摘要:

Background.Before 2001, echovirus 13 accounted for only 65 of ∼45 000 reported enteroviral isolates in the United States. During spring 2001, several outbreaks of echovirus 13 meningitis occurred, primarily affecting children. We investigated a large outbreak in Shelby County, TN, to determine the characteristics and clinical manifestations of echovirus 13 meningitis.Methods.We identified cases of aseptic meningitis at a children’s hospital from April through August 2001 by reviewing discharge records. For patients with laboratory-confirmed echovirus 13 meningitis, we reviewed charts and interviewed parents.Results.We identified 303 hospitalizations caused by aseptic meningitis at the children’s hospital from April through August. Hospitalizations peaked in May. Twenty-six percent of hospitalized patients were infants age <4 months; 63% were male. Hospitalization rates were 3 times greater among black children than among white children (140vs.47 per 100 000). Echovirus 13 was isolated from specimens from 37 (80%) of 46 patients with positive viral cultures. Of those with laboratory-confirmed echovirus 13, 35 (95%) had fever, 26 (70%) had vomiting, 20 (54%) had headache, 16 (43%) had stiff neck and 16 (43%) had irritability. No sequelae or deaths were identified.Conclusions.Echovirus 13 emerged as a predominant strain of enterovirus associated with aseptic meningitis in the United States in 2001. In this outbreak echovirus 13 meningitis appeared to be clinically indistinguishable from aseptic meningitis caused by other enteroviruses.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Human astroviruses cause infantile gastroenteritis worldwide, but the prevalence of disease varies greatly by setting. Since 1997 we have conducted a survey to determine the causes of diarrhea among Spanish children attending an emergency room in Madrid and to characterize the clinical features of viral-associated gastroenteritis.Objectives.To define the epidemiologic role of astrovirus-associated gastroenteritis in Spanish children, to review its clinical features and to compare these illnesses with those caused by rotavirus. To assess the sensitivity of two methods of detection [enzyme-linked immunosorbent assay (EIA) and reverse transcriptase (RT)-PCR].Methods.Fecal specimens from 822 children with acute diarrhea treated at an emergency room were screened by EIA assays. Random astrovirus-positive samples were characterized by RT-PCR and nucleotide sequencing for their phylogenetic grouping.Results.Astrovirus was detected in 44 (5.3%) of 822 specimens tested by EIA. No pathogens were detected in fecal specimens from 238 (29%) children; however, in 137 of those with adequate remaining specimens, we found an additional 50 (6.1%) that were positive by RT-PCR. HAstV-1 was the most prevalent type followed by HAstV-2. The gastroenteritis associated with astrovirus alone was slightly less severe and had a lower score or risk of hospitalization than that associated with rotavirus (P< 0.05).Conclusions.Astrovirus was found in 11.4% of all children whom we tested for enteric viral and bacterial pathogens, making it the second most common cause of acute gastroenteritis among Spanish children. True prevalence of astrovirus could be underestimated if only EIAs were used for detection.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Acute bacterial meningitis (ABM) is an important cause of mortality in Africa, but most studies are based in urban referral hospitals. Poor laboratory facilities make diagnosis difficult, and treatment is limited to inexpensive antibiotics.Methods.We retrospectively reviewed data from children admitted with ABM to a Kenyan district hospital from 1994 through 2000. We calculated the minimum incidence in children admitted from a defined area. We also examined the antibiotic susceptibility patterns.Results.We identified 390 cases (1.3% of all admissions) of whom 88% were <5 years old. The apparent minimum annual incidence in children younger than 5 years of age increased from 120 to 202 per 100 000 between 1995 and 2000 (P< 0.001). Increasing the lumbar punctures performed by including prostrated or convulsing children significantly increased the number of cases detected (P< 0.005). The most common organisms in infants <3 months were streptococci and Enterobacteriaceae. Streptococcus pneumoniae(43.1%) andHaemophilus influenzae(41.9%) were predominant in the postneonatal period. The overall mortality was 30.1%, and 23.5% of survivors developed neurologic sequelae. Chloramphenicol resistance ofH. influenzaerose from 8% in 1994 to 80% in 2000 (P< 0.0001) accompanied by an apparent increase in mortality. A short history, impaired consciousness and hypoglycemia were associated with death. Prolonged coma and low cerebrospinal fluid glucose were associated with neurologic sequelae.Conclusion.ABM in rural Kenya is a severe illness with substantial mortality and morbidity. Prognosis could be improved by broadening the criteria for lumbar puncture and use of appropriate antibiotics.

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:

Background.Pseudomonas aeruginosasepsis is often considered to be hospital-acquired and to affect mainly children with underlying problems. Fewer than 50 cases of community-acquired sepsis associated withP. aeruginosain previously healthy infants and children have been reported in English language literature.Methods.We retrospectively reviewed the medical records of 121 infants and children younger than 15 years of age who had 124 episodes ofP. aeruginosasepsis and were hospitalized at Chang Gung Memorial Hospital and Chang Gung Children’s Hospital during 1983 and 1998. Forty-three episodes of community-acquired infection occurring in previously healthy children were evaluable for this study.Results.Thirty-two children (74%) were male and 36 (84%) were <1 year of age. Ten patients (23%) died. The onset ofP. aeruginosasepsis occurred during May to October in 34 cases (79%). Fever (91%) and diarrhea (72%) were the 2 most common initial symptoms. On admission leukopenia (leukocyte count <5000/mm3) was present in 24 cases (57%) and in 9 of 10 fatal cases.P. aeruginosawas also isolated from other sites than bloodstream in 25 cases (58%), including 10 (43%) of 23 fecal specimens. The initial antibiotic regimen was inappropriate in 16 cases (38%), and the rate of inappropriate initial antibiotic regimen was significantly higher (P= 0.002) in fatal cases (90%) than that in nonfatal cases (24%).Conclusion.Community-acquiredP. aeruginosasepsis in previously healthy infants is not rare in Taiwan. During warm weather seasons, in infants with fever and diarrhea who suddenly develop a septic appearance, it is advisable to cover forP. aeruginosasepsis with aminoglycosides and/or anti-Pseudomonasbeta-lactam antibiotics.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Childhood tuberculosis (TB) is difficult to diagnose reliably because signs and symptoms are nonspecific and sputum for direct microscopy is difficult to obtain, especially in very young children. This diagnostic dilemma is thought to have increased with the HIV pandemic. Few studies on treatment outcome of dually infected children in high endemic countries have been reported. This study examines the impact of HIV infection on clinical presentation, diagnostic criteria and treatment outcome of TB in Ethiopian children.Methods.A prospective cohort study of children with TB diagnosed in Addis Ababa from December 1995 to January 1997 in which HIV-positive children were compared with HIV-negative children with regard to medical history, signs and symptoms, nutritional status, chest radiography, tuberculin skin test, response to TB treatment and final outcome.Mycobacterium tuberculosiswas cultured in children with pulmonary manifestations.Results.HIV-positive children were younger, were underweight and had a 6-fold higher mortality than HIV-negative children. The tuberculin skin test was less sensitive and chest radiography was less specific in HIV-infected patients. Adherence to treatment was high (96%), and the cure rate was 58% for HIV-positive and 89% for HIV-negative TB patients.Conclusion.HIV-positive children are at risk of diagnostic error as well as delayed diagnosis of TB. TB manifestations are more severe and progression to death is more rapid than in HIV-negative children. Weight for age may be used to identify children at high risk of a fatal outcome.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.To reduce morbidity and mortality adjuvant cytokine therapy was administered to septic neonates with variable results. The objective of this case series was to compare the effectiveness of recombinant human granulocyte-macrophage colony-stimulating factor (rhuGM-CSF) and recombinant granulocyte colony-stimulating factor (rG-CSF) with that of placebo in correcting neutropenia induced by sepsis.Methods.Symptomatic, septic premature neonates with or without a positive blood culture were eligible. Twenty-eight patients were randomized: 10 received rG-CSF (5 &mgr;g/kg/dose iv twice a day); 10 received rhuGM-CSF (4 &mgr;g/kg/dose iv twice a day) and 8 received placebo for a maximum of 7 days, or until an absolute neutrophil count (ANC) of 10 000 cells/mm3was reached.Results.A significant increase in the ANC above the baseline was present on Day 2 in the rG-CSF group (P= 0.015) and on Day 5 in the rhuGM-CSF (P= 0.002) and placebo (P= 0.027) groups. The ANC of the rG-CSF group was significantly above that in the rhuGM-CSF and placebo groups on Day 7 (P= 0.03). Mortality and neonatal intensive care unit morbidity was not significantly different between the groups.Conclusion.The neutrophil count in the rG-CSF-treated group increased significantly faster than that in the placebo or rhuGM-CSF group.

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