Objective: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. Methods: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. Results: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. Conclusions: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently.

Neospora caninum, a cause of abortion and stillbirth in cattle, was studied by histology, immunohistochemistry, and nested-PCR, using primers from the Nc5 region of the genomic DNA (PCR PLUS) and primers from the ITS1 region of the ribosomal DNA (PCR JB). A total of 105 fetal samples sent to the Centro de Pesquisa e Desenvolvimento de Sanidade Animal do Instituto Biológico from January 2006 to May 2008 were examined for evidence of N. caninum. Histological examination revealed 71.4% with non-suppurative inflammation in the heart, lung, liver, kidney, placenta, and brain. Immunohistochemistry detected infections in 8.6% of the samples, mainly in the brain, placenta, and heart. Nested-PCR JB revealed 6.7% with infections, while nested-PCR PLUS returned 20.9% positive results, mainly in brain and placenta, and in the pooled liver and heart. Kappa statistics demonstrated little agreement among the three techniques. The three methods are complementary, since they have distinct diagnostic characteristics and were combined to give a positivity rate of 24.8%.

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Introduction: Human adenoviruses (HAdV) play an important role in the aetiology of severe acute lower respiratory infection, especially in immunocompromised individuals. The aim of the present study was to detect HAdV using two different methods, direct fluorescence assay (DFA) and nested polymerase chain reaction (nested PCR), in samples collected from patients with acute respiratory infection (ARI) within 7 days of symptom onset. Methods: Samples (n=643) were collected from patients in different risk groups from 2001 to 2010: 139 adult emergency room patients (ERP); 205 health care workers (HCW); 69 renal transplant outpatients (RTO); and 230 patients in a haematopoietic stem cell transplantation program (HSCT). Results: Adenovirus was detected in 13.2% of the 643 patients tested by DFA and/or PCR: 6/139 (4.3%) adults in the ERP group, 7/205 (3.4%) in the HCW group, 4/69 (5.8%) in the RTO group and 68/230 (29.5%) in the HSCT patient group. Nested PCR had a higher detection rate (10%) compared with the DFA test (3.8%) (p<0.001). HSCT patients exhibited a significantly higher rate of HAdV infection. Conclusions: The adenovirus detection rate of the nested PCR assay was higher than that of the DFA test. However, the use of molecular methods in routine diagnostic laboratory work should be evaluated based on the specific circumstances of individual health services.

BackgroundThe respiratory syncytial virus (RSV) is recognized as an important cause of respiratory tract infections. Immunocompromised patients, healthcare workers (HCWs) and children contacts are at increased risk of acquiring the infection. However, the impact of asymptomatic infection in transmission has not been well studied. Objectives: this study evaluated the frequency and viral load (VL) of RSV in nasal swab samples of individuals with different risk factors for acquiring infection in a university hospital in Sao Paulo, Brazil.MethodsWe included 196 symptomatic children and their 192 asymptomatic caregivers, 70 symptomatic and 95 asymptomatic HCWs, 43 samples from symptomatic HIV‐positive outpatients, and 100 samples of asymptomatic HIV patients in the period of 2009‐2013.ResultsRSV infection was detected in 10.1% (70/696) of samples, 4.4% (17/387) of asymptomatic patients, and 17.1% (53/309) from symptomatic patients. (P < .0001). The VL of symptomatic patients (4.7 log copies/mL) was significantly higher compared to asymptomatic patients (2.3 log copies/mL). RSV detection among asymptomatic caregivers (6.8%; 13/192) was significantly higher compared to other asymptomatic adults, HIV and HCWs (2.0%; 4/195; P = .0252). A close contact with an infected child at home was an important risk to RSV acquisition [OR 22.6 (95% CI 4.8‐106.7)]. Children who possibly transmitted the virus to their asymptomatic contacts had significantly higher viral load than children who probably did not transmit (P < .0001).ConclusionsAccording to our results, it is important to know if people circulating inside the hospital have close contact with acute respiratory infected children.

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Highlights In one day, 4% (6 in 150) of hospital visitors had asymptomatic COVID-19. Potential of visitors’ viral shedding in healthcare facilities is underestimated. SARS-CoV-2 introduction into facilities is not fully blocked by universal masking.

Pandemic H1N1 2009 influenza virus had disseminated globally after being identified in Mexico and the United States in April. The H1N1 2009 morbidity and mortality were particularly severe in Brazil during the first pandemic wave. H1N1 2009 has been associated with a higher severity rate among some risk groups and young adults than seasonal influenza. 1 The frequency of viral coinfections with seasonal or pandemic Infuenza A and clinical correlation is not well known.The purpose of this study was to investigate coinfection of confirmed influenza A and other respiratory virus in samples collected from hospitalized patients during the first pandemic wave in a Brazilian Sentinel Hospital.We conducted a retrospective study including inpatients at the Universidade de São Paulo Hospital, São Paulo City, Brazil from August 19 to November 31, 2009. A total of 159 nasal/ throat swab samples were collected from enrolled patients. Patient inclusion criteria were fever plus cough plus dyspnea plus hospitalization due to clinical suspicion of H1N1 2009 infection, according to the National Program Protocol. Viral RNA were extracted using QIAamp Viral RNA extraction Kit (QIAGEN -Germany) and DNA using QIAamp DNA B l o o d K i t ( Q I A G E N -G e r m a n y ) , a c c o r d i n g t o t h e manufacturer's instructions. Influenza A seasonal (IAV) and H1N1 2009 detections were performed following the real time protocol published by the CDC. Seasonal influenza virus B (IBV), human rhinovirus (HRV), human metapneumovirus (hMPV), adenovirus (AdV), human respiratory syncytial virus (HRSV) and human coronavirus ( H C o V ) d e t e c t i o n s w e r e p e r f o r m e d a s p r e v i o u s l y described. [2][3][4][5][6][7][8] Demographic, clinical, laboratory and radiologic data were obtained from medical records. Nosocomial acquisition of the H1N1 2009 was defined as an onset of illness after more than 72 hours of hospital admission.Descriptive statistics consisted of the characterization of the studied individuals and the assessment of coinfection through calculation of the respective median value and range. Chi-squared test was used in univariate analysis comparing