Maria Bitsori - Academia.edu (original) (raw)
Papers by Maria Bitsori
Pediatric nephrology (Berlin, Germany), Jan 16, 2015
Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully... more Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre. The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed. Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 ...
OBJECTIVE.Vesicoureteral reflux (VUR) is a common finding in children presenting with urinary tra... more OBJECTIVE.Vesicoureteral reflux (VUR) is a common finding in children presenting with urinary tract infection (UTI) and prenatally diagnosed urinary tract dilatation and in relatives of index patients. Children with VUR are at risk for ongoing renal damage with subsequent infections. Detecting VUR and renal scarring currently depends on imaging modalities with associated problems of radiation, invasive- ness, and expense. Noninvasive
Archives of Disease in Childhood, 2002
Among 40 children undergoing tonsillectomy for recurrent pharyngitis, 15 (37.5%) had presented pr... more Among 40 children undergoing tonsillectomy for recurrent pharyngitis, 15 (37.5%) had presented preoperatively with complaints compatible with PFAPA syndrome. All 15 had had periodic fever every three to four weeks and pharyngitis; 12 (80%) had cervical adenitis and five (33%) aphthous stomatitis. All children had been well between episodes and showed a dramatic postoperative improvement. PFAPA syndrome is not uncommon
Advances in experimental medicine and biology, 2011
ABSTRACT The term "rickettsiosis" has traditionally included not only diseases ... more ABSTRACT The term "rickettsiosis" has traditionally included not only diseases caused by pathogenic species of the genus Rickettsia but also diseases caused by Orientia, Ehrlichia, Anaplasma and even Coxiella species, which often present with similar clinical manifestations but are now known to belong to diverse genera, families, orders or even classes [1-3] (Fig. 1). Rickettsiae and related pathogens are obligate intracellular Gram-negative coccobacilli and their life-cycle involves small vertebrate hosts and arthropod vectors, with the exception of C. burnetii, which is a zoonosis infecting humans through contaminated soil. Humans are only incidental hosts and do not contribute to the persistence of the organisms in nature, with the exception of R. prowazekii. Identification and classification of these organisms occurred during the twentieth century and is still ongoing, however the diseases have plagued humans since antiquity and often shaped the history of mankind.
International journal of dermatology, 2003
Acta paediatrica (Oslo, Norway : 1992), Jan 2, 2015
Information on the epidemiology of childhood urinary tract infections (UTIs) is scarce and mostly... more Information on the epidemiology of childhood urinary tract infections (UTIs) is scarce and mostly based on retrospective data. This study investigated incidence rates, morbidity and risk factors for UTIs in a prospective cohort of children. We explored UTIs in a representative cohort of 1049 neonates from birth to 6 years of age, using maternal interviews that were verified by hospital records. The majority (88.2%) completed the first-year, and more than half (56.2%) completed the 6-year follow-up. By 6 years of age, more than 10% of our sample had been affected by UTIs. The cumulative incidence for the first year of life was 3.77%, without significant differences between genders, and for one to 6 years, it was 6.81% and 5.7 times higher in girls than boys. Clinical information was available for 63 children: 25 were hospitalised, 16 suffered recurrences, 10 received prophylaxis, eight had urinary tract malformations, three required surgery, and two had impaired renal function. UTIs ...
Acta paediatrica (Oslo, Norway : 1992), 2005
To estimate the vaccination coverage in a sample of adolescents in Greece. Vaccination status was... more To estimate the vaccination coverage in a sample of adolescents in Greece. Vaccination status was estimated in 483 adolescents aged 15-19 y in four prefectures. The criteria for full vaccination were based on the recommendations of the Greek National Vaccination Schedule. The participation rate in the study was 78.7% (380/483 adolescents). The rates of full vaccination were 94.2% for poliomyelitis, 78.4% for hepatitis B, 77.4% for BCG, 65.0% for tetanus and 54.4% for diphtheria. The rates of full vaccination for measles, rubella and mumps were 65.0%, 57.6%, and 56.0%, respectively. For pertussis, the full vaccination rate was only 36.0%, and 7.1% of the study population was totally unvaccinated. The most missed dose for all vaccines was the final booster dose, which is usually administered in older children or adolescents. Adolescent vaccination coverage was not satisfactory in this study, mainly due to non-compliance to the final booster dose. Completion of missing vaccines at this...
Pediatric nephrology (Berlin, Germany), 2005
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery ...
World journal of urology, 2004
The aim is to present how an eminent philosopher perceived, reported and faced his progressing an... more The aim is to present how an eminent philosopher perceived, reported and faced his progressing and ultimately fatal uropathy, 23 centuries ago. All available ancient Greek sources about Epicurus' life and death were used and urinary tract-related medical knowledge in this era was reviewed. Epicurus died at the age of 71 from urinary calculus after having bravely suffered for a long time. Although he is often cited for his teachings against the fear of pain and death, his own way to death has been overlooked. His exceptional description of his own symptoms provides an unusual insight, given that our knowledge on diseases in older times is mainly based on surviving texts written by the then medical practitioners. Epicurus reported on his terminal symptoms, being entirely aware of the fatal outcome of a disease incurable at that time. Very soon after, Ammonius the Lithotomus in Alexandria was to improve the surgical procedures for urinary calculi. In an era when urinary tract surge...
BMJ (Clinical research ed.), Jan 21, 2002
Gustav Klimt was the second of seven children born to a family of gold engravers who had immigrat... more Gustav Klimt was the second of seven children born to a family of gold engravers who had immigrated to Vienna from Bohemia. In 1876, at the age of 14, he was admitted with distinction to the Kunstgewerbeschule, the public school of arts and crafts. Gustav, his younger brother ...
BMC musculoskeletal disorders, 2001
Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents ... more Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure. We report a case of polymyositis and myocarditis in a 13-year old immunocompetent girl with toxoplasmosis. The patient presented with proximal muscle weakness, dysphagia, palms and soles rash and elevated serum levels of muscle enzymes, with liver and myocardial involvement. The diagnosis of toxoplasmosis was confirmed by serology. The patient was treated with prednisolone and had an excellent outcome. During a follow-up period of four years no relapses occurred and antibody levels to the T. gondii significantly decreased. Although several previous cases of toxoplasmosis occuring in association with polymyositis have been described in the literatur...
Scandinavian Journal of Infectious Diseases
Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonell... more Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonellae species; however, several invasive cases have previously been reported. We report 3 cases of otherwise healthy children with S. virchow bacteraemia, monoarthritis and prevertebral abscess, only 1 of whom had previously had gastroenteritis. All 3 children responded to antibiotic regimens consisting of cefotaxime for 10 d, ceftriaxone for 3 weeks and ceftriaxone plus clindamycin for 4 weeks, respectively. In conclusion, S. virchow may be a more invasive serotype in immunocompetent children and present with a wider spectrum of manifestations than considered previously.
Pediatrics International, 2008
Pediatric Nephrology, 2011
Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as i... more Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as in vesicoureteral reflux (VUR) even in the absence of infection. In this study we further investigated urine IL-8 in infants with congenital anomalies of the kidneys and urinary tract and with antenatally diagnosed isolated pelvic dilatation. Urine IL-8 was measured in 159 infants aged 1 month to 1 year with acute UTI (group A, n = 26), resolved UTI (group B, n = 16), VUR without recent UTI (group C, n = 44), non-VUR congenital urinary anomalies without recent UTI (group D, n = 30), isolated antenatal pelvic dilatation (group E, n = 14) and in infants without known urinary tract condition (control group F, n = 29). Median values of urine IL-8/creatinine levels were 61.5, 4.64, 15.5, 14.3, 1.06 and 4.19 pg/μmol in groups A, B, C, D, E and F respectively. Compared with the control group, urine IL-8 was elevated in infants with acute UTI, VUR without acute UTI and congenital anomalies without acute UTI (p < 0.0001; p < 0.005; and p = 0.027 respectively), but not in infants with resolved UTI or with antenatal pelvic dilatation. Urine IL-8 levels are elevated in a variety of infectious and non-infectious urinary tract conditions, and hence may serve as a sensitive but not specific screening biomarker of urinary tract diseases.
Pediatric Surgery International, 2005
The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, ... more The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, usually monozygotic, have been sporadically reported as evidence for the genetic origin of the disease. We present a case of IHPS in a pair of dizygotic male twins together with a review of the literature, focusing on the question of whether the twin cases actually support a
World Journal of Urology, 2004
The aim is to present how an eminent philosopher perceived, reported and faced his progressing an... more The aim is to present how an eminent philosopher perceived, reported and faced his progressing and ultimately fatal uropathy, 23 centuries ago. All available ancient Greek sources about Epicurus' life and death were used and urinary tract-related medical knowledge in this era was reviewed. Epicurus died at the age of 71 from urinary calculus after having bravely suffered for a long time. Although he is often cited for his teachings against the fear of pain and death, his own way to death has been overlooked. His exceptional description of his own symptoms provides an unusual insight, given that our knowledge on diseases in older times is mainly based on surviving texts written by the then medical practitioners. Epicurus reported on his terminal symptoms, being entirely aware of the fatal outcome of a disease incurable at that time. Very soon after, Ammonius the Lithotomus in Alexandria was to improve the surgical procedures for urinary calculi. In an era when urinary tract surgery was considered to be an extraordinary means of treatment, Epicurus peacefully passed away, firm to his own teachings about tolerance to disease and pain, and leaving to us both an unusual medical record and a courageous attitude towards suffering and death.
Scandinavian Journal of Infectious Diseases, 2002
Ochrobactrum anthropi is an emerging pathogen in immunocompromised patients but infections with t... more Ochrobactrum anthropi is an emerging pathogen in immunocompromised patients but infections with the bacterium have very rarely been documented in normal hosts. We report the characteristics of O. anthropi bacteraemia in 11 immunocompetent children, aged 2 months to 7 y, hospitalized in a general hospital during a 5-y period. Children commonly presented with fever, non-specific respiratory or gastrointestinal manifestations, leukocytosis and neutrophilia and had a rapid recovery, even when they did not receive a specific treatment. In 10 cases positive blood cultures were obtained on admission and in all cases subsequent cultures were sterile. In conclusion, O. anthropi may cause bacteraemia in immunocompetent hosts, although further studies are required to clarify whether these isolates represent pseudobacteraemia or whether O. anthropi is a potential pathogen of low virulence.
Pediatric Nephrology, 2005
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gramnegative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
Pediatric Nephrology, 2014
The aim of this study was to identify long-term resistance trends of uropathogens and determine t... more The aim of this study was to identify long-term resistance trends of uropathogens and determine the effect of prophylaxis in a pediatric patient population. A total of 638 uropathogens were isolated from urine samples collected from children hospitalized for urinary tract infection during the 12-year study period (1997-2008) and analyzed. The most frequent uropathogen identified was Escherichia coli (69 %), followed by Klebsiella spp. (9.7 %), Pseudomonas aeruginosa (6.7 %), Enterococcus spp. (5.6 %), and Proteus spp. (4.4 %). High resistance rates were observed for common agents used for empiric treatment, such as amoxicillin, cotrimoxazole, and ceftriaxone. Resistance increased over time for nitrofurantoin, ceftriaxone, and piperacilin-tazobactam (chi-square for trend p < 0.0002, p < 0.0034 and p < 0.014, respectively) and decreased for cefuroxime (p < 0.016) and gentamicin (p < 0.014). The use of prophylaxis was related to an increased proportion of non-E. coli pathogens (46.9 vs. 26.9 %; odds ratio 2.4, 95 % confidence interval 1.61-3.55; p < 0.0001), as well as to increased resistance of non-E. coli pathogens, and was a major risk factor associated with resistance to amoxiclav (p < 0.005), cotrimoxazole (p < 0.0001), cefuroxime (p < 0.0001), ceftriaxone (p < 0.0001), gentamicin (p < 0.0001), and nitrofurantoin (p < 0.0001). Our findings point to considerable changes in the long-term resistance patterns of uropathogens and an association of prophylaxis with resistance. Our results suggest the need for continuous surveillance, re-evaluation of empiric regimens and further assessment of the role of prophylaxis in the treatment of urinary tract infection.
Pediatric Nephrology, 2009
The aim of this study was to investigate the prevalence trends and risk factors for urinary tract... more The aim of this study was to investigate the prevalence trends and risk factors for urinary tract infection (UTI) caused by Enterobacteriaceae resistant to broadspectrum β-lactams in children. All Enterobacteriaceae uropathogens from children <15 years during the 11-year period 1997-2007 were included, and risk factors were evaluated. Of 523 Enterobacteriaceae isolated from 473 children, 30 (5.73%) were phenotypically resistant to broad-spectrum β-lactams (18 Escherichia coli, ten Klebsiella spp, one Enterobacter spp, and one Citrobacter spp). The prevalence of resistance increased during the study period (p=0.031). Resistance to cefoxitin was common (26/ 30), pointing to AmpC enzyme expression, and 2/30 isolates were resistant to carbapenems. Resistant Enterobacteriaceae were often community acquired (22/30, 73.3%) and related to male gender (p<0.05), urinary tract abnormalities (p < 0.05), prophylactic antibiotics (p < 0.0001), longer hospitalization (p<0.001), and UTI recurrences (p <0.001). Co-resistance was more likely for cotrimoxazole, gentamicin, and ciprofloxacin (p<0.0001).
Pediatric nephrology (Berlin, Germany), Jan 16, 2015
Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully... more Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre. The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed. Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 ...
OBJECTIVE.Vesicoureteral reflux (VUR) is a common finding in children presenting with urinary tra... more OBJECTIVE.Vesicoureteral reflux (VUR) is a common finding in children presenting with urinary tract infection (UTI) and prenatally diagnosed urinary tract dilatation and in relatives of index patients. Children with VUR are at risk for ongoing renal damage with subsequent infections. Detecting VUR and renal scarring currently depends on imaging modalities with associated problems of radiation, invasive- ness, and expense. Noninvasive
Archives of Disease in Childhood, 2002
Among 40 children undergoing tonsillectomy for recurrent pharyngitis, 15 (37.5%) had presented pr... more Among 40 children undergoing tonsillectomy for recurrent pharyngitis, 15 (37.5%) had presented preoperatively with complaints compatible with PFAPA syndrome. All 15 had had periodic fever every three to four weeks and pharyngitis; 12 (80%) had cervical adenitis and five (33%) aphthous stomatitis. All children had been well between episodes and showed a dramatic postoperative improvement. PFAPA syndrome is not uncommon
Advances in experimental medicine and biology, 2011
ABSTRACT The term "rickettsiosis" has traditionally included not only diseases ... more ABSTRACT The term "rickettsiosis" has traditionally included not only diseases caused by pathogenic species of the genus Rickettsia but also diseases caused by Orientia, Ehrlichia, Anaplasma and even Coxiella species, which often present with similar clinical manifestations but are now known to belong to diverse genera, families, orders or even classes [1-3] (Fig. 1). Rickettsiae and related pathogens are obligate intracellular Gram-negative coccobacilli and their life-cycle involves small vertebrate hosts and arthropod vectors, with the exception of C. burnetii, which is a zoonosis infecting humans through contaminated soil. Humans are only incidental hosts and do not contribute to the persistence of the organisms in nature, with the exception of R. prowazekii. Identification and classification of these organisms occurred during the twentieth century and is still ongoing, however the diseases have plagued humans since antiquity and often shaped the history of mankind.
International journal of dermatology, 2003
Acta paediatrica (Oslo, Norway : 1992), Jan 2, 2015
Information on the epidemiology of childhood urinary tract infections (UTIs) is scarce and mostly... more Information on the epidemiology of childhood urinary tract infections (UTIs) is scarce and mostly based on retrospective data. This study investigated incidence rates, morbidity and risk factors for UTIs in a prospective cohort of children. We explored UTIs in a representative cohort of 1049 neonates from birth to 6 years of age, using maternal interviews that were verified by hospital records. The majority (88.2%) completed the first-year, and more than half (56.2%) completed the 6-year follow-up. By 6 years of age, more than 10% of our sample had been affected by UTIs. The cumulative incidence for the first year of life was 3.77%, without significant differences between genders, and for one to 6 years, it was 6.81% and 5.7 times higher in girls than boys. Clinical information was available for 63 children: 25 were hospitalised, 16 suffered recurrences, 10 received prophylaxis, eight had urinary tract malformations, three required surgery, and two had impaired renal function. UTIs ...
Acta paediatrica (Oslo, Norway : 1992), 2005
To estimate the vaccination coverage in a sample of adolescents in Greece. Vaccination status was... more To estimate the vaccination coverage in a sample of adolescents in Greece. Vaccination status was estimated in 483 adolescents aged 15-19 y in four prefectures. The criteria for full vaccination were based on the recommendations of the Greek National Vaccination Schedule. The participation rate in the study was 78.7% (380/483 adolescents). The rates of full vaccination were 94.2% for poliomyelitis, 78.4% for hepatitis B, 77.4% for BCG, 65.0% for tetanus and 54.4% for diphtheria. The rates of full vaccination for measles, rubella and mumps were 65.0%, 57.6%, and 56.0%, respectively. For pertussis, the full vaccination rate was only 36.0%, and 7.1% of the study population was totally unvaccinated. The most missed dose for all vaccines was the final booster dose, which is usually administered in older children or adolescents. Adolescent vaccination coverage was not satisfactory in this study, mainly due to non-compliance to the final booster dose. Completion of missing vaccines at this...
Pediatric nephrology (Berlin, Germany), 2005
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery ...
World journal of urology, 2004
The aim is to present how an eminent philosopher perceived, reported and faced his progressing an... more The aim is to present how an eminent philosopher perceived, reported and faced his progressing and ultimately fatal uropathy, 23 centuries ago. All available ancient Greek sources about Epicurus' life and death were used and urinary tract-related medical knowledge in this era was reviewed. Epicurus died at the age of 71 from urinary calculus after having bravely suffered for a long time. Although he is often cited for his teachings against the fear of pain and death, his own way to death has been overlooked. His exceptional description of his own symptoms provides an unusual insight, given that our knowledge on diseases in older times is mainly based on surviving texts written by the then medical practitioners. Epicurus reported on his terminal symptoms, being entirely aware of the fatal outcome of a disease incurable at that time. Very soon after, Ammonius the Lithotomus in Alexandria was to improve the surgical procedures for urinary calculi. In an era when urinary tract surge...
BMJ (Clinical research ed.), Jan 21, 2002
Gustav Klimt was the second of seven children born to a family of gold engravers who had immigrat... more Gustav Klimt was the second of seven children born to a family of gold engravers who had immigrated to Vienna from Bohemia. In 1876, at the age of 14, he was admitted with distinction to the Kunstgewerbeschule, the public school of arts and crafts. Gustav, his younger brother ...
BMC musculoskeletal disorders, 2001
Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents ... more Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure. We report a case of polymyositis and myocarditis in a 13-year old immunocompetent girl with toxoplasmosis. The patient presented with proximal muscle weakness, dysphagia, palms and soles rash and elevated serum levels of muscle enzymes, with liver and myocardial involvement. The diagnosis of toxoplasmosis was confirmed by serology. The patient was treated with prednisolone and had an excellent outcome. During a follow-up period of four years no relapses occurred and antibody levels to the T. gondii significantly decreased. Although several previous cases of toxoplasmosis occuring in association with polymyositis have been described in the literatur...
Scandinavian Journal of Infectious Diseases
Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonell... more Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonellae species; however, several invasive cases have previously been reported. We report 3 cases of otherwise healthy children with S. virchow bacteraemia, monoarthritis and prevertebral abscess, only 1 of whom had previously had gastroenteritis. All 3 children responded to antibiotic regimens consisting of cefotaxime for 10 d, ceftriaxone for 3 weeks and ceftriaxone plus clindamycin for 4 weeks, respectively. In conclusion, S. virchow may be a more invasive serotype in immunocompetent children and present with a wider spectrum of manifestations than considered previously.
Pediatrics International, 2008
Pediatric Nephrology, 2011
Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as i... more Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as in vesicoureteral reflux (VUR) even in the absence of infection. In this study we further investigated urine IL-8 in infants with congenital anomalies of the kidneys and urinary tract and with antenatally diagnosed isolated pelvic dilatation. Urine IL-8 was measured in 159 infants aged 1 month to 1 year with acute UTI (group A, n = 26), resolved UTI (group B, n = 16), VUR without recent UTI (group C, n = 44), non-VUR congenital urinary anomalies without recent UTI (group D, n = 30), isolated antenatal pelvic dilatation (group E, n = 14) and in infants without known urinary tract condition (control group F, n = 29). Median values of urine IL-8/creatinine levels were 61.5, 4.64, 15.5, 14.3, 1.06 and 4.19 pg/μmol in groups A, B, C, D, E and F respectively. Compared with the control group, urine IL-8 was elevated in infants with acute UTI, VUR without acute UTI and congenital anomalies without acute UTI (p &amp;amp;amp;amp;amp;amp;amp;lt; 0.0001; p &amp;amp;amp;amp;amp;amp;amp;lt; 0.005; and p = 0.027 respectively), but not in infants with resolved UTI or with antenatal pelvic dilatation. Urine IL-8 levels are elevated in a variety of infectious and non-infectious urinary tract conditions, and hence may serve as a sensitive but not specific screening biomarker of urinary tract diseases.
Pediatric Surgery International, 2005
The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, ... more The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, usually monozygotic, have been sporadically reported as evidence for the genetic origin of the disease. We present a case of IHPS in a pair of dizygotic male twins together with a review of the literature, focusing on the question of whether the twin cases actually support a
World Journal of Urology, 2004
The aim is to present how an eminent philosopher perceived, reported and faced his progressing an... more The aim is to present how an eminent philosopher perceived, reported and faced his progressing and ultimately fatal uropathy, 23 centuries ago. All available ancient Greek sources about Epicurus&amp;amp;amp;amp;amp;amp;amp;#39; life and death were used and urinary tract-related medical knowledge in this era was reviewed. Epicurus died at the age of 71 from urinary calculus after having bravely suffered for a long time. Although he is often cited for his teachings against the fear of pain and death, his own way to death has been overlooked. His exceptional description of his own symptoms provides an unusual insight, given that our knowledge on diseases in older times is mainly based on surviving texts written by the then medical practitioners. Epicurus reported on his terminal symptoms, being entirely aware of the fatal outcome of a disease incurable at that time. Very soon after, Ammonius the Lithotomus in Alexandria was to improve the surgical procedures for urinary calculi. In an era when urinary tract surgery was considered to be an extraordinary means of treatment, Epicurus peacefully passed away, firm to his own teachings about tolerance to disease and pain, and leaving to us both an unusual medical record and a courageous attitude towards suffering and death.
Scandinavian Journal of Infectious Diseases, 2002
Ochrobactrum anthropi is an emerging pathogen in immunocompromised patients but infections with t... more Ochrobactrum anthropi is an emerging pathogen in immunocompromised patients but infections with the bacterium have very rarely been documented in normal hosts. We report the characteristics of O. anthropi bacteraemia in 11 immunocompetent children, aged 2 months to 7 y, hospitalized in a general hospital during a 5-y period. Children commonly presented with fever, non-specific respiratory or gastrointestinal manifestations, leukocytosis and neutrophilia and had a rapid recovery, even when they did not receive a specific treatment. In 10 cases positive blood cultures were obtained on admission and in all cases subsequent cultures were sterile. In conclusion, O. anthropi may cause bacteraemia in immunocompetent hosts, although further studies are required to clarify whether these isolates represent pseudobacteraemia or whether O. anthropi is a potential pathogen of low virulence.
Pediatric Nephrology, 2005
Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals w... more Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gramnegative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
Pediatric Nephrology, 2014
The aim of this study was to identify long-term resistance trends of uropathogens and determine t... more The aim of this study was to identify long-term resistance trends of uropathogens and determine the effect of prophylaxis in a pediatric patient population. A total of 638 uropathogens were isolated from urine samples collected from children hospitalized for urinary tract infection during the 12-year study period (1997-2008) and analyzed. The most frequent uropathogen identified was Escherichia coli (69 %), followed by Klebsiella spp. (9.7 %), Pseudomonas aeruginosa (6.7 %), Enterococcus spp. (5.6 %), and Proteus spp. (4.4 %). High resistance rates were observed for common agents used for empiric treatment, such as amoxicillin, cotrimoxazole, and ceftriaxone. Resistance increased over time for nitrofurantoin, ceftriaxone, and piperacilin-tazobactam (chi-square for trend p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0002, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0034 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.014, respectively) and decreased for cefuroxime (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.016) and gentamicin (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.014). The use of prophylaxis was related to an increased proportion of non-E. coli pathogens (46.9 vs. 26.9 %; odds ratio 2.4, 95 % confidence interval 1.61-3.55; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), as well as to increased resistance of non-E. coli pathogens, and was a major risk factor associated with resistance to amoxiclav (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005), cotrimoxazole (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), cefuroxime (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), ceftriaxone (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), gentamicin (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and nitrofurantoin (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Our findings point to considerable changes in the long-term resistance patterns of uropathogens and an association of prophylaxis with resistance. Our results suggest the need for continuous surveillance, re-evaluation of empiric regimens and further assessment of the role of prophylaxis in the treatment of urinary tract infection.
Pediatric Nephrology, 2009
The aim of this study was to investigate the prevalence trends and risk factors for urinary tract... more The aim of this study was to investigate the prevalence trends and risk factors for urinary tract infection (UTI) caused by Enterobacteriaceae resistant to broadspectrum β-lactams in children. All Enterobacteriaceae uropathogens from children <15 years during the 11-year period 1997-2007 were included, and risk factors were evaluated. Of 523 Enterobacteriaceae isolated from 473 children, 30 (5.73%) were phenotypically resistant to broad-spectrum β-lactams (18 Escherichia coli, ten Klebsiella spp, one Enterobacter spp, and one Citrobacter spp). The prevalence of resistance increased during the study period (p=0.031). Resistance to cefoxitin was common (26/ 30), pointing to AmpC enzyme expression, and 2/30 isolates were resistant to carbapenems. Resistant Enterobacteriaceae were often community acquired (22/30, 73.3%) and related to male gender (p<0.05), urinary tract abnormalities (p < 0.05), prophylactic antibiotics (p < 0.0001), longer hospitalization (p<0.001), and UTI recurrences (p <0.001). Co-resistance was more likely for cotrimoxazole, gentamicin, and ciprofloxacin (p<0.0001).