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European Journal of Pediatrics Oct 2023Benign acute childhood myositis (BACM) is a self-limited childhood illness, and viral infections mainly cause it. Clinical and laboratory alterations usually normalize...
Benign acute childhood myositis (BACM) is a self-limited childhood illness, and viral infections mainly cause it. Clinical and laboratory alterations usually normalize rapidly; generally, the only medical intervention required is supportive (hydration and analgesic medication). The low awareness about BACM often led to delayed diagnosis and unneeded ancillary investigations. This study aims to better characterize the clinical and laboratory features of BACM to improve the diagnostic process and inpatient and outpatient management. We conducted a retrospective study selecting all children admitted to Meyer's Children's Hospital-IRCCS (Florence, Italy) with a diagnosis of BACM over the last 5 years, both those visited at Emergency Department (ED) and those admitted to the Pediatric Unit. Clinical, laboratory, and instrumental data were collected from electronic clinical records and analyzed. Overall, sixty-five patients were enrolled; 49 children were visited and discharged directly from ED, whereas 16 were admitted in the Pediatric or Neurologic Wards. The median age was 6.56 years (IQR 4.9-9.1). Male gender (66.1%) and Caucasian ethnicity (70%) were prevalent. Most patients were admitted during winter, and a second peak was found in autumn. All patients had bilateral calf pain, most of them (87.7%) associated with asthenia and refuse to walk (93.8%). Prodromal symptoms were fever (75.3%), cough (32.3%), coryza (26.1%), sore throat (26.1%), and vomiting (15.3%). The median value of CPK was 1827 U/L (IQR 915.5-2462) at peak. CPK median time to normalization was 7 days (IQR 7-8.5) from the nadir. Influenza B was the virus most frequently BACM associated, followed by Influenza A; a novel association with Sars-CoV-2 has been detected. Two patients had pathogenic variants at the Next Generation Sequencing myopathies panel. Conclusion: School-aged children admitted to the hospital with walking difficulty and myalgia, generally after an upper respiratory tract infection with a moderate CPK elevation, should remind at first of BACM. Rapid complaint resolution and biochemical markers normalization will prevent unnecessary tests and inappropriate therapies. What is Known: • BACM is a self-limited syndrome associated with acute infections. Influenza A and B viruses are the main etiological agents, but BACM may be related to many other microorganisms like Parainfluenza virus, Epstein-Barr virus, Cytomegalovirus, Human herpesvirus 6, Respiratory syncytial virus, Coxsackieviruses, Mycoplasma pneumoniae, Streptococcus pyogenes, Legionella, and Salmonella spp. • Clinical and laboratory alterations usually normalize rapidly; generally, the only medical intervention required is supportive (hydration, analgesic medication). Evolution in rhabdomyolysis and kidney damage is possible but rarely reported. What is New: • Sars-CoV-2 could be an emerging possible cause of BACM. During and after the Sars-CoV-2 outbreak, virus infection seasonality has changed, and so has BACM seasonality. • Screening tests for muscular and metabolic disorders are recommended in recurrent myositis and/or cases with marked CPK elevation (≥ 5000 U/L).
Topics: Humans; Child; Male; Influenza, Human; Retrospective Studies; Epstein-Barr Virus Infections; Hospitals, Pediatric; Tertiary Healthcare; Herpesvirus 4, Human; Acute Disease; Myositis; Analgesics
PubMed: 37462800
DOI: 10.1007/s00431-023-05115-9 -
Cancer Immunology, Immunotherapy : CII Nov 2023Immune checkpoint inhibitors (ICI) substantially improve outcome for patients with cancer. However, the majority of patients develops immune-related adverse events...
BACKGROUND
Immune checkpoint inhibitors (ICI) substantially improve outcome for patients with cancer. However, the majority of patients develops immune-related adverse events (irAEs), which can be persistent and significantly reduce quality of life. Neurological irAEs occur in 1-5% of patients and can induce severe, permanent sequelae or even be fatal. In order to improve the diagnosis and treatment of neurological irAEs and to better understand their pathogenesis, we assessed whether previous neurotropic infections are associated with neurological irAEs.
METHODS
Neurotropic infections that might predispose to ICI-induced neurological irAEs were analyzed in 61 melanoma patients from 3 countries, the Netherlands, Australia and Germany, including 24 patients with neurotoxicity and 37 control patients. In total, 14 viral, 6 bacterial, and 1 protozoal infections previously reported to trigger neurological pathologies were assessed using routine serology testing. The Dutch and Australian cohorts (NL) included pre-treatment plasma samples of patients treated with neoadjuvant ICI therapy (OpACIN-neo and PRADO trials; NCT02977052). In the Dutch/Australian cohort a total of 11 patients with neurological irAEs were compared to 27 control patients (patients without neurological irAEs). The German cohort (LMU) consisted of serum samples of 13 patients with neurological irAE and 10 control patients without any documented irAE under ICI therapy.
RESULTS
The association of neurological irAEs with 21 possible preceding infections was assessed by measuring specific antibodies against investigated agents. The seroprevalence of all the tested viral (cytomegalovirus, Epstein-Barr-Virus, varicella-zoster virus, measles, rubella, influenza A and B, human herpes virus 6 and 7, herpes simplex virus 1 and 2, parvovirus B19, hepatitis A and E and human T-lymphotropic virus type 1 and 2), bacterial (Borrelia burgdorferi sensu lato, Campylobacter jejuni, Mycoplasma pneumoniae, Coxiella burnetti, Helicobacter pylori, Yersinia enterocolitica and Y. pseudotuberculosis) and protozoal (Toxoplasma gondii) infections was similar for patients who developed neurological irAEs as compared to control patients. Thus, the analysis provided no evidence for an association of described agents tested for seroprevalence with ICI induced neurotoxicity.
CONCLUSION
Previous viral, bacterial and protozoal neurotropic infections appear not to be associated with the development of neurological irAEs in melanoma patients who underwent therapy with ICI across 3 countries. Further efforts are needed to unravel the factors underlying neurological irAEs in order to identify risk factors for these toxicities, especially with the increasing use of ICI in earlier stage disease.
Topics: Humans; Immune Checkpoint Inhibitors; Seroepidemiologic Studies; Quality of Life; Antineoplastic Agents, Immunological; Australia; Melanoma; Retrospective Studies
PubMed: 37606856
DOI: 10.1007/s00262-023-03498-0 -
China CDC Weekly Feb 2024Acute respiratory infections (ARIs) are a significant contributor to illness and death in children. There has been a notable rise in the occurrence of ARIs and the...
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?
Acute respiratory infections (ARIs) are a significant contributor to illness and death in children. There has been a notable rise in the occurrence of ARIs and the associated pathogens in China, which has garnered worldwide attention.
WHAT IS ADDED BY THIS REPORT?
This study conducted a retrospective analysis of the clinical characteristics of children with ARIs in Wuhan City from September to November 2023. The study evaluated the epidemiological patterns of common respiratory viruses and (MP), revealing a continued prevalence of MP and a growing trend of influenza. Our findings emphasize that the circulation of respiratory viruses and MP has not returned to pre-pandemic levels, underscoring the importance of enhancing surveillance for respiratory pathogens.
WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?
The epidemiology of ARIs and the pathogens involved need to be emphasized. This highlights the importance of developing policies to protect children from respiratory pathogens such as MP, influenza, and respiratory syncytial virus.
PubMed: 38476821
DOI: 10.46234/ccdcw2024.027 -
MMWR. Morbidity and Mortality Weekly... Feb 2024
Topics: Child; Humans; Adolescent; United States; Pneumonia, Mycoplasma; Pandemics; COVID-19; Antibodies, Bacterial
PubMed: 38386615
DOI: 10.15585/mmwr.mm7307a3 -
Ear, Nose, & Throat Journal Apr 2024Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The...
Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The etiology of KFD is unknown, and diagnosis is based mainly on lymph node biopsy. KFD has been reported to be associated with infection. However, the role of antibiotic treatment is unclear. We reported 2 cases of KFD associated with infection and were successfully treated with a macrolide.
Topics: Humans; Female; Histiocytic Necrotizing Lymphadenitis; Pneumonia, Mycoplasma; Lymphadenopathy; Fever; Biopsy
PubMed: 34605286
DOI: 10.1177/01455613211044225 -
Frontiers in Cellular and Infection... 2023Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Timely and accurate pathogen detection is crucial for proper...
BACKGROUND
Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Timely and accurate pathogen detection is crucial for proper clinical diagnosis and therapeutic strategies. The low detection efficiency of conventional methods and low specificity using respiratory samples seriously hindered the accurate detection of pathogens.
METHODS
In this study, we retrospectively enrolled 1,032 children to evaluate the performance of metagenomics next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) sample and protected bronchial brushing (BB) sample in diagnosing pneumonia in children. In addition, conventional tests (CTs) were also performed.
RESULTS
The specificity of BB mNGS [67.3% (95% CI 58.6%-75.9%)] was significantly higher than that of BALF mNGS [38.5% (95% CI 12.0%-64.9%)]. The total coincidence rate of BB mNGS [77.6% (95% CI 74.8%-80.5%)] was slightly higher than that of BALF mNGS [76.5% (95% CI 68.8%-84.1%)] and CTs [38.5% (95% CI 35.2%-41.9%)]. During the epidemics of , the detection rate of in the >6-year group (81.8%) was higher than that in the 3-6-year (78.9%) and <3-year groups (21.5%). The highest detection rates of bacteria, fungi, and viruses were found in the <3-year, >6-year, and 3-6-year groups, respectively. mNGS detection should be performed at the duration of 5-7 days after the start of continuous anti-microbial therapy or at the duration of 6-9 days from onset to mNGS test.
CONCLUSIONS
This is the first report to evaluate the performance of BB mNGS in diagnosing pulmonary infections in children on a large scale. Based on our findings, extensive application of BB mNGS could be expected.
Topics: Humans; Child; Metagenomics; Retrospective Studies; Pneumonia; Respiratory Tract Infections; High-Throughput Nucleotide Sequencing; Mycoplasma pneumoniae
PubMed: 37637461
DOI: 10.3389/fcimb.2023.1165432 -
Nature Biotechnology Aug 2023Engineered live bacteria could provide a new modality for treating lung infections, a major cause of mortality worldwide. In the present study, we engineered a...
Engineered live bacteria could provide a new modality for treating lung infections, a major cause of mortality worldwide. In the present study, we engineered a genome-reduced human lung bacterium, Mycoplasma pneumoniae, to treat ventilator-associated pneumonia, a disease with high hospital mortality when associated with Pseudomonas aeruginosa biofilms. After validating the biosafety of an attenuated M. pneumoniae chassis in mice, we introduced four transgenes into the chromosome by transposition to implement bactericidal and biofilm degradation activities. We show that this engineered strain has high efficacy against an acute P. aeruginosa lung infection in a mouse model. In addition, we demonstrated that the engineered strain could dissolve biofilms formed in endotracheal tubes of patients with ventilator-associated pneumonia and be combined with antibiotics targeting the peptidoglycan layer to increase efficacy against Gram-positive and Gram-negative bacteria. We expect our M. pneumoniae-engineered strain to be able to treat biofilm-associated infections in the respiratory tract.
Topics: Humans; Mice; Animals; Anti-Bacterial Agents; Pseudomonas Infections; Pneumonia, Ventilator-Associated; Gram-Negative Bacteria; Gram-Positive Bacteria; Intubation, Intratracheal; Biofilms; Lung
PubMed: 36658340
DOI: 10.1038/s41587-022-01584-9 -
Infection and Drug Resistance 2024To explore the clinical characteristics, treatment, and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children.
PURPOSE
To explore the clinical characteristics, treatment, and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children.
PATIENTS AND METHODS
The medical records of 16 children who were diagnosed with MPP associated with PE between January 2016 and January 2023 at Children's Hospital, Zhejiang University School of Medicine were retrospectively reviewed.
RESULTS
The average age patients were 8.24 ± 1.99 years. All cases were diagnosed with refractory mycoplasma pneumoniae pneumonia (RMPP) and presented complications in the form of necrotizing pneumonia (NP). The main symptoms observed were cough and fever (n = 16, 100%), chest pain (n = 8, 50%), dyspnea (n = 8, 50%), and hemoptysis (n = 4, 25%). In these cases, 12 patients had involvement of the pulmonary artery, 3 patients experienced issues with the pulmonary vein, and 1 patient had simultaneous involvement of both the pulmonary artery and pulmonary vein. Among the 12 pulmonary artery embolism cases, 6 involved the right pulmonary artery, 4 involved the left pulmonary artery, and 2 involved both the right and left pulmonary arteries. The mean D-dimer level was 8.50 ± 4.76 mg/L. All patients received anticoagulant therapy, and after treatment, there was a significant improvement in their symptoms and lung lesions.
CONCLUSION
Children with RMPP, chest pain, hemoptysis, and elevated D-dimer levels should be closely monitored for the potential development of PE. The co-occurrence of MPP and PE often involves the presence of NP. In cases of confirmed PE, anticoagulation therapy may be a suitable consideration. PE and NP resulting from MPP generally had a favorable overall prognosis.
PubMed: 38779350
DOI: 10.2147/IDR.S459626 -
Archives of Rheumatology Mar 2024This study aimed to clarify the relationship between and Kawasaki disease by conducting an updated systemic review and meta-analysis of published studies. (Review)
Review
OBJECTIVES
This study aimed to clarify the relationship between and Kawasaki disease by conducting an updated systemic review and meta-analysis of published studies.
MATERIALS AND METHODS
Studies mentioning and Kawasaki disease before October 2022 were included in this meta-analysis. The pooled prevalence was calculated, and the log odds ratio in the random effects model was applied to estimate the pooled prevalence of infection in pediatric patients with Kawasaki disease. In addition, the clinical parameters, such as hemoglobin and erythrocyte sedimentation rate, were analyzed. Six studies with a total of 1,859 pediatric patients with Kawasaki disease were enrolled. The focused outcome was the pooled prevalence and clinical parameters.
RESULTS
The pooled prevalence of infection was statistically significant in pediatric patients with Kawasaki disease. In addition, the values of hemoglobin and erythrocyte sedimentation rate were significantly different between -infected and non--infected patients with Kawasaki disease. Other clinical parameters were not significantly different between -infected and non--infected patients with Kawasaki disease.
CONCLUSION
The results suggest that infection is significantly prevalent in pediatric patients with Kawasaki disease. The lower values of hemoglobin and erythrocyte sedimentation rate in -infected patients with Kawasaki disease might be needed to investigate further.
PubMed: 38774705
DOI: 10.46497/ArchRheumatol.2023.10149 -
Infection and Drug Resistance 2023is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant (MRMP) has become increasingly prevalent, and...
BACKGROUND
is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.
CASE PRESENTATION
We report a patient with severe refractory pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that was resistant to macrolide. PCR confirmatory test about resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant .
CONCLUSION
As a new molecular level detection, mNGS is an effective method for detecting resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.
PubMed: 37465181
DOI: 10.2147/IDR.S419873