1/21. Post-varicella epiglottitis and necrotizing fasciitis.Varicella is a nearly ubiquitous acquired childhood disease. Infectious complications of varicella can be life- or limb-threatening. These complications appear 3 to 4 days after the appearance of varicella exanthem and are heralded by fever, pain, and erythema of the overlying skin. Airway complications of varicella are rare, rapidly evolving, and, unfortunately, difficult to visualize. We report a child who presented with a unique combination of varicella-induced airway complications-acute epiglottitis and subsequent necrotizing fasciitis of the head and neck. varicella, epiglottitis, necrotizing fasciitis, group A beta-hemolytic streptococcus, nasopharyngoscopy.- - - - - - - - - - ranking = 1keywords = streptococcus (Clic here for more details about this article) |
2/21. Donor organ transmission of varicella zoster due to cardiac transplantation.BACKGROUND: We report a case of donor-transmitted varicella zoster viral (VZV) infection in a cardiac transplant recipient. A 15-month-old girl developed primary VZV infection 12 days after cardiac transplantation. The donor suffered from varicella 2 weeks before death from pneumococcal meningitis. methods: Despite treatment of the seronegative recipient with intravenous acyclovir from the time of surgery, she developed symptoms of fever, a nonspecific macular rash, and small palatal vesicles. RESULTS: After rapid diagnostic confirmation by direct immunofluorescence on vesicular fluid, high-dose intravenous acyclovir was commenced. In addition, the cyclosporine dose was reduced by 25%. The child made a quick and uncomplicated recovery. CONCLUSIONS: Donor organ transmission of VZV has not, to our knowledge, been previously reported. It occurred despite treatment with acyclovir and resulted in an atypical cutaneous eruption. It responded to an increased dose of acyclovir and a reduced level of immunosuppression.- - - - - - - - - - ranking = 0.30808229824557keywords = meningitis (Clic here for more details about this article) |
3/21. endocarditis attributable to group A beta-hemolytic streptococcus after uncomplicated varicella in a vaccinated child.Varicella is generally a benign, self-limited childhood illness; however, severe, life-threatening complications do occur. A live, attenuated vaccine exists to prevent this illness, but controversy remains concerning the need to vaccinate children for what is generally a benign, self-limited disease, although more states are currently recommending this vaccine. We report a previously healthy 3-year-old who developed varicella 6 months after vaccination with no apparent skin superinfections, who subsequently developed group A beta-hemolytic streptococcus (GABHS) bacteremia resulting in endocarditis of a normal heart valve. We are unaware of previous reports of endocarditis related to GABHS after varicella. After developing a harsh, diastolic murmur that led to an echocardiogram, aortic valve endocarditis was diagnosed. A 6-week course of intravenous penicillin g was administered. Two weeks after the initiation of therapy, the diastolic murmur was harsher, and echocardiography revealed a large vegetation on the posterior leaflet of the aortic valve, with severe aortic insufficiency and a dilated left ventricle. The patient subsequently developed congestive heart failure requiring readmission and aggressive management. One month after the initial echocardiogram, a repeat examination revealed worsening aortic regurgitation and mitral regurgitation. The patient received an additional 4 weeks of intravenous penicillin and gentamicin followed by aortic valve replacement using the Ross procedure. Our patient, the first reported case of bacteremia and endocarditis from GABHS after varicella, illustrates the need for the health care practitioner to consider both common and life-threatening complications in patients with varicella. While cellulitis, encephalitis, and septic arthritis may be readily apparent on physical examination and commonly recognized complications of varicella, the possibility of bacteremia without an obvious skin superinfection should also be entertained. The case we report is unique in that the patient had normal immune function, had been previously vaccinated, and developed a rare complication of varicella-endocarditis-in a structurally normal heart with a previously unreported pathogen. Although a child may have been vaccinated against varicella, the chance of contracting the virus still exists and parents should be informed of this risk. group A beta-hemolytic streptococcus, endocarditis, varicella, Varivax, complications of varicella.- - - - - - - - - - ranking = 6keywords = streptococcus (Clic here for more details about this article) |
4/21. Group a streptococcus spinal epidural abscess during varicella.Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.- - - - - - - - - - ranking = 5keywords = streptococcus (Clic here for more details about this article) |
5/21. Cardiac complications in children following infection with varicella zoster virus.Infection with varicella zoster virus, leading to chicken pox in susceptible hosts, is usually a benign self-limiting disease conferring immunity in those affected. Cardiac complications are rare, but when present may lead to severe morbidity or mortality. We have recently encountered three children, all of whom developed significant cardiac complications secondary to infection with varicella. myocarditis has long been associated with such infection. The pathological mechanism is presumed similar to other cardiotropic viruses, where both direct cytopathic and secondary auto-immune effects contribute to myocardial cellular destruction and ventricular dysfunction. Complications include arrhythmias and progression to dilated cardiomyopathy. pericarditis, and secondary pericardial effusion, related to infection with the virus is most commonly associated with secondary bacterial infiltration. Both cardiac tamponade and chronic pericardial constriction may result. endocarditis complicating varicella has only been described in the last fifteen years, and is associated with the emergence of virulent strains of both streptococcus and staphylococcus, the two organisms most commonly associated with endocarditis. The exact mechanism by which varicella causes secondary bacterial endocarditis remains unclear. Whilst cardiac complications of infection with the varicella zoster virus are rare, the resulting complications are potentially life threatening. Evidence of varicella-induced carditis must be aggressively pursued in any child with signs of acute cardiac decompensation in whom chicken pox is confirmed or suspected.- - - - - - - - - - ranking = 1keywords = streptococcus (Clic here for more details about this article) |
6/21. Varicella infection in a pediatric AIDS patient presenting as umbilicated papules.An 8-year-old girl with acquired immunodeficiency syndrome presented with fever and alteration of consciousness. She had a history of persistent cryptococcal meningitis. She developed multiple discrete umbilicated papules that resembled cutaneous cryptococcosis on the second day of admission. skin biopsy revealed an ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed intracellular edema, margination of nucleoplasm and multinucleated cells, consistent with herpes infection. The diagnosis of varicella-zoster virus infection was confirmed by the identification of herpesvirus dna from the lesion and differentiation from other herpesviruses by restriction fragment length polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500 mg/m2, three times daily for 14 days which resulted in resolution of the skin lesions within 2 weeks.- - - - - - - - - - ranking = 0.30808229824557keywords = meningitis (Clic here for more details about this article) |
7/21. Membranoproliferative glomerulonephritis with partial lipodystrophy: discordant occurrence in identical twins.The course of disease of a patient with membranoproliferative glomerulonephritis and partial lipodystrophy is described. The case is further characterized by a deficiency of C3 and C3- activator, by normal values of C4, by evidence of the nephritogenic factor, by raised fibrin degradation products and by an unselective proteinuria. The course of the glomerulonephritis runs parallel to a pronounced susceptibility to infection (at first varicella, tonsillitis and measles, later pneumonia, meningitis, encephalitis and hepatitis). On account of a nephrotic syndrome and an initative impairment of the renal function, a cytostatic treatment was begun, which although raising the C3 level did not influence the further course of the disease. As the patient has a healthy identical twin sister without lipodystrophy, who shows no reduction in C3 and no nephritogenic factor, this case proves that these diseases are acquired and not genetically determined.- - - - - - - - - - ranking = 0.30808229824557keywords = meningitis (Clic here for more details about this article) |
8/21. streptococcus pyogenes meningitis complicating varicella in a 3-month-old child.Varicella is a common, usually self-limited infectious disease, and complications are believed to be rare. Despite the dramatic increase in invasive Streptococcus pyogenes infections associated with varicella zoster virus infections in recent years, post-varicella S. pyogenes meningitis occurs very rarely. The third case in the literature is described here.- - - - - - - - - - ranking = 1.5404114912278keywords = meningitis (Clic here for more details about this article) |
9/21. Varicella zoster virus meningitis in a previously immunized child.We are reporting a previously well 5-year-old child with varicella-zoster meningitis who had a history of a previous immunization against varicella. This child also developed a transient sensorineural hearing loss. The child was treated with acyclovir and made a full recovery.- - - - - - - - - - ranking = 1.5404114912278keywords = meningitis (Clic here for more details about this article) |
10/21. Group A streptococcal subdural empyema as a complication of varicella.Group A beta-hemolytic streptococcus and staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from british columbia, canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and streptococcus pyogenes was recovered from the subdural fluid. central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.- - - - - - - - - - ranking = 1keywords = streptococcus (Clic here for more details about this article) |
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