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OBJECTIVE: To determine whether there is a seasonal peak onset of systemic juvenile rheumatoid arthritis (SOJRA) suggestive of an infectious etiology. We examined the seasonal variability of SOJRA in Israel. METHODS: A multicenter retrospective chart review of 59 patients with SOJRA, enrolled from 10 rheumatology units or pediatric departments in Israel. All patients met defined criteria of SOJRA. RESULTS: Fifty-nine patients (31 female, 28 male) were followed from 1982 to 1997. Their mean age was 7.1 +/- 4.3 years (range 0.9-16). Forty-six were Jewish and 13 were Arabs or of Bedouin origin. Eighteen patients (31%) had disease onset in the winter, 16 (27%) in the spring, 12 (20%) in the summer, and 13 (22%) in the fall. Twenty-eight patients had a monophasic disease subtype, while 31 had a chronic or cyclic subtype. The seasonal onset in the patients with the monophasic type versus the chronic or the cyclic type shows 7 versus 11 in the winter, 7 versus 9 in spring, 8 versus 4 in summer, and 6 versus 7 in fall, respectively. CONCLUSION: There is no seasonal pattern to SOJRA disease onset in Israel. However, the disease onset of patients having the chronic or the polycyclic subtype tends to be more common in winter and spring. Since patients with this type have more severe disease, it is possible that another specific infectious agent is one of the factors involved in the pathogenesis of the disease. Larger sampling and multicenter studies are required to clarify this point.

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A 10-year-old girl was admitted with a 3-day history of fever, cough, abdominal pain and vomiting. Severe neutropenia (total neutrophil count 186/mm3), a mild increase in ALT and AST, and a positive titer of IgM antibodies against parvovirus B19 were found. The neutropenia resolved and liver enzymes became normal as she recovered. We conclude that parvovirus B19 infection should be considered in the evaluation of an acute illness accompanied by severe neutropenia.

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A 14-year-old girl with fever and low back pain was diagnosed as having brucellosis and diskitis. Treatment with doxycycline and gentamicin had no effect nor was there any improvement when the treatment was changed to doxycycline and rifampicin. With cessation of this treatment and administration of cloxacillin fever was reduced and the back pain disappeared. After 12 days of i.v. cloxacillin, she was released from hospital with instructions to continue cloxacillin orally for another 4 weeks. We conclude that when a patient is suffering from brucellosis and diskitis and does not respond to the usual anti-brucellosis treatment, an anti-staphylococcal preparation should be added.

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We report the first Israeli pediatric case of Kikuchi's disease in a 10-year-old male. He was hospitalized for evaluation of migrating arthralgia and fever. Axillary adenopathy was the main physical finding. A biopsy showed a histiocytic necrotizing lymphadenitis. Diagnosis, therapeutic options and the clinical significance of Kikuchi's disease are discussed. Kikuchi's disease should be considered in the differential diagnosis of fever of unknown origin in children, even in the absence of cervical adenopathy. A long follow-up is advised because of possible links with systemic lupus erythematosus and to detect eventual late recurrences.

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OBJECTIVES: Our major goals in this study were to determine the prevalence of Helicobacter pylori among Israeli children with recurrent abdominal pain and to establish whether a link exists between eradication of Helicobacter pylori and the recovery from abdominal pain. The alternative target was to examine whether the serological test can replace endoscopy in children. METHODS: Upper gastrointestinal endoscopy was performed in 80 children with recurrent abdominal pain. During endoscopy, antral biopsies were taken and sent for histological and bacteriological examination. RESULTS: The prevalence of H. pylori, which was indicated by Gram stain and urease test, was 54%. The positive cases were treated with bismuth combined with amoxycillin and metronidazole. Two months after completion of the treatment, 34 patients were reexamined. Twenty-nine of them (85%) became symptom free, and five (15%) remained symptomatic. These five children were retreated, and they also became symptom free. Eight months after completion of treatment, all 34 patients were reexamined and found to be asymptomatic. CONCLUSIONS: We found a high prevalence of H. pylori (54%) among Israeli children with recurrent abdominal pain; we also found that symptoms were effectively and significantly reduced by the eradication of H. pylori. The endoscopic examination cannot be replaced by serological test.

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A 6-week-old infant was admitted because of anorexia, irritability and convulsions. He was born after an uneventful pregnancy and delivery. He was a normal healthy infant with no previous illnesses and had not been on any medication. The mother's medical history was unremarkable. The convulsions continued during hospitalization and investigation led to the diagnosis of CMV meningoencephalitis, based on the presence of IgM anti-CMV antibodies. He was successfully treated with acyclovir and made an uneventful recovery.

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A survey of breast-feeding habits of Jewish and Arab mothers was carried out in Hadera county in Israel. Jewish mothers breast-fed their babies approximately 3 months, while Arab mothers did so for 5 months. The rate of breast-feeding among Jewish and Arab mothers was 84% and 94.4%, respectively. The results indicated that education, previous experience, enjoyment, husband's encouragement, previous information about the importance of breast-feeding, belief that breast-feeding strengthens the mother-child relationship, and the convenience of breast- over bottle-feeding were all factors that had an impact on breast-feeding habits among Jewish but not Arab mothers. Breast-feeding as a means of birth control, religion, and impairment of the breast's shape were factors that had no effect on either Arab or Jewish mothers. Complications during pregnancy and cesarean delivery decrease the probability of breast-feeding in Arab and Jewish mothers. Jewish mothers stopped breast-feeding because of insufficient milk, fatigue, work obligations, and physician's recommendation. Among Arab mothers the main reasons were insufficient milk, physician's recommendation, baby's refusal, and nipple problems. Jewish mothers who decided not to breast-feed stated that the reasons were previous experience with insufficient milk, nipple problems, and unpleasant feelings. The few Arab mothers who did not breast-feed cited medical or nipple problems.

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Persistent bile-stained vomiting in a neonate led to a radiologic workup that revealed the existence of a situs inversus and a partial duodenal obstruction. A duodenal diaphragm with a central aperture was diagnosed. Surgery confirmed the preoperative diagnosis. In addition, an annular pancreas with an anterior gap and a right parietocolic internal hernia containing all the small bowel were discovered. Embryologic aspects, therapeutic options, and the literature were discussed.

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In 13 of 17 infants (aged 10.5 +/- 4.3; mean +/- SD mo) with iron-deficiency anemia, the serum 24,25-dihydroxyvitamin D concentration was below the normal range and in 9 of these 13 the serum 25-hydroxyvitamin D concentration was below the normal range despite the fact that these infants received 10 micrograms vitamin D/d from the age of 1 mo. The infants were treated with intramuscular iron dextran (Imferon). The iron-dextran treatment increased the hemoglobin and serum iron concentrations as well as 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D concentrations. It is known that iron deficiency impairs fat and vitamin A intestinal absorption. Therefore, it is suggested that absorption of vitamin D may also be impaired. This may contribute to the development of vitamin D deficiency. Iron supplementation may have improved the absorption of vitamin D in the small intestine and hence increased the vitamin D concentration in the plasma.

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A 9-year-old boy developed inapparent infection with hepatitis A virus (HAV) and glomerulonephritis, simultaneously. The diagnosis was confirmed by the finding of serum anti-HAV IgM. We suggest that the kidney involvement was also caused by HAV. Recovery was uneventful.

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A 5-year-old girl who was an asymptomatic carrier of hepatitis B surface antigen developed simultaneously acute type A viral hepatitis and acute glomerulonephritis. She recovered from both acute illnesses uneventfully. We suggest that the kidney involvement was also caused by the hepatitis virus.

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