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This report describes a 15-year-old with an 11.1 × 8.2 × 8.4 cm multiloculated liver abscess caused by methicillin-sensitive Staphylococcus aureus who failed extensive catheter drainage and intravenous antibiotics. Daily intra-abscess oxacillin was instilled for 7 days with rapid clinical improvement and sterilization of the abscess. One month later, an ultrasound of the abdomen revealed a normal liver.

1. Monika L. Dietrich, MD* 2. Russell W. Steele, MD†,‡ 1. *Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 2. †Department of Pediatrics, Ochsner Health Center for Children, New Orleans, LA 3. ‡University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA * Abbreviations: ANF: : acute necrotizing fasciitis ARF: : acute rheumatic fever GAS: : group A Streptococcus IVIG: : intravenous immunoglobulin MRSA: : methicillin-resistant Staphylococcus aureus MSSA: : methicillin-susceptible S aureus PANDAS: : pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PSGN: : poststreptococcal glomerulonephritis STSS: : streptococcal toxic shock syndrome 1. Clinical prediction rules for group A Streptococcus pharyngitis are unreliable in children, and unless viral etiology is strongly suspected, throat swab with a rapid antigen detection test should be performed. 2. Avoid “proof of cure” cultures when treating pharyngitis. 3. Clindamycin is important in invasive group A Streptococcus infection for toxin mediation but should not be used alone secondary to possible resistance. After completing this article, readers should be able to: 1. Understand the epidemiology, transmission, and major virulence factors of group A Streptococcus (GAS) infections. 2. Plan the appropriate diagnostic evaluation of suspected GAS infection. 3. Recognize the clinical features of, and major complications associated with, invasive and noninvasive GAS infections. 4. Plan appropriate management for a patient with a GAS infection. In 1933, Rebecca Lancefield changed our understanding of β-hemolytic streptococci by developing a system of serologic classification based on the carbohydrate composition of cell wall antigens. Of these organisms, the most significant in human pathogenicity is group A Streptococcus (GAS), otherwise known as Streptococcus pyogenes . (1) GAS is responsible for an impressively wide variety of clinical manifestations, from noninvasive infections, such as pharyngitis, scarlet fever, erysipelas, and cellulitis, to invasive disease, including sepsis, streptococcal toxic shock syndrome (STSS), and necrotizing fasciitis (Table 1). It has also been linked to multiple nonsuppurative complications including acute rheumatic fever (ARF), poststreptococcal glomerulonephritis (PSGN), and the controversial pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Globally, an estimated 18 million people are suffering from a serious GAS-related illness, with about 1.78 million new cases annually. Hundreds of millions of people develop less serious GAS infection every year, placing a massive burden on healthcare systems. The …

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed “extensively resistant typhi,” has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the bacterial pathogens causing disease, pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. It is apparent that anaerobic bacteria play a major role in this infection thereby influencing the natural history of disease and directing, to a great degree, medical management.

Young children are most likely to travel to developing countries with their parents to visit relatives. Preparation for such travel must include careful counseling and optimal use of preventive vaccines and chemoprophylaxis. For infants and very young children, data defining safety and efficacy of these agents are often limited. However, accumulated experience suggests that young travelers may be managed similarly to older children and adults.

A 4-month-old female infant with no current medical complaints was seen for a routine 4-month-old wellchild appointment. She was brought to the appointment by her new foster parents, who had taken over her care 1 month prior to presentation. They reported no major illnesses, but did note that her right arm and leg seemed larger than her left; a difference that they felt was particularly noticeable in the upper extremities. Other than this size discrepancy they reported no other current problems. Development was appropriate for age, with the child laughing, cooing, grabbing for objects, and able to roll from front to back on her own. There were no reported constitutional symptoms and weight gain was appropriate; the patient had no easy bruising, no jaundice, no pallor, and had appropriate formula intake and urine output. The patient was born to an HIV-positive mother who was on highly active antiretroviral therapy (HAART) and the patient was treated with zidovudine for the first 6 weeks of life. Her HIV-PCR-DNA assays at 2 weeks and 4 weeks, and testing during the present visit at 4 months of age were all negative, documenting that she was not infected. Physical examination revealed a well-nourished, normal-appearing, happy female infant in no apparent distress. Vital signs were as follows: weight 7 kg (90th percentile), length 65 cm (90th percentile), head circumference 42 cm (75th percentile), temperature 97.9°F, heart rate 119 bpm, respiratory rate 24 breaths/min, and blood pressure 85/56 mm Hg. Oropharyngeal examination revealed moist mucus membranes with a normal sized tongue and no pharyngeal erythema or exudate; the anterior fontanelle was open, soft, and flat, and pupils were equal, round, and reactive to light. There was no cervical, auricular, axillary, or inguinal adenopathy. Heart and lung examinations were within normal limits, and the abdomen was soft, nontender, nondistended, with nor moactive bowel sounds, and without any palpated organomegaly. Measurements were obtained and showed a subtle difference between the left and right side in both upper and lower extremities (Table 1). Tone and range of motion were appropriate for age. The limbs on the right were auscultated, with no bruits appreciable. Given the association between hemihyperplasia (hemihypertrophy) and malignancy, the decision was made to obtain an abdominal ultrasound of the liver and kidneys to rule out an abdominal neoplasm.

Nonaccidental trauma can be difficult to differentiate from osteogenesis imperfecta (OI), especially in the face of multiple fractures. When nonaccidental trauma is being considered, medical causes of injury must be ruled out. In this report, we discuss the case of an 11-month-old female infant who presented with a transverse femur fracture and was also found to have a healing transverse humeral fracture and rib fractures. Medical causes of the fractures were investigated by performing an analysis of urine organic acids, serum amino acids, vitamin D, parathyroid hormone, ceruloplasmin, copper, and blood sequencing for COL1A1 and COL1A2. A mutation of the gene COL1A1 was found, which is consistent with OI type I.

We present the case of a young boy who was born to a human immunodeficiency virus (HIV)-positive mother and originally found to be uninfected. Evidence-based guidelines were followed regarding the mother’s prenatal and infant’s postnatal care, including the avoidance of breast milk. HIV DNA polymerase chain reaction qualitative tests were obtained at birth, 6 weeks and 4 months, and were all negative. He also received 6 weeks of prophylactic zidovudine. Despite these measures, his health began to decline at 17 months of age and antibody and serology tests performed at this time confirmed HIV infection. Guidelines no longer recommend routine antibody testing at 18 months of age to confirm the absence of infection in exposed infants with a record of negative virology in the first year of life. Based on this case and others we propose that this test be added back to the national guidelines for the early detection and prompt treatment of HIV infection in infants born to HIV-positive mothers.