Anomalous drainage of the inferior caval vein to the left atrium

We report a girl, aged 11(7/12) years, who presented with cyanosis. Cardiac catheterization showed occlusion of the infrahepatic segment of the inferior caval vein, with drainage of the hepatic veins into the left atrium. Transoesophageal echocardiography revealed an anomalous Eustachian valve that baffled the vein to the left atrium. This lesion is an extremely rare cause of cyanosis.

Natural history of serum immunoglobulin concentrations in low birth weight infants and association with respiratory tract infections

Infections are a significant cause of morbidity and mortality among low birth weight (LBW) infants.

THE AIMS OF OUR STUDY WERE

(1) to investigate whether serum antibody concentrations in 62 LBW infants (1,500-2,500 g) were normalized by 1 year of life, and (2) to determine the clinical relevance of humoral immaturity in these children during the 1st year compared to 20 appropriate-for-gestational-age (AGA) term infants. At 1 year of life, immunoglobulin serum concentrations in LBW infants were comparable to those of the control group. The incidence of respiratory tract infections during the 1st year of life was not significantly different between LBW and AGA term infants. Interestingly, we demonstrated that LBW infants with a higher frequency of reported febrile upper respiratory tract infections had more elevated serum total IgG, IgG(1), IgG(3), total IgA, and IgA(1) concentrations. Thus, infants with a birth weight of 1,500-2,500 g do not appear to have an increased risk of respiratory tract infections compared to AGA term children during the 1st year of life. Furthermore, our data suggest that especially febrile infections induce higher serum immunoglobulin concentrations in LBW infants.

Papillary fibroelastoma of the left atrium in a 3-year-old boy

A 3 year old boy presented with a cardiac murmur. Except for mildly impaired physical condition that was more likely due to asthmatic bronchitis, he was asymptomatic. Cardiac echocardiography disclosed a large tumor in the left atrium originating from the interatrial septum. The patient was immediately referred to surgery for excision of the tumor. Histological examination of the tumor showed a typical papillary fibroelastoma. The occurrence of a papillary fibroelastoma in a child is a rarity.

Cytotoxic effects of streptolysin o and streptolysin s enhance the virulence of poorly encapsulated group a streptococci

Although the toxicity of streptolysin O (SLO) and streptolysin S (SLS) in purified group A streptococci (GAS) has been established, the effect of these molecules in natural infection is not well understood. To identify whether biologically relevant concentrations of SLO and SLS were cytotoxic to epithelial and phagocytic cells that the bacteria would typically encounter during human infection and to characterize the influence of cell injury on bacterial pathogenesis, we derived GAS strains deficient in SLO or SLS in the background of an invasive GAS M3 isolate and determined their virulence in in vitro and in vivo models of human disease. Whereas bacterial production of SLO resulted in lysis of both human keratinocytes and polymorphonuclear leukocytes, GAS expression of SLS was associated only with keratinocyte injury. Expression of SLO but not SLS impaired polymorphonuclear leukocyte killing of GAS in vitro, but this effect could only be demonstrated in the background of acapsular organisms. In mouse invasive soft-tissue infection, neither SLO or SLS expression significantly influenced mouse survival. By contrast, in a mouse model of bacterial sepsis after intraperitoneal inoculation of GAS, SLO expression enhanced the virulence of both encapsulated and acapsular GAS, whereas SLS expression increased the virulence only of acapsular GAS. We conclude that the cytotoxic effects of SLO protect GAS from phagocytic killing and enhance bacterial virulence, particularly of strains that may be relatively deficient in hyaluronic acid capsule. Compared to SLO, SLS in this strain background has a more modest influence on GAS pathogenicity and the effect does not appear to involve bacterial resistance to phagocytosis.

Analysis of T-cell receptor V-beta 2 in peripheral blood lymphocytes as a diagnostic marker for Kawasaki disease

BACKGROUND

Kawasaki disease (KD) is the most frequent cause of acquired heart disease in children, yet there are no specific diagnostic markers for it. There is controversy whether and by what mechanism selective expansion of T-cell subsets occurs and whether this phenomenon might be helpful for early diagnosis.

PATIENTS AND METHODS

To obtain age-related normal values of V-beta 2(+) T-lymphocytes in healthy children and to investigate expansion in KD, we measured expression in 228 children. Peripheral CD3(+) cells were stained with monoclonal antibodies to V-beta 2.1 and the percentage of V-beta 2(+) T-cells was analyzed using flow cytometry.

RESULTS

In a control group of 184 healthy subjects (0 to 17 years; median age 6.0 years) we found age-related changes. Levels were highest from 0-2 years (9.02+/-2.80%) and declined towards adolescence (7.56+/-2.42% in 11-15 year olds) (p < 0.001). Results were compared with 24 patients with acute febrile diseases of origin other than KD and with 20 patients with presumed diagnosis KD at admission. Interestingly, while all seven patients whose clinical picture retrospectively confirmed KD showed elevated levels, none of the other children, including none of the patients with initially suspected but not clinically confirmed KD, had levels higher than normal, with the exception of two teenage girls with toxic shock syndrome, a classical superantigen-mediated disease.

CONCLUSION

When compared with appropriate age-matched controls, estimation of V-beta 2(+) T-cells might be a valuable tool when making diagnostic decisions suspecting KD.

T cell reactivity in neonates from an East and a West German city--results of the LISA study

BACKGROUND

Within an ongoing birth cohort study (LISA) the cytokine production of cord blood T cells was compared between neonates from Leipzig (East Germany) and Munich (West Germany). The aim of this study was to analyse regional differences and influencing factors of the immune status.

METHODS

Cytokine production was measured in a randomly selected subgroup of 158 children from the LISA (Life style - Immune system - Allergy) cohort by intracellular cytokine staining. Information on family "atopy" history (FAH) and home characteristics was obtained from questionnaires.

RESULTS

Reduced numbers of interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) producing T cells were found in association with biparental FAH and housing renovation during pregnancy. In addition, cytokine production was influenced by season. In Munich, the frequency of biparental FAH and of renovation measures during pregnancy was significantly higher as compared to Leipzig. Neonates from Munich showed significantly decreased amounts of IFN-gamma and TNF-alpha and elevated levels of interleukin-4 (IL-4) producing T cells. Differences in cytokine production between Munich and Leipzig were influenced by season (IL-4) and housing renovation (IFN-gamma, TNF-alpha).

CONCLUSIONS

Since differences in the T cell cytokine production of neonates in Munich and Leipzig are independent from FAH our findings may provide evidence for the impact of environmental factors upon the fetal immune system.

[Urinary tract infection by Staphylococcus saprophyticus in a child]

Staphylococcus (S.) saprophyticus belongs to the coagulase-negative staphylococci and is the cause of urinary tract infections, especially in young women, rarely in children and in elderly men. Probably the real incidence of urinary tract infections due to these organisms is higher than usually accepted. We report on a 11 3/12-year-old girl, who developed symptoms of a urinary tract infection (dysuria, flank pain), but without fever and elevated CRP. In the bladder aspirate we found leukocytes and S. saprophyticus (cotrimoxazole-resistant). Ultrasound detected intrarenal doubling, but no typical anomalies, disposing for urinary tract infections. The treatment with cefuroxim i.v. and clindamycin p.o. was successful.

CONCLUSION

Coagulase-negative staphylococci cultivated in urine represent contamination (mostly S. epidermidis--except in patients, who have undergone manipulation or catheterization of the urinary tract) or they are the cause of an urinary tract infection (mostly S. saprophyticus).