BACKGROUND

Persistent symptoms following SARS-CoV-2 infection have increasingly been reported globally, although currently there are no available local epidemiological data on this. This study aimed to determine the prevalence, common manifestations, and clinical predictors of post COVID-19 condition among the pediatric population.

METHODS

A cross-sectional analytical study adapting the ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) Global COVID 19 – pediatric survey questionnaire was done. There were 356 patients with confirmed SARS-CoV-2 infection (RNA detected by RT-PCR/GeneXpert). Out of the 189 with complete data and who responded, 3 were excluded due to deaths during the acute infection. A total of 186 children aged 0-18 years old were enrolled and children of the same age group having SARS-CoV-2 negative result were included as control in 1:1 ratio. Univariate and multivariate regression analyses were performed to identify variables associated with post COVID-19 symptoms.

RESULTS

The prevalence of post COVID-19 condition was 15%. The most common presenting symptoms during the acute infection were fever and cough, while the common post COVID-19 symptoms included persistent cough (65%), rhinorrhea (55%) and loss of taste (3%). In the univariate analysis, the age group 5-11 years (OR 13.83, p value < 0.05) and hospitalization (OR 2.37, p value < 0.05) were statistically correlated with persisting symptoms. However, multivariate logistic regression analysis showed that hospitalization (aOR 4.1, p value < 0.05) was the only factor significantly associated with the persistence of symptoms.

CONCLUSION

Children less than 11 years old and male sex have a higher prevalence of persistent symptoms following acute COVID-19 infection. The age group 5-11 years old was identified as a clinical predictor of post COVID-19 condition along with those who were hospitalized.

Covid-19

BACKGROUND

The Philippines is hyperendemic for hepatitis B infection. Vaccination is crucial for protection. Local data on the antibody response after completion of the primary vaccination series is limited.

OBJECTIVE

This study aimed to measure the anti-HBs levels among college students who completed primary hepatitis B vaccination series, compare seropositivity across stratified groups and correlate anti-HBs levels with the time elapsed since the last vaccine dose.

METHODS

This cross-sectional study included 111 college students in health-related courses with immunization record showing the complete primary Hepatitis B vaccination series. Participants were stratified based on the following vaccination schedules: 0-1-6-month group; 0-1-2-month group; and booster group. Anti-HBs titers were determined.

DATA ANALYSIS

Statistical analyses included One-way ANOVA, Kruskal-Wallis test, Fisher’s Exact test and Shapiro-Wilk normality test. Kaplan-Meier Survival Estimate assessed the probability of anti-HBs seropositivity over time. Data were analyzed using STATA 13.1.

RESULTS

The baseline characteristics of the study population were homogenous. The median anti-HBs titer several years after primary vaccination was low at 2.9 mIU/mL. Participants in the booster group had the highest seropositivity rate (57.14%) with a median titer of 30.16 mIU/mL. There was an inverse relationship between anti-HBs titer and elapsed time since the last vaccine dose. Kaplan-Meier Survival Estimate showed that the seropositivity decreases to 90.56% after 15.8 years, 51.3% after 17.5 years, and 2.97% at 18 years.

CONCLUSION

This study revealed low anti-HBs titers among students who previously completed primary vaccination series, with no significant difference between two schedules. Booster doses resulted in the highest seropositivity. Over-all, seropositivity declines over time.

Hepatitis B ; Hepatitis B Antibodies

BACKGROUND

Cycle threshold (Ct) value has gained clinical attention in the study of COVID-19 as it has been used as an indirect method of quantifying the viral RNA in a specimen. Investigating its utility will aid in discovering transmission dynamics and clinical decision-making.

OBJECTIVE

To determine the association between the RT-PCR Ct value with the timing of sample collection and presenting manifestations of COVID-19 among pediatric patients.

METHODS

A retrospective, analytical, cross sectional research was done which included all patients with a positive RT-PCR admitted in a private tertiary hospital in Davao City. Ct values and clinical and demographic data were retrieved. Descriptive statistics were used to present and analyze the profiles. Independent t-test, analysis of variance and Pearson r were used for comparison and correlation of variables.

RESULTS

A total of 48 subjects were included in the study. Of the presenting manifestations, the most common were fever and cough. There was no significant difference in the Ct values of the different presenting manifestations. There was a weak positive correlation between Ct value and time of sample collection (r 0.3027). A weak negative correlation between Ct value and number of presenting manifestations was also noted (r -0.2045).

CONCLUSION

Ct value increases with time and is significantly low during the first three days of illness. There is no significant difference in the mean Ct values of the different presenting manifestations. Furthermore, the higher number of presenting manifestations is associated with lower Ct values.

Covid-19

OBJECTIVE

To determine the clinical profile, management and outcome of pediatric patients with COVID-19 infection admitted at the Zamboanga City Medical Center (ZCMC) from March 2020 to December 2022.

METHODOLOGY

This was a retrospective cohort study which enrolled patients 19 years old and below with SARS-CoV-2 infection admitted at the ZCMC. Charts were retrieved and uploaded on a database. Demographic and clinical information were gathered including history of exposure to COVID-19, history of COVID-19 vaccination, comorbidities, clinical manifestations, laboratory examination, medications and clinical outcome. Data were analyzed using descriptive statistics.

RESULTS

There were 145 evaluable patients. The mean age was 8.4 years with 40% aged less than 5 years old. Majority were males (58.62%). Half (50.34%) had no known exposure to COVID-19. None received COVID-19 vaccine. Ninety-seven (66.90%) patients were underweight. Sixty-nine (47.59%) patients were asymptomatic, 30 (20.69%) had mild infection while 24 (16.55%) had severe to critical illness. There were 5 (3.45%) cases of multisystem inflammatory syndrome in children (MISC). The most common symptoms were fever, vomiting/nausea, cough and shortness of breath. The most common chest radiograph findings were bilateral lung opacities. Majority of the patients received antibiotics (68.97%). Other medications given included corticosteroids (14.48%), intravenous immunoglobulin (3.45%), remdesivir (4.83%) and tocilizumab (5.52%).The mortality rate was 11.72%.

CONCLUSION

Pediatric COVID-19 in Southwestern Mindanao affects all age groups. Majority of hospitalized patients were asymptomatic or had mild infection. Fever was the most common manifestation. Antibiotic use was high. Mortality rate was 11.72%.

Covid-19 ; Sars-cov-2 ; Child ; Children

BACKGROUND

Pneumonia in children causes significant morbidity and mortality especially in those less than 5 years of age. Accuracy of multiplex diagnostic tests for rapid identification of microbial etiology is not well established. This study was undertaken to determine the diagnostic accuracy of a pneumonia panel multiplex RT-PCR assay in the detection of respiratory pathogens among pediatric patients with pneumonia.

METHODOLOGY

This retrospective analytic cross-sectional study included children less than 19 years old diagnosed with pneumonia between June 2022 to June 2023 with respiratory samples for bacterial culture and pneumonia panel multiplex RT PCR assay.

RESULTS

A total of 211 pediatric patients were included in the study. Of these, 72% were diagnosed with community acquiredpneumonia, 95% of them had endotracheal aspirate specimens. Bacterial pathogens were detected in 131 patients (61%). Of the 172 patients who had positive detections, 51 (30%) had at least one antibiotic-resistant gene identified. There was moderate agreement between the two methods (72.51%, kappa = 0.4632). Pneumonia panel multiplex RT-PCR assay showed acceptable discriminative ability (0.74) with accuracy at 72.51% and high sensitivity (88.42%), but specificity was only 59.48%. Its useresulted to the escalation of antimicrobial therapy in 15% of patients.

CONCLUSION

The pneumonia panel multiplex RT PCR assay is a valid diagnostic aid in the detection of respiratory pathogens for children with pneumonia given its good discriminative ability, high accuracy, and sensitivity.

Pneumonia ; Pediatrics

BACKGROUND

Many neonates are started on antibiotics even if they are well-appearing due to presence of risk factors. The Early Onset Sepsis (EOS) calculator is a web-based tool that calculates for composite risk scores for sepsis and limits empiric antibiotic therapy only as necessary.

OBJECTIVE

This study aims to determine if there is a significant difference between the proportion of neonates recommended for antibiotics using the EOS calculator and AAP guidelines for neonatal sepsis.

METHODS

This is a retrospective hospital-based cohort study where review of charts of neonates ≥34 weeks age of gestation (AOG) who were started on intravenous antibiotics within 72 hours of life for the period of 2019 to 2023 was done. Peripartum risk factors were used to calculate for EOS risk score and categorize those to be recommended for treatment using the score as well as the AAP guidelines. Newborns with growth on blood culture were identified. McNemar’s test was used to determine if there is a significant difference between the two proportions. Sensitivity and specificity of both tools were calculated.

RESULTS

Out of 916 neonates, 345 (38%) and 469 newborns (51%) were advised empiric antibiotic therapy by the EOS calculator and AAP 2018 guidelines respectively. A McNemar Test revealed a significantly lower proportion of neonates recommended for antibiotic treatment using the EOS calculator (p < 0.001). Blood culture was taken from 208 newborns and six had positive isolates. Both the EOS calculator and AAP guidelines had 100% sensitivity and recommended antibiotics for these culture-proven sepsis cases. EOS calculator had a higher specificity (45% vs 32%).

CONCLUSION

The EOS calculator as a risk assessment tool could significantly reduce use of antibiotics. The proportion of those who were recommended for antibiotics using the EOS calculator was significantly lower by 13% (p value =
Sepsis ; Infant, Newborn

BACKGROUND

Candida infections range from oral candidiasis to candida endophthalmitis, peritonitis and candidemia. Invasive fungal disease or disseminated candidiasis is highly fatal among children. There are no studies done in the pediatric population to detect early candida infection to help identify those who will benefit from early and prompt medical treatment.

OBJECTIVE

This study determined the value of Candida scoring (CS) as a predictive tool for invasive candidiasis among pediatric patients admitted in the intensive care units of a tertiary referral center.

METHODS

This was a retrospective cross sectional study where 4184 charts of pediatric patients and admitted in the ICU between January 2018 to December 2020 were reviewed. Patients were scored upon admission, after 3 days, after 1 week and weekly thereafter until discharge or demise. The scoring tool used was developed by Leon et al., and uses four variables: presence of sepsis, use of total parenteral nutrition (TPN), presence of multifocal colonization and presence of surgery. Data collected for Candida scores were presented as frequencies and percentages.

RESULTS

There were 396 patients enrolled in this study and 25.7% were treated for candida infection. Majority were newborns where 78.7% had a CS >3, which is statistically significant, p =3 which is statistically significant. Among intubated patients, 84% had a CS of >3 and all patients on TPN had a CS of >3, both of which are significant. CS could correctly predict 64.6% of patients who will likely have candida infection.

CONCLUSION

Candida scoring is a tool that can be used in patients at high risk of developing Candida infection. In this study, a CS of >3 can be used to predict Candida infection in the ICU.

Candidemia ; Candidiasis, Invasive

BACKGROUND

Dengue is a global health concern, particularly in tropical regions such as the Philippines. In 2019,Cebu City reported the highest number of dengue cases in Central Visayas with 3,290 cases and 20 deaths, an 11.8% increase compared to 20181 . To help predict disease outcomes and provide timely management, a scoring system, the Daily Dengue Severity Score (DDSS)² was utilized.

OBJECTIVE

To determine the clinicodemographic profile of dengue patients, determine the accuracy of the DDSS in assessing disease severity, and determine a cut off score that suggests severe dengue.

METHODS

Patients 1 month to 18 years admitted for dengue at Perpetual Succour Hospital from January 2018 to December 2020 were included. Cases were classified as Dengue without Warning Signs, Dengue with Warning Signs, and Severe Dengue, and scored using the DDSS. Statistical analysis used were Geometric mean and Area Under the Receiver Operating Characteristic (AUROC) curves to analyze the discriminative performance of the DDSS among the different disease severity states.

RESULTS

Out of 327 cases, 34 were classified as Dengue without Warning Signs, 271 Dengue with Warning Signs, and 22 Severe Dengue. The highest mean DDSS was 17.7 ±14.0 at Day -4 among those with Severe Dengue, and the lowest mean DDSS was 1.1 ± 2.0 at Day +3 among those with Dengue without Warning Signs. A cut off point of 10 on Day -1 predicted subsequent Severe Dengue among patients with Dengue with Warning Signs. In 91.39% of cases, there was a significant relationship between the DDSS and dengue classification, and the higher the DDSS, the more severe the disease.

CONCLUSION

Majority of dengue patients were males, aged 8.1 to 9.2 years. DDSS showed 66.67% sensitivity, 92.86% specificity, a positive likelihood ratio of 9.3, and a cutoff of 10 is predictive of severe dengue among patients with dengue with warning signs.

Human ; Dengue ; Scoring Methods ; Research Design ; Patient Monitoring ; Monitoring, Physiologic

Human ; Environment ; Work ; Philippines

BACKGROUND

Rabies remains to be a neglected tropical disease in the Philippines, with the country reporting a higher number of cases compared to its counterparts in Asia.

OBJECTIVE

To describe the demographics, animal bite characteristics, and post-exposure prophylaxis of animal bite patients coming in for care at the Research Institute for Tropical Medicine (RITM), a large government referral center for infectious diseases, and animal bites.

METHODS

Electronic patient records from January 1, 2018 to December 31, 2019 were obtained from the National Rabies Information System (NaRIS) database of the Department of Health, and summarized using applicable descriptive statistics.

RESULTS

A total of 14,614 patients were included over the two-year study period, and more than third of the patients were children below 15 years old, while more than half were adult males. Lower extremities were the most frequently affected area, while with children, more than a third of exposures were in the head and neck areas. Intradermal route was mostly used for the post-exposure prophylaxis, while WHO prequalified vaccines were utilized in more than 90% of the patients. Only 55.7% of patients completed the prophylaxis regimen at RITM.

CONCLUSION

These findings reflect the significant exposure of children from animal bites, and the non-compliance of patients to the prescribed post-exposure prophylaxis.

Human ; Animals ; Rabies ; Post-exposure Prophylaxis ; Rabies Vaccines