Clinical Manifestations In Children Research Articles

Clinical manifestations of children with COVID‐19: A systematic review

BackgroundThe coronavirus disease 2019 (COVID‐19) outbreak is an unprecedented global public health challenge, leading to thousands of deaths every day worldwide. Despite the epidemiological importance, clinical patterns of children with COVID‐19 remain unclear. The aim of this study was to describe the clinical, laboratorial, and radiological characteristics of children with COVID‐19.MethodsThe Medline database was searched between December 1st 2019 and April 6th 2020. No language restrictions were applied. Inclusion criteria were (a) studied patients younger than 18 years old; (b) presented original data from cases of COVID‐19 confirmed by reverse‐transcription polymerase chain reaction; and (c) contained descriptions of clinical manifestations, laboratory tests, or radiological examinations.ResultsA total of 38 studies (1124 cases) were included. From all the cases, 1117 had their severity classified: 14.2% were asymptomatic, 36.3% were mild, 46.0% were moderate, 2.1% were severe, and 1.2% were critical. The most prevalent symptom was fever (47.5%), followed by cough (41.5%), nasal symptoms (11.2%), diarrhea (8.1%), and nausea/vomiting (7.1%). One hundred forty‐five (36.9%) children were diagnosed with pneumonia and 43 (10.9%) upper airway infections were reported. Reduced lymphocyte count was reported in 12.9% of cases. Abnormalities in computed tomography were reported in 63.0% of cases. The most prevalent abnormalities reported were ground‐glass opacities, patchy shadows, and consolidations. Only one death was reported.ConclusionsClinical manifestations of children with COVID‐19 differ widely from adult cases. Fever and respiratory symptoms should not be considered a hallmark of COVID‐19 in children.

Clinical Manifestations in Children with Staphylococcal Bacteremia Positive for Panton-Valentine Leucocidin: A Nationwide Survey in a Low Methicillin-Resistance Setting.

A total of 714 pediatric cases of Staphylococcus aureus bacteremia were identified from 2008 to 2015 in Denmark; 98% were methicillin-susceptible S. aureus (MSSA). Fifteen isolates (2,1%) were Panton-Valentine leucocidin positive (0.17/100,000 children/year) and 87% MSSA. Eight cases (53%) were severe, including all pneumonia cases. Panton-Valentine leucocidin positive Staphylococcus aureus bacteremia is rare in our setting with high MSSA-prevalence. Half of the cases were uncomplicated.

Epidemiology of COVID-19 Among Children in China.

To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China. Nationwide case series of 2135 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020, were included. The epidemic curves were constructed by key dates of disease onset and case diagnosis. Onset-to-diagnosis curves were constructed by fitting a log-normal distribution to data on both onset and diagnosis dates. There were 728 (34.1%) laboratory-confirmed cases and 1407 (65.9%) suspected cases. The median age of all patients was 7 years (interquartile range: 2-13 years), and 1208 case patients (56.6%) were boys. More than 90% of all patients had asymptomatic, mild, or moderate cases. The median time from illness onset to diagnoses was 2 days (range: 0-42 days). There was a rapid increase of disease at the early stage of the epidemic, and then there was a gradual and steady decrease. The disease rapidly spread from Hubei province to surrounding provinces over time. More children were infected in Hubei province than any other province. Children of all ages appeared susceptible to COVID-19, and there was no significant sex difference. Although clinical manifestations of children's COVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection. The distribution of children's COVID-19 cases varied with time and space, and most of the cases were concentrated in Hubei province and surrounding areas. Furthermore, this study provides strong evidence of human-to-human transmission.

Clinical Characteristics of COVID-19 Infection in Newborns and Pediatrics: A Systematic Review.

World Health Organization has declared COVID-19 a pandemic and a global health emergency. Thus, it is necessary to clearly characterize clinical manifestations and management of COVID-19 infection in children to provide accurate information for healthcare workers. Accordingly, the present study was designed to review articles published on clinical manifestations and characteristics of children and infants with COVID-19. In this systematic review, medical databases including Cochrane Library, Web of Science, Embase, Scopus, SID, Medline, WHO and LitCovid were searched using English and Persian keywords including COVID-19, Pediatrics, Newborn, Coronavirus 2019, 2019-nCoV, SARS-CoV-2. Finally, data of 14 related articles were included in the study. A total of 2228 children, newborns and infants were studied. Clinical manifestation in children may be mild (72%), moderate (22%) or severe (6%), and the most common symptoms include dry cough (91%) and fever (96%). According to the included articles, two children had died, one of which was a 14-year-old boy and his exposure history and underlying disease were unclear, and the other was a male newborn with gestational age of 35 weeks and 5 days, birth weight of 2200, Apgar score of 8, 8 (1 min and 5 min) and his first symptom was increased heart rate. No differences were found between male and female children regarding infection with COVID-19. Most pediatrics were infected with COVID-19 due to family cluster or history of close contact. Infected children have relatively milder clinical symptoms compared to infected adults. We should pay special attention to early diagnosis and early treatment in children infected with COVID-19.

Association of Vaccinations and Clinical Manifestations in Children with COVID–19

Background: The aim of the present study was to explore the association of vaccinations and clinical manifestations in pediatric patients with Coronavirus Disease 2019 (COVID–19). Methods: Pediatric patients with COVID–19 were recruited from Wuhan Children’s Hospital and Shanghai Children’s Medical Center, including 248 laboratory–confirmed and 56 suspected cases from January 21 to March 12, 2020. Suspected and confirmed cases were diagnosed basing on the Novel Coronavirus 2019 Diagnosis and Treatment Protocol, seventh version. The associations of initial symptoms with age, vaccinations, pathogens, and cytokines were determined via Chi–square tests, Spearman correlations, and logistic regressions. Findings: We assessed 248 (81.58%) laboratory–confirmed cases and 56 (18.42%) suspected cases of COVID–19. The median age of all patients was 6.82 years (interquartile range: 2.08–10.20), and 186 cases (61.18%) were boys; furthermore, 30.26% of all patients were asymptomatic cases. The percentage of asymptomatic cases vaccinated with Bacillus Calmette Guerin (BCG) was not significantly higher than that without BCG vaccination (86/280 [30.71%] vs 6/13 [46.15%], P = 0.203), initial symptoms was not corrected with immunized influenza vaccine ( P = 0.267). Significant correlations were found between age and immunoglobulin (Ig) A (P < 0.001), IgE (P = 0.021), IgG (P < 0.001), complement C4 (P = 0.031), interleukin (IL)–10 (P = 0.003), and tumor necrosis factor (TNF)–α (P = 0.044). Compared to parameters in pediatric patients with normal body temperatures, patients with fever had higher high sensitivity C reactive protein (hs-CRP) (P < 0.001), IL–4 (P = 0.005), IL–10 (P = 0.038), TNF–α (P = 0.004), and TNF–γ (P = 0.036). Interpretation: Pediatric COVID–19 patients with BCG vaccinations exhibit similar clinical manifestations compared to those without BCG vaccinations, and the severity of symptoms in pediatric patients may be related to the maturity of immune function. Funding Statement: This study was partly supported by Top Medical Young Talents of Hubei Province, the National Science Foundation of China [81872637], Shanghai Municipal Commission of Health and Family Planning[201840324], Science and Technology Development Program of Pudong Shanghai New District [PKJ2017–Y01], Shanghai Professional and Technical Services Platform [18DZ2294100], and Shanghai Science and Technology Commission of Shanghai Municipality (17411965300, 17XD1402800,19441904400]. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Review Board of Wuhan Children’s Hospital (IEC–2020R003–E01) and Shanghai Children’s Medical Center (SCMCIRB– K2020019–1).

Role of Mechanical Force on the Growth Plate

The shape and size of the limb is determined by genetic, biochemical, and mechanical factors resulting from weight bearing activity or muscle contraction. Changes in bone shape in response to mechanical forces was first reported by Wolf, 1892. Observations by Hueter‐Volkman indicated that supraphysiological forces lead to reduced skeletal growth. More recently, Frost (1990) proposed the concept of chondral modeling to describe physiological loading. In this case, both tension and compression lead to increased skeletal growth up to a peak then compression beyond that peak leads to inhibition of growth. Recent experiments using zebra fish, chick, and muscle‐less Spd mice indicated a specific connection between mechanical load and endochondral bone formation in embryonic skeleton. A role for mechanical forces on postnatal skeletal development is apparent in clinical manifestations of children with hemiplegia resulting in unequal loading of developing limbs. A large proportion of children with hemiplegia demonstrated significant limb length discrepancy with the paralyzed limb being shorter than the other limb. An age dependent effect of force on limb development in mice during spaceflight and tail suspended rats indicated a critical developmental window where loading regulates growth plate function. Longitudinal growth of limbs occurs through cartilaginous structures called the growth plate in a process called endochondral bone formation. One important feature of the growth plate is that the cells align into columns that represent a continuum of differentiation. It was suggested that the magnitude of bone growth is dependent on chondrocyte proliferation, matrix deposition, and hypertrophy; however, without the columnar structure, growth would not be longitudinal and the proper length and shape of skeletal elements would be disrupted. Recent experimental data indicate that mechanical load is required to regulate growth plate function including proliferation of chondrocytes and column formation. The molecular mechanism governing proliferation and column formation in response to load are not known but may involve chondrocytes sensing mechanical changes in the environment thought their actin cytoskeleton. Unloading mouse hind limb results in disorganization of the actin structure in chondrocytes, loss of columnar structure in the growth plate, and reduced limb length. Mice with conditional deletion of genes associated with regulation of the actin cytoskeleton demonstrate similar alterations in their growth plates. These observations highlight the importance of mechanical loading on growth plate function but there is still limited understanding of the molecular mechanisms of how limb length is regulated in response to mechanical loads.Support or Funding InformationNIH/NIAMS R21 AR070097 and the US‐Israel Bi‐national Science Foundation

Pay attention to SARS-CoV-2 infection in children.

Pay attention to SARS-CoV-2 infection in children.

Retracted: Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen

Objective: To describe the characteristics of clinical manifestations and epidemiology of children with 2019 novel coronavirus (2019-nCoV) infection. Methods: All 34 children with laboratory-confirmed 2019-nCoV infection by quantitative real-time reverse transcription-PCR through nasopharyngeal swab specimens were admitted to the Third People's Hospital of Shenzhen from January 19 to Febuary 7, 2020. Clinical data and epidemiological history of these patients were retrospectively collected and analyzed. Results: Among the 34 cases, 14 were males, and 20 were females. The median age was 8 years and 11 months. No patients had underlying diseases. There were 28 children (82%) related with a family cluster outbreak. There were 26 children (76%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 22 (65%) common cases, 9 (26%) mild cases and 3 (8.8%) asymptomatic cases. No severe or critical cases were identified. The most common symptoms were fever (17 cases, 50%) and cough (13 cases, 38% ). In the 34 cases, the white blood cell counts of 28 cases (82%) were normal. Five cases had white blood cell counts more than 10×10(9)/L. One case had white blood cell counts less than 4×10(9)/L. Neutropenia and lymphopenia was found in one case, respectively. C-reactive protein levels and erythrocyte sedimentation rates were elevated in 1 and 5 case, respectively. Elevated procalcitonin was found in 1 case and D-Dimer in 3 cases. The levels of lactic dehydrogenase (LDH) were more than 400 U/L in 10 cases. The CT images of these patients showed bilateral multiple patchy or nodular ground-glass opacities and/or infiltrating shadows in middle and outer zone of the lung or under the pleura. Twenty patients were treated with lopinavir and ritonavir. Glucocorticoids and immunoglobulin were not used in any cases. All the cases improved and were discharged from hospital. Further following up was need. Conclusions: The clinical manifestations in children with 2019-nCoV infection are non-specific and are milder than that in adults. Chest CT scanning is heplful for early diagnosis. Children's infection is mainly caused by family cluster outbreak and imported cases. Family daily prevention is the main way to prevent 2019-nCoV infection.

Pediatric autoimmune connective tissue diseases – epidemiology, clinical manifestations, diagnosis and treatment

Pediatric autoimmune connective tissue diseases are a group of disorders characterized by the presence of anti­bodies formed against tissue antigens. These di­seases in­clude: systemic lupus erythematosus (SLE), der­ma­to­myo­sitis (DM), polymyositis (PM), scleroderma (SSc) and Sjögren’s syndrome. The incidence is reduced in children and among the most frequent are lupus erythematosus, dermatomyositis and scleroderma. There are many studies based on these disorders in adult population, but only a few describe the pathogenesis and clinical manifestations in children which are essential for the choice of treatment and outcome. In addition to morbidity and mortality due to internal organs damage, the prognosis is also influenced by the adverse effects of immunosuppresive drugs and by emotional, mental, social and economic factors which can have an impact on patients and their families.

Investigating the Effect of Montelukast on the Pyelonephritis Symptoms in Children

BackgroundMontelukast as an anti-inflammatory drug has a protective effect on the kidney’s tissue and also on children with pyelonephritis.ObjectivesTherefore, this study aimed at investigating the effect of montelukast on the pyelonephritis symptoms in children.MethodsIn this study, 100 children with pyelonephritis were divided into two groups, including the intervention (n = 50) and control (n = 50) groups. Patients in both groups received routine antibiotic therapy and in the intervention group, montelukast (5 mg/day, oral) was prescribed (for 14 days). Finally, the clinical manifestations of the patients were evaluated and compared between two groups.ResultsThe mean age (± SD) in intervention and control groups was 7.2 (± 0.43) and 7.18 (± 0.43) years, respectively. Analysis of the results showed that the duration of fever (P < 0.0001), dysuria (P < 0.0001), abdominal pain (P < 0.0001) and urgency (P = 0.003) were significantly lower in the intervention group than the control group.ConclusionsMontelukast lead to rapid improvement of clinical manifestations in children with pyelonephritis and may can be used as an effective auxiliary treatment in these patients.

Clinical and genetic analysis of two pedigrees affected with aromatic L-amino acid decarboxylase deficiency

To delineate the clinical and genetic features of two pedigrees affected with aromatic L-amino acid decarboxylase (AADC) deficiency. The clinical features, family history and results of genetic testing of 2 patients with AADC deficiency were retrospectively analyzed. Both patients featured hypotension, developmental delay and oculogyric crisis during infancy. Genetic testing confirmed that they have respectively carried c.714+ 4 (IVS6) A to T/c.175(exon2)G TO A compound heterozygous variants and c.714+ 4(IVS6)A to T homozygous variant. The clinical manifestation of children with AADC deficiency may include hypotonia, developmental delay and paroxysmal oculogyric crisis. The combination of 3-O-methyldopa testing and variant analysis is not only very useful for early diagnosis, but also important for the evaluation of treatment effect and prognosis of the disease. Discovery of the novel variants has enriched the variant spectrum of AADC deficiency.

Production Strategies for Pentamer-Positive Subviral Dense Bodies as a Safe Human Cytomegalovirus Vaccine.

Infections with the human cytomegalovirus (HCMV) are associated with severe clinical manifestations in children following prenatal transmission and after viral reactivation in immunosuppressed individuals. The development of an HCMV vaccine has long been requested but there is still no licensed product available. Subviral dense bodies (DB) are immunogenic in pre-clinical models and are thus a promising HCMV vaccine candidate. Recently, we established a virus based on the laboratory strain Towne that synthesizes large numbers of DB containing the pentameric protein complex gH/gL/UL128-131 (Towne-UL130repΔGFP). The work presented here focuses on providing strategies for the production of a safe vaccine based on that strain. A GMP-compliant protocol for DB production was established. Furthermore, the DB producer strain Towne-UL130rep was attenuated by deleting the UL25 open reading frame. Additional genetic modifications aim to abrogate its capacity to replicate in vivo by conditionally expressing pUL51 using the Shield-1/FKBP destabilization system. We further show that the terminase inhibitor letermovir can be used to reduce infectious virus contamination of a DB vaccine by more than two orders of magnitude. Taken together, strategies are provided here that allow for the production of a safe and immunogenic DB vaccine for clinical testing.

Clinical value of QST classification in the treatment of children with craniopharyngioma

Objective To explore the clinical manifestation of children with different QST classification of craniopharyngioma (CP) and its role in prognosis. Methods We retrospectively analyzed 149 children with CP who underwent surgery at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 1998 to December 2015. Of those, 70 (47.0%) children underwent operation through frontal base approach, 46 (30.9%) through pterional approach and 33 (22.1%) through transsphenoidal approach for tumor removal. All patients underwent clinical follow-up after surgery, including MRI review of the sellar region to determine the tumor resection and recurrence, and measurement of relevant indicators to assess the prognosis. All 149 children were classified according to the QST classification criteria, and the differences in clinical characteristics of different types of children were analyzed. Furthermore, multivariate logistic regression analysis was used to determine the clinical factors affecting the prognosis of children. Results All children in this series underwent successful operation and 138 (92.6%) out of those had total resection and 11 (7.4%) had subtotal resection. The median follow-up duration of 149 patients was 87 months (range: 11-236 months). Good outcomes were reported in 134 patients and poor outcome in 15. In this study, 91 patients were type Q (Q-group), 14 were type S (S-group) and 44 were type T (T-group) according to the QST classification criteria. There were no significant differences in age, gender, maximum diameter, tumor calcification degree, degree of tumor resection and tumor recurrence between the 3 groups (all P>0.05), while the clinical symptoms, incidence of hydrocephalus, pre- and post-operative pituitary function, operation approach and pathological types were significantly different in patients with different QST classifications among 149 children with CP (all P<0.05). The T-type was more often associated with hydrocephalus, the Q-type was more prone to have abnormal pituitary function, and the S-type was more likely to have vision and visual field damage. Multivariate logistic regression analysis showed that QST classification(OR=5.984, 95%CI: 1.529-23.417, P=0.037) and degree of tumor resection(OR=8.220, 95%CI: 2.158-31.318, P=0.002) were independent prognostic factor in children with CP. Conclusions The clinical characteristics of children with different QST classification of craniopharyngioma are different, and QST classification is one of the independent risk factors affecting the prognosis of children with craniopharyngioma. Key words: Craniopharyngioma; Child; Prognosis; Disease attributes; QST typing

An evaluation of phase angle, bioelectrical impedance vector analysis and impedance ratio for the assessment of disease status in children with nephrotic syndrome

BackgroundOedema, characterized by accumulation of extracellular water (ECW), is one of the major clinical manifestations in children suffering from nephrotic syndrome (NS).The lack of a simple, inexpensive and harmless method for assessing ECW may be solved by the use of the bioelectrical impedance analysis (BIA) technique.The aims of this study were to examine whether phase angle (PA), bioelectrical impedance vector analysis (BIVA) and the impedance ratio (IR) reflect change in disease status in children with NS.MethodsEight children (age range: 2–10 years) with active NS (ANS group) were enrolled. In five of these (ANS* subgroup), impedance was also measured at remission (NSR group). Thirty-eight healthy children (age range: 2–10 years) were included as healthy controls (HC group). Whole-body impedance was measured with a bioimpedance spectroscopy device (Xitron 4200) with surface electrodes placed on the wrist and ankle.ResultsValues of PA, BIVA and IR were found to be significantly lower (p-value range < 0.001 to < 0.01) in the ANS patients compared to the HC and NSR groups. No significant differences were observed between the NSR and HC groups.ConclusionThe studied parameters can be used to assess change in disease status in NS patients. Data were consistent with NS being associated with expansion of ECW.

An unusual etiology of multifocal osteomyelitis in a previously healthy African American male

Introduction: Multifocal osteomyelitis secondary to Bartonella henselae (B. henselae) is a rare clinical manifestation in children that can mimic chronic recurrent multifocal osteomyelitis (CRMO), with its indolent clinical course as well as similar findings on a Whole Body Magnetic Resonance Imaging (WB-MRI). Clinicians should be aware that disseminated B. henselae infection can be distinguished from CRMO, with epidemiologic link, serologic evidence, and visceral involvement (from hematologic spread). Case Presentation: A previously healthy 11-year-old African American male presented to emergency department (ED) for 12 days of fever (Tmax 104 F) at home, with associated headache …

Enteroparasitism and Risk Factors Associated with Clinical Manifestations in Children and Adults of Jalisco State in Western Mexico.

ObjectivesTo determine the prevalence and risk factors associated with intestinal parasites in the population of San Juan Cosala, Jalisco, Mexico.MethodsA total of 277 samples from 104 participants were analysed using direct smear, flotation, formaldehyde/ethyl acetate, and modified Kinyoun’s acid-fast stain methods. The Graham method was applied only for samples from children under 12 years of age for the diagnosis of Enterobius vermicularis.ResultsThe prevalence of parasite infections in the study population was 77.9% including: Entamoeba histolytica/E. dispar/E. moshkovskii/E. bangladeshi (37.5%), Giardia intestinalis (11.5%); commensals: Endolimax nana (44.2%), Entamoeba coli (27.9%), Chilomastix mesnili (6.7%) and Iodamoeba bütschlii, (2.9%); emerging intestinal protozoans: Blastocystis spp. (49%), Cryptosporidium spp. (7.7%) and Cyclospora cayetanensis (2.9%); and helminths: Enterobius vermicularis (18.3%) and Ascaris lumbricoides (5.8%). The results also showed that 58.64% of the studied population presented polyparasitism. A significant association was found between protozoan infections and housewives, and houses that were not built with concrete ceilings, brick walls and cement floors (p < 0.05).ConclusionPolyparasitism was observed in over half the study population. The most prevalent parasite was Blastocystis spp, whilst the prevalence of helminths was less than that of protozoans. The risk factors for infection to intestinal parasites were being a housewife and not having solid brick, cement and concrete materials for house construction.

Tolosa-Hunt Syndrome: Clinical Manifestations in Children

BackgroundTolosa-Hunt syndrome (THS) is a rare condition in children characterized by painful ophthalmoplegia caused by inflammation of unknown etiology in the cavernous sinus, superior orbital fissure, or orbital apex. Our main purpose was to report two pediatric cases of THS, a typical one and another extremely rare one preceded by facial palsy. MethodsBoth cases were diagnosed with THS based on the 2013 International Classification of Headache Disorders (ICHD-3 beta) criteria. A literature review was also performed concerning epidemiology, clinical and imaging features, diagnostic criteria, treatment, and outcome of THS with a focus on children. ResultsThe first patient was a 14-year-old boy who presented with third nerve palsy, four weeks after the diagnosis and treatment of peripheral seventh nerve palsy and the second patient was a 10-year-old girl who presented with a five-day history left-sided ptosis, periorbital pain, and diplopia. ConclusionsTHS is a rare condition in pediatric population that requires an extensive evaluation before the final diagnosis is made. Seventh nerve palsy preceding the diagnosis of THS is particularly rare in children. This patient represents only the second reported example of seventh nerve involvement in a child with THS.

Increasing Epstein-Barr virus infection in Chinese children: A single institutional based retrospective study.

The Epstein-Barr virus (EBV) is a common virus in humans and the most common causative agent of Infectious Mononucleosis. EBV primary infection has recently risen in some countries and children below 2 years of age are highly susceptible. The clinical manifestations in children with EB virus infection involve multiple systems, causing severe illness, meaning attention should be paid during diagnosis and treatment. Objective: This single institution based retrospective study was carried out with the aim of estimating the overall prevalence of EBV infection and identifying high-risk age group among children. Methods: This study include total 253 patients under 15 years of age found to be positive for EBV DNA by serum PCR who were admitted to the Pediatrics Department of Renmin Hospital,(Shiyan, China) during a 4-year period from 2014 to 2017. Patients were divided into three groups; 0-<4years, 4-<6years and 6-<15years. We then calculated the percentage and prevalence of EBV DNA-positive cases. Results: The yearly EBV prevalence rate was 4.99 per 1000 admissions in 2014, 6.97 per 1000 admissions in 2015, 10.42 per 1000 admissions in 2016, and 12.16 per 1000 admissions in 2017. Out of 253 EBV-positive cases, those under 4 years had the highest rate of EBV infection (74.7%). The rate drops to 11.06% in the 4-6 years group, and was 14.22% in the 6-15 years group. Those between 6 months and 1 year are those at the highest risk. Conclusion: The rate of hospital admission of children due to EBV infection is increasing day by day. Children under 4 years of age are highly susceptible to infection and children of age between 6 months and 1 year are the high-risk group for EBV infection.

Increasing Epstein-Barr virus infection in Chinese children: A single institutional based retrospective study.

The Epstein-Barr virus (EBV) is a common virus in humans and the most common causative agent of Infectious Mononucleosis. EBV primary infection has recently risen in some countries and children below 2 years of age are highly susceptible. The clinical manifestations in children with EB virus infection involve multiple systems, causing severe illness, meaning attention should be paid during diagnosis and treatment. Objective: This single institution based retrospective study was carried out with the aim of estimating the overall prevalence of EBV infection and identifying high-risk age group among children. Methods: This study include total 253 patients under 15 years of age found to be positive for EBV DNA by serum PCR who were admitted to the Pediatrics Department of Renmin Hospital,(Shiyan, China) during a 4-year period from 2014 to 2017. Patients were divided into three groups; 0-<4years, 4-<6years and 6-<15years. We then calculated the percentage and prevalence of EBV DNA-positive cases. Results: The yearly EBV prevalence rate was 4.99 per 1000 admissions in 2014, 6.97 per 1000 admissions in 2015, 10.42 per 1000 admissions in 2016, and 12.16 per 1000 admissions in 2017. Out of 253 EBV-positive cases, those under 4 years had the highest rate of EBV infection (74.7%). The rate drops to 11.06% in the 4-6 years group, and was 14.22% in the 6-15 years group. Those between 6 months and 1 year are those at the highest risk. Conclusion: The rate of hospital admission of children due to EBV infection is increasing day by day. Children under 4 years of age are highly susceptible to infection and children of age between 6 months and 1 year are the high-risk group for EBV infection.

Clinical analysis of eosinophilic gastroenteritis in children

Objective To discuss the clinical manifestations, laboratory indexes, imageological examination results, endoscopic and histopathological features of eosinophilic gastroenteritis(EG) in children. Methods Thirty-three children with EG were collected with clinical manifestations, allergic history, laboratory examination, endoscopic and histopathological features and treatments, who were hospitalized at department of pediatric gastroenterology of Shengjing Hospital of China Medical University between January 2012 and December 2017. Results The main clinical manifestations of EG were abdominal pain(75.8%), vomiting(30.3%)and diarrhea(21.2%). The hemoglobin level decreased in 7 cases(21.2%). The eosinophil count increased in 13 cases(39.4%). Total serum IgE elevated in 18 cases(54.5%), while 23 cases were positive in serum food or respiratory specific IgE.The fecal occult blood test showed positive in 7 cases(21.2%). Among 28 children conducted with whole abdominal CT, there were 13 cases of pelvis fluid, 12 cases of enlarged lymph nodes and 4 cases of thickened intestinal wall.All 33 children went through the endoscopic examination, the main histological change were erythema-exudation(31 cases, 93.9%), mucosal hyperemia edema(5 cases, 15.2%) and hemorrhage(4 cases, 12.1%). The main pathological change was mucosal inflammation with a large number of eosinophil infiltration(≥20 per HPF). Among the 33 cases, 17 cases relieved through treatment of avoiding allergen, antacids, anti-allergic agents and leukotriene receptor antagonist, with 1 case recurrence.The other 16 cases relieved after treatment of glucocorticoid and the above therapy, with 3 cases recurrence. Conclusion The clinical manifestations of children with EG are various and lack of specificity.In terms of diagnosis, the elevated level of eosinophil count and total serum IgE, or positive in serum food specific IgE may be taken as reference.The definite diagnosis is based on pathological examination (eosinophil infiltration≥20 per HPF). For treatment, avoiding allergen, antacids, anti-allergic agents and leukotriene receptor antagonist are effective in several children.Glucocorticoid can obtain satisfactory curative effect in the uneffective children. Key words: Eosinophilic gastroenteritis; Children; Clinical features; Endoscopy