Stephen Ray (United Kingdom)

University of Liverpool Clinical Infection, Microbiology and Immunology
I am a paediatric registrar with a passion for improving the management and outcome of critically ill children in the resource poor setting, with a specialist interest in paediatric infections, particularly involving the brain. An intercalated undergraduate M.Phil at Alder Hey catalysed my interest in research. Since graduating, I have always had an academic component within my clinical training. Firstly, as an academic foundation doctor with the Liverpool brain infections group, I published research focused on acute encephalopathy among Nepali children. This sparked my focus on paediatric non-traumatic encephalopathies; it became clear many questions surrounding aetiology, pathogenesis and treatment are inadequately answered. I returned to the UK to undertake specialist training in paediatrics, working clinically in tertiary level infectious diseases and neurology posts and as an academic clinical fellow (ACF) within the same research group. I conducted research investigating new commercial diagnostics for severe childhood infections and non-invasive tools to monitor cerebral function, with future potential to guide treatment of acute encephalopathy. Thereafter, I successfully obtained a Wellcome Trust Clinical PhD Fellowship. I am currently investigating the aetiology, pathogenesis and outcome of febrile encephalopathy in Malawian children. For the last 2.5 years I have been based full time in Malawi. My time is split between clinical duties as acting consultant on the acute paediatric research ward and high-dependency unit, within the largest government referral hospital in the country and principal investigator within the Malawi Liverpool Wellcome Trust. This work in the resource poor setting has stoked my enthusiasm to pursue a life-long academic career. I relish the opportunity undertake a formal collaboration with the Wilson laboratory, University of California San Francisco, exploiting powerful methodologies, such as next generation sequencing and phage display antibody discovery technologies to improve early diagnosis and better understand the pathogenesis of febrile encephalopathy. Long term, I aim to run pragmatic clinical trials in resource poor settings to identify diagnostics, treatments and supportive management that reduce mortality in critically ill children. Examples of such interventions could include early application of syndromic diagnostics and physiologically tailored fluid interventions.

Presenter of 1 Presentation

NEUROLOGICAL MANIFESTATIONS OF COVID-19 INFECTION IN CHILDREN: RESULTS OF A NATIONAL BRITISH SURVEILLANCE STUDY (ID 1182)

Abstract

Background

Neurological complications associated with COVID-19 are reported in adults. We undertook an observational study to examine the neurological manifestations of COVID-19 infection in children across the United Kingdom

Methods

The CoroNerve Study Group (www.coronerve.com) developed an online network of secure rapid-response notification portals via major UK neuroscience & psychiatry bodies. Cases were included if they met the case definitions and reported prospectively onto a standardised online case report form.

Results

Fifty two cases were included: 25 (48%) had PIMS-TS; the remaining 27 (52%) were termed the COVID neurology group. The median age was 9 years (range 1-17); the majority were non-caucasian [36 (69%)]. In the COVID neurology group, 14 had encephalopathy: 6 encephalitis (4 ADEM, 2 encephalitis), 7 status epilepticus and 1 encephalopathy; 5 had Guillain-Barré syndrome, three demyelinating disorders; two acute psychosis, two chorea, one TIA. The PIMS-TS group had overlapping neurological manifestations including 21 (84%) with encephalopathy [two strokes] and nine (36%) with peripheral nervous system involvement (table 1).

Twenty-eight had CSF analysis; 8 (29%) had a pleocytosis (median 20 white cell count/mm, range 6-6075). All had negative molecular screening (including 3 tested for SARS-CoV-2). Central nervous system imaging was abnormal in 24/46 (52%). Patients in the PIMS-TS group were more likely to be admitted to ICU [20/25 (80%) vs 8/27 (30%)] and require immunomodulation [22/25 (88%) vs 6/27 (22%)]. Thirty-five children (67%) had apparent full recovery (Modified Rankin Score 0-1) and one child (2%) died (PIMS-TS stroke).

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Conclusions

Neurological manifestations associated with COVID-19 infection in children are uncommon but include a wide spectrum of phenotypes (often overlapping in PIMS-TS). Stroke and psychiatric presentations are less common than in adults and short-term outcome appears good.

Clinical Trial Registration

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