Mesothelial cell proliferation and localized pleural pseudotumour associated with Mycoplasma pneumoniae infection

A 9-year-old boy had serological evidence of Mycoplasma pneumoniae infection. Mycoplasma organisms were cultured from throat swabs. A chest X-ray and computed tomography revealed a localized pleural tumour with pleural fluid containing mesothelial cells. It is suggested that mesothelial cell hyperplasia developed as a reactive change following M. pneumoniae infection.     

Streptococcus pneumoniae invasive disease in the neonatal period: An increasing problem?

Abstract A series of 11 cases of invasive infection withStreptococcus pneumoniae, occurring over an 11-year period, is reported. Eight of the 11 cases occurred during the final 2 years of the study suggesting that the incidence of infection may be increasing. Infection carries a high mortality (3/11). Morbidity includes meningitis, convulsions and respiratory failure. In one caseS. pneumoniae meningitis occurred in both mother and newborn. Most mothers and newborn. Most mothers who carried the organism were asymptomatic at the time of delivery.Conclusion S. pneumoniae should be specifically sought in swabs taken from the pregnant mother and newborn and if isolated, even in the absence of symptoms, antibiotic therapy against the organism should be strongly considered.     

Serotype distribution and antimicrobial susceptibility of <Emphasis Type="Italic"> Streptococcus pneumoniae </Emphasis>causing invasive infections and acute otitis media in children

A prospective study was conducted to determine the serotypes and antibiotic resistance patterns of pneumococcal isolates from children with invasive pneumococcal disease (IPD) and acute otitis media (AOM). From October 2001 to May 2002, 65 children with IPD (28 bacteraemic pneumonia, 24 bacteraemia without focus, 7 meningitis, 6 other infections) and 78 with AOM were identified. The most common serotypes causing IPD were 14 (32.3%), 6B (20.0%), 1 (18.5%) and 19F (7.7%) whereas the predominant serotypes causing AOM were 19F (35.9%), 14 (16.7%) and 23F (9.1%). Sixty-nine percent of IPD and 70.5% of AOM were caused by vaccine serotypes. The vaccine serotypes were more commonly encountered in meningitis cases and in children younger than 2 years of age. Intermediate resistance to penicillin was observed in 6 of 65 (9.2%) IPD isolates, one of which was intermediately resistant to cefotaxime (1.6%), whereas none exhibited high-level resistance to penicillin or other beta-lactam antibiotics. A higher proportion of antimicrobial resistance was noted in AOM isolates; 29 of 78 (37.4%) exhibited intermediate resistance and 8 (10.2%) high level resistance to penicillin, four of which had intermediate resistance to cefotaxime. Significant resistance was also noted to erythromycin; 38.5% of IPD and 48.7% of AOM isolates were resistant. Multidrug resistance was observed in one IPD and in eight AOM isolates. Conclusion:these findings have implications in the potential use of 7-valent conjugate vaccine in our region.Abbreviations AOM acute otitis media - IPD invasive pneumococcal disease - MIC minimal inhibitory concentration     

Complicated parapneumonic effusion in Belgian children: increased occurrence before routine pneumococcal vaccine implementation

An increased occurrence of complicated parapneumonic effusions in children has been reported from the UK and USA. Data from mainland Europe are scarce. We investigated the incidence of complicated parapneumonic effusion and empyaema in children admitted to the University Hospital of Leuven between 1993 and 2005, an era when pneumococcal conjugated vaccination had not yet been implemented. Sixty-eight cases were identified. The incidence increased from 20–55/100,000 hospital admissions to 120–130/100,000 hospital admissions in 2005, with 50% of the cases occurring from 2003 onwards (late cohort). This increase occurred later than that reported in the UK and US, but is of similar magnitude. The median patient age was 3.6 years (range 0.5–17 years). The median duration of symptoms before admission was 4 days (quartile values 3–7 days). The median white blood cell (WBC) count was 15,450 WBC/mm³ (quartile values 11,300–21,200 WBC/mm³) and the median C-reactive protein (CRP) level was 242 mg/L (quartile values 143–344 mg/L). Patients in the late cohort seemed to have worse disease compared to early cohort patients; significantly higher pleural lactate dehydrogenase (LDH) level (P = 0,02), higher pleural WBC, lower pleural glucose level and significantly longer duration of hospitalisation in the later cohort (P < 0,05), possibly reflecting more severe disease. In both cohorts, Streptococcus pneumoniae was the most frequently isolated pathogen, with serogroup 1 prevailing. The occurrence of complicated parapneumonic effusion increased in Belgian children before pneumococcal vaccination was added to routine childhood immunisations. This increase is pronounced from 2003 onwards (late cohort) and, thus, occurred later than that reported in the UK and USA; several parameters point towards the occurrence of more serious disease in the late cohort patients. Tine Van Ackere and Marijke Proesmans contributed equally to this paper and are the first authors.     

Antibiotic susceptibility of acute otitis media pathogens in otitis-prone Belgian children

A regional surveillance study was carried out in children with recurrent acute otitis media (AOM) to determine the antimicrobial susceptibility of three common AOM pathogens. Susceptibility to relevant antimicrobial agents was determined on 149 Streptococcus pneumoniae, 246 Haemophilus influenzae and 119 Moraxella catarrhalis strains isolated between January 1999 and January 2002, either from the nasopharynx or middle ear of 74 children with recurrent AOM, the majority (77%) being otitis-prone. Overall pneumococcal resistance to penicillin was 9.4% (6.7% penicillin-intermediate resistant, 2.7% penicillin-resistant), whereas cotrimoxazole and erythromycin resistance accounted for 25.5% and 38.9% respectively. The prevalence of antimicrobial-non-susceptible S. pneumoniae was the highest in middle ear isolates (P<0.05) and in otitis-prone children (P<0.01). Moreover, otitis-prone children harboured significantly more pneumococci resistant to at least two antimicrobial agents (24.3% versus 7.4%; P<0.01). No patient age related variation was observed. Five serogoups (6, 19, 23, 14 and 9) covered by the 7-valent pneumococcal conjugate vaccine, constituted most of the antibiotic resistant pneumococci. Among nasopharyngeal and middle ear H. influenzae isolates, 17.1% were resistant to ampicillin and 16.3% to cotrimoxazole. For M. catarrhalis, 92.4% of all isolates was ampicillin-resistant. Conclusion: this study confirms international and national differences in antimicrobial susceptibility profiles of three acute otitis media pathogens with relatively favourable antibiotic resistance rates in Belgian children with frequent acute otitis media. This at risk population of otitis-prone children is shown to harbour more antimicrobial resistant and multidrug resistant pneumococci. If antimicrobial therapy in this group of children is indicated, high dose amoxicillin is recommended whereas the use of macrolides is obsolete.Abbreviations AOM acute otitis media - MEF middle ear fluid - MIC minimal inhibitory concentration     

Determination of pneumococcal serotypes/genotypes in nasopharyngeal secretions of otitis media children by multiplex PCR

The appropriate clinical applications of pneumococcal polysaccharide vaccines against recent increases in antimicrobial resistant Streptococcus pneumoniae (S. pneumoniae) urgently require accurate analytical methodologies for determining and characterizing the serotypes. The results of current immunological determinations of serotypes with anti-capsular polysaccharide-specific sera are difficult to interpret in terms of quellung changes of the pneumococci. In this study, we applied the multiplex PCR technique for the rapid identification of pneumococci and simultaneous rapid determinations of their serotypes and genotypes that directly correlated with antimicrobial susceptibilities from nasopharyngeal secretions (NPS). Serogroups 6, 19F and 23F were the predominant capsular types of S. pnuemoniae in the NPS samples. Strains of serotypes 19F and 23F frequently had mutations in pbp1a, pbp2x and pbp2b and expressed ermB and mefA; they also were mostly resistant to both penicillin G (PCG) and clarithromycin (CAM). Two NPS samples contained the strain of serotype 19F together with the strain of serotype 23F, although only the strain of serotype 19F was identified by a conventional bacterial culture. Pneumococci were identified in six NPS samples and their serotypes determined by the multiplex PCR, while a conventional bacterial culture failed to identify the pathogens. Our findings suggest that PCR-based serotyping and genotyping can provide an accurate and rapid distribution of pneumococcal serotypes and antimicrobial resistance. The relatively minor populations in the nasopharynx may be determined using molecular techniques.     

<Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis>: nervous system complications in childhood and review of the literature

Mycoplasma pneumoniae is an important pathogen which causes nervous system disorders during or after the course of a respiratory tract infection. The exact pathogenic mechanism which causes neurological disorders still remains unknown. Although meningoencephalitis and acute disseminated encephalomyelitis are common complications, there are few cases of acute transverse myelitis and isolated abducens nerve palsy associated with M. pneumoniae infection in childhood. The association between ocular myasthenia gravis and M. pneumoniae infection has not been described before. Here, we describe five patients with different nervous system complications associated with M. pneumoniae infection and discuss the pathological features of central nervous system involvement.     

Successful intravenous immunoglobulin therapy for recurrent pneumococcal otitis media in young children

Serum immunoglobulin levels and naturally occurring antibody titres againstStreptococcus pneumoniae were measured in seven children aged 1–1.9 years with recurent pneumococcal acute otitis media (AOM). Three of them had low IgG₂ levels. Mean antibody levels of anti-pneumococcal IgG₁ and anti-pneumococcal IgG₂ were significantly lower in patients when compared to those of healthy controls and children who had less frequent episodes of AOM. Following treatment with intravenous immunoglobulin (IVIG) for 6 months, anti-pneumococcal IgG₁ and IgG₂ antibody levels increased and the number of episodes of AOM decreased in all patients. Following the discontinuation of IVIG therapy, no AOM episode occurred. Serum levels of anti-pneumococcal IgG₁ and IgG₂ were normal, which were measured in three subjects at 5,6, and 12 months after the cessation of IVIG therapy. These results suggested that delayed maturation of anti-pneumococcal antibody production caused recurrent AOM and this condition was corrected by IVIG therapy.     

不同胸部影像学表现的肺炎支原体肺炎儿童的肺功能变化特征

目的 探讨不同胸部影像学改变的肺炎支原体肺炎（MPP）患儿肺功能异常的特点。方法 根据胸部影像学结果将确诊为MPP 的215 名患儿分为支气管肺炎组（125 例）、大叶性肺炎组（69 例）和间质性肺炎组（21 例）,比较3 组间肺功能检测指标用力肺活量（FVC）、第1 秒时间用力呼出气体容量（FEV1）、最高呼气流速（PEF）和最大呼气中段流速（MMEF 25%~75%）的差异。结果 支气管肺炎组患儿急性期PEF（实测值和实测值/ 预计值）明显低于其他两组患儿;大叶性肺炎组患儿急性期MMEF 25%~75% 显著低于其他两组;间质性肺炎组患儿急性期FVC 明显低于其他两组患儿。3 组患儿恢复期肺功能与急性期比较,除大叶性肺炎组患儿FEV1 无明显好转外,其他指标均明显改善。结论 胸部影像学为支气管肺炎改变的MPP 患儿主要表现为大气道功能受损;大叶性肺炎改变者以小气道功能受损更为明显;间质性肺炎改变患儿既有阻塞性通气功能障碍,又有限制性通气功能障碍。     

Adult respiratory distress syndrome associated withMycoplasma pneumoniae infection

A 13-year-old boy is described who developed severe adult respiratory distress syndrome (ARDS), biochemical pancreatitis and skin vasculitis after an acute respiratory infection due toMycoplasma pneumoniae. The boy was mechanically ventilated for 17 days, but could be discharged in good clinical condition after 36 days of hospitalization. However, major disturbances of the lung function tests persisted, suggesting interstitial fibrosis. To the best of our knowledge, this is the first case of ARDS afterM. pneumoniae infection in childhood.     

Complete heart block from mycoplasma pneumoniae infection

Summary Complete heart block (CHB) in infants and children is usually congenital. Nonsurgical acquired CHB is rare. Occasionally, transient acquired CHB is seen in association with viral myocarditis. We describe here an unusual case of transient CHB in a 12-year-old boy with endomyocardial biopsy-proven myocarditis and evidence ofMycoplasma pneumoniae infection.     

Magnetic resonance imaging of lymphomas in children

Magnetic resonance imaging has been used to evaluate 10 children with lymphomas and was able to identify disease in all 10 cases and monitor response to therapy in all three patients with follow-up studies. It could not distinguish between the different histological types of lymphoma. The image intensity of a diseased spleen in one case was different from that of five other normal spleens in six children with Hodgkins disease. Magnetic resonance imaging compared well with computed tomography and it was especially good at identifying blood vessels.     

Late onset subgaleal hemorrhage infection with <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis>?

We report a case of an infected subgaleal hematoma caused by an unusual micro-organism in a previously healthy 11-month-old girl. Our patient presented at the emergency department with an increasing scalp swelling for 2 weeks, and culture of the evacuated fluid yielded Streptococcus pneumoniae. Although she was born after vacuum delivery and a scalp swelling was noticed from the third day of life, this swelling disappeared completely at the age of 3 months. Parents were thoroughly questioned but we could not find out a new traumatic head event. We postulate that in our patient, a subgaleal hemorrhage developed after vacuum delivery and possibly infected 11 months later, presumably from hematogenous seeding of an acute otitis media. The patient recovered well after surgical drainage and antimicrobial therapy.     

Magnetic resonance imaging in children with kernicterus

The magnetic resonance (MR) findings of three children with severe neonatal jaundice who were suspected to be suffering from kernicterus were examined. In all children high intensity areas in the globus pallidus were demonstrated bilaterally on T2-weighted imaging. The posteromedial border of the globus pallidus was shown to be the most sensitive area to kernicterus by MR findings. D Athetosis, cerebral palsy, globus pallidus, kernicterus, magnetic resonance imaging
K Yokochi, Ohzora-no-iye Hospital, 7448 Nakagawa, Hosoe, Inasa, Shizuoka 431-13, Japan     

Early <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis> infection presenting as multiple pulmonary masses: an unusual presentation in a child

Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings.     

Impact of amoxicillin, associated or not with clavulanic acid, on pharyngeal colonization and selection of Streptococcus pneumoniae resistance in children under 5 years of age

Among young children, pneumococcal nasopharyngeal colonization (NPC) rates of >90% have been described. The aim of our study was to assess the effect of amoxicillin exposure on the NPC. From Dec 2001 to Feb 2004, less than 5 years old children with respiratory symptoms and fever who were prescribed amoxicillin were eligible. Three nasopharyngeal swabs were taken: at the time of the initial visit (IV), 60 hours after amoxicillin discontinuation (end of treatment visit, ETV), and 4 weeks later (follow-up visit, FUV). One hundred and thirty four children were included. NPC was detected in 58.5%, 42.9% and 51% of <1, 1-2 and >2 years-old children respectively (NS). Vaccine serotypes (VS) or vaccine-related serotypes (VRS) were identified in 80%, 40% and 55% of <1-year-old, 1-2 year-old and >2-year-old children respectively (NS). The proportion of PNSSP was 60% in <1-year-old children, 43% in 1-2 year-old children and 40% in >2-year-old children (NS). 49 out of 134 (36.5%) children completed the three study visits. 51%, 22.4% and 46.9% of those were colonized at IV, ETV and FUV, respectively (p=0.007). The percentage of resistant SP was 28%, 45.5% and 8.7% (p=0.05) for penicillin. In children <1 year of age, a higher proportion of SP colonization, presence of VS and PNSSP was found. A downfall of NPC at the end of therapy was observed. NPC returned to baseline levels thanks to "de novo" colonization in half of the cases, a few weeks after.     

Magnetic resonance imaging of knee injuries in children

The purpose of this study was to evaluate the significance of meniscal appearances and determine the frequency of abnormalities seen on magnetic resonance (MR) imaging in children with knee injuries. We reviewed 78 consecutive MR imaging studies of 74 children aged 5–16 years with unfused epiphyses. Menisci were evaluated using conventional grading techniques. We used ² to compare the frequencies of medial and lateral meniscus and anterior cruciate ligament (ACL) tears with each other and with published data for children. Similarly, we compared the proportions of tears of these structures with published data. Arthroscopy results from 26 children were used to calculate sensitivity and specificity of MR imaging for meniscal tears, which were 100 % (8/8) and 89 % (16/18), respectively. The majority of studies (82 %) had grade I or II signal intensity in one or both menisci. Arthroscopy results available in 33 % of this group revealed normal menisci. Tears of the medial and lateral menisci were significantly more common than of the ACL. Injuries of the ACL were seen significantly less frequently than previously reported. Grade I or II meniscal signal intensity in children with knee injuries is consistent with a normal meniscus. Tears of the menisci are more common than ACL tears. MR imaging in this context appears reliable.