Effects of meteorologic factors and schooling on the seasonality of group A streptococcal pharyngitis.

The objective of this study was to determine the seasonal pattern of group A streptococcal pharyngitis in children attended at a hospital emergency department in the Mediterranean island of Mallorca (Spain), and its association with meteorologic factors and schooling. We conducted a retrospective review of the medical records of children aged 1-15 years with a diagnosis of Streptococcus pyogenes pharyngitis between January 2006 and December 2011. The number of S. pyogenes pharyngitis was correlated to temperature, humidity, rainfall, atmospheric pressure, wind speed, solar radiation, and schooling, using regression and time series techniques. A total of 906 patients (median, 4 years old) with S. pyogenes pharyngitis, confirmed by throat culture, were attended during the study period. A seasonal pattern was observed with a peak activity in June and a minimum in September. Mean temperature, solar radiation, and school holidays were the best predicting variables (R(2) = 0.68; p < 0.001). S. pyogenes activity increased with the decrease of mean temperature (z = -2.4; p < 0.05), the increase of solar radiation (z = 4.2; p < 0.001), and/or the decrease in school holidays (z = -2.4; p < 0.05). In conclusion, S. pyogenes pharyngitis had a clear seasonality predominating in springtime, and an association with mean temperature, solar radiation, and schooling was observed. The resulting model predicted 68 % of S. pyogenes pharyngitis.

Streptococcus pyogenes cervical intertrigo with secondary bacteremia.

We report a 12-month-old infant girl with cervical intertrigo caused by Streptococcus pyogenes. This form of intertrigo has been reported in only five children, but it is clearly underestimated. It should be suspected for well-demarcated beefy-red lesions of the neck not responding to antifungal therapy. A rapid streptococcal antigen test of a lesion specimen is a useful diagnostic tool. Our patient was notable for the development of S. pyogenes bacteremia, a complication that has not been previously associated with this condition.

Varicella precipitating febrile ulceronecrotic Mucha-Habermann disease.

We report a 9-year-old boy with skin lesions clinically and histologically compatible with pityriasis lichenoides et varioliformis acuta that evolved to the severe variant febrile ulceronecrotic Mucha-Habermann disease and finally to pityriasis lichenoides chronica. Varicella-zoster virus (VZV) was isolated in culture medium from the skin lesions and serum serology was positive for VZV. This is the first time that a virus has been isolated in culture in this condition.

Diagnostic value of the skin lesions in immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome.

We report a child with immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome due to a de novo c.1190G>A (p.R397Q) mutation in exon 11 of the forkhead domain of the FOXP3 gene. He had chronic dermatitis with an eczematous and ichthyosiform appearance and had an allogeneic bone marrow transplantation. IPEX syndrome is a rare, often fatal recessive disease caused by mutations in the FOXP3 gene on the X chromosome (Xp11.23-q13.3).

Clinical and economic impact of oral ondansetron for vomiting in a pediatric emergency department.

In this study, we determine the clinical impact of 1 dose of oral ondansetron for children with vomiting and evaluate the economic consequences of its use. The strategies compared were administering oral ondansetron in addition to oral rehydration therapy (group A) versus oral rehydration solution alone (group B) in children attended to for vomiting in a pediatric emergency department. The study population was 1871 children between 0 and 14 years of age treated for vomiting during a 2-year period (2009-2010). Outcome measures were need for intravenous rehydration, length of stay in the emergency department, return visits, and hospitalization. Estimates of the costs in the emergency department and hospitalization were derived from administrative databases. During the study period, 580 (31%) of 1871 patients received oral rehydration therapy. Oral ondansetron before oral rehydration solution was used in 109 (18.8%) of 580 patients. An equal number of patients not receiving ondansetron were randomized and analyzed for comparison (group B). Patients of group A had a significantly decreased risk of hospitalization (relative risk, 0.22; 95% confidence interval, 0.08-0.63) and intravenous rehydration (relative risk, 0.31; 95% confidence interval, 0.14-0.63), but there were no differences in the length of stay or return visits to the emergency department. There were no differences in the medical costs between both groups in the emergency department (US $22,078 vs US $21,987, respectively). The hospitalization cost was US $9600 for group A and US $25,079 for group B, providing a 73.7% saving. In conclusion, the administration of oral ondansetron to children with vomiting in the emergency department is clinically effective and results in significant economic savings.

Risk of varicella complications in children treated with inhaled steroids.

We have studied the complications of varicella in children treated with inhaled steroids. From 1995 to 2005, 3/213 (1.4%) children hospitalized on the island of Mallorca, Spain, for varicella had received inhaled steroids. The rate of hospitalization for varicella complications in children receiving inhaled steroids was 17/100,000 children taking inhaled steroids, a rate similar to the rest of the children's population (18.2/100,000). Inhaled steroids did not increase the risk of varicella complications (relative risk 0.94; 95% confidence interval: 0.3-2.89).

Meteorologic conditions and respiratory syncytial virus activity.

BACKGROUND: The factors that determine the initiation and persistence of yearly epidemics of respiratory syncytial virus (RSV) bronchiolitis are not well known. A limited number of studies have found that meteorologic conditions could be associated with RSV activity. OBJECTIVES: We analyzed the association of certain atmospheric conditions with RSV activity, as determined by the number of hospitalizations of infants with bronchiolitis in Mallorca (Spain). METHODS: We conducted a retrospective review of the medical records of children ≤ 2 years of age with acute bronchiolitis between January 1995 and December 2006. Climatic data were obtained from a weather station located 15 km from the hospital. The number of RSV hospitalizations were correlated to temperature, barometric pressure, relative humidity and water vapor pressure using different time models and regression analyses. RESULTS: A total of 1495 infants with RSV bronchiolitis were hospitalized during the study period, with a seasonal pattern from November to March. Weekly RSV activity could be predicted (R= 0.88; P < 0.001) by mean temperature and atmospheric pressure. Monthly RSV activity was significantly associated (R= 0.95; P < 0.001) with mean and minimum temperature, water vapor pressure, relative humidity and barometric pressure. The peak of RSV activity was observed within 9°C mean temperature, 5°C minimum temperature, 16°C maximum temperature, 1032 hPa atmospheric pressure, 83% relative humidity and 910 hPa water vapor pressure. CONCLUSIONS: The annual patterns of RSV hospitalizations were strongly associated with the meteorologic conditions. The mean temperature and atmospheric pressure were the main factors that correlated with increases and declines in RSV activity.

Old world Leishmania infantum cutaneous leishmaniasis unresponsive to liposomal amphotericin B treated with topical imiquimod.

We present a case of a child with Leishmania infantum cutaneous leishmaniasis unresponsive to 2 courses of intravenous liposomal amphotericin B, a treatment failure that has not been reported in this Leishmania species. The patient responded to topical imiquimod and had no relapse. We review the literature on the treatment failure of liposomal amphotericin B for cutaneous leishmaniasis.