Comunidad de Especialistas en la piel de los más pequeños

Bacille Calmette-Guerin Lymphadenitis: A single center experience

Abstract To describe the clinical presentation, course and management of infants that presented with the diagnosis of lymphadenitis after Bacille Calmette-Guerin (BCG) vaccination.

This is a descriptive study of 89 patients that were referred to the pediatric infectious disease clinic at King Hussein Medical Center in Jordan with regional lymphadenitis after BCG vaccination.

The presentation, course and treatment options of these cases were discussed.

The study was conducted between September 2006 and September 2007. Eighty-nine patients (47 males (53%) and 42 females (47%) were studied. All infants received the same type of vaccine used by our Ministry of Health, which is the Danish strain. Unilateral axillary lymph node enlargement was the most commonly seen (47%).

Cervical lymph nodes were noted in 22 patients (25%) and supraclavicular lymphadenopathy was seen in 16 (18%). Sinus formation was seen in 16 (18%) patients. 27 cases (30%) had fluctuating lymph nodes. Four infants had disseminated infection.

The majority (65%) of patients had their symptoms starting within the first 2 months after BCG vaccination. Forty-two (47%) infants had conservative observational management. Anti-tuberculosis medications were commenced in 27 (30%). Surgical excision was performed in 10 (11.5%) cases.

All infants but one had complete recovery by the end of the study period. BCG lymphadenitis is a potential complication that necessitates an early recognition and implementing appropriate treatment protocols.

Complete healing of suppurative lymphadenitis after BCG vaccine can be achieved using different treatment protocols.Keywords BCG, Danish strain, lymphadenitis




Microbiology and Antibiotic Management of Orbital Cellulitis


OBJECTIVES: Orbital infections caused by methicillin-resistant Staphylococcus aureus may be increasing. Because Staphylococcus aureus infections have important treatment implications, our objective was to review the microbiology and antibiotic management of children hospitalized with orbital cellulitis and abscesses. 

PATIENTS AND METHODS: This study was a retrospective chart review of all patients admitted to a tertiary care children’s hospital between 2004 and 2009 with orbital infections confirmed by a computed tomography scan. Patients with preceding surgery or trauma, anatomic eye abnormalities, malignancy, immunodeficiency, or preseptal infections were excluded. 

RESULTS: There were 94 children with orbital infections. A true pathogen was recovered in 31% of patients. The most commonly identified bacteria was the Streptococcus anginosus group (14 of 94 patients [15%]). Staphylococcus aureus (1 patient with methicillin-resistant Staphylococcus aureus) was identified in 9% of patients. Combination antimicrobial agents were frequently used (62%), and vancomycin use increased from 14% to 57% during the study period. Patients treated with a single antibiotic during hospitalization (n = 32), in contrast to combination therapy (n = 58), were more likely to be discharged on a single antibiotic (P < .001). Twenty-five (27%) patients were discharged on combination antibiotics. Thirteen (14%) patients were discharged on intravenous therapy. 

CONCLUSIONS: The Streptococcus anginosus group is an emerging pathogen in pediatric orbital infections. Although methicillin-resistant Staphylococcus aureus was uncommon, patients frequently received vancomycin and combination antibiotics. A simplified antibiotic regimen may help limit the development of resistant organisms and facilitate transition to an oral agent.


Should we say NO to body piercing in children? Complications after ear piercing in children



The popularity of body piercing procedures is increasing around the world. The trend for body ornamentation is not free from risks. The percentage of various complications following such procedures is growing. The aim of this paper is to present a rare complication after earlobe piercing, which happened to a child. Materials and methods
A 7-year-old girl was admitted to the Department of Plastic, Reconstructive and Aesthetic Surgery complaining of inflammatory lesions, caused by the presence of foreign bodies in both of her earlobes, which developed after the body piercing procedure. Her earlobes had been pierced in a beauty parlor six weeks earlier. Results
With regard to the child’s age, the embedded parts of the earrings were removed in the operating theatre. In our description, the hind parts of the earrings started to embed five weeks after the piercing procedure. Too strong and constant pressure caused by fixing clips led to skin ischemia, followed by inflammation and decubitus ulcer, and consequently to the penetration of clips into the earlobes. Conclusions
Complications after body piercing are observed in adults, as well as in children, in whom the decision of piercing performance should be carefully considered and rather postponed until self care is achievable.
Document Type: Research article


Prediction of atopic dermatitis in 2-yr-old children by cord blood IgE, genetic polymorphisms in cytokine genes, and maternal mentality during pregnancy


Atopic dermatitis (AD) is the most common skin disease in childhood and the first step of atopic march. This study aimed to investigate whether AD in children could be better predicted by biologic markers (cord blood IgE [cbIgE], LT-αNcoI alleles, and FcεRI-β E237G genotypes) and maternal mentality during pregnancy, taking into account gender, socio-demographic factors, and parental atopy. From 2001 to 2005, 1264 mother–infant pairs were recruited to participate in a birth cohort study. Prenatal questionnaire was used to collect family history, maternal gestational conditions and mentality, and environmental exposures. Cord blood was collected and assayed for genotypes and IgE levels. Phone interviews at 6 months and 2 yrs of age were conducted to inquire children’s health status, including AD occurrence. In addition to the known risk factors such as gender, maternal education, and parental atopy, biomarkers and maternal mentality during pregnancy were screened by logistic regression as candidate predictors of AD. Area-under-curve (AUC) statistic from receiver-operating characteristic (ROC) curve analysis was used to compare two predicting models with and without biomarkers and maternal mentality. A total of 730 pairs completed the prenatal questionnaire and phone interview and were included in final analysis. The prevalence of ever having physician-diagnosed AD by 2-yr-olds was 5.9%. Elevated cbIgE levels (≥0.5 kU/l), LT-αNcoI alleles, FcεRI-β E237G genotype, and maternal psychologic stress during pregnancy were significantly associated with AD. Comparison with AUCs of the classic model (including gender, maternal education, and parental atopy), the model adding cbIgE levels, genotypes in cytokine genes, and maternal stress (model 2) showed higher ability to discriminate between children with and without AD (AUC statistics: 0.63 [95% CI = 0.60–0.67] vs. 0.73 [95% CI = 0.70–0.76], respectively; model comparison, p = 0.027). We conclude that elevated cbIgE, LT-α and FcεRI-β genotypes, and maternal stress during pregnancy were associated with ever having physician-diagnosed AD in 2-yr-old children and increased the predictive ability for AD after taking into account gender, maternal education, and parental atopic history


Churg-strauss syndrome without respiratory symptoms in a child

Churg-Strauss Syndrome (CSS) is rare in children. It consists of a small- and medium-sized vessel vasculitis, with skin and peripheral nerve involvement. It is characterized by eosinophilia, extravascular necrotizing granuloma, and eosinophilic infiltration of multiple organs particularly the lungs, but may also involve the gastrointestinal tract, the heart, and the kidneys. The condition is usually associated with a preceding history of asthma or allergic sinusitis. It has rarely been reported in children, where most of the cases had pre-existing asthma, allergic rhinitis, or atopic disease. We report a 10-year-old Arab girl proven to have CSS, with no history of asthma or allergic rhinitis, who presented with tender cutaneous nodules of lower extremities, foot drop, and peripheral eosinophilia, without any clinical respiratory symptoms or signs.


Keywords: Churg-Strauss Syndrome, ANCA, vasculitis