To the Parents of the Boy We Lost.

Recently, we took care of a teenage boy in our PICU who had been struggling with a lifelong chronic illness and accompanied him and his parents during the last few days of his life. We had the privilege of getting to know him and his parents quite well during the last few years, as he required hospitalization several times during this time. We saw how extremely dedicated his parents had been to him and his care, how they left no stone unturned and sacrificed everything they could to help him have the best quality of life possible.

Seizure as Presenting Symptom of Multisystem Inflammatory Syndrome in Children.

We describe the case of a 13-year-old girl who presented with a new-onset seizure and fever and subsequently developed severe cardiac dysfunction, coronary artery dilation, and shock due to the surprising diagnosis of multisystem inflammatory syndrome in children (MIS-C). Although the clinical entity we now call MIS-C was first mentioned in the medical literature in April 2020, the full picture of this disease process is still evolving. Neurologic involvement has been described in cases with MIS-C; however, seizures are not a typical presenting symptom.

Case Report of a Child after Hematopoietic Cell Transplantation with Acute Tracheobronchitis as a Cause for Respiratory Failure.

Rapid respiratory failure due to invasive mycosis of the airways is an uncommon presentation of infection, even in immunocompromised patients, and very few pediatric cases have been reported. Patients with tracheobronchitis present with nonspecific symptoms, and radiologic studies are often noninformative, leading to a delay in diagnosis. Prompt initiation of adequate antifungal therapies is of utmost importance to improve outcome.

Impact of Microbiota on Resistance to Ocular Pseudomonas aeruginosa-Induced Keratitis.

The existence of the ocular microbiota has been reported but functional analyses to evaluate its significance in regulating ocular immunity are currently lacking. We compared the relative contribution of eye and gut commensals in regulating the ocular susceptibility to Pseudomonas aeruginosa-induced keratitis. We find that in health, the presence of microbiota strengthened the ocular innate immune barrier by significantly increasing the concentrations of immune effectors in the tear film, including secretory IgA and complement proteins.

Intestinal Microbiota of Mice Influences Resistance to Staphylococcus aureus Pneumonia.

Th17 immunity in the gastrointestinal tract is regulated by the intestinal microbiota composition, particularly the presence of segmented filamentous bacteria (sfb), but the role of the intestinal microbiota in pulmonary host defense is not well explored. We tested whether altering the gut microbiota by acquiring sfb influences the susceptibility to staphylococcal pneumonia via induction of type 17 immunity. Groups of C57BL/6 mice which differed in their intestinal colonization with sfb were challenged with methicillin-resistant Staphylococcus aureus in an acute lung infection model.

Group A streptococcal bacteremia without a source is associated with less severe disease in children.

We analyzed characteristics of 86 Group A streptococcal bacteremia cases at Boston Children's Hospital from 1992 to 2012. Twenty-three percent of children had severe disease, using intensive care unit admission (18), disability (7) or death (2) as indicators. Children with bacteremia without a source (30% of cases) were less likely to have severe disease than children with focal infections in adjusted models.

Postoperative adrenal crisis in an adolescent with Loeys-Dietz syndrome and undiagnosed adrenoleukodystrophy.

Purpose: We present an unusual case involving an adolescent who experienced cardiovascular collapse postoperatively. He had more than one rare life-threatening genetic disorder, and herein we review the anesthetic management of a patient with Loeys-Dietz syndrome (LDS) and adrenoleukodystrophy.

Clinical Features: A 12-yr-old male (41.