Etienne JAVOUHEY (France)
Hospices Civils de Lyon - Hopital Femme Mere Enfant Service de Reanimation et Urgences PediatriquesAuthor Of 3 Presentations
AN UNCONTROLLED AND DISSEMINATED BONE INFECTION
Abstract
Title of Case(s):
An uncontrolled and disseminated bone infection
Background:
Salmonella typhimurium is the most common serotype of Salmonella identified in western countries (23,4%). Disease mainly expresses by gastroenteritis syndrome but sometimes can show characteristics of invasive infection (5.7%). Risk factors for invasive infection are well known: HIV, malaria coinfection, malnutrition, and sickle cell disease.
Case Presentation Summary:
We present the case of a 2 years-old boy with sickle cell disease coming back from Senegal, consulting at our paediatric hospital in Lyon after 6 days of limping with fever, with an initial clinical presentation of septic shock. Cultures were positives for Salmonella typhimurium in stools, blood cultures, bone biopsy specimen and cerebrospinal fluid. He was treated empirically with CLAFORAN and 3 days of AMIKACINE then with CLAFORAN and CIPROFLOXACINE. Despite a multi sensible bacteria, usual doses of combination antibiotic therapy for osteomyelitis, drainage of an abscess of the right-side femur, and negative blood cultures, he was still febrile and painful at 4 weeks from the start of management. We repeated radiologic staging for uncontrolled osteomyelitis, with radiographies, ultra-sound, scintigraphy, and MRI. Finally, a total body MRI at day 27 showed a multifocal osteomyelitis with disseminated localisation: skull, rachis, ribs, sternum, and the four limbs. He underwent a surgery to control the source of infection, with irrigation and drainage of all abscesses over 2 cm, and of all the diaphysis of long bones of the 4 limbs. At day 35 we decided to optimize the pharmacokinetic-pharmacodynamic with continuous intravenous Beta-lactam antibiotic, as CEFOTAXIME residual level was under the minimum inhibitory concentrations. Clinical and biological outcomes were finally favourable at 3 months after the surgery, allowing us to stop the antibiotic therapy.
Key Learning Points:
Salmonella typhimurium can sometimes present with invasive and disseminated infection especially in sickle cell patients. Source control and optimization of pharmacokinetic-pharmacodynamics parameters are essentials in bone infection.
HYPER INFLAMMATORY SYNDROME FOLLOWING COVID-19 MRNA VACCINE IN CHILDREN: A NATIONAL POST-AUTHORIZATION PHARMACOVIGILANCE STUDY
Abstract
Backgrounds:
Multisystem inflammatory syndrome in children (MIS-C) is the most severe clinical entity associated with pediatric SARS-CoV-2 infection with a putative role of the spike protein into the immune system activation. Whether COVID-19 mRNA vaccine can induce this complication in children is unknown. We aimed to assess the risk of hyper-inflammatory syndrome following COVID-19 mRNA vaccine in children.
Methods:
We conducted a post-authorization national population-based surveillance using the French enhanced pharmacovigilance surveillance system for COVID-19 vaccines. All cases of suspected hyper-inflammatory syndrome following COVID-19 mRNA vaccine in 12–17-year-old children between June 15th, 2021 and January 1st, 2022, were reported. The reporting rate of this syndrome was compared to the MIS-C rate per 1,000,000 12–17-year-old children infected by SARS-CoV-2.
Results:
Up to January 2022, 8,113,058 COVID-19 mRNA vaccine doses were administered to 4,079,234 12–17-year-old children. Among them, 12 presented a hyper-inflammatory syndrome with multisystemic involvement. Main clinical features included male predominance (10/12, 83%), cardiac involvement (10/12, 83%), digestive symptoms (10/12, 83%), coagulopathy (7/12, 58%), cytolytic hepatitis (6/12, 50%), and shock (5/12, 42%). 4/12 (33%) required intensive care unit transfer, and 3/12 (25%) hemodynamic support. All cases recovered. In eight cases, no evidence of previous SARS-CoV-2 infection was found. The reporting rate was 1.5 (95%CI [0.8; 2.6]) per 1,000,000 doses injected, i.e. 2.9 (95%CI [1.5; 5.1]) per 1,000,000 12–17-year-old vaccinated children. As a comparison, 113 MIS-C (95%CI [95; 135]) occurred per 1,000,000 12–17-year-old children infected by SARS-CoV-2.
Conclusions/Learning Points:
Very few cases of hyper-inflammatory syndrome with multi-organ involvement occurred following COVID-19 mRNA vaccine in 12–17-year-old children. The low reporting rate of this syndrome, compared to the rate of post-SARS-CoV-2 MIS-C in the same age-group, largely supports the vaccination in a context of an important circulation of SARS-CoV-2.
PICU ADMISSION RELATED TO SARS-COV-2 BY VACCINATION STATUS.
Abstract
Backgrounds:
COVID-19 mRNA vaccine immunogenicity and effectiveness is well established in children and adolescents. Summer and autumn 2021 in France were marked by both, waves of COVID-19 cases due to the Delta variant, and by the recommendation of the French Public Health Agency (FPHA) to vaccinate children from the age of 12 years. The aim of this national study was to estimate PICU admission related to SARS-CoV2 by vaccination status - PICURE Study
Methods
From September 1, 2021 to January 5, 2022, all pediatric patients diagnosed with MIS-C according to WHO criteria and/or a positive SARS-CoV2 PCR and admitted to the 41 French Pediatric Intensive Care Units (PICU) were prospectively included in this study. Data regarding age, gender, admission to PICU, vaccination status of patients between 12 and 18 years, hereafter referred to as adolescents, were recorded. To account for the increasing numbers of adolescents vaccinated over time including during the period, hazard ratio (HR) of unvaccinated versus vaccinated adolescents was estimated using Cox proportional hazards model.
Results:
Among the 233 admitted children, 94 (40%) were females. Median age was 77 months (IQR: 7 to 138 months). Admission was related to 71(31%) acute SARS CoV-2 infection, to 109(47%) MIS-C, and 52 (22%) incidental diagnosis of SARS-CoV-2. At least one comorbidity was identified in 73 (31%) cases. Among the 55 included adolescents, 43 were not vaccinated, 5 were vaccinated against COVID-19 and the information was missing for 7 patients. The HR for PICU admission related to SARS-CoV2 was 0.04 (95% CI 0.02 to 0.10, p<.001) after COVID-19 mRNA vaccine compared with unvaccinated adolescents.
Conclusions/Learning Points:
The data suggest that COVID-19 mRNA vaccine in adolescents was associated with a decrease of PICU admission related to SARS-CoV2.