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Paediatric spondylodiscitis (SD) (discitis) is a rare bacterial infection involving the inter-vertebral disc space and adjacent vertebrae. The non-specific manifestations of SD can lead to delayed diagnosis, which may ultimately result in spinal deformities and even devastating neurological complications. The main purpose of this review is to discuss the epidemiology, clinical, laboratory and radiological features, management and outcome of paediatric SD to help paediatricians recognise and treat this important condition. [ABSTRACT FROM AUTHOR]

Aim: A prospective observational study was conducted to estimate the prevalence of oropharyngeal carriage of Kingella kingae in healthy Australian pre-school children.Methods: Screening for carriage of K. kingae as well as Streptococcus pyogenes, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Haemophilus influenzae, and K. kingae was undertaken using a single bacterial throat swab taken from well children aged 6 months to 4 years. Standard laboratory procedures were used for culture and identification of organisms.Results: One hundred children were enrolled between October and December 2014 at the Children's Hospital at Westmead. Median age was 24.0 months (range 6.1-48.8 months); 52 children were male and 36 attended day-care facilities. Forty-one children had siblings aged less than 5 years and 67 children had siblings of any age. K. kingae oropharyngeal carriage was not detected in any of the children. Rates of carriage of other organisms were: 30% S. aureus, 21% H. influenzae, 2% S. pneumoniae and 2% S. pyogenes. Thirty-eight children were colonised with Kingella denitrificans.Conclusions: Our results suggest that prevalence of K. kingae carriage in pre-school children in Sydney is very low and support local and national guidelines that recommend flucloxacillin as empiric first-line therapy for children with osteoarticular infections. Studies conducted over the winter months and in other Australian centres could help answer outstanding questions regarding differences in carriage rates of K. kingae in children. [ABSTRACT FROM AUTHOR]

The article presents a case study of a six-year-old girl presented with cough, fever and difficulty in breathing for a week with no response to oral amoxicillin. It states that Mycoplasma pneumoniae IgM returned positive on the third day after intubation and ventilation on day two of admission. It also states that antibiotics had been empirically changed to moxifloxacin on day seven given limited clinical improvement and the possibility of macrolide-resistant M. pneumoniae.

Aim: Influenza causes a large burden of disease in children. Point-of-care testing (POCT) can rapidly diagnose influenza with the potential to reduce investigation and hospital admission rates, but information on its use in an Australian setting is limited.Methods: Through a retrospective review of laboratory-confirmed influenza cases presenting at a paediatric emergency department (ED) in 2009, we evaluated children diagnosed by POCT versus standard testing (direct fluorescent antibody, polymerase chain reaction or viral culture) and assessed differences in investigations, admission requirements, length-of-stay (LOS) in ED/hospital and antibiotic/antiviral prescription. The rate of serious bacterial infection was examined.Results: Compared with standard testing (n = 65), children diagnosed by positive POCT (n = 236) had a shorter median hospital LOS by 1 day (P = 0.006), increased antiviral prescription (odds ratio 3.31, P < 0.001) and a reduction in the time to influenza diagnosis (2.4 vs. 24.4 h, P < 0.001); however, a negative POCT result (n = 63) resulted in delayed diagnosis (44.0 h, P = 0.001). POCT did not decrease LOS in ED. Interpretation of reductions in admission and investigations with POCT may be limited by possible confounding. Approximately 4% of influenza patients had a serious bacterial infection; urinary tract infections were commonest (2.7%), but no cerebrospinal fluid cultures were positive. A single positive blood culture was seen among 332 immunocompetent influenza patients.Conclusions: Influenza diagnosis by POCT was quicker and reduced LOS of hospitalised children, whereas negative results delayed diagnosis. Negative POCT should not alter usual investigations if influenza remains suspected. A controlled prospective study during the influenza season is needed to clarify the direct benefits of POCT. [ABSTRACT FROM AUTHOR]

Aim: An estimated 1.1% of Australian adults are infected with hepatitis C virus (HCV). Many develop chronic liver disease, and some develop liver failure or hepatocellular carcinoma. HCV infection in Australian children is poorly defined. We aimed to determine the reported incidence, clinical and epidemiological features of newly diagnosed HCV infection in Australian children presenting to paediatricians.Methods: We undertook prospective active national surveillance, using the Australian Paediatric Surveillance Unit, of incident HCV cases in children aged <15 years between 1(st) January 2003, and 31(st) December 2007.Results: There were 45 confirmed cases of newly diagnosed HCV infection over five years (<1 per 100,000 children aged <15 years per year). Median age at diagnosis was 2.9 years. Positive maternal HCV serostatus was the most frequent reported risk factor for HCV infection in children (40/45). Three children (all aged > 14), were exposed through their own IV drug use. No children were co-infected with HIV and only one child was co-infected with HBV. All children were asymptomatic at diagnosis, although many had minor elevations in liver transaminases. Many clinicians reported difficulties with follow-up.Conclusions: Childhood HCV infection is uncommon in Australia, although our data likely underestimate the incidence. Only a small number of children aged <18 months was identified, despite known perinatal exposure. Opportunistic investigation of children at risk for HCV, improved education regarding vertical transmission for health care providers, and increased coordination of childhood HCV services are required to improve recognition and management of children with HCV. [ABSTRACT FROM AUTHOR]

I Fusobacterium nucleatum i is a rare cause of osteomyelitis, but may cause subacute musculoskeletal infections that respond well to appropriate therapy. If early aerobic tissue cultures are negative, I Fusobacterium i infection should be considered, particularly if osteomyelitis occurs subsequent to dental procedures or a recent tooth abscess. [Extracted from the article]

The article describes the case of a two-year-old boy with clinical left knee septic arthritis whose magnetic resonance imaging of the knee showed osteomyelitis involving the left distal epiphysis and complicated by a Brodie's abscess. Topics discussed include the incidence of pediatric osteomyelitis in high-income countries, recurrence of osteomyelitis at the prior anatomical site of the infection, and management of osteoarticular infections in children.

Aim To evaluate the clinical presentation and profile of malaria cases diagnosed at a tertiary children's hospital in Australia Methods A retrospective file review of children diagnosed with malaria at the Children's Hospital Westmead from 1 January 2000 to 31 December 2010. Results During the 11-year study period, 40 children were diagnosed with malaria; 30 (75%) presented with fever; 14 (35%) complained of nausea, vomiting or abdominal pain; and eight (20%) were completely asymptomatic. The median time between arrival in Australia and malaria diagnosis was 32 (range 4-434) days. Sixteen (40%) were refugees from sub- Saharan Africa, six (15%) were immigrants from South- East Asia, and seven (18%) recently travelled to or visited friends and family in malaria-endemic areas. Most (68%) cases had P lasmodium falciparum; Plasmodium vivax was identified in four cases with exposures in India and Papua New Guinea; one had mixed P . falciparum and P . vivax infection. Conclusion Malaria signs and symptoms were non-specific, with an absence of fever in a quarter of cases. Diagnostic vigilance is required in all children with potential malaria exposure in the preceding year. Asymptomatic parasitaemia should be considered in recent migrants from malaria-endemic areas. [ABSTRACT FROM AUTHOR]

Acute flaccid paralysis can be caused by many members of the enterovirus genus, most notably the three poliviruses types 1 to 3. We report the case of acute flaccid paralysis caused by echovirus 19. The Western Pacific region has been declared polio free by the WHO since 2000. Australia is now using inactivated polio vaccine in the National Immunization Schedule. This vaccine does not carry the extremely rare risk of vaccine associated acute flaccid paralysis but it does leave our newly vaccinated population open gastrointestinal infection with polioviruses and the risk of circulation of the wild-type virus. Continued surveillance of cases of acute flaccid paralysis is to detect polioviruses is essential until poliovirus is completely eradicated. [ABSTRACT FROM AUTHOR]

We report the case of a 16-day-old neonate who presented with fever and irritability. Blood and cerebrospinal fluid (CSF) samples collected on his admission grew methicillin sensitive Staphylococcus aureus on culture, prompting an urgent search for parameningeal collections or an occult sinus involving the central nervous system. Magnetic resonance imaging revealed a pyogenic collection within the epidural space extending from the upper cervical to lumbosacral level and multiple other deep tissue collections that required repeated surgical drainage. Central nervous system infections due to S. aureus are uncommon, particularly in the absence of an anatomical defect or prior neurosurgical instrumentation. This case demonstrates the importance of a timely and thorough search for parameningeal foci when CSF cultures are positive for unusual organisms such as S. aureus. [ABSTRACT FROM AUTHOR]

Aim: To describe the clinical presentation and course of children admitted to the paediatric intensive care unit (PICU) with human metapneumovirus (hMPV) infection, and compare them with children admitted to the PICU with respiratory syncytial virus (RSV) infection. Methods: hMPV was identified by immunofluorescence in 22 children admitted to the PICU over a 16-month period. The medical records of these children were reviewed retrospectively, and their clinical and laboratory data were compared with 66 children admitted to the PICU with positive tests for RSV over the same period. Results: Children admitted to the PICU with hMPV were significantly older than children with RSV ( P= 0.003). Children with hMPV presented more commonly with pneumonia or pneumonitis (29% vs. 16%), and less commonly with bronchiolitis (43% vs. 68%) than RSV ( P= 0.13). Invasive ventilation was required in 10 patients (48%) with hMPV, and non-invasive ventilation was required in a further 5 (28%), similar to patients with RSV. Children with hMPV were more likely to have an underlying co-morbidity ( P= 0.11). Conclusions: Children admitted to the PICU with hMPV have a similar disease presentation and severity as children admitted with RSV, including some with extremely severe disease who require additional ventilatory or cardiovascular support. Children with hMPV are likely to be older than those with RSV, and more likely to present with pneumonia and less likely to present with bronchiolitis. [ABSTRACT FROM AUTHOR]

To determine the impact of rotavirus immunisation on rotavirus hospitalisations in young children. Annual hospitalisations for rotavirus gastroenteritis to The Children's Hospital at Westmead, a tertiary care paediatric hospital in Sydney, were recorded from 2001 for 6 years prior to and 2.5 years following the introduction of rotavirus vaccines to the National Immunisation Program. Data on hospital-acquired rotavirus gastroenteritis were collected prospectively. Hospitalisations for rotavirus gastroenteritis declined in the two full rotavirus seasons (2008 and 2009) after vaccine introduction by 75% compared with mean annual hospitalisations from 2001 to 2006. The greatest decline was seen in those <12 months of age (93%), but the reduction occurred consistently across all age groups, even in children not eligible for immunisation, suggesting an effect on herd immunity. A substantial decline in nosocomial rotavirus gastroenteritis was seen from 2007 to 2009, suggesting a reduction in virus transmission in the hospital setting. This study demonstrates a substantial reduction in hospitalisations in children of all ages to a large paediatric hospital and reduced nosocomial infections since the introduction of a nationally funded rotavirus immunisation programme in Australia. [ABSTRACT FROM AUTHOR]

Objective: Active surveillance to determine influenza disease burden in children admitted to hospital with influenza-like illness (ILI). Methods: A prospective hospital-based cohort study conducted June–October 2006 in children <5 years hospitalised at The Children's Hospital at Westmead with ILI (fever and respiratory symptoms). Influenza and other viral infections were diagnosed either by antigen detection using immunofluorescence or nucleic acid amplification testing of nasopharyngeal aspirates. Data were collected using researcher-administered questionnaires. Main outcome measures include proportion of hospitalisations with influenza, vaccination and treatment, risk factors for influenza and associated medical and social burdens. Results: Data on 275 children with ILI aged <5 years were analysed. Thirty-one (11%) children with ILI had influenza (22 had influenza A and 9 had influenza B). Thirty-five percent were under 6 months of age and 61% under 1 year. Twenty-nine percent of children with influenza A were born prematurely. The mean duration of hospital stay for influenza was 2.8 days (95% confidence interval 2.1–3.4) and 26% had a lumbar puncture. Although 68% received intravenous antibiotics, only 3% (one case) was given an antiviral. Eighty-four percent had visited their local doctor before admission and all came through the emergency department. On average, in one-third (32%) of families of children with influenza a parent developed, ILI during admission or soon after hospital discharge resulted in an average of 3.2 days of work absenteeism. Only 3.5% (7/199) of children older than 6 months with ILI received any influenza vaccination. Conclusions: Both the burden of influenza in childhood morbidity and its social impact are substantial. There is considerable room for improvement in both the prevention and early recognition (trigger treatment with antivirals) of influenza. Our data will inform decisions regarding the value of a universal influenza vaccine programme. [ABSTRACT FROM AUTHOR]

Aims: Because of the paucity of previous data, we report the organisms causing infection in children with injuries from lawnmowers and farm machinery. Methods: Retrospective study of children admitted to the Children's Hospital at Westmead for lawnmower and farm machinery-related injuries from 1998 to 2007. Results: Twenty-four patients were admitted for lawnmower-related injuries. They had a bimodal age distribution, with peaks at 2–4 years and 14 years. Twenty-one (87.5%) were boys. Positive wound cultures were obtained in 16.7% and included Gram-positive and Gram-negative organisms. Eight patients were admitted for farm machinery-related injuries. Two patients (25%) returned positive wound cultures with multiple organisms including bacteria, fungi and mycobacteria and were diagnosed with osteomyelitis caused by Stenotrophomonas maltophilia and Scedosporium prolificans, respectively. Conclusion: The rate of infection in our small series of children with lawnmower and farm machinery-related injuries was comparable to previous reports. We found a wide range of causative organisms, often inherently antibiotic resistant, and we add a case of invasive fungal infection to previous case reports. Because of the wide range of organisms, empirical antibiotic therapy is difficult and our data emphasise the need for cultures to direct ongoing therapy. [ABSTRACT FROM AUTHOR]

Aim: To determine the incidence of sterile cerebrospinal fluid (CSF) pleocytosis in infants ≤6 months old with urinary tract infection (UTI). Methods: Retrospective study of children admitted to a tertiary children's hospital in 2006 and 2007 with UTI who also had a lumbar puncture performed. All urine specimens were tested for anti-microbial activity. Results: Twelve (11.3%) of 106 infants with UTI had concurrent CSF pleocytosis. None of these patients had anti-microbial activity in the urine, showing that they had not received prior antibiotics. None of the 15 neonates (≤28 days old) with UTI and lumbar puncture had CSF pleocytosis. Antibiotics were stopped after a maximum of 10 days. Conclusion: Our results are compatible with published reports on the proportion of infants with UTI who have concurrent sterile CSF pleocytosis. We were able to exclude previous antibiotic therapy by measuring urinary anti-microbial activity. Our work supports the hypothesis that CSF pleocytosis in UTI is inflammatory and not because of infection of the central nervous system. [ABSTRACT FROM AUTHOR]

Respiratory viruses like coronaviruses and influenza infect us through inhaling droplets or by touching contaminated surfaces then rubbing our nose, mouth or eyes. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. 3 Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in health care workers: A systematic review and meta-analysis of randomized trials. [Extracted from the article]

To what extent do children transmit SARS-CoV-2 virus? Concern that children might be major spreaders of SARS-CoV-2, the virus which causes COVID-19, stems largely from past experience: children are certainly major spreaders of other respiratory viral infections, such as influenza and measles. Children infected with SARS-CoV-2 are often asymptomatic: 4-28% in published studies[[1], [3]] and 13% in the most detailed study from China.[1] Asymptomatic child carriers were important spreaders of polio during epidemics, but this does not mean that asymptomatic children often transmit SARS-CoV-2. [Extracted from the article]

An 11-year-old girl had four episodes of fever in a year, lasting 7-10 days and associated with headache and neck stiffness. She had a long history of recurrent urticaria, usually preceding the fevers. There was also a history of vague pains in her knees and in the small joints of her hands. Her serum C-reactive protein was moderately raised at 41 g/L (normal <8). Her rheumatologist felt the association of recurrent fevers that lasted 7 or more days with headaches, arthralgia and recurrent urticaria suggested one of the periodic fever syndromes. Genetic testing confirmed she had a gene mutation consistent with one of tumour necrosis factor receptor-associated periodic syndrome. [ABSTRACT FROM AUTHOR]

Should I be worried about carrying the virus that causes COVID-19 home on my clothes? Health-care workers (HCW) frequently ask whether they can carry SARS-CoV-2 virus home on their clothes and pass it on to family members or even infect themselves later in the day. The only information on the environmental stability of SARS-CoV-2 comes from artificial experiments in which drops of virus were pipetted onto surfaces; the surfaces were tested for virus some time later. [Extracted from the article]

The article describes the case of a boy with extensive fasciitis of both lower limbs and pelvis detected by magnetic resonance imaging. Topics discussed include medical history of the patient, finding on the echocardiogram performed, and a discussion on Kingella kingae, a Gram-negative coccobacillus that usually colonises the oropharynx of young children.

A letter to the editor is presented in response to the article regarding nosocomial rotavirus infection in an Australian children's hospital that was published in a 2006 issue.