Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study

Background: Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe. Methods: The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures. Findings: 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4–93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0–80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8–100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis. Interpretation: Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Cat sensitivity: 7 yr audit in children attending a pediatric allergy clinic in north Italy.

Sensitivity to cats and exposure to cat allergen is a common cause of asthma exacerbation in children. To date, there is no data on the prevalence of cat sensitivity in children living in North Italy. Therefore, a 7-yr survey was performed in patients attending an allergy clinic for the first time. Skin prick tests (SPT) for perennial allergens and for pollens relevant to the region were performed in 4,957 children attending the outpatient clinic 1992-1998. A questionnaire on present or past cat ownership was presented to all cat-skin prick test positive children. An evaluation of cat ownership on the general population was made by telephone interview on a random sample of 1,268 families living in the same area. With a 3-mm wheal as a positive cut-off 439 (8.85%) children had a positive SPT to cats. Of these 103 (23.4%) had a cat at home and 336 (76.6%) never had a cat in the house. With a greater positive cut-off(a wheal diameter > or =4 mm) 140 (2.8%) showed a positive SPT to cats of these 35 (25%) had a cat at home and 105 (75%) had only an indirect exposure to the pet. Of the telephone interviewed families; 16% stated they had a cat at home. Cat sensitivity is less prevalent in Italy, in this hospital based population, compared with other European countries and this is in agreement with a lower rate of cat ownership. Cat sensitivity was three times more frequent in children who never had a cat at home, than in children living with cats, when the selected positive cut-off was either a wheal diameter of 3 mm or > or =4 mm. Thus in a population with a low prevalence of cat ownership public exposure seems to be more important than domestic exposure for the development of sensitivity

Adrenal insufficiency after treatment with fluticasone. Data on fluticasone are reassuring but what about doctors\u2019 prescribing?\u201d

No abstract available

The role of house dust mite elimination in the management of childhood asthma: an unresolved issue

Indoor allergens are likely to be direct environmental causes of asthma and mite exposure, and sensitization is the most important environmental risk factor for childhood asthma in temperate zones. Analagous to occupational asthma, allergen avoidance in asthmatic children sensitized and exposed to mite allergens is associated with a reduction in airway hyperresponsiveness and symptoms associated with improvement in lung function. The long-term effect of this strategy needs to be prospectively evaluated considering both the timing and duration of exposure, as well as the timing and duration of removal. In order to be successful, it is important to achieve and maintain a major reduction on allergen levels, for a long period of time

Determination of serum eosinophil cationic protein, eosinophil count, and total lgE in children with different severities of atopic diseases

Eosinophil cationic protein (ECP) levels may be of value in assessing tissue inflammation in atopic diseases. However, conflicting results have been reported regarding levels of serum ECP (s-ECP) and symptom activity in asthma, atopic dermatitis, or allergic rhinitis. To examine s-ECP levels, eosinophil counts and total immunoglobulin E (IgE) in relation to atopic disease activity in a random population of children admitted to hospital for atopic and nonatopic conditions. s-ECP, eosinophil counts, and total IgE were evaluated in all the children admitted, to a pediatric ward, excluding patients treated with systemic steroids. A total of 216 children were studied. Shin prick tests (SPT) and a validated questionnaire for asthma, atopic: dermatitis, and allergic rhinitis were obtained. s-ECP was significantly higher in children with symptomatic atopic disease (19.88 mu g/L) compared with nonatopic control patients (8.58 mu g/L). The levels of s-ECP were also elevated in patients with a positive response to the ISAAC Questionnaire for symptoms of asthma, atopic dermatitis, or rhinitis in the previous 12 months (9.12 mu g/L) or a positive SPT to relevant allergens (8.58 mu g/L), but no symptoms of atopy at the time of examination. Intermediate values of s-ECP were found in children with combined positive SPT and positive response to the ISAAC Questionnaire (13.7 mu g/L), but no symptoms of atopic disease at the time of examination. s-ECP is more elevated in symptomatic atopic subjects than in nonallergic patients. Subjects with latent (nonsymptomatic) allergy conditions show intermediate values probably reflecting allergen exposure and minimal persistent tissue inflammation