Luca Pierantoni
@aosp.bo.it
S. Orsola-Malpighi Polyclinic
Scopus Publications
Scopus Publications
Luca Pierantoni, Laura Andreozzi, Giacomo Stera, Gaia Toschi Vespasiani, Carlotta Biagi, Daniele Zama, Elena Balduini, Lawrence Matthew Scheier, and Marcello Lanari
Elsevier BV
Giulia Brigadoi, Giulia Camilla Demarin, Riccardo Boracchini, Luca Pierantoni, Sara Rossin, Elisa Barbieri, Francesca Tirelli, Anna Cantarutti, Gaia Tempo, Carlo Giaquinto,et al.
MDPI AG
Respiratory tract infections (RTIs) are the most common infectious syndromes, primarily caused by viruses. The primary objective was to compare the illness courses between historical RTIs and recent SARS-CoV-2 infections. The study cohort consisted of RTI cases evaluated at the Pediatric Emergency Departments of Padua and Bologna, discharged or admitted with microbiologically confirmed viral RTI between 1 November 2018 and 30 April 2019 (historical period) and 1 March 2020 and 30 April 2021 (recent period). We evaluated the risk of oxygen or respiratory support, hospitalization, antibiotic therapy, and complications among different viral infections. The odds ratio (OR) and the 95% confidence intervals (CIs) were estimated through mixed-effect logistic regression models, including a random intercept on the individual and hospital. We identified 767 RTIs: 359 in the historical period compared with 408 SARS-CoV-2 infections. Infections of SARS-CoV-2 had a lower risk of being admitted (OR 0.04, 95% CI 0.03–0.07), receiving respiratory support (OR 0.19, 95% CI 0.06–0.58), needing antibiotic therapy (OR 0.35, 95% CI 0.22–0.56) and developing complications (OR 0.27, 95% CI 0.14–0.51) compared to all other viral RTIs. COVID-19 in children is clinically similar to other viral RTIs but is associated with a less severe infection course. Thus, most prevention strategies implemented for SARS-CoV-2 should still be considered during RSV and Influenza epidemics.
Daniele Zama, Luigi Altimari, Martina Ruscelli, Luca Pierantoni, Monia Gennari, Francesco Toni, Caterina Campoli, Livio Presutti, and Marcello Lanari
Medico e Bambino
The incidence of orbital cellulitis in the paediatric age is around 1.6/100,000 cases per year. Most cases are mild and limited to the preseptal space; however, severe and complicated cases are possible. Paediatricians should be able to recognize high-risk adverse outcome conditions that require prompt intervention. Clinical evaluation supported by laboratory workup is the key for the diagnosis. Intraorbital and intracranial complications may be ruled out through diagnostic imaging. Depending on the extension of the infection, clinicians may choose between conservative treatment with antibiotic therapy or surgical drainage at first. The paper proposes an algorithm to aid clinicians in the management of paediatric orbital cellulitis through the description of three emblematic clinical cases observed in the Paediatric Emergency Room.
Arianna Dondi, Elisa Manieri, Giacomo Gambuti, Stefania Varani, Caterina Campoli, Daniele Zama, Luca Pierantoni, Michelangelo Baldazzi, Arcangelo Prete, Luciano Attard,et al.
MDPI AG
Background: Visceral leishmaniasis (VL) is a potentially fatal disease, with an increasing occurrence in northern Italy, affecting children and both immunocompetent and immunocompromised adults. Methods: This retrospective study conducted at the St. Orsola University Hospital of Bologna, Italy, evaluates the characteristics of 16 children (with a median age of 14.3 months) who were hospitalized between 2013 and 2022 for VL. Results: Seventy-five percent of patients presented with a triad of fever, cytopenia, and splenomegaly. An abdominal ultrasound examination revealed splenomegaly and hypoechoic spleen abnormalities in 93.8% and 73.3% of cases, respectively. Five VL cases were complicated by secondary hemophagocytic lymphohistiocytosis. Eleven patients were treated with a single 10 mg/kg dose of Liposomal Amphotericin B (L-AmB), while five received two doses (total of 20 mg/kg); one of the former groups experienced a recurrence. The fever generally decreased 48 h after the first L-AmB dose, and hemoglobin levels normalized within a month. The splenomegaly resolved in approximately 4.5 months. Conclusions: Pediatricians should consider VL in children with fever of an unknown origin, anemia, cytopenia, and splenomegaly. In our experience, abdominal ultrasounds and molecular tests on peripheral blood contributed to diagnosis without the need for bone marrow aspiration. The short-course therapy with two 10 mg/kg doses of L-AmB is safe and effective.
Marianna Fabi, Matteo Meli, Davide Leardini, Laura Andreozzi, Giulio Maltoni, Maria Bitelli, Luca Pierantoni, Chiara Zarbo, Arianna Dondi, Cristina Bertulli,et al.
MDPI AG
Background: Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage. Aim: The aim of this study is to investigate cardiac damage in HTN, its risk factors (RFs), and evolution. Methods: We conducted a prospective/retrospective study involving children referred to the Childhood Hypertension Outpatient Clinic. This study included clinical and echocardiographic assessments of cardiac morphology and function at three time points: enrollment (T0) and follow-up (T1 and T2). Results: Ninety-two patients (mean age 11.4 ± 3 years) were enrolled. Cardiac eccentric and concentric hypertrophy were present in 17.9% and 9%, respectively, with remodeling in 10.5%. Overweight/obese subjects exhibited significantly higher systolic blood pressure (SBP), frequency of HTN, and body mass index (BMI) at T0 compared with patients with chronic kidney disease (CKD). SBP and BMI persisted more during follow-up. Normal-weight vs. overweight/obese patients were significantly more likely to have normal geometry. Positive correlations were found between BMI and left ventricular (LV) mass at T0, BMI and SBP at T0 and T1. Gender, BMI, SBP, and diastolic blood pressure (DBP) significantly predicted LV mass index (LVMI), but only BMI added significance to the prediction. During follow-up, the variation of BMI positively correlated with the variation of SBP, but not with LVMI. Conclusions: In our cohort, body weight is strongly associated with HTN and cardiac mass. Importantly, the variation in body weight has a more significant impact on the consensual variation of cardiac mass than blood pressure (BP) values. A strict intervention on weight control through diet and a healthy lifestyle from early ages might reduce the burden of CV morbidity in later years.
Roberta Pellegrino, Edoardo Timitilli, Maria Carmen Verga, Alfredo Guarino, Iride Dello Iacono, Immacolata Scotese, Giovanna Tezza, Giulio Dinardo, Simona Riccio, Sofia Pellizzari,et al.
Springer Science and Business Media LLC
AbstractThis study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5–7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known:• GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases.• GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New:• Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk.• The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy.
Sara Cerasi, Davide Leardini, Nunzia Lisanti, Tamara Belotti, Luca Pierantoni, Daniele Zama, Marcello Lanari, Arcangelo Prete, and Riccardo Masetti
Springer Science and Business Media LLC
AbstractFebrile neutropenia (FN) represents one of the main complications of pediatric patients with oncological and hematological diseases. In these patients, it is crucial to identify bacterial infections. The aim of this study is to evaluate presepsin as an early biomarker of bacterial infections during FN. We compared patients with oncological and hematological diseases and a 2:1 age-matched healthy control group. In the FN group, we evaluated 4 biomarkers, namely, C reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL6) and presepsin at the onset of fever (T0) and 48 h after T0 (T1). In the control group, we only evaluated presepsin. We enrolled a total of 41 children with oncological and hematological diseases disease experiencing 50 FN episodes and 100 healthy patients in the control group. In patients with FN, we found that presepsin was significantly higher than in the control group (p < 0.001). However, in the FN group, we did not find a statistically significant difference between patients with and without bacteremia (p = 0.989 at T0, p = 0.619 at T1). Presepsin values at T1 were higher in patients experiencing an unfavorable outcome (p = 0.025). This study shows that presepsin increases in neutropenic patients, but it only revealed useful in predicting an unfavorable outcome 48 h from the onset of fever.
Sara Cerasi, Davide Leardini, Nunzia Lisanti, Tamara Belotti, Luca Pierantoni, Daniele Zama, Marcello Lanari, Arcangelo Prete, and Riccardo Masetti
Springer Science and Business Media LLC
Arianna Dondi, Elisa Manieri, Ludovica Betti, Ada Dormi, Claudio Carbone, Carlotta Biagi, Luca Pierantoni, Daniele Zama, Marco Paglione, and Marcello Lanari
Wiley
BACKGROUND
Outdoor air pollution is supposed to influence the course of bronchiolitis, but the evidence is limited. The present study aimed at evaluating the role of outdoor air pollutants on hospitalization for bronchiolitis.
METHODS
Infants aged ≤12 months referred for bronchiolitis to our Pediatric Emergency Department in Bologna, Italy, from 1 October 2011 to 16 March 2020 (nine epidemic seasons) were retrospectively included. Daily concentrations of benzene (C6 H6 ), nitrogen dioxide (NO2 ), particulate matter ≤2.5 μm (PM2.5 ), and ≤10 μm (PM10 ), and the mean values of individual patient exposure in the week and the 4 weeks before hospital access were calculated. The association between air pollutants exposure and hospitalization was evaluated through logistic regression analysis.
RESULTS
A total of 2902 patients were enrolled (59.9% males; 38.7% hospitalized). Exposure to PM2.5 in the 4 weeks preceding bronchiolitis was identified as the main parameter significantly driving the risk of hospitalization (odds ratio [95% confidence interval]: 1.055 [1.010-1.102]). After stratifying by season, higher values of other outdoor air pollutants were found to significantly affect hospitalization: 4-week exposure to C6 H6 (Season 2011-2012, 4.090 [1.184-14.130]) and PM2.5 (Season 2017-2018, 1.282 [1.032-1.593]), and 1-week exposure to C6 H6 (Season 2012-2013, 6.193 [1.552-24.710]), NO2 (Season 2013-2014, 1.064 [1.009-1.122]), PM2.5 (Season 2013-2014, 1.080 [1.023-1.141]), and PM10 (Season 2018-2019, 1.102 [0.991-1.225]).
CONCLUSION
High levels of PM2.5 , C6 H6 , NO2 , and PM10 may increase the risk of hospitalization in children affected by bronchiolitis. Open-air exposure of infants during rush hours and in the most polluted areas should be avoided.
Luca Pierantoni, Valentina Lasala, Arianna Dondi, Marina Cifaldi, Ilaria Corsini, Marcello Lanari, and Daniele Zama
MDPI AG
Background: Lower respiratory tract infections (LRTIs) and community-acquired pneumonia (CAP) are among the most frequent reasons for referrals to the pediatric emergency department (PED). The aim of this study is to describe the management of antibiotic prescription in febrile children with LRTI or CAP admitted to a third-level PED and to investigate the different variables that can guide physicians in this decision-making. Methods: This is an observational, retrospective, monocentric study including patients < 14 years old who were presented to the PED for a febrile LRTI or CAP during the first six months of the year 2017. Demographic and clinical data, PED examinations, recommended therapy, and discharge modality were considered. Two multivariate logistic regression analyses were performed on patients with complete profiles to investigate the impact of demographic, laboratory, and clinical variables on antibiotic prescription and hospital admission. Results: This study included 584 patients with LRTI (n = 368) or CAP (n = 216). One hundred and sixty-eight individuals (28.7%) were admitted to the hospital. Lower age, higher heart rate, and lower SpO2 were associated with an increased risk of hospitalization. Antibiotics were prescribed to 495 (84.8%) patients. According to the multivariate logistic regression, the diagnosis and duration of fever were substantially linked with antibiotic prescription. Conclusions: The present study reports real-life data about our PED experience. A high rate of antibiotic prescription was noted. In the future, it is necessary to improve antibiotic stewardship programs to increase clinical adherence to guidelines.
Giovanni Autore, Luca Bernardi, Filippo Ghidini, Claudio La Scola, Alberto Berardi, Giacomo Biasucci, Federico Marchetti, Andrea Pasini, Maria Elena Capra, Claudia Castellini,et al.
MDPI AG
Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.
Giulia Piccirilli, Alessandro Rocca, Eva Caterina Borgatti, Liliana Gabrielli, Daniele Zama, Luca Pierantoni, Marta Leone, Camilla Totaro, Matteo Pavoni, Tiziana Lazzarotto,et al.
MDPI AG
Respiratory Syncytial Virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. The role of RSV load in disease severity is still debated. We present the interim results of a prospective monocentric study enrolling previously healthy infants hospitalized for RSV bronchiolitis, collecting nasopharyngeal aspirates every 48 h from admission to discharge, and evaluating RSV load dynamics in relation to clinical outcome measures of bronchiolitis severity, including: need, type and duration of oxygen therapy, length of hospitalization, and the bronchiolitis clinical score calculated at admission. The results showed that the highest viral replication occurs within the first 48 hours after admission, with a significant decrease at subsequent time points (p < 0.0001). Moreover, higher RSV-RNA values were associated with the need for oxygen therapy (p = 0.03), particularly high-flow nasal cannula type (p = 0.04), and longer duration of respiratory support (p = 0.04). Finally, higher RSV load values were correlated with lower white blood cells, especially lymphocyte counts and C-reactive protein levels (p = 0.03, p = 0.04, and p = 0.01, respectively), as well as with patients of a younger age (p = 0.02). These data suggest that RSV may actively contribute to the clinical severity of bronchiolitis, together with other potential non-viral factors.
Edoardo Muratore, Alessandro Ruggi, Nicoletta Abram, Andrea Zanaroli, Luca Pierantoni, Marcello Lanari, and Daniele Zama
Medico e Bambino
Anaemia is a common issue in the paediatric age group and it is not uncommon to encounter severe cases of anaemia in the Paediatric Emergency Unit. The correct identification of patients requiring urgent care is of central importance to provide timely interventions. However, considering that most patients are haemodynamically stable, transfusions are not always mandatory. Even in the setting of the Emergency Unit, the differential diagnosis can be narrowed with specific laboratory tests. The paper presents three exemplary cases from the experience of a Paediatric Emergency Unit that will help to provide a summary of the diagnostic and therapeutic approach to severe anaemia in infants and children.
Carlotta Biagi, Ludovica Betti, Elisa Manieri, Arianna Dondi, Luca Pierantoni, Ramsiya Ramanathan, Daniele Zama, Monia Gennari, and Marcello Lanari
MDPI AG
Bronchiolitis is the main cause of hospitalization in infants. Diagnosis is clinical, and treatment is based on hydration and oxygen therapy. Nevertheless, unnecessary diagnostic tests and pharmacological treatments are still very common. This retrospective study aimed to evaluate whether the setting of bronchiolitis care influences diagnostic and therapeutic choices. The management of 3201 infants, referred to our Italian Tertiary Care Center for bronchiolitis between 2010 and 2020, was analyzed by comparing children discharged from the pediatric emergency department (PEDd group) undergoing short-stay observation (SSO group) and hospitalization. Antibiotic use in PEDd, SSO, and ward was 59.3% vs. 51.6% vs. 49.7%, respectively (p < 0.001); inhaled salbutamol was mainly administered in PEDd and during SSO (76.1% and 82.2% vs. 38.3% in ward; p < 0.001); the use of corticosteroids was higher during SSO and hospitalization (59.6% and 49.1% vs. 39.0% in PEDd; p < 0.001); inhaled adrenaline was administered mostly in hospitalized infants (53.5% vs. 2.5% in SSO and 0.2% in PEDd; p < 0.001); chest X-ray use in PEDd, SSO, and ward was 30.3% vs. 49.0% vs. 70.5%, respectively (p < 0.001). In a multivariate analysis, undergoing SSO was found to be an independent risk factor for the use of systemic corticosteroid and salbutamol; being discharged at home was found to be a risk factor for antibiotic prescription; undergoing SSO and hospitalization resulted as independent risk factors for the use of CXR. Our study highlights that different pediatric acute care settings could influence the management of bronchiolitis. Factors influencing practice may include a high turnover of PED medical staff, personal reassurance, and parental pressure.
Sara Roggiani, Daniele Zama, Federica D’Amico, Alessandro Rocca, Marco Fabbrini, Camilla Totaro, Luca Pierantoni, Patrizia Brigidi, Silvia Turroni, and Marcello Lanari
Frontiers Media SA
IntroductionRespiratory syncytial virus (RSV) is the most common cause of bronchiolitis and hospitalization in infants worldwide. The nasopharyngeal microbiota has been suggested to play a role in influencing the clinical course of RSV bronchiolitis, and some evidence has been provided regarding oral and gut microbiota. However, most studies have focused on a single timepoint, and none has investigated all three ecosystems at once.MethodsHere, we simultaneously reconstructed the gut, oral and nasopharyngeal microbiota dynamics of 19 infants with RSV bronchiolitis in relation to the duration of hospitalization (more or less than 5 days). Fecal samples, oral swabs, and nasopharyngeal aspirates were collected at three timepoints (emergency room admission, discharge and six-month follow-up) and profiled by 16S rRNA amplicon sequencing.ResultsInterestingly, all ecosystems underwent rearrangements over time but with distinct configurations depending on the clinical course of bronchiolitis. In particular, infants hospitalized for longer showed early and persistent signatures of unhealthy microbiota in all ecosystems, i.e., an increased representation of pathobionts and a depletion of typical age-predicted commensals.DiscussionMonitoring infant microbiota during RSV bronchiolitis and promptly reversing any dysbiotic features could be important for prognosis and long-term health.
Marcello Lanari, Elisabetta Venturini, Luca Pierantoni, Giacomo Stera, Guido Castelli Gattinara, Susanna Maria Roberta Esposito, Silvia Favilli, Emilio Franzoni, Eleonora Fusco, Paolo Lionetti,et al.
Springer Science and Business Media LLC
AbstractThe fast diffusion of the SARS-CoV-2 pandemic have called for an equally rapid evolution of the therapeutic options.The Human recombinant monoclonal antibodies (mAbs) have recently been approved by the Food and Drug Administration (FDA) and by the Italian Medicines Agency (AIFA) in subjects aged ≥12 with SARS-CoV-2 infection and specific risk factors.Currently the indications are specific for the use of two different mAbs combination: Bamlanivimab+Etesevimab (produced by Eli Lilly) and Casirivimab+Imdevimab (produced by Regeneron).These drugs have shown favorable effects in adult patients in the initial phase of infection, whereas to date few data are available on their use in children.AIFA criteria derived from the existing literature which reports an increased risk of severe COVID-19 in children with comorbidities. However, the studies analyzing the determinants for progression to severe disease are mainly monocentric, with limited numbers and reporting mostly generic risk categories.Thus, the Italian Society of Pediatrics invited its affiliated Scientific Societies to produce a Consensus document based on the revision of the criteria proposed by AIFA in light of the most recent literature and experts’ agreement.This Consensus tries to detail which patients actually have the risk to develop severe disease, analyzing the most common comorbidities in children, in order to detail the indications for mAbs administration and to guide the clinicians in identifying eligible patients.
Danilo Buonsenso, Giorgio Sodero, Francesco Mariani, Ilaria Lazzareschi, Francesco Proli, Giuseppe Zampino, Luca Pierantoni, Piero Valentini, and Claudia Rendeli
MDPI AG
Introduction: There is marked heterogeneity in clinicians’ choice of antibiotic duration for pediatric urinary tract infections (UTIs). Most patients with bacterial UTIs still receive between 7 and 10 days of antibiotics. Prolonged antibiotic exposure drives the emergence of resistance and increases the occurrence of adverse effects. There is increasing evidence that shorter antibiotic regimens may be equally effective compared with longer ones. However, studies evaluating shorter therapies in children hospitalized with urinary tract infections have not yet been performed. Methods: We performed a retrospective study comparing children hospitalized with UTIs treated with a short antibiotic (<7 days) or standard antibiotic treatment. The primary aim of our study was to assess the efficacy of a shorter antibiotic therapy for children with UTIs, compared with an historical group of children treated with a standard 7–14 days course. Results: 112 patients, 46 of which were females (41.1%) with a median age 6 months were enrolled. A total of 33 patients (29.5%) underwent a short therapy. All patients were successfully discharged from the acute episode, independently from antibiotic duration. Short therapy was associated with a lower risk of urinary tract relapse (22 relapses (95.6%) in the standard group, 1 (4.4%) in the short group; OR 0.081; 95%CI 0.01–0.63). Conclusions: Short antibiotic therapy was equivalent to standard duration therapy for the cure of UTIs in hospitalized children and was also associated with a lower rate of recurrences. This study provides the basis for a larger prospective randomized study to address the role of short antibiotic therapies in children with UTIs requiring hospitalization
Sara Scarpini, Arianna Dondi, Camilla Totaro, Carlotta Biagi, Fraia Melchionda, Daniele Zama, Luca Pierantoni, Monia Gennari, Cinzia Campagna, Arcangelo Prete,et al.
MDPI AG
Visceral Leishmaniasis (VL) is a vector-borne disease caused by an intracellular protozoa of the genus Leishmania that can be lethal if not treated. VL is caused by Leishmania donovani in Asia and in Eastern Africa, where the pathogens’ reservoir is represented by humans, and by Leishmania infantum in Latin America and in the Mediterranean area, where VL is a zoonotic disease and dog is the main reservoir. A part of the infected individuals become symptomatic, with irregular fever, splenomegaly, anemia or pancytopenia, and weakness, whereas others are asymptomatic. VL treatment has made progress in the last decades with the use of new drugs such as liposomal amphotericin B, and with new therapeutic regimens including monotherapy or a combination of drugs, aiming at shorter treatment duration and avoiding the development of resistance. However, the same treatment protocol may not be effective all over the world, due to differences in the infecting Leishmania species, so depending on the geographical area. This narrative review presents a comprehensive description of the clinical picture of VL, especially in children, the diagnostic approach, and some insight into the most used pharmacological therapies available worldwide.
Daniele Dona’, Carlotta Montagnani, Costanza Di Chiara, Elisabetta Venturini, Luisa Galli, Andrea Lo Vecchio, Marco Denina, Nicole Olivini, Eugenia Bruzzese, Andrea Campana,et al.
MDPI AG
Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.
Luca Pierantoni, Giacomo Stera, Laura Andreozzi, Francesco Pellegrino, Arianna Dondi, Marianna Fabi, Ilaria Corsini, Chiara Ghizzi, and Marcello Lanari
Wiley
AIM
Adherence to croup management recommendations has been poorly investigated. This study aimed to describe the treatment patterns in two paediatric emergency departments and analyse the adherence to recommendations.
METHODS
We conducted a retrospective chart review of children diagnosed with croup in two Italian pediatric emergency departments in 2017. Data on clinical presentation, corticosteroid administration and home therapy were collected. Length of stay, hospitalisation and re-access rates were compared among different corticosteroid treatment groups.
RESULTS
We enrolled 632 patients (61.1% males) with a mean age of 42.8±55.1 months. Corticosteroids were administered to 403 (63.8%) children in the emergency departments. Dexamethasone was administered to 1 (0.4%) patient. Inhaled and oral corticosteroids were given to 342 (54.1%) and 226 (35.8%) patients, respectively. Home therapy was prescribed for 603 (95.4%) patients, either with inhaled (86.2%) and/or oral (43.8%) corticosteroids. The re-access rate was 2.8%. The actual pharmaceutical costs were an estimated 10 times higher than they would have been if the recommendations had been followed.
CONCLUSION
A significant gap between the evidence and clinical practice for croup treatment was observed. Improving adherence to the recommendations could lead to clinical and economic benefits.
Daniele Zama, Davide Leardini, Lorenzo Biscardi, Ilaria Corsini, Luca Pierantoni, Laura Andreozzi, and Marcello Lanari
MDPI AG
During the SARS-CoV-2 pandemic, the pediatric emergency department (ED) of Bologna, Emilia-Romagna, Italy faced a reorganization to better deal with the new clinical needs. We herein describe the main changes in the organization and in the attendances to our pediatric ED. From the 1 March 2020 to the 31 January 2022, 796 children positive for SARS-CoV-2 presented to our pediatric ED, but only 26 required hospitalizations, of which only 9 for COVID-19 related reasons. During this period, we also registered a temporal correlation between multisystem inflammatory syndrome in children (MIS-C) admissions and the peaks of SARS-CoV-2 infection in the Italian population. Respiratory syncytial virus (RSV) remained during last year the viral infection with the highest hospitalization rate. The analysis and description of the changes in the activity of the pediatric ED during the SARS-CoV-2 pandemic may help to better understand the routinary activity and be prepared for any possible new challenge.
Martina Giacalone, Luca Pierantoni, Valeria Selvi, Antonino Morabito, Michelangelo Baldazzi, Mario Lima, Marcello Lanari, Stefano Masi, Filippo Incerti, Francesca Fierro,et al.
Springer Science and Business Media LLC
Giovanni Autore, Luca Bernardi, Claudio La Scola, Filippo Ghidini, Federico Marchetti, Andrea Pasini, Luca Pierantoni, Claudia Castellini, Claudia Gatti, Cristina Malaventura,et al.
MDPI AG
Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.
Susanna Esposito, Giacomo Biasucci, Andrea Pasini, Barbara Predieri, Gianluca Vergine, Antonella Crisafi, Cristina Malaventura, Luca Casadio, Marcello Sella, Luca Pierantoni,et al.
Elsevier BV
Cristina De Rose, Luca Pierantoni, and Danilo Buonsenso
Springer Science and Business Media LLC
Since the beginning of the SARS-CoV-2 spread outside China, several hospitals have changed their organisation to increase critical care capacity and isolation areas to COVID19 patients as well as to generate new flows to guarantee safety and care to non-COVID-19 patients. In addition, the paediatric practice has changed completely. SARS-CoV-2 rarely involves children, and most of the time, the paediatric COVID-19 disease is mild [1]. Moreover, parents have stopped routinely bringing their children to the hospital either because of the fear that their children might contract the infection or because of a lockdownrelated drop of seasonal infectious diseases [2]. As a result, the workload of paediatricians has significantly reduced in the past few months [3], and therefore, their inclusion in COVID units should be considered by institutions. Although not directly involved in adult care, paediatricians may play a significant role in managing COVID19 patients for several reasons. From a clinical point of view, several common clinical scenarios can be included in COVID-19 adults that overlap with common paediatric conditions to which paediatricians, especially some categories of them, are already accustomed to their diagnosis and management (Table 1) [4, 5]. In the last few years, in several paediatric settings, lung ultrasound (LUS) has become the first-line imaging method in children evaluated for respiratory disease, allowing the real-time diagnosis and monitoring of lung involvement [6–13]. In recent years, several studies have shown that LUS is a useful and accurate tool for detecting pneumonia in children and it may be better than chest radiography in the diagnosis of community-acquired pneumonia [6–9, 13]. Other studies have shown that LUS can be used to predict more severe pneumonia and monitor antibiotic response, and recently, different LUS patterns have been used to differentiate viral from bacterial pneumonia by defining their etiology [6, 9, 13]. Many studies have described and validated LUS scores (based mainly on vertical artefacts and sub-pleural consolidations) in neonatal respiratory disorders [10] and bronchiolitis. [11, 12]. Over the years, the development of LUS studies on the paediatric population and the use of LUS in paediatric clinical practice have become fundamental in references to studies performed on adults [14, 15], hence the translation of knowledge acquired from these studies in the clinical paediatric practice. However, true collaboration between paediatric and adult specialists is also fundamental, especially in the interpretation of some ultrasound findings, such as in the cases of vertical artefacts and ultrasound interstitial syndrome [7, 14, 15]. Since the outbreak of the pandemic, this sharing/collaboration of experiences and studies has assumed a greater force that takes shape every day in the fight against COVID19. In particular, it is not a coincidence that of all medical professionals, a paediatrician not only suggested that the medical community use ultrasound more frequently in suspected COVID-19 patients but also described the first case of COVID-19 (an adult patient), diagnosed and managed with thoracic ultrasound [16–18]. Since then, LUS has played a key role in the management of patients with COVID-19 pneumonia. More importantly, the ultrasound patterns of viral pneumonia and bronchiolitis in children are similar to those seen in COVID-19 pneumonia patients (e.g. pleural line irregularities and vertical artefacts (B-lines) with patchy distribution, sub-pleural * Danilo Buonsenso danilobuonsenso@gmail.com