ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Pertussis is increasingly recognized as an important cause of cough illness in adolescents and adults.Purpose.To evaluate the safety and antibody response to a single dose of an adult formulation of a five component (pertussis toxoid, filamentous hemagglutinin, pertactin, fimbriae 2 and 3) acellular pertussis vaccine (aP) combined with diphtheria and tetanus toxoids (TdaP) and inactivated poliovirus vaccine (TdaP-IPV) in adolescents and adults and to assess the response to a second dose of the acellular pertussis vaccine in a subset of the adults.Population and setting.The study addressed 1207 healthy participants (736 adults and 466 adolescents) recruited in five Canadian communities.Study design.In a randomized, observer-blind, controlled clinical trial, adult participants received Td followed at a separate visit by aP, TdaP followed by IPV or TdaP-IPV; adolescents received Td-IPV followed at a separate visit by aP or TdaP-IPV. A subgroup of adults was given a booster of aP 1 month after TdaP.Outcome measures.Antibody titers measured before and 1 month after each immunization; adverse events enumerated at 24 h, 72 h and 8 to 10 days.Results.The aP vaccine given by itself was associated with adverse events less frequently than were Td, Td-IPV, TdaP or TdaP-IPV vaccines, but reaction rates did not differ significantly among the latter products. The antibody response againstBordetella pertussisantigens was vigorous in all groups, although adults given the TdaP-IPV vaccine had lower antibody titers against filamentous hemagglutinin, pertactin, diphtheria and tetanus antibodies than those given TdaP vaccine. Similarly adolescents given TdaP-IPV had lower antibody titers against pertussis toxin, filamentous hemagglutinin, fimbriae and agglutinins than those given Td-IPV and aP alone. A second dose of acellular pertussis vaccine was not associated with increased adverse events in adults but elicited increased antibody titers over that achieved by a single dose only against pertussis toxin.Conclusions.This adult formulation five component aP vaccine given as TdaP-IPV is safe and immunogenic in adolescents and adults and is a candidate vaccine for adolescent and adult immunization programs.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Vitamin A has well-recognized benefits for prevention of diarrhea, but the impact of therapeutic doses given during diarrhea on biochemical and clinical outcomes is less clear. We investigated these potential therapeutic benefits within a study of the optimum time for vitamin A supplementation to promote vitamin A status.Methods.Young children with severe diarrhea were randomized to receive 60 mg of retinol as retinyl palmitate during acute diarrhea or once symptoms had resolved, usually after 5 to 8 days. Either during acute diarrhea or after its resolution, children not receiving vitamin A were given identical placebo. On Days 0 and 3 we measured urinary neopterin, plasma retinol and acute phase proteins and intestinal permeability by the lactulose/mannitol test. Eight weeks after discharge children returned to hospital for a modified dose response test of vitamin A stores.Results.Most children presented with watery diarrhea and grossly abnormal intestinal permeability and immune activation markers. At 8 weeks plasma retinol concentrations of children receiving vitamin A during acute diarrhea, compared with those receiving it in early convalescence [0.67 (95% confidence interval, 0.58 to 0.76) &mgr;mol/lvs.0.68 (95% confidence interval, 0.59 to 0.79) &mgr;mol/l], and the proportion of children with deficient vitamin A stores (7 of 34vs.8 of 34) did not differ. Clinical features, lactulose/mannitol tests and urinary neopterin concentrations on Day 3 also did not differ significantly when vitamin A was given early or late.Conclusions.Even when it was given during severe diarrhea, a large dose of vitamin A improved vitamin A stores in a population in whom vitamin A deficiency is a public health problem. Vitamin A did not significantly improve early clinical or biochemical recovery from severe diarrhea.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The bacterial latex agglutination assay is ordered predominantly on the pediatric population, for rapid screening for bacterial surface antigens in cerebrospinal fluid (CSF) or urine specimens. The high cost of this assay and questions raised in the literature regarding its accuracy led to a retrospective review of the use of this assay at a medium-sized midwest teaching hospital. The results of 6370 bacterial latex agglutination tests performed between May, 1995, and November, 1996, and charts of patients being tested were reviewed.Results.This study demonstrated a sensitivity and specificity of 28.6% and 86.7% for urine specimens and 70.0% and 99.4% for CSF specimens. A total of 11 pathogens were accurately detected (7 CSF and 4 urine). There were 13 false negatives and 59 false positives. None of the true positives had a discernible effect on either treatment or hospital course; however, several of the erroneous tests resulted in delayed or unnecessary treatment and workup of the involved patients. The annual billed cost of this test at this institution (fiscal years 1995 to 1997) averaged $167 000 per annum. This does not include indirect costs associated with increased length of hospital stay, overutilization of antibiotics and excess laboratory tests ordered as a result of false positives.Conclusions.Bacterial antigen latex agglutination testing is neither sufficiently sensitive nor specific to be used as a screening test. Accurate results have no demonstrable clinical impact, whereas numerous inaccurate results are often generated at great cost. The continued use of the latex agglutination assay should be seriously questioned in an era when cost containment and clinical efficiency are becoming increasingly important.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Childhood community-acquired pneumonia is a common illness, but there have been relatively few comprehensive studies of the viral and bacterial etiology in developed countries. The aim of the present investigation was to determine the etiology of community-acquired pneumonia in hospitalized children by several laboratory methods.Methods.In a 3-year prospective study a nasopharyngeal aspirate for viral studies and acute and convalescent serum samples for viral and bacterial serology were taken from 254 children with symptoms of acute infection and infiltrates compatible with pneumonia in the chest radiograph. The role of 17 microbes was investigated.Results.A potential causative agent was detected in 215 (85%) of the 254 patients. Sixty-two percent of the patients had viral infection, 53% had bacterial infection and 30% had evidence of concomitant viral-bacterial infection.Streptococcus pneumoniae(37%), respiratory syncytial virus (29%) and rhinovirus (24%) were the most common agents associated with community-acquired pneumonia. Only one patient had a positive blood culture (S. pneumoniae)of 125 cultured. A dual viral infection was detected in 35 patients, and a dual bacterial infection was detected in 19 patients.Conclusions.The possible causative agent of childhood community-acquired pneumonia can be detected in most cases. Further studies are warranted to determine what etiologic investigations would aid in the management of pneumonia. With effective immunization forS. pneumoniaeand respiratory syncytial virus infections, more than one-half of the pneumonia cases in this study could have been prevented.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Nonresponsive acute otitis media (NR-AOM) is reported in >10% of children with AOM treated with antibiotics. Drug-resistantStreptococcus pneumoniaeis currently considered the leading cause of antibiotic failures in AOM. Nasopharyngeal colonization withS. pneumoniaewas found to increase significantly during episodes of AOM.Objectives.To investigate the nasopharyngeal colonization withS. pneumoniaeduring NR-AOM and compare it with that found in AOM not recently treated with antibiotics (NT-AOM); to assess the predictive value of nasopharyngeal pneumococcal cultures results for the bacteriologic assessment of NR-AOM.Materials and methods.Patients age 3 to 48 months with NT-AOM and NR-AOM were prospectively studied. Simultaneous nasopharyngeal cultures forS. pneumoniaeand middle ear fluid cultures were obtained at enrollment. Antibiotic susceptibility testing was performed in allS. pneumoniaeisolates. Penicillin and ceftriaxone MICs forS. pneumoniaewere determined by E-test. The sensitivity, specificity and positive and negative predictive values of positive or negative nasopharyngeal cultures for the presence ofS. pneumoniaein middle ear fluid were calculated.Results.We studied 362 and 217 children with NT-AOM and NR-AOM, respectively. Of the children with NT-AOM and NR-AOM, 95 and 97%, respectively, were younger than 2 years of age.S. pneumoniaewas isolated in the nasopharynx of 66 and 58% of children with NT-AOM and NR-AOM, respectively. Penicillin-nonsusceptibleS. pneumoniaewas isolated more frequently from the nasopharynx of patients with NR-AOM than from those with NT-AOM (84%vs.47%;P< 0.01). Antibiotic susceptibility patterns were similar forS. pneumoniaeisolates recovered from the nasopharynx and those from the middle ear fluid in both NT-AOM and NR-AOM. A positive nasopharyngeal culture had only little predictive value for the presence ofS. pneumoniaein middle ear fluid (41 and 51% for NT-AOM and NR-AOM, respectively). However, the negative predictive value of nasopharyngeal cultures for recovery ofS. pneumoniaein NR-AOM was high and significantly higher in NR-AOM than in NT-AOM (91%vs.78%, respectively;P= 0.009). The negative predictive value of nasopharyngeal cultures for recovery of antibiotic-resistantS. pneumoniaewas 95 and 93% in NT-AOM and NR-AOM, respectively.Conclusions.A significantly higher nasopharyngeal colonization rate with antibiotic-resistantS. pneumoniaewas found in patients with NR-AOM than in those with NT-AOM. Negative nasopharyngeal culture for antibiotic-resistantS. pneumoniaepractically rules out its presence in middle ear fluid.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Few studies have examined the impact of rapid viral diagnostic tests on patient management.Objective.To assess the effect of rapid diagnosis of influenza A infections on patient management.Methods.The medical records of children with respiratory infections who were evaluated at a children’s hospital between July 1, 1995, and June 30, 1997, were reviewed. Children (n= 56) evaluated in the Emergency Department (ED) who had a positive influenza A enzyme immunoassay (EIA) were compared with two control groups for the likelihood of admission, antibiotic use and duration of hospitalization and antibiotic administration.Results.Patients discharged from the ED with a positive EIA test were less likely to receive antibiotics than those with a negative EIA test (20%vs.53%;P= 0.04). Patients admitted to the hospital with a positive EIA test were as likely to receive antibiotics as those without a rapid diagnosis, but the duration of antibiotic administration was significantly shorter in the group with a positive EIA test (3.5vs.5.4 days;P= 0.03). Patients with a positive EIA test also were more likely to receive antiviral therapy than either control group (25%vs.0 and 1.8%;P< 0.001).Conclusions.The detection of influenza A by EIA has a positive impact on medical management by decreasing antibiotic use in pediatric patients evaluated in an ED, by decreasing the duration of antibiotic use in hospitalized patients and by encouraging antiviral therapy.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Although viral infection is a major clinical problem for hematopoietic stem cell transplant recipients, there are few large series reporting on these infections in the pediatric population. We performed a retrospective analysis of the impact of viral infections in this patient population in our center, managed by a uniform antiviral prophylaxis protocol.Methods.We reviewed the medical records of consecutive children and adolescents who received hematopoietic stem cell transplantation at the Division of Pediatrics, The University of Texas M. D. Anderson Cancer Center in Houston, TX, from July, 1992 to August, 1996.Results.During the study period there were 70 episodes of viral infections in 96 transplants. The viruses most commonly encountered were cytomegalovirus (24), varicella-zoster (21) and herpes simplex (10). Fifty of these episodes resulted in clinically apparent diseases, affecting 39 patients. The Kaplan-Meier estimated probability for the development of viral diseases was 62%. Ten percent of these patients died as a direct result of the infectious process, all within 4 months of transplant. Significant factors for development of viral disease were the development of acute graft-vs.-host disease and the duration of preengraftment neutropenia.Conclusions.Viruses are common pathogens after hematopoietic stem cell transplantation in the pediatric population. Despite routine antiviral prophylaxis the morbidity and mortality of viral infections remain high. Enhancement of immune recovery after hematopoietic stem cell transplantation together with the development of new classes of antiviral agents may impact the incidence and prognosis of viral infections in this setting.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.There are no published data for the incidence or etiology of childhood bacteremia in Malawi. We describe the clinical and microbiologic features of children admitted to hospital from whom blood cultures yielded bacterial pathogens.Methods.Any neonate or child admitted to the pediatric wards of the Queen Elizabeth Central Hospital had a blood culture taken in the event of fever without obvious clinical explanation. Clinical and microbiologic data were prospectively collected for children with a significant positive culture.Results.Between September, 1996, and August, 1997, we processed 2123 cultures. Of these, 365 (17.2%) grew a pathogen. Non-typhi salmonellae (NTS) and enteric Gram-negative bacilli constituted 67.4% of isolates, andStreptococcus pneumoniaeconstituted 16.4%. More than two-thirds of NTS episodes coincided with the peak malaria transmission season (January to June); 67% of bacteremic children were malnourished, 28% severely so. Patients with NTS bacteremia were significantly more likely to have coincident malaria and to have splenomegaly and anemia than children with other infecting organisms. The overall mortality was 38% but varied considerably according to age and nutritional status. Prior antibiotic use, coincident malaria or meningitis did not adversely affect outcome.In vitroresistance to the commonly available antibiotics ampicillin and trimethoprim-sulfamethoxazole was found in 76 and 71% of NTS isolates. Screening tests for penicillin resistance suggested a rate of 21% among pneumococci.Conclusions.Bacteremia is common in hospitalized Malawian children and has a high mortality. There are high rates of resistance to some of the commonly used antibacterial agents.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID