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Varicella-zoster virus is an exclusively human pathogen of an acute exanthematous illness usually linked with childhood. Although the disease is commonly considered benign, varicella-zoster virus bears the potential of causing a wide range of different complications, including central nervous system manifestations. In this paper, an assessment of long-term sequelae and the quality of life in a cohort of patients with neurological complications who survived an acute episode is discussed. We enrolled a total of 71 patients aged two months to 16 years with the diagnosis of varicella complicated by central nervous system disease into the study. Data were collected after their discharge from the hospital by mail and by telephone call interviews using standardised questionnaires. The time from the discharge to the filling of the survey varied between the patients, with a median time of 5.4 years. The collected data were analysed, and the results were compared with the literature. The diagnosis of ischaemic stroke and encephalitis was linked to the most unfavourable outcome, as opposed to acute cerebellar ataxia associated with the most favourable prognosis. Neuropsychological performance should be further monitored to prevent a decrease of independence in everyday performance.

Varicella-zoster virus is an exclusively human α-herpesvirus, known as the aetiological factor of chickenpox which is usually linked with childhood. The disease occurs with a worldwide geographic distribution, and in temperate climates shows a seasonal pattern with epidemics occurring mostly during late winter and spring. The annual incidence is estimated at 80–90 million cases worldwide. Children usually acquire varicella during the first five to 10 years of life, and the highest risk of infection is related to household contacts without a history of vaccination. Although the disease is commonly considered benign, varicella-zoster virus bears the potential of causing a wide range of complications, including the most serious ones of central nervous system manifestations. The neuropathogenesis of varicella-zoster virus infections is not well understood. Based on a wide spectrum of clinical syndromes, multiple theories explaining the pathways of spread of the virus, and host immune response to the viral presence have been proposed, including direct retrograde trafficking of the virus and haematogenous spread as well as inflammatory response with vasculitis. Neurological complications related to varicella-zoster virus infection are the second most common indication for hospitalisation in immunocompetent children with varicella, following skin superinfections. In this paper, the neurological aspects of chickenpox in children are discussed. The characteristics of the clinical syndromes, pathogenesis, methods of diagnosis and treatment, as well as long-term consequences are presented.

Autoimmune encephalitis is rare in children and develops as a manifestation of a parainfectious or paraneoplastic syndrome. The disease is characterised by a sudden or subacute onset and a broad spectrum of neurological and/or psychiatric disorders. We present a case of a 17-year-old girl with anti-N-methyl-D-aspartate receptor encephalitis. The patient was admitted to hospital in a severe condition, unconscious, with injuries indicating a recent status epilepticus. Previous infection was found to be the most likely causative factor. Antiviral, antibacterial, immunosuppressive and anticonvulsant treatments were used with good outcomes. The aim of the paper is to point out the need to include autoimmune processes in the differential diagnosis of neuroinfections in children, which will allow for prompt implementation of appropriate treatment and improve prognosis.

Background Although COVID-19 is associated with a mild course in children, a certain proportion requires admission to hospital due to SARS-CoV-2 infection and coexisting diseases. The prospective multicenter study aimed to analyze clinical factors influencing the length of the hospital stay (LoHS) in children with COVID-19. Methods The study included 1283 children from 14 paediatric infectious diseases departments with diagnosed SARS-CoV-2 infection. Children were assessed in respective centres regarding indications for admission to hospital and clinical condition. History data, clinical findings, laboratory parameters, treatment, and outcome, were collected in the paediatric SARSTer register. The group of children with a hospital stays longer than seven days was compared to the remaining patients. Parameters with a statistically significant difference were included in further logistic regression analysis. Results One thousand one hundred and ten children were admitted to the hospital, 763 children were hospitalized >24 h and 173 children >7 days. 268 children had comorbidities. Two hundred and eleven children had an additional diagnosis with coinfections present in 135 children (11%). Factors increasing the risk of higher LoHS included pneumonia [odds ratio—OR 3.028; 95% confidence interval—CI (1.878–4.884)], gastrointestinal symptoms [OR = 1.556; 95%CI (1.049–2.322)], or rash [OR = 2.318; 95%CI (1.216–4.418)] in initial clinical findings. Comorbidities [OR = 2.433; 95%CI (1.662–3.563)], an additional diagnosis [OR = 2.594; 95%CI (1.679–4.007)] and the necessity of the empirical antibiotic treatment [OR = 2.834; 95%CI (2.834–6.713)] were further factors related to higher LoHS. Conclusions The clinical course of COVID-19 was mild to moderate in most children. Factors increasing the risk of higher LoHS included pneumonia, gastrointestinal symptoms, comorbidities, an additional diagnosis, and the empirical antibiotic treatment.

Meningitis is the most common infectious disease of the central nervous system both in children and in adults. The incidence of the disease in Poland, similar to Western Europe, is 6–8 cases per 100,000/year, with the highest figure for children up to 4 years of age. Aim of the study: The aim of the study was to make a detailed analysis of aseptic meningitis cases in children, with a focus on aetiology and course of the disease, and laboratory results. Materials and methods: A retrospective analysis was performed on a group of 59 children aged between 2.5 months and 17 years in whom aseptic meningitis was diagnosed based on clinical evaluation. Results: Between May and October 2018, 44 children aged 7.99 ± 3.93 were hospitalised with the diagnosis of nonpyogenic (aseptic) meningitis. In 9 patients (20.5%), enteroviral neurological infection was found, and in 8 (18.2%) Borrelia burgdorferi, in 5 (11.3%) EBV and in 2 (4.5%) HHV-7 neurological infection was diagnosed. For 20 children (45.5%), the cause of infection could not be established. The longest hospitalisation time was associated with Lyme neuroborreliosis. In the same months of 2017, 15 patients were hospitalised at our department with aseptic meningitis. The numbers of cases for different causes were: undetermined – 9 patients (60%), enteroviral – 2 (13%), EBV – 2 (13%), Parvovirus B19 – 1 patient (7%) and VZV – 1 patient (7%). Conclusions: In 2018, a threefold increase was observed in the number of hospitalisations associated with aseptic meningitis in relation to the same period of 2017, with a lasting predominance of boys. Most frequently, the aetiology was undetermined. Among the cases in which the cause was established, the most common aetiology was enteroviral. In 2018, unlike in 2017, cases of hospitalisation for neuroborreliosis were recorded. Incomplete utilisation of the polymerase chain reaction method was considered to be one of the causes of insufficient identification of neurotropic pathogens. A general examination of the cerebrospinal fluid did not differentiate between causes of aseptic meningitis.

The identification of central nervous system inflammation etiology leads to adjusted therapy. We analyzed the potential inflammatory and neuro-axonal damage markers in children. Our target was to correlate the findings with a disease's course or a sequalae risk and assess their clinical usefulness. The study included 96 children with symptoms of central nervous system inflammation who underwent diagnostics. The research group involved 24 children with autoimmune disorders and 31 with neuroinfection. The control group included patients with both etiologies excluded. We analyzed the results of routine laboratory tests together with chosen serum (neopterin, interleukin [IL]-1β, IL-6) and CSF (metalloproteinase [MMP]-9, S100B protein) markers. In the whole cohort, CSF MMP-9 correlated with CSF cytosis and serum IL-6 and CRP. In the undivided neuroinflammatory group, CSF S100B correlated with serum IL-6 and IgM concentrations. CSF cytosis was associated with CSF MMP-9 and serum neopterin levels. Among the infective patients, IL-6 was linked with increased CSF MMP-9. We conclude that astroglial protein S100B, neopterin, and cytokine concentrations may enable predicting long-term consequences, whereas CSF MMP-9 concentration may reflect the actual central nervous system injury regardless of etiology.

Aim:As obesity rates in children and adolescents increase, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease affecting this organ. This study aimed to evaluate the effectiveness of lifestyle modifications as a method of improving liver function indexes in children with NAFLD.Materials and Methods:The study group consisted of 49 patients with NAFLD (35 boys and 14 girls), age range 3-16 years (mean 10.51±3.18 years). Anthropometric measurements were taken and laboratory tests were performed. Features of steatosis of the liver were evaluated by ultrasound. The mean follow-up period was 2.45±1.45 years. Aspartate aminotransferase (AST) to [Platelet (PLT) Ratio and Pediatric NAFLD Fibrosis Score (PNFS)] were calculated. The Mediterranean diet and physical exercises were recommended. End-point parameters were a decrease in the aminotransferase level and body weight.Results:In the study group, 35 children (71.43%) were obese, and 7 (14.29%) were overweight. In 22/49 cases (44.9%) body mass index (BMI) loss was achieved, in the other patients, BMI gain was noted. Abnormal alanine aminotransferase (ALT) levels were observed in 25/49 children. In the group of children with initial increased ALT levels, significant reduction of ALT, AST and gamma-glutamyltransferase (GGT) levels were found with regard to baseline values. There was also a significant decline in mean AST to PLT Ratio index (APRI) level and PLT count. Moreover, a decrease in ALT level was negatively related to PNFS, APRI and GGT.Conclusion:Lifestyle modification leads to a significant decrease in aminotransferase levels, even in children who fail to achieve BMI reduction.

This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant (III–IV vs. I–II waves of the pandemic, respectively). In addition, the influence of the presence of comorbidities on the clinical course of COVID-19 in infants was studied. This multicenter study, based on the pediatric part of the national SARSTer database (SARSTer-PED), included 940 infants with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 13 Polish inpatient centers. An electronic questionnaire, which addressed epidemiological and clinical data, was used. The number of hospitalized infants was significantly higher in 2021 than in 2020 (651 vs. 289, respectively). The analysis showed similar lengths of infant hospitalization in 2020 and 2021, but significantly more children were hospitalized for more than 7 days in 2020 (p < 0.009). In both analyzed periods, the most common route of infection for infants was household contact. There was an increase in the percentage of comorbidities, especially prematurity, in children hospitalized in 2021 compared to 2020. Among the clinical manifestations, fever was predominant among children hospitalized in 2021 and 2020. Cough, runny nose, and loss of appetite were significantly more frequently observed in 2021 (p < 0.0001). Severe and critical conditions were significantly more common among children with comorbidities. More infants were hospitalized during the period of VOCs dominance, especially the delta variant, compared to the period of wild strain dominance, even though indications for hospitalization did not include asymptomatic patients during that period. The course of COVID-19 was mostly mild, characterized mainly by fever and respiratory symptoms. Comorbidities, particularly from the cardiovascular system and prematurity, were associated with a more severe course of the disease in infants.

Cortisol is a hormone crucial for homeostasis of the human organism. Many researchers proved the role of cortisol and its normal release rhythm in healthy individuals. It led to further investigations of the abnormalities in cortisol levels in those affected by various disorders , especially with neuropsychiatric symptoms. Autism spectrum disorder is one of these conditions which have been intensively researched due to its core and secondary symptoms. We conducted a systematic review of articles in PubMed, including papers that met the search criteria “autism” and “cortisol”. After initial selection of relevant papers, we analyzed data from 56 articles. We divided data into subcategories of studies concerning cortisol diurnal profile, basal cortisol levels, Cortisol Awakening Response (CAR) and cortisol levels in reaction to certain stimuli. Data was unequivocal, however, abnormal diurnal profile, basal level, CAR or stressor response were found in many research groups. It led to suspicion that the abnormalities of cortisol release are a widely-spread phenomenon among individuals with autism spectrum disorder. Very limited data from therapeutic interventions indicated more clinical than biological response. This systematic review should be a drive to action for further randomized clinical trial on larger, homogenous group of patients to obtain more thorough insight into the role of cortisol in autism spectrum disorder

Kawasaki disease is an acute disease caused by systemic vasculitis, which predominantly affects children younger than 5 years of age. It is the leading cause of acquired coronary artery disease in childhood in developed countries. Currently, in the era of COVID-19, an increased number of cases, most likely related to SARS-CoV-2, are being observed. Our study aimed to describe the incidence and course of Kawasaki-like syndrome in patients admitted to the Polish department of infectious diseases during the first wave of COVID-19 pandemic. We identified 6 children with Kawasaki disease within almost 6 weeks of the pandemic. Medical history of 3 children showed contact with a person suspected of SARS-CoV-2 infection. One patient had confirmed SARS-CoV-2 serology (a female patient who lived in the epidemic centre). We did not confirm any bacterial or viral aetiology in 3 patients. Conclusions: Based on the conducted analysis comparing the number of cases during the “spring wave” of SARS-CoV-2 pandemic compared to previous years, an increased incidence of Kawasaki syndrome among children from the Greater Poland was found, similar to that reported by doctors from various European countries. The mean age of patients with Kawasaki disease was higher than previously reported. Analysis of clinical forms in our patients showed the entire spectrum from incomplete Kawasaki disease to full blown Kawasaki disease shock syndrome and multisystem inflammatory syndrome in children. The risk assessment of immunoglobulin resistance using the Kobayashi and Egami scores had no predictive value in patients with Kawasaki disease during the COVID-19 period.

The aim of the study was to draw attention to the danger of vitamin D overdose. The beneficial effects of vitamin D are described in both scientific literature and popular science journals. On the other hand, papers on the symptoms of excess intake of vitamin D are scarce. Since vitamin D preparations are easily accessible, they are widely used in both adults and children without any medical supervision. We present a case of a 2-year-old boy with life-threatening hypercalcaemia due to excess vitamin D intake. The boy required prolonged hospital stay, intensive therapy to reduce blood calcium, complex pharmacotherapy and hemofiltration. Abdominal ultrasonography performed after therapy completion showed enlargement of both kidneys and persistent hyperechogenicity of renal cortex. Expert recommendations specify the route of administration and the dose of vitamin D. In the era of the Internet, however, opinions suggesting doses that are inconsistent with recommendations may be found. Such management may have serious health consequences and even be life-threatening in some cases.

Nonalcoholic fatty disease (NAFLD) affects 3-10% of the pediatric population, making it the most common chronic liver disease among children. The aim of the study is to identify potential biomarkers enabling the diagnosis of NAFLD and monitoring the course of the disease.Proteome analysis was performed in a group of 30 patients (19 boys and 11 girls) in total, of whom 16 children had previously diagnosed NAFLD based on the abdominal ultrasound after excluding other diseases of this organ.A total of 297 proteins have been identified. Thirty-seven proteins (responsible for inflammation, stress response, and regulation of this process) differentiating both experimental groups were identified. Up-regulated proteins included afamin, retinol-binding protein-4, complement components, and hemopexin; while serum protease inhibitors, clusterin, immunoglobulin chains, and vitamin D binding protein were found in the down-regulated group. The correlation between selected proteins and indicators of noninvasive assessment of liver fibrosis (APRI, FIB-4) as well as differences between the serum proteome of patients with normal weight, overweight, and obesity were also assessed.The plasma protein profile is significantly altered in nonalcoholic liver disease in children and may prove to be a valuable source of biomarkers to evaluate the extent of liver disease.

Infections caused by various viruses, mainly belonging to the Herpesviridae family, can trigger the autoimmune process in the CNS in children. This can break brain immune tolerance and induce many molecular and cellular pathways of the immune response. This can lead to the appearance of neuronal auto-antibodies to intracellular, cell-surface or extracellular synaptic antigens. Children may also display a wide spectrum of neurological problems from encephalitis to obsessive–compulsive or tic disorders. In these cases, patients rarely respond to traditional treatment, based on antiviral or/and symptomatic drugs, but early immunotherapy is very effective. The implementation of routine immune tests in all children with acute neurological disorders should be recommended.

Aim of the study Assessment of liver fibrosis as a predictive factor of liver-related mortality in children with nonalcoholic fatty liver disease (NAFLD) is crucial. This study aims to estimate the risk of fibrosis using noninvasive markers. Material and methods The study group of 49 children with NAFLD (age range 3-16, mean 10.51 ±3.18 years) was created. The diagnosis was based on clinical picture, abdominal ultrasound, and laboratory tests; four children underwent liver biopsy. Then homeostatic model assessment (HOMA-IR) and noninvasive hepatic fibrosis scores were calculated, and patients were divided into four groups depending on body mass index (BMI, obese vs. lean) and aminotransferases. Results 71.43% of patients were obese, and 14.29% were overweight. We found that overweight children had lower mean corpuscular volume (MCV) than lean patients. In a group of patients with a high risk of fibrosis or significant fibrosis due to pediatric NAFLD fibrosis score (PNFS), higher alanine aminotransferase (ALT) to platelet ratio (APRI) values were observed. The highest values of APRI were found in a group of lean patients with elevated aminotransferases and the highest value of PNFS - among obese patients with elevated aminotransferases. A strong significant correlation between APRI and PNFS was found (r = 0.88). Conclusions Apart from aminotransferase activity, complete blood count should be assessed looking for lower MCV caused by iron deficiency. In contrast to FIB-4 (fibrosis score), PNFS and APRI proved to be more accurate in our group. PNFS seems to be appropriate to evaluate fibrosis in a noninvasive diagnostic algorithm.

Children with COVID-19 develop moderate symptoms in most cases. Thus, a proportion of children requires hospital admission. The study aimed to assess the history, clinical and laboratory parameters in children with COVID-19 concerning the severity of respiratory symptoms. The study included 332 children (median age 57 months) with COVID-19. History data, clinical findings, laboratory parameters, treatment, and outcome, were evaluated. Children were compared in the groups that varied in the severity of symptoms of respiratory tract involvement. Children who required oxygen therapy represented 8.73%, and intensive care 1.5% of the whole cohort. Comorbidities were present in 126 patients (37.95%). Factors increasing the risk of oxygen therapy included comorbidities (odds ratio (OR) = 92.39; 95% confidence interval (95% CI) = (4.19; 2036.90); p < 0.00001), dyspnea (OR = 45.81; 95% CI (4.05; 518.21); p < 0.00001), auscultation abnormalities (OR = 34.33; 95% CI (2.59; 454.64); p < 0.00001). Lactate dehydrogenase (LDH) > 280 IU/L and creatinine kinase > 192 IU/L were parameters with a good area under the curve (0.804-LDH) and a positive predictive value (42.9%-CK). The clinical course of COVID-19 was mild to moderate in most patients. Children with comorbidities, dyspnea, or abnormalities on auscultation are at risk of oxygen therapy. Laboratory parameters potentially useful in patients evaluated for the severe course are LDH > 200 IU/L and CK > 192 IU/L.

This prospective multicenter cohort study aimed to analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in children. The study, based on the pediatric part of the Polish SARSTer register, included 1283 children (0 to 18 years) who were diagnosed with COVID-19 between 1 March 2020 and 31 December 2020. Household contact was reported in 56% of cases, more frequently in younger children. Fever was the most common symptom (46%). The youngest children (0–5 years) more frequently presented with fever, rhinitis and diarrhea. Teenagers more often complained of headache, sore throat, anosmia/ageusia and weakness. One fifth of patients were reported to be asymptomatic. Pneumonia was diagnosed in 12% of patients, more frequently in younger children. During the second wave patients were younger than during the first wave (median age 53 vs. 102 months, p &lt, 0.0001) and required longer hospitalization (p &lt, 0.0001). Significantly fewer asymptomatic patients were noted and pneumonia as well as gastrointestinal symptoms were more common. The epidemiological characteristics of pediatric patients and the clinical presentation of COVID-19 are age-related. Younger children were more frequently infected by close relatives, more often suffered from pneumonia and gastrointestinal symptoms and required hospitalization. Clinical courses differed significantly during the first two waves of the pandemic.

The study aimed to analyse the clinical course of COVID-19 in 300 infants, selected from 1283 children diagnosed with COVID-19 between March and December 2020, registered in the SARSTerPED multicenter database. Most of the infants were registered in October and November 2020. 44% of the group were girls, and 56% were boys. At diagnosis, the most common symptoms were fever in 77% of the children, cough in 40%, catarrh in 37%. Pneumonia associated with COVID-19 was diagnosed in 23% of the children, and gastrointestinal symptoms in 31.3%. In 52% of the infants, elevated levels of D-dimers were observed, and in 40%, elevated levels of IL-6 serum concentration were observed. During the second wave of the pandemic, 6 times more infants were hospitalized, and the children were statistically significantly younger compared to the patients during the first wave (3 months vs 8 months, p

Non-alcoholic fatty liver disease is the most common chronic disease of the liver in children. This term encompasses a wide spectrum of disorders of liver tissue: from mild steatosis to non-alcoholic steatohepatitis; the abnormalities may eventually lead to liver cirrhosis and the development of hepatocellular carcinoma. The prevalence of non-alcoholic fatty liver disease is estimated to be approximately 25% in the general population, while the rate for the paediatric population ranges from 7.6% to as many as 34.2% in obese children. In accordance with the current definition of non-alcoholic fatty liver disease, the condition is diagnosed after steatosis has been confirmed using histopathological or imaging methods and secondary causes of liver damage have been excluded, such as alcohol abuse, the use of hepatotoxic medicines and congenital or infectious diseases. The disease is most commonly diagnosed in the population of overweight and obese children; it often coexists with insulin resistance. There are reports of the impact of genetic factors on the development of the condition. Clinical signs and symptoms are non-specific: hepatomegaly, malaise and a sense of discomfort in the abdominal cavity. Basic diagnostic investigation includes aminotransferase test and abdominal ultrasound examination. Researchers pay much attention to non-invasive diagnostic methods such as serological markers and fibrosis scores. Due to the fact that no pharmacotherapy has a confirmed efficacy in the treatment of non-alcoholic fatty liver disease, the most important prevention and treatment methods in the paediatric population are lifestyle modification, physical activity and a balanced diet. The utility of vitamin E, ursodeoxycholic acid and metformin has not been confirmed by research. Due to the high prevalence of the condition and the risk of complications, familiarity with the problem is important particularly among general practitioners.

Introduction The global eradication of smallpox and abandonment of mandatory smallpox vaccination has led to an increased proportion of the population who are immunologically naive to infections caused by Orthopoxviruses (OPV). Aim To present the different courses of OPV infection in children and to highlight the diagnostic difficulties in their differentiation from the other inflammatory processes. Material and methods We retrospectively evaluated the medical documentation of 5 children with OPV infection. Clinical diagnosis of OPV infection was based on evaluation of animal contact and skin symptoms, characterised by either a single ulcer or disseminated lesions. In all five cases, blood samples and skin swabs were collected from the lesion(s) to identify specific OPV DNA fragments (Vgf, b9R and D11L genes) using PCR. Results Two children presented with high fever, a single ulcer on the skin and local lymphadenopathy. The three other patients were in good general health and their skin lesions presented as a disseminated vesicular rash. Using the Vgf gene as the target for PCR, OPV infection was confirmed in material collected from skin lesions of all children and in blood samples of 4 children. The B9R and d11L genes tested positive in the skin material of 2 children and blood samples of 2 children. All analysed patients presented a history of ineffective antibiotic therapy. Conclusions In the case of unclear necrotising skin lesions in children, the primary diagnosis always includes bacterial dermatitis. However, if the patient has come into contact with animals, diagnosis of OPV infection should also be considered.

Background Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein-Barr virus (EBV) infection, but it is an atypical clinical presentation. Aim The aim of our study was to analyse AAC occurrence in children with primary symptomatic EBV infection who had been admitted to the hospital. Methods We retrospectively evaluated the medical documentation of 181 children with EBV infection who were diagnosed based on the presence of viral capsid antigen IgM antibodies. All EBV-positive patients underwent transabdominal ultrasonography of the liver in the supine and right anterior oblique positions. Fifteen children who presented with AAC symptoms, including abdominal pain and a positive Murphy's sign, were analysed as a subsample and re-evaluated after 2-3 months. Results The incidence of AAC in children hospitalised with infectious mononucleosis (IM) was estimated at 8.3%. Analysis of the laboratory results confirmed that the C-reactive protein (CRP) concentration was the only parameter which was higher in children who presented with AAC symptoms. The mean number of leucocytes and monocytes and liver enzyme activities were not significantly higher. The radiological findings of AAC were evident: increased GB wall thickness, non-shadowing echogenic sludge and pericholecystic fluid collection. Conclusion AAC during primary EBV infection appears to be a more common pathology than previously suspected. Its relatively mild nature and the lack of laboratory abnormalities mean that ultrasonographic examination is required for diagnosis. This might explain why the prevalence in children is underestimated.

Despite the enormous advances in knowledge about the SARS-CoV-2 infection, the optimal treatment for COVID-19 is still not well defined. The use of convalescent plasma seems to be a promising method of treatment but requires further evaluation. Although it is usually mild, in children with underlying chronic diseases, the course of SARS-CoV-2 infection may be very severe. We described a series of 13 pediatric patients (mean age 10.4 years, median 12) treated with convalescent plasma as a method of COVID-19 therapy. Medical history, with particular emphasis on comorbidities, clinical course, laboratory parameters, supportive treatment and virus elimination time, were analyzed. The mean hospitalization time was 22.6 days (median 20). The most common abnormalities included increased levels of C-reactive protein, D-dimer, and lymphopenia. Median time from symptom onset to convalescent plasma transfusion was 10.6 days (median 7 days). Six patients (46.2%) had a viral clearance on RT-PCR method from a nasopharyngeal swab within 3 days of transfusion, while in the remaining patients the mean elimination time was 12.1 days (median 6 days). Clinical improvement was achieved in all patients; no adverse effects were found in any of the cases. Convalescent plasma may be a promising treatment for COVID-19 in children.

Background Noninvasive diagnostics of nonalcoholic fatty liver disease (NAFLD), the most common cause of liver dysfunction in children, are based on imaging, biochemical tests and their compilation. The study aimed to evaluate the serological biomarkers of steatosis, inflammation and liver fibrosis to assess the risk of NAFLD in children. Methods A total of 73 children were included in the prospective study; 50 of them were diagnosed with NAFLD based on ultrasound, and 23 formed a control group. Basic anthropometric parameters were measured, blood samples were taken for laboratory tests and evaluated proteins were assessed by enzyme-linked immunosorbent assay—adiponectin, tumour necrosis factor alpha, fibroblast growth factor 21, liver fatty acid-binding protein (L-FABP) and interleukin 6. Results Statistically significant differences between the levels of two proteins were found: the adiponectin level was lower in the NAFLD group (12.24 ± 7.01 vs 16.88 ± 9.21 μg/mL, p = 0.024), and L-FABP levels were higher (21.48 ± 20.61 vs 11.74 ± 8.39 ng/mL, p = 0.031). In the group of children with body mass index (BMI)-for-age >1 standard deviation (SD), adiponectin concentration was also significantly lower (12.18 ± 6.43 μg/mL) than in the group with BMI ≤1 SD (17.29 ± 9.42 μg/mL, p = 0.015). The odds ratios and 95% confidence interval for the relation between adiponectin and NAFLD and obesity were 0.868 (0.767–0.982) and 0.838 (0.719–0.977), respectively. Conclusion Adiponectin may be useful in evaluating the risk of NAFLD and obesity in children.

Introduction Children account for a relatively small proportion of laboratory-confirmed SARS-CoV-2 infections. In children, COVID-19 usually has a relatively mild course. However, in rare cases, severe disorders can be observed, and clinical manifestations may differ from adults. Purpose The aim of this study is to analyse the frequency, clinical picture and outcome of COVID-19 in children based on the experience from the tertiary care centre and regional sanitary-epidemiological office. Methods We report a study regarding 106 cases of confirmed SARS-CoV-2 infection cases in PCR from a nasopharyngeal swab (age range 1-month – 17-years). In all cases, history was taken. In children who required hospital admission, physical examination and laboratory test were performed according to clinical indications. Results Twelve of the patients required admission to the hospital. The most common symptoms were anosmia and dysgeusia (75%) and headaches (49%) in outpatients and fever in hospitalised children (75%). Three children from the hospitalised group developed a severe course with increased inflammatory indexes. The clinical picture was more severe in younger children from the hospitalised group. Treatment options were regarded individually in all cases. Conclusion Our study is the first tour knowledge regarding the clinical course of COVID-19 in Polish children. In general, the clinical course of COVID-19 was mild with anosmia and dysgeusia as the most common symptoms. However, in hospitalised children, a severe progression of the disease and less typical signs as aplastic anaemia may be developed.

Human toxocariasis is a worldwide helminth zoonosis caused by roundworms of the genus Toxocara. Toxocariasis is the most common helminth infection in many countries. Disease caused by Toxocara can be classified into five clinical forms: generalised, neurological, ocular, covert, and asymptomatic. The clinical pathology of toxocariasis largely depends on the form of infection, the intensity of the infection, the larvae localisation, and the age of the host. Because histological and molecular examination of toxocariasis is limited by difficulties in obtaining material to analyse, clinical diagnosis is often based on nonspecific tests, such as the detection of eosinophilia and hyperimmunoglobulinemia E (Hyper-IgE). Specific analysis uses an initial ELISA test to detect anti-Toxocara IgG and requires confirmation for all positive results via Western blot. This strategy does not distinguish between actual and recent infections, making the monitoring of disease a challenge for clinicians. Additional research will be required to distinguish active disease from the presence of recent infection.