摘要:

Six hundred seventy isolates from children with Group A streptococcal infections from 1981 through 1990 were typed serologically and their antibiotic susceptibilities were determined. There were 479 isolates from patients with pharyngitis, 133 from those with scarlet fever, 35 from those with suppurative infection and 23 from those with nonsuppurative disease. The prevalent M serotypes were 12, 4, 1, 3 and 28. None of the 670 isolates was resistant to penicillin G and cephalexin. Resistance rates of isolates to erythromycin and lincomycin was 22.2% in 1981 and 1982, but a marked decrease was noted after 1983 and only one has been resistant since 1986. Nineteen of 21 erythromycin-resistant since 1986. Nineteen of 21 erythromycin-resistant isolates were M type 12, and two others were M types 4 and 28. Chloramphenicol resistance was similar to that of erythromycin, and the tetracycline resistance rate decreased gradually from 60% to less than 20%.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We sought to determine whether the detectability of phytohemagglutinin-inducible p24 (PHA-p24) in short term cultures of peripheral blood mononuclear cells correlates with an increased risk of vertical transmission among human immunodeficiency virus type 1 (HIV-1)-infected pregnant women and more severe symptomatology among HIV-1-infected infants. The assay for PHA-p24 was performed on specimens obtained from HIV-1-infected women during their pregnancy and from infants during the first 6 months of life. Infants were followed prospecitively to determine HIV-1 infection outcome and symptomatology. Among PHA-p24 positive women 9 of 19 (47.4%) gave birth to HIV-1-infected infants compared with 4 of 25 (16.0%) of PHA-p24-negative women (P= 0.02). Among women who tested PHA-p24-positive and had a CD4+lymphocyte count <500 cells/mm3, 8 of 15 (53.3%) gave birth to HIV-1-infected infants compared with 4 of 26 (15.4%) not meeting these conditions (P= 0.01). Among HIV-1-infected infants 4 of 5 (80%) of those testing PHA-p24-positive by one month of age developed an opportunistic infection or encephalopathy by 12 months of age, compared with none of the 11 infants testing PHA-p24-negative (P= 0.003). We conclude that PHA-p24-negative (P= 0.003). We conclude that PHA-p24 may be a usefulin vitromeasure for increased risk of vertical transmission among HIV-1-infected pregant women and increased risk for rapid development of severe disease among HIV-1-infected infants.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The earliest, most reliable methods for detecting human immunodeficiency virus type 1 (HIV-1) infection in infants at risk of perinatal HIV-1 and risks for transmission were investigated. Fifteen infants were followed prospectively from birth to age 21 to 48 months. Epidemiologic data on mothers during pregnancy were documented, and maternal proviral load (by quantitative polymerase chain reaction) and viral phenotype by HIV isolation were performed. Infants were assessed clinically and HIV isolation, HIV p24 antigen, polymerase chain reaction and total serum immunoglobulin determinations were performed. Four infants were infected. HIV isolation, HIV p24 antigen and polymerase chain reaction were positive within 3 months in all infected infants (100% sensitivity). False positive rates for a single test were 18, 9 and 9%, respectively. Median age of clearance of maternal antibodies was 13.4 ± 2.1 months. Serum immunoglobulin G was significantly elevated after 6 months in all 4 infected infants. Advanced maternal age (≥30 years; Fisher's exact test,P> 0.014) was associated with transmission. A trend in higher maternal viral burden was observed among transmitters. Non-syncytium-inducing phenotype was present initially in all transmitting mothers.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Using community-based surveillance data for pediatric human immunodeficiency virus (HIV) infection, we examined disease progression using survival analysis among perinatally HIV-infected children and children HIV-infected through a neonatal blood transfusion. As of December 31, 1991, 238 HIV-infected children (classified P-1 or P-2 according to the Centers for Disease Control and Prevention classification system) were identified. Median symptom-free survival time from birth to symptomatic infection (P-2) was different for perinatally acquired (n = 166) and neonatal transfusion-acquired (n= 72) infection (6.4 monthsvs.17.8 months, respectively;P< 0.001). Survival after development of symptomatic infection (P-2) did not differe by transmission mode. Survival differences from birth to death were significant atP< 0.005 (75% of perinatally HIV-infected children survived 44 monthsvs.71 months for transfusion-associated children). Although survival estimates improved for those receiving antiretroviral treatment, differences by mode were still observed. For perinatally HIV-infected children, mortality was highest in the first year of life (12%). Those remaining symptom-free beyond their first year demonstrated survival experiences similar to those for children with transfusion-associated infection.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The incidence, etiology and timing of neonatal infection were assessed in a regional neonatal intensive care unit from 1983 through 1992. Infection onset was considered as very early (<24 hours), early (1 to 7 days) or late (8 to 60 days). Case-fatality reates were determined for different weight groups and time periods (1983 to 1987vs.1988 to 1992). Overall neonatal sepsis incidence changed very little, but there was a marked decrease in very early onset sepsis in 1988 to 1992 especially in very low birth weight (<1500 g) infants, possibly attributable to increased use of prenatal antibiotics. There was an accompanying increase in late onset sepsis, primarily nosocomial infection associated with improved survival of tiny infants, most striking after exogenous surfactant became readily available. During 1988 to 1992, because of very few very early-onset cases, very low birth weight infants had overall case fatality rates of about 10%, which were the same as for larger infants. The predominant organism in very early onset infection was Group BStreptococcus(GBS) (27 of 58) and in late onset infection was coagulasenegative staphylococcus (57 of 103). More cases of early onset GBS pneumonia were seen in the last 5 years. Neonatal meningitis was seen rarely during this decade, with only one case documented in the first 24 hours of life.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

An 8-year-old girl was infected for a second time withSalmonella typhiby contact with her grandmother, a known typhoid carrier. TheS. typhifrom both patient and grandmother had closely related genomic pulsed field gel electrophoresis patterns that differed from epidemiologically unrelated strains. The girl responded well to a 14-day course of oral trimethoprim-sulfamethoxazole. The grandmother was treated successfully with a 28-day regimen of oral ciprofloxacin. Typhoid fever remains an endemic disease in the United States, largely because of recognized chronic stool carriers. Most of these carriers had typhoid in the preantibiotic ear and remain potential sources of disease when they provide meals for others, not uncommonly grandchildren. The importance of this “grand-mother” connection to endemic typhoid fever is reviewed, as is the potential use of pulsed field gel electrophoresis pattern analysis for comparison of strains ofS. typhi.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The antibiotic management of 139 consecutive patients with presumed viral meningitis evaluated during a 6-month period was examined. The presupmitive diagnosis of viral meningitis was made in retrospect by consensus among the authors, using clinical and routinely available laboratory informations. Sixty-eight (51.9%) of 131 patients with complete records were treated with antibiotics after diagnosis, 25 for 2 days or less and 43 for longer than 2 days. Antibiotic treatment was retrospecitvely judged to be unjustified in 35 (81.4%) of the 43 patients treated for longer than 2 days. When compared with untreated patients antibiotic treatment was started in younger female children with lower cerebrospinal fluid glucose values and longer duration of symptoms. There was no difference between the two groups in other cerebrospinal fluid values, peripheral white blood cell count or history of preceding antibiotics. In contrast no associations were found with treatment beyond 2 days, compared with treatment for 2 days or less. Thus the decision to stop antibiotic treatment early did not appear to be made according to consistent clinical ceriteria. This apparent lack of consistent criteria suggests the need to develop clinical guidelines for such decisions, both to aid clinicians and to provide standards for medical audit.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

For identification of risk factors for bloodstream infection (BSI) among neonatal intensive care unit patients, prospective 6-month studies in three neonatal intensive care units were conducted. BSI was diagnosed in 42 of 376 (11.2%) enrolled infants. Pathogens included coagulase-negative staphylococci,Candidasp., Group B streptococci and Gram-negative species. Patients with BSIs were more liley to die during their neonatal intensive care unit stay than were patients who did not acquire BSIs (6 to 42vs.11 of 334,P= 0.007). BSI rate was highest in infants with birth weight < 1500 g (relative risk (RR) = 6.8,P< 0.001), these treated with H-2 blockers (RR = 4.2,P< 0.001) or theophylline (RR = 2.8,P< 0.001) and those with admission diagnoses referable to the respiratory tract (RR = 3.7,P< 0.001). Infants who developed BSI were more severely ill on admission than other infants (Median physiologic stability index 13vs.10 (P< 0.001) and were of lower gestational age (28vs.35 weeks,P< 0.001). In logistic regression analysis, risk of BSI was independently associated only with very low birth weight, respiratory admission diagnoses and receipt of H-2 blockers. Risk of isolation of a pathogen from blood culture was independently associated with Broviac, umbilical vein or peripheral venous catheterization > 10, 7 or 3 days, respectively, at one insertion site. Rate of isolation of a pathogen was higher (9 of 59 (15%)) within 48 hours of a measurable serum interleukin 6 concentration than an interleukin 6 level of 0 pg/ml (10 of 159 (6%),P= 0.04). Conversely < 1 day of exposure to gentamicin or ampicillin before the sepsis evalutation was associated with lower BSI risk in infants with intravascular catheters (20 of 127 (16%)vs.9 of 16 (56%),P= 0.06). These findings indicate that very low birth weight, respiratory diagnoses, H-2 blocker use and prolonged intravascular cath-eterization at one insertion site are associated with elevated risk of BSI. Clinical trials of interventions addressing these risk factors are warranted.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A randomized controlled trial was performed in infants undergoing routine immunization in North Hertfordshire. Ninety-six children received a single dose of inactivated polio vaccine, followed by two doses of live attenuated oral polio vaccine and 97 children received three doses of live attenuated oral polio vaccine at 2, 3 and 4 months of age. Blood samples were taken by study nurses 6 weeks after vaccination and stool samples were collected by parents weekly for 4 weeks after each dose of vaccine. Follow-up was completed for 92 of 96 (96%) children in the combined schedule group and 92 of 97 (95%) in the control group. After vaccination the proportions of children with detectable antibody to poliovirus serotypes 1, 2 and 3 were high and similar between groups and geometric mean titers (95% confidence interval) to poliovirus types 1, 2 and 3 were 264 (200 to 347), 375 (311 to 450) and 189 (144 to 250) in the combined schedule group and 369 (290 to 469), 401 (321 to 498) and 206 (145 to 293) in the live vaccine group, respectively. The only significant difference between groups in rates of viral excretion was observed after the second dose of live attenuated oral polio vaccine, when excretion of type 3 poliovirus was reduced in those children who had received piror inactivated polio vaccine (P= 0.05). This study suggests that, compared with the current schedule, a combined schedule of inactivated and live polivaccines is likely to produce equivalent individual protection against poliomyelitis and is unlikely to substantially alter circulation of poliovirus in the community. Becuase the risk of vaccine-associated polio-myelitis is greatest after the first dose of poliovaccine, this schedule could also reduce the risk to vaccine recipients.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Several standard intravenous immunoglobulin G (IVIG) products are available in the United States and have been used with the intent to treat or prevent infections in neonates. We evaluated more than 100 lots of IVIG, from 6 products, to determine the amount of opsonic antibody against neonatal pathogens. Neutrophilmediated opsonophagocytosis was used to determine opsonic activity in these preparations forStaphylococcus epidermidis; Haemophilus influenzae type b; Streptococcus pneumoniaeserotypes 3, 14 and 19; Group BStreptococcussero-types Ia, Ib, Ia/c, II and III; andEscherichia coli(K1). Pathogen-specific osponic activity of the lots tested ranged from undetectable to 1:80 and was detectable in < 10% to >90% of lots tested depending on the organism and manufacturer. Within an IVIG lot there was variable opsonic activity against different strains or serotypes of the same organisms. Opsonic activity was significanlty (P≤ 0.05) affected by the manufacture's donor pool and less so by the manufacturing method. We conclude that the pathogen-specific opsonic antibody activity of an IVIG lot is: (1) highly variable for several common neonatal pathogens; (2) predominantly dependent on the donor pool and not the manufacturing method. Clinicians may more appropriately select therapy if the pathogen-specific antibody content of IVIG products by lot are known. In the future neonatal IVIG research should focus on using preparations with known pathogen-specific anti-body activity.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID