Pulmonary tuberculosis in Italian children by age at presentation.

AIM: To evaluate the clinical characteristics, diagnostic methods and outcome of paediatric pulmonary tuberculosis (PTB) in relation to children's ages when observed. METHODS: Children under 15, who had been admitted to the Children's Hospital with PTB were prospectively evaluated. Our sample included patients with a positive tuberculin skin test and signs or symptoms of tuberculosis (TB), including abnormal chest X-rays which suggested PTB. We collected demographic, clinical, radiographic and microbiological data from the patients, in addition to carrying out contact investigations in order to find a source case. All the patients involved in this study were subjected to anti-tuberculosis treatment. RESULTS: Sixty-two patients (44% under 5) were eligible for inclusion in our study. Children with presenting symptoms were younger than asymptomatic patients (p<0.05). A source case was found in 38 patients out of 62 children (62%) and children under 5 were more likely to have a source case than that found with older children (p<0.05). Ghon complex (infiltrate + adenopathy) tended to occur in young children (median age of 3.25, p<0.05). Fourteen children (23%) had clinical specimens which tested positive for Mycobacterium tuberculosis (MT), and 20 (32%) for MT DNA according to a polymerase chain reaction (PCR). Resistant strains to 1 or more anti-tuberculosis drugs were found in 5 children and in 4 adult sources. The patients with minimal or no radiographic change during therapy displayed symptoms for a longer period of time and were infected by a resistant strain (p<0.05). CONCLUSION: Improvements in case detection, case management and contact investigations are necessary for controlling paediatric TB, especially in young children. Given that any diagnosis of TB in children is supported by epidemiological and clinical evidence rather than isolating MT, detection of the source case is important in selecting appropriate treatment.

Tuberculosis of the central nervous system in children: 32 years survey.

AIM: In order to study the impact of clinical and diagnostic parameters on the clinical outcome of children with central nervous system tuberculosis (CNS-TB), we retrospectively reviewed all cases of CNS-TB diagnosed over a 32-year period at the Children's Hospital of Palermo, Italy. METHODS: Data were collected with regard to the clinical, laboratory and demographic characteristics of patients, as well as the results of radiological investigations and data on clinical outcome. In relation to the date of introduction of new diagnostic methods (indirect as well direct) and to the change of treatment periods, the authors compared the clinical outcome of patients admitted prior and after 1984. They also classified the patients into 3 different stages of illness according to the severity of the disease on admission. RESULTS: We identified 80 patients with CNS-TB. The mean age of the children was 3 years with 54% of patients younger than 5 years. The contact source was documented in 40 patients (50%). The mean duration of symptoms prior to admission was 22 days (range 5 days - 3 months). Mantoux skin test was positive on admission in 50 patients (62%). CSF smear microscopy and culture were positive in 29% and 45% of patients respectively. PCR for Mycobacterium tuberculosis introduced in 1994 was positive in 11 out of 13 tested patients. Determination of CSF gdT lymphocytes composition applied in 7 patients shows a predominance of Vg9/Vd2 T lymphocytes. Fifteen subjects (19%) died; 11 (13%) suffered from permanent sequelae. The died children and those with permanent sequelae were younger than the others (p<0.05). Prior to 1984, none of the patients were identified during early stage of illness and 4 out of 37 patients with stage II illness died. After 1985, 44% of children were in stage I and 2 out of 4 patients with stage III died (p<0.05). CONCLUSIONS: Stage of disease and young age are still the decisive factors in the clinical outcome of children with CNS-TB. The availability of new advanced methods has improved the identification of patients with CNS-TB in stage I and therefore the possibility of an early treatment of such patients.

Efficacy and safety of clarithromycin as treatment for Mediterranean spotted fever in children: a randomized controlled trial.

Fifty-one children with Mediterranean spotted fever (MSF) were randomized to receive either clarithromycin, 15 mg/kg/day orally in 2 divided doses, or chloramphenicol, 50 mg/kg/day orally in 4 divided doses, for 7 days. Mean time to defervescence was 36.7 h in the clarithromycin group and 47.1 h in the chloramphenicol group (P=.047). Clarithromycin could be an acceptable therapeutic alternative to chloramphenicol and to tetracyclines for children aged <8 years with MSF.

Outbreak of Salmonella enteritis bongori 48:z35:- in Sicily.

Salmonella bongori 48:z 35 :- was first isolated from a lizard in Chad in 1966 and was classified as a biochemically atypical strain of the subgenus I of Kauffmann. Successively, some additional strains with different antigenic formulas but similar bioche

Plasma levels of tumor necrosis factor-alpha and interferon-gamma in Sicilian children with Mediterranean spotted fever.

The plasma levels of tumor necrosis factor-alpha and interferon-gamma were measured in 53 consecutive children with serologically confirmed Mediterranean spotted fever and were found to be increased during the acute phase compared with the convalescent phase (tumor necrosis factor-alpha mean 32.17 vs. 4.12 pg/ml, P < 0.0001; interferon-gamma mean 84.17 vs. 2.65 pg/ml, P = 0.0006). Plasma levels of both cytokines were higher in patients with a typical exanthema rather than those with a very mild or no exanthema; tumor necrosis factor-alpha levels were significantly lower in the latter (tumor necrosis factor-alpha 32.17 vs. 9.85 pg/ml, P < 0.0001; interferon-gamma 84.17 vs. 38.14 pg/ml, P = 0.35). Tumor necrosis factor-alpha and interferon-gamma may be harmful or beneficial to the infected host, depending upon the amounts produced and whether they are circulating or confined locally to the site of inflammation.

[Respiratory syncytial virus lower respiratory tract infection: our series]. / Le infezioni delle basse vie aeree da virus respiratorio sinciziale: la nostra casistica.

The authors report 57 cases of Respiratory Syncytial Virus (RSV) lower respiratory tract infection. The diagnosis was performed by detection of specific serum antibodies of IgM class or by direct detection of RSV antigens in nasopharyngeal specimens. Most of the patients were younger than one year. No one had risk factors for severe RSV infection form. All patients recovered. The authors emphasize the difficulties to discriminate between bronchiolitis and interstitial pneumonitis on the basis of the clinical and radiological features.

[Tuberculous meningo-encephalitis in pediatrics. Considerations on 71 cases (1968-1993)]. / Meningoencefalite tubercolare in età pediatrica. Considerazioni su 71 casi (1968-1993).

The tuberculous meningitis is an uncommon but severe complication of the tuberculosis mainly in childhood. Neurological sequelae are frequent and high mortality rate, till now, occurs. We reviewed the medical records of 71 cases and we evaluated the most frequent symptoms before the admission and signs and symptoms on the admission according to prognosis. An early diagnosis and specific anti-tuberculous treatment are essential in order to prevent permanent neurological sequelae and fatal outcome

[Not Available]. / Malattia acuta esantematica da parvovirus umano.

In June 1994 have been seen 16 patients with HPV B19 infection. The diagnosis was based on a positive E.L.I.S.A. test for IgM antibodies against HPV B19. No one of the patients had hematologic manifestations. Only one patient had fever, arthralgia and headache without skin involvement. The other 15 patients had skin lesion: rubella like rush in 11 cases, haemorragic exanthema in 2 and erythema infectious in 2 cases. Two children had liver involvement and one kidney involvement. The authors of this study remark the broad spectrum of clinical manifestations of HBV B19 infection and suppose a large diffusion of this disease, even in the symptomatic form.