Background: Multisystem inflammatory syndrome in children (MIS-C), temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified in infants <12 months old. Clinical characteristics and follow-up data of MIS-C in infants have not been well described. We sought to describe the clinical course, laboratory findings, therapeutics and outcomes among infants diagnosed with MIS-C. Methods: Infants of age <12 months with MIS-C were identified by reports to the CDC's MIS-C national surveillance system. Data were obtained on clinical signs and symptoms, complications, treatment, laboratory and imaging findings, and diagnostic SARS-CoV-2 testing. Jurisdictions that reported 2 or more infants were approached to participate in evaluation of outcomes of MIS-C. Results: Eighty-five infants with MIS-C were identified and 83 (97.6%) tested positive for SARS-CoV-2 infection; median age was 7.7 months. Rash (62.4%), diarrhea (55.3%) and vomiting (55.3%) were the most common signs and symptoms reported. Other clinical findings included hypotension (21.2%), pneumonia (21.2%) and coronary artery dilatation or aneurysm (13.9%). Laboratory abnormalities included elevated C-reactive protein, ferritin, d-dimer and fibrinogen. Twenty-three infants had follow-up data; 3 of the 14 patients who received a follow-up echocardiogram had cardiac abnormalities during or after hospitalization. Nine infants had elevated inflammatory markers up to 98 days postdischarge. One infant (1.2%) died after experiencing multisystem organ failure secondary to MIS-C. Conclusions: Infants appear to have a milder course of MIS-C than older children with resolution of their illness after hospital discharge. The full clinical picture of MIS-C across the pediatric age spectrum is evolving.

Background Heavy alcohol consumption has been associated with risk-taking behaviors in intravenous drug users (IDU). However, limited information exists on the relationship between alcohol use and injecting and sexual risk in young adult IDU (<30 years) who are at risk for hepatitis C virus (HCV) and HIV infection. Methods We conducted a cross-sectional study of young adult IDU in San Francisco (2006-2012) who had not previously tested positive for HCV. Participants completed a structured interview and HCV testing. We examined whether hazardous drinking (Alcohol Use Disorders Test – Consumption [AUDIT-C] 3-9 for women and 4-9 for men) and probable dependent drinking (AUDIT-C 10-12) levels were associated with injecting and sexual risk behaviors and HCV status, indicated by adjusted odds ratios (AOR) in separate models adjusted for potential confounders. Results Of the 326 participants, 139 (42.6%) were hazardous drinkers and 82 (25.2%) were probable dependent drinkers; thus over two-thirds evidenced problem drinking. Being a hazardous drinker was significantly associated with injecting drug residue from another's drug preparation equipment (AOR 1.93). Probable dependent drinking was significantly associated sharing non-sterile drug preparation equipment (AOR 2.59), and inversely, with daily/near daily injecting (AOR 0.42). Both heavy drinking levels were associated with having ≥2 sexual partners (AOR 2.43 and 2.14). Drinking category was not associated with HCV test results. Conclusion The young adult IDU reported consuming alcohol at very high levels, which was associated with some unsafe sexual and injecting behaviors. Our study demonstrates the urgent need to intervene to reduce alcohol consumption in this population.

Background HIV, hepatitis C (HCV), and human T-cell lymphotropic virus I (HTLV-1) are associated with high global burdens of disease, notably in resource-poor locales. They share similar routes of transmission and cause chronic infections with associated morbidity. We performed a cross-sectional study to assess the impact of HTLV-1 infection on clinical outcomes in HIV/HCV-coinfected patients. Methods We enrolled 102 (72.3%) with HIV/HCV coinfection (Group 1) and 39 (27.7%) triply infected with HIV, HCV, and HTLV-1 (Group 2). We reviewed medical records of two groups of patients followed in two outpatients services in Salvador, Brazil. We collected and compared demographic, behavioral-related information, immunologic, virologic, and histologic parameters for HIV-1 and HCV infection. Results Demographics, virologic, and immunologic characteristics were similar in the two groups; a higher proportion of triply infected patients (Group 2) reported any history of injection drug use compared with dually infected (Group 1) patients (75% vs 45.8%; P = 0.003). No differences were seen between groups in HIV clinical outcomes (CD4 count and viral load). Alanine aminotransferase levels were significantly higher in HIV/HCV-coinfected patients (P = 0.045). Liver fibrosis damage based on Metavir scores was similar between groups (0.97) but was worse with lower CD4 cell count (under 200 cells/mm3) (P = 0.01). Conclusions HIV/HTLV-1 and HIV/HCV coinfections may worsen clinical related outcomes, but virologic and immunologic outcomes were similar in both groups. Hepatic measures were worse in patients with more severe immunosuppression.