Intestinal tuberculosis in a child living in a country with a low incidence of tuberculosis: a case report

Background: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn’s disease because a misdiagnosis can have dramatic consequences. Case presentation: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38°C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn’s disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. Conclusion: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron’s disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems

Sirtuin-mediated DNA damage response by modulation of glutamate dehydrogenase activity in Arabidopsis thaliana

Sirtuins, ClassIII NAD-dependent deacetylases, play a central role in many metabolic pathways related to cell survival and are evolutionary conserved from bacteria to mammals. Among the seven human sirtuins, SIRT4 and SIRT6 share homology domains with the two sirtuins present in Arabidopsis thaliana plants, AtSRT2 and AtSRT1 respectively. With the aim to evaluate sirtuin functions in phylogenetically distant organisms, we report data on a corresponding role between Arabidopsis SRT2 and human SIRT4 genes. We find that AtSRT2 is involved in a defence process already known to be regulated by SIRT4. In fact the DNA Damage Response (DDR) in human cells induces SIRT4 that in turn limits proliferation via repression of glutamine metabolism (Jeong et al, Cancer Cell 2013, 23:450). In Arabidopsis seedlings, the induction of DNA damage promotes transcriptional activation of SRT2 gene and decreased activity of glutamate dehydrogenase (GDH), one of the enzymes that catalyze a-ketoglurate (aKG) production from glutamine. As aKG is a major anaplerotic component of TCA cycle in proliferating cells, the decreased GDH activity is coherent with the slowed cell proliferation that we observed. Moreover, in plants knock out for SRT2, GDH activity and cell proliferation are less affected by DNA damage, confirming the role of AtSRT2 in this metabolic pathway

Neonatal osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis

Acute osteomyelitis is a relatively rare disorder in the neonatal period, with considerable morbidity and mortality. Early diagnosis and prompt treatment are essential for a successful outcome. In this report we present a case of acute osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis, observed in a 30-day-old infan

Acute pancreatitis in children and rotavirus infection. Description of a case and minireview

In this article, we describe a case of acute pancreatitis occurred on a 2-year-old boy following rotavirus gastroenteritis. Its characteristics are analyzed and contextualized among those of other 4 cases of pancreatitis associated with rotavirus infection found through a systematic review of the international literature. None of the five children underwent surgery or was referred to an intensive care unit and all the 5 children cured with normalization of pancreatic enzyme within 5-10 days. The pathogenesis of this rare complication remains to be cleared, and its actual incidence may be higher than that reported. Although acute pancreatitis associated with rotavirus gastroenteritis seems to be a mild disease, attention must be paid by the pediatrician fearing possible complications. Rotavirus infection should be amended to the differential diagnosis panel of pancreatitis in toddlers