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.Lay personnel and many health care workers in the United States believe that head louse infestations caused byPediculus capitisare exceedingly transmissible and that infested children readily infest others. Schoolchildren therefore frequently become ostracized and remain so until no signs of their presumed infestations are evident. Repeated applications of pediculicidal product and chronic school absenteeism frequently result.Methods.To determine how frequently louse-related exclusions from schools and applications of pediculicidal therapeutic regimens might be inappropriate, we invited health care providers as well as nonspecialized personnel to submit specimens to us that were associated with a diagnosis of pediculiasis. Each submission was then characterized microscopically.Results.Health care professionals as well as nonspecialists frequently overdiagnose pediculiasis capitis and generally fail to distinguish active from extinct infestations. Noninfested children thereby become quarantined at least as often as infested children. Traditional anti-louse formulations are overapplied as frequently as are “alternative” formulations. Pediculicidal treatments are more frequently applied to noninfested children than to children who bear active infestations.Conclusions.Pediculicidal treatments should be applied solely after living nymphal or adult lice or apparently viable eggs have been observed. Because health care providers as well as lay personnel generally misdiagnose pediculiasis, and because few symptoms and no direct infectious processes are known to result, we suggest that the practice of excluding presumably infested children from school may be more burdensome than the infestations themselves.

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:

Aim.To compare theMycobacterium tuberculosisisolates of adult index cases with multidrug-resistant (MDR) tuberculosis to the isolates obtained from their child contacts.Patients and methods.A 4-year prospective study in the Western Cape Province of South Africa. We evaluated 149 child contacts of 80 adult MDR pulmonary tuberculosis cases. This report includes those cases where a culture forM. tuberculosiswas obtained from both the adult source case and the child contact. Isolates were compared by drug susceptibility pattern and restriction fragment length polymorphism analysis.Results.Six adult-child pairs with cultures forM. tuberculosiswere identified. Two children had contact with more than one adult tuberculosis case. One child received previous isoniazid prophylaxis. Drug susceptibility pattern and restriction fragment length polymorphism analysis were identical for five adult-child pairs. One child, with no other known source case, had a strain different from that of the identified source case, but the MDRM. tuberculosisstrain with which he was infected was prevalent in the community in which he resided. All children responded well to treatment.Conclusion.This study confirms that most of the childhood contacts of adults with MDR tuberculosis are likely to be infected by these MDR source cases despite their exposure to other drug-susceptible adults with tuberculosis in some instances. Child contacts of adults with MDR tuberculosis should be treated according to the drug susceptibility patterns of the likely source cases’M. tuberculosisstrains unless their own strain’s susceptibility testing indicates otherwise. Contact tracing remains of fundamental importance in identifying children at risk.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Tuberculosis disease incidence increased sharply in New York City (NYC) in the late 1980s in children and adults. The relationship of tuberculosis disease in adults with the coincident epidemic of immunosuppression caused by HIV disease has been well-documented. This paper examines the relationship of tuberculosis and HIV in children in NYC.Methods.Information on tuberculosis was collected by retrospective chart abstraction in a cohort of HIV-exposed and infected children enrolled in a longitudinal study of HIV. Tuberculosis cases were ascertained by chart review or by matching HIV-infected and -exposed children to NYC Tuberculosis Registry cases. NYC Tuberculosis Registry data on children reported from 1989 to 1995, and not reported as HIV-infected, were used for comparison.Results.Tuberculosis disease was found in 45 (3%) of 1426 HIV-infected children (0.61 per 100 child years of observation) and in 5 (0.5%) of 1085 HIV-exposed uninfected children (0.2 per 100 child years). 30% of children were evaluated for HIV only after presenting with tuberculosis. Children with tuberculosis and HIV were more likely than other age-matched HIV-infected children to have decreased CD4+T lymphocyte counts (66%vs.37%,P= 0.02) and more likely than other NYC children with tuberculosis to have culture-confirmed and extrapulmonary tuberculosis. In this series 8 of 21 deaths in HIV-infected children with tuberculosis appeared to be related to tuberculosis.Conclusions.During a period of high tuberculosis incidence in NYC, 3% of HIV-infected children in our cohort had tuberculosis, higher than the rate in uninfected children born to HIV-positive mothers in the same cohort. Because of this association, HIV-infected children with pulmonary illness should be tested for tuberculosis; and all children with tuberculosis should be tested for HIV.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Mycoplasma pneumoniaeis a frequent but underdiagnosed cause of community-acquired pneumonia (CAP) in children, and appropriate macrolide treatment is often given late. The aim of this work was to estimate the frequency of pulmonary involvement in children 6 months after a clinical episode ofMycoplasmaCAP.Methods.We measured carbon monoxide diffusion capacity (TLCO) and conducted spirometric tests in 35 children without asthma or chronic lung disease (ages 4.5 to 15 years), 6 months and 1 year after acute CAP caused byM. pneumoniae(23 children), pneumococci (5 children) or viruses (7 children). Only 11 of 23 patients withM. pneumoniaeCAP required hospitalization, whereas all the patients with pneumococcal or viral pneumonia were admitted to hospital.Results.Lung volumes and spirometric tests were normal for all children. TLCO was normal 6 months after pneumococcal or viral pneumonia (87 to 112% of expected values for height and sex). After acuteM. pneumoniaeCAP, 11 of 23 patients (48%) had TLCO values <80% of the expected value. The extent of change in lung diffusion capacity was correlated with the delay to diagnosis and treatment: TLCO was low in 8 of 11 patients given macrolide treatment 10 days or more after the onset of acute symptomsvs.only 3 of 10 patients given appropriate treatment in the first 10 days. TLCO was low in 7 of 7 who received macrolide therapy for <2 weeks. TLCO had increased slightly after 1 year in the 5 patients retested after a new course of macrolide treatment. TLCO reached the lower normal range in 2 patients controlled after 3 years.Conclusions.The abnormal TLCO values suggest that some children withMycoplasmapneumonia have reduced pulmonary gas diffusion after recovery from the illness. The reduction is related to delay and short macrolide therapy.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.We compared the antibody response toHaemophilus influenzaetype b capsular polysaccharide (PRP) after three doses of a diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine (DTaP) combined with a PRP-tetanus conjugate (PRP-T) in infants randomized to receive oral polio vaccine (OPV) or inactivated polio vaccine (IPV). The polio vaccine was given separately at the same visit.Methods.Three hundred fifty-six infants from pediatric practices in suburban Chicago and New Orleans were randomized into two groups. Group A received OPV at 2 and 4 months of age; Group B received IPV at 2 and 4 months of age. Both groups received DTaP/PRP-T at 2, 4 and 6 months of age and hepatitis B vaccine at 2 and 4 months of age. A serum sample was obtained before immunization (age 2 months) and 1 month after 3 doses of DTaP/PRP-T (age 7 months). Sera were assayed for antibody responses to all relevant vaccine antigens.Results.No significant vaccine antigen interference was found when polio immunization was provided by IPV or OPV for anti-PRP, diphtheria, tetanus or pertussis antibodies. OPV recipients had a significantly higher mean antibody response to serotype 1 (P= 0.03) and 2 (P= 0.0001) poliovirus.Conclusion.Whether polio immunization was accomplished with IPV or OPV did not significantly influence the antibody responses in sera obtained at 7 months of age for anti-PRP, anti-diphtheria and anti-tetanus toxoid antibodies and antibodies to pertussis antigens, when DTaP/PRP-T was given in the primary series.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Tinea gladiatorum is a common problem in competitive wrestling. It impacts on a wrestler’s ability to compete. Several methods have been advocated to prevent these infections; however, no well-designed study of pharmacologic prophylaxis has been conducted.Methods.In a double blind placebo-controlled trial during the 1998 to 1999 regular wrestling season, wrestlers were randomized to receive 100 mg of fluconazole once weekly or placebo once weekly. Those not involved in the study were treated as a second control group. The effects of prophylaxis were also examined by assessing treatment of clinical infections with fluconazole 200 mg weekly for 4 weeks.Results.There was a significantly smaller incidence of infection in those given fluconazole (6%) than in those receiving placebo (22%) and those not involved in the prophylaxis phase (18%) (P< 0.05). There was also a significant reduction in the total number of infections in the fluconazole group (P< 0.05). Prophylaxis with fluconazole did not impact on the severity of disease, if contracted, when compared with the placebo prophylaxis participants who contracted tinea corporis. Of 21 wrestlers with tinea infections and positive cultures, 14 were able to have their isolates identified asTrichophyton tonsurans.Conclusions.Fluconazole is effective and safe for primary prevention of tinea gladiatorum. We must now define when and in what population prophylaxis would be warranted.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objectives.To evaluate concordance for human papillomaviruses (HPVs) between cervix and urine in sexually active adolescents.Methods.Cervical swabs and urine were collected from 80 adolescents in Baltimore, MD. Specimens were tested for 34 HPVs by PCR and for cancer-associated HPVs by Hybrid Capture (HC II) Probe B. Cervicalvs.urine prevalence was evaluated by logistic regression with general estimating equations. Risk factors for prevalence and viral burden were evaluated by Fisher’s exact and Kruskal-Wallis tests, respectively.Results.HPV prevalence by PCR, for any HPV, was very high in the cervix (90.0%) and somewhat lower in urine (75.0%) (odds ratio, 1.07; 95% confidence interval 1.07 to 1.34). Only one adolescent was HPV-positive in urine alone. Among HPV-PCR positives at either or both sites, concordance was 82% for presence of any HPV and 40% for specific HPV types. Multiple infections were common at both sites. On an average, HC II viral burden (relative light unit ratio) was 9-fold higher in cervix than in urine (median, 47.3vs.4.9;P= 0.005) but correlated poorly between the two sites of the same individual (r= 0.14). Compared with normal adolescents, those with squamous intraepithelial lesions had a much higher prevalence of HPV by HC II in cervix (100%vs.28.6,P< 0.0001) as well as in urine (86.7%vs.35.4%,P= 0.002) and a significantly higher viral burden in the cervix (median, 141.8vs.7.3,P= 0.0045) but not in urine (median, 22.7vs.4.38;P= 0.13).Conclusion.There was a very high prevalence of HPV in cervix and urine of sexually active adolescents. Testing urine for HPV may be useful in epidemiologic investigations and in monitoring of infected women.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID