Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.

Routine and recommended vaccinations for travellers.

Travel risks should not be neglected. Health hazard is unprofitable. Adequately planned, individually adjusted prophylaxis makes travel not only pleasant, but safe as well. It is worth to emphasize that fever in person coming back from the tropics requires quick exclusion (or confirmation) of malaria.

[Diagnostic difficulties in neuroborreliosis in children]. / Trudnosci diagnostyczne w neuroboreliozie u dzieci.

OBJECTIVE: Analysis of clinical picture in children hospitalized because of suspicion of neuroborreliosis and evaluation of usefulness of testing serum and cerebrospinal fluid (CSF) for specific antibodies. MATERIAL AND METHODS: 23 children (age: 13 months - 15.5 years) were hospitalized: 11 children with facial palsy, 2 children with radiculopathy and 10 children with headache. In 21 children lumbar puncture and CSF examination was done. Serum of all children and CSF of 21 children were tested by ELISA for specific antibodies (IDEIA DakoCytomation). RESULTS: Meningeal signs in physical examination were found in 4 children and inflammatory CSF changes in 8 children. Specific antibodies in sera of 19 children and in CSF of 7 children. Neuroborreliosis was diagnosed in 12 children: in 9 facial palsy (in 6 with inflammatory CSF changes), in 2 Bannwarth's syndrome and in 1 aseptic meningitis. Diagnosis was confirmed by detection of specific antibodies in sera of 10 children and in CSF of 6 children. CONCLUSIONS: Meningitis in the course of neuroborreliosis is not always accompanied by meningeal signs. Positive serology is not an unequivocal confirmation of neuroborreliosis especially if symptoms are nonspecific (e.g. headache).

[Mumps--an underestimated disease]. / Swinka--niedoceniona choroba.

UNLABELLED: In countries, where vaccination against mumps is not obligatory, epidemic increase in morbidity is observed every 4-5 years. In Poland vaccination had not been obligatory until 2004. Year 2004 was an epidemic year--135,178 cases were reported. In 2005 (up to 31.07.05) 64,062 cases were noted and many hospitalizations. The aim was analysis of clinical course of mumps in children hospitalized between 1.01.04 and 31.07.05. MATERIAL AND METHODS: 292 children in age from 11 months to 16 years, 90 (30,8%) girls and 202 (69,2%) boys. Diagnosis of mumps was based on typical clinical picture, history of exposure and amylase activity in serum and urine. 111/292 (38%) children were referred to the hospital with suspicion of meningitis: in 68/292 (23,3%) lymphocytic meningitis was diagnosed (49 boys and 19 girls) and in 43 meningeal signs were not observed. Orchitis was observed in 48/202 (23,76%) boys 12-16 years old, in 3 of them both testes were affected. In 3 boys meningitis and orchitis were diagnosed, in one of them with encephalitic symptoms. 73/292 (25%) children were admitted to the hospital because of emesis and dehydration. 43/292 were hospitalized with suspicion of meningitis. 15 children were admitted because of high fever with poor response for antipyretics. In two children unilateral deafness was observed. In two children edema of subcutaneous tissue of upper chest. In remaining cases mumps was diagnosed in children with hematologic and oncologic diseases, kidney failure, congenital defects. CONCLUSIONS: Complications of mumps and need for hospitalization in children with mumps still are problems of public health. The only method of prophylaxis is accurate vaccination pragramme.

[Varicella--mild or dangerous disease]. / Ospa wietrzna--lekka choroba, czy zagrozenie?

OBJECTIVE: The aim was an analysis of causes of varicella complications in children hospitalized in the Department if Infectious Diseases In Childhood of Medical University in Warsaw. METHODS AND MAIN OBSERVATIONS: 105 children from 15 day to 15 years of age was observed. 58.1% were male. The median age was 5,8 years. RESULTS AND CONCLUSIONS: Bacterial skin infections and neurological complications were the most frequent complications. Sepsis was diagnosed in 3 children. Vaccination program against varicella can reduce the risk of very severe complications.

[Borreliosis in children - clinical manifestation, diagnosis and treatment]. / Borelioza u dzieci -- manifestacja kliniczna, rozpoznawanie i leczenie.

Lyme Disease (Borreliosis) is a multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi, transmitted by the bite of ixodes infected ticks. We would like to present our experience with the treatment of borreliosis in collaboration with the Warsaw Medical Academy's Department of Infectious Disease. Fifty-nine children (aged between 14 months to 16 years) were hospitalized or ambulatory treated due to borreliosis during 5 years between 1997 and 2001. Erythema migrans was observed in 50 cases. The main localisations of erythema were: face, neck and chest. One patient showed erythema in several other localisations. Erythema migrans returned in two cases after therapy with Amoxicillin in one case at 6 months, in the other one 12 months later. The incubation period of erythema migrans in children varied from 4 to 30 days. Seven cases from the 59 occurred with central nervous system manifestations. These were children between 6 and 16 years of age. The most frequent (65.5%) clinical manifestations of the central nervous system were meningitis and facial nerve palsy, depression and headaches were observed in 6% of cases. In one case admission to hospital was the result of leucopaenia (2800/mm3), bradycardia, headache and fatigue. The positive serologic test results (Elisa assay) were confirmed in two independent laboratories. We had one patient (5 years old boy) with arthritic manifestations. The diagnosis of Lyme disease was based on clinical manifestations and positive serologic test results (Elisa assay). In the acute stage Elisa assay was positive in 33% only. The erythema migrans cases received treatment with Amoxicillin for two weeks, whilst patients with neuroborreliosis were treated for 4 weeks with Ceftriaxon.