Clinical Characteristics of Pediatric Patients With the Coronavirus Disease 2019 During the Third and Fourth Waves of the Epidemic in Korea: A Single Center Retrospective Study

Purpose: Since the coronavirus disease 2019 (COVID-19) pandemic began, new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged, and distinct epidemic waves of COVID-19 have occurred for an extended period. This study aimed to analyze the clinical and epidemiological characteristics of children with COVID-19 from the third wave to the middle of the fourth epidemic wave in Korea. Methods: We retrospectively reviewed the medical records of hospitalized patients aged ≤18 years with laboratory-confirmed COVID-19. The study periods were divided into the third wave (from November 13, 2020 to July 6, 2021) and the fourth wave (from July 7 to October 31, 2021). Results: Ninety-three patients were included in the analysis (33 in the third and 60 in the fourth waves). Compared with the third wave, the median age of patients was significantly older during the fourth wave (6.7 vs. 2.8 years, P=0.014). Household contacts was reported in 60.2% of total patients, similar in both periods (69.7 vs. 55.0%, P=0.190). Eighty-one (87.1%) had symptomatic SARS-CoV-2 infection. Among these, 10 (12.3%) had no respiratory symptoms. Anosmia or ageusia were more commonly observed in the fourth epidemic wave (10.7 vs. 34.0%, P=0.032). Most respiratory illness were upper respiratory tract infections (94.4%, 67/71), 4 had pneumonia. The median cycle threshold values (detection threshold, 40) for RNA-dependent RNA polymerase (RdRp) and envelope (E) genes of SARS-CoV-2 were 21.3 and 19.3, respectively. There was no significant difference in viral load during 2 epidemic waves. Conclusions: There were different characteristics during the two epidemic waves of COVID-19.

Comparison Of The Efficacy And Safety Of Secukinumab, Ustekinumab And Guselkumab For The Treatment Of Moderate To Severe Plaque Psoriasis: A Systematic Review

Psoriasis is a chronic inflammatory skin condition characterized by scaly erythematous patches or plaques affecting the extensor surfaces that are prominent but spreading to all areas of the body, including the flexor surfaces. Psoriasis occurs when the body's immune system attacks the skin;the interleukin (IL)-12 and IL-17/23 axes play a major role in its pathogenesis. Biologic therapies targeting IL-17 or IL-23 have emerged as an important treatment option for psoriasis and have led to substantial improvements in patients' quality of life. This systematic review aimed to evaluate the comparative efficacy and safety of secukinumab, ustekinumab and guselkumab for the treatment of moderate to severe plaque psoriasis. Based on the final analysis, there were 10 articles, namely 5 RCTs and 5 observational. We found that patients who were given secukinumab showed a rapid response, whereas guselkumab was superior in terms of long-term response (approximately 1 year) and complete remission compared to other biologics. Among all the biologics assessed, ustekinumab showed relatively low efficacy.

Using Discarded Facial Tissues to Monitor and Diagnose Viral Respiratory Infections.

Molecular biology amplification enables sensitive detection of most respiratory viruses through nasopharyngeal swabbing. We developed an innovative approach to detect viral genomes on used facial tissues. In 2 communities of children, used tissues were collected once weekly for 1 year. Pooled analysis of tissues enabled detection of successive virus circulation in 4 age groups over time and forecasted by several weeks the circulation of influenza in the general population. At the individual level, in a proof-of-concept study of 30 volunteers with influenza-like signs/symptoms, we identified common respiratory viruses. The signals for SARS-CoV-2 obtained in parallel from 15 facial tissues and swab samples were similar and often higher for the tissues (11/15). Individual analysis of tissues offers a noninvasive, sensitive, and affordable alternative to self-sampling without a medical care requirement. Pooled analyses may be used to detect virus spread in specific communities, predict seasonal epidemics, and alert the population to viral infections.

Personal and Household Hygiene Measures for Preventing Upper Respiratory Tract Infections among Children: A Cross-Sectional Survey of Parental Knowledge, Attitudes, and Practices.

Personal and household hygiene measures are important for preventing upper respiratory tract infections (URTIs) and other infectious diseases, including coronavirus disease 2019 (COVID-19). An online survey recruited 414 eligible parents in Hong Kong to study their hygiene knowledge, attitudes, and practices (KAPs) regarding the prevention of URTIs among their children. The average knowledge score was high (10.2/12.0), but some misconceptions were identified. The majority of the participants agreed that good personal hygiene (93.5%) and good environmental hygiene (92.8%) can prevent URTIs. The average score for hand hygiene practices was high (3.78/4.00), but only 56.8% of the parents always performed hand hygiene before touching their mouths, noses, or eyes. In terms of environmental hygiene, only some household items were disinfected with disinfectants (door handles in 69.8% of the households, toilet seats in 60.4% of the households, the floor in 42.8% of the households, dining chairs in 24.2% of the households, and dining tables in 20.5% of the households). A higher knowledge score was associated with parents having tertiary educational levels or above, working as healthcare professionals, living in private residential flats or staff quarters, or having household incomes of HKD 70,000 or above. The results of multiple regression analyses also indicated that parents who were healthcare professionals and with higher household income had a better parental knowledge of hygiene measures after adjusting the attitude score. For hand hygiene, parents who achieved higher attitude scores obtained higher practice scores. Under the fifth wave of the COVID-19 epidemic, there were some misconceptions regarding hygiene among parents. Any health promotion program should target parents regarding taking proper personal and household hygienic measures, especially for those who had relatively lower socio-economic status and/or from a non-healthcare background. Motivating attitudes toward hand hygiene can lead to better practices.

Evaluation of a clinical decision support system and an automated electronic health record alert on outpatient prescribing of cefdinir

Purpose of Study: Acute bacterial upper respiratory infections, such as acute otitis media, pharyngitis, and sinusitis, are common indications for antibiotics in pediatrics, and it is estimated one-third of these prescriptions may be inappropriate. Cefdinir is an oral cephalosporin commonly used in pediatrics due to taste and ease of once-a-day dosing. However, there are no evidencebased guidelines recommending it as a first-line agent. Outpatient clinician education has demonstrated some improvement in antibiotic prescribing habits but is often not sustainable long term. Clinical decision support systems in the form of pathways and order sets are more feasible in the outpatient setting and have demonstrated sustained improvements in provider prescribing habits. Best practice advisory alerts are commonly used in the inpatient setting and have shown promising results, but there are little data on their use in the outpatient setting. Methods Used: We developed an intervention in our electronic health record consisting of an order-set based on our local acute upper respiratory infection guidelines and a best practice advisory alert targeting Cefdinir use in non-penicillin allergic patients. The pre-intervention period was defined as April 2018 to December 2021. The post-intervention periodwas defined as January 2022 to December 2022. Data shown here are through September 2022. Oral antibiotic prescriptions from all general pediatric clinics within our institution with diagnosis codes pertaining to acute otitis media, pharyngitis, and sinusitis were included. Thesewere then grouped into first-line and non-first-line categories. Patient data were collected for each prescription, including diagnosis, date, sex, and race/ethnicity. The primary endpoint was the percentage of first-line prescribing. Summary of Results: A total of 45 038 prescriptions were included in our analyses with 36 578 in the pre-intervention period and 8460 in the post-intervention period. There was no difference noted between the pre- and postgroups in patient sex, however, there were notable differences in patient race/ethnicity and diagnosis. Firstline prescribing accounted for 73.5% of the pre-intervention group, and 81.9% of the post-intervention group (P = <0.001). Conclusion(s): Implementation of an outpatient order-set coupled with a best practice advisory alertwas associated with an 8.4% increase in first-line antibiotic prescribing for acute upper respiratory infections in outpatient pediatric clinics affiliated with our institution. Differences in diagnoses noted between pre- and post-intervention periods may be attributable to the COVID-19 pandemic. Copyright © 2023 Southern Society for Clinical Investigation.

A Rare COVID-19 Presentation, Relapse of Nephrotic Syndrome in a Pediatric Patient

Background: In early 2020, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) pandemics caused previously unheard of health, social, and economic problems worldwide. The disease can affect different organs such as the lungs, heart, pancreas, kidney, and unusual symptoms can be seen. Information on the clinical impact of SARS-CoV-2 infection on renal function among pediatric age groups is scarce. Case Report: In this report, we presented a 13-year-old boy who was admitted to our hospital with the relapse of nephrotic syndrome caused by COVID-19. The patient had mild upper respiratory tract symptoms, eyelid edema and progressive swelling of the lower extremities. Clinical remission was achieved with oral prednisolone therapy without the use of any antiviral drugs. Conclusion(s): Patients with nephrotic syndrome presenting with relapse should be evaluated for potential COVID-19 infection during the pandemic. The use of routine doses of prednisolone appears to be safe in mild disease. Copyright © 2023 by Erciyes University Faculty of Medicine.

It's not the shunt: an atypical cause of fever in an infant with hydrocephalus

Case Report:We present a 5-year-old male with two days of fever, cough, vomiting, and loose stools. His history is significant for premature birth (35 weeks gestational age) and shunted hydrocephalus. A ventriculoperitoneal (VP) shunt was placed 6 days prior to presentation. Parental report included episodes of post-tussive, nonbloody, non-bilious emesis, poor oral intake, tachypnea, and increased work of breathing. Physical examination demonstrated a dehydrated infant with sunken fontanelles. He had no notable rash, no lymphadenopathy, and clear conjunctiva. His VP shunt site appeared normal without swelling or erythema. Initial evaluation showed elevated inflammatory markers -ESR 51 and CRP 12.32 mg/dL. A viral respiratory PCR panel returned positive for coronavirus (not SARS-CoV-2). A head CT scan and shunt radiography series showed no abnormalities with his shunt. The following morning, Radiology reported an incidental retropharyngeal fluid collection on a re-read of the patient's initial CT scan. A neck CT was obtained and demonstrated a fluid pocket with secondary mass effect in addition to bilateral cervical lymphadenopathy. Screening blood cultures were negative. The patient remained febrile (tmax 103.6F) and developed a transaminitis (ALT 264.9, AST 654), elevated fibrinogen 476, elevated INR 1.4, and low albumin 2.1. Abdominal ultrasound showed a normal the liver and biliary tract. His transaminitis resolved without treatment. The next day, the patient developed lip erythema and conjunctival injection. An echocardiogram showed a dilated right coronary artery (z-score of 3.59) and his inflammatory markers (ESR 26, CRP 9.63) remained elevated. Treatment was initiated with IVIG and moderate-dose aspirin. The patient defervesced, and he remained afebrile for over 48 hours prior to discharge. A repeat echocardiogram 2 days later showed a slight reduction in coronary artery dilatation (z-score 3.39). Hewas discharged on lowdose aspirin, and followed up with cardiology as an outpatient. Kawasaki's Disease (KD) is most common in children from ages 1 to 4 years and is classically characterized by persistent fever with a constellation of symptoms including limbal sparing conjunctivitis, cervical lymphadenopathy, polymorphous rash, strawberry tongue, oral changes, and extremity changes. Our patient presented at a younger age with a concurrent diagnosis of coronavirus upper respiratory tract infection. His atypical hospital course and incidental finding of retropharyngeal edema and transaminitis increased the clinical suspicion for KD. His symptoms rapidly improved after administration of IVIG. Younger patients are at an increased risk for severe complications of KD including coronary aneurysm. KD has been shown in the literature to have an association with coronavirus infection as well as presentation with retropharyngeal edema. Clinicians should consider KD in their differential even if patients do not meet all criteria for diagnosis on initial presentation. Copyright © 2023 Southern Society for Clinical Investigation.

High detection rate of viral pathogens in nasal discharge in children aged 0 till 5 years.

Respiratory tract infections (RTI) in children remain a cause of disease burden worldwide. Nasopharyngeal (NP) & oropharyngeal (OP) swabs are used for respiratory pathogen detection, but hold disadvantages particularly for children, highlighting the importance and preference for a child friendly detection method. We aimed to evaluate the performance and tolerability of a rhinorrhea swab (RS) in detecting viral pathogens when compared to a combined OP(/NP) or mid-turbinate (MT) nasal swab. This study was conducted between September 2021 and July 2022 in the Netherlands. Children aged 0-5 years, with an upper RTI and nasal discharge, were included and received a combined swab and a RS. Multiplex polymerase chain reaction (PCR) and severe acute respiratory syndrome coronavirus-2 PCR were used for viral pathogen detection. Tolerability was evaluated with a questionnaire and visual analog scale (VAS) scores. During 11 months 88 children were included, with a median age of 1.00 year [interquartile range 0.00-3.00]. In total 122 viral pathogens were detected in 81 children (92%). Sensitivity and specificity of the RS compared to a combined swab were respectively 97% (95% confidence interval [CI] 91%-100%) and 78% (95% CI 45%-94%). Rhinorrhea samples detected more pathogens than the (combined) nasal samples, 112 versus 108 respectively. Median VAS scores were significantly lower for the RS in both children (2 vs. 6) and their parents (0 vs. 5). A RS can therefore just as effectively/reliably detect viral pathogens as the combined swab in young children and is better tolerated by both children and their parents/caregivers.

Asymptomatic SARS-CoV-2 Infection in Children's Tonsils

Introduction: The SARS-CoV-2 pandemic killed over 6 million people worldwide. Children were described to have predominantly mild or asymptomatic infections and to be less exposed to the virus, at least for the initial variants. In the present study, we describe how SARS-CoV-2 can silently infect tonsils and adenoids in children undergoing adenotonsillectomy. Method(s): In this cross-sectional study we assessed children who underwent adenotonsillectomy between October 2020 and September 2021 in a secondary hospital in Brazil. All the caregivers denied any symptom of acute viral upper airway infection in the month prior to surgery. Briefly, nasal cytobrush (NC), nasal wash (NW) and tonsillar tissue fragments posttonsillectomy were tested by RT-PCR, immunohistochemistry (IHC), in situ immunofluorescence (IF), and flow cytometry. Result(s): A total of 48 children (18 females, median age 5.5 years) were enrolled. None of them had been vaccinated against COVID-19 at the time of surgery. Only 2 had a history of previous COVID-19 diagnosis, 3 and 5 months, respectively, before surgery. SARS-CoV-2 RNA was detected in 25% (12) of patients-20% in palatine tonsils, 16.27% in the adenoids, 10.41% in NC, and 6.25% in NW. IHC labeling showed viral nucleoprotein presence in both adenoids and palatine tonsils, in epithelial surface and lymphoid cells from extrafollicular and follicular regions. In 5 out of 7 patients, in situ IF showed the expression of ACE2 and TMPRSS2 and viral spike protein in the tonsillar tissue. Flow cytometry revealed that SARS-CoV-2 is predominantly observed in CD123+ dendritic cells (10.57% of all tested sites), followed by CD14+ monocytes (6.32%). Conclusion(s): According to these results, the prevalence of SARS-CoV-2 infection seems to be higher than expected and underdiagnosed in children at this age group. Palatine tonsils and adenoids are important sites of infection and may be a reservoir for the virus. Nevertheless, it is still unclear the impact of these results on virus transmission.

Airway Management and Otolaryngology Involvement in Pediatric Upper Respiratory Infections

Introduction: Viral upper respiratory tract infections (URTI) such as respiratory syncytial virus, rhinoenterovirus coronavirus, and others are common in children, and they can have serious effects on the pediatric airway. The literature is limited on how often ear, nose, and throat (ENT) clinician involvement is required in patients admitted with a URTI. This project aims to characterize and identify factors associated with ENT involvement in care of pediatric patients with positive respiratory virus panels (RVP) and if any require airway interventions. Method(s): A retrospective study was conducted collecting information on patient demographics, comorbidities, course of treatment, incidence of ENT consultation, and incidence of airway interventions (flexible laryngoscopy, intubation, tracheostomy, direct laryngoscopy, etc) for all pediatric patients with a positive RVP who were treated either inpatient or in the emergency department from January 2018 to January 2020 at a tertiary care academic facility. Result(s): A total of 1019 of 1317 consecutive charts with a positive RVP over a 2-year period were reviewed. Preliminary result analysis was completed for the 1019 completed charts. Twenty-eight patients (2.7%) required an ENT consultation. Congenital birth defects were significantly associated with ENT consultation (odds ratio [OR]=3.75;P=.001). Length of stay was significantly associated with higher rate of ENT consultation per day of stay (OR=1.07 per day of stay;P<.001). All other factors studied were not significantly associated with higher rate of ENT consult. Conclusion(s): The incidence of ENT consultation in inpatients with URTIs is relatively uncommon. The preliminary data of this study suggest congenital birth defects and longer length of stay could be used as potential markers to help identify patients who may be at increased risk for worse airway outcomes and need for further airway intervention.

Nasal Irrigation to Prevent and Treat Viral Upper Respiratory Tract Infections During the COVID-19 Pandemic

Introduction: Nasal irrigation is a common treatment used for symptomatic relief during a viral upper raspatory tract infection. It is currently unknown if the regular use of nasal rinses contributes to a reduction in viral load and transmissibility in patients with upper respiratory tract infections, including COVID-19. Method(s): A systematic review was completed in April 2022 with predefined search criteria using keywords related to nasal irrigation and viral illnesses. Common nasal solutions used for irrigation, including saline, corticosteroid and providineiodine were included. Databases included MEDLINE, Embase, Web of Science, Cochrane, ClinicalTrials.gov. Data related to the type of nasal rinse, virus studied, effects on symptoms, viral load, and transmission were gathered in a standardized data extraction tool. Result(s): Title and screening was performed for 1267 unique results, where 65 studies received full-text review and 12 were included in data extraction. Eight of these 12 studies looked specifically at COVID-19. Six out of 10 randomized controlled trials (RCTs) used saline, 3 used providine- iodine, and 1 used an intranasal corticosteroid. Eight out of 10 RCTs showed that nasal irrigation reduced upper respiratory tract symptoms. Three trials showed a reduction in viral load. Four studies demonstrated a reduction of viral load in the nasopharynx. Four studies reported data on side effects. The most common was mild nasal irritation. Study methods were heterogeneous. Data on transmission were reported in only 1 study. Conclusion(s): Nasal irrigation is well tolerated in patients with viral upper respiratory tract infections with minimal risk. The data for nasal rinses for the prevention and treatment of viral infection are limited, and there are conflicting results. Saline and providine-iodine rinses may have some efficacy in reducing viral titres. While nasal rinses appear to be beneficial in reducing nasal symptoms of an upper respiratory tract infection, a larger scale study is needed to identify if these rinses impact the viral load, illness severity, and transmissibility in patients with COVID-19.

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Pulmonary cavitary lesions can have varying etiologies. Among these, Lemierre syndrome is an uncommon disease which usually presents with symptoms of upper respiratory tract infection with unilateral neck pain, tenderness or swelling. In recent years, antibiotic stewardship for upper respiratory illnesses has led to its delayed diagnosis resulting in possible increased morbidity and mortality. There have been few reported cases of pulmonary cavitary lesions as the initial presentation of Lemierre syndrome. Our patient presented with incidental bilateral pulmonary cavitary lesions, which led to a diagnosis of Lemierre syndrome. CASE PRESENTATION: A 30-year-old gentleman with no significant past medical history visited urgent care for reproducible chest pain following motor vehicle accident. Chest x ray obtained for suspected rib fracture showed bilateral patchy and rounded opacities, confirmed by CT as bilateral cavitary nodules and consolidation. He was referred to our hospital for further care. Two weeks prior, following administration of COVID booster vaccine, he had developed fever, sore throat, tender lump behind left ear, left jaw and anterior left neck. Most symptoms self resolved in 3-5 days except persistent fever. On arrival, patient was febrile to 102F and hemodynamically stable. Physical examination revealed dry mucous membranes and erythematous pharynx. Labs were significant for leukocytosis of 24.5uL with bandemia and elevated inflammatory markers. Three sets of blood cultures were drawn and empirically started on vancomycin and piperacillin/tazobactam. Echocardiogram ruled out heart valve vegetations. CT angiography of neck showed intraluminal thrombi in left internal jugular vein. Blood cultures finalized to Fusobacterium nucleatum and antibiotics were tapered to metronidazole. Due to persistent fever, anticoagulation was initiated with apixaban 5mg twice daily. Pan CT showed improvement in size of many pulmonary septic emboli. After 48 hours of patient being afebrile, he was discharged on antibiotics and apixaban for at least 4 weeks until surveillance CT angiography showed non progression of thrombus. DISCUSSION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein which presents within 1-3 weeks following upper respiratory tract infections with multi-system complications. Management involves prolonged antibiotic course with use of anticoagulation and vein stripping still being debated. Our patient came to the hospital with an incidental finding of bilateral cavitary pulmonary lesions which went on to be diagnosed as Lemierre syndrome from positive blood cultures and CT angiography findings. CONCLUSIONS: Lemierre syndrome is an uncommon disease with mortality up to 18%. A call out to health care providers to keep a low threshold for its diagnosis in patients with initial presentation of bilateral pulmonary cavitary lesions, warranting prompt management. Reference #1: Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore). 1989 Mar;68(2):85-94. PMID: 2646510. Reference #2: Golpe R, Marín B, Alonso M. Lemierre's syndrome (necrobacillosis). Postgrad Med J. 1999 Mar;75(881):141-4. doi: 10.1136/pgmj.75.881.141. PMID: 10448489;PMCID: PMC1741175. Reference #3: Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. J Microbiol Immunol Infect. 2020 Aug;53(4):513-517. doi: 10.1016/j.jmii.2020.03.027. Epub 2020 Apr 4. PMID: 32303484. DISCLOSURES: No relevant relationships by Sumukh Arun Kumar No relevant relationships by Megna Machado No relevant relationships by Sushmita Prabhu No relevant relationships by PAWINA SUBEDI No relevant relationships by Mithil Gowda Suresh No relevant relationships by Bradley Switzer

EARLY DESCRIPTIVE STUDY OF PEDIATRIC ED VISITS FOR COVID-19 DURING THE OMICRON WAVE IN QUEENS, NY

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Two years into the COVID-19 pandemic, knowledge about how infection affects children is still lacking. Unlike adults, prior to the recent surge widespread symptomatic childhood illness has not been seen, likely due to school shutdowns, strict social distancing, and less severe illness course. During the omicron surge in NYC, an increase in pediatric cases was noted likely due to reinstatement of in-person learning and relaxing of social distancing. Though vaccines were available, only 9% of children aged 5-11 years and 35% of adolescents aged 12-17 years were vaccinated. During omicron surge, a large proportion of adult patients positive for COVID-19 were asymptomatic. We aimed to explore incidence of ED visits, hospital admissions, vaccine status and presenting complaints in pediatric population who tested positive for COVID-19 during the omicron surge in NYC. METHODS: A retrospective chart review was conducted of patients <18 years who tested positive for COVID-19 at two multiethnic community hospitals during the Omicron wave (Nov 1, 2021-Feb 28, 2022). Demographics, vaccine status, reason for visit, diagnosis and disposition were extracted from EHR. Data were analyzed according to age group: 0 to <5 years (G1), 5 to <12 years (G2) and 12 to <18 years (G3). RESULTS: During this time, close to 2800 patients tested positive for COVID-19 at presentation to the ED or during hospitalization. Of these, 343 were <18 years of age (~10%). Overall, 53% of these pediatric patients were male. Ethnic make-up mirrored that of our community (approx. 60% Hispanic, 20% Asian, 10% Black). Admission status included 27 (7.8%) admitted to our hospitals, 18 (5.2%) transferred to other hospitals from our ED, and 298 (87%) treated and released from the ED. By age group, 183 (59%) were in G1, 76 (24%) in G2 and 51 (17%) in G3. Patients in G1 were <5 years and therefore ineligible for vaccine. Only 5% of G2 and 33% of G3 were fully vaccinated. In all groups, majority of patients presented for symptoms of viral infection (G1>80%, G2>90%, G3>90%). Symptoms of upper respiratory infection were most frequent in all groups (>80%). Convulsions (4.3%, 1.3%), croup (8.2%, 2.6%) and otitis media (3.3%, 1.3%) were noted in G1 and G2, respectively. In G3, acute appendicitis, diabetic ketoacidosis, and otitis media were present on admission in 2% each. Majority of patients requiring admission were from G1 (74%). CONCLUSIONS: Though adults during the recent surge often presented with asymptomatic COVID-19, pediatric patients in our sample typically presented for viral illness. It is difficult to interpret vaccine data except to say that there was a small group of pediatric patients who were symptomatic despite vaccination. CLINICAL IMPLICATIONS: We present early descriptive data from the Omicron surge in NYC in a pediatric sample. DISCLOSURES: No relevant relationships by Won Baik-Han No relevant relationships by Tamana Bismillah No relevant relationships by Kelly Cervellione no disclosure on file for Gagan Gulati;No relevant relationships by LOCHANA KC No relevant relationships by Lily Lew

A CASE OF BORDETELLA BRONCHISEPTICA AND PNEUMOCYSTIS JIROVECI PNEUMONIA IN A YOUNG PATIENT

SESSION TITLE: Procedures in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Pneumonia is a common condition that is seen in hospitals. Pneumocystis Jirovecii is an opportunist fungal pathogen. Bordetella bronchiseptica is a gram negative bacteria that causes infectious bronchitis in dogs and other animals, but rarely infects humans. CASE PRESENTATION: Patient is a 34 year old African American female with history of sickle cell trait, reported Lupus (not on treatment), asthma, COVID pneumonia who was admitted for worsening shortness of breath & productive cough with yellow sputum. She was previously hospitalized and discharged after being treated for Community-Acquired Pneumonia. In the ER, she was febrile, tachycardic, tachypneic, & hypoxic requiring BiPAP. CXR obtained showed findings concerning for multifocal pneumonia. Chest CT Angiogram was negative for PE. Patient was started on Vancomycin & Meropenem for treatment of her pneumonia. Blood cultures, Legionella, Strep pneumoniae, Aspergillus, Beta-D-glucan, Sputum culture, & MRSA screen were ordered for further evaluation of her infection. ANA screen reflex panel, lupus anticoagulant, anticardiolipin antibodies, beta-2 glycoprotein antibodies were also ordered given patient's reported history of SLE and the concern for SLE pneumonitis: ANA & Sjogren's Anti-SSA were positive;otherwise, autoimmune workup was unremarkable. During hospitalization, patient was eventually weaned down to nasal cannula and antibiotic was de-escalated to levaquin. However, sputum culture eventually grew Bordetella Bronchiseptica that was resistant to Levaquin so antibiotic regimen was switched to Doxycycline. In addition, Beta-D-glucan was noted to be elevated. Bronchoscopy was done for further evaluation;multiple transbronchial biopsies were positive Pneumocystis Jirovecii. Patient was then initiated on Bactrim for treatment of PJP Pneumonia along with a steroid taper. Patient was tested for HIV and it was negative. DISCUSSION: In this case, patient was found to have two rare pathogens, that are more common in immunocompromised patients such as those with HIV/AIDS, on high-dose corticosteroids or malignancy. This patient had a unconfirmed diagnosis of SLE and past COVID Pneumonia. Patient had Bordetella bronchiseptica pneumonia that is frequently isolated in the respiratory tract of animals but can cause severe respiratory infection in humans. This microorganism can cause upper respiratory tract infections, pneumonitis, endocarditis, peritonitis, meningitis, sepsis and recurrent bacteremia. Upon further discussion with the patient, she was found to have a recent pet dog. CONCLUSIONS: High level of clinical suspicious is needed in patient presenting with recurrent pneumonia with chest imaging findings suggestive of multifocal pneumonia. The mainstay of treatment for PJP is TMP-SMX and steroid. We recommend Fluoroquinolones or tetracycline for Bordetella bronchiseptica pneumonia. Reference #1: Benfield T, Atzori C, Miller RF, Helweg-Larsen J. Second-line salvage treatment of AIDS-associated Pneumocystis jirovecii pneumonia: a case series and systematic review. J Acquir Immune Defic Syndr. 2008 May 1;48(1):63-7. Reference #2: de la Fuente J, Albo C, Rodríguez A, Sopeña B, Martínez C. Bordetella bronchiseptica pneumonia in a patient with AIDS. Thorax. 1994 Jul;49(7):719-20. doi: 10.1136/thx.49.7.719. PMID: 8066571;PMCID: PMC475067. DISCLOSURES: No relevant relationships by Priya George No relevant relationships by ELINA MOMIN No relevant relationships by Mohammedumer Nagori

Approach to Common Pediatric Upper Respiratory Tract Infections

Upper respiratory tract infection (URI) is one of the most frequent diseases observed at centers for pediatric care and results in significant morbidity worldwide. URI is the most common cause in children treated against acute respiratory infection. The difficulty found by clinicians in establishing the differential and etiologic diagnosis of URIs and the occasionally indiscriminate use of antimicrobial drugs. URIs range from the common, cold-typically a mild, self-limited, catarrhal syndrome of the nasopharynx to life-threatening illnesses such as epiglottitis. Viruses account for most URIs. Appropriate management in these cases may consist of reassurance, education, and instructions for symptomatic home treatment. Diagnostic tests for specific agents are helpful when targeted URI therapy depends on the results. Bacterial primary infection or superinfection may require targeted therapy. The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, gateways to the trachea, bronchi, and pulmonary alveolar spaces. Rhinitis, pharyngitis, sinusitis, epiglottitis, laryngitis, and tracheitis are specific manifestations of URIs. Most URIs are viral in origin. Typical viral agents that cause URIs include the Rhinoviruses, Coronaviruses, Adenoviruses, and Coxsackieviruses. In the emergency department, attention should be paid to the patient's vital signs, including temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation (if obtained). Neonates are obligate nose breathers and may be at greater risk for respiratory distress;hence practitioners should auscultate the lungs for adequate aeration and assess breathing quality. The cardiovascular examination should assess adequate distal perfusion and an appropriate-for-age heart rate. Finally, dehydration can be a complication of any viral illness, and therefore, an assessment of hydration should be a part of the initial evaluation. Tests of nasopharyngeal specimens for specific pathogens are helpful when targeted therapy depends on the results (e.g., group A streptococcal infection, gonococcus, pertussis). Specific bacterial or viral testing is also warranted in other selected situations, such as when patients are immunocompromised, during inevitable outbreaks, or provide specific therapy to contacts. Symptombased therapy represents the mainstay of URI treatment in immunocompetent adults. Antimicrobial or antiviral therapy is appropriate in selected patients.

Quality of Life of Myasthenia Gravis Patients During COVID-19 Pandemic - One Year Follow Up

Purpose: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. Pandemics are severe stressors to vulnerable groups (such as patients with chronic diseases) and this highly contagious disease exerts considerable impacts on mental health. We wanted to investigate the possible impact of COVID-19 pandemic on the quality of life (QoL) of myasthenia gravis (MG) patients and potential changes during the period of one year. Methods: Data on the epidemiological and clinical characteristics of MG was collected. We used a selfdesigned questionnaire (consisting of 12 questions), a revised 15-item Myasthenia Gravis Quality of Life Questionnaire (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAMD) were used. The actual severity of the clinical manifestation was estimated using MG activities of daily life (MGADL). We reassessed patients in April and May 2021, who were tested during April 2020 using the same questionnaires. Results: The study included 57 adult MG patients. We noticed a statistically significant difference between the results obtained at these two time points regarding scores on MGQOL15r (p<0.05). The obtained scores were significantly better in 2021. Some scores on SF-36 subscales were also better in 2021 than in 2020 (such as social functioning, emotional well-being, role limitation due to emotional problems) (p<0.05). MGQOL15r and SF36 scores correlate with severe clinical manifestation, high scores on HAM-A and HAM-D (p<0.01). Higher scores on HAM-D and fear that MG symptoms will be worse if the patient gets an upper respiratory infection were independent predictors of the lower SF36 scores. Regarding MGQOL15r independent predictors of the higher score were higher scores on HAM-D. Conclusions: QoL of myasthenia gravis patients improved during the pandemic. It is important for healthcare workers to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic. eP01.04.07 COVID Spike Antibodies in Neuromuscular Conditions: A KU Experience Pasnoor M1, Tajuddin A1, Jawdat O1, Farmakidis C1, Jabari D1, Heim A1, Higgs K1, Dimachkie M1 1The University of Kansas Medical Center, Kansas City, United States Background: Little is known about the immune response to COVID vaccination in immune suppressed neuromusuclar patients. Multiple studies showed variable data regarding the effect of immunosuppression on the immune response to the vaccination. Objective: To evaluate the COVID spike antibody levels in patients with various neuromuscular conditions who received vaccination and assess the effect of immunosuppressive therapies on antibody levels. Method: We performed a retrospective chart review of patients in neuromuscular clinic who had COVID antibody testing. We collected demographic, clinical, diagnostic and treatment information. Descriptive statistics was performed on the data obtained. Results: The total number of patients enrolled in the study were129, 64 male and 65 female . The mean age of the patients enrolled was 64.82 ±14.50 and the mean duration of antibody acquisition since date of last vaccination dose was 172 days. The number of patients on immunosuppressive therapies was 88(68.2%), 47(53.41%) had high antibody titer (>250), 31(35.23%) had low antibody titer (0.4- 250), 9(10.23%) had undetected antibody titer (<0.4) and 1 (1.1%) had detected unmeasured titer. Immunosuppressive therapies included steroids, methotrexate, azathioprine, myophenolate mofetil, eculizumab, efgartigimod, intravenous immunoglobulin and rituximab. The other group of patients who were not on immunosuppressive medication were 41 (31.8%) , 28 (68.29%) showed high antibody titer (>250), 9(21.95%) showed low antibody titer (0.4-250) , 1(2.44%) showed undetected titer (>0.4) and 3(7.32%) had detected unmeasured titer. 50% of patient who were on rituximab showed undetected antibody titer and 60% of patients who received eculizumab had low antibody titer. 4 % of patients on immunosuppressive drugs did not develop adequate spike antibodies levels to vaccination, compared to 24% on no immunosuppressive therapies. Conclusions: Our study reveals modest impact of immunosuppression on COVID spike antibody titer. While this finding is limited by small number of patients and heterogeneity in therapies, age and interval between vaccination and antibody testing, our finding supports the importance of booster vaccine in this patient population.

ETAVOPIVAT TREATMENT FOR UP TO 12 WEEKS IN PATIENTS WITH SICKLE CELL DISEASE IS WELL TOLERATED AND IMPROVES RED BLOOD CELL HEALTH

Background: Etavopivat, an investigational, once-daily, selective, activator of erythrocyte pyruvate kinase (PKR) increases PKR activity, resulting in decreased 2,3-DPG and increased ATP in red blood cells (RBCs) of healthy volunteers and patients (pts) with sickle cell disease (SCD).1,2 Aims: We report results of an open-label (OL) extension cohort from a Phase 1 study (NCT03815695) designed to characterize the safety and clinical activity of etavopivat at a maximal pharmacodynamic dose in pts with SCD. Methods: 15 pts were enrolled to receive etavopivat 400 mg once daily for 12 wks, followed by a 4-wk follow-up. Assessments included safety, pharmacokinetics, pharmacodynamics, RBC health parameters and systemic markers of SCD pathophysiology. Results: Of 15 pts (age 32.3 ±10.1 yr;HbSS/SC n=13/2), 14 completed 12-wks of treatment (tx);1 pt discontinued tx after ∼2 wks. Etavopivat 400 mg once daily was generally well tolerated. Adverse events (AEs) reported during tx and follow-up were commonly low grade (Gr) and consistent with pts' SCD. Gr1-2 AEs in >2 pts (n [%]) were sickle cell pain events (9 [60%]);headache (5 [33%]);and upper respiratory tract infection (3 [20%]). The Gr3-4 AE in >1 pt was sickle cell vaso-occlusion (VOC;4 [27%]). On-tx serious adverse events (SAEs;1 pt each) were Gr3 VOC post Gr3 COVID (not tx-related) and Gr3 left femoral deep vein thrombosis (possibly related, resulting in tx discontinuation as stated above). SAEs (1 pt each) during the 4-wk follow-up were Gr3 acute chest syndrome + Gr3 VOC, Gr3 non-cardiac chest pain and Gr3 syncope (all unrelated). Observed increases in ATP and decreases in 2,3-DPG were durable over 12 wks of etavopivat tx. Etavopivat tx normalized hemoglobin (Hb)S-oxygen affinity to that of HbA. Etavopivat tx over 12 wks improved overall sickle RBC health, demonstrated by a reduction in point of sickling as well as improved measures of deformability and hydration of sickle RBCs (all P<0.01;Figure). Etavopivat tx over 12 wks was associated with a sustained significant increase in Hb compared with baseline (BL;P<0.0001), with mean maximal increase of 1.5 (range 0.7-2.3) g/dL. Ontx increase in Hb >1g/dL was achieved in 11 (73%) pts, for whom the mean maximal Hb increase was 1.8 (1.2-2.3) g/dL. Absolute reticulocytes, indirect bilirubin and lactate dehydrogenase significantly decreased from BL and were sustained over the 12wk period (all P<0.05), indicative of increased RBC lifespan and decreased hemolysis. Several markers of disease activity significantly decreased from BL during daily etavopivat tx, including the inflammatory marker tumor necrosis factor-α , which decreased by 35% (P<0.001). Based on preliminary exploratory analysis with an aggregate duration of etavopivat exposure of 3.32 pt-yrs in the OL cohort, a decrease in the trend for VOC Hospitalizations was observed: annualized historical and on-tx VOC Hospitalization rates were 0.93 and 0.30, respectively;the 1 on-tx VOC Hospitalization was COVID-related. Summary/Conclusion: Etavopivat 400 mg once daily for up to 12 wks demonstrated a tolerable safety profile and showed improvements in various markers of RBC health in pts with SCD. Rapid and sustained increases in Hb were associated with decreases in reticulocyte counts and markers of hemolysis, supporting increased sickle RBC lifespan and improved anemia. Together, these results support further evaluation of etavopivat in the Phase 2/3 Hibiscus Study (NCT04624659) currently enrolling pts. (Figure Presented).

ZANUBRUTINIB IN OLDER PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) MARGINAL ZONE LYMPHOMA (MZL): SUBGROUP ANALYSIS OF THE MAGNOLIA STUDY

Background: MZL is the second most common lymphoma in older pts. Choosing an optimal treatment can be challenging because of patient-or disease-related risk factors and treatment-related toxicities (Curr Opin Oncol. 2019;31(5):386-393). Zanubrutinib is a potent, irreversible next-generation Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target kinase inhibition, which may improve efficacy outcomes and minimize toxicities, such as cardiac arrythmias and bleeding events. Zanubrutinib received accelerated approval from the United States FDA for the treatment of pts with R/R MZL (Haematologica . 2022;107(1):35-43). Aims: We aim to present a subgroup analysis of efficacy and safety of zanubrutinib in pts aged ≥65 years with R/R MZL enrolled in MAGNOLIA (BGB-3111-214;NCT03846427). Methods: MAGNOLIA is a phase 2, multicenter, single-arm study of adults with R/R MZL who had received ≥1 line of therapy including ≥1 CD20-directed regimen. All were treated with zanubrutinib 160 mg twice daily until disease progression or unacceptable toxicity. Use of long-term antiplatelet and anticoagulation agents was permitted. The primary endpoint was overall response rate (ORR;complete response [CR] and partial response [PR]) determined by an independent review committee (IRC) in accordance with the Lugano classification. Secondary endpoints include ORR by investigator assessment (INV), duration of response (DOR), progression-free survival (PFS), and safety. All pts gave informed consent. Results: As of 18 January 2021, a total of 68 pts were enrolled (Table). Forty (61%) pts were ≥65 years old with a median age of 73 (range, 65-85);18 pts were ≥75 years old. Median number of prior therapies was 2 (range, 1-6) and 10 (25%) pts were refractory to last therapy. Most pts received prior rituximab + cyclophosphamide + vincristine + prednisone (48%) or bendamustine + rituximab (30%), while 5 (13%) pts received rituximab monotherapy. MZL subtypes included extranodal (n=17, 43%), nodal (n=14, 35%), and splenic (n=8, 20%). Median duration of treatment was 14.4 months (mo;range, 0.9-19.6). At a median follow-up of 15.8 mo (range, 2.8-21.8), ORR by IRC was 75% (CR 25%, PR 50%;Table). Responses were observed in all subtypes, with an ORR of 71%, 86%, and 75% in extranodal, nodal, and splenic subtypes, respectively (CR 41%, 21%, and 0%, respectively). Median DOR and PFS were not reached;15-month PFS was 87% and 12-month DOR was 93%. Most (63%) pts are continuing zanubrutinib. Treatment discontinuation due to disease progression was 28% by INV. Most common treatmentemergent adverse events (AEs) observed in ≥20% of pts include contusion (28%), diarrhea (25%), and constipation (20%). Grade ≥3 neutropenia occurred in 5% of pts. The most common infection was upper respiratory tract infection (10%). Two (5%) pts discontinued zanubrutinib due to unrelated fatal AEs (COVID-19 pneumonia and myocardial infarction in a patient with pre-existing coronary artery disease). Atrial fibrillation/flutter and hypertension occurred in 2 (5%) pts each and did not lead to treatment discontinuation. No pts required dose reductions, or experienced major or serious hemorrhage. Image: Summary/Conclusion: The safety profile of zanubrutinib observed in older pts was consistent with previously published results (Clin Cancer Res . 2021;27(23):6323-6332). Zanubrutinib was well tolerated and effective, as demonstrated by a high response rate and durable disease control in older pts with R/R MZL.

CLI120-001 PHASE1B DOSE ESCALATION STUDY OF RVU120 IN PATIENTS WITH AML OR HIGH RISK MDS SAFETY AND EFFICACY DATA UPDATE

Background: CDK8 and its paralog CDK19 have central roles in maintenance of cancer cell viability and undifferentiated state for a variety of tumor types. (Dannappel et al. 2019;Rzymski et al. 2015;Philip et al. 2018). RVU120 (SEL120), a novel CDK8/CDK19 kinase inhibitor with significant efficacy in preclinical AML models, has shown clinical efficacy in a currently ongoing phase Ib trial in patients with relapsed/refractory (R/R) AML or HR-MDS (NCT04021368). This paper provides update with new available data on disease evaluation from ongoing patients and further enrolment into next cohort level 85 mg. Aims: The primary objective of the study is to determine preliminary safety profile, dose limiting toxicities (DLTs), maximum tolerated dose (MTD) and the recommended phase 2 dose of RVU120 as a single agent. Secondary objectives include PK, antileukemic activity and exploratory PD characterization. Methods: The study comprises at least 7 dose escalating cohorts. The first 3 cohorts followed an accelerated scheme, 1 patient enrolled/cohort from 10 to 50 mg dose levels, from cohort 4 (75 mg) to 7 (100 mg) doses onwards a 3+3 design is followed. Data from each cohort is evaluated by a data review committee (DRC). RVU120 is administered orally every other day, for a total of 7 doses, in a 3-week treatment cycle until disease progression/unacceptable toxicity. Adverse events are graded according to NCI-CTCAE v.5.0. DLTs are assessed at completion of C1. Disease evaluation is performed according to Dohner 2017 and Cheson 2006 response criteria for AML and MDS respectively. PK parameters are calculated by non-compartmental analysis. Pharmacodynamic (PD) activity is assessed by flow cytometry measure of pSTAT5 Ser725 levels, that are highly dependent on the activity of CDK8 and CDK19 in AML/MDS cells. Results: At data cut off of 23rd Feb22, 13 pts have been enrolled, median age 73 years and median 2 previous lines of therapy, ECOG PS 2 in 4 pts, 1 in 7, 0 in 2. No DLTs were observed, all 14 Serious Adverse Events, including 1 COVID19 death and 1 pancreatitis, were not related to study drug (G1 fever, G2 Upper Respiratory Infection, G3: pseudomonas sepsis;urinary tract infection;febrile neutropenia;lung infection, pain, hemoptysis, pleural effusion, G5 pneumonitis, death NOS, pancreatitis). Cohort 1 pt, 10 mg dose level, and cohort 2 pt, 25 mg, showed stable (SD) and progressive disease (PD) respectively at the end of C1. Cohort 3 pt, an 81 YO male HR-MDS, escalated from 50 to 75 mg dose from C7, is SD at C24D13 with Erythroid Hematological Improvement on C5, C7, C10, C18. Cohort 4, 75 mg dose pt, a 62 YO male with AML DNMT3A pos, relapsing after Ven/Dec, achieved CRi at the end of C1 and CR in C7, and progressed at the end of C8. Two out of the remaining 4 pts treated at 75 mg reached SD (1 still ongoing at C3D15 and another died on C3D20 while on SD), 1 pt died of COVID-19 pneumonitis on C1D18, 1 pt with AML secondary to MPN was SD at C2 and progressed on C4. Two pt were treated at 110 mg (cohort 5), 1 not evaluable died for pancreatitis and 1 was SD at the end of C1. 2 pt entered cohort 6, 85 mg, and will be evaluable at the end of March 2022. Summary/Conclusion: Preliminary results from the first 6 cohorts have shown a favorable safety and a predictable PK profile of RVU120. Meaningful PD activity and clinical efficacy were observed at 50 and 75 mg doses. Enrollment is currently ongoing at 85 mg cohort.