[Syphilis in children--the outcome of lacking vigilance and insufficient diagnostics]. / Kila u dzieci--nastepstwem braku czujnosci i niedostatecznej diagnostyki.

INTRODUCTION: In the years from 2000 to 2006 our department managed an increasing number of children exposed to congenital infection or with actual Treponema pallidum infection. Our team analyzed the causes, and published the conclusions addressing pediatricians as well as obstetricians. In the years from 2007 to 2008 we did not find any new cases of syphilis in children. However, despite our educational efforts, 2009 brought an increase of incidence of the disease. The aim of this paper was to establish the causes of new morbidity of congenital syphilis, and consequently spread the obtained information to neonatologists, pediatricians and obstetricians. MATERIAL AND METHODS: 87 children were hospitalized due to suspicion of congenital syphilis in the years from 2002 to 2009. The analyzed issues were: number of infected children in consecutive years, prevalence of screening to syphilis in pregnancy, and adequacy of treatment according to recommendations of Polish Gynaecological Society (PTG). RESULTS: From 2000 to 2006 syphilis was confirmed in 13/45 (28.9%) suspected children. In 2007 and 2008 we did not establish any positive diagnoses. In 2009, we confirmed infection in 3/15 (20%) perinatally exposed children. In the following periods: 2002-2006, 2007-2008 and in 2009, consecutively 6/45, 1/27 and 4/15 mothers were not screened to syphilis during pregnancy, 17/45, 11/27 and 4/15 were treated differently than recommended by PTG, 6/45, 9/27 and 5/15 did not receive any treatment. In 7 cases it was not possible to retrace medical management during pregnancy. CONCLUSIONS: Screening to syphilis in pregnancy in Lower Silesia is insufficient, and in detected cases the treatment is inadequate or completely omitted. There is still need for education, and also for proper data flow from obstetricians to neonatologists and pediatricians about cases of syphilis detected during pregnancy.

Herniation to foramen magnum in the course of cerebellitis in a 4-year-old boy, as shown by CT and MRI - case report.

BACKGROUND: Acute cerebellitis is an uncommon but dangerous complication of infectious diseases. Besides neurological examination, neuroimaging (especially MR imaging) is very useful for diagnosing cerebellitis. CASE REPORT: A 4-year-old boy was admitted to the hospital with a 1-week history of fever, vomiting and headache. His past medical history was unremarkable. The physical examination revealed disturbance of consciousness and truncal ataxia. He underwent urgent CT and MRI examinations which demonstrated isolated swelling of the cerebellar hemispheres and the vermis, with increased signal intensity in T2-weighted, FLAIR, and DWI sequence and a significant mass effect associated with tonsillar herniation. An emergent life-saving suboccipital craniectomy was performed with removal of the C1 vertebral arch. There was a gradual clinical improvement, and a follow-up brain MRI revealed disappearance of cerebellar swelling and of mass effect. CONCLUSIONS: Magnetic resonance (MR), including diffusion-weighted imaging (DWI) sequence, plays an important role in the diagnostic work-up of cerebellitis in children. This imaging method is very useful for detecting cerebellitis, evaluating its severity and monitoring the disease.

[Measles antibodies concentration in vaccinated children and adolescents with autoimmune hepatitis]. / Stezenie przeciwcial odrowych u zaszczepionych dzieci i mlodziezy chorej na autoimmunologiczne zapalenie watroby.

UNLABELLED: Etiology and pathogenesis of autoimmune hepatitis (AIH) is still unknown. In several studies significantly increased antibody titers to measles virus in the sera of patients with AIH and chronic active hepatitis as compared to healthy people were observed. Aim of the study was to evaluate the humoral immunity against measles in children and adolescent with AIH after measles vaccination. MATERIAL AND METHODS: 110 subjects of both sexes aged 6-22 year (19 patients with AIH, 41 children with chronic hepatitis B and C (CH) and 50 healthy persons (HP) were tested to measles antibodies. Moreover mumps antibodies were examined for humoral immunity defects exclusion. All subjects were vaccinated against measles but none of them with mumps vaccine. Antibody were tested by enzyme immunoassays (EIA) and standardized by calibration against the International Standard. Geometrical mean concentration (GMC) of antibodies and the number of seropositive patients were calculated. RESULTS: Measles antibodies were found in all AIH patients (GMC 1.33 IU/ml (range 0.5-21.1 IU/ml)), in 85.4% of patients with CH (GMC 1.68 IU/ml (0.5-4.9 IU/ml)) and in 78% of HP (GMC 1.62 IU/ml (0.41-10 IU/ml)). The differences between the number of seropositive patients and between antibody concentrations in three groups were not significant. Mumps antibodies were detected in 82% AIH patients, 70% patients with CH and 76% HP. In AIH group higher antibody titer was observed than in patients with CH (p=0.047). CONCLUSIONS: The vaccination with measles vaccine does not lead to immunoregulation disturbances in AIH patients in contrary to natural measles infection.

Detection of TT virus (TTV) in children and youth with chronic viral hepatitis B and C.

BACKGROUND: TTV is a newly discovered virus and little is known about the frequency of TTV infection in children in Poland. The aim of our study was to investigate the frequency of TTV infection in children with chronic viral hepatitis B and C. MATERIAL/METHODS: Two patient groups were tested: 74 patients with chronic hepatitis B aged 4 to 20 years, and 13 patients with chronic hepatitis C aged 10 to 18 years. Nucleic acids were extracted from serum using the spin column technique (QIAGEN(r), Hilden, Germany), and TTV DNA sequences were amplified by nested PCR. RESULTS: TTV DNA was found in 47.3% of patients with chronic hepatitis B and in 53.8% of patients with hepatitis C. Among those patients with chronic B hepatitis there was no statistical difference between the frequency of coinfection with TTV and clinical-histopathological diagnosis, activity of aminotransaminases, frequency of seroconversion of HBeAg to antiHBe, or interferon alpha therapy. CONCLUSIONS: In Poland, TTV viremia is frequent in patients with chronic viral hepatitis B and C. TTV coinfection did not modify the course and activity of chronic hepatitis B or influence the outcome of interferon therapy.

A longitudinal study of the efficacy of interferon therapy in children with chronic hepatitis B.

BACKGROUND: Interferon alpha (IFN) is the most effective drug in the treatment of chronic hepatitis B. This article presents the results of IFN therapy and 28-month follow-up. MATERIAL/METHODS: 193 Caucasian children (130 boys and 63 girls) aged 1.5-17 years were treated with IFN for 20 weeks (3.0 MIU 3 times a week). They were examined at baseline (period 0), after 6 weeks (period 1), 12 weeks (period 2), 20 weeks (period 3), 6 months (period 4), 12 months (period 5), 18 months (period 6), and 24 months (period 7). RESULTS: HBcAg elimination drom period 3 was: 29.6%, 35.2%, 45.4%, 58.3%, in period 7 63.9% (significantly higher in girls). Significant positive correlations were found in several periods between IFN/m2 and HBeAg, HBsAg elimination, HBeAb, HBsAb presence and negatie correlations between IFN/m2 and ALT activity. ALT activity significantly decreased in girls between periods 0-3, in boys between 0-3 and 4-6. Significant positive correlations between ALT-0 and HBeAg, HBsAg elimination, HBeAb, HBsAb presence was seen in several periods, more frequently in girls. IFN transiently decreased Hb, leukocytes, and thrombocytes, especially in boys. No relationship was found between IFN therapy and bilirubin, protein, albumin and gammaglobulin concentrations. The prothrombin index increased after 6 months of IFN therapy in girls. CONCLUSIONS: The efficacy of IFN therapy is clearer with longer observation, especially in girls. A relationship was found between IFN dose and HBeAg/HbeAb and HBsAg/HBsAb seroconversion. IFN had a transient negative effect on the peripheral blood picture.

Autoantibodies in children with chronic hepatitis B undergoing interferon therapy.

BACKGROUND: The occurrence of various side effects in patients treated with interferon alpha has attracted more attention to the manifestation of autoantibodies. The purpose of our study was to evaluate the side effects of interferon in children suffering from chronic hepatitis B by detecting six autoantibodies. MATERIAL/METHODS: Autoantibodies were examined in 76 children (55 boys and 21 girls) aged 2-16 years, treated with interferon-alpha 3 MU 3 times weekly for 20 weeks. They were tested before treatment (exam I) and after its conclusion (exam II). SMAs were determined by indirect immunofluorescence (Euroimmuno reagents), while ANA, AMA M2, GPC, TPO and ATG were measured by EIA (Biomedica reagents). RESULTS: No statistically significant differences were found between the total number of patients with autoantibodies in examination I and examination II. A comparison of the frequency of presence or absence of autoantibodies in the same patients in exams I and II showed significantly more frequent disappearance of GPC in exam II than appearance (p<0.00005). This was also observed in the case of TPO (p=0.320). In relation to ANA, SMA, AMA M2 and ATG these differences were not significant. CONCLUSIONS: INF-alpha does not induce autoantibody formation in children with chronic hepatitis B. Our results suggest that IFN-alpha may inhibit the formation of some autoantibodies.