Pediatric COVID-19: clinical and epidemiological data of 1303 cases in a general hospital in Brazil / COVID-19 pediátrico: dados clínicos e epidemiológicos de 1303 casos em um hospital geral no Brasil

ABSTRACT Objective: This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. Methods: Epidemiological and clinical data of patients younger than 20 years old were collected from patients' medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. Results: We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. Conclusions: We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.

RESUMO Objetivo: Este estudo teve como objetivo descrever as características clínicas da população pediátrica com COVID-19 no setor de emergência de um hospital geral brasileiro. Métodos: Os dados epidemiológicos e clínicos de pacientes idade inferior a 20 anos foram coletados dos prontuários dos pacientes de fevereiro de 2020 a julho de 2021. A maior parte dos dados epidemiológicos descritos refere-se a pacientes hospitalizados. Também foram revisados as coinfecções, o tratamento e os desfechos de internação e comparadas a primeira e a segunda ondas de COVID-19. Resultados: Foi identificado o total de 1.303 episódios de infecção por SARS-CoV-2. A mediana de tempo desde o início dos sintomas até o diagnóstico foi de três dias. Os sintomas estiveram presentes em 92,3% dos pacientes. Os sintomas mais comuns foram febre (45,2%), congestão/secreção nasal (44,2%) e tosse (39,4%). Radiografia e tomografia de tórax foram realizadas em 7,7 e 3,3% dos casos, com achados anormais em 29,7 e 53,4%, respectivamente. As internações hospitalares ocorreram em 3,5% dos pacientes, principalmente na presença de comorbidades, em crianças menores de cinco anos e naqueles que se apresentaram no pronto-socorro durante a primeira onda de COVID-19. Foi identificada coinfecção viral em 20% dos 71 casos testados e teste rápido positivo para Streptococcus pyogenes em 8% dos 174 casos testados, não havendo impacto dessas coinfecções quanto à internação hospitalar. Conclusões: Observamos que a COVID-19 foi uma doença leve na maioria das crianças de nossa população, com a maior parte das hospitalizações e readmissões ocorrendo durante a primeira onda de COVID-19.

A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers

ABSTRACT In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.

Pediatric hospital admissions from influenza A (H1N1) in Brazil: effects of the 2010 vaccination campaign

lIn 2009, the influenza A (H1N1) virus spread rapidly around the world, causing the first pandemic of the 21st Century. In 2010, there was a vaccination campaign against this new virus subtype to reduce the morbidity and mortality of the disease in some countries, including Brazil. Herein, we describe the clinical and epidemiological characteristics of patients under 19 years of age who were hospitalized with confirmed influenza A (H1N1) infection in 2009 and 2010. We retrospectively reviewed files from the pediatric patients who were admitted to a university hospital with real-time polymerase chain reaction (RT-PCR) confirmed influenza A (H1N1) infection in 2009 and 2010. There were 37 hospitalized patients with influenza A (H1N1) in 2009 and 2 in 2010. In 2009, many of the hospitalized children had an underlying chronic disease and a lower median age than those not hospitalized. Of the hospitalized patients, 78% had a chronic disease, primarily pneumopathy (48%). The main signs and symptoms of influenza were fever (97%), cough (76%), and dyspnea (59%). Complications occurred in 81% of the patients. The median length of hospitalization was five days; 27% of the patients required intensive care, and two died. In 2010, two patients were hospitalized with influenza A (H1N1): one infant with adenovirus co-infection who had received one previous H1N1 vaccine dose and presented with respiratory sequelae and a 2-month-old infant who had a hospital-acquired infection. An impressive reduction in hospital admissions was observed in 2010 when the vaccination campaign took place in Brazil.

Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital

Objectives: To determine the impact of an educational program on the prevention of central venous catheter-related infections in a Brazilian Pediatric Intensive Care Unit. Patients and Methods: All patients admitted to the unit between February 2004 and May 2005 were included in the cohort study in a longitudinal assessment. An educational program was developed based on the Centers for Disease Control and Prevention recommendations for prevention of catheter-associated infections and was adapted to local conditions and resources after an initial observational phase. Incidence of catheter-associated infections was measured by means of on-site surveillance. Results: One hundred eighteen nosocomial infections occurred in 253 patients (46.6 infections per 100 admissions) and in 2,954 patient-days (39.9 infections per 1,000 patient-days). The incidence-density of catheter infections was 31.1 episodes per 1.000 venous central catheter-days before interventions, and 16.5 episodes per 1,000 venous central catheter-days afterwards (relative risk 0.53 [95 percent CI 0.28-1.01]). Corresponding rates for exit-site catheter infections were 8.0 and 2.5 episodes per 1,000 venous central catheter-days [0.32 (0.07-1.49)], and the rates for bloodstream infections were 23.1 and 13.9 episodes per 1,000 venous central catheter-days, before and after interventions [0.61 (0.32-1.14)]. Conclusion: A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit.

Nosocomial infection in a pediatric intensive care unit in a developing country

OBJECTIVE: Determine the rate and outcome of nosocomial infection (NI) in pediatric intensive care unit patients in a developing country. DESIGN: Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomial infection and NNISS (National Nosocomial Infection Surveillance System) methodology. SETTING: São Paulo Hospital - Universidade Federal de São Paulo - Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. PARTICIPANTS: All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. RESULTS: The NI incidence was 18.3 percent and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6 percent), followed by bloodstream infections (17.3 percent), and surgical site infection (17.3 percent). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8 percent), followed by Gram-positive bacterias (23.8 percent), and yeasts. CONCLUSION: Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population.

Meningoencefalite fatal por vírus coxsackie B2 em escolar / Coxsackie B2 viirus fatal meningoencephalitis in a student

Objetivo: Apresentar o caso de uma menina previamente hígida, com evolução fatal devido a meningoencefalite por víirus Coxsackie B2. Métodos: Os autores descrevem um caso de uma criança do sexo feminino com, meningoencefalite fatal por vírus Coxsackie B2 e apresentam revisão da literatura (Medline e Licacs). Resultados: É descrito um caso de uma menina de oito anos de idade, que apresentou quadro meningoencefalítico de má evolução, resultando em óbito no 32§ dia de internação. Os exames realizados mostraram sorologia positiva para Coxsackie B2, sendo o vírus isolado de duas amostras de fezes. O exame liquórico mostrou aumento maior que quatro vezes na titulação para Coxsackie B2. Conclusões: A evolução para óbito de pacientes hígidos apresentando encefalite por enterovírus, conforme o descrito, é pouco referido na literatura, talvez por falta de suspeita clínica. O relato deste caso demonstra a importância do diagnóstico etiológico precoce nas meningoencefalites e da busca de tratamento etiológico específico