摘要:

Background.Hyperbilirubinemia and liver enzyme abnormalities are commonly observed in sepsis. However, the frequency in premature neonates and the specific relation to Gram-negative bacteria are not known.Patients and methods.Charts of all preterm infants who had positive blood cultures for either Gram-negative bacteria or coagulase-negative staphylococci were reviewed. Neonates with Gram-negative bacteremia (n= 54) were compared with neonates with coagulase-negative staphylococcal bacteremia (n= 31). In addition infants with Gram-negative bacteremia and elevated liver enzymes (n= 25) were compared with infants with Gram-negative bacteremia and normal liver enzymes (n= 29).Results.Liver enzyme abnormalities accompanied 46.3% (25 of 54) of Gram-negative bacteremia and 12.9% (4 of 31) of episodes of coagulase-negative staphylococcal bacteremia (P= 0.002). Serum concentrations of liver enzymes were significantly higher in infants with Gram-negative bacteremia than in those with coagulase-negative staphylococcal bacteremia (P< 0.0001), but no difference in alkaline phosphatase serum values was observed. Infants with Gram-negative bacteremia and elevated liver enzymes were not fed for a longer period than infants with Gram-negative bacteremia and normal liver enzymes (7.3 ± 6.3 daysvs.4.0 ± 4.3 days,P= 0.03), and this was accompanied by significant conjugated hyperbilirubinemia (P< 0.0001). Ventilation, total parenteral nutrition and medications were not responsible for the observed differences.Klebsiella pneumoniaebacteremia was commonly associated with elevated liver enzymes (12 of 18), whereas none of the infants withPseudomonas aeruginosabacteremia had elevated liver enzymes.Conclusions.Gram-negative bacteremia is commonly associated with cholestasis in premature neonates. Liver enzyme abnormalities are more common than elevated conjugated bilirubin, not all Gram-negative bacteria have the same effect and the lack of enteral feeding seems to play a more significant role than the administration of parenteral nutrition.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective.To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemicCandidainfection during intensive care stay.Method.We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed withCandidasepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994.Results.Forty-six extremely low birth weight infants with systemicCandidainfection, mean (±sd) gestational age of 24.7 ± 1.6 weeks and birth weight 699 ± 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P= 0.0001), a high incidence of periventricular leukomalacia (26%vs.12%,P= 0.06) and an increase in severe retinopathy of prematurity (22%vs.9%,P= 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41%vs.12% had severe disabilities (P= 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous systemCandidainvolvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome.Conclusions.SystemicCandidainfection is associated with increased short and long term morbidity in extremely low birth weight infants.Candidainfection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Cytomegalovirus (CMV) is the most frequent cause of congenital infection, and both symptomatic and asymptomatic infants may have long term sequelae. Children with congenital CMV infection are chronically infected and excrete CMV in the urine for prolonged periods. However, the effect of prolonged viral replication on the long term outcome of these children is unknown.Objective.To determine whether duration of CMV excretion is associated with outcome at 6 years of life in symptomatic and asymptomatic congenitally infected children.Methods.Longitudinal cohort study. Children congenitally infected with CMV were identified at birth and followed prospectively in a study of long term effects of congenital CMV infection. The relationship between duration of CMV urinary excretion and growth, neurodevelopment and presence and progression of sensorineural hearing loss (SNHL) at 6 years of age was determined.Results.There was no significant difference in the duration of viral urinary excretion between children born with asymptomatic (median, 4.55 years) and symptomatic (median, 2.97 years) congenital CMV infection (P= 0.11). Furthermore there was no association between long term growth or cognitive outcome and duration of viral excretion. However, a significantly greater proportion of children who excreted CMV for <4 years had SNHL and progressive SNHL compared with children with CMV excretion >4 years (P= 0.019,P= 0.009, respectively).Conclusions.Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits. However, SNHL and progressive SNHL were associated with a shorter duration of CMV excretion.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The studies on hepatitis C virus (HCV) vertical transmission, the effect of potential risk factors and the role of breast-feeding have reported conflicting results.Patients and methods.Seventy-three infants of 63 anti-HCV-positive and anti-HIV-negative mothers were studied from 1993 to 1999 in the south of Spain. The mean period of follow-up in children was 29.2 ± 19 months (range, 8 to 76 months); 6 (8%) children were lost to follow-up. Breast milk was studied for HCV-RNA in 68 samples of 35 mothers.Results.Alanine aminotransferase was high in 19 (26%) and HCV-RNA was positive in 46 (63%) pregnant woman. Breast milk HCV-RNA was negative in nonviremic mothers and positive in 20% of the viremic mothers. The overall rate of vertical HCV transmission was 11.9% (n= 8) (95% confidence interval, 6 to 23%) if HCV-RNA was positive one or more times, but only 1.5% (n= 1) (95% confidence interval, 0.1 to 9%) if HCV-RNA was permanently positive. Seven HCV-infected children did not develop antibodies to HCV, and they had a spontaneous clearance of the virus. A 10-month-old baby was HCV-RNA-positive from birth to the end of the follow-up. The genotype in each of the infants was consistent with that of their mother. The rate of HCV transmission was higher for infants of mothers with higher HCV viremia (P< 0.01) and also for infants whose mothers were HCV-RNA-positive in breast milk (P< 0.05). There were no statistically significant differences between other risk factors.Conclusion.The presence of transitory viremia without seroconversion indicates that the vertical transmission of HCV is not important. This could be related to the viral charge and ingestion of milk of HCV-RNA-positive mothers. However, to advise avoidance of maternal breast feeding, it would be necessary to conduct larger studies.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective.To compare the immunogenicity and safety of a trivalent tetanus-diphtheria (low toxoid content)-inactivated poliomyelitis vaccine, Td-IPV (Revaxis; Pasteur Merièux), with a tetanus-diphtheria (low toxoid content) vaccine, Td (Td-Impfstoff Mérieux; Pasteur Merièux), when administered as a booster to children age 6 to 9 years.Methods.A group of 301 children were randomized and vaccinated with Td-IPV (n= 150) or Td (n= 151) in this open, controlled, multicenter trial. Serum specimens were obtained before and 28 days after vaccination. Safety was assessed for up to 28 days postvaccination by parental diary cards. Solicited local and systemic reactions were recorded for 7 days after vaccination.Results.Seroprotection (enzyme-linked immunosorbent assay titer, ≥0.10 IU/ml) against tetanus and diphtheria was induced by either Td-IPV or Td in all subjects. Tetanus and diphtheria geometric mean titer were higher after Td (34.0 and 5.74 IU/ml) than after Td-IPV (15.9 and 4.38 IU/ml). All subjects boosted with Td-IPV were seroprotected against each type of poliovirus (neutralizing antibody titer, ≥5/dilution). The most frequently reported solicited local and systemic symptoms were pain triggered by movement of the arm (54%vs.39.1%) and headache (17.3%vs.7.3%), after Td-IPV and Td, respectively. All other events were similar between the two groups. Reactions were generally mild and all were temporary.Conclusions.A booster dose of Td-IPV induced in all children seroprotection against tetanus, diphtheria and poliomyelitis. The overall safety profile of the two vaccines was acceptable.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Although the recommended standard course of therapy for shigellosis is 5 days of oral ampicillin or trimethoprim-sulfamethoxazole therapy, successful outcome has been reported in adults treated with abbreviated courses of antibiotics. The purpose of this study was to compare short course (2-day)vs.5-day therapy with cefixime for treatment of diarrheal disease caused byShigella sonneiin children.Methods.This was a prospective, randomized, double blind, placebo-controlled study. Patients were eligible if they were at least 6 months of age and presented to the Children’s Hospital of Pittsburgh during an outbreak of diarrhea caused byS. sonnei, with (1) a history of fever and diarrhea (at least three loose or watery stools per day), (2) bloody diarrhea or (3) diarrhea and known exposure to an individual with documented shigellosis. Patients were randomized to receive either 2 days of cefixime (8 mg/kg/day) given once daily followed by 3 days of placebo or 5 days of cefixime. Telephone follow-up was performed on Days 3, 7 and 14 after enrollment. Follow-up stool cultures were obtained on Day 7 to assess bacteriologic cure. There were standardized definitions for cure, improvement, failure and relapse.Results.Forty-seven patients were enrolled. Eleven were eliminated from analysis because their stool cultures were not positive forS. sonnei. There were 36 evaluable patients, 21 in the 2-day group and 15 in the 5-day group. Patients ranged in age from 6 months to 17 years. Forty-four percent of the subjects were male. Symptoms were improved or had resolved by Day 3 of therapy in all patients. There were 8 patients who experienced a clinical relapse: 5 of 21 (24%) patients in the 2-day treatment group and 3 of 15 (20%) in the 5-day group. There were 13 patients who experienced a bacteriologic failure (defined as the occurrence of a positive culture at the Day 7 follow-up visit), 11 of 20 (55%) in the 2-day group and 2 of 14 (14%) in the 5-day group (P< 0.02).Conclusion.Two- and 5-day treatment courses with cefixime for treatment of diarrheal disease caused byS. sonneiresult in similar rates of clinical cure and clinical relapses; however, there was a higher rate of bacteriologic failure with shorter course therapy.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Adenoviruses are the second most common cause of viral acute lower respiratory tract infection (ALRI) requiring hospitalization in Chile. Little information is available with respect to nosocomial infection rate by adenovirus. This issue is important because of its potential severity and long term sequelae.Methods.Infants hospitalized for ALRI were studied to determine the rate of nosocomial cross-infection with respiratory adenovirus and its corresponding genome type. The group studied included all cases younger than 2 years of age admitted to a seven crib ward in the Roberto del Río Children’s Hospital (Santiago, Chile) between May, 1995, and October, 1996. Nasopharyngeal aspirates for immunofluorescence assay and viral isolation were obtained on admission and the next day. On identification of a positive case for adenovirus, samples were obtained from contacts for 2 consecutive days and twice weekly thereafter for 2 weeks.Results.Fifteen index positive cases for adenovirus and their 65 contacts were identified. Secondary attack rate for adenoviral cross-infection was 55%, most of which were diagnosed by viral isolation. Mortality occurred in 4 cases; 3 had underlying diseases. Four secondary cases presented mild respiratory infection after acquiring the cross-infection, and 16 patients developed a moderate and severe ALRI. Twelve patients required supplemental oxygen and 4 needed mechanical respiratory support. Genome types for the 10 index cases and 19 contacts were obtained. All of these corresponded to adenovirus 7h.Conclusions.The high secondary attack rate observed, stresses the importance of adequate isolation of patients and the need for rapid and sensitive viral diagnosis.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Serial C-reactive protein (CRP) measurements have been shown to be useful for guiding duration of antibiotic therapy in neonates. This study sought to determine whether this is a safe and practical approach in a developing country.Methods.The study was conducted at the Johannesburg Hospital between September 15, 1998, and January 15, 1999. Subjects included all neonates evaluated for suspected sepsis in the first 24 h of life who had negative initial and repeat CRP values (≤ 10 mg/dl). Repeat CRP measurements were performed between 24 and 48 h after birth. Antibiotic therapy was stopped in these infants at 24 to 48 h, and they were observed until 72 h, when the final blood culture results were available. The number of positive blood cultures in this group was determined.Results.The repeat CRP estimation correctly identified 99 of 100 infants in the study as not requiring further antibiotic therapy (negative predictive value, 99%; 95% confidence intervals, 95.6 to 99.97%). The 1 infant with a positive blood culture was premature with a gestational age of 31 weeks. Eight babies required repeat evaluation for suspected sepsis, 4 presented on Day 3 to 4 and one of these babies died. All these neonates were of ≤33 weeks gestation.Conclusion.The use of serial CRP measurements to guide antibiotic therapy is a safe and practical approach in neonates with suspected sepsis in a developing country.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Murine typhus is a zoonotic infection caused byRickettsia typhi. This illness used to be endemic in the southeastern and gulf coast of the United States and is now only rarely reported in South Texas and Southern California. Murine typhus causes a febrile illness with headache and rash that has been well-described in adults.Objective.To define the epidemiologic and clinical characteristics, laboratory findings, hospital course and response to therapy of children discharged from our hospital with a diagnosis of murine typhus.Methods.Retrospective chart review of all children discharged from Driscoll Children’s Hospital, Corpus Christi, TX, from January 1, 1990, to June 30, 1998, with a diagnosis of murine typhus.Patients.Thirty children (17 females) ages 2 to 17 years (mean, 10 ± 4 years).Results.Eighty percent of the children were admitted between May and November, and 67% had a history of contact with or exposure to a potential animal reservoir. Children were admitted after a mean of 7 ± 4 days. The most common clinical features were fever 100%, rash 80% and headache 77%. Laboratory abnormalities included elevated erythrocyte sedimentation rate (75%), elevated serum transaminases (67%), hyponatremia (66%) and increased immature leukocytes without leukocytosis (63%). Only one child had leukocytosis and 40% had leukopenia. Defervescence occurred a mean of 35 ± 19 h after initiation of appropriate antibiotics. Hospitalization lasted for a mean of 7 ± 3 days. There were no readmissions and no patients died as a result of the infection.Conclusions.Despite being rarely reported in this country now, murine typhus continues to be an important cause of fever and hospitalization for children in South Texas. Children with murine typhus develop an illness similar to that reported in adults with fever, rash and headache. Children respond quickly to therapy with doxycycline or tetracycline and recover completely from their illness.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective.To determine the epidemiology, management and outcome of Kawasaki syndrome in patients presenting to the major referral centers in Jamaica (population, 2.5 million) from May, 1986, through June, 1998.Design and methods.Retrospective review of all cases of Kawasaki syndrome in major referral centers island wide. American Heart Association diagnostic criteria were used in case definition. Demographic, clinical diagnostic and laboratory data, management and outcome findings were analyzed.Results.Of 98 probable cases 57 were diagnosed with definite Kawasaki syndrome. The average annual incidence was 2.7 per 100 000 children in the 0- to 5-year age group, in a predominantly black population. Eighty-one percent of cases were from the Kingston Metropolitan area (population, 800 000). Children in the first 3 years of life were represented by 67% of cases, with a mean age of presentation of 32 months (range, 5 to 120 months). There was a male preponderance (M:F ratio, 1.71:1). The mean time between onset of illness and diagnosis was 9.1 days (sd 3.9 days). The most common presenting clinical features included fever, anorexia, vomiting, conjunctivitis, exanthema and oropharyngeal and peripheral extremity changes (>45% of patients). Only 7 children received treatment with intravenous gamma-globulin. Overall 38.8% of patients had cardiovascular changes and 28% had coronary artery abnormalities. Girls (8 of 21, 38.1%) were significantly more likely to have coronary changes than boys (8 of 36, 28.5%) {P< 0.05}. Two (3.5%) patients experienced a recurrence.Conclusion.There is a tendency for late recognition and, hence, failure of treatment of Kawasaki syndrome in Jamaica. Greater awareness of the condition needs to be implemented. The finding of female children with an increased occurrence of coronary abnormalities warrants further investigation.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID