Case Series of Severe Multisystem Inflammatory Syndrome in Children (Mis-C) in a Tunisian Picu (2020-2021)

BACKGROUND AND AIM: Multisystem inflammatory syndrome in children (MIS-C) is a new serious emerging disease related to previous exposure to coronavirus infection disease (COVID-19). AIM: To describe the clinical features, laboratory findings, therapies, and outcomes of children with MIS-C in a Tunisian PICU. METHOD(S): Prospective study conducted between 01 November and 30 December 2021. Patients aged less than 15 years, admitted to our PICU, and met the criteria for MIS-C according to the WHO definition case, were included. Demographic and clinical data, laboratory test results, echocardiographic findings, treatment, and outcomes were collected during hospitalization. RESULT(S): The median age was 9 years (IQR: 5-10). Obesity was noted in 1 patient. Ten patients were boys. Median delay between symptom and PICU admission was 6days (IQR:5-7). Fever and gastrointestinal symptoms were reported in all cases. Five patients had marked abdominal pain and were examined by the surgeon for a possible appendicitis. Cardiac dysfunction was reported in 13 cases with a median LVEF 42% (IQR: 33-50). Two patients had a vasoplegic shock and needed norepinephrine. Median CRP was 281mg/l (166-347). Median lymphocyte count was 880cells /mm3(520-1270). Median D-Dimers was 4631 ng/ ml (1582-8672). Median troponin was 339ng/L (IQR: 36 879). Median pro BNP was 9199pg/ml (2825-25000). All patients had positive SARS-COV-2 serology. Only 4 patients required mechanical ventilation. All patients received inotropes, immunoglobulins, methyl prednisolone and a low dose of aspirin. One patient died. CONCLUSION(S): We report herein clinical features, management, and outcomes of critically ill children with MIS-C to highlight the severity of clinical presentation with a good prognosis.

Clinical Characteristics and Outcomes of Severe and Critical Forms of Covid-19 (Delta Variant) in Children

BACKGROUND AND AIM: Clinical signs and illness course during the period of Delta variant predominance have not been well described in critically ill children. AIM: to describe clinical characteristics and outcomes of severe and critical forms of COVID-19 during the fourth wave which was catalyzed by Delta variant. METHOD(S): We performed a retrospective study, between June and August 2021, carried out in a Tunisian PICU. We included all critically ill children, aged under 15 years, with a confirmed case of COVID-19, defined by a real time reversetranscriptase polymerase chain reaction (RT-PCR) positive result testing. Patients 'data were extracted from medical records. RESULT(S): Twenty patients were included, and no underlying medical conditions were recorded. Median age was 47 days (IQR:26.5-77). Six patients were aged < 28 days. Sex-ratio was 0.8. COVID-19 infection was critical in 14 patients and severe in 6. Eleven patients had a pediatric acute respiratory distress syndrome (PARDS) with a median oxygen saturation index (OSI) of 9 (IQR:7-11).The PARDS was mild in 4 cases, moderate in 5 cases and severe in 2 cases. Four patients had a septic shock. seventeen patients required mechanical ventilation with a median duration of 6 days (IQR 2.5 - 12.5). Four patients required inhaled nitric oxide. The 3 remaining patients were exclusively managed with high flow oxygen therapy. Median length of stay was 10 days (IQR: 5-19). Four patients died. CONCLUSION(S): we report herein a case series of critically ill children with COVID-19. Delta variant seems to be responsible of more serious illness in young children.

Epidemiologic changes of Respiratory syncytial virus in the COVID-19 Era

Introduction Respiratory syncytial virus (RSV) is the main agent of bronchiolitis causing hospitalization among infants. The outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has had an impact on the epidemiology of respiratory tract infections worldwide. This has been documented in many studies. The aim of our study was to assess the impact of the SARS-CoV-2 pandemic on the epidemiology of RSV bronchiolitis in Tunisian children. Matériels et méthodes We included in this study respiratory samples from patients who attended the pediatric intensive care unit of the Children's Hospital of Tunis for bronchiolitis between September 15th to December 15th of the years 2020 and 2021. We analyzed RSV detection. Samples have been tested by respiratory multiplex PCRs (Biofire (Filmarray®), Qiastat, (Qiagen®), Respifinder (Pathofinder®)). Résultats During the study period, 265 respiratory samples were collected. RSV was detected in 152 cases (57.35 %). All positive cases were detected in 2021 and none of the samples were tested positive during 2020. The age of RSV positive patients ranged from 1 day to 4 years and 8 months with a median age of 83 days. Children under 6 months of age had the highest rate of VRS positivity (62.5 %). Conclusion The disappearance of SRV bronchiolitis in our hospital is strongly related to the improvements of public health measures applied to prevent SARS-CoV-2 transmission moreover during 2020. The relaxation of these measures during the late 2021 has resulted to RSV outbreak among infants. This suggest that these low-cost hygiene strategies can effectively lower the need of hospitalization of children, which can help in the future public health policy. Aucun lien d'intérêt

Epidemiology of acute kidney injury (AKI) within patients hospitalized in the emergency department of Mahdia

Introduction: Acute renal failure (AKI) is a real global public health which is a diagnostic and therapeutic issue in emergency departments. Better knowledge of the epidemiological characteristics will help improve the prevention and management of this disease. Methods: Prospective descriptive study carried out in the emergency department of the Taher Sfar CHU in Mahdia between March 1 and August 31, 2021. Patients older than 18 years with acute renal impairment were included. Chronic renal insufficiency with hemodialysis stage was excluded as well as renal insufficiency having kept stable creatinine figures. The main objective of this work was to study the epidemiological profile of AKI within patients hospitalized in the emergency department. Results: Our study englobed 103 patients: 53 men and 50 women, with a sex ratio of 1.06. The average age was 66 years. 94% of the patients included had a medical history of: diabetes 58.7% and HTA 54.4%, chronic renal failure was reported in 33%. Thus, most of the cases were under disease-modifying treatment: 64% under diuretics. The COVID attack affected 42% of hospitalized patients. Sepsis was the most common cause of AKI in the emergency room 38.8% of patients, followed by functional AKI(33,9%), 4 patients presented with obstructive AKI requiring placement of a JJ catheter. Patients were classified according to the KDIGO classification: stage I (n = 58) stage II (n = 8) stage (n = 37). Urgent hemodialysis was indicated in the presence of uremic syndrome (14.6%) in 23% of cases, otherwise vascular filling was indicated in 60 patients (58.3%). 64 patients were hospitalized in our emergency room (65%), 15 patients died (14.6%). Full recovery was observed in 18.4% of patients, 29.1% of patients partially recovered while 13.6% were dependent on long-term dialysis. Conclusions: Acute kidney injury is one of the most common serious complications for all hospital admissions. The early diagnosis as well as the management of AKI creates a challenge for the emergency physician.