A survey of current and past Pediatric Infectious Diseases fellows regarding training.

BACKGROUND: The objectives of this study were to characterize the satisfaction of Pediatric Infectious Diseases fellows with their training and to understand how opinions about training have changed over time. METHODS: Anonymous survey studies were conducted with questions designed to include areas related to the 6 ACGME core competencies. Surveys for current fellows were distributed by fellowship directors, while surveys for graduates were mailed to all individuals with Pediatric Infectious Diseases certification. RESULTS: Response rates for current fellows and graduates were 50% and 52%, respectively. Most fellows (98%) and graduates (92%) perceived their overall training favorably. Training in most clinical care areas was rated favorably, however both groups perceived relative deficiencies in several areas. Current fellows rated their training in other competency areas (e.g., systems-based practice, research, and ethics) more favorably when compared to past graduates. Recent graduates perceived their training more favorably in many of these areas compared to past graduates. CONCLUSIONS: Pediatric Infectious Diseases fellowship training is well regarded by the majority of current and past trainees. Views of current fellows reflect improved satisfaction with training in a variety of competency areas. Persistent deficiencies in clinical training likely reflect active barriers to education. Additional study is warranted to validate perceived deficiencies and to establish consensus on the importance of these areas to infectious diseases training.

Evaluation of the 3M rapid detection test for respiratory syncytial virus (RSV) in children during the early stages of the 2009 RSV season.

We report the results of the 3M rapid detection respiratory syncytial virus (RSV) assay. This study includes pediatric patient results from nasopharyngeal swabs submitted from October to December 2009. There was a sensitivity of 74% and specificity approaching 100% compared to the PCR-based xTAG respiratory viral panel.

Orbital compression syndrome presenting as orbital cellulitis in a child with sickle cell anemia.

Orbital bone infarction with subsequent orbital compression syndrome presenting as orbital cellulitis is reported in a child with sickle cell anemia. She deteriorated despite the use of antibiotics and improved after the surgical drainage of the collection. Radiographic findings, absence of sinusitis, hemorrhagic nature of the collection, and negative cultures all were consistent with orbital compression syndrome secondary to a vasoocclusive crisis. This condition needs to be differentiated from the more common orbital cellulitis secondary to sinusitis.

Neurologic manifestations associated with parvovirus B19 infection.

Eighty-one cases of neurologic disease, including encephalitis, meningitis, stroke, and peripheral neuropathy, that were associated with parvovirus B19 infection were reviewed. Most patients were children, and two-thirds had central nervous system manifestations. One-third had altered immunity. Viral symptoms (odds ratio [OR], 5.7; P= .002), rash (OR, 11.5; P< .001), and peripheral nervous system involvement (OR, 12.1; P= .004) were more frequent in immunocompetent patients. Brain magnetic resonance imaging abnormalities were more frequent in patients with altered immunity (OR, 10; P= .04). In central nervous system disease, parvovirus B19 DNA was commonly detected in cerebrospinal fluid (81% of samples) and serum (85%), whereas specific antibodies were found in 33% of cerebrospinal fluid samples. Neurologic sequelae occurred in 22% of 77 patients with a known outcome, and some improvement occurred in 16%. No differences in the prevalence of sequealae were noted between immunocompetent patients (21% of whom experienced sequealae) and patients with altered immunity (25%) or between patients with central nervous system manifestations who received intravenous immunoglobulin with or without steroids and those patients with central nervous system manifestations who did not. Five patients died.

Panniculitis, infection, and dermatomyositis: case and literature review.

The most common cause of panniculitis (inflammation of the subcutaneous adipose tissue) is infection. Clinical panniculitis in dermatomyositis is rare. We found in the English literature 24 cases, including ours. Six cases involved children. Buttocks or thighs and arms were involved more frequently. Lobular panniculitis with lymphoplasmacytic infiltration was the usual pathology. Calcifications of the panniculus were found in 6/24 (25%) of the cases. Membrano-cystic changes were associated with worse prognosis. Sixteen of 18 cases (89%) without associated infection, responded to increased immunosuppression. Eighty-nine percent responded to steroids alone. Intravenous immune globulin (IVIG) was effective in steroid-resistant cases. No spontaneous improvement was reported. Three cases were associated with infection; Staphylococcus aureus in two and Mycobacterium chelonae in one. All three responded to antibiotics with simultaneous decrease of the immunosuppressive therapy. Concomitant infection may play a role in the worsening of panniculitis and needs to be aggressively identified and treated.

Acute encephalopathy and multi-organ involvement with rhabdomyolysis during primary HIV infection.

An adolescent male developed encephalopathy and multiple organ involvement with rhabdomyolysis during primary HIV infection (PHI). All symptoms and signs resolved within a few days. Nineteen cases of central nervous system complications (other than aseptic meningitis) have been reported in PHI. These include encephalopathy, meningoencephalitis, acute disseminated encephalomyelitis, multiple sclerosis, myelopathy, and meningoradiculitis. Half of the patients died or suffered sequelae. Except in cases of multiple sclerosis, steroids were not of benefit. Initiation of antiretrovirals during PHI remains controversial. Rhabdomyolysis was reported in eight patients with PHI. All patients recovered. Primary HIV infection should be considered when the clinician faces patients with unexplained neurologic manifestations, rhabdomyolysis, or multiple organ involvement.

Posterior fossa dermoid cyst with sinus tract and meningitis in a toddler.

Intracranial dermoid cysts are rare, but can cause recurrent bacterial or aseptic meningitis, abscesses or mass effect. We describe a toddler who manifested an occipital "lump" for 6 months without further evaluation. He presented with lethargy and meningitis. A posterior fossa dermoid cyst with a sinus tract was detected by imaging studies. He underwent prompt surgical excision of the cyst and the sinus, and received a prolonged course of antibiotics, because anaerobes were isolated from the contents of the cyst and blood. His postoperative course was complicated, and required the placement of a lumboperitoneal shunt. A high index of suspicion for the detection of dermoid cysts is required when a congenital midline skin lesion such as a dimple or a scalp swelling is reported. Prophylactic excision is indicated to prevent serious sequelae.