摘要:

Objectives.To compare the frequency, clinical and radiologic manifestations and source of infection of pulmonary tuberculosis in children treated in our hospital during two decades (1978 through 1987 and 1988 through 1997) and to evaluate the influence of the emergence of HIV infection (since 1985) and the effect of the discontinuation of Calmette-Guérin bacillus (BCG) vaccination (since 1987) on childhood tuberculosis.Methods.We reviewed 324 children diagnosed with pulmonary tuberculosis in our hospital during the 20 years (1978 through 1997). The data from 2 decades, 1978 through 1987 and 1988 through 1997, were compared. BCG vaccination in Spain was discontinued in 1987, and HIV infection emerged significantly as a public health problem.Results.An increase in the number of children with single hilar adenopathy was observed (32.2% in 1978 through 1987vs.43.4%, in 1988 through 1997,P< 0.05) in comparison with those with parenchymal involvement or a mixed pattern (62.4% in 1978 through 1987vs. 45.7% in 1988 to 1997). Frequency in extrapulmonary manifestations in both periods was similar, with a nonsignificant trend toward a lower rate of tuberculous meningitis in the latter decade (10.4 vs.5.6%,P= 0.07). We were able to identify an adult source case for 67.1% of the children (100 of 149) in the first decade vs.58.3% (102 of 175) in the second (P= NS); 10.8% of adult contacts but only 2.3% of children (all of them in the second period) were HIV-positive.Conclusions.Discontinuation of BCG vaccination and emergence of HIV infection have had little influence on childhood tuberculosis in our area.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The number of children with AIDS in Africa is high. Such children may be at risk for cryptococcal meningoencephalitis, but data are scarce regarding this disease in our population.Methods.We examined records of HIV-infected children (≤16 years) diagnosed with cryptococcal meningoencephalitis in Harare, Zimbabwe, between 1995 and 2000. To elucidate features unique to pediatric disease, the children were compared with adult patients with HIV-associated cryptococcal meningoencephalitis.Results.Thirteen children presented to our institution with headache (85%), nuchal rigidity (69%), vomiting (46%), impaired mental status (38%), convulsions (38%) and focal neurologic signs (23%). The mean duration of symptoms before diagnosis was 9 days. Cerebrospinal fluid examination revealed normal white blood cell counts in 64%, protein value in 67% and glucose concentration in 57% of patients. Children were more likely than adults to have seizures (38%vs.11%,P= 0.02) and normal cerebrospinal fluid protein (67%vs.10%,P< 0.01). The in-hospital mortality was 43%. Convulsions (P= 0.05) and impaired mental status (P< 0.01) were associated with increased mortalityConclusions.Cryptococcal meningoencephalitis in African children presents acutely or subacutely, can have a fulminant picture and is consistent with progressive meningoencephalitis.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Limited information is available on the cellular characteristics of the middle ear fluid (MEF) during acute otitis media (AOM).Objectives.To determine the white blood cell (WBC) composition of the MEF in AOM before and during antibiotic therapy.Materials and methods.Total WBC and differential counts were determined in the MEF of 96 infants and children (ages 2 weeks to 3 years) with AOM who were receiving antibiotics. WBC counts were reported as number of WBC/mg MEF (mean ± sd).Results.One hundred forty-five MEF samples were obtained by tympanocentesis at enrollment (Day 1), and 36 samples were collected on Days 4 to 5 after initiation of antibiotic therapy. Sixty-one percent of the patients were <1 year of age, and 38% were receiving antibiotic therapy at enrollment. Twenty-eight MEF samples were paired (same ear, Day 1 and Days 4 to 5). One hundred twelve pathogens were isolated from 95 of 145 (66%) culture-positive samples obtained on Day 1: 67Haemophilus influenzae, 40Streptococcus pneumoniaeand 5 others. MEF WBC counts were lower on Day 1 in patients who had received previous antibiotic therapy than in those who had not (432.4± 412.8 vs.590.5 ± 436.8,P= 0.03). WBC counts were higher on Day 1 in culture-positive than in culture-negative samples (603.9 ± 504.9 vs.421.4 ± 373.4,P= 0.02). WBC counts were higher on Day 1 in MEF samples positive forS. pneumoniaethan in those positive forH. influenzae(799.2 ± 641.5 vs.506.4 ± 401.9,P= 0.04). There were no differences in the number of neutrophil WBC present in the samples obtained on Day 1 vs.Days 4 to 5 or between samples positive vs.samples negative for bacterial pathogens.Conclusions.WBC counts were higher in the MEF of patients with culture-positive AOM than in those with culture-negative AOM and in those with AOM caused byS. pneumoniae.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ochrobactrum anthropiis an emerging pathogen in immunocompromised hosts, particularly in patients with indwelling catheters. We report the characteristics of 14O. anthropibacteremic episodes in 11 children with Hickman-type central catheters. Children presented with fever and nonspecific clinical manifestations. Bacteremia was successfully treated with antibiotics, but catheter removal was necessary to achieve cure in four cases.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID