Objectives . This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates.  Methods.  Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Results.  Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children  < 4 years of age and in those with uncomplicated TB (p=0.008).  Conclusions.  Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.

Background: Lung ultrasound (US) proved useful in patients with COVID-19, but limited data are available about its use in affected children. Aim: Lung ultrasound (US) is in the front door in the assessment of patients with coronavirus disease 19 (COVID-19), but limited data are available about its use in affected children. We aimed to describe lung US features and discuss its potential applications in COVID-19 children considering the usually mild disease course. Methods: We performed lung US to children with COVID-19 admitted between March 1st and April 27th, 2020. Clinical and radiological data were collected. One or more subsequent lung US were obtained from all subjects. Results: A series of 13 confirmed COVID-19 children were recruited. 8/13 patients showed signs of respiratory interstitial syndrome as for focal or coalescent B-lines or white lung, also in the absence of relevant clinical symptoms. Conclusions: As clinical characteristics of pediatric COVID-19 differ from adults, it is of interest to determine whether pediatric lung US shares the same imaging pattern of adults and whether COVID-19 pneumonia may differ from other virus pneumonia. Our small series highlighted that lung US documented signs of interstitial pneumonia in paucisymptomatic or asymptomatic pediatric patients. In conclusion, we pinpoint the usefulness of point of care lung US for the evaluation of infected children correlated with clinical information.

Gastrointestinal symptoms are common findings in children with SARS-CoV-2 infection.Diarrhea and vomiting have been reported in about 8-9% of cases, reaching more than 20% in some studies. Children with gastrointestinal involvement appear to be younger than those without, but the severity of the disease seems to be similar between the two groups of subjects.Fecal shedding in children has been reported in 20-30% of children and has been observed both in those with and those without overt gastrointestinal involvement. Moreover, prolonged fecal elimination, lasting several days after negativization of real-time polymerase chain reaction assay on respiratory swabs, have been reported with variable frequency in children with SARS-CoV-2 infection. These observations raise the question regarding the possibility of oral-fecal transmission and the possible role of children in spreading the infection, particularly when they appear asymptomatic or with gastrointestinal symptoms but with no respiratory involvement, as well as during their convalescent phase.