Guillain-Barrè syndrome (GBS) refers to a group of immune-mediated, rapidly progressive polyneuropathies. Before the clinical onset, most patients present with potentially triggering events in their history, including infections and vaccinations. The commonly accepted pathogenic mechanism is an autoimmune response targeting the axons and myelin of peripheral nerves. Diagnosis is based on clinical criteria, though it may be supported by consistent laboratory, neurophysiological and neuroradiological findings, increasing diagnostic reliability. Due to its sudden and invalidating onset, GBS represents a possible cause of access to the emergency room. Therefore, physicians must take into account GBS clinical heterogeneity to promote an early diagnosis and promptly start acute phase treatment and supportive therapies
Croup or laryngitis is the most common cause of acute stridor in childhood. It accounts for 15% of pediatric respiratory admission in the emergency department (ED). Most children presenting with an acute onset of barky cough, stridor and indrawing have croup. The differential diagnosis, among other forms of acute obstruction of the larynx (e.g., epiglottitis, foreign body, angioneurotic oedema of the epiglottis), is essential and lifesaving. Corticosteroids are the mainstay of treatment in children with croup of all levels of severity. Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup. Patient management remains of fundamental importance, is necessary to keep children calm by ensuring a relaxed and reassuring atmosphere to minimize oxygen demand and respiratory muscle fatigue
Tick-borne diseases are increasing compared to the past. This group includes various clinical conditions such as Lyme disease, Rocky Mountain spotted fever (RMSF), ehrlichiosis, anaplasmosis, babesiosis, tularemia, Colorado tick fever, and relapsing tick-borne fever. The difficulty is that the symptoms of many tick-borne infections are similar to the common childhood illnesses. Therefore, identifying the location of exposure or the feature of the rash or the identification of tick vector can help us identify the specific disease and recognize, treat, and prevent the complications of these pathologies
Infective endocarditis (IE) is an infection of the endocardium and/or heart valves. Although more common in adults than in children, it is important to identify and treat IE because of its significant morbidity and mortality. This review summarizes the main features involved in the IE pathogenesis and treatment to reduce and prevent IE risk. A comprehensive search of published literature using the PubMed (HTTP:// www.ncbi.nlm.nih.gov/pubmed/) database was carried out to identify all articles published in English in peer-reviewed journals. The search terms included (“Infective Endocarditis”) AND (“Young” OR “Children” OR “Adolescence”)
Acute pyelonephritis (AP) is the most serious bacterial childhood illness that involves renal parenchyma. The most common germ involved in AP is E. Coli (80-90% of the cases). High temperature over 38°C is a sign of renal parenchyma involvement. It may be associated with other clinical symptoms (vomit, abdominal pain, inappetence, dysuria). AP treatment should be initiated after urine analysis and the diagnosis confirmed by culture. This article reviews the difference between outpatient and nosocomial urinary tract infections patients. A comprehensive search of published literature was carried out to identify all articles published on this topic in English and Italian from 2000 to 2020. Key terms used are Acute pyelonephritis, Childhood, Pediatric Emergency Department, Urinary Tract Infection.
Hemolytic uremic syndrome (HUS) is thrombotic microangiopathy characterized by thrombocytopenia, non-immune microangiopathic hemolytic anemia and acute kidney injury. HUS is usually categorized as typical, caused by Shiga toxin-producing Escherichia Coli (STEC) infection, often associated with diarrhea (D+HUS), as atypical HUS due to dysregulated complement activation, not diarrhea associated (D-HUS, aHUS) or more rarely as secondary forms caused by systemic diseases or physiopathological conditions such as infections, malignancy, pregnancy, autoimmune disease, after transplantation or after drug assumption. The common pathogenetic features in STEC-HUS, aHUS, and secondary HUS are simultaneous damage of endothelial cells, intravascular hemolysis, and activation of platelets leading to a procoagulative state, formation of microthrombi, and tissue damage. HUS can develop in response to several different triggers and various clinical situations. The symptoms and clinical signs may overlap among the different forms of HUS; therefore, early diagnosis and identification of underlying pathogenic mechanisms allow instating specific support measures and therapies.
Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) in the last years, sepsis remains one of the leading causes of morbidity and mortality in newborns worldwide. To date, there is no universally accepted definition for neonatal sepsis, as the consensus definition for pediatric patients is not suited for use in the NICU, and it lacks to address the evaluation of organ dysfunction in the premature population. For this reason and the extreme variability of clinical presentation of sepsis in newborns, diagnosis is not always straightforward. This paper aims to provide an updated overview of the current literature on etiology, clinical presentation, diagnosis, and treatment of neonatal sepsis.
Septic shock is a complex condition that is potentially fatal if not promptly treated. There are significant differences between clinical presentation in adults and children. In neonates, sepsis and septic shock are characterized by a nonspecific presentation that may delay an early diagnosis, thus contributing to high morbidity and mortality. Management of septic shock in the neonatal intensive care unit (NICU) is based on a multidisciplinary approach which includes prompt recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function through the use of fluids and inotropes, if necessary; eradication of the underlying infection through the early administration of empiric broad-spectrum antibiotics; treatment of organ system dysfunction. This article aims to review current knowledge about the correct treatment and management of septic shock in the neonatal setting
Sepsis is one of the most frequent causes of morbidity and mortality in the paediatric age, and its early recognition is important to prevent its lethal outcomes. A great variety of novel serum biomarkers of infection have been investigated in the last decades, although most of the research has been performed in adult patients. We report current knowledge on this topic to assess the diagnostic efficacy of novel biomarkers of infection in paediatric patients.
Lysosomal storage disorders (LSDs) are a group of inborn errors of metabolism (IEM) characterized by multisystemic involvement with multi-organ complications. The recent Covid-19 pandemic had a major impact on the management and treatment of patients with LSDs, who also experienced significant psychological distress following the pandemic. Several experiences described so far demonstrate that telemedicine and home therapy programs are valid tools for the follow-up and care of patients suffering from these complex chronic diseases.
Inborn errors of metabolism (IEM) can present as emergencies during acute metabolic decompensation that requires specific therapies to avoid morbidity and death. Metabolic imbalance is usually precipitated by diet or intercurrent illness, and symptoms are nonspecific, increasing the possibility of a missed diagnosis. The principle of acute management is to stop further decompensation and provide adequate metabolic needs.
Ferritin plays an important role in modulating inflammation and is a significant marker in some life-threatening pathological conditions. Hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndrome (MAS), sepsis, and the more recent multisystem inflammatory syndrome in children (MIS-C) share many clinical and laboratory aspects, including the increase in ferritin levels, so that they are considered hyperferritinemic syndromes. In the pediatric emergency setting, the finding of high ferritin levels if associated with fever requires considering these rare syndromes to start a timely therapy.
Protracted bacterial bronchitis (PBB) is defined based on several parameters: (1) wet cough > 4 weeks, (2) improvement of cough within two weeks of antibiotic therapy, and (3) no signs or symptoms due to other underlying etiologies of chronic cough (“cough pointers”). PBB usually affects predominantly children aged<6 years old and male. The aetiology of PBB remains unknown. Predisposing factors include tracheobronchomalacia, positive bronchoalveolar lavage (BAL) culture for Haemophilus influenza, Streptococcus pneumoniae, or Moraxella catarrhalis. Patients affected by PBB typically have wet coughs, especially upon awakening and during exercise. Thoracic objectivity is negative, and the children’s general conditions are good. Therefore, a diagnostic approach for chronic cough should be oriented according to clinical history; a chest X-ray must be obtained, and spirometry must always be performed. The results of these two tests are usually normal, although a chest X-ray may sometimes show peri-bronchial infiltrates, a common and non-specific finding in childhood. Moreover, in the absence of specific “cough pointers” and when PBB is suspected, a sputum culture must always be obtained before starting antibiotic treatment. A positive result strengthens the diagnosis, although it has a low specificity. If “cough pointers” are present or PBB is suspected, antibiotic therapy is ineffective, and a recurrence of symptoms is observed, other etiologies of chronic cough should be investigated. PBB can lead to chronic pulmonary suppurative disease and bronchiectasis if left untreated. PBB and bronchiectasis share common features; however, it remains to be determined whether inflammation and colonization are the cause or an infection-induced effect. PBB treatment is based on antibiotics which are usually amoxicillin-clavulanate, for two weeks, up to a maximum of four according to the clinical course.
Fungi and non-tuberculous mycobacteria (NTM) are increasingly isolated in the sputum of patients with cystic fibrosis (CF), often representing a diagnostic-therapeutic problem for the clinician. For this, it is essential to start screening programs for these pathogens in all patients with CF, especially in individuals with an otherwise unexplained deterioration of lung function. Infections sustained by these pathogens are also a significant cause of morbidity and mortality in the post-transplant period. Early diagnosis and treatment play a central role in the management of all CF patients
In December 2019, in Wuhan (Hubei, China), the first coronavirus disease 2019 (COVID-19) cases due to severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) have been reported. On March 11th, 2020, the World Health Organization (WHO) declared the pandemic. On July 1st, 2021, more than 180 million people had developed the disease, with more than 3.9 million deaths. In Italy, the most updated data show that, among all cases (n= 4.218.979) and deaths (n=125.058) due to COVID-19, 5.5% (n= 231.338) with 11 deaths concern the 0-9 years age group, while 9.6% (n= 406.460) with 15 deaths concern the 10-19 years age group. This review aims to present a comprehensive overview of COVID-19 in children.
Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory condition of the paranasal sinuses and nasal passage. CRS may significantly compromise patients’ quality of life and may represent an alert sign for other underlying systemic diseases. CRS is now considered an umbrella diagnosis for several diseases with distinct mechanistic pathways (endotypes) and variable clinical presentations (phenotypes). Therefore, it is necessary to integrate medical and surgical skills and evaluate and treat the patient through a multidisciplinary approach. Only two biologicals (omalizumab and dupilumab) are approved in adults with severe CRS with nasal polyps. Clinical trials conducted in children and adolescents are needed to reinforce the strength of available efficacy and safety data of biologic therapies in the adult population and children with CRS with nasal polyps.
Human papillomavirus (HPV) skin infections manifest mainly as cutaneous (CWs) and anogenital warts (AGWs). They are quite frequent in children, and genital infections raise problems concerning the nature of transmission, including the possibility of child sexual abuse. HPV skin infections may resolve spontaneously, and the treatment choice should consider the efficacy and tolerability of different therapies. This paper provides an overview of treatments available in children for CWs and AGWs: cryotherapy, salicylic acid, photodynamic therapy, surgery and mechanical therapies, nitric-zinc complex, podophyllin, imiquimod, intralesional immunotherapy, sinecatechins, topical antivirals, such as cidofovir, and other therapies. HPV vaccines have changed the incidence of HPV-related diseases, especially in HPV-naïve people, but their effectiveness in already infected patients is being investigated.