The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age

Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.

We report three cases of invasive Geotrichum capitatum infection in patients with acute leukemia for which an enzyme-linked immunosorbent assay (ELISA) for Aspergillus galactomannan was positive, with no evidence of aspergillosis. Supernatants obtained from suspensions of 17 G. capitatum strains gave positive reactions with the Aspergillus galactomannan ELISA. These clinical and laboratory data seem to suggest that G. capitatum produces a soluble antigen that is cross-reactive with Aspergillus galactomannan.Aspergillus galactomannan detection by a sandwich enzymelinked immunosorbent assay (ELISA) is widely used throughout the world in diagnosing invasive aspergillosis, and it has been introduced among the international microbiological criteria for the diagnosis of this fungal infection in immunocompromised hosts (2, 11). A major problem with the detection of circulating galactomannan is the occurrence of false-positive results, which, in some cases, have been shown to be related to cross-reactivity with other opportunistic fungi (11). We report cases of three acute-leukemia patients who developed disseminated infection by Geotrichum capitatum for which ELISA for Aspergillus galactomannan was positive, with no evidence of aspergillosis.Patient 1 was a 7-year-old child with acute lymphoblastic leukemia in second relapse who underwent salvage chemotherapy in February 2004. Ten days after this treatment, the patient developed fever and periorbital edema; broad-spectrum antibiotics and liposomal amphotericin B were administered. A week later, several serum samples were positive for galactomannan antigen and caspofungin was added. A computedtomography scan showed an abscess of the cerebral base starting from the ethmoidal plan and involving the hypophyseal region. Therefore, a surgical debridement was performed; G. capitatum was isolated from samples of pus, liquor, and bone (identification was performed with the VITEK system [bioMerieux Italia, Rome, Italy]). Galactomannan antigen was detected in the pus. Histology of a bone fragment disclosed necrotic tissue in which mycotic invasion was evident. On periodic acid-Schiff-and Grocott-stained sections, the fungi consisted of septate hyphae, slightly bent with parallel disposition and only occasional branching at a wide acute angle or budding at a right angle. A few spores and fragmentation of the mycelium in arthroconidia were also observed. Caspofungin was replaced with voriconazole. Within a few days, the patient's clinical condition improved and galactomannan antigen, for which tests were previously constantly positive, disappeared from the blood. Two months after surgery, while under voriconazole treatment, the child underwent two consecutive aploidentical bone marrow transplants from his father and his mother, but after a few weeks, the child died from sepsis of an unknown origin. Serum galactomannan antigen was no longer detected.Patient 2 was a 9-year-old girl with a diagnosis of myelodysplasia secondary to acute lymphoblastic leukemia and who underwent an allog...

IMPORTANCESevere gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome.

This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2-3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2-3 weeks leads to a rapid clinical response and a definitive clearance of infection.