this event is credited with emc points silver partnerssrbip.ro/doc/program.pdf · jesus saavedra...

www.srbip.ro/espid

25-26TH

NOVEMBER

2016

EUROPEAN SOCIETY OF PEDIATRICINFECTIOUS DISEASES (ESPID)SUPPORTED TEACHING COURSE

BRAŞOV ROMANIA

THIS EVENT IS CREDITED WITH 12 EMC POINTS

EAST-EUROPEAN AND MEDITERRANEANTEACHING COURSE ON PEDIATRICINFECTIOUS DISEASES

www.srbip.ro/espid

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

GOLD PARTNERS

PLATINUM PARTNER

SILVER PARTNERS

9

8

9TH EUROPEAN SOCIETY OF PEDIATRIC INFECTIOUS DISEASES (ESPID) SUPPORTED TEACHING COURSE8TH EAST-EUROPEAN AND MEDITERRANEAN TEACHING COURSE ON PEDIATRIC INFECTIOUS DISEASES

2

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 onPediatric 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 andTransilvania 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, Span-ish 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)

25TH-26TH

NOVEMBER 2016AULA OF THE TRANSILVANIA UNIVERSITY

BRAŞOV, ROMÂNIA

3

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)

INTERNATIONAL SCIENTIFIC COMMITTEE

HONORARY CHAIRMANRon Dagan (Israel)

CHAIRMANOana Falup-Pecurariu (Romania)

SCIENTIFIC SECRETARIATNational Romanian Society of Pediatric Infectious Diseases

www.srbip.ro Children’s Clinic Hospital

Braşov, RomaniaEmail: [email protected]

Tel: 0721 243 768

Eugen Bleotu Laura Bleotu

Emanuela Cojocaru Oana Falup-Pecurariu

Elena Maria GeorgescuRaluca Lixandru

Alice MercasMarius Moga

Gabriel Moraru Liviu Muntean

Liliana Rogozea

Raluca LixandruElena-Carmen Niculescu

Ron Dagan Aurica Rugina

Adriana Slavcovici Ligia Stanescu

LOCAL ORGANIZING COMMITTEE

POSTER COMMITTEE

4


CONTENTS

FEATURES.......................................................

FACULTY..........................................................

PROGRAMME.................................................

ABSTRACTS....................................................

BIOGRAPHIES................................................

POSTER PRESENTATIONS............................

p. 5

p. 6

p. 10

p. 15

p. 39

p. 65

>

>

>

>

>

>

25TH-26TH


BRAŞOV, ROMÂNIA

FEATURESTARGET AUDIENCEThe Teaching Course is designed for pediatricians, infectious diseases specialists,

epidemiologists, general physicians. Senior physicians, residents, fellows, students may

find this education of value

LEARNING OBJECTIVESAfter 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 EDUCATIONThis 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.


6

Mihaela Balgradean

University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania

Emmanouil Galanakis

Department of Paediatrics, Heraklion University General Hospital, University of Crete, Greece

FACULTY

Ron Dagan

Pediatric Infectious Disease Unit, Soroka University Medical Cen-ter, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Andrei Babus

Sanofi Pasteur Romania

Saul Faust

University Hospital Southampton NHS Foundation Trust, University of Southampton, UK

Shalom Ben Shimol

Pediatric Infectious DiseaseUnit, Soroka University MedicalCenter, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Oana Falup-Pecurariu

Children’s Clinic Hospital, Faculty of Medicine, Transilvania University, Braşov, România

Laura Iulia Bozomitu

Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Romania.

25TH-26TH


BRAŞOV, ROMÂNIA

7

Evelina Moraru

Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Romania

Tudor Pop

2nd Pediatric Clinic,Department Mother and Child,University of Medicineand Pharmacy “Iuliu Hatieganu”Cluj-Napoca, Romania

Jesus Saavedra

Infectious Disease Unit, Gregorio Marañón Hospital, Complutense University, Madrid, Spain

Joseph Standing

Great Ormond Street Hospital, In-stitute of Child Health, University College London, UK

Cheng-Hsun Chiu

Department of Pediatrics at the Chang Gung Children’s Hospital, Chang Gung University, Taipei, Taiwan

Cristian Gheonea

Faculty of Medicine,University of Medicine and Pharmacy Craiova, Romania

Eugen Leibovitz

Pediatric Infectious Diseases Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

David Greenberg

Pediatric Infectious Disease Unit, Soroka University Medical center, Ben-Gurion University of NegevBeer-Sheva, Israel


8

Corneliu Popescu


Theoklis Zaoutis

Perelman School of Medicine at the University of Pennsylvania (PENN), Division of Infectious Diseases at the Children’s Hos-pital of Philadelphia (CHOP), USA

FACULTY

Alexandru Rafila


Hermione Lyall

Pediatric infectious diseases Chief of service for Children at Imperial College Healthcare NHS Trust, London, UK

Pablo Rojo

Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre Madrid, Spain

Emmanuel Roilides

Aristotle University School of Medicine at HippokrationHospital in Thessaloniki,Greece

25TH-26TH


BRAŞOV, ROMÂNIA

9


10

Day 1 – 25th November 201608:00-09:00 Registration and general information

09:00-09:25 WelcomeCourse 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


PROGRAMME

25TH-26TH


BRAŞOV, ROMÂNIA

11

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


12

Day 2 – 26th November 2016CHAIRPERSONS: 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


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

PROGRAMME

25TH-26TH


BRAŞOV, ROMÂNIA

13

15:45-16:20 Shalom Ben-Shimol (Israel)Pneumococcal vaccines impact


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 EvaluationEnd of course

14


25TH-26TH


BRAŞOV, ROMÂNIA

ABSTRACTS →


16

MICROBIOTA GARDENING: HOW TO GET GREEN FINGERS?

Gheonea Cristian, Niculescu Carmen Elena, Stanescu Ligia GeorgetaUniversity 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 “health-beneficial 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.

25TH-26TH


BRAŞOV, ROMÂNIA

17

INVESTIGATING CHILDREN WITH RECURRENT INFECTIONS

Saul FaustUniversity 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.


18

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.

25TH-26TH


BRAŞOV, ROMÂNIA

19

THE VIA DOLOROSA OF PERTUSSIS VACCINATION: SHOULD WE BE HAPPY, SAD OR JUST CONCERNED?

Ron DaganBen-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.


20

ANTIBIOTIC USE IN OUTPATIENT SETTING FOR COMMON INFECTIONS

Theoklis ZaoutisPerelman 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.

25TH-26TH


BRAŞOV, ROMÂNIA

21

MANAGEMENT OF INVASIVE FUNGAL INFECTIONS IN NEONATES

Emmanuel RoilidesAristotle 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.


22

NEW HIGHLIGHTS REGARDING DIAGNOSIS AND TREATMENT OF CHRONIC HEPATITIS C INFECTION IN CHILDREN

Evelina Moraru2nd 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.

25TH-26TH


BRAŞOV, ROMÂNIA

23

URINARY TRACT INFECTIONS 2016

Emmanouil GalanakisDepartment 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.


24

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.

25TH-26TH


BRAŞOV, ROMÂNIA

25

VACCINATION CONVERSATIONS IN SOCIAL MEDIA

Andrei BabusSanofi 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.


26

UPDATE ON THE VIRAL HEPATITIS IN CHILDREN

Tudor L. Pop2nd 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.

25TH-26TH


BRAŞOV, ROMÂNIA

27

ETIOLOGY OF BACTERIAL PHARYNGITIS AT CHILDREN

Alexandru Rafila, Daniela TalapanNational 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.


28

EMERGING NOROVIRUS INFECTION IN POST-ROTAVIRUS VACCINE ERA, TAIWAN

Cheng-Hsun ChiuDivision 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.

25TH-26TH


BRAŞOV, ROMÂNIA

29

PHARMACOKINETICS AND PHARMACODYNAMICS OF ANTIMICROBIAL AGENTS IN CHILDREN

Joseph StandingGreat Ormond Street Hospital, Institute of Child Health, University College London, UK

Pharmacokinetic/pharmacodynamic (PKPD) modelling is the study of the dose-concentration-effect 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.


30

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.

25TH-26TH


BRAŞOV, ROMÂNIA

31

PULMONARY TUBERCULOSIS IN CHILDREN: MANAGEMENT OF A CHILD-CARE CENTER OUTBREAK

Jesús Saavedra-LozanoInfectious 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 life-threatening 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.


32

COMMUNITY-ACQUIRED S. AUREUS INFECTIONS IN CHILDREN IN EUROPE

Pablo RojoPediatric 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 Panton- Valentine 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.

25TH-26TH


BRAŞOV, ROMÂNIA

33

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

Eugen LeibovitzPediatric 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.


34

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.

25TH-26TH


BRAŞOV, ROMÂNIA

35

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.


36

PNEUMOCOCCAL VACCINES IMPACT

Shalom Ben-ShimolPediatric 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 vaccine-type pneumococcal serotype in the etiology of mucosal syndromes, such as pneumonia and otitis media.

25TH-26TH


BRAŞOV, ROMÂNIA

37

PNEUMOCOCCAL CONJUGATED VACCINES – EFFICACY, EFFECTIVENESS AND IMPACT; WHAT HAVE WE LEARNED FROM VACCINE PROBE

David GreenbergPediatric 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 co-infection, 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.

38


THE FUTURE OF INFECTIOUS DISEASES RISING OF A STAR: CLOSTRIDIUM DIFFICILE

Oana Falup-PecurariuChildren’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.

25TH-26TH


BRAŞOV, ROMÂNIA

BIOGRAPHIES →


40

CRISTIAN GHEONEADr. 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.

25TH-26TH


BRAŞOV, ROMÂNIA

41

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.


42

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 ).

25TH-26TH


BRAŞOV, ROMÂNIA

43

RON DAGANRon 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.


44

THEOKLIS ZAOUTISTheoklis 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 peer-reviewed 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 Hospital-based 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.

25TH-26TH


BRAŞOV, ROMÂNIA

45

EMMANUEL ROILIDESEmmanuel 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.


46

TUDOR POPTudor 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).

25TH-26TH


BRAŞOV, ROMÂNIA

47

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

LAURA IULIA BOZOMITU


48

EVELINA MORARUEvelina 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.

25TH-26TH


BRAŞOV, ROMÂNIA

49

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.


50

ANDREI BABUSI 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.

25TH-26TH


BRAŞOV, ROMÂNIA

51

TUDOR L. POPTudor 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.


52

ALEXANDRU RAFILAProfessor 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.

25TH-26TH


BRAŞOV, ROMÂNIA

53

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.


54

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.

25TH-26TH


BRAŞOV, ROMÂNIA

55

MIHAELA BALGRADEANI 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 hands-on-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.


56

JESUS SAAVEDRAMedicine 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).

25TH-26TH


BRAŞOV, ROMÂNIA

57

PABLO ROJOPablo 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.


58

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 2008-2016 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.

25TH-26TH


BRAŞOV, ROMÂNIA

59

CORNELIU PETRU POPESCUDr. 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).


60

SHALOM BEN-SHIMOLDr 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.

25TH-26TH


BRAŞOV, ROMÂNIA

61

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 Ben-Gurion 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.


62

OANA FALUP-PECURARIUDr. 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 Cluj-Napoca, 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.

25TH-26TH


BRAŞOV, ROMÂNIA

63

64


25TH-26TH


BRAŞOV, ROMÂNIA

POSTERS →


66

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 motor-sensory 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.

25TH-26TH


BRAŞOV, ROMÂNIA

67

INFECTIOUS MONONUCLEOSIS IN BIHOR COUNTY

Monica Csep1, Andrei Csep2

1 „Gavril Curteanu” Clinical Hospital Oradea2 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.


68

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.

25TH-26TH


BRAŞOV, ROMÂNIA

69

DIFFICULTIES OF ANTIINFECTIVE THERAPY IN CHILDREN WITH PRIMARY IMMUNODEFICIENCY

Sorin Ioan IurianPediatric 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.


70

ROTAVIRUS GASTROENTERITIS IN VACCINATION ERA - CASES STUDY

Monica Alexoae, Aurica Rugină, Bogdan Stana, Alice Azoicai, Ileana IoniucII 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. „

25TH-26TH


BRAŞOV, ROMÂNIA

71

EFFECTIVENESS OF AZITHROMYCIN IN TRAVELER’S DIARRHEA IN CHILDREN

Radu Spineanu, Cristian Sava, Simona Cheregi, Laura Lele, Andrei Csep, Diana Dubău, Ioan MagyarUniversity 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.


72

DIFFERENTIAL DIAGNOSIS DIFFICULTIES IN MUCOCUTANEOUS ERUPTIONS IN CHILDREN

Mătăcuţă Ioana, Stănişor Paula RoxanaSibiu 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.

25TH-26TH


BRAŞOV, ROMÂNIA

73

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 Moraru2nd 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, low-grade 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.


74

TETANUS IN A 3-YEAR OLD BOY - A CASE REPORT

Man Anca Maria , Potorac Andreea, Lăpuşte SimonaEmergency Children’s Hospital, Cluj Napoca

Introduction: Tetanus is a serious infection caused by Clostridium tetani. The disease can befatal if left untreated and can be prevented by proper immunization with thetetanus 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-preventablediseases is to take the vaccine.

25TH-26TH


BRAŞOV, ROMÂNIA

75

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 “Dr. Victor Babes” Hospital Bucharest2 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.


76

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 Spital Clinic de Pneumoftiziologie Iasi2 ”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.

25TH-26TH


BRAŞOV, ROMÂNIA

77

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 Children’s Clinical Hospital, Braşov, Romania2 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.


78

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 Azoicai2nd 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.

25TH-26TH


BRAŞOV, ROMÂNIA

79

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).


80

SEVERE SEPSIS WITH CUTANEOUS AND PULMONARY COMPLICATIONS IN AN INFANT WITH VARICELLA

Ligia Rodina¹, Ioana Mihaela Popescu¹, Maria Elena Cocuz²1 Infectious Disease Hospital, Brasov, Romania2 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.

25TH-26TH


BRAŞOV, ROMÂNIA

81

INFECTIONS IN CHILDREN WITH DIABETES MELLITUS TYPE 1

Drochioi Ana Simona1, Oltean Carmen2, Bizim Delia2, Diaconu Ramona², Anton-Paduraru Dana-Teodora1

1 ”Gr.T.Popa” University of Medicine and Pharmacy Iasi, Romania - Discipline of Pediatrics2 ”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.


82

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

1 Children’s Emergency Hospital, Cluj-Napoca2 “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca3 Infectious Diseases Hospital, Cluj-Napoca

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.

25TH-26TH


BRAŞOV, ROMÂNIA

83

NURSES’ ATTITUDE TOWARDS PROVACCINATION - A SURVEY IN NURSING SCHOOLS

Klara I. Sarbu1, Laura Repciuc2, I.Cojocariu3, Gina Lazurca,Elizabeth Tcaciuc, Laura Irimescu1 CF Hospital Iasi2 Nurse, Scoala Postliceala Sanitara ”Laureatus” Siret3 Student, Scoala Postliceala Sanitara “Laureatus” Siret

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.


84

ATYPICAL CAMPYLOBACTER REACTIVE ARTHRITIS - A CASE REPORT

Pop Irina1, Roxana Iubu2, Otilia Fufezan3

1 Cluj-Napoca Children’s Hospital, Second Paediatric Clinic, Romania2 Cluj-Napoca Infectious Disease Hospital, Romania3 Cluj-Napoca Children’s Hospital, Third Paediatric Clinic, Romania

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.

25TH-26TH


BRAŞOV, ROMÂNIA

85

EXTRA DIGESTIVE MANIFESTATION OF HELICOBACTER PYLORI INFECTION – REACTIVE ARTHRITIS

Ileana Ioniuc, Alice Azoicai, Alina Murgu, Bogdan Stana, Smaranda Diaconescu, Monica AlexoaeUniversitatea de Medicină și Farmacie “Gr. T. Popa” IasiClinica II Pediatrie, Spitalul Clinic de Urgente pentru Copii “Sf. Maria” IasiClinica 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.


86

HEMORRHAGIC PLEURAL EFFUSION IN ASSOCIATION WITH VARICELLA INFECTION IN A 3 YEARS OLD PATIENT - CAUSES AND MANAGEMENTAlexandra Coroleuca, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen ZapucioiuSCUC 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.

25TH-26TH


BRAŞOV, ROMÂNIA

87

THE IMPORTANCE OF URINALYSIS IN NON-FEBRILE NEONATES WITH BRONCHIOLITIS: A CASE REPORT

Ruian Raluca, Belecciu Andreea, Oana Falup-PecurariuFaculty 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, RDW-CV 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.


88

THE EFFECT OF ZINC THERAPY ON WEIGHT IN CHILDREN WITH ACUTE DIARRHEANicoleta M NegruţDepartment 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.

25TH-26TH


BRAŞOV, ROMÂNIA

89

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.


90

RISK FACTORS FOR BRONCHIOLITIS AT INFANTS IN BRASOV AREABettina L.Boeriu1, Oana Falup-Pecurariu1,2

1 Faculty of Medicine, Transilvania University, Brasov, Romania2 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 cost-effectiveness 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.

25TH-26TH


BRAŞOV, ROMÂNIA

91

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, Cluj-Napoca, Romania2 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.


92

ACUTE INFECTION WITH EPSTEIN-BARR VIRUS IN CHILDREN – CURRENT EPIDEMIOLOGICAL AND CLINICALASPECTS

Cocuz Maria-Elena1,2, Rodina Ligia2, Butnariu Gianina2, Neagu Ionut2, Cocuz Iuliu Gabriel3

1 Faculty of Medicine, University Transilvania of Brasov2 Clinical Infectious Diseases Hospital of Brasov3 University of Medicine and Pharmacy Targu-Mures

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.

25TH-26TH


BRAŞOV, ROMÂNIA

93

NEUROLOGICAL MANIFESTATION OF ROTAVIRUS INFECTION IN CHILDREN: A RETROSPECTIVE STUDY

Anca Stefania Vulcan, Irina LimbasanClinical 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.


94

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, IasiUniversity 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.

25TH-26TH


BRAŞOV, ROMÂNIA

95

RE-EMERGENCE OF CHILDHOOD VISCERAL LEISHMANIASIS IN CRETE

Christina Kamari, Marilia Lioudaki, Chrysoula Perdikogianni, Emmanouil GalanakisDepartment 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.


96

PERIPHERAL LYMPHADENITIS CAUSED BY NON-TUBERCULOUS MYCOBACTERIA IN SPAIN: A MULTICENTER STUDY

Teresa del RosalHospital La Paz, Madrid, Spain

Background: Cervico-facial lymphadenitis is the most common manifestation of non-tuberculous 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

25TH-26TH


BRAŞOV, ROMÂNIA

97

underwent surgery and 23 did not, without difference in outcome in regard to lack of long-term 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.


98

PNEUMONIA IN TWIN NEWBORNS - A CASE PRESENTATION

Nedelcuţă Ramona1, Călin Gigi1, Popescu Mirela2

1 Filantropia Hospital Craiova2 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.

25TH-26TH


BRAŞOV, ROMÂNIA

99

ISSN 2392 – 8751

FINANCIALSUPPORTED

by

ESPID

www.srbip.ro/espid

25-26TH

NOVEMBER

2016

EUROPEAN SOCIETY OF PEDIATRICINFECTIOUS DISEASES (ESPID)SUPPORTED TEACHING COURSE

BRAŞOV ROMANIA

THIS EVENT IS CREDITED WITH 12 EMC POINTS

EAST-EUROPEAN AND MEDITERRANEANTEACHING COURSE ON PEDIATRICINFECTIOUS DISEASES

www.srbip.ro/espid

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

GOLD PARTNERS

PLATINUM PARTNER

SILVER PARTNERS

9

8

ISSN 2392 – 8751

this event is credited with emc points silver partnerssrbip.ro/doc/program.pdf · jesus saavedra...

Documents