Virus Infection In Children Research Articles

P-1203. Acute Respiratory Viral Infections in Children with Malignancy in the CDC New Vaccine Surveillance Network, 2016–2020

Abstract Background Acute respiratory infections (ARI) can be severe in children with malignancy. We studied the frequency of respiratory viruses in children with cancer (leukemia, lymphoma, solid organ, or CNS) who presented with ARI in the CDC New Vaccine Surveillance Network.Table:Characteristics of Children with Cancer and Acute Respiratory Illness by Respiratory Virus Detected (December 2016–September 2021), N=240Abbreviations: N or n= number, NH= Non-Hispanic, ED = emergency department, ICU = intensive care unit*12 co-infections were noted (a total of 144 viruses were isolated)**Applies to inpatients only.*** Flu vaccinated included patients > 6 months of age verified as receiving at least one flu vaccine during the flu season in which the patient was enrolled. We did not examine vaccination timing in relation to illness onset or confounders for this study, and thus did not calculate vaccine effectiveness. The percentages represent the number vaccinated/number eligible for vaccine among patients age > 6 months during flu season.The number and percentages shown for detection of each virus (top row) are row percentages whereas the remaining percentages in the table are column percentage.The (2) SARS-CoV-2 detections were enrolled outside of flu season.*Total of 240 cancer patients, 230 were tested, 179 were eligible for the flu vaccine- those enrolled outside of the flu season or who were too young to receive a flu vaccine were excluded, Methods Active, prospective surveillance was conducted for children < 18 in the emergency department (ED) or hospitalized with ARI at 7 children’s hospitals from 12/1/16-9/28/20. ARI was defined as ≥1 of fever, cough, otalgia, congestion, rhinorrhea, sore throat, wheezing, shortness of breath/rapid or shallow breathing, apnea, or brief resolved unexplained event. Febrile neutropenia without ARI was excluded. Nasal/throat swabs were tested for respiratory syncytial virus (RSV), influenza A/B/C(Flu), parainfluenza 1-4(PIV), human metapneumovirus (HMPV), rhinovirus/enterovirus (RV/EV), adenovirus (AdV), and seasonal coronaviruses (HCoV), and SARS-CoV-2 after 1/1/20. Demographic/clinical data were collected by parent interview and chart abstraction. Patients were considered vaccinated against flu if they were > 6 months and had ≥ 1 dose verified from a registry or provider.. Results Of 34,455 ARI patients enrolled, 240(0.7%) had cancer, with a median age of 7 years and 187(78%) were hospitalized. A virus was detected in 132(55%), with > 1 virus detected in 12(5%). Viruses included RV/EV (38%), RSV (18%), Flu (17%), and PIV (14%) (Table). Inpatient and ICU admissions, respectively, were most common with RSV (83%, 10%), RV/EV (76%, 11%), HMPV (75%, 11%), and PIV (74%, 21%). Prolonged hospitalization ( > 5 days) was more common with PIV (50%), HCoV (43%), and RV/EV (26%). 10/19(53%) flu-positive children were vaccinated compared with 132/160(83%) flu-negative (p< 0.05). Mechanical ventilation was required for 1/50(2%) RV/EV-positive and 4/110(4%) of cancer patients with no virus identified. Conclusion Over 50% of children with cancer and ARI tested positive for ≥ 1 virus. Some viruses were associated with higher rates of hospitalization, ICU, and prolonged stay. There was a lower vaccination rate among flu-positive compared to flu-negative children. The study highlights the impact of viral ARI on children with cancer, emphasizing the need for prevention. Disclosures Janet A. Englund, MD, Abbvie: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Speaker at meeting|SanofiPasteur: Advisor/Consultant|Shinogi: Advisor/Consultant Christopher J. Harrison, MD, GSK: Grant/Research Support|Medscape: Honoraria|Merck: Grant/Research Support|Pfizer: Grant/Research Support|UpToDate: Honoraria Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Grant/Research Support|Abbott: Honoraria|BioMerieux: Grant/Research Support|Cepheid: Grant/Research Support|Diasorin: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Luminex: Grant/Research Support|Qiagen: Grant/Research Support Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support Geoffrey A. Weinberg, MD, Inhalon: Advisor/Consultant|Merck & Company: Honoraria for textbook chapter preparation Mary A. Staat, MD, MPH, Cepheid: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria

P-1170. Impact of Healthcare-associated Respiratory Virus Infections in Children

Abstract Background Respiratory viruses can spread within healthcare facilities despite stringent infection prevention measures. Although healthcare-associated respiratory virus infections (HARVI) pose a significant risk to children, pediatric HARVI are understudied. The present study aimed to evaluate the impact of HARVI on children following the SARS-CoV-2 pandemic at a tertiary children’s hospital. Methods This retrospective study enrolled pediatric inpatients aged ≤18 years who were hospitalized at Tokyo Metropolitan Children's Medical Center between April 2020 and March 2024. HARVI was defined as a viral infection with a new onset of respiratory symptoms past the incubation period following hospitalization. The causative virus was detected using multiplex PCR (FilmArray Respiratory Panel 2.1, BioFire). Patients with other infections were excluded. The primary outcome was the 30-day mortality rate. The secondary outcomes included PICU admission, escalation of respiratory support, and the postponement of discharge, planned surgery or chemotherapy. Results In total, 265 patients with HARVI were enrolled. Male patients comprised 31% of the cohort, and the median age was 31 (IQR [interquartile range]: 12-77) months. Underlying neurologic, cardiac, and congenital or genetic disorders had in 42%, 28%, and 24% of the cohort, respectively. The respiratory viruses detected were the rhinovirus/enterovirus (44%), parainfluenza virus type 3 (15%), and HKU1, NL63, 229E and OC43 coronaviruses (8%). The 30-day mortality rate was 1% in three patients with parainfluenza virus type 3, RSV, and SARS-CoV-2. The PICU admission rate was 2%. The rate of respiratory support escalation was 17%. Postponement of discharge was required in 7% of the cohort for a median period of seven (IQR: 5-8) days. Postponement of surgery was required in 3% of the cohort for a median period of 46 (IQR: 21-82) days. There was no postponement of chemotherapy. Conclusion Pediatric HARVI was associated with mortality and additional medical care. Therefore, strict infection prevention measures are essential. Disclosures Hanako Funakoshi, MD, Pfizer Japan: Husband is an employee.

Impact of water, sanitation, and hygiene indicators on enteric viral pathogens among under-5 children in low resource settings.

Poor water, sanitation, and hygiene (WASH) are the primary risks of exposure to enteric viral infection. Our study aimed to describe the role of WASH conditions and practices as risk factors for enteric viral infections in children under 5. Literature on the risk factors associated with all-cause diarrhea masks the taxa-specific drivers of diarrhea from specific pathogens, limiting the application of relevant control strategies. We analyzed data from children enrolled in the Global Enteric Multicenter Study (GEMS) across seven study sites between December 2007 and March 2011 as cases (moderate-to-severe diarrhea: MSD) and asymptomatic controls. MSD was defined as new and acute diarrhea, with at least one of the following criteria for MSD: dehydration based on the study clinician's assessment, dysentery, or hospitalization with diarrhea or dysentery. Multiple logistic regression was used to examine the role of water quality, sanitation access, and hygiene facilities on the enteric viral pathogens adjusted for potential covariates. Among MSD symptomatic children (cases), longer water retrieval time (≥15 vs <15min) was associated with increased Norovirus (aOR 1.33, 95% CI 1.08-1.64) and Astrovirus (aOR 1.43, 95% CI 1.01-2.02); scooping as drinking water retrieval method was associated with lower Rotavirus (aOR 0.77, 95% CI 0.62-0.96), but higher Adenovirus (aOR 2.3, 95% CI 1.32-4.11) infection compared to non-users. Among asymptomatic children (controls), consumption of non-tube well drinking water was associated with higher Norovirus infection (aOR 1.38, 95% CI 1.01-1.89). Longer drinking water retrieval time (≥15 vs <15min) increased Norovirus (aOR 1.47, 95% CI 1.21-1.78) and Rotavirus (aOR 1.51, 95% CI 1.20-1.89) infections. Pouring (aOR 0.51, 95% CI 0.32-0.83) or scooping drinking water with a cup (aOR: 0.52; 95% CI: 0.32, 0.86) lower Astrovirus infection; restricted water access (aOR 1.57, 95% CI 1.21-2.02) higher Rotavirus infection. Handwashing before cooking was associated with lower Astrovirus (aOR 0.64, 95% CI 0.47-0.88) infection in asymptomatic children. Our analysis did not find a significant effect of poor sanitation on different enteric viral pathogens examined. Norovirus and Astrovirus were detected more commonly in sub-Saharan Africa while Rotavirus was less prevalent than South Asia. Though we found statistically significant associations, we did not observe any overall pattern between WASH and enteric viral pathogens. Our findings provide insights to guide further research on targeted interventions for enteric viral pathogens, responsible for a major burden of pediatric diarrhea globally.

Occult Hepatitis B virus infection in children

Occult Hepatitis B virus infection in children

Imaginations of Feasibility, Method of Production and Benefits of Oral MMR Vaccine

Measles, mumps and rubella are acute infectious diseases caused by viral infections in children and caused great harm before the use of vaccines. The Measles, Mumps and Rubella (MMR) oral vaccine indicates a breakthrough in the fight against three infectious diseases which are measles, mumps and rubella. Unlike the traditional injectable MMR vaccine. This oral vaccine does not require an injection, and it can improve patient acceptance. The purpose of this paper is to provide a comprehensive study of the development, efficacy and safety of the oral MMR vaccine and compare it with the traditional injectable vaccine. It will emphasize the benefits of oral vaccines, such as reduced needle-related fears and increased accessibility, which are particularly beneficial in resource-limited settings where needle vaccination may be impractical. In addition, this paper will discuss the challenges of maintaining vaccine stability, dosage accuracy, vaccine efficacy and safety. Through these analyses, this paper seeks to determine whether oral MMR vaccine can be a viable alternative to global immunization efforts.

Influenza Virus-Associated Acute Necrotizing Encephalopathy in Two Young Children: Case Report

Background and Clinical Significance: Acute necrotizing encephalopathy (ANE) represents a severe complication, mainly described in children, of influenza virus infection. We report the cases of two young girls with ANE associated with influenza virus infection who were diagnosed by MRI cerebral scan. Case Presentation: A 7-year-old girl with a history of a previous episode of ANE presented with a worsening drowsy state and seizures. In the second case, an otherwise healthy 5-year-old girl presented with fever, seizures, and marked neurological deterioration. In both cases, nasopharyngeal swab testing was positive for influenza virus A, while cerebral MRI indicated ANE. Despite aggressive treatment with high-dose corticosteroids and a five-day course ofimmunoglobulins, the ultimate prognosis was poor in both patients. ANE is a serious complication of viral infections in children, with a high mortality rate and a broad spectrum of neurological sequelae. To date, the pathophysiology and management of influenza virus-induced ANE remain uncertain. Although ANE is usually sporadic, familial and recurrent cases have been reported, and anRAN-binding protein (RANBP2) mutation has occasionally been associated with its occurrence.Conclusions: Rapid recognition of neurological symptoms and suspicion of a viral trigger, especially in influenza-like illnesses, are both essential for the timely administration of effective therapy. Further research is needed to clarify the pathophysiology of ANE and establish the best therapeutic strategies to fight such a deadly disease.

Epidemiological characteristics of eleven common respiratory viral infections in children

BackgroundLower respiratory tract infections (LRTIs) are one of the leading causes of hospital admissions among children. In this study, we aimed to describe the epidemiological characteristics of viral pathogens associated with LRTIs in hospitalized children in Yan’an; this has yet to be reported in the literature and may guide public health interventions and resource allocation in this region.MethodsBetween June 2021 and May 2023, we conducted a retrospective analysis of the results of viral detection using oral pharyngeal swabs from 4565 children with LRTIs in the Inpatient Department of Yan’an University Affiliated Hospital. Eleven respiratory viruses, including influenza A virus (Flu A), influenza A H1N1 virus (H1N1), seasonal influenza A H3N2 virus (H3N2), influenza B virus (Flu B), parainfluenza virus (HPIV), adenovirus (HADV), bocavirus (HBoV), rhinovirus (HRV), metapneumovirus (HNPV), coronavirus (HCoV), and respiratory syncytial virus (HRSV), were confirmed by applying a multiplex real-time polymerase chain reaction (PCR) kit for respiratory viruses. We evaluated the epidemiological features of infections caused by respiratory pathogens, including aging, gender and the seasonal variations of different pathogens, and explored the high-risk factors associated with virus-caused pneumonia.ResultsAt least one virus was detected in all 4565 cases; the positivity rate was 27.95%. We also detected a total of 1,276 cases with mixed infections (with two or more viruses). Of the positive cases, 59.3% were male and 40.7% were female (x2 = 0.41, P = 0.68). The highest positivity rates for respiratory pathogens were observed for HRSV, HRV, and HADV, at 5.98%, 5.67%, and 4.38%, respectively. We also observed variations in the number and positivity rates of respiratory pathogen infections by season, age and gender. HPIV (x2 = 12.05, P < 0.05) and HADV (x2 = 11.73, P < 0.05) were more common in children under three years-of-age. Notably, with the exception of the 1 to < 3 years age group, males consistently demonstrated elevated infection rates across other age groups.ConclusionsOur analysis revealed that respiratory pathogen infections varied by gender, season, and age in the enrolled population of children.

Epidemiological characteristics of respiratory syncytial virus infection in children in Nanchang and its correlation with climate environmental factors

To explore the epidemiological characteristics of respiratory syncytial virus (RSV) infection in children in Nanchang and its correlation with climate environmental factors. The clinical data were collected from children with acute respiratory infection in Nanchang who were tested for RSV at Jiangxi Provincial Children's Hospital from January 2019 to December 2023, along with climate environmental data for the same period. The epidemiological characteristics of RSV and their correlation with climate environmental factors were investigated. A total of 178 127 children underwent RSV testing from January 2019 to December 2023, with a positive detection rate of 8.35% (14 873/178 127). The positive detection rate in males was 8.92% (10 137/113 660), which was higher than that in females (7.35%, 4 736/64 467). The differences in RSV positive detection rates among different age groups were statistically significant (P<0.001), with the highest rate observed in the 0 to <3 months age group (14.38%, 3 328/23 142). Peaks in RSV positive detection occurred during winter and spring periods in 2019, 2020, and 2022, while in 2023, it occurred in spring and summer periods, with no seasonality noted in 2021. The RSV positive detection rate showed a positive correlation with average humidity, average atmospheric pressure, monthly PM2.5, and monthly carbon monoxide levels (P<0.05), while it showed a negative correlation with average wind speed, average temperature, and maximum 8-hour ozone levels (P<0.05). In Nanchang, the RSV positive detection rate in children with acute respiratory infection is higher in males than in females. Among children of all age groups, the infants aged 0 to <3 months have the highest detection rate of RSV. RSV infection predominantly occurs in winter and spring periods. Lower temperatures, lower wind speeds, higher humidity, and elevated levels of PM2.5 and carbon monoxide may increase the risk of RSV infection in children.

Onychomadesis and Beau’s Lines- Rare Complications of Hand- foot-and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. Bangladesh J Child Health 2023; Vol 47 (2) : 109-112

Parenteral aciclovir for suspected herpes simplex virus infection in children: 0–18 years

Abstract Background Variations in neonatal aciclovir prescribing for suspected herpes simplex virus (HSV) disease are well-known, but there are limited data describing aciclovir prescribing in older children. Methods Medical records of neonates (≤28 days) and children (29 days to 18 years) prescribed intravenous aciclovir for suspected HSV disease (1 January 2019–12 December 2019) in eight Australian and New Zealand hospitals were reviewed. Prescribing indication, HSV testing, aciclovir prescription details, adverse events and discharge diagnosis were recorded. Results 1426 received empirical aciclovir. For neonates (n = 425), the median duration was 1 day (IQR 1–3), 411/425 underwent HSV investigations and 13/425 had HSV disease (two with disseminated encephalitis, four with encephalitis and seven with skin, eye, mouth disease). Of the 1001 children, 906 were immunocompetent. 136/906 suspected of mucocutaneous disease received aciclovir for a median of 2 days (1–2), 121/136 underwent HSV testing, and 69/136 had proven disease. 770/906 received aciclovir for suspected disseminated disease or encephalitis for a median of 1 day (1–2), 556/770 underwent HSV testing, and 5/770 had disseminated disease or encephalitis. Among 95 immunocompromised children, 53/58 with suspected mucocutaneous disease had HSV testing and this was confirmed in 22. Disseminated disease or encephalitis was suspected in 37/95, HSV testing conducted in 23/37 and detected in one. The median aciclovir duration was 3 (2–7) days for immunocompromised children. Nephrotoxicity occurred in 7/1426 and 24/1426 had an extravasation injury. Conclusion Frequent and often unnecessary intravenous aciclovir prescribing for suspected HSV encephalitis or disseminated disease occurred in children, as evidenced by incomplete HSV investigations and only 5/770 older children having the diagnosis confirmed.

Epidemiological and clinical characteristics of respiratory syncytial virus infections in children in Jiangsu Province, 2014-2023

Objective: To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023. Methods: The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results: In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M(Q1,Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant (χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age (χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) (χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions: RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Burden of Respiratory Syncytial Virus Infection in Children and Older Patients Hospitalized with Asthma: A Seven-Year Longitudinal Population-Based Study in Spain.

(1) Background: To describe hospitalizations due to respiratory syncytial virus (RSV) infection among children and elderly patients with asthma. (2) Methods: We used a nationwide discharge database to select patients with asthma aged 0 to 15 years and ≥65 years admitted to Spanish hospitals from 2016 to 2022. (3) Results: We identified 49,086 children and 471,947 elderly patients hospitalized with asthma (3.52% and 0.51%, respectively, with RSV). The proportion of RSV increased over time in children with asthma (from 1.44% to 7.4%, p < 0.001) and in elderly individuals (from 0.17% to 1.01%, p < 0.001). Among children with RSV infection, the presence of influenza (OR 3.65; 95% CI 1.46-9.1) and pneumonia (OR 1.85; 95% CI 1.02-3.55) increased the risk of poor outcome. The presence of RSV was associated with severity in these patients, defined by use of mechanical ventilation and/or admission to the intensive care unit (OR 1.44; 95% CI 1.11-1.86). In elderly patients with RSV infection, older age, congestive heart failure, COVID-19, and pneumonia increased the risk of in-hospital mortality (IHM). However, RSV infection was not associated with IHM (OR 0.88; 95% CI 0.68-1.15) in these patients. (4) Conclusion: Our results highlight the impact of RSV infection in children and elderly patients hospitalized with asthma. Strategies to improve surveillance, prophylaxis, and management of RSV infection should be evaluated.

Features of hyperinflammation link the biology of EBV infection and cytokine storm syndromes

BackgroundOvert immune activation by viral infections can lead to cytokine storm syndromes, such as hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS). ObjectiveWe aim to compare the immune response to different viral pathogens to understand the connection between infections and cytokine storm syndromes. MethodsWe recruited children who presented to the emergency room with fever for ≥ 3 days. We performed immune profiling using Olink proximity extension assay and flow cytometry. We compared the findings with cases of HLH, MAS, Kawasaki disease (KD), and multisystem inflammatory syndrome in children (MIS-C). ResultsWe enrolled 352 febrile patients and studied 110 cases with confirmed common viral infections. We found that Epstein-Barr virus (EBV) uniquely triggered high levels of multiple cytokines (IL-18, IL-27, tumor necrosis factor, FLT3 ligand, and lymphotoxin alpha) and IFN-γ-induced chemokines (CXCL9/10/11 and CCL19). These patterns are similar to the hyperinflammatory response associated with HLH / MAS, but less consistent with the findings in KD and MIS-C. Flow cytometry analysis revealed that CD38+HLA-DR+ T lymphocytes, which are pathogenic cells responsible for IFN-γ production in HLH / MAS, are vastly expanded in patients with acute EBV infection. Cell sorting identified CD38+HLA-DR+ T cells as atypical lymphocytes that are classically associated with acute EBV infection. ConclusionThis work broadens our understanding of common viral infections in children and provides an immunologic basis for the link between EBV infection and HLH / MAS.

Respiratory Syncytial Virus Infection in Children with Bronchiolitis

Background: Respiratory Syncytial Virus (RSV) is the most common organism causing bronchiolitis. Bronchiolitis is almost always diagnosed clinically. As a result, the availability of bedside sensitive rapid RSV antigen tests is critical for timely RSV acute respiratory infection diagnosis. Methods and materials: This study was conducted to detect RSV antigen positivity and the sociodemographic profile of children with RSV antigen positive bronchiolitis. From October 2022 to March 2023, this observational study was conducted in the pediatrics department of Chattogram Medical College Hospital. Ninety-two nasopharyngeal swabs from children younger than two years, were tested for RSV antigen. The mean and standard deviation were used to express the demographic data. Chi-square analysis was used to examine differences in group proportions. Results: RSV antigen positivity was detected in 45.7% of the 92 cases, with a mean age of 4.18±3.08 months. Severe bronchiolitis cases were more common (22.8%) among antigen positive cases and had the longest hospital stay. During the months of November (42.4%) and December (29.3%), RSV infection levels peaked. This study describes that during the seasonal epidemics, RSV was the main concern, as the number of positive cases decreased in the months that followed. The signs and symptoms of RSV positive and negative cases were not significantly different. Conclusion: A simple, low-cost and bedside RSV test can be considered as a valuable diagnostic tool in a low resource setting. J Bangladesh Coll Phys Surg 2024; 42: 368-378

Onychomadesis and Beau’s Lines- Rare Complications of Handfoot- and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 47-50

Acute onset psychiatric diseases after SARS-CoV-2 virus infection among pediatric patients.

Psychiatric symptoms directly associated with SARS-CoV-2 virus infection have been reported sporadically in children. More cases of new-onset psychosis without severe cardinal symptoms, altered consciousness level, and psychogenic drug usage would offer compelling grounds for the association between the virus infection and psychosis. We collected the clinical data of pediatric patients with new onset psychiatric symptoms after the SARS-CoV-2 virus infection from December 2022 to Feb 2023 and followed up with them for 1 year. These children did not have severe respiratory, cardiovascular, or systemic symptoms. They were not given psychogenic drugs. We also searched Pubmed to identify previously reported acute onset psychiatric cases related to SARS-CoV-2 virus infection in children. We summarized these patients' clinical symptoms, laboratory examination, treatment, and prognosis. We reported 11 new cases of psychiatric disease directly related to SARS-CoV-2 virus infection and reviewed 12 previously reported cases among children and adolescents. They had various psychiatric symptoms within 3 weeks after the virus infection. Brain MRI and EEG recording did not reveal remarkable abnormalities. The cerebrospinal fluid analysis (CSF) could find increased protein, immunoglobulin, and IL-8 levels, disrupted blood-brain barrier, and positive oligoclonal band in a minority of the patients. Most of the patients had good outcomes. New-onset psychiatric symptoms directly related to SARS-CoV-2 virus infection are not rare phenomena among pediatric patients. CSF tests support the presence of central immune responses in some patients. Although these patients received different treatments, most of them had good prognoses.

Incidence and predictors of common opportunistic infections among children living with HIV at Bahir Dar City, Ethiopia

Despite the dramatic decline in the incidence of common opportunistic infections (OIs) after antiretroviral therapy initiation, they remain a significant cause of morbidity and mortality among children with HIV. For better interventions, information regarding the incidence and predictors of common OIs is essential for Children living with HIV. Still, there is a lack of studies in low and middle-income countries, including Ethiopia. Therefore, this study aims to assess the incidence and predictors of common OIs among Children living with HIV on anti-retroviral therapy (ART) at public health institutions in Bahir Dar City, Northwest Ethiopia. The reasons for excluding children not on ART is we want to study the effectiveness of chronic HIV care service, ART drugs and OIs prophylaxis drugs for the prevention of common OIs because it is obvious that the occurrence of OIs in children not on ART and OIs prophylaxis drugs is high. A health institution-based retrospective cohort study was done among 403 Human Immunodeficiency Virus-infected children at public health institutions in Bahir Dar City from 2010 to 2020. Data was entered using Epi-data version 4.6 and analyzed using STATA 14.0. A bivariable Cox-proportional hazards regression model was employed to appreciate the relationship between each explanatory variable with the outcome variable. In the bivariable analysis, variables with a p-value of less than 0.25 were candidates for the multivariable proportional hazard model. The Cox proportional hazards model was used to determine predictors of common opportunistic infections at a 5% significance level. The overall incidence rate of common opportunistic infections was 7.06 with a 95% confidence interval ((CI) 5.78, 9.75) per 100 person-years of observation. Statically significant predictors were World Health Organization (WHO) clinical stage III and IV (adjusted hazard ratio (AHR) = 1.90; (95% CI 1.34, 2.75), having fair/poor adherence to anti-retroviral therapy (ART) (AHR) = 1.80; (95% CI 1.25, 2.94) and hemoglobin level < 10 g/dl (AHR) = 2.00; (95% CI 1.36, 2.89). The overall incidence rate of common OIs among children living with HIV on ART was high. Independent predictors of common OIs among children on ART were advanced-stage of HIV disease, poor ART adherence, and lower hemoglobin level. Therefore, we recommend strongly working on the prevention of advanced stages of HIV disease and improving poor ART adherence to prevent the incidence of OIs among children living with HIV on ART.

Metagenomic characterization of viruses in the serum of children with newly diagnosed cancer

Background and ObjectivesA large cohort of pediatric patients with various forms of childhood cancer was investigated for the presence of viruses using metagenomics. A total of 476 patient samples, collected between 1989 and 2018, were analyzed, representing various pediatric oncological diagnoses and a control group of non-malignant diagnoses. Study designThe study was carried out using metagenomic sequencing of serum samples. Viruses were identified and analyzed using bioinformatics methods, followed by Polymerase chain reaction (PCR) confirmation ResultsThe results indicate that a wide range of viruses can be detected in the bloodstream of children with newly diagnosed cancer. Nine viral genomes were identified: Human Pegivirus (HPgV), Hepatitis C virus, Parechovirus 1, Rhinovirus C, Human papillomavirus 116, Human polyomavirus 10, Parvovirus B19, and different variants of Torque Teno Virus (TTV). In this study, a previously unknown virus was found belonging to the Iflavirdae family in the order Picornavirales. HPGV was significantly more common in patients with leukemia compared to other conditions. ConclusionsThese results highlight the abundance of systemic virus infections in children, and the value of metagenomic sequencing for hypothesis forming regarding the associations between virus infections and cancer.

Epidemiological Characteristics of Upper Respiratory Tract Pathogens in Children in Guangdong, China.

Researches on the epidemiology of various respiratory pathogens at multiple testing points in the pediatric population are limited, and these are crucial for the prevention of respiratory tract infections in children. We obtained 1788 upper respiratory tract swabs from children exhibiting symptoms of respiratory infection (notably fever with a body temperature exceeding 38.5°C) across five hospitals in Guangdong between November 2020 and June 2022. We used the multiplex probe amplification (MPA) PCR testing to identify 11 respiratory viruses and subsequently analyzed the prevalence characteristics of these pathogens among febrile children in hospitals. The overall detection rate of the pathogens was 58.1% (1039/1788). Human rhinovirus (HRV) exhibited the highest detection rate at 19.0% (339/1788), succeeded by human parainfluenza virus (HPIV), human adenovirus (HAdV), and respiratory syncytial virus (RSV). The positivity and coinfection rates were higher in children aged 5 years and below compared to those above 5 years. Moreover, a distinct pathogen spectrum was observed across different age groups. Hospitalized patients demonstrated a significantly higher positivity and coinfection rate compared to outpatients. During COVID-2019, RSV appeared a counter-seasonal trend. Respiratory viral infections in children display distinct characteristics concerning age, hospitalization status, and seasonality. Children under the age of 5 and minor patients admitted to hospitals at least be tested for RSV, HRV, HPIV, and HAdV. The epidemiological patterns of RSV in the post-epidemic period require ongoing surveillance.

Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023.

BackgroundAfter most COVID-19 pandemic control measures were lifted in 2022, many infectious diseases re-emerged. An increase in invasive group A streptococcal (iGAS) infections among adults and young children was reported by several countries. Viral infections including influenza and varicella, known risk factors for iGAS infection, also increased.AimTo estimate the proportion of GAS skin and soft tissue infections (SSTI) and pneumonia/sepsis in children (≤ 5 years) attributable to varicella, and the proportion of GAS pneumonia/sepsis in children and adults attributable to potentially predisposing respiratory viruses influenza A and B, RSV, hMPV and SARS-CoV-2 in the Netherlands.MethodsWe performed time series regression using weekly data on respiratory viruses, varicella and non-invasive GAS infections and GAS isolates cultured from blood, lower airways, skin, pus and wounds, from January 2010 to March 2023.ResultsIn 2010-19, 50% (95% CI: 36-64) of GAS SSTI in children were attributable to varicella. Between January 2022 and March 2023, 34% (95% CI: 24-43) of GAS SSTI cases were attributable to varicella. Of iGAS pneumonia/sepsis between January 2022 and March 2023, 34% (95% CI: 20-49) and 25% (95% CI: 18-32) was attributable to respiratory virus infections in children and adults, respectively, with the largest contributor (17%) being influenza A.ConclusionsPredisposing viral infections likely contributed to, but cannot fully explain, the observed iGAS increase among children and adults in 2022-23 in the Netherlands. Public health measures to control viral infections, such as vaccination against varicella or influenza, might reduce the iGAS disease burden.