Acute Rheumatic Fever: Where Do We Stand? An Epidemiological Study in Northern Italy.

Acute rheumatic fever (ARF) is a non-septic complication of group A ß-hemolytic streptococcal (GAS) throat infection. Since 1944, ARF diagnosis relies on the Jones criteria, which were periodically revised. The 2015 revision of Jones criteria underlines the importance of knowing the epidemiological status of its own region with updated data. This study aims to describe ARF features in a retrospective cohort retrieved over a 10-year timespan (2009-2018) and to report the annual incidence of ARF among children in the Province of Monza-Brianza, Lombardy, Italy during the same period. This is a multicentric cross-sectional/retrospective study; 70 patients (39 boys) were diagnosed with ARF. The median age at diagnosis was 8.5 years (range, 4-14.2 years). Overall, carditis represented the most reported major Jones criteria followed by arthritis and chorea (40, 27, and 20 cases, respectively). In order to calculate the annual incidence of ARF, only children resident in the Province of Monza-Brianza were included in this part of the analysis. Therefore, 47 patients aged between 5 and 14 years were identified. The median incidence during the study time was 5.7/100,000 (range, 2.8-8.3/100,000). In the Province of Monza-Brianza, we found an incidence rate of ARF among children aged 5-14 years constantly above the threshold of low-risk area as defined in the 2015 revision of Jones criteria. Therefore, the diagnosis of ARF should be based on the moderate-high-risk set of Jones criteria. However, given the burden of secondary prophylaxis, expert opinion is advisable when the diagnosis of ARF is uncertain.

Autoimmune rhomboencephalitis: A pediatric case report.

Rhomboencephalitis is a potentially life-threatening condition due to inflammation of the hindbrain with an unpredictable outcome depending on the wide spectrum of etiologies and the promptness of diagnosis and treatment. A 23-month-old Caucasian male presented with fever, clouding of consciousness, and trunk ataxia. Three weeks earlier he received active immunization against varicella-zoster virus. Routine laboratory tests were unremarkable. Cerebrospinal fluid showed might elevation of leukocytes. The infection panel was negative. Brain magnetic resonance showed signal hyperintensity in the dorsal portion of the pons, which was consistent with a rhomboencephalitis. Autoimmune pathogenesis was supposed and a high dose of steroids was started. The patient's neurologic status progressively improved till full recovery and complete regression of previous magnetic resonance lesions after 1 year. Nevertheless, longer follow-up is needed in order not to miss any possible signs of an underlying autoimmune neurologic disorder.

Epidemiological and clinical features of rotavirus among children younger than 5 years of age hospitalized with acute gastroenteritis in Northern Italy.

BACKGROUND: Rotavirus is the major cause of acute gastroenteritis and severe dehydrating diarrhea in young children. METHODS: To estimate the proportion of hospital admissions for rotavirus acute gastroenteritis and identify the circulating G and P genotypes among children under five years of age, we conducted a prospective observational study from January to December 2008, recruiting children consecutively admitted to six hospitals in Milan and nearby towns in northern Italy. Typing was done on stool samples by reverse transcriptase polymerase chain reaction amplification. RESULTS: Of the 521 stool samples from children with acute gastroenteritis, 34.9% (95%CI, 30.8 to 39.2%) were rotavirus-positive. Two thirds (67.6%) were under two years of age, and 13.2% were under six months. The predominant G type was G1 (40.7%), followed by G9 (22.5%), G2 (13.2%), G3 (5.5%), G4 (3.8%) and G10 (1.6%). Twenty-one (11.7%) mixed-G infections were identified: G1+G10 (8.8%); G1+G9 (1.6%); and G2+G10 (1.2%). Only P[8] (67.6%) and P[4] (12.6%) types were P genotyped. The predominant single G/P combination was G1P[8] (39.7%), followed by G9P[8] (25.3%), G2P[4] (14.3%), and G3P[8] (4.1%). All G-mixed types combined with P[8]. CONCLUSIONS: These findings show an high prevalence of rotavirus infections among children admitted to hospital for acute gastroenteritis caused by different rotavirus strains circulating in the area studied.

[Nonne-Milroy's syndrome (hereditary lymphedema type I). Report of a clinical case]. / Sindrome di Nonne-Milroy (linfedema ereditario di tipo I). Descrizione di un caso clinico.

The authors report on a case of a 7-days old girls, with Nonne-Milroy syndrome (type I hereditary lynphedema). The clinical picture of this disease is severe but the outcome is usually good. Its etiology, differential diagnosis, therapy and follow-up are discussed.

Differential diagnosis of IgE-mediated allergy in young children with wheezing or eczema symptoms using a single blood test.

BACKGROUND: Allergy-like symptoms are common in young children, but the case history and physical examination cannot identify the underlying origins of overlapping symptom profiles. OBJECTIVE: To evaluate a blood test, Phadiatop Infant (Pharmacia Diagnostics AB, Uppsala, Sweden), for differentiating the capability of IgE-mediated disease in young children with recurrent wheezing, eczema, or both. METHODS: One hundred forty-seven children (mean age, 2.0 years) were consecutively referred to 2 allergy centers by their primary care physician for recurrent wheezing, eczema, or both. The allergist's clinical evaluation included medical history, physical examination, skin prick testing with inhalant and food allergens, and specific IgE determinations in blood. The accuracy of Phadiatop Infant was evaluated in a masked manner against the allergist's final diagnosis. RESULTS: Sixty-nine children had wheezing, 69 had eczema, and 9 had both symptoms. Sixty-one children were clinically diagnosed as having IgE-mediated allergy, 78 as having non-IgE-associated disease, and 8 as having an inconclusive diagnosis. Fifty-six of the 61 children with IgE-mediated allergy had positive Phadiatop Infant test results, and 64 of 78 without the condition had negative results. Sensitivity was 92% and specificity was 82%, with positive and negative predictive values of 80% and 93%, respectively. Thirteen children with a positive Phadiatop Infant test result and a negative final diagnosis were retested after 2 years; 12 of them were diagnosed as having IgE-mediated allergy using a masked evaluation. CONCLUSIONS: The Phadiatop Infant blood test discriminates between IgE- and non-IgE-mediated symptoms in children younger than 4 years.