Workup Of Children Research Articles

Épidémiologie des malformations associées aux fentes labiales et palatines à propos d’une étude rétrospective de 324 cas

Children with cleft lip and/or palate may have associated malformations, whether or not they are included in a syndromic form. This study's purpose was to provide a better understanding of the epidemiology and distribution of malformations and syndromes associated with these clefts. Retrospective study of 324 patients with cleft lip or palate born between 1994 and 2011. The associated malformations were diagnosed during the 1st year of life. Cleft lip or labioalveolar clefts were less frequently associated with other malformations than cleft palate. These nonsyndromic malformations preferentially affected the urogenital and renal system in case of cleft palate (48.5%) and the cardiovascular system for clefts with a lip defect (30.5%). The syndromic forms were rare in the cleft lip and labioalveolar clefts (3.47%). In contrast, cleft palate appeared much more frequently included in a syndromic form, with 52 children out of 151 (34.4%). The Pierre-Robin sequence was the most frequent syndrome with more than 25% of the cleft palate population. The defect of the palate was associated with a higher rate of other malformations or syndromes (36.51% vs 29.9% for the entire population with a cleft) (n=324) (P<0.001). The distribution of malformations appears to be linked to the type of cleft. These findings underline the importance of conducting a systematic neonatal malformation workup in children born with clefts in order to diagnose abnormalities and organize effective and consistent management.

Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent

BackgroundHuman Enterovirus (EV) and Parechovirus (HPeV) are well recognised as agents causing disease in neonates, but their importance is poorly described in the general paediatric population consulting with a suspicion of infection. ObjectiveWe investigated the prevalence of EV- or HPeV-associated infections in children presenting to a paediatric emergency department with a suspicion of infection. Study designPlasma specimens collected in our paediatric emergency room for clinical reasons were screened by specific real-time RT-PCR for the presence of EV and HPeV. ResultsBased on an analyses of 233 plasma specimens, up to 6.9% and 2.6% were positive for EV and HPeV, respectively. Amongst the population <3y.o, prevalence of EV and HPeV viraemia was 11% and 3.7%, respectively. Importantly, 56.3% of positive EV specimens were detected in infants >3 months of age. ConclusionThe prevalence of EV and HPeV viraemia in children <3 years old is largely underestimated. Our results confirm that EV should be suspected and included in the work-up in children >3 months of age and not restricted to neonates.

PP09.14 – 2843: Congenital absence of gluteal muscles without spina bifida occulta: The first case report

Objective To present a case of congenital gluteal muscles absence associated with renal ectopia, without spina bifida occulta. Methods A 3-years-old child was referred to our child Neurology Unit for motor delay and walking difficulties. Familial and pregnancy history were unremarkable except for right renal ectopia diagnosed with antenatal ultrasound. At birth, he presented flexed hips and lower limbs rigidity. He started walking at 19 months. Neurological examination (28 months) showed waddling gait, gluteal muscles hypoplasia and lumbar hyperlordosis. Laboratory findings, imaging and electrophysiological exams were performed. Results At 28 months of age the child underwent electromyography (with needle of 50 mm) that showed absence of voluntary activity in the territory of gluteal muscles, with normal response in the regions of vastus medialis and sural triceps and normal nerve conduction studies. Laboratory findings (creatine phosphokinase and transaminases) were normal. Musculoskeletal and pelvis magnetic resonance imaging (MRI) revealed a complete, symmetrical fibroadipose replacement of gluteus, gracilis, semitendinosus, semimembranosus and biceps femoris muscles, anterior legs muscles were normal. Spinal magnetic resonance excluded spina bifida occulta. Right kidney was ectopic. Conclusion Bilateral symmetrical congenital absence of muscles is rare, other than Eagle-Barrett syndrome. So far, only three cases of congenital absence of gluteal muscles have been reported and they all had spina bifida occulta. To the best of our knowledge, our case is the first report of congenital absence of gluteal muscles without spinal dysraphism. The only remarkable finding was the kidney ectopia, never described in association with gluteus' agenesis by previous Literature. This association could be explained by a disruption of normal embryologic migration of mesodermal cells during gestational age. Muscular MRI and extensive electromyography should be considered in the diagnostic work-up of children with motor delay and walking difficulties and with clinical suspicion of neuromuscular disorders.

Emergency Department Evaluation and Management of Children With Simple Febrile Seizures.

Workup of simple febrile seizures (SFS) has changed as the American Academy of Pediatrics made revisions to practice guidelines. In 2011, revisions were made regarding need for lumbar puncture (LP) as part of the SFS workup. This study surveyed more than 100 emergency departments regarding workup of children with SFS and performed a medical record review of workup that was performed. The survey shows that laboratory workup is done routinely and LP is done infrequently. The majority documents a complete exam. The medical record review demonstrates documentation of the examination, frequent laboratory and infrequent LP evaluation. Consistent with the American Academy of Pediatrics' revisions, survey and record reviews demonstrate that LP testing is infrequent. Contrary to the guideline, laboratory studies are routinely performed. This study suggests there is an opportunity to improve management of SFS by directing efforts toward finding the source of the fever and away from laboratory workup.

Connexin‐Related (DFNB1) Hearing Loss

Determine if routine computed tomography (CT) imaging is necessary in the workup for children with connexin-related (DFNB1) sensorineural hearing loss (SNHL). Case-control retrospective chart and imaging review. Tertiary care otolaryngology practice. High-resolution temporal bone CT scans of children (n = 21) with DFNB1 SNHL were compared to age-matched controls with either conductive hearing loss (CHL, n = 33) or a nonsyndromic, non-DFNB1 SNHL (n = 33). Sixteen measurements of cochleo-vestibular structures were recorded. Statistical analysis was performed using a repeated analysis of variance model that controlled for both age and gender. Area under the curve (AUC) and multidimensional AUC (MAUC) analyses were also performed. Overall, no statistically significant differences were found between the 3 experimental groups. In addition, comparisons between the DFNB1 and CHL groups, DFNB1 and non-DFNB1 SNHL groups, and CHL and non-DFNB1 SNHL groups failed to demonstrate any statistically significant differences. AUC and MAUC analyses also failed to detect any significant differences between the 3 groups. Patients with DFNB1 SNHL do not have significant anatomic differences on temporal bone CT scans when compared to non-DFNB1 SNHL and CHL control groups. Based on the above analysis, it is reasonable to avoid routine CT imaging of the temporal bones in children with known DFNB1 SNHL unless otherwise clinically indicated.

Cardiac magnetic resonance imaging in children

MRI is an important additional tool in the diagnostic work-up of children with congenital heart disease. This review aims to summarise the role MRI has in this patient population. Echocardiography remains the main diagnostic tool in congenital heart disease. In specific situations, MRI is used for anatomical imaging of congenital heart disease. This includes detailed assessment of intracardiac anatomy with 2-D and 3-D sequences. MRI is particularly useful for assessment of retrosternal structures in the heart and for imaging large vessel anatomy. Functional assessment includes assessment of ventricular function using 2-D cine techniques. Of particular interest in congenital heart disease is assessment of right and single ventricular function. Two-dimensional and newer 3-D techniques to quantify flow in these patients are or will soon become an integral part of quantification of shunt size, valve function and complex flow patterns in large vessels. More advanced uses of MRI include imaging of cardiovascular function during stress and tissue characterisation of the myocardium. Techniques used for this purpose need further validation before they can become part of the daily routine of MRI assessment of congenital heart disease.

Case of 7p22.1 Microduplication Detected by Whole Genome Microarray (REVEAL) in Workup of Child Diagnosed with Autism.

Introduction. More than 60 cases of 7p22 duplications and deletions have been reported with over 16 of them occurring without concomitant chromosomal abnormalities. Patient and Methods. We report a 29-month-old male diagnosed with autism. Whole genome chromosome SNP microarray (REVEAL) demonstrated a 1.3 Mb interstitial duplication of 7p22.1 ->p22.1 arr 7p22.1 (5,436,367–6,762,394), the second smallest interstitial 7p duplication reported to date. This interval included 14 OMIM annotated genes (FBXL18, ACTB, FSCN1, RNF216, OCM, EIF2AK1, AIMP2, PMS2, CYTH3, RAC1, DAGLB, KDELR2, GRID2IP, and ZNF12). Results. Our patient presented features similar to previously reported cases with 7p22 duplication, including brachycephaly, prominent ears, cryptorchidism, speech delay, poor eye contact, and outburst of aggressive behavior with autism-like features. Among the genes located in the duplicated segment, ACTB gene has been proposed as a candidate gene for the alteration of craniofacial development. Overexpression of RNF216L has been linked to autism. FSCN1 may play a role in neurodevelopmental disease. Conclusion. Characterization of a possible 7p22.1 Duplication Syndrome has yet to be made. Recognition of the clinical spectrum in patients with a smaller duplication of 7p should prove valuable for determining the minimal critical region, helping delineate a better prediction of outcome and genetic counseling

The Probability of Invasive Fungal Infection Among Children with Persistent Febrile Neutropenia and Respiratory Viral Infection

▪Febrile neutropenia (FN) is a common complication among children undergoing chemotherapy for hematologic malignancies. A microbial agent is identified in 15–30% of these episodes. Recently, several studies reported a high incidence (25% -60%) of respiratory viral infections (RVI) in children with FN, using RT- PCR analysis. Implementation of routine RVI workup in children with FN was suggested, in order to minimize the overuse of antibiotics.However, data on the incidence of RVI in children with persistent FN (PFN) is meager. In the setting of PFN, invasive fungal infection (IFI) is a major concern.The incidence of IFI among children with hematologic malignancies varies with clinical settings, although most children who present with PFN do not have IFI eventually. Yet, most international guidelines indicate empiric initiation of antifungal therapy after 4-7 days of FN. Alternatively, a “preemptive” approach using currently available diagnostic modalities (CT and serum specific biomarkers) was suggested in adult patients.In children with PFN, however, this workup resulted only in a modest decline in the antifungal treatment rate.Therefore, there is a growing need to enhance diagnostic resolution, in order to stratify pediatric patients according to their risk for IFI, and minimize the overuse of antifungal drugs, imaging, and invasive procedures.To the best of our knowledge, there are no studies comparing the incidence of RVI to that of IFI in the setting of PFN.Based on previous published data, we hypothesized that RV infection is a significant cause of PFN in children with hematologic malignancies, and that IFI is the cause in a minority of cases.We further aimed to investigate whether detection of RVI, as the cause of PFN in these children, would affect their risk of IFI.For that purpose, we analyzed the clinical charts of children (<21 years) with hematologic malignancies who presented to our department during 2007-2013 with PFN (>38oc, for >96 hours and ≤500ANC/µl) and documented PCR results of RV.Patients were considered positive for IFI if they had ‘possible’, ‘probable’ or ‘proven’ infection according to the revised EORTC definition (2008).RVI were detected in nasopharyngeal aspirates using RT-PCR and included: RSV, Influenza A/B, H1N1, Parainfluenza 1/2/3, HMPV, Adenovirus and HHV-6.Additional data included age and gender, specific hematologic malignancy, total number of neutropenia (<500 ANC/µl) days per episode, total number of antibiotic therapy days per episode, bacterial co-infection, anti-fungal prophylaxis, imaging results, BAL/biopsy results and serum biomarkers.A total number of 75 PFN episodes were evaluable, representing 54 patients with ALL (HR n=18; SR n=23), AML (n=6), NHL (n=5) or Hodgkin’s (n=2). Of these, there were 31 episodes with RV-positive infections (41.3%). The most prevalent virus was RSV (29%), followed by Parainfluenza (26%) and Adenovirus (19%).There were 16 possible (21%), 2 probable (2.6%), and 2 proven (2.6%) episodes of IFI. Only in 3 episodes we detected co-infection of IFI (2 possible and 1 probable) and RVI.Multivariate analysis revealed that the total days of neutropenia and antibiotic therapy were independent risk-factors for IFI (p<0.0109; P< 0.0034 respectively). RVI was independently associated with a significant reduced risk for IFI, with an odds ratio of 7.47 (p<0.0082, 95% CI -1.6-50.4). Age, specific hematologic malignancy, bacterial co-infection, and antifungal prophylaxis did not reach significance.Children with PFN and RVI have a significantly lower risk for IFI. This observation may reduce unnecessary imaging and invasive procedures, antifungal treatment, and hospital expanses. Further studies are needed in order to establish whether RV-status can be implemented in the routine workup algorithm of PFN in children with hematologic malignancies. DisclosuresNo relevant conflicts of interest to declare.

Rare Eye Findings in a Case of Sotos Syndrome

Objective : To report uncommon eye findings in a case of Soto’s Syndrome. Method: Case report Results : A 10-year-old girl with underlying Soto syndrome under multidisciplinary care presented with a history of bilateral, painless and progressive blurring of vision for 1 year. On examination, she had accelerated linear growth, dysmorphicfacies, macrodolichocephaly, hypertelorism and cognitive impairment. Anterior segment examination revealed bilateral anterior polar cataract and bilateral keratoconus. Conclusion : What this case highlights is that in addition to the classic features of Soto’s syndrome, we found two rare ocular associations in this patient;-_namely, polar cataract and keratoconus. These new additions to the constellation of ocular manifestations of Sotos syndrome serve as a reminder that an ophthalmological evaluation should be a part of the basic workup of children with Sotos syndrome.

The Prevalence of At-Risk Development in Children 30 to 60 Months Old Presenting With Disruptive Behaviors

This study assessed the prevalence of failed developmental screens in 30- to 60-month-old children who presented with a behavioral complaint of disruptive behavior to a referral clinic. A retrospective chart review was performed in a specialty behavioral pediatric clinic. Outcome measures were obtained from children referred to the clinic with parental concern of disruptive behavior. Out of 151 patients, 66% (99/151) had been screened for developmental delays with a formal screening instrument. Of these, 71% (70/99) failed developmental screening in one or more domains. Preschoolers referred to a behavioral clinic for parental concerns of disruptive behaviors were more than 4 times more likely to be at risk for developmental delays than the general population, with a majority of suspected delays in communication and problem-solving domains. This finding suggests that developmental screening should be a part of the initial workup for children with disruptive behaviors.

A 3-Year-Old Girl with Frequent Nose Bleeds

A 3-year-old girl presented with petechial hemorrhages and repeated nosebleeds. Two weeks earlier she had been admitted to a local hospital with nosebleeds accompanied by 2 episodes of vomiting dark red blood. Results of the laboratory evaluation included: white blood cell count, 8.2 × 109/L [reference interval (RI),3 4 × 109/L to 10 × 109/L]; hemoglobin, 10.7 g/dL (RI, 11–15 g/dL); platelet count, 142 × 109/L (RI, 100 × 109/L to 300 × 109/L), prothrombin time, 11.5 s (RI, 9–13 s); activated partial thromboplastin time, 31.2 s (RI, 26–39 s); and fibrinogen, 2.5 g/L (RI, 2.0–4.0 g/L). The patient was discharged in good condition after insertion of nasal packs. One day before the current admission, the patient had nose bleeds once again, this time accompanied by 4 episodes of hematemesis and tarry stool. At presentation, she had no fever and no diarrhea. She was not on any medications. The patient had a history of easy bruising, repeated gum bleeding, but not hemarthrosis. There was no family history of abnormal bleeding. On examination, she appeared pale, with normal vital signs. Her skin had scattered petechiae. The physical examination was otherwise unremarkable. At presentation, laboratory findings included the following: hemoglobin, 6.2 g/dL (RI, 11–15 g/dL); reticulocyte count, 6.8% (RI, 0.5%–1.5%). Other laboratory results are shown in Table 1. View this table: Table 1. Patient's laboratory results. In vitro testing showed that the patient's platelets did not aggregate in response to ADP, epinephrine, arachidonic acid, or collagen, but platelets had relatively normal ristocetin-induced aggregation. These findings were confirmed on repeat testing. A smear of peripheral blood showed no clusters of normal platelets. A flow cytometry evaluation revealed marked reduction in glycoprotein IIb/IIIa (GPIIb/IIIa). ### QUESTIONS TO CONSIDER 1. What disorders should be considered in the workup of children with repeated nose bleeds? …

Colitis-associated sclerosing cholangitis in children: A single centre experience

ObjectiveSclerosing cholangitis (SC) is an important immune-mediated extra-intestinal manifestation of inflammatory bowel disease (IBD), primarily affecting patients with ulcerative colitis (UC). The reported prevalence of SC in adults and children with UC is low at between 2 and 7%. We present findings from a hepatological work-up in children with inflammatory colitis and elevated liver function tests (LFT) from a tertiary paediatric gastroenterology unit. DesignThis study is designed as a retrospective review of the medical records of 17 children and adolescents with inflammatory colitis and abnormal LFTs who presented to our IBD service between April 2004 and April 2012. ResultsOver the eight year period a total of 52 patients were diagnosed with inflammatory colitis (ulcerative colitis and unclassified colitis). Seventeen of the 52 patients had abnormal liver function tests and underwent liver biopsy and cholangiography. All 17 patients (32.6%) were diagnosed with hepato-biliary disease. ConclusionThis is one of the largest reported series of children with inflammatory colitis and associated hepato-biliary disease. The data from this patient group indicate that the prevalence of IBD-associated hepato-biliary disease in children with abnormal LFTs is much higher than previously reported. As the diagnosis of IBD-associated hepato-biliary disease affects patient management, we recommend liver biopsy and cholangiography in all children with inflammatory colitis and abnormal liver function tests.

Tumors for the general orthopedist: how to save your patients and practice

It is likely that most orthopedic surgeons will see a patient with a benign or a malignant musculoskeletal tumor sometime during their career. However, because of the rarity of these entities, many surgeons may benefit from a review of how to evaluate a patient with a bone lesion or a soft-tissue mass. A logical approach is necessary for the evaluation of imaging studies as well as in the workup of children and adults with a possible tumor. It is important to have a good working relationship with a musculoskeletal radiologist to assist in interpreting the images. If the treatment algorithms lead to a conclusive diagnosis of a benign bone tumor, benign soft-tissue mass, or metastatic bone disease, the orthopedic surgeon may choose to definitively treat the patient. If the workup indicates an indeterminate lesion, it may be prudent to discuss the situation with an orthopedic oncologist or transfer the care of the patient to a physician with more specialized knowledge. A careful, logical workup is needed before surgery to limit risks to the patient and optimize the chances for a favorable outcome.

Yield of Diagnostic Studies in Children Presenting With Complex Febrile Seizures

The objective of this study was to determine the yield of diagnostic workup in children presenting with complex febrile seizures. We performed a retrospective review of charts of patients who presented to our pediatric emergency department with complex febrile seizures (focal, prolonged, or recurrent). Patients with known seizure disorder, congenital central nervous system malformations, or hydrocephalus were excluded. The charts were reviewed for diagnostic workup. There were 71 eligible encounters (mean age, 1.5 years); 59.2% were males. None of the 71 patients had positive blood or urine cultures; none had abnormal blood count or serum chemistries. Only 1 patient who had a very abnormal presentation in febrile status epilepticus had positive cerebrospinal fluid culture and abnormal brain computed tomography scan and magnetic resonance imaging. Most patients with complex febrile seizures do not require extensive diagnostic workup.

Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers

Food allergy is a common problem in France involving 4%-6% of toddlers. As opposed to IgE-mediated cow's milk allergy (CMA), delayed-onset CMA, mostly, non-IgE-mediated, remains difficult to diagnose in toddlers. Our study assessed the diagnostic performances of intestinal permeability and of fecal markers, in comparison with the standard allergic work-up in children referred for CMA diagnosis. Twenty-five consecutive children, mean age (standard deviation) 6.3 months (4.8) with digestive and/or extra-digestive manifestations suggesting CMA, were prospectively studied based on a standardized allergic work-up (specific cow's protein IgE and IgG, skin prick test, atopy patch test and oral open cow's milk challenge) and digestive work-up including fecal microbiota analysis, intestinal permeability determination (urinary lactitol/mannitol ratio) and fecal markers measurement, i.e., α(1)-antitrypsin, tumor necrosis factor-α, calprotectin, β-defensin2, secretory IgA and eosinophil-derived neurotoxin (EDN). Receiver operating characteristic (ROC) curves were calculated for all markers in order to define cut-off levels. The cow's milk challenge was positive in 11 children and negative in 14. The global test performances, i.e., the number of true positive+negative cases/the total number of cases, were 76% for intestinal permeability; 72% for fecal EDN; contrasting with atopy patch test, 68%; IgE, 60%; skin prick test, 55% and IgG, 52%. In this routine diagnosis allergy work-up for CMA in toddlers, the best efficacy was seen for intestinal permeability compared to IgE, IgG, skin prick test and atopy patch test. Moreover, fecal EDN in a single spot sample displayed a similar performance.

Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma

ObjectiveTo quantify radiation exposure and mortality risk from computed tomography (CT) and positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (18F-FDG) in patients with malignant lymphoma (Hodgkin’s disease [HD] or non-Hodgkin’s lymphoma [NHL]).MethodsFirst, organ doses were assessed for a typical diagnostic work-up in children with HD and adults with NHL. Subsequently, life tables were constructed for assessment of radiation risks, also taking into account the disease-related mortality.ResultsIn children with HD, cumulative effective dose from medical imaging ranged from 66 mSv (newborn) to 113 mSv (15 years old). In adults with NHL the cumulative effective dose from medical imaging was 97 mSv. Average fractions of radiation-induced deaths for children with HD [without correction for disease-related mortality in brackets] were 0.4% [0.6%] for boys and 0.7% [1.1%] for girls, and for adults with NHL 0.07% [0.28%] for men and 0.09% [0.37%] for women.ConclusionTaking into account the disease-related reduction in life expectancy of patients with malignant lymphoma results in a higher overall mortality but substantial lower incidence of radiation induced deaths. The modest radiation risk that results from imaging with CT and 18F-FDG PET can be considered as justified, but imaging should be performed with care, especially in children.Key Points Survival of malignant lymphoma has improved dramatically over the past decades. PET and CT currently play important roles for malignant lymphoma patients. The potential hazard of ionising radiation has become an increasingly important issue. When assessing radiation risks, disease-related reduction in life expectancy should be considered. CT and 18 F-FDG PET create a modest radiation-induced mortality risk.

Sensitivity and specificity of skin tests in the diagnosis of clarithromycin allergy

Clarithromycin is one of the most frequently prescribed oral macrolidic antibiotics in the pediatric population. Suspected adverse reactions to clarithromycin have been frequently described by parents of children examined in pediatric allergy units, but there is a lack of reliable methods available in detecting the presence of specific IgE antibodies. To investigate the prevalence of a clarithromycin allergy in children seen in a pediatric allergy unit using standardized skin tests and oral provocation tests (OPTs). Sixty-four children were referred with a history of a clarithromycin-associated adverse drug reaction. All these children underwent skin tests and OPTs. The nonirritating intradermal skin test concentration for clarithromycin was determined in a control group of 18 children who had tolerated clarithromycin in the previous month. The threshold nonirritating intradermal concentration was established at the 10:2 dilution (0.5 mg/mL). Nine of the 64 children had an immediately positive intradermal response to the 10:2 dilution and only 1 child to the 10:3 dilution (0.05 mg/mL). None had positive skin prick test results or delayed skin responses to intradermal tests. Four of 64 children (6%) with previously described adverse reactions due to clarithromycin intake had a positive OPT reaction. When we correlated the intradermal skin test results to the OPT results, intradermal test sensitivity and specificity were 75% and 90%, respectively. Intradermal tests seem to be useful in allergologic workup in children with suspected clarithromycin hypersensitivity and may help reduce the need for OPTs.

The Growing Role of Ultrasonography in Evaluating Children After Urinary Tract Infection

The purpose of this review is to advocate the use of ultrasonography (US) techniques in the work-up of children after a urinary tract infection (UTI). Currently, two major approaches are recognized. The first approach recommends looking for vesicoureteral reflux (VUR) in all children following a UTI. New techniques have been developed where, in the majority of cases, x-ray voiding cystourethrography (VCUG) is first substituted with radionuclide voiding cystography, and finally with echo-enhanced voiding urosonography, and this presented a significant improvement in diminishing the radiation burden on patients; yet there remained the drawback that catheterization is still necessary with all of these techniques. The introduction of catheter-free procedures would be a ‘final solution’, but these are yet to be validated. The second approach recommends screening for scars (mostly using a dimercaptosuccinic acid renal scan), while cystographies (preferably VCUG) are only performed in cases in which renal scarring has been confirmed. It was demonstrated that a dimercaptosuccinic acid renal scan can be safely and efficiently replaced by US, while voiding urosonography can substitute VCUG in children with confirmed scars in whom one believes VUR should be sought. From here on, catheter-free US techniques for VUR detection, although promising a ‘final solution’, still remain to be validated. In conclusion, regardless of which approach one believes is more appropriate in the management of children following a UTI, it is obvious that both protocols can be sufficiently fulfilled by the use of US techniques. At this time, more studies are needed to properly validate the latest noninvasive (catheter-free) US techniques for VUR detection.

Cryptosporidium and other Intestinal Protozoans in Children with Diarrhoea in Lagos, Nigeria

As reports of protozoan intestinal parasites in a mega city such as Lagos, Nigeria are scanty and not updated, this study reports the prevalence of intestinal parasites, especially Cryptosporidium species in One hundred and five (105) children less than five years that presented with gastroenteritis in a major tertiary hospital. Standard parasitologic techniques for stool examination and special stains showed cysts and oocysts of protozoan parasites. The overall prevalence rate of intestinal parasites was 27.6%. E.histolytica/dispar and Cryptosporidium oocyst were the most prevalent (9.5% and 17.1% respectively). The age with the highest infectivity was the 4 -5 year-old children from whom the following parasites were detected: Cryptosporidium oocysts (27.6%), Giardia lamblia (4.8%) and E. histolytica/dispar (9.5%). The infectivity of protozoan intestinal parasite was significantly higher in the 4 -5 age-groups (P< 0.001). The findings of this study (especially the detection of Cryptosporidium oocysts) underscores the need to broaden the laboratory work-up in children that presents with gastroenteritis to include special staining technique so as to properly manage the condition. No intestinal helminth was detected among these children.

Drug Allergy Claims in Children: From Self-reporting to Confirmed Diagnosis

Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Clin Exp Allergy. 2008;38(1):191–198 PURPOSE OF THE STUDY. To assess the prevalence of self-reported adverse drug reactions and drug allergy in a pediatric population and confirm the diagnosis in children with suspected drug allergy. STUDY POPULATION. Patients (n = 1426) responded to an initial cross-sectional survey. A total of 60 of 67 patients with reported drug allergy were evaluated at an allergy clinic. METHODS. The first phase included a cross-sectional survey that assessed the life occurrence of adverse drug reactions and self-reported drug allergy in the outpatient clinic of a pediatric hospital. The second phase involved a diagnostic workup in children with parent-reported drug allergy, including detailed clinical history and in vitro and in vivo investigations. Specific immunoglobulin E (IgE) level determination for β-lactams, prick and intradermal skin testing for β-lactams, local anesthetics and sulfonamides, and patch tests (if a delayed reaction was reported) were performed. If all other investigations were inconclusive and a provocation test was not contraindicated, this test was performed. RESULTS. The prevalence of self-reported adverse drug reactions and drug allergy were 10.2% and 6.0%, respectively. The frequency of a medical diagnosis of drug allergy was 3.9%. The majority of the suspected allergic reactions were nonimmediate cutaneous events attributed to β-lactam antibiotics in younger children. Of 60 patients evaluated in the allergy clinic, 39 patients had a plausible clinical history, and additional investigation including a skin test, IgE-level measurement, and possible provocation tests were conducted. Drug allergy was diagnosed in 3 children on the basis of positive responses in skin (n = 1) and oral provocation (n = 2) tests. CONCLUSIONS. Although adverse drug reactions and suspected drug allergy are frequently reported in children, after a complete evaluation, only a few of these reactions can be attributed to immediate and nonimmediate drug allergy. Overall, 94% of the patients could tolerate the initially suspected drug. REVIEWER COMMENTS. This study underscores a serious problem: patients who experience or perceive a drug reaction are often classified as being truly allergic when this may not be the case. Such overdiagnosis and misdiagnosis may result in suboptimal medication choices. These results show that only 6% of the patients with initially suspected drug allergy were truly allergic. This study demonstrates the importance of a complete and detailed history, with consideration of additional testing including skin-prick tests, specific IgE-level determination, and provocation tests. It should be noted that for nonimmediate drug allergy, an oral provocation test may require prolonged treatment to observe for symptoms. Such provocation tests would not be undertaken for severe previous reactions (eg, toxic epidermal necrolysis).