ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objectives.To compare the bacteriologic and clinical efficacy of amoxicillin/clavulanate and azithromycin in patients with acute otitis media (AOM), particularly the ability to eradicate the predominant AOM pathogens from middle ear fluid as assessed by mandatory second tympanocentesis.Methods.In this single blind study 238 infants and children with AOM were randomized to receive amoxicillin/clavulanate (45/6.4 mg/kg/day in two divided doses for 10 days) or azithromycin (10 mg/kg on Day 1, then 5 mg/kg daily on Days 2 through 5). Tympanocentesis was performed before the first dose and repeated on Day 4, 5 or 6. Clinical response was assessed at end of therapy between Days 12 and 14 and at follow-up between Days 22 and 28.Results.Amoxicillin/clavulanate was significantly more likely to eradicate all bacterial pathogens [83% (54 of 65)vs.49% (35 of 71),P= 0.001] andHaemophilus influenzae[87% (26 of 30)vs.39% (13 of 33),P= 0.0001] from middle ear fluid than was azithromycin. Amoxicillin/clavulanate was also more likely to eradicateStreptococcus pneumoniae, but the difference was not statistically significant [90% (18 of 20)vs.68% (3 of 19),P= 0.095]. On Days 12 to 14, signs and symptoms were more likely to resolve completely or improve in all culture-positive patients [86% (60 of 70)vs.70% (51 of 73),P= 0.023] and in those withH. influenzaeinfections [91% (30 of 33)vs.65% (22 of 34),P= 0.010] who received amoxicillin/clavulanate compared with those who received azithromycin. Otherwise there were no significant differences between groups in clinical outcomes on Days 12 to 14 or at follow-up.Conclusions.Our findings indicate that amoxicillin/clavulanate has superior bacteriologic and clinical efficacy compared with azithromycin in children with AOM.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.In Japan rubella vaccination is generally done once during a lifetime, and the vaccination rate decreased after a revised vaccination law in 1995. History of rubella or vaccination may still be unreliable. Testing for rubella antibody is significant to prevent the occurrence of congenital rubella syndrome. However, the collection of blood samples to detect antibodies from young children is invasive and difficult.Methods.For this study we obtained 853 matched serum and urine samples from 904 healthy students 10 or 14 years of age in the Ibara and Yoshii districts of Okayama, Japan, for a comparison of antibodies for rubella in the matched samples. The serum and urine antibodies were measured with hemagglutination-inhibition and enzyme-linked immunosorbent assays, respectively, and with our urine-based antibody test.Results.The sensitivity, specificity and concordance rates of this urine-based antibody test were 96, 99 and 97% based on the serum antibody results of both assays. The coefficiency was 0.627 between the titers of the urinary and serum antibodies by the enzyme-linked immunosorbent assay. The urinary antibodies were stable for at least 5 months at 4°C and 25°C.Conclusions.Urine-based assay methods are helpful not only because they avoid the invasive approach of venipuncture but also because unprocessed urine specimens can be used and urinary antibody is stable for a long period. Therefore this test is suitable for screening. In addition protective amounts of rubella antibody in blood can be reliably assessed by means of urine samples.

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.Suppression of HIV replication by CD8+T cells and/or their products correlated with the survival of infants. We sought to elucidate the role of CD8+T cell-mediated suppression in seven older children with AIDS.Methods.After separation of each child’s CD4+and CD8+T cells, three different HIV culture assays were performed: (1) patient CD4+T cells and phytohemagglutinin (PHA)-stimulated donor peripheral blood mononuclear cells (PBMC); (2) patient CD8+T cells added to the CD4+T cells and the PHA-stimulated donor PBMC (to test for CD8-mediated T cell suppression of HIV); (3) patient CD8+cells added across a semipermeable membrane to the CD4+T cells and the PHA-stimulated donor PBMC [to determine whether the CD8 cells secreted a soluble factor(s) that suppressed HIV].Results.Cultures from four of seven children showed greater HIV replication with CD4 cells alone than with CD4 and CD8 cells together, demonstrating CD8 suppression; evidence of soluble suppression was also seen. Cultures from two of the seven children showed HIV replication and no evidence of CD8 cell suppression. Cultures from one of the seven children had no appreciable replication of HIV even after removal of CD8 cells.Conclusions.CD8-mediated suppression is present in at least some children with AIDS. Additional mechanisms may be operating to slow the progression of the disease.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective.To evaluate the relationship between nasal quantity of respiratory syncytial virus (RSV) and disease severity in hospitalized infants without underlying cardiopulmonary disease or immunodeficiency.Methods.Nasal aspirates were obtained from hospitalized infants <24 months of age with recently identified RSV infection and evaluated for RSV quantity by a standard plaque assay on HEp-2 cell monolayers. Subjects were classified as having “severe” disease if they required mechanical ventilation at the time of sample collection and as having “nonsevere” disease if they did not. Linear modeling was used to determine the relationship between nasal RSV quantity and various independent variables, including disease severity.Results.Nasal aspirates from 39 patients were evaluated. Age, gender and mean duration of time from symptom onset to sample acquisition (5 days) were similar between the severe (n= 15) and nonsevere (n= 24) groups. Significantly more infants were born at <35 weeks gestation in the severe disease group (7 of 15vs.3 of 24,P= 0.017), and infants born at <35 weeks gestation were significantly more likely to be of non-Caucasian ethnicity than were infants born at ≥35 weeks gestation (8 of 10vs.12 of 29,P= 0.035). The linear model found that higher nasal RSV quantities were associated with severe disease [mean ± SEM, 5.06 ± 0.34 log plaque-forming units (pfu)/mlvs.3.91 ± 0.35 log pfu/ml,P= 0.022], gestational age ≥35 weeks (5.44 ± 0.27 log pfu/mlvs.3.52 ± 0.45 log pfu/ml,P= 0.002) and non-Caucasian ethnicity (5.16 ± 0.30 log pfu/mlvs.3.80 ± 0.37 log pfu/ml,P= 0.006).Conclusions.Nasal RSV quantity correlates with disease severity in hospitalized infants with recently identified RSV infection.

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.The easiest way to identify the presence of current or pastHelicobacter pyloriinfection is to test for antibodies. The aim of this study was to compare an enzyme-linked immunosorbent assay (ELISA) technique based on the detection of IgG antibodies directed against a global antigenic preparation with immunoblotting based on the analysis of IgG antibody reactivity to separate proteins.Methods.Sera were collected from 80 children (mean age, 9.9 ± 4.3 years). The reference tests were microbiologic and histologic examination of gastric biopsies obtained at upper endoscopy.Results.The immunoblotting was more sensitive (100%) and specific (88%) than ELISA (96 and 79%, respectively) in the evaluation ofH. pyloriinfection in children. Its positive predictive value was 92%, and its negative predictive value was 100%. The best performance index of immunoreactive bands to detect antibodies was obtained with the 26-kDa (88.7%), 30-kDa (77.5%) and 19.5-kDa (70%) antigens. Antibodies by immunoblot technique against the CagA antigen were present in 43.1% of children.Conclusion.Immunoblotting is highly sensitive and more specific than ELISA in children and provides additional information about the full serologic profile. Immunoblotting may therefore be a useful complement to serology, particularly in cases with doubtful ELISA results.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited.Methods.Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed.Results.Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (±SD) at diagnosis of GNB was 2.5 ± 2.7 years (median, 1.6). The predominant organisms werePseudomonas aeruginosa(26.4%), nontyphoidalSalmonella(15.3%),Escherichia coli(15.3%) andHaemophilus influenzae(12.5%). The relative frequency, per 5-year interval, ofP. aeruginosabacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases ofH. influenzaebacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogammaglobulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%.Conclusions.A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The number of shots in the childhood immunization schedule has been increasing and is likely to continue to increase in the coming years. Consideration of the psychologic costs of multiple injections, adverse events and vaccine-preventable disease is therefore growing in importance.Methods.We assessed parent preferences, using both the time tradeoff (i.e. amount of parent time willing to trade) and willingness-to-pay (i.e. dollars willing to pay) metrics, for possible outcomes of vaccination among 206 parents of infants receiving care at Kaiser, Northern California Region. We also explored the relationship between preferences and subject characteristics.Results.In general the amount of time subjects were willing to give up and the quantity of money they were willing to spend to avoid an outcome increased with the severity of the outcome. Preferences for our six main outcomes of interest all differed from one another (P< 0.0001, Tukey’s multiple comparisons procedure). Rank correlation coefficients between time tradeoff and willingness-to-pay values for the six main outcomes ranged from 0.42 to 0.52 (allP< 0.004). Subject characteristics, including education, income, race/ethnicity and the child’s birth order, did not explain the variation in parent preferences.Conclusions.In general subjects were willing to give up more money or time to avoid less desired outcomes. They were willing to give up only very small amounts of their own life expectancy or money to avoid minor, temporary outcomes (e.g. moderate fussiness, fever and pain) whereas they were willing to forego substantial lengths of their life or amounts of money to avoid a major, permanent outcome (i.e. permanent disability). Nonetheless much variation surfaced in the amount of time (or money) subjects were willing to trade to avoid outcomes. If this variation represents true differences in preferences, guideline developers must consider the role of individual parent preferences in decisions concerning vaccination.

ISSN:0891-3668    

出版商:OVID    

年代:2000

数据来源: OVID