Paediatrics (RCH) - Research Publications

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Author: Buttery, Jim × Author: Crawford, Nigel × Author: Steer, Andrew × End date: 2022 × Start date: 2020 ×

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    A case report describing the immune response of an infant with congenital heart disease and severe COVID-19
    Wurzel, D ; Neeland, MR ; Anderson, J ; Abo, Y-N ; Do, LAH ; Donato, CM ; Bines, JE ; Toh, ZQ ; Higgins, RA ; Jalali, S ; Cole, T ; Subbarao, K ; McMinn, A ; Dohle, K ; Haeusler, GM ; McNab, S ; Alafaci, A ; Overmars, I ; Clifford, V ; Lee, L-Y ; Daley, AJ ; Buttery, J ; Bryant, PA ; Burgner, D ; Steer, A ; Tosif, S ; Konstantinov, IE ; Duke, T ; Licciardi, PV ; Pellicci, DG ; Crawford, NW (SPRINGERNATURE, 2021-11-15)
    BACKGROUND: Children with SARS-CoV-2 infection generally present with milder symptoms or are asymptomatic in comparison with adults, however severe disease occurs in a subset of children. To date, the immune correlates of severe COVID-19 in young children have been poorly characterised. METHODS: We report the kinetics of immune responses in relation to clinical and virological features in an infant with acute severe COVID-19 using high-dimensional flow cytometry and multiplex cytokine analysis. RESULTS: Systemic cellular and cytokine profiling show an initial increase in neutrophils and monocytes with depletion of lymphoid cell populations (particularly CD8 + T and NK cells) and elevated inflammatory cytokines. Expansion of memory CD4 + T (but not CD8 + T) cells occurred over time, with a predominant Th2 bias. Marked activation of T cell populations observed during the acute infection gradually resolved as the child recovered. Substantial in vitro activation of T-cell populations and robust cytokine production, in response to inactivated SARS-CoV-2 stimulation, was observed 3 months after infection indicating durable, long-lived cellular immune memory. CONCLUSIONS: These findings provide important insights into the immune response of a young infant with severe COVID-19 and will help to inform future research into therapeutic targets for high-risk groups.
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    Invasive group A Streptococcus disease in Australian children: 2016 to 2018 - a descriptive cohort study (vol 19, 1750, 2019)
    Oliver, J ; Thielemans, E ; McMinn, A ; Baker, C ; Britton, PN ; Clark, JE ; Marshall, HS ; Blyth, CC ; Francis, J ; Buttery, J ; Steer, AC ; Crawford, NW (BMC, 2021-05-03)
    An amendment to this paper has been published and can be accessed via the original article.
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    Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease
    Thielemans, E ; Oliver, J ; McMinn, A ; Baker, C ; Britton, PN ; Clark, J ; Marshall, H ; Blyth, CC ; Francis, J ; Buttery, J ; Smeesters, PR ; Crawford, N ; Steer, AC (LIPPINCOTT WILLIAMS & WILKINS, 2020-05)
    BACKGROUND: Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short- and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short- and longer-term outcomes of invasive group A streptococcal disease in children in Australia. METHODS: We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes. RESULTS: We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twenty-six children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively. CONCLUSIONS: Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiologic surveillance and prevention strategies.