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Background and aim of the work Since the introduction of the 7-valent vaccine, invasive pneumococcal disease have greatly decreased; however, changes in the distribution of pneumococcal serotypes have recently highlighted the need for vaccines with wider coverage. The aim of the work was to assess the potential serotype coverage of three pneumococcal conjugate vaccines (7-, 10- and 13-valent) against bacteremic pneumococcal pneumonia and meningitis/sepsis in Italian children. Patients and methods We determined pneumococcal serotypes in immunocompetent patients who had been admitted to hospital with suspicion of invasive bacterial disease and had confirmed bacteremic pneumococcal pneumonia or meningitis/sepsis determined by molecular detection of Streptococcus pneumoniae in a normally sterile site. Positive samples were serotyped using Realtime-PCR. Results Between April 2008 and March 2011, a total of 144 patients (age median 4.1 years; Interquartile range 1.8–5.6) with pneumococcal meningitis/sepsis (n = 43) or pneumonia (n = 101) from 83 participating centers located in 19 of 20 Italian regions were serotyped. The 10 most prevalent serotypes were 1 (29.9%), 3 (16.0%), 19A (13.2%), 7F (8.3%), 5 (4.2%), 14 (4.2%), 6A (3.5%), 6B (3.5%), 18C (3.5%), 19F (3.5%). Overall, serotype coverage for PCV-7, -10 and -13 were respectively 19.4%, 61.8% and 94.4% with no statistical difference between pneumonia and meningitis/sepsis. Potential coverage was similar for children 0–2 or 2–5 years of age. Cultures resulted positive in 35/99 (35.4%) samples simultaneously obtained for both culture and RT-PCR. Conclusion These findings indicate that increasing the potential serotype coverage by introducing PCV13 in the vaccination schedule for infancy could provide substantial added benefit for protection from pneumococcal pneumonia or meningitis/sepsis in Italy in children below 2 years as well in older children. The importance of molecular methods for diagnosis and serotyping of invasive pneumococcal disease was confirmed.

Background & Aims: Celiac patients are at risk to develop an autoimmune liver disease. The aim of this study was to describe the clinical features of children and adolescents presenting with an autoimmune liver disease associated with celiac disease. Methods: A retrospective multicenter national survey was made for the period 1990–2005. Results: Among 140 pediatric patients with autoimmune liver disease in italy, we identified 23 with celiac disease: 19 with autoimmune hepatitis, 2 with autoimmune cholangitis, and 2 with overlap syndrome. Diagnosis of celiac disease preceded the diagnosis of liver disease in 18 of them, but elevation of aminotransferase activity was present in 16 when celiac disease was diagnosed. Acute hepatitis developed in 2 infants on gluten-free diet, and a hidden celiac disease was discovered in 5 other patients. Nineteen patients had liver-related non–organ-specific autoantibodies. Liver histology showed inflammatory lesions with features of autoimmune damage and different degrees of fibrosis in all of them and cirrhosis in 4. All patients, on gluten-free diet, achieved remission on immunosuppressive therapy, 14 relapsed because of discontinuation of therapy or during spontaneous gluten challenge, 20 are still on immunosuppressive treatment, and 3 could stop therapy. Conclusions: Autoimmune liver diseases are frequently associated with celiac disease, but they might remain undiagnosed because of lack of symptoms, because of absence of liver-specific autoantibodies, or because of a misdiagnosis of celiac hepatitis. Acute hepatitis in celiac patients should induce one to suspect an autoimmune origin. Patients with autoimmune liver disease might have a hidden celiac disease, suggesting a rigorous check in any cryptogenic liver disease.