Five pediatric patients not known to be immunocompromised developed severe posterior segment herpes simplex virus-2 ocular disease at a median age of 13 years. Presentations mimicked noninfectious uveitis, optic neuritis, vasculitis and necrotizing retinitis, often delaying diagnosis. Intraocular polymerase chain reaction confirmed herpes simplex virus-2 in 4. Visual morbidity, retinal detachment and the requirement for surgical intervention were common, supporting early polymerase chain reaction testing, antiviral therapy and surveillance.
Background: Panton-Valentine leukocidin (PVL) is a necrotizing cytotoxin that is produced by certain strains of Staphylococcus aureus, causing acute hematogenous osteomyelitis (AHOM). The PVL-positive strains are particularly virulent in the pediatric population, causing profound inflammatory responses. This study aimed to investigate whether the presence of PVL-producing S. aureus altered the clinical course of pediatric patients presenting with AHOM.Methods: This prospective descriptive study included all patients 16 years old or younger who presented to our institution with AHOM caused by S. aureus from September 2021 to September 2024. Patient demographics, clinical presentation and laboratory results, extent of the bone involvement, extraosseous involvement, and management were all recorded. Routinely collected samples were stored and tested in batches for PVL and specific clonal clusters.Results: Seventy-four patients were included in the study period. Seventy-two of 74 (97.3%) isolates tested positive for PVL. Twenty-three (31.10%) patients experienced a severe clinical course. Many patients required 3 or more surgical debridements. No association between PVL-positive S. aureus infection or specific spa-clonal clusters and experiencing a severe clinical course was observed.Conclusions: Despite almost a third of the study participants having a severe clinical course of disease, 97.3% of the patients tested positive for a PVL-producing S. aureus strain, suggesting that having a severe clinical course ismultifactorial. Given the high number of PVL-positive cases, we postulate that these bacteria cause AHOM with subperiosteal abscess formation requiring surgical drainage in our population.
Background: While children were initially less susceptible to coronavirus disease 2019 (COVID-19), emerging variants and eased public health measures shifted the burden to younger populations. This study characterizes pediatric COVID-19 features in South Korea across 7 epidemic waves, evaluating vaccination and comorbidities on disease severity.Methods: This retrospective study used the national K-COV-N database, integrating surveillance and health insurance claims data. Children 1-17 years old with confirmed COVID-19 from January 2020 to August 2023 were included. Participants were stratified by age and dominant variant waves. Logistic regression assessed demographic and clinical risk factors for severity.Results: Among 239,334 cases, the Omicron-dominant era (waves 5-7) accounted for 97.88% of the total burden. Although the mean hospital stay decreased from 12.6 days (wave 1) to 3.7 days (wave 5), mortality and multisystem inflammatory syndrome in children were concentrated during Omicron waves. Children 1-4 years of age experienced the most severe outcomes. Multivariate analysis identified cardiovascular disease (adjusted odds ratio [AOR]: 3.97), neurologic disorders (AOR: 2.88) and obesity (AOR: 2.68) as significant independent risk factors for severity. After adjusting for age and sex, vaccination showed limited protective effects against severe outcomes in this cohort.Conclusions: The pediatric COVID-19 landscape in South Korea shifted to massive community transmission during the Omicron era. While individual clinical severity declined, the absolute burden remained significant due to high prevalence. Future outbreak mitigation requires targeted protection for high-risk groups and scalable healthcare planning.
Background: From 2022 onwards, several countries, including the Netherlands, reported a marked increase in invasive group A streptococcal (iGAS) infections. Therefore, we aimed to describe the clinical presentation, disease course, treatment and outcomes of group A streptococcus (GAS) meningitis, a rare but severe manifestation of GAS infection in pediatric patients.Methods: Children with GAS meningitis were selected from the COPP-iGAS study, a national observational cohort study in children 0-17 years of age with in-hospital diagnosis of iGAS between 2015 and June 2024, conducted across 20 hospitals in the Netherlands, including all 7 academic centers with a pediatric intensive care unit.Results: Twenty-seven children were included, of whom 41% (11/27) were younger than 5 years of age. Most patients presented during the first quarter of the year (n = 13/27, 48%). Admission to an intensive care unit occurred in 15/27 (56%) patients and 4/27 (15%) patients died. Detailed clinical data were available for 13/27 patients. Clinical course data could be evaluated for 12 of these patients. Among those 12 patients, almost two-thirds had a complicated disease course, mainly involving cardiorespiratory failure (4/12, 33%). All 12 patients received prolonged antibiotic therapy [median 43 days (IQR 14-61)], predominantly intravenously [median 42 days (IQR 14-50)]. Adjunctive therapy included corticosteroids (6/12, 50%), antiviral agents (3/12, 25%) and anticoagulants (3/12, 25%).Conclusion: Our findings highlight that pediatric GAS meningitis is a severe condition characterized by high intensive care admission rates and substantial mortality. In the subgroup with detailed clinical data, complications were frequent and prolonged antibiotic treatment was common. Increased clinical awareness is warranted.
Background: Seasonal influenza virus infections remain a major public health burden. During the last years, several case reports of severe influenza infections in children have been published.Cases: We report 4 fatal influenza cases in young children (2-6 years old) which occurred in Southwest Germany in the seasons 2022/23 and 2023/24. All 4 children were previously healthy; a forensic autopsy was conducted due to an unknown cause of death. Postmortem samples from the respiratory tract and organ tissues were tested for respiratory viruses via real-time polymerase chain reaction (RT-PCR) and analyzed by whole-genome sequencing.Results: In 1 child, RT-PCR revealed influenza B virus, and 3 children died with influenza A (H1N1)pdm09 infection. No mutations associated with high virulence were detected. In 1 case, influenza A(H1N1)pdm09 could be cultivated in cell culture from brain tissue.Conclusions: This case series underlines the potential risk of fatal outcomes of influenza infections in children. This should be considered when re-evaluating the vaccination recommendations for healthy children.
