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A 3-month-old, full term female infant, adequate for gestational age, and exclusively breastfed, was admitted with a 10 day history of generalised scaling erythematous dermatitis, affecting the face (perinasal, nasolabial folds and periauricular), acral and intertriginous areas, with irritability and failure to thrive. Her mother had been treated with isoniazid since the third trimester because of family contact with tuberculosis. Based on a diagnosis of suspected impetiginised eczema, the infant was treated with flucloxacillin and prednisolone, and maternal isoniazid was suspended, with no improvement. Investigations found low serum zinc levels in the infant (33 μg/dL; normal range (NR) >60 μg/dL), normal plasma zinc levels in the mother (111.3 μg/dL; NR 68–120 μg/dL) and lower than the normal range of zinc levels in breast milk (270μg/L; NR 1000–2500 μg/L), suggesting acrodermatitis caused by zinc deficiency. Oral zinc supplementation (3 mg/kg/day) was started with a marked improvement in skin lesions, as well as good weight gain. At the age of 6 months, after food diversification, supplementation was suspended, without any recurrence of symptoms.

Henoch–Schönlein purpura (HSP) is characterized by nonthrombocytopenic palpable purpura, arthritis or arthral­gia, and gastrointestinal and/or renal involvement. Gastrointestinal symptoms are reported in 50%-75% and they are related to a previous group A streptococcal infection in 40%. A healthy 5-year-old girl presented with a three-week history of a recurrent purpuric rash on the lower limbs, ar­thralgia and angioedema, without renal involvement. During the third relapse, she had severe, diffuse and persistent abdominal pain and bloody stools. An abdominal ultrasound revealed transmural edema of the last ileal segment, compatible with ileitis. She received prednisolone for five days, with full clinical recovery. Antistreptolysin O titer was elevated. The remaining laboratory tests were normal (antinuclear, anti-neutrophil and anti-Saccharomyces cerevisiae antibodies; rheumatoid factor; stool cultures, parasitological examination and viral antigen tests). One month later, an abdominal ultrasound revealed no abnormalities. Terminal ileitis is a very rare complication of HSP in children but has a good prognosis.

Aedes aegypti (Ae. aegypti) is responsible for the spread of diseases that compromise public health such as dengue fever, urban yellow fever, chikungunya and zika. Synthetic insecticides are used to control Ae. aegypti, however, this substance use results in vector resistance and environment contamination. Essential oils (OEs) derived from plants are natural alternatives to replace the commercial synthetic insecticides and repellents, since they present components that may be toxic to this vector. This review had as its objective to research the literature surrounding the repellent and adulticide action of essential oils against Ae. aegypti, using electronic research databases (Pubmed, Science Direct and Scielo), to provide an overall view on the plant species used to obtain EOs, the plant parts, extraction methods and analytical techniques used as well as the major components in the EOs. The data showed 16 families, 35 genera and 49 species, with Lamiaceae, Zingiberaceae, Myrtaceae and Rutaceae families being the ones with the most species. Moreover, all plant parts were shown to be used to extract essential oils, especially with hydro-distillation and steam-distillation methods, with Gas Chromatography coupled to Mass Spectrometry (GC–MS) as the main analytical technique. The data revealed the chemical composition of EOs, especially of terpenes. Therefore, essential oils are promising options for the production of natural insecticides due many reasons: they are less harmful to human beings and to the environment; they can be used in association with synthetic insecticides and repellents, reducing the concentration used of the last ones; and can be produced in a perennial manner by producers, using subproducts from the crop industries. By all these reasons, they can be used in insect vector control programs, rather than using synthetic insecticides.

Non-typhoidal Salmonella osteomyelitis in healthy children is a very rare condition. A previously healthy 7-year-old boy presented with foot pain following a small injury. Local inflammatory signs of the foot were observed, with a normal radiograph. Two weeks before, he had had gastroenteritis. Assuming cellulitis, flucloxacillin was began. Early during admission, surgical subcutaneous abscess drainage was performed and Salmonella enteritidis was identified. According to bacterial susceptibility, antibiotherapy was changed to ceftriaxone. A foot radiograph and an MRI scan, performed on the 9th and the 12th days, revealed findings suggestive of osteomyelitis of the metaphysis of the fifth metatarsal. Clinical worsening persisted and surgical extensive debridement was needed. A 6-week antibiotic treatment was completed, with a good outcome. Osteomyelitis with a poor evolution in children with risk factors (prior gastrointestinal illness, warm weather and previous exposure to antibiotics) can raise the possibility of a non-typhoidal Salmonella infection.

Non-typhoidalSalmonellaosteomyelitis in healthy children is a very rare condition. A previously healthy 7-year-old boy presented with foot pain following a small injury. Local inflammatory signs of the foot were observed, with a normal radiograph. Two weeks before, he had had gastroenteritis. Assuming cellulitis, flucloxacillin was began. Early during admission, surgical subcutaneous abscess drainage was performed andSalmonella enteritidiswas identified. According to bacterial susceptibility, antibiotherapy was changed to ceftriaxone. A foot radiograph and an MRI scan, performed on the 9th and the 12th days, revealed findings suggestive of osteomyelitis of the metaphysis of the fifth metatarsal. Clinical worsening persisted and surgical extensive debridement was needed. A 6-week antibiotic treatment was completed, with a good outcome. Osteomyelitis with a poor evolution in children with risk factors (prior gastrointestinal illness, warm weather and previous exposure to antibiotics) can raise the possibility of a non-typhoidalSalmonellainfection.

An exclusively breastfed five-month-old female was referred with anaemia, pallor and hyperpigmented genitalia and inner thighs (top). She was also lethargic, irritable and showed failure to thrive. Laboratory studies revealed a macrocytic anaemia with haemoglobin concentration (Hb) 73 g/l (normal range 95‒140), mean corpuscular volume (MCV) 104 fl (85–97) and neutropenia 0 52 9 10/l (1 0‒ 5 6). The blood film showed macrocytosis, rare poikilocytes and neutropenia. Serum vitamin B12 was undetectable, with high plasma homocysteine [78 8 lmol/l (3 7–13 9 lmol/l)]) and negative anti-parietal cell and anti-intrinsic factor antibodies. Her mother’s laboratory evaluation showed Hb 132 g/l (115–150), MCV 93 6 fl (80–97) and undetectable serum vitamin B12, with antibodies to parietal cells and intrinsic factor being detected. Intramuscular* hydroxocobalamin was started, with progressive haematological and clinical improvement. The infant’s vitamin B12 level was normal on follow-up evaluation 2 months after diagnosis and the hyperpigmentation gradually improved (bottom). Early diagnosis of neonatal B12 deficiency is very important as infants can develop severe neurological sequelae. Mothers are frequently asymptomatic and nonspecific clinical findings are easily overlooked. Cobalamin deficiency affects all age groups and multiple systems, namely the bone marrow and the gastrointestinal and nervous systems. Mucocutaneous signs are less common but can predate other manifestations. In fact, this deficiency must be considered in the differential diagnosis of cutaneous hyperpigmentation. Treatment usually reverses the abnormalities, but some may persist.

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare. info:eu-repo/semantics/publishedVersion

Objectivo: Caracterizar a população que utiliza o serviço de urgência, as circunstâncias que determinam a procura de um médico e as razões porque recorrem a um serviço de urgência hospitalar. Material e métodos: Numa amostra aleatória de 1000 utentes recolhem-se os dados relativos à idade/sexo/residência/classe social/tipo de assistência médica/patologia e razões da ida ao Hospital. Registam-se depois o diagnóstico, exames complementares e, a necessidade de atendimento num serviço hospitalar é avaliada. Resultados: Esta série (n = 1000) foi constituida por 533 (53,3%) crianças do sexo masculino e 467 (46,7%) do sexo feminino, com idades compreendidas entre os três dias de vida e os 15 anos (média de 3,4 anos), 92,4% provenientes da área da grande Lisboa. A grande maioria (94,2%) recorre por iniciativa própria, 46,7% nas primeiras 24 horas de doença e 26,3% já tinham consultas prévias pela mesma doença. Das várias razões apontadas como causa de consulta há a salientar 26,5% de utilizadores habituais. A patologia respiratória foi predominante (39,6%). Apenas 24,6% das situações foram consideradas urgentes, embora nem todas necessitassem do nível de cuidados de um hospital central. Não se verificaram diferenças relativamente ao grupo etário e ao estrato sócio económico, entre o grupo referenciado e o que recorreu por iniciativa própria, sendo contudo significativa a diferença destes grupos quanto à percentagem de internamentos e ao número de urgências. Conclusão: Após análise dos resultados, propõem-se algumas soluções possíveis para o grande afluxo de crianças ao serviço de urgência, por motivos não urgentes., Portuguese Journal of Pediatrics, Vol 26 No 6 (1995)

Resumo: A gastropatia hipertrófica exsudativa (GHE) é uma doença rara na criança. Manifesta-se de forma aguda, com sintomas gastrointestinais associados quase invariavelmente a edema. A clínica varia desde manifestações discretas a situações de anasarca. A etiologia relaciona-se frequentemente com a infecção pelo citomegalovírus (CMV). Descrevem-se quatro casos de crianças com idades entre os dezasseis meses e os quatro anos, internadas com vómitos, epigastralgia e edema. A hipoalbuminémia, sem proteinúria nem disfunção hepática, levantou a suspeita clínica de GHE. O diagnóstico foi confirmado pela endoscopia digestiva alta e pela biópsia gástrica. As serologias revelaram-se compatíveis com infecção aguda por CMV. A evolução foi favorável com terapêutica sintomática. Atendendo às formas de apresentação ligeiras e auto-limitadas, admitimos tratar-se de uma doença sub-diagnosticada, Portuguese Journal of Pediatrics, vol. 39 n.º 1 (2008)

Epstein-Barr virus infection is common in children, usually presenting as infectious mononucleosis, including fever, tonsillitis and lymphadenopathy associated with self-resolving increase in transaminases. Cholestasis is rare in children with only a few cases reported but it was described in up to 55% of the adult population affected. We present a case of a 6-year-old boy with fever, vomiting and choluria. The physical examination showed hepatomegaly and jaundice and was otherwise unremarkable. The laboratory studies revealed increased transaminases (aspartate aminotransferase 97 U/L, alanine aminotransferase 166 U/L), hyperbilirubinaemia (total bilirubin 3.2 mg/dL, direct bilirubin 2.89 mg/dL) and increased γ-glutamyl transpeptidase (114 mg/dL). Urine urobilinogen was increased. The abdominal ultrasound showed hepatomegaly. Epstein-Barr viral capsid antibody IgM was positive and IgG was negative. Serological studies for other viruses were negative. We underline the need to consider Epstein-Barr virus in the cholestatic hepatitis differential diagnosis, in order to avoid unnecessary investigations.

Infective Endocarditis is caused by bacteria or fungi involving the heart or the great vessels (Endarteritis). It is a rare and potentially ominous disease, with increasing incidence. Despite technological advances it remains difficult to diagnose and treat, particularly in children below two years. Congenital heart disease is the main risk factor for Infective Endocarditis in children. A patent ductus arteriosus clinically silent is infrequently implied. Over two-month-old Streptococci spp and Staphylococcus aureus are the main agents, responsible for 62-77% of cases. Gram negative rods count for 4-6%, being Klebsiella pneumoniae a rare pathogen. The authors report a case of a previously healthy four-months-old infant, admitted for bronchiolitis. He developed a Klebsiella pneumoniae persistent bacteremia related to Endarteritis of a silent patent ductus arteriosus. After prolonged and successful antibiotic therapy, the ductus arteriosus was surgically closed. He suffered no complication during the disease process and recovered uneventfully.