Invasive meningococcal disease in children in Greece: comparison of serogroup A disease with disease caused by other serogroups.

Although invasive meningococcal disease caused by serogroup A is not prevalent in developed countries, a considerable number of cases were recently recorded in Greece. In this study, serogroup A meningococcal disease was compared prospectively with meningococcal disease caused by other serogroups, using similar settings of testing and management during a 5-year period between 1999 and 2003. The Neisseria meningitidis serogroup was determined in 262 cases. Serogroup B predominated, accounting for 158 (60%) of the cases. Serogroup A was second most frequent (19%), followed by serogroups W135 (11%), C (8%), and Y (2%). No cases due to serogroup C were recorded during the last year of the study. Patients with serogroup A disease were older and had a milder course compared to patients infected with serogroups B or C. Toxic appearance, purpura, thrombocytopenia, abnormal coagulation tests, and the need for admission to the intensive care unit, fluid resuscitation, inotropic drugs, and mechanical ventilation were less common. Although morbidity and mortality were lower in these patients, the differences were not significant. Serogroup B is predominant in our area, and the introduction of an effective vaccine against it is a priority. Serogroup A has emerged as the second most common serogroup, but the illness associated with it is milder.

Petrositis and cerebellar abscess complicating chronic otitis media.

A 12-year-old girl with chronic otitis media complicated by petrositis and cerebellar abscess is presented. Early surgical intervention, in combination with broad-spectrum antibiotics, provided a good outcome. Life-threatening complications of otitis media, although rare, still occur in developed countries.

Hepatitis in children hospitalized with measles: the experience acquired after a Greek epidemic.

OBJECTIVE: In childhood, hepatitis is an uncommon and ill-defined complication of measles. We studied prospectively the prevalence of hepatitis in 189 children with measles, admitted to hospital during a measles epidemic in Greece. METHODOLOGY: Diagnosis of measles was based on clinical features and a fourfold rise of the haemagglutination inhibiting antibody titre, while liver impairment was based on a twofold or greater increase in liver enzymes. RESULTS: Nine children (4.8%) had increased liver enzymes. Hepatitis was not related to the duration and severity of fever or the coexistence of other complications, and in all children but one, was subclinical and resolved rapidly. One child with mental retardation who was being treated with anti-epileptic therapy and had normal liver enzymes prior to measles, developed hepatic coma from which he recovered 1 month later. CONCLUSIONS: Liver involvement in childhood measles is rare and transient but it may be severe in children receiving hepatotoxic drugs.

Paediatric AIDS--related linear gingival erythema: a form of erythematous candidiasis?

Three vertically HIV-infected children showed, in addition to oral candidiasis, HIV-gingivitis, which healed on antimycotic treatment. The intense linear gingival erythema of a fourth child was also clinically evaluated as a possible form of erythematous oral candidiasis. Direct microscopic examination of material from the gingival lesions of the latter disclosed yeast cells and hyphae. Subsequent culture, biochemical and serological tests identified the yeast as Candida dubliniensis. As the patient was on long-term prophylaxis with fluconazole, ketoconazole was administered and led to a good clinical response. This is the first report implicating this new Candida species as a pathogen in linear gingival erythema in a HIV-positive individual. The case reports presented provide evidence that linear gingival erythema may be of candidal origin. Further clinical and laboratory observations are required to establish whether this condition constitutes a variant of erythematous candidiasis associated with paediatric HIV infection.

Oral lesions in children with perinatally acquired human immunodeficiency virus infection.

Fifteen vertically HIV-infected children aged between 2 and 12 years were followed up for 1 year, weekly to monthly, to study the incidence of oral lesions. At the time of first examination, oral candidiasis (OC) was observed in nine children. Seven children presented with the erythematous type only and two with pseudomembranous oral candidiasis. Four cases of cheilitis were seen in association with the erythematous forms of oral candidiasis. One erythematous candidiasis progressed to pseudomembranous form. A second case of erythematous OC, after multiple recurrences in the form of erythematous OC, recurred as pseudomembranous OC. Another case of erythematous OC and one of pseudomembranous OC presented after multiple recurrences as a persistent, adherent pseudomembranous OC. An orofacial herpes-zoster infection, a hairy leukoplakia and a necrotic lingual ulcer were observed as second lesions and in association with oral candidiasis in three children. Erythematous oral candidiasis was the most frequent oral HIV-related lesion, was observed in different stages of HIV-infection, and in some cases progressed to pseudomembranous candidiasis. A different, selectively resistant, Candida clone was isolated in three cases of recurrent candidiasis.

Molecular epidemiology of vertical human immunodeficiency virus type 1 transmission in Greece: evidence of non-B subtypes.

OBJECTIVES: To investigate the subtype classification of the circulating virus strains among human immunodeficiency virus type 1 (HIV-1)-infected children in Greece. STUDY DESIGN/METHODS: Since the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in Greece in 1982, 23 children have been reported to be vertically infected with HIV-1. Blood samples were available for 19 of these children, and the C2-C4 env region was successfully amplified by nested polymerase chain reaction (PCR) for 16 subjects. HIV-1 subtype was established by the heteroduplex mobility assay (HMA) in 16 subjects and confirmed by DNA sequencing and phylogenetic analysis in 8 subjects. RESULTS: Most subjects (9; 56%) fell into subtype B. However, a substantial proportion (44%) were classified as subtypes A (3; 19%), C (1; 6%), D (1; 6%), and I (2; 12%). According to epidemiologic information, 5 of 7 children infected with non-B HIV-1 subtypes were born to Greek parents. CONCLUSION: These findings clearly suggest that non-B strains have been introduced into Greece, providing evidence that HIV epidemic in this country will probably change profile over time. In addition, subtype I was identified in 2 HIV-1-infected children, both of whom were born to Greek parents.

Epidemiology of invasive Haemophilus influenzae type b infections among children in Greece before the introduction of immunization.

We prospectively examined the epidemiology of invasive Haemophilus influenzae type b (Hib) infections among children under 5 y of age in the Greater Athens area before the introduction of immunization. The annual incidence of systemic Hib infections was 12/100000. Meningitis was the most common clinical entity and accounted for 69% of the cases. In the prevaccine era, the incidence of systemic Hib disease, particularly that of meningitis, was much lower in Greece compared to rates reported from Northern and Central Europe.

Herpes zoster in children.

BACKGROUND: The clinical studies of series of children with herpes zoster (HZ) are rather limited. OBJECTIVE: The purpose of this study was to evaluate the epidemiologic conditions, clinical manifestations, therapy, and outcome of HZ in children. METHODS: Twenty-one patients with HZ have been studied. Five patients who had herpes simplex virus infection were excluded. The laboratory diagnosis was made by fluorescent techniques. Acyclovir was administered systematically for 2 more days after no new lesions had developed. RESULTS: Thirteen patients (group A) were immunocompromised; eight patients (group B) were otherwise healthy. Two patients from group B had intrauterine varicella; the other six patients had had varicella under the age of 4 years. Three patients were recently exposed to varicella. The duration of HZ was significantly longer in group A than in group B, but the outcome was good in all patients. CONCLUSION: Herpes simplex virus infection may simulate the pattern of HZ; varicella in early childhood is a risk factor for HZ in otherwise healthy children; exposure of a child to varicella may cause reactivation of latent HZ virus; and acyclovir therapy within 3 days of exanthem onset prevents significant morbidity and death in immunocompromised children with HZ.

Enterobacter sepsis in infants and children due to contaminated intravenous fluids.

Sixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens, Enterobacter cloacae and Enterobacter agglomerans contaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The "epidemic" terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.