Ingemar Helin

Recovery of Clostridium difficile from children.

The occurrence of Clostridium difficile in faecal specimens of 218 children, aged 2 weeks to 15 years, was studied. The organism was recovered from 43 (20%) of the children (range 2 weeks to 10 years). The isolation frequency was significantly correlated to age. Thus, in children 1 to 8 months of age the organism occurred in 64%, while in children below and above that age C. difficile could only be recovered in 4%. No significant difference in the recovery frequency could be demonstrated between children with (23%) and without (17%) gastroenteritis. C. difficile occurred numerically more often in non-antibiotic treated children (22%) than in those given such drugs (13%). None of the children in the present study had evidence of pseudomembranous colitis. A comparative study of different selective media did not demonstrate any difference in the recovery frequency of C. difficile. The media used were Chopped Meat Glucose broth with cycloserine and either kanamycin or cefoxitin, and Cycloserine-Cefoxitin-Fructose agar.

Bone Mineral Content in Preterm Infants at Age 4 to 16

Using photon absorptiometry the forearm bone mineral content (BMC) was determined in 75 children aged 4 to 16, who all had a low birth weight. Forty‐five of them were born preterm AGA (27 boys, 18 girls, mean weight 1580 g; range 920‐2060 g) and 30 preterm SGA (17 boys, 13 girls, mean weight 1510; range 940‐2130 g). The results were compared with a control group of children of the same age, and analyses of covariance with age, height and weight as the covariant factors were performed. The BMC, weight and height did not differ between the children born AGA or SGA. Irrespective of AGA or SGA, the BMC was significantly decreased in boys but the difference was less pronounced and less significant when height and weight were used as covariant factors. Boys who had been born preterm had a less BMC than the control boys for their age but the were also somewhat shorter and lighter than expected with regard to their age.

CLOSTRIDIUM DIFFICILE TOXIN IN FAECAL SPECIMENS OF HEALTHY CHILDREN AND CHILDREN WITH DIARRHOEA

ABSTRACT. Presence of cytopathogenic effect (CPE) that could be inhibited by an antitoxin to Clostridium sordelli, known to cross‐react with Clostridium difficile toxin, was sought in faecal specimens from 101 infants. Of the children, 45 were healthy, while 56 had been hospitalized because of diarrhoea. CPE was found in 12 of the healthy infants and in 5 of those hospitalized. Faecal specimens of these 5 gave a CPE at titres of 103‐4, whereas in the 12 healthy infants the titres were 101‐2. Studies on consecutive samples showed that the CPE could persist for between 7‐11 weeks up to 9 months and more. Of the 45 healthy infants, 11 harboured C. difficile compared with 6 of the 56 with diarrhoea. In both groups, 3 CPE‐positive infants were culture‐negative for C. difficile. Four of those hospitalized had recently been given antibiotics; all were negative in both culture and CPE tests. The present study demonstrates that care should be exercised when interpreting the results of cultures for C. difficile and tests for CPE made on faecal specimens in order to establish a diagnosis of antibiotic‐associated enterocolitis in infants and children.

CHRONIC RENAL FAILURE IN SWEDISH CHILDREN

Abstract. Helin, I. and Winberg, J. (Departments of Paediatrics, Malmö General Hospital, Malmö, University of Lund, and Karolinska Hospital, Karolinska Institute, Stockholm, Sweden). Chronic renal failure in Swedish Children. Acta Paediatr Scand, 69: 607, 1980.—In a retrospective study covering the years 1974 to 1977 the prevalence of non‐terminal renal failure in Swedish children on to 15 years of age was registered as 4.50 per million total population. The mean yearly incidence of terminal renal failure during the same period was registered as 0.94 per million total population. Nephronophthisis was the most common single cause of renal failure. No case of coarse renal scarring due to recurrent urinary tract infections was reported. The Swedish study shows a good agreement with an earlier Swiss one concerning the diseases causing chronic renal failure in children. The frequency of chronic renal failure is expected to be essentially unchanged until breakthroughs occur in research on glomerulonephritis.

Acute sinusitis in children--symptoms, clinical findings and bacteriology related to initial radiologic appearance.

In a series of 175 children with suspected sinusitis the symptoms and clinical signs were compared with the radiologic and bacteriologic findings. URI, purulent nasal secretion and pain were the main symptoms predicting radiologic changes. In 75% of the patients the presence of two or three of these symptoms was co-existent with major radiological changes. As assessed by nasopharyngeal culture Haemophilus influenzae seemed to be the major pathogen.

Outbreak of coxsackievirus A-14 meningitis among newborns in a maternity hospital ward.

ABSTRACT. During the late winter of 1983, 16 newborns with vague symptoms of failure to thrive, reluctance to feed and a slight rise in body temperature, were found to have meningitis caused by Coxsackievirus A‐14. The cerebrospinal fluid showed pleocytosis with polymorphonuclear cells in excess but was otherwise normal. The clinical course was uneventful in all infants, but two of them demonstrated clinical signs of incipient cerebral oedema during the acute phase of the illness. An electroencephalogram (EEG) during the initial course of the disease and at nine months of age was normal in all. During a follow‐up period of 21/2 years they all developed normally and no sequelae were noted. The presentation also demonstrates the usefulness of Vero cells for the propagation of the responsible virus.

Three-day therapy with cephalexin for lower urinary tract infections in children.

In a prospective study of children with an acute infection of the lower urinary tract, the effectiveness of a 3-day course of cephalexin, 25-50 mg/kg body weight and day was compared with that of a 10-day course of nitrofurantoin, 3-4 mg/kg/day. 19 children were allotted to treatment with cephalexin and 24 were treated with nitrofurantoin. The immediate cure rates were 90% and 96%, respectively. Two relapses were noted in the cephalexin group and 1 in the nitrofurantoin group. During a mean follow-up period of 7-8 months 2 of the cephalexin treated patients and 4 patients treated with nitrofurantoin had a reinfection. No side effects were noted in either of the treatment groups. The results suggest that treatment with cephalexin for 3 days is a reasonable alternative in children with an acute lower urinary tract infection when commonly used medications for one reason or another are less well tolerated.

Muco-epidermoid tumour of the bronchus

A 7-year-old boy with recurrent pneumonia of the right lower lobe is described. At bronchoscopy a small tumour almost totally obliterating the right lower lobe was detected. Surgical treatment was undertaken. Histopathologic studies showed findings consistent with those of a muco-epidermoid tumour. The case emphasizes bronchoscopy as an important investigation in children with recurrent pneumonia. It also shows the importance of performing the bronchoscopy during a prolonged course of antibiotic prophylaxis in order to ensure a minimum of infected mucus within the bronchi. This report is completed with a short review of the literature on muco-epidermoid tumours of the bronchus in children. Their favourable prognosis and very low malignant potential is underlined.

HAEMORRHAGIC CYSTITIS COMPLICATING CYCLOPHOSPHAMIDE TREATMENT IN CHILDREN

Haemorrhagic cystitis complicating cyclo‐phosphamide treatment is a serious complication. The bladder irritation is considered to be a consequence of direct contact between bladder wall and urine containing metabolites of cyclo‐phosphamide. The early symptoms are vesical tenesmus, pollakisuria and haematuria. Endo‐scopy is the essential way of diagnosing the cyclophosphamide cystitis. High daily fluid regimen and frequent voiding must be recommended as the prophylaxis of choice. Moreover the drug must be administered as a single 24‐hour‐dose in the morning. Surgical techniques differ according to the severity of the bleeding. Administration of an anti‐fibrinolytic agent proved ineffective.

A simple reliable agglutination test for screening P-fimbriated Escherichia coli in children with urinary tract infections gives valuable clinical information

Most urinary tract infections (UTI) are caused by Escherichia coli (E. coli) and the pathogenetic mechanisms of this bacterium have been thoroughly studied. Lipopolysaccharide (LPS), capsular polysaccharides and fimbrial structures are among the more important virulence markers. P-fimbriae, with a specificity for the carbohydrate structure of the P blood group system (alpha-D-Gal-1,4-beta-D-Gal) have attracted particular interest, as non-fimbriated E. coli rarely give rise to pyelonephritis, unless the normal defence mechanisms of the urinary tract are impaired. We have evaluated a commercial test (Orion Diagnostica, PF test), developed to detect P-fimbriae on E. coli from clinical isolates. It is based on latex particles with covalently bound receptors (alpha-D-Gal-1,4-beta-D-gal). In this study a high correlation was found between pyelonephritis, as judged by clinical and biochemical criteria, and a positive PF test.