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Introduction. Previous studies demonstrated that in multi-infected atients, viral interactions can modify disease activity and in perinatal ettings may affect mother-to-infant transmission of singles viruses. By ontrast, it is still unknown whether the risk of transmission of multiple nfections increases with the number of viruses infecting the mother. The im of this study was to describe the risk of mother-to-infant transmission f multiple infections from multi-infected mothers. Materials and methods. Forty-one pregnant women infected by heptitis C virus (HCV) and at least another 1 virus among human immunodeciency virus-type 1 (HIV-1), TT virus (TTV) and hepatitis G virus (HGV), ogether with their 41 infants, were studied. Due to size of study group we id not perform analyses on transmission of singles viruses and of specific ulti-infections. Mothers infected by 2, 3, 4 viruses, independently of virus ype, were defined bi-, triand quadri-infected, respectively. Results. Transmission of mono-infection and of bi-infection from binfected mothers was, respectively 4/21 (19%) and 3/21 (14.3%) and from ri-infected mothers 6/16 (37.5%) and 1/16 (6.2%). One (25%) mononfected infant was born from the 4 quadri-infected mothers. In the linear egression analysis, transmission of monoor bi-infection was not signifiantly associated with the number of virus infecting the mother (p= 0.7). Conclusions. Our results suggest the absence of a synergistic effect rom viral interactions towards mother-to-infant transmission of multiple nfections and support the hypothesis that transmission from multi-infected others is the result of the specific interaction between each virus and the ost. Current knowledge in mother-to-infant transmission of HIV-1 and HCV an support this hypothesis. Infection of maternal peripheral blood mononulear cells (PBMCs) is crucial in mother-to-infant HIV-1 and HCV transmision. Virus entry in PBMCs is mediated by specific interaction between viral pitopes and host cell receptors. Different viruses have different receptors nd for the same virus different quasispecies may not interact with recepors. In multi-infected mothers, PBMCs infection and consequent effect on other-to-infant transmission, depends on phenotype of single virus and irus-specific interaction with receptors expressed by the host. Another possible explanation involves the relationship between verical transmission, major hystocompatibility complex (MHC) genes and iral polymorphisms. In mother-to-infant transmission specific class I and I MHC alleles among infants have been associated with protective effect rom perinatal HIV-1 and HCV transmission. HIV-1 and HCV heterogenety, providing mutations at critical amino acids in the epitopes recognised y cytotoxic T lymphocytes (CTLs), may allow the virus to evade host’s mmune CTLs surveillance thus favouring mother-to-infant transmission. lthough similar less-studied mechanisms are also possible for TTV and GV. Our observations may be of clinical relevance in perinatal counselling.

Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune, inflammatory disease. Gastrointestinal (GI) involvement, extensively described in adults, is less characterised in paediatric-onset SLE (pSLE). The aim of the present narrative review was to provide a comprehensive summary and update on GI involvement in pSLE. A literature search on PubMed and EMBASE was conducted to identify original articles, reviews, case series and editorials published in English from 2000 to 31 August 2020. Based on this, we reported the prevalence, pathogenetic mechanisms, clinical issues, diagnostic tools and management of each form of GI involvement in pSLE. Lupus enteritis is the most frequent type of GI involvement in pSLE, followed by intestinal pseudo-obstruction, protein-losing enteropathy, hepatic disease and acute pancreatitis. The most common presenting GI symptoms are non-specific and include abdominal pain, anorexia, nausea, vomiting. In most cases, they are associated with other clinical and laboratory manifestations of SLE. The complications of GI involvement, including perforation and intestinal infarction, can be life-threatening. Laboratory findings and imaging studies can help to rule out non-SLE related causes for GI manifestations and to reveal typical features of the single forms of GI involvement. Early diagnosis and treatment are crucial to improve prognosis and avoid unnecessary surgery. Most SLE GI manifestations respond well to glucocorticoids and immunosuppressants. In conclusion, GI involvement is frequent in pSLE and its diagnosis and management can be a challenge for clinicians. In view of the limited available data, further studies are needed to better explore the prevalence, prognosis and treatment recommendations for GI involvement in pSLE.

Background Pneumococcal serotyping is usually performed by Quellung reaction, considered the gold standard test. However the method cannot be used on culture-negative samples. Molecular methods can be a useful alternative. The aim of the study was to evaluate the use of Multiplex-sequential-PCR (MS-PCR) or Realtime-PCR on blood samples for diagnosis and serotyping of invasive pneumococcal disease (IPD) in a pediatric clinical setting. Methodology/Principal Findings Sensitivity and specificity of MS-PCR and Realtime-PCR have been evaluated both on 46 well characterized pneumococcal isolates and on 67 clinical samples from children with culture-negative IPD. No difference in sensitivity and specificity between MS-PCR and Realtime PCR was found when the methods were used on isolates: both methods could type 100% isolates and the results were always consistent with culture-based methods. On the contrary, when used on clinical samples 43/67 (64.2%) were typeable by MS-PCR and 61/67 (91.0%) by Realtime-PCR (p = 0.0004,K Cohen 0.3, McNemar's p

Mother-child human leukocyte antigen (HLA) diversity is protective for vertical transmission of some viruses. The aim of this study is to evaluate the role of mother-child HLA diversity on hepatitis C virus (HCV) vertical transmission. Forty consecutive HCV infected and 46 consecutive control uninfected children born to HCV-RNA positive mothers were evaluated for HLA class-1 type concordance with their mothers. No significant difference in the degree of HLA concordance was found between HCV infected and uninfected children both when A, B, C ( p=0.30) and when only A and B alleles were evaluated ( p=0.59). Mother-infant HLA concordance does not affect HCV vertical transmission.

The aims of this study were to evaluate the incidence of invasive pneumococcal disease (IPD) in Italian children and perform serotyping by PCR-based assays directly on clinical samples. A 1-year paediatric (0-14 years) population-based surveillance study was designed to evaluate the incidence of IPD in the province of Florence, Italy, by cultural and molecular methods. Among 92 children (80 with pneumonia, 8 with meningitis/sepsis, 4 with arthritis), 4 cases of IPD were diagnosed both by culture and real-time PCR and 18 cases exclusively by molecular methods. The sensitivity of molecular methods was significantly higher than that of cultural methods (Cohen's kappa 0.41; McNemar P=0.000008). The incidence of IPD in children below 2 years of age was 11.5/100,000 and 51.8/100,000 by cultural and molecular methods, respectively. Pneumococcal serotyping by multiplex sequential PCR was obtained in 19/22 samples. Real-time PCR and multiplex sequential PCR can be used directly on biological samples, improving the ability to diagnose IPD. The incidence of IPD appears 5-10 times higher by PCR than by cultural methods.

Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day–17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.