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In sub-Saharan Africa, most children with severe community-acquired pneumonia are discharged from care with the causative agent unidentified. In the few diagnosed cases, diagnosis is usually based on positive blood [...]

Most common respiratory viruses are present in children with acute otitis media (AOM) and seem to actually be contributory to causing or increasing the risk of AOM. The viruses were found in 75% of 92 children between the ages of three months and seven years and included human rhinovirus (HRV), respiratory syncytial virus and coronavirus. HRV was the most common, found in 24% - 35% of the children with AOM. These tests reinforce, confirm and extend conclusions of earlier studies., Objective. To determine the frequencies of human rhinovirus (HRV), respiratory syncytial virus (RSV), and coronavirus (HCV) infection in children with acute otitis media (AOM). Methods. Middle ear fluids (MEF) collected by tympanocentesis and nasopharyngeal aspirates (NPA) at the time of the AOM diagnosis were examined by reverse transcriptase polymerase chain reaction for HRV, RSV, and HCV RNA. Patients. Ninety-two children aged 3 months to 7 years during a 1-year period. Results. Virus RNA was detected in a total of 69 children (75%) and in 44 MEF samples (48%) and 57 NPA samples (62%) at the time of AOM diagnosis. HRV RNA was detected in both MEF and NPA in 18 (20%), in MEF alone in 4 (4%), and in NPA alone in 10 (11%). RSV was detected in both MEF and NPA in 12 (13%), in MEF alone in 5 (5%), and in NPA alone in 9 (10%). HCV RNA was detected in both MEF and NPA in 5 (5%), in MEF alone in 2 (2%), and in NPA alone in 9 (10%). Dual viral infections were detected in 5% of children. HRV and RSV were detected simultaneously in 2 MEF samples and in 2 NPA samples; RSV and HCV were detected in I NPA sample. Bacterial pathogens were detected in 56 (62%) MEF from 91 children. Viral RNA was detected in 20 (57%) MEF of 35 bacteria-negative and in 25 (45%) of 56 bacteria-positive MEF samples. No important differences in the risk of treatment failure, relapse, or occurrence of late secretory otitis media were noted between children with virus-positive and virus-negative MEF aspirates. Conclusion. These findings highlight the importance of common respiratory viruses, particularly HRV and RSV, in predisposing to and causing AOM in young children. Pediatrics 1998;102:291-295; RT-PCR, acute otitis media, rhinovirus, respiratory syncytial virus, coronavirus., ABBREVIATIONS: AOM, acute otitis media; RSV, respiratory syncytial virus; HRV, human rhinovirus; RT-PCR, reverse transcriptase polymerase chain reaction; HCV human coronavirus; NPA, nasopharyngeal aspirates; MEF, middle ear fluids; PBS, phosphate-buffered [...]

Beckwith-Wiedemann syndrome is a genetic fetal overgrowth disturbance characterized by organomegaly, abdominal wall defects, postnatal hypoglycemia, and increased frequency of embryonic and postnatal tumors. Hearing loss in connection with this syndrome is rare. We describe a patient with Beckwith-Wiedemann syndrome having a progressive conductive hearing loss caused by a stapedial footplate fixation occurring during preschool age. We studied progression of the hearing impairment audiometrically from the patient's fourth year of life until age 19. In the right ear, it progressed from a mean pure-tone hearing level of 10 dB to 70 dB, with a perceptive component of 30 dB. The hearing level of the left ear remained at 25 dB. An exploratory tympanotomy disclosed stapedial fixation, and a partial stapedectomy improved the hearing level in the right ear to 30 to 35 dB. In patients with Beckwith-Wiedemann syndrome, a progressive conductive hearing loss, caused by stapedial footplate fixation, may develop after birth. Clinically, the fixation is identical to otosclerosis, but the typical family history of otosclerosis is lacking. [ABSTRACT FROM AUTHOR]

Incidence, morbidity and mortality of bacterial meningitis in developing countries are manifold greater than those in the industrialized world. We reviewed retrospectively children with meningitis treated in the paediatric hospital of Luanda in 2004. Among the 555 children, median age 11.0 months, the leading agents were Haemophilus influenzae type b (Hib), pneumococcus, and meningococcus in 60%, 24%, and 10%, respectively. The median length of illness before admission was 7 d. 65% had convulsed. Altered level of consciousness was observed in 61% and blood haemoglobin lower than 8 g/dl in 36% of cases. Case fatality was 35% and, of survivors, 24% were left with severe neurological sequelae. Blood transfusion appeared beneficial since fatality of children with and without transfusion was 23% versus 39% (p=0.003). While awaiting large-scale vaccinations, tools to improve the prognosis of meningitis in Angola comprise generating better awareness to reduce the delay, better fluid treatment and monitoring and active use of blood transfusions.

Purpose: To evaluate the prevalence of localized hypoattenuating areas in the cochlear otic capsule at temporal-bone thin-section computed tomography (CT) in pediatric patients and correlate the findings with clinical information., Materials and Methods: Temporal-bone thin-section CT images obtained in 73 patients aged 0-9 years (20 Austrian, 53 Finnish; 36 female and 37 male patients) were evaluated for the presence of localized hypoattenuating foci in the region of the fissula ante fenestram of the otic capsule. Clinical information collected for all patients was also evaluated. The data were analyzed with a logistic regression model., Results: Hypoattenuating areas in the region of the fissula ante fenestram were observed in 23 of 73 patients (32%). Hypoattenuating foci were substantially more prevalent in patients younger than 3 years than in those 3 years or older (odds ratio, 0.14; 95% CI: 0.04, 0.52; P =.001). The prevalence did not differ between sexes or according to clinical diagnosis. Only three of the 23 patients with hypoattenuating foci had clinical findings suggestive of otosclerosis, and none had osteogenesis imperfecta. After adjustment for age and sex, the finding was more prevalent among the Finnish patients (odds ratio, 5.4; 95% CI: 1.19, 24.52; P =.02) than among the Austrian patients., Conclusion: Hypoattenuating areas in the region of the fissula ante fenestram in the otic capsule at thin-section CT are prevalent among children younger than 3 years in the absence of clinical evidence of otosclerosis or osteogenesis imperfecta and appear in children up to 9 years old., (Copyright RSNA, 2004)

Beckwith-Wiedemann syndrome is a genetic fetal overgrowth disturbance characterized by organomegaly, abdominal wall defects, postnatal hypoglycemia, and increased frequency of embryonic and postnatal tumors. Hearing loss in connection with this syndrome is rare. We describe a patient with Beckwith-Wiedemann syndrome having a progressive conductive hearing loss caused by a stapedial footplate fixation occurring during preschool age. We studied progression of the hearing impairment audiometrically from the patient's fourth year of life until age 19. In the right ear, it progressed from a mean pure-tone hearing level of 10 dB to 70 dB, with a perceptive component of 30 dB. The hearing level of the left ear remained at 25 dB. An exploratory tympanotomy disclosed stapedial fixation, and a partial stapedectomy improved the hearing level in the right ear to 30 to 35 dB. In patients with Beckwith-Wiedemann syndrome, a progressive conductive hearing loss, caused by stapedial footplate fixation, may develop after birth. Clinically, the fixation is identical to otosclerosis, but the typical family history of otosclerosis is lacking.