ABSTRACT
INTRODUCTION: The North Lisbon University Hospital Center was activated for referral of SARS-CoV-2 infected patients on the 11th March 2020. The aim of this study is to describe the experience at the Department of Pediatrics in the approach and the clinical outcomes of infected children. MATERIAL AND METHODS: A descriptive observational study was performed. Children and adolescents (0 to 18 years) with SARS-CoV-2 infection, diagnosed in the emergency room or admitted to the Department of Pediatrics between March 11th and June 18th, were included. Hospital records and Trace COVID-19 platform were reviewed and patient caregivers were interviewed to assess follow up. RESULTS: Among 103 diagnosed children, 83% had a known previous contact with an infected patient, 43% presented fever and 42% presented respiratory symptoms. Ten percent had risk factors and 21% were aged under one year old. Ten percent were hospitalised, one needing intensive care, with paediatric inflammatory multisystem syndrome. Blood tests were performed in 9% and chest radiograph in 7%. No children required ventilation, antiviral therapy or underwent thoracic computed tomography scan. Eight percent of children returned to the emergency room and one child was hospitalised. The clinical outcome is known in 101 patients and is favourable in all. DISCUSSION: Most children had an epidemiological link and little clinical repercussion, even during the first year of life. The expected mild severity in children justified the use of established clinical criteria and recommendations for similar conditions, regarding tests and hospitalizations. No antiviral treatments were given due to lack of evidence of its benefits. CONCLUSION: This strategy contributed to a low consumption of hospital resources and proved safe in this series.
Introdução: O Centro Hospitalar Universitário Lisboa Norte foi ativado para referência de doentes com infeção SARS-CoV-2 em 11 de março de 2020. O objetivo deste estudo é descrever a experiência do Departamento de Pediatria na abordagem e evolução clínica de crianças infetadas.Material e Métodos: Realizámos um estudo observacional descritivo. Incluímos as crianças e adolescentes (0 aos 18 anos) com infeção por SARS-CoV-2 diagnosticados na urgência e internamento do nosso departamento entre 11 de março e 18 de junho de 2020. Consultámos registos internos e a plataforma Trace COVID-19 e contactámos os cuidadores para avaliação de seguimento.Resultados: De 103 crianças diagnosticadas, 83% tiveram contacto prévio identificado com doente infetado, 43% doentes apresentaram febre e 42% sintomas respiratórios. Em 10% havia fatores de risco; 21% tinham idade inferior a um ano. Foram internadas 10% das crianças, uma em cuidados intensivos com síndrome inflamatória multissistémica pediátrica. Foi efetuada avaliação laboratorial em 9%, radiografia torácica em 7%. Nenhum recebeu suporte ventilatório, terapêutica antiviral ou realizou tomografia computorizada torácica. Foram reobservadas em serviço de urgência 8% das crianças, sendo internada uma. A evolução foi conhecida em 101 casos sendo favorável em todos.Discussão: A maioria dos doentes tinha link epidemiológico familiar e pouca repercussão clínica, mesmo no primeiro ano de vida. A menor gravidade esperada na criança motivou a adoção de critérios habituais noutros quadros clínicos semelhantes para a realização de exames complementares de diagnóstico e internamento hospitalar. Não foi administrada terapêutica antiviral em nenhum doente por se considerar haver pouca evidência de benefício.Conclusão: Esta estratégia traduziu-se num baixo consumo de recursos hospitalares e revelou-se segura nesta série.
Subject(s)
COVID-19 , Adolescent , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Child , Child, Preschool , Humans , Infant , Portugal , Time FactorsABSTRACT
On page 801, fifth, where it reads: "No início da pandemia, teorizou-se que a vacina BCG pudesse ter um efeito protetor relativamente à COVID-19,27,28 mas não se encontrou até à data evidência para tal, não estando atualmente recomendada a vacinação BCG na prevenção da COVID-19.28,29 No nosso estudo, a maioria dos doentes (76%) tinha sido vacinada. Analisámos separadamente o subgrupo de crianças nascidas após janeiro de 2016, altura em que passaram a ser vacinadas apenas as crianças pertencentes a grupos de risco.30 A taxa de vacinação neste grupo foi de 51%, sendo superior à taxa de 30,1% estimada para crianças nascidas em Portugal com um ano de idade referido a 2019.31" It should read: "No início da pandemia, teorizou-se que a vacina BCG pudesse ter um efeito protetor relativamente à COVID-19,27,28 mas não se encontrou até à data evidência para tal, não estando atualmente recomendada a vacinação BCG na prevenção da COVID-19.28 No nosso estudo, a maioria dos doentes (76%) tinha sido vacinada. Analisámos separadamente o subgrupo de crianças nascidas após janeiro de 2016, altura em que passaram a ser vacinadas apenas as crianças pertencentes a grupos de risco.29 A taxa de vacinação neste grupo foi de 51%, sendo superior à taxa de 30,1% estimada para crianças nascidas em Portugal com um ano de idade referido a 2019.30" Paper published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/14537.
Na página 801, quinto parágrafo, onde se lê: "No início da pandemia, teorizou-se que a vacina BCG pudesse ter um efeito protetor relativamente à COVID-19,27,28 mas não se encontrou até à data evidência para tal, não estando atualmente recomendada a vacinação BCG na prevenção da COVID-19.28,29 No nosso estudo, a maioria dos doentes (76%) tinha sido vacinada. Analisámos separadamente o subgrupo de crianças nascidas após janeiro de 2016, altura em que passaram a ser vacinadas apenas as crianças pertencentes a grupos de risco.30 A taxa de vacinação neste grupo foi de 51%, sendo superior à taxa de 30,1% estimada para crianças nascidas em Portugal com um ano de idade referido a 2019.31" Deverá ler-se: "No início da pandemia, teorizou-se que a vacina BCG pudesse ter um efeito protetor relativamente à COVID-19,27,28 mas não se encontrou até à data evidência para tal, não estando atualmente recomendada a vacinação BCG na prevenção da COVID-19.28 No nosso estudo, a maioria dos doentes (76%) tinha sido vacinada. Analisámos separadamente o subgrupo de crianças nascidas após janeiro de 2016, altura em que passaram a ser vacinadas apenas as crianças pertencentes a grupos de risco.29 A taxa de vacinação neste grupo foi de 51%, sendo superior à taxa de 30,1% estimada para crianças nascidas em Portugal com um ano de idade referido a 2019.30"Artigo publicado com erros: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/14537.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Conjunctivitis, Bacterial/microbiology , Gonorrhea/microbiology , Levofloxacin/therapeutic use , Neisseria gonorrhoeae/pathogenicity , Orbital Cellulitis/microbiology , Adolescent , Coitus , Conjunctivitis, Bacterial/drug therapy , Gonorrhea/drug therapy , Humans , Male , Orbital Cellulitis/drug therapy , Photophobia , Treatment OutcomeABSTRACT
Horner's syndrome (HS) is caused by a disruption in the oculosympathetic pathway. Both congenital and acquired HS are unusual in children. Acquired HS can be caused by trauma, surgical intervention, tumours, vascular malformations or infection.We describe the case of a 6-year-old boy who was brought to our emergency department with ptosis, miosis, painful cervical lymphadenopathy and a cat scratch on a hand. The diagnosis of a cat scratch disease was confirmed by serology. A full recovery was observed on antibiotic treatment and cervical lymphadenomegaly reduction 3 weeks later.
Subject(s)
Blepharoptosis/diagnosis , Cat-Scratch Disease/blood , Horner Syndrome/blood , Miosis/diagnosis , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bartonella Infections/complications , Bartonella Infections/drug therapy , Bartonella Infections/microbiology , Bartonella henselae/isolation & purification , Blepharoptosis/etiology , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/drug therapy , Cat-Scratch Disease/microbiology , Cats , Child , Emergency Service, Hospital , Horner Syndrome/diagnosis , Horner Syndrome/drug therapy , Horner Syndrome/microbiology , Humans , Lymphadenopathy/microbiology , Lymphadenopathy/pathology , Male , Miosis/etiology , Neck/pathology , Treatment OutcomeABSTRACT
A 22-month-old girl with a history of a congenital occipital cutaneous cyst was brought to the paediatric emergency department for lethargy and occipital headache. She had been discharged 5â days before for acute meningitis without bacterial isolates. At physical observation, she presented with irritability and neck hyperextension, with negative meningeal signs. CT scan revealed a vermian cyst and hydrocephalus. She was submitted to neurosurgery with removal of an infected midline dermoid cyst with a fistulous track to the skin. Surgery was successful and without complications. During follow-up, the child was asymptomatic with normal psychomotor development.
Subject(s)
Brain Neoplasms/diagnosis , Dermoid Cyst/diagnosis , Meningitis/diagnosis , Skin Neoplasms , Brain Neoplasms/complications , Brain Neoplasms/surgery , Cysts/congenital , Dermoid Cyst/complications , Dermoid Cyst/surgery , Female , Fistula , Head , Headache/diagnosis , Headache/etiology , Humans , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Hydrocephalus/surgery , Infant , Infections/complications , Lethargy/diagnosis , Lethargy/etiology , Meningitis/etiology , Mothers , Neural Tube , Neurosurgical Procedures , Skin Neoplasms/congenital , Tomography, X-Ray ComputedSubject(s)
Chickenpox/diagnosis , Exanthema/diagnosis , HIV Infections/diagnosis , HIV-1/isolation & purification , Herpesvirus 3, Human/isolation & purification , Pneumonia, Viral/diagnosis , Acyclovir/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , CD4 Lymphocyte Count , Chickenpox/drug therapy , Child, Preschool , Clindamycin/therapeutic use , Drug Therapy, Combination , Exanthema/drug therapy , Floxacillin/therapeutic use , HIV Infections/drug therapy , HIV Infections/immunology , Humans , Male , Pneumonia, Viral/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
A newborn of 26 days, born in Lisbon, Portugal, presented with fever, anaemia and thrombocytopaenia. She was admitted considering neonatal sepsis, but Plasmodium vivax was identified in the second peripheral blood smear performed. Parenteral quinine was started with good evolution. Despite clinicians' unfamiliarity with congenital malaria in non-endemic areas, this diagnosis, although rare, should not be forgotten in the evaluation of newborns/infants born to women from endemic areas or with recent trip to these areas.
Subject(s)
Malaria, Vivax/congenital , Female , Humans , Infant, Newborn , Malaria, Vivax/diagnosis , PortugalABSTRACT
HIV-1 mother-to-child transmission (MTCT) was evaluated in terms of the molecular characterization of the env and nef genomic regions and quantification of maternal RNA viral loads. Assignment of viral subtype was achieved by direct sequencing of PCR 1172 products amplified from proviral DNA in 45 HIV-1-nontransmitting mothers (NTM), along with 13 pairs of HIV-1-transmitting mothers (TM) and their infected children (C). Analysis of the env C2V3C3 and nef sequences revealed that subtypes G and B, and their genetic combinations (AG, BG), accounted for over 84.5% of all viruses identified. The genetic structure form envA-nefG was the most commonly observed, with a lower frequency in the NTM (13.3%) compared to the TM (23.1%) group. A greater number of genetic forms was observed among NTM, namely the presence of sequences assigned to subtypes D and F, as well as the intergenetic A/J, and C/U, recombinant forms, along with a mosaic provirus with a complex putative envA-nefEGE genetic structure. No significant differences were found when RNA viral loads were evaluated as a function of the viral subtypes. Nevertheless, a relatively high quantification of HIV-1 RNA was obtained in the NTM group, emphasizing the importance of the compliance and effectiveness of therapeutic schemes to control viral replication and reduce the risk of HIV vertical transmission. V3 sequences displaying features associated with the R5 phenotype dominated in both groups. Both C2V3C3 and Nef's functional domains were conserved during HIV-1 vertical transmission.
Subject(s)
HIV Envelope Protein gp120 , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical , Peptide Fragments , Viral Load , env Gene Products, Human Immunodeficiency Virus , nef Gene Products, Human Immunodeficiency Virus , Adult , Child , Female , Genetic Variation , HIV Envelope Protein gp120/chemistry , HIV Envelope Protein gp120/genetics , HIV Infections/virology , HIV-1/classification , HIV-1/genetics , HIV-1/physiology , Humans , Molecular Sequence Data , Peptide Fragments/chemistry , Peptide Fragments/genetics , RNA, Viral/blood , Recombination, Genetic , Sequence Analysis, DNA , env Gene Products, Human Immunodeficiency Virus/chemistry , env Gene Products, Human Immunodeficiency Virus/genetics , env Gene Products, Human Immunodeficiency Virus/metabolism , nef Gene Products, Human Immunodeficiency Virus/chemistry , nef Gene Products, Human Immunodeficiency Virus/genetics , nef Gene Products, Human Immunodeficiency Virus/metabolismABSTRACT
Orbital cysticercosis is a rare condition and its management is controversial. We report 2 cases of orbital cellulitis associated with cysticercosis in which the treatment with antihelminthics was withheld. The 2 children had good evolution with spontaneous progressive resolution. The current literature is reviewed.
