RESUMO
The lymphotropic herpesviruses, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6B (HHV-6B) can reactivate and cause disease in organ transplant recipients; the contributions of HHV-6A and HHV-7 to disease are less certain. Less is known about their pathogenic roles in children undergoing treatment for malignancies. Children with newly diagnosed cancer were followed for 24 months. Clinical information and blood samples were collected during routine visits and during acute visits for fever or possible viral infections. Lymphotropic herpesvirus DNA in blood was measured by polymerase chain reaction (PCR). Although HHV-6B DNA was detected at least once in about half of the patients; the other viruses were seldom detected. There was no association between HHV-6B detection and individual acute clinical events, however, HHV-6B detection was more common in children who experienced more frequent acute clinical events. In children being treated for various malignancies, HHV-6B detection was common, but was not associated with individual events of acute illness. Thus, if HHV-6B is not assessed longitudinally, clinical events may be misattributed to the virus. The elevated frequency of detection of HHV-6B in sicker children is consistent with prior reports of its detection during apparently unrelated acute clinical events. J. Med. Virol. 88:1427-1437, 2016. © 2016 Wiley Periodicals, Inc.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/virologia , Herpesvirus Humano 6/isolamento & purificação , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Infecções por Roseolovirus/virologia , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , DNA Viral/sangue , Tratamento Farmacológico , Feminino , Herpesvirus Humano 6/genética , Herpesvirus Humano 7/genética , Herpesvirus Humano 7/isolamento & purificação , Humanos , Lactente , Estudos Longitudinais , Masculino , Neoplasias/virologia , Reação em Cadeia da Polimerase , Infecções por Roseolovirus/diagnóstico , Infecções por Roseolovirus/etiologia , Carga Viral , Adulto JovemRESUMO
PURPOSE: Though it has become increasingly clear that religion and spirituality are important aspects of whole patient care, little is known about how this topic is taught to medical students. This systematic review examined the structure of courses teaching spirituality to medical students and assessed their impact on reported student outcomes. METHODS: In October 2020, the authors conducted a systematic review of the literature from 1926 to 2020 to identify published articles describing medical school spirituality curricula. Included studies were English-language articles that described spirituality courses predominantly designed for medical students, specified a curricular structure, and evaluated outcomes of the course. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of the included studies and summarized course structures, curricular content, and study outcomes. RESULTS: Nineteen publications of the 1889 reviewed met the inclusion criteria. These studies were of moderate quality (mean MERSQI = 9.9). The majority of curricula were taught in United States medical schools. Courses were evenly split between mandatory versus elective classes, with mandatory courses having a shorter duration and higher total student participation. Most studies with clear student outcome evaluation had a pre- and post-test design. Common themes throughout the curricula included teaching how to take a spiritual history, delineating differences between spirituality and religion, and experience shadowing chaplains interacting with patients. CONCLUSIONS: This broad systematic review of the literature revealed a small but growing number of studies describing specific course structure and curricula for teaching spirituality at the medical student level. For the most concise approach, one short, mandatory didactic session followed by application with standardized or hospital patients can be an effective method of introducing students to the importance of spirituality. Important topics to address include the differences between religion and spirituality, recognizing spiritual distress, how to take a spiritual history, and the relevance of spirituality to student well-being. Measured student outcomes should encompass behavioral changes during patient care in addition to changes in knowledge and attitudes. Suggested methods of evaluation include reflective writing and adding a standardized patient case in which the patient is in spiritual distress in an Objective Structured Clinical Examination (OSCE).
Assuntos
Educação Médica , Estudantes de Medicina , Currículo , Humanos , Faculdades de Medicina , Espiritualidade , Estados UnidosRESUMO
Although a safe and effective vaccine has been available for over 6 decades, vaccine hesitancy in the United States and social and political unrest globally have led to undervaccination. As a result, in recent months, vaccine control of measles has been threatened with an alarming upswing in measles cases nationally and internationally. Here, we review the disease and its management in view of recent outbreaks.
Assuntos
Surtos de Doenças/prevenção & controle , Vacina contra Sarampo/uso terapêutico , Sarampo/epidemiologia , Doenças Preveníveis por Vacina/epidemiologia , Humanos , Sarampo/prevenção & controle , Estados Unidos , Doenças Preveníveis por Vacina/prevenção & controleRESUMO
We conducted a cross-sectional study of beta-herpesviruses in febrile pediatric oncology patients (n = 30), with a reference group of febrile pediatric solid-organ transplant recipients (n = 9). One (3.3%) of 30 cancer patients and 3 (33%) of 9 organ recipients were PCR positive for cytomegalovirus. Four (13%) of 30 cancer patients and 3 (33%) of 9 transplant recipients had human herpesvirus 6B (HHV-6B) DNAemia, which was more common within 6 months of initiation of immune suppression (4 of 16 vs. 0 of 14 cancer patients; p = 0.050). HHV-6A and HHV-7 were not detected. No other cause was identified in children with HHV-6B or cytomegalovirus DNAemia. One HHV-6B-positive cancer patient had febrile disease with concomitant hepatitis. Other HHV-6B-positive children had mild "viral" illnesses, as did a child with primary cytomegalovirus infection. Cytomegalovirus and HHV-6B should be included in the differential diagnosis of febrile disease in children with cancer.
Assuntos
Betaherpesvirinae/isolamento & purificação , Infecções por Herpesviridae/complicações , Infecções por Herpesviridae/virologia , Hospedeiro Imunocomprometido , Neoplasias/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Transplante de Órgãos/efeitos adversos , Viremia/complicações , Viremia/virologiaRESUMO
An observational study was performed at a level III neonatal intensive care unit to assess the impact of a hand hygiene promotion educational program on rates of compliance with hand hygiene on entrance into the unit. There was an initial improvement in the rate of compliance at 1 month after the intervention (from 89% [168 of 189 opportunities] to 100% [212 of 212 opportunities]; P<.001], but the rate decreased to the baseline rate at 3 months (89% [85 of 96 opportunities]).
Assuntos
Fidelidade a Diretrizes , Desinfecção das Mãos/normas , Unidades de Terapia Intensiva Neonatal/normas , Cuidadores , Seguimentos , Hospitais de Ensino , Humanos , Controle de Infecções/normas , Capacitação em Serviço , Recursos Humanos em HospitalRESUMO
BACKGROUND AND OBJECTIVES: Greater parent participation in a child's hospital care is associated with better child outcomes in the hospital and after discharge. This study examined the relationships between perceived need fulfillment for parents, parent participation in hospital care, and parent psychological distress. We hypothesized that greater perceived need fulfillment would be associated with greater participation in hospital care and decreased psychological distress. METHODS: In this prospective cohort study, 166 parents completed questionnaires on a pediatric (nonintensive care) floor. Eligible parents were fluent in English and had a child who was hospitalized ≥2 nights. Previously validated questionnaires were used to assess parent participation in hospital care and psychological distress (defined here as symptoms of anxiety/depression). A modified version of the Bereaved Parent Needs Assessment was used to assess perceived need fulfillment. The association between perceived need fulfillment and each outcome variable was examined using multiple linear regression analyses. RESULTS: Of 186 eligible parents, 166 were enrolled (1 declined, 19 missed/not present). In multivariable analyses, greater perceived need fulfillment was associated with greater participation in hospital care and fewer symptoms of depression, even after controlling for relevant covariates. Exploratory analyses identified needs that were differentially important within groups of parents at risk for distress. CONCLUSIONS: This study suggests that assessing and supporting parent needs during a child's hospitalization may improve parent and child outcomes by increasing parents' ability to participate in hospital care and decreasing psychological distress. Future research is needed to investigate the impact of interventions targeting specific parent needs.
Assuntos
Criança Hospitalizada , Participação da Comunidade , Hospitais Pediátricos , Pais/psicologia , Estresse Psicológico , Adulto , Criança , Criança Hospitalizada/psicologia , Criança Hospitalizada/estatística & dados numéricos , Participação da Comunidade/métodos , Participação da Comunidade/psicologia , Demografia , Feminino , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/normas , Humanos , Masculino , Avaliação das Necessidades , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Melhoria de Qualidade , Fatores Socioeconômicos , Estatística como Assunto , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Inquéritos e Questionários , Estados UnidosRESUMO
We report a significantly higher occurrence of adverse events associated with prolonged courses of piperacillin-tazobactam compared with other antibacterial agents used for pediatric outpatient parenteral antimicrobial therapy. These adverse events were characterized by a constellation of clinical findings including fever, hematologic abnormalities and transaminitis. Adverse events related to piperacillin-tazobactam should be considered in patients who develop a febrile illness associated with a prolonged course of therapy.
Assuntos
Antibacterianos/efeitos adversos , Infusões Parenterais/estatística & dados numéricos , Ácido Penicilânico/análogos & derivados , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Ácido Penicilânico/administração & dosagem , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/uso terapêutico , Piperacilina/administração & dosagem , Piperacilina/efeitos adversos , Piperacilina/uso terapêutico , Combinação Piperacilina e TazobactamRESUMO
Pseudomonas stutzeri is a rare cause of nosocomial infection. We report a pediatric case of nosocomially acquired P. stutzeri brain abscess after subdural grid implantation before surgery for refractory epilepsy and review the literature.
Assuntos
Abscesso Encefálico/microbiologia , Infecção Hospitalar , Procedimentos Neurocirúrgicos/efeitos adversos , Infecções por Pseudomonas/etiologia , Pseudomonas stutzeri , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Criança , Remoção de Dispositivo , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/microbiologia , Epilepsia do Lobo Frontal/cirurgia , Contaminação de Equipamentos , Feminino , Lobo Frontal/cirurgia , Humanos , Imageamento por Ressonância Magnética , Procedimentos Neurocirúrgicos/instrumentação , Próteses e Implantes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/terapia , Reoperação , Técnicas EstereotáxicasRESUMO
OBJECTIVE: To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU). DESIGN: Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR). SETTING: Level III NICU in a tertiary care center. PARTICIPANTS: Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual. INTERVENTIONS: Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week. RESULTS: Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU. CONCLUSION: An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.
Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa do Profissional para o Paciente , Doenças Nasais/complicações , Otite Externa/complicações , Infecções Estafilocócicas/transmissão , Bacteriemia/microbiologia , Doença Crônica , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Controle de Infecções/métodos , Unidades de Terapia Intensiva Neonatal , Masculino , Resistência a Meticilina , Doenças Nasais/microbiologia , Ohio , Otite Externa/microbiologia , Reação em Cadeia da Polimerase , Vigilância da População , Estudos Prospectivos , Estudos Retrospectivos , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificaçãoRESUMO
BACKGROUND: Congenital cytomegalovirus (CMV) infection is a leading cause of disabilities in children, yet the general public appears to have little awareness of CMV. METHODS: Women were surveyed about newborn infections at 7 different geographic locations. RESULTS: Of the 643 women surveyed, 142 (22%) had heard of congenital CMV. Awareness increased with increasing levels of education (P<.0001). Women who had worked as a healthcare professional had a higher prevalence of awareness of CMV than had other women (56% versus 16%, P <.0001). Women who were aware of CMV were most likely to have heard about it from a healthcare provider (54%), but most could not correctly identify modes of CMV transmission or prevention. Among common causes of birth defects and childhood illnesses, women's awareness of CMV ranked last. CONCLUSION: Despite its large public health burden, few women had heard of congenital CMV, and even fewer were aware of prevention strategies.
Assuntos
Infecções por Citomegalovirus/congênito , Citomegalovirus , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Adulto , Infecções por Citomegalovirus/fisiopatologia , Infecções por Citomegalovirus/prevenção & controle , Infecções por Citomegalovirus/transmissão , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Acetamidas/administração & dosagem , Antibacterianos/administração & dosagem , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/administração & dosagem , Adolescente , Criança , Pré-Escolar , Enterococcus/efeitos dos fármacos , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Lactente , Recém-Nascido , Linezolida , Masculino , Resultado do Tratamento , Resistência a VancomicinaRESUMO
UNLABELLED: The history of an older child victim of Munchausen by proxy (MBP) is described. He was referred for evaluation after repeated sinus surgeries for recurrent sinus infections believed to be related to a falsified history of an immunodeficiency. The perpetrator was the mother of this 14-year-old victim, consistent with the majority of such cases. This case prompted a review of cases of MBP in older children reported in our hospital as well as a literature search for other cases in older children. METHODS: This study was a chart review of children over 6 years of age who had been evaluated by social services at the Children's Hospital at the Cleveland Clinic and reported as cases of Munchausen by proxy to Child Protective Services between January 2001 and June 2003. Also, an OVID, Psychline, and Pubmed literature review of published cases of Munchausen by proxy were identified, and cases occurring in the older child were selected for review. RESULTS: Older children who are the victims of Munchausen by proxy may have an induced illness, but falsified reports of symptoms and medical history to coerce the child to undergo medical procedures may be more common. Collusion of the victim with the perpetrator may also become a factor as the child ages and adopts the deception. Given the complex relationship that exists between the parent and child, it is difficult to predict whether the victim either will assist the caregiver in maintaining the factitious illness or be able to recognize the falsification. CONCLUSIONS: Older children who are the victims of Munchausen by proxy may fear consequences of revealing the factitious illness. Physicians must consider the possibility of this diagnosis whenever there are discrepancies in a child's illness that makes a factitious illness a consideration.
Assuntos
Síndrome de Munchausen Causada por Terceiro/psicologia , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Síndrome de Munchausen Causada por Terceiro/diagnósticoRESUMO
Six cases of factitious disease and malingering in pediatric patients referred to an infectious diseases practice in a tertiary care children's hospital are described, and implications for general clinical practice are reviewed. All patients were girls aged 9-15 years. Two patients were malingering with the secondary gain of avoiding attendance at school. The other 4 patients presented with factitious illness without clear link to secondary gain, but rather for a psychological purpose. Three of the subjects admitted to self-induced or feigned illness. The 2 patients diagnosed with malingering did very well with early parental support, psychotherapy, and attention paid to school difficulties. The outcomes of the others with underlying psychological conflicts were less resolved. Factitious disorders and malingering occur in the pediatric population. A high index of suspicion is needed for prompt diagnosis and care.
Assuntos
Transtornos Autoinduzidos/etiologia , Simulação de Doença/psicologia , Comportamento Autodestrutivo/psicologia , Adolescente , Criança , Aconselhamento , Transtornos Autoinduzidos/diagnóstico , Transtornos Autoinduzidos/terapia , Feminino , Humanos , Simulação de Doença/etiologia , Simulação de Doença/terapiaRESUMO
BACKGROUND: Identification of the agents of infectious diarrhea may facilitate appropriate therapy and prevent inappropriate antibiotic use. OBJECTIVES: To better define the etiology of infectious diarrhea for children <12 years in our community and to study the ordering patterns of physicians. STUDY DESIGN: We reviewed test results of stool specimens from children <12 years old at our institution (CCF) and those submitted through our reference laboratory for rotavirus enzyme immunoassay (REIA) and stool cultures for a 7-month period (11/1/00-6/1/01). For CCF patients, REIA and stool cultures for usual bacterial enteric pathogens (BEP) were performed, regardless of the test ordered (i.e. REIA alone, stool culture alone or both). We compared the results with the orders placed to determine if requests for rotavirus alone or bacterial stool culture alone missed BEP or rotavirus, respectively. RESULTS: Overall, REIAs were performed on 81% (538/661) of stool specimens, with 37% positive. Stool cultures were performed on 62% (408/661) of stool specimens, with 4.4% positive. Stool specimens (280) from CCF pediatric patients were evaluated for both rotavirus and BEP. Some 42% of REIA and 23% of stool cultures were ordered as single tests, while both tests were ordered for 35% of the patients. Of the REIA ordered alone, 34% were positive for rotavirus; however, 2.5% of these contained BEP that would have been missed. Of the stool cultures that were ordered alone, 8% were positive; however, 19% of these contained rotavirus that would have been missed. When both tests were ordered, 22% contained rotavirus and 2% contained BEP. CONCLUSION: Both rotavirus and bacterial enteric infections were missed with selective viral versus bacterial specific ordering patterns. A rotaviral screen prior to stool culture may be useful for children with diarrhea during the winter months.
Assuntos
Gastroenterite/diagnóstico , Padrões de Prática Médica , Infecções por Rotavirus/diagnóstico , Criança , Pré-Escolar , Infecção Hospitalar/diagnóstico , Diarreia Infantil/diagnóstico , Fezes/microbiologia , Fezes/virologia , Gastroenterite/tratamento farmacológico , Gastroenterite/microbiologia , Gastroenterite/virologia , Hospitalização , Humanos , Lactente , Laboratórios , Guias de Prática Clínica como Assunto , Rotavirus/isolamento & purificação , Infecções por Rotavirus/tratamento farmacológico , Infecções por Rotavirus/virologia , Estações do AnoRESUMO
OBJECTIVE: To describe and quantify the presentations of Kawasaki disease (KD) in a children's hospital over 10 years to assess the Harada score in a US population. METHODS: A retrospective chart review from 2001 to 2011 of children discharged from Cleveland Clinic with the diagnosis of KD. Demographic and clinical data were collected and Harada scores were derived to evaluate efficacy in predicting risk for coronary artery aneurysms (CAAs). RESULTS: A total of 105 children met diagnostic criteria for KD, and 97 of 105 had long-term follow-up. Full criteria for KD were found in 67 of 105 (64%); 38 had incomplete presentations. CAA developed in 10 children, 5 during follow-up despite treatment with intravenous immunoglobulin (IVIG.) Children with incomplete presentations had a higher risk of developing CAA (20% vs 5%, P = .03) and a delayed diagnosis (median days from fever to diagnosis 8.0 vs 5.0 days, P < .001). Of children who developed CAA, 9 of 10 had a positive Harada score (sensitivity of 90%). All children who developed CAA after IVIG were in the high-risk group, but 1 child with an incomplete presentation who had a CAA at presentation was missed by the score. Overall, the negative predictive value was 98%. CONCLUSIONS: As in Japanese studies, a positive Harada score in a US population could be used to identify a high-risk population for CAA development. All children who developed CAA after treatment with IVIG would have been assigned to a high-risk category. Though not specific enough to select initial therapy, the score might be useful in identifying high-risk children for evaluation of new therapies and more frequent follow-up.
Assuntos
Aneurisma Coronário/diagnóstico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Aneurisma Coronário/etiologia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco , Estados UnidosRESUMO
BACKGROUND: Staphylococcus aureus is an important cause of cardiac surgical site infection. Based on studies in adults, nasal screening to detect S aureuscolonization is used to guide decolonization and selection of prophylactic antibiotics. In our Children's Hospital, a sensitive polymerase chain reaction (PCR)-based assay is used to screen patients undergoing cardiac surgery for nasal colonization with methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA). Additionally for patients in diapers, cultures are used to detect MRSA colonization of the groin. The purpose of this study was to determine whether screening two anatomic locations results in a higher MRSA detection rate among children undergoing cardiac surgery. METHODS: A retrospective chart review determined whether the frequency of bacterial colonization with MRSA differed by anatomic site. Records for 322 pediatric cardiac surgery procedures performed between January 2009 and June 2011 were reviewed. Both a nasal PCR and a second anatomic site culture were performed before 102 procedures. RESULTS: The overall rate of colonization with MRSA and MSSA was 4.2% and 29.1%, respectively. Of the seven dually screened patients who tested positive for MRSA, two were identified solely via a groin test, four by nasal screening alone, and one by both the tests. Screening of only the nose would have failed to detect 28.6% of the MRSA cases. CONCLUSION: Preoperative detection of MRSA colonization may be enhanced by screening both the nose and a second anatomic site. The clinical utility of the extranasal MRSA culture was limited due to the long assay turnaround time.
Assuntos
Infecção Hospitalar/prevenção & controle , Cardiopatias Congênitas/cirurgia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Virilha/microbiologia , Humanos , Masculino , Nariz/microbiologia , Reação em Cadeia da Polimerase , Cuidados Pré-Operatórios/métodosRESUMO
Tuberculous radiculomyelitis is an uncommon but serious complication of tuberculosis that can lead to considerable morbidity and mortality. We present the case of a 21-month-old male Congolese refugee diagnosed with tuberculous radiculomyelitis who presented with gradual motor and speech regression, and likely an infection-related seizure 2 months before diagnosis.
Assuntos
Mielite/diagnóstico , Radiculopatia/diagnóstico , Tuberculose do Sistema Nervoso Central/diagnóstico , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Mielite/microbiologia , Radiculopatia/microbiologia , Tuberculose do Sistema Nervoso Central/microbiologiaRESUMO
The authors describe the clinical features and management of lateral sinus thrombosis associated with mastoiditis and otitis media in children. Of 475 patients with mastoiditis and otitis media, 13 (2.7%) had lateral sinus thrombosis identified by magnetic resonance imaging/magnetic resonance venography (n = 11) and angiography (n = 2). Clinical features included headache, vomiting, fever, diplopia, papilledema, sixth nerve palsy, seventh nerve palsy, and unilateral cerebellar ataxia. All patients received antibiotics for 1 to 8 weeks. Four patients underwent mastoidectomy alone, 5 mastoidectomy with concurrent myringotomy and ventilation tube, and 1 myringotomy with tube without mastoidectomy. Three underwent anticoagulation for 6 months (1 had heterozygous factor V Leiden mutation). All survived; deafness occurred in 5 patients (4 transient, 1 persistent). Magnetic resonance imaging/magnetic resonance venography should be obtained in any child with otitis media having features of raised intracranial pressure and/or focal neurodeficits to rule out lateral sinus thrombosis. Antibiotics and mastoidectomy are essential in management. A hypercoagulable state may predispose to lateral sinus thrombosis.
Assuntos
Trombose do Seio Lateral/diagnóstico , Trombose do Seio Lateral/etiologia , Imageamento por Ressonância Magnética , Mastoidite/complicações , Otite Média/complicações , Criança , Surdez/etiologia , Humanos , Trombose do Seio Lateral/patologia , Trombose do Seio Lateral/terapia , Angiografia por Ressonância Magnética , Flebografia , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: To develop a risk-stratification tool to help identify medical child abuse (MCA) in children evaluated for failure to thrive (FTT). PATIENTS AND METHODS: In this case-control study, the control group consisted of children who were seen in the pediatric gastroenterology department and diagnosed with FTT before the age of 5 years between 2000 and 2010. Cases were distinguished by having also been referred to the Child Advocacy Committee at the Cleveland Clinic Foundation (CCF) and/or reported to the Department of Child and Family Services by the CCF as a possible case of MCA. We used retrospective chart review to compare 17 cases of MCA with 68 controls. Classification-tree analysis was used to generate the risk-stratification tool. RESULTS: A risk-stratification tool, in the form of a classification tree, was developed and incorporated the following individual risk indicators: (1) ≥ 5 organ systems involved; (2) absence of serious congenital anomaly or confirmed genetic disorder; (3) ≥ 5 reported allergies; and (4) refusal of services from a multidisciplinary feeding team. Overall, the classification tree had a sensitivity of 100% and a specificity of 96%. CONCLUSIONS: The results of this study suggest that a diagnosis of MCA may be suspected in children with FTT on the basis of features in the initial presentation and clinical course. Using the proposed risk-stratification tool that incorporates these features might assist in earlier identification of medically abused children and reduce morbidity and mortality.
Assuntos
Maus-Tratos Infantis/diagnóstico , Insuficiência de Crescimento/etiologia , Estudos de Casos e Controles , Maus-Tratos Infantis/classificação , Pré-Escolar , Árvores de Decisões , Humanos , Medição de RiscoRESUMO
We report herpes simplex encephalitis (HSE) in a toddler after a subtotal hemispherectomy for seizures related to HSE 16 months earlier. Herpes simplex virus reactivation in the cerebrospinal fluid shortly after treatment of HSE has been described, but is extremely rare in other situations. HSE reactivation is a potential complication of epilepsy surgery after HSE in children.