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Romani L, Roversi M, Bernardi S, Venturini E, Garazzino S, Donà D, Krzysztofiak A, Montagnani C, Funiciello E, Calò Carducci FI, Marabotto C, Castagnola E, Salvini F, Lancella L, Lo Vecchio A, Galli L, Castelli Gattinara G. Use of Remdesivir in children with COVID-19: report of an Italian multicenter study. Ital J Pediatr 2024; 50:32. [PMID: 38413992 PMCID: PMC10900665 DOI: 10.1186/s13052-024-01606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study conducted in 10 Italian Hospitals to investigate the safety of RDV in children affected by COVID-19. METHODS We collected the clinical data of children with COVID-19 treated with RDV between March 2020 and February 2022 in 10 Italian hospitals. Clinical data were compared according to a duration of RDV therapy more or less than 5 days. Linear regression model was used to determine the association of significant variables from the bivariate analysis to the duration of RDV therapy. RESULTS A total of 50 patients were included, with a median age of 12.8 years. Many patients had at least one comorbidity (78%), mostly obesity. Symptoms were fever (88%), cough (74%) and dyspnea (68%). Most patients were diagnosed with pneumonia of either viral and/or bacterial etiology. Blood test showed leukopenia in 66% and increased C-reactive protein (CRP) levels in 63% of cases. Thirty-six patients received RDV for 5 days, nine patients up to 10 days. Most children who received RDV longer were admitted to the PICU (67%). Treatment with RDV was well tolerated with rare side effects: bradycardia was recorded in 6% of cases, solved in less than 24 h after discontinuation. A mild elevation of transaminases was observed in 26% of cases, however for the 8%, it was still detected before the RDV administration. Therefore, in these cases, we could not establish if it was caused by COVID-19, RDV o both. Patients who received RDV for more than 5 days waited longer for its administration after pneumonia diagnosis. The presence of comorbidities and the duration of O2 administration significantly correlated with the duration of RDV therapy at the linear regression analysis. CONCLUSION Our experience indicates that RDV against SARS-CoV-2 is safe and well-tolerated in pediatric populations at high risk of developing severe COVID-19. Our data suggest that delaying RDV therapy after diagnosis of pneumonia may be associated with a longer duration of antiviral therapy, especially in patients with comorbidities.
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Affiliation(s)
- Lorenza Romani
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- PhD Course "Immunology, Molecular Medicine and Applied Biotechnology", University of Rome Tor Vergata, Rome, Italy
| | - Stefania Bernardi
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elisa Funiciello
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Caterina Marabotto
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elio Castagnola
- Hematology and Oncology, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Filippo Salvini
- Pediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Lancella
- Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
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Palmas G, Trapani S, Agosti M, Alberti I, Aricò M, Azzari C, Bresesti I, Bressan S, Caselli D, Cazzato S, Da Dalt L, Felici E, Garazzino S, Giannattasio A, Iudica G, Lanari M, Marchisio P, Martelli G, Milani GP, Soro F, Piccotti E, Tirelli F, Resti M, Indolfi G. Disrupted Seasonality of Respiratory Viruses: Retrospective Analysis of Pediatric Hospitalizations in Italy from 2019 to 2023. J Pediatr 2024; 268:113932. [PMID: 38309520 DOI: 10.1016/j.jpeds.2024.113932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/07/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
This multicenter study in Italian hospitals highlights the epidemiologic disruptions in the circulation of the 5 main respiratory viruses from 2019 to 2023. Our data reveal a resurgence of respiratory syncytial virus and influenza during the 2022-2023 winter season, with an earlier peak in cases for both viruses, emphasizing the importance of timely monitoring.
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Affiliation(s)
- Giordano Palmas
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Massimo Agosti
- Department of Woman and Child, University of Insubria, Varese, Italy
| | - Ilaria Alberti
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Aricò
- Pediatric Unit, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Chiara Azzari
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Ilia Bresesti
- Department of Woman and Child, University of Insubria, Varese, Italy
| | - Silvia Bressan
- Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Desiree Caselli
- Pediatric Infectious Diseases Unit, Giovanni XXIII Children's Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Silvia Garazzino
- Unit of Pediatric Infectious Diseases, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Giovanna Iudica
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; Pediatric Emergency Unit, IRCCS-Policlinico Ospedaliero Universitario di Bologna, Bologna, Italy
| | - Paola Marchisio
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Martelli
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Gregorio Paolo Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Soro
- Department of Preventive Medicine, University of Brescia, Brescia, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Francesca Tirelli
- Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Massimo Resti
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
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3
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Venturini E, Fusani L, Lo Vecchio A, Scarano SM, Garazzino S, Pruccoli G, Donà D, Lancella L, Castelli Gattinara G, Galli L. Safety of Sotrovimab use in children with COVID-19: an Italian experience. J Chemother 2024; 36:45-48. [PMID: 37605372 DOI: 10.1080/1120009x.2023.2250138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
Sotrovimab is a monoclonal antibody approved in adult and adolescents at high risk for COVID-19. Thirty-three children evaluated in five Italian paediatric centres received Sotrovimab infusion and were retrospectively enrolled from December 2021 to April 2022. In more than half of cases (19/33, 57.6%) Sotrovimab was prescribed off-label. Overall, the infusion was well tolerated with no significative differences in those receiving an off-label prescription. All children had a complete recovery. Data on the safety of Sotrovimab should be investigated in a larger paediatric cohort, considering the continuous selection of new SARS CoV-2 variants which may be more or less susceptible to the effects of the Sotrovimab.
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Affiliation(s)
- Elisabetta Venturini
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Lara Fusani
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Sara Maria Scarano
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | | | - Luisa Galli
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Casale R, Boattini M, Bianco G, Comini S, Corcione S, Garazzino S, Silvestro E, De Rosa FG, Cavallo R, Costa C. Bloodstream Infections by Pantoea Species: Clinical and Microbiological Findings from a Retrospective Study, Italy, 2018-2023. Antibiotics (Basel) 2023; 12:1723. [PMID: 38136757 PMCID: PMC10740582 DOI: 10.3390/antibiotics12121723] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: The widespread use of MALDI-TOF coupled to mass spectrometry has improved diagnostic accuracy by identifying uncommon bacteria. Among Enterobacterales, Pantoea species have been seen to be implicated in several human infections, but their clinical and microbiological framework is currently based on a few anecdotal reports. (2) Methods: We conducted this five-year (2018-2023) single-center study aimed at investigating the prevalence and clinical and microbiological findings of Pantoea species bloodstream infections. (3) Results: Among the 4996 bloodstream infection Gram-negative isolates collected during the study period, Pantoea species accounted for 0.4% (n = 19) of isolates from 19 different patients, 5 of them being pediatric cases. Among Pantoea species isolates, P. agglomerans was the most frequently detected (45%; n = 9) followed by P. eucrina (30%; n = 6) and P. septica (15%; n = 3). Malignancy (35.7%) in adults and malignancy (40%) and cerebrovascular disease following meconium aspiration (40%) in pediatric patients as comorbidities and shivering and/or fever following parenteral infusion (36.8%) as a symptom/sign of Pantoea species bloodstream infection onset were the most frequently observed clinical features. Among adults, primary bloodstream infection was the most frequent (50%), whereas among pediatric patients, the most commonly identified sources of infection were catheter-related (40%) and the respiratory tract (40%). Overall, Pantoea species bloodstream infection isolates displayed high susceptibility to all the antibiotics except for ampicillin (63.2%), fosfomycin (73.7%), and piperacillin/tazobactam (84.2%). Targeted antibiotic treatment was prescribed as monotherapy for adults (71.4%) and combination therapy for pediatric patients (60%). The most prescribed antibiotic regimens were piperacillin/tazobactam (21.4%) in adults and meropenem- (40%) and aminoglycoside-containing (40%) antibiotics in pediatric patients. The overall 28-day all-cause mortality rate was 5.3% (n = 1). (4) Conclusions: The prevalence and 28-day mortality rate of Pantoea species bloodstream infections were low. The prescription of targeted therapy including broad-spectrum antibiotics could indicate an underestimation of the specific involvement of the Pantoea species in the onset of the disease, warranting further studies defining their pathogenic potential.
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Affiliation(s)
- Roberto Casale
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Erika Silvestro
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
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5
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Pellegrino R, Timitilli E, Verga MC, Guarino A, Iacono ID, Scotese I, Tezza G, Dinardo G, Riccio S, Pellizzari S, Iavarone S, Lorenzetti G, Simeone G, Bergamini M, Donà D, Pierantoni L, Garazzino S, Esposito S, Venturini E, Gattinara GC, Lo Vecchio A, Marseglia GL, Di Mauro G, Principi N, Galli L, Chiappini E. Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives. Eur J Pediatr 2023; 182:5259-5273. [PMID: 37819417 PMCID: PMC10746578 DOI: 10.1007/s00431-023-05211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
This study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5-7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known: • GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases. • GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New: • Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk. • The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy.
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Affiliation(s)
- Roberta Pellegrino
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | - Edoardo Timitilli
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Iride Dello Iacono
- Unit of Allergology, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Giovanna Tezza
- Department of Pediatrics, Ospedale San Maurizio, Bolzano, Italy
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Simona Riccio
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sofia Pellizzari
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Sonia Iavarone
- Department of Maternal, Infantile, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Lorenzetti
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Susanna Esposito
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Nicola Principi
- Professor Emeritus of Pediatrics, University of Milan, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy.
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6
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Funiciello E, Mula J, Mignone F, Silvestro E, Ragazzi P, Pilloni G, Costa C, D'Avolio A, Garazzino S. Plasmatic and CSF concentrations of cefiderocol in an infant with extensively drug-resistant Pseudomonas aeruginosa meningoencephalitis. J Antimicrob Chemother 2023; 78:2776-2778. [PMID: 37671818 DOI: 10.1093/jac/dkad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
- Elisa Funiciello
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Jacopo Mula
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Turin, Italy
| | - Federica Mignone
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Erika Silvestro
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Paola Ragazzi
- Paediatric Neurosurgery Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pilloni
- Paediatric Neurosurgery Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Cristina Costa
- Microbiology Unit, Molinette Hospital, University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
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7
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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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8
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Scarselli V, Calderoni D, Terrinoni A, Davico C, Pruccoli G, Denina M, Carducci C, Smarrazzo A, Martucci M, Presicce M, Marcotulli D, Arletti L, Ferrara M, Garazzino S, Mariani R, Campana A, Vitiello B. A Neuropsychiatric Assessment of Children with Previous SARS-CoV-2 Infection. J Clin Med 2023; 12:3917. [PMID: 37373611 DOI: 10.3390/jcm12123917] [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: 02/12/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
AIM Concerns have been raised about possible neuropsychiatric sequelae of COVID-19. The objective of this study was to examine the plausibility of long-term mental health consequences of COVID-19 by assessing a sample of children after the resolution of the acute SARS-CoV-2 infection. METHOD As part of a systematic follow-up assessment of pediatric patients with COVID-19 conducted at two university children's hospitals, 50 children (56% males) aged 8 to 17 years (median 11.5), 26% with previous multisystem inflammatory syndrome in children (MIS-C), without a prior history of neuropsychiatric disorders, received a battery of clinical neuropsychiatric and neuropsychological rating scales that included the Pediatric Migraine Disability Assessment (PedMIDAS), Sleep Disturbance Scale for Children (SDSC), Multidimensional Anxiety Scale for Children (MASC-2), Child Depression Inventory (CDI-2), Child Behavior Checklist (CBCL), and the NEPSY II (Neuropsychological Assessment, Second Edition). The assessments were conducted between 1 and 18 months (median 8 months) after the acute infection. RESULTS The CBCL internalizing symptoms score was in the clinical range for 40% of the participants (vs. a population expected rate of about 10%, p < 0.001). A sleep disturbance was detected in 28%, clinically significant anxiety in 48%, and depressive symptoms in 16%. The NEPSY II scores showed impairment in attention and other executive functions in 52%, and memory deficits in 40% of the children. CONCLUSIONS These data from direct assessment of a sample of children who had SARS-CoV-2 infection show higher than expected rates of neuropsychiatric symptoms, thus supporting the possibility that COVID-19 may have mental health sequelae long after the resolution of the acute infection.
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Affiliation(s)
- Veronica Scarselli
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Dario Calderoni
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Arianna Terrinoni
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Giulia Pruccoli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Marco Denina
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Chiara Carducci
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Andrea Smarrazzo
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Melania Martucci
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Mariaelena Presicce
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Daniele Marcotulli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Luca Arletti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Mauro Ferrara
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Silvia Garazzino
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Rosanna Mariani
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Andrea Campana
- Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, 00165 Rome, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
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9
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Pellegrino F, Funiciello E, Pruccoli G, Silvestro E, Scolfaro C, Mignone F, Tocchet A, Roasio L, Garazzino S. Meningitis-retention syndrome: a review and update of an unrecognized clinical condition. Neurol Sci 2023; 44:1949-1957. [PMID: 36867276 PMCID: PMC10175389 DOI: 10.1007/s10072-023-06704-0] [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: 12/17/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES We summarized the clinical and radiological characteristics of meningitis-retention syndrome (MRS), its therapeutic options, and urological outcome, to better understand the pathogenesis of this syndrome and to evaluate the effectiveness of corticosteroids in reducing the period of urinary retention. METHODS We reported a new case of MRS in a male adolescent. We also reviewed the previously 28 reported cases of MRS, collected from inception up to September 2022. RESULTS MRS is characterized by aseptic meningitis and urinary retention. The mean length of the interval between the onset of the neurological signs and the urinary retention was 6.4 days. In most cases, no pathogens were isolated in cerebrospinal fluid, except for 6 cases in which Herpesviruses were detected. The urodynamic study resulted in a detrusor underactivity, with a mean period for urination recovery of 4.5 weeks, regardless of therapies. DISCUSSION Neurophysiological studies and electromyographic examination are not pathological, distinguishing MRS from polyneuropathies. Although there are no encephalitic symptoms or signs, and the magnetic resonance is often normal, MRS may represent a mild form of acute disseminated encephalomyelitis, without radiological detectable medullary involvement, due to the prompt use of steroids. It is believed that MRS is a self-limited disease, and no evidence suggests the effectiveness of steroids, antibiotics, and antiviral treatment in its clinical course.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Regina Margherita Children's Hospital, Postgraduate School of Pediatrics, University of Turin, Piazza Polonia 64, Turin, Italy.
| | - Elisa Funiciello
- Department of Pediatric and Public Health Sciences, Regina Margherita Children's Hospital, Postgraduate School of Pediatrics, University of Turin, Piazza Polonia 64, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Erika Silvestro
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Carlo Scolfaro
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Federica Mignone
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Aba Tocchet
- Child and Adolescent Neurology and Psychiatry Division, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Luca Roasio
- Pediatric Department, E. Agnelli Hospital, Via Brigata Cagliari 39, Pinerolo, TO, Italy
| | - Silvia Garazzino
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
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10
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Denina M, Appendini L, Ronco L, Funiciello E, Bignamini E, Garazzino S. Cardiopulmonary exercise testing in children six months after COVID-19. Pediatr Pulmonol 2023. [PMID: 37036065 DOI: 10.1002/ppul.26406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Marco Denina
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Lorenzo Appendini
- Department of Paediatric Pulmonology, Regina Margherita Children's Hospital, Turin, Italy
| | - Lucia Ronco
- Department of Paediatric Pulmonology, Regina Margherita Children's Hospital, Turin, Italy
- Postgraduate School of Paediatrics, University of Torino, Torino, Italy
| | - Elisa Funiciello
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
- Postgraduate School of Paediatrics, University of Torino, Torino, Italy
| | - Elisabetta Bignamini
- Department of Paediatric Pulmonology, Regina Margherita Children's Hospital, Turin, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
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11
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Raffaldi I, Garazzino S, Ballardini G, Zaffaroni M, Grasso N, Bona G, Tovo PA, Guala A. Vitamin D status in internationally adopted children: the northwest Italy experience. Minerva Pediatr (Torino) 2023; 75:197-200. [PMID: 28922908 DOI: 10.23736/s2724-5276.17.04883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The majority of internationally adopted children, before adoption, might have experienced malnutrition, exposure to infectious diseases, environmental deprivation, and neglect; they could also develop medical problems such as vitamin D deficiency. Scantly data are available about vitamin D status in internationally adopted children and, to our knowledge, no report exists on Italian adoptees. METHODS We carried out a prospective multicenter study, involving three Pediatric Centers in Piedmont, Italy, to collect information about 25-hydroxyvitamin D (25[OH]D) profile in adoptees, shortly after their arrival in Italy. RESULTS In 142/158 internationally adopted children 25(OH)D was measured: 75 males and 67 females, with a mean age of 4.22±2.2 years. Fifty-three (37.3%) of them came from Asia, 48 (33.8%) from Africa, 24 (16.9%) from Eastern Europe, and 17 (12%) from Latin America. The median level of 25(OH)D in serum was 21.5 ng/mL (IQR range 14.3-29.7 ng/mL): 26 (18.2%) of the examined children had an insufficiency of 25-OHD, whereas 36 (25.2%) had a deficiency. Adoptees with longer time of institution stay had a significant risk to develop 25(OH)D deficiency. The Asian origin proved to be a risk factor to develop 25(OH)D deficiency, whereas the age >1 year was significantly associated with 25(OH)D insufficiency. CONCLUSIONS Our survey showed that vitamin D deficiency and insufficiency, in internationally adoptees, are frequent and relevant health problems.
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Affiliation(s)
- Irene Raffaldi
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy -
| | - Silvia Garazzino
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Mauro Zaffaroni
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Nicolino Grasso
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Gianni Bona
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Pier-Angelo Tovo
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Andrea Guala
- Unit of Pediatrics, Castelli Hospital, Verbania, Italy
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12
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Tovo PA, Garazzino S, Savino F, Daprà V, Pruccoli G, Dini M, Filisetti G, Funiciello E, Galliano I, Bergallo M. Expressions of Type I and III Interferons, Endogenous Retroviruses, TRIM28, and SETDB1 in Children with Respiratory Syncytial Virus Bronchiolitis. Curr Issues Mol Biol 2023; 45:1197-1217. [PMID: 36826024 PMCID: PMC9954910 DOI: 10.3390/cimb45020079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Interferons (IFNs) and IFN-stimulated genes (ISGs) play essential roles for the control of viral infections. Their expression in infants with respiratory syncytial virus (RSV) bronchiolitis is poorly defined. Human endogenous retroviruses (HERVs) represent 8% of our genome and modulate inflammatory and immune reactions. TRIM28 and SETDB1 participate in the epigenetic regulation of genes involved in the immune response, including IFNs and HERVs. No study has explored the expression of HERVs, TRIM28, and SETDB1 during RSV bronchiolitis. We assessed, through a PCR real-time Taqman amplification assay, the transcription levels of six IFN-I ISGs, four IFNλs, the pol genes of HERV-H, -K, and -W families, the env genes of Syncytin (SYN)1 and SYN2, and of TRIM28/SETDB1 in whole blood from 37 children hospitalized for severe RSV bronchiolitis and in healthy children (HC). The expression of most IFN-I ISGs was significantly higher in RSV+ patients than in age-matched HC, but it was inhibited by steroid therapy. The mRNA concentrations of IFN-λs were comparable between patients and age-matched HC. This lack of RSV-driven IFN-III activation may result in the defective protection of the airway mucosal surface leading to severe bronchiolitis. The expression of IFN-III showed a positive correlation with age in HC, that could account for the high susceptibility of young children to viral respiratory tract infections. The transcription levels of every HERV gene were significantly lower in RSV+ patients than in HC, while the expressions of TRIM28/SETDB1 were overlapping. Given the negative impact of HERVs and the positive effects of TRIM28/SETDB1 on innate and adaptive immune responses, the downregulation of the former and the normal expression of the latter may contribute to preserving immune functions against infection.
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Affiliation(s)
- Pier-Angelo Tovo
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Correspondence: Correspondence: (P.-A.T.); (M.B.)
| | - Silvia Garazzino
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Francesco Savino
- Early Infancy Special Care Unit, Department of Pediatric Care, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Valentina Daprà
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - Giulia Pruccoli
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Maddalena Dini
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - Giacomo Filisetti
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Early Infancy Special Care Unit, Department of Pediatric Care, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Elisa Funiciello
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy
| | - Ilaria Galliano
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - Massimiliano Bergallo
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
- Correspondence: Correspondence: (P.-A.T.); (M.B.)
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13
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Garazzino S, Denina M, Pruccoli G, Funiciello E, Ramenghi U, Fagioli F. Long COVID-19/post-COVID condition in children: do we all speak the same language? Ital J Pediatr 2023; 49:12. [PMID: 36670478 PMCID: PMC9859668 DOI: 10.1186/s13052-023-01417-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
Post-COVID condition is a new and highly debated entity that is still to be outlined in its complexity, especially in the pediatric population. In response to the article by Trapani and colleagues, we report the results of a long-term follow-up conducted in the outpatient clinic of the Pediatric Infectious Diseases Unit on children admitted to our hospital with SARS-CoV-2 infection.
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Affiliation(s)
- Silvia Garazzino
- Unit of Pediatric Infectious Diseases, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
| | - Marco Denina
- grid.415778.80000 0004 5960 9283Pediatric Emergency Department, Regina Margherita Children’s Hospital, Turin, Italy
| | - Giulia Pruccoli
- Unit of Pediatric Infectious Diseases, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
| | - Elisa Funiciello
- Unit of Pediatric Infectious Diseases, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
| | - Ugo Ramenghi
- Department of Public Health and Pediatric Sciences, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
| | - Franca Fagioli
- Department of Public Health and Pediatric Sciences, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
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14
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Pruccoli G, Castagno E, Raffaldi I, Denina M, Barisone E, Baroero L, Timeus F, Rabbone I, Monzani A, Terragni GM, Lovera C, Brach del Prever A, Manzoni P, Barbaglia M, Roasio L, De Franco S, Calitri C, Lupica M, Felici E, Marciano C, Santovito S, Militerno G, Abrigo E, Curtoni A, Quarello P, Bondone C, Garazzino S. The Importance of RSV Epidemiological Surveillance: A Multicenter Observational Study of RSV Infection during the COVID-19 Pandemic. Viruses 2023; 15:v15020280. [PMID: 36851494 PMCID: PMC9963567 DOI: 10.3390/v15020280] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The restrictive measures adopted worldwide against SARS-CoV-2 produced a drastic reduction in respiratory pathogens, including RSV, but a dramatic rebound was thereafter reported. In this multicenter retrospective observational study in 15 Pediatric Emergency Departments, all children <3 years old with RSV infection admitted between 1 September and 31 December 2021 were included and compared to those admitted in the same period of 2020 and 2019. The primary aim was to evaluate RSV epidemiology during and after the COVID-19 pandemic peak. The secondary aims were to evaluate the clinical features of children with RSV infection. Overall, 1015 children were enrolled: 100 in 2019, 3 in 2020 and 912 in 2021. In 2019, the peak was recorded in December, and in 2021, it was recorded in November. Comparing 2019 to 2021, in 2021 the median age was significantly higher and the age group 2-3 years was more affected. Admissions were significantly higher in 2021 than in 2020 and 2019, and the per-year hospitalization rate was lower in 2021 (84% vs. 93% in 2019), while the duration of admissions was similar. No difference was found in severity between 2019-2020-2021. In conclusion, after the COVID-19 pandemic, an increase in RSV cases in 2021 exceeding the median seasonal peak was detected, with the involvement of older children, while no difference was found in severity.
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Affiliation(s)
- Giulia Pruccoli
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Elisa Barisone
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-0113135396
| | - Luca Baroero
- Department of Pediatrics, Martini Hospital, 10141 Turin, Italy
| | - Fabio Timeus
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso (TO), Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | | | - Cristina Lovera
- Department of Pediatrics, A.O. S.Croce e Carle, 12100 Cuneo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics, Ospedale Degli Infermi di Ponderano, University of Turin, 13900 Biella, Italy
| | | | - Luca Roasio
- Department of Pediatrics, Edoardo Agnelli Hospital, 10064 Pinerolo (TO), Italy
| | - Simona De Franco
- Department of Pediatrics, Ospedale di Borgomanero, 28021 Borgomanero (NO), Italy
| | - Carmelina Calitri
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Maddalena Lupica
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Cinzia Marciano
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Savino Santovito
- Department of Pediatrics, Ospedale Maria Vittoria, ASL Città di Torino, 10143 Turin, Italy
| | - Gaia Militerno
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Enrica Abrigo
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paola Quarello
- Department of Pediatric Onco-Hematology, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
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15
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Venturini E, Giometto S, Tamborino A, Becciolini L, Bosis S, Corsello G, Del Barba P, Garazzino S, Lo Vecchio A, Pugi A, Signa S, Stera G, Trapani S, Castelli Gattinara G, Lucenteforte E, Galli L. Sensitivity of three commercial tests for SARS-CoV-2 serology in children: an Italian multicentre prospective study. Ital J Pediatr 2022; 48:192. [PMID: 36461032 PMCID: PMC9716520 DOI: 10.1186/s13052-022-01381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND US Food and Drug Administration has issued Emergency Use Authorizations for hundreds of serological assays to support Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) diagnosis. The aim of this study is to evaluate, for the first time in children, the performance of three widely utilized SARS-CoV-2 serology commercial assays, Diesse Diagnostics (IgG, IgA, IgM) and Roche Diagnostics, both Roche Nucleocapsid (N) IgG and Roche Spike (S) IgG assays. METHODS Sensitivity and 95% confidence intervals (CIs) were estimated for each of the three different serological tests and mixed and direct comparison were performed. Univariate and multivariate Poisson regression models were fitted to calculate incidence rate ratios and 95% CIs as estimate of the effects of age, gender, time on the serology title. A p-value < 0.05 indicated statistical significance. RESULTS Overall, 149 children were enrolled in the study. A low sensitivity was found for Diesse IgA, IgM and IgG. Compare to Diesse, Roche S had a higher sensitivity at 15-28 days from infection (0.94, 95%CI: 0.73-1.0) and Roche N at 28-84 days (0.78, 95%CI: 0.58-0.91). When a direct comparison of IgG tests sensitivity was feasible for patients with pairwise information, Roche S and Roche N showed a statistically significant higher sensitivity compared to Diesse in all the study periods, whereas there was no difference between the two Roche tests. CONCLUSION Roche S and Roche N serology tests seem to better perform in children. Large prospective studies are needed to better define the characteristics of those tests.
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Affiliation(s)
- Elisabetta Venturini
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Sabrina Giometto
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agnese Tamborino
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy
| | - Laura Becciolini
- grid.413181.e0000 0004 1757 8562Clinical Chemistry and Microbiology Laboratory, Meyer Children’s Hospital, Florence, Italy
| | - Samantha Bosis
- grid.414818.00000 0004 1757 8749Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517Unit of Pediatrics and Neonatal Intensive Therapy, Department of Promotion of Maternal and Infantile and Internal Medicine Health, and Specialist Excellence “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Paolo Del Barba
- grid.18887.3e0000000417581884Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Garazzino
- grid.7605.40000 0001 2336 6580Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- grid.4691.a0000 0001 0790 385XSection of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Pugi
- grid.413181.e0000 0004 1757 8562Clinical Trial Office, Meyer Children’s Hospital, Florence, Italy
| | - Sara Signa
- grid.419504.d0000 0004 1760 0109Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Stera
- grid.6292.f0000 0004 1757 1758Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy
| | - Sandra Trapani
- grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
| | - Guido Castelli Gattinara
- grid.414603.4Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ersilia Lucenteforte
- grid.5395.a0000 0004 1757 3729Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisa Galli
- grid.413181.e0000 0004 1757 8562Infectious Disease Unit, Meyer Children’s Hospital, Florence, Italy ,grid.8404.80000 0004 1757 2304Department of Health Sciences, University of Florence, Florence, Italy
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16
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Dona’ D, Montagnani C, Di Chiara C, Venturini E, Galli L, Lo Vecchio A, Denina M, Olivini N, Bruzzese E, Campana A, Giacchero R, Salvini F, Meini A, Ponzoni M, Trapani S, Rossi E, Lombardi MH, Badolato R, Pierri L, Pruccoli G, Rossin S, Colomba C, Cazzato S, Pacati I, Nicolini G, Pierantoni L, Bianchini S, Krzysztofiak A, Garazzino S, Giaquinto C, Castelli Gattinara G. COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease? Viruses 2022; 14:v14102256. [PMID: 36298812 PMCID: PMC9612333 DOI: 10.3390/v14102256] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
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Affiliation(s)
- Daniele Dona’
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3388946412
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Costanza Di Chiara
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Nicole Olivini
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Andrea Campana
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | | | - Filippo Salvini
- Department of Pediatrics, Niguarda Hospital, 20162 Milan, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
| | - Sandra Trapani
- Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | | | - Mary Haywood Lombardi
- Ospedale Pediatrico Bambino Gesù, UOC Pediatria Multispecialistica, Fiumicino, 00050 Rome, Italy
| | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, 25121 Brescia, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, 90133 Palermo, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy
| | - Ilaria Pacati
- Paediatric Unit, Ospedale Bolognini ASST Bergamo Est, 24068 Seriate, Italy
| | | | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, 40138 Bologna, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Diseases Unit, Academic Department, Bambino Gesù Pediatric Hospital, 00146 Rome, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy
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Castagno E, Raffaldi I, Del Monte F, Garazzino S, Bondone C. New epidemiological trends of respiratory syncytial virus bronchiolitis during COVID-19 pandemic. World J Pediatr 2022; 19:502-504. [PMID: 36163542 PMCID: PMC9512956 DOI: 10.1007/s12519-022-00623-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy.
| | - Irene Raffaldi
- Present Address: Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Francesco Del Monte
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children’s Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Claudia Bondone
- Present Address: Department of Pediatric Emergency, Regina Margherita Children’s Hospital - A.O.U. Città Della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
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18
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Denina M, Trada M, Tinti D, Funiciello E, Novara C, Moretto M, Rosati S, Garazzino S, Bondone C, De Sanctis L. Increase in newly diagnosed type 1 diabetes and serological evidence of recent SARS-CoV-2 infection: Is there a connection? Front Med (Lausanne) 2022; 9:927099. [PMID: 35966867 PMCID: PMC9371320 DOI: 10.3389/fmed.2022.927099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Several studies have investigated the correlation between the COVID-19 pandemic and the onset of type 1 diabetes (T1D) in children, reporting an increased incidence of T1D and severe diabetic ketoacidosis (DKA). This study aimed to investigate the infection by SARS-CoV-2 in children with newly-diagnosed T1D to explore a possible link between SARS-CoV-2 infection, T1D and DKA. Thirty-nine children with a T1D new onset between October 15, 2020, and April 15, 2021, were enrolled. SARS-CoV-2 infection was investigated through a polymerase chain reaction on the nasal swab, dosage of specific antibodies, and an anamnestic question form. Nine (23%) of them had antibodies directed toward SARS-CoV-2, and five (12%) had a history of recent SARS-CoV-2 infection in themselves or in their family. No molecular swabs were positive. Compared to the general pediatric population, the overall incidence of COVID-19 was 5.6 times higher in the T1D patients' group (p < 0.00001). Referring only to the cases in the metropolitan area, we find a net increase in the incidence of T1D compared to the 5 years preceding our study, by 50% compared to the same months in 2016/2017 and 2017/2018, by 69% compared to 2018/2019 and by 77% compared to 2019/2020. The same trend was observed regarding DKA cases. The attributable risk of the pandemic cohort compared to the previous year is 44%. The abnormal disproportion of SARS-CoV-2 infection between children with T1D and the pediatric reference population, with a ratio of 5.6, appears to support the causative role of SARS-CoV-2 in triggering the immune response underlying diabetes, as often described for other viral infections. The difficulty accessing care services during the pandemic, with a consequent diagnosis delay, does not justify the increase in observed T1D cases, which could to be directly linked to the pandemic. The acceleration of the immune process provoked by SARS-CoV-2 may play a suggestive role in the development of T1D with DKA. Multicenter studies are needed to deepen and fully understand the pathophysiological link between SARS-CoV-2 and the onset of T1D in children.
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Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
- Infectious Diseases Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- *Correspondence: Marco Denina
| | - Michela Trada
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Davide Tinti
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elisa Funiciello
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Chiara Novara
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Martina Moretto
- Department of Pediatrics and Public Health, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Sergio Rosati
- Department of Veterinary Science, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa De Sanctis
- Department of Pediatrics, Center of Pediatric Diabetology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Singh B, Lant S, Cividini S, Cattrall JWS, Goodwin LC, Benjamin L, Michael BD, Khawaja A, Matos ADMB, Alkeridy W, Pilotto A, Lahiri D, Rawlinson R, Mhlanga S, Lopez EC, Sargent BF, Somasundaran A, Tamborska A, Webb G, Younas K, Al Sami Y, Babu H, Banks T, Cavallieri F, Cohen M, Davies E, Dhar S, Fajardo Modol A, Farooq H, Harte J, Hey S, Joseph A, Karthikappallil D, Kassahun D, Lipunga G, Mason R, Minton T, Mond G, Poxon J, Rabas S, Soothill G, Zedde M, Yenkoyan K, Brew B, Contini E, Cysique L, Zhang X, Maggi P, van Pesch V, Lechien J, Saussez S, Heyse A, Brito Ferreira ML, Soares CN, Elicer I, Eugenín-von Bernhardi L, Ñancupil Reyes W, Yin R, Azab MA, Abd-Allah F, Elkady A, Escalard S, Corvol JC, Delorme C, Tattevin P, Bigaut K, Lorenz N, Hornuss D, Hosp J, Rieg S, Wagner D, Knier B, Lingor P, Winkler AS, Sharifi-Razavi A, Moein ST, SeyedAlinaghi S, JamaliMoghadamSiahkali S, Morassi M, Padovani A, Giunta M, Libri I, Beretta S, Ravaglia S, Foschi M, Calabresi P, Primiano G, Servidei S, Biagio Mercuri N, Liguori C, Pierantozzi M, Sarmati L, Boso F, Garazzino S, Mariotto S, Patrick KN, Costache O, Pincherle A, Klok FA, Meza R, Cabreira V, Valdoleiros SR, Oliveira V, Kaimovsky I, Guekht A, Koh J, Fernández Díaz E, Barrios-López JM, Guijarro-Castro C, Beltrán-Corbellini Á, Martínez-Poles J, Diezma-Martín AM, Morales-Casado MI, García García S, Breville G, Coen M, Uginet M, Bernard-Valnet R, Du Pasquier R, Kaya Y, Abdelnour LH, Rice C, Morrison H, Defres S, Huda S, Enright N, Hassell J, D’Anna L, Benger M, Sztriha L, Raith E, Chinthapalli K, Nortley R, Paterson R, Chandratheva A, Werring DJ, Dervisevic S, Harkness K, Pinto A, Jillella D, Beach S, Gunasekaran K, Rocha Ferreira Da Silva I, Nalleballe K, Santoro J, Scullen T, Kahn L, Kim CY, Thakur KT, Jain R, Umapathi T, Nicholson TR, Sejvar JJ, Hodel EM, Tudur Smith C, Solomon T. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One 2022; 17:e0263595. [PMID: 35653330 PMCID: PMC9162376 DOI: 10.1371/journal.pone.0263595] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Affiliation(s)
- Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan W. S. Cattrall
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lynsey C. Goodwin
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Benjamin
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Benedict D. Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ayaz Khawaja
- Department of Neurology, Wayne State University, Detroit, Michigan, United States of America
| | | | - Walid Alkeridy
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Durjoy Lahiri
- Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Rebecca Rawlinson
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sithembinkosi Mhlanga
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Evelyn C. Lopez
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Brendan F. Sargent
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anushri Somasundaran
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Glynn Webb
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Komal Younas
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yaqub Al Sami
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Heavenna Babu
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tristan Banks
- Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matthew Cohen
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Emma Davies
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Shalley Dhar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anna Fajardo Modol
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hamzah Farooq
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jeffrey Harte
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Samuel Hey
- Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Albert Joseph
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dileep Karthikappallil
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Kassahun
- Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland
| | - Gareth Lipunga
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rachel Mason
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Minton
- Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Gabrielle Mond
- North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Poxon
- Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sophie Rabas
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Germander Soothill
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Yenkoyan
- Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia
| | - Bruce Brew
- St Vincent’s Hospital, Sydney, Australia
| | | | | | - Xin Zhang
- St Vincent’s Hospital, Sydney, Australia
| | - Pietro Maggi
- Saint-Luc University Hospital, Brussels, Belgium
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- The 940th Hospital of Joint Logistic Support Force of the People’s Liberation Army, Lanzhou, China
| | | | | | | | | | | | | | | | - Kévin Bigaut
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Norbert Lorenz
- Children’s Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany
| | - Daniel Hornuss
- Medical Center University of Freiburg, Freiburg, Germany
| | - Jonas Hosp
- Medical Center University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Medical Center University of Freiburg, Freiburg, Germany
| | - Benjamin Knier
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany
| | | | | | - Shima T. Moein
- Institute for Research in Fundamental Sciences (IPM), Tehran, Islamic Republic of Iran
| | | | | | - Mauro Morassi
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | | | | | - Simone Beretta
- San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | | | - Matteo Foschi
- Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | | | - Federica Boso
- Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy
| | - Silvia Garazzino
- Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
| | | | | | | | | | | | - Roger Meza
- Hospital Regional Docente de Trujillo, Trujillo, Peru
| | | | | | | | - Igor Kaimovsky
- Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Jasmine Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | - Matteo Coen
- Hopitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Yildiz Kaya
- Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey
| | - Loay H. Abdelnour
- Ulster Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Rice
- University of Bristol and North Bristol NHS Trust, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Hamish Morrison
- Gloucestershire Royal Hospital, Gloucester, United Kingdom of Great Britain and Northern Ireland
| | - Sylviane Defres
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Noelle Enright
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Jane Hassell
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Lucio D’Anna
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Benger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laszlo Sztriha
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Eamon Raith
- The National Hospital for Neurology & Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Krishna Chinthapalli
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Nortley
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Paterson
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Arvind Chandratheva
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - David J. Werring
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Samir Dervisevic
- Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Kirsty Harkness
- Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Ashwin Pinto
- Wessex Neurological Centre, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Dinesh Jillella
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Scott Beach
- Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kulothungan Gunasekaran
- Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | | | - Krishna Nalleballe
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jonathan Santoro
- Children’s Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California, United States of America
| | - Tyler Scullen
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Lora Kahn
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Carla Y. Kim
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kiran T. Thakur
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Rajan Jain
- New York University Grossman School of Medicine, New York, New York, United States of America
| | | | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Maria Hodel
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- * E-mail:
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Agagliati F, Silvestro E, Denina M, Garazzino S, Mignone F, Zoppo M, Pruccoli G, Scolfaro C. Imported malaria in children: A 13 years retrospective study. Travel Med Infect Dis 2022; 46:102273. [DOI: 10.1016/j.tmaid.2022.102273] [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: 10/28/2020] [Revised: 01/15/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
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Chiappini E, Lisi C, Giacomet V, Erba P, Bernardi S, Zangari P, Di Biagio A, Taramasso L, Giaquinto C, Rampon O, Gabiano C, Garazzino S, Tagliabue C, Esposito S, Bruzzese E, Badolato R, Zanaboni D, Cellini M, Dedoni M, Mazza A, Pession A, Giannini AM, Salvini F, Dodi I, Carloni I, Cazzato S, Tovo PA, de Martino M, Galli L. Off-label use of combined antiretroviral therapy, analysis of data collected by the Italian Register for HIV-1 infection in paediatrics in a large cohort of children. BMC Infect Dis 2022; 22:55. [PMID: 35033018 PMCID: PMC8760752 DOI: 10.1186/s12879-022-07026-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early start of highly active antiretroviral therapy (HAART) in perinatally HIV-1 infected children is the optimal strategy to prevent immunological and clinical deterioration. To date, according to EMA, only 35% of antiretroviral drugs are licenced in children < 2 years of age and 60% in those aged 2-12 years, due to the lack of adequate paediatric clinical studies on pharmacokinetics, pharmacodynamics and drug safety in children. METHODS An observational retrospective study investigating the rate and the outcomes of off-label prescription of HAART was conducted on 225 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. RESULTS 22.2% (50/225) of included children were receiving an off-label HAART regimen at last check. Only 26% (13/50) of off-label children had an undetectable viral load (VL) before the commencing of the regimen and the 52.0% (26/50) had a CD4 + T lymphocyte percentage > 25%. At last check, during the off label regimen, the 80% (40/50) of patients had an undetectable VL, and 90% (45/50) of them displayed CD4 + T lymphocyte percentage > 25%. The most widely used off-label drugs were: dolutegravir/abacavir/lamivudine (16%; 8/50), emtricitbine/tenofovir disoproxil (22%; 11/50), lopinavir/ritonavir (20%; 10/50) and elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide (10%; 10/50). At logistic regression analysis, detectable VL before starting the current HAART regimen was a risk factor for receiving an off-label therapy (OR: 2.41; 95% CI 1.13-5.19; p = 0.024). Moreover, children < 2 years of age were at increased risk for receiving off-label HAART with respect to older children (OR: 3.24; 95% CI 1063-7.3; p = 0.001). Even if our safety data regarding off-label regimens where poor, no adverse event was reported. CONCLUSION The prescription of an off-label HAART regimen in perinatally HIV-1 infected children was common, in particular in children with detectable VL despite previous HAART and in younger children, especially those receiving their first regimen. Our data suggest similar proportions of virological and immunological successes at last check among children receiving off-label or on-label HAART. Larger studies are needed to better clarify efficacy and safety of off-label HAART regimens in children, in order to allow the enlargement of on-label prescription in children.
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Affiliation(s)
- Elena Chiappini
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
| | - Catiuscia Lisi
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Vania Giacomet
- Paediatric Infectious Diseases Unit, Department of Paediatrics, ASST FBF SACCO, University of Milan, Milan, Italy
| | - Paola Erba
- Paediatric Infectious Diseases Unit, Department of Paediatrics, ASST FBF SACCO, University of Milan, Milan, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Zangari
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Di Biagio
- Infectious Disease Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Lucia Taramasso
- Infectious Disease Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Osvalda Rampon
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Clara Gabiano
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Claudia Tagliabue
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Domenico Zanaboni
- Department On Internal Medicine and Therapeutics, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Monica Cellini
- Department of Medical and Surgical Sciences, Section of Paediatric Hemato-Oncology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Dedoni
- Department of Paediatrics, Ospedale Microcitemico, Cagliari, Italy
| | - Antonio Mazza
- Paediatric Unit, "S. Chiara" Hospital, Trento, Italy
| | - Andrea Pession
- Andrea Pession, Paediatric Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Anna Maria Giannini
- Paediatric Infectious Diseases Unit, University Hospital Policlinico Giovanni XXIII, Bari, Italy
| | - Filippo Salvini
- Department of Paediatrics, University of Milan, Niguarda Hospital, Milan, Italy
| | - Icilio Dodi
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Pier Angelo Tovo
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Maurizio de Martino
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Luisa Galli
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
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Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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Venturini E, Montagnani C, Garazzino S, Donà D, Pierantoni L, Vecchio AL, Krzysztofiak A, Nicolini G, Bianchini S, Galli L, Villani A, Gattinara GC. Treatment of children with COVID-19: update of the Italian Society of Pediatric Infectious Diseases position paper. Ital J Pediatr 2021; 47:199. [PMID: 34620212 PMCID: PMC8495664 DOI: 10.1186/s13052-021-01132-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Department for Woman and Child Health, Division of Pediatric Infectious Diseases, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrzej Krzysztofiak
- Universitarian-Hospital Department, Bambino Gesù Children Hospital - IRCCS, Rome, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Bambino Gesù Children Hospital - IRCCS, Rome, Italy
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Denina M, Giannone V, Curtoni A, Zanotto E, Garazzino S, Urbino AF, Bondone C. Can we trust in Sars-CoV-2 rapid antigen testing? Preliminary results from a paediatric cohort in the emergency department. Ir J Med Sci 2021; 191:1767-1770. [PMID: 34519927 PMCID: PMC8438652 DOI: 10.1007/s11845-021-02776-z] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
Background Rapid identification of Covid-19 in the paediatric emergency department is critical; Antigen tests are fast but poorly investigated in children. Aims To investigate Sars-CoV-2 antigen rapid test in children. Methods We compare the performance of LumiraDx with molecular tests in a paediatric emergency department. Results A retrospective cohort of 191 patients with AT and PCR tests performed in the same episode was analysed; 16% resulted positive for Sars-CoV-2. Using the PCR test as the gold standard, we calculated antigen testing overall sensitivity of 94.1%, specificity of 91.9%, and NPV of 99.4%. Only one false-negative test was found. Conclusions AT may be helpful in the initial screening of patients at PED.
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Affiliation(s)
- Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy. .,Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy.
| | - Virginia Giannone
- Department of Pediatrics and Public Health, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Curtoni
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Molinette Hospital, University of Turin, Città della salute e della Scienza, Turin, Italy
| | - Elisa Zanotto
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Molinette Hospital, University of Turin, Città della salute e della Scienza, Turin, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
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25
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Krzysztofiak A, Chiappini E, Venturini E, Gargiullo L, Roversi M, Montagnani C, Bozzola E, Chiurchiu S, Vecchio D, Castagnola E, Tomà P, Rossolini GM, Toniolo RM, Esposito S, Cirillo M, Cardinale F, Novelli A, Beltrami G, Tagliabue C, Boero S, Deriu D, Bianchini S, Grandin A, Bosis S, Ciarcià M, Ciofi D, Tersigni C, Bortone B, Trippella G, Nicolini G, Lo Vecchio A, Giannattasio A, Musso P, Serrano E, Marchisio P, Donà D, Garazzino S, Pierantoni L, Mazzone T, Bernaschi P, Ferrari A, Gattinara GC, Galli L, Villani A. Italian consensus on the therapeutic management of uncomplicated acute hematogenous osteomyelitis in children. Ital J Pediatr 2021; 47:179. [PMID: 34454557 PMCID: PMC8403408 DOI: 10.1186/s13052-021-01130-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acute hematogenous osteomyelitis (AHOM) is an insidious infection of the bone that more frequently affects young males. The etiology, mainly bacterial, is often related to the patient's age, but it is frequently missed, owing to the low sensitivity of microbiological cultures. Thus, the evaluation of inflammatory biomarkers and imaging usually guide the diagnosis and follow-up of the infection. The antibiotic treatment of uncomplicated AHOM, on the other hand, heavily relies upon the clinician experience, given the current lack of national guidelines for the management of this infection. METHODS A systematic review of the studies on the empirical treatment of uncomplicated AHOM in children published in English or Italian between January 1, 2009, and March 31, 2020, indexed on Pubmed or Embase search engines, was carried out. All guidelines and studies reporting on non-bacterial or complicated or post-traumatic osteomyelitis affecting newborns or children older than 18 years or with comorbidities were excluded from the review. All other works were included in this study. RESULTS Out of 4576 articles, 53 were included in the study. Data on different topics was gathered and outlined: bone penetration of antibiotics; choice of intravenous antibiotic therapy according to the isolated or suspected pathogen; choice of oral antibiotic therapy; length of treatment and switch to oral therapy; surgical treatment. CONCLUSIONS The therapeutic management of osteomyelitis is still object of controversy. This study reports the first Italian consensus on the management of uncomplicated AHOM in children of pediatric osteomyelitis, based on expert opinions and a vast literature review.
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Affiliation(s)
- Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Chiappini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisabetta Venturini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Livia Gargiullo
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Roversi
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlotta Montagnani
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Bozzola
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Chiurchiu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Vecchio
- Rare Disease and Medical Genetics, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elio Castagnola
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Renato Maria Toniolo
- Surgery Department, Traumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Andrea Novelli
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Giovanni Beltrami
- Department of Orthopaedic Oncology and Reconstructive Surgery, AOU Careggi, Florence, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Silvio Boero
- Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy
| | - Daniele Deriu
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Annalisa Grandin
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Martina Ciarcià
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Daniele Ciofi
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Trippella
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | | | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Paola Musso
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Serrano
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Paola Bernaschi
- Microbiology Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | | | | | - Luisa Galli
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Tovo PA, Garazzino S, Daprà V, Pruccoli G, Calvi C, Mignone F, Alliaudi C, Denina M, Scolfaro C, Zoppo M, Licciardi F, Ramenghi U, Galliano I, Bergallo M. COVID-19 in Children: Expressions of Type I/II/III Interferons, TRIM28, SETDB1, and Endogenous Retroviruses in Mild and Severe Cases. Int J Mol Sci 2021; 22:7481. [PMID: 34299101 PMCID: PMC8303145 DOI: 10.3390/ijms22147481] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023] Open
Abstract
Children with the new coronavirus disease 2019 (COVID-19) have milder symptoms and a better prognosis than adult patients. Several investigations assessed type I, II, and III interferon (IFN) signatures in SARS-CoV-2 infected adults, however no data are available for pediatric patients. TRIM28 and SETDB1 regulate the transcription of multiple genes involved in the immune response as well as of human endogenous retroviruses (HERVs). Exogenous viral infections can trigger the activation of HERVs, which in turn can induce inflammatory and immune reactions. Despite the potential cross-talks between SARS-CoV-2 infection and TRIM28, SETDB1, and HERVs, information on their expressions in COVID-19 patients is lacking. We assessed, through a PCR real time Taqman amplification assay, the transcription levels of six IFN-I stimulated genes, IFN-II and three of its sensitive genes, three IFN-lIIs, as well as of TRIM28, SETDB1, pol genes of HERV-H, -K, and -W families, and of env genes of Syncytin (SYN)1, SYN2, and multiple sclerosis-associated retrovirus (MRSV) in peripheral blood from COVID-19 children and in control uninfected subjects. Higher expression levels of IFN-I and IFN-II inducible genes were observed in 36 COVID-19 children with mild or moderate disease as compared to uninfected controls, whereas their concentrations decreased in 17 children with severe disease and in 11 with multisystem inflammatory syndrome (MIS-C). Similar findings were found for the expression of TRIM-28, SETDB1, and every HERV gene. Positive correlations emerged between the transcriptional levels of type I and II IFNs, TRIM28, SETDB1, and HERVs in COVID-19 patients. IFN-III expressions were comparable in each group of subjects. This preserved induction of IFN-λs could contribute to the better control of the infection in children as compared to adults, in whom IFN-III deficiency has been reported. The upregulation of IFN-I, IFN-II, TRIM28, SETDB1, and HERVs in children with mild symptoms, their declines in severe cases or with MIS-C, and the positive correlations of their transcription in SARS-CoV-2-infected children suggest that they may play important roles in conditioning the evolution of the infection.
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Affiliation(s)
- Pier-Angelo Tovo
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy; (S.G.); (F.M.); (C.S.); (M.Z.)
| | - Valentina Daprà
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, 10126 Turin, Italy;
| | - Giulia Pruccoli
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
| | - Cristina Calvi
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, 10126 Turin, Italy;
| | - Federica Mignone
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy; (S.G.); (F.M.); (C.S.); (M.Z.)
| | - Carla Alliaudi
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, 10126 Turin, Italy;
| | - Marco Denina
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
| | - Carlo Scolfaro
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy; (S.G.); (F.M.); (C.S.); (M.Z.)
| | - Marisa Zoppo
- Infectious Diseases Unit, Department of Pediatrics, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy; (S.G.); (F.M.); (C.S.); (M.Z.)
| | - Francesco Licciardi
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
| | - Ugo Ramenghi
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
| | - Ilaria Galliano
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, 10126 Turin, Italy;
| | - Massimiliano Bergallo
- Department of Pediatric Sciences and Public Health, University of Turin, Piazza Polonia 94, 10126 Turin, Italy; (G.P.); (C.C.); (C.A.); (M.D.); (F.L.); (U.R.); (I.G.)
- Pediatric Laboratory, Department of Pediatric Sciences and Public Health, University of Turin, 10126 Turin, Italy;
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Silvestro E, Marino R, Cusenza F, Pruccoli G, Denina M, De Intinis G, Licciardi F, Garazzino S, Scolfaro C. Antimicrobial stewardship experience in paediatrics: first-year activity report. Eur J Clin Microbiol Infect Dis 2021; 40:1727-1735. [PMID: 33745086 DOI: 10.1007/s10096-021-04222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
Antimicrobial resistance is one of the most relevant threats in public health worldwide. Strategies as antimicrobial stewardship programs, aiming to preserve our antibiotic armamentarium, have been implemented since 2007 in adult and paediatric patients. We aim to describe the first experience of a paediatric antimicrobial stewardship program. We conducted a retrospective observational study in a tertiary care children's hospital. A team composed of a microbiologist, an infectious diseases physician, and a paediatrician led the project. All positive blood and cerebrospinal fluid cultures and other biological samples yielding multi-drug-resistant bacteria were collected and reviewed through a prospective-audit-with-feedback strategy. We recorded patient characteristics and worth monitoring prescribed antibiotics. The antimicrobial stewardship audit could end in intervention (step-up/step-down and broadening/narrowing) or recommendation(s). We then checked out wards staff compliance. The team performed 192 interventions out of 584 reviews, mostly suggesting discontinuation of antibiotics (in 76.0% of cases and 39.7% of running molecules). The antibiotic spectrum was more likely tapered than expanded (p < 0.0001), and we ordered more narrow-spectrum antibiotic molecules than local medical staff straightaway did (p = 0.0113). Interventions were most likely needed in case of documented infections (p < 0.0001) and in surgical patients (p = 0.0002). In 85.9% of interventions, ward teams fully agreed with our argument. This study demonstrated an antimicrobial stewardship program to be a suitable method for improving the appropriateness of antimicrobial use in hospitalized children.
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Affiliation(s)
- Erika Silvestro
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy.
| | - Raffaella Marino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Francesca Cusenza
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Giulia Pruccoli
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Marco Denina
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Gianfranco De Intinis
- Microbiology and Virology Unit, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Licciardi
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Carlo Scolfaro
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
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Denina M, Aguzzi S, Versace A, Rossi R, Pruccoli G, Mignone F, Bondone C, Garazzino S. Testing strategy for SARS-CoV-2 in the paediatric emergency department. Arch Dis Child 2021; 106:e11. [PMID: 32586931 DOI: 10.1136/archdischild-2020-319806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Sonia Aguzzi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Federica Mignone
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
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29
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Del Borrello G, Giraudo I, Bondone C, Denina M, Garazzino S, Linari C, Mignone F, Pruccoli G, Scolfaro C, Spadea M, Pollio B, Saracco P. SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: A single-center observational study. J Thromb Haemost 2021; 19:522-530. [PMID: 33305475 PMCID: PMC9906296 DOI: 10.1111/jth.15216] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple investigators have described an increased incidence of thromboembolic events in SARS-CoV-2-infected individuals. Data concerning hemostatic complications in children hospitalized for COVID-19/multisystem inflammatory syndrome in children (MIS-C) are scant. OBJECTIVES To share our experience in managing SARS-CoV-2-associated pro-coagulant state in hospitalized children. METHODS D-dimer values were recorded at diagnosis in children hospitalized for SARS-CoV-2-related manifestations. In moderately to critically ill patients and MIS-C cases, coagulation and inflammatory markers were checked at multiple time points and median results were compared. Pro-thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases. RESULTS Thirty-five patients were prospectively enrolled. D-dimer values did not discriminate COVID-19 of differing severity, whereas were markedly different between the COVID-19 and the MIS-C cohorts. In both cohorts, D-dimer and C-reactive protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. Six patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths or thrombotic or bleeding complications occurred. CONCLUSIONS COVID-19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS-C cases showed laboratory signs of an inflammatory driven pro-coagulant status. Universal anticoagulant prophylaxis in hospitalized children with SARS-CoV-2-related manifestations is not warranted, but may be offered to patients with other pro-thrombotic risk factors in the context of a multi-modal therapeutic approach.
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Affiliation(s)
| | - Isaac Giraudo
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Claudia Bondone
- Paediatric Emergency Department, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Marco Denina
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Claudia Linari
- Laboratory Medicine, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Federica Mignone
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Giulia Pruccoli
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Carlo Scolfaro
- Paediatric Infectious Disease Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Manuela Spadea
- Sciences of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Berardino Pollio
- Immune-Haematology and Transfusion Medicine, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Saracco
- Paediatric Haematology Unit, Department of Paediatrics, University Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
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30
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Chiappini E, Larotonda F, Lisi C, Giacomet V, Erba P, Bernardi S, Zangari P, Di Biagio A, Taramasso L, Giaquinto C, Rampon O, Gabiano C, Garazzino S, Tagliabue C, Esposito S, Bruzzese E, Badolato R, Zanaboni D, Cellini M, Dedoni M, Mazza A, Pession A, Giannini AM, Salvini F, Dodi I, Carloni I, Cazzato S, Tovo PA, de Martino M, Galli L. Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018. Front Pediatr 2021; 9:665764. [PMID: 34336735 PMCID: PMC8322739 DOI: 10.3389/fped.2021.665764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001-2006 to 0.27/100 person-years in 2007-2012 and 0.07/100 person-years in 2013-2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013-2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.
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Affiliation(s)
- Elena Chiappini
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Francesca Larotonda
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Catiuscia Lisi
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Vania Giacomet
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Paola Erba
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefania Bernardi
- Unit of Immune and Infectious Diseases, Stefania Bernardi Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Paola Zangari
- Research Unit of Clinical Immunology and Vaccinology, Paola Zangari Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padua, Italy
| | - Osvalda Rampon
- Department of Women and Child Health, University of Padova, Padua, Italy
| | - Clara Gabiano
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Claudia Tagliabue
- Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico Foundation, University of Milan, Milan, Italy
| | - Susanna Esposito
- Paediatric Department, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Eugenia Bruzzese
- Paediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Domenico Zanaboni
- Department on Internal Medicine and Therapeutics, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Monica Cellini
- Paediatric Hemato-Oncology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Dedoni
- Department of Paediatrics, Ospedale Microcitemico, Cagliari, Italy
| | - Antonio Mazza
- Department of Paediatrics, "S. Chiara" Hospital, Trento, Italy
| | - Andrea Pession
- Paediatric Unit, IRCCS Scientific Institute for Research and Healthcare, Sant'Orsola Hospital, Bologna, Italy
| | - Anna Maria Giannini
- Paediatric Infectious Diseases Unit, University Hospital Policlinico Giovanni XXIII, Bari, Italy
| | - Filippo Salvini
- Department of Paediatrics, Niguarda Hospital, University of Milan, Milan, Italy
| | - Icilio Dodi
- Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Pier Angelo Tovo
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Maurizio de Martino
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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31
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Serranti D, Nebbia G, Cananzi M, Nicastro E, Di Dato F, Nuti F, Garazzino S, Silvestro E, Giacomet V, Forlanini F, Pinon M, Calvo PL, Riva S, Dodi I, Cangelosi AM, Antonucci R, Ricci S, Bartolini E, Mastrangelo G, Trapani S, Lenge M, Gaio P, Vajro P, Iorio R, D'Antiga L, Indolfi G. Efficacy of Sofosbuvir/Ledipasvir in Adolescents With Chronic Hepatitis C Genotypes 1, 3, and 4: A Real-world Study. J Pediatr Gastroenterol Nutr 2021; 72:95-100. [PMID: 32810039 DOI: 10.1097/mpg.0000000000002900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Sofosbuvir/Ledipasvir (SOF/LDV) has been approved by the European Medicine Agency (EMA) for the treatment of children and adolescents (at least 3 years of age) with chronic hepatitis C (CHC) genotype 1, 3, and 4 infection. The aim of this study was to evaluate the efficacy and safety of SOF/LDV in adolescents (12 to <18 years old) with CHC in the real-world setting. METHODS Prospective, open-label, multicentre study involving 12 Italian centres. Patients received the fixed-dose combination of SOF/LDV (400/90 mg) once daily ± ribavirin as per EMA approval and recommendations. The key efficacy endpoint was sustained virological response 12 weeks after the end of treatment (SVR12) as per intention-to-treat analysis. Safety was assessed by adverse events and clinical/laboratory data. RESULTS Seventy-eight consecutive adolescents (median age 15.2 years, range 12-17.9; girls 53.8%) were enrolled and treated between June 2018 and December 2019. Genotype distribution was as follows: genotype 1 (82.1%), 3 (2.5%), and 4 (15.4%). Seventy-six (97.4%) patients completed treatment and follow-up. Overall, SVR12 was 98.7%. One patient was lost to follow-up after 4 weeks of treatment; 1 patient completed treatment and missed the follow-up visit. No virological breakthrough or relapse were observed. No patient experienced grade 3 to 4 adverse event or serious adverse event. CONCLUSIONS The results of this real-world study confirmed the high efficacy and the optimal safety profile of SOF/LDV for treatment of CHC in adolescents.
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Affiliation(s)
- Daniele Serranti
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze
| | - Gabriella Nebbia
- Pediatric Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Mara Cananzi
- Unit of Gastroenterology, Digestive Endoscopy, Hepatology and Care of Children with Liver Transplantation, University Hospital of Padova, Padova
| | - Emanuele Nicastro
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo
| | - Fabiola Di Dato
- Pediatric Liver Unit, University of Naples Federico II, Napoli
| | - Federica Nuti
- Pediatric Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Silvia Garazzino
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza della Città di Torino, Infectious Diseases Unit, University of Turin, Torino
| | - Erika Silvestro
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza della Città di Torino, Infectious Diseases Unit, University of Turin, Torino
| | - Vania Giacomet
- Unit of Paediatric Infectious Disease ASST FBF SACCO, University of Milan, Milan
| | - Federica Forlanini
- Unit of Paediatric Infectious Disease ASST FBF SACCO, University of Milan, Milan
| | - Michele Pinon
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza della Città di Torino, Pediatric Gastroenterology Unit, Torino
| | - Pier Luigi Calvo
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza della Città di Torino, Pediatric Gastroenterology Unit, Torino
| | - Silvia Riva
- Unità di Epatologia Pediatrica e Trapianto di Fegato ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo
| | - Icilio Dodi
- U.O.C. Pediatria Generale e d'Urgenza, Ospedale dei Bambini "Pietro Barilla", Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Antonina Marta Cangelosi
- U.O.C. Pediatria Generale e d'Urgenza, Ospedale dei Bambini "Pietro Barilla", Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari
| | - Silvia Ricci
- Immunology Division, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children's University Hospital of Florence
| | - Elisa Bartolini
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze
| | - Greta Mastrangelo
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze
| | - Sandra Trapani
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze
| | - Matteo Lenge
- Clinical Trial Office, Meyer Children's University Hospital of Florence, Firenze
| | - Paola Gaio
- Unit of Gastroenterology, Digestive Endoscopy, Hepatology and Care of Children with Liver Transplantation, University Hospital of Padova, Padova
| | - Pietro Vajro
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università di Salerno, Salerno
| | - Raffaele Iorio
- Pediatric Liver Unit, University of Naples Federico II, Napoli
| | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy
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Garazzino S, Lo Vecchio A, Pierantoni L, Calò Carducci FI, Marchetti F, Meini A, Castagnola E, Vergine G, Donà D, Bosis S, Dodi I, Venturini E, Felici E, Giacchero R, Denina M, Pierri L, Nicolini G, Montagnani C, Krzysztofiak A, Bianchini S, Marabotto C, Tovo PA, Pruccoli G, Lanari M, Villani A, Castelli Gattinara G. Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results From an Italian Multicenter Study. Front Pediatr 2021; 9:649358. [PMID: 33796491 PMCID: PMC8007917 DOI: 10.3389/fped.2021.649358] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. Methods: The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020. Results: As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission (p < 0.01) and linearly to length of stay (p = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications (p < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission (p < 0.05). Conclusions: Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.
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Affiliation(s)
- Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Icilio Dodi
- Emergency and General Pediatric Unit, Pietro Barilla Children's Hospital, Parma, Italy
| | | | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | | | - Marco Denina
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Luca Pierri
- Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | | | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Caterina Marabotto
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | - Pier-Angelo Tovo
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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33
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Venturini E, Montagnani C, Garazzino S, Donà D, Pierantoni L, Lo Vecchio A, Nicolini G, Bianchini S, Krzysztofiak A, Galli L, Villani A, Castelli-Gattinara G. Treatment of children with COVID-19: position paper of the Italian Society of Pediatric Infectious Disease. Ital J Pediatr 2020; 46:139. [PMID: 32972435 PMCID: PMC7512208 DOI: 10.1186/s13052-020-00900-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
A statement of consensus was formulated after reviewing available literature on pediatric treatment strategies for COVID-19 by the Steering and Scientific Committee of the Italian Society of Infectious Pediatric Diseases in connection with the Italian Society of Paediatrics.
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Affiliation(s)
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Garazzino
- Pediatric Infectious Disease Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Sonia Bianchini
- Department of Pediatrics, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | | | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department Ospedale Bambino Gesù IRCCS, Rome, Italy
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34
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Tovo PA, Garazzino S, Saglio F, Scolfaro C, Bustamante J, Badolato R, Fagioli F. Successful Hematopoietic Stem Cell Transplantation in a Patient with Complete IFN-γ Receptor 2 Deficiency: a Case Report and Literature Review. J Clin Immunol 2020; 40:1191-1195. [PMID: 32909233 PMCID: PMC7567729 DOI: 10.1007/s10875-020-00855-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Pier-Angelo Tovo
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Saglio
- Pediatric Oncohematology Division, Stem Cell Transplantation and Cell Therapy Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Carlo Scolfaro
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, INSERM U1163, and Center for the Study of Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, University of Paris, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockfeller University, New York, NY, USA
| | | | - Franca Fagioli
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.,Pediatric Oncohematology Division, Stem Cell Transplantation and Cell Therapy Unit, Regina Margherita Children's Hospital, Turin, Italy
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35
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Lo Vecchio A, Krzysztofiak A, Montagnani C, Valentini P, Rossi N, Garazzino S, Raffaldi I, Di Gangi M, Esposito S, Vecchi B, Melzi ML, Lanari M, Zavarise G, Bosis S, Valenzise M, Cazzato S, Sacco M, Govoni MR, Mozzo E, Cambriglia MD, Bruzzese E, Di Camillo C, Pata D, Graziosi A, Sala D, Magurano F, Villani A, Guarino A, Galli L. Complications and risk factors for severe outcome in children with measles. Arch Dis Child 2020; 105:896-899. [PMID: 30636224 DOI: 10.1136/archdischild-2018-315290] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE AND DESIGN Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. RESULTS Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). CONCLUSION The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carlotta Montagnani
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Piero Valentini
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Rossi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Irene Raffaldi
- Department of Pediatrics and Neonatology, Ospedale Civile di Ciriè, Turin, Italy
| | - Maria Di Gangi
- Pediatric Infectious Disease Unit, Children Hospital 'ISMEP Di Cristina', Palermo, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Universita degli Studi di Perugia, Perugia, Italy
| | - Barbara Vecchi
- Pediatric Unit and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Maria Luisa Melzi
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences - Pediatric Emergency Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgio Zavarise
- Pediatric Unit, Hospital of Negrar 'Sacro Cuore Don Calabria', Verona, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariella Valenzise
- Pediatric Unit, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Michele Sacco
- Pediatric Unit, Research Institute Hospital 'Casa Sollievo della Sofferenza' San Giovanni Rotondo, Foggia, Italy
| | | | - Elena Mozzo
- Pediatric Unit, Hospital of Dolo, Verona, Italy
| | - Maria Donata Cambriglia
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Chiara Di Camillo
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy.,Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy
| | - Davide Pata
- Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Debora Sala
- Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
| | - Fabio Magurano
- National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy.,National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
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36
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Denina M, Pellegrino F, Morotti F, Coppo P, Bonsignori IM, Garazzino S, Ravanini P, Avolio M, Cavallo R, Bertolotti L, Felici E, Acucella G, Montin D, Rabbone I, Licciardi F. All that glisters is not COVID: Low prevalence of seroconversion against SARS-CoV-2 in a pediatric cohort of patients with chilblain-like lesions. J Am Acad Dermatol 2020; 83:1751-1753. [PMID: 32781180 PMCID: PMC7414307 DOI: 10.1016/j.jaad.2020.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Francesco Pellegrino
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Francesco Morotti
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Paola Coppo
- Unit of Chirurgia Plastica Pediatrica-Dermatologia, Città della salute e della Scienza, Regina Margherita, Children's Hospital, Turin (TO), Italy
| | - Ilaria Maria Bonsignori
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Silvia Garazzino
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Paolo Ravanini
- Laboratorio di Microbiologia e virologia-AOU Maggiore della Carità di Novara, Novara (NO), Italy
| | - Maria Avolio
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Città della salute e della Scienza, Molinette Hospital, University of Turin, Turin (TO), Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, Microbiology and Virology Unit, Città della salute e della Scienza, Molinette Hospital, University of Turin, Turin (TO), Italy
| | - Luigi Bertolotti
- Department of Veterinary Science, University of Turin, Turin (TO), Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children's Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria (AL), Italy
| | | | - Davide Montin
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara (NO), Italy
| | - Francesco Licciardi
- Department of Pediatrics and Public Health, University of Turin, Turin (TO), Italy.
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37
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Denina M, Scolfaro C, Silvestro E, Pruccoli G, Mignone F, Zoppo M, Ramenghi U, Garazzino S. Lung Ultrasound in Children With COVID-19. Pediatrics 2020; 146:peds.2020-1157. [PMID: 32317309 DOI: 10.1542/peds.2020-1157] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Carlo Scolfaro
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Erika Silvestro
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Federica Mignone
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Marisa Zoppo
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Ugo Ramenghi
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
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38
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Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, Bernardi S, Giacchero R, Lo Vecchio A, Marchisio P, Nicolini G, Pierantoni L, Rabbone I, Banderali G, Denina M, Venturini E, Krzysztofiak A, Badolato R, Bianchini S, Galli L, Villani A, Castelli-Gattinara G. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32400362 PMCID: PMC7219028 DOI: 10.2807/1560-7917.es.2020.25.18.2000600] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day–17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.
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Affiliation(s)
- Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Carlotta Montagnani
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Antonella Meini
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Enrico Felici
- Paediatric and Pediatric Emergency Unit, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Stefania Bernardi
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
| | | | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Luca Pierantoni
- Paediatric Emergency Unit, Policlinico di Sant'Orsola, Bologna, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Giuseppe Banderali
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | | | - Raffaele Badolato
- Pediatrics Clinic, University of Brescia and ASST-Spedali Civili of Brescia,, Brescia, Italy
| | - Sonia Bianchini
- Department of Paediatrics, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Luisa Galli
- Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy
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- The members of the Italian SITIP-SIP SARS-CoV-2 paediatric infection study group are listed at the end of this article
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Garazzino S, Altieri E, Silvestro E, Pruccoli G, Scolfaro C, Bignamini E. Ceftolozane/Tazobactam for Treating Children With Exacerbations of Cystic Fibrosis Due to Pseudomonas aeruginosa: A Review of Available Data. Front Pediatr 2020; 8:173. [PMID: 32432060 PMCID: PMC7214539 DOI: 10.3389/fped.2020.00173] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022] Open
Abstract
Ceftolozane-tazobactam is a novel fifth-generation cephalosporin/β-lactamase inhibitor combination recently approved for treatment of both complicated intra-abdominal and urinary tract infections in adults. Considering its potent bactericidal activity against Pseudomonas aeruginosa, it might represent an important option also for treating children with exacerbations of cystic fibrosis due to Pseudomonas aeruginosa when other alternative treatments have been exhausted. We hereby review available data on the use of ceftolozane-tazobactam in children, focusing on cystic fibrosis.
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Affiliation(s)
- Silvia Garazzino
- Department of Child Pathology and Treatment "Regina Margherita", Unit of Infectious Diseases, University of Turin, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elena Altieri
- Department of Child Pathology and Treatment "Regina Margherita", Unit of Infectious Diseases, University of Turin, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Silvestro
- Department of Child Pathology and Treatment "Regina Margherita", Unit of Infectious Diseases, University of Turin, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giulia Pruccoli
- Postgraduate School of Pediatrics, University of Turin, Turin, Italy
| | - Carlo Scolfaro
- Department of Child Pathology and Treatment "Regina Margherita", Unit of Infectious Diseases, University of Turin, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elisabetta Bignamini
- Division of Pulmonology, Pediatric Cystic Fibrosis Centre, Città della Salute e della Scienza di Torino, Turin, Italy
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Pruccoli G, Silvestro E, Pace Napoleone C, Aidala E, Garazzino S, Scolfaro C. Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. Infez Med 2019; 27:175-178. [PMID: 31205041] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although few cases of bacteremia or sepsis caused by probiotics have been reported, it is important to consider their pathogenic potential, especially in some categories of patients. We report a case of Bifidobacterium spp bacteremia in a child with heart disease, undergoing probiotic supplementation to prevent antibiotic-associated diarrhea.
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Affiliation(s)
- Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Torino, Italy; Department of Pediatric and Public Health Sciences, University of Torino, Torino, Italy
| | - Erika Silvestro
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Carlo Pace Napoleone
- Department of Pediatric Cardiac Surgery, Regina Margherita Children's Hospital, Torino, Italy
| | - Enrico Aidala
- Department of Pediatric Cardiac Surgery, Regina Margherita Children's Hospital, Torino, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Carlo Scolfaro
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, Torino, Italy
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Chiappini E, Zaffaroni M, Bianconi M, Veneruso G, Grasso N, Garazzino S, Arancio R, Valentini P, Ficcadenti A, Da Riol MR, La Placa S, Galli L, de Martino M, Bona G. Italian multicentre study found infectious and vaccine-preventable diseases in children adopted from Africa and recommends prompt medical screening. Acta Paediatr 2018; 107:1581-1586. [PMID: 29364534 DOI: 10.1111/apa.14237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/07/2017] [Accepted: 01/19/2018] [Indexed: 11/26/2022]
Abstract
AIM This study evaluated the prevalence of infectious diseases and immunisation status of children adopted from Africa. METHODS We studied 762 African children referred to 11 Italian paediatric centres in 2009-2015. Clinical and laboratory data were retrospectively collected and analysed. RESULTS The median age of the children (60.3% males) was 3 years and 6 months, 52.6% came from Ethiopia and 50.1% had at least one infectious disease. Parasitic infections accounted for the majority of the infectious diseases (409 of 715), and the most common were Giardia lamblia (n = 239), Toxocara canis (n = 65) and skin infections (n = 205), notably Tinea capitis/corporis (n = 134) and Molluscum contagiosum (n = 56) Active tuberculosis (TB) was diagnosed in nine children (1.2%). Latent TB infections were diagnosed in 52 (6.8%) children, and only 23 had concordant positive tuberculin skin tests and Quantiferon Gold In-Tube results. Discordant results were associated with Bacille de Calmette-Guérin vaccinations (odd ratio 6.30 and 95% confidence interval of 1.01-39.20, p = 0.011). Nonprotective antitetanus or antihepatitis B antibody titres were documented in 266 (34.9%) and 396 (51.9%) of the 762 children. CONCLUSION The prevalence of infectious conditions and not-protective titres for vaccine-preventable diseases observed in our population underlines the need for prompt and complete medical screening of children adopted from Africa.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Mauro Zaffaroni
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Martina Bianconi
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Giuseppina Veneruso
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Nicolino Grasso
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Piero Valentini
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gemelli Hospital, Catholic University A, Rome, Italy
| | - Anna Ficcadenti
- Pediatric Division, Department of Clinical Sciences, Polytechnic University of Marche, Ospedali Riuniti, Presidio Salesi, Ancona, Italy
| | | | - Simona La Placa
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Meyer University Hospital, University of Florence, Florence, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
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Raffaldi I, Garazzino S, Ballardini G, Zaffaroni M, Grasso N, Bona G, Tovo PA, Guala A. Vitamin D status in internationally adopted children: the experience in Northwest Italy. Minerva Pediatr 2017:S0026-4946.17.04883-6. [PMID: 28922908 DOI: 10.23736/s0026-4946.17.04883-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The majority of internationally adopted children, before adoption, might have experienced malnutrition, exposure to infectious diseases, environmental deprivation and neglect; they could also develop medical problems such as vitamin D deficiency. Scantly data are available about vitamin D status in internationally adopted children and, to our knowledge, no report exists on Italian adoptees. METHODS We carried out a prospective multicenter study, involving three Pediatric Centers in Piedmont, Italy, in order to collect information about 25-hydroxyvitamin D [25(OH)D] profile in adoptees, shortly after their arrival in Italy. RESULTS In 142/158 internationally adopted children 25(OH)D was measured: 75 males and 67 females, with a mean age of 4.22 ± 2.2 years (range 0.7-14.6 years). Fifty-three (37.3%) of them came from Asia, 48 (33.8%) from Africa, 24 (16.9%) from Eastern Europe, and 17 (12%) from Latin America. The median level of 25(OH)D in serum was 21.5 ng/mL (IQR range 14.3-29.7 ng/mL): 26 (18.2%) of the examined children had an insufficiency of 25-OHD, whereas 36 (25.2%) had a deficiency. Adoptees with longer time of institution stay had a significant risk to develop 25(OH)D deficiency. The Asian origin proved to be a risk factor to develop 25(OH)D deficiency, whereas the age >1 year was significantly associated with 25(OH)D insufficiency. CONCLUSIONS Our survey showed that vitamin D deficiency and insufficiency, in internationally adoptees, are frequent and relevant health problems.
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Affiliation(s)
- Irene Raffaldi
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy -
| | - Silvia Garazzino
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | | | - Mauro Zaffaroni
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Nicolino Grasso
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Gianni Bona
- Pediatric Clinic, University of Eastern Piedmont, Novara, Italy
| | - Pier-Angelo Tovo
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Andrea Guala
- Unit of Pediatrics, Castelli Hospital, Verbania, Italy
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43
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Calitri C, Scolfaro C, Colombo S, De Intinis G, Carraro F, Garazzino S, Tovo PA. Extended-Spectrum Beta Lactamase-producing Enterobacteriaceae among the pediatric population: who is at risk and why? Results from a single-centre prospective study. Infez Med 2016; 24:318-325. [PMID: 28011968] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A prospective 18-month case-control study was performed in a tertiary Paediatric Centre in Turin (Italy) to analyse the disease burden and identify risk factors for acquisition of Extended Spectrum Beta Lactamase-producing Enterobacteriaceae (ESBL-pE). Children with ESBL-pE isolation were enrolled as cases, with controls matched according to age, type of pathogen isolated and sample of isolation. Out of 83 children (37 males, mean age 4.7 ± 5.46 years), 45 were identified as infected (54.2%) and 38 as colonised (45.8%) by ESBL-pE. Twenty-nine (64.4%) infectious disease episodes were categorised as community-acquired, 16 (35.6%) as healthcare-associated. Escherichia coli was the most frequently isolated pathogen (52, 62.7%) and the urinary tract the most frequent site involved (26, 57.9%). No deaths occurred, even in bloodstream infection cases. Hospitalisation and exposure to broad-spectrum penicillins and III/IV generation cephalosporins in the 90-day period before bacteria isolation were found to be independent risk factors at multivariate analysis. Immunodepression, prolonged central venous catheter (CVC) and urine catheter stay, and receiving a total parenteral nutrition (TPN) in the previous 30 days were otherwise recognized as potential risk factors at univariated analysis. ESBL-producing Enterobacteriaceae infections are a growing threat even in children. Careful recognition of patients at risk should promote targeted interventions in order to reduce the ESBL burden.
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Affiliation(s)
- Carmelina Calitri
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Carlo Scolfaro
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Sara Colombo
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Gianfranco De Intinis
- Microbiology Laboratory, Regina Margherita Children's Hospital and Sant'Anna Hospital, A.O.U. Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Francesca Carraro
- Oncohematological Department, Regina Margherita Children's Hospital, A.O.U. Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy
| | - Pier-Angelo Tovo
- Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy
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Chiappini E, Lo Vecchio A, Garazzino S, Marseglia GL, Bernardi F, Castagnola E, Tomà P, Cirillo D, Russo C, Gabiano C, Ciofi D, Losurdo G, Bocchino M, Tortoli E, Tadolini M, Villani A, Guarino A, Esposito S. Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 2016; 35:1-18. [PMID: 26476550 DOI: 10.1007/s10096-015-2507-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 10/07/2015] [Indexed: 01/10/2023]
Abstract
Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.
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Lo Vecchio A, Lancella L, Tagliabue C, De Giacomo C, Garazzino S, Mainetti M, Cursi L, Borali E, De Vita MV, Boccuzzi E, Castellazzi L, Esposito S, Guarino A. Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country. Eur J Clin Microbiol Infect Dis 2016; 36:177-185. [PMID: 27696233 DOI: 10.1007/s10096-016-2793-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/16/2016] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.
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Affiliation(s)
- A Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - L Lancella
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - C Tagliabue
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - C De Giacomo
- Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - S Garazzino
- Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - M Mainetti
- Hospital of Ravenna, Via Vincenzo Randi 5, Ravenna, Italy
| | - L Cursi
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - E Borali
- Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - M V De Vita
- Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - E Boccuzzi
- Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy
| | - L Castellazzi
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - S Esposito
- Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy
| | - A Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Denina M, Scolfaro C, Colombo S, Calitri C, Garazzino S, Barbui AM, Brossa S, Tovo PA. Erratum to: Magicplex TM Sepsis Real-Time test to improve bloodstream infection diagnostics in children. Eur J Pediatr 2016; 175:1253. [PMID: 27457371 DOI: 10.1007/s00431-016-2753-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy.
| | - Carlo Scolfaro
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Sara Colombo
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Carmelina Calitri
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Anna Maria Barbui
- Department of Virology and Microbiology, A.O. Città della Salute e della Scienza (Molinette), University of Turin, Turin, Italy
| | - Silvia Brossa
- Department of Virology and Microbiology, A.O. Città della Salute e della Scienza (Molinette), University of Turin, Turin, Italy
| | | | - Pier-Angelo Tovo
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
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Denina M, Scolfaro C, Colombo S, Calitri C, Garazzino S, Barbui Anna A, Brossa S, Tovo PA. Magicplex(TM) Sepsis Real-Time test to improve bloodstream infection diagnostics in children. Eur J Pediatr 2016; 175:1107-11. [PMID: 27357410 DOI: 10.1007/s00431-016-2745-3] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 05/20/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Sepsis is the major cause of morbidity and mortality in children, especially in immunocompromised patients, and a rapid identification of causative pathogen is strongly related with a better outcome. This prospective study analyzes the role of a multiplex real-time polymerase chain reaction in sepsis' etiological diagnosis. Magicplex(TM) Sepsis Real-Time tests were performed in tertiary Regina Margherita Children's Hospital (Turin, Italy), and the medical records of children who underwent a Magicplex test were prospectively evaluated. Results of the Magicplex test were compared with those of blood culture collected at a close time point. One hundred fifty Magicplex tests were collected from 89 patients (54 males and 35 females, age interquartile range: 2.6-12.1 years). Etiological definition was achieved in 60 bloodstream infection cases (40 %). In 32 episodes, Magicplex test alone gave a positive result, and blood culture alone permitted the etiological diagnosis in 5 septic episodes. Magicplex test allowed a 143 % increase in the diagnostic value of blood cultures. CONCLUSION These results suggest that molecular biology can be useful for rapid pathogen's identification also in children. WHAT IS KNOWN • Sepsis represents a major cause of morbidity and mortality in children. • Sepsis outcome is strongly related to rapid microbiological identification and prompt initiation of an appropriate chemotherapy. What is New: • This manuscript is the first that describes the use of Magicplex (TM) Sepsis Real-Time test in children. • The results suggest that molecular biology can be useful for rapid pathogen's identification also in children.
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Affiliation(s)
- Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy.
| | - Carlo Scolfaro
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Sara Colombo
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Carmelina Calitri
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
| | - Anna Barbui Anna
- Department of Virology and Microbiology, A.O. Città della Salute e della Scienza (Molinette), University of Turin, Turin, Italy
| | - Silvia Brossa
- Department of Virology and Microbiology, A.O. Città della Salute e della Scienza (Molinette), University of Turin, Turin, Italy
| | | | - Pier-Angelo Tovo
- Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children' s Hospital, University of Turin, Piazza Polonia 94, Turin, 10126, Italy
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Esposito S, Mayer A, Krzysztofiak A, Garazzino S, Lipreri R, Galli L, Osimani P, Fossali E, Di Gangi M, Lancella L, Denina M, Pattarino G, Montagnani C, Salvini F, Villani A, Principi N, Italian Pediatric Infective Endocarditis Registry. Infective Endocarditis in Children in Italy from 2000 to 2015. Expert Rev Anti Infect Ther 2016; 14:353-8. [PMID: 26708337 DOI: 10.1586/14787210.2016.1136787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/19/2022]
Abstract
OBJECTIVE The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy. METHODS A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015. RESULTS Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications. CONCLUSION In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Alessandra Mayer
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Andrzej Krzysztofiak
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Silvia Garazzino
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | - Rita Lipreri
- d Pediatric Unit , Niguarda Hospital , Milan , Italy
| | - Luisa Galli
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Patrizia Osimani
- f Pediatric Infectious Diseases Unit , Salesi Hospital , Ancona , Italy
| | - Emilio Fossali
- g Emergency Room Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maria Di Gangi
- h Pediatric Infectious Diseases Unit , Di Cristina Hospital , Palermo , Italy
| | - Laura Lancella
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Marco Denina
- c Pediatric Infectious Diseases Unit, Regina Margherita Children's Hospital , University of Turin , Turin , Italy
| | | | - Carlotta Montagnani
- e Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Filippo Salvini
- i Pediatric Clinic, San Paolo Hospital , University of Milan , Milan , Italy
| | - Alberto Villani
- b Unit of General Pediatrics and Pediatric Infectious Diseases , IRCCS Bambino Gesù Hospital , Rome , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Tovo PA, Calitri C, Scolfaro C, Gabiano C, Garazzino S. Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression. World J Gastroenterol 2016; 22:1382-1392. [PMID: 26819507 PMCID: PMC4721973 DOI: 10.3748/wjg.v22.i4.1382] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/18/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023] Open
Abstract
The worldwide prevalence of hepatitis C virus (HCV) infection in children is 0.05%-0.4% in developed countries and 2%-5% in resource-limited settings, where inadequately tested blood products or un-sterile medical injections still remain important routes of infection. After the screening of blood donors, mother-to-child transmission (MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%. Maternal HIV co-infection is a significant risk factor for MTCT and anti-HIV therapy during pregnancy seemingly can reduce the transmission rate of both viruses. Conversely, a high maternal viral load is an important, but not preventable risk factor, because at present no anti-HCV treatment can be administered to pregnant women to block viral replication. Caution is needed in adopting obstetric procedures, such as amniocentesis or internal fetal monitoring, that can favor fetal exposure to HCV contaminated maternal blood, though evidence is lacking on the real risk of single obstetric practices. Mode of delivery and type of feeding do not represent significant risk factors for MTCT. Therefore, there is no reason to offer elective caesarean section or discourage breast-feeding to HCV infected parturients. Information on the natural history of vertical HCV infection is limited. The primary infection is asymptomatic in infants. At least one quarter of infected children shows a spontaneous viral clearance (SVC) that usually occurs within 6 years of life. IL-28B polymorphims and genotype 3 infection have been associated with greater chances of SVC. In general, HCV progression is mild or moderate in children with chronic infection who grow regularly, though cases with marked liver fibrosis or hepatic failure have been described. Non-organ specific autoantibodies and cryoglobulins are frequently found in children with chronic infection, but autoimmune diseases or HCV associated extrahepatic manifestations are rare.
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Galli L, Lancella L, Garazzino S, Tadolini M, Matteelli A, Migliori GB, Principi N, Villani A, Esposito S. Recommendations for treating children with drug-resistant tuberculosis. Pharmacol Res 2016; 105:176-82. [PMID: 26821118 DOI: 10.1016/j.phrs.2016.01.020] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
Tuberculosis (TB) is still one of the most difficult infectious diseases to treat, and the second most frequent cause of death due to infectious disease throughout the world. The number of cases of multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB), which are characterised by high mortality rates, is increasing. The therapeutic management of children with MDR- and XDR-TB is complicated by a lack of knowledge, and the fact that many potentially useful drugs are not registered for pediatric use and there are no formulations suitable for children in the first years of life. Furthermore, most of the available drugs are burdened by major adverse events that need to be taken into account, particularly in the case of prolonged therapy. This document describes the recommendations of a group of scientific societies on the therapeutic approach to pediatric MDR- and XDR-TB. On the basis of a systematic literature review and their personal clinical experience, the experts recommend that children with active TB caused by a drug-resistant strain of Mycobacterium tuberculosis should always be referred to a specialised centre because of the complexity of patient management, the paucity of pediatric data, and the high incidence of adverse events due to second-line anti-TB treatment.
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Affiliation(s)
- Luisa Galli
- Department of Health Sciences, University of Florence, Pediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy
| | - Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy
| | - Marina Tadolini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alberto Matteelli
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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