Sir, We should like to report what we believe to be the first recorded case of mucocutaneous lymph node syndrome (MLNS) in a white English child resident in this country. A 9-year-old boy presented in January 1978 with a severe cough, was diagnosed as having bronchitis and treated with ampicillin by his general practitioner. Four days later, after an apparent recovery, he developed a sore throat and tender cervical lymph nodes. Diarrhoea and vomiting followed 2 days later with some abdominal discomfort. A rash appeared on his hands and feet, spreading to his trunk. He was febrile and 2 days later, when there was no improvement, he was admitted to hospital. On admission, 9 days after the onset, he was an ill, febrile child (peak temperature 40°C), with strikingly congested conjunctiva and a florid erythematous rash, more marked on the extremities. There was vague abdominal tenderness, and anorexia and vomiting which persisted for some days. His pyrexia persisted despite active measures and on the 3rd day in hospital his liver became palpably enlarged and tender. Because of concern about his fluid intake, intravenous fluids were started. Despite careful monitoring, later the same day he went into cardiac failure with gallop rhythm and pulmonary oedema. This was controlled during the next 24 hours but occasional ectopic beats persisted and his pulse remained high for some days. During the course of the illness he developed a sore strawberry tongue and complained of occasional joint pain although there were no objective signs of joint involvement. On the 5th day, general improvement began, his temperature fell and his rash began to fade. The liver enlargement gradually diminished. On the 9th day in hospital an early systolic murmur was heard for the first time. The hands started desquamating on the 13th day and the feet the day after. After 3 weeks in hospital he was discharged with no remaining signs or symptoms, apart from the murmur. He remains completely well at followup 6 months later. The relevant laboratory investigations were: bilirubin-27 ,umol/l (1.6 mg/100 ml); SGOT-46 IU/I; LDH-567 IU/l; electrophoresis of plasma proteinincreased X2-globulin; gamma GT-71 IU/l; WBC25.5 x 109/l (25 500/mm3); neutrophils-81 %; ESR-80 mm in 1st hour; viral studies-negative; ASO titrenormal. The MLNS was first described in Tokyo (Kawasaki, 1967). In 1972 the Japanese Mucocutaneous Lymph Node Syndrome Research Committee (Tanaka et al., 1976) stipulated that before a diagnosis could be made, a child must have a fever for at least 5 days with no response to antibiotics, and 3 of the following: (1) bilateral congestion of the ocular conjunctiva; (2) changes in the peripheral limbs including indurative peripheral oedema and erythema of the palms and feet, followed later in the illness by membranous desquamation of the fingertips; (3) changes in the lips and mouth including dry red fissured lips, strawberry tongue, and red oral and pharyngeal mucosa; (4) a polymorphous xanthoma of the trunk without crusts or vesicles. Other findings reported are acute nonpurulent cervical lymphadenopathy, mild diarrhoea, arthritis or arthralgia, proteinuria and pyuria, leucocytosis with neutrophilic shift to the left, increased ESR, and positive C-reactive protein. Evidence of aseptic meningitis, mild jaundice, increase in serum transaminase and OC2-globulin, and evidence of carditis have also been described. Our case fulfilled all these criteria and many of the others. Previously reported cases in the UK are of a girl of Italian parentage in Nottingham (Hewitt, 1977), a Japanese in Birmingham (Fossard and Thompson, 1977), and 3 West Indians in London (Scopes and Hulse, 1977; Lyen and Brook, 1978). With widespread recognition of the MLNS it seems likely that the diagnosis will be made with increasing frequency in children of all ethnic groups. The differential diagnosis (Kawasaki et al., 1974) includes erythema multiforme, scarlet fever, Stevens-Johnson syndrome, and Still's disease. In the past MLNS may well have been diagnosed as any of these. The prognosis is generally excellent but there is the occasional report of a child meeting a sudden cardiac death due to arteritis of the coronary system (Kegel et al., 1977), making follow-up of cases desirable. We would like to thank Drs W. J. Appleyard and C. A. Porter for their help in the preparation of this case. GARETH J. MORGAN and MARGARET A. LYNCH Department ofPaediatrics, Kent and Canterbury Hospital, Canterbury CT] 3NG, Kent References

https://adc.bmj.com/content/archdischild/53/11/916.full.pdf

Kawasaki disease in Canterbury.

We have reviewed 35 deaths of infants who were found face down on polystyrene-filled beanbags or their equivalents. Most of the deaths were recorded as sudden infant death syndrome. One-half of the children died before the age of 2 months. It is suggested that the bags played a major factor in the babies' deaths and are dangerous for young children. Mechanisms involved in the deaths of infants on beanbags may also be applicable to deaths of infants on other types of bedding.

Deaths of infants on polystyrene-filled beanbags.

Intentional Suffocation in Infants and Young Children

SIR,-During the past three months, six female members of a hospital staff of approximately 1600-three nurses, two domestics, and one administrator-have presented with a similar clinical picture. This consisted of the sharp onset of severe and persistent pain in the cervical region, which was rigidly held in the erect central position and resisted the least movement, active and passive, in any direction, the pain being greatly augmented by such attempts. With one exception resolution was complete within a few days and the impression gained was that this was spontaneous rather than attributable to the local application of heat and the collar supplied. One recurrence has taken place, of identical nature and duration. Systemic upset, pyrexia, other abnormal physical signs, and radiological changes were all absent. Although chest pains have not infrequently been reported among the staff during this period, no example suggestive of Bornholm disease has been encountered nor has inquiry in the medical wards yielded information of its presence or that of the stiff-neck syndrome among the patients. The clustering of the cases raises the possibility of an infective aetiology. It would be of interest to learn of experience of like nature.

/pdf/suffocation-and-sudden-infant-death-1kdtvryl3l.pdf

Suffocation and sudden infant death.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

A Jay

Author Tools

Chat about Author

Papers

Suffocation and sudden infant death.