E. coli in Acute Gastroenteritis
Diarrheagenic Escherichia coli was isolated significantly more often in children with acute gastroenteritis in an emergency department, compared with inpatients and controls, said Mitchell B. Cohen, M.D., of Cincinnati Children's Hospital Medical Center, and his associates. In a study of 684 children who presented to an emergency department, 643 inpatient children, and 555 controls, the investigators used DNA probes to evaluate stool samples. A majority in each group was aged 5 years or younger (J. Pediatr. 2005;146:54–61).
Diarrheagenic E. coli was present in 167 (24%) of 684 ED patients, compared with 78 (14%) of 555 control patients. However, there was no significant difference in prevalence of E. coli between the inpatients (13%) and controls (14%). There also was no significant difference in prevalence of E. coli between the inpatients and controls in the subset aged 5 years and younger (13.5% vs. 15.4%). In addition, the researchers found a significantly high isolation rate of enteroaggregative E. coli in ED patients less than 1 year old, compared with controls (10% vs. 1.4%). “Diarrheagenic E. coli may be an important, unrecognized cause of diarrhea in children in the [United States], perhaps accounting for 10% of all acute gastroenteritis,” the investigators said. Rotavirus was the most common single etiologic agent, found in 20.3% of inpatients and 20.2% of ED patients, compared with 1.1% of controls.
Antipsychotic Use in Young Children
Nearly one-quarter of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.
The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362–6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of the subgroup 9 years and younger were boys.
Salmonella From Turtles
Small pet turtles were linked to four cases of salmonella in children in 2004, according to the Centers for Disease Control and Prevention and the public health departments of Wisconsin and Wyoming (MMWR 2005;54:223–6).
A 4-year-old girl from Kansas developed diarrhea and a 4-day fever shortly after vacationing in Wisconsin and purchasing a small turtle at a souvenir store. The girl was treated with trimethoprim/sulfamethoxazole for 3 days and had recovered after 5 days. A 2-year-old boy and a 10-year-old boy in Wisconsin developed similar symptoms, including diarrhea and fever, which were traced to pet turtles purchased from different souvenir shops in Wisconsin.
In addition, a 6-year-old boy in Wyoming presented with nausea, diarrhea, vomiting, and a persistent fever. A stool sample yielded Salmonella typhimurium, which was traced to the boy's two pet turtles. Although salmonella infections generally resolve after mild gastroenteritis, they can develop into serious illnesses.
Despite a Food and Drug Administration ban on the sale of turtles with a carapace of less than 4 inches, local health and environmental officials must consider the potential for infections transmitted by turtles that are sold illegally.
Continuum of Eating Disorders Seen
Subclinical eating disorders were diagnosed in 7% of 259 female students aged 17–20 years, reported Paolo Cotrufo, Ph.D., of the University of Naples, Caserta, Italy, and associates.
The investigators sought to characterize less severe forms of eating disorders. The girls completed a sociodemographic questionnaire, the General Health Questionnaire, and the Eating Disorder Inventory 2 (EDI 2). The EDI 2 consists of 11 subscales, including drive for thinness, bulimia, and body dissatisfaction. Two psychologists interviewed the 49 girls who scored at least 14 on the drive for thinness scale. Each girl completed the EDI 2 Symptom Checklist, which measures eating attitudes, compensatory strategies, and menstrual regularity (J. Adolesc. 2005;28:147–54).
Two girls met the criteria for full-blown bulimia nervosa, nine met partial criteria for bulimia, one met partial criteria for binge-eating disorder, 15 met the criteria for subclinical anorexia, and three met the criteria for subclinical bulimia. The other 19 were false-positive cases. The higher prevalence of subclinical anorexia vs. full and partial bulimia suggests that eating disorders might begin with the psychopathology of anorexia and evolve toward bulimia.