Clinical Manifestations In Children Research Articles

Larval toxocariasis and its clinical manifestation in childhood in the Slovak Republic

Results are presented of 90 children aged 1-15 years hospitalized with toxocariasis. Blood count analysis and laboratory examination were done by routine clinical laboratory methods. Anti-Toxocara antibodies were detected in the serum of patients using an ELISA method. Demographic analysis of the children's families exposed to the risk of disease allowed estimation of age-specific rates for clinical toxocariasis. The probability of toxocaral infection and the intensity of its clinical manifestations in children are determined by the epidemiology of this zoonosis and by the risk factors in the family. The presence of high titres of specific IgG antibodies in all age categories correlates with the clinical manifestations of toxocariasis. The highest admission rate is in the age categories of 3-5 years (43.3%) and 6-10 years (36.7%). Laboratory findings show that the most conspicuous changes occur in the age category 1-5 years. The high percentage of seropositive dog-keeping and puppy-breeding families and the possibility of infection with repeated doses of larvae stimulate eosinophilia, which prevails in children under the age of five years. We present the percentage of patients whose parameters showed deviations from the reference values for a particular age category. Analyses of laboratory indices and of clinical manifestations will contribute to the accuracy of diagnosis and effectiveness of treatment of this disease.

Prevalence and clinical aspects of congenital cytomegalovirus infection

OBJECTIVES: The objectives of the present study were to determine the prevalence of congenital CMV infection, as well as to evaluate the importance of this agent as cause of congenital disease, and to describe the clinical manifestations in children attended at a General Hospital in Ribeirão Preto, SP, Brazil. POPULATION AND METHODS: A first group including 189 newborns and their mothers was evaluated for the prevalence of the congenital CMV infection. A second group including 130 newborns and 74 infants who presented clinical manifestations of congenital disease were also investigated to evaluate the importance of the CMV as a cause of this disease and to describe the clinical findings. Diagnosis of congenital CMV infection was established by detecting the virus using viral isolation in tissue culture, polymerase chain reaction DNA amplification in urine samples and detection of specific anti-CMV IgM and IgG by immunofluorescence indirect test. RESULTS: The prevalence of congenital CMV infection was 2.6% and the prevalence of CMV antibodies in mothers was 95%. In the first group, none of the 5 congenitally infected presented clinical apparent disease at birth, although one of them had intracranial calcifications. In the second group, CMV was recognized as a causative of congenital disease in 12 children (5.9%). Of these, 10(83%) were identified after the neonatal period. The clinical findings included hepatosplenomegaly (75%), jaundice with direct hyperbilirubinemia (42%), neurologic disease consisting of microcephaly and intracranial calcifications in 42% of these children. CONCLUSIONS: The prevalence of congenital CMV infection was similar to that reported in other studies about highly immune populations. Infants with asymptomatic congenital CMV infection may have diseases of the central nervous system that are not clinically evident at birth, such as punctate calcifications. CMV infected patients who are symptomatic at birth have a multisystem disease, and the differential diagnosis of any newborn with clinical abnormalities including involvement of the hepatobiliary, hematopoietic and central nervous systems should include congenital CMV infection. CMV was an important agent of these abnormalities, and the majority of symptomatic patients were identified after the neonatal period, making the diagnosis more difficult.

Anaphylaxis in children: clinical and allergologic features.

Despite the importance of anaphylaxis, little information is available on its clinical features. To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996. Ninety-five episodes of anaphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six children (87%) had only one episode of anaphylaxis, while 10 (13%) had two or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children with venom-induced anaphylaxis usually had negative skin tests to the allergens tested. A younger age and eczema were more frequent among children with food-dependent anaphylaxis, whereas an older age together with urticaria-angioedema were common among those with exercise-induced anaphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovascular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom (12%), exercise (9%), additives (1%), specific immunotherapy (1%), latex (1%), and vaccines (2%), but in 6 cases (6%) the agent was never determined. Among the foods, seafood and milk were the most frequently involved. As for location, 57% of the anaphylactic events occurred in the home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fields (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the patients (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95]). Patients were treated with corticosteroids in 72% of the cases (68/95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/95), with beta2-agonists in 5% (5/95), and with oxygen in 4% (4/95). In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Food-induced anaphylaxis often occurs in younger children with a severe food allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-induced variant usually presents itself in nonatopic subjects. Given the fact that most of the children had only one anaphylactic reaction, prevention is almost impossible. Epinephrine, although it is the first-choice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.

Children with focal sharp waves: clinical and genetic aspects.

To investigate the spectrum of clinical manifestations in children with benign focal sharp waves in the EEG to gain further insight into the genetic background of clinical and EEG symptomatology in a family study. All 147 children (134 with seizures, 13 without) met the following inclusion criteria: (a) at least one EEG with focal sharp waves characteristic of benign partial epilepsies, and (b) at least 1 sibling investigated by EEG. The families were questioned orally or in writing regarding the occurrence of seizures. Patients' records were evaluated by a standardized scheme. The following types of seizures occurred: febrile convulsions (FC), afebrile generalized tonic-clonic seizures (GTCS), simple and (rarely) complex partial seizures; and rolandic seizures in the strict sense. Neonatal seizures were overrepresented (6%); there were no indications of lesional causes. FC occurred in 38 children (26%). As compared with unselected cases of FC, complex symptoms were overrepresented. Family data suggested a maternal preponderance in the transmission of FC liability. Affected relatives of FC probands manifested FC more often than did relatives of probands without FC. Families of 32 patients with typical rolandic seizures (24% of the 134 probands with seizures) showed no aggregation of rolandic epilepsy, but did show variable seizure types. In the entire sample, EEG investigations showed focal sharp waves in 11% of siblings aged 2-10 years. No relation existed between clinical symptomatology and sharp wave findings in siblings. In 66% of probands, the EEG disclosed generalized genetic patterns. Siblings with generalized spike-waves (sw) and/or theta rhythm had focal sharp waves more often than those without sw and/or theta rhythm. The phenotypic expression of the genetic anomaly underlying focal sharp waves shows considerable variability. The clinical and EEG findings are in agreement with a multifactorial pathogenesis of epilepsies with "benign" focal epileptiform sharp waves.

Diagnosis of thromboembolic disease during infancy and childhood.

Thromboembolic disorders are frequent complications in pediatric patients and the incidence seems to rise. Adult guidelines for thromboembolism do not hold for children because there are many age-related features. Congenital prethrombotic disorders play a major role in the pediatric population and activated protein C (APC) resistance is also the most frequently encountered problem. Acquired risk factors in children are central venous line thrombosis with serious complications, cardiac diseases such as cardiomyopathies, prosthetic heart valves and aneurysms, renal vein thrombosis, and nephrotic syndrome. Renal vein thrombosis primarily affects newborns. Children with the antiphospholipid antibody syndrome also have thromboses although less frequent than adults, but systemic lupus erythematosus is associated with a high incidence. Acute lymphoblastic leukemia is frequently associated with thrombosis in children, especially when complicated by APC resistance. The greatest risk of thrombosis in children is during the neonatal period, and again congenital prethrombotic states and catheter placement play a major role. The clinical manifestations in children reflect the site of the thrombosis and extensive laboratory evaluations and advanced diagnostic procedures must be employed to diagnose the thrombotic events.

Group B coxsackie disease in children.

The group B coxsackieviruses (CVB) cause a wide variety of clinical manifestations in children. Some disease syndromes are identical to, or share many common features with, diseases caused by other enteroviruses. Indeed, most clinical virology laboratories no longer identify isolated enteroviruses by group or by serotype, since this information is rarely of immediate importance to physicians and their patients. Nonetheless, there are several clinical syndromes which are uniquely associated with CVB infection, such as myopericarditis and pleurodynia (Bornholm disease). This chapter covers several important CVB-related diseases in childhood including CNS infection, respiratory tract infections, pleurodynia, and vertically transmitted infections. A complete discussion of myopericarditis, which is also an important pediatric disease, can be found in Chap. 3.

Representations, attitudes, and practices related to Cutaneous Leishmaniasis in people from Acosta County, San Jose province, Costa Rica. An exploratory anthropological study

An exploratory anthropological study on representations, attitudes, and practices related to Cutaneous Leishmaniasis (CL) among the rural population of Acosta County, Costa Rica, aimed to estimate the applicability of epidemiologically-based control measures. Open interviews with a small sample of individuals from both case and control households provided the basic for a Propositional Discourse Analysis (PDA). Results are that Acosta people consider CL a distinct nosologic entity, but they are mainly interested in its clinical manifestations in children (who are mainly affected), as well as in their own capacity to act on the disease using folk remedies. The idea of control measures on reservoirs, on vectors, or on the spatial and temporal context of contact does not arise spontaneously in people's thinking. Nevertheless, CL is perceived as a disruption in the safe domiciliary and peridomiciliary space, so that control measures intervening there could have a chance for success.

Clinical manifestations in children with occipital spike-wave paroxysms.

The pattern of occipital-posterotemporal spike-wave paroxysms (O-PT SWPs), is a distinctive EEG abnormality observed primarily with occipital epilepsy of childhood and basilar artery migraine. We studied EEG and clinical features in 30 children and young adults with this EEG pattern. Prolonged and brief O-PT SWPs were observed. Prolonged discharges (greater than 6 s) were observed only in children with seizures (p less than 0.001), and brief discharges (1-6 s) were observed immediately after eye closure. Generalized SWPs (11 patients, 37%) and background abnormalities (17 patients, 57%) were common. Photic activation of O-PT SWPs was not observed. Twenty-four patients (80%) manifested paroxysmal phenomena-seizures (20 patients, 67%) and migraine (12 patients, 40%, 4 alone and 8 with seizures). Fifteen patients (75%) had partial seizures, and 5 (25%) had absence seizures. In 7 patients with partial seizures, an etiology was evident. Neurologic examination was more often abnormal in patients with secondary partial seizures than in those with idiopathic partial seizures (p less than 0.05) and absence seizures. Conversely, migraine was more often associated with idiopathic partial seizures than with secondary partial seizures (p less than 0.05) and absence seizures. Six children (20%) had no paroxysmal events. Generalized SWPs were uncommon in patients with idiopathic partial seizures. We conclude that O-PT SWPs is a nonspecific epileptiform abnormality that may occur in children with (a) idiopathic partial, (b) symptomatic partial, and (c) absence epilepsies, but it may also occur in patients with no evidence of seizures.

Psoriatic arthritis in children.

This paper reviews the typical features of psoriatic arthritis, with emphasis on the clinical manifestations in children. The concepts of seronegative spondyloarthropathy and enthesopathy are described. Recent information is presented on genetics, possible pathophysiologic mechanisms, and treatment.

ELECTROPHYSIOLOGIC ASSESSMENT OF PERIPHERAL NEUROPATHY in CHILDREN WITH CHRONIC RENAL FAILURE (CRF)

Peripheral nerve function is frequently altered in CRF although clinical manifestations in children are rare. For assessment of uremic neuropathy the measurement of motor nerve conduction velocity (MNCV) has widely been used. In an earlier study we failed to find a correlation between MNCV and severity of CRF. In the present study a more sensitive neurographic parameter has been applied: the relative refractory period as estimated by neuromuscular reaction to paired stimuli (NMRPS). This method was tested in 24 children with CRF on conservative treatment(CT), 11 pts immediately before and after a haemodialysis(HD) session and 13 pts after transplantation(TP). In CT a correlation was found between some parameters of NMRPS and serum creatinine(SCR). The changes of NMRPS correlated even better with those of SCR during a HD session. After TP a significant improvement of MNCV was observed whereas NMRPS was unchanged. These data suggest that 1) NMRPS is a sensitive parameter of uremic neuropathy which might be used to control adequacy of therapy, 2) short term improvement of neuroaxonal function occurs by HD, 3) long-term improvement of myelin sheeth function is induced after TP.

Yersinia Enterocolitica Infections in Children

SUMMARY Y. enterocolitica has been increasingly associated with a wide range of age-related clinical manifestations in children and adults, including febrile gastroenteritis, pseudoappendicitis, arthritis, sepsis, and focal suppurative disease. Although definite patterns of incidence, prevalence, transmission, and pathophysiology are emerging, much remains to be explained. The alert clinician who notifies his clinical laboratory colleagues that special isolation techniques are required to recover this organism from stool samples, and who submits mesenteric lymph nodes for bacteriologic examination in cases of mesenteric adenitis, will aid attempts to further delineate the significance of this emerging pathogen in the United States. Therapy depends on the form and severity of illness and must be guided by in vitro sensitivity, pending animal and epidemiologic studies.

Yersinia Enterocolitica Infections in Children

Y. enterocolitica has been increasingly associated with a wide range of age-related clinical manifestations in children and adults, including febrile gastroenteritis, pseudoappendicitis, arthritis, sepsis, and focal suppurative disease. Although definite patterns of incidence, prevalence, transmission, and pathophysiology are emerging, much remains to be explained. The alert clinician who notifies his clinical laboratory colleagues that special isolation techniques are required to recover this organism from stool samples, and who submits mesenteric lymph nodes for bacteriologic examination in cases of mesenteric adenitis, will aid attempts to further delineate the significance of this emerging pathogen in the United States. Therapy depends on the form and severity of illness and must be guided by in vitro sensitivity, pending animal and epidemiologic studies.

Tetanus—clinical manifestations in children

Tetanus—clinical manifestations in children

RECURRENT POLYSEROSITIS ("PERIODIC DISEASE," "FAMILIAL MEDITERRANEAN FEVER") IN CHILDREN

A series of 19 cases of recurrent polyserositis is presented. All but one child were of Oriental Jewish parentage, and the disease sometimes showed a familial occurrence. The average age of onset was 4 years. The symptoms consisted of fever; abdominal, chest, and joint pains; and skin eruptions. The clinical manifestations often simulated those of acute rheumatic fever, particularly since cardiac murmurs occurred in more than half of the patients. The laboratory findings were those accompanying nonspecific inflammations such as leukocytosis, accelerated enythrocyte sedimentation rate, elevated antistreptolysin titer, and positive C-reactive protein. Though some patients showed transitional albuminunia, no cases of amyloidosis were found. The difference in the clinical manifestations in children as compared with adults, and possible etiological factors are discussed.

Cardiac involvement in progressive muscular dystrophy

Summary 1. A child with progressive muscular dystrophy and cardiac muscle involvement has been presented. 2. Clinical manifestations in children as reported in the literature have been summarized.

Snapping thumb in infants and children

Summary The literature has been reviewed and seven cases of snapping thumb in children are added to the sixty-six cases previously reported in the world literature. For the first time the syndrome is reported in twins, one of which was bilateral. This may give further evidence for a congenital predisposition theory. In one of our cases locking occurred in extension which has never previously been described previously. Both the thickened tendon sheath and nodule on the tendon were palpable in this case. The chief variance of the clinical manifestations in children is the greater tendency for locking and less frequent incidence in the fingers. Surgery is the treatment of choice with uniformly satisfactory results.