Comparison of a rapid antigen test versus polymerase chain reaction for detecting respiratory syncytial virus, influenza A/B virus, and adenovirus in children

Claire Sommelette (1), Marc Bourgeois (2), David Tuerlinckx (3) Published in the journal : April 2022 Category : Pediatrics

Viruses are a common cause of respiratory infections in children. This study sought to compare the performance of a rapid antigen test versus the polymerase chain reaction (PCR) method for detecting three viruses (respiratory syncytial virus [RSV], adenovirus [ADV], and influenza A/B ([INF A/B]). We herein report the results of a prospective study conducted as part of the Sciensano (Institute of Public Health in Belgium) acute respiratory infection (ARI) surveillance. Between October 2018 and April 2019, 140 nasopharyngeal cell samples were collected from 135 children hospitalized for ARI at the University Hospital Dinant Godinne (Belgium). The rapid antigen test came back positive for 71/140 (50.7%) samples, while PCR came back positive for at least one virus for 123/140 (87.8%) samples. We determined the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of the rapid test compared to the RT-qPCR (PCR), which is used as the gold standard. The results for the rapid antigen test were as follows: Se 80.3%, Sp 100%, PPV 100%, and NPV 85% for RSV; Se 6.25%, Sp 99%, PPV 66.7%, and NPV 78.1% for ADV; Se 87.5%, Sp 98.4%, PPV 87.5%, and NPV 98.4% for INF.

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Reflections on the management of antenatal hydronephrosis

Hélène Legrand (1), Nathalie Godefroid (2), Axel Feyaerts (3), Stéphane Thiry (3), David Tuerlinckx (4) Published in the journal : January 2021 Category : Pediatrics

Antenatal hydronephrosis is the most common congenital abnormality. The post-natal management is, however, still controversial, specifically concerning further testing, as well as and benefit of antibiotic prophylaxis. The systematic indication of performing a voiding cystourethrogram for vesicoureteral reflux screening and of prescribing antibiotic prophylaxis for preventing urinary tract infections has been increasingly questioned by recent study data. A less aggressive approach is discussed here, which is essentially based on post-natal ultrasound findings.

We herein propose an algorithm that is based on these study data.

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A pediatric case of locked-in-syndrome

Laura Wulleman, Magali De Roy, Sybille Andries, Christine Bonnier, Leslie Danvoye Published in the journal : April 2020 Category : Pediatrics

The locked-in syndrome (LIS) is a rare neurologic disorder, especially in the pediatric population. It is defined by five clinical criteria: (1) persistence of eye opening and presence of vertical eye movements; (2) preserved superior cortical functions; (3) aphonia or severe hypophonia; (4) quadriplegia or quadriparesis; (5) initial communication mode with vertical eye movements or blinking. The LIS should be considered as part of the differential diagnoses appertaining to vegetative states and comas. The most common etiology is a pontine stroke, caused by vertebrobasilar artery thrombosis. We herein describe a pediatric clinical case of this pathology, which represents a challenge in terms of both diagnosis and management.

In this article, we present the etiological factors of ischemic pediatric stroke, a problem with multiple risk factors, with particular attention paid to post-varicella vasculopathy and its therapeutic management.

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Septic shock and pyomyositis in a 1-year-old boy caused by Panton-Valentine leukocidin-secreting Staphylococcus aureus

Julien Charlier (1), Astrid Haenecour (2), Dimitri Van der Linden (3) Published in the journal : December 2019 Category : Pediatrics

Pyomyositis is an acute bacterial infection involving one or multiple striated muscles, potentially leading to abscess formation. Albeit being uncommon, its consequences for the patient can be severe, even fatal. Primarily described in tropical countries, this condition may also occur in temperate regions. Its pathophysiology is still poorly understood. The initiating process could be a minor muscle traumatism followed by bacterial hematogenous colonization of the muscle. Generally, its clinical presentation is insidious and unspecific, its diagnosis being challenging for the clinician. Nevertheless, a rapid diagnosis allows an early antibiotherapy to be established and complications to be prevented. The cornerstone of pyomyositis diagnosis is magnetic resonance imaging (MRI), along with bacterial cultures from biological fluids. The main bacteria involved in this condition is Staphylococcus aureus (SA), while Panton-Valentine leucocidin (PVL) is a toxin secreted by SA. This toxin is reported to be a virulence factor in invasive SA infections, whereas its precise role is still controversial depending on the infection site. We herein present a case of pyomyositis caused by Panton-Valentine leukocidin-secreting SA, with abdominal wall involvement, in a 1-year-old boy from a tropical country who was spending his holiday in Belgium.

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Management of chronic hepatitis C in children

Pauline Van Gyseghem, Etienne Sokal (1) Published in the journal : December 2018 Category : Pediatrics

With about 11 million children suffering from chronic hepatitis C infection worldwide, hepatitis C remains a major concern in pediatrics. In children, the main source of transmission is vertical, from the mother to the child around birth. Overall, 80% of infected children will develop a chronic infection, with about 1-2% evolving into hepatic cirrhosis. Pediatric treatments aim to eradicate the virus in order to reduce the transmission risk and prevent tissue damage in the long-term. Classical treatments based on pegylated interferon and ribavirin allow sustained virologic response to be achieved in about 45 to 95% of cases (1). In adults, new direct-acting antiviral (DAA) regimens have been approved in recent years and are now being used in the first-line setting. The first successful study that tested their efficacy in a pediatric population reported a sustained virological response in 97 to 100% of cases (2). If this rate is confirmed in other ongoing studies, disease eradication in the pediatric population should be feasible, enabling us to eradicate the virus reservoir, a latent source of new contaminations and chronic liver diseases.

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Management of neonates at risk of early-onset sepsis: priority to a clinical strategy

Morgane Hancart(1), Danielle Rousseaux(2), Véronique Thiry(3), Jean-Paul Langhendries(4), Pierre Maton(4) Published in the journal : November 2018 Category : Pediatrics

The screening of early-onset sepsis in asymptomatic neonates at risk of infection is challenging and remains controversial. The objective of this study was to analyze the impact of standardized and optimized clinical surveillance in a targeted population of neonates at risk of infection, based on the updated Belgian recommendations.

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Pulmonary arteriovenous malformation and Peutz-Jeghers syndrome: literature review and discussion about diagnostic update, follow-up and treatment

Priscila Jijón(1), François Marolleau(2), Polycarpe Shango(3), Thierry Sluysmans(3), Stéphane Moniotte(3) Published in the journal : June 2018 Category : Pediatrics

Patients with PAVM may have hypoxemia, orthodeoxia, chest pain, hemoptysis, paradoxical embolizations leading to stroke and brain abscess. Peutz-Jeghers Syndrome is a disease characterized by the development of hamartomatous polyps in the gastrointestinal tract, mucocutaneous melanotic pigmentation and high risk of cancer. This is a case-report of the fortuitous association of these 2 diseases.

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Hypokalemic periodic paralysis

Elise Osterheld (1), Julien Mergen (1), Marianne Michel (1), Evelyne Heylen (2) Published in the journal : April 2018 Category : Pediatrics

Hypokalemic periodic paralysis is a rare autosomal dominant disorder, caused by a defect in calcium or sodium channels. Common triggers include intense physical activity, high carbohydrate intake, and stress. These paralysis episodes usually resolve within a few hours to a few days.

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IgA Nephropathy and Henoch-Schönlein purpura : discussion and consequences of their likely common physiopathology

Marie-Julie Debuf (1), Elise Hennaut (2), Jean-Philippe Stalens (3) Published in the journal : April 2018 Category : Pediatrics

Henoch-Schönlein purpura is a vasculitis characterized by IgA immune deposits in small vessels and involving the skin, digestive tract, renal glomeruli, and joints. IgA nephropathy is a glomerulonephritis that is characterized by mesangial deposits of IgA and is associated with episodes of hematuria and/or proteinuria mainly occurring after respiratory or gastrointestinal infections. Despite some differences regarding the typical age of onset and natural history, a growing number of clinical, histological, and biochemical evidence suggests that these diseases are different clinical expressions of the same pathophysiological process, which could have consequences on their management.

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When heart failure reveals itself as bronchiolitis

Georges de Bilderling (1), Claire Geurten (1), Jean Evrard (1), François Kanen (1), Laurent Houtekie (2), Alain Poncelet (3), Karlien Carbonez (4), Stéphane Moniotte (4) Published in the journal : April 2017 Category : Pediatrics

A 2-month-old baby is admitted to our unit for bronchiolitis. Due to the infant's prolonged symptoms with predominant feeding difficulties and because of a heart murmur noted on auscultation, cardiac ultrasound is performed, resulting in the diagnosis of ALCAPA syndrome (Anomalous Left Coronary Artery from Pulmonary Artery). ALCAPA is a rare but severe cardiac malformation, with early diagnosis and treatment being key to a good prognosis. Bronchiolitis can provoke heart failure, whereas clinical features of heart failure may mimic bronchiolitis. This clinical case underlines the need for performing a complete clinical examination, along with oriented diagnostic investigations, when confronted with a baby suffering from a respiratory condition whose severity or evolution appears unusual.

Key Words

ALCAPA, coronary malformation, cardiac failure, bronchiolitis, infant

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