Along with the emergence of coronavirus disease 2019 (COVID-19), a hyperinflammatory multisystemic syndrome in children called PIMS appeared. Despite its close similarity to the Kawasaki disease (KD), the conclusion of PIMS being a distinct disease entity was reached quickly. Since then, research projects have been implemented to find differences and reliable distinction parameters with conflicting results. Therefore, the aim of this study was to explore existing prognostic models on their ability to distinguish the diagnoses. Two externally developed prognostic models were applied to 2 distinct datasets: one consisting solely of 26 KD and PIMS cases from Bayreuth, the other comprising 632 cases of both diagnoses reported by pediatricians from all over Germany and Innsbruck, Austria. The potential of the models to distinguish the diagnoses on a phenotypic level was evaluated based on their sensitivities and specificities, κ-coefficients by Cohen and correlation analysis. The sensitivity and specificity of both prognostic models did not display a reliable distinguishability between KD and PIMS. Moreover, correlation analysis cannot confirm the correlation of most parameters utilized in the models with the PIMS diagnosis. The only parameter showing a positive correlation in both datasets was the patients' older age. These findings are congruent with the general inconclusiveness in research concerning the distinction of KD and PIMS. We could not reproduce a distinguishability using the models or a correlation between the utilized parameters and PIMS except for one. Henceforth, research will need to focus on nonphenotypical properties for differentiation of KD and PIMS.
No analyses have explored the differential clinical characteristics of cyclosporiasis compared with other diarrheal etiologies. We conducted a prospective study of 118 children with diarrheal illnesses. Stool samples were analyzed using Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) targeting the ssu rRNA gene. Positive PCR samples were sequenced to identify phylogroups (A, B and C). Quantitative variables were compared using the Mann-Whitney U test. Qualitative associations were analyzed using odds ratios (ORs) and Fisher exact or χ2 tests. A parsimonious multivariate logistic regression identified independent predictors while controlling for sample size effects. Cyclosporiasis was identified in 18.6% (n = 22) by ZN and 19.5% (n = 23) by PCR. Diagnostic agreement was substantial (kappa = 0.81). Stool pH was significantly more alkaline in the ZN-positive group (median: 7.5, range: 4.0-9.0) than in the negative group (median: 6.0, range: 4.0-9.0; P = 0.0206). High-output diarrhea (OR = 3.58; 95% confidence interval: 1.29-9.94; P = 0.011) and abdominal pain (OR = 3.05; 95% confidence interval: 1.16-7.99; P = 0.020) were the primary clinical hallmarks of cyclosporiasis. Lineage B was the endemic strain, causing most acute, high-output secretory diarrhea cases. The parasite was found in domestic water and food (coriander) with 100% identity with lineage B. Pediatric Cyclospora infection presents with a distinct clinical triad: high-volume watery diarrhea, abdominal pain and alkaline stool Ph. Lineage B is the drive core of cases with waterborne transmission as a primary pathway.
Bloodstream infections (BSIs) are associated with a high mortality ratio among critically ill children. BSIs caused by multidrug-resistant (MDR) bacteria are a challenge due to limited therapeutic options. In this multicenter cohort study, factors associated with death of children with bacterial laboratory-confirmed BSI (LC-BSI) admitted to the intensive care unit (ICU) were analyzed, with a focus on MDR bacterial infection and appropriateness of therapy. A prospective cohort of children aged ≤18 years with LC-BSI, and admitted to 9 ICUs, was conducted from January 1, 2016, to December 31, 2018, in Rio de Janeiro, Brazil. Risk factors of 30- and 7-day death of LC-BSI were identified using multivariable logistic regression analyses. Two hundred thirty-eight LC-BSI episodes occurred in 215 patients; 31.1% were caused by MDR bacteria. Inappropriate initial antibiotic therapy and definitive antibiotic therapy were administered in 50.4% and 8.4% of the episodes, respectively. The 30- and 7-day mortality ratios were 18.5% and 8.8%, respectively. Hematologic disease as primary condition, pediatric risk of mortality score ≥20 on date of LC-BSI, use of vasopressors, ICU-acquired BSI and LC-BSI from hospital B were independently associated with 30-day death. Inappropriate definitive antibiotic therapy; infectious disease, congenital heart disease and hematologic disease as primary conditions; PRISM score ≥20 at the time of LC-BSI; use of/vasopressors and LC-BSI secondary to respiratory tract or intra-abdominal infection were independently associated with 7-day death. Key clinical and healthcare-related factors associated with mortality in LC-BSI were identified.
The prevalence of Staphylococcus aureus endocarditis (SAE) in children with S. aureus bacteremia (SAB) varies widely and is generally lower than that in adults. This study aimed to determine the prevalence of SAE in pediatric patients with SAB and to identify the associated clinical risk factors. This retrospective study included all children aged 0-18 years diagnosed with SAB at a university hospital in Thailand between 2003 and 2023, identified using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes. Endocarditis was defined using the modified Duke criteria, in accordance with the 2023 European Society of Cardiology guidelines for the management of endocarditis. Among the 171 children with SAB, 15 (8.8%) met the criteria for definite infective endocarditis. Methicillin-sensitive S. aureus was the predominant pathogen in both uncomplicated SAB and SAB complicated by endocarditis. Congenital heart disease was significantly associated with SAE (P = 0.02). Additional risk factors included protein-energy malnutrition (PEM) (P = 0.04) and more than 2 positive blood cultures (P = 0.001), whereas immunocompromised status was associated with a reduced risk (P < 0.001). Both SAB and SAE were associated with prolonged hospitalization and increased mortality. SAE occurred in 8.8% of pediatric SAB cases. Congenital heart disease, protein-energy malnutrition and persistent bacteremia were key predictors of SAE. In settings where echocardiography is not immediately accessible, these clinical risk factors can guide the early identification of high-risk patients and support decisions regarding monitoring intensity and timely referral. Larger prospective studies are needed to validate these associations and to facilitate the development of practical prediction tools for pediatric SAE.
Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children. The impact of viral factors like RSV subtype and viral load (VL) on disease severity remains unclear. We screened 1171 hospitalized children ≤3 years of age with respiratory symptoms in winter seasons (2017-2020) for RSV infection by Reverse Transcription Polymerase Chain reaction. Disease severity was assessed using length of hospital stay and a previously validated disease severity score (RSV-CLASS, range 0-4, higher scores indicating more severe disease). Univariate/multivariate analyses were performed to identify predictors of VL. In total, n = 351/1171 children were tested RSV positive (RSV A: n = 146/351 [41.6%], RSV B: n = 205/351 [58.4%]) with a median VL of 4.7 × 108 (interquartile range [IQR] 5.6 × 107 to 1.3 × 109). The median age was 3.5 months (IQR 1.5-11.0), and most children were <6 months (n = 223/351 [63.5%]). Bronchiolitis was the leading admission diagnosis, and children were hospitalized for a median duration of 3 days (IQR 2-5), and the median RSV-CLASS disease severity score value was 2 (IQR 1-3). Higher clinical severity scores were observed in children with lower respiratory tract infections (P < 0.01) and were associated with longer hospital stay (ρ = 0.14, 95% confidence interval [CI]: 0.04-0.25). Clinical symptoms did not differ between RSV subtypes. However, younger age, shorter symptom duration, lower weight and reduced blood leukocyte count were associated with higher VL. In multivariate linear regression analysis adjusted for age and sex, weight and leukocyte count remained significant. This study highlights that RSV subtype and VL are not associated with disease severity in hospitalized children.
Routine blood cultures (BCs) are frequently obtained in hospitalized children with suspected infection. Although bacterial pathogens are the primary concern, fungal infections remain a consideration in high-risk populations, prompting clinicians to order fungal blood cultures (FBCs) in addition to routine BCs. However, given the prolonged incubation time and labor-intensive nature of FBCs, their incremental diagnostic value beyond routine BCs is uncertain. We performed a retrospective, single-center study of hospitalized children aged 0-18 years at the Children's Hospital of Philadelphia between October 2015 and December 2022. Electronic health record data were used to identify all FBCs and associated BCs obtained during hospitalizations lasting ≥24 hours. Demographic and clinical characteristics, including admitting service, neutropenia status and presence of a central venous catheter, were collected. Culture results were grouped into diagnostic episodes by hospitalization. FBC results were compared with BCs obtained within 5 days to assess diagnostic yield and clinical utility, defined as identification of a unique organism leading to a change in clinical management. A total of 540 FBCs were ordered for 244 patients across 159,563 inpatient admissions, representing 296 diagnostic episodes. Patients were predominantly male, non-Hispanic, and White, with 28.7% younger than 1 year. Most diagnostic episodes occurred in oncology, hematology, transplant, critical care or surgical settings; 25.3% involved patients with central venous catheters and 17.2% with neutropenia. Fifty-four FBCs were positive, corresponding to 22 diagnostic episodes (7.4%). Most positive cultures grew fungal pathogens, commonly Candida parapsilosis , Trichosporon asahii and Candida albicans . Only 1 FBC identified an organism not detected on routine BCs, and this finding did not alter the management. Over 7 years, FBCs provided no additional clinically actionable information beyond routine BCs. These findings support diagnostic stewardship efforts to limit routine FBC use and clarify scenarios in which they may be beneficial.
The abrupt re-escalation of the three-decade conflict in eastern Democratic Republic of the Congo (DRC) in January 2025, the July peace deal and new mineral extraction agreements highlight the Congo Basin's global significance. Known as the world's largest rare mineral reserve, the 'second lung of the planet', and a hotspot for emerging infectious diseases, the region embodies critical planetary health challenges. The conflict intensifies sylvatic-to-human transmission of zoonoses (involving at least 15 known pathogens), undermines climate change mitigation and conservation, disrupts human development-including education-and inflicts intergenerational harm.In the Congo basin, conflict-driven displacement and close contact with forests create ideal conditions for sporadic disease spillover. These risks are magnified by ecosystem disruptions from logging, mining, agriculture, wildlife trade, firewood collection and tourism, all intersecting with demographic shifts that push communities deeper into forested areas.Global demand for DRC minerals is surging, but without parallel investments in human development, biodiversity protection and disease surveillance, exploitation could accelerate regional instability and global health threats. The June 2025 peace deal and the rise of a mineral-based economy present a critical opportunity to align extraction with peacebuilding, sustainable development and climate resilience. Investments in enhanced surveillance and preparedness systems are essential to prevent transboundary pathogen spread and preserve fragile ecosystems. As the world grows increasingly dependent on the Congo's mineral wealth, realising its benefits requires renewed global commitment to ensure that resource extraction strengthens peace, resilience and planetary health rather than deepening conflict and instability.
Echovirus 11 (E11) is a common circulating enterovirus globally and in Malaysia. In recent years, severe neonatal E11 infections have been increasingly reported in Europe and Asia. An increase in severe E11 cases reported in Malaysia highlights significant potential for transmission in postnatal environments in hospitals and the community. We present clinical and laboratory findings for 5 neonates admitted with laboratory-confirmed E11 infection in Kuala Lumpur, Malaysia, between September 2023 and January 2024. E11 was diagnosed by virus culture or polymerase chain reaction. The E11 VP1 genes were sequenced and compared to other global E11 sequences. Patients were between 2 and 9 days of age. Four cases presented with multiorgan failure with prominent liver dysfunction requiring intensive care, and 2 died. Two had the unusual complication of thrombotic microangiopathy. The fifth patient had uncomplicated meningitis. All cases had E11 viruses of D5 genotype, similar to recently reported global sequences. Two patients with identical virus sequences had been in the same neonatal unit of another hospital, implying a common source. The other 3 were community-acquired cases with related viral sequences. Three cases were admitted from different confinement centers, which are postnatal community care facilities for newborns and mothers. E11 genotype D5 is the main cause of the recent global upsurge of severe neonatal E11 infections. Severe multiorgan disease and hemorrhagic hepatitis syndrome are associated with poor prognosis. E11 transmission in postnatal settings shows the importance of stringent infection control practices, especially in community confinement centers, which are becoming increasingly widespread.
Increasing prevalence of multidrug-resistant Gram-negative bacteria (MDR-GNB) necessitates the use of tigecycline in children, yet pediatric-specific data are limited. To evaluate the clinical and microbiologic outcomes, susceptibility patterns and safety profile of tigecycline in pediatric MDR-GNB infections. A retrospective observational study was conducted at a tertiary university hospital from January 2015 to December 2024. We included patients aged ≤18 years who received tigecycline for ≥48 hours for confirmed MDR-GNB infections. Forty-six treatment episodes were identified in 43 patients (median age: 16 months; interquartile range, 2-100). The majority (91.3%) required intensive care, with ventilator-associated pneumonia (56.5%) being the primary indication. Causative pathogens were carbapenem-resistant Acinetobacter baumannii (69.6%), carbapenem-resistant Enterobacterales (23.9%) and Stenotrophomonas maltophilia (6.5%). Clinical improvement was achieved in 73.9% of episodes, and microbiologic eradication in 60.9%. Although 45.7% of isolates were nonsusceptible to tigecycline (minimum inhibitory concentration >2 mg/L), clinical success remained high. Higher improvement rates were observed in children aged ≥8 years and those receiving a loading dose, though statistical significance was not reached. Adverse events were mild and predominantly gastrointestinal; no treatment discontinuations due to toxicity were reported. Tigecycline is a viable salvage therapy for severe pediatric MDR-GNB infections, demonstrating a manageable safety profile. However, the mortality rate of 23.9% and relatively modest microbiologic eradication rates underscore the complexity of such infections and emphasize the pressing need for pharmacokinetic data to refine dosing in younger children, where evidence remains sparse.
Nonprimary maternal cytomegalovirus (CMV) infections, resulting from reactivation or reinfection in seropositive women, are increasingly recognized as contributors to congenital CMV (cCMV) disease. However, their clinical impact compared with primary infections remains insufficiently characterized. We conducted a retrospective cohort study of symptomatic cCMV identified from a single-center series (2005-2022) and a multicenter registry (2023-2025). Infants were included if they had a positive urine CMV polymerase chain reaction within the first 3 weeks of life and met criteria for symptomatic infection based on central nervous system involvement. Maternal infection type (primary vs. nonprimary) was determined by serologic testing. Clinical characteristics, neuroimaging findings and auditory outcomes were compared between groups. We identified 360 symptomatic infants; maternal infection type was unknown in 55, leaving 305 for analysis [243 (79.7%) primary; 62 (20.3%) nonprimary]. The proportion of nonprimary infections among symptomatic cases increased from 11.4% in 2005-2009 to 37.3% in 2020-2025 (odds ratio: 4.77; 95% confidence interval: 1.63-13.92; P = 0.004). Absolute counts mirrored these trends: nonprimary 5 of 44 in 2005-2009 to 22 of 59 in 2020-2025. Clinical manifestations, including neuroimaging and hearing outcomes, were broadly similar between groups. In the era of maternal screening and interventions focused on primary CMV infection, nonprimary infections represent a rising share of symptomatic cCMV and a relevant clinical burden. These findings highlight the importance of recognizing nonprimary infections in clinical care and public health planning and support the need to reassess current strategies for maternal counseling and neonatal care.
Limited data exist on integrase strand transfer inhibitor (INSTI) use among children. We assessed dolutegravir (DTG) and raltegravir (RAL) use and outcomes among Latin American and Caribbean children with HIV. Cohorts from Brazil, Haiti and Honduras contributed data for children (age <18 years) receiving care since the widespread availability of DTG and RAL (approximately 2013-2022). Trends and factors associated with INSTI (DTG/RAL) initiation were examined using multivariable logistic and Cox regression models among antiretroviral therapy (ART)-naïve and -experienced children, respectively. We compared viral and treatment outcomes among ART-naïve children by INSTI use with log-rank tests. Among ART-naïve children, 77/110 started DTG, 5/109 started RAL and 91 started other ART. The proportion of ART-naïve children initiating DTG increased from 0% in 2016 to 93% (13/14) in 2022. Starting DTG was more likely in older ART-naïve children and in more recent calendar years (P ≤ 0.01). Among ART-experienced children, 122/273 switched to DTG, and 25/288 switched to RAL. More recent calendar year and a greater number of prior ART regimens were associated with a higher incidence of switch to DTG and RAL (P < 0.01). There was no statistical difference in virologic suppression among ART-naïve children by use or non-use of DTG; however, children started on DTG had a longer duration of the first regimen than those started on other ART (P < 0.01). INSTI use among children has increased in parts of Latin American And Caribbean. As more children start INSTI regimens, further research is needed on their clinical impact.
Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children. The "weekend effect"-reduced care quality outside standard hours due to lower senior supervision-has been reported for various pediatric conditions, but its impact on AOM management remains unexplored. We conducted a retrospective cross-sectional study of children aged 6 months to 10 years diagnosed with uncomplicated AOM in a secondary academic pediatric emergency department (PED) between 2017 and 2024. Treatment appropriateness was assessed against the 2023 Israeli AOM guidelines. Care optimality was stratified by visit timing and physician seniority into 3 levels: level 0 (weekday, attending present), level 1 (after-hours, attending present) and level 2 (after-hours, no attending). Of 288 children included, weekend and weekday visitors were clinically and demographically comparable. The presence of attending physicians was significantly higher on weekdays (82.8% vs. 55.6%, P < 0.001). Guideline-appropriate treatment was achieved in 72.9% of cases overall, with amoxicillin as the first-line chosen antibiotic therapy. No significant differences in treatment appropriateness were found between weekend and weekday visits, nor across care optimality levels (P = 0.363), indicating that physician supervision level did not influence guideline adherence. AOM management was guideline-adherent regardless of visit timing or physician supervision level, with no weekend effect identified. These findings suggest effective standardization of clinical practice in our pediatric emergency department and support maintaining current protocols as a model for consistent AOM care in emergency settings.
While children were initially less susceptible to coronavirus disease 2019 (COVID-19), emerging variants and eased public health measures shifted the burden to younger populations. This study characterizes pediatric COVID-19 features in South Korea across 7 epidemic waves, evaluating vaccination and comorbidities on disease severity. This retrospective study used the national K-COV-N database, integrating surveillance and health insurance claims data. Children 1-17 years old with confirmed COVID-19 from January 2020 to August 2023 were included. Participants were stratified by age and dominant variant waves. Logistic regression assessed demographic and clinical risk factors for severity. Among 239,334 cases, the Omicron-dominant era (waves 5-7) accounted for 97.88% of the total burden. Although the mean hospital stay decreased from 12.6 days (wave 1) to 3.7 days (wave 5), mortality and multisystem inflammatory syndrome in children were concentrated during Omicron waves. Children 1-4 years of age experienced the most severe outcomes. Multivariate analysis identified cardiovascular disease (adjusted odds ratio [AOR]: 3.97), neurologic disorders (AOR: 2.88) and obesity (AOR: 2.68) as significant independent risk factors for severity. After adjusting for age and sex, vaccination showed limited protective effects against severe outcomes in this cohort. The pediatric COVID-19 landscape in South Korea shifted to massive community transmission during the Omicron era. While individual clinical severity declined, the absolute burden remained significant due to high prevalence. Future outbreak mitigation requires targeted protection for high-risk groups and scalable healthcare planning.
In Argentina, widespread 13-valent pneumococcal conjugate vaccine (PCV13) use has reshaped pediatric invasive pneumococcal disease (IPD) epidemiology, with ongoing serotype shifts. We assessed IPD burden, clinical and microbiological features, PCV20 coverage, and mortality risk factors. Multicenter prospective observational study based on active surveillance, conducted in 6 pediatric sentinel hospitals (October 2022-September 2025). Children ≤15 years hospitalized with laboratory-confirmed IPD were included. Hospitalization rates per 10,000 discharges were calculated with 95% confidence intervals (CIs). Mortality risk factors were assessed using logistic regression. Among 136,018 hospital discharges, 218 IPD cases were identified (16.0 per 10,000; 95% CI, 14.0-18.3; 0.16% of hospitalizations), with the highest rates in children aged 2-4 years (26.5 per 10,000; 95% CI: 20.6-33.5). Half (45.9%) had underlying conditions. Pneumonia predominated (65.6%), often complicated by pleural effusion/empyema or necrotizing disease, and 18.9% required mechanical ventilation; meningitis occurred in 14.7%. Among 119 serotyped isolates, 30.3% were PCV13, 21.0% additional PCV20 and 48.7% non-PCV20 serotypes, yielding an estimated PCV20 coverage of 51.3%. All isolates were ceftriaxone-susceptible; penicillin resistance (4.6%) was limited to meningitis. Case fatality was 5.0%. In multivariable analysis, sepsis (adjusted odds ratio [aOR] 20.82; 95% CI: 4.23-102.58) and meningitis (aOR 10.75; 95% CI: 2.10-54.95) were strongly associated with mortality. In the late PCV13 era, pediatric IPD in Argentina remains clinically severe and shows marked serotype replacement. PCV20 increases coverage to approximately half of circulating serotypes. Sepsis and meningitis remain key mortality determinants, underscoring the need for early recognition, timely treatment, improved vaccination coverage and continued surveillance to assess PCV20 impact.
Late-onset sepsis (LOS) remains a leading cause of morbidity and mortality in preterm infants, with decreasing incidence in high-income countries but persistent challenges in low- and middle-income countries. This study aimed to evaluate the epidemiology, microbiological profile, and short-term outcomes of LOS in very low birth weight (VLBW) preterm infants in Brazil. A multicenter cohort study across 18 level 3 neonatal units of the Brazilian Network on Neonatal Research included 13,439 VLBW infants (400-1499 g birth weight, 22-36 weeks gestation) admitted between 2010 and 2020, excluding those with major malformations, congenital infections or death before 72 hours. Main outcomes included incidence of proven and clinical LOS, in-hospital mortality, and associated short-term morbidities. The cohort had a mean gestational age of 29 ± 3 weeks and birth weight of 1079 ± 275 g. The incidence of proven LOS was 24.6%, and clinical LOS was 19.2%. Gram-positive bacteria predominated (64.1%, with 49.4% coagulase-negative staphylococci), followed by Gram-negative bacteria (27.2%) and fungi (8.8%). Over the decade, fungal infections decreased, while Gram-negative bacterial infections and proven LOS incidence increased. In-hospital mortality was 24.8%, showing no reduction. LOS was associated with an increased risk of death and severe morbidities. This comprehensive 10-year cohort in Brazil reveals a concerning epidemiological shift, characterized by a significant increase in Gram-negative infections and a persistent, high LOS incidence and mortality among VLBW infants. These findings, particularly the lack of improvement in prognosis, underscore the urgent need for targeted and effective preventive and control interventions tailored for resource-limited settings.
Herein, we report the first case of confirmed maternal reinfection in an immunocompetent woman, resulting in congenital toxoplasmosis in Colombia. The child was referred to an infectious disease pediatrician at 17 months of age because of strabismus and typical bilateral chorioretinitis scars with elevated immunoglobulin (Ig)G anti-Toxoplasma. The mother tested positive for Toxoplasma antibodies (IgG-positive and IgM-negative) in 2020. Four months before becoming pregnant in 2023, both IgG and IgM were positive. Serotyping indicated that the mother had antibodies against GRA6 types I and III strains, but the child only had antibodies against type I, suggesting that the mother was reinfected with a different strain during the periconceptional period, which was transmitted to the child.
People living with HIV on antiretroviral therapy (ART) experience neurocognitive impairments, oral disease and epigenetic age acceleration (EAA) at higher rates than the general population. The objective of this study was to examine the associations between EAA and measures of neurocognition and oral health among adolescents living with HIV (ALHIV) and matched controls. The Uncovering the Biological Link Between Oral and Mental Health in Adolescents Living With HIV study enrolled 116 adolescents (10-13 years old) at the University of Benin Teaching Hospital in Nigeria. Fifty-eight ALHIV and 58 age- and sex-matched HIV-unexposed-uninfected participants were included in this cross sectional analysis. Participants completed two neurocognitive tests, NeuroScreen and NIH Toolbox Cognition Battery, and clinical oral exams. Peripheral blood DNA underwent methylation profiling, and epigenetic age and EAA were calculated with six validated algorithms (Horvath1, Horvath2, Hannum, PhenoAge, GrimAge and PedBE). In adjusted models among all participants and ALHIV, EAA was associated with poorer verbal learning/encoding scores. Among ALHIV, EAA (GrimAge) was inversely associated with processing speed [number speed; ß, -2.58 (95% confidence interval: -4.22 to -0.94)]. Inverse and positive associations between EAA and neurocognition assessed by the NIH Toolbox were detected. Higher EAA was not significantly associated with poorer oral health in this population. EAA may be linked to diminished processing speed and verbal learning in ALHIV on antiretroviral therapy. Oral disease was not strongly linked to EAA in this study. These findings indicate the need for longitudinal studies of EAA and neurocognitive and oral health outcomes in this population.
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Pneumocystis jirovecii can cause severe pneumonia in HIV-negative infants with underlying immunodeficiency. We report an infant with prior acute respiratory distress syndrome and recurrent infections unresponsive to antibiotics. Persistent interstitial opacities led to immunologic testing, revealing T-cell lymphopenia and a CARD11 mutation. Respiratory polymerase chain reaction confirmed P. jirovecii. Treatment with trimethoprim-sulfamethoxazole and intravenous immunoglobulin led to recovery.