Pediatric Infectious Diseases Clinic Research Articles

P-917. Management of pediatric focal intracranial infections: opportunities to reduce low-value care

Abstract Background Focal intracranial infections are rare but life-threatening complications of sinusitis, otitis media and mastoiditis in children. Management requires collaboration between multiple specialists and prolonged antimicrobial treatment. Methods We retrospectively identified patients hospitalized at our tertiary care children’s hospital with focal intracranial infections from Jan 2022 - April 2024 followed in infectious disease clinic. Patient charts were reviewed to inventory imaging, surgical interventions and antibiotic treatment received. We further identified complications in each case requiring intervention, including surgery, hospitalizations and emergency room visits. MRI imaging was defined as low-value if ordered over 2 weeks prior to the study in a patient without new symptoms, or ordered for a hospitalized patient who was afebrile without neurologic symptoms or parental concerns after 30 days of antibiotic therapy. Results Thirty-four patients were followed in pediatric infectious disease clinic for outpatient management of: subdural empyema (13, 38%), epidural empyema (11, 33%) and brain abscess (10, 29%). Patients were most likely male (68%) and Black or African American (74%), with a median age of 12 (range: 2-18). Nearly all (94%) had at least one MRI; 19 (56%) had a repeat MRI during hospitalization, 22 (65%) had a repeat MRI after discharge. About one-third of MRIs (31%) after discharge required sedation. In our cohort 18 patients had a low-value MRI (53%) and 5 of these (28%) had more than one low-value MRI. No low-value MRI led to a finding requiring surgical intervention. The mean duration of antibiotic treatment was 42 days (SD 10.8 days). Four patients (12%) returned to the ED while on antibiotic therapy for PICC line issues, with one patient returning 3 times for PICC concerns. Conclusion Some management strategies for pediatric focal intracranial infections may be unnecessary or have unrecognized consequences. Repeat MRI for half our cohort was of low-value, exposed many to risks of sedation, and consumed significant family and system resources. Children on prolonged IV antibiotic therapy were at risk for line complications. Routine management of these infections merits reconsideration to decrease unwarranted costs and risks to patient. Disclosures All Authors: No reported disclosures

Nutritional status of HIV-infected children at Federal University Teaching Hospital, Owerri, Nigeria: A prospective analysis of rural and urban dwellers.

Malnutrition is a critical concern among children living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in regions heavily affected by the HIV epidemic, such as sub-Saharan Africa. In 2019, nearly 2.84 million children under 19 years of age were living with HIV globally, with over 90% residing in sub-Saharan Africa. Concurrently, malnutrition remains prevalent in the region, with approximately 49 million children under the age of 5 experiencing stunting and 149 million suffering from wasting in 2018. This burden of malnutrition is exacerbated by factors such as poverty, food insecurity, and HIV/AIDS, which collectively contribute to adverse health outcomes among affected children. The bidirectional relationship between HIV/AIDS and malnutrition is well-established, with HIV infection increasing the risk of malnutrition and malnutrition worsening the progression of HIV/AIDS. Studies have consistently demonstrated higher rates of stunting, underweight, and wasting among HIV-infected children compared to their uninfected counterparts. Moreover, malnutrition significantly impacts the disease progression, morbidity, and mortality of HIV-infected individuals, further underscoring the importance of addressing this issue in pediatric HIV care. A total of 99 HIV-infected children, aged 2 to 16 years, were consecutively recruited from the pediatric infectious disease clinic of the Federal University Teaching Hospital Owerri. Anthropometric measurements, including weight and height, were obtained using a stadiometer (RGZ-160 England). Weight status was categorized as normal, underweight, overweight, or obese, while height status was classified as stunted, normal, or tall stature. The study participants ranged in age from 2 to 16 years. Approximately 20.2% of the children were underweight, and 6.1% were classified as obese. Stunting was observed in 29.3% of the participants. Notably, all forms of malnutrition, including underweight and overweight, were more prevalent among children residing in rural areas. In addition, stunting was more common among rural dwellers. This study highlights the high prevalence of malnutrition among HIV-infected children attending the pediatric infectious disease clinic at the Federal University Teaching Hospital Owerri. The findings underscore the urgent need for targeted nutritional interventions, particularly in rural areas, to improve the health outcomes of HIV-infected children.

Impact of Cytomegalovirus (CMV) on an Academic Pediatric Infectious Diseases Outpatient Clinic Referral Population, 2005-2020: Will the Advent of Universal Congenital CMV (cCMV) Screening Change Clinical Practice Referral Patterns?

Cytomegalovirus (CMV) infections exert a substantial impact on the practice of pediatric infectious diseases. Although most infections in children are minimally symptomatic, several populations are at risk for CMV-associated disease, including immunosuppressed children, children with HIV infection, and, most significantly, children with congenital CMV (cCMV) infection. In spite of the ubiquitous nature of CMV infection, few studies have quantified the impact of CMV-associated care in a pediatric outpatient clinic setting. We evaluated the impact of CMV on clinical care in an outpatient clinic setting over a fifteen-year period at the University of Minnesota (UMN) Masonic Children's Hospital Pediatric Infectious Diseases (PID) Clinic. A retrospective review of clinic appointments identified 253 unique patients specifically evaluated over this time period for consideration of CMV infection. Of these, 242 were pediatric patients. The majority of the pediatric patients evaluated in the PID clinic were referred for either confirmed or suspected cCMV infection, including children referred for consideration of CMV as a potential reason for a failed newborn hearing screen (NHS) and/or for evaluation of CMV as a possible etiology for documented hearing loss. In total, 116 of the children evaluated during this time period (48%) were unequivocally confirmed as having cCMV infection, with an additional 37 (15%) presenting with presumed, probable, or possible cCMV infection. A total of 16 (7%) of the pediatric CMV cases were confirmed to be post-natally acquired infections. Of the 253 total patients, 11 (4%) of the referrals were for pregnant patients seeking advice about potential therapies in the setting of a known or suspected primary maternal infection during their pregnancies, with an attendant risk of fetal CMV infection. This overview of the demographics and referral patterns for patients evaluated for known or suspected CMV infections in a tertiary care center outpatient PID clinic will serve as a useful baseline assessment, even as future patterns of outpatient care are highly likely to evolve. We predict that PID clinic referrals for newborns identified by universal cCMV screening programs will result in a shift of the CMV outpatient population to healthier infants with clinically inapparent infections, and care will need to be taken by practitioners not to over-medicalize management for these asymptomatic newborns.

Non-Tuberculous Mycobacterial Cervicofacial Lymphadenitis in Children-10-Year Experience in a Tertiary Pediatric Center.

Lymphadenitis is the most common manifestation of non-tuberculous mycobacteria (NTM) infection in children. We describe the epidemiology and clinical characteristics of NTM lymphadenitis, determine diagnostic yield from tissue sampling, and review management and outcomes. This was a 10-year retrospective review of children aged 0-16 years diagnosed with NTM cervicofacial lymphadenitis who were seen in a pediatric infectious disease clinic in a tertiary public hospital. Data relating to patient demographics, clinical features, surgical and antimicrobial treatment, complications, and outcomes were retrieved from patients' electronic medical records and analyzed. There were 48 episodes of NTM cervicofacial lymphadenitis in 45 children (17 males and 28 females). Of these episodes, 43.7% manifested as a unilateral single node, mostly parotid (39.6%) and submandibular (29.2%). All patients underwent diagnostic fine-needle aspiration or surgery. Surgical excision more frequently yielded positive histological findings (P = .016). NTM was identified in 22/48 episodes (45.8%) via culture or molecular sequencing. Mycobacterium abscessus was most commonly found (47.8%). Thirty-eight children (79.2%) received antibiotics. Outcomes in 43 episodes revealed full resolution in 69.8%, while 25.6% had de novo disease and 4.6% experienced recurrence at the same site. Overlying skin changes and multiple or bilateral nodal diseases were significantly associated with de novo disease or recurrence (P = .034 and .084, respectively). Complications occurred in 11/70 (15.7%) procedures. Antibiotic-associated adverse effects occurred in 14/38 (36.8%) episodes. NTM lymphadenitis remains a challenging condition. More aggressive management with surgical excision and antibiotics is recommended for those with overlying skin changes and extensive nodal disease.

Cryptococcal antigenaemia amongst HIV infected children in Owerri, South East Nigeria

Objective: Cryptococcosis is an opportunistic infection caused by Cryptococcus and can result in cryptococcal meningitis, which is an AIDS-defining condition associated with high morbidity and mortality. Although a high prevalence of Cryptococcal antigenemia (CrAg) preceding cryptococcal disease has been reported in HIV-infected Nigerian adults, it is more common in patients with low CD4, stage 3 or 4 HIV. However, there is only one study on Cryptococcal antigenemia in HIV-infected Nigerian children. Therefore, this study aimed to determine the burden of cryptococcosis in HIV-infected children. Material and Methods: This study was a hospital-based cross-sectional study conducted between October 2018 and January 2019 at the Pediatric Infectious Disease Clinic of the Federal Medical Centre, Owerri. The study population consisted of HIV-infected children (aged 2-16 years) attending the clinic. The subjects were recruited consecutively and underwent a thorough physical examination and anthropometric measurements before a single blood sample was taken. Cryptococcal antigen was assayed using the Lateral Flow Assay method, and CD4+ counts were assayed using cyflow. Results: A total of 100 children were involved in the study, of which 51 (51%) were female and 49 (49%) were male (M:F, 1:1). The average age of the participants was 9.73 ± 3.12 years. Among the 100 children tested, there was no cryptococcal antigenemia (0%). Statistical analysis was limited to simple description. Conclusion: Cryptococcosis is not a common opportunistic infection among HIV-infected children attending the Pediatric Infectious Disease Clinic in Federal Medical Centre Owerri. Therefore, it may not be considered as a differential diagnosis for HIV-positive children with meningoencephalitis.

Non-neuropsychiatric Long COVID Symptoms in Children Visiting a Pediatric Infectious Disease Clinic After an Omicron Surge.

Although much interest has emerged regarding post-COVID conditions, data on children and adolescents are limited. The prevalence of long COVID and common symptoms were analyzed in this case-control study of 274 children. Prolonged non-neuropsychiatric symptoms were more frequent in the case group (17.0% and 4.8%, P = 0.004). Abdominal pain (6.6%) was the most common long COVID symptom.

Prevalence and Factors Associated With Delayed Puberty Among Adolescents on Boosted Protease Inhibitor-based Second-line Antiretroviral Therapy: A Cross-sectional Study at a Pediatric Infectious Diseases Clinic in Uganda.

Delayed puberty is a recognized phenomenon among children living with HIV type 1 infection but has not been widely reported among adolescents on second-line or newer treatments in high burden settings. The study aimed to determine the prevalence of, and factors associated with delayed puberty among adolescents on boosted protease inhibitor-based second-line antiretroviral therapy (ART) in Uganda. Between December 2017 and May 2018, we conducted a cross-sectional study among adolescents living with HIV (ALWHIV) 10-19 years of age on atazanavir- and lopinavir-based regimens at the Paediatric Infectious Diseases Clinic, Kampala. Participants were on ART for at least 3 months and had a recent viral load. Sociodemographics, clinical measurements: body mass index for age Z score, height for age Z score, Tanner staging were collected. ART history was extracted from medical records. The outcome was delayed puberty defined as absence of signs of breast development in a girl 13 years of age or a testicular volume of less than 4 mL in a boy 14 years of age by Tanner staging, or an age for Tanner staging which was at least 2 standard deviations above the expected mean. Among 230 perinatally infected ALWHIV participants, 14.7 ± 3.1 years of age were included, 54.9% were female, 5.2% were wasted and the median duration on ART was 9.5 years (interquartile range 7.3-11.7). The prevalence of delayed puberty was 8.7% (10.4% females, 6.7% males). Overall mean age estimates at different Tanner stages by sex were significantly higher than reference populations. Age at ART initiation (adjusted odds ratio 1.37, 95% confidence interval: 1.06-1.77) and body mass index for age Z score (adjusted odds ratio: 7.63, 95% confidence interval: 1.80-32.38) were associated with delayed puberty. Timely initiation of ART and nutritional monitoring could optimize body weight and consequently, normal puberty for ALWHIV. Longitudinal studies could establish biological diagnoses and guide treatment of delayed puberty in this population.

The Brief Case: the Boy Who Cried Worm.

A 13-year-old, otherwise healthy, male patient living in northeast Ohio presented to the pediatric infectious diseases clinic, reporting to have seen multiple worm segments in his stool during the previous 13 months. With the first occurrence, the specimen was brought to a local urgent care center but was not sent for further identification. The patient was prescribed albendazole (400 mg), with a repeat dose in 2 weeks.

1740. Antibiotic Allergy Delabeling in Pediatric Infectious Disease Clinic: Missed Stewardship Opportunities

Abstract Background Reported beta lactam antibiotic allergies are common, with up to 10% of individuals carrying a penicillin [PCN] allergy label and approximately 1% carrying a cephalosporin allergy label. However, >90% of patients with a PCN allergy label can safely tolerate penicillins. Incorrect antibiotic allergy label can contribute to increases in antibiotic resistance and medication side effects. Appropriate medication allergy history taking is necessary and sometimes sufficient to effectively remove inappropriate allergy labels. We aimed to evaluate opportunities for addressing inappropriate PCN allergy labels in a pediatric infectious diseases clinic. Methods Electronic medical records (EMRs) for patients seen in an academic outpatient pediatric infectious diseases clinic from January 1, 2021 through April 30, 2021 were reviewed for presence of documented antibiotic allergy at time of visit, antibiotic class (PCN, cephalosporin [Ceph.], or non-beta lactam), reaction type, documentation of full reaction history needed to stratify for potential delabeling, and whether or not potential allergy delabeling was addressed during the visit. Results Antibiotic allergy labels were present in the EMR in 18% (n=16) of the 90 encounters reviewed, representing 19% (n=15) of patients seen. Beta lactam antibiotic reactions accounted for 69% (11/16) of documented allergies; 8 PCN class (73%), 2 Ceph. class (18%), 1 with both PCN and Ceph. class allergy (9%). Reactions included rash (6 visits; 54%), hives (3; 27%), nausea/vomiting (1; 9%), diarrhea (1; 9%), swelling (1; 9%), and none recorded (2; 18%). [Sum >100% due to multiple reactions listed]. No additional reaction history was obtained for any patient during the visits. Antibiotic allergy delabeling or assessment by an allergist was only addressed during 1 of the 16 visits with documented antibiotic allergy (6.3%). Conclusion Antibiotic allergy labels are common in pediatric infectious diseases clinic patients. However, appropriate medication allergy histories and the potential for allergy delabeling were not documented for the majority of patients with antibiotic allergy labels. This represents a significant missed opportunity for antibiotic allergy delabeling and a target for future antimicrobial stewardship opportunities. Disclosures All Authors: No reported disclosures.

1083. Clinical Features and Long-Term Follow-up of Children Evaluated for Persistent Unwellness Following Acute COVID-19

Abstract Background Few data exist on the clinical features and outcome of pediatric patients with persistent unwellness following acute COVID. Methods Norton Children’s and the University of Louisville School of Medicine opened a Post-COVID Clinic (PCC) in Oct 2020. The study cohort included all 104 patients referred to the PCC through Dec 2021. Clinical data were collected using a standardized template during routine care. Diagnostic tests and subspecialty referrals were ordered at the discretion of clinic physicians. A telephone interview in 2022 assessed long-term outcomes. Results The median age at first visit was 14 y (IQR=12,16); the age distribution of PCC patients was different from that of Pediatric Infectious Diseases Clinic (PIDC) patients in that there were few patients under 10 y. Males and females were equally represented. The racial distribution was similar to that of PIDC, but patients were more often from mid/upper socioeconomic status (using commercial insurance as a surrogate; p=0.001). The median interval from onset of COVID to the first PCC visit was 2 mo (IQR=1.5,4.4), and an increase in referrals was seen 2 mo after each COVID wave in the community (Figure 1). Most PCC patients reported good health prior to COVID. Fifty-four percent of patients experienced moderate or severe disability according to Modified Functional Disability Inventory scores at the first PCC visit (Figure 2; median score 14, IQR=6,19). Common symptoms were fatigue or lethargy (73%), headache (60%), shortness of breath or difficulty breathing (48%), exercise intolerance (47%), and chest pain (39%). Few abnormalities were found on routine diagnostic tests. Common subspecialty referrals were to Neurology, Cardiology, Pulmonology, Physical Therapy, and Psychiatry; the total number and types of referrals varied widely among patients. Most patients did not receive a specific diagnosis other than post-COVID syndrome. Sixty-three follow-up interviews were completed a median of 6 mo after the initial PCC visit; 79% of patients were improved or back to normal. Figure 1Reported COVID-19 cases in persons <20 years of age in Jefferson County, KY and number of new patients seen in Norton Children’s Infectious Diseases Post-COVID Clinic, by 2-week intervals. Figure 2 Box and whisker plot of Modified Functional Disability Inventory scores at first visit to Post-COVID Clinic. Upper and lower quartiles are marked by the top and bottom of the boxes. The median is marked by a horizontal line inside the box and the mean is shown by the “x.” Top whiskers indicate the largest value ≤ the 3rd quartile plus 1.5 times the interquartile range; bottom whiskers indicate the smallest value ≥ the 1st quartile minus 1.5 times the interquartile range. Open circles extending beyond the whiskers represent outliers. Disability categories are from Kashikar-Zuck S, et al. Pain 2011;152:1600-1607. Conclusion This large experience with a PCC established early in the pandemic demonstrates that symptoms of post-COVID unwellness are non-specific and varied, routine tests are seldom diagnostic, and the natural history is one of gradual recovery. Disclosures Shanna M. Barton, M.D., M.Sc., Sanofi Pasteur: Grant/Research Support Victoria A. Statler, M.D., M.Sc., Astellas: University Research Support|Gilead: University Research Support|Pfizer: Advisor/Consultant|Sanofi: University Research Support|Seqirus: Advisor/Consultant Gary S. Marshall, MD, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|GlaxoSmithKline: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Advisor/Consultant|Seqirus: Grant/Research Support|Seqirus: Honoraria.

Clinical, Microbiological Profile and Treatment Outcomes of Infants with BCG Adenitis: A Retrospective Study.

Bacille Calmette-Guérin (BCG) adenitis is an uncommon complication following BCG vaccination. In rare cases, infants can develop other complications. Controversy exists regarding the diagnosis and management of these cases. Not much information is available in literature regarding their microbiological and immunological characteristics. Electronic medical records of children presenting to the Pediatric Infectious Diseases clinic in a tertiary care hospital from January 2011-December 2020 with a diagnosis of BCG adenitis were retrospectively reviewed. Their clinical, microbiological, treatment and follow-up data were noted and analyzed. During the study period, 40 infants presented with a probable diagnosis of BCG adenitis with or without disseminated BCG. Median age at symptom onset was 4(2.5-5.9) months. Nine infants had disseminated disease at presentation. Fifteen infants were suspected to have underlying immune deficiency of whom 12 had proven defects in immune function. On multivariable logistic regression analysis, presence of disseminated disease was the only factor predictive of underlying immunodeficiency. Isoniazid monoresistance was seen in seven cases (32%) of the 22 samples sent for TB cultures. Though BCG adenitis runs a benign course, it could rarely be the first manifestation of an underlying immune defect. There is sizable isoniazid monoresistance, hence sending tissue samples for microbiologic evaluation is necessary to guide anti-tubercular therapy.

A behavior change model to address caregiver hesitancy around COVID-19 vaccination in pediatrics

IntroductionMany families express hesitancy around immunizing their children against COVID-19. We sought to better understand the perspectives of vaccine hesitant caregivers, and develop targeted recommendations for health care workers and policymakers to engage in more effective vaccine discussions. MethodsWe conducted semi-structured telephone interviews with 23 caregivers recruited from a pediatric infectious diseases clinic, including a subset of patients referred to discuss vaccine hesitancy. Thematic analysis of the interviews identified themes that were mapped using behavior change models to identify perceived barriers and facilitators towards COVID-19 immunization. ResultsBarriers and facilitators were mapped to the WHO (World Health Organization) 3C’s (confidence, complacency, convenience) model of vaccine hesitancy as well as the COM-B (capability, opportunity, motivation) behavior change model. Barriers included mistrust in authorities, misperception of the risk of COVID-19 in children, and perceived health contraindications and negative previous vaccine experiences. Facilitators included positive relationships with healthcare workers, the promise of a “return to normal”, and societal pressures to immunize. ConclusionsEfforts to increase vaccine uptake in the pediatric population must target specific barriers and facilitators to immunization expressed by caregivers. To address these concerns, we suggest: 1. Educating hesitant caregivers by highlighting the long-term pandemic effects on children and the threat of COVID-19 to children’s health, 2. Building on the trust caregivers have in healthcare workers by involving frontline workers in public health policy, and 3. Harnessing the power of peer pressure by mobilization of societal pressures and establishing COVID-19 vaccination as the norm in children.

Çocukluk çağında bruselloz: 37 olgunun retrospektif değerlendirilmesi ve literatürün gözden geçirilmesi

Introduction: The aim of this study is to evaluate the demographic, clinical and laboratory characteristics and treatment results of pediatric patients followed up with the diagnosis of brucellosis in our clinic.Methods: Patients who were followed up with the diagnosis of brucellosis in Kayseri Training and Research Hospital, Pediatric Infectious Diseases Clinic between October 2016 and December 2018 were retrospectively analyzed.Results: A total of 37 patients, 26 (70.3%) male, were included in the study. The mean age of the patients whose ages ranged from 1 to 17 years was 9.3±4.3 years. Unpasteurized milk and/or dairy products were consumed in 86.5% of the patients and 48.6% had a family history of brucellosis. Joint pain (75.7%) was the most common presenting complaint. In the laboratory evaluation, 8.1% of the patients had leukopenia, 2.7% had thrombocytopenia and 21.4% had ALT elevation. Doxycycline plus rifampicin (43.2%) was the most commonly preferred treatment regimen. Addition of aminoglycoside to initial therapy in hospitalized patients was statistically higher than in outpatients (81.2% vs. 23.8%) (p=0.001). During the follow-up, relapse developed in a total of 4 (10.8%) patients, 3 of whom were outpatients. There was no statistical relationship between the initial treatment regimen and relapse (p=0.418).Conclusion: In conclusion, brucellosis should be kept in mind in terms of differential diagnosis in patients who present with joint pain in our country and who have cytopenia and/or isolated aminotransferase elevation in their investigations.Keywords: Child, Brucellosis, Relapse

Predictors of Mucocutaneous Disorders in HIV-infected Children in Port Harcourt, Southern Nigeria

Background: Unindentified and untreated mucocutaneous disorders can lead to adverse consequences among HIV-infected children. These include physical discomfort, disfigurement , loss of school attendance, social stigma , low self esteem and depression
 Aim: To determine the predictors of mucocutaneous disorders in HIV-infected children receiving care in two tertiary hospitals in Port Harcourt, Southern Nigeria.
 Place and Duration of Study: the study was conducted over a six month period at the Pediatric infectious diseases clinic of the University of Port Harcourt Teaching Hospital (UPTH) and Rivers State University Teaching Hospital (RSUTH) Port Harcourt.
 Materials and Methods: It was a cross sectional study involving 372 HIV-infected children. Study participants were recruited by simple random sampling. Diagnosis of mucocutaneous disorders was based on clinical findings and relevant laboratory investigations.
 Results: The prevalence of mucocutaneous disorders in the study subjects was 30.1% with Pruritic Papular Eruptions as the most occurring lesion. Factors predictive of the occurrence of mucocutaneous disorders in HIV-Infected-subjects included: low socio-economic status (p-value=0.048;AOR=1.81, 95% CI=1.01-3.24), sub-optimal adherence to HAART (p-value=0.008; AOR=2.72,95% CI=1.29-5.73), WHO clinical stages 3 and 4 (p-value=0.043;AOR=2.48,95% CI=1.03-5.97) and non viral suppression (p-value=0.0001; AOR=15.78, 95% CI=8.52-29.25).
 Conclusion: The presence of these factors in a HIV-infected child indicates a need for prompt evaluation for mucocutaneous lesions so as to limit morbidity and mortality from these disorders.

Nutritional status and its associated factors among HIV adolescents on second line regimen at Pediatric Infectious Diseases Clinic in Uganda

We performed a cross-sectional study to describe the nutritional status among HIV positive adolescents on Atazanavir-based regimen attending Pediatric Infectious Diseases Clinic (PIDC), in which 132 adolescents were included. Undernutrition was defined as a binary composite outcome (thinness or stunting): 28% were undernourished, 7.25% were thin, and 25% were stunted. Adolescents with no parent were more likely to be undernourished (APR: 2.50, 95% CI: 1.15–5.39, p-value = .020). Adolescents who had attained at least secondary education were less likely to be undernourished (APR: 0.54, CI:0.32–0.92, p-value = .024). Prevalence of undernutrition observed among HIV positive adolescents was lower compared to other studies. However, this is still high for an urban center, and this is concerning with increasing rates of drug resistance in an era of increased ART accessibility. This calls for more support and appropriate interventions for further optimizing nutrition care among adolescents on HIV treatment to mitigate the rise of resistance to second line regimens.

Behavioural abnormalities among school-age children living with HIV at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: The human immunodeficiency virus infection has manifestations causing behavioural and cognitive abnormalities among children. The aim of this study was to assess the magnitude and correlates of behavioural abnormalities among school-age children living with HIV attending follow-up at the Pediatric Infectious Diseases Clinic of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. Methods: A sample of 251 children and their primary caregivers were included in this study. The Strengths and Difficulties Questionnaire was used to assess behavioural abnormalities. Descriptive statistics and bivariate analysis using logistic regression were done to assess the determinants of abnormal behaviour scores. Results: The overall prevalence of any form of behavioural abnormalities was 49%. The prevalence of emotional symptoms was 31.5%, peer problems 21.5% and hyperactivity deficit was 13.1%. Children residing out of Addis Ababa, the capital city (AOR 0.18; 95% CI 0.03–0.94), children having both parents (AOR 0.29; 95% CI 0.12–0.70) and children having either of their parents (AOR 0.39; 95% CI 0.18–0.83) were less likely to have behavioural abnormalities. Moreover, children whose primary caregivers had elementary education or lower were more likely to have any form of behavioural abnormalities (AOR 2.44; 95% CI 1.05–5.69) Conclusions: The magnitude of behavioural abnormalities among children living with HIV is substantial. We recommend that children living with HIV, particularly those with parental losses and those having less-educated primary caregivers, be closely monitored for behavioural problems.

Prevalence of oral mucosal lesions in human immunodeficiency virus-infected children attending the Pediatric Infectious Diseases Clinic in Cape Town.

ObjectiveInvestigation of the prevalence of oral mucosal lesions in human immunodeficiency virus (HIV)‐infected children undergoing highly active antiretroviral therapy (HAART).Materials and MethodsCross‐sectional study of 66 HIV seropositive children, comprised of 28 (42.4%) females and 38 (57.6%) males (average age of 6 years). Study participants all required data regarding CD4+ T‐helper cell counts and the viral load. All participants underwent an orofacial clinical examination by calibrated clinicians. Associations between the presence of oral mucosal lesions, CD4+ cell counts, and viral load were analyzed using Poisson regression.ResultsThe prevalence of oral manifestations was detected in 21 children (31.8%). Oral lesions were detected in 16 children with viral load copies <50 cells/mm3 and 22 children with CD4+ counts >500 cells/mm3. Predominant lesions identified included angular cheilitis (36.7%), candidiasis (13.3%) and atypical oral ulcers (13.3%). The presence of one lesion was the most prevalent represented by 19 children. Oral lesions in relation to the CD4+ counts >500 resulted in; 14 children with one oral lesion, 5 with two lesions and 3 with three oral mucosal lesions. The other half of this CD4+ count patient group presented with no oral mucosal lesions. Oral lesions in relation Viral load copies <50 resulted in; 9 children with one oral lesion, 3 with two oral mucosal lesions and 4 with three oral mucosal lesions. The other half of this Viral load patient group presented with no oral mucosal lesions. No significant correlations were established between the presence of oral mucosal lesions and low CD4+ counts (p = 0.715) nor with high viral load counts (p = 0.638).ConclusionHIV‐related oral mucosal lesions still presented in the participants despite management with HAART. Based on the results, CD4+ counts and viral load does not appear to be suitable markers of orofacial involvement in children.

Comparing Watchful Waiting Approach vs. Antibiotic Therapy in Children with Nonsevere Acute Otitis Media: A Randomized Clinical Trial.

Objective To compare both approaches for the treatment of nonsevere acute otitis media (AOM) in Iran. Methods This randomized clinical trial was performed at a pediatric infectious diseases clinic in Buali tertiary hospital in Sari, north of Iran, from 2016 to 2018. All participants in this study were previously healthy children with AOM diagnosis, who were 6 months to 6 years old. The patients were randomly assigned into two groups: the intervention (80 mg/kg/day amoxicillin for 7-10 days) and the control group (watchful waiting approach). AOM recovery and adverse drug reactions were evaluated after 72 hours, and the patients were followed for the frequency of AOM and middle ear effusion 1 and 3 months' postintervention. Results A total of 396 children have participated in this study. AOM recovery was significantly different in the two groups (73% vs. 44% in the intervention and control groups, respectively). Recurrence of AOM and middle ear effusion (MEE) persistence, one month following the intervention, have not shown any significant differences between the two groups. However, the AOM recurrence between 1 and 3 months was more frequent in the control group. The frequency of diarrhea was also higher in the intervention group compared to the control but no significant difference was found between the two groups regarding vomiting and skin rash. Conclusion The faster recovery from AOM is achieved when an antibiotic treatment regimen is applied, although the risk of potential side effects should be considered.

ÇOCUKLARDA DERİN BOYUN ENFEKSİYONLARI; ÜÇÜNCÜ BASAMAK HASTANESİ VERİLERİ

OBJECTIVE: Deep neck infections (DNIs) are the infections developing in potential spaces between the layers of deep servical fascia. Clinical course may progress from early manifestations such as cellulite, myositis to serious DNI such as phlegmon and abscess. DNIs have crucial importance because of delayed diagnosis, fast progression, and severe complications. In this descriptive study, we aimed to present our seven-year experience about pediatric DNIs based on the clinical and laboratory characteristic of our patients.MATERIAL AND METHODS: Data of 58 hospitalized children who diagnosed with DNI between January 2010 and January 2017 in Pediatric Infectious Diseases Clinic were analysed retrospectively. Patients’ medical history and physical examination findings, laboratory and radiological imaging results, treatment modalities, and clinical courses were evaluated by reviewing medical records.RESULTS: Thirty (51.7%) of the patients were male, average age was 5.6±4.9 years. The most common symptom and physical finding was neck swelling (96.5%). Rates of C-reactive protein elevation, leucocytosis, and sedimentation elevation were 93%, 89%, and 72% respectively. By considering clinical condition, ultrasound scan was performed on patients with nonserious DNI (=cellulite phase) (n=26), computed tomography scan was performed on patients with serious DNI (= abscess) (n=28), and magnetic resonance imagination was performed (n=4) if CT scanner is out of order. In patients with abscess formation parapharyngeal localization (75%) was the most common. According to ultrasound scan, submandibular involvement (%46) was the most frequent region. The most common two etiology were acute tonsillopharyngitis (34%) and odontogenic factors (10%), and unknown etiology rate was 51%. Average duration of hospitalization was 9.7±5.9 days, 55% of patients were treated with intravenous ampicillin-sulbactam whereas 43% were treated with intravenous clindamycin. Twenty-two (38%) patients healed with medical treatment. Surgical drainage was performed on 36 (62%) patients in addition to medical treatment. There were bacterial growths in 18 (50%) drainage material cultures. Two (3.4%) patients were complicated with airway obstruction and mediastinitis while there was no mortality.CONCLUSIONS: Children with neck swelling and fever should be evaluated in terms of DNI, and also dental and tonsillar examinations should be done carefully. Contrast CT scan should be performed for pre-diagnosis of cases with serious DNI and surgical drainage should be performed in cases with abscess formation. DNIs threatening airway patency may cause severe morbidity and mortality, so early diagnosis, appropriate antibiotic therapy with or without surgical drainage may improve prognosis.

Factors Affecting the Prevalence of Skin Disorders among Human Immunodeficiency Virus (HIV) Infected Children in Aminu Kano Teaching Hospital (AKTH) Kano, Nigeria

Introduction: Among HIV infected children, skin disorders are vital as they give a clue to diagnosis of the HIV disease. Various factors are associated with occurrence of skin disorders among HIV infected children. Objectives: To determine the factors associated with prevalence of skin disorders among HIV infected children in Aminu Kano Teaching Hospital (AKTH) Kano, Nigeria. Materials and Methods: It was a cross-sectional study conducted to determine the factors affecting skin disorders among HIV infected children attending Paediatric Infectious Disease Clinic of Aminu Kano Teaching Hospital, Kano, Nigeria. A total of 223 HIV infected participants aged 6weeks to14 years were recruited for this study. Chi-square test or Fishers exact test where necessary were used to determine the difference between proportions of categorical variables and level of significance was set at 0.05. Multivariate analysis was used to further analyse significant relationships from the univariate analysis. The confidence level was set at 95% and a p-value less than 0.05 was considered statistically significant Results: There were 110 (49.3%) males and 113 females (50.7%). The male to female ratio was found to be 1:1.1. Seventy-eight percent (78%) of the children had skin disorder. A multivariate analysis showed that only age, social class and immune status were significantly associated with the occurrence of skin disorders. Conclusion: Among the HIV infected children, age, socioeconomic class and immune status were the factors found to determine the Prevalence of skin disorders.