Childhood acute urticaria in northern and southern Europe shows a similar epidemiological pattern and significant meteorological influences.

Acute urticaria (AU) is a common condition that often presents in childhood. Although there is a general perception of cyclic annual trends in AU, no one has tried to identify any seasonal variation on its prevalence and incidence, associate environmental influences and impute geographic, ethnic, or even genetic features that may contribute to its onset. We aimed to analyze the influence of climate and geographic parameters on annual fluctuation of AU cases referred to the Emergency Departments (EDs) of Norwich (UK) and Heraklion (Crete, Greece), compare all identifiable potential triggers and severity, and calculate the prevalence and incidence of AU. Record-based data of all children up to 14 yr of age referred to both EDs between June 2005 and May 2007 were examined retrospectively. Demographic characteristics and any potential identifiable triggers of AU were recorded and compared. Poisson's regression was utilized to examine any influence of meteorological parameters on AU incidence. Edwards' test for seasonality was applied to identify any significant seasonal trend of the AU incidence within each city. Seven hundred and twenty-nine AU cases were identified (324 in Norwich and 405 in Heraklion), among 56,624 total referrals (28,931 and 27,693 cases, respectively). Respiratory infections were found to be the most commonly associated potential triggers of AU and food allergens the least. AU cases and incidence rates in both cities were equally distributed during the study period. A non-significant seasonal trend in AU incidence (October, April-May) was observed in Norwich, in contrast to a significant seasonal pattern (December, February-May) of AU in Heraklion. Temperature was inversely associated with AU incidence, while the statistically significant effect of relative humidity varied. Acute childhood urticaria shows a similar epidemiological pattern in northern and southern Europe regardless of the expected differences in genetic, geographic, and environmental background. Temperature and humidity are correlated with AU incidence. Seasonality of several acute respiratory viral infections, the most prominent associated trigger of AU, coincides with the observed AU seasonality, suggesting a potential linkage. However, this needs to be elucidated from larger epidemiological studies.

Further identification of the hyperunstable alpha-globin chain variant Hb Heraklion [codons 36/37 (-CCC); Pro-->0 (alpha1)] in Greek cases with co-inherited alpha+-thalassemia mutations.

We report four Greek cases (from three unrelated families), who all had a similar atypical thalassemia intermedia phenotype, characterized by chronic moderate anemia, mild hemolysis and splenomegaly in the absence of abnormal hemoglobin (Hb) fractions. In all four cases (two unrelated children and two siblings), DNA analysis identified common alpha(+)-thalassemia (alpha(+)-thal) mutations in trans to the in frame 3 bp deletion (-CCC) on the alpha1-globin gene between codons 36 and 37, which has previously been reported as Hb Heraklion in a single Greek case. Clinical, hematological and biochemical findings in all cases, including a follow-up evaluation of the original case, are described. All the cases originated from the Greek island of Crete.

Ectopic intrathyroidal thymus misdiagnosed as a thyroid nodule: sonographic appearance.

An 11-year-old boy under suppression therapy for a solitary thyroid nodule was referred for sonographic examination. The diagnosis had been made at another institution, based only on sonography without cytopathologic verification. A small fusiform lesion, which was homogeneously hypoechoic with diffuse bright internal echoes, was demonstrated in the right lower pole of the thyroid. A normal elongated thymus with a cervical component was then found connected to the thyroid with an accessory lobe, which was embedded in the lower thyroid pole mimicking a solitary nodule. We discuss the developmental abnormalities of the thymus and their clinical significance in childhood with a brief review of the literature.

RANTES promoter gene polymorphisms and susceptibility to severe respiratory syncytial virus-induced bronchiolitis.

BACKGROUND: Severe respiratory syncytial virus (RSV) infection is characterized by enhanced chemokine activity. Several studies have linked increased regulated on activation, normal T cell expressed and secreted (RANTES) expression with severe RSV disease. Three single nucleotide polymorphisms, -28C/G, -403G/A, and In1.1T/C in the RANTES gene, have been correlated with the gene's transcriptional activity. In the present study, we explored the possible correlation of the genetic variability of the RANTES gene with the clinical manifestation of RSV disease. METHODS: DNA samples were obtained from 106 children hospitalized for RSV bronchiolitis, in a 2-year period. One hundred twenty sex-matched healthy adults, without a history of severe lower respiratory tract infections, formed the control group. RESULTS: No association was established between -28C/G polymorphism and RSV-induced bronchiolitis, mainly because of its extreme rarity in the studied population. No statistically significant differences were observed in cases and controls regarding genotype and allele frequencies of each of the In.1.1T/C and -403G/A polymorphisms. By contrast, the -28C/C-403G/AIn1.1T/T combined genotype was significantly more common in cases than in controls. CONCLUSIONS: Our results indicate an association between a common genotype with severe RSV infection. This observation supports the previously reported results indicating RANTES as an important mediator of RSV infection.

Antimicrobial resistance of urinary tract pathogens in children in Crete, Greece.

The aim of the present study was to identify the organisms responsible for community acquired febrile UTI in children and to investigate their susceptibility to commonly used antibiotics. A 5-y prospective analysis was performed in children hospitalized for a first episode of UTI, in Crete, Greece. A total of 262 children, 40.1% males and 59.9% females, aged 0.08 to 13 y, were enrolled in the study. Escherichia coli (E. coli) was the leading uropathogen. Antimicrobial resistance of E. coli isolates was most commonly to ampicillin (56.4%) followed by trimethoprim-sulfamethoxazole (TMP-SMX) (27.3%), cefaclor (22.5%), amoxicillin-clavulanate (15.5%), gentamicin (4.9%), cefuroxime (3.1%), nitrofurantoin (2.6%), and ceftriaxone (1.6%). Interestingly, a significant decrease in E. coli resistance to TMP-SMX was observed during the study period. Resistance to ampicillin, TMP-SMX and cefaclor was noted for 61%, 28% and 27% of the total uropathogens, respectively, making these agents inappropriate for empirical treatment of febrile UTI in our region. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate. More than 90% of the uropathogens are susceptible to cefuroxime, ceftriaxone, gentamicin, and nitrofurantoin. In conclusion, several of the first-line agents for empirical treatment of childhood UTI seem to have become ineffective in the area of this study.

T280M variation of the CX3C receptor gene is associated with increased risk for severe respiratory syncytial virus bronchiolitis.

BACKGROUND: Recent data suggest that immunologic response during respiratory syncytial virus (RSV) infection is partially modified through interaction of viral G glycoprotein with the host's chemokine receptor, CX3CR1. We hypothesized that two nonsynonymous, single-nucleotide polymorphisms of the CX3CR1 gene (CX3CR1-V249I and CX3CR1-T280M) that disrupt the affinity of CX3CR1 for its natural ligand (fractalkine) could also affect the G glycoprotein-CX3CR1 pathway. METHODS: To test the hypothesis, DNA samples were obtained from 82 children hospitalized for RSV bronchiolitis in a 1-year period. One hundred twenty sex-matched healthy adults, without a history of severe lower respiratory tract infections, formed the control group. RESULTS: Epidemiologic data showed an increase in the RSV infection rate during the late winter season, with a peak rate in early spring. Genotyping revealed predominance of the 280M-containing genotypes (M/M or T/M) in cases compared with controls (37.8% versus 20.8%, respectively; odds ratio, 2.03; 95% confidence interval, 1.1-3.9; P = 0.025), demonstrating an association between the common CX3CR1-T280M variations and increased risk of severe RSV bronchiolitis. CONCLUSIONS: Our findings support the hypothesis of the pivotal role of the G glycoprotein CX3CR1 pathway in the pathogenesis of RSV bronchiolitis and propose CX3CR1 as a potential therapeutic target.

Spleen length in childhood with US: normal values based on age, sex, and somatometric parameters.

PURPOSE: To investigate with ultrasonography (US) normal spleen length in healthy children. MATERIALS AND METHODS: The study comprised 512 healthy children (274 girls) with ages ranging from 1 day (full-term neonate) to 17 years who were examined between 1996 and 2001. The main sample comprised 454 children (249 girls) with body measurements (weight and height) between the 5th and 95th percentiles of the relevant growth curves. The remaining 58 children (25 girls) with body measurements outside the normal ranges formed a separate sample used for cross-validation. None had a problem that could affect spleen size. The relationships between the US-measured spleen length and age and body parameters were studied with nonlinear regression and multiple (backward stepwise) regression techniques. Normal ranges and related statistics were estimated and tabulated according to age group and sex. Spleen length growth curves and upper limits defined by the 90% upper confidence limit (UCL) are presented in graphs according to height, weight, and body surface area (BSA). RESULTS: Spleen length was highly correlated with age, height, weight, and BSA; there was no statistically significant difference between the sexes. The exact pattern of these relationships was nonlinear (polynomial type of third order for age, height, and weight and exponential type for BSA). Multiple regression analysis indicated that age, height, and either weight or BSA had significant positive associations with spleen length. The spleen lengths among the sample of 58 children whose height and weight were outside the normal ranges of growth parameters did not influence the proposed upper limits (almost all were within the 90% UCLs with respect to height and weight for the main sample). CONCLUSION: Normal spleen lengths and ranges in childhood were obtained with US in a large sample of individuals.

Urinary tract infection caused by Shigella sonnei.

This report describes a case of urinary tract infection caused by Shigella sonnei in a 6-y-old girl with vesicoureteric reflux and a preceding history of gastroenteritis. The strain was resistant to ampicillin and cotrimoxazole, and treatment with cefotaxime eradicated the infection. The role of Shigellae as urinary tract pathogens is reviewed and possible sources of infection are discussed.