We reviewed cases of mastitis in infants treated at Children's Healthcare of Atlanta from 2005 to 2011. Among infants with breast cultures, Staphylococcus aureus was the most common cause. No infant with a positive breast culture had a concordant positive culture elsewhere. Our findings argue that urine, blood and spinal fluid cultures are unnecessary in well-appearing afebrile infants with mastitis.
We conducted a retrospective review of electronic medical records of all cases of bacterial meningitis in neonates and young infants at our institution from 2004 to 2014. Fifty-six cases were identified. The most common causative organism was group B streptococcus, followed by Escherichia coli and then Listeria monocytogenes. Forty-four of the 56 patients in the study had abnormalities of the blood white blood cell (WBC) count. The most common WBC count abnormalities were leukopenia and elevation of the immature to total (I:T) neutrophil ratio. Six patients in the case series lacked cerebrospinal fluid (CSF) pleocytosis. Overall, just 3 of the 56 patients had normal WBC count with differential, CSF WBC count, and urinalysis. Only 1 of the 56 patients was well appearing with all normal lab studies. Our study indicates that bacterial meningitis may occur without CSF pleocytosis but very infrequently occurs with all normal lab studies and well appearance.
We reviewed the characteristics of infants <3 months of age with central nervous system herpes simplex virus infection at our institution. Twenty-six cases were identified. The age range was 4-73 days. Most infants presented with fever, seizure activity and skin lesions. The blood herpes simplex virus polymerase chain reaction was positive in 91% of patients tested. Suppressive oral acyclovir therapy was likely helpful in preventing disease recurrence.
A case of primary adenocarcinoma of the small intestine metastazing to the ovary is described. The patient was erroneously thought to suffer from a primary ovarian malignancy. To avoid unnessessary surgery, severe gastrointestinal symptoms in a patient thought to have an ovarian cancer should warn the surgeon against a possible gastrointestinal cancer.
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