Acute diarrhoea induced by rotavirus in children hospitalysed in Provincial Hospital for Infectious Diseases in Bydgoszcz in 2014 year

OBJECTIVE: The aim of the present study was to describe the epidemiology and course of rotavirus infection in children hospitalized at the T. Browicz Provincial Hospital for Infectious Diseases in Bydgoszcz, Poland in 2014 year. INTRODUCTION: Rotavirus infection is responsible for over 2 millions hospitalizations per year among children under 5 year old. Rotavirus gastroenterocolitis is one of the most common cause of severe dehydration, electrolyte disturbances and metabolic acidosis, leading to 400-600 thousand deaths per year in children younger than 5 years of age worldwide. MATERIAL AND METHODS: Retrospective analysis of medical records of 401 patients hospitalized in 2014 year in the Pediatric Infectious Diseases and Hepatology Ward at Provincial Hospital for Infectious Diseases in Bydgoszcz, diagnosed with rotavirus gastroenterocolitis was taken. RESULTS: Over the study period, 1205 children with acute gastroenterocolitis were hospitalized. Rotavirus-related diarrhea was diagnosed in 401 (33%) cases. The mean age of admitted patients was 2,75 years and it ranged from 3 weeks to 17 years of age. In the analyzed group, 56% cases occurred in children 1-3 years of age. The mean length of hospitalization was 5,5 days (ranged from 1 to 55 days). Most of children ­ 244/401 (61%) were hospitalized for 4-7 days. Presence of additional etiological factor was related with prolonged hospitalization ­ average up to 8,3 days. There were reported a hypertransaminazemia (ALAT 47-429 IU/l) in 11% cases. Hypoglycemia (<60 mg/dl) was noted in 18/213 (8,45%) children. Metabolic acidosis (pH ≤7,350) occurred in 35/146 (24%) cases. Hypokalemia (K+ <3,5 mmol/l) were reported in 16/154 (10%) patients, and hyponatremia (Na+ <135 mmol/l) in 73/154 (47,4%) patients. In our studies 19/401 (4,7%) children were vaccinated against rotaviruses. CONCLUSIONS: 1. Rotavirus infections are the most common cause of diarrheas in children, concerning mainly patients under 4 years of age. 2. Rotavirus infections can lead to many serious complications - electrolyte disturbances, metabolic acidosis and hypoglycemia. 3. Among our patients rotavirus vaccination insensibly reduced duration of hospitalization.

Vertical genotype 1 HCV infection treated successfully in the second year of life: a case report.

BACKGROUND: Perinatal HCV transmission appears to be an important cause of HCV in children. Treatment of chronic hepatitis C in young children is controversial because of spontaneous HCV clearance and possible adverse events. CASE REPORT: Vertical HCV genotype 1 infection was diagnosed in a 3-month-old infant. In the subsequent clinical examination we still observed hepatomegaly, fluctuations of ALT, AST and GGT activity, with the highest values 2206 U/L, 1319 U/L, and 297 U/L, respectively. In qPCR, HCV RNA was >700.000 IU/ml. In the 42nd week of observation, liver biopsy was performed with Grade 1 grading and Grade 1 staging. At age 12 months, interferon-alpha2b (1.5 MU 3 times a week) and ribavirin (2×80 mg daily) were administered for 48 weeks. At the beginning of the treatment we observed fever after IFN injection. In the 12th week of therapy, HCV RNA disappeared followed by SVR, and it was sustained for 6 years. To our knowledge, this is the first report of a pediatric (1-year-old) patient treated with combined IFN alpha-2b and ribavirin therapy. CONCLUSIONS: This case report confirms the possibility of successful anti-HCV treatment in a young child, with 6-year sustained virological response without significant adverse events.

[Clostridium difficile infection in children--experience of clinical centre in Bydgoszcz]. / Zakazenia Clostridium difficile u dzieci--doswiadczenia osrodka bydgoskiego.

UNLABELLED: Clostridium difficile (CD) is one of the main factors of nosocomial infections both in children and adults and the number these infections is still growing. There is an increasing number of community-associated CDAD and CDIs with no exposure to antibiotics. Tests for CD among children are not routinely conducted because of high rate of carrying (from 13 to 70% infants). The objective of a study was to assess the frequency CDI among children with diarrhea, analysis of the risk factors of CDI and to compare the course of infection and the response to the treatment depending on type of bacteria toxigenic profile. MATERIAL AND METHODS: The retrospective analysis of the clinical case record was made on 16 children at the age of 9 months to 10 years with CDI. PCR tests (Xpert C.Difficile) were used to identify CD in stool specimens. RESULTS: 1,6% children with diarrhea was diagnosed with CDI. It constituted 8,9 cases per 1000 admissions. All children with CDI received antibiotics before. Correlation between hospitalization and development of CDI was found in 56% children. In 62% children the toxin B-producing B strains were revealed whereas in the others hiperwirulent strains NAP1/B1/027 (38%). SIRS was found in 50% cases infected by NAP 1/B1/027. CONCLUSION: CD may be very important etiological factor of antibiotic-associated diarrhea in hospitalized children, especially with severe diseases and community-acquired CDs. CDI should be considered in all cases of prolonged or relapse of diarrhea.

Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection.

BACKGROUND: Treatment of hepatitis C virus (HCV) infection with interferon (IFN) and ribavirin (RBV) is associated with adverse events, which may affect the patient's adherence to the treatment regimen and the treatment efficacy. OBJECTIVES: The aim of this study was to assess the sustained viral response (SVR) and interdependence between the haematological characteristics (leukocyte count, platelet count, and haemoglobin levels) in patients with chronic hepatitis C (CHC) infection during treatment with IFN and RBV. PATIENTS AND METHODS: We conducted a retrospective cohort study of 170 children with CHC infection who completed treatment with IFN-α and RBV. The children were divided into 2 groups: the first group (group I, n = 119) underwent a 48-week course of treatment with recombinant IFN α-2b (Intron A) at a dosage of 3 MU 3 times a week subcutaneously and RBV at a dosage of 15 mg/kg per day orally, and the second group (group II, n = 51) was administered pegylated IFN (peg-IFN)-α-2b (PegIntron) at a dosage of 1.5 µg/kg per week subcutaneously and RBV at a dosage of 15 mg/kg per day orally for 48 weeks. The dose of IFN was not adjusted but that of ribavirin was in 2 children from group II. Hematological growth factors and erythropoietin were not used. SVR was defined as undetectable serum HCV RNA 24 weeks after the end of treatment (study week 72). Serum HCV RNA was determined by performing polymerase chain reaction, and the HCV genotypes and hematological parameters were evaluated. Serum HCV RNA levels were analysed by descriptive statistics. Means and standard deviations were calculated for values collected at the baseline, on the 12th and 48th weeks during treatment, and after 24 weeks of untreated follow-up (study week 72). RESULTS: Eighty-six (50%) of the 170 patients who underwent treatment achieved SVR: 62 (51%) out of 119 children from group I and 24 (47%) out of 51 from group II. The mean serum hemoglobin levels and leukocyte and platelet counts at week 12 were significantly lower than the baseline values in both responders and non-responders from both the groups (P < 0.05). In the responders in group I, the mean levels of serum hemoglobin after 24 weeks of treatment and at the end of therapy were significantly lower than the mean levels at baseline. In the group treated with peg-IFN-α-2b and RBV (group II), the mean serum hemoglobin levels at week 12 was lower in the responders than in the non-responders (P < 0.05). The decrease in the hemoglobin levels was associated with viral response. In both the responders and non-responders from both the groups, leukocyte counts decreased during treatment, and after 12 weeks, they were more significantly lower than the baseline value. The decrease was more marked in children treated with peg-IFN-α-2b + RBV (P < 0.05). After 12 weeks of treatment, the platelet count was low in children from group II who had achieved SVR. CONCLUSIONS: A mild decrease in hemoglobin levels and leukocyte and platelet counts during treatment with IFN and RBV in children with CHC infection may be factors responsible for SVR induction.

[Budd-Chiari syndrome--from diagnosis to treatment--case reports]. / Zespól Budd-Chiari--od rozpoznania do leczenia--opisy przypadków.

Budd-Chiari syndrome is a rare disease, caused by obstruction of the hepatic venous outflow at the level of either the large hepatic veins or (and) the subdiaphragm segment of the inferior vena cava. The hematological disorders (myeloproliferative disorders, factor V Leiden deficiency), tumor and chronic inflammatory diseases are the most frequent causes of BCS in Europe and North America. Two cases of BCS, recognized in 24 and 43 years old females with subacute and chronic forms of the disease are presented in this article. The underlying cause was polycythemia rubra vera and osteomyolofibrosis. In first case, except causal and anticoagulation therapy, a transjugular intrahepatic portosystemic stent has been performed. In the second one low - sodium diet and diuretic for the control of ascites and oedemas were used. Hydroxycarbamid was the first choice line medication in treatment hematological disorders and acenocumarol in the prevention of the trombotic complications.

[The increased of alanine aminotransferase in rotavirus diarrhea]. / Podwyzszona aktywnosc AlAT w przebiegu biegunki wywolanej przez rotawirusy.

The results of retrospective analysis of 97 children treated at Observation and Liver Diseases Unit in Bydgoszcz between 1st Jun and 30th Jun 2006 because of retrovirus diarrhea were presented. Those results took the liver activity into consideration. The age of children with hypertransaminazemia was assessed--the duration, intensity and date of occurrence of hypertransaminazemia was taken into consideration. In 25% of analyzed cases an increased activity of ALT (lasting from 7 days to 6 months) without other disturbance of liver activities was stated.

[Difficulties of diagnosis of Hirschsprung disease in an 8-year-old girl]. / Trudnosci w rozpoznawaniu choroby Hirschsprunga u 8-letniej dziewczynki.

This report presents the difficulty in diagnosing of Hirschsprung disease in an 8-year-old girl admitted to hospital with an acute diarrhea. Authors underline that the definite diagnosis of disease is confirmed by a full-thickness rectal biopsy and findings that indicate an absence of ganglion cells.

[Tropical malaria in a 9 years old girl. A case report]. / Przypadek zimnicy tropikalnej u 9-letniej dziewczynki.

Malaria occurs in Poland sporadically. It is imported from endemic regions, exceptionally by children. Lack of knowledge of the clinical course may result in false diagnosis and fatal outcome of the disease. We present the case of falciparum malaria in the 9-years old girl during infection of Plasmodium falciparum.

[Serum IL-2 and sIL-2R concentration in children with chronic hepatitis B]. / Stezenie IL-2 i sIL-2R u dzieci z przewleklym zapaleniem watroby typu B.

UNLABELLED: The aim of the study was evaluation of serum IL-2 and sIL-2R concentration in children with chronic hepatitis B without previous treatment. MATERIAL AND METHODS: Investigations were performed on sera from 27 children, 13 HBsAg and HBeAg positive (group I) and 14 HBsAg positive, HBeAg negative, anti-HBe positive (group II). Serum IL-2 and sIL-2R concentrations were detected with ELISA method. RESULTS: In all examined children serum IL-2 concentrations were decreased. The mean values of sIL-2R in group I was 4,40 (from 1,78 to 15,74) and in group II was 2,60 ( from 1,59 to 4,81) ng/ ml and were statistically significant higher in HBeAg positive children (group I, p < 0.005). The mean ALT activity in this group of children was increased (mean 74 U/I) . The positive correlation between sIL-2R and ALT activity was observed in group I. CONCLUSIONS: In children with chronic hepatitis B a deficiency of Th1 mediated immunological response was observed. HBeAg/anti-HBe seroconversion seems to change the IL-2/sIL-2R balance.

[Tympanoplasty decision making in a child with HIV contamination--case report]. / Problem wykonywania tympanoplastyki u dzieci zakazonych wirusem HIV--na podstawie przypadku.

Otologic problems are infrequent in HIV patients. Authors present the case of chronic otitis media in the HIV infected child. The patient with significant hearing loss, and prolonged aural discharge, resistant to local and systemic antibiotic treatment was treated surgically. Mastoidectomy with myringoplasty was performed. The substantial hearing improvement has been obtained, ear discharge never returned. However due to episodes of chronic otitis media with effusion ear drainage with tympanostomy tubes, after initial surgery have been performed two times. The controversies regarding surgery decision-making in this group of patients are discussed.

[Complications of chickenpox as reason for children's hospitalization]. / Powiklania ospy wietrznej u dzieci jako przyczyna hospitalizacji.

Chickenpox is self limiting disease, with potentially dangerous course. Chickenpox complications can evoke the necessity of hospitalization. Assess the types and courses of chickenpox complications in child patients hospitalized in Provincial Hospital of Infectious Diseases in Bydogoszcz between 1999 and 2003. Cases of chickenpox complications being the reason of children hospitalization were retrospectively analyzed. The total number of children hospitalized because of chickenpox complication is 153. Patients age ranged from 18 days to 18 years, with average of 5,4 years. 62% of children were younger than 5 and, 1/3 children were younger than 1. The average period of hospitalization was 7 days. 17% of patients stayed in hospital longer than 10 days. 53% of patients were male. In 5 cases chronic diseases were diagnosed. The most common reason of hospitalization connected with chickenpox were symptoms of alimentary canal disorder (30%), respiratory tract inflammations, with pneumonia and bronchitis in the lead (30/47). Neurological complications during chickenpox occurred in 23 of 153 hospitalized (15%): febrile convulsions - 6/153, cerebellar ataxia - 9/153, meningitis and brain fever - 6/153, peripheral nerve - 2/153. Bacterial skin infection as the reason of hospitalization of 16 children, hepatitis of 3 and joints inflammation of 1 child.