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1. A multi-platform approach to identify a blood-based host protein signature for distinguishing between bacterial and viral infections in febrile children (PERFORM): a multi-cohort machine learning study

Author

Jackson, Heather Ruth, Zandstra, Judith, Menikou, Stephanie, Hamilton, Shea, McArdle, Andrew J, De, Tisham, Agyeman, Philipp K A, Von Both, Ulrich, Carrol, Enitan D, Emonts, Marieke, Eleftheriou, Irini, Van der Flier, Michiel, Fink, Colin, De Groot, Ronald, Moll, Henriette A, Pokorn, Marko, Pollard, Andrew, Schlapbach, Luregn J, Tsolia, Maria, Usuf, Effua, Wright, Victoria, Yeung, Shunmay, Zavadska, Dace, Zenz, Werner, Coin, Lachlan JM, Cunnington, Aubrey J, Martinon-Torres, Federico, Herberg, Jethro, De Jonge, Marien I, Levin, Michael, Kuijpers, Taco, Kaforou, Myrsini, Abdulla, Amina, Aebi, Christoph, Agbeko, Rachel, Ali, Ladan, Alkema, Wynand, Allen, Karen, Anderson, Suzanne, Ansari, Imran, Arif, Tasnim, Avramoska, Tanja, Baas, Bryan, Bahovec, Natalija, Balode, Anda, Bãrdzdina, Arta, Barendregt, A M, Barral-Arca, Ruth, Bath, David, Bauchinger, Sebastian, Baumard, Lucas, Baumgart, Hinrich, Baxter, Frances, Bell, Kathryn, Bell, Ashley, Bello, Xabier, Bellos, Evangelos, Benesch, Martin, Bennet, Joshua, Berger, Christoph, Bernhard-Stirnemann, Sara, Bibi, Sagida, Bidlingmaier, Christoph, Binder, Alexander, Binder, Vera, Blackmore, Jennifer, Bojang, Kalifa, Borensztajn, Dorine M, Brengel-Pesce, Karen, Broderick, Claire, Buschbeck, Judith, Calvo-Bado, Leonides, Carnota, Sandra, Carter, Michael J, Castro, María Barreiro, Cebey-López, Miriam, Ceesay, Samba, Ceolotto, Astrid, Chan, Adora, Cocklin, Elizabeth, Collings, Kalvin, Crulley, Stephen, Curras-Tuala, María José, D'alessandro, Umberto, D'Souza, Giselle, Danhauser, Katharina, Darboe, Saffiatou, Darnell, Sarah, De Haan, L, De Vries, Gabriella, Deksne, Dãrta, Devine, Kirsty, Dewez, Juan Emmanuel, Dik, W, Dudley, Julia, Eber, Ernst, Fabian, Daniel, Farto, Cristina Balo, Fernández, Sonia Serén, Fidler, Katy, Fitchett, Elizabeth, Galassini, Rachel, Gallisti, Siegfried, García, Mirian Ben, Gardovska, Dace, Geissler, J, Gerrits, G P J M, Giannoni, Eric, Gloerich, Jolein, Gómez-Carballa, Alberto, González, Fernando Álves, Gores, Gunther, Grãvele, Dagne, Griese, Matthias, Grope, Ilze, Gurung, Meeru, Haas, Nikolaus, Habgood-Coote, Dominic, Hagedoorn, Nienke N, Haidl, Harald, Harrison, Rebekah, Hauer, Almuthe, Heidema, J, Heininger, Ulrich, Henriet, Stefanie, Hibberd, Martin, Hoggart, Cllive, Hösele, Susanne, Hourmat, Sara, Hude, Christa, Huijnen, Martijn, Iglesias, Pilar Leboráns, Iglesias, Marisol Vilas, Jennings, Rebecca, Johnson, Joanne, Jongerius, Ilse, Jorgensen, Rikke, Kahlert, Christian, Kandasamy, Rama, Kappler, Matthias, Keldorfer, Markus, Kelly, Dominic F, Khanijau, Aakash, Kim, Nayoung, Kim, Eunjung, King, Sharon, Kolberg, Laura, Kolnik, Mojca, Kloosterhuis, Lieke, Kohlfürst, Daniela S, Kohlmaier, Benno, Krenn, Larissa, Leigh, Simon, Leitner, Manuel, Leurent, Baptiste, Lim, Emma, Lin, Naomi, Liu, Ching-Chuan, Löffler, Sabine, Lurz, Eberhard, Mackerness, Christine, Maconochie, Ian, Mallet, Francois, Marmarinos, Antonis, Martin, Alex, Martin, Mike, Martinón Sánchez, José María, Martinón-Torres, Nazareth, McAlinden, Paul, McDonald, Sam, McDonell, Anne, Meiere, Anija, Meierford, Anne, Miedema, C J, Miners, Alec, Mistry, Ravi, Mommert, Marine, Morris, Sophie, Muench, Georg, Murdoch, David R, Mustafa, Sobia, Natalucci, Giancarlo, Neeleman, C, Newall, Karen, Nichols, Samuel, Niederer-Loher, Anita, Niedrist, Tobias, Nijman, Ruud, Nokalna, Ieve, Nordberg, Gudrun, O'Connor, Daniel, Obihara, C C, Oliver, Zoe, Oosthoek, Wilma, Ora, Miguel Sadiki, Osterman, Veronika, Pachot, Alexandre, Pajkrt, D, Pardo-Seco, Jacobo, Pavãre, Jana, Paz, Ivonne Pena, Paulus, Stéphane, Pérez, Belén Mosquera, Persand, Salina, Pfleger, Andreas, Pfurtscheller, Klaus, Philipsen, Ria, Pickering, Alisa, Pierce, Benjamin, Pilch, Heidemarie, Pischedda, Sara, Pölz, Lena, Posfay-Barbe, Klara M, Powell, Oliver, Prunk, Petra, Pučuka, Zanda, Rajic, Glorija, Rashid, Aqeela, Redondo-Collazo, Lorenzo, Reiter, Karl, Relly, Christa, Rhodes, Mathew, Rial, Jose Gómez, Richmond, Vivien, Riedel, Thomas, Rivero Calle, Irene, Roca, Anna, Rödl, Siegfried, Rodríguez, Lidia Piñeiro, Rodríguez-Tenreiro, Carmen, Romaine, Sam, Rowlands, Emily, Rudzate, Aleksandra, Sagmeister, Manfred, Saidykhan, Momodou, Sallas, Antonio, Sarr, Isatou, Schoen, Carola, Schonenberg, D, Schweintzger, Nina, Secka, Fatou, Selecka, Katrīna, Shah, Priyen, Shen, Ching-Fen, Shrestha, Shrijana, Skrabl-Baumgartner, Andrea, Soon, Joshua, Sperl, Matthias, Sprenkeler, Evelien, Spyridis, Nikos, Srovin, Tina Plankar, Stampfer, Laura, Stevens, Molly, Stocker, Martin, Strenger, Volker, Suárez, Carlos Durán, Svile, Dace, Syggelou, Kelly, Tal, Chantal, Tambouratzi, Maria, Tavliavini, Emma, Thakker, Clare, Thomson, Evelyn, Throson, Stephen, Till, Holger, Tramper-Stranders, G A, Trasorras, Cristina Serén, Trobisch, Andreas, Urbãne, Urzula Nora, Usman, Mariama, Valentine, Lucille, Van Aerde, Koen, Van den Berg, J M, Van den Broek, Bryan, Van der Giessen, Ilona, Van der Kuip, M, Van der Velden, Fabian, Van Furth, A M, Van Gool, Alain J, Van Leur, M, van Mierlo, G, Vázquez, Sara Ray, Vermont, Clementien, Vicente, Luisa García, Vincek, Katarina, Vito, Ortensia, Voice, Marie, Wallia, Diane, Walsh, Ben, Wang, Shih-Min, Wedderburn, Catherine, Willems, Esther, Wilson, Clare, Wood, Amanda, Woodsford, Phil, Wyss, Verena, Xagorari, Marietta, Zachariasse, Joany, Zaman, Syed M A, Zurl, Christoph, Zwerenz, Manuela, Jackson, Heather R, Hamilton, Melissa Shea, Fischer, Roman, Thorne, Adam M, Huang, Honglei, Tanck, Michael W, Jansen, Machiel H, Pollard, Andrew J, Tsolia, Maria N, Wright, Victoria J, Coin, Lachlan J M, Casals-Pascual, Climent, Herberg, Jethro A, de Jonge, Marien I, and Kuijpers, Taco W

Published
2023
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2. Antibiotic Prescriptions in Hospitalized Patients with an Exacerbation COPD and a Proven Influenza or RS Virus Infection

Author

van Brummelen S, Tramper-Stranders G, Jonkman K, de Boer G, in 't Veen J, and Braunstahl GJ

Subjects
copd, exacerbation, influenza virus, antibiotic treatment, rs virus, Diseases of the respiratory system, RC705-779
Abstract

Sigrid van Brummelen,1 Gerdien Tramper-Stranders,2 Kelly Jonkman,1 Geertje de Boer,1,3 Johannes in ’t Veen,1,3 Gert-Jan Braunstahl1,3 1Department of Pulmonology, Franciscus Gasthuis and Vlietland, Rotterdam, 3045 PM, the Netherlands; 2Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, 3045 PM, the Netherlands; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, 3015 GD, the NetherlandsCorrespondence: Sigrid van Brummelen, Department of Pulmonology, Franciscus Gasthuis and Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands, Email s.brummelen@franciscus.nlBackground: COPD exacerbations (AE-COPD) add up to over 200,000 hospitalization days annually in the Netherlands. Viral respiratory infections play a role in about half of COPD exacerbations. Although the prevalence of bacterial superinfection is estimated 10– 40% in admitted AE-COPD patients with an influenza infection, the majority is treated with antibiotics. Current national and international guidelines provide limited guidance regarding antibiotic use in hospitalized patients with an AE-COPD with proven viral respiratory pathogens.Study Goal: We aimed to investigate antibiotic prescription in hospitalized patients with a COPD exacerbation and an influenza- or RS virus infection.Patients and methods: We performed a retrospective cohort study in patients admitted with an AE-COPD and influenza- or RS virus infection. We compared clinical characteristics of patients with and without antibiotic treatment on admission and estimated adequacy of antibiotic prescriptions.Results: We included 134 patients. Seventy-nine (59%) received antibiotics on admission. Chest X-ray infiltrates and plasma CRP level (≥ 50 mg/L) were correlated with the prescription of antibiotics. Outcomes, such as number of hospitalized days and mortality, were not significantly different between the groups with and without antibiotic treatment. Antibiotic treatment was considered “probably adequate” in 52/79 (65.8%) patients; “not necessary” in 12/79 patients (15.2%) and “probably not necessary” in another 15/79 patients (19.0%).Conclusion: Prescription of antibiotics in hospitalized COPD patients is common practice despite a proven viral infection on admission. A significant antibiotic reduction of 34.2% in these patients seems feasible. Future guidelines should include recommendations regarding antibiotic stewardship in hospitalized patients with AE-COPD with a proven viral respiratory infection.Keywords: COPD, exacerbation, influenza virus, antibiotic treatment, RS virus

Published
2022

4. Genomic investigations of unexplained acute hepatitis in children

Author

Morfopoulou, Sofia, Buddle, Sarah, Torres Montaguth, Oscar Enrique, Atkinson, Laura, Guerra-Assunção, José Afonso, Moradi Marjaneh, Mahdi, Zennezini Chiozzi, Riccardo, Storey, Nathaniel, Campos, Luis, Hutchinson, J. Ciaran, Counsell, John R., Pollara, Gabriele, Roy, Sunando, Venturini, Cristina, Antinao Diaz, Juan F., Siam, Ala’a, Tappouni, Luke J., Asgarian, Zeinab, Ng, Joanne, Hanlon, Killian S., Lennon, Alexander, McArdle, Andrew, Nijman, Ruud, Peters, Mark, Emonts, Marieke, van der Zee, Carlijn, Vermont, Clementien L., Moll, Henriëtte A., Borensztajn, Dorine M., Hagedoorn, Nienke N., Tan, Chantal, Zachariasse, Joany, Dik, W., van der Flier, Michiel, Stocker, Martin, Tempel, Dennie, Hoffmann, Florian, de Groot, Ronald, Willems, Esther, de Haan, L., Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, de Vries, Gabriella, van den Berg, J. M., Barendregt, A. M., Breuer, Judith, Pediatrics, Erasmus MC other, Rehabilitation Medicine, Immunology, Cardiology, Business Economics, Erasmus School of Economics, Radiotherapy, Economics, Obstetrics & Gynecology, Psychiatry, and BV's

Subjects
SDG 3 - Good Health and Well-being
Abstract

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

Published
2023

6. Relationship between molecular pathogen detection and clinical disease in febrile children across Europe:a multicentre, prospective observational study

Author

Shah, Priyen, Voice, Marie, Calvo-Bado, Leonides, Rivero-Calle, Irene, Morris, Sophie, Nijman, Ruud, Broderick, Claire, De, Tisham, Eleftheriou, Irini, Galassini, Rachel, Khanijau, Aakash, Kolberg, Laura, Kolnik, Mojca, Rudzate, Aleksandra, Sagmeister, Manfred, Schweintzger, Nina, Secka, Fatou, Thakker, Clare, van der Velden, Fabian, Vermont, Clementien, Vincek, Katarina, Agyeman, Philipp K.A., Cunnington, Aubrey J., De Groot, Ronald, Emonts, Marieke, Fidler, Katy, Kuijpers, Taco, Mommert-Tripon, Marine, Brengel-Pesce, Karen, Mallet, Francois, Moll, Henriette, Paulus, Stéphane, Pokorn, Marko, Pollard, Andrew, van der Flier, Michiel, Borensztajn, Dorine M., Hagedoorn, Nienke N., Zachariasse, Joany, Dik, W., Stocker, Martin, Willems, Esther, De Haan, L., Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, De Vries, Gabriella, van den Berg, J. M., Barendregt, A. M., Shah, Priyen, Voice, Marie, Calvo-Bado, Leonides, Rivero-Calle, Irene, Morris, Sophie, Nijman, Ruud, Broderick, Claire, De, Tisham, Eleftheriou, Irini, Galassini, Rachel, Khanijau, Aakash, Kolberg, Laura, Kolnik, Mojca, Rudzate, Aleksandra, Sagmeister, Manfred, Schweintzger, Nina, Secka, Fatou, Thakker, Clare, van der Velden, Fabian, Vermont, Clementien, Vincek, Katarina, Agyeman, Philipp K.A., Cunnington, Aubrey J., De Groot, Ronald, Emonts, Marieke, Fidler, Katy, Kuijpers, Taco, Mommert-Tripon, Marine, Brengel-Pesce, Karen, Mallet, Francois, Moll, Henriette, Paulus, Stéphane, Pokorn, Marko, Pollard, Andrew, van der Flier, Michiel, Borensztajn, Dorine M., Hagedoorn, Nienke N., Zachariasse, Joany, Dik, W., Stocker, Martin, Willems, Esther, De Haan, L., Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, De Vries, Gabriella, van den Berg, J. M., and Barendregt, A. M.

Abstract

Background: The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice. Methods: Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016–2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed. Findings: Of 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92–5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07–7.59), Group A streptococcus (OR 2.73, 95% CI 1.13–6.09) and E. coli (OR 2.7, 95% CI 1.02–6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11–0.46), influenza B (OR 0.12, 95% CI 0.02–0.37) and RSV (OR 0.16, 95% CI: 0.06–0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23–0.72) and EBV (OR 0.71, 95% CI 0.56–0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively. Interpretation: Most febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which

Published
2023

7. Emergency medical services utilisation among febrile children attending emergency departments across Europe:an observational multicentre study

Author

Tan, Chantal D., Vermont, Clementien L., Zachariasse, Joany, von Both, Ulrich, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael, Lim, Emma, Maconochie, Ian, Martinon-Torres, Federico, Nijman, Ruud G., Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Zenz, Werner, Zavadska, Dace, Moll, Henriëtte A., Carrol, Enitan D., Cunnington, Aubrey, De, Tisham, Kaforou, Myrsini, Hagedoorn, Nienke N., Dik, W., Stocker, Martin, Groot, Ronald de, Willems, Esther, Haan, L. de, Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, Vries, Gabriella de, Velden, Fabian van der, Haas, N., Berg, J. M.van den, Barendregt, A. M., Tan, Chantal D., Vermont, Clementien L., Zachariasse, Joany, von Both, Ulrich, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael, Lim, Emma, Maconochie, Ian, Martinon-Torres, Federico, Nijman, Ruud G., Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Zenz, Werner, Zavadska, Dace, Moll, Henriëtte A., Carrol, Enitan D., Cunnington, Aubrey, De, Tisham, Kaforou, Myrsini, Hagedoorn, Nienke N., Dik, W., Stocker, Martin, Groot, Ronald de, Willems, Esther, Haan, L. de, Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, Vries, Gabriella de, Velden, Fabian van der, Haas, N., Berg, J. M.van den, and Barendregt, A. M.

Abstract

Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1–42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1–59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1–0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4–1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented. What is Known: •Children constitute a

Published
2023

9. Antibiotic Prescriptions in Hospitalized Patients with an Exacerbation COPD and a Proven Influenza or RS Virus Infection

Author

van Brummelen, S., Tramper-Stranders, G., Jonkman, K., de Boer, G., Veen, J. V., Braunstahl, G. J., van Brummelen, S., Tramper-Stranders, G., Jonkman, K., de Boer, G., Veen, J. V., and Braunstahl, G. J.

Abstract

Background: COPD exacerbations (AE-COPD) add up to over 200,000 hospitalization days annually in the Netherlands. Viral respiratory infections play a role in about half of COPD exacerbations. Although the prevalence of bacterial superinfection is estimated 10–40% in admitted AE-COPD patients with an influenza infection, the majority is treated with antibiotics. Current national and international guidelines provide limited guidance regarding antibiotic use in hospitalized patients with an AE-COPD with proven viral respiratory pathogens. Study Goal: We aimed to investigate antibiotic prescription in hospitalized patients with a COPD exacerbation and an influenza-or RS virus infection. Patients and methods: We performed a retrospective cohort study in patients admitted with an AE-COPD and influenza-or RS virus infection. We compared clinical characteristics of patients with and without antibiotic treatment on admission and estimated adequacy of antibiotic prescriptions. Results: We included 134 patients. Seventy-nine (59%) received antibiotics on admission. Chest X-ray infiltrates and plasma CRP level (≥50 mg/L) were correlated with the prescription of antibiotics. Outcomes, such as number of hospitalized days and mortality, were not significantly different between the groups with and without antibiotic treatment. Antibiotic treatment was considered “probably adequate” in 52/79 (65.8%) patients; “not necessary” in 12/79 patients (15.2%) and “probably not necessary” in another 15/79 patients (19.0%). Conclusion: Prescription of antibiotics in hospitalized COPD patients is common practice despite a proven viral infection on admission. A significant antibiotic reduction of 34.2% in these patients seems feasible. Future guidelines should include recommendations regarding antibiotic stewardship in hospitalized patients with AE-COPD with a proven viral respiratory infection.

Published
2022

10. Trends in SARS-CoV-2 seroprevalence amongst urban paediatric patients compared with a nationwide cohort in the Netherlands

Author

Rotee, I. L.M., Ong, D. S.Y., Koeleman, J. G.M., Vos, E. R.A., Tramper-Stranders, G. A., Rotee, I. L.M., Ong, D. S.Y., Koeleman, J. G.M., Vos, E. R.A., and Tramper-Stranders, G. A.

Abstract

Objectives: The extent of SARS-CoV-2 infection amongst children and their role in transmission remains unclear. Therefore, we aimed to estimate the SARS-CoV-2 antibody seroprevalence amongst children who presented to our hospital for non-COVID-19-related morbidity during the first and second epidemic wave in 2020 and compared these to the general Dutch paediatric population. Methods: We collected residual plasma samples from all paediatric patients (1 month-17 years of age) visiting our clinic or emergency room, who had blood drawing for various medical reasons. Samples were analysed for the presence of total antibodies against SARS-CoV-2 by Wantai ELISA. The seroprevalence in two separate periods (July-Sep 2020, and Oct-Dec 2020) was compared to regional and national data (PIENTER-Corona study, September 2020), and associations with co-morbidities were assessed. Results: A total of 209 samples in period 1 and 240 samples in period 2 were collected (median age 7.1 years, IQR 1.5–13.5). SARS-CoV-2 antibodies were detected in 4.1% and 13.8%, respectively (p< 0.001). Seroprevalence was higher compared to national paediatric data, but did not differ with regional estimates. Most children with SARS-CoV-2 antibodies were seen in the outpatient clinic for general paediatric problems with no differences in medical reasons for presentation between the two periods. Conclusions: These data confirm a rapid three-fold increase in SARS-CoV-2 seroprevalence in paediatric patients in the second half of 2020 with a trend towards a higher seroprevalence compared to randomly-selected children in a nationwide study. Underlying morbidity in children might not play an important role in acquiring SARS-CoV-2 infection.

Published
2021

11. Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Author

Maat, Josephine, Peeters, D, Nieboer, Daan, van Wermeskerken, AM, Smit, FJ, Noordzij, Jeroen, Tramper-Stranders, G, Driessen, Gertjan, Obihara, CC, Punt, J, Lei, Johan, Polinder, Suzanne, Moll, Henriette, Oostenbrink, Rianne, Maat, Josephine, Peeters, D, Nieboer, Daan, van Wermeskerken, AM, Smit, FJ, Noordzij, Jeroen, Tramper-Stranders, G, Driessen, Gertjan, Obihara, CC, Punt, J, Lei, Johan, Polinder, Suzanne, Moll, Henriette, and Oostenbrink, Rianne

Published
2020

12. Immunology of COVID-19: mechanisms, clinical outcome, diagnostics and perspectives - a report of the European Academy of Allergy and Clinical Immunology (EAACI)

Author

CTI Research, CTI, MS Dermatologie/Allergologie, Infection & Immunity, Sokolowska, M, Lukasik, Z, Agache, I, Akdis, C A, Akdis, D, Akdis, M, Barcik, W, Brough, H, Eiwegger, T, Eliaszewicz, A, Eyerich, S, Feleszko, W, Gomez Casado, C, Hoffmann-Sommergruber, K, Janda, J, Jiménez-Saiz, R, Jutel, M, Knol, E, Kortekaas Krohn, I, Kothari, A, Makowska, J, Moniuszko, M, Morita, H, O'Mahony, L, Nadeau, K, Ozdemir, C, Pali-Schöll, I, Palomares, O, Papaleo, F, Prunicki, M, Schmidt-Weber, C B, Sediva, A, Schwarze, J, Shamji, M H, Tramper-Stranders, G, van, W, de Veen, R., Untersmayr, E, CTI Research, CTI, MS Dermatologie/Allergologie, Infection & Immunity, Sokolowska, M, Lukasik, Z, Agache, I, Akdis, C A, Akdis, D, Akdis, M, Barcik, W, Brough, H, Eiwegger, T, Eliaszewicz, A, Eyerich, S, Feleszko, W, Gomez Casado, C, Hoffmann-Sommergruber, K, Janda, J, Jiménez-Saiz, R, Jutel, M, Knol, E, Kortekaas Krohn, I, Kothari, A, Makowska, J, Moniuszko, M, Morita, H, O'Mahony, L, Nadeau, K, Ozdemir, C, Pali-Schöll, I, Palomares, O, Papaleo, F, Prunicki, M, Schmidt-Weber, C B, Sediva, A, Schwarze, J, Shamji, M H, Tramper-Stranders, G, van, W, de Veen, R., and Untersmayr, E

Published
2020

16. Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Author

Wang, Xinzhu, Nijman, Ruud, Camuzeaux, Stephane, Sands, Caroline, Jackson, Heather, Kaforou, Myrsini, Emonts, Marieke, Herberg, Jethro A., Maconochie, Ian, Carrol, Enitan D., Paulus, Stephane C., Zenz, Werner, Van der Flier, Michiel, de Groot, Ronald, Martinon-Torres, Federico, Schlapbach, Luregn J., Pollard, Andrew J., Fink, Colin, Kuijpers, Taco T., Anderson, Suzanne, Lewis, Matthew R., Levin, Michael, McClure, Myra, Gormley, Stuart, Hamilton, Shea, Hourmat, Bernardo, Hoggart, Clive, Sancho-Shimizu, Vanessa, Wright, Victoria, Abdulla, Amina, Agapow, Paul, Bartlett, Maeve, Bellos, Evangelos, Eleftherohorinou, Hariklia, Galassini, Rachel, Inwald, David, Mashbat, Meg, Menikou, Stefanie, Mustafa, Sobia, Nadel, Simon, Rahman, Rahmeen, Thakker, Clare, Coin, Lachlan M. J., Bokhand, S., Power, Sue, Barham, Heather, Pathan, N., Ridout, Jenna, White, Deborah, Thurston, Sarah, Faust, S., Patel, S., McCorkell, Jenni, Davies, P., Crate, Lindsey, Navarra, Helen, Carter, Stephanie, Ramaiah, R., Patel, Rekha, Tuffrey, Catherine, Gribbin, Andrew, McCready, Sharon, Peters, Mark, Hardy, Katie, Standing, Fran, O'Neill, Lauren, Abelake, Eugenia, Deep, Akash, Nsirim, Eniola, Willis, Louise, Young, Zoe, Royad, C., White, Sonia, Fortune, P. M., Hudnott, Phil, Alvez Gonzalez, Fernando, Barral-Arca, Ruth, Cebey-Lopez, Miriam, Jose Curras-Tuala, Maria, Garcia, Natalia, Garcia Vicente, Luisa, Gomez-Carballa, Alberto, Gomez Rial, Jose, Grela Beiroa, Andrea, Justicia Grande, Antonio, Leborans Iglesias, Pilar, Martinez Santos, Alba Elena, MartinonTorres, Nazareth, Martinon Sanchez, Jose Maria, Morillo Gutierrez, Beatriz, Mosquera Perez, Belen, Obando Pacheco, Pablo, Pardo-Seco, Jacobo, Pischedda, Sara, RiveroCalle, Irene, Rodriguez-Tenreiro, Carmen, Redondo-Collazo, Lorenzo, Salas Ellacuriagal, Antonio, Seren Fernandez, Sonia, Porto Silva, Maria del Sol, Vega, Ana, Vilanova Trillo, Lucia, Salas, Antonio, Beatriz Reyes, Susana, Leon Leon, Maria Cruz, Navarro Mingorance, Alvaro, Gabaldo Barrios, Xavier, Onate Vergara, Eider, Concha Torre, Andres, Vivanco, Ana, Fernandez, Reyes, Gimenez Sanchez, Francisco, Sanchez Forte, Miguel, Rojo, Pablo, Ruiz Contreras, J., Palacios, Alba, Epalza Ibarrondo, Cristina, Fernandez Cooke, Elizabeth, Navarro, Marisa, Alvarez Alvarez, Cristina, Jose Lozano, Maria, Carreras, Eduardo, Brio Sanagustin, Sonia, Neth, Olaf, Martinez Padilla, Ma del Carmen, Prieto Tato, Luis Manuel, Guillen, Sara, Fernandez Silveira, Laura, Moreno, David, van Furth, A. M. Tutu, Boeddha, N. P., Driessen, G. J. A., Emonts, M., Hazelzet, J. A., Pajkrt, D., Sanders, E. A. M., van de Beek, D., van der Ende, A., Philipsen, H. L. A., Adeel, A. O. A., Breukels, M. A., Brinkman, D. M. C., de Korte, C. C. M. M., de Vries, E., de Waal, W. J., Dekkers, R., Dings-Lammertink, A., Doedens, R. A., Donker, A. E., Dousma, M., Faber, T. E., Gerrits, G. P. J. M., Gerver, J. A. M., Heidema, J., Homan-van der Veen, J., Jacobs, M. A. M., Jansen, N. J. G., Kawczynski, P., Klucovska, K., Kneyber, M. C. J., Koopman-Keemink, Y., Langenhorst, V. J., Leusink, J., Loza, B. F., Merth, I. T., Miedema, C. J., Neeleman, C., Noordzij, J. G., Obihara, C. C., van Overbeek-van Gils, A. L. T., Poortman, G. H., Potgieter, S. T., Potjewijd, J., Rosias, P. P. R., Sprong, T., ten Tussher, G. W., Thio, B. J., Tramper-Stranders, G. A., van Deuren, M., van der Meer, H., van Kuppevelt, A. J. M., van Wermeskerken, A. M., Verwijs, W. A., Wolfs, T. F. W., Agyeman, Philipp, Aebi, Christoph, Berger, Christoph, Giannoni, Eric, Stocker, Martin, Posfay-Barbe, Klara M., Heininger, Ulrich, Bernhard-Stirnemann, Sara, Niederer-Loher, Anita, Kahlert, Christian, Hasters, Paul, Relly, Christa, Baer, Walter, Frederick, Hannah, Jennings, Rebecca, Johnston, Joanne, Kenwright, Rhian, Pinnock, Elli, Agbeko, Rachel, Secka, Fatou, Bojang, Kalifa, Sarr, Isatou, Kebbeh, Ngange, Sey, Gibbi, Momodou, Saidy Khan, Cole, Fatoumata, Thomas, Gilleh, Antonio, Martin, Klobassa, Daniela S., Binder, Alexander, Schweintzger, Nina A., Sagmeister, Manfred, Baumgart, Hinrich, Baumgartner, Markus, Behrends, Uta, Biebl, Ariane, Birnbacher, Robert, Blanke, Jan-Gerd, Boelke, Carsten, Breuling, Kai, Brunner, Juergen, Buller, Maria, Dahlem, Peter, Dietrich, Beate, Eber, Ernst, Elias, Johannes, Emhofer, Josef, Etschmaier, Rosa, Farr, Sebastian, Girtler, Ylenia, Grigorow, Irina, Heimann, Konrad, Ihm, Ulrike, Jaros, Zdenek, Kalhoff, Hermann, Kaulfersch, Wilhelm, Kemen, Christoph, Klocker, Nina, Koester, Bernhard, Kohlmaier, Benno, Komini, Eleni, Kramer, Lydia, Neubert, Antje, Ortner, Daniel, Pescollderungg, Lydia, Pfurtscheller, Klaus, Reiter, Karl, Ristic, Goran, Roedl, Siegfried, Sellner, Andrea, Sonnleitner, Astrid, Sperl, Matthias, Stelzl, Wolfgang, Till, Holger, Trobisch, Andreas, Vierzig, Anne, Vogel, Ulrich, Weingarten, Christina, Welke, Stefanie, Wimmer, Andreas, Wintergerst, Uwe, Wueller, Daniel, Zaunschirm, Andrew, Ziuraite, Ieva, Zukovskaja, Veslava, Wang, Xinzhu, Nijman, Ruud, Camuzeaux, Stephane, Sands, Caroline, Jackson, Heather, Kaforou, Myrsini, Emonts, Marieke, Herberg, Jethro A., Maconochie, Ian, Carrol, Enitan D., Paulus, Stephane C., Zenz, Werner, Van der Flier, Michiel, de Groot, Ronald, Martinon-Torres, Federico, Schlapbach, Luregn J., Pollard, Andrew J., Fink, Colin, Kuijpers, Taco T., Anderson, Suzanne, Lewis, Matthew R., Levin, Michael, McClure, Myra, Gormley, Stuart, Hamilton, Shea, Hourmat, Bernardo, Hoggart, Clive, Sancho-Shimizu, Vanessa, Wright, Victoria, Abdulla, Amina, Agapow, Paul, Bartlett, Maeve, Bellos, Evangelos, Eleftherohorinou, Hariklia, Galassini, Rachel, Inwald, David, Mashbat, Meg, Menikou, Stefanie, Mustafa, Sobia, Nadel, Simon, Rahman, Rahmeen, Thakker, Clare, Coin, Lachlan M. J., Bokhand, S., Power, Sue, Barham, Heather, Pathan, N., Ridout, Jenna, White, Deborah, Thurston, Sarah, Faust, S., Patel, S., McCorkell, Jenni, Davies, P., Crate, Lindsey, Navarra, Helen, Carter, Stephanie, Ramaiah, R., Patel, Rekha, Tuffrey, Catherine, Gribbin, Andrew, McCready, Sharon, Peters, Mark, Hardy, Katie, Standing, Fran, O'Neill, Lauren, Abelake, Eugenia, Deep, Akash, Nsirim, Eniola, Willis, Louise, Young, Zoe, Royad, C., White, Sonia, Fortune, P. M., Hudnott, Phil, Alvez Gonzalez, Fernando, Barral-Arca, Ruth, Cebey-Lopez, Miriam, Jose Curras-Tuala, Maria, Garcia, Natalia, Garcia Vicente, Luisa, Gomez-Carballa, Alberto, Gomez Rial, Jose, Grela Beiroa, Andrea, Justicia Grande, Antonio, Leborans Iglesias, Pilar, Martinez Santos, Alba Elena, MartinonTorres, Nazareth, Martinon Sanchez, Jose Maria, Morillo Gutierrez, Beatriz, Mosquera Perez, Belen, Obando Pacheco, Pablo, Pardo-Seco, Jacobo, Pischedda, Sara, RiveroCalle, Irene, Rodriguez-Tenreiro, Carmen, Redondo-Collazo, Lorenzo, Salas Ellacuriagal, Antonio, Seren Fernandez, Sonia, Porto Silva, Maria del Sol, Vega, Ana, Vilanova Trillo, Lucia, Salas, Antonio, Beatriz Reyes, Susana, Leon Leon, Maria Cruz, Navarro Mingorance, Alvaro, Gabaldo Barrios, Xavier, Onate Vergara, Eider, Concha Torre, Andres, Vivanco, Ana, Fernandez, Reyes, Gimenez Sanchez, Francisco, Sanchez Forte, Miguel, Rojo, Pablo, Ruiz Contreras, J., Palacios, Alba, Epalza Ibarrondo, Cristina, Fernandez Cooke, Elizabeth, Navarro, Marisa, Alvarez Alvarez, Cristina, Jose Lozano, Maria, Carreras, Eduardo, Brio Sanagustin, Sonia, Neth, Olaf, Martinez Padilla, Ma del Carmen, Prieto Tato, Luis Manuel, Guillen, Sara, Fernandez Silveira, Laura, Moreno, David, van Furth, A. M. Tutu, Boeddha, N. P., Driessen, G. J. A., Emonts, M., Hazelzet, J. A., Pajkrt, D., Sanders, E. A. M., van de Beek, D., van der Ende, A., Philipsen, H. L. A., Adeel, A. O. A., Breukels, M. A., Brinkman, D. M. C., de Korte, C. C. M. M., de Vries, E., de Waal, W. J., Dekkers, R., Dings-Lammertink, A., Doedens, R. A., Donker, A. E., Dousma, M., Faber, T. E., Gerrits, G. P. J. M., Gerver, J. A. M., Heidema, J., Homan-van der Veen, J., Jacobs, M. A. M., Jansen, N. J. G., Kawczynski, P., Klucovska, K., Kneyber, M. C. J., Koopman-Keemink, Y., Langenhorst, V. J., Leusink, J., Loza, B. F., Merth, I. T., Miedema, C. J., Neeleman, C., Noordzij, J. G., Obihara, C. C., van Overbeek-van Gils, A. L. T., Poortman, G. H., Potgieter, S. T., Potjewijd, J., Rosias, P. P. R., Sprong, T., ten Tussher, G. W., Thio, B. J., Tramper-Stranders, G. A., van Deuren, M., van der Meer, H., van Kuppevelt, A. J. M., van Wermeskerken, A. M., Verwijs, W. A., Wolfs, T. F. W., Agyeman, Philipp, Aebi, Christoph, Berger, Christoph, Giannoni, Eric, Stocker, Martin, Posfay-Barbe, Klara M., Heininger, Ulrich, Bernhard-Stirnemann, Sara, Niederer-Loher, Anita, Kahlert, Christian, Hasters, Paul, Relly, Christa, Baer, Walter, Frederick, Hannah, Jennings, Rebecca, Johnston, Joanne, Kenwright, Rhian, Pinnock, Elli, Agbeko, Rachel, Secka, Fatou, Bojang, Kalifa, Sarr, Isatou, Kebbeh, Ngange, Sey, Gibbi, Momodou, Saidy Khan, Cole, Fatoumata, Thomas, Gilleh, Antonio, Martin, Klobassa, Daniela S., Binder, Alexander, Schweintzger, Nina A., Sagmeister, Manfred, Baumgart, Hinrich, Baumgartner, Markus, Behrends, Uta, Biebl, Ariane, Birnbacher, Robert, Blanke, Jan-Gerd, Boelke, Carsten, Breuling, Kai, Brunner, Juergen, Buller, Maria, Dahlem, Peter, Dietrich, Beate, Eber, Ernst, Elias, Johannes, Emhofer, Josef, Etschmaier, Rosa, Farr, Sebastian, Girtler, Ylenia, Grigorow, Irina, Heimann, Konrad, Ihm, Ulrike, Jaros, Zdenek, Kalhoff, Hermann, Kaulfersch, Wilhelm, Kemen, Christoph, Klocker, Nina, Koester, Bernhard, Kohlmaier, Benno, Komini, Eleni, Kramer, Lydia, Neubert, Antje, Ortner, Daniel, Pescollderungg, Lydia, Pfurtscheller, Klaus, Reiter, Karl, Ristic, Goran, Roedl, Siegfried, Sellner, Andrea, Sonnleitner, Astrid, Sperl, Matthias, Stelzl, Wolfgang, Till, Holger, Trobisch, Andreas, Vierzig, Anne, Vogel, Ulrich, Weingarten, Christina, Welke, Stefanie, Wimmer, Andreas, Wintergerst, Uwe, Wueller, Daniel, Zaunschirm, Andrew, Ziuraite, Ieva, and Zukovskaja, Veslava

Abstract

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics.

Published
2019

18. Initial Pseudomonas aeruginosa infection in patients with cystic fibrosis:characteristics of eradicated and persistent isolates

Author

Tramper-Stranders, G A, van der Ent, C K, Molin, S, Yang, L, Hansen, S K, Rau, M H, Ciofu, Oana, Johansen, H K, Wolfs, T F W, Tramper-Stranders, G A, van der Ent, C K, Molin, S, Yang, L, Hansen, S K, Rau, M H, Ciofu, Oana, Johansen, H K, and Wolfs, T F W

Abstract

Despite intensive eradication therapy, some CF patients with early Pseudomonas aeruginosa infection rapidly develop a chronic infection. To elucidate factors associated with this persistence, bacterial characteristics of early P. aeruginosa isolates were analysed that were either eradicated rapidly or persisted despite multiple antimicrobial treatments. Eighty-six early infection episodes were studied. First P. aeruginosa isolates from patients with eradication (36) or persistent infection (16) were included; isolates from patients with intermittent infection (34) were omitted from the study. Virulence assays, antimicrobial resistance, cytotoxicity and mutation frequencies were analysed in vitro. P. aeruginosa was genotyped by SNP-array. Transcriptomic profiles of two eradicated and two persistent strains were compared. Nineteen per cent of patients developed persistent infection; 42% achieved eradication. Secretion of virulence factors and mutation frequencies were highly variable among both eradicated and persistent isolates and were not different between the groups. Cytotoxicity was present in 57% of eradicated vs. 100% of persistent isolates (p <0.01). None of the isolates were resistant to antibiotics. The isolates were genotypically highly diverse. Multivariate analysis showed that in vitro determined bacterial characteristics could not predict persistence after first P. aeruginosa infection. Preliminary transcriptomic data showed increased expression of some genes related to a metabolic pathway. The early onset of chronic infection was not associated with (in vitro determined) bacterial characteristics only. Although the persistent isolates were more often cytotoxic, for the individual patient it was not possible to predict the risk of persistence based on bacterial characteristics. Unknown factors such as host-pathogen and pathogen-pathogen interactions should be further explored.

Published
2012

21. Trends in SARS-CoV-2 seroprevalence amongst urban paediatric patients compared with a nationwide cohort in the Netherlands.

Author

Rotee ILM, Ong DSY, Koeleman JGM, Vos ERA, and Tramper-Stranders GA

Abstract

Objectives: The extent of SARS-CoV-2 infection amongst children and their role in transmission remains unclear. Therefore, we aimed to estimate the SARS-CoV-2 antibody seroprevalence amongst children who presented to our hospital for non-COVID-19-related morbidity during the first and second epidemic wave in 2020 and compared these to the general Dutch paediatric population., Methods: We collected residual plasma samples from all paediatric patients (1 month-17 years of age) visiting our clinic or emergency room, who had blood drawing for various medical reasons. Samples were analysed for the presence of total antibodies against SARS-CoV-2 by Wantai ELISA. The seroprevalence in two separate periods (July-Sep 2020, and Oct-Dec 2020) was compared to regional and national data (PIENTER-Corona study, September 2020), and associations with co-morbidities were assessed., Results: A total of 209 samples in period 1 and 240 samples in period 2 were collected (median age 7.1 years, IQR 1.5-13.5). SARS-CoV-2 antibodies were detected in 4.1% and 13.8%, respectively ( p < 0.001). Seroprevalence was higher compared to national paediatric data, but did not differ with regional estimates. Most children with SARS-CoV-2 antibodies were seen in the outpatient clinic for general paediatric problems with no differences in medical reasons for presentation between the two periods., Conclusions: These data confirm a rapid three-fold increase in SARS-CoV-2 seroprevalence in paediatric patients in the second half of 2020 with a trend towards a higher seroprevalence compared to randomly-selected children in a nationwide study. Underlying morbidity in children might not play an important role in acquiring SARS-CoV-2 infection., Competing Interests: The authors declare no conflicts of interest., (© 2021 The Authors.)

Published
2021
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22. Improved pathogen detection in neonatal sepsis to boost antibiotic stewardship.

Author

Keij FM, Kornelisse RF, Tramper-Stranders GA, and Allegaert K

Subjects
Bacteria classification, Bacteria genetics, Humans, Infant, Newborn, Neonatal Sepsis microbiology, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship methods, Bacteria drug effects, Bacteria isolation & purification, Neonatal Sepsis diagnosis, Neonatal Sepsis drug therapy
Published
2020
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23. [A child with abdominal pain and fever: consider acute lobar nephritis - diagnostic considerations when the appendix is invisible on ultrasound].

Author

Bakker AM, Vijgen GHEJ, Hartwig NG, and Tramper-Stranders GA

Subjects
Abdominal Abscess diagnosis, Abdominal Abscess etiology, Abdominal Pain etiology, Acute Disease, Appendicitis diagnosis, Appendix diagnostic imaging, Child, Child, Preschool, Diagnosis, Differential, Fever etiology, Humans, Kidney pathology, Magnetic Resonance Imaging, Male, Nephritis complications, Ultrasonography methods, Nephritis diagnosis
Abstract

Acute lobar nephritis (ALN) is a focal interstitial bacterial infection of the renal parenchyma. ALN is described as a midpoint between an acute pyelonephritis and renal abscess. ALN is underdiagnosed in children due to both non-specific symptoms and negative urinalysis/bacteriuria laboratory findings. The gold standard for diagnosis of ALN is CT scanning, however MRI can be considered to avoid radiation exposure. Diagnosing ALN is relevant, because it requires prolonged antibiotic treatment. Insufficient antibiotic treatment could cause renal scarring and subsequent hypertension or renal failure. Outpatient follow-up is indicated to exclude congenital urogenital abnormalities. We describe two paediatric patients with acute abdominal pain and fever who were suspected to have appendicitis (appendix not visualised by ultrasonography), but eventually were diagnosed with ALN and a renal abscess (despite absence of pyuria). These reports serve to highlight the issues around the recognition and diagnosis of ALN in children, and the need for clinicians to be mindful of this condition.

Published
2018

24. [A teenage girl with non-infectious osteomyelitis].

Author

Deden AC, Hissink Muller P, Appelman-Dijkstra NM, Kroon HM, and Tramper-Stranders GA

Subjects
Adolescent, Chronic Disease, Female, Humans, Magnetic Resonance Imaging, Osteomyelitis drug therapy, Pain, Recurrence, Anti-Bacterial Agents therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Osteomyelitis diagnosis
Abstract

Background: Osteomyelitis is usually caused by an infection. A non-infectious cause should be considered if antibiotic treatment is insufficiently effective and disease is recurrent, multifocal or migrating., Case Description: A 14-year-old girl, an active volleyball player, developed episodes of fever and pain in her right lower leg. MRI showed osteomyelitis in her right tibia. She received prolonged intravenous antibiotic treatment. Shortly after recovery, she developed osteomyelitis in her left lower leg. After exclusion of infection and malignancy, we diagnosed chronic recurrent multifocal osteomyelitis (CRMO). The patient was successfully treated with a NSAID and a bisphosphonate., Conclusion: CRMO is an auto-inflammatory condition characterised by recurrent, non-infectious, multifocal or migrating osteomyelitis. Patients experience recurrent episodes of bone pain, sometimes accompanied by fever and slightly elevated infection parameters. The disease course usually is self-limiting, without residual damage. Symptomatic treatment with NSAIDs and bisphosphonates often leads to remission.

Published
2017

25. Detection of Pseudomonas aeruginosa in patients with cystic fibrosis.

Author

Tramper-Stranders GA, van der Ent CK, and Wolfs TF

Subjects
Antibodies, Bacterial blood, Cystic Fibrosis immunology, Genetic Techniques, Humans, Pseudomonas aeruginosa immunology, Respiratory System microbiology, Cystic Fibrosis microbiology, Pseudomonas aeruginosa isolation & purification
Abstract

Chronic pulmonary colonisation with Pseudomonas aeruginosa (PA) in patients with CF is associated with a high morbidity and mortality. Adequate treatment of first acquisition of PA might prevent or postpone chronic colonisation. Early detection of PA is therefore of major importance. Currently, cultures of oropharynx or sputum are most commonly practised. However, oropharyngeal culture has limitations both in the positive and negative predictive value for the presence of PA in the lower respiratory tract. Induction of sputum has little benefit in detection of PA. Serology might have additional value in early detection, when bacterial density is too low to be detected by culture. Molecular techniques are not yet widespread used for detection of PA, but have in general a high sensitivity. In this review, we describe the value of different diagnostic techniques for detecting PA.

Published
2005
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