ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Testing for urinary excretion of capsular polysaccharide antigen was carried out in 40 four-month-old Navajo infants who had received injections of aHaemophilus influenzaetype bNeisseria meningitidisouter membrane protein conjugate vaccine (PedvaxHIB®; Merck, Sharp and Dohme Research Laboratories) as part of an ongoing efficacy trial of the vaccine. Urine from 12 placebo recipients was also analyzed. Urine samples were collected on the day of injection (the first voided urine following the injection) and 3, 7, 10, 14, 21 and 30 days later. All vaccine recipients had at least 1 positive specimen. Vaccine recipients excreted antigen for a median period of 14 days after injection. On the first day 54% of vaccinees excreted antigen. Antigen was excreted by 89% of vaccinees on Day 3, 79% on Day 7, 82% on Day 10, 64% on Day 14, 56% on Day 21 and 41% on Day 30. Urine from placebo recipients tested positive in 12% on Day 1, 18% on Day 3, none on Day 7, 14% on Day 10, 11% on Day 14, 10% on Day 21 and none on Day 30. The rate of positive test results was significantly higher among vaccine recipients than among controls. Physicians should not rely on urinary antigen detection tests for predicting the presence of invasive disease caused byH. influenzaetype b in infants for at least 30 days after injections with this conjugate vaccine, and possibly longer.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Among a group of hospitalized children in Fukuoka, southern Japan, an epidemic of pharyngoconjunctival fever-like disease caused by adenovirus type 11 was observed in the autumn of 1988. Of the 47 children studied 38 were seronegative in neutralizing antibody for adenovirus type 11 before the epidemic, and sero-conversion occurred in 16 (42%) including 5 subclinical cases. Of the 11 symptomatic patients the incidences of conjunctivitis, pharyngitis and fever were 91, 64 and 46%, respectively. Four patients (36%) had all three symptoms. Fifteen patients (94%) were boys. The sex predominance and high incidence of conjunctivitis suggested that infection may have been transmitted in the large bathroom where boys took baths together.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We treated 96 cases of pyogenic arthritis from January 1, 1980, to December 31, 1990, 16 of whom had adjacent osteomyelitis. Presenting symptoms in the latter were indistinguishable from those in 80 cases of primary pyogenic arthritis with regard to involved joints, aspirate findings and pathogens; however, adjacent osteomyelitis patients tended to be younger and were more likely to be symptomatic more than 7 days and to have received prior antibiotics. Prompt joint drainage was done in 15 of 16 cases but adjacent osteomyelitis was recognized in only 5. Bone scan was misleading in 3 of the 4 cases where it was performed as part of the initial evaluation. Persistent pain, swelling and/ or fever occurred in 9 patients, 6 of whom underwent further joint drainage. Radiographs were diagnostic in 1 patient at admission, 10 during hospitalization and in 5 at follow-up. Sequelae were found in 8 of 13 patients with bone and joint infectionsvs.8 of 41 patients

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Of the 14 pediatric patients with deep neck infections hospitalized at our institution from 1981 through 1990, only 6 were managed surgically. The remaining 8 patients received antibiotic therapy and their infection resolved without the need for surgical drainage. All 8 patients were hospitalized within 4 days (mean, 1.8 days) of onset of illness. Computerized tomography of the neck was performed in 7 and revealed soft tissue swelling and a round or oval cystic lesion in the parapharyngeal region in all 7. Parenteral antibiotic therapy was administered to all patients for 2 to 9 days (mean, 5.5 days) before changing to oral therapy which was continued for 10 to 35 days (mean, 15.1 days). Clinical improvement was evident in all patients 1 to 3 days (mean, 1.6 days) after the onset of antibiotic therapy, with defervescence within 7 days (mean, 3.8 days). Follow-up computerized tomography scans were obtained in 4 patients revealing improvement in 3. It is known that patients with cellulitis of the deep neck tissues may respond well to antibiotic therapy; our experience suggests that some patients with apparent abscess formation as determined by computerized tomography scan may also respond favorably to antibiotic therapy and not require surgical drainage.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Four thousand forty-two healthy children and adolescents, ages 12 months to 17 years, were vaccinated with a single dose of live attenuated varicella vaccine (VARIVAX®; Merck Sharp and Dohme Research Laboratories) containing ∼1000 to 1625 plaque-forming units/dose during clinical trials conducted from 1987 to 1989. Clinical follow-up of vaccinees revealed that 2.1 and 2.4% of vaccinees developed modified cases of varicella in the first and second years, respectively, after vaccination. Most of those who developed varicella postvaccination had an attenuated illness, characterized by fewer lesions and a lower incidence of fever (≥100°F, oral) than after natural infection. The likelihood of developing varicella postvaccination decreased (P < 0.0001) as the 6-week postvaccination glycoprotein-based enzyme-linked immunosorbent assay titer increased. In addition the number of lesions in these cases tended to decrease (P= 0.07 for Year 1 andP= 0.02 for Year 2) as the 6-week glycoprotein-based enzyme-linked immunosorbent assay titer increased. Thus the 6-week postvaccination glycoprotein-based enzyme-linked immunosorbent assay titer can be used as a surrogate marker for protection from natural disease.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The appreciation ofUreaplasma urealyticumas a human pathogen and documentation of antibiotic resistance have heightened interest in drug susceptibilities and treatment alternatives for patients infected with this organism. Neonates pose special problems when therapy must be considered because of potential toxicities, clinical unfamiliarity or lack of experience. Forty-three isolates ofU. urealyticumobtained from the lower respiratory tracts of neonates were tested against chloramphenicol, ciprofloxacin, clindamycin, erythromycin, doxycycline, and gentamicin by a microbroth dilution technique in 10B broth.In vitroresistance was observed in 1 or more strains for each of the drugs tested, except for erythromycin (minimal inhibitory concentration (MIC) range, 0.125 to 4 μg/ml, MIC90= 2 μg/ml). MIC90values for the remaining five antibiotics were: doxycycline, 2 μg/ml; chloramphenicol, 8 μg/ml; ciprofloxacin, 8 μg/ml; clindamycin, 16 μg/ml; and gentamicin, 32 μg/ml. The effect of pH and/or media components on MICs was evaluated by comparing MICs of American Type Culture Collection reference strainStaphylococcus aureus29213 obtained in Mueller-Hinton broth (pH 7.2 to 7.4) and 10B broth (pH 6.0). No appreciable effect was detected for ciprofloxacin, chloramphenicol or doxycycline, whereas gentamicin, erythromycin and clindamycin all had MICs elevated by one to several dilutions when tested in 10B broth. In some instances the difference was sufficient to alter the interpretation of the MIC. Clinical experience in treating neonatal ureaplasmal infections is reviewed along with recommendations for obtaining cultures, initiating and monitoring efficacy of therapy.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

During a 3-year period we followed 128 human immunodeficiency virus (HIV) antibody-positive children ages 6 days to 11 years clinically and with an HIV diagnostic panel consisting of antibody (by enzyme-linked immunosorbent assay and confirmed by indirect fluorescence assay or Western blot), p24 antigen detection, HIV isolation from peripheral blood culture and molecular detection of HIV nucleic acids by polymerase chain reaction (PCR). The PCR procedure included 30 cycles of amplification using two separate gag primer pairs (SK38/39 and SK101/145), followed by detection with probes to areas amplified (SK19 and SKI02). Results of PCR were available within 48 hours and were sensitive (97%) and specific (100%). PCR should be obtained on all children exposed perinatally, and aggressive management should be undertaken for those found to be positive.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To better understand the natural history of severe pediatric human immunodeficiency virus infection, reported cases of perinatally acquired pediatric acquired immunodeficiency syndrome (AIDS) in New York City were examined for differences in survival and age at diagnosis before and after implementation of an expanded case definition in 1987. One hundred ninety-six children reported through August, 1987, and 333 children reported between September, 1987, and February, 1990, and diagnosed through 1989 were compared. Significant differences were not found in survival by either gender or race/ethnicity although Hispanics were slightly more likely to be diagnosed withPneumocystis cariniipneumonia (PCP) and blacks with lymphocytic interstitial pneumonitis (LIP). The most striking differences were noted regardless of race between children whose earliest AIDS-specific diagnosis was PCP and those whose earliest diagnosis was LIP. In the group reported through August, 1987, median survival from birth was 10 months with PCPvs.54 months with LIP, median age at diagnosis 5 monthsvs.20 months, and median survival after diagnosis 2 monthsvs.22 months, respectively. Twelve-month survival for PCP improved in the two time periods examined, but survival with LIP did not. After implementation of the 1987 case definition, bacterial infections replaced LIP as the second most common diagnosis. This study provides data on children diagnosed and reported with AIDS. Ongoing prospective studies of children who have a full spectrum of human immunodeficiency virus infection with and without reportable AIDS will further elucidate survival in children infeced with human immunodeficiency virus.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cord blood was anonymously screened to determine the prevalence of human immunodeficiency virus (HIV) seropositivity in neonates admitted to the neonatal intensive care unit (NICU) at the Bronx Lebanon Hospital Center, located in the South Bronx. We speculated that factors leading to admission to the NICU such as low birth weight, prematurity and being small for gestational age would also be associated with an increased prevalence of HIV seropositivity. During the study period the prevalence of HIV seropositivity was 11.6% in the NICU population. There was no significant difference in maternal age, gravidity, race and sex in HIV-seropositivevs.HIV-seronegative newborns. There was a significantly increased incidence of maternal drug use (P< 0.01), babies small for gestational age (P< 0.005) and microcephaly (P< 0.02) in seropositivevs.seronegative NICU babies. The results of this study suggest that the NICU population may comprise a significant number of infants of HIV-infected mothers.

ISSN:0891-3668    

出版商:OVID    

年代:1992

数据来源: OVID