Liver abscess (LA) is a serious infectious disease, but is relatively rare in the paediatric population, especially in developed countries. Mostly, hepatic abscesses are pyogenic, caused by Staphylococcus aureus, while in extremely rare cases can be caused by parasites, such as Ascaris lumbricoides. Antimicrobial therapy and percutaneous drainage are the treatments of choice, lowering the mortality caused by this infection. We report a case of a 3-year-old girl admitted to the hospital for abdominal pain and a low-grade fever, with abdominal ultrasonography revealing a hepatic lesion. Initial laboratory tests showed moderate anaemia, thrombocytosis, eosinophilia, high inflammatory markers, and normal liver function. A computed tomography scan revealed two liver abscesses located subdiaphragmatically, and a high immunoglobulin E (IgE) value (22,300 U/mL). After excluding other possible etiologies, the patient was tested for parasitic infections. IgE for Ascaris lumbricoides came slightly higher. In addition to empirical antibiotic treatment, the patient received albendazole and made an uneventful recovery, with the full remission of the abscesses and without the need for drainage. In certain cases, parasites such as Ascaris lumbricoides are capable of inducing a T helper 2 (Th2) dominated immune response, predisposing the host to eosinophilia, hyperIgE, and increased susceptibility to bacterial infections. Early diagnosis and treatment in these cases may lead to less invasive therapy options in order to obtain a full recovery. To the best of our knowledge, this is the only reported case in the literature of a paediatric patient with parasite-induced liver abscesses, with extremely high IgE values, minimal symptomatology, that made a fast, full recovery without the need of drainage.
Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in the world, and it is currently estimated that approximately half of the world's population is infected with the bacterium. The correct diagnosis and effective treatment of H. pylori gastric infection are essential in controlling this condition. The available diagnostic methods have advantages and limitations related to factors such as age of patients, technical difficulty level, costs and extensive accessibility in hospitals. The eradication therapy of H. pylori infection is still a challenge for gastroenterologists. One of the main causes of failure in H. pylori eradication is antibiotic resistance. Biopsy cultures are the most widely used methods among the antimicrobial susceptibility tests. In case of a negative culture, H. pylori can be clearly recognised in histological sections. The sensitivity and specificity of histology for the diagnosis depend on clinical settings, density of colonisation and the experience of the histopathologist. A prospective study was performed in order to analyse patients with H. pylori gastric infection with positive histology and positive culture versus positive histology and negative culture.
Hymenolepis diminuta is primarily a rodent parasite that is ubiquitously distributed worldwide, but with only a few cases described as human infections. We report a case of Hymenolepis diminuta infection in a 15-month-old child, living in an urban setting, with no previous medical history. The patient presented with two episodes of seizures, and complaints of abdominal pain, vomiting, and diarrhea, with no apparent history of rodent contact. Furthermore, the patient’s gastrointestinal symptoms were linked to the emission of suspected tapeworm proglottids in the feces. After excluding other possible etiologies, a diagnosis of Hymenolepis diminuta infection was made, based on the examination of characteristic eggs in a concentrated stool specimen. The infant was successfully treated with praziquantel and fully recovered. After two weeks, the stool sample was free of Hymenolepis diminuta eggs. The clinical follow-up over the next 3 years was normal. Hymenolepis diminuta is rarely found in humans, and, when present, the infection is frequently asymptomatic. Abdominal pain, irritability, itching, eosinophilia, and seizures have also been reported. In this paper, we report, for the first time in the literature, an infection with Hymenolepis diminuta in a Romanian infant who had atypical neurological presentation, with full recovery, without subsequent neurological sequelae.
One of the most widespread bacterial infections worldwide, Helicobacter pylori is thought to affect almost half of the world’s population. Due to rising antibiotic resistance, treatment should be tailored according to antibiotic susceptibility testing (AST). This study aims to evaluate Helicobacter pylori antibiotic resistance and its therapeutic efficacy in children. We conducted a prospective, single-center study, that evaluated 68 children referred for upper gastrointestinal endoscopy (UGE) following chronic dyspeptic syndrome. Each patient underwent multiple biopsies to perform bacterial cultures with AST and histopathological examinations for the diagnosis. Patients without antibiotic resistance or negative cultures received a 10-day sequential therapy, while the others had the antibiotic regimen tailored based on AST. Fifty-nine patients with a positive biopsy-based diagnosis (24 males) were finally included. Bacterial cultures with AST were positive for 13 patients (22.03%) and the antibiotic resistance for clarithromycin was 15.38%. Fifty-seven patients were administered sequential therapy with an eradication rate of 94.73%. Clarithromycin-resistant patients were successfully treated with 10-day triple therapy of esomeprazole, amoxicillin, and metronidazole. Although bacterial cultures had a low positivity rate, sequential therapy had a successful eradication rate. Further studies are necessary to better assess Helicobacter pylori antibiotic resistance to provide tailored treatment and identify children that need closer monitoring.
Wilson’s disease (WD) is an autosomal recessive disorder, in which the metabolism of copper is affected by metal accumulation in several organs that causes gradual organ degeneration. Since Wilson’s initial description of WD over a century ago, there have been significant improvements in understanding and managing the condition. Nevertheless, the ongoing gap between the onset of symptoms and diagnosis highlights the difficulties in identifying this copper overload disorder early. Despite being a treatable condition, detecting WD early remains a challenge for healthcare professionals at all levels of care, likely due to its rarity. The key challenge is, therefore, to educate physicians on how to identify atypical or infrequent symptoms of WD, prompting them to consider the diagnosis more carefully. The purpose of our review is to draw attention to the difficulties associated with diagnosing pediatric WD, starting from our personal experience of a complex case and then examining relevant literature. In summary, the diagnosis of WD in children is intricate and requires a heightened level of suspicion to identify this infrequent condition. A thorough evaluation by a multidisciplinary team of physicians, along with genetic testing, histopathologic examination, and specialized imaging studies, may be necessary to confirm the diagnosis and guide treatment.
Background and aimsThe mechanism underlying symptoms in gastroesophageal reflux disease remain to be fully elucidated. Weakly acid reflux and the presence of gas in the refluxing could be relevant in the pathogenesis of symptoms. We aimed to evaluate the role of gas reflux in children evaluated with pH-metry associated with multichannel intraluminal impedance (MII-pH) and analyse there clinical and therapeutical implications.MethodsWe performed a retrospective study. We examined all our recording of patients referred for suspected gastroesophageal reflux disease evaluated with MII-pH and selected the registrations with pathological gas reflux. The limit value for pathological gas reflux was 72.ResultsThirty two children (18 male) were selected for the study, according to protocol, aged between 4 months and 16 years (average age was 3 years and 5 months). Predisposing conditions for gaseous reflux were identified in 24 children: 20 children were diagnosed with alimentary allergies (17 non IgE mediated) and four children with small intestinal bacterial overgrowth detected by determining the level of expired hydrogen, after glucose ingestion. 11 patients were treated with proton pump inhibitors for acid RGE.ConclusionsCombining impedance and pH monitoring improves the detection and characterisation of GER. The majority of children with gaseous reflux were allergic (62.5%), 6.25% of them suffered from constipation. For 31,25% we have not found predisposing conditions causes.
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