Evaluation of post-infectious inflammatory reactions in a retrospective study of 3 common invasive bacterial infections in pediatrics
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Published on: June 29, 2021
Pauline Abraham1, Gregory Marin2, Anne Filleron3,4
1Service de pédiatrie, CH de Sète, Sète, France.
Insights
Post-infectious inflammatory reactions (PIIR) can occur in children after invasive bacterial infections. PIIR occurrence is linked to initial disease severity, not the specific bacteria causing the infection.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Clinical Research
Background:
- Infectious diseases can trigger unexpected post-infectious inflammatory reactions (PIIR).
- Understanding PIIR in common pediatric bacterial infections is crucial for clinical management.
Purpose of the Study:
- To investigate the incidence and characteristics of PIIR in children hospitalized for invasive Streptococcus pneumoniae, Neisseria meningitidis, or Streptococcus pyogenes infections.
- To identify risk factors associated with PIIR development in pediatric patients.
Main Methods:
- Retrospective monocentric study of children hospitalized between 2003 and 2012.
- Inclusion criteria: invasive infections by S. pneumoniae, N. meningitidis, or S. pyogenes; PIIR onset 3-15 days post-infection without fever despite antibiotics.
- Descriptive analysis and multivariate analysis to determine PIIR risk factors.
Main Results:
- 189 pediatric patients were included; 39 developed PIIR (20.6%).
- PIIR occurred a median of 8 days after infection and lasted 3 days.
- Associated factors for PIIR included pleuropneumonia, intensive care unit (ICU) admission, and elevated C-reactive protein (CRP).
- Fever, arthritis, and pleural effusion were common symptoms during PIIR.
Conclusions:
- PIIR are observed in approximately 20% of children following invasive S. pneumoniae, N. meningitidis, or S. pyogenes infections.
- PIIR development is associated with the initial severity of the infection, such as pleuropneumonia and ICU admission, rather than the specific etiological microorganism.
- Further research is needed to validate these findings and elucidate the mechanisms of PIIR.
Abstract:
Infectious diseases can result in unanticipated post-infectious inflammatory reactions (PIIR). Our aim was to explore PIIR in 3 frequent pediatric bacterial invasive infections in France by a retrospective monocentric study. We included children hospitalized between 2003 and 2012 for Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), or Streptococcus pyogenes invasive infections. The PIIR had to have occurred between 3 and 15 days without fever despite an individually tailored antibiotic therapy. A descriptive analysis was carried out to determine PIIR risk factors. We included 189 patients, of whom 72, 79, and 38 exhibited invasive infections caused by S pyogenes, SP, and NM, respectively. The mean age was 44 months. PIIR were observed in 39 cases, occurring after a median of 8 days (5-12), with a median duration of 3 days (2-6). Fever, arthritis, and pleural effusion were observed in 87%, 28.2%, and 25.6%, respectively. In multivariate analysis, PIIR were associated with pleuropneumonia, hospitalization in an intensive care unit (ICU), and elevated C-reactive protein (CRP). PIIR were observed in 20% of children after SP, NM, or S pyogenes invasives infections. Their occurrence was associated with the initial severity but not the etiological microorganism. Further studies are warranted to confirm these findings.
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