All hands on deck: A multidisciplinary approach to SARS-CoV-2-associated MIS-C.

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of SARS-CoV-2 infection with overlapping features of Kawasaki disease and toxic shock syndrome. In May 2020, a provincial multidisciplinary working group was established in anticipation of emerging cases following the first wave of SARS-CoV-2 infections. Methodology: Our centre established a multidisciplinary working group for MIS-C cases in British Columbia. The group developed guidelines using the World Health Organization MIS-C case definition. Guidelines were updated using quality improvement methods as new reports and our local experience evolved. We included all children who were evaluated in person or had samples sent to our centre for MIS-C evaluation from May 2020 to April 2021. We prospectively collected patient demographics, clinical and laboratory characteristics, and treatment. Results: Fifty-two children were included. Eleven were diagnosed as confirmed MIS-C. Ten of the 11 MIS-C cases presented with shock. Gastrointestinal and mucocutaneous involvement were also prominent. Common laboratory features included elevated C-reactive protein, D-dimer, troponin, and brain natriuretic peptide. Four out of 11 (36%) had myocardial dysfunction and 3/11 (27%) had coronary artery abnormalities. All 11 patients had evidence of SARS-CoV-2 infection. Ten out of 11 (91%) received intravenous (IV) immunoglobulin and IV corticosteroids. Conclusion: Our provincial cohort of MIS-C patients were more likely to present with shock and cardiac dysfunction, require ICU admission, and be treated with corticosteroids compared to ruled out cases. Our working group's evolving process ensured children with features of MIS-C were rapidly identified, had standardized evaluation, and received appropriate treatment in our province.

Local incidence of Jarisch-Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series.

Background: The literature suggests that the Jarisch-Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic blood pressure <90 mmHg), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

Historique: Selon les publications, la réaction de Jarisch­Herxheimer (J-H) est courante après le traitement antimicrobien de la syphilis et peut précipiter une activité utérine. La pratique locale consiste à transférer les parturientes syphilitiques des régions rurales dont l'âge gestationnel de viabilité est confirmé vers un centre de soins tertiaires, en vue d'être traitées. L'étude visait à déterminer l'incidence locale et les facteurs de risque de la réaction de J-H chez les femmes enceintes traitées pour la syphilis. Méthodologie: Les chercheurs ont effectué une analyse rétrospective des dossiers chez les femmes enceintes atteintes de syphilis qui ont été traitées dans un centre de soins tertiaires entre 2012 et 2018. La réaction de J-H était définie par l'apparition d'au moins l'un des symptômes suivants dans les 24 heures suivant le début du traitement antibiotique : fièvre (température ≥38 °C), description clinique de lésion cutanée douloureuse ou prurigineuse, hypotension (tension systolique <90), contractions utérines ou décélérations de la fréquence cardiaque du fœtus. Les chercheurs ont procédé à une analyse statistique descriptive, la moyenne et la médiane étant utilisées pour mesurer la tendance centrale des données continues et catégoriques, respectivement. Résultats: Au total, 58 dossiers étaient admissibles. Les femmes avaient un âge moyen de 25,1 ans (ÉT 5,6) et un âge gestationnel moyen de 20,4 semaines (ÉT 9,5) au moment du diagnostic de syphilis. Une patiente (une sur 58, 1,7 %) respectait les critères de réaction de J-H. Les patientes ont accouché à un âge gestationnel moyen de 37,1 semaines de grossesse (ÉT 3,4), et une mortinaissance (1,7 %) a été recensée. Conclusions: La réaction de J-H est moins courante au centre où a été réalisée l'étude que dans les publications. Il sera important d'effectuer d'autres recherches pour déterminer les facteurs de risque associés à la réaction de J-H pour optimiser l'affectation des ressources dans le cadre du traitement de la syphilis pendant la grossesse.

Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis.

OBJECTIVE: There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature. METHODS: PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1st to October 5th, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes were included. RESULTS: 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51; I2 = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I2 = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07; I2 = 36%). CONCLUSIONS: Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.

Candida albicans ventriculoperitoneal shunt infection in an infant: A case report and review of the literature.

Ventriculoperitoneal shunt malfunction is commonly seen with infection. Fungal cases are rare. We report the case of an infant with a ventriculoperitoneal shunt infection who presented with accelerated head growth. Cerebrospinal fluid cultures demonstrated Candida albicans. She was successfully treated with device removal and 3 weeks of intravenous antifungal therapy. This case highlights challenges with the diagnosis and treatment of fungal shunt infections.

La dysfonction du shunt ventriculopéritonéal est courante en cas d'infection, mais les cas fongiques sont rares. Les auteurs rendent compte du cas d'un nourrisson de sexe féminin ayant une infection du shunt ventriculopéritonéal et qui présentait une croissance accélérée du périmètre crânien. Les cultures du liquide céphalorachidien ont révélé un Candida albicans. Le traitement, constitué du retrait du dispositif et de l'administration d'un antifongique pendant trois semaines, a été concluant. Ce cas fait ressortir les difficultés liées au diagnostic et au traitement des infections fongiques des shunts.