The high prevalence of viral and mixed viral-bacterial infections supports the notion that the presence of a virus, acting either as a direct or an indirect pathogen, may be the rule rather than the exception in the development of CAP in school-age children requiring hospitalization.

Respiratory syncytial virus (RSV) subtypes A and B are present either simultaneously or alternate during yearly epidemics. It is still not clear whether clinical severity of acute bronchiolitis differs between the two subtypes. Reverse transcription polymerase chain reaction was used to subtype RSV in previously healthy infants hospitalized with RSV bronchiolitis during a winter epidemic. A severity index based on heart rate, respiratory rate, wheezing, difficulty in feeding and oxygen saturation was calculated upon admission. Infants infected with RSV subtype-A were found to have a significantly higher (more severe) clinical score than those infected with RSV-B. There was no statistically significant difference in duration of hospitalization or need of intensive care. Boys and infants younger than 3 months of age were also more severely affected than girls or older infants, respectively. These results support the notion that RSV-A-induced bronchiolitis is more severe than RSV-B-induced one, in agreement with the majority of previously published studies.

New therapies have been introduced for the prophylaxis and treatment of respiratory syncytial virus (RSV) infection in recent years. The aim of the study was to determine the epidemiological and clinical characteristics of infants hospitalized with bronchiolitis in our area. All patients under 1 year of age admitted with acute bronchiolitis during four consecutive RSV seasons from February 1, 1997 to June 30, 2000 were enrolled in the study. The records of patients admitted during the first season were reviewed retrospectively while the rest were followed prospectively. A total of 636 infants with bronchiolitis were admitted and RSV infection was documented in 61% of those tested. Admission to intensive care unit (ICU) was required for 6.2% of them and was more common in premature infants (26%) (p < 0.001). Case fatality rate was 0.7% (overall 0.3%). RSV bronchiolitis accounted for about 12% of all infant admissions during the 5 months of the yearly outbreak. Patients with documented RSV infection had a more severe illness with a higher ICU admission rate (6 vs. 1%, p = 0.008) and longer duration of hospitalization (mean 6.3 vs. 5.3 days, p < 0.001) compared to those who tested negative. Although none of the patients had a positive blood culture on admission a considerable number of them (210/636, 33%) were treated with antibiotics. RSV infection has a significant impact on infant morbidity in our settings which is more serious among those born prematurely. Documentation of RSV infection may be a marker of more severe illness in infants hospitalized with bronchiolitis. Antibiotic use has to be restricted since the occurrence of a serious bacteraemic illness on admission is a very rare event.

EBV seroprevalence is higher in children with AITD compared to controls and the underlying pathology remains to be elucidated.

Current practice favors serotesting adolescents with a negative history of chickenpox rather than offering presumptive vaccination. Recent epidemiologic data from Greece indicate that a high proportion of adolescents (21.5%) are susceptible to chickenpox. We assessed the reliability of negative varicella history in relation to type of exposure in 311 children and 283 adolescents. In children with social or unknown exposure to varicella, a negative history had a high negative predictive value (NPV = 73.5), supporting the clinical practice of presumptive vaccination. Conversely, children with a negative history and household exposure had a low NPV (13.8), suggesting that pre-vaccination serologic testing is warranted. In conclusion, based on our local epidemiologic data, presumptive varicella vaccination should be offered to all adolescents with the exception of the subgroup of adolescents with household exposure.

We conclude that RSV appears to be an important contributing factor for the occurrence of AOM in young children hospitalized with respiratory distress. The occurrence of a second episode of acute respiratory distress did not appear to correlate with the previous RSV infection, but longer-term follow-up is required.

A 13-year-old girl presented with a 15 day history of fever, left cervical lymphadenopathy and arthralgia of the left hip that started 4 days after the fever. She received treatment with clarithromycin for 4 days without improvement.Her past medical history was unremarkable. She admitted having recent contact with young cats.Physical examination indicated left cervical lymphadenopathy (1.5 ¥ 2 cm) and painful left hip without other signs of inflammation or any scratch site on her skin. Plain hip radiograph was normal. Left hip ultrasound showed a small anechoic joint effusion, which had disappeared 5 days later, excluding the possibility of septic arthritis.Scintigram with 99m Tc-MDP showed increased uptake in the left acetabulum (phase II and III), suggesting an inflammatory process.The serology findings and the clinical presentation confirmed the diagnosis of acute Bartonella infection (Table 1). Abdominal ultrasound indicated a normal size spleen with four hypoechoic small lesions that were considered to be abscesses. The patient received an alternative treatment of choice with ceftriaxone for 10 days. On the second day of treatment the fever and the hip pain resolved. The patient was discharged after 10 days with all infectious markers being negative. One month later a serology repeat for Bartonella henselae indicated seroconversion (IgM: negative, IgG > 1/1024). A second abdominal ultrasound showed a decrease in the size of all abscesses (diameter < 3 mm).Cat-scratch disease (CSD) is a common infectious disease caused by B. henselae. Cats are the main reservoir, with up to 50% of domestic cats having antibodies to B. henselae. 1 Karpathios et al. reported that 75% of patients had an identifiable lesion on the skin. Typical CSD affects young people and consists of fever and isolated lymphadenopathy that is proximal to the inoculation site and which resolves within 2-4 weeks. 2 Atypical presentations occur in approximately 10% of patients, and include Parinaud's oculoglandular syndrome, optic neuritis, transverse myelitis, granulomatous hepatitis, skin rashes, osteolytic lesions, arthritis and splenic involvement, which can result in spontaneous rupture. 2,3 Arthropathy begins concurrently with or within 1 week of the appearance of lymphadenopathy. 4 The most frequently affected joints are the knee, ankle, elbow, and wrist. In the present patient arthritis/arthralgia lasted for 14 days and was considered reactive because there was not a scratch site and the hip ultrasonography did not show a significant amount of fluid. CSD-associated arthropathy is uncommon and affects young and middle-aged women. It is often severe and may have a chronic course. Carithers described 1200 patients with CSD, mostly children, none of whom was reported to suffer from arthritis/arthralgia. 5 According to the current literature, monoarthritis with splenic abscesses in such a young patient is a very rare and atypical manifestation of CSD. Based on the clinical course and the imaging results, monoarthritis was considered a reactive p...

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