Unusual osseous presentation of blastomycosis in an immigrant child: a challenge for European pediatricians.

Blastomycosis, caused by the thermally dimorphic fungus Blastomyces dermatitidis is a systemic pyogranulomatous infection, endemic in United States and Canada, with few reported cases in Africa and Asia. It is uncommon among children and adolescents, ranging from 3% to 10%. Clinical features vary from asymptomatic spontaneously healing pneumonia, through acute or chronic pneumonia, to a malignant appearing lung mass. Blastomycosis can originate a "metastatic disease" in the skin, bones, genitourinary tract and central nervous system. Bone is the third most common site of blastomycotic lesions, after lung and skin. Bones may be involved in 14-60% of cases of blastomycosis. Direct visualization of single broadbased budding yeast with specific stains in sputum or tissue samples at microscopy is the primary method for diagnosis, while culture is timeconsuming and other methods are unreliable. CASE PRESENTATION: We report a case of severe osteoarticular Blastomycosis occurring in a 3-years-old presented to our Emergency Department with pain and swelling of the left knee, successfully treated with surgical curettage and antifungal therapy. To our knowledge this is the first case reported in Europe. CONCLUSIONS: Blastomycosis represents a challenge for European physicians, and it should be included in the differential diagnosis of unexplained infections in patients coming from endemic areas

Pediatric tuberculosis in Italian children: Epidemiological and clinical data from the Italian register of pediatric tuberculosis

Tuberculosis (TB) is one of the leading causes of death worldwide. Over the last decades, TB has also emerged in the pediatric population. Epidemiologic data of childhood TB are still limited and there is an urgent need of more data on very large cohorts. A multicenter study was conducted in 27 pediatric hospitals, pediatric wards, and public health centers in Italy using a standardized form, covering the period of time between 1 January 2010 and 31 December 2012. Children with active TB, latent TB, and those recently exposed to TB or recently adopted/immigrated from a high TB incidence country were enrolled. Overall, 4234 children were included; 554 (13.1%) children had active TB, 594 (14.0%) latent TB and 3086 (72.9%) were uninfected. Among children with active TB, 481 (86.8%) patients had pulmonary TB. The treatment of active TB cases was known for 96.4% (n = 534) of the cases. Overall, 210 (39.3%) out of these 534 children were treated with three and 216 (40.4%) with four first-line drugs. Second-line drugs where used in 87 (16.3%) children with active TB. Drug-resistant strains of Mycobacterium tuberculosis were reported in 39 (7%) children. Improving the surveillance of childhood TB is important for public health care workers and pediatricians. A non-negligible proportion of children had drug-resistant TB and was treated with second-line drugs, most of which are off-label in the pediatric age. Future efforts should concentrate on improving active surveillance, diagnostic tools, and the availability of antitubercular pediatric formulations, also in low-endemic countries

Unusual osseous presentation of blastomycosis in an immigrant child: a challenge for European pediatricians

Abstract Background Blastomycosis, caused by the thermally dimorphic fungus Blastomyces dermatitidis is a systemic pyogranulomatous infection, endemic in United States and Canada, with few reported cases in Africa and Asia. It is uncommon among children and adolescents, ranging from 3% to 10%. Clinical features vary from asymptomatic spontaneously healing pneumonia, through acute or chronic pneumonia, to a malignant appearing lung mass. Blastomycosis can originate a "metastatic disease" in the skin, bones, genitourinary tract and central nervous system. Bone is the third most common site of blastomycotic lesions, after lung and skin. Bones may be involved in 14-60% of cases of blastomycosis. Direct visualization of single broadbased budding yeast with specific stains in sputum or tissue samples at microscopy is the primary method for diagnosis, while culture is timeconsuming and other methods are unreliable. Case presentation We report a case of severe osteoarticular Blastomycosis occurring in a 3-years-old presented to our Emergency Department with pain and swelling of the left knee, successfully treated with surgical curettage and antifungal therapy. To our knowledge this is the first case reported in Europe. Conclusions Blastomycosis represents a challenge for European physicians, and it should be included in the differential diagnosis of unexplained infections in patients coming from endemic areas.</p

Se non è Guillain-Barré... ?!?

La MAT è una sindrome clinica neurologica provocata da infiammazione del midollo spinale, monofasica e monofocale, che si presenta isolatamente o nell’ambito di un’altra malattia (infettiva, autoimmune, infiammatoria, demielinizzante, neoplastica, paraneoplastica, vascolare). L’esordio è improvviso, con deficit neurologico (a rapida evoluzione, dipendente dal livello midollare interessato), dolore addominale o lombare, debolezza e parestesie degli arti inferiori, compromissione della sensibilità termo-dolorifica al di sotto del livello interessato e disfunzioni autonomiche. Il trattamento specifico è rappresentato da alte dosi di cortisosteroidi, associate a terapia di supporto di eventuali disturbi autonomici e a fisioterapia, da intraprendere precocemente. L’esame neuroradiologico consente la diagnosi di MAT tra le patologie a presentazione simile (Sdr. di Guillain-Barré, neoplasie del midollo spinale e dell’osso, Sdr. della cauda equina e cono midollare, disturbo demielinizzante, malformazioni vascolari), fornendo gli strumenti per l’opportuno intervento terapeutico

PARA-PARESI: UN RARO ESORDIO DI LINFOMA DI HODGKIN.

Il linfoma di Hodgkin (LH) è una patologia linfoproliferativa a cellule B, con peculiari caratteristiche cliniche, istologiche e immunofenotipiche. La patologia può diffondere dai linfonodi paravertebrali attraverso i forami intervertebrali in regione toracica o addominale causando compressione spinale. In casi rari può esordire con dolore, indebolimento degli arti inferiori e deficit sensitivi con successiva perdita del controllo degli sfinteri e para-paresi. Tale sintomatologia è più frequente nel decorso di malattia. Queste forme sono altamente resistenti alla chemioterapia