No abstract

Clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 are nonspecific. In this retrospective cohort study of 39 patients evaluated for MIS-C, 11 had non-SARS-CoV-2 infections, 3 of whom were also diagnosed with MIS-C. Clinical features were similar in patients with MIS-C and patients with non-SARS-CoV-2 infections. Clinicians should consider non-SARS-CoV-2 infections in patients undergoing MIS-C evaluation.

No abstract

Background: Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan. Methods: In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years. Results: A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB. Conclusions: This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.

We record 392 species or morphospecies of bees (Hymenoptera: Apoidea) for Manitoba, Canada, which is 154 more species than reported in 2015 and includes five new generic records since 2015 (Ashmeadiella, Brachymelecta, Eucera, Neolarra, and Triepeolus). Thirteen new records reported here are new for Canada: Calliopsis (Nomadopsis) australior Cockerell, Perdita (Perdita) tridentata Stevens, Brachymelecta interrupta (Cresson), Diadasia (Dasiapis) ochracea (Cockerell), Melissodes bidentis Cockerell, Nomada crawfordi crawfordi Cockerell, Nomada fuscicincta Swenk, Nomada sphaerogaster Cockerell, Nomada xantholepis Cockerell, Triepeolus cf. grindeliae Cockerell, Dianthidium (Dianthidium) parvum (Cresson), Coelioxys (Xerocoelioxys) nodis Baker, and Megachile (Megachiloides) dakotensis Mitchell. We remove the following species from the list of Manitoba bees based on re-examination of voucher material: Andrena (Ptilandrena) geranii Robertson, Andrena (Rhacandrena) robertsonii Dalla Torre, Andrena (Simandrena) nasonii Robertson, Andrena (Trachandrena) ceanothi Viereck, Andrena (Trachandrena) quintilis Robertson, Lasioglossum (Hemihalictus) pectoraloides (Cockerell), Lasioglossum (Lasioglossum) forbesii (Robertson), and Dianthidium (Dianthidium) concinnum (Cresson). We propose that Nomada alpha paralpha Cockerell, 1921 and N. alpha dialpha Cockerell, 1921 are junior synonyms of N. alpha Cockerell, 1905. Nomada arenicola Swenk, 1912 is considered a junior synonym of N. fervida Smith, 1854. Protandrena albertensis (Cockerell) and Neolarra mallochi Michener are recognised as valid species. We provide additional notes on taxonomy, nomenclature, and behaviour for select species in the list.

Objective To map which tuberculosis care models are best suited for children and adolescents. Methods We conducted a scoping review to assess the impact of decentralized, integrated and family-centred care on child and adolescent tuberculosis-related outcomes, describe approaches for these care models and identify key knowledge gaps. We searched seven literature databases on 5 February 2021 (updated 16 February 2022), searched the references of 18 published reviews and requested data from ongoing studies. We included studies from countries with a high tuberculosis burden that used a care model of interest and reported tuberculosis diagnostic, treatment or prevention outcomes for an age group < 20 years old. Findings We identified 28 studies with a comparator group for the impact assessment and added 19 non-comparative studies to a qualitative analysis of care delivery approaches. Approaches included strengthening capacity in primary-level facilities, providing services in communities, screening for tuberculosis in other health services, co-locating tuberculosis and human immunodeficiency virus treatment, offering a choice of treatment location and providing social or economic support. Strengthening both decentralized diagnostic services and community linkages led to one-to-sevenfold increases in case detection across nine studies and improved prevention outcomes. We identified only five comparative studies on integrated or family-centred care, but 11 non-comparative studies reported successful treatment outcomes for at least 71% of children and adolescents. Conclusion Strengthening decentralized services in facilities and communities can improve tuberculosis outcomes for children and adolescents. Further research is needed to identify optimal integrated and family-centred care approaches.

Objective To apply a cascade-of-care framework to evaluate the effectiveness—by age of the child—of an intensified tuberculosis patient-finding intervention. Design From a prospective screening program at four hospitals in Pakistan (2014–2016) we constructed a care cascade comprising six steps: screened, positive screen, evaluated, diagnosed, started treatment, and successful outcome. We evaluated the cascade by each year of age from 0 to 14 and report the age-specific mean proportion and standard deviation. Results On average across all ages, only 12.5% (standard deviation: 2.0%) of children with a positive screen were not evaluated. Among children who had a complete evaluation, the highest percentages of children diagnosed with tuberculosis were observed in children 0–4 (mean: 31.9%; standard deviation: 4.8%), followed by lower percentages in children 5–9 (mean: 22.4%; standard deviation: 2.2%), and 10–14 (mean: 26.0%; standard deviation:5.4%). Nearly all children diagnosed with tuberculosis initiated treatment, and an average of 93.3% (standard deviation: 3.3%) across all ages had successful treatment outcomes. Conclusions This intervention was highly effective across ages 0–14 years. Our study illustrates the utility of applying operational analyses of age-stratified cascades to identify age-specific gaps in pediatric tuberculosis care that can guide future, novel interventions to close these gaps.

Children undergoing solid organ and hematopoietic stem cell transplantation are at high risk of morbidity and mortality from tuberculosis (TB) disease in the post-transplant period. Treatment of TB infection and disease in the post-transplant setting is complicated by immunosuppression and drug interactions. There are limited data that address the unique challenges for the management of TB in the pediatric transplant population. This review presents the current understanding of the epidemiology, clinical presentation, diagnosis, management, and prevention for pediatric transplant recipients with TB infection and disease. Further studies are needed to improve diagnosis of TB and optimize treatment outcomes for these patients.