Nonsurgical management of deep neck infections in children.

Of the 14 pediatric patients with deep neck infections hospitalized at our institution from 1981 through 1990, only 6 were managed surgically. The remaining 8 patients received antibiotic therapy and their infection resolved without the need for surgical drainage. All 8 patients were hospitalized within 4 days (mean, 1.8 days) of onset of illness. Computerized tomography of the neck was performed in 7 and revealed soft tissue swelling and a round or oval cystic lesion in the parapharyngeal region in all 7. Parenteral antibiotic therapy was administered to all patients for 2 to 9 days (mean, 5.5 days) before changing to oral therapy which was continued for 10 to 35 days (mean, 15.1 days). Clinical improvement was evident in all patients 1 to 3 days (mean, 1.6 days) after the onset of antibiotic therapy, with defervescence within 7 days (mean, 3.8 days). Follow-up computerized tomography scans were obtained in 4 patients revealing improvement in 3. It is known that patients with cellulitis of the deep neck tissues may respond well to antibiotic therapy; our experience suggests that some patients with apparent abscess formation as determined by computerized tomography scan may also respond favorably to antibiotic therapy and not require surgical drainage.     

Acute diarrhoea and rotavirus infections in young children in Kuwait

The role of rotavirus infections in acute diarrhoea in young children was studied over a period of one year. Rotavirus was detected by electron microscopy and enzyme immunoassay methods in 40.2% of faecal specimens from 343 children with acute diarrhoea and in 4.7% of 86 controls. The infections were most common in children aged 2-12 months (42.3%). Twelve per cent of the rotavirus infected children were also infected with bacterial enteropathogens (Salmonellae, Shigellae and enteropathogenic Escherichia coli). The incidence of rotavirus infections was not related to sex, socio-economic or nutritional status of children. Rotavirus-associated diarrhoea differed in several clinical parameters from bacterial associated and nonspecific diarrhoea. Rotavirus was detected throughout the year but was most frequent during months with little rainfall and low humidity (March-May). Our results suggest that in Kuwait, rotavirus infection is a major cause of childhood diarrhoea.     

Acute bone and joint infections in children: current concepts

Paediatric bone and joint infections can be associated with devastating consequences for the growing child. The diagnosis is challenging, requiring experienced clinical examination with adjunct diagnostic tests to aid the distinction between a multitude of differential diagnoses which includes transient synovitis, fracture, neoplasia, rheumatological conditions, blood disorders and infection. Emergent diagnosis is required to prevent consequences such as sepsis, chronic infection, angular deformity and disruption of longitudinal bone growth. The clinical presentation of bone and joint infections in children is varied and includes pain, erythema and swelling, fever, reduced range of movement and the inability to weight bear. Blood and tissue samples should be obtained, if possible, prior to commencing antimicrobial therapy in order to secure the best chance of identifying a causative organism and guide treatment. However, this should not delay treatment. Various imaging modalities can be helpful. Whilst there is some variation depending on the child's age, Staphylococcus aureus is the commonest causative organism in both septic arthritis and osteomyelitis. Septic arthritis and osteomyelitis in children should be treated jointly by paediatricians and orthopaedic surgeons, with input from the wider multi-disciplinary team. Trends towards reduced rates of surgical intervention and shorter antibiotic courses have been evident over recent decades. In this article we present a review of the continuously evolving concepts for the management of paediatric bone and joint infections.     

Acute respiratory tract infections in children. A three-year follow-up from birth

Respiratory tract infections (RTIs) in small children account for a considerable proportion of health care expenditure. In 113 children, followed for the first three years of life, we studied the frequency of acute RTI and its relationship to the factors: type of day-care, age, sex, family size, living conditions, allergic predisposition, family smoking habits, and season. To elucidate the influence of age, the frequency of acute RTI and its relationship to type of day-care was longitudinally studied on a quarterly basis. The frequency of acute RTI diagnosis increased gradually from birth culminating in a peak at the beginning of the second year. Besides age and season, type of day-care was the only factor studied to show any relationship with the frequency of acute RTI diagnosis. Up to the age of almost 2 1/2 years, children attending day-care centres accounted for more RTI diagnoses than did those in home care or family day-care, categories with comparable frequencies.     

Acute lower respiratory infections in Gambian children: maternal perception of illness.

A study of mothers' perceptions of childhood acute respiratory infections (ARI) was performed in a rural Gambian population. A total of 25,046 interviews were recorded over a 1-year period with mothers from three villages and four hamlets, and these were analysed together with the results of surveillance of their children for episodes of ARI. Mothers recognized acute lower respiratory infection as a severe disease and recognized fast and difficult breathing as features which discriminated it from upper respiratory infections (sensitivity 73%, specificity 73%). They sought treatment for their children on 51% of occasions when chest pain was reported and on 70% of occasions when 'open chest' was reported. We conclude that even in poorly educated populations in which traditional medical beliefs and practices are widespread, it may be possible to educate mothers to identify lower respiratory infections and to seek early treatment. Community education should play a major role in all national ARI programmes and may be a critical determinant of the success of case management strategies in preventing ARI-related mortality in children.     

Acute respiratory tract infections in Indian children with special reference to Mycoplasma pneumoniae

A total of 70 Indian children of either sex and under 5 years of age who were admitted to the All India Institute of Medical Sciences, New Delhi during a 1-year period (January 1994-December 1994) with complaints suggestive of acute respiratory tract infections (ARTI), were investigated for bacterial aetiology of infection with special reference to Mycoplasma pneumoniae. Microbial aetiology could be established in 44/70 (62.8 per cent) of cases of ARTI. Mycoplasma pneumoniae infection was seen in 21/70 (30 per cent), aerobic bacteria in 14/70 (20 per cent), Chlamydia pneumoniae in 2/70 (2.8 per cent), and mixed infection with mycoplasma either with bacteria and/or chlamydia in 7/70 (10 per cent). However, in 26/70 (37.1 per cent) cases no cause could be detected. Diagnosis of infection with M.pneumoniae was based on culture in 2/20 (10 per cent) cases, antigen detection in throat swab by indirect immunofluorescence assay using specific antibody in 16/70 (22.8 per cent) cases, and demonstration of IgM antibody in serum by serodia Myco II particle agglutination test in 17/70 (24.2 per cent). Streptococcus pneumoniae (9/70, 12.8 per cent) and Staphylococcus aureus (5/70, 7.1 per cent) were the aerobic isolates from blood in these patients. Results of this study indicate that M.pneumoniae plays a significant role in respiratory tract infection in an Indian paediatric population. Rapid diagnostic procedures, such as antigen detection and IgM antibody demonstration, should be used more widely to determine the infective aetiology early in the course of illness. The study also highlights the mixed aetiology in ARTI in children, which has important therapeutic implications.     

Acute lower respiratory infections: a major cause of death in children in Bangladesh

The importance of acute lower respiratory infections (ALRI) as a cause of death in children was estimated using systematically collected demographic data on the population of the Teknaf area of southern Bangladesh. Of 1349 children aged 1-59 months who died between 1 January 1982 and 31 December 1985, ALRI was diagnosed by verbal autopsy in 390 (29%) and was the leading cause of death. ALRI mortality rates were highest in the youngest age groups (136/1000 for those less than or equal to 5 months) and decreased in older children (16/1000 for those 3-4 years old). Half of all fatal ALRI cases occurred in children less than 6 months old. In older children, ALRI-associated deaths tended to occur during the months October to January, while deaths in infants tended to follow the seasonal birth pattern. Significant predisposing factors for fatal ALRI were malnutrition and measles, detected, respectively, in 18% and 8% of children who died from ALRI. This study emphasizes the importance of ALRI as a major cause of death in developing countries and suggests that interventions to reduce childhood mortality are needed and should be targeted to specific age groups at risk.     

Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo

BACKGROUND: Acute lower respiratory infections are major causes of hospitalization in children and are mainly caused by respiratory viruses. In the present study, we investigated the etiologic agents responsible for acute lower respiratory infections from the period November 1986 to October 1992 in order to determine the seasonal pattern and different characteristics of age distribution of respiratory infectious agents, mainly virus infections. METHODS: A total of 1521 patients with lower respiratory infections was hospitalized in Saiseikai Central Hospital, Tokyo, Japan. Nasopharyngeal secretions were obtained for virus isolation and paired sera in the acute and convalescent phases were obtained for serological examination. RESULTS: Etiological agents were identified in 668 of 1521 patients (43.9%) by serological antibody responses, virus isolation and/or detection of virus antigen: 240 (15.8%) with respiratory syncytial (RS) virus; 62 (4.1%) with influenza virus type A; 26 (1.7%) with influenza virus type B; 86 (5.7%) with adenovirus; 81 (5.3%) with parainfluenza virus; 32 (2.1%) with measles virus; 20 (1.3%) with enteroviruses or Herpes virus other than respiratory viruses; 75 (4.9%) with Mycoplasma pneumoniae; 10 (0.7%) with pertussis; and 36 (2.4%) with mixed infections. In the remaining 853 patients (56.1%), etiologic agents were not identified. Respiratory syncytial (RS) virus was a main causative agent of respiratory infections in patients younger than 3 years of age. Influenza virus and M. pneumoniae were two main causative agents in patients with acute respiratory illness over 5 years of age. Parainfluenza virus type 3 was frequently observed in infants from 9 to 12 months of age. A distinct seasonal pattern of viral infections was consistently observed in each year during the study period; RS and influenza viruses were prevalent in winter, parainfluenza virus was prevalent in spring and M. pneumoniae was prevalent in summer and autumn. However, adenovirus infections were observed in all seasons. Serological responses were poor in patients younger than 1 year of age and they were mainly diagnosed by virus isolation or detection of virus antigen. CONCLUSIONS: Virological epidemiology provides useful information in daily clinical practice for the prediction of etiological agents based on patient age and the seasonal distribution of agents. We should examine virus isolation and the detection of virus antigen, along with serological examinations in patients with respiratory infections, especially in infants younger than 1 year of age because of poor serological responses.     

Surgical infections in children

Skin and soft tissue infections in intensive care unit settings can be life threatening and have a variety of causative agents. Expeditious diagnosis and aggressive medical and surgical treatment are necessary. Infections of the deeper spaces such as the neck, pleural, or peritoneal cavities usually are blood borne or the result of direct spread from adjacent organs (such as lungs in case of empyema) or a perforated viscus (as with perforated esophagus or gut). Children with such infections require intensive management. The recent advances in antimicrobial therapy have tremendously improved the outcome for these patients. Prompt surgical interventions, however, remain invaluable in most cases. Copyright © 2000 by W.B. Saunders Company