Please cite this paper as: Esposito et al. (2012) Impact of viral infections in children with community‐acquired pneumonia: results of a study of 17 respiratory viruses. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00340.x. Background  Little is known about the prevalence of viral infections in children with community‐acquired pneumonia (CAP). Objectives  To describe the clinical and virological data collected from children with radiographically confirmed CAP in whom 17 respiratory viruses were sought in respiratory secretion samples during the acute phase of the disease. Patients and methods  The study involved 592 children with radiographically confirmed CAP whose respiratory secretion samples were tested using the Luminex xTAG Respiratory Virus Panel Fast assay, which simultaneously detects influenza A virus, influenza B virus, respiratory syncytial virus (RSV)‐A and ‐B, parainfluenzavirus‐1, ‐2, ‐3, and ‐4, adenovirus, human metapneumovirus, coronaviruses 229E, NL63, OC43, and HKU1, enterovirus/rhinovirus, and bocavirus. A real‐time PCR assay was used to identify the rhinovirus in the enterovirus/rhinovirus‐positive samples. Results  A total of 435 children (73·5%) were positive for at least one virus: the most frequently detected was RSV, which was found in 188 (31·7%), followed by rhinovirus (n = 144, 24·3%), bocavirus (n = 60, 10·1%), influenza viruses (n = 57, 9·6), and hMPV (n = 49, 8·2%). Viral co‐infections were found in 117 children (19·7% of the enrolled children; 26·9% of those with viral infections). Marginal differences were found between the infections owing to a single virus. Co‐infections showed radiographic evidence of alveolar pneumonia significantly more frequently than single infections (OR 1·72, 95% CI 1·05–2·81). Conclusions  The findings of this study highlight the importance of respiratory viruses (mainly RSV and rhinovirus) in children with CAP and show the characteristics of both the single infections and co‐infections associated with the disease.

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Wolf-Hirschhorn syndrome (WHS) is a rare microdeletion syndrome associated with a characteristic facial appearance, failure to thrive, psychomotor delays, and various major malformations of internal organs; many medical complications have been described (feeding difficulties, epilepsy, hearing problems). Benign or malignant oncologic problems are not a typical feature of the natural history of these patients. We report on two patients with WHS patients in whom hepatic adenoma (HA) were diagnosed during adolescence. The clinical evolution of liver involvement was different between the two. We discuss the possibility of considering HA as a rare medical problem in the follow-up of WHS patients. © 2013 Wiley Periodicals, Inc.

Up to 40% of donor-recipient pairs in SCT have some degree of ABO incompatibility, which may cause severe complications. The aim of this study was to describe available options and survey current practices by means of a questionnaire circulated within the EBMT Pediatric Diseases Working Party investigators. Major ABO incompatibility (donor's RBCs have antigens missing on the recipient's cell surface, towards which the recipient has circulating isohemagglutinins) requires most frequently an intervention in case of bone marrow grafts, as immediate or delayed hemolysis, delayed erythropoiesis and pure red cell aplasia may occur. RBC depletion from the graft (82%), recipient plasma-exchange (14%) were the most common practices, according to the survey. Graft manipulation is rarely needed in mobilized peripheral blood grafts. In case of minor incompatible grafts (donor has isohemagglutinins directed against recipient RBC antigens), isohemagglutinin depletion from the graft by plasma reduction/centrifugation may be considered, but acute tolerability of minor incompatible grafts is rarely an issue. According to the survey, minor ABO incompatibility was either managed by means of plasma removal from the graft, especially when isohemagglutinin titer was above a certain threshold, or led to no intervention at all (41%). Advantages and disadvantages of each method are discussed.

HSCT provides effective treatment for lymphoproliferative disorders in children with primary immunodeficiency To the Editor: Patients affected by primary immunodeficiencies (PIDs) have a well-recognized risk of malignancy. In children, approximately half are of lymphoid origin, representing a 8-to 10-fold increased risk. 1 Within this patient group, lymphoproliferative disorders (LPDs) present specific diagnostic/management challenges, including increased sensitivity to chemotherapy and preexisting comorbidities, making supportive care more challenging and hematopoietic stem cell transplantation (HSCT) more complex. 2 Consequently, overall survival (OS) is 40% to 50%, substantially lower than for children without PIDs. Allogeneic HSCT is a curative treatment option for PIDs, with survival approaching 80% to 90%. 3 Although data on the role of HSCT in patients with PIDs presenting with LPDs are scarce, existing reports are not encouraging, with mortality rates nearing 70%. 4,5 Across UK's

Introduction: Osteonecrosis (ON) is one of the most debilitating sequelae in pediatric patients with ALL, related with front-line, second-line chemotherapy or HSCT. Many studies reported ON incidence and risk factors, but results differ substantially. Clinical significance of radiological findings is not fully established, due to deficiencies in available radiological classifications and a consensus regarding therapeutic approach is still lacking. Recently Niinimäki proposed a new scoring system for ON in oncologic patients (Niinimäki et al., 2015). Materials and methods: 270 consecutive patients enrolled in the AIEOP-BFM ALL 2009 protocol from October 2010 to December 2016 in our institution have been prospectively analysed. Patients were tested with MRI in case of clinical suspicion of ON; a subgroup of 19 out of 39 transplanted patients underwent MRI as screening before HSCT. 168 MRI (average 4 per patient) were reviewed and 318 ON lesions classified according to the Niinimäki score. Steinberg classification was used to evaluate femoral head and specially adapted for convex surfaces of the major joints involved. Surgery mainly consisted of core-decompression +/- bone marrow concentrate autografting. Surgical outcome was assessed by means of quality of life assessment questionnaires (SF-36) and joint specific questionnaires before and 6 months after surgery. Results: Out of 270, 43 patients developed ON (16%); 62% of them were male (p-value 0.42), 63% ≥10 years and 26% ≥15 years (p-value <0.001), 26% T-ALL (p-value 0.01) and 58% high risk (p-value <0.001). 3 out of 4 Ph+ ALL patients, who received additional TKI, developed ON: 1 was younger than 6 years, 2 of 3 underwent surgery for severe ON. A multivariate analysis assess that the risk of ON is 6-fold higher in high risk patients, compared with standard and intermediate risk (HR 6.3; p-value <0.0001), 12-fold higher in patients ≥10 years-old (HR 11.983; p-value <0.0001), while no significant impact of immunophenotype could be demonstrated. Considering ON diagnosis also after relapse and transplant, the risk of ON remains significantly higher in high risk patients (HR 3.2; p-value 0.0005) and in patients ≥10 years-old (HR 9.8; p-value <0.0001), while a significant impact of transplant couldn't be assessed (p-value 0.16). Cumulative incidence of ON at 5-years was 18.9% (SE 2.7) and after censoring patients at relapse and transplant was 14.2% (SE 2.3). At first MRI, knees were involved in 25 patients (58%), hips in 15 (35%), ankles in 22 (52%), shoulders in 3 patients (with available upper limbs MRI), tibial diaphyses in 28 patients (67%). The total number of affected joints was 138, with a median of 3 per patient; the total amount of lesions detected anytime was 399 (median 8 lesions per patient; range 1-22, IQ 5-12). The bilateral involvement of the same joint was found in 8 of the 17 patients with ON of the hip, 26/35 for the knee (74%) and 23/25 (92%) for the ankle, 26/29 (90%) for the tibial diaphysis. The Niinimäki classification allowed to compare different type of ON lesions: convex surface, concave surface, diaphysis. Diaphyseal lesions had virtually no clinical significance, with around 25% of tibial lesions disappearing. Lesions involving concave surfaces had scarce clinical significance, with almost half lesions resolved or improving during follow-up. The lesions of the convex surface were the most severely affected causing the worst disabilities. Niinimaki and Steinberg classifications were not consistent with each other for convex surfaces and the Steinberg scoring better predictive of subsequent disabilities. Seventeen over 43 patients (39%) underwent core decompression, in 10 patients implemented by autologous implantation of bone marrow concentrate. In 9 patients multiple sites underwent surgery during the same procedure (range 1 - 6), the knee was the most involved (19 joints operated). Quality of life and performance status questionnaires, assessed in 10 patients, demonstrated pain reduction and improvement of joint activity after surgery, especially for the knee. Conclusions: ON has a high prevalence in ALL pediatric patients, who generally present with multiple lesions. The most relevant lesions involved convex surfaces, for which the Niinimäki classification lacked in specificity for clinical outcome and a new score system is under evaluation. Core decompression appears as a promising approach also in pediatric patients. Disclosures No relevant conflicts of interest to declare.

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