Perianal infectious dermatitis(PID) represents a super-ficial inflammation of the perianal skin, which is of bac-terial origin(classically, group A beta-hemolytic strepto-cocci). This narrative review aims to critical...Perianal infectious dermatitis(PID) represents a super-ficial inflammation of the perianal skin, which is of bac-terial origin(classically, group A beta-hemolytic strepto-cocci). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author's knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search(from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides up-dated information about essential aspects of PID(epi-demiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations(like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn's disease, psoriasis, sebor-rheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy(oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.展开更多
Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, o...Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, or obsessive-compulsive disorder (OCD), whose symptoms are exacerbated by group A streptococcal (GAS) infection. PANDAS has been known to cause a sudden onset of reward deficiency syndrome (RDS). RDS includes multiple disorders that are characterized by dopaminergic signaling dysfunction in the brain reward cascade (BRC), which may result in addiction, depression, avoidant behaviors, anxiety, tic disorders, and/or OCD. According to research by Blum et al., the dopamine receptor D2 (DRD2) gene polymorphisms are important prevalent genetic determinants of RDS. The literature demonstrates that infections like Borrelia and Lyme, as well as other infections like group A beta-hemolytic streptococcal (GABHS), can cause an autoimmune reaction and associated antibodies target dopaminergic loci in the mesolimbic region of the brain, which interferes with brain function and potentially causes RDS-like symptoms/behaviors. The treatment of PANDAS remains controversial, especially since there have been limited efficacy studies to date. We propose an innovative potential treatment for PANDAS based on previous clinical trials using a pro-dopamine regulator known as KB220 variants. Our ongoing research suggests that achieving “dopamine homeostasis” by precision-guided DNA testing and pro-dopamine modulation could result in improved therapeutic outcomes.展开更多
Importance:The use of the rapid antigen-detection test(RADT)has become the standard of care in the early diagnosis of group A beta-hemolytic Streptococcus(GAS)pharyngitis.Concern has been expressed over increased fals...Importance:The use of the rapid antigen-detection test(RADT)has become the standard of care in the early diagnosis of group A beta-hemolytic Streptococcus(GAS)pharyngitis.Concern has been expressed over increased false positives when the child had been treated recently for GAS pharyngitis,resulting in over use of antibiotics.Objective:To determine if the false positive rate for RADT is increased in children recently treated for GAS pharyngitis.Methods:We conducted a prospective study to evaluate 300 children from a private practice with acute pharyngitis who were treated for GAS pharyngitis within the preceding 28 days(study group)compared to 306 children of comparable age who had not been previously treated(control group).RADT and throat culture were performed on all children presenting with signs and symptoms of acute pharyngitis.The false positive and false negative rates were determined and compared in both groups.results:The false positive rate of 11.5%(23/200)in the study group was significantly higher than the false positive rate of 0 in the control group.False positives were more likely to occur in younger children.Interpretation:These data would indicate that while RADT is reliable in most children,it can lead to over treatment in children who have been recently treated for GAS.In children treated in the preceding 28 days for GAS pharyngitis,the presence of infection should be determined with a throat culture only.Treatment based on a positive RADT should be reserved for children not recently treated for GAS pharyngitis.展开更多
目的对A族β溶血性链球菌(beta-haemolytic group A streptococcus isolates,GAS)进行多位点序列分型(multilocus sequence typing,MLST)。方法应用多聚酶链反应(polymerase chain reaction,PCR)对来源于2007年北京和上海两地区分属于不...目的对A族β溶血性链球菌(beta-haemolytic group A streptococcus isolates,GAS)进行多位点序列分型(multilocus sequence typing,MLST)。方法应用多聚酶链反应(polymerase chain reaction,PCR)对来源于2007年北京和上海两地区分属于不同emm分型及其亚型、且对大环内酯类抗生素高水平耐药的14株致儿童猩红热GAS的7对等位看家基因进行扩增,并将目的基因产物测序,然后将所测得的每对等位看家基因的基因序列提交到MLST网站,获得相应的由7对等位看家基因组成的等位基因谱,最后将等位基因谱再次提交到MLST网站,确定GAS临床分离株MLST序列分型(sequence type,ST)。结果 St5240、emm1.0型及其亚型GAS等位基因图谱为4-3-4-4-4-2-4,属于ST28型;emm4.0型GAS等位基因谱为5-7-8-5-15-2-1,属于ST38型;emm12.0型及其亚型GAS等位基因谱为5-2-2-6-6-2-2,属于ST36型;emm22.0型GAS等位基因谱为9-8-1-1-1-3-4,属于ST46型。结论致2007年北京和上海两地区儿童发生猩红热的14株GAS分属于ST28、ST38、ST36及ST46四个不同的克隆系。展开更多
文摘Perianal infectious dermatitis(PID) represents a super-ficial inflammation of the perianal skin, which is of bac-terial origin(classically, group A beta-hemolytic strepto-cocci). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author's knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search(from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides up-dated information about essential aspects of PID(epi-demiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations(like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn's disease, psoriasis, sebor-rheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy(oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.
文摘Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, or obsessive-compulsive disorder (OCD), whose symptoms are exacerbated by group A streptococcal (GAS) infection. PANDAS has been known to cause a sudden onset of reward deficiency syndrome (RDS). RDS includes multiple disorders that are characterized by dopaminergic signaling dysfunction in the brain reward cascade (BRC), which may result in addiction, depression, avoidant behaviors, anxiety, tic disorders, and/or OCD. According to research by Blum et al., the dopamine receptor D2 (DRD2) gene polymorphisms are important prevalent genetic determinants of RDS. The literature demonstrates that infections like Borrelia and Lyme, as well as other infections like group A beta-hemolytic streptococcal (GABHS), can cause an autoimmune reaction and associated antibodies target dopaminergic loci in the mesolimbic region of the brain, which interferes with brain function and potentially causes RDS-like symptoms/behaviors. The treatment of PANDAS remains controversial, especially since there have been limited efficacy studies to date. We propose an innovative potential treatment for PANDAS based on previous clinical trials using a pro-dopamine regulator known as KB220 variants. Our ongoing research suggests that achieving “dopamine homeostasis” by precision-guided DNA testing and pro-dopamine modulation could result in improved therapeutic outcomes.
文摘Importance:The use of the rapid antigen-detection test(RADT)has become the standard of care in the early diagnosis of group A beta-hemolytic Streptococcus(GAS)pharyngitis.Concern has been expressed over increased false positives when the child had been treated recently for GAS pharyngitis,resulting in over use of antibiotics.Objective:To determine if the false positive rate for RADT is increased in children recently treated for GAS pharyngitis.Methods:We conducted a prospective study to evaluate 300 children from a private practice with acute pharyngitis who were treated for GAS pharyngitis within the preceding 28 days(study group)compared to 306 children of comparable age who had not been previously treated(control group).RADT and throat culture were performed on all children presenting with signs and symptoms of acute pharyngitis.The false positive and false negative rates were determined and compared in both groups.results:The false positive rate of 11.5%(23/200)in the study group was significantly higher than the false positive rate of 0 in the control group.False positives were more likely to occur in younger children.Interpretation:These data would indicate that while RADT is reliable in most children,it can lead to over treatment in children who have been recently treated for GAS.In children treated in the preceding 28 days for GAS pharyngitis,the presence of infection should be determined with a throat culture only.Treatment based on a positive RADT should be reserved for children not recently treated for GAS pharyngitis.