[Acute pyelonephritis in children with minimal or normal urine findings]

BACKGROUND

Over the past years we have seen several children with serious bacterial infections in whom the focus of the infection was found in the kidneys despite of normal or minimal urine findings.

MATERIAL AND METHODS

We review the cases of all children hospitalised at our paediatric department from 1995-2000 with normal or minimal urine findings, and in whom acute pyelonephritis was diagnosed by means of computerized tomographic imaging of the kidneys.

RESULTS

All 10 children (aged 9 months to 9 years) had focal areas of decreased enhancement in the kidney parenchyma. All received intravenous antibiotic treatment. Vesicouretheral reflux was detected in four patients and required surgical intervention in one. One patient had considerable renal scarring and decreased renal function on dimercaptosuccinic acid (DMSA) scintigraphy.

INTERPRETATION

In children with suspected serious bacterial infection, it is important to have the possibility of renal infection in mind in spite of normal urine findings. The importance of establishing the right diagnosis lies in the fact that patients with pyelonephritis need further investigation and follow-up.

[Kawasaki disease]

Kawasaki syndrome was first described in 1967. The diagnosis is based on clinical criteria including fever for more than five days, conjunctivitis, lymph node enlargement and changes in the oral mucosa as well as in the palms and soles. Coronary complications including aneurysmal dilatation have been reported in 20-25% of untreated patients. Kawasaki syndrome is now the most common cause of acquired heart disease in children. Six patients were seen in our department during the period 1980-99. Five were treated with intravenous immunoglobulin. All of them showed immediate improvement of their general condition and were afebrile after 24-48 hours. One patient had a coronary aneurysm of moderate size, and four patients had signs of coronary vasculitis. All coronary changes were normalized after a maximum of 17 months. An update on Kawasaki disease is presented.

[Respiratory syncytial virus infections in hospitalized children in Akershus]

INTRODUCTION

The study describes hospitalisations for RSV infections among children < 15 years.

MATERIAL AND METHODS

The study is a population-based retrospective analysis of admission data from February 1993 through January 2000 of children who tested positive for RSV in nasopharyngeal aspirates.

RESULTS

1,002 cases were identified of which 69.5% were < 1 year old children. Estimated annual incidence of RSV infection requiring hospitalisation was 2.1/1,000 Children < 15 years, 24.9/1,000 infants < 1 year, and 28.4/1,000 infants < 6 months old. Males were more likely to be hospitalised than females. The overall mortality was 0.5%. Premature infants with birthweight < or = 1,000 g had the highest hospitalisation rates, the longest hospital stay and most complications. However, surprisingly many complications occurred among previously healthy infants.

INTERPRETATION

Recommendations for RSV prophylaxis among preterm infants should be investigated in a larger study. Development of an RSV vaccine should be a priority.

[Hepatitis C virus infection among pregnant women and their children in Norway]

Estimates indicate the births of 6 to 78 children vertically infected with hepatitis C virus infection each year in Norway. There is insufficient knowledge of the magnitude of this health problem and the National Institute of Public Health commissioned the authors to approach issues relating to vertical transmission of hepatitis C virus (HCV) infection in Norway. The risk of vertical transmission of HCV appears to be associated with the titre of the maternal viral load. Vertical transmission from nonviraemic mothers has not been demonstrated. No postexposure prophylaxis exists. There is a lack of association between vertical HCV transmission and delivery mode and no association with breast feeding. Universal screening for HCV infection among pregnant women is not recommended. Children born to women known to be HCV-positive should be followed up with antibody and polymerase chain reaction investigations in order to clarify their HCV status. More studies of HCV infection among pregnant women and their children in Norway are needed.

Severe organophosphate (demeton-S-methyl) poisoning in a two-year-old child

A previously healthy 2-y-old boy was admitted to the hospital 30 min after the ingestion of 10 ml of demeton-S-methyl (META-SYSTOX). Treatment consisted of gastric decontamination, atropine, reactivator (obidoxime) and supportive therapy. Atropine was given to control the muscarinic features. Assisted ventilation was required for 6 h; however, this treatment was able to be discontinued following the second injection of obidoxime 11.5 h after the ingestion. Excess salivation and slight bradycardia were easily controlled with small doses of atropine for 5 d following admission to Ullevaal Hospital. Further course was uneventful, and the patient was discharged on the 8th d without any sequelae. Plasma cholinesterase levels were initially low (<400 U/l), but returned to reference values upon discharge. In this case, adequate supportive therapy and the rapid administration of both atropine and obidoxime were clearly associated with a favorable outcomes

[Typhoid fever]

The epidemiology, clinical presentation, diagnosis and treatment of typhoid fever has been studied retrospectively in 50 hospitalized patients. Typhoid fever is increasing in Norway, owing to more travel, especially by immigrants visiting their home countries. Among 50 patients admitted to hospital for typhoid, we found no fatal complications. Fever was a main symptom, and 13 of the 50 patients had additional concomitant infections. The standard treatment was chloramphenicol for 14 days. In 1990 and 1991, however, most cases were caused by multi-resistant strains of Salmonella typhi. The adults were therefore treated with ciprofloxacin and the children with third generation cephalosporins. All the multiresistant infections had been contracted in Pakistan or India. There were no secondary cases among the more than 214 family contacts in the 47 families involved. The increase in resistant strains of typhoid fever may affect future treatment and control strategies.

[Outbreak of typhoid fever in a family]

We describe a small epidemic of typhoid fever in a family who came originally from Pakistan. In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period. The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever. Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse. The source of her first infection is unknown. The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case. Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome. There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.

[Human parvovirus B19 as the cause of aplastic crisis in hereditary spherocytosis]

A seven months old boy was admitted to hospital for investigation and treatment of severe anaemia. The final diagnosis was hereditary spherocytosis. When, six weeks later, he developed an aplastic crisis, serological criteria provided evidence of recent human parvovirus B19 infection. The same disease was detected in the family. Human parvovirus B19 is shown to be of particular interest in aplastic crisis.