Faculty Bibliography

BACKGROUND/UNASSIGNED:Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disorder that occurs in children and adults. CASE/UNASSIGNED:We report a case of a 10-year-old female with AQP4+ NMOSD who presented with paraparesis from longitudinally extensive transverse myelitis (LETM) from C2 to the conus medullaris. The patient showed gradual improvement in strength and sensation with solumedrol and plasma exchange therapy. Given her severe presentation, eculizumab therapy was also initiated acutely. She had near complete recovery, although she developed a myelitis relapse during transition to rituximab treatment. CONCLUSION/UNASSIGNED:This case demonstrates the role of eculizumab as a safe and effective treatment option in treating an acute attack of pediatric AQP4+ NMOSD. More data are needed to understand the risk of relapse if transitioning off of these highly effective medications.

NYC Health + Hospitals/Bellevue Hospital (Bellevue) conducts quarterly drills to test the readiness and preparedness of its special pathogen program. As a Regional Emerging Special Pathogen Treatment Center, Bellevue maintains a state of readiness to respond to patients infected with highly infectious pathogens. On March 29, 2024, Bellevue conducted a no-notice drill to simulate the arrival of a pediatric patient suspected of a viral hemorrhagic fever (VHF). Notification of the special pathogens unit (SPU) activation for a suspected VHF patient was communicated to Bellevue supervisors and leadership. Once responders arrived at their respective reporting stations, they were informed that this was a drill and instructed to read through their role-specific Roles & Responsibilities sheet. All respondents reported to assume their role in the SPU activation within the expected time frame. The cost savings of running this drill, as opposed to a full unit activation, was estimated to be nearly USD 2,000. Following the exercise, participants were offered to complete an anonymous survey assessing their perceptions of the drill and readiness for SPU activation. Key findings were that while most staff felt adequately prepared and understood their roles and responsibilities, suggestions for improvement included more frequent training sessions. This study underscores the importance of regular preparedness exercises to maintain SPU readiness. Insights gained from this drill can inform future training models, enhance the effectiveness of communication strategies during real-world activations, and can be replicated to improve the special pathogen preparedness of healthcare institutions across the United States, regardless of resource availability.

INTRODUCTION: Adult racial and ethnic minorities in the U.S. with COVID-19 are known to have worse outcomes. The CDC reported higher incidence of COVID-19 among minority children, but data regarding disparities in pediatric COVID-19 outcomes remains limited.
METHOD(S): A total of 837 children < 18 years of age hospitalized with COVID-19 in the U.S. were entered into the SCCM VIRUS Registry from 03/2020 to 01/2021. They were grouped into either of the following: Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Other or Unknown. Demographic and clinical characteristics, interventions and outcomes were compared. Critical illness was defined using a composite index of in-hospital mortality and organ support requirement, including vasopressors/inotropes, ECMO and CRRT. Comparisons were made using ANOVA, Kruskal-Wallis or Pearson's Chi-square. We used multivariable logistic and linear regression analysis to examine associations between race and ethnicity and critical illness, hospital and ICU length of stay and hospital mortality.
RESULT(S): Fever was reported in 67%, with no difference among the groups. MIS-C was reported with a significantly higher proportion in non-Hispanic Blacks (36%) than in non- Hispanic Whites (26%) [p=0.02]. Adjusting for age, sex, obesity, immune compromise and asthma, the non-Hispanic Asian group was significantly associated with higher odds of critical illness [OR=5.83, 95% CI=2.13-15.81]. Non-Hispanic Blacks also had higher odds of critical illness than non-Hispanic Whites, though not significant [OR=1.59, 95% CI=0.99-2.54]. With each yearly increase in age, the odds of critical illness was higher [OR=1.04, 95% CI=0.99-1.07] given all other covariates remain the same. While there was a higher proportion of obesity in the Hispanic group, this did not increase their odds of critical illness. Non- Hispanic Blacks had longer hospital length of stay compared to non-Hispanic Whites, though not significant [OR=1.76, 95% CI=-0.17-3.68]. ICU length of stay and mortality were not significantly associated with race or ethnicity.
CONCLUSION(S): Racial and ethnic disparities in pediatric COVID-19 outcomes exist that are not associated with preexisting conditions. These findings may guide the allocation of critical care resources towards minority groups at higher risk for severe disease

Plesiomonas shigelloides is a rare cause of self-limiting gastroenteritis. We report a case of extraintestinal P. shigelloides infection in an adolescent with sickle-cell disease who presented with bacteremia complicated by a splenic abscess. Despite the high mortality rate reported in extraintestinal P. shigelloides infection, the patient survived after drainage of the abscess and treatment with antibiotics.