Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections ( p < 0.001); and were younger (median 40 (IQR 21–83) vs 56 (IQR 36–85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring ( p < 0.001). Conclusion : In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease. What is Known: • Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited. What is New: • In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04718-y.
The efficacy and safety of the nasally administered drug Allergodil in the treatment of allergic rhinitis were evaluated in a prospective drug monitoring programme conducted in Germany. Data from 489 children under the age 13 were included. The study was designed to gain knowledge about Allergodil in a normal clinical setting. Dosing was at the judgement of the investigator bearing in mind data sheet recommendations, i.e. one spray-puff (0.14 mg) per nostril twice daily. Patients were treated for four weeks. The occurrence of ten nasal, eye and throat symptoms was rated (0 = never, 1 = sometimes, 2 = often). All symptoms showed a statistically significant improvement at the final visit, as did the overall sums of the scores. These changes were clinically significant. Overall assessment of efficacy by the physicians and the patients was very good and good in more than 85% of patients. 70% of patients required no concomitant medication. 13.5% of patients experienced adverse events, mostly mild or moderate in severity. Safety and tolerance were assessed as very good and good in more than 97% of cases. No sedation was seen. With respect to both efficacy and safety, there were no differences between patients younger than 6 years and those aged 6-12 years. In conclusion, these results suggest that Allergodil is an effective treatment of the symptoms of allergic rhinitis in children. The subgroup of 48 young patients studied shows that Allergodil was safe and well tolerated in patients aged 2-6 years.
Im Sinne einer selektiven Prävention psychischer Störungen ist es notwendig, Personen zu identifizieren, die aufgrund sozialer oder biologischer Faktoren ein erhöhtes Risiko für die Entwicklung einer psychischen Störung aufweisen. Klinikaufenthalte im Kindesalter werden seit Beginn des 20. Jahrhunderts als mögliche psychosoziale Risikofaktoren diskutiert. In dieser Studie wurde die Auswirkung eines Klinikaufenthaltes auf die soziale Unsicherheit untersucht, einen starken Prädiktor für die spätere Entwicklung von psychischen Störungen, insbesondere von Angststörungen und Depression. Zu zwei Messzeitpunkten wurden bei 42 Kindern zwischen sechs und 13 Jahren die Konstrukte „Soziale Unsicherheit“, „Sozialbeziehungen“ und „Selbstwertgefühl“ im Selbst- und Elternurteil erfasst. Verglichen wurden eine Gruppe gesunder Kinder, chronisch kranker Kinder in ambulanter Behandlung und chronisch kranker Kinder in stationärer Behandlung. Die Ergebnisse zeigen keine negativen bzw. positiven Veränderungen der sozialen Unsicherheit, der Sozialbeziehungen und des Selbstwertgefühls. Die erhobenen Auffälligkeiten decken sich mit den Prävalenzraten aktueller epidemiologischer Studien. Ein Klinikaufenthalt allein stellt nach den Befunden der vorliegenden Untersuchung keinen psychosozialen Risikofaktor (mehr) dar.
In the original published version of the above article, the names of members of the EUCLIDS consortium were not introduced in the authorship section. The names are now properly displayed.The original article has been corrected.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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