Objective: To evaluate the clinical value of new coagulation biomarkers including soluble thrombomodulin (sTM) and tissue plasminogen activator inhibitor complex (t-PAI·C) for the diagnosis and prognosis of sepsis in children. Methods: The prospective observational study enrolled 59 children who were diagnosed with sepsis including severe sepsis and septic shock in the Department of Pediatric Critical Care Medicine of Shanghai Children's Medical Center affiliated to the Medical College of Shanghai Jiao Tong University from June 2019 to June 2021. The sTM, t-PAI·C and conventional coagulation tests were detected on illness day one of sepsis. Twenty healthy children were selected as the control group, and the above parameters were detected on the day of inclusion. Children with sepsis were divided into survival group and non-survival group according to prognosis at discharge. Baseline comparisons between groups were performed using Mann-Whitney U test. Multivariate Logistic regression analysis was used to evaluate the risk factors for the diagnosis and prognosis of sepsis in children. Receiver operating characteristic (ROC) curve was conducted to evaluate the predictive values of above variables for the diagnosis and prognosis of sepsis in children. Results: The sepsis group included 59 patients (39 boys and 20 girls), aged 61(22, 136)months. There were 44 patients in the survival group and 15 patients in the non-survival group, respectively. The control group consisted of 20 boys, aged 107 (94,122) months. Patients in the sepsis group had higher sTM and t-PAI·C ((12 (9, 17)×10³ vs. 9(8, 10)×10³ TU/L, 10(6, 22) vs. 2 (1, 3) μg/L, Z=-2.15, -6.05, both P<0.05) compared with children in the control group. The t-PAI·C was superior to sTM for the diagnosis of sepsis. The areas under the curve (AUC) of t-PAI·C and sTM for the diagnosis of sepsis were 0.95 and 0.66, respectively, and the optimal cut-off value were 3 μg/L and 12×10³ TU/L, respectively. Patients in the survival group had lower sTM (10 (8, 14)×10³ vs. 17 (11, 36)×10³ TU/L, Z=-2.73, P=0.006) than those in the non-survival group. Logistic regression analysis showed that sTM was a risk factor for death at discharge (OR=1.14, 95%CI 1.04-1.27, P=0.006). The AUC of sTM and t-PAI·C for predicting death at discharge were 0.74 and 0.62, respectively, and the optimal cut-off values were 13×10³ TU/L and 6 μg/L, respectively. The AUC of sTM combined with platelet counts for predicting death at discharge was 0.89, which was superior to sTM and t-PAI·C. Conclusion: The sTM and t-PAI·C had clinical application values in diagnosing and predicting prognosis in pediatric sepsis.
Child ; Female ; Humans ; Male ; Biomarkers ; China ; Sepsis/diagnosis* ; Shock, Septic ; Tissue Plasminogen Activator ; Infant ; Child, Preschool

A 5-year-old, 8.95 kg, female Schnauzer presented anorexia with a 3-day history and increased heart sound intensity. Based on the clinical and echocardiographic findings along with the positive blood culture result, the dog was diagnosed with infective endocarditis (IE). Using proper antibiotics treatment, clinical signs were improved within 3 days and resolved within 1 week. For exact identification of the causative agent, multiplex polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP) methods were performed. The etiological agent was confirmed as Staphylococcus pseudintermedius with antibiotics resistance genes such as beta-lactamase (blaZ) and methicilline resistance (mecA). The bacterial virulence factors included pyogenic toxin genes such as staphylococcal enterotoxins A, B, C, D, and E and toxic shock syndrome toxin 1. Diagnosis of IE is challenging due to a variety of non-specific clinical presentations, rapid disease progression, and lack of a confirmative diagnostic technique. This report demonstrated that such molecular diagnostics could be very useful for diagnosing and identifying characteristics of the causative organism for prediction of prognosis and proper treatment. To our knowledge, this is the first report on the isolation of S. pseudintermedius using molecular diagnostics from a clinical case of canine IE.
Animals ; Anorexia ; Anti-Bacterial Agents ; beta-Lactamases ; Child, Preschool ; Diagnosis ; Disease Progression ; Dogs ; Echocardiography ; Endocarditis* ; Enterotoxins ; Female ; Heart Sounds ; Humans ; Methicillin ; Multiplex Polymerase Chain Reaction ; Pathology, Molecular ; Prognosis ; Shock, Septic ; Staphylococcus* ; Virulence Factors

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.
Abdominal Wall ; Anti-Bacterial Agents ; Buttocks ; Chickenpox* ; Child* ; Child, Preschool ; Debridement ; Early Diagnosis ; Fasciitis, Necrotizing* ; Fatal Outcome ; Female ; Fever ; Humans ; Hypotension ; Magnetic Resonance Imaging ; Shock, Septic* ; Skin ; Streptococcus ; Streptococcus pyogenes ; Thigh ; Vomiting

BACKGROUND: Nasopharyngeal carcinoma (NPC) is very rare in children and adolescents. The aim of this study was to evaluate clinical characteristics and treatment outcomes of pediatric NPC.METHODS: Medical records of 9 patients treated for NPC at the Seoul National University Children's Hospital between 1988 and 2012 were analyzed retrospectively.RESULTS: The median age at diagnosis was 11 years (range, 9-13 years). One patient had stage II disease, 3 had stage III disease, and 5 had stage IV disease. The histologic subtypes were undifferentiated carcinoma and squamous cell carcinoma in 7 and 2 patients, respectively. All patients were initially treated with cisplatin (100 mg/m2 intravenous [IV] every 4 weeks for 4-6 months), bleomycin (15 unit/m2 IV every 1 weekx7), and fluorouracil (1,000 mg/m2 IV every 4 weeks for 1 year). Eight patients received radiotherapy with doses of 45-59.4 Gy at the primary site and neck nodes. Seven patients (77.8%) achieved complete remission, 1 (11.1%) achieved partial remission, and 1 (11.1%) showed disease progression. Six patients developed fluorouracil-related neurotoxicity; the regimen was changed to cisplatin, epirubicin, and bleomycin in five of the 6 patients. One patient died of progressive disease without responding to treatment. Treatment-related mortality occurred in 1 patient owing to septic shock. Secondary osteosarcoma developed in 1 patient 6 years after treatment. The overall survival was 77.8%, with a median follow-up of 40.8 months (range, 4.5-287.6 months).CONCLUSION: Children and adolescents with advanced NPC treated with combined chemotherapy and radiotherapy have a good survival rate.
Adolescent ; Bleomycin ; Carcinoma ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Child ; Cisplatin ; Diagnosis ; Disease Progression ; Drug Therapy ; Epirubicin ; Fluorouracil ; Follow-Up Studies ; Humans ; Korea ; Medical Records ; Mortality ; Nasopharyngeal Neoplasms ; Neck ; Osteosarcoma ; Pediatrics ; Radiotherapy ; Retrospective Studies ; Seoul ; Shock, Septic ; Survival Rate

Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications.Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered. Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.
Chickenpox ; complications ; Child ; Fasciitis, Necrotizing ; diagnosis ; drug therapy ; etiology ; Female ; Humans ; Shock, Septic ; diagnosis ; drug therapy ; etiology

OBJECTIVESepsis, severe sepsis, and septic shock are frequently encountered and highly lethal conditions among children treated in ICU; however, no many reports on research on serum albumin levels of children under these conditions are available in literature and little is known about the relationship between serum albumin level and prognosis. In this prospective study, the author observed the levels of serum albumin of children with sepsis/severe sepsis/septic shock, and explored the relationship between serum albumin level and severity of illness or prognosis.

METHODFor sepsis/severe sepsis/septic shock patients admitted to the pediatric intensive care unit (PICU) during the year 2008, serum albumin concentration in peripheral blood was examined within 24 h after admission. According to the diagnostic criteria, hypoalbuminemia was defined as serum albumin level of < 35 g/L.

RESULTA total of 247 cases of sepsis/severe sepsis/septic shock children were enrolled. In the order of sepsis/severe sepsis/septic shock group, there were 143, 65 and 39 cases. Overall rate of hypoalbuminemia was 72.9% (180/247). The rate of hypoalbuminemia in children with sepsis, severe sepsis or septic shock was 59.4% (85/143), 86.2% (56/65) and 100% (39/39), respectively. The mortality of hypoalbuminemic patients in sepsis, severe sepsis and septic shock group showed significant difference (P < 0.001). The rates of hypoalbuminemia of the survived cases (69.5%) was significantly lower than that of the non-survived cases (94.1%). Pediatrics critical illness score (PCIS) and serum albumin concentration was positively correlated (P < 0.001), and the mortality was negatively correlated with serum albumin concentration (P < 0.05).

CONCLUSIONHypoalbuminemia is common among children with sepsis/severe sepsis/septic shock and serum albumin level is closely related to prognosis. Serum albumin level monitoring on the basis of PCIS scoring has important clinical prognostic significance in evaluating the prognosis of severe sepsis/septic shock patients.

Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Prognosis ; Prospective Studies ; Sepsis ; blood ; diagnosis ; Serum Albumin ; metabolism ; Shock, Septic ; blood ; diagnosis

OBJECTIVESepsis and septic shock remain a common problem that results in significant mortality and morbidity in pediatric intensive care units (PICU). According to literature, the use of more physiologic steroid replacement therapy is associated with hemodynamic and survival benefits in adult patients with relative adrenal insufficiency (RAI) and catecholamine-resistant septic shock. But little information is available in children. The aim of the current prospective study was to determine the prevalence of adrenal insufficiency in children with sepsis and septic shock using a low-dose adrenocorticotropic hormone (ACTH) stimulation test (1 microg/1.73 m2) in children.

METHODSThe authors performed cortisol estimation at baseline and after low-dose (1 microg/1.73 m2) ACTH stimulation at 30 mins in children during the first 24 hours in patients with sepsis or septic shock admitted to our PICU. Adrenal insufficiency was defined as a response < or = 90 microg/L. Absolute adrenal insufficiency (AAI) was further defined as baseline cortisol (T0) < 200 microg/L and RAI insufficiency by T0 > or = 200 microg/L.

RESULTSSixty-two consecutive cases with sepsis and septic shock admitted to PICU of Shanghai Jiaotong University Affiliated Children's Hospital from April, 2006 to March, 2007. The median age was 37.6 months (range, 2 - 168 months), and their gender distribution was 42 (67.7%) males and 20 (32.3%) females, 53 cases had sepsis (85.5%) and 9 had septic shock (14.5%). The mean pediatric critical illness score (PCIS) was 79.3 +/- 9.2 and median pediatric risk of mortality score (PRMSIII) 11.3 (5 - 19), respectively. Overall mortality of sepsis and septic shock was 27.42%. The evaluation of adrenal insufficiency was conducted as follows. (1) The mean cortisol levels at baseline (T0) and 30 mins after ACTH stimulation (T1) were (318.6 +/- 230.4) microg/L, (452.3 +/- 230.7) microg/L and (454.7 +/- 212.7) microg/L, (579.3 +/- 231.9) microg/L in patients with severe sepsis and septic shock group, respectively. There were no significant difference between the two groups (P > 0.05). (2) The proportion of patients with adrenal insufficiency in the study population was 40.3% as defined by a response < or = 90 microg/L post test. The proportion of patients with adrenal insufficiency in sepsis and septic shock were 39.6% and 44.4%, respectively (chi2) = 0.073, P > 0.05). (3) The serum T0 and T1 levels were (320.5 +/- 223.9) microg/L, (462.3 +/- 212.0) microg/L and (384.3 +/- 258.3) microg/L, (500.7 +/- 470.6) microg/L, respectively, and the proportion of patients with adrenal insufficiency were 37.8% and 47.1% in the survivors and the dead (P > 0.05). The levels of T0 and T1 were related to the PCIS (P < 0.05). The morbidity of adrenal insufficiency was not related to the PCIS, PRISMIII, and number of organ that developed functional insufficiency (P > 0.05).

CONCLUSIONSAdrenal insufficiency may occur in patients with sepsis and septic shock in children. ACTH stimulation test may be helpful to determine whether corticosteroid therapy has a survival benefit in patients with relative adrenal insufficiency. A low-dose ACTH stimulation test can be used to evaluate the adrenal function status of severe sepsis and septic shock in children.

Adolescent ; Adrenal Insufficiency ; diagnosis ; etiology ; Adrenocorticotropic Hormone ; metabolism ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Prospective Studies ; Sepsis ; physiopathology ; Shock, Septic ; physiopathology ; Systemic Inflammatory Response Syndrome ; physiopathology

Background: Septic shockis often seen in severe disease to be hospitalized at Intensive Care Unit. In America, there are about 400,000 infection cases in which 20% to 40% develop into septic sock. Objectives:This study aims to find out some prognostic factors of death in treatment of septic shock in children. Subjects and method:A prospective and descriptive study was conducted on 67 patients suffering from septic shock based on \u201cThe 2002 American College of Critical Care Medicine/Society of Critical Care Medicine \ufffd?combined with standard of 1993 National conference on Intensive care whom admitted Intensive care unit of National Hospital of Pediatrics (N.H.P) Results:The severity of shock affecting mortality rate [OR=33.0; 95% CI (6.6 - 163.0), P < 0.001]. The delay of shock diagnosis significantly affected the results of treatment and mortality rate [OR= 52.0; 95% CI (5.8 - 446.0); p < 0.001]. The severity of acidosis has affected on results of treatment and mortality rate [OR= 4.00; p<0.05]. The blood lactate of > 5.5 mmol/l indicated a bad prognosis and high mortality risk; Se 79%, Sp 52%, AUC 0.75%. The lactate level affected the mortality rate [OR = 10.0; 95% CI (1.9 - 62.0); p < 0.05]. Conclusion: The factors effected to the treatment results and mortality risk consisted of severe sock level, late diagnosis, infected severe high lactate concentration.
Shock ; Septic/ diagnosis ; mortality ; Child

The study included 49 patients from 1 month to 15 years old who had diagnosis of septic shock and treated at ICU of the National Hospital of Paediatrics. The result showed that: group of age<5 years is 71.4%; The male/female ratio is 2.06/1. Patients admitted to hospital from April to June (42.8%). About 90% of cases have local infections such as respiratory infection (34.7%), gastrointestinal infection (24.5%), skin, musle and bone infections (22.4%). All of them have uncompensated shock with symptoms of poor tissue perfusion and hypodynamic; disorded status (100%); cool extremities (91.8%); refill>3 seconds (100%); drop blood pressure (69.4%); weak pulse (71.4%), oliguria and anuresis (100%) and CVP<5 cmH2O (51.2%)
Shock, Septic, Child, Diagnosis

Kawasaki disease is an acute febrile vasculitis that occurs predominantly in young children under 5- years-old. The patients present generally with a high spiking fever that is unresponsive to antibiotics and lasts for more than five days at least. Prolonged fever has been shown to be a risk factor in the development of coronary artery disease. It seems to be certain that infectious agents are associated with the pathogenesis of Kawasaki disease. The differential diagnosis of Kawasaki disease must rule out infectious diseases including scarlet fever, toxic shock syndrome, measles, and so on. This is very important for adequate treatment and prevention of cardiac complications of Kawasaki disease. We experienced a 25-month-old boy who had high fever and pneumonic consolidation in the right middle and lower lobe of the lung that was considered as mycoplasma pneumonia on admission and developed coronary artery aneurysmal dilatation during treatment with roxythromycin.
Aneurysm ; Anti-Bacterial Agents ; Child ; Child, Preschool ; Communicable Diseases ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis, Differential ; Dilatation ; Fever ; Humans ; Lung ; Male ; Measles ; Mucocutaneous Lymph Node Syndrome* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Risk Factors ; Scarlet Fever ; Shock, Septic ; Vasculitis