Since its first identification in Scotland, over 1000 cases of unexplained pediatric hepatitis in children have been reported worldwide, including 278 cases in the UK 1 . Here we report investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator subjects, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in liver, blood, plasma or stool from 27/28 cases. We found low levels of Adenovirus (HAdV) and Human Herpesvirus 6B (HHV-6B), in 23/31 and 16/23 respectively of the cases tested. In contrast, AAV2 was infrequently detected at low titre in blood or liver from control children with HAdV, even when profoundly immunosuppressed.AAV2, HAdV and HHV-6 phylogeny excluded emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T-cells and B-lineage cells.Proteomic comparison of liver tissue from cases and healthy controls, identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins.HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and in severe cases HHV-6B, may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

The aim of this study was to investigate parental perception of febrile illness in their children, the most commonly applied management practices, as well as the expectations from clinicians when coping with fever in children. The study included parents of patients admitted to the Emergency and Observation Department of Children’s Clinical University Hospital in Rīga, Latvia. Data were collected via semi-structured interviews. All interviews were transcribed, and the transcripts analysed by inductive thematic analysis. Thirty-four parental interviews were analysed. Six themes emerged from the study, which were: signs causing concern; beliefs regarding fever; assessment and monitoring of fever; fever management practices; help-seeking behaviour; and expectations from the healthcare personnel. Many parents believed that fever could potentially cause injuries to the nervous system, kidneys, the brain, other internal organs, and even cause death. The perceived threat of fever resulted in frequent temperature measurements and administration of antipyretics. Meeting the emotional and information needs of the parents were considered as equally important to meeting the child’s medical needs. The study found that fever phobia exists among parents. Parental misconceptions of fever lead to overly zealous management practices. Parental education initiatives must be organised in order to improve parental knowledge of fever and its management in children.

Background Serious bacterial infections (SBI) are a significant cause of mortality worldwide. Parental concern and clinician’s gut feeling that there is something wrong has been associated with increased likelihood of developing SBI in primary care studies. The aim of this study is to assess the diagnostic value of parental concern and gut feeling at the emergency department of a tertiary hospital. Methods This prospective observational study included children with fever attending the emergency department of Children’s Clinical University hospital in Riga between October 2017 and July 2018. Data were collected via parental and clinician questionnaires. “Gut feeling” was defined as intuitive feeling that the child may have a serious illness, and “Sense of reassurance” as a feeling that the child has a self-limiting illness. “Parental concern” was defined as impression that this illness is different from previous illnesses. SBI included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, appendicitis, bacterial gastroenteritis, and osteomyelitis. Pearson’s Chi-Squared test or Fisher’s exact test were used to compare the variables between children with and without SBI. Positive likelihood ratio was calculated for “gut feeling”, “sense of reassurance”, and parental concern. Results The study included 162 patients aged 2 months to 17.8 years. Forty-six patients were diagnosed with SBI. “Sense of reassurance” expressed by all clinicians was associated with lower likelihood of SBI (positive likelihood ratio 8.8, 95% confidence interval 2.2–34.8). “Gut feeling” was not significantly predictive of the patient being diagnosed with SBI (positive likelihood ratio 3.1, 95% confidence interval 1.9–5.1), The prognostic rule-in value of parental concern was insignificant (positive likelihood ratio 1.4, 95% confidence interval 1.1–1.7). Conclusion Sense of reassurance was useful in ruling out SBI. Parental concern was not significantly predictive of SBI. Electronic supplementary material The online version of this article (10.1186/s12887-019-1591-7) contains supplementary material, which is available to authorized users.

Introduction.Acute hematogenous osteomyelitis (AHO) is one of the most serious bacterial infections in children that may result in severe complications, such as sepsis, septic shock, bone and joint destruction, disruption of longitudinal bone growth, and even death. Early recognition and evaluation of severity of AHO, awareness of the local prevalence of different microorganisms, as well as timely initiated adequate treatment are crucial for prevention of serious complications. Aim of the Study. To identify the main causative agents of AHO and their antibacterial susceptibility, and to evaluate the applied treatment strategies of AHO in pediatric patients in Clinical Children’s University Hospital (CCUH) in Riga, Latvia. Material and methods. All patients diagnosed with AHO and treated at CCUH were included in retrospective, descriptive study conducted between 1st of January 2014 and 31st of December 2017. Results. The main causative agent for AHO in the study patients was methicillin-sensitive Staphylococcus aureus (MSSA), which was isolated from blood cultures of 40% (n=24) of patients and from 79% (n=57) of intraoperative cultures. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was low (found only in one patient, or 1.4%). Thirteen different antibiotics were applied for treatment of AHO, of which Oxacillin was the most common (received by 89.4% of patients). In 57% of cases (n=54) the patients received monotherapy, and 43% of patients (n=40) received a combination of two or more antimicrobials. The most commonly used combination of antibiotics was Oxacillin plus Clindamycin, which was applied in 25.5% of cases (n=24). In 77% of cases (n=72). a transition from one antibiotic to another was observed. On discharge, oral treatment with Cefuroxime or Clindamycin was most commonly prescribed (in 52.5% and 36% of cases, respectively). The total duration of treatment varied between 5 and 20 days, with a median of 25 days. Conclusions. The main causative agent of acute hematogenous osteomyelitis in children treated at Children’s Clinical University Hospital was Methicillin-sensitive Staphylococcus aureus (MSSA). The prevalence of MRSA at CCUH was very low, which must be considered when prescribing empirical antibacterial treatment, giving preference to narrow spectrum antibiotics. Establishment of local guidelines for management of AHO in children at CCUH, including necessary investigations, treatment algorithm for inpatient and outpatient use with defined duration of treatment and time of conversion to oral antibiotics, follow-up and clinical endpoint criteria, and information for parents or carers.