What’s New with Upper Respiratory Infections?

Professor Ellen Wald, the chair of Pediatrics at the University of Wisconsin, has long been a highly respected voice in the pediatric infectious diseases community, and she has organized an outstanding set of articles for this issue of Pediatric Annals. I am very grateful for her editorship of these contributions, mostly by her disciples and former trainees. The topics covered here obviously account for the majority of sick children doctor visits. In what may be a first for this journal, we have a two-generation contribution, as Ellen is the Guest Editor, and her son, Eric Wald, now an attending physician in our pediatric intensive care unit at Children’s Memorial Hospital in Chicago, has authored an excellent up-to-date review of croup (page 16). Finally, there is consensus on the role of corticosteroids in croup, with uniform recommendations for their use in croup of any severity. Ellen Wald has long been considered the “sinusitis guru” in our field, and she has recruited outstanding individuals to coauthor a review of acute sinusitis (Greg DeMuri, see page 34) and to author a review of chronic sinusitis (Itzhak Brook, see page 41). These are the clearest reviews of these topics I’ve seen recently and will be of great assistance to pediatricians on the front lines. Similarly, Shaikh and Hoberman succinctly review acute otitis media (see page 28) and include great photos of tympanic membranes. Last, but by no means least (because it is one of my favorite topics of interest), we have an excellent review of pharyngitis by Judy Martin (see page 22), with appropriate emphasis on the continuing need to identify and treat streptococcal pharyngitis and on the fact that penicillin or amoxicillin continue to be the drugs of choice. This article doesn’t have the space or intent to discuss why acute rheumatic fever (ARF) has become such a rare disorder almost everywhere in the United States and Canada and in many other developed areas. We had the opportunity to compare the M-types of group A strep that caused acute pharyngitis in children in the 1960s in Chicago with those causing pharyngitis this decade (40 years later). We found a dramatic decline in the proportion of so-called “rheumatogenic” types of group A strep causing acute pediatric pharyngitis both in Chicago and across the United States and Canada. We believe that this, in large measure, explains why ARF has declined so dramatically over the past decades. At our hospital in Chicago, we now see a handful of children with Sydenham chorea and maybe one with acute rheumatic carditis each year, whereas we see about 70 Kawasaki patients annually. [For more information, see Shulman ST, Stollerman G, Beall B, Dale JB, Tanz RR. Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States. Clin Infect Dis. 2006;42(4):441-447.] The pharyngitis article in this issue, of course, is focused mainly on streptococcal pharyngitis. The four stamps chosen to accompany this article all honor Louis Pasteur, and if you look very carefully, two of them actually portray cocci in chains (streptococci). Pasteur (1822-1895) is considered, with Robert Koch, the founder of the science of bacteriology. Among Pasteur’s many contributions to the field was his recognition of the parallel between fermentation, which he showed was caused by bacteria, and purulent infection/putrefaction of tissues, also caused by bacteria. Pasteur was born in the town of Dôle, France, in the Jura region, in his father’s tannery/family home, and the family and tannery business later moved to the town of Arbois. Both of these sites are now interesting museums in small French cities. Pasteur’s initial scientific interests were in crystal structure and other chemical topics, which eventually led to his discovery of the world of bacteriology. Of course, he also became famous, even revered, for his development of a highly effective vaccine against the universally fatal infection rabies. The two Pasteur stamps that portray streptococci are the red, brown, and blue one from the French territory of Afars and Issas (now Republic of Djibouti) and the blue and brown one from the Archipelago of Comoros in the Indian Ocean off the southeast coast of Africa. The yellow and brown Pasteur stamp is from a British colony, St. Helena, a volcanic island in the South Atlantic, and the fourth is from France.

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