ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever ≥40°C (104°F) or, ≥39.5°C (103°F) with white blood cells (WBC) ≥15 × 109/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures:Streptococcus pneumoniae, 51;Haemophilus influenzaeb, 6;Neisseria meningitidis, 2; and Group BStreptococcus, 1. Subgroups of high risk were identified as fever ≥39.5°C and WBC ≥15 × 109/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC ≥30 × 109/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever ≥39.5°C and WBC <15 × 109/liter, 5 of 182 or 2.7% positive and those with WBC <10 × 109/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children. Children 3 to 36 months old with fever ≥39.5°C and WBC ≥15 × 109/liter and no focus of infection are at high risk (≥16%) for having occult bacteremia. Antimicrobial treatment of febrile children with these high risk criteria appears prudent whereas routine treatment of those with low risk criteria does not. Both treatment regimens evaluated are rational and all patients did well.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

During a 24-month period 446 children with diarrhea and 16 controls had examination of their stools for leukocytes and for occult blood. Fecal leukocytes were found in 36, 16 and 18% of children withSalmonella-Shigella-Campylobacter, rotavirus or enterotoxigenicEscherichia coli, or cryptosporidial diarrhea, respectively. Similarly 43, 39 and 38% of these groups, respectively, as well as 13% of controls had occult blood. Notably 70% of 10Shigellacases had fecal leukocytes. In 166 children with mixed pathogens leukocytes were seen in 27 and 8% of children withSalmonella-Shigella-Campylobacteror noninvasive pathogen, respectively. Likewise 44 and 18% of these groups had occult blood. Agreement between both tests being positive was poor, the highest result being 5O7o forShigella.Dysentery combined with both tests positive was associated with 15 (88%) cases of invasive agents present in stool cultures, and combination of dysentery with fecal leukocytes was associated with 21 (72%) cases of invasive agents recovered. The results of these tests should be interpreted in the context of the clinical situation. A combined clinical-epidemiologic and screening tests-based approach to infectious diarrhea of childhood is suggested.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Late in 1991, before the implementation of a national immunization program againstHaemophilus influenzaetype b (Hib) in the United Kingdom, we performed a 4-year follow-up of 120 children who in 1987 had been enrolled in an immunogenicity trial in which 60 of them (vaccinees) received an Hib conjugate vaccine (HbOC) at the same time as diphtheria-tetanus toxoid-pertussis vaccine at the ages of 3, 5 and 9 months. Sixty others (controls) received only diphtheria-tetanus toxoid-pertussis vaccine at the same ages and were not subsequently immunized against Hib. We investigated Hib pharyngeal colonization using the antiserum agar method and the concentrations of serum IgG antibody to the type b capsule by enzyme-linked immunosorbent assay. At 4 years of age the Hib colonization rates in vaccinees and controls were 8% (5 of 60) and 5% (3 of 60), respectively. The children colonized with Hib had greater serum anti-capsular IgG concentrations than did noncolonized children (P< 0.001), and colonized vaccinees tended to have higher concentrations than colonized controls (P= 0.053). Regardless of Hib colonization status vaccinees had greater antibody concentrations than controls (P< 0.001). Forty-nine percent of vaccinees had an antibody concentration >1 Mg/ml. There was an inverse relationship between the Hib colony count on culture and the serum IgG

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We compared the immunogenicity of the four availableHaemophilus influenzaetype b (Hib) conjugate vaccines in Alaska Native infants. Three of the vaccines, Hib oligosaccharide-CRM197(HbOC), polyribosylribitol phosphate-diphtheria toxoid (PRP-D) and polyribosylribitol phosphate-tetanus toxoid (PRP-T), were given at 2, 4 and 6 months of age, and the PRPNeisseria meningitidisouter membrane protein (PRP-OMP) conjugate vaccine was given at 2 and 4 months of age. Enrollment was largely sequential by vaccine availability beginning with HbOC and ending with PRP-T. A total of 225 infants completed the full vaccination series. Groups of infants receiving the different vaccines did not differ significantly by sex, ethnicity, degree Alaska Native or age at vaccination. The only vaccine that induced a response with the first 2-month dose was PRP-OMP; 91% of infants had ≥0.15 μg/ml and 57% had ≥1.0 Mg/ml of anti-PRP antibody by 4 months of age. After two doses it also remained the most immunogenic. After the full three vaccine series…

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A distinct clinical syndrome of cholestasis and hepatitis occurred during early infancy in seven infants with perinatally acquired human immunodeficiency virus 1 infection. In five infants hepatitis was the first manifestation of human immunodeficiency virus 1 infection. The median age of onset of hepatitis was 7 months (range, 5 to 10 months). The mean total bilirubin concentration at presentation was 7.4 mg/dl (range, 3.9 to 11 mg/dl), the mean aspartate amino-transferase was 1512 IU/liter (range, 782 to 2960 IU/liter) and the mean alanine amino-transferase 512 IU/liter (range, 92 to 1247 IU/liter). The absolute CD4 count at the time of onset of hepatitis ranged from 191 to 2298 cells/mm3(mean, 766 cells/mm3). Six of the seven children died within 12 weeks of onset of hepatitis, three as a result of complications ofPneumocystis cariniipneumonia, and two died of complications secondary to cytomegalovirus. In only one infant was the cause of death the direct consequence of liver failure. The seventh infant died 17 months after the onset of hepatitis of dilated cardiomyopathy. No specific etiologic agent has been identified as the cause of cholestatic hepatitis in these infants.In situhybridization studies to detect human immunodeficiency virus 1 messenger RNA was negative in the liver tissue obtained at biopsy and autopsy in five of the samples tested.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Descriptions in the medical literature of human immunodeficiency virus type 1 (HIV-1) in children with tuberculosis (TB) are scanty. This study determined the seroprevalence of HIV-1 in 237 hospitalized children between the ages of 1 month and 14 years with a clinical diagnosis of TB (125 males and 112 females) and in 242 control children (149 males and 93 females). The overall HIV-1 seroprevalence rate in patients with TB was 37% (88 of 237) compared with 10.7% (26 of 242) among the control group (P< 0.00001: odds ratio 5.37, 95% confidence interval = 3.21 < 5.37 < 9.47). HIV-1 seropositivity in children with TB ranged from 53% (31 of 58) in the 12− to 18-month age group to 14% (9 of 61) in the 10− to 14-year-olds. The risk of TB attributable to HIV infection was 29%. The predominant clinical presentation in both seronegative (84.6%) and seropositive (89.7%) groups was that of pulmonary TB and there were no significant differences in clinical presentation between the two groups of patients. Only 54.8% of the patients attended follow-up clinics regularly whereas 32% were lost to follow-up within 3 months.Bacillus Calmette-Guérinvaccination coverage was 87.3% among TB patients and 90.5% in the controls. No significant differences inB. Celmette-Guérinvaccination rates between the seronegative and seropositive children were seen. Coinfection with HIV and TB in children is now one of the major public health problems in Zambian children.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

As a support service for a pertussis vaccine efficacy trial, a central diagnostic laboratory was established. Physicians in the geographic areas of the planned study were encouraged to send nasopharyngeal specimens from children and household contacts with cough illnesses whether or not the illnesses were typical of pertussis. From April, 1991, to February, 1992, 3629 specimens were received and in 601 instances (16.6%)Bordetella pertussiswas isolated. Only 3.3% of patients with positive cultures had received pertussis vaccine whereas 16.1% of culture-negative patients had received vaccine (P< 0.0001). Fever was more common (12.2%) in patients with negative cultures compared with those with positive cultures (5.4%) (P< 0.0001).B. pertussisisolation rates fell markedly after 21 days of cough. Significantly more patients with negative cultures compared with those with positive cultures had been treated with erythromycin (8.5vs.2.9%;P< 0.0001). Patients with cough for greater than 4 weeks and specimen collection within 2 weeks of cough onset had aB. pertussisisolation rate of 59%. Similarly if whoop occurred under the same circumstances the isolation rate was 80%. In this study 25.5% of patients with culture confirmed pertussis had illnesses with cough of less than 21 days duration. This finding suggests to us that a pertussis case definition in efficacy …

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In order to delineate the efficacy of plasmin-treated intravenous gammaglobulin (IVGG) in the treatment of Kawasaki syndrome, we compared the frequency of coronary artery abnormalities in children treated or not with IVGG for Kawasaki syndrome. Among 291 cases of Kawasaki syndrome diagnosed during the period of 1987 to 1991 without coronary abnormalities within 10 days of the onset of illness, 128 were treated with IVGG and aspirin and were compared with 163 treated with aspirin alone. IVGG was given in a dosage of 400 mg/kg/day for 4 consecutive days. The detection of coronary abnormalities was monitored by two dimensional echocardiography. Two weeks after enrollment coronary artery abnormalities were present in 37 (22.7%) of 163 children in the aspirin group and in 9 (9%) of 128 in the gamma-globulin group (P< 0.05). Seven weeks after enrollment, abnormalities were present in 20 (12.3%) of 163 children in the aspirin group and in 6 (4.6%) of 128 in the IVGG group (P< 0.05). We conclude that plasmin-treated IVGG is effective in reducing the prevalence of coronary artery abnormalities in Kawasaki syn…

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID