RESUMEN
In winter 2015-16, norovirus GII.17 Kawasaki 2014 emerged as a cause of sporadic gastroenteritis in children in Italy. Median patient age was higher for those with GII.17 than GII.4 infection (55 vs. 24 months), suggesting limited cross-protection for older children.
Asunto(s)
Infecciones por Caliciviridae/epidemiología , Infecciones por Caliciviridae/virología , Gastroenteritis/epidemiología , Gastroenteritis/virología , Norovirus/genética , Adolescente , Infecciones por Caliciviridae/historia , Niño , Preescolar , Brotes de Enfermedades , Gastroenteritis/historia , Genotipo , Historia del Siglo XXI , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Norovirus/clasificación , Sistemas de Lectura Abierta , Vigilancia de la Población , Estaciones del AñoRESUMEN
This report describes a case of acute pancreatitis in a 2-year-old boy following rotavirus gastroenteritis. Its characteristics are analyzed and discussed in the light of another 4 cases of pancreatitis associated with rotavirus infection found through a systematic review of the international literature. None of the five children underwent surgery or was referred to an intensive care unit and all 5 children recovered with normalization of pancreatic enzymes within 5-10 days. The pathogenesis of this rare complication remains unsettled, and its actual incidence may be higher than reported. Although acute pancreatitis associated with rotavirus gastroenteritis seems to be a mild disease, attention must be paid by the pediatrician fearing possible complications. Rotavirus infection should be amended to the differential diagnosis panel of pancreatitis in toddlers.
Asunto(s)
Gastroenteritis/complicaciones , Pancreatitis/etiología , Infecciones por Rotavirus/complicaciones , Niño , Preescolar , Gastroenteritis/virología , Humanos , Lactante , MasculinoRESUMEN
BACKGROUND: Bronchiolitis is the primary infection of the lower respiratory tract in children under 2 years of age. Although it is generally considered a single nosological entity, recent studies suggested remarkable clinical heterogeneity. To date, no studies have identified classes of children with bronchiolitis within the Italian population. This study aimed to identify discrete profiles of Italian children hospitalized with bronchiolitis using a clustering approach and to compare findings with those obtained in international cohorts. METHODS: This was a retrospective single-centre study conducted on children aged ≤2 years hospitalised with bronchiolitis (n = 401) at the Department of Infectious Diseases and the University Department of General Pediatrics in "Giovanni Di Cristina" Pediatric Hospital of Palermo, Italy, between November 2012 and May 2019. Bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical characteristics at admission and viral aetiology. RESULTS: Three profiles were identified. Class 1 (49%) was composed of 45% male children; all children were aged ≤6 months at hospitalization; 77% were infected with RSV; 100% had respiratory distress, 11% had apnea and none had cough. Class 2 (77%) was mainly composed of male subjects (51%); 19% were aged > 6 months at admission; 37% were infected with RSV; 12% had respiratory distress, 5% had apnea and 90% had cough. Class 3 (19%) included the largest proportion of male subjects (94%) and was mostly composed of children aged > 6 months at the time of admission (68%); 70% had cough, 12% showed respiratory distress and none presented with apnoea. Children in Class 1 were more frequently born near the epidemic season (p = 0.028); breastfeeding duration was significantly longer for children in Class 3 (p = 0.004). CONCLUSIONS: The study identified distinct clinical profiles of bronchiolitis by a clustering approach in a single-centre study of children hospitalised for bronchiolitis in Italy. The three bronchiolitis profiles share some similarities with those identified in international studies using the same statistical approach. These findings may help to increase the understanding of the phenotypic variability that typically characterizes bronchiolitis, with relevant implications for future research.
Asunto(s)
Bronquiolitis/epidemiología , Análisis de Clases Latentes , Niño Hospitalizado , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Estudios RetrospectivosRESUMEN
Bronchiolitis is the most common disease of the lower respiratory tract occurring in children during their first year of life, becoming the most frequent cause of hospitalization. Although the disease can also be caused by other viruses, more than 70% of bronchiolitis cases are caused by respiratory syncytial virus (RSV). RSV bronchiolitis clinically presents rhinitis, coughing, increased breathing and eating difficulties; the symptoms are usually mild, but in some cases may be so severe as to require hospitalization. Diagnosis is mainly clinical and is based on a thorough medical history and a physical examination. Therapy is substantially of support, and has the aim of ensuring alimentation/hydration and optimal oxygenation. It has been recently noted that RSV infections may cause extra-pulmonary manifestations, including liver problems, as rarely described in the literature. The aim of this paper is to present three cases of RSV bronchiolitis in children with elevated transitory transaminase levels.
Asunto(s)
Bronquiolitis/sangre , Bronquiolitis/virología , Infecciones por Virus Sincitial Respiratorio/sangre , Transaminasas/sangre , Preescolar , Humanos , Lactante , MasculinoRESUMEN
BACKGROUND: Acute cerebellitis (AC) and acute cerebellar ataxia (ACA) are the principal causes of acute cerebellar dysfunction in childhood. Nevertheless. there is no accepted consensus regarding the best management of children with AC/ACA: the aim of the study is both to assess clinical, neuroimaging and electrophysiologic features of children with AC/ACA and to evaluate the correlation between clinical parameters, therapy and outcome. METHODS: A multicentric retrospective study was conducted on children ≤ 18 years old admitted to 12 Italian paediatric hospitals for AC/ACA from 01/01/2003 to 31/12/2013. A score based on both cerebellar and extracerebellar signs/symptoms was computed for each patient. One point was given for each sign/symptom reported. Severity was divided in three classes: low, moderate, severe. RESULTS: A total of 124 children were included in the study. Of these, 118 children received a final diagnosis of ACA and 6 of AC. The most characteristic finding of AC/ACA was a broad-based gait disturbance. Other common symptoms included balance disturbances, slurred speech, vomiting, headache and fever. Neurological sequelae were reported in 6 cases (5%) There was no correlation among symptoms, cerebrospinal fluid findings, clinical outcome. There was no correlation between clinical manifestations and clinical score on admission and length of hospital stay, sex, age and EEG findings with sequelae (P > 0.05). Children with pathological magnetic resonance imaging (MRI) or computed tomography (CT) had a higher probability of having clinical sequelae. Treatment was decided independently case by case. Patients with a higher clinical score on admission had a higher probability of receiving intravenous steroids. CONCLUSIONS: We confirmed the literature data about the benign course of AC/ACA in most cases but we also highlighted a considerable rate of patients with neurological sequelae (5%). Pathological MRI or CT findings at admission correlate to neurological sequelae. These findings suggest the indication to perform an instrumental evaluation in all patients with AC/ACA at admission to identify those at higher risk of neurological outcome. These patients may benefit from a more aggressive therapeutic strategy and should have a closer follow-up. Randomized controlled trials are needed to confirm these observations. The ultimate goal of these studies could be to develop a standardized protocol on AC/ACA. The MRI/CT data, associated with the clinical manifestations, may allow us to define the class risk of patients for a neurological outcome.
Asunto(s)
Enfermedades Cerebelosas/epidemiología , Enfermedad Aguda , Adolescente , Antivirales/uso terapéutico , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Neuroimagen , Estudios Retrospectivos , Esteroides/uso terapéuticoRESUMEN
OBJECTIVES: Although the importance of serum Procalcitonin (PCT) levels at diagnosis is well established in adult Community-Acquired Pneumonia (CAP), its use remains controversial in pediatric CAP. The aim of our study is to investigate the role of PCT and C-Reactive Protein (CRP) in the assessment of pediatric CAP severity defined by the extent of consolidation on chest X-rays and the presence of pleural effusion. In this particular setting, no clinical severity score is available at present and chest X-ray, although important for diagnosis confirmation, is not recommended as routine test. DESIGN AND METHODS: The study involved 119 children admitted to the Department of Pediatric Infectious Disease for radiographically documented CAP aged 1 year to 14 years, without chronic diseases. Baseline PCT, CRP and routine laboratory tests were performed on admission. RESULTS: The median PCT (µg/L) and CRP (mg/L) were 0.11 (0.050.58) and 21.3 (4.248.1), respectively. PCT showed a good correlation with CRP, neutrophils and WBC (r = 0.538, P < 0.001; r = 0.377, P < 0.001; r = 0.285, P0.002, respectively). CRP, but not PCT, was associated with lobar consolidation (P = 0.007) and pleural effusion (P = 0.002). Logistic regression analysis revealed that only CRP was a predictor of lobar consolidation (OR: 1.078; 95% CI: 1.0171.143; P = 0.011) and pleural effusion (OR: 1.076; 95% CI: 1.0051.153; P = 0.036). CONCLUSION: Our findings revealed that PCT is correlated to the main inflammatory markers in children with CAP. CRP, unlike PCT, is able to predict the extent of chest X-ray infiltration and ultimately the severity of the disease confirming its usefulness in the management of pneumonia
Asunto(s)
Proteína C-Reactiva/metabolismo , Calcitonina/sangre , Infecciones Comunitarias Adquiridas/sangre , Neumonía Bacteriana/sangre , Precursores de Proteínas/sangre , Adolescente , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Infecciones Comunitarias Adquiridas/fisiopatología , Femenino , Humanos , Lactante , Masculino , Neumonía Bacteriana/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
STUDY DESIGN: This study aimed to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) to distinguish bacterial from viral community-acquired pneumonia (CAP) and to identify severe cases in children hospitalized for radiologically confirmed CAP. Index test results were compared with those derived from routine diagnostic tests, i.e., white blood cell (WBC) counts, neutrophil percentages, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels. METHODS: This prospective, multicenter study was carried out in the most important children's hospitals (n = 11) in Italy and 433 otherwise healthy children hospitalized for radiologically confirmed CAP were enrolled. Among cases for whom etiology could be determined, CAP was ascribed to bacteria in 235 (54.3%) children and to one or more viruses in 111 (25.6%) children. A total of 312 (72.2%) children had severe disease. RESULTS: CRP and PCT had the best performances for both bacterial and viral CAP identification. The cut-off values with the highest combined sensitivity and specificity for the identification of bacterial and viral infections using CRP were ≥7.98 mg/L and ≤7.5 mg/L, respectively. When PCT was considered, the cut-off values with the highest combined sensitivity and specificity were ≥0.188 ng/mL for bacterial CAP and ≤0.07 ng/mL for viral CAP. For the identification of severe cases, the best results were obtained with evaluations of PCT and MR-proANP. However, in both cases, the biomarker cut-off with the highest combined sensitivity and specificity (≥0.093 ng/mL for PCT and ≥33.8 pmol/L for proANP) had a relatively good sensitivity (higher than 70%) but a limited specificity (of approximately 55%). CONCLUSIONS: This study indicates that in children with CAP, sTREM-1, MR-proANP, and MR-proADM blood levels have poor abilities to differentiate bacterial from viral diseases or to identify severe cases, highlighting that PCT maintains the main role at this regard.
Asunto(s)
Adrenomedulina/sangre , Factor Natriurético Atrial/sangre , Infecciones Comunitarias Adquiridas/sangre , Infecciones Comunitarias Adquiridas/etiología , Glicoproteínas de Membrana/sangre , Precursores de Proteínas/sangre , Receptores Inmunológicos/sangre , Biomarcadores/sangre , Niño , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Demografía , Femenino , Humanos , Masculino , Sensibilidad y Especificidad , Receptor Activador Expresado en Células Mieloides 1RESUMEN
BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn's disease because a misdiagnosis can have dramatic consequences. CASE PRESENTATION: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38 °C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn's disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. CONCLUSION: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron's disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems.
Asunto(s)
Enfermedades del Íleon/diagnóstico , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Miliar/diagnóstico , Adolescente , Antituberculosos/uso terapéutico , Biopsia , Enfermedad de Crohn/diagnóstico , Diagnóstico Diferencial , Errores Diagnósticos , Quimioterapia Combinada , Femenino , Humanos , Enfermedades del Íleon/tratamiento farmacológico , Enfermedades del Íleon/epidemiología , Enfermedades del Íleon/microbiología , Incidencia , Italia/epidemiología , Mycobacterium tuberculosis/aislamiento & purificación , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Gastrointestinal/tratamiento farmacológico , Tuberculosis Gastrointestinal/epidemiología , Tuberculosis Gastrointestinal/microbiología , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/epidemiología , Tuberculosis Miliar/microbiología , Imagen de Cuerpo Entero/métodosRESUMEN
Acute osteomyelitis is a relatively rare disorder in the neonatal period, with considerable morbidity and mortality. Early diagnosis and prompt treatment are essential for a successful outcome. In this report we present a case of acute osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis, observed in a 30-day-old infant.
Asunto(s)
Resistencia a la Meticilina , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus epidermidis , Astrágalo , Femenino , Humanos , Recién Nacido , Staphylococcus epidermidis/efectos de los fármacosRESUMEN
Haemophagocytic lymphohistiocytosis is a rare but potentially fatal disease resulting from dysregulated activation and proliferation of lymphocytes. We present a case of haemophagocytic syndrome occurring in a 5-year-old Italian boy as a complication of Mediterranean spotted fever. The characteristics of this case have been analysed and contextualized among those of another 15 cases of haemophagocytic syndrome associated with rickettsial diseases found through a systematic review of the international literature.
Asunto(s)
Fiebre Botonosa/complicaciones , Linfohistiocitosis Hemofagocítica/diagnóstico , Antibacterianos/uso terapéutico , Fiebre Botonosa/tratamiento farmacológico , Preescolar , Humanos , Italia , Linfohistiocitosis Hemofagocítica/patología , Masculino , Resultado del TratamientoRESUMEN
Intestinal intussusception is the invagination of an intestinal segment into another. Childhood intussusception is usually idiopathic, whereas adult intussusception is usually due to a definable intraluminal lesion or to a systemic disease. Although the aetiology of idiopathic forms often remains unclear, there is appreciable evidence to support an indirect role played by certain infectious agents. In this report we present a case of childhood intussusception probably due to adenovirus infection.
Asunto(s)
Infecciones por Adenoviridae/complicaciones , Válvula Ileocecal , Intususcepción/virología , Femenino , Humanos , Enfermedades del Íleon/virología , LactanteRESUMEN
OBJECTIVES: Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization for lower respiratory tract infections (LRTI) in young children worldwide.We evaluate the epidemiological and clinical patterns of RSV infection in infants hospitalized for LRTI in in Palermo, South Italy, Sicily. METHODS: We collected the demographic details of infants hospitalized to G. Di Cristina Children's Hospital in Palermo for LRTI between November 2005 and May 2006. We also included all cases occurred in newborns hospitalized in the Neonatal Intensive Care Unit (NICU) Of Palermo. RESULTS: During the studied period, 335/705 hospitalized infants for LRTI were enrolled in the study. The trend of hospitalization started in late winter and lasting until May 2006 with an epidemic peak in spring. 178/335 infants tested for viral infection showed RSV disease. Three cases occurred in preterm newborns hospitalized from birth in NICU. The likelihood to be RSV+, rather than RSV negative (RSV-) was higher for infants < 6 months and lower for infants with history of breast feeding (P < 0.05). RSV infection was associated with a higher likelihood to be admitted to intensive care unit and to a longer hospitalization and oxygen therapy. CONCLUSION: The study shows that, in Sicily, RSV is an important cause of LRTI in infants. The seasonal distribution shows that both LRTI and RSV infections peak in late spring, in contrast to Northern Italy. Our data could help to define the regional appropriate start of prophylactic interventions.