Chemokines CXCL10, CXCL11, and CXCL13 in acute disseminated encephalomyelitis, non-polio enterovirus aseptic meningitis, and neuroborreliosis: CXCL10 as initial discriminator in diagnostic algorithm?

We investigated potential diagnostic usefulness of serum and cerebrospinal fluid (CSF) concentrations of chemokines CXCL10, CXCL11, and CXCL13 in pediatric patients with acute disseminated encephalomyelitis (ADEM) (n = 23), non-polio enterovirus aseptic meningitis (NPEV AM) (n = 20), and neuroborreliosis (NB) (n = 21) and children with acute infectious diseases with neurological symptoms but with excluded neuroinfection/neuroinflammation (controls, n = 20). CSF levels of CXCL10 and CXCL11 were higher in patients with NPEV AM than those in other children, and CXCL10 levels showed a high discriminative potential (area under the receiver operating characteristic curve, ROC, 0.982) with high specificity and sensitivity (both 95%). CSF levels of CXCL13 were higher in NB patients than those in other children; however, discriminative potential (area under ROC curve 0.814) and diagnostic properties were moderate (sensitivity 67%, specificity 97%). Data suggest usefulness of chemokine quantification as a diagnostic aid in children with suspected ADEM, NPEV AM, or NB.

[CONTRAST ENHANCED VOIDING UROSONOGRAPHY (CEVUS) IN THE DIAGNOSIS OF VESICOURETERAL REFLUX]. / MIKCIJSKA UROSONOGRAFIJA POJACANA KONTRASTOM (CEVUS) U DIJAGNOSTICI VEZIKOURETERALNOG REFLUKSA.

Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children and can be associated with reflux nephropathy (RN). Some patients with RN develop chronic kidney disease, hypertension and a small number of patients progress to end-stage renal disease. Early detection of children with these clinical characteristics should be the goal of clinical, biochemical, and radiological evaluation of patients presenting with prenatal hydronephrosis or febrile urinary tract infection. The goals of imaging procedure in general are to confirm the diagnosis suspected with a high degree of sensitivity and specificity, to aid treatment and allow prognosis. The diagnosis of vesicoureteric reflux (VUR) is a relatively straightforward and well-established procedure. There is increasing awareness of the risks of radiation exposure and invasivness of VUR investigation which can be unpleasant experience for both child and parents. Currently, contrast enhanced voiding urosonography (ceVUS) is a radiation free, highly sensitive imaging modality for vesicoureteral reflux (VUR) and urethral imaging in children. It employs ultrasound technology (contrast-specific software) in combination with commercially available second generation ultrasound contrast administered intravesically via a bladder catheter.

Pneumonia With Empyema: A Rare Clinical Presentation of Bartonella henselae Infection in a 10-Year-Old Boy.

BACKGROUND: Cat-scratch disease is a common zoonosis in children. However, atypical clinical presentation of cat-scratch disease is less common, and lung involvement is particularly rare. The usual presentation of lung disease in bartonellosis includes other organ involvement and is more common in immunocompromised patients. CASE REPORT: We present a 10-year-old immunocompetent patient with pneumonia and inoculated empyema caused by Bartonella henselae, without any other organ involvement, which occurred 2 weeks after lymphadenopathy. The definite diagnosis was established using the polymerase chain reaction of the empyema obtained from thoracocentesis. The boy was treated with several antibiotics (ceftriaxone, azithromycin, amoxicillin with clavulanic acid, meropenem and vancomycin) and completely recovered after the 3-month follow-up period. CONCLUSIONS: This is a unique case of the difficult-to-treat pneumonia with inoculated empyema, caused by B. henselae, in an immunocompetent child, without any other organ involvement. The clinical course was favorable. A high level of clinical suspicion is mandatory for the diagnosis.

Lemierre Syndrome in Adolescent with Active Ulcerative Colitis.

Inflammatory bowel disease (IBD) is a well-recognized risk factor for thrombotic events in adults but data on children are scarce. In the great majority of adult patients, thrombotic events are usually deep vein thrombosis and pulmonary embolism. Other sites such as jugular veins are extremely rare. We present a case of Lemierre syndrome in an adolescent girl with active ulcerative colitis and discuss possible risk factors. This is the first reported case of severe Lemierre syndrome with thrombus extension to cranial veins in a patient with ulcerative colitis. Early recognition of Lemierre syndrome in patients who present with rapidly worsening symptoms of neck pain, fever and signs of pharyngitis is imperative because it increases a chance of favorable prognosis. It is important for pediatricians treating IBD patients not to underestimate possible thrombotic events in children with IBD. Recognition of additional risk factors is crucial for prompt diagnosis and adequate treatment.