Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications.

Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.

Cat scratch disease presenting as orbital abscess and osteomyelitis.

Ocular manifestations of cat scratch disease are uncommon. The diagnosis is usually made on the basis of increasing Bartonella henselae serum antibody titers. We report a child presenting with orbital abscess and osteomyelitis who was diagnosed with hepatosplenic cat scratch disease by detection of B. henselae DNA in the orbital abscess fluid.

Candida dubliniensis infections in a pediatric population: retrospective identification from clinical laboratory isolates of Candida albicans.

Candida dubliniensis is a recently described species that shares many phenotypic and morphological features with Candida albicans. The clinical significance of isolating C. dubliniensis from the pediatric population is not clear, as most clinical isolates have been recovered from the oral cavities or bloodstreams of adults infected with human immunodeficiency virus. In order to understand further the epidemiology of C. dubliniensis in our pediatric population, we identified C. dubliniensis isolates from clinical isolates previously identified in the laboratory as C. albicans and conducted a retrospective chart review of cases of C. dubliniensis infections. A total of 205 isolates from 183 patients were tested, and only 14 (6.8%) were identified as C. dubliniensis. In 5 of the 14 positive cultures, C. dubliniensis was the sole organism isolated (two respiratory tract specimens, one tongue specimen, one vaginal specimen, and one skin specimen). A case review showed that there were no adverse outcomes for any of the patients, and only one of the patients with cultures positive for C. dubliniensis was immunocompromised. In our pediatric population, the distinction of C. dubliniensis from C. albicans did not prove to have significant clinical relevance. Data from further investigations may help to define better the role of C. dubliniensis as a potential pathogen in children.