RESUMO
Pasteurella multocida is a well-known cause of skin and soft tissue infections resulting from animal bites. The patient was a newborn male with no perinatal abnormalities except for a cephalohematoma on the left parietal region. At 10 days of age, he had a bite wound to the cephalohematoma from an indoor dog. The wound was very mild and there was no bleeding. At 12 days of age, he visited a local hospital with a fever and poor feeding. At presentation, he was in septic shock and was transferred to the intensive care unit of the hospital. On day three of hospitalization, P. multocida was identified in the blood culture. On day four of hospitalization, CT of the head revealed multiple low-density lesions in the cerebral parenchyma, and aspiration of the cephalohematoma was performed. A culture of the aspirated fluid also grew P. multocida. On day five of hospitalization, the patient underwent drainage of the cephalohematoma. The patient developed hydrocephalus and worsening cerebral edema injuries, ultimately resulting in severe neurological sequelae. We summarized previous reports on P. multocida infections in children 60 days old or younger. Of the reported cases, neonates accounted for a majority of cases. In addition, nontraumatic exposure was more common than traumatic exposure. The patients requiring surgical intervention and those with neurological sequelae were all neonates. Neonatal P. multocida infection can cause severe systemic illness and neurological sequelae, even in the absence of traumatic exposure.
RESUMO
Neurological complications are frequent non-respiratory complications associated with coronavirus disease 2019 (COVID-19), and acute encephalopathy (AE) has been reported to occur in 2.2% of patients. Among many phenotypes of AEs, acute necrotizing encephalopathy (ANE) is associated with multiple organ failure (MOF), leading to severe neurological morbidity and mortality. A previously healthy seven-year-old girl presented with a one-day history of fever followed by 12 hours of vomiting and altered consciousness. On arrival, the patient was in shock. Blood tests revealed severe acute liver failure and kidney injury, accompanied by coagulopathy. The serum interleukin-6 levels were also elevated. PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. A head CT scan showed heterogeneous low-density areas in the bilateral thalamus, without brainstem involvement. She was diagnosed as ANE complicated with MOF (ANE severity score = 6). Intravenous methylprednisolone and therapeutic plasma exchange (TPE) were initiated with neurocritical care. After the introduction of TPE, hemodynamics improved rapidly, followed by gradual improvement in neurological manifestations. Upon follow-up after two months, no neurological or systemic sequelae were noted. Although further studies are needed, our case suggests that early immunomodulatory therapy and TPE may have contributed to the improvement in ANE and MOF associated with COVID-19.
RESUMO
During influenza epidemics, Japanese clinicians routinely conduct rapid influenza diagnostic tests (RIDTs) in patients with influenza-like illness, and patients with positive test results are treated with anti-influenza drugs within 48 h after the onset of illness. We assessed the vaccine effectiveness (VE) of inactivated influenza vaccine (IIV) in children (6 months-15 years old, N = 4243), using a test-negative case-control design based on the results of RIDTs in the 2018/19 season. The VE against influenza A(H1N1)pdm and A(H3N2) was analyzed separately using an RIDT kit specifically for detecting A(H1N1)pdm09. The adjusted VE against combined influenza A (H1N1pdm and H3N2) and against A(H1N1)pdm09 was 39% (95% confidence interval [CI], 30%-46%) and 74% (95% CI, 39%-89%), respectively. By contrast, the VE against non-A(H1N1)pdm09 influenza A (presumed to be H3N2) was very low at 7%. The adjusted VE for preventing hospitalization was 56% (95% CI, 16%-77%) against influenza A. The VE against A(H1N1)pdm09 was consistently high in our studies. By contrast, the VE against A(H3N2) was low not only in adults but also in children in the 2018/19 season.