RESUMEN
We report a case of perinatal infection that we believe is the first documented report of a congenital vesicular eruption due to Haemophilus influenzae type b and the second report of puerperal sepsis with this organism. A vesicular eruption was noted at birth on an infant delivered at 37 weeks following 34 hours' premature rupture of membranes. Gram-negative rods were seen on Gram stain of vesicular fluid, and H. influenzae type b grew on cultures of vesicular fluid. The mother sustained postpartum septicemia with the same organism. Amnionitis and funistis were demonstrated histologically. Results of all viral studies were negative. Infant and mother did well with antibiotic therapy.
Asunto(s)
Infecciones por Haemophilus/congénito , Infección Puerperal/etiología , Sepsis/etiología , Enfermedades Cutáneas Infecciosas/congénito , Adulto , Femenino , Haemophilus influenzae , Humanos , Recién Nacido , Masculino , Embarazo , Infección Puerperal/microbiología , Sepsis/microbiologíaRESUMEN
Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of greater than or equal to 1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.
Asunto(s)
Artritis Infecciosa/tratamiento farmacológico , Infecciones Bacterianas/tratamiento farmacológico , Cefalosporinas/administración & dosificación , Cefradina/administración & dosificación , Osteítis/tratamiento farmacológico , Administración Oral , Adolescente , Cefradina/sangre , Niño , Preescolar , Evaluación de Medicamentos , Femenino , Humanos , Inyecciones Intravenosas , Masculino , PenicilinasRESUMEN
A prospective double blind trial compared the fixed combination of erythromycin-sulfisoxazole (E/S) with cefaclor in the treatment of acute otitis media. One hundred nineteen children in six centers across Canada were studied. Diagnostic tympanocentesis of 134 ears yielded 135 bacterial isolates: Streptococcus pneumoniae (42%); Haemophilus influenzae (21%); Branhamella catarrhalis (10%); Streptococcus pyogenes (5%); and other bacteria (22%). Seventy-seven percent of strains of B. catarrhalis and 14% of strains of H. influenzae were beta-lactamase producers. E/S exhibited greater in vitro activity against H. influenzae and B. catarrhalis. Twenty-three patients had bacteriologically sterile middle ear fluid. The overall clinical outcome at Days 10 and 31 was identical in both treatment groups. Otoscopic findings improved more rapidly in the E/S group than in the cefaclor group at 10 and 31 days (P less than or equal to 0.04). In cases where pre-treatment middle ear fluid was negative on routine bacterial culture, complete cure at 10 days was observed in 75% of patients treated with E/S but only in 14% of those treated with cefaclor (P = 0.02). Side effects were infrequent and comparable between the test drugs. E/S is at least as effective as cefaclor in the management of acute otitis media and may be superior, particularly for cases not yielding bacteria on routine culture.
Asunto(s)
Antibacterianos/uso terapéutico , Cefaclor/uso terapéutico , Cefalexina/análogos & derivados , Eritromicina/uso terapéutico , Otitis Media con Derrame/tratamiento farmacológico , Sulfisoxazol/uso terapéutico , Enfermedad Aguda , Adolescente , Ampicilina/farmacología , Antibacterianos/farmacología , Cefaclor/farmacología , Niño , Preescolar , Ensayos Clínicos como Asunto , Método Doble Ciego , Combinación de Medicamentos/farmacología , Combinación de Medicamentos/uso terapéutico , Eritromicina/farmacología , Femenino , Haemophilus influenzae/efectos de los fármacos , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Masculino , Moraxella/efectos de los fármacos , Moraxella/aislamiento & purificación , Otitis Media con Derrame/microbiología , Estudios Prospectivos , Distribución Aleatoria , Recurrencia , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Sulfisoxazol/farmacologíaRESUMEN
To test the hypothesis that abnormalities on 67Ga-citrate scans parallel the clinical course of acute osteomyelitis and revert to normal with successful antibiotic therapy, serial scans were performed in ten children. Scans improved markedly within the first two to four weeks of treatment, but abnormalities persisted at six or more weeks in over 50% of the cases, despite complete clinical resolutions of disease.
Asunto(s)
Radioisótopos de Galio , Osteomielitis/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Niño , Preescolar , Citratos , Femenino , Humanos , Masculino , Osteomielitis/tratamiento farmacológico , CintigrafíaAsunto(s)
Automóviles , Educación en Salud , Cinturones de Seguridad , Niño , Humanos , Instituciones Académicas , Estados UnidosAsunto(s)
Infecciones Bacterianas , Osteomielitis , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/etiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/etiología , Infecciones Bacterianas/terapia , Cefalosporinas/uso terapéutico , Niño , Cloranfenicol/uso terapéutico , Femenino , Gentamicinas/uso terapéutico , Infecciones por Haemophilus , Haemophilus influenzae , Humanos , Lactante , Masculino , Osteomielitis/diagnóstico , Osteomielitis/etiología , Osteomielitis/terapia , Penicilinas/uso terapéutico , Infecciones por Pseudomonas , Infecciones EstafilocócicasAsunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/tratamiento farmacológico , Absceso/tratamiento farmacológico , Absceso Encefálico/tratamiento farmacológico , Derivaciones del Líquido Cefalorraquídeo , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Meningitis/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológicoAsunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Bronquiolitis Viral/tratamiento farmacológico , Bronquitis/tratamiento farmacológico , Celulitis (Flemón)/tratamiento farmacológico , Niño , Crup/tratamiento farmacológico , Empiema/tratamiento farmacológico , Epiglotis , Humanos , Laringitis/tratamiento farmacológico , Órbita , Otitis Media/tratamiento farmacológico , Faringitis/tratamiento farmacológico , Neumonía/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Tonsilitis/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tos Ferina/tratamiento farmacológicoRESUMEN
Infections due to pneumococci with decreased susceptibility (or resistance) to penicillin have been infrequently recognized. Our experience and that of others suggest that (1) penicillin susceptibility testing of significant pneumococcal isolates should become routine; (2) penicillin may not be adequate therapy for CNS infections due to pneumococci whose penicillin minimal inhibitory concentration is greater than 0.1 microgram/ml; and (3) long-term penicillin "prophylaxis" may be inappropriate in the splenectomized patient in areas where these organisms are prevalent.
Asunto(s)
Meningitis Meningocócica/microbiología , Penicilinas/farmacología , Streptococcus pneumoniae/efectos de los fármacos , Niño , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Resistencia a las Penicilinas , EsplenectomíaRESUMEN
We describe four children with severe supraglottic infections caused by group A beta-hemolytic streptococci. In each case the clinical presentation suggested Hemophilus influenzae epiglottitis. In only one patient was there significant involvement of the epiglottis, whereas all had striking inflammation of the aryepiglottic folds. Group A beta-hemolytic streptococcus was isolated in blood cultures in two patients and from the supraglottic area and trachea in two others. Fever persisted for 6 to 22 days, and tracheal intubation was necessary for 2 to 16 days, despite appropriate antibiotic therapy. The evolution of streptococcal supraglottitis may be protracted, and it must be managed accordingly.
Asunto(s)
Epiglotitis/diagnóstico , Laringitis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Niño , Preescolar , Diagnóstico Diferencial , Epiglotitis/tratamiento farmacológico , Epiglotitis/microbiología , Femenino , Infecciones por Haemophilus/diagnóstico , Haemophilus influenzae , Humanos , Masculino , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificaciónRESUMEN
Two members of a family have manifested a syndrome of chronic active Epstein-Barr virus (EBV) infection. A father and his daughter suffered prolonged or recurrent mononucleosis, with splenomegaly, anemia, and intermittent fever; persistent immunological abnormalities included defective natural killer (NK) cytotoxicity, inverted CD4/CD8 ratios, hyper IgG1, high EBV viral capsid antigen (VCA) and early antigen (EA) antibodies, and low or undetectable EBV nuclear antigen (EBNA) antibody titers. The EBV seronegative member of the family was free of these abnormalities. However, NK activity in the seronegative individual was low-normal and its EBV-specific antibody-dependent K-cell cytotoxicity (EBV-ADCC) was abnormally low, suggesting that this K-NK cell defect may be primary. The father, who suffered from the syndrome for more than 15 years, lacked (or lost) antibodies to EBV-envelope and infected cell membranes, such as antibody-dependent cellular cytotoxicity (ADCC), neutralizing (NT), and gp 350/220 antibodies. Slow improvement over a period of years was heralded by rising NK cytotoxicity.
Asunto(s)
Proteínas de la Cápside , Herpesvirus Humano 4/inmunología , Mononucleosis Infecciosa/inmunología , Células Asesinas Naturales/inmunología , Adolescente , Anticuerpos Antivirales/análisis , Citotoxicidad Celular Dependiente de Anticuerpos , Antígenos Virales/análisis , Western Blotting , Niño , Enfermedad Crónica , Antígenos Nucleares del Virus de Epstein-Barr , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina G/inmunología , Mononucleosis Infecciosa/diagnóstico , Mononucleosis Infecciosa/fisiopatología , Interferón Tipo I/biosíntesis , Interferón gamma/biosíntesis , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Pruebas SerológicasRESUMEN
Perorally administered acyclovir was evaluated in the therapy of acute infectious mononucleosis in a multicentered, randomized, double-blind, placebo-controlled trial. A total of 120 patients received 600 mg of acyclovir or placebo five times daily for 10 days. All patients were entered into the study within 7 days of symptom onset and had a positive Monospot test. Analysis of mean values and time to resolution of fever, lymphadenopathy, weight change, hepatomegaly, splenomegaly, liver function tests, atypical lymphocytes, hours of bed rest, sense of well-being, and return to normal activities revealed no significant differences. There was a trend toward suppression of Epstein-Barr virus excretion in the oropharynx in acyclovir recipients. No toxicity was detected in patients treated with acyclovir. Under the conditions of the study, there was no evidence that treatment with perorally administered acyclovir affected the course of infectious mononucleosis.