On May 23 and 24, 2013, the First PANS Consensus Conference was convened at Stanford University, calling together a geographically diverse group of clinicians and researchers from complementary fields of pediatrics: General and developmental pediatrics, infectious diseases, immunology, rheumatology, neurology, and child psychiatry. Participants were academicians with clinical and research interests in pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) in youth, and the larger category of pediatric acute-onset neuropsychiatric syndrome (PANS). The goals were to clarify the diagnostic boundaries of PANS, to develop systematic strategies for evaluation of suspected PANS cases, and to set forth the most urgently needed studies in this field. Presented here is a consensus statement proposing recommendations for the diagnostic evaluation of youth presenting with PANS.

Male fetal gender is associated with singleton preterm birth, an effect most evident in white women, particularly if married. Among preterm white twins, there is also a male excess, limited to gestations under 34 weeks. The excess of males in selected groups suggests the existence of a mechanism of preterm birth influenced by fetal gender. Preterm births in blacks and in twin gestations greater than 33 weeks may be more often due to alternative mechanisms that are independent of fetal gender.

The limulus gelation assay was utilized to investigate endotoxin inactivation by a number of antibiotics in vitro. Endotoxin activity was sharply reduced by polymyxin B and sodium colistimethate. The effect of the polymyxin was not significantly inhibited by 0.001 M calcium or 90% serum. Crude endotoxins from a variety of aerobic gram-negative bacteria, including several not previously studied, could be inactivated 1 or more logs by as little as 1 Og of polymyxin B per ml, whereas Bacteroides fragilis endotoxin was poorly detoxified. A 10,000-fold range in the relative susceptibility of different endotoxins to inactivation by polymyxin B was found. The endotoxin most susceptible to polymyxin B was derived from an organism resistant to polymyxin B by disk sensitivity testing, suggesting that the bacteriocidal and endotoxin detoxifying properties of polymyxin need not be directly related.Recent studies have demonstrated the capacity of polymyxin B to protect animals from a variety of toxic effects of endotoxin, including the generalized Schwartzman reaction (5, 23), diffuse intravascular coagulation (6, 7), renal cortical necrosis (6, 7), leukopenia (6, 7), and death (6,12,21,23). The limulus gelation test, developed by Levin and others (13,14), has provided a useful in vitro means to assess an endotoxin activity which corresponds with in vivo indices of toxicity (3,15,24). We have previously found this assay to be useful in evaluating endotoxin inactivation processes (4). The present study was designed to evaluate the effect of polymyxin B and other antibiotics upon endotoxin, the conditions of the reaction, and the relative polymyxin susceptibility of endotoxins from a variety of gram-negative bacteria. MATERIALS AND METHODS

In a whole genome-based phylogeny, clinical and fecal isolates of Escherichia coli sequence type 131 (H30R1 and H30Rx subclones) from six households formed household-specific clusters, interspersed among reference ST131 genomes. This supported the fecal-urethral hypothesis and confirmed within-household strain sharing.

A fluoroquinolone-resistant Escherichia coli strain of sequence type ST131 caused severe septic arthritis and contiguous osteomyelitis in an 8-month-old girl, and colonized the girl's healthy mother, who shared a different fecal E. coli strain with the father. Within-household transmission can contribute to the dissemination of the emerging, multidrug-resistant ST131 clonal group, which has evident invasive potential for otherwise-healthy children.