The Link - December 2024

Febrile seizures are common in the pediatric population, with approximately 2%-5% of children experiencing a febrile seizure. Although there is low risk of significant adverse events with supportive care alone, caregivers of patients often experience significant distress. Part of providing supportive care for patients and their families who experience a febrile seizure includes acknowledging their stress and providing anticipatory guidance including reviewing the risk of recurrence of seizures. The purpose of this article is to provide a quick primer on the definition of febrile seizures, diagnostic considerations, the risk of recurrence after their first episode, and tips for clearly communicating with families.

In July of this year, this column provided an update about a developing outbreak of HPAI (highly pathogenic avian influenza) A(H5N1) in cows that resulted in two known human cases of infection. The affected individuals both had contact with cows and both developed conjunctivitis, but otherwise minimal symptoms. Since this report, HPAI A(H5N1) infection has been detected in 58 people, with cattle contacts in 35 cases and poultry contacts noted in 21 cases (see Table). There is no clear origin for infection in two cases, one each in California and Missouri. These latter two cases were detected through national influenza surveillance testing (65,000 other specimens were negative for HPAI A(H5N1)). The remaining positives were detected while monitoring 9,000 people exposed to infected animals and testing more than 470 of these potential cases. Infections in poultry (112 million affected birds) have been noted in 49 states; infections in cows (718 dairy herds) in 15 states.

Acute bacterial rhinosinusitis (ABRS) has been traditionally treated with prolonged courses of antibiotics of 10 days or greater. Although the 2012 Infectious Diseases Society of America guidelines recommended shortening antibiotic durations for adults with ABRS to five to seven days based on robust data, longer durations continue to be recommended to children due to historical practice and the lack of evidence from pediatric studies.¹ More recent national and international guidelines with a focus on adult and pediatric patients recommend shorter duration of antibiotics.

On Oct. 24, 2024, the Advisory Committee on Immunization Practices (ACIP) voted to revise the immunization schedule for Bexsero (MenB-4C). This recommendation aligns with the full product approval that the U.S. Food and Drug Administration granted Bexsero on Aug. 19, 2024. Following new immunogenicity data, the schedule recommendation was updated to provide the most optimal protection.  

A 5-year-old boy with a history of systemic lupus erythematosus (SLE) presented to the dermatology clinic for evaluation of a new rash. Mother noted that the rash developed one month ago, initially appearing as “bumps” around his nose, which gradually spread around his mouth and eyes. She observed that some lesions became larger and pink, resembling “pimples.” The rash does not seem to bother the patient, and it has not bled, drained or itched. Initially, the mother used oatmeal soap to wash the area but has been using warm water for the past few days without improvement.

She denies any recent illness, travel history, exposure to sick contacts, family members with similar rashes, new soaps or detergents, or any other known rash triggers.

The patient was diagnosed with SLE two years ago after presenting with fevers and a rash. His condition has since been well controlled with an oral prednisolone taper, hydroxychloroquine, mycophenolate mofetil and rituximab infusions.