Clostridium difficile Colitis in Patients Undergoing Surgery for Adolescent Idiopathic Scoliosis.

PURPOSE OF THE STUDY To identify risk factors associated with developing Clostridium difficile infection (CDI) in adolescent idiopathic scoliosis patients after surgery and to describe the clinical presentation of CDI in these patients. Clostridium difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on CDI rates and its consequences on patient undergoing surgery for adolescent idiopathic scoliosis. MATERIAL AND METHODS A retrospective database review of patients who underwent elective idiopathic scoliosis surgery between January 2019 to June 2021 was conducted. The population was divided into patients who developed Clostridium difficile colitis and those who did not. RESULTS A total of 128 patients were included in the study. We did not find notable risk factors for the development of CDI. In 2 patients diagnosis of CDI, was made. Length of hospital stays, and readmissions were significantly higher in patients with CDI. CONCLUSIONS CDI is a rare post-surgical complication in patients who undergo surgery for idiopathic scoliosis. Currently, we cannot identify predisposing factors for the development of CDI in adolescent idiopathic scoliosis patients. A high index of suspicion is necessary for timely diagnosis and treatment in patients presenting with abdominal symptoms around post-operative day 5 after surgical treatment for idiopathic scoliosis. Key words: Clostridium difficile infection, adolescent idiopathic scoliosis, abdominal pain, diarrhea.

Humidifier-associated paediatric Legionnaires' disease, Israel, February 2012.

We report a fatal case of community-acquired Legionnaires' disease in an infant aged under six months. Epidemiological and microbiological investigations suggested that a free-standing cold water humidifier using domestic tap water contaminated with Legionella pneumophila serogroup 1 served as a vehicle for infection. These findings were corroborated by sequence-based typing (SBT). Humidifier-associated Legionnaires' disease can be prevented by appropriate control measures. This case also illustrates the emerging role of SBT in the investigation of legionellosis.

Bulging fontanelle in febrile infants: is lumbar puncture mandatory?

OBJECTIVE: To determine the aetiologies and clinical characteristics of infants with fever and a bulging fontanelle. DESIGN: The medical records of all febrile infants with a bulging fontanelle who underwent a lumbar puncture from January 2000 to February 2008 in Assaf Harofeh Medical Center, a university affiliated hospital in central Israel, were identified. RESULTS: 153 patients met the inclusion criteria. The male to female ratio was 100:53; age range was 3-11 months with a mean age of 5.6 (SD 1.8) months and a median age of 5 months. Cerebrospinal fluid pleocytosis was found in 42 cases (27.3%), including one case of bacterial meningitis (0.6%). Other leading diagnoses were aseptic meningitis (26.7%), upper respiratory tract infection (18.3%), viral disease not otherwise specified (15.6%), roseola infantum (8.5%) and acute otitis media (6.5%). Appearance on admission was described as good to excellent in 113 (73.8%) infants, none of whom had bacterial meningitis. 32 had aseptic meningitis and 17 had other bacterial disease (pneumonia, acute otitis media, pyelonephritis, bacteraemia, shigella or salmonella gastroenteritis). All the latter had, upon admission, symptoms, signs, laboratory tests or imaging studies suggesting a bacterial aetiology. CONCLUSIONS: In this large cohort, all infants who appeared well on admission and had normal clinical, laboratory and imaging studies had benign (non-bacterial) disease. In an infant who appears well and has no evidence of bacterial disease, it is reasonable to observe the infant and withhold lumbar puncture. Prospective studies should be carried out to confirm this approach.

A phase II study of combined administration of dacarbazine and carboplatin with home therapy of recombinant interleukin-2 and interferon-alpha 2a in patients with advanced malignant melanoma.

Chemotherapy and interleukin-2 (IL-2) and/or interferon alpha (IFN alpha) produce objective responses in a proportion of patients with advanced malignant melanoma. The duration of response to chemotherapy is usually less than 4 months, and immunotherapy has resulted in long-lasting remissions in a small number of patients with metastatic melanoma. The current study was conducted to improve the antitumor efficacy and the interactions between recombinant (r) IL-2, rIFN alpha 2a and chemotherapy. A total of 16 evaluable patients with metastatic malignant melanoma were entered into a phase-II study designed to assess the response rate and therapeutic efficacy of dacarbazine and carboplatin followed by rIL-2 and rIFN alpha 2a. Patients received 750 mg/m2 dacarbazine with 400 mg/m2 carboplatin each by intravenous bolus on days 1 and 22. Recombinant IL-2 and IFN alpha 2a were administered on an outpatient basis (home therapy) subcutaneously for 6 consecutive weeks: 4.8 x 10(6) IU/m2 rIL-2 daily, 5 days a week; 6.0 x 10(6) IU/m2 rIFN alpha 2a thrice weekly. There were responses in 6 of the 16 enrolled patients with an overall response rate of 37.5% (95% confidence interval: 14%-61%). All responding patients had partial responses. The median survival time of the responding patients was significantly better than that of patients with progressive and stable disease (P = 0.03). The median duration of response was 11 months (range 2-24 months). Responses in lung, liver, soft tissue and lymph-node sites were noted.