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Aim: Pre‐admission viral screening is used only in exceptional situations such as pandemics. We therefore evaluated pre‐admission screening for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), respiratory syncytial virus (RSV) and influenza during the COVID‐19 pandemic, comparing epidemiology and clinical features of admitted children. Methods: Children were screened at a paediatric emergency department from 1 March 2020 to 30 June 2022 by nasopharyngeal sampling and polymerase chain reaction kit. We retrospectively retrieved positive results from the laboratory and scrutinised charts of admitted children. Results: Out of 15 927 screened children, 522, 127 and 572 were positive and admitted with RSV, influenza A or SARS‐CoV‐2, respectively. Of these, 29 (5.6%), 26 (24.1%) and 245 (44.8%) were incidental findings, lacking symptoms of infection. RSV and influenza A were initially absent but re‐emerged in the autumn of 2021. The rate of COVID‐19 rose when the Omicron variant emerged in December 2021. The median age of children with RSV was 0.3 years, of those with influenza A 6.7 years and of those with COVID‐19 1.6 years. Major complications were rare. Conclusion: Frequent incidental detections of SARS‐CoV‐2 likely reflected widespread presence of a mild infection. Clinically, COVID‐19 was like other viral respiratory infections in children. [ABSTRACT FROM AUTHOR]

Aim: The pneumococcal conjugate vaccine, which covered seven serotypes of Streptococcus pneumoniae (PCV7), was introduced in Stockholm, Sweden, in 2007. It was replaced by a 13‐valent vaccine (PCV13) in 2011. We previously reported a decreased incidence of pneumonia and sinusitis among young children 4 years after the introduction of the PCV7. This study followed the incidence of pneumonia, sinusitis, mastoiditis and meningitis for four more years. Methods: We studied validated hospital registry data covering children up to 17 years of age, who were hospitalised in the Stockholm region from 2003 to 2016, when the child population peaked at 485 687. All 11 115 cases diagnosed with pneumonia, coded as bacterial pneumonia, sinusitis, mastoiditis, bacterial meningitis or empyema, were identified. The controls had viral pneumonia or pyelonephritis. Results: The incidence rates for children under 2 years of age hospitalised for sinusitis, mastoiditis and meningitis decreased significantly by 61%–79% during the eight‐year post‐vaccination period. Hospitalisations for bacterial pneumonia decreased by 19%–25% in the same age group. These changes were probably due to both the vaccines and changes in diagnosis routines. Conclusion: The effect of vaccination on children under 2 years of age was sustained 8 years after the introduction of the pneumococcal conjugate vaccines. [ABSTRACT FROM AUTHOR]

Aim: Human bocavirus 1 (HBoV1) has been associated with respiratory tract infections in children. We aimed at retrospectively describing patient characteristics, seasonality, pre‐existing medical conditions, codetections, clinical manifestations and complications of HBoV1 infection in relation to viral load in the child population in Stockholm, with the overarching aim of elucidating the clinical significance of HBoV1. Methods: We included all hospitalised children 0—17 years testing positive for HBoV1 by real‐time polymerase chain reaction on nasopharyngeal aspirates 1 July 2008—30 June 2019. Patients with HBoV1 single detection, high viral load expressed as an HBoV1‐DNA cycle threshold (Ct) < 25, or both, were separately analysed. We retrieved information on pre‐existing conditions and clinical course from the medical records. Results: We found 768 episodes in 727 children, 496 (64.6%) male and 441 (60.7%) previously healthy. The median age was 17.6 months. Most (476/768, 62.0%) episodes occurred during December–March. HBoV1 was in 549 episodes (71.5%) codetected with other viruses. Ct < 25 was independently associated with young age, single detection of HBoV1 and presentation early in the epidemic season. We saw few differences in clinical manifestations between the subgroups. Conclusion: Our findings are consistent with primary HBoV1 infection causing mild‐to‐severe respiratory tract manifestations in young children. [ABSTRACT FROM AUTHOR]

Background: Vaccination against rotavirus was offered in Stockholm to children born on 1 March 2014 and onwards with 85% coverage after two years. We investigated changes in nosocomial diarrhoea 2010—2018 in children admitted to Astrid Lindgren Children's Hospital, Stockholm, Sweden. Methods: We retrospectively identified cases from diagnostic and virology department registers. Complications and chronic medical conditions were retrieved from the case records. Children <18 years of age who developed diarrhoea ≥48 h after admission for another diagnosis and had a faecal sample submitted to the virology department were included. Results: There were 474 episodes of nosocomial diarrhoea. Of these, 401 (85%) occurred in children with chronic medical conditions. In children <5 years the rates of nosocomial rotavirus gastroenteritis, with 95% confidence intervals, significantly decreased from 0.34 (0.25—0.45) per 100 admissions prevaccination to 0.09 (0.04—0.17) postvaccination and from 0,66 (0.48—0.88) to 0.16 (0.07—0.30) cases per 1000 hospital days. Postvaccination norovirus became the most frequent pathogen. Virus-positive cases were more common in young children and in winter months. Conclusions: Before the initiation of rotavirus vaccination, norovirus and rotavirus were equally common causes of nosocomial diarrhoea. Postvaccination, rotavirus was reduced by approximately 75% while the frequency of other viruses did not change. [ABSTRACT FROM AUTHOR]

In Stockholm, Sweden, rotavirus vaccination was offered to children born after 1 March 2014. Our aim was to describe rates of hospitalisation due to community-acquired gastroenteritis before and after the introduction of the vaccine, and aetiology, underlying medical conditions and complications in admitted children. We retrospectively included patients from our catchment area hospitalised with a diagnosis of gastroenteritis during ten infection seasons 2008/2009–2017/2018, whereof six seasons prevaccination and four seasons postvaccination. We studied virus detection data and the patients' medical records. We included 3718 episodes in 3513 children. In 2967 (80%), stools were tested with virus isolation, ELISA, PCR, or bacterial culture; 479 (16%) tested negative. The incidence rates, with 95% confidence intervals, for children <5 years hospitalised for rotavirus gastroenteritis were 2.9 (2.8–3.1) per 1000 person-years prevaccination and 0.65 (0.56–0.74) postvaccination, for a rate ratio (RR) of 0.22 (0.19–0.26, p <.001). The rates for all-cause gastroenteritis were 5.6 (5.4–5.9) prevaccination and 2.5 (2.3–2.7) postvaccination, RR 0.45 (0.42–0.50, p <.001). In 5–17-year-old children norovirus dominated with little change over time. Of patients <5 years, those with underlying conditions constituted a larger proportion postvaccination than prevaccination (30.7% vs. 24.2%, p <.001). A complication other than dehydration, most commonly seizures, arose in 8.8% of the patients <5 years prevaccination and 11.4% postvaccination (p <.05). Rotavirus vaccination reduced the number of children <5 years requiring hospital care for gastroenteritis. We saw no replacement of rotavirus by other viruses. [ABSTRACT FROM AUTHOR]

Aim: This study explored the differences in demographic and socio‐economic factors between children hospitalised due to four common viral infections. Methods: Demographic data were obtained from Statistics Sweden on >3000 children admitted to Astrid Lindgren Children's Hospital in 2009–2014 with rotavirus, influenza, respiratory syncytial virus (RSV) or chickenpox. We compared demographic and socio‐economic factors between case groups using logistic regression with rotavirus cases as reference. Results: There were differences in the median age at admission; RSV cases were younger (0.4 years), influenza (2.4 years) and chickenpox cases (2.7 years) older than rotavirus cases (1.2 years). RSV, influenza and chickenpox cases lived in families with more children than rotavirus cases. RSV and influenza cases were more likely to have underlying chronic conditions. Mothers of RSV cases were more likely to be born in Sweden. Further socio‐economic differences were not robustly confirmed in sensitivity analyses. Conclusion: We found a few differences in demographic factors between children hospitalised with the four common infections, which were mainly explained by the epidemiology and transmission patterns of these infections. [ABSTRACT FROM AUTHOR]

Aim: Since the introduction in 1979 of rapid testing using immunofluorescence, we have collected information about children hospitalised for confirmed respiratory syncytial virus (RSV) infection in the northern Stockholm area. We here report hospitalisation rates, risk factors and complications in 2008‐2016 compared with 1986‐1998. Methods: Microbiological laboratory reports and retrospective chart review. Comparison of the two periods was complicated by changing testing routines, with a more sensitive method and increased testing of older children in the late period. Results: In infants, there was an 12.3% increase in the population‐based rate of hospital admission for RSV infection from 12.2 to 13.7/1000. Including all children <5 years, there was a 48% increase from 2.7 to 4.0/1000. The median length of stay remained unchanged at 3 days. The need of intensive care decreased in healthy infants but remained high in older children with comorbidity. Conclusion: Considering the changed diagnosis routines, we believe that the rate of hospital admission of infants for RSV infection was unchanged throughout the observed years. The increased rates of older children with confirmed RSV likely resulted from increased testing of children with risk factors for a complicated course. [ABSTRACT FROM AUTHOR]

Aim: Children with osteomyelitis present with a range of signs and symptoms and with varying degree of severity. The purpose of this study was to provide data on a population‐based 10‐year material of children with acute osteomyelitis. Methods: All children, 0–14 years in Stockholm Region with acute osteomyelitis hospitalised in July 2005–June 2015, were retrospectively studied. Time to hospital presentation, disease localization, inflammation markers, imaging procedures, microbiology, severity classified by the presence of complications, surgical procedures, hospital length of stay and seasonal variation were recorded. Results: There were 430 children with acute osteomyelitis; 61% were boys. The incidence per 100 000 person‐years was 11.6; 9.3 in girls and 13.1 in boys. Median age at admission was 2.9 years with no peak later in childhood. Median time from first symptom to diagnosis was 4 days (range 1–21) and 48% of the cases were localised to femur or tibia. Mean C‐reactive protein was 59 mg/L (range 1–376). Blood (n = 82) or tissue cultures (n = 54) were positive in 118 (28%) children. The most common pathogen was Staphylococcus aureus (n = 88) followed by Streptococcus pyogenes (n = 12). Surgery was performed in 71 children (17%). There was no mortality. Severe complications were seen in 14 (3.3%) children, five of whom were admitted to intensive care. Median hospital length of stay was 4 days (range 1–60). Conclusions: Osteomyelitis in children is a diagnostic challenge with a low yield of positive bacterial cultures. Few children with uncomplicated disease need surgery, but the risk of severe complications is not negligible. [ABSTRACT FROM AUTHOR]

Aim: We present our results using interferon-gamma release assays in any child <18 years or tuberculin skin tests in Bacille Calmette-Guérin unvaccinated children for tuberculosis contact investigation in Stockholm, Sweden.Methods: During 2000-2019, we investigated 892 children with a median age of seven years. We explored associations between TB infection and characteristics such as closeness to contact, age, sex, BCG status and foreign origin.Results: The overall rates were for TB infection 10.2% (n = 91) and for TB disease 1.1% (n = 10). In addition to infectiousness of index case and closeness of contact, foreign background, male sex and increasing age were independently associated with infection. In foreign-born children, the rates of tuberculosis infection and disease were 18.7% and 3.9%, respectively. In 18/46 (39%) infected foreign-born children, a baseline negative tuberculosis test supported a diagnosis of recent infection.Conclusion: Foreign background, older age and male sex were associated with infection. In a significant proportion of infected children, a previous negative test made recent infection likely. [ABSTRACT FROM AUTHOR]

Background: Few prospective cohort studies have estimated the overall impact of severe rotavirus gastroenteritis (RVGE) leading to hospitalization on families and society. We assessed human and economic resources needed to care for an affected average child aged <5 years in Sweden. Methods: The study was conducted in Astrid Lindgren Children’s Hospital which serves approximately 14% of all Swedish children <5 years of age. All children admitted with acute gastroenteritis in the study period were tested for rotavirus. Health care consumption was collected prospectively and publically available unit costs used to calculate direct costs. Non-medical and indirect costs were collected in interviews with families using a standardized questionnaire during the hospital stay and approximately 14 days post-discharge. Results: 144/206 children (70%) with laboratory-confirmed RVGE were included. The median age was 14 months. The average total cost per hospitalized child was €3894, of which €2169 (56%) was due to direct healthcare-related costs (including Emergency Department visits and in-patient care), €104 (2%) to non-medical direct costs and €1621 (42%) to indirect costs due to productivity loss. Carers of children with severe RVGE were absent from work on average five days per study child: four days during hospitalization of affected child and one day due to gastroenteritis in the carer. Conclusions: Costs for RVGE are dominated by direct costs which are similar to some other countries in Europe, but indirect costs due to productivity loss are also important, and should be considered in decisions to introduce rotavirus vaccines into national vaccination programmes. [ABSTRACT FROM AUTHOR]

An immunocompetent six-year old child presented with a bronchial occluding mass that was diagnosed as an endobronchial Mycobacterium avium infection. The child was successfully treated with a combination of surgery and tuberculostatics. [ABSTRACT FROM AUTHOR]

Background:Minors with a stated age <18 years unaccompanied by a responsible adult form an increasing part of refugees to Europe. They are older than other asylum-seeking children and many come from countries with a high tuberculosis (TB) incidence. During the 2015 refugee crisis, 35,369 of 162,877 refugees (22%) seeking asylum in Sweden were unaccompanied minors, which gave us the opportunity to study their burden of TB infection and disease. Methods:Of the unaccompanied minors seeking asylum in Sweden during 2015, 2936 (8.3%) were allocated to northern Stockholm. Of these, 2422 were from countries with an incidence of TB exceeding 100/105, and were screened for TB infection with a Mantoux tuberculin skin test or a QuantiFERON-TB Gold®. Those from countries with a lower TB incidence were screened only if they had other risk factors for TB exposure. Results:Of those screened, 349 had a positive test and were referred to the northern paediatric TB clinic at Astrid Lindgren Children’s Hospital. Of these, 16 had TB disease and 278 latent tuberculosis infection (LTBI), while we considered 53 uninfected. In addition, eight sought medical attention with symptomatic TB outside the screening system. Cohort rates were 6.8% of LTBI and 0.5% of TB in minors from Afghanistan and 26–32% of LTBI and 3.4–3.5% of TB among those from Eritrea, Ethiopia or Somalia. Conclusion:We conclude that TB infection and disease is common among asylum-seeking unaccompanied minors, especially among those from the Horn of Africa. [ABSTRACT FROM AUTHOR]

Aim: This study described the epidemiology and clinical features of childhood tuberculosis (TB) in Stockholm over a 45-year period, when there was a resurge of tuberculosis concomitant with increased immigration.Methods: We describe 220 children up to the age of 16 years with active TB, seen at the Astrid Lindgren Children's Hospital from 1971 to 2015. The study period was divided into three 15-year periods.Results: Cases increased from ten children in 1971-1985 to 76 in 1986-2000 and 134 in 2001-2015, with overall incidence increasing from <1 to four per 100 000. From 2001 to 2015, 79% of cases, or at least one parent, were born in high-incidence countries. The incidence in this group was 35 per 100 000, but remained at 0.9 per 100 000 in other children. After 2000, most cases were detected by active contact tracing and immigrant screening. The most common manifestation was from the lungs. Meningitis and miliary tuberculosis were found in 7%, with two deaths. Antimicrobial resistance was an increasing problem.Conclusion: The increasing incidence of TB in Stockholm was largely limited to children with a background in high-incidence countries. Most children today have subclinical forms of TB. Although preventive measures are effective, severe cases still occur, especially among adolescent immigrants. [ABSTRACT FROM AUTHOR]

Background: The aim of this prospective cohort study was to estimate the burden of severe disease caused by rotavirus-induced gastroenteritis in Swedish children aged < 5 y. Methods: Rotavirus-positive children admitted to hospitals serving 3 geographical regions with 155,838 children aged < 5 y, were offered inclusion in this 1-year study. Rotavirus strains identified were genotyped using multiplex PCR. Disease progression was documented through interviews and chart reviews. Results: In total, 604 children with rotavirus-induced gastroenteritis were included in the study. Forty-nine of 604 (8.1%) fulfilled the criteria for nosocomial infection. The minimum incidence was 388 per 100,000, with significant variability between study regions, ranging from 280 to 542 per 100,000. In all regions, the peak season occurred in February-April, but the season start varied, with first cases observed in October in the eastern region and December in the northern region. Genotypes identified differed between the regions: G1[P8] was most prevalent in all regions (77%), while the most varied pattern was observed in the western region, with G1[P8] observed in 61%, G4[P8] in 13%, G9[P8] in 10%, G2[P4] in 8%, and G3[P8] in 8% of the children. The median age of hospitalized children was 14 months and the median total duration of diarrhoea was 6.9 days. Sixty-eight percent reported a temperature > 38.5°C upon admission. Complications occurred in > 10% of the children, with hypertonic dehydration (32/604) and seizures (10/604) occurring most frequently. Conclusions: Rotaviruses may cause severe febrile acute gastroenteritis leading to dehydration requiring acute rehydration in hospital. In addition, further complications occurred in > 10% of hospitalized children. [ABSTRACT FROM AUTHOR]

Background: The swine-origin influenza A(H1N1)pdm09 pandemic of 2009 had a slower spread in Europe than expected. The human rhinovirus (HRV) has been suggested to have delayed the pandemic through viral interference. The importance of co-infections over time during the pandemic and in terms of severity of the disease needs to be assessed. Objective: The aim of this study was to investigate respiratory viruses and specifically the presence of co-infections with influenza A(H1N1)pdm09 (H1N1) in hospitalized children during the H1N1 pandemic. A secondary aim was to investigate if co-infections were associated with severity of disease. Methods: A retrospective study was performed on 502 children with influenza-like illness admitted to inpatient care at a pediatric hospital in Stockholm, Sweden during the 6 months spanning the H1N1 pandemic in 2009. Respiratory samples were analyzed for a panel of 16 viruses by real-time polymerase chain reaction. Results: One or more viruses were detected in 61.6% of the samples. Of these, 85.4% were single infections and 14.6% coinfections (2-4 viruses). The number of co-infections increased throughout the study period. H1N1 was found in 83 (16.5%) children and of these 12 (14.5%) were co-infections. HRV and H1N1 circulated to a large extent at the same time and 6.0% of the H1N1-positive children were also positive for HRV. There was no correlation between co-infections and severity of disease in children with H1N1. Conclusions: Viral co-infections were relatively common in H1N1 infected hospitalized children and need to be considered when estimating morbidity attributed to H1N1. Population-based longitudinal studies with repeated sampling are needed to improve the understanding of the importance of co-infections and viral interference. [ABSTRACT FROM AUTHOR]

Abstract: We studied the effectiveness of the AS03-adjuvanted monovalent vaccine (Pandemrix®) for the prevention of severe pandemic influenza A(H1N1)pdm09 in children, in 2009. All children hospitalized for influenza-like illness in Stockholm County during the peak of the pandemic were included. We compared the frequency of vaccinated children between influenza A(H1N1)pdm09 PCR positive cases and PCR negative controls in a retrospective case–control study. 95 cases and 177 controls were identified. About half of the children in both groups were between 6 months and 2 years of age. Only 1/95 (1%) cases had been vaccinated more than 14 days prior to admission, compared to 23/177 controls (13%), corresponding to a vaccine effectiveness, adjusted for co-morbid conditions, of 91% (95% confidence interval [CI] 30–99). In contrast, the risk for being a case was significantly higher among children vaccinated between 1 and 14 days prior to hospitalization, than among those who were non-vaccinated 13/95 vs. 7/177 (OR 3.6, 95% CI 1.4–9.5). We conclude that a single dose of adjuvanted vaccine was highly protective against hospitalization for influenza A(H1N1)pdm09 in children 6 month to 17 years. The reason for the increased rate of hospitalizations with confirmed influenza in children just following immunization is unclear and should be studied further. [Copyright &y& Elsevier]

The aim of this retrospective observational study was to evaluate age, length of hospital stay and development of complications in children hospitalized with community- or nosocomially- acquired rotavirus gastroenteritis (RV GE). In total, medical records of 984 children with RV GE were analysed retrospectively. The median age was 13.8 months (3 weeks to 99 months) in children with community acquired RV GE (n=723) and 9.0 months (range 3 weeks to 82 months) in children with nosocomially acquired RV GE (n=261). During this 11-y surveillance, only 2 children were admitted twice for a RV GE, suggesting development of subsequent protective immunity against severe rotavirus gastroenteritis after the first episode. Complications occurred in 16.5% of the children with community acquired RV GE and only in 1.9% of the nosocomially acquired RV GE. Identified complications in children with community acquired RV GE were: severe dehydration resulting in intensive care (1.7%), death (0.1%), hypertonic dehydration (9.1%), seizures (4.0%) and encephalitis with abnormal EEG (1.7%). The median age of children in need of intensive care was 9.1 months and in those developing hypertonic dehydration 10.8 months, both significantly lower than in children with no complications (p<0.05). Interestingly, the age of children developing seizures and signs of encephalitis was significantly higher than in children with no complications (p<0.01). [ABSTRACT FROM AUTHOR]

In January 2006, an after-school carer in Stockholm was diagnosed with open pulmonary tuberculosis (TB) after having been symptomatic for 3 months. The aim of this paper is to illustrate the difficulties encountered in estimating recent transmission of TB among children in an immigrant school population. A tuberculin skin test was performed on 261 pupils aged 6-15 y and an additional interferon-gamma release assay was performed on 20 children. In total, 76% of the children were born in Sweden; however, 95% of the parents originated from countries with TB incidence >25/100,000. Three active TB cases were identified, 1 of whom was culture-positive with the same strain as the index case. Latent tuberculous infection (LTBI) was diagnosed in 35 children. However, the increased risk of earlier infection in this population makes it difficult to evaluate when transmission occurred. The magnitude of recent transmission from the index case will thus be uncertain and indications to treat less clear. [ABSTRACT FROM AUTHOR]

Dietary supplements with lactic-acid producing microorganisms like Lactobacillus have been used to maintain or re-establish the 'ecological balance' of the intestinal microflora. The aim of the present investigation was to study the impact of probiotic products containing a strain of Lactobacillus paracasei spp. paracasei isolate F19 (Lactobacillus F19) on the prevalence of lactobacilli (other than Lactobacillus F19), bifidobacteria and Clostridium difficile in the fecal microflora in elderly persons sero-positive for Helicobacter pylori and in children. Sixty-one healthy children and 30 elderly persons completed the study. They had been randomized into treatment and placebo groups. Children in the treatment group received gelatine capsules containing freeze-dried bacteria twice daily for 3 weeks and the older age group, a fermented milk product with Lactobacillus F19 twice daily for 12 weeks. Subjects in the placebo groups received similar products but with no active ingredients. Fecal samples were collected from the children before, during (at 2-3 weeks) and 2 weeks after the administration and from the elderly persons before, during (at 4 and 12 weeks) and 20 weeks after the start of the study. Samples were diluted and inoculated on selective agars for detection of lactobacilli, bifidobacteria and C. difficile. The numbers of Lactobacillus F19 increased significantly during the study period in both age groups. In six of 30 children and in one of 13 elderly persons, Lactobacillus F19 was detected 2 and 8 weeks, respectively, after the end of the administration period. No major changes occurred in the numbers of lactobacilli other than Lactobacillus F19 or of bifidobacteria in children, while there was a significant increase in the numbers of lactobacilli in elderly persons during the administration of Lactobacillus F19. In fecal samples of seven of 18 children, C. difficile was detected at the first sample occasion. Two weeks after the end of administration, C. difficile was detected in only four children. None of the elderly persons had any detectable C. difficile. No effect was observed on H. pylori infection measured by means of urea breath test. Lactobacillus F19 survived the passage through the gastrointestinal tract and remained in 8-20% of subjects for at least several weeks as a part of the normal microflora. [ABSTRACT FROM AUTHOR]

There are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. This was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. Incidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe – postseptal orbital, intracranial or osseous – complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. There is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis. [ABSTRACT FROM AUTHOR]