Crescenzo Coppola

Pediatric malaria in non-endemic regions poses diagnostic and management challenges, particularly in the context of migration and international travel. This study aimed to characterize clinical, laboratory, and epidemiological features of pediatric malaria in a European non-endemic setting and to evaluate whether presumed immune status influences disease severity. We conducted a retrospective study of children diagnosed with malaria at a tertiary center in Milan, Italy (2004-2024). Patients were stratified by presumed immune status into Non-Immune (NI) (Italian-born) and Presumed-Immune (PI) (foreign-born or frequent travelers to endemic areas). Differences between groups were analyzed using the Mann-Whitney U and Fisher's exact tests. Associations between laboratory markers (serum sodium, C-reactive protein [CRP], and platelet count) and clinical outcomes (length of hospital stay and fever duration) were evaluated using Spearman's rank correlation (ρ). Seventy-four cases were included (59% male; median age 9.0 years). Patients were stratified into Non-Immune (NI, 47.3%) and Presumed-Immune (PI, 52.7%) groups; the PI group was significantly older (p < 0.001). P. falciparum (62.2%) and P. vivax (27%) were the main species. Severe malaria (WHO 2015 criteria) occurred in 23% of patients, with no significant difference between NI and PI groups (p = 0.783). Spearman's analysis showed that serum sodium levels were inversely associated with length of hospital stay (ρ = - 0.284, p = 0.020), while CRP levels correlated positively with fever duration (ρ = 0.256, p = 0.033) and strongly negatively with platelet counts (ρ = - 0.585, p < 0.001). A significant therapeutic shift occurred post-2015, with intravenous artesunate replacing quinine as the gold standard treatment for severe malaria. Pediatric malaria severity and biochemical profiles appeared largely independent of presumed immune status in non-endemic settings. Clinical outcomes were more closely associated with admission laboratory markers-particularly hyponatremia and elevated CRP levels-than with geographic proxies of immunity. The adoption of intravenous artesunate as first-line therapy after 2015 was associated with improved clinical management. These findings highlight the need for careful monitoring of all pediatric malaria cases, regardless of prior exposure, as traditional classifications based on presumed immunity may not reliably predict disease severity.

Background/Objectives: To summarize the available evidence on the use of corticosteroids in the treatment of pediatric Mycoplasma pneumoniae pneumonia, including severe and refractory forms. Methods: We conducted a narrative literature review of studies published between 2000 and 2024 that investigated corticosteroid therapy in children with Mycoplasma pneumoniae pneumonia, including various clinical presentations such as severe Mycoplasma pneumoniae pneumonia and refractory Mycoplasma pneumoniae pneumonia. Both randomized controlled trials and observational studies were included. Results: Early administration of corticosteroids, particularly within 24–36 h of hospital admission, was associated with improved clinical outcomes, including faster fever resolution, shorter hospital stay, and enhanced radiological recovery. High-dose regimens (≥5 mg/kg/day) or pulse therapy appeared effective in severe or refractory cases, while inhaled corticosteroids showed benefit in milder forms. Predictive factors for corticosteroid response included elevated C-reactive protein, lactate dehydrogenase, and ferritin levels. The overall safety profile was acceptable, with minimal adverse effects reported in most studies. Conclusions: Corticosteroids may play a beneficial role as adjunctive therapy in pediatric Mycoplasma pneumoniae pneumonia, especially in selected cases. However, further high-quality studies are required to define optimal timing, dosage, and patient selection.

The purpose of this narrative review is to analyze the most recent studies about the role of C-reactive protein (CRP) and procalcitonin (PCT), two of the main biomarkers of infection, in distinguishing viral from bacterial etiology, in predicting the severity of infection and in guiding antibiotic stewardship in children with community-acquired pneumonia (CAP). The studies examined reveal that both CRP and PCT play a valuable role in diagnosing pediatric CAP, though each has limitations. CRP has moderate accuracy in distinguishing bacterial from viral infections, but its elevated levels are not exclusive to bacterial infections; PCT, however, shows higher specificity for bacterial CAP, with studies confirming its ability to differentiate bacterial causes, especially in severe cases. When integrated with clinical findings, CRP and PCT improve the sensitivity of pneumonia diagnoses and help in predicting severe outcomes such as sepsis and empyema; furthermore, both biomarkers prove useful in guiding antibiotic therapy, with PCT showing a more dynamic response to treatment. However, even though CRP and PCT offer valuable insights into the diagnosis and management of pediatric CAP, their application should be always integrated with clinical assessment rather than used in isolation. More studies are needed to define standardized thresholds and decision algorithms that incorporate these biomarkers.

Rivista di formazione e di aggiornamento professionale del pediatra e del medico di base, realizzata in collaborazione con l'Associazione Culturale Pediatri

Rivista di formazione e di aggiornamento professionale del pediatra e del medico di base, realizzata in collaborazione con l'Associazione Culturale Pediatri