Background:Bronchiolitis is a potentially life-threatening respiratory illness commonly affecting children who are less than two years of age. Patients with viral lower respiratory tract infection are at risk for co-bacterial infection.Aim:The aim of our study was to evaluate the use of C-reactive protein (CRP) in predicting bacterial co-infection in patients hospitalized for bronchiolitis and to correlate the results with the use of antibiotics.Patients and Methods:This is a prospective study that included patients diagnosed with bronchiolitis admitted to Makassed General Hospital in Beirut from October 2008 to April 2009. A tracheal aspirate culture was taken from all patients with bronchiolitis on admission to the hospital. Blood was drawn to test C-reactive protein level, white cell count, transaminases level, and blood sugar level.Results:Forty-nine patients were enrolled in the study and were divided into two groups. Group 1 included patients with positive tracheal aspirate culture and Group 2 included those with negative culture. All patients with a CRP level ≥2 mg/dL have had bacterial co-infection. White cell count, transaminases and blood sugar levels were not predictive for bacterial co-infection. The presence of bacterial co-infection increased the length of hospital stay in the first group by 2 days compared to those in the second group.Conclusion:Bacterial co-infection is frequent in infants with moderate to severe bronchiolitis and requires admission. Our data showed that a CRP level greater than 1.1 mg/dL raised suspicion for bacterial co-infection. Thus, a tracheal aspirate should be investigated microbiologically in all hospitalized patients in order to avoid unnecessary antimicrobial therapy and to shorten the duration of the hospital stay.

SummarySystemic lupus erythematosus (SLE) is a serious chronic autoimmune disease with intense inflammatory response and damage in many target organs including joints, skin, kidneys, heart and nervous system. Cardiac tamponade is extremely rare as a cardinal presentation of SLE in children with only a few cases reported in the literature. We report two cases of a 9-year-old boy and an 11-year-old girl presenting with acute cardiac tamponade and later recognition of elevated anti-double-stranded DNA (anti-dsDNA) titre. We also present a literature review about similar cases in children and we stress on the importance of screening all cases of acute cardiac tamponade in children with antinuclear and anti-dsDNA antibodies to avoid any delay in SLE diagnosis and treatment. BACKGROUND

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