Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Community-Associated and Health care- Associated Methicillin-Resistant Staphylococcus aureus in Children: A Microbiological and Epidemiological Study.

Aims: Novel methicillin-resistant Staphylococcus aureus have been causing infections in the community and are now invading hospitals. In this study we aimed to determine, using epidemiological and microbiological parameters, the characteristics of circulating S. aureus clinical isolates. Methods: From July 2009 to April 2012, S. aureus isolates from children hospitalized in Santa Casa de São Paulo, a tertiary care-center in São Paulo, Brazil, were included. All isolates grew in cultures from sterile sites and we included only one isolate per patient. Results: Fifty-five isolates were included during the study period, 47 from blood, six from abscesses, one from pleural fluid and one from spinal fluid. Among these isolates, 34 were methicillin susceptible S. aureus (MSSA) and 21 were methicillin-resistant S. aureus (MRSA). Eleven patients were excluded (5 MSSA and 6 MRSA) because clinical charts were not available for review, reducing the total to 29 MSSA and 15 MRSA isolates. After searching for risk factor for healthcare-associated infections, 11 of the 15 MRSA isolates were epidemiologically considered health care-associated MRSA (HCA-MRSA) and 4 community-associated MRSA (CA-MRSA). Using the microbiological classification (multiresistance), five were considered as HCA-MRSA and 10 were CA-MRSA. Interestingly, of the 11 isolates considered as epidemiological HCA-MRSA (presence of any risk factor), six had a microbiological profile (non-multiresistant) consistent with CAMRSA circulating clones. Conclusion: Our results clearly show that the boundaries between CA-MRSA and HCAare increasingly difficult to determine.