Non-Typhoidal Salmonella Infection in Children: Influence of Antibiotic Therapy on Postconvalescent Excretion and Clinical Course-A Systematic Review.

(1) Background: Although published recommendations are available, the use of antibiotics in non-typhoidal Salmonella (NTS) infections in children is still controversially debated in clinical practice. Patients might even be put at risk, with necessary antibiotic therapy being withheld due to the widespread concern of prolonged post-convalescent shedding. The authors conducted a systematic review to assess whether antibiotic treatment influences fecal excretion or the clinical course in children with NTS infection. (2) Methods: The review was carried out following the PRISMA guidelines. In a Medline database search, studies assessing the influence of antibiotic therapy on excretion and/or the clinical course of NTS infections were selected. Studies reporting on adults only were not considered. Out of 532 publications which were identified during the systematic literature search, 14 publications were finally included (3273 patients in total). Quality and bias assessment was performed using the Newcastle-Ottawa scale (NOS) or the Cochrane risk-of bias tool (ROB-2). (3) Results: Four early studies from decades ago demonstrated a prolongation of intestinal NTS excretion in children after antibiotic treatment, whereas most studies published more recently observed no significant influence, which might be due to having used more "modern" antibiotic regimes (n = 7 studies). Most studies did not describe significant differences regarding the severity and duration of symptoms between untreated patients and those treated with antibiotics. Quality and bias were mainly moderate (NOS) or variable (ROB-2), respectively. (4) Conclusions: There is no substantial evidence of prolonged excretion of NTS in pediatric patients after treatment with newer antimicrobials. Consequently, clinicians should not withhold antibiotics in NTS infection for children at risk, such as for very young children, children with comorbidities, and those with suspected invasive disease due to concerns about prolonged post-convalescent bacterial excretion. In the majority of cases with uncomplicated NTS diarrhea, clinicians should refrain from applying antibiotics.

Loss of syntaxin 3 causes variant microvillus inclusion disease.

Microvillus inclusion disease (MVID) is a disorder of intestinal epithelial differentiation characterized by life-threatening intractable diarrhea. MVID can be diagnosed based on loss of microvilli, microvillus inclusions, and accumulation of subapical vesicles. Most patients with MVID have mutations in myosin Vb that cause defects in recycling of apical vesicles. Whole-exome sequencing of DNA from patients with variant MVID showed homozygous truncating mutations in syntaxin 3 (STX3). STX3 is an apical receptor involved in membrane fusion of apical vesicles in enterocytes. Patient-derived organoid cultures and overexpression of truncated STX3 in Caco-2 cells recapitulated most characteristics of variant MVID. We conclude that loss of STX3 function causes variant MVID.

Multiple aseptic splenic abscesses in a 15 year old patient.

BACKGROUND: Splenic abscesses in children are rare. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults. CASE PRESENTATION: We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patient's clinical condition and inflammatory parameters. Eventually corticosteroid therapy led to complete and long lasting resolution of symptoms. Further diagnostic work-up revealed autoimmune thyroiditis, but no signs of inflammatory bowel disease. CONCLUSION: Aseptic splenic abscesses should always prompt clinicians to initiate further diagnostics to determine a potential underlying condition and a regular follow-up. Anaerobic bacteria may play a role in the pathogenesis of the disease and besides corticosteroid treatment antibiotics covering anaerobes may be beneficial.

Acute hemorrhagic edema of infancy: report of 4 cases and review of the current literature.

Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic vasculitis that usually occurs in children younger than 2 years of age. It is a rare disease characterized by mild fever, a violent onset of hemorrhagic skin lesions, and edema usually followed by a spontaneous and complete recovery. Although the etiology is unknown, AHEI often follows infections, drug treatment, or vaccination. In the present report, the authors describe 4 cases of AHEI and review the relevant literature.