ABSTRACT
Despite recent advances in pediatric chronic cholestatic diseases, the causes and effective therapies remain elusive, and many patients progress to liver failure and need liver transplantation.Malnutrition is a common complication in these patients and is a well-recognized, tremendous challenge for the clinician.The malnutrition and failure to thrive are associated with increased risks of morbidity and mortality, and they also affect the outcomes of liver transplantation, including long-term survival.Malnutrition in children with chronic cholestatic disease is multifactorial and with multiple potential nutritional deficiencies.Supplemental feeding, including medium-chain triglycerides, essential fatty acids, branched-chain amino acids.In order to improve the life expectancy and quality of life of children with chronic liver disease, this paper reviews ways to address the nutritional needs for specific cause of malnutrition in children.
ABSTRACT
Macrophage activation syndrome(MAS)is a rare and fatal complication of Kawasaki disease.So far, many possible causative factors have been explored, including infectious agents and immunologic mechanisms, but the exact etiology remains unclear.Early diagnosis and timely and reasonable treatment are needed for it, because of its insidious onset, rapid progression, multiple organ system involvement, critical clinical symptoms and high mortality.There is no international unified diagnostic criteria and treatment regimen for Kawasaki disease complicated with macrophage activation syndrome at present, many children have the missed diagnosis and miss the best time for treatment.This review aims to analyze Kawasaki disease complicated with macrophage activation syndrome in detail in terms of epidemiology, pathogenesis, clinical characteristics, diagnosis and treatment in order to establish the more specific diagnostic criteria and the more standardized treatment to enable children with such severe KD to receive timely diagnosis and appropriate treatment.
ABSTRACT
Objective:To investigate the clinical features, diagnosis, treatment and prognosis of children with osteomyelitis caused by Streptococcus pneumonia. Methods:The demographic characteristics, diagnosis, clinical manifestations, imaging features, treatment and short-term prognosis of Streptococcus pneumonia osteomyelitis cases in 18 children′s hospitals from January 2012 to December 2017 were retrospectively collected and analyzed. Results:A total of 9 cases were enrolled, with a median age of 1 year and 3 months.Four children had underlying diseases.The main manifestations were local swelling, pain, limited mobility (9 cases) and fever (8 cases). Sites of infection included humerus (4 cases), femur (3 cases) and tibiofibula (2 cases), and 8 cases were complicated with septic arthritis; The laboratory tests showed increased white blood cells (8 cases, median 22.02×10 9/L), C-reactive protein (7 cases, median 55.44 mg/L) and erythrocyte sedimentation rate (6 cases, median 70 mm/1 h) of those patients.Five patients received monotherapy in the initial treatment regimen with cephalosporins. Then the therapeutic schedules were adjusted according to the culture and antibiotic sensitivity. All patients were treated with puncture, incision drainage or fenestrating decompression.Eight patients were cured and discharged finally. Conclusions:Streptococcus pneumonia osteomyelitis is more common in younger children and may have no risk factors.The common infection site is long bone metaphysis, and those patients are easily complicated with septic arthritis.Antibiotic combined with surgical treatment are crucial to a good outcome.
ABSTRACT
Objective:To explore the clinical characteristics of children with Streptococcus pneumoniae cellulitis. Methods:The bacterial culture information management system in 18 children′s hospitals from January 2012 to December 2017 were reviewed.Among 1 138 children diagnosed with invasive pneumococcal disease(IPD), 7 cases were hospitalized with cellulitis.Clinical information was collected and analyzed.Results:Seven cases of Streptococcus pneumoniae cellulitis accounted for 0.6%(7/1 138 cases) of 1 138 IPD cases in 18 hospitals.There were 5 males and 2 females.The onset age was from 1 month to 6 years old, and the median age was 2 years old.There were 4 cases in rural areas and 3 cases in urban areas.Langerhans cell histiocytosis (LCH) was found in 1 case.Clinical manifestations: fever, local swelling and pain with infection.The focus of cellulitis: orbital cellulitis in 2 cases, buccal infection in 2 cases, upper extremity, head and buttock infection in 1 case, respectively.At the beginning of the disease: 2 cases of orbital cellulitis were accompanied by nasosinusitis and suppurative otitis media, 1 case was treated with acute periapical inflammation, 1 case was 10 months after chemotherapy.Type of infection: 6 cases were complicated with bloodstream infection, 2 cases with bacterial meningitis and 1 case with pneumonia.Other culture results: 6 cases of Streptococcus pneumoniae were cultured in peripheral blood, 2 cases were positive in local pus culture.Drug sensitivity test: 6 cases were sensitive to Penicillin and Cephalosporin (Cefotaxime/Ceftriaxone), 1 case was resistant.Treatment: 3 patients were treated with Cephalosporins alone, 2 cases with Cephalosporins and Penicillins, 2 cases with Vancomycin and Meropenem for meningitis, 3 cases with local abscess by incision and drainage, 2 cases with meningitis in Intensive Care Unit, and 1 case with endotracheal intubation and ventilator assisted ventilation.The average length of stay was 14.3 days(5-41 days). Discharge outcome: 6 cases improved and 1 case died. Conclusions:Cellulitis is a rare type of infection in children with IPD.It is mainly found in the head, face and around the orbit.It may be accompanied by bloodstream infection or bacterial meningitis.Most of them have a good prognosis.
ABSTRACT
Periodic fever, aphthous stomatitis, pharyngitis and adenitis(PFAPA)syndrome which is generally considered to be an autoinflammatory disease with multiple etiologies and heterogeneous inheritance, is the most common cause of periodic fever in childhood.So far, many possible causative factors have been explored, including infectious agents, immunologic mechanisms and genetic predisposition, but the exact etiology remains unclear.At the same time, due to the lack of standardized diagnosis and treatment standards, many children received unnecessary examinations and unreasonable treatment.This review aims to analyze PFAPA syndrome in detail in terms of clinical characteristics, pathogenesis, diagnosis, differential diagnosis and treatment in order to establish the more specific diagnostic criteria and the more standardized treatment to enable children with PFAPA to receive timely diagnosis and appropriate treatment.
ABSTRACT
Objective To explore the clinical and epidemiological characteristics of severe measles in infants. Methods Clinical data of 62 infants with severe measles were analyzed retrospectively.Results Of 62 infants with severe measles,42 (67.74%)were aged < 9 months,of whom 37(88.10%)were not vaccinated against measles. The onset months were February-May,41 cases (66.13%)were found in March-April.All patients had fever and skin rash,the rates of other symptoms and complications were as follows :oral leukoplakia 80.65%(n=50),Ca-tarrh symptom 77.42%(n=48),conjunctivitis 79.03%(n=49),history of choked water cough 75.81%(n=47), pneumonia 95.16%(n=59),acute laryngitis 35.48% (n=22),electrolyte disorder 20.97%(n=13),acute respir-atory distress syndrome 9.68%(n=6),liver function damage 9.68%(n=6),pneumothorax 8.06% (n=5),myo-cardial damage 4.84% (n=3),respiratory failure 3.23% (n=2),toxic encephalopathy 3.23%(n=2),measles en-cephalitis 1.61% (n= 1),and pleural effusion 1.61% (n = 1 ).Of all cases,41 cases were cured,19 cases im-proved,1 case died,and 1 case gave up treatment.Conclusion These severe measles cases occurred mainly in in-fants aged<9 months and were not vaccinated against measles;infants had history of choked water cough;the main onset months were March-April ;pneumonia was still a predominant complication of infant measles.
ABSTRACT
Objective To realize the clinical and epidemiological characteristics of measles,and explore effective measures to control measles epidemic.Methods Clinical data of 554 hospitalized measles children between January 2009 and December 2013 were analyzed retrospectively.Results All children had fever,cough,and skin rash,507 (91.52% )had typical clinical manifestations of measles,47(8.48% )had mild manifestations;the major population were children aged≤6 months(n= 176,31.77% )and 7-8 months (n= 346,62.45% );132 (23.83% )children had contact history of confirmed measles,19(3.43% )measles children’s mothers also developed measles (all were cases of 2013),227 (40.97% )children had history of repeated infusion or hospitalization in large medical institutes dur-ing the measles incubation period (all were cases of 2013,there were measles children who had infusion or hospitali-zation in the same hospital during the same period). The peak incidence of measles usually occurs in January-May. Conclusion Intensive immunization of measles for young women of reproductive age and vaccination with“pre-mea-sles vaccine”for early infancy,and strengthening the medical management of fever outpatients are important meas-ures to prevent measles epidemic.