Rabies: Reality Bites
Fiorito, Theresa M; Krilov, Leonard R
Clinical Outcomes of Children With Extended-spectrum ÃŸ -Lactamase Urinary Tract Infection Receiving Discordant Empiric Antibiotic: A Comparative Study of Fever Duration, Length of Stay, and Readmissions
Begaj, Xhesika; Lee, Hannah; Noor, Asif; Fiorito, Theresa; Agarwalla, Vipin; Kambhampati, Ooha; Islam, Shahidul; Krilov, Leonard R
There has been a recent increase in the incidence of urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, which are resistant to third-generation cephalosporins. Our goal was to compare the clinical responses of patients with ESBL UTI and non-ESBL UTI who received empiric third-generation cephalosporins. A retrospective analysis was performed on data collected between June 1, 2013, and June 30, 2017, from children aged 0 days to 19 years old who presented to NYU Langone Long Island Hospital's pediatric ED and/or were admitted with a UTI caused by Enterobacteriaceae. There was no significant difference in median length of fever duration. However, ESBL patients had significantly longer hospital stays, higher 30-day readmission rate, and higher 7-day revisit rate. It is reasonable to maintain an empiric UTI antibiotic choice rather than selecting a broad-spectrum antibiotic, such as carbapenem for children at high risk of ESBL UTI.
Multivalvular Endocarditis With Abscess: A Wild Goose Chase
Abuso, Stephanie; Rubin, Lily; Geraghty, Brian; Hoque, Tasneem; Better, Donna; Kumar, T K Susheel; Small, Adam; Halpern, Dan; Weisenberg, Scott; Fiorito, Theresa M
We report a case of Streptococcus mutans multivalvular infective endocarditis complicated by aortic root abscess and septic emboli in a 19-year-old male with a bicuspid aortic valve. This case illustrates the progression of untreated subacute bacterial endocarditis and highlights the importance of ongoing clinical suspicion for infective endocarditis in patients with underlying valvular defects.
Diagnosing PFAPA during the COVID-19 era: clarity during quarantine [Letter]
Fiorito, Theresa; Akerman, Meredith; Noor, Asif; Krilov, Leonard R
Diurnal Temperature Variation: Addressing Once-Daily Nighttime Fevers in the Era of COVID-19
Fiorito, Theresa M; Krilov, Leonard R
Pediatric patients with "once-daily" fevers are often referred to pediatric infectious disease specialists for evaluation. Often, these fevers occur at nighttime in the absence of additional symptoms and come to the caregiver's attention after a viral illness. It is crucial for caregivers and providers to be able to define and measure fever accurately when trying to ascertain the true etiology of this clinical picture. Fever education is critical in providing reassurance to parents, and fever diaries should be encouraged. In a well-appearing child without any additional symptoms, at least a percentage of these fevers can be explained by normal diurnal variation of temperature. [Pediatr Ann. 2022;51(5):e202-e205.].
RESPIRATORY SYNCYTIAL VIRUS INFECTION AND RISK OF APNEA IN FULL TERM HEALTHY INFANTS: APPREHENSION ALONE OR JUSTIFIED HOSPITALIZATION? [Meeting Abstract]
Picache, D; Kogan, D; Noor, A; Leavens-Maurer, J; Krilov, L; Fiorito, T; Senken, B; Akerman, M
Purpose of Study We studied the risk of apnea in otherwise healthy infants < 6 mo based on severity of illness at presentation. We also compared clinical courses between mild and severe disease groups. Methods Used This is a retrospective chart review of infants evaluated in the emergency department (ED) over 3 consecutive RSV seasons: 2017-2018, 2018-2019, and 2019-2020. We included infants < 6 mo with RSV diagnosed using multiplex PCR assay. Infants with history of prematurity ( 37 weeks), past apnea, chronic lung disease, heart disease, airway anomalies, neuromuscular diseases, and genetic disorders were excluded. Clinical data were reviewed to separate patients into mild or severe cases. Infants with respiratory rate (RR) >= 60, retractions, oxygen saturation < 90%, poor oral intake, or dehydration were classified as severe. Summary of Results A total of 161 infants met study criteria: 52 mild and 109 severe. There was no risk of apnea in mild cases and low risk in severe cases. Significant differences included length of stay (LOS), oxygen requirement, ICU admission, and hospital readmission (table 1). About 59% of severe cases required oxygen support, the majority of which received high flow nasal cannula, while 29% of mild cases required support and most were placed on regular nasal cannula (table 2). Twenty-seven severe cases required ICU and LOS was 1 day longer than mild. Forty-two severe cases were readmitted after initial discharge compared to 2 mild cases. Conclusions There was a low incidence of apnea in full term infants < 6 mo with RSV regardless of severity of disease, suggesting that risk of apnea is not a reliable factor when considering hospital admission. Conversely, high RR, retractions, hypoxia on presentation, poor PO intake, and dehydration were specific to severe RSV disease. The differences in oxygen support, ICU admission, and readmission emphasize the importance of identifying mild versus severe RSV to anticipate clinical courses. Further studies are needed to standardize and validate characteristics of RSV that require hospitalization. (Table Presented)
Suspected Case of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection Presenting as Acute Pancreatitis in a Child With Leukemia [Case Report]
Goldstein, Rebecca; Kogan, Diana; Fiorito, Theresa M; Glasser, Chana L
Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 may present with fever, elevated inflammatory markers, and multiorgan involvement. Although the gastrointestinal system is commonly affected in MIS-C patients, associated necrotizing pancreatitis is rare. We present an 11-year-old boy with B-cell acute lymphoblastic leukemia in remission undergoing maintenance chemotherapy presenting with acute necrotizing pancreatitis. He developed fevers, fluid and electrolyte imbalance, respiratory distress, cytopenias, and coagulopathy, and was found to have markedly elevated inflammatory markers and positive SARS-CoV-2 antibodies. The patient met criteria for MIS-C and was treated with intravenous immunoglobulin with significant clinical improvement. This is the first known reported case of a child with B-cell acute lymphoblastic leukemia who met criteria for MIS-C presenting as acute pancreatitis, and highlights the importance of considering a broader differential for pancreatitis in children given the current SARS-CoV-2 pandemic.
Human Papillomavirus Knowledge and Communication Skills: A Role-Play Activity for Providers
Fiorito, Theresa M; Krilov, Leonard R; Nonaillada, Jeannine
Introduction:Human papillomavirus (HPV) infection and related cancers are a major cause of morbidity and mortality worldwide. Routine vaccination against HPV is recommended for patients starting at age 9-12 years. Discussing this vaccine with parents of young children can be challenging for clinicians. Barriers include parental beliefs, strength and quality of clinician recommendations, physician knowledge of HPV disease and vaccines, and provider comfort levels with discussing sexuality. Methods:Our interactive workshop began with a predidactic role-play session addressing common concerns about the HPV vaccine where participants took turns playing a concerned parent or provider. We then gave a 30-minute didactic lecture and conducted a postdidactic role-play session to practice communication skills in promoting the HPV vaccine. All participants completed pre- and postintervention knowledge and skill self-assessments. Results:< .0001, average score based on a 5-point Likert scale). Discussion:An interactive workshop utilizing role-play supplemented by a didactic lecture was effective in improving participants' knowledge, communication skills, comfort levels, and confidence levels regarding HPV disease and vaccines. The workshop offers a practical and interpersonal approach to improving learners' skills in discussing the HPV vaccine with parents.
Neonatal Conjunctivitis Caused by Neisseria cinerea: A Case of Mistaken Identity
Fiorito, Theresa M; Noor, Asif; Silletti, Rodger; Krilov, Leonard R
We report a case of a 3-day-old boy with Neisseria cinerea conjunctivitis, originally misidentified as Neisseria gonorrhoeae conjunctivitis. Neonates are at increased risk for disseminated gonococcal infection, and physicians should be cognizant of N cinerea and its potential to be mistaken for N gonorrhoeae.
Cold Weather Viruses
Noor, Asif; Fiorito, Theresa; Krilov, Leonard R