born children, incidence rates were higher and peaked in 2016, with 13.7 per 100,000 (p = 0.018). The median interval between arrival in Switzerland and TB diagnosis was 5 (IQR 1-21) months, and 80% were diagnosed within 24 months of arrival. In 58% of the cases, TB disease was confirmed by culture or molecular assays. Age >10 years, presence of fever, or weight loss were independent factors associated with confirmed TB. CONCLUSION The annual pediatric TB incidence rate only varied among foreign-born children and was highest in 2016 when refugee influx peaked in Europe. Importantly, most foreign-born children with TB were diagnosed within 2 years after arrival in Switzerland. Thus, the early period after arrival in Switzerland is associated with a higher risk of TB disease in children, and this should be considered for screening guidance in refugees.
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Affiliation(s)
- Nora Fritschi
- Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Axel J Schmidt
- Infectious Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Ritz
- Department of Clinical Research, Mycobacterial and Migrant Health Research Group, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Victoria, Australia
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Noguera-Julian A, Buonsenso D, Mckenna L, Seddon JA, Ritz N. Availability of fixed-dose, child-friendly formulations of first-line tuberculosis drugs in Europe. Eur Respir J 2021; 58:13993003.01196-2021. [PMID: 34049946 DOI: 10.1183/13993003.01196-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain.,Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Pediatrics, University of Barcelona, Barcelona, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Both authors share credit for 1st authorship
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Ital.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Rome, Italy.,Both authors share credit for 1st authorship
| | | | - James A Seddon
- Department of Infectious Diseases, Imperial College, London, UK.,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Nicole Ritz
- Infectious Diseases Unit and Migrant Health Service, University Children's Hospital Basel, University of Basel, Basel, Switzerland .,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Schlapbach LJ, Andre MC, Grazioli S, Schöbi N, Ritz N, Aebi C, Agyeman P, Albisetti M, Bailey DGN, Berger C, Blanchard-Rohner G, Bressieux-Degueldre S, Hofer M, L'Huillier AG, Marston M, Meyer Sauteur PM, Pachlopnik Schmid J, Perez MH, Rogdo B, Trück J, Woerner A, Wütz D, Zimmermann P, Levin M, Whittaker E, Rimensberger PC. Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland. Front Pediatr 2021; 9:667507. [PMID: 34123970 PMCID: PMC8187755 DOI: 10.3389/fped.2021.667507] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 02/13/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce. Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing. Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance. Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation. Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.
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Affiliation(s)
- Luregn J. Schlapbach
- Pediatric and Neonatal Intensive Care Unit, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Paediatric Intensive Care Unit, Child Health Research Centre, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Maya C. Andre
- Division of Respiratory and Critical Care Medicine, University of Basel Children's Hospital, Basel, Switzerland
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Eberhard Karls University, Tübingen, Germany
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Child, Woman, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nina Schöbi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Alder Hey Children's Hospital, National Health System Foundation Trust, Liverpool, United Kingdom
| | - Nicole Ritz
- Department of Infectiology and Vaccinology, University Children's Hospital Basel, Basel, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Albisetti
- Department of Haematology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Douggl G. N. Bailey
- Pediatric and Neonatal Intensive Care Unit, Children's Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Géraldine Blanchard-Rohner
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | | | - Michael Hofer
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, and University Hospitals of Geneva, Geneva, Switzerland
| | - Arnaud G. L'Huillier
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mark Marston
- Division of Respiratory and Critical Care Medicine, University of Basel Children's Hospital, Basel, Switzerland
| | - Patrick M. Meyer Sauteur
- Division of Infectious Diseases, Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Bjarte Rogdo
- Pediatric and Neonatal Intensive Care Unit, Children's Hospital St. Gallen, St. Gallen, Switzerland
| | - Johannes Trück
- Division of Infectious Diseases, Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
- Division of Immunology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Andreas Woerner
- Department of Rheumatology, University Children's Hospital Basel, Basel, Switzerland
| | - Daniela Wütz
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, Faculty of Science and Medicine, Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Paediatric Infectious Diseases, Imperial College Healthcare National Health System Trust, London, United Kingdom
| | - Elizabeth Whittaker
- Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Paediatric Infectious Diseases, Imperial College Healthcare National Health System Trust, London, United Kingdom
| | - Peter C. Rimensberger
- Division of Neonatal and Pediatric Intensive Care, Department of Child, Woman, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Margineanu I, Mor Z, Garcia D, Gilpin C, Dhawan S, Ritz N, Zenner D. TB and COVID-19 in migrants - the need to focus on both conditions. Int J Tuberc Lung Dis 2021; 25:333-335. [PMID: 33977899 DOI: 10.5588/ijtld.21.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- I Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Rijksuniversiteit Groningen, Groningen, the Netherlands
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel, Ashkelon Academic College, School of Health Sciences, Ashkelon, Israel
| | - D Garcia
- Migrant Clinicians Network, Austin, TX, USA
| | - C Gilpin
- International Organization for Migration, Geneva, Switzerland
| | - S Dhawan
- Partasia Biopharm, New Delhi, India, SHARE INDIA, Delhi, India
| | - N Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, Mycobacterial and Migrant Health Research, University Children´s Hospital Basel, University of Basel, Basel, Switzerland
| | - D Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University of London, London, UK
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von Both U, Gerlach P, Ritz N, Bogyi M, Brinkmann F, Thee S. Management of childhood and adolescent latent tuberculous infection (LTBI) in Germany, Austria and Switzerland. PLoS One 2021; 16:e0250387. [PMID: 33970930 PMCID: PMC8109774 DOI: 10.1371/journal.pone.0250387] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Methods Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. Results A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%. Conclusion This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries.
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Affiliation(s)
- Ulrich von Both
- Division of Pediatric Infectious Diseases, Dr von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
- German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - Philipp Gerlach
- Division of Pediatric Infectious Diseases, Dr von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Nicole Ritz
- Pediatric Infectious Diseases Unit, University Children’s Hospital Basel, The University of Basel, Basel, Switzerland
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, Australia
| | - Matthias Bogyi
- Department of Paediatrics, Wilhelminenspital, Vienna, Austria
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité –Universitätsmedizin, Berlin, Germany
- * E-mail:
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Noguera-Julian A, Calzada-Hernández J, Brinkmann F, Basu Roy R, Bilogortseva O, Buettcher M, Carvalho I, Chechenyeva V, Falcón L, Goetzinger F, Guerrero-Laleona C, Hoffmann P, Jelusic M, Niehues T, Ozere I, Shackley F, Suciliene E, Welch SB, Schölvinck EH, Ritz N, Tebruegge M. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis 2021; 71:2561-2569. [PMID: 31796965 DOI: 10.1093/cid/ciz1138] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de 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
| | - Joan Calzada-Hernández
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Folke Brinkmann
- Department of Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Robindra Basu Roy
- Department of Paediatrics, Oxford University, Oxford, United Kingdom.,Children's Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Olga Bilogortseva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Michael Buettcher
- Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Isabel Carvalho
- Department of Pediatrics, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Vira Chechenyeva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.,Center of Infectious Diseases, "Clinic for Children With HIV/AIDS", National Specialized Children's Hospital (Okhmatdyt), Kiev, Ukraine
| | - Lola Falcón
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Florian Goetzinger
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Carmelo Guerrero-Laleona
- Infectious Diseases Unit, Pediatric Department, Miguel Servet University Hospital-University of Zaragoza, Zaragoza, Spain
| | - Peter Hoffmann
- Department of Internal Medicine, Gastroenterology, and Diabetology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tim Niehues
- Immunodeficiency and Rheumatology Center, Helios Klinikum Krefeld, Krefeld, Germany
| | - Iveta Ozere
- Department of Infectious Diseases and Dermatology, Riga Stradinš University, Riga, Latvia.,Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Fiona Shackley
- Department of Paediatrics, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Elena Suciliene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elisabeth H Schölvinck
- University of Groningen, University Medical Center Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Marc Tebruegge
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Infection, Immunity, and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Zimmermann P, Ritz N, Perrett KP, Messina NL, van der Klis FRM, Curtis N. Correlation of Vaccine Responses. Front Immunol 2021; 12:646677. [PMID: 33868282 PMCID: PMC8050335 DOI: 10.3389/fimmu.2021.646677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The humoral response to vaccinations varies widely between individuals. There is no data available on the correlation between responses to different vaccines. In this study, we investigated the correlation of antibody responses between routine vaccine antigens in infants. Methods One and seven months after the 6-month vaccinations and one month after the 12-month vaccinations, antibody concentrations to diphtheria, tetanus, pertussis, polio (serotypes 1-3), Haemophilus influenzae type b (Hib), pneumococcus (13 serotypes), meningococcus C, measles, mumps and rubella were measured using fluorescent bead-based multiplex immune-assays. For the correlation of antibody responses, Spearman's rank correlation coefficients (ρ) with 95% confidence intervals (CI) were calculated between responses to each vaccine antigen. Results The correlation between concentrations of antibodies to the vaccinations ending at 6 months of age was higher one month compared to seven months after vaccination. The strongest correlations at both time points were observed between antibody responses to different polio serotypes, certain pneumococcal serotypes and between responses to diphtheria and pneumococcal (conjugated to a diphtheria toxoid) vaccine antigens. Correlation between responses to tetanus, Hib, pertussis, polio and other vaccine antigens were weak. The correlation between antibody responses to the 12-month vaccine antigens was weaker than to the 6-month vaccine antigens and there was a negative correlation between responses to measles, mumps, rubella vaccine and non-live vaccine antigens (meningococcus C, tetanus and Hib). There was only weak correlation between antibody responses to vaccines of the same type (e.g. conjugated polysaccharide or toxoid vaccines). Conclusion Correlation between antibody responses to similar antigens in the same vaccine (such as different serotypes of a bacteria or virus), as well as responses to antigens conjugated to similar carrier proteins, are strong. In contrast, correlation between responses to other vaccines are weak. Measuring antibody responses to one or a few vaccine antigens therefore does not offer a reliable surrogate marker of responses to unrelated vaccines.
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Affiliation(s)
- Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Nicole Ritz
- University of Basel, Basel, Switzerland.,The University of Melbourne, Parkville, VIC, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Nicole L Messina
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | - Nigel Curtis
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Lehrnbecher T, Averbuch D, Castagnola E, Cesaro S, Ammann RA, Garcia-Vidal C, Kanerva J, Lanternier F, Mesini A, Mikulska M, Pana D, Ritz N, Slavin M, Styczynski J, Warris A, Groll AH. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol 2021; 22:e270-e280. [PMID: 33811814 DOI: 10.1016/s1470-2045(20)30725-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
Paediatric patients with cancer and those undergoing haematopoietic cell transplantation are at high risk of bacterial infections. The 8th European Conference on Infections in Leukaemia (ECIL-8) convened a Paediatric Group to review the literature and to formulate recommendations for the use of antibiotics according to the European Society of Clinical Microbiology and Infectious Diseases grading system. The evaluation of antibacterial prophylaxis included mortality, bloodstream infection, febrile neutropenia, emergence of resistance, and adverse effects as endpoints. Initial antibacterial therapy and antibiotic de-escalation or discontinuation focused on patients with a clinically stable condition and without previous infection or colonisation by resistant bacteria, and on patients with a clinically unstable condition or with previous infection or colonisation by resistant bacteria. The final considerations and recommendations of the ECIL-8 Paediatric Group on antibacterial prophylaxis, initial therapy, and de-escalation strategies are summarised in this Policy Review.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Dina Averbuch
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roland A Ammann
- Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jukka Kanerva
- Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Alessio Mesini
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dorothea Pana
- Department of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Nicole Ritz
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Monica Slavin
- Department of Infectious Diseases and National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
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Meier NR, Battegay M, Ottenhoff THM, Furrer H, Nemeth J, Ritz N. HIV-Infected Patients Developing Tuberculosis Disease Show Early Changes in the Immune Response to Novel Mycobacterium tuberculosis Antigens. Front Immunol 2021; 12:620622. [PMID: 33777000 PMCID: PMC7994263 DOI: 10.3389/fimmu.2021.620622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In individuals living with HIV infection the development of tuberculosis (TB) is associated with rapid progression from asymptomatic TB infection to active TB disease. Sputum-based diagnostic tests for TB have low sensitivity in minimal and subclinical TB precluding early diagnosis. The immune response to novel Mycobacterium tuberculosis in-vivo expressed and latency associated antigens may help to measure the early stages of infection and disease progression and thereby improve early diagnosis of active TB disease. Methods: Serial prospectively sampled cryopreserved lymphocytes from patients of the Swiss HIV Cohort Study developing TB disease ("cases") and matched patients with no TB disease ("controls") were stimulated with 10 novel Mycobacterium tuberculosis antigens. Cytokine concentrations were measured in cases and controls at four time points prior to diagnosis of TB: T1-T4 with T4 being the closest time point to diagnosis. Results: 50 samples from nine cases and nine controls were included. Median CD4 cell count at T4 was 289/ul for the TB-group and 456/ul for the control group. Viral loads were suppressed in both groups. At T4 Rv2431c-induced and Rv3614/15c-induced interferon gamma-induced protein (IP)-10 responses and Rv2031c-induced and Rv2346/Rv2347c-induced tumor necrosis factor (TNF)-α responses were significantly higher in cases compared to controls (p < 0.004). At T3 - being up to 2 years prior to TB diagnosis - Rv2031c-induced TNF-α was significantly higher in cases compared to controls (p < 0.004). Area under the receiver operating characteristics (AUROC) curves resulted in an AUC > 0.92 for all four antigen-cytokine pairs. Conclusion: The in vitro Mycobacterium tuberculosis-specific immune response in HIV-infected individuals that progress toward developing TB disease is different from those in HIV-infected individuals that do not progress to developing TB. These differences precede the clinical diagnosis of active TB up to 2 years, paving the way for the development of immune based diagnostics to predict TB disease at an early stage.
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Affiliation(s)
- Noemi Rebecca Meier
- University of Basel Children's Hospital, Mycobacterial Research Laboratory, Basel, Switzerland.,University of Basel, Faculty of Medicine, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Faculty of Medicine, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tom H M Ottenhoff
- Leiden University Medical Center, Department of Infectious Diseases, Leiden, Netherlands
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Nemeth
- Division of Infectious Diseases, Zürich University Hospital, University of Zürich, Zurich, Switzerland
| | - Nicole Ritz
- University of Basel Children's Hospital, Mycobacterial Research Laboratory, Basel, Switzerland.,University of Basel, Faculty of Medicine, Basel, Switzerland.,University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland.,Royal Children's Hospital Melbourne, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Meier NR, Sutter TM, Jacobsen M, Ottenhoff THM, Vogt JE, Ritz N. Machine Learning Algorithms Evaluate Immune Response to Novel Mycobacterium tuberculosis Antigens for Diagnosis of Tuberculosis. Front Cell Infect Microbiol 2021; 10:594030. [PMID: 33489933 PMCID: PMC7820115 DOI: 10.3389/fcimb.2020.594030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Rationale Tuberculosis diagnosis in children remains challenging. Microbiological confirmation of tuberculosis disease is often lacking, and standard immunodiagnostic including the tuberculin skin test and interferon-γ release assay for tuberculosis infection has limited sensitivity. Recent research suggests that inclusion of novel Mycobacterium tuberculosis antigens has the potential to improve standard immunodiagnostic tests for tuberculosis. Objective To identify optimal antigen–cytokine combinations using novel Mycobacterium tuberculosis antigens and cytokine read-outs by machine learning algorithms to improve immunodiagnostic assays for tuberculosis. Methods A total of 80 children undergoing investigation of tuberculosis were included (15 confirmed tuberculosis disease, five unconfirmed tuberculosis disease, 28 tuberculosis infection and 32 unlikely tuberculosis). Whole blood was stimulated with 10 novel Mycobacterium tuberculosis antigens and a fusion protein of early secretory antigenic target (ESAT)-6 and culture filtrate protein (CFP) 10. Cytokines were measured using xMAP multiplex assays. Machine learning algorithms defined a discriminative classifier with performance measured using area under the receiver operating characteristics. Measurements and main results We found the following four antigen–cytokine pairs had a higher weight in the discriminative classifier compared to the standard ESAT-6/CFP-10-induced interferon-γ: Rv2346/47c- and Rv3614/15c-induced interferon-gamma inducible protein-10; Rv2031c-induced granulocyte-macrophage colony-stimulating factor and ESAT-6/CFP-10-induced tumor necrosis factor-α. A combination of the 10 best antigen–cytokine pairs resulted in area under the curve of 0.92 ± 0.04. Conclusion We exploited the use of machine learning algorithms as a key tool to evaluate large immunological datasets. This identified several antigen–cytokine pairs with the potential to improve immunodiagnostic tests for tuberculosis in children.
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Affiliation(s)
- Noëmi Rebecca Meier
- Mycobacterial Research Laboratory, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thomas M Sutter
- Department of Computer Science, Medical Data Science, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Marc Jacobsen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinreich Heine University, Düsseldorf, Germany
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Julia E Vogt
- Department of Computer Science, Medical Data Science, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Nicole Ritz
- Mycobacterial Research Laboratory, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Pediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Department of Pediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Parkville, VIC, Australia
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Brandenberger J, Pohl C, Vogt F, Tylleskär T, Ritz N. Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study. BMC Public Health 2021; 21:81. [PMID: 33413242 PMCID: PMC7791630 DOI: 10.1186/s12889-020-10082-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. Methods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.
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Affiliation(s)
- Julia Brandenberger
- University of Basel Children's Hospital, Migrant Health Service, Spitalstrasse 33, 4056, Basel, Switzerland. .,Pediatric Emergency Department, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Christian Pohl
- Neonatal Intensive Care Unit, Perth Children's and Kind Edward Memorial Hospitals, Perth, Australia
| | - Florian Vogt
- Unit of NTDs, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Nicole Ritz
- University of Basel Children's Hospital, Migrant Health Service, Spitalstrasse 33, 4056, Basel, Switzerland.,University of Basel Children's Hospital, Pediatric Infectious Disease and Vaccinology, Basel, Switzerland.,Department of Pediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Parkville, Australia
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Affiliation(s)
- Jaan Toelen
- Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - J Peter de Winter
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- Department of Pediatrics, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands.
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Bamford A, Dixon G, Klein N, Marks S, Ritz N, Welch SB, Tebruegge M. Correction to: Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Pediatr Nephrol 2021; 36:3283. [PMID: 33591410 PMCID: PMC8587393 DOI: 10.1007/s00467-020-04893-w] [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: 10/22/2022]
Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - Garth Dixon
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatric Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nigel Klein
- grid.424537.30000 0004 5902 9895Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen Marks
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicole Ritz
- grid.6612.30000 0004 1937 0642Paediatric Infectious Diseases and Vaccinology Department, Migrant Health Service, University of Basel Children’s Hospital, Basel, Switzerland ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Steven B. Welch
- grid.412563.70000 0004 0376 6589Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Marc Tebruegge
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia ,grid.451052.70000 0004 0581 2008Department of Paediatric Infectious Diseases and Immunology, Evelina London Children’s Hospital, Guy’s and St Tomas’ NHS Foundation Trust, London, UK
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47
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Bamford A, Dixon G, Klein N, Marks SD, Ritz N, Welch SB, Tebruegge M. Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Pediatr Nephrol 2021; 36:3023-3031. [PMID: 33245418 PMCID: PMC8445864 DOI: 10.1007/s00467-020-04844-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease.
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Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - Garth Dixon
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatirc Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nigel Klein
- grid.424537.30000 0004 5902 9895Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Stephen D. Marks
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.424537.30000 0004 5902 9895Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicole Ritz
- grid.6612.30000 0004 1937 0642University of Basel Children’s Hospital, Paediatric Infectious Disease and Vaccinology Department, Migrant Health Service, Basel, Switzerland ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Steven B. Welch
- grid.412563.70000 0004 0376 6589Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Marc Tebruegge
- grid.451056.30000 0001 2116 3923University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia ,grid.420545.2Department of Paediatric Infectious Diseases & Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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48
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Prader S, Ritz N, Baleydier F, Andre MC, Stähli N, Schmid K, Schmid H, Woerner A, Diesch T, Meyer Sauteur PM, Trück J, Gebistorf F, Opitz L, Killian MP, Marchetti T, Vavassori S, Blanchard-Rohner G, Mc Lin V, Grazioli S, Pachlopnik Schmid J. X-Linked Lymphoproliferative Disease Mimicking Multisystem Inflammatory Syndrome in Children-A Case Report. Front Pediatr 2021; 9:691024. [PMID: 34414143 PMCID: PMC8369030 DOI: 10.3389/fped.2021.691024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Most children with a SARS-CoV-2 infection are asymptomatic or exhibit mild symptoms. However, a small number of children develop features of substantial inflammation temporarily related to the COVID-19 also called multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), clinically similar to Kawasaki disease, toxic shock syndrome and hemophagocytic lymphohistiocytosis (HLH). It is well-known that genetic pre-disposition plays an important role in virally-triggered diseases such as Epstein-Barr virus (EBV)-associated HLH, while this has not yet been established for patients with MIS-C. Here we describe a male patient fulfilling the diagnostic criteria of MIS-C, who was initially treated according to current consensus guidelines. Presence of hypofibrinogenemia, normal lymphocyte counts and C-reactive protein, but substantial hyperferritinemia distinguish this patient from others with MIS-C. The clinical course following initial presentation with acute respiratory distress syndrome was marked by fatal liver failure in the context of EBV-associated HLH despite treatment with steroids, intravenous immunoglobulins, interleukin (IL)-1 receptor blockade and eventually HLH-directed treatment. X-linked lymphoproliferative disease type 1 (XLP1), a subtype of primary HLH was diagnosed in this patient post-mortem. This case report highlights the importance of including HLH in the differential diagnosis in MIS-C with severe disease course to allow specific, risk-adapted treatment and genetic counseling.
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Affiliation(s)
- Seraina Prader
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ritz
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Frédéric Baleydier
- Pediatric Hemato-Oncology Unit, Department for Women, Children, and Adolescents, University Hospitals Geneva, Geneva, Switzerland.,CANSEARCH Research Laboratory, Medical Faculty, Geneva University, Geneva, Switzerland
| | - Maya C Andre
- University Children's Hospital, Division of Respiratory and Critical Care Medicine, University of Basel, Basel, Switzerland
| | - Noémie Stähli
- Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Schmid
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hanna Schmid
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital Basel, Basel, Switzerland
| | - Andreas Woerner
- Division of Pediatric Rheumatology, University of Basel Children's Hospital Basel, Basel, Switzerland
| | - Tamara Diesch
- Division of Pediatric Hematology/Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Johannes Trück
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Fabienne Gebistorf
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Lennart Opitz
- Functional Genomic Center Zurich, University of Zurich and Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Michael P Killian
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Tommaso Marchetti
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Stefano Vavassori
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Géraldine Blanchard-Rohner
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valerie Mc Lin
- Swiss Pediatric Liver Center, Department for Women, Children, and Adolescents, University Hospitals Geneva, Geneva, Switzerland.,Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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49
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Buettcher M, Trueck J, Niederer-Loher A, Heininger U, Agyeman P, Asner S, Berger C, Bielicki J, Kahlert C, Kottanattu L, Meyer Sauteur PM, Paioni P, Posfay-Barbe K, Relly C, Ritz N, Zimmermann P, Zucol F, Gobet R, Shavit S, Rudin C, Laube G, von Vigier R, Neuhaus TJ. Correction to: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr 2021; 180:675-677. [PMID: 33001233 PMCID: PMC7886751 DOI: 10.1007/s00431-020-03820-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The article “Swiss consensus recommendations on urinary tract infections in children”
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Affiliation(s)
- Michael Buettcher
- Paediatric Infectious Diseases, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Luzern 16, Switzerland.
| | - Johannes Trueck
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Anita Niederer-Loher
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Ulrich Heininger
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Philipp Agyeman
- Department of Pediatric Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Sandra Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Julia Bielicki
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Christian Kahlert
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Lisa Kottanattu
- Pediatric Infectious Diseases, Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland
| | - Patrick M. Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Klara Posfay-Barbe
- General Pediatrics & Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva & Medical School of Geneva, 6, rue Willy-Donzé, 1211, Geneva 14, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Nicole Ritz
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Rita Gobet
- Paediatric Urology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Sandra Shavit
- Paediatric Surgery, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Christoph Rudin
- Pediatric Nephrology, University Children’s Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland
| | - Guido Laube
- Pediatric Nephrology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Rodo von Vigier
- Pediatric Clinic, Wildermeth Children’s Hospital, Kloosweg 84, 2502 Biel-Bienne, Switzerland
| | - Thomas J. Neuhaus
- Paediatrics, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
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50
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Pittet LF, Tebruegge M, Dutta B, Donath S, Messina N, Casalaz D, Hanekom WA, Britton WJ, Robins-Browne R, Curtis N, Ritz N. Mycobacterium ulcerans-specific immune response after immunisation with bacillus Calmette-Guérin (BCG) vaccine. Vaccine 2020; 39:652-657. [PMID: 33371993 DOI: 10.1016/j.vaccine.2020.11.045] [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] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/17/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bacillus Calmette-Guérin (BCG) vaccine provides partial protection against Buruli ulcer caused by Mycobacterium ulcerans in epidemiological studies. This study aimed to quantify M. ulcerans-specific immune responses induced by BCG immunisation. METHODS Intracellular cytokine analysis of in-vitro experiments done 10 weeks after BCG immunisation in 130 Australian infants randomised to one of three BCG vaccine strains given either at birth (BCG-Denmark, BCG-Japan, or BCG-Russia) or at two months of age (BCG-Denmark). RESULTS Proportions of polyfunctional CD4+ T-cells were higher in M. ulcerans-stimulated compared to unstimulated control samples. These proportions were not influenced by the vaccine strain or timing of the immunisation. The M. ulcerans-specific immune responses showed similar patterns to those observed in M. tuberculosis-stimulated samples, although they were of lower magnitude. CONCLUSIONS Our data show that BCG immunisation induces M. ulcerans-specific immune responses in infants, likely explaining the cross-protective effect observed in epidemiological studies. (ACTRN12608000227392).
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Affiliation(s)
- Laure F Pittet
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Binita Dutta
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicole Messina
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Dan Casalaz
- Neonatal Intensive Care Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | | | - Warwick J Britton
- Centenary Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Roy Robins-Browne
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| | - Nicole Ritz
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; University of Basel Children's Hospital Basel, Infectious Diseases Unit and Migrant Health Service, Basel, Switzerland; Mycobacterial Research Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
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