ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Aim.To determine the incidence of overdiagnosis and overtreatment of Lyme disease in children residing in endemic areas using standardized CDC diagnostic criteria.Methods.Case series, using data collected prospectively from patients referred for Lyme disease to a tertiary care center located in an area endemic for Lyme disease. Data were collected on all referred cases during a 30-month period from August, 1995, to February, 1998.Results.We evaluated 216 patients with ages from birth to 18 years. Results of Lyme enzyme-linked immunosorbent assay and Western blot studies were available for all patients evaluated. Of these, 68 (31%) fulfilled the criteria for active Lyme disease, most commonly having arthritis, facial nerve palsy, aseptic meningitis or erythema migrans; 39 (18%) had a prior history of Lyme disease and were referred with an acute intercurrent illness or lower school grades attributed to the previous Lyme disease; 77% of these were receiving therapy at the time of referral; 109 (50%) of 216 had no past or current evidence of Lyme disease, yet 79% were receiving therapy at the time of referral.Conclusions.Overdiagnosis and overtreatment of Lyme disease is a major concern in areas endemic for Lyme disease, even after 1995 when standard criteria for diagnosis were published. The most common problem in diagnosis was misinterpretation of Western immunoblot results.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Trovafloxacin is a new fluoroquinolone that exhibits good penetration into the central nervous system and excellent antimicrobial activity against common meningeal pathogens, including beta-lactam-resistant pneumococci.Purpose and design.A multicenter, randomized clinical trial was conducted in children with bacterial meningitis to compare the safety and efficacy of trovafloxacin with that of ceftriaxone with or without vancomycin therapy.Results.A total of 311 patients, ages 3 months to 12 years, were enrolled, of whom 203 were fully evaluable, 108 treated with trovafloxacin and 95 with the conventional regimen. Both groups were comparable with regard to baseline characteristics: age; cerebrospinal fluid findings; use of dexamethasone; history of seizures; and etiologic agents. No significant differences between trovafloxacin and the comparator, respectively, were detected in any of the following outcome measures: clinical success at 5 to 7 weeks after treatment (79%vs.81%); deaths (2%vs.3%); seizures after enrollment (22%vs.21%); and severe sequelae (14%vs.14%). Only 4 of 284 children developed joint abnormalities up to 6 months after treatment, 1 (0.9%) child received trovafloxacin and 3 (3.1%) received the comparator regimen. None of the evaluable patients experienced significant abnormalities of liver function during treatment. One nonevaluable patient who received trovafloxacin for 5 days and ceftriaxone for 11 days was readmitted to the hospital with hepatitis of unknown etiology 1 day after discharge. The episode resolved with liver function tests returning to normal within 2 months.Conclusions.We conclude that trovafloxacin is an effective antibiotic for treatment of pediatric bacterial meningitis. These favorable results support further evaluation of fluoroquinolone therapy for children with meningitis or other serious bacterial infections.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective.To determine how often neonates with coagulase-negative staphylococcal (CONS) bacteremia can be treated successfully without removing the central venous catheter (CVC).Methods.A cohort study of CONS bacteremia and CVCs was conducted in infants in a neonatal intensive care unit in a 5-year period (1994 through 1998). CONS bacteremia was defined as at least two positive blood cultures within 3 days of each other.Results.Fifty-six infants had early removal CVC (ER-CVC) within 3 days, and 63 infants had late removal CVC (LR-CVC) >3 days after the first positive blood culture. All cases of CONS bacteremia were treated with vancomycin. There was no significant difference between infants in the ER-CVC and LR-CVC groups in terms of recurrence of bacteremia or case fatalities. CONS bacteremia of >3 days duration was more frequent in LR-CVC patients than ER-CVC patients: 43%vs.13% (relative risk, 3.4; 95% confidence interval, 1.6 to 7.2). CONS bacteremia was successfully treated without CVC removal in 46% of LR-CVC cases. Seventy-nine percent of LR-CVC cases with CONS bacteremia lasting 1 or 2 days were treated successfully without CVC removal. The success rate decreased to 44% with a 3- to 4-day duration of bacteremia. None of 19 infants with CONS bacteremia lasting >4 days was treated successfully until CVCs were removed.Conclusions.Prolonged CONS bacteremia was avoided by early removal of CVCs. Retention of CVCs was successful in 46% of neonates with CONS bacteremia in whom it was attempted, but it was never successful if bacteremia lasted >4 days.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The etiology of Henoch-Schönlein purpura (HSP) has been ascribed to a variety of infectious and noninfectious agents. Because we encountered a patient with HSP who had evidence ofBartonella henselaeinfection and a prior report of a patient with systemic cat-scratch disease presenting as leukoclastic vasculitis, we investigated the association ofB. henselaeinfection with HSP.Methods.We determined the antibody titers toB. henselaeon the sera of 18 patients with HSP and on 57 controls. All patients presented with the characteristic leukoclastic rash of HSP. About one-half of the patients had joint or abdominal symptoms, and four had hematuria at presentation. An indirect immunofluorescent assay was used to determine serum antibody titers toB. henselae.Sera that were reactive at a dilution of 1/64 were considered positive.Results.Eight of the 57 (14%) control sera and 12 of the 18 (67%) patient sera were positive forB. henselaeantibody (P< 0.0001).Conclusion.The results of this study indicate a significant association of antecedentB. henselaeinfection with HSP. The frequency of this association (67%) exceeds that of previously ascribed etiologic agents for this disease, such as the group AStreptococcus.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Based on single case reports, parvovirus B19 (B19) has repeatedly been proposed as an etiologic agent in patients with Henoch-Schönlein purpura (HSP), perhaps causing vasculitis by direct invasion of vascular endothelial cells because of the tissue distribution of the cellular B19 receptor. A cohort of children with HSP and other vasculitic diseases was investigated and compared with healthy control children to assess the role of B19 as well as parvovirus V9 (a putative emerging B19-like virus).Patients and methods.Serum samples from 36 children with HSP (n= 29) or other vasculitic diseases (n= 7) were examined, and 38 healthy bone marrow donors were used as controls. The presence of specific B19 and V9 IgM and IgG antibodies was determined with a recently developed enzyme-linked immunosorbent assay, and viral DNA was detected by a novel nested PCR.Results.Specific IgM was not present in any of the patient or control serum samples. B19 DNA was detected in one patient, a previously healthy 8-year-old boy diagnosed with HSP, whereas none of the controls was B19-positive. V9 was not detected in any of the clinical or control samples. It seems likely that B19 infection might have triggered the development of HSP in the B19-positive patient, because B19 viremia is otherwise uncommon.Conclusions.Although causality is difficult to construe in single cases, the data indicate that B19 is not a common contributing factor in the pathogenesis of vasculitis and that this pathogen is only rarely associated temporally with HSP or vasculitic diseases in children.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.We hypothesized that systemic release of endogenous leukocyte-derived polypeptide antimicrobial defensins (polymorphonuclear leukocyte-specific) and lactoferrin (polymorphonuclear leukocyte and epithelial cell derived) occurs in nonneutropenic children with severe sepsis.Methods.We performed a prospective cross-sectional and longitudinal study in a university children’s hospital pediatric intensive care unit. Ninety-two consecutive children meeting criteria for sepsis and 14 critically ill children without sepsis (controls) were enrolled, and plasma defensins and lactoferrin concentrations were measured on Days 1 and 3 of sepsis.Results.Nonneutropenic sepsis patients (n= 71) had increased defensins and lactoferrin plasma concentrations compared with critically ill control patients [defensins, 450 ng/mlvs.150 ng/ml; lactoferrin, 332 ng/mlvs.176 ng/ml (median values);P< 0.05] and neutropenic sepsis patients [n= 21; defensins, 450 ng/mlvs.50 ng/ml; lactoferrin, 332 ng/mlvs.20 ng/ml (median values);P< 0.05]. Neutropenic sepsis patients had similar plasma defensin concentrations and a decrease in plasma lactoferrin concentrations compared with control patients (P< 0.05). Defensins and lactoferrin plasma concentrations correlated to total white blood cell and absolute neutrophil count (P< 0.05). There was no association between plasma defensin concentration and organ failure or outcome; however, increased plasma lactoferrin concentrations were observed with the development of organ failure (P< 0.05).Conclusion.These data suggest that increased circulating defensins and lactoferrin release are dependent in part on neutrophil count and might play a role in host defense in children with severe sepsis.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Recent studies have shown a rise inCandidaglabratainfections among immunocompromised adults. In published case series of neonatal candidemia, however, the speciesglabratais uncommon. We conducted a retrospective chart review to examine the epidemiology, clinical presentation and outcome of neonatal infection withC. glabratacompared with other species ofCandida.Methods.Neonatal and microbiology databases of two affiliated hospitals were searched for all cases of candidemia in neonatal intensive care unit patients with suspected sepsis from 1991 through 1998.Results.Of 58 cases ofCandidasepsis, 9 (15%) were caused byC. glabrata(CG), 41 (71%) byC. albicans(CA) and 8 (14%) byC. parapsilosis(CP). There was no change in the proportion of candidemia caused byglabrataspecies in the years studied. Although there was a significantly higher proportion of CG cases at 1 hospital (29%vs.6%,P= 0.01), there was no case clustering to suggest direct nosocomial spread. Compared with otherCandidaspecies, CG occurred in infants of higher gestational age (CG 29.7 weeks, CA 26.6 weeks, CP 27.3 weeks) and birth weight (CG 1442 g, CA 931 g, CP 965 g). Patients with CG sepsis were more likely to be receiving broad spectrum antibiotics at the time of diagnosis (CG 67%, CA 38%, CP 38%), were less likely to present with apnea and had less severe thrombocytopenia. Of 9 patients with CG sepsis, 1 had meningitis, 1 had necrotizing enterocolitis and 3 had candiduria.Conclusion.C. glabratais a significant nosocomial pathogen in the neonate.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Influenza infections can cause severe respiratory disease in high risk persons such as those with asthma, but immunization rates for high risk groups remain suboptimal. An investigational influenza virus vaccine, trivalent, types A and B, live, cold-adapted (CAIV-T) administered by intranasal spray was shown previously to be effective in healthy adults and healthy children.Purpose.To assess the safety and tolerability of CAIV-T in subjects 9 years of age and older with moderate to severe asthma.Methods.In this randomized, double blind, placebo-controlled study, spirometry was performed twice before vaccination to establish a baseline forced expiratory volume at 1 s (FEV1) and once 2 to 5 days thereafter. The primary outcome index was the percent change in percent predicted FEV1before and after vaccination. Peak flows, clinical asthma symptom scores and nighttime awakening scores were measured daily from 7 days pre- to 28 days postvaccination.Results.The primary outcome index (percentage change in percent predicted FEV1) was not different between the two groups (0.2%vs.0.4% for the treatment and placebo groups, respectively;P= 0.78). Secondary outcomes did not differ between the two groups; these included the number of subjects with a decrease in FEV1≥15% from baseline, reductions in peak flows ≥15%, ≥30% or ≥2 sd below baseline, use of beta-adrenergic rescue medications, asthma exacerbations and clinical asthma symptom scores before and after vaccination. The same proportion of subjects in each group experienced postvaccination symptoms within 10 days (92% and 91%, respectively;P= 1.0). No serious adverse event occurred.Conclusion.CAIV-T was generally safe and well-tolerated in children and adolescents with moderate to severe asthma.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID