Tuberculous Pericarditis in Childhood: A Case Report and a Systematic Literature Review.

Tuberculous pericarditis (TBP) is an important cause of pericarditis worldwide while being infrequent in childhood, especially in low-TB-incidence countries. We report a case of TBP and provide a systematic review of the literature, conducted by searching PubMed, Scopus, and Cochrane to find cases of TBP in pediatric age published in the English language between the year 1990 and the time of the search. Of the 587 search results obtained, after screening and a backward citation search, 45 studies were selected to be included in this review, accounting for a total of 125 patients. The main signs and symptoms were fever, cough, weight loss, hepatomegaly, dyspnea, and increased jugular venous pressure or jugular vein turgor. A definitive diagnosis of TBP was made in 36 patients, either thanks to microbiological investigations, histological analysis, or both. First-line antitubercular treatment (ATT) was administered in nearly all cases, and 69 children underwent surgical procedures. Only six patients died, and only two died of TBP. TBP in childhood is relatively uncommon, even in high-TB-prevalence countries. Clinical manifestations, often suggestive of right-sided cardiac failure, are subtle, and diagnosis is challenging. TBP has an excellent prognosis in childhood; however, in a significant proportion of cases, invasive surgical procedures are necessary.

Mucosal Relapse of Visceral Leishmaniasis in a Child with SARS-CoV-2 Infection.

Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania and is transmitted through the bite of infected female sandflies. In the Mediterranean region, visceral leishmaniasis is caused by Leishmania. infantum, and it is usually responsible for symptoms such as fever, pancytopenia and enlargement of the liver and spleen. Relapse is rare in immunocompetent patients as much as the mucous involvement. We present a rare case of mucosal relapse of visceral leishmaniasis in a child with SARS-CoV-2 infection and perform an extensive review of the literature about leishmaniasis relapses in children. Atypical mucosal involvement during Leishmaniasis relapse is an eventuality in pediatric patients. Clinical follow-up and periodic PCR tests must be considered essential for the early recognition and treatment of an eventual relapse.

Streptococcus mitis as a New Emerging Pathogen in Pediatric Age: Case Report and Systematic Review.

Streptococcus mitis, a normal inhabitant of the oral cavity, is a member of Viridans Group Streptococci (VGS). Generally recognized as a causative agent of invasive diseases in immunocompromised patients, S. mitis is considered to have low pathogenic potential in immunocompetent individuals. We present a rare case of sinusitis complicated by meningitis and cerebral sino-venous thrombosis (CSVT) caused by S. mitis in a previously healthy 12-year-old boy with poor oral health status. With the aim of understanding the real pathogenic role of this microorganism, an extensive review of the literature about invasive diseases due to S. mitis in pediatric patients was performed. Our data define the critical role of this microorganism in invasive infections, especially in immunocompetent children and in the presence of apparently harmful conditions such as sinusitis and caries. Attention should be paid to the choice of therapy because of VGS's emerging antimicrobial resistance patterns.

Granulicatella spp., a Causative Agent of Infective Endocarditis in Children

Granulicatella spp. are non-motile, non-sporulating, facultatively anaerobic Gram-positive cocci. Throughout the literature, these organisms have been referred to by several names, such as "nutritionally deficient streptococci", "vitamin-B dependent streptococci" and "pyridoxal-dependent streptococci", because of their fastidious nutritional requirements, which can often make culture isolation challenging. Known to be a member of the normal microbiota of the human oral cavity and urogenital and intestinal tracts, similar to other streptococci, Granulicatella spp. can cause bacteremia, sepsis and infective endocarditis. Considering the difficulty in growing this organism on culture medium, the fact that it is now included among the bacteria known to be responsible for culture-negative infective endocarditis suggests that its pathogenic role could be highly underestimated. Moreover, being considered such a rare causative agent, it is not a target of standard antibiotic empiric treatment. We present a rare case of G. elegans endocarditis in a young child and review the medical literature on Granulicatella endocarditis in the pediatric population, with the aim of sharing knowledge about this microorganism, which can be challenging for a clinician who is not familiar with it.

Third Case of Visceral Leishmaniasis in COVID-19: Mini Review Article.

BACKGROUND: In the currently ongoing coronavirus pandemic, coinfections with unrelated life-threatening febrile conditions may pose a particular challenge to clinicians. Leishmaniasis is a zoonosis that may present general symptoms, including fever, malaise, and arthralgia, rendering it indistinguishable from COVID-19. METHODS: In this paper, we aim to draw attention to this issue and analyze the clinical characteristics of the coinfection SARS-CoV-2/Leishmania through a systematic review of the literature. We were motivated by the observation of the first case of visceral leishmaniasis and COVID-19 in a paediatric patient. CONCLUSION: Our case is a reminder for healthcare providers to consider the diagnosis of visceral leishmaniasis in patients presenting with febrile syndrome in endemic regions during the COVID-19 pandemic.

Predictors of prolonged mechanical ventilation in a cohort of 5123 cardiac surgical patients.

BACKGROUND: Prolonged mechanical ventilation (PMV) after heart surgery is associated with increased patient morbidity and mortality. METHODS: In this prospective observational cohort study the aim was to assess PMV predictors and its impact on ICU, hospital length of stay and survival in cardiac surgical patients admitted to our eight-bed ICU from January 2000 to December 2006. All perioperative patient variables were put into an electronic database. Five thousand one hundred and twenty-three patients were divided into two cohorts: early extubation, undergoing a successful extubation for 12 h or less, and delayed extubation, needing a mechanical ventilation for more than 12 h. RESULTS: A logistic regression model identified the following as PMV predictors: age more than 65 years [odds ratio (OR), 1.296; 95% confidence interval (CI), 1.017-1.069; P = 0.016], chronic renal failure (OR, 1.571; 95% CI, 1.566-2.466; P = 0.011), chronic obstructive pulmonary disease (OR, 1.453; 95% CI, 1.695-2.454; P = 0.006), redo surgery (OR, 2.010; 95% CI, 1.389- 2.114; P = 0.001), emergency surgery (OR, 1.622; 95% CI, 1.515-2.494; P = 0.016), New York Heart Association/Canadian Cardiovascular Society class higher than 2 (OR, 1.491; 95% CI, 1.704-2.321; P = 0.001), left ventricular ejection fraction of 30% or less (OR, 2.125; 95% CI, 1.379-1.991; P = 0.000), red blood cell (OR, 5.430; 95% CI, 3.636-8.130; P = 0.000) and fresh frozen plasma transfusion units more than four (OR, 3.019; 95% CI, 1.808-5.050; P = 0.000) and cardiopulmonary bypass time more than 77 min (OR, 2.030; 95% CI, 1.248-2.174; P = 0.002). Early extubation group patients showed a higher probability of being discharged from ICU to cardiac surgical ward (log-rank = 1108.951; P = 0.000) and from cardiac to rehabilitation ward (log-rank = 598.005; P = 0.000) and higher hospital survival (log-rank = 53.215; P = 0.000). CONCLUSION: This review allowed us to assess predictors, helping us to identify 'a priori' patients more likely to undergo PMV.