ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The aim of this study was to determine the causes of fever of unknown origin, to evaluate new diagnostic tests and to elucidate risk factors for chronic or life-threatening disorders. The medical records of 113 children who had undiagnosed fever for at least 3 weeks were reviewed. Infection (N= 41) was the most frequent cause of fever of unknown origin. Respiratory tract infections were the most common causes in infants and endocarditis and tuberculosis were more frequent in older children. Neo-plastic disorders (N= 11) occurred in children older than one year. Juvenile rheumatoid arthritis (N= 9) was the most common collagen-vascular disorder (N= 15). Miscellaneous disorders and factitious fever occurred in 21 and 4 cases, respectively. Twenty-two patients remained undiagnosed. History and physical examination led to a final diagnosis in 81% of cases. Abdominal ultrasonography was performed in 71 patients (61%) and was helpful for diagnosis in 15%. Children with life-threatening or chronic disorders (N= 58) were older than those with self-limiting conditions (N= 55;P= 0.017). Cardiovascular and articular signs and symptoms were more frequent in the former group (P= 0.01).

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Annual specific rates for acute rheumatic fever (ARF) in Auckland children less than 15 years were 22/100 000 for the years 1980 to 1984. From 1984 to 1992 the rates remained relatively constant with an average of 45 (range, 30 to 70) children annually admitted with ARF to the Auckland Children's Hospital. This study examined retrospectively Group A streptococci identified from hospitalized pediatric patients during these 9 years. The total of 2410 isolates included 32 isolates from well-documented cases of ARF and an additional 6 from siblings of cases. Results of M typing indicated that streptococci associated with ARF are generally different from those described overseas and involved types which cause more skin than throat infections in the community.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Parainfluenza types 1, 2 and 3 were studied in a pediatric outpatient population from 1976 to 1992 to compare seasonal patterns over time and to define better the spectrum of illness in all ages of children caused by these viruses. Parainfluenza type 1 occurred in the fall of odd numbered years; parainfluenza type 2 was less predictable; and parainfluenza type 3 appeared yearly with peak activity in spring or summer. The parainfluenza viruses were the major cause of croup and also accounted for one-half of the cases of laryngitis and over one-third of all lower respiratory tract illness in children from whom a virus was isolated. The major clinical manifestations of infection with parainfluenza types 1 and 2 were croup, upper respiratory infections and pharyngitis; for parainfluenza type 3 upper respiratory tract infection was predominant in all age groups.The parainfluenza viruses cause appreciable respiratory morbidity each year among infants and young children. They are the major cause of croup but also produce a spectrum of diseases ranging from mild upper respiratory tract infection to bronchiolitis and pneumonia.1–3Most studies have focused on the morbidity of parainfluenza viruses in infants and young children who are hospitalized.4–6Less appreciated is the impact of parainfluenza viral infections in outpatients and in older children.The parainfluenza viruses have a striking epidemiologic pattern which has evolved over the past 30 years. In the early 1960s parainfluenza types 1, 2 and 3 were all reported to be endemic.1Subsequently parainfluenza type 1 appeared repeatedly in outbreaks in the fall of even numbered years until the early 1970s when it switched to outbreaks in the odd numbered years. Parainfluenza type 2 has been more sporadic in its appearance, and parainfluenza type 3 changed in 1978 from an endemic to more of an epidemic pattern.7,8Since 1980 the epidemiologic pattern of the parainfluenza viruses has not been described. Hence in this prospective longitudinal study conducted during 16 years we describe the evolving epidemiology of parainfluenza viruses 1, 2 and 3 and their impact on children cared for in private pediatric offices.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The objective was to assess the degree of disease control and to evaluate the protective efficacy of licensedHaemophilus influenzaetype b (Hib) conjugate vaccines (HbOC, PRP-OMP, PRP-D) used routinely in children 2 to 35 months of age. We conducted a case-control study in Los Angeles County between January 1, 1991, and December 31, 1992, and a cohort analysis of Hib cases between 1983 and 1992. For the case-control study 105 cases of invasive Hib disease were identified and 767 geographically and age-matched controls were selected by random digit telephone dialing. Sixteen HbOC vaccine failures occurred >14 days after a single dose of vaccine, 6 vaccine failures after 2 doses and 3 failures after 3 doses; 2 cases occurred 6 and 12 days, respectively, after an initial dose of HbOC. The protective efficacy of a single HbOC vaccine dose was 71.1% (95% confidence interval (CI), 37.5 to 87.2%). After 2 doses the efficacy was 88.8% (95% CI, 59.5 to 96.9%) and after 3 doses it was 94.4% (95% CI, 68.0% to 99.0%). Similar 95% CIs were seen for 1 and 2 doses of PRP-OMP vaccine. Adjustment of efficacy estimates for potential confounding variables did not significantly alter the results. Despite relatively low rates of immunization (20 to 60%) the rates of Hib disease decreased strikingly between 1990 and 1992 (from 24.2 to 4.4/100 000 children <5 years of age). The HbOC conjugate vaccine, used predominantly but incompletely during this period, provided substantial protection against invasive Hib disease in children immunized between 2 and 35 months of age. Optimal protection was afforded only after 3 doses of HbOC vaccine, but appreciable protection was afforded by 1 or 2 doses. The decreased rates of Hib disease suggest that a reduced likelihood of disease was afforded to unvaccinated children as well.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

During a 12-month period we tested all isolates ofStreptococcus pneumoniaerecovered from patients at St. Louis Children's Hospital for resistance to penicillin and other antibiotics. Twenty-seven (20%) of 136 had relative penicillin resistance (minimum inhibitory concentration 0.1 to 1.0 μg/ml) and 8 (6%) were fully resistant (minimum inhibitory concentration ≥ 2.0 μg/ml). Sixteen percent from blood and cerebrospinal fluid were resistant, compared with 30% from other body sites. The resistant isolates were of diverse serotypes and included 38% intermediate and 6% resistant to cefotaxime, 40% resistant to trimethoprim-sulfamethoxazole and 20% resistant to erythromycin. Patients with resistant isolates were more likely to have taken antibiotics of the aminopenicillin class and to be of the white race. We conclude that penicillin-resistant pneumococci, including some with resistance to third generation cephalosporins and some with multidrug resistance to non-beta-lactam antibiotics, are widespread in the St. Louis area. The presence of these stains requires reconsideration of current approaches to the antibiotic therapy of a variety of infectious diseases in which pneumococci play a prominent role.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Erythromycin is receiving renewed attention as an alternative for treatment of neonatal infections caused byUreaplasma urealyticumbecause of recently proved abilities of this organism to produce systemic disease in this population. Although erythromycin has been used clinically for almost 40 years, very little is known about its activity in the preterm neonate. Fourteen neonates, birth weights ≤1500 g and ≤15 days of age, from whomU. urealyticumwas isolated from the lower respiratory tract were randomized to receive erythromycin lactobionate either 25 or 40 mg/kg/day in four divided doses at 6-hour intervals scheduled for a total of 10 days. Blood samples collected at multiple time points after initial and steady state doses were assayed for erythromycin by liquid chromatography. Minimal inhibitory concentrations (MICs) of erythromycin for the

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Urinary N-acetyl-beta-glucosaminidase (NAG) and beta-2-microglobulin (B2M) concentrations were measured in 24 pediatric patients with febrile urinary tract infection (UTI) and compared with the technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan results, in order to evaluate a noninvasive means to localize the site of UTI. Increased urinary B2M and NAG were not associated with renal inflammation (pyelonephritis), as defined by positive dimercaptosuccinic acid scan. Median NAG concentrations were 114.2 μmol/hour/mg creatinine (CR) (range, 5.7 to 305.4) in 17 febrile UTI patientsvs.13.8 (range, 3.4 to 104.3) in 17 age and sex-matched febrile controls with negative urine cultures,P= 0.0001. The sensitivity and specificity of NAG ≥40 μmol/hour/mg of CR in predicting UTI in febrile patients, regardless of the site of infection, were 88 and 88%, respectively. Increased urinary NAG is associated with UTI in febrile patients regardless of the level of infection (scan status), and may be an informative indicator of UTI.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Changes in body water and electrolytes were studied in 30 children, 2 months to 5 years old, with acute meningitis. Total body water (TBW), extracellular water (ECW) and urinary and serum sodium and osmolality were estimated on the day of hospitalization (Day 1) and after recovery/Day 10. Thirty age- and sex-matched children served as their controls. The TBW (683 ± 63 (mean ± SD) ml/kg) as well as ECW (311 ± 76 ml/kg) was significantly higher in children with meningitis on Day 1 than in the controls (TBW 642 ± 49 ml/kg, ECW 271 ± 62 ml/kg) (P< 0.01), whereas the values after recovery (TBW 643 ± 48 ml/kg, ECW 272 ± 63 ml/kg) were similar to those of controls. Thus on the average a child with acute meningitis had excess body water, all of which was in the ECW compartment. The mean ECW excess was 33 ± 32 ml/kg. Twenty-four of 27 surviving children had higher TBW and ECW at the time of admission compared with the values after recovery.On multiple regression analysis, the only significant determinant of ECW excess was severity of the illness (partialr2= 0.62). The ECW excess was 70 ± 8 ml/kg in severely ill, 50 ± 32 ml/kg in moderately ill and only 12 ± 18 ml/kg in mildly ill children (P< 0.01). Those who had complications or sequelae had much higher ECW (49 ± 26 ml/kg) than those who recovered completely (17 ± 27 ml/kg). Syndrome of inappropriate secretion of antidiuretic hormone according to set criteria was diagnosed in 14 children; each had an ECW excess of >45 ml/kg. The ECW excess had a very high negative correlation with serum sodium concentration (r= −0.82). On multiple regression analysis ECW excess was the only significant determinant of serum sodium concentration (partialr2= 0.47). From our data it appears reasonable to consider fluid restriction in those children with acute meningitis who have the syndrome of inappropriate secretion of antidiuretic hormone or hyponatremia. However, further studies are needed to evaluate the impact of fluid restriction on the outcome of acute meningitis.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID