Single donor-derived strongyloidiasis in three solid organ transplant recipients: case series and review of the literature.

Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney-pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed. S. stercoralis larvae were detected in duodenal aspirates, bronchial washings, cerebrospinal fluid, urine and stool specimens. Treatment with ivermectin and albendazole was successful in two of the three patients identified. The Centers for Disease Control and Prevention was contacted and performed an epidemiologic investigation. Donor serology was strongly positive for S. stercoralis antibodies on retrospective testing while all pretransplant recipient serum was negative. There should be a high index of suspicion for parasitic infection in transplant recipients and donors from endemic regions of the world. This case series underscores the need for expanded transplant screening protocols for Strongyloides. Positive serologic or stool tests should prompt early treatment or prophylaxis in donors and recipients as well as timely notification of organ procurement organizations and transplant centers.

Mucosal biopsy.

Intestinal mucosal biopsy has become an invaluable tool for the evaluation of children with abdominal complaints. Multiple techniques and biopsy instruments have each been developed with advantages and limitations. Physicians caring for infants and children must be familiar with indications for tissue sampling, timing of the biopsies, and interpretations of biopsy specimens.

The use of nifedipine for the treatment of achalasia in children.

Four adolescents with achalasia were treated with nifedipine. All the patients' symptoms improved dramatically. On manometric evaluation, following oral nifedipine, the lower esophageal sphincter pressure decreased approximately 50%. No change in esophageal peristaltic activity was noted. Side effects were minimal; two patients had mild headache initially. Nifedipine, which is commonly used in adult patients with achalasia, may be beneficial for short-term symptomatic relief in children until more definitive therapy can be performed.

Comparison of the pediatric Broviac silastic catheter with a standard no. 3 French silastic catheter for central venous alimentation.

Two No. 3 French silastic central venous catheters designed for infants, a pediatric Broviac catheter, and a standard infant catheter were used in 41 (group I) and 33 infants (group II), respectively, to compare the effectiveness of each in providing access to the central venous circulation. Group I patients used 52 Broviac catheters or 1.2 catheters per patient for an average of 75 days per catheter. Thirty-five patients had one catheter placed. Group II patients had 66 catheters or 2.0 catheters per patient for an average of 45 days per catheter. One episode of sepsis occurred for every 1,950 days of usage in group I, but in group II, one episode occurred every 750 days. Eight of 52 catheter placements in group I were associated with localized infections at the catheter insertion site, but this was the case with only two of 66 catheters in group II. Dislodgement of the catheter occurred four times as frequently in group II as compared with group I. Repair of cracked catheters was successfully completed in 90% of those in group I, but none in group II. The pediatric Broviac catheter proved to be more durable than a standard No. 3 French silastic catheter.

Hemangioendothelioma of the hepatobiliary system: the classic and the unusual.

Two children are reported with hemangioendothelioma of the hepatobiliary system. One patient, a 7-month-old girl, presented with classic symptomatology of hepatomegaly and congestive heart failure, but did not have any cutaneous lesions. She was treated with systemic steroids and supportive therapy and did very well. The other patient, a 22-month-old boy, is the first patient reported with exclusive involvement of the extrahepatic biliary tree. His symptoms included hepatomegaly and obstructive jaundice. He was evaluated with an endoscopic retrograde cholangiopancreatogram and a transhepatic cholangiogram. He did very well after resection of the lesion and Roux-en-Y drainage of the proximal biliary tree and remains asymptomatic 2 years after surgery.

Prolonged elevation of transaminase concentration in children with unsuspected myopathy.

Prolonged elevation of the serum transaminase concentration in an asymptomatic child is usually thought to be secondary to liver disease. Four children with unexplained persistent elevation of serum transaminase concentration were referred to a pediatric gastroenterologist for studies of liver disease. Subsequent evaluation disclosed abnormal muscle biopsy findings in all four patients. This experience suggests that an appropriate workup for occult myopathy is indicated in such patients before invasive diagnostic procedures for evaluation of liver disease are undertaken.