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Background Lately, one of the major clinical and public health issues has been represented by Coronavirus disease of 2019 (COVID-19) during pregnancy and the risk of transmission of the infection from mother to child. Debate on perinatal management and postnatal care is still ongoing, principally questioning the option of the joint management of mother and child after birth and the safety of breastfeeding. According to the available reports, neonatal COVID-19 appears to have a horizontal transmission and seems to be paucisymptomatic or asymptomatic, compared to older age groups. The aim of this work is to describe a cluster of neonatal COVID-19 and discuss our experience, with reference to current evidence on postnatal care and perinatal management. Methods This is a retrospective observational case series of five mother-child dyads, who attended the Labor and Delivery Unit of a first-level hospital in Italy, in March 2020. Descriptive statistics for continuous variables consisted of number of observations, mean and the range of the minimum and maximum values. Results Five women and four neonates tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In one case, the mother-child dyad was separated and the neonate remained negative on two consecutive tests. Two positive neonates developed symptoms, with a predominant involvement of the gastrointestinal tract. Blood tests were unremarkable, except for a single patient who developed mild neutropenia. No complications occurred. Conclusions We agree that the decision on whether or not to separate a positive/suspected mother from her child should be made on an individual basis, taking into account the parent’s will, clinical condition, hospital logistics and the local epidemiological situation. In conformity with literature, in our study, affected neonates were asymptomatic or paucisymptomatic. Despite these reassuring findings, a few cases of severe presentation in the neonatal population have been reported. Therefore, we agree on encouraging clinicians to monitor the neonates with a suspected or confirmed infection.

As the global COVID-19 pandemic progresses, it is paramount to gain knowledge on adaptive immunity to SARS-CoV-2 in children to define immune correlates of protection upon immunization or infection. We analyzed anti-SARS-CoV-2 antibodies and their neutralizing activity (PRNT) in 66 COVID-19-infected children at 7 (±2) days after symptom onset. Individuals with specific humoral responses presented faster virus clearance and lower viral load associated with a reduced in vitro infectivity. We demonstrated that the frequencies of SARS-CoV-2-specific CD4+CD40L+ T cells and Spike-specific B cells were associated with the anti-SARS-CoV-2 antibodies and the magnitude of neutralizing activity. The plasma proteome confirmed the association between cellular and humoral SARS-CoV-2 immunity, and PRNT+ patients show higher viral signal transduction molecules (SLAMF1, CD244, CLEC4G). This work sheds lights on cellular and humoral anti-SARS-CoV-2 responses in children, which may drive future vaccination trial endpoints and quarantine measures policies., Graphical abstract, Cotugno et al. show that neutralizing antibodies affect SARS-CoV-2 viral load in infected children. Antigen-specific B and T cells are positively associated with virus neutralization. This information provides a basis for defining SARS-CoV-2 adaptive responses in children.

Community-acquired pneumonia (CAP) is still the most important cause of death in countries with scarce resources. All children (33 months ± 35 DS) discharged from the Pediatric Unit of Itigi Hospital, Tanzania, with a diagnosis of CAP from August 2014 to April 2015 were enrolled. Clinical data were gathered. Dried blood spot (DBS) samples for quantitative real-time polymerase chain reaction (PCR) for bacterial detection were collected in all 100 children included. Twenty-four percent of patients were identified with severe CAP and 11% died. Surprisingly, 54% of patients were admitted with a wrong diagnosis, which increased complications, the need for antibiotics and chest X-rays, and the length of hospitalization. Comorbidity, found in 32% of children, significantly increased severity, complications, deaths, need for chest X-rays, and oxygen therapy. Malnourished children (29%) required more antibiotics. Microbiologically, Streptococcus pneumonia (S. p.), Haemophilus influenza type b (Hib) and Staphylococcus aureus (S. a.) were the bacteria more frequently isolated. Seventy-five percent of patients had mono-infection. Etiology was not correlated with severity, complications, deaths, oxygen demand, or duration of hospitalization. Our study highlights that difficult diagnoses and comorbidities negatively affect clinical evolution. S. p. and Hib still play a large role; thus, implementation of current vaccine strategies is needed. DBS is a simple and efficient diagnostic method for bacterial identification in countries with scarce resources.

A tutt’oggi non esiste un test diagnostico per le diverse malattie reumatologiche, ma gli esami di laboratorio possono fornire un valido supporto per la gestione della malattia e della terapia. Solo nel forte sospetto clinico sostenuto da solidi dati anamnestici vanno richiesti esami ematochimici, che altrimenti possono risultare fuor- vianti. E opportuno iniziare sempre con esami di primo livello (emo- cromo, indici di flogosi, enzimi muscolari ed esame delle urine) che, se correttamente interpretati, possono indicarci la necessita di ese- guire a scopo diagnostico esami di secondo livello (titolo anti-strep- tolisinico, complemento, ferritina e pannello auto-anticorpale). Tuttavia, in reumatologia, le indagini di laboratorio servono soprattutto per monitorare l’attivita della malattia e gli effetti collaterali della terapia, consentendo una miglior definizione in termini prognostici e terapeutici.

Background The so-called component-resolved immunotherapy of allergies proposes an immunization tailored to the molecular sensitization profiles of individual patients. Objectives We sought (1) to investigate the profiles of IgE sensitization to Phleum pratense in children with grass pollen allergy and (2) to define the compatibility of these profiles with a mixture of recombinant allergenic molecules of P pratense previously proposed for specific immunotherapy. Methods We examined 200 children (age, 4-18 years; 126 boys) with allergic rhinitis, asthma, or both ascertained through validated questionnaires. Each child underwent skin prick testing (ALK-Abello) and serum IgE assays (ImmunoCAP, Phadia) with 9 pollen extracts. Sera reacting against P pratense were tested for the individual molecules (rPhl p 1, rPhl p 2, rPhl p 4, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11, and Phl p 12). Through a combinatorial approach, the IgE individual sensitization profiles were matched against an experimental allergen-specific immunotherapy (SIT) preparation containing Phl p 1, Phl p 2, Phl p 5, and Phl p 6. Results Among the 176 of 200 children with IgE sensitization to P pratense extract, 39 profiles of sensitization to the 8 allergenic molecules tested (cutoff, 0.35 kU/L) were identified. This high heterogeneity was reduced by considering only 6 or 4 P pratense molecules but not by increasing the cutoff levels of IgE positivity. The molecular profile of the experimental SIT preparation matched that of 7 (4%) of 176 patients only; the remaining 169 patients were classified in 4 mismatch categories: underpowered (29%), overpowered (32%), underpowered/overpowered (32%), and unrelated (3%). Conclusions IgE sensitization profiles to P pratense are highly heterogeneous. Molecularly designed SIT preparations tailored to patients' needs should consider this high heterogeneity and be driven by locally performed population studies.

We describe the case of a 14 year old girl, followed by our Pediatric Allergology and Immunology Service for persistent rhinitis and asthma. The child suffered from asthma since the age of three years with a worsening of symptoms during the winter months. At 4 years of life, she was hospitalized for the first severe asthma episode. The SPT were positive for dust mites, Alternaria, pollens of grasses, Cypress, Birch, Plane, epithelium of dog and cat, fish and soy. She started a fish and soy free diet and therapy with ICS (50 mcg daily for 2), antihistamine and antileukotriene. At six years of life she performed spirometry, that showed moderate airflow obstruction (FEV1 75.8%) and significant dilatation after salbutamol (+16%). For persistence of asthma despite the therapy, at the age of 8 years she added LABA to the ICS (25/125 mcg daily for 2), with significant improvement for the next two years; spirometry normalized (FEV1 88.2%). When ten, she started with almost daily wheezing that required the use of OCS; spirometry showed severe bronchial obstruction and restriction (FEV1 58.8%). Chest X-ray was performed, showing peribronchial infiltration and air trapping; ph-metry, sweat test and Mantoux were negative; HRCT showed areas of thickening with appearance "ground glass" air trapping and bronchiectasis predominantly in the upper lobes. Immunological and autoimmune evaluation were negative. Monitoring with the Peak Flow Meter showed the persistence of frequent and severe symptoms; FEV1 was 48.5% with expansion of 28.6% after salbutamol. The girl was considered a candidate for therapy with omalizumab and this was started in Autumn 2011 (575 mg/2 weeks) with significant improvement (FEV1 100.5%). To date she is still treated with omalizumab, plus therapy with CSI + LABA, antileukotriene and antihistamine, with good control of asthma. On the basis of our experience, the use of omalizumab is an effective treatment for asthma resistant to common therapies, to reduce bronchial reactivity, symptoms and use of OCS.