Mădălina Maria Merişescu

Sinogenic intracranial complications in children - cases report

Background Although uncommon, intracranial suppurative complication of sinusitis in children can occur. The progressive pneumatization of the sinuses after birth and the late appearance of the sphenoid and frontal sinuses explain the predilection for intracranial sinogenic complications in older children and adolescents. Early imaging is crucial to diagnosis and brain MRI is the most useful test. Medical therapy combined with neurosurgical and otolaryngological surgical intervention may improve outcome and reduce the neurological sequelae.

Salmonella spp acute enterocolitis - an overview of antibiotic therapy and chemosensitivity patterns among children

Background Acute Salmonella spp infections represent an important public health issue worldwide, particularly among children. Romania is a country with endemic Salmonella infections which reports occasionally summer outbreaks. Our study aimed to analyze the submitted cases and to appreciate the germ’s susceptibility to antibiotics, starting from the urging issue related to the emerging resistance of Enterobacteriaceae to common drugs. Methods We conducted a clinic-based retrospective (2010-2013) surveillance that analyzed the confirmed pediatric cases of Salmonella spp infections treated at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania. The clinical and demographic patient features followed were: age, sex, home environment, severity of the disease and the complications. All the bacterial strains were isolated after culturing the stool samples on differential culture media and the identification was performed respecting the standard laboratory methodology. The antibiotic sensitivity spectrum was determined using the API ATB G-5 tests for the following drugs: ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, trimethoprim/sulfamethoxazole, nalidixic acid, fluoroquinolones, tetracycline and third generation cephalosporins. Results During the studied period we identified 135 cases of acute Salmonella spp infection among hospitalized children, which stands for 8.5% of the total cases of acute diarrheal diseases. The most affected age group was the 1-4 years group, with a male predominance. The serotype distribution was: AO – 12.6%, BO – 31.1%, CO – 19.2% and DO – 37.1%. The chemosensitivity analysis revealed: 100% sensitivity to fluoroquinolones, carbapenems and third generation cephalosporins, 92.6% sensitivity to nalidixic acid and trimethoprim/sulfamethoxazole, 72.6% sensitivity to amoxicillin/clavulanate, ampicillin/sulbactam, 62.9% sensitivity to tetracycline and only 53.3% sensitivity to ampicillin.

The role of PCR in the diagnosis of tuberculous meningoencephalitis in children – Case report.

Background Tuberculous (TB) meningoencephalitis is an extremely severe condition which requires a quick and correct diagnosis in order to institute a specific etiological treatment in a timely manner. The current “classical” diagnosis of TB meningitis is established through CSF cultures. The result is often inconclusive or is heavily delayed in the case of positive cultures (4-6 weeks). PLEX-ID is a new method which can establish an etiological diagnosis of bacterial infection in a matter of hours by detecting bacterial DNA in various pathological products (blood, CSF, synovial and pleural fluid).

Severe sepsis with Stevens Johnson syndrome caused by Mycoplasma pneumoniae – case presentation

Background Mycoplasma pneumoniae is widely known as the etiological agent of “atypical pneumonia”, the most common clinical aspects of the infection being bronchiolitis and acute tracheobronchitis. It can also determine extrapulmonary manifestation such as ear, nose and throat infections, neurological, cardiac or dermatological manifestations. Dermatological involvement is second most common, after respiratory infections, and it can vary from urticaria-like rashes to Stevens-Johnson syndrome. Stevens-Johnson syndrome is severe form of immunecomplex–mediated hypersensitivity complex characterized by a hallmark of skin lesions spanning from mild forms to extensive involvement of skin and mucosa. It can be caused by a viral or bacterial infection or it can be drug induced.

Viral encephalitis caused by respiratory viruses

Results Using molecular diagnostic methods (PLEX-ID, Multiplex PCR) we identified, in the respiratory secretions and in the CSF: H1N1 influenza virus (2009), influenza AH3 virus, influenza B virus, coronavirus and adenovirus. The most severe forms of the disease were caused by the influenza virus H1N1. There were 2 cases of encephalitis admitted with this etiology, one of which had a fatal outcome and the other progressed to neurological decline. Other cases of encephalitis, having as etiology other respiratory viruses, have evolved favorably, with full recovery without sequelae.

Epidemiology and clinical characteristics of severe non-polio enteroviruses infections: the pediatric experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, a 5 year survey

Results There were 63 laboratory-confirmed enteroviruses severe infections during this period. In our cohort 67% of the patients were males and the median age was 4.2±2.2 years of age. The average days from onset to deterioration were 4.3 days (range 1–10 days). Interestingly, more than half did not have oral ulcers, and/or characteristic skin rashes, thus making earlier diagnosis more difficult. The vast majority (92% of the patients) associated gastrointestinal manifestations. A total of 23 patients were diagnosed with severe nonpolio enterovirus aseptic meningitis, with the highest prevalence of the cases in the summer of 2012, when 18 children developed acute flaccid paralysis, 13 manifested non-specific febrile skin rashes and 9 presented with viral hepatitis. The average time of hospitalization was 6.4 days (range 4-31 days) and all patients required interdisciplinary consults, 12 required kineto-therapy after discharge but neither one of our patients had a fatal outcome.

Management of brain abscesses in children.

Results In the aforementioned period we registered 12 cases of bacterial brain abscesses in children. The female gender and the 8 to 14 age group have prevailed. 50% of cases presented a congenital heart defect, 25% untreated bacterial infections, 12.5% a history of craniocerebral injury and 12.5% presented no evident predisposing cause. The onset consisted of: fever, vomiting, nausea, seizures, neurological problems. All of the cases required emergency neurosurgical treatment and specific antibiotherapy. Before the etiology of the infection was established, patients received empiric broad spectrum antibiotherapy (meropenem and linezolid), with subsequent antibiotic de-escalation over the next 6 weeks. The treatment was monitored clinically, biologically and with imaging studies. The evolution was favorable in all cases. No deaths were registered. Neurological sequelae were present in 41.7% of the cases: hemiparesis, sight and speech problems, psycho-motor impairment, seizures.

The importance of molecular diagnosis in severe sepsis determined by Neisseria meningitidis in the intensive care unit

Background Infections caused by Neisseria meningitidis are an important cause of infant mortality worldwide. They take many clinical forms from simple respiratory infections to purpura fulminans, a severe form of sepsis, fatal in many cases. PLEX-ID is a novel method for etiologic diagnosis of bacterial infections. It can detect bacterial DNA found in various pathological products. We studied the correlation of data obtained by classical culture methods versus molecular method results and the clinical and biological evolution of the patients under treatment.

Severe complications in acute Epstein Barr infection – case reports

Background Epstein-Barr virus (EBV) infects almost a large percent of the world’s adult population. Antibody prevalence rates reach 95% or higher among elderly individuals. Even in the pediatric population, Epstein Barr infection is common. Young children most likely acquire primary EBV infection from close contact that involves exchange of oral secretions via shared items such as toys, bottles and other objects. It may present with mild or no symptoms or with potentially life-threatening fulminant illness. Infectious mononucleosis caused by Epstein-Barr virus (EBV) is usually a benign systemic viral disease and occurs without sequelae but occasionally, it may be complicated by a variety of neurologic, hematologic, respiratory and hepatic complications.

Acute hemorrhagic encephalopathy - diagnostic challenges in a pediatric case

Background Acute hemorrhagic encephalomyelitis (AHEM) is considered a rare form of Acute disseminated encephalomyelitis (ADEM), due to acute cerebral vasculitis. The symptomatology consists in similar neurological findings, (meningismus, headache, seizures, multifocal neurologic signs, asymmetrical neurological deficits and coma) with rapid onset of encephalopathy and biphasic evolution. Although previous respiratory disease was registered days before this condition, establishing etiology is quite a challenge, viruses being incriminated.