ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

During a 5-year period, 280 of 2010 patients admitted to the meningitis ward of a referral hospital in Cairo, Egypt, were clinically diagnosed as having tuberculous meningitis and were treated with either antituberculous chemotherapy and dexamethasone or antituberculous chemotherapy alone. Fatality rates and neurologic sequelae were compared for the 2 treatment groups in the 160 patients who had cerebrospinal fluid cultures positive forMycobacterium tuberculosis. The overall mortality rate of 51% reflects the delay in receiving appropriate therapy (79% with symptoms for more than 2 weeks) and the severity of illness on admission (56% in coma, 39% drowsy). The fatality rate was significantly lower in the group receiving dexamethasone (43% vs. 59%, P < 0.05), particularly in the drowsy patients (15% vs. 40%P< 0.04), and in patients surviving long enough to receive at least 10 days of treatment (14% vs. 33%,P< 0.02). Development of neurologic complications after initiation of therapy (4 vs. 10) and permanent sequelae (6 vs. 13) were significantly lower in the dexa-methasone-treated group (P< 0.02).

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In June, 1989, an outbreak of nosocomial listeriosis occurred in Costa Rica.Listeria monocytogeneswas isolated from 9 ill infants 4 to 8 days old who were born after the delivery of an infant with early onset listeriosis. One nosocomial infection was fatal, 2 required mechanical ventilation and 1 resulted in hemiparesis. A higher proportion of cases than other infants born during the outbreak were delivered by cesarean section (55% us. 24%,P= 0.04). Compared with the mothers of 36 random controls, case mothers were more often primiparous (odds ratio, 6.2,P= 0.03) or received general anesthesia before delivery (odds ratio, 4.4,P= 0.09). All infants were bathed with mineral oil from a multidose container. Culture of the oil by cold enrichment grewL. monocytogenes4b with the same electrophoretic enzyme type as the outbreak strain. We hypothesize that aspiration of contaminated oil may have resulted in systemic listeriosis. General anesthesia may have increased the risk of aspiration. Lung tissue from the infant who died showed lipid-laden macrophages consistent with oil aspiration and had evidence ofL. monocytogenesDNA detected by polymerase chain reaction. This is the

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To evaluate the occurrence of infections in asymptomatic and symptomatic human immunodeficiency virus (HlV)-infected children we performed a prospective comparative cohort study. Twenty-seven HIV-infected children were individually matched with paired immu-nocompetent controls and followed up for a total of 543 months (mean per child, 19.4 ± 11 months). Collected data were evaluated considering HIV-infected children both as a whole and as P1 and P2 patients according to the Centers for Disease Control classification. Twenty-seven HIV-infected children had 185 infectious episodes vs. 27 matched controls who experienced 118 infections. P1 children had a number of infections similar to those of normal controls (99 vs. 86) whereas P2 children had a significantly higher number of infections than did controls (86 vs. 32). Pneumonia and oral candidiasis occurred significantly more frequently in symptomatic HIV-infected children than in normal controls. Severe infections occurred almost exclusively in HIV-infected symptomatic children.

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The medical records of 61 children 0 to 18 years of age treated for empyema complicating pneumonia from 1977 to 1989 were reviewed with attention to clinical presentation, bacteriology, treatment and outcome.Streptococcus pneumoniaswas the most common infecting organism, followed byStaphylococcus aureus, other streptococcal species, anaerobes,Haemophilias influemaetype b,Pseudomonas aeruginosa, andEikenella corrodens. No organisms were recovered in 39% of patients. Twelve patients were treated successfully with antibiotics and thoracentesis alone, 23 patients underwent closed tube thoracostomy and 26 required decortication. A thickened pleural “peel,” scoliosis and opacification of a hemithorax on chest radiograph, as well as low pleural pH and glucose concentration, were associated with a poor response to medical management. A scoring system was developed to define the severity of pleural disease. In patients with severe pleural infections, decortication allowed more rapid defervescence (2.2 vs. 6.5 days) and earlier hospital discharge (4.4 vs. 12.4 days) than did closed tube thoracostomy (P< 0.001).

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Between October, 1985, and February, 1987, 28 (8.7%) cases of scrub and murine typhus were diagnosed among 320 children with ≥ 1 week history of obscure fever. Scrub typhus is a rural disease and characterized by fever, tachypnea and hepatosplenomegaly. Skin rash was rare and eschar was absent. Four patients had pneumonia and two had meningitis. Murine typhus, more an urban disease, was milder and half the patients presented exclusively because of night fever. Slightly enlarged liver and skin rash were the only significant physical signs. Lacking the classical textbook presentations, both rickettsioses often were missed or diagnosed as enteric fever. Recognition is important because patients with either disease respond well to treatment with chloramphenicol or doxycycline.

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A survey of untoward reactions, especially central nervous system reactions, after the administration of a newly introduced measles, mumps and rubella (MMR) vaccine in Gunma Prefecture, Japan, was initiated soon after 4 patients were hospitalized for aseptic meningitis. Thirty-five, 6 and 2 children developed meningitis, convulsive disorders and parotitis, respectively, within 2 months after MMR vaccination during the 8-month period extending from April to November, 1989. The time lag between MMR vaccination and meningitis ranged from 14 to 28 days in the 35 cases of meningitis. Mumps virus, isolated from the cerebrospinal fluid in 13 patients with aseptic meningitis, was characterized by determination of the nucleotide sequences of thePgene as mumps vaccine strain. The incidence of aseptic meningitis with positive mumps vaccine virus was estimated to be 0.11% (0.3% as a whole) during the 8 months from April to November and increased to 0.3% (0.7% as a whole) in September and October. We conclude that the incidence of aseptic meningitis after MMR vaccination seems to be higher than that reported previously.

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In 1989 a nationwide surveillance of neurologic complications after the administration of mumps vaccine was conducted in Japan, based on the notification of cases and the testing of mumps viruses isolated from cerebrospinal fluid for their relatedness to the vaccine by nucleotide sequence analysis. Among 630 157 recipients of measles-mumps-rubella trivalent (MMR) vaccine containing the Urabe Am9 mumps vaccine, there were at least 311 meningitis cases suspected to be vaccine-related. In 96 of these 311

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Impedance tympanometry and acoustic reflectometry tracings were obtained on 406 ears of children between 4 and 16 years of age. The angle formed by the acoustic reflectometry tracing was measured. The reflectivity and the angle of the curve were compared with tympanometric results. Analysis of data on 182 normal ears and 224 abnormal ears revealed a sensitivity of 76.3% and a specificity of 89.6% when a reflectivity of 5.0 was used as the cut point. Utilizing a cut point of 90 degrees resulted in a sensitivity of 92.8% and a specificity of 93.9%. Using both a 5.0 reflectivity and a 90-degree angle as cut points improved sensitivity to 98.7% and specificity to 94.5%.

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To minimize the exposure of health care workers to aerosolized ribavirin, we designed a double tent containment system with circulating mist and suction applied between the tents and we evaluated the ability of this system to contain and evacuate aerosolized ribavirin. While the drug was administered with this system at three institutions, three air sampling pumps at different locations in the room and one worn by the investigator (personal breathing zone) collected air samples onto filters for assay of ambient ribavirin. Ribavirin determinations were made by high performance liquid chromatography. A 5− to > 20-fold decrease in ambient ribavirin concentrations was observed with the containment system compared with those detected with a single oxyhood in use. The personal breathing zone concentration was 566.0 μg/m3with the oxyhood alone and fell to a mean concentration of 43.81 ± 33.40 μg/m3with the containment system. Though the risk to exposed health care workers is unknown, this system offers a simple way to decrease significantly occupational exposure to ribavirin.

ISSN:0891-3668    

出版商:OVID    

年代:1991

数据来源: OVID