ObjectiveMost studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in ...adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED.Design and settingThe MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12–18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection).Results37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as highly urgent (38.9% vs 34.5%) and described as ill appearing (23.1% vs 15.6%) than younger children. Increased work of breathing and a non-blanching rash were present less often in adolescents, while neurological signs were present more often (1% vs 0%). C reactive protein tests were performed more frequently in adolescents and were more often abnormal (adjusted OR (aOR) 1.7, 95% CI 1.5 to 1.9). Adolescents were more often diagnosed with SBI (OR 1.8, 95% CI 1.6 to 2.0) and sepsis/meningitis (OR 2.3, 95% CI 1.1 to 5.0) and were more frequently admitted (aOR 1.3, 95% CI 1.2 to 1.4) and treated with intravenous antibiotics (aOR 1.7, 95% CI 1.5 to 2.0).ConclusionsAlthough younger children presented to the ED more frequently, adolescents were more often diagnosed with SBI and sepsis/meningitis. Our data emphasise the importance of awareness of severe infections in adolescents.
INFEKCIJSKE BOLEZNI PRI OTROKU Jagodic Bašič, Veronika; Berkopec, Tanja; Prodanović, Nina ...
Slovenska pediatrija,
05/2022, Letnik:
29, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Nalezljive bolezni povzroča širjenje mikroorganizmov (bakterij, virusov, gliv ali parazitov) ali prionov na ljudi z drugih ljudi, živali ali okolja. Okužbe se prenašajo kontaktno, kapljično ali ...aerogeno. Prenašajo se neposredno s človeka na človeka, preko okuženih predmetov, z uživanjem kontaminirane hrane ali pijače, s stikom s kontaminiranimi telesnimi tekočinami in z ugrizom ali pikom živali. V prispevku opisujemo zdravstveno obravnavo pri Lymski boreliozi in klopnem meningoencefalitisu, mišji mrzlici, ter okužbah povzročenih z virusom ošpic ter virusom varicella zoster virus. Številne nalezljive bolezni, kot so ošpice in norice, lahko preprečimo s cepivi. V bolnišničnem okolju moramo izvajati postopke aerogene izolacije. če okuženi ne potrebuje hospitalizacije, se mora izolirati v domačem okolju. Pri boleznih, ki jih prenašajo živali, upoštevamo preventivne ukrepe. Ozaveščanje prebivalcev o pomembnosti zaščite pred vbodom klopa in dosledno samopregledovanje sta ključnega pomena za zmanjševanje šte-vila okuženih z Lymsko boreliozo in klopnim meningoencefalitisom. Preventivno ravnanje proti mišji mrzlici je zaščita pred vdihovanjem aerosolov. Za zaščito proti klopnemu meningoencefalitisu je na voljo cepivo, ki ga priporočamo otrokom od prvega leta dalje. Zaradi vojne v Ukrajini in velikega števila razseljenih je možen porast okužb s tuberkulozo in ošpicami ter multirezistentnimi bakterijami. Pri bolnišnični obravnavi oseb s tega področja upoštevamo z zdravstveno oskrbo povezane ukrepe za preprečevanje in obvladovanje okužb.
Systemic capillary leak syndrome is a rare condition, characterized by hypotension, edema, hemoconcentration and hypoalbuminemia. We describe 2 episodes of systemic capillary leak syndrome, following ...influenza A virus infection, occurring during 2 subsequent influenza seasons, in an 8-year-old boy.
This study determines and compares the frequency of human mastadenovirus (HAdV) presence in children with acute bronchiolitis (AB), acute gastroenteritis (AGE), and febrile seizures (FS), ascertains ...types of HAdVs associated with each individual syndrome and contrasts the findings with a control group of children. The presence of HAdVs was ascertained in simultaneously collected nasopharyngeal (NP) swabs and stool samples amplifying the hexon gene by RT-PCR; these were sequenced to determine the types of HAdVs. HAdVs were grouped into eight different genotypes. Of these, three (F40, F41, and A31) were found solely in stool samples, whereas the others (B3, C1, C2, C5, and C6) were found in both stool samples and NP swabs. The most common genotypes in NP swabs were C2 (found in children with AGE and FS) and C1 (only in children with FS), whereas in stool samples genotypes F41 (in children with AGE) and C2 (in children with AGE and FS) prevailed, and C2 was simultaneously present in both samples. HAdVs were more often detected in stool samples than in NP swabs in patients (with the highest estimated viral load in stool samples in children with AB and AGE) and healthy controls and were more common in NP swabs in children with AGE than in children with AB. In most patients, the characterized genotypes in NP swabs and stool samples were in concordance.
Prevalence of complement deficiencies (CDs) is markedly higher in Slovenian primary immunodeficiency (PID) registry in comparison to other national and international PID registries.
The purposes of ...our study were to confirm CD and define complete and partial CD in registered patients in Slovenia, to evaluate frequency of clinical manifestations, and to assess the risk for characteristic infections separately for subjects with complete and partial CD.
CD was confirmed with genetic analyses in patients with C2 deficiency, C8 deficiency, and hereditary angioedema or with repeated functional complement studies and measurement of complement components in other CD. Results of genetic studies (homozygous subjects vs. heterozygous carriers) and complement functional studies were analyzed to define complete (complement below the level of heterozygous carriers) and partial CD (complement above the level of homozygous patients). Presence of characteristic infections was assessed separately for complete and partial CD.
Genetic analyses confirmed markedly higher prevalence of CD in Slovenian PID registry (26% of all PID) than in other national and international PID registries (0.5-6% of all PID). Complement functional studies and complement component concentrations reliably distinguished between homozygous and heterozygous CD carriers. Subjects with partial CD had higher risk for characteristic infections than previously reported.
Results of our study imply under-recognition of CD worldwide. Complement functional studies and complement component concentrations reliably predicted risk for characteristic infections in patients with complete or partial CD. Vaccination against encapsulated bacteria should be advocated also for subjects with partial CD and not limited to complete CD.
Duchennova mišična distrofija (DMD) je najpogostejša in ena najresnejših mišičnih bolezni otroške dobe. Gre za na kromosom X vezano recesivno živčno-mišično bolezen, ki jo povzroča mutacija v genu za ...distrofin. Primarno prizadene skeletne mišice in srčno mišico.
Pri večini dečkov se klinični znaki bolezni izrazijo z napredujočo mišično šibkostjo med 3. in 5. letom starosti. Mišična šibkost je bolj izražena v proksimalnih kot distalnih mišicah in v začetni fazi bolj vpliva na poslabšanje funkcije spodnjih kot zgornjih udov. Bolezen postopno napreduje. Pri nezdravljenih otrocih večinoma po 11. do 12. letu starosti vodi v takó resno zmanjšanje zmožnosti gibanja, da le-ti že za premagovanje krajših razdalj potrebujejo invalidski voziček. Napredujoča šibkost dihalnih mišic vodi v kronično dihalno odpoved in potrebo po pomoči pri predihavanju. Okvara funkcije srca je splošno prisotna, kajti po študijah so klinični znaki kardiomiopatije prisotni pri vseh bolnikih po 18. letu starosti.
Na podlagi klinične slike diagnozo DMD potrdimo z laboratorijskimi in genetskimi preiskavami. V primeru negativnih rezultatov genetskih preiskav, a ob močnem kliničnem sumu za DMD, pa se za potrditev diagnoze poslužujemo mišične biopsije.
Zdravljenje bolnikov z DMD zahteva multidisciplinarno obravnavo. Z uporabo kortikosteroidov (KS), fizioterapije, podpornega zdravljenja in opreme s pripomočki sta se življenjska doba in kakovost življenja bolnikov z DMD izboljšala. V fazi razvoja je več zdravil, katerih delovanje se usmerja v zmanjšanje okvare mišic, a tudi zdravil, ki bi odpravile osnovni, tj. genetski vzrok bolezni.
Kawasaki disease (KD) is a vasculitis of early childhood mimicking several infectious diseases. Differentiation between KD and infectious diseases is essential as KD's most important complication-the ...development of coronary artery aneurysms (CAA)-can be largely avoided by timely treatment with intravenous immunoglobulins (IVIG). Currently, KD diagnosis is only based on clinical criteria. The aim of this study was to evaluate whether routine C-reactive protein (CRP) and additional inflammatory parameters myeloid-related protein 8/14 (MRP8/14 or S100A8/9) and human neutrophil-derived elastase (HNE) could distinguish KD from infectious diseases.
The cross-sectional study included KD patients and children with proven infections as well as febrile controls. Patients were recruited between July 2006 and December 2018 in Europe and USA. MRP8/14, CRP, and HNE were assessed for their discriminatory ability by multiple logistic regression analysis with backward selection and receiver operator characteristic (ROC) curves. In the discovery cohort, the combination of MRP8/14+CRP discriminated KD patients (
= 48) from patients with infection (
= 105), with area under the ROC curve (AUC) of 0.88. The HNE values did not improve discrimination. The first validation cohort confirmed the predictive value of MRP8/14+CRP to discriminate acute KD patients (
= 26) from those with infections (
= 150), with an AUC of 0.78. The second validation cohort of acute KD patients (
= 25) and febrile controls (
= 50) showed an AUC of 0.72, which improved to 0.84 when HNE was included.
When used in combination, the plasma markers MRP8/14, CRP, and HNE may assist in the discrimination of KD from both proven and suspected infection.
Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high ...risk of hospitalisation in order to improve ED flow.
The MOFICHE study prospectively collected data on febrile children (0–18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculating the area under the receiver operating curve (AUC).
Of 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84).
The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likelihood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predictive value 0..95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90- 0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use.
Patient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow.
European Union, NIHR, NHS.
Antibiotike v času poroda uporabljamo za preprečevanje in zdravljenje okužb pri materi ter za preprečevanje okužb pri novorojenčkih. Kratkotrajna terapija med porodom se uporablja za preprečevanje ...okužb s streptokokom skupine B (SSB) pri novorojenčkih, poporodnega endometritisa in za zdravljenje horioamnionitisa. Številne raziskave so dokazale, da z uporabo profilaktičnih odmerkov antibiotikov lahko podaljšamo nosečnost (in nato izboljšamo rezultate obolevnosti in umrljivosti novorojenčkov) po predčasnem prezgodnjem razpoku plodovih jajčnih ovojev (PPROM).
Pri nosečnicah z aktivnim prezgodnjim porodom priporočamo: penicilin G 3g (ali 5mE) intravensko nato 1,5 g (ali 2,5 mE) intravensko v 4-urnih intervalih do poroda.
Pri nosečnicah, ki so alergične na penicillin, priporočamo:
Pri ženski, ki je imela blago obliko alergije s kožnim izpuščajem, svetujemouporabo cefalosporina. V primeru zabeležene hujše oblike alergije na penicillin, svetujemo uporabo vankomicina. Terapija s klindamicinom, zaradi visoke rezistence SSB na klindamicin, ni več priporočljiva.
V primeru dolgotrajnega PPROM je potrebno v primeru aktivnega poroda predpisati široko spektalni intravenski antibiotiki, ki preprečuje tudi SSB okužbo novorojenca (priporočamo Cefazolin 2g i. v in nato 1g v 8-urnih intervalih do poroda). V primeru PPROM priporočamo čim prej po PPROM pričeti s terapijo s: ampicilinom (2 g i.v. vsake 6 ur) za 48 ur hkrati z azitromicinom (1g p.o. v enkratnem odmirku), nadaljujemo s amoksicilinom (500 mg p.o. vsakih 8 ur) za 5 dni ali do poroda novorojenca.
Focal renal infections in children have to be diagnosed early in order to enable an appropriate antibiotic treatment. The purpose of this paper was to investigate the efficacy and clinical utility of ...intravenous renal contrast-enhanced ultrasound (CEUS) as an alternative imaging method for the diagnosis and follow-up of focal renal infections in children.
Fourteen children aged from 6 months to 17 years (mean 6.5 years) in whom focal renal infection was suspected were included in this retrospective study. All data were obtained from medical and imaging records of the patients.
CEUS was performed for the diagnosis in all 14 children and then also for follow-up in seven children with renal abscess. In three children enhancement pattern was concordant with focal nephritis and in four children CEUS excluded focal renal infection and the diagnosis of pseudolesion was confirmed.
Renal CEUS was proven to be an efficient and self-sufficient imaging in diagnosis and further follow-up of focal renal infections in children. CEUS patterns of focal renal infections are described as well as relevant CEUS enhancement patterns important for differential diagnosis. Renal abscess follow-up algorithm with CEUS is suggested.
All clinically relevant imaging data was obtained by CEUS and no other imaging was necessary for the diagnosis and follow-up.
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