Orli Megged

Down syndrome and respiratory syncytial virus infection.

We reviewed the medical records of all children with Down syndrome (DS), hospitalized in our medical center due to infection with respiratory syncytial virus. During the 9-year study period, there were 41 hospitalizations of 39 children with DS. Mean age was 1.3 years; mean duration of hospitalization was 10.9 days. Patients with DS were older than healthy controls with respiratory syncytial virus infection and needed longer hospitalization.

Extended-spectrum β-lactamase-producing bacteria causing community-acquired urinary tract infections in children

BackgroundExtended-spectrum β-lactamase (ESBL)-producing bacteria are infrequent pathogens of community-acquired (CA) urinary tract infections (UTIs) in children. The aim of this study was to assess the frequency of and identify risk factors for CA-UTIs due to ESBL-producing microorganisms (CA-ESBL-UTI).MethodsThe medical records of all children diagnosed with CA-ESBL-UTI at our medical center between 2003 and 2013 were reviewed. Patients with non-ESBL-UTIs during the same period were included as controls.ResultsEighty cases of CA-ESBL-UTI were identified. The incidence of ESBL-UTI increased from 2 to 3.8% during the study period. Compared to children with non-ESBL-UTI, those with ESBL were more likely to be of Arab descent, to have underlying medical conditions, to have received antibiotics in the month prior to the UTI and to have been previously hospitalized. The mean duration of hospitalization for patients with an ESBL-UTI was significantly longer than that for patients with a non-ESBL UTI (3.6 vs. 2 days; P = 0.01). In multivariate analysis, Arab ethnicity [odds ratio (OR) 6.1; 95 % confidence interval (CI) 2.7–13.6] and recent antibiotic treatment (OR 4.0; 95 % CI 1.6–10.4) were risk factors for CA-ESBL-UTI.ConclusionsThe incidence of CA-ESBL-UTI is rising. The empiric treatment for suspected UTI in children who had been previously hospitalized and who had received antibiotics in the last month should cover ESBL-producing bacteria.

Purulent pericarditis in children: is pericardiotomy needed?

Objectives This study aimed to describe our experience with pediatric bacterial pericarditis and review the optimal therapy for this entity. Methods This is a retrospective study in a pediatric intensive care unit in a university hospital. Three children were diagnosed with purulent pericarditis. They were all treated with antibiotics, echocardiography-guided pericardial fluid drainage, and placement of a pericardial catheter, with no need for thoracotomy or pericardial window. Results All 3 children fully recovered, and none developed constrictive pericarditis. Conclusions Children with purulent pericarditis usually can be treated with antibiotics and drainage of pericardial effusion, with no need for thoracotomy or pericardial window.

Comparative incidence dynamics and serotypes of meningitis, bacteremic pneumonia and other-IPD in young children in the PCV era: Insights from Israeli surveillance studies

INTRODUCTION Widespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD. We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5years in Israel. METHODS A prospective, population-based, active nationwide surveillance. All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000-2008), PCV7 (2009-2011) and PCV13 (2014-2016). Incidence rate ratios (IRRs) were calculated. RESULTS Overall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD. In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p<0.001) and similar to that of meningitis (37.6%, p=0.1). The proportion of episodes in children <12months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p<0.001 for both). The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR=0.76; 95% CI 0.57-1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction. Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD. CONCLUSIONS Following PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities.

Pantoea agglomerans foreign body-induced septic arthritis.

A 4-year-old boy was admitted because of left knee arthritis. Synovial fluid culture yielded Pantoea agglomerans identified by 16S rDNA polymerase chain reaction. Ultrasound examination revealed a foreign body in the synovial fluid. The patient underwent arthroscopy with removal of a thorn. This article highlights the need to search for a foreign body in Pantoea septic arthritis.

Mutated podocin manifesting as CMV-associated congenital nephrotic syndrome

Abstract.We report a girl with congenital nephrotic syndrome (CNS) associated with cytomegalovirus (CMV) infection and histological findings on renal biopsy that suggested a causal relationship between the two. She was subsequently found to be homozygous for a nonsense mutation in the NPHS2 gene encoding podocin (R138X), which is the true cause of her NS. Based on review of the literature and our findings in this patient, we propose that the clinical entity known as CMV causing CNS may not exist.

Brucellosis Outbreak in Children and Adults in Two Areas in Israel.

Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.

Glucose-6-Phosphate Dehydrogenase Screening in Israel-Arab and Palestinian-Arab Neonates

OBJECTIVE To evaluate the frequency of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, the incidence of clinically significant jaundice (any serum total bilirubin value >75th percentile on the hour-specific bilirubin nomogram), and the need for phototherapy in the pooled male Israeli-Arab and Palestinian-Arab population born at the Shaare Zedek Medical Center in Jerusalem, Israel. STUDY DESIGN Quantitative G-6-PD enzyme testing of umbilical cord blood was performed during birth hospitalization. G-6-PD deficiency was defined as any G-6-PD value <7.0 U/gHb. Transcutaneous bilirubin was performed daily during birth hospitalization, with serum total bilirubin testing in those with a transcutaneous bilirubin value >75th percentile. RESULTS Ten of 286 (3.5%) consecutively delivered male Arab newborns had G-6-PD deficiency. Clinically significant jaundice was higher in the population with G-6-PD deficiency compared with normal controls (relative risk, 3.45; 95% CI, 1.24-9.58). Thirty percent of the newborns with G-6-PD deficiency met American Academy of Pediatrics indications for phototherapy according to the high-risk (middle) curve on the phototherapy graph. CONCLUSION The frequency of G-6-PD deficiency in the Arab neonatal population delivering at this medical center meets World Health Organization criteria for neonatal G-6-PD screening (3%-5%). As in other ethnic groups, clinically significant jaundice is more frequent in newborns of this ethnic group with G-6-PD deficiency compared with G-6-PD-normal controls. Neonatal G-6-PD screening for both males and females of this population subgroup, in conjunction with parental education regarding the dangers of the condition and its prophylaxis, has now been incorporated into our institutions routine G-6-PD screening program.

Invasive Pneumococcal Disease in Infants Younger Than 60 Days

Objective. To review the epidemiology and clinical course of invasive pneumococcal diseases of infants younger than 60 days. Study design. All Streptococcus pneumoniae strains isolated from blood and cerebrospinal fluid cultures of infants below the age of 60 days during the years 1999-2009 were included in this study. Demographic, clinical, and laboratory data were collected from medical records. Results. In all, 24 cases of pneumococcal invasive infections were identified. The primary diagnoses were bacteremia without a focus (n = 13), meningitis (n = 6), bacteremia with otitis media (n = 3), and joint infection with bacteremia (n = 2). Only one of the serotypes found is included in the heptavalent pneumococcal conjugated vaccine (PCV7). Conclusions. Streptococcus pneumoniae should be considered and treated empirically in infants with suspected invasive bacterial disease during the first 60 days of life. Routine vaccination with PCV7 in not expected to substantially reduce the incidence of invasive pneumococcal disease in Israeli infants of this age as a result of herd immunity.

Kingella kingae Corneal Infections in Children

To THE EDITOR—We describe 2 children with Kingella kingae corneal infection. Case 1 A 15-year-old female complained of redness and pain in her right eye. She was wearing soft daily contact lenses. Examination revealed red eye with engorged conjunctival and episcleral vessels and mucupurulent discharge. The cornea had a small stromal infiltrate near the limbus at the 4 o’clock position, with an overlying 2-mm epithelial defect and 4 adjacent punctuate infiltrates without overlying epithelial defects. Inflammatory signs were found in the anterior chamber in the form of cell andflare was graded as plus 2 of 4. The rest of the examination was unremarkable. She was admitted with infected corneal ulcer OD (Oculus Dexter, right eye) to ensure adequate eye drops administration. Culture from the corneal ulcer yielded Kingella kingae. The patient was treated with cefazolin (5%) and gentamicin (1.4%) eye drops every 30 minutes with cyclopentolate (1%) three times per day. She was discharged after 4 days with less than one-half-mm remnants of the ulcer. After 6 weeks of treatment the ulcer healed, leaving a faint corneal scar without visual impairment.