ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Facial nerve palsy has long been considered to have an infectious etiology. Recent diagnostic analyses in children and adults have provided convincing evidence that reactivation of varicella-zoster virus (VZV), sometimes during infectious mononucleosis, can lead to cranial nerve VII palsy. The site of reactivation from latency is the geniculate ganglion. Virus most likely enters the ganglion during chickenpox, via the sensory branches of the facial nerve located on the ear and tongue. Retrospective reviews suggest that patients with VZV-related facial nerve palsy have poorer outcomes than other cases of Bell’s palsy. Therefore treatment with acyclovir is suggested when VZV reactivation is likely.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.With improved socioeconomic conditions, adults are more frequently seronegative for hepatitis A virus (HAV) and therefore susceptible to infection. A safe and efficacious active HAV vaccine has been developed and licensed. The general recommendation is to vaccinate populations at increased occupational exposure to HAV.Aim.To determine the seroprevalence of HAV antibodies among children’s hospital employees and to correlate seropositivity with demographic and occupational variables as a basis for formulating vaccine recommendations.Methods.The staff of a tertiary pediatric medical center participated by answering a structured questionnaire on demographic and occupational data and by donating venous blood for determining HAV antibodies by an enzyme immunoassay. Univariate and multivariate analyses were conducted to identify variables associated with HAV seropositivity.Results.HAV antibodies were found in 48.3% of the 499 employees studied, being lowest in pediatricians (38.7%), and increased with years of work at the hospital, job percentage and contact with pediatric patients. However, multivariate analysis showed that only the sociodemographic variables (age and crowding during childhood) were independently and significantly associated with seropositivity.Conclusions.HAV seropositivity was associated mainly with sociodemographic variables. Most children’s hospital employees, especially pediatricians and other young (<40 years) employees, are seronegative and therefore susceptible to HAV. Vaccination of the high risk groups should be considered.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The objective of this study was to describe the epidemiology of foodborne disease outbreaks in schools and to identify where preventive measures could be targeted.Methods.Reports by state and local health departments of foodborne disease outbreaks occurring in primary and secondary schools, colleges and universities from January 1, 1973, through December 31, 1997, were reviewed. Data from ill persons identified through foodborne outbreak investigations and subsequently reported to the Centers for Disease Control and Prevention in the Foodborne Outbreak Surveillance System were examined. The number and size of foodborne disease outbreaks, as well as the etiologic agents, food vehicles of transmission, site of food preparation and contributing factors associated with outbreaks were also examined.Results.From 1973 through 1997, states and local health departments reported 604 outbreaks of foodborne disease in schools. The median number of school outbreaks annually was 25 (range, 9 to 44). In 60% of the outbreaks an etiology was not determined, and in 45% a specific food vehicle of transmission was not determined.Salmonellawas the most commonly identified pathogen, accounting for 36% of outbreak reports with a known etiology. Specific food vehicles of transmission were epidemiologically identified in 333 (55%) of the 604 outbreaks. The most commonly implicated vehicles were foods containing poultry (18.6%), salads (6.0%), Mexican-style food (6.0%), beef (5.7%) and dairy products excluding ice cream (5.0%). The most commonly reported food preparation practices that contributed to these school-related outbreaks were improper food storage and holding temperatures and food contaminated by a food handler.Conclusions.Strengthening food safety measures in schools would better protect students and school staff from outbreaks of foodborne illness. Infection control policies, such as training and certification of food handlers in the proper storage and cooking of foods, meticulous hand washing and paid sick leave for food handlers with gastroenteritis, could make meals safer for American students.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The recent number and rate of infant hospitalizations with a respiratory syncytial virus (RSV)-coded diagnosis have not been published.Methods.Retrospective data analysis. National Hospital Discharge Survey data for 1997 to 1999 were analyzed for discharges of infants <1 year old with an RSV-coded diagnosis (ICD-9-CM 466.11, 480.1, 079.6). Hospitalization rates were estimated with annual midyear Census data.Results.RSV bronchiolitis was the leading primary diagnosis annually for all infants hospitalized for any reason. Between 1997 and 1999, 297 684 RSV-coded discharges of infants with an RSV-coded diagnosis occurred. The associated hospitalization rate was 25.2 per 1000 infants. RSV-coded discharges peaked in February.Conclusion.RSV bronchiolitis was the leading cause of hospital admissions of infants younger than age 1 year for any reason between 1997 and 1999.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Cerebrospinal fluid shunts transfer cerebrospinal fluid (CSF) from the lateral ventricles in the brain to the peritoneum (ventriculoperitoneal shunt) or the right atrium (ventriculoatrial shunt) via subcutaneous Silastic tubing. As with any implanted foreign body, infection is a serious complication. Although there are several therapeutic modalities currently used for the treatment of shunt infections, controversy remains as to which is best given that there has been only one randomized trial comparing their effectiveness.Objective.To determine which treatment modality is most effective by using decision analysis to compare three approaches with regard to cure rate, morbidity and mortality.Methods.We constructed a decision tree to map out the different treatment modalities and assigned probability values obtained from previously published studies. A utility value was assigned to each treatment outcome, ranging from 0 to 1.0, with a higher score indicating a more favorable outcome. Calculations were performed using Decision Analysis TreeAge computer software.Results.The removal of an infected shunt with establishment of external ventricular drainage or ventricular taps and administration of antibiotics leads to the highest expected value, 0.86. Removal of an infected shunt followed by immediate replacement and administration of antibiotics is less effective, with an expected value of 0.76. The use of antibiotics alone results in the lowest expected value, 0.61. Sensitivity analysis showed the above findings to be robust with respect to clinically relevant changes for the baseline probabilities and utility values.Conclusion.A protocol of shunt removal, external ventricular drainage placement or ventricular taps and antibiotics, followed by creation of a new shunt when CSF sterility is achieved, is the most effective method of treatment for CSF shunt infection.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The etiology of acute myringitis remains controversial although it is usually encountered in connection with acute otitis media (AOM). In most cases of acute myringitis a bacterial pathogen has been detected in the middle ear fluid, but the role of respiratory viruses has remained unclear. Our objective was to investigate the etiologic role of viruses in the pathogenesis of acute bullous and hemorrhagic myringitis in children <2 years of age.Methods.A prospective longitudinal cohort study of 2028 children ages 7 to 24 months in primary care in the Finnish Otitis Media Vaccine Trial. Nasopharyngeal aspirate (NPA) and middle ear fluid (MEF) samples taken at the time of the diagnosis were examined by a time-resolved fluoroimmunoassay for antigen detection of adenoviruses; influenza viruses A and B; parainfluenza viruses 1, 2 and 3; and respiratory syncytial virus and by reverse transcription polymerase chain reaction for human rhinovirus and human enterovirus.Results.Eighty-two children with bullous myringitis and 37 children with hemorrhagic myringitis were diagnosed during the 18-month follow-up period. In bullous myringitis a respiratory virus was detected in 70% of NPA samples and in 27% of MEF samples. In hemorrhagic myringitis 57% of NPA samples and 28% of MEF samples were virus-positive. The viral distribution was similar to that of AOM (virus positive 64% of NPA and 37% of MEF).Conclusions.We could not confirm any specific respiratory virus to be the etiologic agent in acute myringitis. The etiology of acute myringitis is similar to that of AOM in children <2 years of age.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.A 3-day intramuscular ceftriaxone regimen was superior to a 1-day regimen in the treatment of nonresponsive acute otitis media caused by resistantStreptococcus pneumoniae. However, the effect of various regimens of intramuscular cefriaxone on the nasopharyngeal carriage ofS. pneumoniaeand especially that of resistant strains during and after therapy has not been thoughtfully studied.Objectives.To compare the effect of one dose and three dose intramuscular ceftriaxone regimens on the nasopharyngeal carriage ofS. pneumoniaein patients with nonresponsive acute otitis media treated with these two regimens and to document the dynamics of nasopharyngeal colonization withS. pneumoniaeduring and after completion of these two therapeutic regimens.Patients and methods.In a prospective study performed during January, 1998, through September, 1999, 170 evaluable patients ages 3 to 36 months with nonresponsive acute otitis media were randomized to receive the 1 (n= 83)- or 3 (n= 87)-day intramuscular ceftriaxone regimen (50 mg/kg/day), respectively. Nasopharyngeal cultures forS. pneumoniaewere obtained on Days 1, 4 to 5, 11 to 14 and 28 to 30. Susceptibility ofS. pneumoniaeto penicillin and ceftriaxone was determined by E-test.Results.On Day 1 nasopharyngealS. pneumoniaecarriage was found in 108 (64%) patients, 54 in each treatment group. Forty-seven of 54 (87%) and 9 of 54 (17%)S. pneumoniaeisolates from the one dose group were nonsusceptible to penicillin and ceftriaxone, respectively; the respective values in the three dose group were 49 of 54 (91%) and 8 of 54 (15%). On Days 4 and 5 negative nasopharyngeal cultures were achieved in 43 of 83 (52%) and 70 of 87 (80%) cases from the one dose and three dose group, respectively (P< 0.001). Eradication of penicillin-nonsusceptibleS. pneumoniaewas achieved on Day 4 to 5 in 18 of 49 (37%) and 39 of 49 (80%) organisms isolated from the one dose and three dose groups, respectively (P< 0.001). NasopharyngealS. pneumoniaecarriage among evaluable patients on Days 11 to 14 and Days 28 to 30 was 43 of 69 (62%) and 31 of 45 (69%) for the one dose group and 42 of 73 (58%) and 31 of 50 (62%) for the three dose group, respectively (Pnot significant). A decrease was observed during the study period in the proportion of highly penicillin-resistantS. pneumoniaeisolated in the three dose group compared with the one dose group (30, 24, 17 and 13%vs.30, 27, 19 and 26% at Days 1, 4 to 5, 11 to 14 and 28 to 30, respectively;P= 0.05).Conclusions.A marked reduction in the carriage of penicillin-nonsusceptibleS. pneumoniae(including highly penicillin-resistant organisms) was achieved on Days 4 to 5 of therapy with both ceftriaxone regimens. The 3-day intramuscular ceftriaxone regimen was significantly superior to the 1-day regimen in the reduction of carriage during the treatment period. The reduction of overallS. pneumoniaenasopharyngeal carriage by both ceftriaxone regimens was a short-lived phenomenon followed by rapid recolonization of the nasopharynx.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.HIV genotyping has been beneficial when choosing salvage regimens in adults failing highly active antiretroviral therapy (HAART). Our objectives were to evaluate the usefulness of genotyping in HIV-infected children failing HAART and to determine whether the presence of resistance mutations was associated with previous antiretroviral therapy.Methods.We followed the progress of pediatric patients who had HIV genotyping performed after HAART failure. Charts were reviewed at 3-month intervals for 1 year after genotyping for changes in viral load and CD4+cell percentage. Patients whose antiretroviral therapy was changed after genotyping were compared with those whose medications were not changed. We also compared the proportion of patients with genotypic mutations according to antiretroviral exposure at time of genotyping.Results.Eighteen pediatric patients were eligible for inclusion. None of 10 patients who had antiretroviral therapy changed after genotyping had a decrease in viral load at 12 months after genotyping. One of 8 patients who had no changes in antiretroviral therapy had a sustained decrease in viral load at 12 months. Two-thirds of patients had resistance mutations to antiretrovirals without prior exposure to that drug.Conclusions.This study did not demonstrate substantial clinical benefit to HIV genotyping in antiretroviral agent-experienced pediatric patients with high viral loads. These results contrast with favorable short term clinical and virologic responses to therapeutic changes after genotyping in HIV-infected adults. However, medication history alone does not appear to be an adequate alternative to genotyping in choosing salvage regimens in antiretroviral agent-experienced children.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Entry inhibitors, a new class of antiretroviral agents, interfere with the attachment, coreceptor interaction or fusion of HIV-1 with host target cells. The fusion inhibitor T-20 is the first in this new class, and the present study is the first to examine chronic sc administration of T-20 to HIV-1-infected children.Methods.Fourteen children, 4 to 12 years of age, with incompletely suppressed HIV-1 were studied. The median plasma viral load at baseline was 26 866 copies/ml (4.4 log10), and the median CD4 count was 523 cells/mm3. T-20 was administered twice daily by sc injection at 30 or 60 mg per m2of body surface area per dose. For 7 days T-20 was added to the patients’ background antiretroviral regimens; at Day 7 each subject’s background therapy was changed to a regimen that was predicted to be virologically active, while T-20 was continued. Results are presented for the first 24 weeks of chronic T-20 dosing.Results.T-20 was generally well-tolerated. One child discontinued the drug because of aversion to injections, but no child discontinued because of adverse events. Eleven (79%) of 14 children had local injection site reactions at some time during the chronic T-20 dosing. Eleven of 14 subjects achieved the protocol-specified milestone of at least a 0.7-log10reduction in plasma HIV-1 RNA by Day 7. In 10 subjects (71%) virologic suppression of 1.0 log10or greater was achieved at 24 weeks; 6 subjects (43%) had viral loads <400 copies/ml and 3 (21%) had fewer than 50 copies/ml at 24 weeks.Conclusions.These results indicate that a 24-week regimen of twice daily sc dosing of T-20 in HIV-1-infected children is safe and tolerable and that it is associated with suppression of HIV-1 replication during 24 weeks of administration.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID