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.

Cutaneous manifestations of the COVID-19 pandemic in schoolchildren and adolescents.

This review article focuses on cutaneous manifestations in schoolchildren and adolescents 6 to 18 years old connected with various aspects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, including personal protective equipment (PPE), SARS-CoV-2 infection, and the SARS-CoV-2 vaccine. The use of PPE has been associated with mask-related acne due to microbiome dysbiosis and disruption of skin homeostasis, leading to the emergence of new acne or exacerbation of preexisting acne. Chilblain-like lesions, erythema multiforme-like eruptions, and cutaneous manifestations of multisystem inflammatory syndrome related to SARS-CoV-2 are the most commonly described skin manifestations of SARS-CoV-2 infection. The proposed mechanisms involve either the direct interaction of the virus with the skin through cutaneous receptor angiotensin-converting enzyme 2 in the epidermal basal layer or hyperactive immune responses. The impact of SARS-CoV-2 infection has also been described on adnexa, including hair changes such as alopecia areata and telogen effluvium, as well as nail changes presenting as onychomadesis and periungual desquamation. Cutaneous adverse effects of the SARS-CoV-2 vaccine have been described in case reports and differ from those in adults. Therefore, there is a need for increased awareness regarding the most prevalent cutaneous manifestations associated with COVID-19 in children because they tend to be mild or nonspecific in nature.

Divergent Trends in the Prevalence of Children's Asthma, Rhinitis and Atopic Dermatitis and Environmental Influences in the Urban Setting of Zagreb, Croatia.

BACKGROUND: Previous studies have reported that the allergy epidemic in developed countries has reached its plateau, while a rise is expected in developing ones. Our aim was to compare the prevalence of allergic diseases among schoolchildren from the city of Zagreb, Croatia after sixteen years. METHODS: Symptoms of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) and risk factors were assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. An allergic profile was determined by a skin prick test. RESULTS: The prevalence of current, ever-in-a-lifetime and diagnosed AR of 35.7%, 42.5% and 14.9% and AD of 18.1%, 37.1% and 31.1% demonstrated a significant increase. The asthma prevalence has remained unchanged. The allergen sensitivity rate has remained similar, but pollens have become dominant. Mould and dog exposure are risks for asthma (OR 14.505, OR 2.033). Exposure to cat allergens is protective in AR (OR 0.277). Parental history of allergies is a risk factor in all conditions. CONCLUSION: Over sixteen years, the prevalence of AR and AD, but not of asthma, have increased. The proportion of atopy has remained high. The AR/AD symptom rise is probably a consequence of increased pollen sensitisation united with high particulate matter concentrations. The stable asthma trend could be a result of decreasing exposures to indoor allergens.

[Ankle-brachial pressure index as a predictor of future cardiovascular outcomes]. / Omjer tlaka nad gleznjem i nadlakticom-metoda procjene kardiovaskularnog rizika.

Peripheral arterial occlusive disease is very common in the general population and it is mostly of atherosclerotic origin. About 50%-75% of patients are asymptomatic. Many studies have shown the ankle-brachial pressure index (ABPI) to be a simple and reliable test with high sensitivity (90%) and specificity (98%) in the diagnosis of hemodynamically relevant stenosis of an arterial segment and also in detection of asymptomatic patients. The values of ABPI < 0.90 suggest widespread atherosclerosis, while the ABPI > 1.40 is associated with arterial calcification and wall stiffening. This test is highly specific (92.7%) in predicting future cardiovascular and cerebrovascular risk and could provide a tool for more focused prevention strategies.