Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5−13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C.
- Publikační typ
- časopisecké články MeSH
V následujícím přehledu uvádíme základní informace o infekčních onemocněních, která lze očekávat při ošetřování dětí z Ukrajiny, které přicházejí do ČR v průběhu tamního konfliktu. Za nejčastější lze považovat běžné respirační a GIT infekce, impetigo a gingivostomatitidy. Dále jsou uvedeny méně pravděpodobná onemocnění, která se na Ukrajině vyskytují ve větší míře, nebo proti kterým je ukrajinská populace méně proočkovaná (hepatitidy, HIV, TBC, spalničky, polio, záškrt, tyfus, vzteklina, tetanus).
The present review provides basic information on infectious diseases that can be encountered in the treatment of children from Ukraine arriving in the Czech Republic due to the ongoing conflict. The most frequent ones include common respiratory and GIT infections, impetigo, and gingivostomatitis. Also mentioned are less likely diseases that are more prevalent in Ukraine or those for which vaccination rates in the Ukrainian population are low (hepatitis, HIV, TB, measles, polio, diphtheria, typhoid fever, rabies, or tetanus).
- Klíčová slova
- UA point,
- MeSH
- hepatitida MeSH
- infekční nemoci * MeSH
- ozbrojené konflikty MeSH
- pediatrie * MeSH
- pokrytí očkováním MeSH
- preventabilní nemoci MeSH
- vakcinace MeSH
- Geografické názvy
- Ukrajina MeSH
We present the case report of an unvaccinated Czech child with tetanus. The child had not received any vaccines due to its parent's refusal. The disease originated from the wound in the nose caused by a small flat battery. The typical onset of tetanus followed after two weeks, rapidly progressing to respiratory failure with the need for mechanic ventilation despite intensive treatment. The child spent five weeks in the hospital. Mild long-term sequelae persisted 5 months.
V následujícím článku jsou shrnuty vybrané informace o cystické fibróze s důrazem na aktuální poznatky. Nejzásadnějším přínosem posledních let je objev a uvedení do praxe první kauzální léčby, která působí na samotnou podstatu nemoci. V diagnostice je zásadním posunem zavedení novorozeneckého screeningu. V komplikacích jsou i nadále na předním místě infekce, u kterých se prosazují dříve vzácné patogeny a dochází k revizím předchozích antiinfekčních strategií. Léčba spočívá stále na tradičních pilířích dechové rehabilitace, výživy a kontroly infekcí. Současně však léčba musí řešit nové komplikace a stává se čím dál komplexnější. S novými postupy a možnostmi stoupá cena péče i nutnost její organizace do nově vyhlášených center péče o pacienty s cystickou fibrózou.
In the following article, selected information on cystic fibrosis is summarised, with emphasis on contemporary findings. The most important contribution of the recent years is the discovery and introduction into practice of causal treatment which acts on the essential causes of the disease itself. In diagnostics, neonatal screening is a major breakthrough. In terms of complications, infections are still the most common one. Formerly rare pathogens are becoming increasingly common and previously efficient anti-infection strategies are in need of revision. At the same time, the treatment needs to respond to new complications and it is becoming more and more complex. With new therapeutic options and procedures, the price of the treatment is on the rise and it is becoming necessary to organise it into newly formed centres of care for patients with cystic fibrosis.
- MeSH
- bakteriální infekce klasifikace MeSH
- Burkholderia cepacia komplex MeSH
- cystická fibróza * diagnóza ekonomika komplikace mikrobiologie patofyziologie terapie MeSH
- genetické testování MeSH
- klinický obraz nemoci MeSH
- léčivé přípravky MeSH
- lidé MeSH
- mutace genetika MeSH
- podvýživa terapie MeSH
- příznaky a symptomy MeSH
- protein CFTR genetika metabolismus MeSH
- Pseudomonas aeruginosa MeSH
- transplantace plic MeSH
- virové nemoci MeSH
- Check Tag
- lidé MeSH
Předkládáme kazuistiku malého chlapce s cystickou fibrózou komplikovanou pertussi a pneumothoraxem. Kvůli neprospívání nebylo dítě vakcinováno proti pertussi. Ve 4 měsících věku se pacient nakazil Bordetellou pertussis. Průběh nemoci byl těžký a vedl k respirační insuficienci a spontánnímu pneumothoraxu. Diagnóza pertusse byla potvrzena sérologicky. Podezření na cystickou fibrózu vzniklo na základě protrahovaného průběhu onemocnění a anamnestickému údaji o dlouhodobém neprospívání. Komplexní došetření objevilo přítomnost Pseudomonas aeruginosa v dýchacích cestách, anémii, insuficienci exokrinního pankreatu, pozitivní potní test a přítomnost dvou mutací CFTR genu. Po nasazení komplexní léčby cystické fibrózy se záhy pacientův stav zlepšil a začal prospívat.
We present a case report of a small boy with cystic fibrosis complicated by pertussis and pneumothorax. The child had not been vaccinated against Bordetella pertussis due to the failure to thrive and was infected with the bacterium at the age of 4 months. The course of the disease was severe, with respiratory distress and spontaneous pneumothorax. The diagnosis of pertussis was serologically confirmed. A suspicion for cystic fibrosis increased after an unusually prolonged course of the disease and a history of the failure to thrive. A comprehensive diagnostic procedure revealed Pseudomonas aeruginosa respiratory infection, anemia, pancreatic insufficiency, a positive sweat test and the presence of two CFTR gene mutations. The patient, treated with comprehensive cystic fibrosis therapy, recovered from acute respiratory illness and started to thrive soon.
- MeSH
- cystická fibróza komplikace diagnóza MeSH
- kojenec MeSH
- lidé MeSH
- pertuse komplikace diagnóza MeSH
- pneumotorax komplikace MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
