Background: Infections caused by S. aureus strains encoding Panton–Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present the pediatric case of an invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) found studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or in adult populations. A logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46–86.09; p < 0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches.

Tuberculous pericarditis (TBP) is an important cause of pericarditis worldwide while being infrequent in childhood, especially in low-TB-incidence countries. We report a case of TBP and provide a systematic review of the literature, conducted by searching PubMed, Scopus, and Cochrane to find cases of TBP in pediatric age published in the English language between the year 1990 and the time of the search. Of the 587 search results obtained, after screening and a backward citation search, 45 studies were selected to be included in this review, accounting for a total of 125 patients. The main signs and symptoms were fever, cough, weight loss, hepatomegaly, dyspnea, and increased jugular venous pressure or jugular vein turgor. A definitive diagnosis of TBP was made in 36 patients, either thanks to microbiological investigations, histological analysis, or both. First-line antitubercular treatment (ATT) was administered in nearly all cases, and 69 children underwent surgical procedures. Only six patients died, and only two died of TBP. TBP in childhood is relatively uncommon, even in high-TB-prevalence countries. Clinical manifestations, often suggestive of right-sided cardiac failure, are subtle, and diagnosis is challenging. TBP has an excellent prognosis in childhood; however, in a significant proportion of cases, invasive surgical procedures are necessary.

Background: Infections caused by S. aureus strains encoding Panton-Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present a pediatric case of invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) evidenced studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or adult populations. Logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46 - 86.09; p<0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches.

Immunization is a preventive measure of crucial importance. As with any other medication, side effects are a possibility and include the rare occurrence of severe infections, such as osteomyelitis. We report an unusual case of pediatric osteomyelitis following vaccination and provide a review of similar reports submitted to the Vaccine Adverse Event Report System (VAERS), aiming to explore the association between the vaccination procedure and the occurrence of osteomyelitis in childhood. A previously healthy infant, with no history of trauma or infection, presented with hyperpyrexia, swelling, and functional impairment in the left leg and was eventually diagnosed with osteomyelitis of the left femur. An edema was noted at the site of the injection that he received days before for immunization purposes. The infection required surgical drainage and a four-week-long intravenous antibiotic treatment, and the patient was discharged upon showing improved clinical conditions. Forty-seven reports of similar cases submitted to VAERS between 1994 and 2023 were collected, and several cases from the literature, including a case of femoral osteomyelitis in a newborn vaccinated against Hepatitis B, attributed to improper injection technique. Another case was reported in a 15-year-old girl, which aligned with six similar cases of osteomyelitis in adolescents following HPV vaccines collected from VAERS. Despite the small sample number, the findings that in 77% of cases the infection was localized in the vaccinated limb and that symptoms appeared on average 4.3 days (IQR 1.0–5.7 days) post-vaccination suggest a possible link to the injection procedure and highlight the need to adhere to recommendations regarding skin preparation and the selection of the appropriate needle length and injection site.

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis, resulting in 3.6 million hospitalizations for acute lower respiratory tract infections and 101,400 deaths in children under 5 years of age worldwide each year. In Europe, the estimated incidence of RSV-related hospitalizations in infants is 1.8%. We describe the incidence of RSV infection in patients hospitalized in Sicily (Italy) between 2008 and 2021, examine the clinical-epidemiological characteristics of RSV-positive patients, and assess comorbidities associated with illness severity. All data were retrospectively collected from standard hospital discharge records (HDRs). Significant factors from the univariate analysis were included in a multivariate logistic regression using the stepwise forward selection method to calculate adjusted odds ratios (aORs) and identify independent risk factors for ICU admission. Collectively, within the study time frame, 4,485 hospital admissions were RSV-related, 271 patients (6%) were admitted to the ICU, and eight deceased (0.2%). The majority of hospitalized patients (86%) were infants (up to 1 year old), 16.5% were newborns (<28 days), and 10.1% were in the 1–4-year-old group. Several predictors of ICU admission, including neonatal sepsis, neonatal respiratory distress, and younger age (in months), were identified through multivariate logistic regression analysis. RSV-associated pathologies are important causes of hospitalization in Sicily, and young age (particularly 0–3 months) and comorbidities, including nutritional and metabolic disorders (with a stronger effect in the pediatric subgroup) and congenital heart diseases, are important outcome predictors. However, considering that RSV-related diseases continue to require hospitalizations in healthy children and adults, it is important to continue monitoring RSV-related hospitalizations through updated epidemiological studies, which can guide the implementation of existing preventive strategies and inform the cost‒benefit analysis of new ones.

Following the first pediatric review on Legionnaires' Disease (LD) in 2006, we provide an updated literature review on LD in a pediatric population. We reviewed PubMed and Scopus for case reports and case series of LD in children, extracted clinical-epidemiological data and used the CARE checklist to assess completeness of reporting. We report a severe case of LD in a previously healthy 15-month-old girl who developed the infection following short-term steroid therapy. The disease was likely acquired in a healthcare setting, despite the implementation of standard water-safety prevention strategies. To contextualize this finding, we systematically reviewed the available literature, identifying a total of 44 pediatric LD cases, predominantly from Europe, Asia, and North America. Sixty-four percent (n=28/44) were up to one year of age, with neonates accounting for one-third of cases (34%, n=15/44). Comorbidities and immune deficiencies were present in 61% (n=27/44) and 41% (n=18/44) of cases, respectively. Hospital-acquired cases were common (55%, n=18/33). Diagnosis relied on PCR (93% positivity, n=26/28) and culture (57%, n=25/44) performed mainly on respiratory samples. Targeted antibiotic therapy was strongly associated with reduced mortality (p=0.031). The overall mortality rate was 23% (n=10/44). Our findings appear consistent with previous observations suggesting a potential benefit of early identification of LD and timely targeted treatment. The high proportion of healthcare-associated LD cases stresses the need for strengthened prevention and infection-control strategies.