Download 25-26TH

9
EUROPEAN SOCIETY OF PEDIATRIC
INFECTIOUS DISEASES (ESPID)
SUPPORTED TEACHING COURSE
8
EAST-EUROPEAN AND MEDITERRANEAN
TEACHING COURSE ON PEDIATRIC
INFECTIOUS DISEASES
THIS EVENT IS CREDITED WITH 12 EMC POINTS
BRAŞOV
ROMANIA
25-26TH
NOVEMBER
2016
www.srbip.ro/espid
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
WELCOME WORDS
Dear colleagues,
The 8th East-European and Mediterranean Teaching Course and the 9th European
Society of Pediatric Infectious Diseases (ESPID) supported Teaching Course on
Pediatric Infectious Diseases will be held in Brasov, Romania during 25th-26th November
2016.
This Course is under the auspice of ESPID, which is financially supporting it and
Transilvania University from Brasov, Romania.
Our academic partners are Romanian National Society of Pediatric Infectious Diseases,
Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, Israel, Spanish Society of Pediatric Infectious Diseases, Israeli Society of Pediatric Infectious Diseases,
Israeli Society of Infectious Diseases.
The Organizing Committee would like you to have fruitful idea exchanges, interesting and
interactive discussions.
On behalf of the Organizing Commitee and Scientific Committee we warmly wish you a
pleasant stay and enjoyeable time in Brasov.
Oana Falup-Pecurariu
(Chairman)
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
HONORARY CHAIRMAN
Ron Dagan (Israel)
CHAIRMAN
Oana Falup-Pecurariu (Romania)
INTERNATIONAL SCIENTIFIC COMMITTEE
Mihaela Bălgrădean (Romania)
Shalom Ben-Shimol (Israel)
Laura Bozomitu (Romania)
Ron Dagan (Israel)
Oana Falup-Pecurariu (Romania)
Saul Faust (UK)
Emmanouil Galanakis (Greece)
Cristian Gheonea (Romania)
Cheng-Hsun Chiu (Taiwan)
David Greenberg (Israel)
Eugen Leibovitz (Israel)
Hermione Lyall (UK)
Evelina Moraru (Romania)
Tudor Pop (Romania)
Corneliu Popescu (Romania)
Alexandru Rafila (Romania)
Emmanuel Roilides (Greece)
Pablo Rojo (Spain)
Jesus Saavedra (Spain)
Joseph Standing (UK)
Theoklis Zaoutis (USA)
LOCAL ORGANIZING COMMITTEE
Eugen Bleotu
Laura Bleotu
Emanuela Cojocaru
Oana Falup-Pecurariu
Elena Maria Georgescu
Raluca Lixandru
Alice Mercas
Marius Moga
Gabriel Moraru
Liviu Muntean
Liliana Rogozea
POSTER COMMITTEE
Raluca Lixandru
Elena-Carmen Niculescu
Ron Dagan
Aurica Rugina
Adriana Slavcovici
Ligia Stanescu
SCIENTIFIC SECRETARIAT
National Romanian Society of Pediatric Infectious Diseases
www.srbip.ro
Children’s Clinic Hospital
Braşov, Romania
Email: [email protected]
Tel: 0721 243 768
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
CONTENTS
FEATURES....................................................... >
p. 5
FACULTY.......................................................... >
p. 6
PROGRAMME................................................. >
p. 10
ABSTRACTS.................................................... >
p. 15
BIOGRAPHIES................................................ >
p. 39
POSTER PRESENTATIONS............................ >
p. 65
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
FEATURES
TARGET AUDIENCE
The Teaching Course is designed for pediatricians, infectious diseases specialists,
epidemiologists, general physicians. Senior physicians, residents, fellows, students may
find this education of value
LEARNING OBJECTIVES
After attending this Course, participants will be able to:
> Recognize patients with serious pediatric infectious diseases (PID)
> List diagnostic techniques to identify patients with pediatric infectious diseases
> Start a management plan for PID
> Identify promising research that could lead to new vaccine development
CONTINUING EDUCATION
This Teaching Course is accredited by the Romanian College of Medical Doctors
(Colegiul Medicilor din Romania CMR) with 12 CME points to provide continuing medical
education for physicians.
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
FACULTY
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Andrei Babus
Saul Faust
Sanofi Pasteur Romania
University Hospital
Southampton NHS Foundation
Trust, University of
Southampton, UK
Mihaela Balgradean
Emmanouil Galanakis
University of Medicine and
Pharmacy “Carol Davila”
Bucharest, Romania
Department of Paediatrics,
Heraklion University General
Hospital, University of Crete,
Greece
Ron Dagan
Oana Falup-Pecurariu
Pediatric Infectious Disease Unit,
Soroka University Medical Center, Ben-Gurion University of the
Negev, Beer-Sheva, Israel
Children’s Clinic Hospital,
Faculty of Medicine, Transilvania
University, Braşov, România
Laura Iulia Bozomitu
Shalom Ben Shimol
Faculty of Medicine, University
of Medicine and Pharmacy
“Gr. T. Popa” Iasi, Romania.
Pediatric Infectious Disease
Unit, Soroka University Medical
Center, Ben-Gurion University of
the Negev, Beer-Sheva, Israel
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
Cheng-Hsun Chiu
Evelina Moraru
Department of Pediatrics at the
Chang Gung Children’s Hospital,
Chang Gung University, Taipei,
Taiwan
Faculty of Medicine, University
of Medicine and Pharmacy “Gr. T.
Popa” Iasi, Romania
Cristian Gheonea
Tudor Pop
Faculty of Medicine,
University of Medicine and
Pharmacy Craiova, Romania
2nd Pediatric Clinic,
Department Mother and Child,
University of Medicine
and Pharmacy “Iuliu Hatieganu”
Cluj-Napoca, Romania
David Greenberg
Jesus Saavedra
Pediatric Infectious Disease
Unit, Soroka University Medical
center, Ben-Gurion
University of Negev
Beer-Sheva, Israel
Infectious Disease Unit, Gregorio
Marañón Hospital, Complutense
University, Madrid, Spain
Eugen Leibovitz
Joseph Standing
Pediatric Infectious Diseases
Unit, Soroka University Medical
Center, Ben-Gurion
University of the Negev,
Beer-Sheva, Israel
Great Ormond Street Hospital, Institute of Child Health, University
College London, UK
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
FACULTY
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Hermione Lyall
Alexandru Rafila
Pediatric infectious diseases
Chief of service for Children at
Imperial College Healthcare NHS
Trust, London, UK
University of Medicine and
Pharmacy “Carol Davila”
Bucharest, Romania
Corneliu Popescu
Emmanuel Roilides
University of Medicine and
Pharmacy “Carol Davila”
Bucharest, Romania
Aristotle University School of
Medicine at Hippokration
Hospital in Thessaloniki,
Greece
Pablo Rojo
Theoklis Zaoutis
Pediatric Infectious Diseases
Unit, Hospital Universitario 12
de Octubre Madrid, Spain
Perelman School of Medicine at
the University of Pennsylvania
(PENN), Division of Infectious
Diseases at the Children’s Hospital of Philadelphia (CHOP), USA
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
PROGRAMME
Day 1 – 25th November 2016
08:00-09:00 Registration and general information
09:00-09:25 Welcome
Course and speakers presentation
CHAIRPERSONS: Ron Dagan (Israel), Emmanouil Galanakis (Greece),
Cristian Gheonea (Romania)
09:25-10:00 Cristian Gheonea (Romania)
Microbiota gardening: how to get green fingers?
10:00-10:35 Saul Faust (UK)
Investigating children with reccurent infections
10:35-11:10 Hermione Lyall (UK)
HIV management of children
11:10-11:40 Coffee break
CHAIRPERSONS: Hermione Lyall (UK), Oana Falup-Pecurariu (Romania)
11:40-12:15 Ron Dagan (Israel)
The Via Dolorosa of Pertussis Vaccination: Should We Be Happy, Sad or Just
Concerned?
12:15-12:50 Special Invited Lecture - Theoklis Zaoutis (USA)
Antibiotic use in outpatient setting for common infections
12:50-13:00 Discussion
13:00-14:00 Lunch
CHAIRPERSONS: Theoklis Zaoutis (USA), Saul Faust (UK), Emmanuel Roilides (Greece)
14:00-14:35 Emmanuel Roilides (Greece)
Management of Invasive Fungal Infections in Neonates
14:35-15:10 Evelina Moraru (Romania)
New highlights regarding diagnosis and treatment of chronic hepatitis C infection in
children
15:10-15:45 Emmanouil Galanakis (Greece)
Urinary tract infections 2016
15:45-16:15 Coffee break
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
CHAIRPERSONS: Evelina Moraru (Romania), Joseph Standing (UK), Shalom Ben-Shimol
(Israel)
16:15-16:50 Laura Bozomitu (Romania)
Dynamics of the etiology of acute gastroenteritis in children and diagnostic
approach in the last decade
16:50-17:25 Andrei Babus (Romania)
Vaccination conversations in social media
17:25-17:39 Discussions
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
PROGRAMME
Day 2 – 26th November 2016
CHAIRPERSONS: Laura Bozomitu (Romania), Cheng-Hsun Chiu (Taiwan),
Tudor Pop (Romania)
09:00-09:35 Tudor Pop (Romania)
Update on the viral hepatitis in children
09:35-10:10 Alexandru Rafila (Romania)
Etiology of bacterial pharyngitis at children
10:10-10:45 Cheng-Hsun Chiu (Taiwan)
Emerging Norovirus Infection in Post-Rotavirus Vaccine Era, Taiwan
10:45-11:20 Joseph Standing (UK)
Pharmacokinetics and Pharmacodynamics of Antimicrobial agents
11:20-11:50 Coffee break
CHAIRPERSONS: Pablo Rojo (Spain), Eugen Leibovitz (Israel)
11:50-12:25 Mihaela Balgradean (Romania)
Typical hemolitic uremic syndrome
12:25-13:00 Jesus Saavedra (Spain)
Pulmonary tuberculosis in children: management of a child-care center
outbreak
13:00-13:35 Pablo Rojo (Spain)
Risk factors for Community acquired S. Aureus invasive infections
13:35-14:35 Lunch
CHAIRPERSONS: Mihaela Balgradean (Romania), Alexandru Rafila (Romania), Corneliu
Popescu (Romania)
14:35-15:10 Eugen Leibovitz (Israel)
The Epidemiologic, Microbiologic and Clinical Picture and Outcome of
Bacteremia among Febrile Children Managed as Outpatients at the Emergency
Room, Before and After Initiation of the Routine Anti-Pneumococcal
Immunization
15:10-15:45 Corneliu Popescu (Romania)
Neurological manifestation of viral infection in children
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
15:45-16:20 Shalom Ben-Shimol (Israel)
Pneumococcal vaccines impact
16:20-16:40 Coffee break
CHAIRPERSONS: David Greenberg (Israel), Jesus Saavedra (Spain)
16:40-17:15 David Greenberg (Israel)
Pneumococcal conjugated vaccines – efficacy, effectiveness and impact; what
have we learned from vaccine probe
17:15-17:50 Oana Falup-Pecurariu (Romania)
The future of infectious diseases rising of a star: Clostridium Difficile
17:50-18:00 Evaluation
End of course
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25 TH-26 TH
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AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
ABSTRACTS →
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
MICROBIOTA GARDENING: HOW TO GET
GREEN FINGERS?
Gheonea Cristian, Niculescu Carmen Elena, Stanescu Ligia Georgeta
University of Medicine and Pharmacy Craiova, Romania
There is an increasing body of evidence that microbiota has a critical impact on important
functions in the host. This impact includes, but it is not by far limited to, the normal
development and functioning of the immune system and the production of “healthbeneficial bioactive metabolites”. The practitioner has to be aware of the significance of
microbiota and to promote those therapeutic interventions that have minimal negative
impact on the consonant interaction between microbiota and host. This commandment is of
utmost importance especially in pediatric patients, where complex epigenetic interactions
are involved during growth and development. If one compares the diversity and abundance
of microbiota with a well kept garden, than a practitioner has to learn tips and to get
experience (“to have green fingers”) in preserving the alive, organic, and vital character of
the “lown”, rather than one too homogeneous and rigidly ordered.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
INVESTIGATING CHILDREN WITH
RECURRENT INFECTIONS
Saul Faust
University of Southampton, UK
This talk will use cases to explain a clinical approach to the investigation of children with
recurrent infections. Well established and new investigation strategies will be explained,
including how new genomic approaches can make a difference to children in clinic in the
real world.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
MODERN TREATMENT FOR CHILDREN WITH
HIV
Hermione Lyall
Imperial College Healthcare NHS Trust, London, UK
Over the last 20 years the diversity and effectiveness of treatment for HIV has significantly
improved. Modern combinations are much easier to taken have less side effects and less
frequent daily dosing, future combinations may be given by depot infection monthly or
even less frequently. Unfortunately for children access to fixed dose combinations has
lagged behind, but they are still benefitting from more modern and less toxic combinations.
In this talk modern treatment options for different ages of children will be discussed as well
as current randomised controlled trials. Different international guidelines for treatment
(PENTA, WHO, USA) will be compared, and case studies will be used to highlight treatment
dilemmas and complications.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
THE VIA DOLOROSA OF PERTUSSIS
VACCINATION: SHOULD WE BE HAPPY, SAD
OR JUST CONCERNED?
Ron Dagan
Ben-Gurion University of the Negev, Beer-Sheva, Israel
Pertussis is one of the most dreadful childhood diseases worldwide, with high morbidity
and mortality. Most children globally are now immunized against pertussis, a program that
has started first in the USA in ~1944. The vaccine used for >40 years was a whole cell vaccine
(wP), usually in combination with Diphtheria and Tetanus toxoids. Although many adverse
events were related to wP vaccination, the vaccine was extremely effective resulting in
great impact and reduction of ~99% of pertussis cases where it was widely used. However –
because of its side effects – a more tolerable vaccine was developed – the acellular vaccine
(aP). Just before the introduction of aP in the late 1980s, it became clear that pertussis cases
start increasing and continued increasing faster after aP introduction. Several reasons could
be enumerated, one important was attributed to the difference between aP and wP, and the
issue of carriage and spread of Bordetella pertussis, the main causative agent of pertussis,
despite increasing vaccination in additional ages and occasions.
A series of studies in Baboons permitted a better understanding of the problems related
to carriage and spread associated with aP, and it became clear that even widespread
vaccination with aP will not prevent transmission of disease to the neonates – the group
at the highest risk for severs disease and mortality from pertussis. Maternal immunization
during late pregnancy became thus recently highly practiced. This intervention assured
that neonates are born with high antibodies capable to protect against pertussis, with great
success. However some new problems may emerge from this successful approach.
Thus – we can call the way from start of pertussis vaccination – “via dolorosa” of the pertussis
vaccination, since for each success – some problems arise. Still pertussis vaccination is doing
generally great.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
ANTIBIOTIC USE IN OUTPATIENT SETTING
FOR COMMON INFECTIONS
Theoklis Zaoutis
Perelman School of Medicine, University of Pennsylvania, Division of Infectious Diseases, the
Children’s Hospital of Philadelphia, USA
In the European Union, antibiotic prescribing is highest in young children and outpatient acute
respiratory tract infections (ARTIs) account for the majority of these prescriptions. It has been estimated
that almost 50% of antibiotic prescriptions given to children are unnecessary or inappropriate and
the use of the broad-spectrum antibiotics. There is accumulating evidence linking overuse/misuse
of antibiotics and worse patient outcomes and increased healthcare costs. Antibiotic resistance is
considered one of the major global public health threats according to the World Health Organization.
Infections from resistant bacteria are now too common and some pathogens have even become
resistant to multiple types or classes of antibiotics. The loss of effective antibiotics will undermine our
ability to fight infectious diseases and manage the infectious complications common in vulnerable
patient. In this lecture, we will discuss appropriate antibiotic management of the most common ARTIs
including otitis media, pharyngitis and sinusitis as well as the broader principles of antimicrobial
stewardship.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
MANAGEMENT OF INVASIVE FUNGAL
INFECTIONS IN NEONATES
Emmanuel Roilides
Aristotle University, Thessaloniki, Greece
Low birth-weight neonates are especially vulnerable to invasive fungal infections (IFI),
especially invasive candidiasis, partly because of their young age and immunoimmaturity
and partly because of the invasive procedures commonly used in intensive care units.
Candida albicans continues to be the most prevalent isolate. However, an increasing role
of non-C. albicans (NAC) spp., some of which are intrinsically or potentially resistant to
antifungal agents, has been observed. Other yeasts, such as Trichosporon spp., Malassezia
spp. and Rhodotolura spp. may rarely cause fungemia in these patients. Filamentous fungi,
mostly Aspergillus and Mucor species are also very rare but life-threatening pathogens in
the nursery.
Candida spp. are among the pathogens frequently causing late-onset sepsis in the neonates.
Early diagnosis is an effective way of pre-emptively treating neonates with IFI. Molecular
methods, detection of mannan and high index of clinical suspicion help in early starting
antifungal therapy. Prompt removal of lines and initiation of antifungal treatment are
the milestones of management. Conventional amphotericin B remains a commonly used
antifungal agent, whereas its lipid formulations and fluconazole are also used frequently.
Echinocandins may be used as alternative agents in neonates with candidemia.
Fluconazole prophylaxis has been shown to be efficacious in NICU’s with very high
prevalence of Candida colonization and infections (>20%). Other antifungal strategies,
such as empirical therapy in a high-risk neonate with fulfillment of specific criteria and after
receipt of cultures or pre-emptive therapy with the use of early diagnostic markers such as
PCR and mannan or beta-D-glucan are under investigation.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
NEW HIGHLIGHTS REGARDING DIAGNOSIS
AND TREATMENT OF CHRONIC HEPATITIS C
INFECTION IN CHILDREN
Evelina Moraru
2nd Pediatrics Clinic, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Hepatitis C in children is a worldwide public health problem, with growing costs and
necessity of extensive health programs. HCV genotypes are predictors of severity and
infection with multiple viral strains is possible. Genotypes also influence the response to
interferon therapy and prevents preparation of effective vaccines. The goal of treatment
is to eradicate the viral infection by eliminating virus, achieving a sustained virological
response (SVR). In the last years the depicting of the molecular structure of the hepatitis
C virus proteins has allowed the new drugs, direct-acting antiviral agents (DAA), with direct
effect on the viral replication. Those agents, although expensive, have been approved for
treatment in adults but not yet for children.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
URINARY TRACT INFECTIONS 2016
Emmanouil Galanakis
Department of Pediatrics, Heraklion University General Hospital, University of Crete, Greece
Urinary tract infections are quite common in both boys and girls in infancy and the first years
of life. Given this considerable morbidity and the potential for long-term sequelae, early
diagnosis and appropriate investigation and management seem to be of crucial importance.
Several guidelines have tried to accommodate relevant clinical issues, however opinions
have often been diverse, occasionally controversial and witha lack of consensus over the
two to three past decades. This review summarizes current views on this topic, including
issues of definition, the value of urinalysis and culture, the contribution of vesicoureteral
reflux and/or other congenital urinary malformations to recurrences and kidney scarring,
the indications for ultrasonography, micturating cysteourethrogram, scintigraphy and
urography, as well as the importance of the history of antenatal renal findings and issues of
empiric treatment and prophylaxis. Going through the clinical practice of the last decades
there seems to be a shift from more to less vigorous and patient-based approach in urinary
tract infection diagnosis and management encouraging radiological investigation only in
children at risk and discouraging routine prophylactic antibiotic use.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
DYNAMICS OF THE ETIOLOGY OF ACUTE
GASTROENTERITIS IN CHILDREN AND
DIAGNOSTIC APPROACH IN THE LAST
DECADE
Laura Bozomitu1, Dan Moraru2, Bogdan Stana3
1
- 5th Clinic of Pediatrics; 2 – Arcadia Hospital Iasi; 3 – 2nd Clinic of Pediatrics, University of Medicine
and Pharmacy “Gr. T. Popa”, Iasi
Acute gastroenteritis (AGE) is on the second place after respiratory infections, with a
morbidity of 71,5% in children aged 0-17; the morbidity decreases in developed countries
by hygienic methods, vaccines and new therapies, while in poor developed countries it still
remains the main cause of mortality, annually 1 milliard episodes of diarrhea in children
till 5 years and 3,5 millions of deaths; incidence of AGE is of 2-3 episodes /year in children
under 3 years in Europe (1,3%-4,46%).
Norovirus (NoV) is the second agent after Rotavirus, being involved in 10-15% of the
hospitalized cases; the most frequent found bacteria are Campylobacter jejuni and
Salmonella and in some cases are involved protozoa like Cryptosporidium, Giardia lamblia
and Entamoeba.
The rate of infection with Cl. Difficile is of 25-80% in infants, many of them being
asymptomatic; high rates of colonization were found in children with comorbidities
(oncologic, IBD) and with frequent hospitalization (24%). Interpretation of data involving
Cl. difficile still remains a challenge in ruling out the infection in case of colonization only.
In clinic assessment of AGE one should follow the correct evaluation of dehydration , to
evaluate the severity (Vesikari score); microbiologic investigations will be made in very
well established circumstances, trying to rule out bacterial infection by clinical features,
hematologic or stool markers; in severe forms one should emphasize the biochemical
findings.
In conclusion, children’s AGE remains a worldwide health problem, by dynamics of etiology,
which needs continuously updated.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
VACCINATION CONVERSATIONS IN SOCIAL
MEDIA
Andrei Babus
Sanofi Pasteur, Bucharest, Romania
Usage of social media and digital tools is continuously increasing. Among the world
population, 3.42 billion (13% increase vs 2015) are active internet users and 2.31 billion
(11% increase vs 2015) have active social media accounts.
Social media is not anymore a new space, it is an establish channel hosting huge amount
of conversations which changes continuously. Today, it’s not possible to avoid anymore the
influence of social media. Take for example Arab spring, Romanian Presidential elections or
more recently, US election of Donald Trump: social media could change political outcomes.
But how it works and what could resonate better with social media audience? We assume
that it’s all about personal stories and authenticity.
In healthcare, and especially when we speak about vaccination, the public increasingly
searches online for information. While we cannot impose scientific reliable information on
people’s searching results, we can still bring visibility to a pro-vaccination message.
What is social media, how it works, what’s happening there… we try to understand it better
in order to see how Healthcare professional could shape the tone of discussions and
counteract anti vaccination movement.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
UPDATE ON THE VIRAL HEPATITIS IN
CHILDREN
Tudor L. Pop
2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania
Viral hepatitis is still an important cause of liver disease in children. The aim of this course
is to provide an update on the management of the viral hepatitis in children, with data that
are relevant for a pediatrician.
Acute hepatitis A is frequent in Romania, most of the cases being with a benign evolution,
without complications. Fulminant hepatitis is possible, with liver failure and death and
also persistent forms are present, even with the onset of autoimmune features. The use of
anti-hepatitis A vaccine is the main prevention method of hepatitis A infection in the target
population.
Even that the prevalence of hepatitis B virus infection decreased during the last years, it still
remains a public health problem in our country. The vaccination had an important impact
on the prevalence of infection in children. Prevention of the hepatitis B mother to child
transmission involves the use of the vaccine and also specific immunoglobulin. Clinical
forms of hepatitis B infection in children are mainly the chronic forms, fulminant liver failure
being very rare, but possible fatal. Treatment for chronic hepatitis B is based on few drugs,
with serious side effects, unsatisfactory conversion rates and high frequency of resistance:
interferon, lamivudine, entecavir, adefovir, tenofovir and telbivudine. Chronic hepatitis D
is more frequent in Romania compared to other countries from Europe. The evolution of
hepatitis D in adolescents is more severe and the treatment should be more intense that in
patients with chronic hepatitis B.
Chronic hepatitis C is not so frequent in children, but is important for pediatrician to evaluate
the patients at risk for complications and the ones that should receive antiviral treatment. In
adults there were important progresses for the treatment, with cure rates up to 100%, but
the medication is not yet available for children.
Hepatitis E in children has similar presentation forms as hepatitis A. Hepatitis E is usually a
self-limiting disease, but few cases can develop acute liver failure. Transmission is mainly
through fecal-oral route. The role of transmission from animal reservoirs is not clear in
children.
26
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
ETIOLOGY OF BACTERIAL PHARYNGITIS AT
CHILDREN
Alexandru Rafila, Daniela Talapan
National Institute of Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
Viral pharyngitis cause most sore throats, but streptococcal pharyngitis has similar symptoms
and should be rapidly diagnosed and treated. The most common etiologic agent of bacterial
pharyngitis is group A streptococci. Most are identified in school aged children and there
are much less isolated in adults. Others serogroups (C,G,F) may produce .pharyngitis, both
in children and adults.
Quality of specimen collection and transport is essential for microbiological diagnosis.
Negative rapid antigen tests should be generally followed by a conventional culture in
children. Culture, isolation and identification of beta-hemolitic streptococci represent the
gold standard for diagnosis of bacterial pharyngitis.
Antibiotic treatment of streptococcal pharyngitis aims to reduce the simptoms and to avoid
complications as rheumatic fever and glomerulonephritis. Limitation of transmission of the
infection is another important role of antibiotic treatment in children. Penicillin remains
the drug of choice, but resistace to macrolides and clindamycin is concerning, especially to
those allergic to penicillin.
One year retrospective study performed in the National Institute of Infectious Diseases
”Prof. Dr. Matei Bals” have shown interesting results regarding etiology of streptococcal
pharyngytis in children and adults and resistance patterns of isolated strains to macrolides
and clindamycin.
27
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
EMERGING NOROVIRUS INFECTION IN
POST-ROTAVIRUS VACCINE ERA, TAIWAN
Cheng-Hsun Chiu
Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital,
Chang Gung University College of Medicine, Taoyuan, Taiwan
Norovirus, a genus within the Caliciviridae family, is the leading cause of sporadic
and epidemic acute gastroenteritis (AGE) worldwide. Our understanding of norovirus
epidemiology has significantly progressed in recent years due to the development of
sensitive molecular diagnostic techniques. We now understand that human noroviruses
are extremely diverse, with three genogroups (GI, GII, and GIV), at least 25 genotypes, and
numerous subgenotypes or variants identified in the past two decades. In recent years, only a
few strains, primarily those of genogroup II, genotype 4 (GII.4) have been responsible for the
majority of outbreaks. Norovirus genotype GII.4 is responsible for the majority of outbreaks,
but new variants are continuously emerging. We recently investigated norovirus infections
from the community outbreak in October 2011-September 2012 and an earlier outbreak
in 2006-2007 in northern Taiwan. Norovirus genotypes and their variants were validated
using molecular methods. We found that hospitalized children infected by norovirus in
2012 showed a significantly higher incidence of intestinal hemorrhage, as indicated by
grossly bloody feces (P = .012) and occult blood in feces (P < .001), and also presented with
more high fever >39oC (P < .001), fever >38.5 oC (P < .001), and fever of any temperature >
38oC (P < .001), compared to children hospitalized in 2006-2007. Norovirus GII.4 was the
most prevalent. Analysis of 20 near-full-length genome sequences indicated an emergence
of GII.4 2012 variants in 2011-2012. The emerging new variants of norovirus GII.4 caused a
distinct clinical syndrome of AGE with severe fever and a high rate of intestinal hemorrhage
in children. The genetic diversity associated with changing clinical manifestations poses
major obstacles to norovirus control. On the other hand, we also explored the microbiota
associated with severe or complicated AGE to characterize the influence of enteric viral
infection on intestinal microbiota in children. Our study demonstrated a significant reduction
of intestinal microbial diversity in patients with severe AGE, especially those with rotavirus
infection. Recent studies showed that norovirus infection of B cells was facilitated by the
bacteria that expressed an appropriate histo-blood group antigen. This could be the reason
for the difference in intestinal microbiota between rotavirus and norovirus infections.
28
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
PHARMACOKINETICS AND
PHARMACODYNAMICS OF ANTIMICROBIAL
AGENTS IN CHILDREN
Joseph Standing
Great Ormond Street Hospital, Institute of Child Health, University College London, UK
Pharmacokinetic/pharmacodynamic (PKPD) modelling is the study of the dose-concentrationeffect relationship using mathematical and statistical models. It is a fundamental part of drug
development used from pre-clinical to late-phase clinical studies in order to optimise the
dose to maximise the probability of therapeutic success whilst minimising toxicity. Since
the mathematical models are usually nonlinear, and the experiemntal units (patients) are
repeatedly sampled with time, it is necessary to use nonlinear mixed effects modelling, the
so-called population approach. This so-called pharmacometric approach to data analysis
is increasingly recognised as being an important supplement to randomised control trial
(RCT) data, particularly for antimicrobials where drug effects are often inferred from in vitro
and pre-clinical data, and where recruitment to RCTs is problematic, such as in children and
neonates.
A refresher on paediatric pharmacokinetic principles of scaling for size and age will be
presented, along with an outline of why pharmacokinetic-pharmacodynamic (PKPD) is
crucial in understanding of the dose-concentration-effect relationship. The basic principles
of population PKPD will be presented, and the use of PKPD for paediatric dose finding
(including the incorporation of in vitro antimicrobial pharmacology into PKPD models),
clinical trial design and personalised medicine will also be reviewed.
There will follow an overview of three case studies looking at antimicrobial drug handling
in paediatric intensive care, the optimum treatment of neonatal sepsis and meningitis with
PKPD principles, and the use of Bayesian statistics in personalisation of antimicrobial dosing.
29
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
TYPICAL HEMOLYTIC UREMIC SYNDROME
Mihaela Balgradean
“Marie S. Curie” Emergency Clinical Children’ Hospital, University of Medicine “Carol Davila”
Bucuresti, Romania
Author presents clinical pathology in hemolytic uremic syndrome (HUS) with prodromal
diarrhea, typical SHU, caused by Shiga-like toxins produced by enterohemorhagic, invasive,
type of Ecoli EHEC- Stx. HUS is a thrombotic microangiopathy defined by hemolytic anemia,
thrombocytopenia and acute renal injury (AKI).
HUS, the most frequent and severe form of AKI during childhood, is not only a kidney disease,
but a systemic one, it is responsible for severe complications and still high mortality rates
during the acute phase of the disease. Stx1 and Stx2 are produced inside the intestine by
enterohemorrhagic type of Ecoli and afterwards delivered into the blood flow. They are
the main aggressive factors, being responsible for the endothelial microvascular lesions
noticed in HUS. Endothelial tumefactions, accumulation of fibrinoid material and arteriolar
thrombosis take place in afferent arterioles and, less frequent, in the efferent arterioles. The
mortality rates is constantly associated with extrarenal involvement of the disease, with
multiple organ failure, and mainly central nervous system involvement (cerebral edema,
vascular injuries, intracranial hypertension) followed by seizures and other neurological signs
early in the course of the disease. Some other HUS major complications are also described:
colonic strictures, intestinal perforations, intussusception, billiary lithiasis, pancreatitis,
diabetes, cardiac, pulmonary and muscle impairment, hypertension, and progressive renal
disease or ESRD, in 4% of cases who need dialytic therapy. In HUS, in the acute phase of the
disease, treatment is supportive, targets AKI and all others manifestations of the disease. In
diarrhea phase is very important to maintain fluid balance. Saline boluses at the beginning
of the disease, limits the intravascular depletion, reducing the intensity of thrombosis,
hypoperfusion, hypoxia and consecutive ischemia lesions. About 2/3 of children with
HUS (Stx- E.coli) requires dialysis and specific electrolyte therapy, monitoring treatment
of hematological complications and progressive CKD. If clinical features are suggestive of
encephalopathy / neurologic manifestations associated HUS, recent recommendations
indicate use pulse therapy with methylprednisolone for 3 consecutive days (vascular
injuries responsible for ECA are the result of endothelial damage caused by cytokines). More
rapid introduction (if possible) of oral nutrition is mandatory.
Typical SHU starts suddenly in infants and young children, perfectly healthy until then,
has an extremely severe, yet deadly, clinical ongoing (pathology is found also in adult).
Multisystemic implication increases the dramatic of the disease. HUS promotes collaboration
between nephrologists, surgeons, infectionists, epidemiologists, public health, intensive
care, endothelial function and complement biology, but pediatrician nephrologists led
consistently the therapy and research in HUS. Although HUS is an entity (etiological,
clinical, pathogenic) well known, it is still seeking the earliest, effective and safe treatment
modalities to mitigate the severity of the disease.
30
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
PULMONARY TUBERCULOSIS IN CHILDREN:
MANAGEMENT OF A CHILD-CARE CENTER
OUTBREAK
Jesús Saavedra-Lozano
Infectious Disease Unit, Gregorio Maranon Hospital, Complutense University, Madrid, Spain
Pulmonary tuberculosis continues being a pandemic infection all over the world. Tuberculosis
in children is a sentinel event that may indicate recent spreading of the infection and,
thus, circulating mycobacteria from adult foci. Furthermore, this infection may be a lifethreatening disease in pediatrics, especially in young children. Therefore, a rapid evaluation
of a child with tuberculosis and his/her possible contacts is mandatory.
It is presented here an outbreak of pulmonary tuberculosis in a school in children between
3-6 years of age. The approach to the outbreak, collaboration with public health to determine
the extension of the disease among children and surrounding adults and management of
the infection is presented. Finally, the most interesting aspects of the 2016 WHO and IDSA
guidelines in tuberculosis therapy will be commented.
The objectives of this presentation are:
1) To give a brief summary of the most important aspects of TBC in children, with especial
review of the 2016 WHO and IDSA/CDC guidelines on tuberculosis therapy.
2) To present an outbreak of pulmonary tuberculosis in a day-care center and its approach
by Public Health and the PID Unit from the referred hospital in Madrid, Spain.
31
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
COMMUNITY-ACQUIRED S. AUREUS
INFECTIONS IN CHILDREN IN EUROPE
Pablo Rojo
Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre Madrid, Spain
Staphylococcus aureus is one of the most common human pathogens and is usually
responsible for minor skin and soft tissue infections (SSTIs). However, this pathogen is also
the main cause of bone and joint infections worldwide and is capable of causing complicated
pneumonia and other invasive diseases. Invasive disease often occurs as a complication
of a preceding SSTI or viral respiratory tract infections (particularly influenza), but also
spontaneously in otherwise healthy children without recognized preceding infections or
risk factors. In the past 15 years, there has been an increase of publications describing
severe cases of CA-SA infections. This has occurred simultaneously with the emergence of
community-acquired (CA) methicillin-resistant S. aureus (MRSA) in the United States Several
risk factors associated with the increasing prevalence of severe S. aureus infections have
been studied. Some authors have suggested that methicillin resistance could be related to
an increase of illness severity, although others have found no relationship. Other risk factors,
including the interaction of host and pathogen, have been studied. One of the potential
virulence factors to be associated with severity and worse outcome has been PantonValentine leukocidin (PVL). PVL is a bicomponent, pore-forming toxin produced by some
strains of S. aureus. There is some evidence suggesting that PVL presence is indeed related
to severity, and there are also data questioning the importance of PVL in pathogenesis of
severe infections.
We will discuss the epidemiology of Community-acquired S. aureus infections and the
prevalence and role of both methicillin resistance and PVL.
32
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
THE EPIDEMIOLOGIC, MICROBIOLOGIC
AND CLINICAL PICTURE AND OUTCOME
OF BACTEREMIA AMONG FEBRILE
CHILDREN MANAGED AS OUTPATIENTS
AT THE EMERGENCY ROOM, BEFORE AND
AFTER INITIATION OF THE ROUTINE ANTIPNEUMOCOCCAL IMMUNIZATION
Eugen Leibovitz
Pediatric Infectious Diseases Unit, Soroka University Medical Center, Ben-Gurion University of the Negev,
Beer-Sheva, Israel
While the epidemiological, clinical and microbiological picture of bloodstream infections
(BSI) was frequently described among adult patients, information is lacking about this
phenomenon among children, and if exists, it refers mainly to nosocomial infections and
not to children examined and discharged from Pediatric Emergency Room (PER). Children
with BSI managed at a PER visit can be divided into two major groups: BSI associated with a
diagnosed infectious focus (bacteremia with focus, BwF), and BSI without focus (including
clinically suspected sepsis or occult bacteremia-OB). Of them, patients with OB and a
considerable amount of those with BwF may be managed as outpatients.
Obtaining blood cultures is a standard procedure for the diagnosis of bacteremia and blood
cultures are performed frequently at PER. However, while the indication for obtaining blood
cultures in patients with clinical suspicion of sepsis or meningitis is obvious, this indication
in children who appear well and are suspected of being at risk for OB is less well defined,
being closely related to specific age and temperature cut-offs. Furthermore, obtaining blood
cultures may be common practice in certain focal infections (like pneumonia or urinary tract
infections) and much less common in others (like acute otitis media, tonsillitis or cellulitis).
OB may be present under the syndrome of fever without source, particularly in infants/
young children <3 years of age. Around 1.5-11% (mean 4.3% in patients with fever >390C)
of children with fever without source may develop an infectious focus or sepsis as a result
of OB. Children with fever >390C, WBCs counts >15,000 or <5,000/mm3, stabemia and
high erythrocyte sedimentation rate or CRP are considered at high risk of OB. Furthermore,
pneumonia may be diagnosed roentgenically in 20-30% of the febrile young children
without any suggestive clinical findings, but with WBCs >20,000/mm3. Traditional protocols
(according to Baraff criteria) require that young children with fever and >15,000 WBCs/mm3
should receive antibiotic treatment (amoxicillin or ceftriaxone) at discharge from PER and
continue therapy till the results of blood cultures are available.
33
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
Today, the use of the anti H. influenzae type b vaccine, together with the relatively new
use of the vaccination against S. pneumoniae (pneumococcal conjugate vaccines, PCVs),
have changed completely the picture of OB among 3-36 months-old children and made it a
rarely encountered entity. The introduction of PCVs was associated with a major decrease
in the incidence of invasive pneumococcal infections in children. It seems today, taking into
consideration the low rates of OB in vaccinated patients, that new guidelines advocating for
a management change are needed in the approach to the previously healthy febrile toddler
in the PER.
In Israel, PCV7 was introduced to the national immunization plan in 07/2009, and was
replaced by PCV13 in 11/2010. This presentation will try to characterize the epidemiological,
clinical and microbiological picture and outcome of OB and of BwF among febrile infants/
children <3 years of age examined and managed as outpatients at PER in southern Israel,
before and after the introduction of PCVs.
34
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
NEUROLOGIC MANIFESTATION OF VIRAL
INFECTIONS IN CHILDREN
Corneliu Petru Popescu1,2, Simona Ruta1
1
- Carol Davila University of Medicine and Pharmacy, Bucharest, 2 - Dr. Victor Babes Clinical Hospital of
Infectious and Tropical Diseases, Bucharest, Romania
The central nervous system (CNS) may be infected by various agents, especially viruses
and bacteria. Viruses usually cause self-limited diseases, but neurologic manifestations
(meningitis, encephalitis, myelitis or combinations) can occur. The clinical presentation of
CNS infection depends on the pathways of spread of the infection to the CNS, the virulence
of the etiologic agent, and the area of CNS involvement. Several pathways for viruses’ entery
in the CNS have been described (spread along neurons, via mucosa of the nasal cavity or
via blood-brain barrier). Identification of causative agents is important for epidemiological
reasons and for selection of a specific treatment. The Californian Encephalitis Project, which
included a large number of patients, failed to identify etiologic agent of encephalitis in
63% of cases. In a spanish study, ECOVE, the etiologic diagnosis was established in 35%,
being more frequent herpes simplex virus and enterovirus. High mortality rates and severe
neurologic sequelaes have been reported in viral neuroinvasive infections, the outcome
being dependent on the virus type, patient age and comorbidities. Treatment of neurologic
infections with viruses is symptomatic, only for specific viruses (especially herpesviruses)
we have antiviral medication. Etiologic diagnosis and treatment of neurologic manifestation
of viral infections in children remain a challenge for the future.
35
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
PNEUMOCOCCAL VACCINES IMPACT
Shalom Ben-Shimol
Pediatric Infectious Diseases Unit, Soroka University Medical Center, Ben-Gurion University of the
Negev, Beer-Sheva, Israel
Streptococcus pneumoniae is a leading cause of childhood morbidity and mortality, and is a
leading bacterial cause of invasive disease, pneumonia, and acute otitis media in children.
The introduction of the pneumococcal conjugate vaccines (PCVs) to the national immunization
plans (NIP) worldwide resulted in substantial rate reductions of various pneumococcal
disease end-points, including invasive pneumococcal disease )IPD), pneumonia and otitis
media, including unvaccinated age groups and individuals.
Important components determining PCV impact include vaccine uptake (affecting both
direct and indirect impact), serotype coverage of the vaccine (PCV7, 10, 13), time elapsed
since vaccine introduction (affecting indirect impact), vaccine efficacy against different
disease end points (i.e. IPD vs. mucosal) and local epidemiologic characteristics, including
serotype distribution before PCV introduction and immunodeficient population (i.e. HIV
prevalence).
Impact studies are also important in advancing our understanding of the role of vaccinetype pneumococcal serotype in the etiology of mucosal syndromes, such as pneumonia and
otitis media.
36
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
PNEUMOCOCCAL CONJUGATED VACCINES
– EFFICACY, EFFECTIVENESS AND IMPACT;
WHAT HAVE WE LEARNED FROM VACCINE
PROBE
David Greenberg
Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva,
Israel
Streptococcus pneumoniae (Pnc) infections have different clinical presentations. It is mainly
difficult to determine Pnc mucosal infections such as community acquired pneumonia (CAP)
and acute otitis media (AOM) since in many cases these infections also involve other bacteria
as well as respiratory viruses. Thus, using the pneumococcal conjugated vaccine (PCV) as a
clinical probe can clarify the role of Pnc in these infections and specifically of the serotypes
included in the PCVs.
In pre-licensure studies the efficacy of PCV7 for alveolar CAP was varied between 20%
and 37%. However, after the introduction of the PCV7 the reduction in CAP was not so
impressive and in Israel was only <4%. In contrary, after the introduction of the PCV13 the
impact on alveolar CAP in children <5 years of age was 54%. This reduction of CAP cases
was less impressive in hospitalized children, only 32%, while in ambulatory treated patients
the reduction was a remarkable 68%. The clinical presentation of hospitalized children with
alveolar CAP after the introduction of PCVs resembled less of “bacterial features” and more
of a “viral presentation” with more hypoxemia and fast breathing compare with hospitalized
children before the introduction of the PCVs. This correlates with the finding that PCV related
serotypes carried during alveolar CAP tend to be less associated with respiratory viruses coinfection, mainly of RSV. In addition, these findings correspond with the reduction of the Pnc
PCV related serotypes carriage rates during CAP after the introduction of PCV13 compared
with pre-PCVs period in children <5 years of age in southern Israel.
The reduction in AOM after the introduction of the PCVs was very similar to alveolar CAP with
a reduction of 60% of all AOM and near elimination of PCV serotypes in AOM in children in
southern Israel. Surprisingly, reduction in non-Pnc AOM was also observed with reduction of
non-typable Haemophilus influenzae by 75% and Moraxella catarrhalis by 81%. Moreover,
impressive reductions in rates of antibiotic resistant Pnc, isolated from the middle ear fluid
by tympanocentesis from children with AOM, were also observed.
In conclusion: the impact of the PCV7 and mainly of PCV13 surpassed all expectations with
tremendous reduction in alveolar CAP and Pnc-AOM. Surprisingly, non-Pnc AOM rates also
declined after the introduction of PCV7 and PCV13 as well as antibiotic resistant Pnc in
AOM. These impacts should be use to convince stakeholders to implement the PCV13 in
national immunization programs worldwide.
37
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
THE FUTURE OF INFECTIOUS DISEASES
RISING OF A STAR: CLOSTRIDIUM DIFFICILE
Oana Falup-Pecurariu
Children’s Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania
Clostridum difficile (C.difficile) is the most prevalent hospital aquired infection at least for
the USA. The total number of patients infected with C.difficile anually is around 453000.
The total costs of hospitalization for C.difficile is around 1.5 billion dollars anually.
Despite all this detailed data regarding adult infection, the literature is still scare regarding
the incidence and prevalence of the infection due to this particular bacteria in children.
In this talk I will present a case report of Clostridium difficile at a child of 2 years of age
admitted for intense abdominal pain and vomiting and a general overview regarding the
Clostridium difficile infection at children.
The incidence of the infection at children in steadily increasing due mainly to a high rate of
antibiotic prescription.
Colonization with Clostridium difficile is also high between 2-75%. Children are the
reservoir of the disease. One of the major factors that may affect colonization is actually
recent food diversification.
The major risk factors are improper usage of antibiotics the most incriminated being
penicillins, cephalosporines and fluorochinolons.
Clinical symptoms of the Clostridium difficile overlap on those of the usual diarrhea but
sometimes they can develop complications such as toxic megacolon as happened in our
case report.
The human microbiota has its own ways to protect itself from Clostridium difficile. Probiotics
may also show in the future, beneficial effects of their concomitant usage with antibiotics.
Antibiotic stewardship may reduce the incidence of the disease at children.
38
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
BIOGRAPHIES →
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
CRISTIAN GHEONEA
Dr. Cristian Gheonea graduated and then started his academic career at the University of Medicine and
Pharmacy of Craiova, where is currently Senior Paediatrician, Professor of Paediatrics and the Dean of the
Faculty of Medicine. His research activities in the field of Paediatrics are focused on AIDS/HIV infection,
and clinical immunology and allergology. He is Vice-President of the Romanian Society of Paediatrics and
member of the Steering Committee of the Paediatric Section of the Romanian Society of Pneumology. Dr.
Gheonea serves as the European Correspondent for the European Clinical Research Infrastructures Network
(ECRIN) and is member of the Strategic Working Group “Health and Food” of the European Strategic Forum
on Research Infrastructures (ESFRI) for the European Commission.
40
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
SAUL N FAUST
Saul N Faust FRCPCH PhD is Professor of Paediatric Immunology & Infectious Diseases at the University
of Southampton, Director of the Southampton NIHR Wellcome Trust Clinical Research Facility and
Associate Medical Director for R&D at University Hospital Southampton NHS Foundation Trust.
As an MRC Clinical Training Fellow in Paediatric Intensive Care & Infectious Diseases and then Clinical
Lecturer at Imperial College London, he completed his PhD on the pathophysiology of coagulation
abnormalities in meningococcal sepsis, work that led directly to clinical trials in paediatric intensive
care. SF is a clinical researcher with projects bridging the clinical-laboratory interface in paediatric
infectious diseases, immunology and respiratory medicine, developing local and national collaborative
clinical trials in paediatric infectious diseases, and conducting paediatric and adult vaccine trials as part
of the UK academic paediatric vaccine group.
SF is a member of the UK Genomics England Clinical Interpretation Partnerships for Primary
Immunodeficiency, Paediatric Sepsis and Paediatrics. SF is currently Chair of the UK National Institute
for Health Research Paediatric Theme Speciality Group for Allergy, Immunity and Infectious Diseases, a
member of the NHS England Clinical Reference Group for Paediatric Medicine. SF chaired the UK NICE
Guideline Committee for sepsis in children and adults published in July 2016, and is current Chair of
the NICE Guideline Committee for Lyme Disease in children and adults.
SF is founding Director of the Imperial College London MRCPCH Clinical Examination Preparation
Course (now in its 20th year), was co-Chair of the European Society for Paediatric Infectious Diseases
(ESPID) Annual Scientific Meeting in 2016; and is tutor for the University of Oxford Diploma in Paediatric
Infectious Diseases.
41
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
Hermione Lyall
I am a consultant in paediatric infectious diseases and Clinical Director for Children’s Services at Imperial
College Healthcare NHS Trust, London. Prevention of transmission of HIV from mother to infant, and
management of HIV infected children and young people are my main areas of clinical work. I am also
interested in other congenital infections (CMV, syphilis, toxoplasmosis, etc.) and their prevention. I am
a member of the steering committee of PENTA (Paediatric European Network for the Treatment of AIDS)
and participate in treatment trials for HIV infected children. For the last 3 years I have had the privilege
to be chair the European Society for Paediatric Infectious Diseases (ESPID) training committee, this has
been a great opportunity to work within the ESPID family to develop local and distance learning courses
for ESPID members, as well as the paediatric community more widely (http://www.espid.org/content.
aspx?Page=ESPID%20Online%20Courses%202016 ).
42
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
RON DAGAN
Ron Dagan is Distinguished Professor of Pediatrics and Infectious Diseases at the Ben-Gurion University of
the Negev, Beer-Sheva. He founded the Pediatric Infectious Disease Unit at the Department of Pediatrics,
Soroka University Medical Center, Beer-Sheva, Israel, and served as its director from 1987 to June 2014.
His previous appointments include Adjunct Associate Professor of Pediatrics at the University of Rochester,
New York, USA, from 1993 to 1998, in addition to Advisor for Infectious Diseases at the Israeli Ministry of
Health. Professor Dagan obtained his MD degree in 1974 from the Hadassah Medical School of the Hebrew
University, Jerusalem, Israel. In 1982, he embarked on a 3-year Fellowship in pediatric infectious diseases at
the University of Rochester, Rochester, NY.
A member of several national and international advisory committees and medical and scientific associations,
Professor Dagan was the Chairman of the Advisory Committee for Infectious Diseases of the Israeli Society
of Pediatrics from 1992 to 1997 and has served on the National Advisory Committee on Infectious Diseases
and Immunization since 1991. He is also a Founding Member of the World Society of Pediatric Infectious
Diseases (WSPID), Member of the Executive Committee of the International Society of Infectious Disease
(ISID) and a Fellow of the Infectious Diseases Society of America (IDSA). Professor Dagan has been involved
in the World Health Organization (WHO) Working Group on Pneumococcal Nasopharyngeal Carriage and the
WHO Pneumonia Radiology Working Group. He served as President of the European Society for Paediatric
Infectious Diseases (ESPID) from 2004 to 2006 and as President of the World Society for Pediatric Infectious
Diseases (WSPID) from 2006 through 2009. Prof. Dagan was the chair of the board of the International
Symposia on Pneumococcus and Pneumococcal Diseases (ISPPD) from 2010 to 2016.
Professor Dagan serves on the editorial board of several peer-reviewed journals, including Pediatric Infectious
Disease Journal, Infection, Human Vaccines, Journal of Infectious Diseases, Vaccine and International Journal
of Infectious Diseases. He is a recipient of many grants and awards. During his professional career, he has
contributed over 500 original articles, reviews and book chapters, and has presented more than 500 papers
at national and international scientific meetings. Professor Dagan has earned international recognition for
his research, which has focused largely on the development on vaccine preventable diseases, with particular
emphasis on pneumococcal vaccines; the understanding of hepatitis A epidemiology and introduction of
hepatitis A vaccines; the epidemiology of respiratory infections in children; clinical aspects of vaccination
against antibiotic-resistant pneumococci; the pathology of otitis media, role of resistant organisms in
otitis media and prediction of bacteriological response to various antibiotics; and the epidemiology and
prevention of enteric and invasive infections in young children.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
THEOKLIS ZAOUTIS
Theoklis Zaoutis, MD, MSCE, PhD is the Werner and Gertrude Henle Endowed Professor of Pediatrics and
Professor of Epidemiology at the Perelman School of Medicine at the University of Pennsylvania (PENN)
and Chief of the Division of Infectious Diseases at the Children’s Hospital of Philadelphia (CHOP). He is
also Senior Scholar in the Center for Clinical Epidemiology and Biostatistics at PENN. He served as Director
of the Antimicrobial Stewardship Program at CHOP from 2004-2010. He is the author of over 230 peerreviewed publications, most of which are in pediatric infectious diseases with a focus on healthcare acquired
infections, antimicrobial resistance, and antimicrobial use.
Dr. Zaoutis is the director of the Master of Science in Clinical Epidemiology degree program at PENN and
course director for the Issues in Research Protocol Development course, a core course in the Master’s
program. In 2009, Dr. Zaoutis was awarded the Excellence in Teaching Epidemiology Award at PENN.
He also serves as the Director for the Center for Pediatric Clinical Effectiveness (CPCE) at the CHOP Research
Institute. The mission of the CPCE is to discover, disseminate, and implement knowledge about best practices
in pediatrics. For ESPID, he currently is serving on the guideline committee for the management of bone and
joint infections in children and is an instructor in the annual Research Master Class held at the ESPID Annual
Meeting.
Dr. Zaoutis currently serves as Editor-in-Chief of the Journal of the Pediatric Infectious Diseases Society. He
is also on the Centers for Disease Control and Prevention’s Office of Infectious Disease Board of Scientific
Counselors’Antimicrobial Resistance Working Group, NIAID’s Antimicrobial Resistance Leadership Group.
The Antibiotic Resistance and Prescribing in European Children Working Group and the AAP’s Committee
on Infectious Diseases (Red Book Committee). He has served 1) on the Best Pharmaceuticals for Children
Act Prioritization Meeting NICHD Expert Review Panel; 2) as an expert consultant for the CDC for Hospitalbased Antimicrobial Surveillance; 3) as a co-investigator at the PENN Centers for Education on Research and
Therapeutics administered by AHRQ; and 4) an Associate Editor for Pharmacoepidemiology and Drug Safety.
In 2009, he was received the Society for Healthcare Epidemiology of America Pediatric Investigator Award.
In 2015, he was awarded the Pediatric Infectious Diseases Society Distinguished Service Award.
44
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NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
EMMANUEL ROILIDES
Emmanuel Roilides, MD, PhD, FIDSA, FAAM is Professor of Paediatrics – Infectious Diseases in Aristotle
University School of Medicine at Hippokration Hospital in Thessaloniki, Greece. He received his medical
and doctor of philosophy degrees from the University of Athens in Greece, and worked for seven years
at the National Institutes of Health (National Child Health and Cancer Institutes) in Bethesda, Maryland,
USA. Since 1993, Professor Roilides has been a faculty member in the Aristotle University School of
Medicine. He currently directs the research laboratory as well as the Division of Infectious Diseases
of the 3rd Department of Pediatrics. His research interests focus on serious infections in children such
as fungal infections. Professor Roilides is on the Editorial Board of several international biomedical
journals. He is the author of more than 500 peer reviewed articles and book chapters. He has contributed
as co-ordinator or as partner in several multicentre or multinational studies.
45
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
TUDOR POP
Tudor L. Pop is Consultant in Pediatrics and Lecturer at 2nd Pediatric Clinic of University of Medicine and
Pharmacy Iuliu Hatieganu Cluj-Napoca, Romania, from where he graduated in 1995.
His clinical work is in the field of Pediatric Gastroenterology and mainly Pediatric Hepatology where he focuses
on neonatal cholestasis and liver transplantation, acute and chronic hepatitis. His PhD studies were in the
area of autoimmunity associated with chronic viral hepatitis in children. The main research activity areas are
cholestasis, hepatitis, metabolic liver disorders (Wilson disease), acute liver failure and non-invasive evaluation
of the liver (director or member in 4 national funded research grants).
He is the author of a book (Cholestasis in Children – Guide for diagnostic and treatment) and several book
chapters, 46 articles in peer-reviewed international and national journals and he presented over 180
papers at pediatric congresses or meetings. He is the General Secretary of Romanian Society of Pediatric
Gastroenterology, Hepatology and Nutrition and of the Romanian Society of Social Pediatrics, member in
the National Council of the Romanian Society of Pediatrics, and member in other national and international
societies. He is Associate Editor of e-learning program and Website Coordinator of the European Society of
Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).
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NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
LAURA IULIA BOZOMITU
Dr. Laura Iulia Bozomitu is Lecturer on Pediatrics at the Faculty of Medicine of “Gr.T.Popa” University from
Iasi, Romania. She obtained her MD degree in 1995 from the University of Medicine “Gr.T.Popa” from Iasi,
Romania and PhD in 2007 from the same University.
Dr. Bozomitu scientific interest is in the field of pediatric gastroenterology and hepatology. At present
time, she is working as senior physician at University Children’s Hospital from Iasi, Lecturer of Pediatrics at
“Gr.T.Popa” University. She is a member of the Romanian Society of Pediatrics and of Romanian Society of
Gastroenterology and also of Groupe Francophone d’Hépato-Gastroentérologie et Nutrition Pédiatriques
47
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
EVELINA MORARU
Evelina Moraru is an Associate Professor of Pediatrics at “Gr. T. Popa” University of Medecine and Pharmacy in
Iasi, Romania.
She has graduated from the “Gr. T. Popa” University of Medicine and Pharmacy in Iasi, Romania and she got her
PhD title from the “Carol Davila” University of Medicine and Pharmacy in Bucharest, Romania.
Along the main specialty as a pediatrician, she is also an allergo-immunologist and gastroenterologist, with
specialization in hepatology. Among her interests as a clinician there are the complex implications of the
child immune system in the pathogenesis of various diseases: viral hepatitis, metabolic diseases, respiratory
disorders, immunological disorders. Her research interests include particular immune responses of children
in those conditions and also the evolutive characteristics of certain conditions in children (liver cirrhosis,
steatosis, obesity).
Evelina MORARU is a member of the Romanian Academy of Medical Sciences. She is the author and co-author
of several books in the field of Pediatrics and Hepatology and she has also more than 200 scientific papers
published in Romania and in international scientific journals. She is the editor-in-chief of Pediatru.ro, a well
known romanian journal indexed in several international databases that covers all specialties in the field of
Pediatrics.
As a recognition of her complex scientific and research activity she received a few national and international
awards, among which the Award of Romanian Association for the Study of the Liver for Contribution to the
Development of Scientific Literature (2006). She is a member of more than 20 scientific societies both from
Romania and abroad.
48
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
EMMANOUIL GALANAKIS
Emmanouil (Manolis) Galanakis graduated from School of Medicine, University of Athens and School of
Philosophy, University of Ioannina, Greece, and studied Theology at the University of Athens. He obtained
a Doctoral Degree in Medicine (Social Paediatrics) and in Philosophy (Ethics). He has served as Fellow and
Visiting Faculty in Hospitals and Universities in the UK and the USA, and the ECDC, Stockholm.
Currently he is caring for sick children at Heraklion University Hospital, Crete, teaching Paediatrics and
Infectious Diseases and supervising projects of junior colleagues. He is actively involved in research and
has published in major peer-reviewed journals. He has served as a Board Member of European Society for
Paediatric Infectious Diseases and is Secretary of Hellenic Society for Paediatric Infectious Diseases. He has
taught Medical Ethics in Greek and European Courses, performed research on vaccination and communicable
diseases ethics and on Greek attitudes towards medical futility and good death, and authored relevant
books and articles.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
ANDREI BABUS
I did my university studies in Bucharest, Romania and Lyon, France where I graduated from EMLYON
Business School with a MSc in Management.
Highly interested in digital marketing, I joined Sanofi Pasteur in 2014 with the strong challenge to
implement online projects in this regulated environment.
Beyond all the digital marketing initiatives with commercial purposes, I’m also interested in people’s
attitude toward vaccination. For that, I’m continuously analyzing social media environment in order to
identify the barriers and drivers of people to get vaccinated or not.
50
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
TUDOR L. POP
Tudor L. Pop is Consultant in Pediatrics, with Competency in Pediatric Gastroenterology and Lecturer
at the 2nd Pediatric Clinic of the University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca,
Romania, from where he graduated in 1995.
His clinical work is in the field of Pediatric Gastroenterology and mainly in Pediatric Hepatology where
he focuses on neonatal cholestasis and liver transplantation, acute and chronic hepatitis and metabolic
liver diseases. His PhD studies were in the area of autoimmunity associated with chronic viral hepatitis
in children. The main research activity areas are cholestasis, hepatitis, metabolic liver disorders (Wilson
disease), acute liver failure and non-invasive evaluation of the liver.
He is the author of a book on Cholestasis in Children and several book chapters, author or coauthor of
46 articles in peer-reviewed international and national journals and he presented over 200 papers at
pediatric congresses or meetings. He is the Editor of e-learning program and Website Coordinator of
the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). He is the
President of the Romanian Society of Social Pediatrics and General Secretary of the Romanian Society
of Pediatric Gastroenterology, Hepatology and Nutrition, and of the Pediatric Associations of the Balkan.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
ALEXANDRU RAFILA
Professor Alexandru Rafila is currently the Chief of Microbiology Department of University of Medicine
and Pharmacy “Carol Davila” and of the National Institute for Infectious Diseases Matei Bals” in
Bucharest, Romania. He received his medical degree in 1987 and attained a Ph.D degree in Microbiology
in 2004. He has been a senior specialist in Microbiology and Public Health since 2000.
Dr. Rafila is the elected President of the Romanian Society of Microbiology and has served in central
administration as Secretary of State, General Director for Public Health and several times as Personal
Adviser of the Minister of Health. He is a previous Director of the Public Health Institute Bucharest.
In addition to his standing in his own country, Professor Rafila’s expertise is recognized internationally.
He acts as Member of Standing Committee of Regional Office of Europe of WHO and represented
Romania in the Management Board of ECDC.
An active organizer and participant in many international medical conferences and events on
microbiology, public health and vaccines, Dr. Rafila has also authored microbiology manuals, book
chapters and guidelines for public health and laboratory practice.
52
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
CHENG-HSUN CHIU
Prof. Cheng-Hsun Chiu is currently a Professor at the Department of Pediatrics at the Chang Gung
Children’s Hospital and Chang Gung University, Taipei, Taiwan.
Prof. Chiu received his Doctor of Medicine from Chung Shan Medical and Dental College, and Doctor of
Philosophy from Chang Gung University College of Medicine. He obtained his postdoctoral fellowship
from University of British Columbia, Vancouver, Canada. He is on the Editorial Board for several journals,
including Journal of the Formosan Medical Association, Pediatrics and International Child Health
(formerly Annals of Tropical Paediatrics), and Journal of Medical Microbiology and is Executive Editor
of Pediatrics and Neonatology (formerly Acta Paediatrica Taiwanica). He is also a reviewer for several
journals, including Clinical Infectious Diseases, BMC Infectious Diseases, Pediatric Infectious Disease
Journal, and Vaccine. He is member of a number of professional organizations including the American
Society for Microbiology, the Chinese Taipei Pediatric Association, and the Pediatric Infectious Diseases
Society, USA.
Prof. Chiu’s research interests include infectious diseases, antimicrobial resistance, vaccines, bacterial
genetics and genomics, and bacterial pathogenesis. He has authored or co-authored more than 300
scientific papers, including some in highly prestigious journals such as New England Journal of Medicine
and Lancet, for which he has earned international recognition. Moreover, he is the author of 5 book
chapters and has presented papers in many national and international scientific and medical meetings.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
JOSEPH STANDING
Studied Pharmacy at University of Manchester and worked as a hospital pharmacist for 3 years
ultimately specialising in paediatrics as a resident pharmacist at Great Ormond Street Hospital in
London. Undertook PhD at University of London School of Pharmacy/University College London (UCL)
Institute of Child Health (whilst working as paediatric surgical pharmacist) in Clinical Pharmacology
of diclofenac (pharmacokinetic, pharmacovigilance and pharmacogenetic studies). Then to the
Department of Pharmaceutical Sciences, University of Uppsala, Sweden (Prof Mats Karlsson’s group)
for a 2 year postdoctoral fellowship in pharmacometrics. Returned to London in 2010 to Great Ormond
Street Hospital as the Antimicrobial Pharmacist and as a Research Fellow at the School of Pharmacy. In
2011 awarded 4-year UK Medical Research Council (MRC) Methodology fellowship in collaboration with
Pfizer based at Department of Infection and Immunity at UCL ICH. During this time completed Masters
in Statistics at UCL, awarded Fellowship of the Royal Statistical Society (2014) and invited to become
member of European Medicines Agency Modelling and Simulation Working Group (2014 to present).
Currently hold a 5-year MRC clinician scientist fellowship focussing on antimicrobial PKPD, nonlinear
mixed effects modelling in immunology, and clinical pharmacology in neonatal/paediatric critical care.
54
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
MIHAELA BALGRADEAN
I have contributed to the development of Pediatrics and Pediatrics Nephrology – from the perspective
of Academic teaching (teaching and medical training), scientific research, and professional medical
experience and from the perspective of my academic and medical management positions.
On my academic, scientific and professional (medical) career itinerary
• I am a writer in 8 books in the pediatric field: coordinator in 3 pediatric treatises, I was editor, and
single writer, in two monographies in the field of pediatric nephrology, I was also a writer in 14 chapters
in treatises and in others monographies and co-writer in a chapter of a pediatric treatise.
• I am principal writer or single writer in 263 publications : 58 works in the medical journals ISI –
IF indexed, CNCSIS B+ ( BDI and PubMed indexed) CNCSIS B, D and written summaries in ISSN/ISBN
conferences or congress books, I have 15 citations in BDI-CNCSIS medical journals, I have had 54
invitations as a lector in different medical scientific national and international meetings with CME
accreditation and I have had already 128 scientific papers, and posters in conferences, symposiums and
medical congresses.
• I was involved in 1 POSDRU project which had as principal partner University Of Medicine “Carol
Davila” Bucuresti, intern evaluator and responsible of ARACIS project for QA of the University of
Medicine “Carol Davila” Bucuresti, 3 national and international projects (2 CEEX projects, in one of
them as a project director), in one prestigious international project of research and medical training
which had as principals partners, the Minister of Health, and the Minister of Education and Teaching
from Romania, and some prestigious Universities of USA named ” American Baylor- Humana USA
– Universities. Transforming Romanian Health Care”. I participated also at many clinical studies : 4
national and international studies.
• I am coordinator in 2 National Educational and Training projects (1. National Program Coordinator in
the Program of Medical Training in Pediatrics and 2. National Coordinator in the Program of Medical
Training in Pediatric Nephrology).
On this level of my career, as a Professor of “Carol Davila”- University of Medicine and Pharmacy, I have
had a complex program of activities and charges concerning teaching activities and medical training, for
students and residents; to prepare the interesting, interactive and modern courses on electronic support
and to establish an evaluation system based on theoretical information correlated with hospital handson-experience. Clinical hospital stages were based on a better relationship / communication, between
doctors and between doctors and their patients, the coordination and the training of residents in the
all day clinical activities and in the teamwork system for preparing different papers for conferences,
symposiums and congresses. I was coordinator and writer in 3 pediatrics books/ treatises, I published
articles and summaries of different studies in BDI and indexed journals, I had presented papers and I
was invited as a lector in different scientific manifestations. I had continued my activities and charges
as Vice Dean at “Carol Davila” University of Medicine and Pharmacy – Bucharest: I coordinate the
resident physician (rezidentiat) annual competition, and I coordinate also the medical activity (as head
of the pediatric clinical service) in the “Marie S.Curie” Emergency Clinical Children’ Hospital.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
JESUS SAAVEDRA
Medicine degree: Autónoma University of Madrid, 1990.
Specialist in Pediatrics at Hospital Universitario 12 de Octubre, Madrid, 1992-1995. Subespeciality:
Infectious Diseases.
Research Fellow at UT Southwestern Medical Center in Dallas. 1996-1997.
Clinical Fellow in Pediatric Infectious Disease at UT Southwestern Medical Center in Dallas. 1999- 2002.
Doctoral thesis presented on January 2007 at the Faculty of Medicine of the Complutense University of
Madrid: “Latency and HIV”
Attending physician in Pediatrics at Fuenlabrada Hospital, Madrid, 2003-2007.
Attending physician in Pediatrics at Gregorio Marañón Hospital in Madrid, in the Infectious Disease Unit,
since 2007.
Assistant Professor in Pediatrics, Complutense University, Madrid, since 2012.
Investigator and co-investigator in multiple projects and clinical trials, including HIV infection, vaccines,
viral respiratory infections, tuberculosis, Group A Streptococcus and osteoarticular infections.
Author and coauthor of several book chapters and multiple manuscripts.
Member of the ESPID board from 2013-2016.
Co-organizer of the 35th ESPID Conference in Madrid, Spain (2017).
56
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
PABLO ROJO
Pablo Rojo is a Pediatric Infectious Diseases Specialist of Hospital 12 de Octubre, Madrid, Spain. He
is also Associate Professor of Complutense University, Madrid, Spain. He obtained his MD and PhD
from Complutense University. He has been a member of the Board of the Spanish Society of Pediatric
Infectious Diseases (SEIP) from 2010 to 2014 and member of the ESPID Research Masterclass
Committee since 2013. He is author and coauthor of over 80 peer reviewed scientific articles and
book chapters. His main research activities are related to HIV, S. aureus and congenital CMV infection.
Related to Pediatric HIV, he is member of the PENTA Steering Committee and EPPICC Committee, he
has participated in many clinical trials with antiretrovirals and is part of the EPICCAL project pursuing
a therapeutic vaccine for HIV-infected children. He participates as a Technical advisor for Pediatric
HIV for Spanish Government, he participates in a collaborating project on Pediatric HIV in Equatorial
Guinea and has also advised WHO in Pediatric HIV treatment. Related to S. aureus he is focused on
community-acquired S. aureus infection and virulence factors, he is the principal investigator of the
European Project on Pediatric Invasive S. aureus Infections. Related to congenital CMV infection he is
member of the Panel Group on congenital CMV of the Spanish Society of Pediatric Infectious Diseases
and co-coordinator of the Spanish Cohort of congenital CMV. He co-organizes an International meeting
on congenital CMV infection every two years in Madrid, Spain.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
EUGENE LEIBOVITZ
Dr. Eugene Leibovitz was born in Iasi, Romania and completed the first 3 years of his medical education
at the “G. T. Popa” Faculty of Medicine from Iasi. He immigrated to Israel in 1973 and received his
medical degree from the Sackler School of Medicine, Tel Aviv, Israel, in 1978. After serving as a military
physician in the Israeli Army during 1978-1982, dr. Leibovitz completed in 1989 his medicine residency
in pediatrics at the Kaplan Hospital in Rehovot (affiliated with the Hadassah Medical School in Jerusalem).
During 1996-1997 he completed a 6-month research fellowship in pediatric infectious diseases at
SUNY at Buffalo Children’s Hospital. This was followed by a three-year fellowship in Pediatric Infectious
Diseases at New York University, New York, NY. Since 1994 Dr. Leibovitz works as senior physician at the
Pediatric Infectious Disease Unit and the Pediatric Division of the Soroka University Medical Center of
the Ben-Gurion University of the Negev, Beer-Sheva, Israel. In 2005, Dr. Leibovitz spent six months as a
Visiting Professor at Boston University Medical Center in the Pediatric Infectious Disease Unit.
Dr. Leibovitz has published more than 180 research papers in well known and highly rated medical
journals. Dr. Leibovitz’s work is primarily in the area of acute otitis media and other respiratory
infections, the pathogens responsible for these disease states and their resistance to antibiotics, as well
as their prevention by vaccines. His research includes various topics related the etiology and diagnosis
of acute otitis media, as well as its appropriate antibiotic treatment, particularly in complicated and
nonresponsive to treatment cases. In addition, Dr. Leibovitz has published a considerable number
of research papers and reviews on the topic of neonatal sepsis, with special emphasis on fungal
colonization and invasive fungal infections in premature neonates, their prevention and treatment
with new antifungal agents. Dr. Leibovitz has a special interest in infections at the pediatric emergency
room, with special emphasis on occult bacteremia, pneumonia and urinary tract infections.
Dr. Leibovitz has served as principal investigator on several of his research projects. Dr. Leibovitz is
a member of several professional societies, including ESPID, IDSA and ICAAC and in 2000 received
the degree of Associate Professor of Pediatrics and Pediatric Infectious Diseases at the Ben-Gurion
University of the Negev. In 2008, dr. Leibovitz received the title of full Professor of Pediatrics and
Pediatric Infectious Diseases at the Ben-Gurion University of the Negev. Since 2010, he is Professor
Honorificus at the Faculty of Medicine of the Transylvania University, Brasov, Romania. During 20082016 he worked as Director of the Pediatric Emergency Medicine Department at Soroka University
Medical Center of the Ben-Gurion University of the Negev. Since July 2016 he is the director of the
pediatric research unit at Soroka University Medical Center of the Ben-Gurion University of the Negev.
58
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NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
CORNELIU PETRU POPESCU
Dr. Corneliu Petru Popescu graduated the Faculty of Medicine from the University of Medicine and
Pharmacy Carol Davila Bucharest in 1999 and obtained specialization in infectious diseases in 2007,
infectious disease senior physician since 2012. He is Assistant Professor in Virology Department of
Carol Davila University of Medicine and Pharmacy and Head of the Intensive Care Unit and Infectious
and Tropical Diseases Department of „Dr Victor Babes” Clinical Hospital of Infectious and Tropical
Diseases from Bucharest, Romania.
He is the general secretary of the Romanian Society of Human Papillomavirus, member of the
Romanian National Society of Infectious Diseases, ESCMID (European Society of Clinical Microbiology
and Infectious Diseases), ESPID (European Society for Pediatric Infectious Diseases), ESCV (European
Society for Clinical Virology), ISTM (International Society of Travel Medicine).
Over 50 published papers and lectures on congresses on different issues: encephalitis, varicella,
mumps, measles, hepatitis, infective endocarditis, pneumococcal diseases, tropical diseases (malaria,
leishmaniasis), participated in several clinical trials and research programs. Current areas of interest are
central nervous system infections, vaccines and maternal-fetal infections, travel medicine and tropical
diseases, severe infection (endocarditis, osteodiscitis, sepsis).
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
SHALOM BEN-SHIMOL
Dr Ben-Shimol graduated from the Medical School of Beer-Sheva, Israel in 2002, and specialized in
Pediatrics in the Soroka University Medical Center, Beer-Sheva, Israel.
He worked as a senior pediatrician in the Department of Pediatrics, in the Soroka University Medical
Center, Beer-Sheva, Israel, since 2009 and in 2012 completed his Fellowship in Infectious Diseases, at
the same hospital.
Since 2012 is a lecturer in Pediatrics at Ben-Gurion University of the Negev, Beer-Sheva, Israel, working
at the clinical level as a consultant at the Department of Pediatrics of the same University hospital.
His current research / scientific interests focus on parasitic infections, pneumococcal infections and
vaccines.
Dr. Ben-Shimol has contributed over 40 peer-reviewed articles, review articles and book chapters both
in local and international scientific publications and has presented his research work in numerous
National and International congresses.
He is member of the European Society of Pediatric Infectious Diseases, Israeli Pediatric Society and the
Israeli Infectious Diseases Society. Additionally, he is an observer at the Israeli National Committee on
Infectious Diseases and Vaccination. Dr Ben-Shimol has been a member of several committees in the
Faculty of Health Sciences at the Ben-Gurion University of the Negev.
60
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
DAVID GREENBERG
David Greenberg is the director of the Pediatric Infectious Disease Unit of the Soroka University
Medical Center, Beer-Sheva, Israel since 2014 and Professor of Pediatrics and Infectious Diseases at
the BenGurion University of the Negev. Prof. Greenberg obtained his MD degree in 1991 from the BenGurion University of the Negev. In 1999, he embarked on a 2-year fellowship in Pediatric Infectious
Diseases at the British Columbia Children’s Hospital and University of British Columbia, Vancouver
B.C. Canada. Upon his return he joined the department of Pediatrics and Pediatric Infectious Disease
Unit at the Soroka Univ Med Ctr at a pediatrician and consultant in Pediatrics ID. He is also a senior
attending pediatrics at the Pediatrics Oncology Dept. Prof. Greenberg acts as a pediatrics infectious
diseases consultant for the southern district of the Israel General Health Insurance. He is a member of
the National Vaccine and Infectious Disease Advisory Board. Since 2010, he has served as the deputy
director of the School of Medicine of the Faculty of Health Sciences of the Ben-Gurion University of
the Negev. He served as the chairman of the Israel Clinical Pediatrics Society from 2007 to 2011.
Between 2007-2009, he served as the medical manager of the renowned center for severely disabled
young adults “ALEH Negev”. Prof. Greenberg is the founder and serves a the medical director of several
companies, such as AIT LTd. and ENOX Biopharma and holds several patents in the field of diagnostics
and treatment of infectious diseases. On the international level, Prof. Greenberg has been a member of
the WHO’s Pneumonia Vaccine Trial Investigators Group. He is a board member of ESPID’s educational
committee. Together with European researchers he is a member of the community-acquired pneumonia
pediatric research initiative consortium (CAP-PRI). In the last 10 years, Prof. Greenberg has received
research grants from, acts as a consultant for, and served on scientific boards of several large
pharmaceutical companies such as MSD, GSK, Pfizer, Astra Zeneca and Abbvie. He has contributed over
150 peer-reviewed articles, review articles and book chapters both in local and international scientific
publications. Dr. Greenberg’s research activities focus on the epidemiology, diagnosis, prevention and
treatment of respiratory infections and in particular of community-acquired pneumonia; pneumococcal
vaccines and the spread of antibiotic-resistant pneumococci in the community; invasive infections
including bacteremia and meningitis; viral respiratory infections and their interaction with bacterial
infection in community-acquired pneumonia.
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OANA FALUP-PECURARIU
Dr. Oana Falup-Pecurariu is Associate Professor of Pediatrics at the Faculty of Medicine, Transilvania
University from Brasov, Romania.
She obtained her MD degree in 1995 from the University of Medicine “Iuliu Hatieganu” from ClujNapoca, Romania and PhD in 2006 from the same University.
Dr. Falup-Pecurariu’s main scientific interest is in the field of respiratory infections, particularly
pneumococcal, Haemophilus influenza and viral infections and their pathogenesis, clinical implications
and prevention by vaccines.
She was chairman in conjunction of 8 ESPID supported and 7 East-European and Mediterranean
Teaching Courses in Brasov, Romania, with the participation of prominent researchers in pediatric
infectious diseases. At present time, she is working as Head of Department at Children’s Clinic Hospital
from Brasov, Associate Professor of Pediatrics at Transilvania University. She is recipient of ESPID Small
Grant Award.
Dr.Falup-Pecurariu was member of the International Scientific Committee of the World Society of
Paediatric Infectious Diseases (WSPID) Congress in Melbourne/Australia in 2011 and in Cape Town/
South Africa in 2013, member of the Education Committee of the European Society of Paediatric
Infectious Diseases (ESPID), member of the International Scientific Committee of the ESPID 2015
Congress.
Currently she is an ESPID Board and ESPID Research Networking Committee Member.
She spent training periods in pediatrics in Israel, Netherlands, Japan, UK.
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POSTERS →
9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
GUILLAIN–BARRÉ SYNDROME: A CASE OF
A BOY WITH MOTOR-SENSORY AXONAL
NEUROPATHY
Claudia Sirbe, Cornel Aldea, Dan Delean, Bogdan Bulata, Aurel Bizo
”Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca
Introduction: Guillain–Barré syndrome (GBS) is an immune-mediated polyneuropathy,
characterized as a post-infectious acute flaccid paralysis. More often cited in adults, GBS
is less often seen in infants and children, the incidence being 0.34-1.34/100.000 children.
Materials and methods: A previously healthy 15-year-old boy was admitted to the Renal
Unit of the Emergency Hospital for Children Cluj Napoca, after accusing progressive
weakness of the limbs with sensory deficits, such as paraesthesias. Moreover, he complained
of not being able to walk and use his arms properly, neuropathic pain, abnormal sweating,
recurrent hiccups. Physical examination revealed symmetric weakness with absent Achilles
and brachioradialis reflexes, retraction of flexor tendons (4th and 5th digit), transient
hypertension. No triggering factor was found.
Results: Laboratory investigations showed a viral infection (leukocytosis, lymphocytosis
with no inflammatory syndrome) and rhabdomyolysis. Tests resulted negative for infections
with: Campylobacter, Cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumoniae,
Haemophilus influ¬enzae, HIV, Borrelia burgdorferi, Herpes simplex, Coxsackie virus.
Lumbar puncture could not be performed due to parental refusal of consent. Cerebral MRI
was normal. Based on muscle and nerve electrophysiology, the case was classified as motorsensory axonal neuropathy. After treatment with intravenous immune globulin (400 mg/kg
for five days), the outcome was favorable, but with incomplete recovery.
Conclusions: Despite the large amount of information on pathogenesis of GBS in nearly
one century, further research is still needed for the few cases where no preceding infection
could be cited. AMSAN is considered a rare subtype of GBS in Europe and is uncommon
in children. Even in the areas with higher incidence of GBS, no statistical analysis of the
prognosis in AMSAN was performed.
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BRAŞOV, ROMÂNIA
INFECTIOUS MONONUCLEOSIS IN BIHOR
COUNTY
Monica Csep1, Andrei Csep2
1
2
„Gavril Curteanu” Clinical Hospital Oradea
University of Oradea
Introduction: Infectious mononucleosis is a viral infection especially caused by Epstein-Barr
virus, also known as human herpesvirus 4, member of the herpesvirus family.
Purpose. Our goal was to study the clinical and paraclinical features of the patients,
diagnosed with infectious mononucleosis.
Methods: We studied 71 patients with infectious mononucleosis, who were admitted in the
Infectious Diseases Clinic in Oradea between 01.01.2014-31,12.2015. Positive diagnosis
was based on the serological test (IgM VCA).
Results: The incidence of infectious mononucleosis was higher in urban environment
(60,5%), where the interhuman contact is closer, then in rural environment (39,5%).
According to the age groups, patients between 16-20 years old had a high incidence of
infectious mononucleosis (33%). A significant proportion of patients were diagnosed in
spring and summer (71%). According to the severity of illness, the clinical forms have been
grouped in easy forms 15 cases (21,1%), medium forms 49 cases (69%) and severe forms 7
cases (9,9%). The most frequent complications were: hepatic (28%), hematologic (15,5%)
and chronic fatigue syndrome (4,8%).
Conclusion: The clinical forms of infectious mononucleosis are closely connected with the
complications of the disease.
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ASPECTS OF INFECTION WITH
CLOSTRIDIUM DIFFICILE IN CHILDREN
Indries Mirela
University of Oradea, Clinical Infectious Diseases Hospital of Oradea, Romania
Introduction: the increasing prevalence of infection with Clostridium difficile (ICD) in the last
4 years in our country will inevitably increase morbidity in children, although Clostridium
difficile colonizes more than 50% of children under 1 year. The CDC estimates that annually
there are about 17,000 ICD in children between 1 and 17 years, with no differences between
genders, most between 12 and 23 months.
Objectives: this study sought to assess ICD children in our service and risk factors of this
condition in children.
Methods: this is a retrospective analysis of cases of Clostridium difficile infection in children
over a period of 15 months, admitted to the Infectious Diseases Section Oradea. We excluded
all cases where data were not sufficient to support the diagnosis of ICD (CD toxin negative).
Results: in the mentioned period there were 113 cases of patients with ICD. Of these, only
6.19% were children aged 2 months to 10 years. Most of the children had between 4-5
years. In case of children, the main driver remains antibiotics, but more than 2/3 of children
with ICD come from community, unlike adults where 2/3 of the ICD have nosocomial aspect.
Prematurity, artificial nutrition and anemia were other factors in the case of a relapse in an
infant of two months.
Conclusions: in recent years there has been an upward trend in the prevalence of ICD among
children, mostly between 1 and 4 years.
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BRAŞOV, ROMÂNIA
DIFFICULTIES OF ANTIINFECTIVE
THERAPY IN CHILDREN WITH PRIMARY
IMMUNODEFICIENCY
Sorin Ioan Iurian
Pediatric Clinic, „Lucian Blaga” University, Sibiu, Romania
Background: Because of improvement of molecular biology techniques, more children are
diagnosed with a primary (congenital) immunodeficiency. Primary immunodeficiencies
(PIDs) are a group on inborn disorders with defects of immune system, characterized by
high incidence of severe infections, autoimmunity and malignancies. The children with PIDs
could have a predisposition to a specific pathogen.
Objective: The author emphasize not only aspects about causative, but also peculiarities
regarding clinical presentation, management and therapy in children with immunodeficiency.
The author mention also diagnosis peculiarities and treatment difficulties in two
immunodeficient children.
Conclusions:
1. The author present a synopsis about the pathogens involved in infectious diseases in
children with PIDs and therapeutic methods.
2. The author also described 2 pediatric cases with recurrent and severe infections making
difficult the proper treatment.
3. Patients with severe and recurrent infections need additional investigations in order to
identify primary immunodeficiency.
4. Regarding the therapy, the immunocompromised children represent a serious challenge.
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ROTAVIRUS GASTROENTERITIS IN
VACCINATION ERA - CASES STUDY
Monica Alexoae, Aurica Rugină, Bogdan Stana, Alice Azoicai, Ileana Ioniuc
II Pediatric Clinic, UMF Gr. T Popa Iași
Rotavirus infection is an ubicvitar infection affecting over 95% of children under five years
old worldwide, without differences between geographic areas, socio economic status or
hygiene conditions. In the pediatric patients, this virus is responsible of severe clinical
form of gastroenteritis with high mortality due to acute dehydration and hydro electrolytic
disturbances.
Background: this study evaluate the rotavirus infection regarding the patient age, the
relation with specific immunization, onset type, clinical manifestations, the evolution
severity related to associate diseases.
Methods: 36 months retrospective study on 71 children diagnosed with rotavirus infection
(2013-2015), admitted in II Pediatric Clinic Iasi. Rotavirus stool specific antigen was
determined by a rapid, qualitative, immune chromatographic method.
Results: diagnosis average age was 11.82 months with high season distribution between
December and April (52/37 cases). 3 patients was prior immunized (4.22%); 15 cases was
considerate nosocomial infections; 2 children presented coinfection with Campylobacter
spp. Clinical manifestation at the onset was dominated by fever (31/71 cases), vomiting
(29/71 cases), nasal obstruction (21/71 cases); in evolution the patients associate diarrhea
with mucous (32/71 cases) or blood (7/71 cases) elimination, acute dehydration (47/71
cases), majority with normal sodium levels (31/47cases), metabolic acidosis (23/71 cases).
Risk factors for severe dehydration were represented by: small age, artificial alimentation,
malnutrition, transient immunodeficiency, lack of specific immunization.
Conclusions: Rotavirus infection remains a real problem of public health by its major risk of
dehydration, impressive direct and indirect costs and its contagiousness. In the absence of
specific therapy, the vaccination should represent a real priority. „
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EFFECTIVENESS OF AZITHROMYCIN IN
TRAVELER’S DIARRHEA IN CHILDREN
Radu Spineanu, Cristian Sava, Simona Cheregi, Laura Lele, Andrei Csep, Diana Dubău, Ioan
Magyar
University of Oradea, Faculty of Medicine and Pharmacy Oradea, Romania
Background: The number of families opting for vacations in countries with higher incidence
of traveler’s diarrhea is increasing.
Purpose: Evaluation of treatment with azithromycin in travelers’ diarrhea in children.
Methods: Between 2012 and 2015 we recorded 92 families with 164 children: 43 (26.2%)
enrolled in the 0-3 years age group, 53 (32.3%) in the 4-6 years age group, 40 (24.4%)
7-10 years, and 28 (17.1%) over 11 years, who were planning to travel to countries with
increased risk for traveler’s diarrhea. They were interested about the medications needed
for any diseases likely to affect their children during travelling; we recommended for
travelers’ diarrhea, as antibiotic, azithromycin. They were asked to fill a questionnaire when
they returned from vacation.
Results: 79 children, representing 48.2% of cases, contracted traveler’s diarrhea: 24 children
(55.8%) of 0-3 years group, 27 children (51%) of 4-6 years group, 18 children (45%) of
7-10 years group and 10 children (35.7%) of adolescents group. Children received oral
rehydration salts (ORS) and azithromycin 10 mg / kg once a day for three days immediately
after the onset of diarrhea. The clinical course was good, fluid loss was stopped and the
number of stools normalized in a range of 4-7 days in 71 children (89.9%). Eight children
belonging to small age groups, recovered in a week. An eight months old infant presenting
hyperpyrexia, vomiting, dehydration required hospitalization.
Conclusions: Prompt administration of azithromycin in children with travelers’ diarrhea
effectively acts on severity and duration of illness.
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DIFFERENTIAL DIAGNOSIS DIFFICULTIES
IN MUCOCUTANEOUS ERUPTIONS IN
CHILDREN
Mătăcuţă Ioana, Stănişor Paula Roxana
Sibiu Pediatric Hospital
We present the clinical and biological characteristics of a patient with a mucocutaneous
eruption, whose unfolding challenged the clinicians’ team in terms of diagnosis and
treatment.
A 1 year old female infant was admitted in our pediatric service presenting a pruritic
macular erythematous rash on the neck and torso, accompanied by facial edemas, with
a sudden onset the day before, initially attributed to an allergic reaction. After 24 hours
from the admission in the hospital, the macules rapidly transformed into papular lesions,
then into a generalized papulovesicular rash with bullous elements, the facial edemas and
erythema intensified and associated periorificial fissures, purulent secretions and crusts,
subfebrility and oral ulcerations, with subsequent feeding difficulties. Considering the
unexpected turn of the case, a multidisciplinary team was formed (pediatrician, infectious
diseases specialist, dermatologist and plastic surgeon) and the diagnosis was reevaluated,
taking into account immune mediated disorders, infectious diseases and Kawasaky disease.
The clinical presentation was suggestive of staphylococcal scalded-skin syndrome (SSSS)
with elements of staphylococcal toxic shock syndrome (STSS). We started Vancomycin iv
50 mg/kgc/24h after additional tests (including cultures), with favorable evolution under
treatment. The staphylococcal etiology was confirmed.
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BRAŞOV, ROMÂNIA
ATYPICAL CUTANEOUS MANIFESTATION IN
MYCOPLASMA PNEUMONIAE INFECTION
(CASE PRESENTATION)
Alice Azoicăi, Bogdan Stana, Paula Popovici, Ileana Ioniuc, Monica Alexoae, Irina Crișcov,
Tania Rusu, Alina Murgu, Aurica Rugina, Evelina Moraru
2nd Clinic of Pediatrics, “Sf. Maria” Emergency Hospital for Children, Iasi, Romania
„Gr. T. Popa“ University of Medicine and Pharmacy, Iasi, Romania
Introduction: Mycoplasma pneumoniae is a bacterial organism that unlike other bacteria
lacks a cell wall, causing, mainly, respiratory tract infections. In many cases infection due to
M pneumoniae is asymptomatic, or results in non-specific symptoms such as headache, lowgrade fever, dry cough and malaise. The respiratory examination is often normal, though
scattered crepitations and wheeze may be detected. M. pneumoniae can also result in
complications in other organ systems, as a result of direct invasion by the bacteria or the
immune response to the infection. The complications are sometimes more severe than the
primary respiratory infection.
Material and method: a 6 yers old girl, previously known with repetitive food allergy
episodes, is admitted with maculo-papular erythema of the face, limbs and abdomen.
Clinical examination revealed moderate congestion of the pharynx, overweight, periocular
and pretibial edema, and cough. Biological findings showed non-specific inflammation
at that point. Given the personal history, we first thought of initiating antihistaminic and
corticosteroid therapy, but the clinical response wasn’t as predicted.
Results: Assesing the differentials, we demanded an opinion regarding the cutaneous
manifestation, in which the infectionist raised the possibility of a M.pneumoniae infection
(confirmed by positive serology). Further evolution was beyond expectation, with total
remission of the symptoms after initiating oral macrolid therapy.
Conclusion: The particularity of the case reveals both the multiple (possible)etiology of
cutaneous manifestation, but also the atypical symptomatology of M pneumoniae infection.
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TETANUS IN A 3-YEAR OLD BOY - A CASE
REPORT
Man Anca Maria , Potorac Andreea, Lăpuşte Simona
Emergency Children’s Hospital, Cluj Napoca
Introduction: Tetanus is a serious infection caused by Clostridium tetani. The disease can be
fatal if left untreated and can be prevented by proper immunization with the
tetanus vaccine.
Objectives: Awareness of vaccine-preventable disease risks. The consequences of refusing
vaccines. The power of vaccines to save lives.
Methods: A 3-year-old boy from Satu Mare, presented in Emergency Children Hospital,
Cluj Napoca with a one-week history of difficulties opening the mouth, ulcerative lesions of
the mouth, afterwards developing signs of trismus and muscle rigidity. He also had nuchal
rigidity and spasm of the whole body. The patient lacked immunization and presented scars
on the body, which lead to a suspicion of tetanus infection. He was transferred for a consult
to the Hospital of Infectious Diseases in Cluj Napoca with the suspicion of contamination
by tetanus, suspicion of meningoencephalitis, aphthous stomatitis at an unvaccinated child.
Results: Tetanus diagnosis was confirmed. Subsequently the patient was transferred
to a pediatric intensive care unit with the specific treatment from the infectionist with
antimicrobial treatment, sedatives and intravenous rehydration. The treatment was initiated
with the administration of anti-tetanus immunoglobulins and after 2 days the patient was
given active immunization against diphteria, tetanus and polio. The evolution of this case
has been slow, with slight improvement in general condition. After 5 days of hospitalization
the patient was transferred to the Hospital of Infectious Diseases for further therapy.
Conclusions: The best way to protect against tetanus and the other vaccine-preventable
diseases is to take the vaccine.
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BRAŞOV, ROMÂNIA
EVOLUTION OF BLOODY DIARRHEA IN
HOSPITALIZED CHILDREN DURING THE
COLD SEASON OF 2015-2016 AT HOSPITAL
OF INFECTIOUS DISEASES „DR.VICTOR
BABEŞ”, BUCHAREST
Carmen Marcu1, Stefan Lazar2, Loredana Draghici1, Maria Nica2, Simin Aysel Florescu2,
Corneliu Petru Popescu2, Emanoil Ceausu2
1
2
“Dr. Victor Babes” Hospital Bucharest
UMF Carol Davila Bucharest
Acute bloody diarrhea is associated with pathogenic bacteria in pediatric patients. Diarrhea
due to Campylobacter, Salmonella and Shigella is usually self-limiting, with most patients
showing significant improvement a few days after the onset of illness.
Objectives: frequency, evolution and treatment of bloody diarrhea in hospitalized children
at “Dr Victor Babes” Hospital, the etiologies compared to cases in cold season 2014-2015.
Material and methods: Retrospective study on a group of 1510 children patients with acute
diarrheal disease hospitalized at “Dr Victor Babes” Hospital from octomber 2015 to april
2016.
Results: In total there were 1510 children patients with acute diareehea disease of which
110 patients had bloody diarrhea. 56 % were male and the rest of 44 % were females.
Only 21 patients (19%) were younger than one year, while 50 patients (46%) were between
1 and 3 years of age, 39 patients (35%) were between 4 and 15 years old. In 46 cases we
were able to identify the etiology, the most comon cause was Campylobacter followed by
Rotavirus infection and Salmonella. The average time of hospitalization was 3 days. Most
cases were uncomplicated and had a favorable evolution. 80 % patients received antibiotics.
Conclusions: We found a higher percentage of bloody diarrhea cases compared to winter
2014-2015, with a high incidence of the Campylobacter infection. Rotavirus infection can
be considered one of the etiologies of this disease.There were no cases of infection with E.
Coli enterohaemorragic or syndrome hemolytic uremic( which can complicate the evolution
of this disease) in hospitalized children. In a large number of bloody diarrhea the etiology
was not found probably due to antibiotics given before admission.
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A RARE LOCATION OF EXTRA-PULMONARY
TUBERCULOSIS IN CHILDREN: ONE CASE
REPORT
Nicoleta Brinza1, Ionela Beleaga2, Elena Bunea2, Mariana Pagute2,
Adriana-Ioana Sorete-Arbore1
1
2
Spital Clinic de Pneumoftiziologie Iasi
”St Mary” Children’s Clinical Emergency Hospital, Iasi
Cutaneous tuberculosis is a rare location (< 2%) of all cases of TB and can mimic the clinical
features of many other skin diseases. This atypical presentation may lead to a delay in
tuberculosis diagnosis and anti-tuberculosis treatment. We would like to discuss the case of
cutaneous and pulmonary tuberculosis in an immunocompetent boy aged 17 years old. The
subject was admitted with a 4 months history of abdominal pain, asthenia, and significant
weight loss. He did not recall having contact with individuals who were chronically ill or
who suffered from a chronic cough. Physical examination revealed two tumor formations
in the left lumbar region of the abdominal wall. PPD test showed an induration of 11 mm.
Chest X-ray highlighted two inhomogeneous opacities in the left lung area. Chest CT scan
showed two radiopaque lesions in the left lung area and mediastinal lymphadenopathy. The
abdominal CT scan showed three subcutaneous opacities in the left lumbar region of the
abdominal wall. Subcutaneous formations were biopsied, and the diagnosis of tuberculosis
was confirmed through histology and bacteriology. The evolution was satisfactory with the
adjunction of anti-tuberculosis treatment.
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CLINICAL AND BIOLOGICAL FEATURES
IN VT-1 AND VT-2 ENTEROCOLITIS
DIAGNOSED IN BRAŞOV CHILDREN’S
CLINIC HOSPITAL IN 2006
Mihaela Bucur1, Corina Fainarea1, Oana Falup-Pecurariu1,2
1
2
Children’s Clinical Hospital, Braşov, Romania
Faculty of Medicine, University „Transilvania”, Braşov, România
Background: acute enterocolitis caused by verotoxin producing E.coli strains is of major
importance due to rare, but extremely severe hemolytic uremic syndrome.
Purpose: analysis of clinical, biogical and treatment features in VT-1 and VT-2 enterocolitis.
Method: retrospective study of a group of children admitted in Brasov Children Clinic
Hospital from January 2016 to August 2016 diagnosed with VT-1 and/or VT-2 Enterocolitis.
Results: during the period mentioned above, 19 cases of positive VT-1 and/or VT-2
Enterocolitis were registered. The average age of children was 9,3 months. The most
important simptoms were diarrhea and fever. All the patients had positive VT-2 and 18 of
19 diagnosed children presented positive VT-1. Samples were taken for 74% of the cases
for the control of VT-1 wich highlighted negative values after the treatment administration.
Stool culture was negative for all the 19 children. The average values of the main biological
indicators analyzed were: WBC = 10,40*103/mm3, platelets = 403*103/mm3 , CRP=
2,39 mg/dl, blood urea nitrogen = 21,76 mg/dl, creatinine=0,49 mg/dl. The therapeutical
measures adopted aimed rebalancing electrolyte, antibiotics, probiotics, adsorbent. The
man antibiotics administered were Ceftazidime and Ceftriaxone.
Conclusion: early diagnosis and pathogen identification with a adequate treatment for
acute enterocolitis decreases the risk of complication.
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CAT-SCRATCH DISEASE IN CHILDREN:
CONSIDERATION UPON TWO CASES
Bogdan A. Stana, Evelina Moraru, Alina Murgu, Ileana Ioniuc, Monica Alexoae, Paula
Popovici, Irina Criscov, Alice Azoicai
2nd Pediatrics Clinic, “Gr. T. Popa” University of Medecine and Pharmacy, Iasi, Romania
Cat-scratch disease is caused by Bartonella henselae, a bacterial infection spread by cats. It
presents with regional lymphadenopathy, a clinical finding that requires careful differential
diagnosis with tuberculosis, Epstein Barr virus infection, malignancies like lymphomas
and metastases. Authors present two clinical cases that presented for laterocervical and
axilar lymphadenopathies. After ruling out other diagnosis, positive serology for Bartonella
henselae established the diagnosis.
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COLLODION BABY ASSOCIATED
INFECTIOUS RISK
Alina Murgu, Anca Chiriac, Cristina Rusu, Georgiana Russu, Fl. Cristogel, Bogdan Stana
”St Mary” Children’s Clinical Emergency Hospital, Iasi
Collodion baby is a rare inherited skin disorder, with autosomal recessive transmission,
belonging to the ichtyosis group, which is manifested since birth compared to other types
of ichthyosis which manifest after the age 3 months. To date 270 cases are reported. The
disease is caused by mutations in the gene of keratinocyte transglutaminase 1 (TGM1)
enzyme in 55% of cases. Sometimes it can be associated with other genetic syndromes (e.g.
Netherton syndrome, Gaucher disease type 2 etc).
TGM1 is involved in terminal differentiation of epidermis, being responsible for the
assembling envelope of keratin, providing functional skin barrier integrity.
Especially in the neonatal period, due to collodion membrane detachment there is an
increased risk (45%) for threatening complications such as infectious, severe dehydration,
impaired thermoregulation, respiratory distress, aspiration pneumonia.
The authors present the case of a newborn diagnosed with collodion baby syndrome
who required prolonged hospitalization in the Intensive Care unit because of infectious
complications - fungal sepsis and other bacterial superinfections. The case has many
diagnostic and therapeutic particularities and management difficulties.
In conclusion, “collodion baby” is a complex pathology in the neonatal period by its potentially
fatal complications that require multidisciplinary management team (neonatologist /
pediatrician, geneticist, dermatologist, ophthalmologist, audiologist, psychologist).
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SEVERE SEPSIS WITH CUTANEOUS AND
PULMONARY COMPLICATIONS IN AN
INFANT WITH VARICELLA
Ligia Rodina¹, Ioana Mihaela Popescu¹, Maria Elena Cocuz²
1
2
Infectious Disease Hospital, Brasov, Romania
University „Transilvania” Brasov, Faculty of Medicine
Varicella is generally regarded as a benign disease in children, but a significant number of
varicella cases are associated with complications (especially in young children). Second cases
within the househould are often more severe. Skin lesions infection are common, sometimes
requiring multidisciplinary treatment ( both medical and surgical).
We present a nine-month-old female who was in good health before developing chickenpox.
She was admitted to Infectious Disease Hospital of Brasov four days after onset of varicella,
with fever, poor oral intake and vomiting. On examination, she was pyrexial and tachycardic,
with no other signs of shock. The varicella exanthem was focal hemorrhagic crusted over,
with some of them having pus discharge suggestive of bacterial suprainfection. In the next
few hours she developed signs of compensated shock with tachycardia, tachypnoae and
low superficial blood flow, with a generalized mottled appearance. She was mildly hypoxic
( oxygen saturation 88% ) and agitated. Laboratory investigations showed an inflammatory
syndrome with significant increase of PCR, procalcitonin and leukocytosis. Chest radiography
showed widespread patchy densities throughout both lung fields, left lung consolidation with
heterogeneous opacities. In the second day after the admission she associated fluctuating
pus, in the right axillar and right inguinal areas. A culture from the abcess was made and it
turned positive for MRSA. With the proper antibiotic treatment, associated with repeated
surgical drainage, her evolution has remarcably improved and she was discharged after 15
days of hospitalization.
Giving the importance association between chickenpox and bacterial complications, all the
children with chickenpox should be carefully investigated by physician, in order to control and
prevent varicella complications and further reduce varicella morbidity and mortality.
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INFECTIONS IN CHILDREN WITH DIABETES
MELLITUS TYPE 1
Drochioi Ana Simona1, Oltean Carmen2, Bizim Delia2, Diaconu Ramona²,
Anton-Paduraru Dana-Teodora1
1
2
”Gr.T.Popa” University of Medicine and Pharmacy Iasi, Romania - Discipline of Pediatrics
”St Mary” Children’s Clinical Emergency Hospital, Iasi - 3rd Clinic of Pediatrics
Background: Infectious diseases are more frequent and/or serious in patients with diabetes
mellitus, which potentially increases their morbidities and mortality. The infections affect
all organs and systems.
Methods: We performed a retrospective study over a period of 7 years, on 130 children,
diagnosed with diabetes mellitus type 1 in 3rd Clinic of Pediatrics Iasi. We followed: the
type and location of infection, etiology of infections, germs sensitivity to antibiotics used,
inflammatory and culture tests for evidence of pathogens, blood level of glucose.
Results: Onset of disease was precipitated by infections in 51,5% cases. From the 130 cases,
114 had different types of infections: respiratory (pharyngo, laryngitis, sinusitis, pneumonia)
– 78,9% cases, dermatological (phlegmon, pityriasis, eruptive diseases, Staphylococcal
or and Streptococcal skin infectious) – 25,4%, digestive (Shigella or Rotavirus diarrhea,
gastroduodenitis with H. pylori, intestinal parasites, hepatitis A) – 75,4% , mouth infections
(stomatitis, gingivitis, periodontitis) –78,9%, urinary infections with E. coli and Candida
albicans, vulvovaginitis with Candida, balanoposthitis) – 20,1%, sense organs (otitis,
conjunctivitis, hordeolum) – 15,7%. It was observed association of several infections in
the same patients. Maximum frequency of infections was recorded in group 0-3 years.
Inflammatory tests have supported the infections and the treatment differ depending on
the location of the infection. During infection patients have high glycemic values.
Conclusions: Diabetes mellitus type 1 is a disease that through metabolic and immunological
abnormalities favors the infections. It must perform regular checks to adjust the insulin
dosage during infections, infections decompensate diabetes and decompensate diabetes
favors infections.
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8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
HAEMOPHAGOCYTIC SYNDROME IN A
PAEDIATRIC PATIENT DIAGNOSED WITH
HIV INFECTION
A.D. Ionescu1,2, L.E. Pop1,2 , C. Marcu3, C.L. Blag1,2, C. Itu2,3
Children’s Emergency Hospital, Cluj-Napoca
“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
3
Infectious Diseases Hospital, Cluj-Napoca
1
2
Introduction: The most frequent presentation of the haemophagocytic syndrome is in
association with other infections or malignancies (lymphomas more often). The role of HIV
infect ion in the hemophagocyt ic syndrome is current ly not clearly established.
Case description: The patient is a 14-year-old boy who presented with persistent diarrhea,
symptom which was investigated with no etiology being identified. After five months,
he presented weight loss (7 kilograms in one month) and chest burns. An ELISA test was
performed and the result was positive for HIV. The cause for the chest burns turned out
to be esophageal Candida albicans. Associated infections such as HBV, HCV, EBV, TB were
ruled out. The blood tests showed severe neutropenia and a bone marrow aspiration was
performed, which allowed the diagnosis of haemophagocytic syndrome to be established.
Soon after, the ARV treatment was started, associated wit h G-CSF, cortisonic therapy and
high doses of IVIG. The lack of a favorable response lead to the initiation of the HLH-2004
protocol. For the first months of treatment, CD4 levels and the neutrophile count remained
low and simultaneously, after 6 months they both showed significant increase. During the
treatment, the patient presented a spontaneous D11 vertebral fracture. The MRI showed
vertebral compression and osteomalacia, probably secondary to the cortisonic treatment.
Discussion: Having ruled out the usual associated infections and malignancies, this is
a case of a haemophagocytic syndrome secondary to the HIV infection. The fact that the
neutrophile count increased only after the CD4 value improved, supports this hypothesis.
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NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
NURSES’ ATTITUDE TOWARDS
PROVACCINATION - A SURVEY IN NURSING
SCHOOLS
Klara I. Sarbu1, Laura Repciuc2, I.Cojocariu3, Gina Lazurca,
Elizabeth Tcaciuc, Laura Irimescu
CF Hospital Iasi
Nurse, Scoala Postliceala Sanitara ”Laureatus” Siret
3
Student, Scoala Postliceala Sanitara “Laureatus” Siret
1
2
Despite the availability of an effective vaccine for over 50 years, measles remains the leading
cause of vaccine-preventable deaths in children. In 2012, it was estimated that there were
122 000 measles deaths globally. More than 95% of measles deaths occur in developing
countries. The World Health Organization strategy for measles mortality reduction includes
achieving and maintaining high levels of population immunity by providing high vaccination
coverage with two doses of measles vaccine. During 2000–12, improvements in routine
vaccination coverage and implementation of measles supplemental immunization activities
resulted in a 78% decrease in the estimated number of global measles deaths.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
ATYPICAL CAMPYLOBACTER REACTIVE
ARTHRITIS - A CASE REPORT
Pop Irina1, Roxana Iubu2, Otilia Fufezan3
Cluj-Napoca Children’s Hospital, Second Paediatric Clinic, Romania
Cluj-Napoca Infectious Disease Hospital, Romania
3
Cluj-Napoca Children’s Hospital, Third Paediatric Clinic, Romania
1
2
Introduction: Campylobacter jejuni, one of the major causes of acute gastroenteritis, with
two incidence peaks (younger than 1 year; between the ages of 15-29), may induce systemic
illness by bacteria translocation to the mesenteric lymph nodes. Reactive arthritis (ReA)
may occur in 1-5% of those infected.
Objectives: We present the case of a 3 month-old girl with a 7 days history of swelling and
inability to move in the scapulohumeral joint.
Matherial and method: This is a case report of a patient who, three weeks prior to admission,
presented with fever and watery stools containing traces of blood. Two days after discharge,
she stopped moving her right arm.
Results: Clinical examination showed an asymmetrical position of the arm, swelling of the
shoulder, erythema, increased warmth, tenderness, restricted passive movement. Brachial
plexus palsy and clavicle fracture were excluded. Given the recent gastrointestinal infection,
the suspicion of a ReA was raised. Investigations showed ESR=40mm/h. Campylobacter
jejuni was identified in the stool culture. The ultrasound of the joint showed hypoechoic
fluid containing debris. An enlarged proximal humeral metaphysis was visible on
radiological examination. The patient received antibiotic treatment according to guidelines,
analgesics and probiotics, in addition to the immobilization of the joint, with improvement
of symptoms.
Conclusion: The case particularity consists in the severity of the arthritis, with a non
characteristic site, at a young age and slow response to treatment. The emotional impact on
parents must be taken into consideration.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
EXTRA DIGESTIVE MANIFESTATION OF
HELICOBACTER PYLORI INFECTION –
REACTIVE ARTHRITIS
Ileana Ioniuc, Alice Azoicai, Alina Murgu, Bogdan Stana,
Smaranda Diaconescu, Monica Alexoae
Universitatea de Medicină și Farmacie “Gr. T. Popa” Iasi
Clinica II Pediatrie, Spitalul Clinic de Urgente pentru Copii “Sf. Maria” Iasi
Clinica V Pediatrie, Spitalul Clinic de Urgente pentru Copii “Sf. Maria” Iasi
Helicobacter pylori (HP), the main etiological factor of gastritis and ulcers, are gram negative
microaerophilic bacteria which colonize the gastric mucosa and induce an important local
inflammatory response. In the last years, numerous studies have shown the association of
HP infection with a series of extra digestive events, from cardiovascular, immunological,
dermatological disease to idiopathic thrombocytopenic purpura, iron deficiency anemia,
Raynaud syndrome and arthritis, underlying that the immunological response caused by
the presence of the bacteria is not local, but also systemic. The authors present 3 cases
admitted in II Pediatric Clinic for evaluation the diagnosis of idiopathic juvenile arthritis.
All 3 cases presented oligoarticular arthritis and only one of them epigastric pain. The
onsets are insidious and the symptoms last between 2 weeks to 5 weeks, with minimal
improvement under nonsteroidal anti inflammatory drugs treatment. After a wide range
of investigation for an accurate differential diagnostic, the symptoms were considered as
reactive arthritis to HP infection, the stool Antigen test for HP being positive in all cases.
In 2 patients, the superior digestive endoscopy shows typical aspects of HP gastritis. After
specific antibiotic therapy, the articular symptoms disappear, and at the 1 month follow
up the patients were asymptomatic. Our findings underling that we could consider HP a
bacterial trigger for reactive arthritis, together with Campylobacter, Salmonella, Shigella or
Yersinia, well known to be involved in this pathology.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
HEMORRHAGIC PLEURAL EFFUSION IN
ASSOCIATION WITH VARICELLA INFECTION
IN A 3 YEARS OLD PATIENT - CAUSES AND
MANAGEMENT
Alexandra Coroleuca, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu
SCUC Grigore Alexandrescu Bucuresti, Romania
Introduction: Varicella infection can lead to severe complications even in previously
imunocompetent children. A series of severe cases of group A beta hemolytic Streptococcal
(GABHS) infections are described complicating varicella or during the varicella convalescence,
such as pneumonia, pleural effusion, streptococcal toxic shock syndrome etc.
Study objective: The main objectiv of this paper is to highlight the relationship between
GABHS and varicella infection or varicella recovery.
Material and method: We present a case of a 3 year old boy who was addmited in the
clinic between may an July 2015. The patient was tranfered to us from an Infectious Disease
Hospital on the 10th day of varicella, presentig masive pleural effusion.
Results: The patient was admitted to the Intensive Care Unit.The blood tests were sugestive
for severe bacterial infection. After pleural drainage was performed the evolution was
unfavorable. Patient presented worsening status due to respiratory symptoms. A thoracic CT
was performed and it showed masive pleural effusion, many pleural adhesions which were
removed endoscopically. The pleural liquid cultures were positive for GABHS with Penicilline
sensitivity. Empirical antibiotic therapy was started from the first day of addmision and was
changed due to the cultures results. The evolution was slow favorable but with long-term
complications as pachypleuritis and thoracic deformation for which the pacient recives
physical therapy.
Conclusions: GABHS infections associated with varicella can be life-threatening and can lead
to long-term complications. We must pay particular attention to these cases. Vaccination
can significantly improve outcome.
86
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NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
THE IMPORTANCE OF URINALYSIS IN NONFEBRILE NEONATES WITH BRONCHIOLITIS:
A CASE REPORT
Ruian Raluca, Belecciu Andreea, Oana Falup-Pecurariu
Faculty of Medicine, University Transilvania Brasov
Background: Bronchiolitis is one of the most common respiratory diseases affecting infants.
Urinary tract infection (UTI) is often suspected when children present with fever in addition
of cough, respiratory distress and clinical findings of the disease.
Neonates present with various symptoms that are nonspecific to a disease. Often, without
the presence of fever, urinalysis is not mandatory.
In this case, a neonate patient presents with no fever and erythematous rash which makes us
question the importance of urinalysis in neonates even in the absence of symptoms.
Case presentation: A 1-month-old male neonate, born at W38, is taken to the emergency
department. Patient presents with erythematous rash on face, neck and abdomen, sore
throat and respiratory distress which has been ongoing for 3 days. He is treated at home
with Amoxicillin but condition worsens. Paraclinical tests reveal UTI with Extended Spectrum
-Lactamase-producing (ESBL) Klebsiella pneumoniae and MRSA colonization. RSV testing
is negative, laboratory values are modified as is: AST 40 U/l, Creatinine 0.54 mg/dl, RDWCV 16.7%, RDW-SD 56.7 fl, Na+ 135 mmol/l, K+ 5.8 mmol/l, Serum Total Protein 5.6 g/dl.
Patient is further investigated and lactose intolerance is confirmed on addition of all clinical
findings.
Conclusions: Diagnosis of UTI associated with bronchiolitis remains a challenge in the
medical world. This case shows the importance of correctly identifying underlying cause of
infection in neonates in order to ensure proper treatment.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
THE EFFECT OF ZINC THERAPY ON WEIGHT
IN CHILDREN WITH ACUTE DIARRHEA
Nicoleta M Negruţ
Department of Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea,
Romania
Background: In acute diarrheal diseases, weight loss can occur by decreasing food intake,
increased loss of water and electrolytes, decreased intestinal absorption of nutrients and
increased metabolism.
Methods: During 2009-2011, a prospective, randomized, controlled, simple blind study was
conducted on a sample of children with acute diarrhea, aged 0 - 3 years, coming from Bihor
County, Romania. The initial group was subdivided in study group and control group. The
study group received zinc sulfate (20 mg/day for children older than 6 months, and 10 mg/
day for children less than 6 months), for 10 days. During the progression of the disease,
body weight values were analyzed on admission and again at release from the hospital. The
program IBM SPSS statistics version 22 was used for analysis of the data.
Results: In the period mentioned above, a total of 103 children were available for analysis.
In the day of hospital discharge, there were significant differences between number of
children with weight loss in study group (n=53) compared with controls (n=50) (9 versus 29,
p < 0.001, Pearson’s chi-squared test). Comparison of growth rate changes during disease
progression showed lower weight loss rates in children with acute diarrhea who received
zinc compared with those from the control group (1.86 ± 0.48% versus 3.81 ± 0.97%, p <
0.001, Pearson’s chi-squared test).
Conclusion: The magnitude of weight loss during the course of the disease was lower in
children treated with zinc and a smaller number of children registered weight loss.
88
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
LYME DISEASE IN BIHOR COUNTY IN THE
LAST 5 YEARS
Andrei Csep
University of Oradea, Faculty of Medicine and Pharmacy
Background: Lyme disease or Lyme borreliosis is caused by the tick-borne spirochete
Borrelia burgdorferi sensu lato, which is the most common vector-borne disease in Europe.
Purpose. Our goal was to monitor the clinical and biological manifestaions of Lyme disease
in children and adults in Bihor county.
Methods: The study sample included 1120 patients, that presented in the Outpatient Clinic
of Infectious Disease Department, for tick bites, between 01.01.2011-31.12.2015. The
ELISA test was used for the detection of Lyme disease (IgM Borrelia burgdorferi)
Results: 210 patients representing 18,7 % of cases were diagnosed with Lyme disease, all of
them in stage I. We identified 4 types of Borrelia burgdorferi sensu lato. The most frecquently
was afzelii (38%), followed by garinii (29,5%), sensu stricto (19,5%) and spielmanii
(13%). The most important sign was the erythema migrans (80%), often accompanied
by myalgia and paresthesia, which disappear especially in 15-21 days after initiating the
antibiotherapy. A very important proportion were presented in spring months, April (19,5%)
and May (20,8%), followed by summer months, June (13,5%) and August (12%). According
to the age groups, patients between 21-30 years, were presented in a high number ( 45%),
followed by the age group 31-40 years (30%). The Borrelia IgM antibodies were negative
most frecquently, 4-6 month after starting the antibiotherapy (55%), in small percentage
maintaining positive after 12 month of presentation (5%).
Conclusions: Lyme disease has a high incidence among patients with tick bite, the most
common type in our study being Borrelia afzelii.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
RISK FACTORS FOR BRONCHIOLITIS AT
INFANTS IN BRASOV AREA
Bettina L.Boeriu1, Oana Falup-Pecurariu1,2
1
2
Faculty of Medicine, Transilvania University, Brasov, Romania
Childrens Clinic Hospital, Brasov, Romania
Introduction: Bronchiolitis is the most common admittance reason for children in both
developed and developing countries.
Aim of the study: primary objectives were to identify risk factors for bronchiolitis at infants
under 2 months,while the secondary ones were: to find any correlations between clinical
and lab exams, to estimate the risk of recurrence in the following two years, to assess costeffectiveness of RSV immunoprophylaxis using palivizumab for those infants, to evaluate
the effectiveness of the treatment with dexamethasone.
Patients and methods: A retrospective study 2011-2012 was conducted including
135 infants under 2 months old admitted to the Children’s Clinic Hospital Brasov with
bronchiolitis.
Results: In the analysed group 20.4% did present recurrence in the next years: 53% came
from urban area and 75% of them were boys. The analysis carried out on the pacients
associated the following risk factors: gender (P=0.01); low gestational age (P=0.02); low
gestational weight (P=0.005); lack of breastfeeding (P=0.026). Exposure to maternal
smoking (44% vs 38%), living in crowded conditions and/or in unhealthy households (40%
vs 45%),cesarean delivery (P=0.61) are not risk factors for the disease.
Dexamethasone was not associated with any clinically improvement, length of hospital stay
or less new episodes of bronchiolitis in the next 2 years of life.
Using Palivizumab, is not cost-effective its costs being greater than hospitalisation days
(22500 RON vs 1500- 20432 RON)
Conclusion: Relevant risk factors from our study for hospitalization for bronchiolitis in
infants under 2 months in our region are prematurity,formula feeding and male gender.
90
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
ASSOCIATION OF VITAMIN D DEFICIENCY
WITH SEPSIS IN CHILDREN
Adriana Slavcovici1, Raluca Elena Tripon1, Amanda Radulescu1, Mihaela Sabou1,
Roxana Iubu2, Cristian Marcu2, Monica Muntean1
1
Iuliu Hatieganu University of Medicine and Pharmacy, Department of Infectious Diseases, ClujNapoca, Romania
2
Infectious Diseases Teaching Hospital, Cluj-Napoca, Romania
Introduction: Several recent studies have demonstrated the relationship between vitamin D
deficiency and the severity of illness and mortality.
Objectives: The purpose of this study was to assess the vitamin D (25(OH)D) status in
children with sepsis.
Methods: A prospective study was conducted including children 1-16 years of age admitted
with acute community-acquired infections. Patients were stratified in sepsis and without
sepsis groups. Blood samples were collected within 24 hours of admission and 25(OH)D was
measured by Enzyme Linked Fluorescent Assay method. Deficiency was defined as 25(OH)
D concentrations <20 ng/mL. Mann-Whitney test was used to compare nonparametric
variables. Logistic regression adjusted for age was performed to estimate the association of
25(OH)D, PRISM-III score and C-reactive protein with sepsis.
Results: Twenty-eight patients with sepsis and 21 without-sepsis were enrolled. In sepsis
group children had a significantly low levels of 25(OH)D (21.35 ng/mL versus 34.8 ng/mL, p
0.0004), HDL-cholesterol, albumin, and calcium (p<0.05). In logistic regression adjusted for
age, we found a negative association of 25(OH)D level with sepsis (adjusted OR 0.79 [95%CI
0.64 to 0.95]). However, we found a positive association of PRISM-III score and C-reactive
protein with sepsis (adjusted OR 3.72 [95%CI 1.4 to 9.87]; adjusted OR 1.38 [95%CI 1.03
to 1.83], respectively). The area under the ROC curve for 25(OH)D levels at admission in
relation to sepsis was 0.80 (95%CI 0.67 0.93), the cutoff <20ng/mL had a likelihood ratio
2.53 with 80% specificity for sepsis.
Conclusions: Low 25(OH)D levels are associated with sepsis, especially under 20ng/mL
concentrations.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
ACUTE INFECTION WITH EPSTEINBARR VIRUS IN CHILDREN – CURRENT
EPIDEMIOLOGICAL AND CLINICAL
ASPECTS
Cocuz Maria-Elena1,2, Rodina Ligia2, Butnariu Gianina2, Neagu Ionut2, Cocuz Iuliu Gabriel3
Faculty of Medicine, University Transilvania of Brasov
Clinical Infectious Diseases Hospital of Brasov
3
University of Medicine and Pharmacy Targu-Mures
1
2
Introduction: Infection with Epstein Barr (EBV) virus is widespread, causing immunization
in most cases up to adulthood. In less developed countries seroconversion occurs
mainly in childhood. Positive diagnosis of infectious mononucleosis is based on clinical
manifestations, changes of WBC counts and serum specific serological tests.
Objectives: Evaluation of some current clinical and epidemiological characteristics of
infectious mononucleosis in children.
Material and methods: Retrospective study, descriptive, conducted on 65 child patients
admitted to Clinical Infectious Diseases Hospital of Brasov during 01.01.2015 – 30.06.2016
with infectious mononucleosis, confirmed by serological tests.
Results: Most children were aged 1-3 years (32,31%) and 4-6 years (27,69%). The males were
represented by 72,31% cases and 66,15% of patients were from urban areas. Leukocytosis
was found only to 66,15% of children while 95.38% had monocytosis. Hepatitis was
diagnosed in 75,38% of cases, associated with liver enlargement (to ultrasound examination)
only to 20,83% patients; 91,67% of the children had splenomegaly. There were found 16
cases with concomitant EBV and CMV acute infection (IgM or seroconversion), while 39,53%
of children had only CMV- IgG.
Conclusions: Admissions for infectious mononucleosis prevailed in young children, in
masculine gender and in patients from urban areas, without seasonality. The most common
hematologic disorder was monocytosis. Mononucleosis hepatitis require laboratory tests
for diagnosis. A large number of children had concomitant acute infection with EBV and
CMV, situation that suggests common infection sources and transmission pathways.
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25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
NEUROLOGICAL MANIFESTATION OF
ROTAVIRUS INFECTION IN CHILDREN: A
RETROSPECTIVE STUDY
Anca Stefania Vulcan, Irina Limbasan
Clinical Hospital of Pediatrics, Sibiu, Romania
Background: Rotavirus infection is the most common cause of gastroenteritis in children.
Neurologic complications were reported, most common being febrile or afebrile seizures,
but also were reported cases with acute encephalopathy.
Aim: To study and raise awareness of the extra digestive manifestations of rotavirus
infections.
Methods: A 5-year retrospective study on association of neurological manifestations and
rotavirus gastroenteritis performed on 11 hospitalized pediatric patients in the Clinical
Hospital of Pediatrics – Sibiu.
Results: The children (6 males, 5 females) were aged 4 to 40 months had Stool antigen
testing (coloured chromatographic immunoassay) positive for rotavirus, and no other
pathogens were cultured from the stool or blood.
Ten children had generalized seizures (<5 minutes) and one had, in addition transient flaccid
paralysis.
All 11 had a normal neurological examination and normal electroencephalogram EEG. In
two of the cases were performed cerebrospinal fluid studies CFS and computer tomography
CT, both normal.
8 children received a short course of oral anticonvulsant therapy (2 to 4 weeks).
All 11 children had a spontaneously recovery within a few days. On long term follow up to
12 months, all had normal development milestones without further convulsions.
Conclusions: Rotavirus infection should be considered during differential diagnosis of
neurological manifestations, because in most cases they represent benign conditions,
and carry an excellent prognosis; invasive (CFS) and expensive investigations (CT) or
anticonvulsivants are not necessary in most cases.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
EPIDEMIOLOGICAL ASPECTS OF
CHILDHOOD DIARRHEA
Frăsinariu Otilia-Elena, Buga Ana-Maria Laura, Rugina Aniela, Ciomaga Irina,
Neculai Nistor, Ștreangă Violeta
”St. Mary” Emergency Hospital for Children, Iasi
University of Medicine and Pharmacy ”Grigore T. Popa”, Iasi
Introduction: Diarrheic disease is still a major health issue, despite improvements in
standard of living, education and hygiene level, causing 9% of deaths in children worldwide.
Aim: To evaluate the epidemiological aspects of diarrhea in pediatric patients.
Methods: The study group consists in 151 children, 68 girls and 83 boys, aged 0-7 years,
hospitalized in First Pediatric Clinic from ”St. Mary” Hospital Iasi during 1 year, diagnosed
with diarrhea. Stool samples have been collected from each child for fecal culture, stool
white blood cell test and fecal rotavirus and adenovirus antigens.
Results: From the study group, in 76% children an infectious cause of diarrhea was
identified, while 24% of the cases were considered as noninfectious diarrhea. The principal
causal agents of diarrhea were bacteria (61 % of cases), the most frequent identified being
Escherichia coli (31.3% of cases) and Campylobacter (20.9% of cases). Rotavirus was
identified in 27 % of children and Adenovirus in 7% of children. Only 6 cases of diarrhea
were caused by parasites. The seasonal distribution of infections showed that diarrhea
due to bacteria was more predominant in the summer, while enteropathogen viruses were
predominant in the cold season. The average period of hospitalization was 5.27 days in
infectious diarrhea and 3 days in noninfectious cases.
Conclusion: Diarrheic disease occurs mainly in boys and in children from rural areas. The
most common cause of diarrhea was bacterial infections followed by Rotavirus infections.
Therefore, parents should be well informed about the importance of proper nutrition
according to child’s age, food hygiene and not only and least but not last the benefits of
vaccination against rotavirus.
94
25 TH-26 TH
NOVEMBER 2016
AULA OF THE TRANSILVANIA UNIVERSITY
BRAŞOV, ROMÂNIA
RE-EMERGENCE OF CHILDHOOD VISCERAL
LEISHMANIASIS IN CRETE
Christina Kamari, Marilia Lioudaki, Chrysoula Perdikogianni, Emmanouil Galanakis
Department of Paediatrics, Heraklion University General Hospital, University of Crete, Greece
Background: Leishmaniasis is a vector-borne zoonosis, with mammalian reservoir hosts
including rodents and dogs and requiring a vector such as sandflies to be transmitted to
humans. The disease has been long endemic in the Mediterranean basin where it is mainly
attributed to Leishmania donovani infantum. In Greece, morbidity of both visceral and
cutaneous leishmaniasis decreased during the last decades of the 20th century, but recently
more cases are seen again.
Objective: to study the tendency of visceral leishmaniasis cases among children in the
island of Crete for the 10-year period 2007 through 2016.
Patients and Methods: This study included all apparently immunocompetent children who
were diagnosed with leishmaniasis at the Heraklion University General Hospital. Diagnosis
was based on clinical presentation and serology and/or isolation of Leishmania spp. in
aspiration material and/or molecular methods in blood/aspiration.
Results: A total of 14 patients (8 boys, 6 girls), aged 3 months to 7.5 (median, 4.5) years were
seen with visceral leishmaniasis during the study period. An additional case of cutaneous
leishmaniasis was observed in a boy. A recent increase of leishmaniasis cases in our region
was obvious since almost all cases clustered in the 2 last years of the study period. Clinical
manifestations usually started during summer and early autumn, but cases were well
seen in January and March as well. All children were successfully treated with liposomal
amphotericin and all had an excellent outcome. Canine seroprevalance in the study area is
difficult to be precisely estimated, but it seems to be higher than 20%.
Conclusions: Visceral leishmaniasis seems to be re-emerging in the study area, most
probably related to high incidence in dogs and the increase of vector populations.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
PERIPHERAL LYMPHADENITIS CAUSED BY
NON-TUBERCULOUS MYCOBACTERIA IN
SPAIN: A MULTICENTER STUDY
Teresa del Rosal
Hospital La Paz, Madrid, Spain
Background: Cervico-facial lymphadenitis is the most common manifestation of nontuberculous mycobacteria (NTM) infection in healthy children. The diagnosis of NTM
infections can be challenging, and the optimal management (observation, antimicrobials,
surgery) remains unclear.
Hypothesis and aims:
- To create a national register of peripheral lymphadenitis caused by NTM in children in
Spain.
- The combined use of tuberculin skin test (TST) and interferon-gamma release assays
(IGRAs) allows the distinction between NTM and tuberculous lymphadenitis.
- To compare the effectiveness and outcome of different treatment approaches in NTM
lymphadenitis.
Methods: Ongoing retrospective and prospective, multi-center observational study among
Red Española de Tuberculosis Pediátrica (pTBred, Spain) centers/investigators. Patients
below 18 years with a microbiologically-confirmed diagnosis (culture and/or PCR-positive)
of peripheral NTM lymphadenitis are eligible. Epidemiological, clinical and treatment data
are collected using REDcap software. Data are analyzed using SPSS.
Results: During 2015, 118 patients (48% males; mean[SD] age, 32.5[17.3] months) were
included. The majority were non-BCG-vaccinated (95%) and without known risk factors
for tuberculosis (95%). Most patients had unilateral (92%) single-site (70%) localised
lymphadenitis (submandibular, 70%; superficial cervical, 27%). At diagnosis, median
(IQR) duration of symptoms was 3 (2-5) weeks and clinical stages were 1 (painless and
firm), 2 (fluctuant), 3 (skin changes) and 4 (fistula) in 47%, 8%, 39% and 6%, respectively.
Mycobacterium lentiflavum (38%) and M. avium (35%) were the most commonly identified
causative species. TST results were positive (≥5mm induration) in 59%. IGRAs were performed
in 39 (34%) cases, with the following results: negative (n=34; 87%), indeterminate (n=2;
5%) and positive (n=3; 8%: M.lentiflavum, M.avium and M.szulgai infection, one patient
each). Most patients with a negative IGRA result (29/34; 85%) showed some TST induration
(mean diameter, 9 mm). There was no concordance between TST and IGRA results (Cohen’s
kappa coefficient, 0.06). Of 63 patients with clinical stages 1-2 at diagnosis, 40 initially
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BRAŞOV, ROMÂNIA
underwent surgery and 23 did not, without difference in outcome in regard to lack of longterm sequelae (47% vs. 52%;p=0.71).
Conclusions: In previously healthy children presenting with long-standing unilateral
cervico-facial lymphadenitis, the combination of a negative IGRA result together with some
induration on TST testing is highly suggestive of NTM infection. M.lentiflavum was the most
common causative species in Spain, contrasting with the predominance of M. avium in
most previous studies. In children diagnosed in the early stages of NTM lymphadenitis, the
outcome of surgical and medical treatment is similar.
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9 TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE
8 TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES
PNEUMONIA IN TWIN NEWBORNS - A CASE
PRESENTATION
Nedelcuţă Ramona1, Călin Gigi1, Popescu Mirela2
1
2
Filantropia Hospital Craiova
Emergency Hospital Craiova
Introduction: Pneumonia, a common condition with extremely varied etiology (viruses,
bacteria, fungi, mycoplasma, chlamydia), has a higher risk in newborn due to the physiological
particularities and severe evolutionary potential.
Aim. The particularity of the treatment of pneumonia at 0-1 months of age is a “a priori”
indication for antibiotic treatment, before the identification and antibiogram study of
bacterial species.
Material and method: We conducted a prospective study in two brothers, fraternal twins,
14 days old, hospitalized for severe respiratory disease, accompanied by acute respiratory
failure and perioral and extremities cyanosis.
We studied several parameters: age, gender, environment, clinical examination, imaging
tests (radiography, ultrasound) tests inflammatory, urea, creatinine, bilirubin, transaminases,
calcium, magnezemia, ionogram, pharyngeal cultures. The evolution was slow and favorable
using treatment with cephalosporins, anti-inflammatory drugs, oxygen therapy, with
complete healing in 12 days.
Results and discussions: The initial evolution was severe, within 24 hours, with aggravation
of acute respiratory failure and decreased oxygen saturation, making necessary oxygen
therapy.
The association of folliculitis, jaundice and urinary tract infection in one case had prolonged
hospitalization.
The thymus hypertrophy amplified probably the “physiological” immune deficiency in both
cases, delaying healing.
Healing with “restitutio ad integrum” has been confirmed 3 months after the initial episode
in clinical and radiological follow-up.
Conclusions: The peculiarity of cases was the radiological association of significant thymus
hypertrophy with bronchopneumonia and the positive cultures for staphylococcus aureus
(coexistence with folliculitis) and Klebsilella (urinary infection). The lung disease repeated
during 6 months (2 more episodes), with the same pre-existing thymic hypertrophy.
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F IN AN C IA L
SUPPORTED
by
ESP ID
ISSN 2392 – 8751
99
PLATINUM PARTNER
GOLD PARTNERS
SILVER PARTNERS
PROFESSIONAL CONGRESS ORGANIZER
+40 213 17 31 38
+40 720 100 280
+40 213 17 31 32
[email protected]
Splaiul Independenței, 319B,
Sector 6, București, 060044
ISSN 2392 – 8751
www.srbip.ro/espid