Cluster of neurological manifestations of rotavirus infection in children.

Rotavirus infection in children in the resource-rich countries is usually benign but complications are reported rarely. Four children presented within 4 weeks with neurological symptoms and stool virology positive for rotavirus. All four made a quick recovery and were discharged home after a few days without medication. At 6 weeks all were well, with no further neurological episodes. This is the first reported cluster of this nature. Potential mechanisms for how rotavirus causes its rare neurological complications are briefly discussed, along with clinical implications for clinicians managing such patients.

Lumps and bumps.

Over the course of 6 months, an 8-year-old boy presented with cutaneous lumps: a postauricular lump, a fluctuant scalp lump, a lump adjacent to his shin, and a firm chest wall lump. Although he was born in the UK, his family were from Kenya and had visited there after the symptoms started. After multiple courses of antibiotics and antifungals with no improvement, he underwent ultrasound scanning that showed erosion of bone under the lumps and computed tomographic (CT) scanning which showed tibial osteomyelitis. A biopsy of the chest wall lump showed granulomatous inflammation, and pus was extracted from the shin lump that was negative on Ziehl-Neilsen and Gram staining. A tuberculin skin test was equivocal, Quantiferon test positive and 12 days later Mycobacterium tuberculosis was cultured from the pus. The patient was started on quadruple antituberculous therapy and his skin lumps have improved. The long term outcome of the osteomyelitis remains to be seen.

Not every cough in bronchiolitis season is bronchiolitis.

A 2-month-old male infant presented to hospital for the third time in late autumn with a 4 week history of cough and respiratory distress. He had presented to hospital on two occasions during the previous two weeks, and had twice been discharged with a diagnosis of bronchiolitis, based on clinical findings and the season. That the nasopharyngeal aspirate (NPA) was negative for respiratory viruses did not alter the diagnosis as this was felt to be a common false negative finding. However his cough worsened and on his third presentation he had respiratory distress with bilateral crackles and wheeze. The C reactive protein was 121 mg/l but the NPA was again negative for viruses. He was investigated for atypical causes of lower respiratory tract infection and the NPA was positive for Chlamydia trachomatis by polymerase chain reaction. He was treated with a 5 day course of azithromycin and made a full recovery.