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Owing to uncharacteristic initial symptoms and rapid progression, invasive meningococcal disease is still a challenge to diagnose and treat, even in high-income countries. Waterhouse-Friderichsen syndrome is a potentially fatal complication of invasive meningococcal disease, presenting as acute adrenal insufficiency due to haemorrhagic necrosis of the adrenal glands. We report a case of 5.5-year-old boy who presented to the hospital with fever, impaired consciousness, vomiting, and upper respiratory tract infection symptoms. Despite prompt diagnosis of invasive disease and adequate treatment, the patient died. We underline the need to increase parents’ knowledge and better access to vaccines against meningococci for Polish paediatric patients. Paediatricians and primary care physicians must remain alert and be ready to suspect invasive meningococcal disease in their patients.

Objectives: Multisystem inflammatory syndrome in children (MIS-C) is the result of an immune response triggered by a previous exposure to SARS-CoV-2. The clinical presentation of MIS-C overlaps with other life-threatening bacterial infections, in which antimicrobials are the mainstay therapy. The aim of study was to describe the use of antibiotics in children with MIS-C in Poland. Methods: The analysis of 345 children reported from 42 Polish cities to the national MultiOrgan Inflammatory Syndromes COVID-19 Related Study (MOIS-CoR Study) from June 2020 to April 2021. Results: At least one antibiotic was used in 310 (90%) children, mainly third-generation cephalosporin (251/310). Broad-spectrum antibiotics were used in 258 (75%) children and 224 (87%) received this treatment for more than 3 days. Concentrations of serum procalcitonin >2 µg/l and the presence of lower respiratory symptoms were associated with increased odds of receiving any antibiotic. Conclusion: Although bacterial infections in patients with MIS-C are uncommon, we show that MIS-C poses a challenge to clinicians who are faced with the decision to start, continue, or stop antimicrobial therapy. Antibiotic stewardship in patients with MIS-C should be improved to ensure that likely pathogens are treated and that antimicrobials are stopped when bacterial infections are excluded and the diagnosis of MIS-C is made.

Allergen immunotherapy (AIT) is the only casual method of allergy treatment. It is based on regular administration of a gradually increasing dose of an allergen to induce immunological tolerance to a particular sensitising factor. Due to proven efficacy, including preventive effect as well as favourable safety profile, it should be widely applicable, particularly among older children and adolescents. While the number of patients suffering from non-communicable diseases, including allergies, is rising, there is a false impression that the impact of infectious diseases can be disregarded. Thanks to prophylactic vaccines, many infectious diseases that used to be a threat to people’s lives have been forgotten. In order to tackle familiar and emerging infectious diseases (such as COVID-19), there is a need to keep in mind vaccinations in all age groups. As allergen immunotherapy and prophylactic vaccines affect the immunologic system, performing both interventions in one patient may raise concerns about safety and effectiveness. However, a large-scale study on this topic has not been performed to date. This article summarises immunological responses occurring after contact with pathogens and allergens as well as describes reactions triggered by prophylactic vaccines and AIT. What is more, possible interference of receiving both a prophylactic vaccine and AIT is discussed.

Extrusion-cooking, as a modern and versatile processing method, may be applied to create the properties of food ingredients and active components, especially beans and legumes. Two varieties of bean (red Toska and white Aura) were extruded with twin-screw extruder under various conditions (water dosing 0.8–2.4 l h−1, screw speed 300–700 rpm). Physical properties (energy consumption, expansion ratio, water absorption and solubility, viscosity, texture, color) and chemical characteristics (protein, fiber, reducing sugars, total phenols, anthocyanins, flavonoids, antioxidant activity and reducing power) were evaluated. Regardless of the bean cultivar, energy consumption significantly increased for about 60% with the extruder screw speed increase, and at the same time, the greater water addition reduced energy consumption by about 30%. The physical properties and texture of extruded bean were significantly connected with processing conditions for both bean varieties. Chemical composition and nutritional characteristics were different for red and white bean, especially phenols and anthocyanins levels were higher in red bean extrudates; significant effects of extrusion variable conditions were found in most characteristics. Nevertheless, the knowledge of the effect of red and white beans extrusion treatment on tested characteristics allows to select processing conditions to achieve ready-to-eat extrudates or functional additives with specific features.

Vaccines against infectious diseases may raise safety concerns in patients undergoing allergen immunotherapy (AIT). The objective of our study was to investigate influenza vaccine and other selected prophylactic vaccines coverage in patients treated with AIT and the attitude of physicians towards vaccinations in this group of patients. We conducted a questionnaire-based study among patients undergoing AIT and physicians. The patients’ survey evaluated influenza and other prophylactic vaccines coverage. The physicians’ survey assessed their experience and opinions on prophylactic vaccinations during AIT. In total, 176 patients (aged 18–79 years) and 120 doctors filled the questionnaires. Patients were assigned to two groups—inhaled allergens group (n = 101) and insect venoms group (n = 68). The number of patients who received any dose (36% and 45%, p = 0.26), as well as two or more doses (17% and 22%, p = 0.43) of influenza vaccine was comparable between two groups. However, in both groups there was a significant (p < 0.0001) decrease in influenza vaccine uptake after the beginning of AIT. Patients from the inhaled allergens group declared a higher tetanus vaccine rate (41% vs. 19%, p = 0.004). The groups did not differ in the pneumococcal and tick-borne encephalitis vaccination coverage. A majority of doctors believe that prophylactic vaccinations in patients undergoing AIT are safe and effective (96% and 94%, respectively); however, as many as 87% of them identify with the need to create clear recommendations regarding vaccinating patients undergoing AIT. Prophylactic vaccine coverage is not satisfactory among Polish adult patients undergoing AIT. Polish doctors are convinced of the validity of prophylactic vaccinations during AIT.

BackgroundMacrophage activation syndrome (MAS) is a potentially life-threatening complication of various inflammatory disorders, including multisystem inflammatory syndrome in children (MIS-C). MIS-C refractory to treatment should raise suspicion of MAS, which can be fatal if a definitive diagnosis is delayed. Unfortunately, there is a lack of data on MAS in children with MIS-C.ObjectiveOur study aims to analyze the risk factors for the development of MAS in MIS-C, its clinical course and response to treatment, and identify predictive factors for pediatric intensive care.Material and methodsWe analyzed data from the Polish MIS-C registry of the MultiOrgan Inflammatory Syndromes COVID-19 Related Study. Patients were diagnosed according to the WHO MIS-C definition and treated according to national guidelines (Polish Pediatric Society) based on international consensus. MAS definition was based on 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis.ResultsTwo-hundred and seventy four children met the study inclusion criteria. Fifty-nine patients fulfilled MAS classification criteria, nine of which required admission to the pediatric intensive care unit (PICU). MIS-C patients with MAS were significantly older than patients without MAS (median 11.2 vs. 8.1 years). Multivariable analysis showed that age, symptoms characteristic of atypical Kawasaki disease, and skin erosions were significant factors associated with MAS in MIS-C patients. Analysis of laboratory parameters showed that on admission, MIS-C patients with MAS had significantly lower median lymphocyte and platelet counts, albumin and sodium levels, and higher median levels of C-reactive protein, procalcitonin, ferritin, D-dimers, triglycerides, serum creatinine, urea, and γ-glutamyl transpeptidase, and neutrophil count. Multivariate analysis showed that higher procalcitonin, ferritin, and fibrinogen levels at admission were predictive of MAS. Only elevated troponin level was a factor indicating a requirement of PICU hospitalization for children with MAS. MIS-C patients fulfilling MAS criteria were treated more often with intravenous immunoglobulins and steroids than children without MAS. Children with MAS more often required mechanical ventilation. None of the patients required biological agents.ConclusionsThe clinical course of MAS in MIS-C seems milder, treatment less aggressive, and the prognosis better than expected based on the current knowledge on MAS complicating other rheumatological diseases.