Meningitis and Riga-Fede disease: an unusual condition

BACKGROUND

Riga-Fede disease (RFD) is a benign inflammatory disorder characterised by the appearance of a traumatic ulceration of the oral mucosa. Early detection of RFD and its adequate management are very important.

CASE REPORT

The authors present a an unusual case of RFD with concomitant Staphylococcus aureus meningitis. A 36-day-old female infant was referred to the emergency room of the Hospital of the University of Siena for a 4-day history of high fever. Clinical evaluation revealed the presence of lingual ulceration caused by natal tooth. Few hours later, clinical manifestations were overshadowed by neurological symptoms. The cerebrospinal fluid examination showed the presence of Staphylococcus aureus. The wound healing after extraction of the tooth and the antibiotic therapy have been important for the resolution of this case. A conservative approach is preferable for natal teeth, but in this case the extraction was suggested since a more radical treatment was more likely to avoid major complications.

Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.

Replantation of tooth involved in dentigerous cyst: a case report

AIM

Dentigerous cyst (DC) is a disembriogenetic lesion. The cyst wall encloses the crown of an impacted tooth. Several therapeutic approaches have been mentioned in the literature for management of this lesion. Case Report This article describes the management of an adolescent with a mandibular DC surgically treated with extraction of the tooth, enucleation of the cyst and replantation of the permanent tooth involved. Final outcome shows complete healing of the bone socket with eruption of a vital tooth. No orthodontic traction was required. No recurrence was detected at the radiographic follow-up at 12 months, thus confirming the success of this therapeutic approach. After a 7-year follow-up period the tooth responded positively to the vitality test.

CLINICAL IMPLICATIONS

In selected cases surgical enucleation of the lesion without loss of involved tooth, might be considered as a viable treatment to obtain healing of the lesion, spontaneous eruption of the tooth and physiological restoration of bone.

Four-year review of cigarette ingestions in children

The objective of our study was to assess the demographics, incidence, types of symptoms, and outcomes of cigarette product ingestions in children. The study was a retrospective database review. Seven hundred children under six years of age ingesting cigarettes or cigarette butts reported to a Poison Control Center between 1988 and 1991. Among 143 patients (20.4%) with symptoms, vomiting was the only symptom in 138 (98.6%) and occurred in less than 20 minutes in 104 (74.3%). The five remaining patients (two with vomiting, three without) developed transient lethargy or irritability that completely resolved. Forty-four of 700 patients ingested potentially toxic amounts and were referred to the emergency department; three were lost to follow-up. Initially asymptomatic patients never developed symptoms. Symptomatic patients improved without sequelae. No patient developed seizures. We concluded that significant toxicity from the ingestion of cigarette products in children is rare. Vomiting within 20 minutes is the most common symptom. Its absence predicts a favorable outcome, even when large amounts are suspected to have been ingested.

Juvenile nephronophthisis associated with new skeletal abnormalities, tapetoretinal degeneration and liver fibrosis

This report concerns a boy presenting renal disease with tubulointerstitial nephropathy which suggests familial juvenile nephronophthisis, hepatosplenomegaly due to congenital hepatic fibrosis, tapetoretinal degeneration, probable endocrine involvement and congenital skeletal abnormalities. The associations presented in this paper have not previously been reported.

Accidental terfenadine ingestion in children

Terfenadine is a newly marketed non-sedating antihistamine. It binds strongly with peripheral H-1 receptors and only weakly with muscarinic, alpha and beta-adrenergic receptors. There is limited information about ingestion by children 1-5 years old and no reports in the literature of accidental ingestion. We performed a 1-year retrospective study at the DVRPCC and NJPIES. Twenty-eight cases of accidental ingestions of terfenadine by children aged 1-5 yrs were identified; 27 cases were treated at home and 1 treated in a hospital. Two cases (120 mg and 300 mg) received ipecac at home and were followed by telephone with 1.4 and 24 hr callbacks. No symptoms were reported. In 1 case (180 mg) ipecac was advised but the mother refused to give it. No symptoms were reported on followup. One case (2 yr, 900mg) was referred to a hospital and arrived asymptomatic 2 hr postingestion. The child received activated charcoal and sorbitol, remained asymptomatic and was discharged 6 hr postingestion. The remaining 24 cases (60 mg-120 mg) were treated at home with observation alone. Twenty-one of these cases reported no symptoms on followup. Three cases were lost to followup. Evidence suggests that accidental ingestions of small doses of terfenadine (60 mg-120 mg) in children will not produce toxicity. Larger studies may be needed to verify these findings.

[Changes of the lipid and protein profile in the obese child in diet therapy (with and without added fiber)]

Considering the overcoming importance that cholesterol levels and lipoprotein pattern presents as atherosclerosis risk factor, the Authors have performed lipoprotein analysis in two groups of obese children (weight excess over 50% of the ideal weight). The patients were hospitalized and treated by dietetic therapy and moderate exercise for 15 days. In group 1 the diet was daily supplemented by fibres. In both groups a weight drop as well as reduction of total cholesterol and LDL cholesterol was observed, while serum triglycerides and VLDL cholesterol and HDL cholesterol remain substantially unchanged.