MICROBIAL TECHNOLOGY
Dr Charlene Rodrigues, Consultant in Paediatric Infectious Diseases, St Mary’s Hospital, London, and the London School of Hygiene & Tropical Medicine.
detect any organism present rather than being restricted to a limited number of predefined targets. In addition, it is more able to detect resistance and virulence markers and a lot more data about the organism are obtained, making typing for example using existing MLST schemes possible using the sequencing data obtained. Against this it has the disadvantages that is slower than other molecular methods, uses more specialised techniques and requires bioinformatic analyses.
As is always the case sequencing contaminating DNA will reduce sequencing of infecting organisms. Currently, mNGS is best placed to determine relatedness of isolates (by antibiogram, typing and sequence alignment). But there is still some way to go before molecular methods replace culture-based methods in the laboratory.
Post-COVID childhood infections The last presentation of the day was the most topical! Dr Charlene Rodrigues, Consultant in Paediatric Infectious Diseases, St Mary’s Hospital, London, and the London School of Hygiene & Tropical Medicine, updated us on group A streptococcal infections and other infections in children in the post-COVID pandemic period. The presentation gave an insight into the changes in paediatric infectious diseases that followed the COVID pandemic and restrictions in social interactions. Existing diseases re-emerged; there was an unusually high peak in group A streptococcal infections in children, which was accompanied by a corresponding increase in invasive streptococcal (iGAS) disease. Although the isolates were no more deadly and the case fatality rate was no higher, the media coverage made the
Dr Mark Wilks, Chair of the BSMT; Research Fellow and Hon Senior Lecturer, Barts and the London School of Medicine and Dentistry, Queen Mary University of London.
public aware of the infection, and large numbers of parents were presenting in emergency departments, concerned that their children may have iGAS disease. Some of the challenges were that the initial symptoms of iGAS are non-specific; children were swabbed but due to the relatively slow speed of culture, penicillin had to be given before culture results were available, which led to shortages. Culture did allow retrospective analysis of treatment pathways, but a rapid point-of- care test would have been more useful. Children seemed to be sick for longer and have a lot of inflammation, with different clinical phenotypes than previously seen, such as increased lung involvement, which posed the question as to whether this GAS could have other, additional virulence factors post-pandemic. New conditions were identified in
children in the post-pandemic period. Paediatric inflammatory multisystem syndrome (PIMS) occurred in some children about six weeks after becoming infected with COVID. The most serious complications of this syndrome were cardiac involvement, specifically myocarditis. Another new syndrome was acute hepatitis in young children, which was not caused by any of the hepatitis viruses (A–E). Affected children had liver failure and required transplantation. Here, metagenomics was used to sequence samples from clusters of severe cases, and was able to identify adeno-associated virus 2 in symptomatic children, although the pathogenic mechanism of this disease is still unknown.
The pandemic also had a negative
effect on infection prevention, shown by the steady decline in measles vaccine uptake during this period. The UKHSA briefing in May 2023 reminded us that measles was eliminated in the UK in 2016, but vaccine hesitancy has been
WWW.PATHOLOGYINPRACTICE.COM JUNE 2023
worsened by the COVID pandemic, resulting in an increase in cases. Measles is a highly contagious disease, easily tested by serology and PCR, but it is better to reduce the burden of infection by encouraging parents to have their children vaccinated. There were also cases of more
severe complications from enterovirus infections in neonates, with clusters of enterovirus myocarditis in South West England and South Wales – these were all disproportionately severe, but it is not known why. A possibility is that social distancing in mothers during the pandemic could have affected the severity of disease experienced by infants. There are no good management strategies for these cases, and there are currently no approved antiviral medications for enteroviral infections.
Postscript
The event did indeed cover ‘Current Topics in Microbiology and Infection’, with excellent speakers sharing insights into their specialist areas, from the development and control of antimicrobial resistance to infections in children in the post-COVID pandemic period. The BSMT committee would like to extend warm thanks to all who attended and participated to make the conference a great success. The programme for the day is available on the BSMT website (
https://bsmt.org.uk/), and it is planned to make the presentations available to all who attended the conference, plus to others for a small fee – please email Valerie Bevan (
vbevan@bsmt.org.uk) if you are interested in receiving them. Thanks to BSMT committee members
Carmel Aldridge, Valerie Bevan, Carolyne Horner, Deborah Karim, Ruhi Siddiqui and David Westrip for help in writing and editing this review.
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