Background In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). MethodsWe did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). Findings 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0•85-1•22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8-14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 µg/L to 1659 µg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1•0 × 10⁹ cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died.Interpretation During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown.Funding None.

During a mesocosm study in Raunefjorden, Norway, a Micromonas spp. population, initially showing exponential net growth, dramatically declined after Day 4 of the experiment. Using a modification of the dilution approach originally developed to quantify grazing by microzooplankton on phytoplankton, it was possible to partition the mortality of Micromonas spp. between grazing and viral lysis on Days 5, 6 and 7 during the population decline. Parallel dilution experiments were carried out in which 0.2 µm-and 10 kDa-filtered water was used as the diluents. In this way, gradients of grazing pressure (0.2 µm series) and grazing pressure + viral concentration (10 kDa series) were produced. Model 1 linear regression of the fraction of whole water versus the apparent growth rate of chlorophyll a and Micromonas spp. provided an estimate of mortality in the 0.2 µm and 10 kDa dilution series. On Days 5, 6 and 7, the slopes of the linear regressions of 0.2 µm and 10 kDa dilution series were significantly different at p = 0.083, 0.001 and 0.093 respectively. From the differences in slope between the series, estimates of viral mortality amounted to a turnover rate of the Micromonas spp. standing stocks of 10, 25 and 9% d -1 . This compares to a turnover rate by the microzooplankton of 48, 26 and 23% d -1 . On all 3 d the combined viral lysis and grazing mortality exceeded estimates of the potential production of Micromonas spp., in part accounting for the population decline. This study demonstrates that the dilution approach can be adapted to directly determine virus-induced mortality rates of specific phytoplankton. However, further work is required to determine how the specificity of viral infection and variety of viral infection cycles affect the results of this modified dilution approach when applied to other phytoplankton taxa and communities. KEY WORDS: Viral lysis · Microzooplankton grazing · Micromonas spp. · Dilution techniqueResale or republication not permitted without written consent of the publisher

The effect of viral infection of Emiliania huxleyi (Lohman) Hay and Mohler on the concentration of intracellular reactive oxygen species (ROS), hydrogen peroxide (H 2 O 2 ) excretion and cell photosynthetic capacity (CPC) was examined. During the crash of an E. huxleyi culture induced by viruses intracellular ROS concentrations were generally elevated and reached levels of approximately double those observed in non-infected control cultures. H 2 O 2 concentrations also increased in the media of the infected cultures from background levels of around 130 nM to approximately 580 nM while levels in the controls decreased. These data suggest that oxidative stress is elevated in infected cells. Although the precise mechanism for ROS production was not identified, a traditional defense related oxidative burst was ruled out, as no evidence of a rapid intracellular accumulation of ROS following addition of the virus was found. CPC declined substantially in the infected culture from a healthy 0.6-0 arbitrary units. Clearly infection disrupted normal photosynthetic processes, which could lead to the production of ROS via interruption of the electron transport chain at the PSII level. Alternatively, ROS may also be a necessary requirement for viral replication in E. huxleyi, possibly due to a link with viral-induced cell death or associated with general death processes.

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The oleaginous yeast, Candida curvata D, was grown in both batch and continuous culture on 5 different carbon sources to compare the efficiency of fat production from the various substrates. Maximum lipid accumulation occurred in batch culture with xylose as the carbon source on nitrogen-limited medium reaching a level of 49% (w/w) of the biomass, but this was reduced to 37% at the optimum dilution rate (D = 0.05/hr) in a chemostat. Both the highest biomass and lipid yields were attained in continuous culture with lactose as the sole carbon source at a dilution rate of D = 0.04/hr, giving an efficiency of substrate conversion of 60 g of biomass and 18.6 g lipid per 100 g lactose utilized. The relative proportions of the major fatty acids (16:0, 18:0, 18:1, 18:2) in the lipid were found to vary considerably in batch culture and in continuous culture under carbon-limited conditions. However, on nitrogen-limited media in the chemostat, the fatty acid composition remained relatively constant over the whole range of dilution rates employed. Lipid from xylose-grown cells contained the greatest percentage of stearic acid (18:0) 15% and the lowest linoleic acid (18:2) 4%, whereas lipid from ethanol-grown cells contained elevated levels of oleic acid (18:1) 51% and decreased palmitic acid (16:0) 25%.