Welcome to the ESPID 2022 Meeting Calendar

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Displaying One Session

Session Type
Walter Marget Workshop
Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Room
MC 2 HALL
Session Description
This is a 1.5-day clinically-oriented educational workshop focusing on the diagnosis and management of infectious diseases in children. The closed workshop is attended by invited trainees and is held every year in the days leading up to the ESPID Annual Meeting. Attendance is by invite only.

Welcome to WMW

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
13:00 - 13:10

Introduction

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
13:10 - 13:12

Topic 1 - Acute Bone and Joint Infections: Keynote Lecture

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
13:12 - 14:00

Topic 1 Acute Bone and Joint Infections: Case Discussions Introduction - Part I

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:00 - 14:02

FEVER, RASH AND POLYARTHRITIS IN A 5-YEAR-OLD BOY

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:02 - 14:10

Abstract

Title of Case(s):

Fever, rash and polyarthritis in a 5-year-old boy

Background:

Bacterial arthritis (BA) in children usually presents with acute onset of fever, swelling and pain of joints and limitations of movement. Rapid drainage and antibiotic treatment are keystones to prevent complications. However, overlap exists with systemic juvenile idiopathic arthritis (sJIA), presenting with fever, arthritis and rash. Affection of several joints points towards sJIA, while high neutrophil count in synovial fluid (> 50.000/µl, >70% neutrophils) is indicative for BA. Rat-bite fever, a rare and potentially underdiagnosed bacterial condition, reveals findings of both BA and sJIA.

Case Presentation Summary:

A 5-year-old boy presented with fever of 39°C for 4 days, and a rash on palms and soles for two days. In addition, he reported pain in the left knee for one day. The clinical exam showed arthritis in both wrists, left elbow, left hip, right ankle and a swollen and tender left knee. Inflammatory parameters were elevated (ESR 105 mm/h, blood leucocytes 21.4 G/L, ferritin 407 ng/ml, CrP 90.8 mg/L, S100A8/A9 34’400 ng/ml). Lab findings, rash, fever and involvement of several small and big joints pointed towards sJIA. Knee puncture with intraarticular steroid instillation, however, revealed 181’750/µl leucocytes with 96% neutrophils, suggesting BA and ampicillin/sulbactam was started. Blood and synovial fluid cultures remained sterile after 48 hours and sJIA therapy with steroids and methotrexate was initiated. The patients’ condition improved markedly. On the fourth day, Streptobacillus moniliformis grew in the synovial fluid cultures and repeated medical history revealed close contact to a fancy rat. Immunosuppressive treatment was stopped and sultamicillin was started for 14 days. On follow-up the patient showed full recovery.

Key Learning Points:

- Rat-bite fever caused by Streptobacillus moniliformis is a rare cause of polyarthritis, which untreated may progress to lethal endocarditis or meningitis.

- Taking a careful history of animal contacts is crucial for differential diagnosis.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:10 - 14:17

"JUST A LIMP?"

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:17 - 14:25

Abstract

Title of Case(s):

Just a limp?

Background:

Interferon gamma (IFN-y) stimulates anti-microbial activities of monocytes and plays a major role in activation of cell-mediated immunity. Disseminated infection with non-tuberculous mycobacteria is the most common clinical presentation of IFN-y receptor deficiency.

Case Presentation Summary:

A five-year-old girl presented with a three-month history of limp, a two-week history of cough, lethargy, fever and night sweats. Background partial interferon-gamma receptor 1 deficiency, heterozygous IFNGR1 mutation. No prior BCG, on no regular medication. Reduced range of movement left hip. Chest x-ray showed generalised lymphadenopathy, nodular opacification. Pelvic x-ray showed a lucency left pubic bone. Abdominal USS showed multiple hypoechoic hepatosplenic lesions. MRI showed multifocal osteomyelitis. CT chest showed diffuse consolidation and ground glass opacification, cavitation right upper lobe. Gastric aspirate, bronchial secretions, bone marrow aspirate and biopsy left femur cultured Mycobacterium avium intracellulare, sensitive to amikacin and clarithromycin. She was commenced on azithromycin, ethambutol, rifampicin, ciprofloxacin, after two months isoniazid was added and ciprofloxacin stopped, based on extended sensitivity testing. Interferon gamma-1b replacement. Two months into treatment MRI showed progression of bony lesions, cortical breach and abscess formation at multiple sites, with concern about scalp abscess and intracranial extension. Four months into treatment she developed swelling and skin break down at the site. Repeat imaging showed increased occipital skull lesions, enhancing mass extending to the occipital lobe, multi-level spinal involvement, paraspinal abscess, C2 lytic lesion. After five months amikacin and clofazimine were added. Twelve months into treatment there was clinical and radiological improvement, amikacin was stopped. N-Acetylcysteine was administered alongside amikacin. No detectable hearing loss at follow-up.

Key Learning Points:

Patients with IFN-y receptor deficiency may respond poorly to treatment for disseminated mycobacterial infection. IFN replacement therapy has demonstrated benefit. In this case clinical improvement was observed after addition of injectable aminoglycoside amikacin and clofazimine, concomitant IFN replacement. N-Acetylcysteine may have prevented ototoxicity.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:25 - 14:32

Summary & Live Voting

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:32 - 14:40

Break

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
14:40 - 15:00

Topic 1 Acute Bone and Joint Infections: Case Discussions Introduction - Part II

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:00 - 15:02

ADOLESCENT WITH PROGRESSIVE LOW BACKACHE

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:02 - 15:10

Abstract

Title of Case(s):

ADOLESCNT WITH PROGRESSIVE LOW BACKACHE

Background:

Spondylodiscitis in children and adolescents is rare. The condition has an incidence of 2-4% of all infectious skeletal diseases and is caused by haematogenous spread of pathogens with Staphylococcus aureus to be the most frequently detected bacterium.

Case Presentation Summary:

A Greek female adolescent was admitted to our Hospital due to back pain gradually deteriorated for the last five months with periodic episodes of low grade fever. From the personal history, a traumatic episode during intensive ballet training was reported the previous months. There were no gastrointestinal symptoms. Clinical examination revealed tenderness to palpation to lower lumbar area. Paraparesis and bowel-bladder dysfunction were not present. Blood testing revealed elevated inflammatory markers (max CRP 85mg/l and ESR 110mm/1hr). MRI study showed destruction of L1-L2 disc and involvement of paradiscal regions of L1 and L2 with para-vertebral collection at the same level. Blood cultures were negative. Tuberculosis, immunologic deficits and malignancies were ruled out by appropriate diagnostic procedures. A CT-guided needle biopsy was performed and Salmonella spp. was isolated from bone specimen. Despite the limited surgical exposure, our patient did not develop any complications, she remained neurologically intact and responded favourably to appropriate antibiotic therapy and spinal stabilization. We speculate that the cause of our patient’s spondylodiscitis was her mild spinal trauma secondary to the intensive training. Post-operatively a search was made for predisposing condition but tests were negative for any hemoglobinopathy. At final follow-up, the patient had resolution of back pain with full return to normal activity.

Key Learning Points:

Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell disease or immunosuppression. Although uncommon in immunocompetent patients and without any history of gastrointestinal symptoms or an origin from endemic area, salmonella spondylodiscitis should be considered in immunologically normal patients who have features of infective spondylodiscitis.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:10 - 15:17

AN UNCONTROLLED AND DISSEMINATED BONE INFECTION

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:17 - 15:25

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.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:25 - 15:32

Summary & Live Voting

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:32 - 15:40

Introduction

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:40 - 15:42

Topic 2 Lymph node associated infections: Keynote Lecture

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
15:42 - 16:30

Topic 2 Lymph node associated infections: Case Discussions Introduction - Part I

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
16:30 - 16:32

A PARADOXICAL CASE OF MISSED RESISTANCE

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
16:32 - 16:40

Abstract

Title of Case(s):

A paradoxical case of missed resistance

Background:

Paradoxical reaction (PR) to antituberculous therapy is well described in HIV infected children (immune reconstitution inflammatory syndrome). However, it is not uncommon in immunocompetent children, particularly when young. PR can be clinically challenging to differentiate from other causes of deterioration such as drug resistance, and in some cases they co-exist.

Case Presentation Summary:

A previously healthy, HIV uninfected 3-year-old girl presented to clinic in Cape Town, South Africa with chronic cough and TB contact (her mother – sputum GeneXpert MTB/RIF Ultra (GXPU) positive, rifampicin sensitive, no cultures done).

The child had never received BCG. On examination, bilateral crackles and expiratory wheeze heard, no respiratory distress. Tuberculin skin test positive (18mm) and chest radiograph highly suggestive pulmonary TB:

04oct2021_ap.jpg

04oct2021_lateral.jpg

Empiric drug sensitive antituberculous therapy was started.

Initial improvement of symptoms at two weeks, however by one month there was clinical and radiological deterioration despite good treatment adherence. Clinical examination revealed decreased breath sounds in right upper and middle zones, no respiratory distressed. Repeat chest radiograph showed further enlarged lymph nodes, new bronchus intermedius attenuation and features suggestive lobar collapse.

cropped15nov2021_ap.jpg

cropped15nov2021_lateral.jpg

Culture results showed INH-monoresistance. Child admitted for bronchoscopy revealing 100% occlusion of bronchus intermedius. CT chest confirmed compression by clusters of confluent necrotic lymph nodes and resultant lobar collapse. Prednisone 2mg/kg/day added and antituberculous treatment changed to appropriate drug resistant regimen. Sputum cultures and drug sensitivity testing requested for the mother.

Two weeks later there was significant clinical and radiological improvement. Shortly thereafter the mother’s sputum culture showed INH-monoresistance.

29nov2021_ap.jpg

29nov2021_lateral.jpg

Key Learning Points:

Deterioration on TB treatment can present a clinical challenge differentiating causes such as poor adherence, PR or drug resistance. They can also occur simultaneously.

GXPU reports rifampicin resistance only, thus INH monoresistance can be missed. Routine drug culture and sensitivity is imperative in adult contacts of children in high burden settings.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
16:40 - 16:47

Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
16:55 - 17:02

Summary & Live Voting

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:02 - 17:10

Topic 2 Lymph node associated infections: Case Discussions Introduction - Part II

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:10 - 17:12

A NOT SO SIMPLE LYMPHADENITIS.

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:12 - 17:20

Abstract

Title of Case(s):

A Not So Simple Lymphadenitis.

Background:

Lymphadenitis caused by Candida species is an uncommon occurrence but has been observed in children with underlying immunodeficiency disorders such as chronic granulomatous disease (CGD).

Case Presentation Summary:

A 2 month-old, term male born to non-consanguineous parents, presented to hospital with acute respiratory distress and cervical lymphadenitis. His chest radiograph demonstrated left lung hyperinflation with significant right mediastinal shift. A chest CT scan identified a 2cm mediastinal lymph node causing complete occlusion of the left main bronchus while neck ultrasound scan showed multiple enlarged lymph nodes. A whole-body MRI scan did not detect any further abnormalities. Incisional biopsy of a cervical lymph node revealed multiple non-caseating granulomata with scanty yeast cells seen and Candida albicans was isolated from culture as well as 18S pan-fungal PCR. Mycobacterial and bacterial culture were negative. Bronchoalveolar lavage also detected C. albicans by PCR. Immune function investigations showed normal lymphocyte subsets, immunoglobulins and negative HIV serology, however his neutrophil oxidative burst test was abnormal confirming the diagnosis of CGD (<1% of neutrophils stimulated). Genetic testing identified a hemizygous CYBB variant of uncertain significance that has been implicated in X-linked CGD. He was commenced on steroid therapy and liposomal amphotericin with transition to oral posaconazole prior to transfer to a regional paediatric immunology centre where he received a haematopoietic-stem-cell-transplant from an unrelated-matched donor with good result.

Key Learning Points:

CGD is a rare inherited disorder of the oxidase pathway within neutrophils leading to the failure to generate microbicidal reactive oxidant anions and metabolites including hydrogen peroxide. This leads to recurrent life-threatening bacterial and fungal infections, with Staphylococcus aureus and Aspergillus being most common. Candida accounts for 6-14% of all invasive fungal infections in CGD and is the leading cause of fungal-related lymphadenitis, fungaemia and meningitis in this population. Candida lymphadenitis should prompt clinicians to investigate for CGD.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:20 - 17:27

LYMPHADENOPATHY IN AN ECZEMATOUS INFANT

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:27 - 17:35

Abstract

Title of Case(s):

Lymphadenopathy in an eczematous infant

Background:

Severe or infected eczema may be associated with widespread lymphadenopathy. We present a case where significant lymphadenopathy in a baby with ezcema was the sentinel feature of a rare condition.

Case Presentation Summary:

A 4 month old boy presented with one month of increasing left axillary swelling. He was the 5th child of non-consanginous Bangladeshi parents. He was born at term and received IV antibiotics for culture-negative neonatal sepsis. He had developed a severe generalised scaly skin rash at 2 weeks of age which had responded to topical clobetasone, emollients and an hydrolysed formula after dermatology review. Skin swabs had grown methicillin-sensitive staphylococcus aureus and he had received 2 courses of oral antibiotics. He was vaccinated, including BCG vaccination at 1 month of age. He was gaining weight (2nd centile).

Examination found a 5cm x 5cm non-tender mass with mild overlying erythema (confirmed to be a conglomerate of enlarged abnormal left axillary lymph nodes with ultrasound scan). The BCG site appeared erythematous, without discharge. Examination was otherwise normal apart from some improving eczematous skin.

Investigations revealed T-B-NK+ severe combined immunodeficiency with a RAG1 mutation. Further chest, abdominal and brain imaging showed no features of disseminated BCG.

He was commenced on BCG treatment (isoniazid, rifampicin, clarithromycin, amikacin) and continued on this throughout a matched sibling bone marrow transplant one month later. He is now doing well, off BCG therapy with good donor marrow engraftment.

Key Learning Points:

The combination of neonatal lymphopenia (present in this patient), neonatal eczematous rash (maternal T cell engraftment) and atypical infection requires immunodeficiency investigation. All neonatal lymphopenia should be followed up.

BCG dissemination is more common in immunodeficiency and is a major complicating factor in transplant. Neonatal SCID screening was been recently induced in London and may prevent BCG administration in children with primary immunodeficiency.

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Discussion

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:35 - 17:42

Summary & Live Voting

Date
Mon, 09.05.2022
Session Time
13:00 - 18:25
Session Type
Walter Marget Workshop
Room
MC 2 HALL
Lecture Time
17:42 - 17:50