Search

Background Pertussis is an important cause of infant death worldwide and continues to be a public health concern even in countries with high vaccination coverage. Severe (critical) pertussis with hyperleukocytosis is a severe form of the disease with up to 80% mortality rate. Attempts have been reported to reduce the white blood cell burden by exchange transfusion (ET) with conflicting conclusions. Case Report We report a case of critical pertussis in a neonate who was treated with ET, in view of a comprehensive literature review. Results The patient was discharged without any sequelae. Conclusion ET should be considered in all infants suffering from critical pertussis and hyperleukocytosis, even in secondary care community hospitals.

OBJECTIVE. N-terminal pro-B-type natriuretic peptide has been shown to be a marker for cardiac dysfunction. The peptide level is also elevated in patients with sepsis. The purpose of this study was to assess whether N-terminal pro-B-type natriuretic peptide levels can differentiate pediatric patients with sepsis from patients with acute left ventricular dysfunction. PATIENTS AND METHODS. Pediatric patients admitted to an ICU with sepsis or acute left ventricular dysfunction were evaluated clinically, and the grade of systemic inflammatory-response syndrome was determined. Echocardiography was performed, and their levels of N-terminal pro-B-type natriuretic peptide were measured. The N-terminal pro-B-type natriuretic peptide level was also measured in patients with simple febrile illness. RESULTS. There were 10 patients with sepsis and 10 with acute left ventricular dysfunction. The age of the patients was similar, and systemic inflammatory-response syndrome grading was not different (sepsis: 2.8 ± 0.4; acute left ventricular dysfunction: 2.6 ± 0.7). N-terminal pro-B-type natriuretic peptide levels were elevated in patients with sepsis (median: 6064 pg/mL; range: 495–60417 pg/mL) but were significantly higher in patients with acute left ventricular dysfunction (median: 65630 pg/mL; range: 15125–288000). The area under the receiver operating characteristics curve for the diagnosis of acute left ventricular dysfunction was 0.9. N-terminal pro-B-type natriuretic peptide levels of patients with sepsis and impaired systolic function were not different from those of patients with sepsis and normal systolic function. The N-terminal pro-B-type natriuretic peptide levels of 20 patients with simple febrile illness were significantly lower. CONCLUSIONS. N-terminal pro-B-type natriuretic peptide levels are elevated in pediatric patients with sepsis but are higher in some, but not all, patients with acute left ventricular dysfunction. The overlap between N-terminal pro-B-type natriuretic peptide levels in sepsis and acute left ventricular dysfunction precludes the use of the peptide's level as a sole means to differentiate between these conditions. Excessive elevation in N-terminal pro-B-type natriuretic peptide levels, however, suggests cardiac etiology for acute hemodynamic deterioration in infants and children.

We describe an 8-month-old infant with infantile spasms treated with adrenocorticotropic hormone (ACTH) who presented with fatal Legionella pneumophila and Pneumocystis jirovecii infection. Emphasis is placed on the ensuing immunosuppression and infectious sequelae of ACTH therapy. Given that ACTH therapy may increase the risk of fatal infection, patients undergoing such treatment should be closely monitored, with particular attention paid to the functioning of the immune system.

Pertussis is an important cause of infant death worldwide and continues to be a public health concern even in countries with high vaccination coverage. Severe (critical) pertussis with hyperleukocytosis is a severe form of the disease with up to 80% mortality rate. Attempts have been reported to reduce the white blood cell burden by exchange transfusion (ET) with conflicting conclusions.We report a case of critical pertussis in a neonate who was treated with ET, in view of a comprehensive literature review.The patient was discharged without any sequelae.ET should be considered in all infants suffering from critical pertussis and hyperleukocytosis, even in secondary care community hospitals.

Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. Respiratory syncytial virus infection is also associated with a number of extrapulmonary manifestations, including the cardiac system. Pericardial effusion, however, is a very rare occurrence with respiratory syncytial virus infection. We report a very young infant with respiratory syncytial virus bronchiolitis whose clinical course was associated with pericardial effusion, treated conservatively.

We present two children with abscesses located adjacent to the urinary bladder without a demonstration of intestinal pathology. The abscesses were caused by Staphylococcus aureus and were successfully treated with computerized tomography-guided drainage and antimicrobials. We would like to stress that not every abdominal abscess is secondary to bowel disease or perforation. Therefore, the organisms cultured may differ from the classic mixed gut flora. Hence, especially if there is no evidence of intestinal disease and the location is not typical for intestinal pathology (e.g., perivesical), S. aureus must be considered a potential etiologic factor.