摘要:

Background.This study determined the safety, pharmacokinetics, antiviral activity and immunologic effects of efavirenz liquid formulation, nelfinavir and nucleoside reverse transcriptase inhibitors (NRTIs) in HIV-infected children, 3 to 9 years of age.Methods.Plasma HIV-1 RNA and lymphocyte subsets were measured at various intervals after initiation of therapy. Pharmacokinetic studies were performed at Week 2, and doses of efavirenz and nelfinavir were adjusted if area under the curve values fell outside specified target ranges.Results.This combination of antiretrovirals was well-tolerated. Pharmacokinetic values were similar to those observed in a previous study of older children who received efavirenz capsules in combination with nelfinavir and NRTIs. After 48 weeks of therapy 63% of subjects had plasma HIV RNA levels of <400 copies/ml, and 58% had <50 copies/ml in an intent-to-treat analysis. CD4 cell count and percentage rose significantly over this time, whereas the number of activated CD8 cells declined.Conclusions.Combination therapy with efavirenz liquid formulation, nelfinavir and NRTIs is an attractive treatment option for HIV-infected children >3 years of age who are unable to take efavirenz capsules.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Mother-to-child transmission of HIV has decreased in industrialized countries because of widespread use of antiretroviral therapy (ART) by HIV-infected pregnant women and perhaps to increased use of elective cesarean section. We evaluated changes in the use of ART and mode of delivery among HIV-positive pregnant women in North Carolina.Methods.We reviewed the medical records of HIV-exposed infants born in North Carolina between January 1, 1998, and December 31, 1999, who were tested for HIV DNA. These results were compared with data collected on HIV-exposed infants born from 1993 through 1997.Results.The use of combination ART increased from 1.5% in 1996 to 73% in 1999. The most common ART was zidovudine/lamivudine (39%) followed by zidovudine-lamivudine-nelfinavir (34%), although 34 combinations were used. Elective cesarean sections in the state increased significantly from 16.5% in the first half of 1998 to 49.4% in the second half of 1999. Overall transmission rates declined from 24.5% in 1993 to an average of 10.6% in 1994 to 1996 (41 of 385) and to 3.5% in 1997 to 1999 (15 of 428).Conclusions.Increased use of combination ART and elective cesarean section was accompanied by consistently low rates of perinatal transmission. However, because perinatal transmission rates were also low among women who used combination therapy and had vaginal deliveries, it is difficult to determine how much additional benefit cesarean section affords. Most HIV transmission occurred among women who lacked prenatal care and did not receive or adhere to ART.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Information on the causative agents of acute otitis media (AOM) in infants <2 months of age is limited.Objectives of the study.To analyze the etiology, pathogen susceptibility patterns, clinical presentation and frequency of serious bacterial infections in infants <2 months of age with AOM and to determine the relationship between the organisms isolated systemically and those isolated from the middle ear fluid in the patients with serious bacterial infections in the presence of AOM.Methods.The medical records of 137 infants <2 months of age with AOM who underwent tympanocentesis in the emergency room of Soroka University Medical Center between January 1, 1995, and May 30, 1999, were reviewed. The main variables analyzed included demography, frequency of serious bacterial infections, bacteriologic results, susceptibility patterns of the pathogens and clinical presentation.Results.Median age was 38.7 ± 13 days; 112 of 137 (82%) infants were hospitalized. Six (4%), 27 (20%), 46 (34%) and 58 (42%) episodes were recorded at age 0 to 2, 3 to 4, 5 to 6 and 7 to 8 weeks, respectively. Fever (temperature >38°C) was present in 96 (70%) of the cases. Culture-negative (bacterial) meningitis was diagnosed in 3 cases. Blood and urine cultures were positive in 1 and 6 infants, respectively. None of the afebrile infants developed serious bacterial infection. One hundred twenty-two bacterial pathogens were isolated from the middle ear fluid of 109 of 137 (80%) patients:Streptococcus pneumoniaein 56 (46%),Haemophilus influenzaein 41 (34%), group AStreptococcusin 12 (10%), enteric Gram-negative bacilli in 9 (7%),Moraxella catarrhalisin 3 (2%) andStreptococcus faecalisin 1 (1%). Eleven (20%) of the 56S. pneumoniaeisolates were nonsusceptible to penicillin. Serious bacterial infections were diagnosed in 6 of 137 (4%) patients. Whereas blood and urine grew pathogens typical for blood and urinary tract infections, the middle ear fluid isolates represented different pathogens usually isolated in AOM without any correlation between these 2 groups of pathogens.Conclusions.(1) Most cases of AOM in infants <2 months of age are caused by pathogens similar to those causing AOM in older children; (2) antibiotic resistance may already be present at early age and should be considered in the empiric treatment of AOM in infants <2 months of age; (3) the presence of AOM does not predict a higher risk for serious bacterial infections in afebrile and febrile infants <2 months of age.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Aim.Infected parents, especially infected mothers, may play a key role in transmission ofHelicobacter pyloriwithin the family. The aim of this population-based study was to determine the role of parental infection status in transmission ofH. pylorito the child by taking into consideration the infection status of both parents simultaneously.Methods.Study subjects were a sample of preschool children in the city of Ulm, located in Southern Germany, who were screened for school fitness between January and July, 1998. The infection status of the children was determined by the13C-urea breath test (UBT). Parental infection status was determined by measurement of specificH. pyloriIgG antibodies in saliva using a modified immunoassay (MileniaH. pyloriIgG; DPC, Biermann, Germany). The parents provided additional information through a standardized questionnaire.Results.We included 305 children ages 5 to 7 years (mean age, 5.8 years) and their parents in the analysis. Prevalence ofH. pyloriinfection in children by means of UBT was 10.2% [95% confidence interval (CI) 7.0–14.1%]. The prevalence of infection was 5.1% if the mother showed no salivary antibody response againstH. pyloriand 17.3% if she did. Prevalence of infection in children was 6.8% if the father showed no salivary antibody response and 19.1% if he did. After adjustment for potential confounders (including infection of the spouse), the odds ratio forH. pyloriinfection of the child was 3.9 (95% CI 1.4 to 10.6) when the mother was saliva-positive and 2.0 (95% CI 0.8 to 5.3) when the father was saliva-positive.Conclusion.This study strengthens previous evidence that in the population studied infected parents, in particular mothers may play a key role in transmission ofH. pylorito the child.

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:

Respiratory syncytial virus (RSV) is the most important causative agent of viral respiratory tract infections in infants and young children. Passive immunization against RSV became available recently, but this does not apply to an effective vaccine as a result of dramatic adverse results of immunization with a RSV candidate vaccine in the 1960s and the lack of full knowledge of the immune response induced by RSV. Nonetheless intensive research during the past two decades has resulted in several interesting candidate vaccines, of which some have gone through testing in humans. These include the subunit vaccines PFP-1, PFP-2, BBG2Na and cold-passaged/temperature-sensitive mutants. The development of candidate vaccines against RSV is discussed. Because of questions, uncertainties and difficulties with the development of effective vaccines against RSV, it will probably be at least another 5 to 10 years before routine immunization against RSV becomes available.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Abiotrophia defectiva,formerly designated as the member of nutritionally variant streptococci, is a part of normal oral flora and may be a cause of culture-negative endocarditis. We report a case of infective endocarditis caused byA. defectivainvolving the mitral valve in a 12-year-old girl. She received antibiotic treatment for 8 weeks and was symptom-free 6 months after discharge. We also reviewed the pediatric cases of nutritionally variant streptococcal endocarditis published in the English literature since 1971.

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