ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although the symptoms of the acutely ill child are important both in the diagnosis and follow-up of acute otitis media (AOM), data about them are quite limited. We carried out a prospective survey by collecting information on 354 consecutive children visiting a pediatrician, otolaryngologist or general practitioner because of any kind of acute symptoms to compare symptoms of children with acute otitis media with those of children with other acute infectious diseases. The symptoms and signs observed at home were recorded by the parents before the visit and the findings in the physical examination were recorded later by the physician. AOM was diagnosed in 191 patients (54.0%). The most important symptoms increasing the likelihood of AOM significantly were ear-related symptoms, such as earache (relative risk (RR) 5.4;P< 0.001), rubbing of the ear (RR 5.0;P< 0.001) and feeling of blocked ear (RR 4.5;P< 0.05). However, only 67.7% of children younger than 2 years of age with AOM had any ear-related symptoms. The children with tympanostomy tubes had earache (47.8%) and rubbing of the ear (58.8%) of the same magnitude as did children without tubes. Thinitis increased the likelihood of AOM (RR 2.3;P< 0.001) as did excessive crying in children older than 2 years of age (RR 3.0;P< 0.001). Fever, earache or excessive crying was present in 90.1% of patients with AOM but also in 72.4% of patients without AOM. Many symptoms previously thought to tbe related to AOM, such as fever, cough, poor appetite, diarrhea and vomiting, were not more common in children with AOM than in children with other acute illnesses. The duration of any of the symptoms was not markedly different in children with AOM than in children with other acute diagnoses. We conclude that AOM does not cause any specific symptoms that parents could use in their decision to seek medical advice for their child.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To investigate the long term natural course of primary hepatitis C virus infection in children from the beginning, we prospectively followed up 88 children at risk because of frequent blood transfusions or of hepatitis C virus infection from the mother. Ten of the 88 children contracted primary infection during follow-up. In the acute stage of infection acute hepatitis with elevation of aminotransferases and a positive IgM antibody was found in both children infected during open heart surgery, 3 of the 5 multiply transfused children with congenital hemolytic anemia and none of the 3 infants infected by their mother. Four of the 10 children later lost hepatitis C virus RNA, whereas 6 had a chronic course. Three of the latter 6 children had abnormal aminotransferase activities in the chronic phase. Our study suggests that the very young age of primary infection and the underlying status of the host may affect the clinical course of hepatitis C virus infection in children.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Typhoid fever occurs in children less than 2 years of age but is thught to be a mild, often unrecognized illness. Neonatal typhoid fever is a rare but often life-threatening illness, uniformly fatal in the preantibiotic era. Vertical intrauterine transmission from a typhoid-infected mother is implicated in neonatal typhoid fever. Ten cases at a rural African hospital are presented. Three patients died with two dieaths associated with empiric management inappropriat forSalmonella typhi.A second clinical presentation in the neonate is asymptomatic persistent excretion. Infants ≥3 weeks old may also be infected from an exogenous source and have severe disease. Where typhoid is endemicS. typhishould be considered as a cause of sepsis neonatorum and appropriate antibiotics included in empiric therapy.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

There is an ongoing debate on the best way to screen febrile infants for urinary tract infection. We examined the urinanalysis (UA) findings on admission among infants less than 16 weeks old, with and without acute pyelonephritis (APN), as defined by the dimercaptosuccinic acid (DMSA) renal scan findings, performed during a 57-month period. Forty-nine cases with a positive DMSA scan were compared with 79 negative study cases. A negative UA for leukocytes (<5 white blood cells/high power field) was found in 4 of 49 (8.1%) cases with APN by DMSA, and in 34 of 79 (43%) cases with a negative DMSA (odds ratio 10.88 (95% confidence interval, 2.31 to 70.3;P< 0.001)). Three of the 4 infants not suspected to have APN by their UA findings would have been admitted for a full sepsis workup based on their clinical presentation and/or their laboratory findings on admission. We conclude that a fresh UA may be a sufficient screening method for the exclusion of APN in infants assessed for fever of no obvious origin.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although penicillin-resistant pneumococi (PR-PnC) are reconized as an increasing problem worldwide, data on the prevalence of these strains among pediatric patients are incomplete. The present study was conducted in southern Israel (1) to investigate the frequency of PR-PnC in invasive and middle ear infections in pediatric patients and (2) to assess the impact of resistance on the potential role of the candidate conjugate vaccines in preventing childhood PR-PnC infections. A total of 120 blood or cerebrospinal fluid isolates from 1987 to 1993 and 78 ear isolates from 1992 to 1993 were serogrouped and tested for susceptibility to antibacterial agents. The prevalence of PR-PnC among invasive isolates increased from 16% in the years 1987 to 1991 to 36% in 1992 to 1993 (P= 0.019). This increase was noted mainly for intermediately resistant strains (minimal inhibitory concentration, 0.12 to 1.0 μg/ml) whereas the prevalence of highly resistant strains was 3 and 2% for the 2 periods, respectively. The prevalence of PR-PnC among ear isolates in 1992 to 1993 was 42%. Resistance to other antimicrobial agents (one or more of the followng: tetracycline, erythormycin, clindamycin and chloramphenicol) was found in 16 (8%) isolates, and multiple resistance (resistance to ≥3 antibacterial agents) was found in 9 (5%) isolates. Sixty-five (99%) of the 66 resistant isolates belong to Serogroups 6, 14, 19 and 23. The prevalence of these 4 serogroups rose from 37% in 1987 to 1991 to 66% in 1992 to 1993 (P= 0.043). This rise was mainly because of Serogroup 23, the prevalence of which rose from 3% in 1987 to 1991 to 23% in 1992 to 1993 (P< 0.001). Eighty-five percent of all isolates belonging to Serougroup 23 were resistant to penicillin. Because Serogroups 6, 14, 19 and 23 are among the commonest pediatric pneumococcal strains, the newly developed conjugate pneumococcal vaccines contain these 4 serogroups. The selection of antibiotic-resestant strains has thus led to a change in the spectrum of serotypes causing invasive disease and to a situation of potential increase in vaccine coverage for the proposed pneumococcal conjugate vaccines.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thirty-two episodes ofEnterobacterbacteremia were identified in 30 patients at Children's Hospital of Michigan between September, 1989, and November, 1992. Fifty-six percent of the episodes were nosocomial.Enterobacteraccounted for 14% of all nosocomial bacteremias and was the most common Gram-negative organism causing such infections.Enterobacter cloacaewas the most commonly isolated species (72%). Twentynine (97%) patients had underlying risk factors for infection, including central venous catheters in 22. The susceptibility pattern of 46Enterobacterisolates from blood during the same study period showed high resistance to extended spectrum penicillins and third generation cephalosporins but low resistance to aminoglycosides alosporins but low resistance to aminoglycosides and trimethoprim-sulfamethoxazole (TMP/SMX). Resistance to third generation cephalosporins increased throughout the study period and was higher in patients who had received these agents during tthe previous month. In situations where there is a high frequency of Gram-negative bacteremias with organisms resistant to third generation cephalosporins, we suggest that initial therapy be a combination of a beta-lactam agent and an aminoglycoside or TMP/SMX.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A subunit vaccine for respiratory syncytial virus (RSV) consisting of purified fusion glycoprotein (designated PFP-1) was tested in children 24 to 48 months old. Two doses of 20 μg (n= 13) and 50 μg (n= 10) were compared with a saline (n= 24) placeb control group. Local and systemic reactions, reported within 96 hours postvaccination, were mild, transient, and did not differ significantly from the control cohort. Long term follow-up through at least one, and in some cases two, RSV seasns showed no serious RSV illness in vaccinees at any time. There was, therefore, no evidence of disease enhancement postvaccination. In the 20-μg cohort, 92% responded to vaccination by a 4-fold increase in enzyme-linked immunosorbent titer to the F glycoprotein and 42% had a 4-fold or greater rise in neutralizing titer to the A2 virus. In the 50-μg cohort 100% responded by enzyme-linked immunosorbent to the F glycoprotein and 70% responded by A2-neutralizing titers. The neutralizing titers in the vaccinated cohorts were similar to those seen previously in adults. These data show the ability of the subunit vaccine to boost existing immunity exposure in children who were seronegative at the time of vaccination.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To analyze the effects of quinolones on growth and joints in children we identified 78 patients who had been receiving nalidixic acid for 116 days on the average (range, 3 to 570 days) from a random sample of 3094 of 16 409 children treated with long term medication because of recurrent urinary tract infection. Two controls per each index case, matched for sex and the age at which the first medication for recurrent urinalry tract infection occurred, were chosen. Frequency of joint symptoms and examinations or possible treatments for arthropatiies were similar in the index (n= 44) and control (n= 62) cases. Detailed growth data were analyzed from 39 case-control pairs after the mean follow-up time of 19.6 years (range, 14.8 to 24.7 years), and no growth disturbances were found. The final heights (age, >18 years) of the index and control cases were similar (n= 31 case-control pairs). We conclude that nalidixic acid does not cause arthropathies or hamper growth in children, which supports the suggestion that at least short treatment periods with quinolones are safe.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Progressive disseminated histoplasmosis is often fatal without treatment and requires rapid and accurate laboratory diagnosis. Radioimmunoassay forHistoplasma capsulatumvar.capsulatumantigen has been established as a sensitive and accurate diagnostic technique for disseminated histoplasmosis in adults; this study examines the radioimmunoassay in children. The clinical and laboratory records of 26 patients 18 years old or younger in whomH. capsulatumantigen was detected in urine by radioimmunoassay and at least one other positive corroborative standard test were evaluated. Twenty-two (85%) had disseminated disease, and 4 (15%) had self-limited pulmonary disease. Positive corroborative tests included serologic tests in 17 of 22 (77%) patients tested, tissue stains in 5 of 9 (56%) and fungal cultures in 16 of 24 (67%). Patients with disseminated histoplasmosis had a greater degree of antigenuria than those with self-limited infection. In 20 patients with progressive disease treated with amphotericin B, antigen levels declined, and the decrease in antigenuria correlated with clinical improvement. The radio-immunoassay forH. capsulatumantigen in urine is an important test in the diagnosis of disseminated histoplasmosis and is useful for assessing the efficacy of treatment. The presence of urinary antigen is strong evidence for progressive disease that requires treatment.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID