Compared with earlier studies, UTIs now are found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.

In the United States, routine vaccinations with Haemophilus influenzae type b and S. pneumoniae vaccines have made bacteremia in the previously healthy toddler a rare event. As the incidence of pneumococcal bacteremia has decreased, E. coli, Salmonella spp. and Staphylococcus aureus have increased in relative importance. The use of the white blood cell count alone to guide the empiric use of antibiotics is not indicated. New guidelines are needed to approach the previously healthy febrile toddler in the outpatient setting.

Our study indicates bacteremia in young infants occurs infrequently and in only 2.2% of those who had a blood culture drawn. On the basis of the epidemiology of pathogens found in this large cohort, these data suggest a change in currently recommended presumptive antibiotic coverage in 1-week to 3-month-old infants with suspected bacteremia.

The detection of virus is used to diagnose human immunodeficiency virus type 1 (HIV-1) infection in infants due to the persistence of maternal antibodies for a year or more. An HIV-1 DNA PCR assay with simple specimen collection and processing was developed and evaluated. Whole blood was collected on filter paper that lysed cells and bound the DNA, eliminating specimen centrifugation and extraction procedures. The DNA remained bound to the filter paper during PCR amplification. Assays of copy number standards showed reproducible detection of 5 to 10 copies of HIV-1 in 5 l of whole blood. The sensitivity of the assay did not decrease after storage of the standards on filter paper for 3 months at room temperature or after incubation at 37 or 45°C for 20 h. The primers used for nested PCR of the HIV-1 pol gene amplified templates from a reference panel of multiple HIV-1 subtypes but did not amplify a subtype A or a subtype C virus from children living in Seattle. The assay had a sensitivity of 98.4% and a specificity of 98.3% for testing of 122 specimens from 35 HIV-1-infected and 16 uninfected children and 43 seronegative adults living in Washington. The assay had a sensitivity of 99% and a specificity of 100% for testing of 102 HIV-1-positive (as determined by enzyme immunoassay) Peruvian women and 6 seropositive and 34 seronegative infants. This assay, with adsorption of whole blood to filter paper and no specimen processing, provides a practical, economical, sensitive, and specific method for the diagnosis of HIV-1 subtype B infection in infants.

n early 2020, dermatologists in Europe noticed a sharp increase in chilblains, an inflammatory dermatosis that generally affects the dorsal feet or hands during periods of damp and cold, but not freezing, conditions, associated with the COVID-19 pandemic. [1][2][3][4][5][6][7][8] Few patients with chilblains tested positive for SARS-CoV-2 or its antibodies, although access to testing was limited. [1][2][3][4] Subsequent reports of series with complete viral and antibody testing indicated low frequencies of tests with positive results. [5][6][7][8] The underlying causes of an increase in chilblains related to the pandemic are controversial. 5,[7][8][9][10] Published cases of presumed secondary chilblains in the setting of confirmed COVID-19 infection indicate that COVID-19associated symptoms preceded chilblains by up to 30 days. 2,11 On noticing an increase in chilblains after the shelter-athome order was initiated in 6 Bay Area counties in California on March 16, 2020 (and statewide on March 18, 2020), we conducted a retrospective cohort study to test the hypothesis that increased cases of chilblains appeared in the same locations as increased cases of COVID-19 over time. Methods Setting and DesignKaiser Permanente Northern California provides comprehensive, integrated care to 4.4 million people, with all clinical information entered into an electronic medical record. The health care system operates 23 medical centers that are located to serve defined urban, suburban, and exurban population centers. Northern California is known for its microclimates. The IMPORTANCE Beginning in March 2020, case reports and case series linked the COVID-19 pandemic with an increased occurrence of chilblains, but this association has not been evaluated in an epidemiologic study.OBJECTIVE To assess whether a correlation exists between COVID-19 incidence and chilblains incidence. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted within the Kaiser Permanente Northern California system from January 1, 2016, to December 31, 2020; health plan members of all ages were included.EXPOSURE COVID-19 incidence in 207 location-months, representing 23 geographic locations in northern California across 9 months. MAIN OUTCOME AND MEASURESChilblains incidence was the main outcome. The association of chilblains incidence with COVID-19 incidence across the 207 location-months was measured using the Spearman rank correlation coefficient. RESULTSOf 780 patients with chilblains reported during the pandemic, 464 were female (59.5%); mean (SD) age was 36.8 (21.8) years. COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P = .01). However, only 17 of 456 (3.7%) patients with chilblains tested during the pandemic were positive for SARS-CoV-2, and only 9 of 456 (2.0%) were positive for SARS-CoV-2 within 6 weeks of the chilblains diagnosis. Test results of 1 of 97 (1.0%) patients were positive for SARS-CoV-2 IgG antibodies. Latinx patients were disproportionately affected by C...