ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Polymerase chain reaction assays of the peripheral blood mononuclear cells (PBMC) and plasma may facilitate the diagnosis of neonatal herpes simplex virus (HSV).Methods.Assays for HSV DNA were submitted from at least 1 specimen site (PBMC, plasma or cerebrospinal fluid) in 11 consecutive cases of neonatal HSV infection.Results.HSV DNA was detected by PCR in the PBMC of 6 of 10 infants tested (60%), the plasma of 4 of 6 tested (67%) and the cerebrospinal fluid of 4 of 11 tested (36%).Conclusions.HSV viremia is more frequent than previously appreciated, and detection of HSV DNA in PBMC and plasma is a useful diagnostic tool, particularly in infants without skin lesions.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Acute epiglottitis is an important manifestation of invasiveHaemophilus influenzaetype b (Hib) infection. In 1992 and 1993 Hib vaccination was introduced in the general childhood vaccination program in Sweden. The aim of the present investigation was to study the impact of Hib vaccination on the diagnosis of epiglottitis in Sweden in children as well as adults.Methods.A retrospective national population-based study on the incidence of epiglottitis in Sweden was performed for the 10-year period 1987 to 1996. The incidence calculations were based on figures from the national register of all patients treated at Swedish hospitals. The incidence (cases/100 000/year) for the prevaccination period 1987 to 1991 was compared with the incidence after Hib vaccination was introduced.Results.In children a substantial decrease was found after introduction of large scale vaccination against Hib. Below 5 years of age the annual incidence decreased from 20.9 in 1987 to 0.9 in 1996. In adults a tendency toward a decrease in incidence was evident.Conclusions.Introduction of Hib vaccination in a general childhood program was followed not only by a >90% reduction in the incidence in the youngest age group but also by a reduction in the incidence in the older age groups and among adults.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The prevention and management of multidrug-resistant (MDR) tuberculosis has received much attention, but little attention has been given to children with MDR tuberculosis or children in contact with adults with MDR tuberculosis. The aim of this study was to determine the prevalence of tuberculous infection and disease in childhood contacts of adults with MDR pulmonary tuberculosis.Method.All children <5 years of age in household contact with 75 recently diagnosed adults with MDR pulmonary tuberculosis were evaluated. Evaluation included clinical examination, tuberculin skin test, chest radiography and culture forMycobacterium tuberculosisfrom gastric aspirates.Results.One hundred twenty-eight children, median age 27 months, were evaluated. Fifty children had recent contact with other adult tuberculosis cases. Sixty-six children previously had chemoprophylaxis or treatment of whom 36 defaulted treatment or received insufficient chemoprophylaxis. One child had HIV infection. Forty-seven children were classified as noninfected, 66 were considered infected only (Mantoux test, ≥15 mm) and 15 had disease. Three children, who had not previously received antituberculosis drugs, had positive cultures forM. tuberculosis;all were multidrug-resistant.Conclusion.This study documents the transmission of multidrug-resistantM. tuberculosisto childhood contacts, the development of disease in these contacts and the importance of knowing the index case'sM. tuberculosissusceptibility pattern in choosing a proper treatment regimen for the childhood contact.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Shigellais an important cause of diarrheal disease in children in developing countries. The increasing prevalence of antibiotic-resistant strains has stimulated interest in the use of multivalentShigellavaccines. BecauseShigellavaccines under development are based on eliciting immunity to O antigens, monitoring the distribution of serotypes in defined target populations is critical. We initiated health center-based surveillance in a poor semirural community in Colina, Santiago (7489 children <60 months of age) to determine the age-specific incidence ofShigelladisease and the responsible serotypes.Findings.Surveillance was maintained at the 2 health centers during warm seasons (November 1 through April 30) for 4 successive years (1994 to 1998).Shigellawas recovered from 54 of 243 cases of dysentery (22%) and from 215 of 3966 cases of nondysenteric diarrhea (5.4%) (P< 0.001). The peak mean annual incidence of shigellosis occurred among children 12 to 47 months of age (9.0 to 12.6 cases/103children), although the incidence in infants (5.2/103) and children 48 to 59 months of age (6.2/103) was also substantial. During the 1995 through 1996 season, an age-matched healthy control was cultured for every child <60 months of age with diarrhea.Shigellaisolation from cases (34 of 576, 5.9%) was >8-fold higher than controls (4 of 576, 0.7%) (P< 0.01). Four serotypes,Shigella sonnei(45%),Shigella flexneri2b (19%),S. flexneri2a (14%) andS. flexneri6 (11%), accounted for 89% of all cases.Interpretation.Shigellaremains an important pediatric pathogen in Santiago. The serotype distribution from Colina, which closely resembles data from a population-based surveillance study in Santiago in the mid-1980s, demonstrates a remarkable degree of serotype stability in Santiago during a 15-year period.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Pertussis in infants is often severe, resulting in complications and prolonged hospitalization. Treatment is limited to supportive care. Antibiotics do not significantly alter the course of the disease. Therapies directed at pertussis toxin, a major virulence factor ofBordetella pertussis,might be beneficial. This study examines the safety and pharmacology of intravenous pertussis immunoglobulin (P-IGIV), which has high levels of pertussis toxin antibodies.Methods.P-IGIV was prepared as a 4% IgG solution from the pooled plasma from donors immunized with inactivated pertussis toxoid. The IgG pertussis toxin antibody concentration of 733 μg/ml is >7-fold higher than contained in conventional intravenous immunoglobulin products. Children with presumptive pertussis were allocated to one of three treatment doses of P-IGIV.Results.Twenty-six of 30 enrolled children had confirmed pertussis. There were no adverse events associated with P-IGIV except one patient who had transient hypotension that responded to an infusion rate decrease. P-IGIV doses of 1500, 750 and 250 mg/kg achieved ≥4-fold, ≥3-fold and >2-fold rises in peak geometric mean titers of pertussis toxin IgG antibodies, respectively. P-IGIV exhibited a half-life of 38.4 days and a volume of distribution of 87.8 ml/kg. All three treatment groups showed declines in lymphocytosis (P< 0.05) and paroxysmal coughing by the third day after P-IGIV infusion compared with preinfusion values.Conclusion.P-IGIV is safe and achieves high pertussis toxin antibody titers in infants. This study provides data for a prospective, controlled trial of P-IGIV.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Experience in adults has shown that combination therapy including HIV protease inhibitors (PI) can profoundly affect viral replication and slow progression of HIV-associated disease. Trials defining the influence of PI and combination therapies on long term outcome of HIV infection in children have not yet been completed. Experience with infants and children who were receiving routine care in an HIV specialty clinic was reviewed to characterize the effect of changes involving one, two or three antiretrovirals.Methods.Clinical and laboratory findings of children in whom antiretroviral therapy was changed were retrospectively reviewed. Successful response was defined as a reduction of viral load of at least 0.7 log10RNA copies/ml lasting for at least 3 months. Differences in characteristics and the character of the response associated with successful and unsuccessful changes were analyzed.Results.Of the 72 changes in therapy that were made in 54 children, 29 resulted in a successful response. A change involving 3 antiretrovirals was more likely to produce a successful response than a change involving 1 agent (6 of 9vs.6 of 24;P< 0.04). Reduction of viral load by >100-fold or to undetectable amounts occurred more frequently in children who responded to a regimen containing a PI than in children who responded to reverse transcriptase inhibitors (11 of 21 vs. 1 of 8;P= 0.05). Furthermore successful responses associated with addition of a PI were associated with a greater reduction in viral load than those that involved reverse transcriptase inhibitors (1.63 ± 0.60vs.0.99 ± 0.12 log10;P= 0.003).Conclusions.This experience suggests that changing antiretroviral therapy in HIV-infected children to regimens containing three drugs is more likely to result in a successful virologic outcome than changes in therapy involving one drug. This experience further supports the conclusion that including a PI as part of an antiretroviral regimen is more likely to result in a greater reduction in viral load in children.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives.To assess risk factors for nasopharyngeal carriage ofStreptococcus pneumoniae, Haemophilus influenzaeandMoraxella catarrhalisin a large sample of healthy children.Methods.In this point prevalence survey nasopharyngeal specimens were obtained from 1723 healthy children, ages 1 to 7 years, attending day-care centers or schools in 18 Italian cities. Written questionnaires for obtaining information about the demographics and medical history of the children were completed by the parents in the presence of a pediatrician.Results.The overall carrier rate of respiratory pathogens was 17.9% (S. pneumoniae,3.5%;H. influenzae,11.9%;M. catarrhalis,4.1%). Only 5% ofS. pneumoniaestrains were penicillin-resistant whereas ∼40% were erythromycin-resistant. Beta-lactamase production was found in 5.8% ofH. influenzaeand 88.7% ofM. catarrhalisisolates. By multivariate analysis age (≤3 years), having older siblings, a history of prolonged full-time day-care attendance and living in a rural area significantly influenced the odds of carrying nasopharyngeal respiratory pathogens, particularly in children ages 1 to 5 years. Sex, breast-feeding, passive smoking and recent upper respiratory tract infections were not significant variables. Antibiotic treatment in the previous 3 months did not affect nasopharyngeal carriage, whereas repeated treatments with a macrolide were associated with carriage ofS. pneumoniae.Conclusions.Our results suggest that there is a strong and long term relationship between exposure to large numbers of children in the first years of life and nasopharyngeal carriage of all respiratory pathogens. In addition antimicrobial restrictive guidelines should be tailored to local microbiologic sceneries.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective.Early onset group B streptococcal (EOGBS) infection, the major neonatal infection in industrialized countries, can be prevented by intrapartum antibiotics, but population studies are lacking. This study aimed to determine the incidence of early onset infections caused by group BStreptococcus(GBS) and other organisms in Australia and to assess intrapartum antibiotic use.Design.Longitudinal, prospective surveillance of neonatal infections in Australian neonatal units from 1991 to 1997. Early onset infection defined as clinical sepsis in first 48 h after birth, with positive cultures of blood or cerebrospinal fluid or positive urine GBS antigen detection.Results.The incidence of EOGBS sepsis fell from 2.0 per 1000 live births (95% confidence interval, 1.4, 2.5) in 1991 to 1993, to 1.3 (1.2, 1.4) in 1993 to 1995, to 0.5 (0.4, 0.7) in 1995 to 1997 (P< 0.0001). The incidence in Aboriginal babies was 5.2 (1.8, 8.6) in 1991 to 1993, 5.1 (3.0, 7.2) in 1993 to 1995 and 1.8 (1.1, 2.5) in 1995 to 1997 (P< 0.05). The incidence of early onset infections caused by organisms other than GBS also fell, from 1.2 per 1000 live births (0.8, 1.7) in 1991 to 1993, to 0.8 (0.7, 0.9) in 1993 to 1995 and 0.5 (0.3, 0.7) in 1995 to 1997 (P< 0.0001). In 1991, 3 of 9 study hospitals had a formal policy on intrapartum antibiotic use, whereas in 1997 all 11 hospitals had a formal policy (P= 0.002).Conclusions.A steady fall in EOGBS infections in Australia from 1991 to 1997 has been associated with increasing use of intrapartum antibiotics. Increased antibiotic use is probably causal in the fall in GBS, because the incidence of early onset infections caused by other organisms has also fallen.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The epidemiology of early onset neonatal group B streptococcal (GBS) disease has changed appreciably, but there are no recent assessments of the in-hospital resource utilization it incurs.Study design.We performed a retrospective cohort study of infants delivered from 1987 through 1995 at Massachusetts' largest obstetrics hospital. A matched cohort design was used to assess care occurring after transfer to another acute care hospital.Results.There were 135 cases of early onset neonatal GBS infection complicating 85 062 deliveries (1.6/1 000 births) in 9 years, with a substantial decline beginning in 1994, when maternal intrapartum chemoprophylaxis was widely introduced. Most (73%) infants had birth weights of 2500 g or more; 93% survived. Overall both the median and mean lengths of stay were 8 days longer for infants with GBS disease than for those without this infection (P< 0.001). Total hospital charges for neonates with GBS disease also were higher, with the difference in medians of $5323 and in means of $10 004 (P< 0.001). Differences were greatest among >2500-g birth weight infants; no excess was evident for infants with birth weights of <1500 g.Conclusion.There was a substantial excess length of stay and charges associated with early onset neonatal GBS disease, although this was less than previously reported.

ISSN:0891-3668    

出版商:OVID    

年代:1999

数据来源: OVID