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Post-Artesunate Delayed Hemolysis in Pediatric Malaria Patients in the United States

Sundararaman, Sesh A; Hanze Villavicencio, Karen L; Roper, Brianne; Wang, Ziyi; Davis, Amy K F; Mayhew, Jonathan A; Wang, Michelle L; Tang, Nina L; Soma, Vijaya L; Shust, Gail F; Feeney, Margaret E; Trehan, Indi; Weatherhead, Jill E; John, Chandy C; Gerber, Jeffrey S; Odom John, Audrey R
Post-artesunate delayed hemolysis (PADH) occurred in 6 of 24 children treated with artesunate for severe malaria in the United States; however severe hemolysis requiring hospitalization or transfusion was rare. In children in the U.S. treated with artesunate, counseling and symptom monitoring may be preferred to weekly laboratory surveillance for PADH.
PMID: 39149792
ISSN: 2048-7207
CID: 5679082

Hospital and ICU Admission Risk Associated With Comorbidities Among Children With COVID-19 Ancestral Strains

Ungar, Stephanie P; Solomon, Sadie; Stachel, Anna; Shust, Gail F; Clouser, Katharine N; Bhavsar, Sejal M; Lighter, Jennifer
A large proportion of children have been affected by COVID-19; we evaluated the association between comorbidities and hospitalization/ICU (intensive care unit) admission among 4097 children under age 21 years with symptomatic COVID-19 (not just polymerase chain reaction [PCR]-positive or multisystem inflammatory syndrome in children associated with COVID-19 [MIS-C]) from 2 large health systems from March 2020 to September 2021. Significant comorbidities and demographic factors identified by univariable analysis were included in a multivariable logistic regression compared with children ages 6 to 11 without comorbidities. In all, 475 children (11.6%) were hospitalized, of whom 25.5% required ICU admission. Children under 1 year had high hospitalization risk, but low risk of ICU admission. Presence of at least 1 comorbidity was associated with hospitalization and ICU admission (odds ratio [OR] > 4). Asthma, obesity, chronic kidney disease, sickle cell disease, bone marrow transplantation, and neurologic disorders were associated with hospitalization (adjusted odds ratio [AOR] > 2). Malignancy, intellectual disability, and prematurity were associated with ICU admission (AOR > 4). Comorbidities are significantly associated with hospitalization/ICU admission among children with COVID-19.
PMCID:9895283
PMID: 36661087
ISSN: 1938-2707
CID: 5419282

HIV Pre-Exposure Prophylaxis: What Do Pediatricians Need to Know?

Ungar, Stephanie P; Paret, Michal; Shust, Gail F
Pediatricians and adolescent providers play an important role in the health and well-being of adolescents and young adults, including their sexual health. HIV remains an ongoing concern for young people, with 21% of new HIV diagnoses occurring in this age group. The use of antiretroviral therapy for pre-exposure prophylaxis (PrEP) to prevent transmission of HIV to people who are not infected has been proven safe and effective. PrEP can be considered as part of a comprehensive risk mitigation strategy for adolescents and young adults, with clear guidelines for baseline evaluation and ongoing management. [Pediatr Ann. 2022;51(5):e191-e195.].
PMID: 35575536
ISSN: 1938-2359
CID: 5468942

SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation

Paret, Michal; Lalani, Karim; Hedari, Carine; Jaffer, Annum; Narayanan, Nisha; Noor, Asif; Lighter, Jennifer; Madan, Rebecca Pellett; Shust, Gail F; Ratner, Adam J; Raabe, Vanessa N
PMID: 34193619
ISSN: 1098-4275
CID: 4926782

Multisystem Inflammatory Syndrome in Children [Editorial]

Shust, Gail F; Soma, Vijaya L; Kahn, Philip; Ratner, Adam J
PMID: 34210761
ISSN: 1526-3347
CID: 4927192

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Young, Trevor K; Shaw, Katharina S; Shah, Jinal K; Noor, Asif; Alperin, Risa A; Ratner, Adam J; Orlow, Seth J; Betensky, Rebecca A; Shust, Gail F; Kahn, Philip J; Oza, Vikash S
Importance/UNASSIGNED:To date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms. Objective/UNASSIGNED:To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020. Design, Setting, and Participants/UNASSIGNED:A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C. Main Outcomes and Measures/UNASSIGNED:Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists. Results/UNASSIGNED:Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity. Conclusions and Relevance/UNASSIGNED:In this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.
PMID: 33295957
ISSN: 2168-6084
CID: 4708992

Multisystem inflammatory syndrome in children

Soma, Vijaya L; Shust, Gail F; Ratner, Adam J
PURPOSE OF REVIEW/OBJECTIVE:Here we summarize current knowledge about multisystem inflammatory syndrome in children (MIS-C), a presumed postinfectious inflammatory condition that has emerged as an important COVID-19-associated complication, to help clinicians identify and manage cases. RECENT FINDINGS/RESULTS:Clinical presentation of MIS-C is dominated by significant inflammation. Fever, gastrointestinal symptoms, cardiac dysfunction, and hypotension are common features. Kawasaki disease-like findings are common, but epidemiologic data and recent mechanistic studies suggest that distinct inflammatory pathways mediate Kawasaki disease and MIS-C. A broad diagnostic approach is recommended, given overlapping presentations between MIS-C and many other disease processes. Current management of MIS-C is highly variable, depending on illness severity, and can range from supportive care to aggressive immune modulation. A multidisciplinary approach with early involvement of multiple pediatric subspecialists is recommended for complicated cases. SUMMARY/CONCLUSIONS:Several studies have described the clinical manifestations of MIS-C, but definitive diagnosis remains challenging. Robust information about long-term outcomes awaits further study, as do immunologic data to refine diagnostic and therapeutic strategies.
PMID: 33278107
ISSN: 1531-698x
CID: 4708332

SARS-CoV-2 infection (COVID-19) in febrile infants without respiratory distress

Paret, Michal; Lighter, Jennifer; Pellett Madan, Rebecca; Raabe, Vanessa N; Shust, Gail F; Ratner, Adam J
We report two cases of SARS-CoV-2 infection (COVID-19) in infants presenting with fever in the absence of respiratory distress who required hospitalization for evaluation of possible invasive bacterial infections. The diagnoses resulted from routine isolation and real-time RT-PCR-based testing for SARS-CoV-2 for febrile infants in an outbreak setting.
PMID: 32301967
ISSN: 1537-6591
CID: 4383852

COVID-19-Associated Myocarditis in an Adolescent

Trogen, Brit; Gonzalez, Francisco J; Shust, Gail F
A 17-year-old obese male was admitted to the pediatric intensive care unit after presenting with fluid-responsive septic shock following 7 days of fever, gastrointestinal symptoms and neck pain. Initial workup was positive for SARS-CoV-2 and elevated troponin I and brain natriuretic peptide. Echocardiography and cardiac magnetic resonance imaging confirmed acute myocarditis. One week after discharge, repeat echocardiogram demonstrated improved heart function with only residual myocardial dysfunction.
PMID: 32502128
ISSN: 1532-0987
CID: 4469552

Invasive group G streptococcal infection in a paediatric patient [Case Report]

Bhavsar, Sejal Makvana; Shust, Gail F
We present a paediatric case of group G streptococcal bacteraemia and vertebral osteomyelitis. The patient is a 14-year-old girl with Gaucher disease type 1 who presented with severe thoracolumbar pain. She was treated with a 4-week course of antibiotics for presumed osteomyelitis with clinical improvement.
PMID: 27993825
ISSN: 1757-790x
CID: 2572222