Gamma-hydroxybutyrate and cocaine intoxication in a Danish child

GHB intoxication must be considered in children with coma and a suspicion of drug intoxication. Furthermore, mixed intoxication with several substances and the possibility of unpredictable symptom profiles should be anticipated to ensure optimal symptomatic treatment of patients

Evaluation of dual target-specific real-time PCR for the detection of <i>Kingella kingae</i> in a Danish paediatric population

<p><b>Background:</b> We aimed to evaluate the relevance of dual target real-time polymerase chain (PCR) assays targeting the rtxA and cpn60 genes of the paediatric pathogen <i>Kingella kingae</i>. We also studied for the first time the clinical and epidemiological features of <i>K. kingae</i> infections in a Danish population.</p> <p><b>Method:</b> Children with <i>K. kingae</i>-positive cultures were identified from 11,477 children and 86 children younger than 16 years old from whom blood cultures and joint fluid cultures were obtained between January 2010 and November 2016. Results were then compared to microbiological results obtained from 29 joint fluids (28 children) tested by dual target <i>K. kingae</i> real-time PCR from September 2014 to November 2016. Epidemiological data of all children with microbiologically confirmed <i>K. kingae</i> infections were collected.</p> <p><b>Results:</b> From 2010 to 2016, we diagnosed 17 children with microbiological-proven <i>K. kingae</i> infections. During this period, blood cultures from five children and joint fluid cultures from a single child yielded <i>K. kingae</i>. Dual target <i>K. kingae</i> real-time PCR allowed us to increase the diagnostic yield of <i>K. kingae</i> infections by detecting the organism in 12 of 29 (41.4%) specimens. Notably, the 12 real-time PCR-positive specimens were <i>rtxA</i>-positive whereas only 10 (83.3%) were <i>cpn60</i>-positive. PCR-positive children were significantly younger than PCR-negative children (<i>p-</i>value: .01). A significant seasonal variation was found for patients with proven <i>K. kingae</i> infection (<i>p-</i>value: <.001), with a peak in autumn.</p> <p><b>Conclusion:</b> Dual target-specific real-time PCR markedly improved the detection of <i>K. kingae</i> in clinical specimens when compared to culture methods.</p

Atrial standstill presenting as cerebral infarction in a 7-year-old girl

Atrial standstill is a rare arrhythmia defined by the absence of mechanical and electrical activity in the atria. Few cases of atrial standstill have been described in children, none of which have presented with cerebral infarction confirmed by imaging. We report a unique case of a 7-year-old girl presenting with expressive aphasia, central facial palsy and irregular pulse with cerebral infarction secondary to atrial standstill. This case illustrates that cardiogenic cerebral embolism in children can be caused by rare conditions like atrial standstill and should be considered in paediatric patients undergoing evaluation for stroke. There are no established treatment guidelines for atrial standstill. We recommend that treatment be directed towards any potential underlying cause. All patients with atrial standstill should receive long-term oral anticoagulation treatment and a permanent cardiac pacemaker implant to reduce the risk of further strokes or other cardiac events