European journal of pediatrics
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Review Case Reports
Multiple herpetic whitlow lesions in a 4-year-old girl: case report and review of the literature.
Herpetic whitlow is a herpes simplex virus type 1 or 2 infection of the fingers characterised by erythema and painful, non-purulent vesicles. In children it typically occurs after auto-inoculation from herpes stomatitis, herpes labialis or genitalis. Occasionally, person-to-person transmission occurs from family members with herpes labialis. We report a 4-year-old girl with multiple herpetic whitlows secondary to herpetic stomatitis and present a review of the medical literature based on a systematic MEDLINE search of published paediatric patients (English, French and German language). Of 42 identified patients, 72% were younger than 2 years, most had endogenous or exogenous inoculation of herpes simplex virus type 1 and 65% were initially misdiagnosed as having "bacterial felon". Recurrences were reported in 23%. ⋯ herpetic whitlow should be suspected based on clinical signs. Specific diagnosis can be made by polymerase chain reaction or culture. The high rate of misdiagnosed cases indicates that this entity is not sufficiently known. Lesions are self-limited; surgical interventions can be harmful and should be avoided. Recurrences occur as frequently as in adults.
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The World Health Organisation recommends nasopharyngeal catheters as a safe and efficient method of oxygen administration in infants. However, little is known about the mechanisms of the improvement in oxygenation. The aim of the present study was to determine whether nasopharyngeal oxygen therapy produces positive end-expiratory pressure (PEEP). Nine spontaneously breathing infants (median age 13 months, range 10 days to 20 months) after heart surgery were investigated. All patients had normal pulmonary blood flow at the time of the study (Qp:Qs=1:1). Oxygen (oxygen fraction 1.0) was delivered by an 8 F catheter inserted into the nasopharynx (tip just visible below the soft palate). The pulmonary mechanics were analysed using a single compartment model of the respiratory system. Oesophageal pressure (Pes) at end-expiration, dynamic lung compliance (C(L)) and resistance (R(L)), minute ventilation, PaCO2 and PaO2 were measured at baseline without a nasopharyngeal catheter or oxygen, and at oxygen flows of 0.5 l/min, 1.0 l/min and 2.0 l/min. All the flows generated significant increases in PEEP. Mean difference in PEEP (SD, paired t-test versus baseline): 1.6 cm H2O (1.4, P=0.008) with 0.5 l/min of oxygen; 2.8 cm H2O (2.7, P=0.014) with 1.0 l/min of oxygen; and 4.0 cm H2O (2.9, P = 0.004) with 2.0 l/min of oxygen. There was a significant correlation between all the nasopharyngeal flows (in ml/kg per min) and the generated PEEP (P<0.001) and between the C(L) values and the generated PEEP (P < 0.05). There was no significant difference in PaCO2 and R(L). Minute ventilation was significantly less with nasopharyngeal oxygen than at baseline. As expected, PaO2 increased significantly with increasing oxygen flows. ⋯ Administration of oxygen through an 8 F nasopharyngeal catheter at flow rates recommended by the World Health Organisation (0.5 l/min in newborns, 1.0 l/min in infants) produces moderate amounts of positive end-expiratory pressure. The levels achieved may contribute to an improvement in oxygenation by altering the visco-elastic properties of the lung.