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Background Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort. Methods Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression. Results From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not. Conclusions Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding. [ABSTRACT FROM AUTHOR]

This national study characterized invasive Haemophilus influenzae serotype b infections. Vaccinated (n = 41) and nonvaccinated (n = 10) cases were similar regarding presentation as meningitis (68.8% vs 90.0%; P =.25), predisposing factors (29.3% vs 20.0%; P =.76), admission to intensive care unit or death (22.0% vs 10.0%; P = 1.00), or sequelae (21.6% vs 10.0%; P =.81). Haemophilus influenzae serotype b occurred in vaccinated, healthy children with comparable disease course. [ABSTRACT FROM AUTHOR]

Background PCV13 implementation in children resulted in a substantial decline in carriage of and disease by vaccine serotypes (VT13). However, disease caused by non-PCV13 serotypes (NVT) is still relatively prevalent and even increasing, leading to an effort to develop a 20-valent vaccine (PCV20), containing the additional 7 serotypes: 8, 10A, 11A, 12F, 15B/C, 22F, 33F (VT20-13). We assessed dynamics of VT13, VT20-13, and non-PCV20 (NVT20) in nasopharyngeal carriage, respiratory infections, and IPD in children < 2 years following PCV13 implementation. Methods Multiple prospective, population-based surveillance projects, conducted in Israel between 2009 and 2017 were used. We studied isolates from IPD; otitis media (OM); conjunctivitis; carriage in healthy children; carriage during lower respiratory tract infections with chest radiography examination (LRI); and carriage during non-LRI illnesses. We added data from healthy children in the community since 2011. Prevalence rate ratios were calculated, comparing VT13, VT20-13 and NVT20 rates in late-PCV13 (2015–2017) vs. early-PCV (2009–2011) periods. Results Overall, 9,089 episodes were recorded. VT13 declined significantly in all 6 groups by 75–86% (Figures 1 and 2). Proportions of VT20-13 significantly increased in all groups, excluding conjunctivitis. The highest increases were observed in IPD, OM, and carriage during LRI. In 2015–2017, VT20-13 consisted 24%, 23%, and 19% of carriage in healthy children, carriage in non-LRI illness, and conjunctivitis, respectively, vs. 51%, 33%, and 32% in IPD, OM, and carriage during LRI. VT20-13 rapidly became the leading fraction in IPD. NVT20 proportions increased in all groups. Conclusion (1) PCV13 implementation resulted in a substantial increase in NVT carriage and disease; (2) In IPD, VT20-13 became the dominant group; (3) The increases in the proportion of VT20-13 seen in OM and carriage during LRI was significantly higher than in conjunctivitis and in carriage without LRI. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]

Background Worldwide, pneumonia is the leading cause of death in children <5 years of age and the second most common reason for hospitalization in children in the United States and Europe. This study was designed to describe the clinical characteristics and etiology of community-acquired pneumonia (CAP) in children. Methods We conducted a prospective, multicenter, observational study of CAP among previously healthy children aged 2 months through 18 years in six children's hospitals in Ohio. Blood, pleural fluid, and nasopharyngeal swabs were collected for pathogen detection by culture and/or molecular diagnostics. Patient clinical management including antibiotic therapy and respiratory support, followed the standard of care at each study site. Follow-up information regarding clinical outcomes was collected via a survey 6–8 weeks after enrollment. Results We enrolled 441 children (n = 380, 86% hospitalized) with CAP from 2015 to 2018. Median age was 5 years (IQR: 2.1–8.9y). Intensive care and respiratory support were required for 15% and 49% of children, respectively. Consolidation and pleural effusion were identified in 26% and 21%, respectively. Among hospitalized children, 99% received antibiotics during hospitalization, and 91% continued antibiotic treatment at discharge. There were no children with any kind of sequelae or deaths from CAP, but 4.4% were readmitted within 30 days after discharge. Pathogens were identified in 64% patients; including pyogenic bacteria in 4%, atypical bacteria in 9%, and viruses in 56%. A total of 18 (4%) children had both bacterial (9 pyogenic and 9 mycoplasma) and viral pathogens. Among children with a virus detected (n = 245), 17% had more than one virus. The most commonly detected bacteria were M. pneumoniae (n = 39) and S. pneumoniae (n = 10). Rhinovirus was the most common virus detected (RV; n = 81, 28%), followed by respiratory syncytial virus (RSV; n = 75, 26%). Conclusion In this multicenter cohort, the most commonly detected viruses in children with CAP were RV and RSV, and M. pneumoniae and S. pneumoniae among bacteria. Clinical outcomes in children with CAP were overall good, but there was a high burden of hospitalization and antibiotic use. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation: Research Grant; Janssen: Research Grant; Merck: Advisory Board; NIH: Research Grant; Ohio Children's Hospital Association (OCHA): Research Grant; Pfizer: Advisory Board, Consultant, Lectures; Sanofi/Medimmune: Advisory Board. [ABSTRACT FROM AUTHOR]

Background Rapid antigen detection testing (RADT) is needed to differentiate Group A Streptococcal (GAS) pharyngitis from viral pharyngitis. Guidelines do not recommend RADT in patients with viral symptoms or in children <3 years old without GAS exposure. Reduction in unnecessary RADT use may impact inappropriate antibiotic use by decreasing prescriptions in children likely colonized with GAS. We examined the impact of guideline concordant education of appropriate RADT and antibiotic use in pharyngitis on providers' (physician and APRN) use of RADT in an academic and private pediatric primary care clinic. Methods Retrospective chart review of 1,085 healthy children, age 1–5 years old, seen in clinics between September 2015 and March 2019 (355 pre- and 730 post-education; 211 academic and 874 private). Education occurred in 3/2017. Cases selected had either complaint of sore throat, RADT, or diagnosis of GAS pharyngitis or pharyngitis. Data collected included the presence of viral symptoms (e.g. cough, rhinorrhea), RADT/GAS culture results, diagnosis, and prescribed antibiotics. RADT was deemed unnecessary for all children < 3 years old without GAS exposure, in patients with ≥ 2 viral symptoms, or in patients ≥ 3 years old without pharyngitis. Results Overall, RADT use decreased from pre to post intervention (72.1% vs. 23.4% of patients, P ≤ 0.0001). Unnecessary RADT use decreased overall (50.4% vs. 16.2%, P ≤ 0.0001), in all clinics (private: 56.2% vs. 16.0%, P ≤ 0.0001; academic: 38.1% vs. 17.4%, P = 0.0012), and with all providers (physician: 41.6% vs. 18.3%, P ≤ 0.0001; APRN: 58.8% vs. 14.1%, P ≤ 0.0001). Unnecessary RADT use decreased for children <3 years old (28.1% vs. 7.4%, P ≤ 0.0001) and ≥2 viral symptoms (65.7% vs. 16.5%, P ≤ 0.0001). Conclusion Unnecessary RADT use decreased in the post-education period overall (34%), in children <3 years old (21%), and in patients with ≥ 2 viral symptoms (49%). Reductions were also seen in both academic (21%) and private (40%) clinics as well as with both physicians (23%) and ARPNs (45%). Limitations include lack of a control group and sample size variance by the clinic. We observed positive trends in RADT reduction following provider education in private and academic settings; however, further research including control and optimal sample size is needed to confirm any direct impact. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Acute pharyngitis is mostly of viral etiology; GAS, the leading bacterial cause, comprises 20%–30% of pediatric pharyngitis. Patients with pharyngitis and additional acute respiratory illness (ARI) symptoms more suggestive of viral etiology, including cough, rhinorrhea and conjunctivitis, are not recommended for GAS testing. The use of highly sensitive GAS PCR assays in patients with sore throat and viral ARI symptoms may detect GAS colonization and lead to antibiotic overuse. We evaluated GAS PCR in viral ARI inpatients and asymptomatic healthy controls (HC) to illustrate the potential negative impact of offering GAS PCR test in poorly selected patients. Methods In November 2015–June 2016, 458 ARI inpatients (< 18 years) and 205 HC (< 5 years, no ARI symptoms within 72 hours) in Kansas City were enrolled in the New Vaccine Surveillance Network study. Mid-turbinate and throat swabs were tested by multiplex respiratory panel PCR and leftover nucleic acid extracts were further tested by real-time GAS PCR. Presenting symptoms of cough, rhinorrhea and/or conjunctivitis, plus sore throat were assessed by parent interview. Results Overall, 6.3% of HC < 5 years old and 8.7% of ARI subjects < 18 years were GAS (+); mostly in the 3–15 year old age group (25/40, 62.5%). Among 3–15 year old GAS (+) ARI subjects, 92.8% had cough, 76.2% rhinorrhea and 37.2% conjunctivitis; 80% had > 2 of 3 symptoms noted above. Among 40 GAS (+) ARI subjects, a virus was co-detected in 34 (85%), among which Rhinovirus/Enterovirus were predominant 22/34 (55%). Of the 130 (28%) ARI subjects with sore throat, more tested positive for viruses (107/130, 82.3%) than for GAS (9/130, 6.9%). All GAS (+) HC (13/205, 6.3% overall) were < 3 year olds. Conclusion PCR detected GAS in 6.3% HC < 5 years old and 8.7% ARI subjects < 18 years old; mostly in 3- to 15-year-old ARI subjects. Most GAS (+) ARI children had cough, rhinorrhea or conjunctivitis and/or virus co-detection suggesting GAS carriage. Our data demonstrate that GAS may be detected in patients with a low clinical suspicion for acute GAS pharyngitis. These findings highlight the need to review patient selection and exercise caution in implementing highly sensitive GAS PCR assays especially in such clinical settings. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Poster presentation Tuesday 8 October Background Antinuclear antibodies (ANA) are autoantibodies that recognise cellular antigens found predominantly in the cell nucleus. They are associated with numerous autoimmune diseases such as systemic lupus erythematosus, but may also be found in infectious diseases, malignancies and healthy individuals. ANA is requested as part of an initial work-up for autoimmune conditions. In healthy children (5-18%), positive ANA titres of 1/80 to 1/320 have been reported. A prospective study of healthy children with positive ANA found that children who developed autoimmune disease had clinical features at presentation that were suspicious for such an outcome. Therefore, the usefulness of a positive ANA result for diagnosing autoimmune conditions is limited without clinical correlation. The aim of our study was to assess whether high ANA titre and clinical features at presentation could predict final diagnosis. Methods Single centre retrospective study at Great Ormond Street Hospital for Children (GOSH). The immunology laboratory provided a list of positive ANA results (using indirect immunofluorescence technique) from January 2013 to July 2018. A retrospective chart review was performed to ascertain presence of clinical features at presentation under the five following titles: arthritis, skin involvement, eyes, CNS involvement and Raynaud's phenomenon. We then reviewed the last clinical contact to document confirmed diagnosis. Results We performed a retrospective chart review on 1,354 children (67% female; median age 7.5 years (0.1-17.5); median follow-up 4.8 years (0-18)) with positive ANA results (titres 1/160, 1/320, 1/640, 1/1280, 1/2560 and >1/2560). Table 1 reports ANA titres at first presentation in relation to final diagnosis. A titre of 1/640 or above was most commonly seen (>50%) in children with an autoimmune rheumatology condition. In fact, children with the highest titre (>1:2560) were significantly more likely to be diagnosed with one of these conditions. Finally, we looked at the number of presenting features and correlated with final diagnosis. Those diagnosed with a CTD were most likely to present with 2-5 clinical features (p < 0.0001). P24 Table 1: Percentage of patients grouped according to their diagnosis and ANA titres Final Diagnoses   ANA Titres   >1: 2560   1: 2560   1: 1280   1: 640   1: 320   1: 160     Connective Tissue Diseases  24%  9%  13%  16%  16%  22%  JIA and Uveitis  8%  11%  15%  22%  22%  22%  JIA  6%  8%  13%  24%  24%  25%  Autoimmune (other)  4%  5%  11%  19%  32%  29%  Unidentified autoimmune/ autoinflammatory  8%  12%  -  24%  12%  44%  Vasculitis  -  -  5%  26%  16%  53%  Sarcoidosis  -  20%  -  20%  -  60%  Autoinflammatory  7%  -  -  43%  -  50%  Malignancy  -  -  -  25%  -  75%  Other  3%  2%  3%  17%  28%  47%  Non-inflammatory MSK  3%  -  9%  18%  27%  43%  Final Diagnoses   ANA Titres   >1: 2560   1: 2560   1: 1280   1: 640   1: 320   1: 160     Connective Tissue Diseases  24%  9%  13%  16%  16%  22%  JIA and Uveitis  8%  11%  15%  22%  22%  22%  JIA  6%  8%  13%  24%  24%  25%  Autoimmune (other)  4%  5%  11%  19%  32%  29%  Unidentified autoimmune/ autoinflammatory  8%  12%  -  24%  12%  44%  Vasculitis  -  -  5%  26%  16%  53%  Sarcoidosis  -  20%  -  20%  -  60%  Autoinflammatory  7%  -  -  43%  -  50%  Malignancy  -  -  -  25%  -  75%  Other  3%  2%  3%  17%  28%  47%  Non-inflammatory MSK  3%  -  9%  18%  27%  43%  P24 Table 1: Percentage of patients grouped according to their diagnosis and ANA titres Final Diagnoses   ANA Titres   >1: 2560   1: 2560   1: 1280   1: 640   1: 320   1: 160     Connective Tissue Diseases  24%  9%  13%  16%  16%  22%  JIA and Uveitis  8%  11%  15%  22%  22%  22%  JIA  6%  8%  13%  24%  24%  25%  Autoimmune (other)  4%  5%  11%  19%  32%  29%  Unidentified autoimmune/ autoinflammatory  8%  12%  -  24%  12%  44%  Vasculitis  -  -  5%  26%  16%  53%  Sarcoidosis  -  20%  -  20%  -  60%  Autoinflammatory  7%  -  -  43%  -  50%  Malignancy  -  -  -  25%  -  75%  Other  3%  2%  3%  17%  28%  47%  Non-inflammatory MSK  3%  -  9%  18%  27%  43%  Final Diagnoses   ANA Titres   >1: 2560   1: 2560   1: 1280   1: 640   1: 320   1: 160     Connective Tissue Diseases  24%  9%  13%  16%  16%  22%  JIA and Uveitis  8%  11%  15%  22%  22%  22%  JIA  6%  8%  13%  24%  24%  25%  Autoimmune (other)  4%  5%  11%  19%  32%  29%  Unidentified autoimmune/ autoinflammatory  8%  12%  -  24%  12%  44%  Vasculitis  -  -  5%  26%  16%  53%  Sarcoidosis  -  20%  -  20%  -  60%  Autoinflammatory  7%  -  -  43%  -  50%  Malignancy  -  -  -  25%  -  75%  Other  3%  2%  3%  17%  28%  47%  Non-inflammatory MSK  3%  -  9%  18%  27%  43%  Conclusion This study suggests that, patients presenting with higher ANA titres and a combination of clinical features should be assessed systemically and followed-up as they may have increased risk of developing an autoimmune rheumatological conditions. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Poster presentation Tuesday 8 October Background Juvenile idiopathic arthritis (JIA) is a heterogeneous group of arthritic conditions presenting in children and young people, in which physical limitations and associated complications can have detrimental effects on physical and psychosocial wellbeing. This study aims to investigate the impact of living with JIA on different aspects of health-related quality of life (HRQoL) and to explore how this changes over time, using data from the Childhood Arthritis Prospective Study (CAPS). Methods Longitudinal data collected as part of CAPS were analysed. HRQoL was assessed at baseline, 1 year and 3 years post-diagnosis using the Child Health Questionnaire (CHQ), a parent-completed form for children from 5 years of age. The CHQ measures physical, emotional and social components of child health status. Raw domain scores were transformed via algorithm into values ranging from 0-100, with higher scores indicating better health status. Mean (standard deviation) and median (interquartile range) for each domain were determined. Differences between median scores at baseline and 3 years were assessed using the Wilcoxon signed-rank test. Mean scores of each domain were visually compared with a reference population sample of healthy children from the United States. Results 184 participants completed the questionnaire at all 3 time points. At baseline, compared to the reference population, children with JIA scored lower in every domain although scores were closer between the 2 groups at 3 years. Median scores improved over time, the exception being the "general health perceptions" domain which decreased after baseline. Domains with the greatest improvement were "physical functioning", "bodily pain" and "social-physical". The largest changes occurred from baseline to 1 year. Statistically significant differences between baseline and 3 year scores were found for all domains. Conclusion JIA has significant impact on HRQoL, which improves within 3 years of diagnosis. Physical health domains show greater improvement over time than psychosocial domains, although psychosocial scores were generally higher throughout the study. Further research should explore measurable patient or disease-related drivers of HRQoL. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Neisseria meningitides (Nm) cause different types of invasive infections.Nm pharyngeal carriage is a necessary condition for invasive meningococcal disease. In 2017 Argentina introduced a tetravalent meningococcal conjugated vaccine (MenACYW) to the National Immunization Program.Aims To assess the rate of Nm carriage in healthy children and adolescents attending a public hospital in Buenos Aires city, to determine genogroup and clonal complex distribution,to describe genogroup distribution of Nm isolated from ID in Argentina, during the same period. Methods Between March and December 2017, a single-center, cross-sectional study was performed among 1,751 children 1–17 years old attending Ricardo Gutiérrez Children Hospital in Buenos Aires, Argentina. From oro-pharyngeal swabs, genogroup and clonal complex (CC) were identified. We analyzed Nm ID genogroups data reported to the Regional Surveillance Program (SIREVA II) in the same year. at the same period were relevated. Results 114Nm were isolated from the carriage study, with an overall carriage of 6.5%.Genogroups distribution: B 25(21.9%), W 9(7.8%), Y 7(6.1%), Z 6(5.2%), C 4(3.5%), non-groupable 9(7.8%) and non-capsulated (NC)54 (47.3%). 105 Clonal complex (CC) were determined: Genogroup B isolates belonged to ST-41/44, ST-35, ST-32 and ST-865. Genogroup W was associated to ST-11 and ST-35. SIREVA reported 76 strains of Nminvasive infections in 2017, 53.9% meningitis, 11.8% meningitis and sepsis, 22.4% sepsis, and 11.8% others. Genogroupsdistribution: B59.2% (45), W 23.6% (18), C 10.5% (8), Y 6.5% (5). Conclusion Genogroup B is the most frequent cause of ID followed by W in our country. In the pharyngeal carriage study we found that NmNC was prevalent and genogroup B was the most frequent among the encapsulated.Genogroup B CCs detected in our carriage study coincided with those found previously in ID in Argentina. Genogroup W carriage was low and hypervirulent CC ST-11 was detected. Although genogroup Z does not cause ID in our country it was found in carriage. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background While vaccine effectiveness varies across seasons and age groups, influenza vaccination is still the most effective means of preventing influenza infection. Current vaccine effectiveness improvement efforts are focused on manufacturing methods whereby the use of eggs as a growth medium is being minimized to prevent egg adaptation mutations that render the vaccine less effective. This study compared children's immune response to two FDA-approved influenza vaccines, cell-based vs. egg-based, in an unblinded randomized controlled trial. Methods Racially diverse, healthy children ages 4–20 years were randomly assigned 1:1 in blocks of 4 to receiveeither quadrivalent inactivated cell-based or egg-based influenza vaccine. Blood was drawn at Day 0 before vaccination and at Day 28 post vaccination (range = 19–35 days) and analyzed for hemagglutination inhibition (HAI) titers using standard protocols against egg-grown vaccine antigens. Primary outcome measures were seropositivity, defined as HAI titer ≥1:110 and ≥1:40; seroconversion, defined as the HAI titer ratio of Day 28/Day 0 ≥4 and HAI titer at Day 28 ≥40; and fold-rise, defined as antilog of average log2HAI titer ratio of Day 28/Day 0. Secondary outcomes were compared for those vaccinated and not vaccinated the previous year. Results Baseline demographics including age, sex, race, ethnicity, parental educational status, health insurance coverage, and exposure to household smoking did not differ between vaccine groups. There were no differences in any HAI antibody response between the two vaccine groups (table). Participants unvaccinated in the prior season (2017–2018, N = 62) were more likely than those vaccinated (N = 86) to seroconvert to any strain in 2018–2019 (≥1 strain seroconverted: 68% unvaccinated vs. 35% vaccinated in 2017–2018, P < 0.001). Day 28 titer fold-rise difference was 2.0 for A/H1N1, 0.65 for A/H3N2, 1.1 for B/Colorado and 0.9 for B/Phuket. Conclusion There were no differences for any HAI antibody titer outcome between children receiving the two vaccines. Overall, the cohort had HAI titers at levels sufficient to be considered seropositive at baseline. Those unvaccinated in the preceding season had higher seroconversion rates than those vaccinated in both seasons. Disclosures Patricia Nowalk, PhD, Merck & Co. (Grant/Research Support); others, no reported disclosures. [ABSTRACT FROM AUTHOR]

Background Streptococcus pneumoniae is the most common pyogenic bacteria associated with CAP in children, but the proportion of cases might be underestimated because of the low sensitivity of current standard diagnostic methods. Nasopharyngeal (NP) carriage of pneumococcus commonly precedes the development of pneumococcal pneumonia, and facilitates pneumococcus interactions with other respiratory pathogens and the host immune response. This study investigated the relationship between pneumococcal carriage and the severity of CAP in children. Methods We conducted a prospective, multicenter, observational study for CAP among previously healthy children aged 2 months through 18 years in six children's hospitals in Ohio. Blood, pleural fluid, and NP swabs were collected for pathogen detection by culture and/or polymerase chain reaction (PCR). S. pneumoniae was quantified in NP swabs by real-time PCR. Patient management followed the standard of care in each study site. Results Among 441 children with radiologically confirmed CAP, 156 (35.4%) had no bacterial or viral pathogens identified as etiologic agents. NP pneumococcal carriage rate in this group was 34.6%. Children with CAP and pneumococcal carriage (53/156) were younger (5.9 vs. 9.6 years, P < 0.001) than those with no carriage (103/156). Median neutrophil counts and median procalcitonin concentrations were significantly higher in the pneumococcal carriage group (12,030 vs. 8,370 cells/mm3 and 1.0 vs. 0.5 mg/dl, respectively; P < 0.05 for both) than in the non-carriage group. Children with documented pneumococcal carriage received respiratory support more frequently (50.0% vs. 28.2%, p = 0.012) and had a longer duration of hospitalization (3.5 ± 3.8 vs. 2.1 ± 2.0 days, P = 0.026) than those without pneumococcal carriage. Age was not associated with any of the variables used to assess clinical disease severity. Conclusion Pneumococcal carriage was associated with higher inflammatory markers and greater clinical disease severity in children with CAP in whom no pathogens were identified by standard diagnostics. This suggests that NP carriage of pneumococcus in children with CAP may modulate the host immune response and possibly influence clinical disease severity. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation: Research Grant; Janssen: Research Grant; Merck: Advisory Board; NIH: Research Grant; Ohio Children's Hospital Association (OCHA): Research Grant; Pfizer: Advisory Board, Consultant, Lectures; Sanofi/Medimmune: Advisory Board. [ABSTRACT FROM AUTHOR]

Balamuthia mandrillaris is a recently described ameba known to cause a subacute to chronic central nervous system infection called granulomatous amebic encephalitis. Evidence suggests that apparently immunocompetent persons are at risk for disease and show a similar nonspecific presentation to that of immunodeficient persons. However, evidence of hematogenous dissemination, which has been found in immunodeficient patients, has been lacking in immunocompetent patients. Here, we describe a previously healthy patient with B mandrillaris– associated granulomatous amebic encephalitis in whom both central nervous system and renal disease were found during autopsy, which suggests hematogenous dissemination. We also provide a comprehensive review of the pediatric literature on this disease and its clinical presentation in children. [ABSTRACT FROM AUTHOR]