Life-threating complication of parapharyngeal abscess and mediastinitis in a 10-year-old otherwise healthy girl following elective tonsillectomy - first reported paediatric case.

BACKGROUND: Parapharyngeal abscess and mediastinitis are rare but very severe post-operative complications following an elective tonsillectomy. Parapharyngeal abscess as a complication to tonsilectomy is very seldom described in the literature and no cases in the paediatric population have been described.Case reportThis paper presents, to our knowledge, the first case of life-threatening parapharyngeal abscess and mediastinitis following elective adenotonsillectomy in an otherwise healthy, fully vaccinated 10-year-old girl. CONCLUSION: Diagnosing parapharyngeal abscess and mediastinitis can be challenging, but should be suspected and ruled out in cases of post-operative odynophagia, fever, and/or neck swelling and thoracic pain. Diagnosis is made based on magnetic resonance imaging and computed tomography findings. Prompt broad-spectrum intravenous antibiotic treatment and surgical drainage should be initiated. Other severe complications such as meningitis should also be considered.

Liver fat content investigated by magnetic resonance spectroscopy in obese children and youths included in multidisciplinary treatment.

UNLABELLED: What is already known about this subject • Investigations of non-alcoholic fatty liver disease (NAFLD) by non-invasive imaging procedures have limited evidence. • Thirty percent of obese children are estimated to have NAFLD and implications for future morbidity are uncertain. What this study adds • Many obese children and youths exhibit a high liver fat content as examined by magnetic resonance spectroscopy. • Associations between liver fat content, anthropometry, abdominal adipose tissue distribution and liver enzymes are illustrated. SUMMARY: The study aims to investigate the degree of hepatic steatosis and associations with the amount of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), anthropometric data and biochemical measures of liver enzymes in children and youths included in obesity treatment. The study included 164 patients, aged 6-20 years, with a body mass index (BMI) above the 90th percentile for sex and age. Liver fat content was measured by magnetic resonance spectroscopy (MRS). SAT and VAT were measured by magnetic resonance imaging. Hepatic steatosis was defined as liver fat content >5% (steatosis-5%) and 9% (steatosis-9%), respectively. Data on waist circumference (WC) and blood samples were available in 124 patients. Steatosis-5% and steatosis-9% were identified in 45% and 27% of the patients, respectively. These patients had increased SAT, VAT, BMI standard deviation score, WC/height ratio, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels. GGT, ALT and VAT were found to be independent risk factors of hepatic steatosis. In this study, a substantial proportion of obese children and youths have hepatic steatosis. Therefore, it is important to examine these subjects for the degree of fat in their liver. Future studies focusing on hepatic steatosis should consider the use of MRS in addition to blood samples.

Secretory IgM and IgA antibodies to respiratory syncytial virus in nasopharyngeal aspirates: a diagnostic supplement to antigen detection.

BACKGROUND: RSV-shedding during an RSV-infection declines dramatically after the first week of infection. It could be of interest to be able to diagnose RSV-infection for a longer period of time by detection of specific RSV-IgM and RSV-IgA in nasopharyngeal aspirates (NPA) in order to minimize unnecessary antibiotics. OBJECTIVES: To evaluate an ELISA to detect specific RSV-IgM and RSV-IgA in NPA as a supplement to RSV-antigen detection. STUDY DESIGN: A total of 104 NPA from 101 children (median age 9 months) with acute respiratory disease (group 1) admitted to hospital and consecutive NPA (collected on day 0, 7, 14, 30 and 60) from 11 children (median age 3 months) with a proven RSV infection (group 2) were collected. All NPA from group 1 were analysed for RSV-antigen, RSV-IgM and RSV-IgA. NPA from group 2 were analysed for RSV-IgM and RSV-IgA. RESULTS: Thirty-five NPA in group 1 were positive for RSV-antigen and 64 were positive for RSV-antigen test alone found 44% and the RSV-IgM test alone found 80%. In group 2 8/11 (73%) has an excellent RSV-IgM response day 7, the rest responded later. Only 5/11 (46%) had a less pronounced RSV-IgA response on day 7, three cases responded later and three did not respond at all. RSV-IgM disappeared in 8/11 (73%) and RSV-IgA in 7/8 (88%) between day 30-60. CONCLUSIONS: Specific RSV-IgM is a valuable supplement to RSV-antigen detection for the diagnosis of acute and recent RSV infection.

Branhamella catarrhalis in children and adults. A study of prevalence, time of colonisation, and association with upper and lower respiratory tract infections.

The colonisation rate of Branhamella catarrhalis in patients from 0 to 45 years of age was examined. Of 561 women admitted to hospital in labour, 6 (1%) carried B. catarrhalis in their throats but none carried the organism in their vaginas. None of 534 newborn babies became colonised at birth or during their 5 days' stay in hospital. Neither were 102 neonates < 1 month of age in hospital colonised. The maximum colonisation rate during childhood was observed in children 1-48 months of age with 143 of 266 (54%) children colonised. Among children 4-15 years of age, four of 57 (7%) children with healthy respiratory tracts were colonised. Significantly more children with upper or lower respiratory tract infections (RTI) were colonised (68%) than were children without such infections (36%), (P < 0.001). After recovery from RTI, the isolation rate in the RTI group fell to that of the non-RTI group. A seasonal variation in prevalence was not observed. Of all the strains of B. catarrhalis isolated, 84% produced beta-lactamase.

Maternal antibodies and acquired serological response to Moraxella catarrhalis in children determined by an enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) for determination of serum immunoglobulin G (IgG) antibodies to Moraxella catarrhalis was developed, with an ultrasonic extract of M. catarrhalis immobilized on polystyrene microtiter plates serving as the antigen. The specificity was determined by adsorption tests. All of the 541 women tested showed a high level of maternal IgG antibodies to M. catarrhalis in umbilical cord blood specimens. One hundred eighty-nine children aged 0 to 15 years were examined. A low level of IgG antibodies to M. catarrhalis in serum was found in children aged up to 1 year; in older children, the levels increased with age. Levels in the same range as maternal IgG antibody levels were reached at the age of 10 years. The level of antibodies in children did not correlate with the state of colonization with M. catarrhalis or with the state of acute lower respiratory tract infection. Pairs of acute-phase and convalescent-phase serum samples did not discriminate between the children with M. catarrhalis in pure culture and those with mixed cultures of M. catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae. In adult women, high IgG antibody levels and low colonization rates with M. catarrhalis were found, whereas in small children, low IgG antibody levels and high colonization rates were found.

Malformations, withdrawal manifestations, and hypoglycaemia after exposure to valproate in utero.

An unselected series is presented of 17 infants born to epileptic mothers and exposed to sodium valproate during pregnancy. Nine infants had minor abnormalities and of these infants five also had major malformations, described as the 'fetal valproate syndrome'. The most frequent malformation was congenital heart disease. Nine of the infants had manifestations of withdrawal, such as irritability, jitteriness, abnormalities of tone, seizures, and feeding problems. Four of these infants had an unrelated hypoglycaemia. The frequency of withdrawal symptoms was significantly related to the dose of valproate given to the mothers in the third trimester, and there was a tendency for both the frequency of the minor abnormalities and the major malformations to be related to the valproate dosage in the first trimester.

Beta-lactamase production in Branhamella catarrhalis isolated from lower respiratory tract secretions in Danish children: an increasing problem.

Findings in specimens from the lower respiratory tract of children were reviewed retrospectively in order to assess the rate of Branhamella catarrhalis and beta-lactamase production. B. catarrhalis was isolated in 139 of 756 samples (18.4%) in 1986 and 211 of 723 samples (29.2%) in 1989. Beta-lactamase production was found in 55.6% of B. catarrhalis strains in 1986 and 80.1% in 1989 (p less than 0.001). Prevalence of beta-lactamase in B. catarrhalis has now reached the same level in Europe as in the USA.

Actinomycotic osteomyelitis in a child.

Contrary to what used to be the case, actinomycosis is now a rare disease and only infrequently mentioned in otolaryngological textbooks (Ballantyne, J. and Groves, J. 1979). The disease is a chronic suppurative infection caused by micro-organisms from the actinomyces group, most often israelii. Actinomyces species are all oral commensals. They are gram-positive, non acid-fast, anaerobic or microaerophilic filamentous bacteria (Walker et al., 1981; Bennhoff, 1984). Associated flora of both aerobic and anaerobic bacteria are always present, most frequently anaerobic streptococci, fusiform or gram-negative bacilli, and hemophilus species. The associated flora form a kind of symbiosis with the actinomyces species and may cause an anaerobic environment which furthers the growth of these species (Bennhoff, 1984). Topographically, a distinction is made between 3 favorite localizations: 1. Cervico-facial (55 per cent); 2. Abdomino-pelvic (20 per cent); and 3. Pulmo-thoracic (15 per cent).