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Journal of the American Academy of... Sep 2019Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.
BACKGROUND
Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.
OBJECTIVE
To investigate the triggers, clinical manifestations, and treatment of pediatric EM.
METHODS
Systematic literature review of pediatric EM.
RESULTS
After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children.
LIMITATIONS
Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias.
CONCLUSION
Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.
Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Drug Eruptions; Erythema Multiforme; Glucocorticoids; Herpes Simplex; Humans; Infant; Mouth Mucosa; Palliative Care; Pneumonia, Mycoplasma; Rare Diseases; Recurrence; Severity of Illness Index; Vaccination
PubMed: 31331726
DOI: 10.1016/j.jaad.2019.02.057 -
Pediatric Pulmonology Dec 2020Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is spreading all over the world and poses a great threat to humans. This study aimed to systematically review... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is spreading all over the world and poses a great threat to humans. This study aimed to systematically review the current situation and public health burden associated with children infected with SARS-CoV2.
METHODS
We searched four electronic databases without language limitations. The pooled proportion or odds ratio (OR) and 95% CI confidence interval (CI) were calculated for each analysis to explore the prevalence of asymptomatic infection and coinfection, as well as to assess the sex of SARS-CoV-2-infected children.
RESULTS
We obtained data from 14 eligible studies with 410 patients for the meta-analysis. The pooled proportion of asymptomatic infection was 40.45% (95% CI, 24.04-56.85), while coinfection was 10.14% (95% CI, 3.97-16.30), of which Mycoplasma pneumonia (50%; 95% CI, 28.24-71.76) and influenza virus or parainfluenza virus (22.76%; 95% CI, 4.76-40.77) were the most common pathogens. Both male and female children were susceptible to SARS-CoV2 infection. And the pooled proportion of family clustering infection was 83.63% (95% CI, 77.54-89.72).
CONCLUSION
A high proportion of asymptomatic infections occurs in children infected with SARS-CoV2, who are also susceptible to coinfection regardless of sex. These data affirm the increasing public health burden arising from infected children regarding the causation of asymptomatic infection or misdiagnosis and as a significant contributor to virus spread. The public should pay more attention to children during epidemics and conduct multimethod detection to further effectively identify infected children and control the source of infection.
Topics: Asymptomatic Infections; Betacoronavirus; COVID-19; Child; Child, Preschool; Coinfection; Coronavirus Infections; Humans; Infant; Pandemics; Pneumonia, Viral; Prevalence; Public Health; SARS-CoV-2
PubMed: 32757374
DOI: 10.1002/ppul.25008 -
Medicine Jun 2024Budesonide, capable of reducing vascular permeability, suppressing mucus secretion, and alleviating edema and spasms, is widely used in China for combined infectious... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Budesonide, capable of reducing vascular permeability, suppressing mucus secretion, and alleviating edema and spasms, is widely used in China for combined infectious disease treatment. This study assesses budesonide's efficacy and safety as an adjunct to azithromycin in pediatric Mycoplasma pneumonia management in China, aiming to establish a strong theoretical foundation for its clinical application.
METHODS
We conducted a comprehensive search for qualifying studies across 5 English databases and 4 Chinese databases, covering publications until October 31, 2023. Endpoint analyses were performed using standard software (Stata Corporation, College Station, TX). This study was conducted in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
RESULTS
A total of 24 randomized controlled trials were involved in the current study, including 2034 patients. Our findings indicate that the combination of budesonide with azithromycin for the treatment of pediatric Mycoplasma pneumonia delivers superior therapeutic efficacy (Intravenous: odds ratio [OR], 0.156, P < .001; Sequential: OR, 0.163, P = .001; Oral: OR, 0.139, P < .001), improved pulmonary function (Forced expiratory volume in 1 second: weighted mean differences [WMD], -0.28, P = .001; Peak expiratory flow: WMD, -0.554, P = .002; Forced vital capacity: WMD, -0.321, P < .001), diminished lung inflammation (IL-6: WMD, 4.760, P = .002; c-reactive protein: WMD, 5.520, P < .001; TNF-α: WMD, 9.124, P < .001), reduced duration of fever, faster resolution of cough and rales, all without increasing the occurrence of adverse events.
CONCLUSION
The combination of budesonide and azithromycin demonstrates enhanced therapeutic effectiveness, promotes improved pulmonary function, shortens the duration of symptoms, and effectively mitigates the overexpression of inflammatory factors like c-reactive protein, TNF-α, and IL-6, all without an associated increase in adverse reactions in pediatric mycoplasma pneumonia.
Topics: Humans; Azithromycin; Pneumonia, Mycoplasma; Budesonide; Child; Drug Therapy, Combination; China; Anti-Bacterial Agents; Administration, Inhalation; Randomized Controlled Trials as Topic; Treatment Outcome; Child, Preschool; East Asian People
PubMed: 38875395
DOI: 10.1097/MD.0000000000038332 -
Medicine Mar 2021Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children.
METHODS
Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0.
RESULTS
We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109-7.456), pleural effusion (OR 6.922, 95% CI 2.058-23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146-28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990-34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116-11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548-1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979-1.091) and the risk of RMPP.
CONCLUSIONS
Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.
Topics: C-Reactive Protein; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Bacterial; Female; Fever; Humans; Lung; Male; Mycoplasma pneumoniae; Pleural Effusion; Pneumonia, Mycoplasma; Radiography; Risk Assessment; Risk Factors
PubMed: 33725960
DOI: 10.1097/MD.0000000000024894 -
Journal of Medical Microbiology Nov 2019is regarded as the important infectious agent of acute respiratory infections (ARIs) in the world. However, there is little knowledge about the prevalence of in Iran.... (Meta-Analysis)
Meta-Analysis
is regarded as the important infectious agent of acute respiratory infections (ARIs) in the world. However, there is little knowledge about the prevalence of in Iran. Therefore, the aim of this study was to investigate the prevalence of in Iran through a meta-analysis of included studies. A systematic search was done by using electronic databases from papers that were published by Iranian authors to the end of February 2019. Then, 12 publications, which met our inclusion criteria, were enrolled for data extraction and analysis by using the 'metaprop program' in stata version 14.0. The pooled prevalence of was 9 % (95 % confidence intervals: 5-16 %) ranging from 1 to 26 %. There was a significant heterogeneity among the 12 studies (X=128.29; <0.001; =91.43 %). The funnel plot for publication bias showed no evidence of asymmetry. The frequency of in Iran is comparable with other parts of the world. Although the overall prevalence of was low, awareness about the distribution of these agent is very important because of higher infection rates in susceptible groups. In addition, these results showed the rates of had variation based on location, type of infection and sample, gender and detection rate and there was evidence of publication bias.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Iran; Male; Middle Aged; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prevalence; Respiratory Tract Infections; Young Adult
PubMed: 31524582
DOI: 10.1099/jmm.0.001079