Community-associated Staphylococcus aureus infections and nasal carriage among children: molecular microbial data and clinical characteristics.

An increasing number of infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carrying the Panton-Valentine leukocidin (PVL) genes was recently identified in Greece. In the present study, 170 patients with S. aureus infections and 123 uninfected children (<15 years old) who had been tested for nasal carriage were evaluated during a 2-year period. The MecA, PVL and superantigen family genes, and MRSA clones, were investigated by molecular methods. Sites of infection and laboratory findings for patients were recorded. The results were compared and statistically analysed. Among 123 uninfected children 73 (59%) carried S. aureus, including four MRSA strains. Of these, three MRSA and three methicillin-sensitive S. aureus (MSSA) strains were PVL-positive (p <0.0001). Ninety-six patients (96/170) exhibited skin and soft-tissue infections (SSTIs), and 74 exhibited invasive infections. The incidence of staphylococcal infections increased during July to September each year. In total, 110 S. aureus isolates were PVL-positive (81 from SSTIs and 29 from invasive infections, p <0.0001). Ninety-nine out of 106 MRSA (93%) isolates from 170 patients carried the PVL genes (p <0.0001); 97 belonged to the clonal complex CC80. Leukocyte and polymorphonuclear cell counts were higher among children with MRSA infections (p <0.005). MSSA predominated among patients with invasive infections (43/74), and carried mainly genes of the superantigen family. Children <5 years of age showed a higher risk of MRSA infection. The present study demonstrates that infections due to PVL-positive CA-MRSA spread easily among children, and SSTIs can lead to invasive infections. Nasal colonization may be an additional factor contributing to the emergence of CA-MRSA.

[Sacroilitis and osteomyelitis of the humeral bone du to Brucella melitensis in an adolescent]. / Sacro-iléite et ostéo-myélite de l'humérus dues à Brucella melitensis chez une adolescente.

We describe a case of a 10 year old patient who presented with intermittent fever and pain in the pelvis and elbow region. From the history, imaging and laboratory tests, a diagnosis of Brucella sacroiliitis and elbow osteoarthritis was made. The patient was given an antibiotic treatment for 3 months with a progressive improvement of symptoms to complete recovery, and normalization of imaging and laboratory findings.

Methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin as a cause of acute osteomyelitis in children.

Staphylococcus aureus was identified as the cause of acute childhood osteomyelitis in 19 patients. A single clone of community-acquired methicillin-resistant S. aureus (MRSA) carrying the type IV mecA staphylococcal cassette chromosome and the Panton-Valentine leukocidin (PVL) genes was isolated from five patients. Among the remaining 14 patients, two methicillin-sensitive S. aureus (MSSA) isolates were PVL-positive. The maximal erythrocyte sedimentation rate and C-reactive protein values, and the time required for normalisation, were significantly different in patients with PVL-positive strains (MRSA and MSSA), suggesting that the production of PVL is an important factor that contributes to the course of the disease.

Correlative analysis of the sagittal profile of the spine in patients with beta-thalassemia and in healthy persons.

This prospective study compares several roentgenographic parameters of the thoracic and lumbar spine in patients with beta-thalassemia and in healthy persons who served as controls. Eighty-four patients with beta-thalassemia and 84 age- and gender-matched healthy persons were examined clinically and radiologically (thoracic kyphosis, lumbar lordosis, and vertebral and sacral inclination). Although there was a significant difference in the vertebral inclination from T6 to L1, L4, and L5 between patients and controls, thoracic kyphosis and lumbar lordosis did not differ in the two groups. The apical vertebra of the thoracic kyphosis in patients and controls was T7 and T6, respectively, whereas L4 was the apical vertebra of the lumbar lordosis in both groups. There were no age- or gender-related differences in the magnitude of sacral inclination, thoracic kyphosis, or lumbar lordosis in the patients with beta-thalassemia compared with controls. Lumbar lordosis was significantly correlated with sacral inclination in both patients with beta-thalassemia and controls. Beta-thalassemia does not affect sagittal profile of the thoracic and lumbar spine but it is associated by structural changes on the frontal plane of the spine that are expressed as a high prevalence of scoliosis.

Concentration of iron and distribution of iron and transferrin after experimental iron overload in rat tissues in vivo: study of the liver, the spleen, the central nervous system and other organs.

The purpose of this study was to estimate the iron concentration in the liver, spleen and brain of control rats and rats overloaded with iron and to determine the distribution of iron and of transferrin (TF). Iron was administered to Wistar rats by food supplemented with 3% carbonyl iron for 3 months, or intraperitoneally, or intraveneously as iron polymaltose for 4 months (total administered dose: 300 or 350 mg/rat, respectively). Iron concentration was estimated by atomic absorption spectrophotometry and iron- and TF-distribution histochemically and immunohistochemically, respectively. In control rats the organ with the highest iron content was the spleen, followed by the liver and brain. After iron loading the increase of iron in the liver was greater than that of the spleen; iron concentration in the brain did not change significantly. Distribution of iron in the liver was in Kupffer cells throughout the lobule and in hepatocytes at its periphery. No difference in the number of positive cells or staining intensity for TF was observed between control rats and iron overloaded animals in the liver or central nervous system (CNS); the spleen was negative for TF. Distribution of TF in the liver showed a centrilobular localisation in hepatocytes. TF reaction in the brain occurred in oligodendrocytes, vessel walls, choroid plexus epithelial cells and some neurons. In conclusion, experimental iron overload in rats leads to iron uptake mainly by reticuloendothelial (RE) cells and hepatocytes, indicating that hepatocytes are of particular importance for iron metabolism. Iron uptake by the brain was not significant, probably because the brain is protected against iron overload. Iron overload did not influence location and quantity of TF in the liver and CNS, whereas the visualisation of iron and TF did not coincide. This indicates that TF may have other functions beyond iron transport.

Response to interferon alfa-2b therapy in mutitransfused children with beta-thalassemia and chronic hepatitis C.

Hepatitis C virus is responsible for the majority of cases of post-transfusion non-A non-B hepatitis in patients with thalassemia major. Interferon alfa is an effective treatment for patients with chronic hepatitis C. Response to therapy is related to the duration of treatment, the viral load in serum, and the hepatitis C virus genotype. The purpose of this study was to estimate the response of multitransfused children with beta-thalassemia and chronic hepatitis C to interferon alfa-2b therapy. Thirteen patients with beta-thalassemia and chronic hepatitis C, (mean age+/-SD, 14.1 +/- 1.7 years) participated in the study. Liver biopsy, estimation of HCV RNA, and virus genotyping were performed before onset of treatment. All patients were positive for HCV RNA in a low concentration; two patients carried the la genotype, four had genotype 3, and seven had genotype 4. Patients were treated with 3 x 10(6) U of subcutaneous interferon alfa-2b three times weekly. Eleven of 13 patients received therapy for 18 months; the remaining two underwent therapy for 6 months. Six of 13 patients responded completely to therapy, four responded partially, and three did not respond at all. The grade of inflammation and stage of fibrosis was lower in complete responders. Complete responders had lower ferritin values compared with the values for partial and nonresponders before starting therapy. The results suggest that interferon therapy should be recommended for children with beta-thalassemia major complicated by a low viral concentration of hepatitis C.

Influence of iron overload on manganese, zinc, and copper concentration in rat tissues in vivo: study of liver, spleen, and brain.

Although hemochromatosis and pathological situations due to chronic iron overload have been extensively described, there is little information about the influence of iron on other trace elements in the cell. The aim of this study was to investigate changes in the concentration of zinc, manganese, and copper in the liver, spleen, and brain of rats after iron overload. Iron overload in Wistar rats was achieved by iron-supplemented diet or by intraperitoneal or intravenous injection of polymaltose iron. Iron, zinc, manganese, and copper were determined by atomic absorption spectrophotometry. Iron overload in rats, regardless of the route of its application, resulted in an increase not only of iron but also of zinc and manganese in the liver and the spleen, whereas the content of these metals in the brain did not change. The copper content of the liver, spleen, and brain remained the same after iron overload. The increase of zinc and manganese in the liver and spleen following iron overload was probably a result not only of increased intestinal absorption but also of increased uptake from the cell. This is also supported by the fact that no increase in the zinc and manganese concentrations occurred in the brain since, despite iron overload, the iron content remained constant.

Comparative study of tolerability and efficacy of iron protein succinylate versus iron hydroxide polymaltose complex in the treatment of iron deficiency in children.

One-hundred children, 48 males and 52 females, mean age +/- SD 39.9 +/- 28.2 months (range 12 to 113) with sideropenia or sideropenic anemia were randomly divided into 2 groups of 50 patients each (groups A and B) and were treated with iron protein succinylate (group A) or iron hydroxide polymaltose complex (group B). Patients of both groups received 4 mg/kg elemental iron, maximally 80 mg daily, for 2 months. Side-effects of therapy and laboratory values (RBC, hematocrit, hemoglobin, MCV, serum iron, total iron binding capacity, and ferritin) were registered before treatment, 30 days after the beginning of therapy as well as after 60 days in order to evaluate tolerability and efficacy of the drugs. Both drugs were well tolerated and showed only few adverse reactions, which were comparable in severity and frequency. Iron protein succinylate led not only to a faster increase of hemoglobin, hematocrit, MCV, serum iron, and ferritin than iron hydroxide polymaltose complex, but the laboratory values remained higher in group A than in B even after 2 months of treatment.

Use of tolfenamic acid in febrile children with and without glucose-6-phosphate dehydrogenase deficiency.

The purpose of this study was to evaluate the antipyretic action of tolfenamic acid, as well as its possible adverse reactions, especially in children with severe or partial form of glucose-6-phosphate dehydrogenase (G6PD) deficiency. In the study 55 febrile children were included, whose mean age was +/- SD 3.5 +/- 3.3 years, range 0.5-15. Ten of them had severe or partial form of G6PD deficiency. Fifty-three of the patients responded with a decrease of temperature which lasted at least 6 hours, though in 2 of them the temperature decrease lasted less than 6 hours. The tolerance of the drug was good and no side-effects were noted. None of the patients with or without G6PD deficiency showed symptoms, signs, or laboratory findings indicating hemolysis before administration of the drug and 4 days thereafter. In conclusion, tolfenamic acid is a strong antipyretic agent with excellent tolerance and high safety in children.

Lack of transmission of hepatitis C in household contacts of children with homozygous beta-thalassaemia.

Forty-eight household contacts of 25 children with homozygous beta-thalassaemia and chronic hepatitis C (index cases) were evaluated for antibodies against hepatitis C virus (HCV) and increased transaminase values in the blood. The mean age +/- SD of the household contacts was 36.4 +/- 17.0 years (range 5-67) and 20 of them were males. All thalassaemic patients (age 14.3 +/- 3.0 years, range 8-19) were positive for anti-HCV antibodies by repeated determinations. HCV-RNA was detected in the blood of 22 of 23 patients tested by polymerase chain reaction. Liver biopsies were performed in 18 patients and showed chronic active hepatitis in 14 and chronic persistent hepatitis in 4. The mean duration of contact between the index cases and the household contacts while the index cases were anti-HCV positive was 45.3 +/- 10.2 months (range 17-57). None of the household contacts was found to be positive for anti-HCV antibodies nor did they have elevated transaminases in the two examinations performed within an interval of about 2 years. Among the HCV-negative household contacts are included 14 who mentioned needlestick injuries with needles used by the index cases.

beta-Thalassaemia and factors affecting the metabolism of lipids and lipoproteins.

Total cholesterol, triglycerides (TG), LDL-cholesterol, HDL-cholesterol, alpha-lipoprotein (LP) (HDL-LP), pre-beta-LP (VLDL-LP) and beta-lipoprotein (LDL-LP) were measured in the blood of 104 patients with major and intermedia form of beta-thalassaemia and 112 control subjects, mean age +/- SD 10.2 +/- 3.5 and 9.1 +/- 3.8 years, respectively. Cholesterol, LDL- and HDL-cholesterol were significantly decreased and TG was significantly increased in the patients compared to the control subjects. TG values in male patients were significantly higher than in male control subjects, but no differences were found in females. Patients with major and intermedia forms of beta-thalassaemia and chronic hepatitis C have significantly lower values of cholesterol and beta-LP and higher values of HDL-cholesterol than patients without hepatitis C. An increase of HDL-cholesterol and alpha-LP was found in patients with diabetes mellitus or impaired glucose tolerance (IGT) compared to patients without IGT. In the thalassaemic patients there was an increase of TG and pre-beta-LP and a decrease of HDL-cholesterol and alpha-LP with increasing ferritin values. There was a positive correlation of the patients' age with TG and pre-beta-LP whereas no such correlation was found in the control subjects. It appears, therefore, that many factors as iron overload, liver injury, hormonal disturbances and aging affects lipids and LP pattern in patients with major and intermedia form of beta-thalassaemia.

Peripheral neuropathy in patients with beta-thalassaemia.

As some patients with beta-thalassaemia manifested neurological signs, clinical and electrophysiological investigations were carried out on 53 thalassaemic patients and 29 healthy control subjects. Twenty per cent of the patients showed clinical and electrophysiological findings of a mild peripheral sensorimotor neuropathy, mainly of the lower limbs. The clinical symptoms were numbness, pins and needles sensations, muscular cramps, myalgia and muscle weakness. The electrophysiological abnormalities were manifested by decreased motor conduction velocity (MCV) and prolonged F-wave latencies of the tibial and the peroneal nerves. Borderline increase in the latencies of the sensory potentials of the median nerve was also observed. The electromyographic findings of the patients with diminished MCVs were compatible with a predominantly motor peripheral neuropathy. This neuropathy appears during the second and third decade of life.

Hepatitis B in household contacts of children with beta-thalassemia.

The hepatitis B virus (HBV) markers have been studied in 184 household contacts of 110 thalassemic patients and 184 normal individuals matched for age and socioeconomic status with the study subjects. The mean age (+/- SD) in both patients and control subjects was 31.1 +/- 13.5 years. HBV infection had occurred in 51.6% of the household contacts and in 32.1% of the control subjects. This difference is highly significant (p less than 0.001). The most frequent marker observed was the antihepatitis B core IgG followed by the antihepatitis B surface antibody. It is noteworthy that none of the thalassemic patients infected in the past was seropositive for the hepatitis B surface antigen at the time of the study, whereas its frequency in the general population was 8.1%. The findings indicate that the household contacts of thalassemic patients have a greater seroprevalence for hepatitis B infection. Furthermore, the household contacts of thalassemic patients are infected at a younger age than the control population. The high infection rate with HBV in all groups tested suggests that vaccination should be considered not only for the household contacts of thalassemic patients but possibly for the entire Greek population.