We often hear the following question during our clinical practice: Isn’t it a scientific abuse if we want to know the exact genetic background beyond the diagnosis of our patient? The brief answer is: NO. Why? This is what we try to highlight with genetic mosaic conditions involving genetics based therapies of intractable epilepsies and high quality of life
trisomy 21 and trisomy 18 patients as well. There are orphan diseases even within rare conditions where genetic background matters.

Clostridioides difficile is known as the most common cause of adult’s hospital acquired diarrhea. The last 20 years resulted in significant increase in the incidence of childhood infection. The diagnosis and therapy are not finally decided. There are accepted recommendations for adults in particular. Due to the specificities of childhood, different
epidemiology, risk factors and the lack of standardized clinical trials, these can only be partially adapted. The resolution on their own was drafted by the American Academy of Pediatrics in 2013. This paper summarizes knowledge about pediatric infection, diagnosis, and treatment options.

S. aureus is a leading pathogen in human bacterial infections. It is the most common cause of skin and soft tissue infections and one of the most important agents of therapeutically challenging severe, invasive infections (deep-seated abscesses, endocarditis). S. aureus also plays a significant role in nosocomial infections (postoperative wound infection, catheter-related sepsis). The difficulty of treatment is due not only to the difficulty of accessing the site of infection for antiinfectives, but also to the resistance of the pathogen to antibiotics. In addition to antistaphylococcal drugs for methicillin-susceptible S. aureus, the paper reviews the characteristics of the novel, in the pediatric practice infrequently used, antistaphylococcal agents that are active against the methicillin-resistant S. aureus.

There is a big difference between living in fear because of a perceived risk or dying due to a preventable disease, that is a real risk. Many patients are beeing cared only by specialists because of their chronic conditions. However, specialists do not provide primary care; their patients may not receive complete recommendations for immunization against vaccine preventable diseases (VPD). The prevention of infectious diseases for immunocompromised patients should be a significant part of their medical attendance. The immunization practice is safe and efficient among patients at-risk and most of the patients are susceptible to VPD, and what is more, their serostatus is unknown. According to vaccination guidelines Hungarian Special Immunization Service (SIS) increasingly emphasizes the immunization of
patients with special conditions. This paper is dedicated to raise awareness of this practice and to provide some assistance by a professional consultant for physicians and their patients about vaccination.

The SARS-CoV-2 rapidly spreading across the globe has profoundly affected many aspects of our life and confrontates globally the health care systems with severe challenges. The therapeutic options are limited. To contain the pandemy is still relied on epidemiological restrictive measures, that only can be changed in the long term by large-scale vaccination programs. Children are less vulnerable to the infection and they typically have milder disease course. Our paper gives a short overview of the etiology, epidemiology and clinical features of the COVID-19 disease, primarily from paediatric perspective.

The prevalence of children with acquired immune deficiency syndrome is very low in Hungary, but we have to count with 1-2 new cases per year. The disease can manifest at any age, perinatally acquired cases occur in Hungary.
Treatment options have expanded significantly in recent decades, and today everything is in place to ensure that children who are recognized in time can live full, healthy lives and have HIV-negative children.

The combination of amoxicillin and clavulanic acid is used more often than amoxicillin alone, although in some clinical scenarios and areas it is not always well established. In those cases, when pathogens do not produce the beta-lactamase enzyme, the addition of clavulanic acid is unnecessary. Gram-negative organisms require higher and more sustained levels of both amoxicillin as well as the clavulanic-acid component for optimal therapy; thus for clinical syndromes in which Gram-negative pathogens are causative, a narrower ratio (e.g. 4:1) is needed for efficacy. It should also be emphasized that amoxicillin, without clavulanic acid, has fewer side effects and can be used in higher doses (even up to 100 mg/kg/day).

Based on its course, E-viral hepatitis (HEV) was previously considered as a rare disease, hardly distinguishable from hepatitis caused by the HAV. In immunosuppressed patients one can see protean forms of the illness: chronic hepatitis, hepatic cirrhosis and its extrahepatic manifestations. Doctors of different disciplines must be aware of these facts. In case of elevated aminotransferase level of unknown origin, extrahepatic symptoms and graft dysfunction in transplant patients HEV testing is mandatory. There exist recommendations for virological diagnosis. Spontaneously improving infection in an otherwise healthy patient does not need treatment. In the case of fulminant course ribavirin therapy may be considered. Immunosuppressed patients with hepatitis E definitely must be given ribavirin. Transplant patients also should be advised to avoid eating undercooked meat or raw seafood in order to prevent zoonotic infection.

PFAPA syndrome an autoinflammatory condition characterised by alternation of febrile and asymptomatic periods.
Diagnosis is based on the typical recurring symptoms, the laboratory results and the exclusion of other diseases. 48 children were diagnosed with PFAPA between January 2010 and July 2019 in our clinic. Laboratory findings included elevated inflammatory markers during febrile episodes which normalised in the asymptomatic periods. Our patients
were treated with steroid during the attack which resolved the fever almost immediately in most of the cases.
Tonsillectomy was also proven to be effective in the treatment of the syndrome.

A 12 year old boy has been admitted to our Intensive Care Unit, presenting with septic shock, after short course of illness. Due to diagnostics an acute osteomyelitis of the clavicle has been revealed, that has triggered the systemic inflammation. Moreover the patient has developed clinical signs of toxic shock syndrome. Our patient’s condition has shown a rapid improvement under adequate therapy.
Conclusion: The typical clinical symptoms of the osteomyelitis are local pain, swelling and loss of function, however it can occasionally manifest as sepsis, associated with the signs of toxic shock syndrome. In these cases the local symptoms can be obscured by the fulminant systemic inflammatory reaction, so the diagnosis can be challenging.