Clinical presentation of tuberculosis in culture-positive children. Pediatric Tuberculosis Consortium.

BACKGROUND: Because tuberculosis (TB) in children implies recent infection, children serve as sentinels for disease transmission within a community. Despite the significance of diagnosing tuberculosis in children, most cases are diagnosed on clinical evidence rather than laboratory findings. METHODS: We analyzed the demographic and clinical presentation of 156 children with culture proven tuberculosis using Epi-Info Version 6. RESULTS: Although the clinical characteristics of this population were generally consistent with those seen in previous studies, several unexpected results were observed. Boys were overrepresented in the group of very young children (72% < 1 year). Many of the children had coexisting diseases not known to predispose to TB (37%). Cavitation, usually observed in older children, was seen in four children < or = 1 year of age. Few children were homeless or HIV-infected, but many (42%) lived in female-headed households. Of the adult contacts at risk for TB, many (49%) were recent immigrants to the US. Overall 34% of the population was either foreign born or the children of recent immigrants. CONCLUSIONS: This series of 156 culture-positive children provides an understanding of the risk factors and clinical presentation of pediatric tuberculosis. The data emphasize the impact of the child's environment on the risk for tuberculosis.

Decrease in dopamine, its metabolites and noradrenaline in cerebrospinal fluid of schizophrenic patients after withdrawal of long-term neuroleptic treatment.

Dopamine (DA), homovanillic acid (HVA), dihydroxyphenylacetic acid (DOPAC), noradrenaline (NA), and 5-hydroxyindolacetic acid (5HIAA) were measured in cerebrospinal fluid (CSF) of 15 chronic schizophrenic patients before and 2 weeks after withdrawal of long-term neuroleptic treatment. Total neuroleptic-like activity in serum (NLA) was determined at the same times. Levels of DA and its metabolites (DOPAC and HVA) and NA were significantly reduced after the discontinuation of neuroleptic treatment. No change was observed in 5HIAA values. NLA was substantially reduced, but still remained detectable. The decrease in DA, DOPAC, and HVA all showed positive correlations with each other, and correlated negatively with NLA measured after 2 weeks. Our data implies that the decrease in DA turnover is the result of the discontinuance of DA receptor blockade, while the change in NA level is independent of it.

CSF dopamine turnover and positive schizophrenic symptoms after withdrawal of long-term neuroleptic treatment.

Dopamine (DA), dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) were measured in cerebrospinal fluid (CSF) of 14 schizophrenic inpatients before and 2 weeks after withdrawal of long-term neuroleptic medication. Total neuroleptic-like activity (NLA) in serum was determined at the same times. DA and its metabolites (DOPAC and HVA) were significantly reduced after neuroleptic discontinuation. NLA was substantially diminished. The decrease in DA and DOPAC was positively correlated with positive symptoms of postwithdrawal deterioration, and low prewithdrawal DOPAC level predicted severe relapse. These results are compatible with the hypothesis linking an overregulated central DA system to the positive symptoms of schizophrenia.

[Follow-up studies of patients with neonatal icterus using acoustic evoked potential audiometry]. / Ujszülöttkori icterusos betegek utánvizsgálata akusztikus kiváltott potenciál audiometria (BERA) segítségével.

Neonatal hyperbilirubinaemia is a common cause of sensorineural hearing loss. There is no exact method to detect the neurotoxicity of bilirubin. On the other hand the auditory pathway is known to be one of the most sensitive part of the CNS to this toxic agent. 39 one-year-old children were examined by BERA, who had had hyperbilirubinaemia in the newborn period. According to the risk factors the patients were divided into two groups but there was no significant difference in BERA changes. Two infants were found suffering serious hearing loss, who required hearing aids. Five more had some subclinical BERA changes. The authors emphasize the value of acoustic evoked potentials in evaluation infants after neonatal jaundice.

[Screening of newborn infants for medium-chain acyl-CoA dehydrogenase deficiency in Hungary]. / A középszénláncú zsírsav acil-CoA dehidrogenáz hiány újszülöttkori szürövizsgálata Magyarországon.

The authors publish for the first time the Hungarian frequency of the medium chain acyl-CoA dehydrogenase (MCAD) deficiency. The determination was carried out with molecular biological methods in 1121 newborns. The disease is inherited as an autosomal recessive trait, caused by mutation in the enzyme gene. The deficiency is extremely frequent in the Anglo-Saxon populations. Here it is as common as phenylketonuria. The first episode presents usually in the first 2 years of life, and the mortality may approach 60 percent. Early and prompt diagnosis can lead to an effective management of the disorder. The severity of the disease and its frequency in foreign countries made the screening necessary.

[Evaluation of hearing loss by means of inner ear acoustic emission in neonates treated with aminoglycoside]. / Halláskárosodás megítélése a belsö fül hangenergia kibocsátásának segítségével aminoglikoziddal kezelt újszülöttekben.

Despite their ototoxic and other side effects, aminoglycosides are still widely used in the treatment of neonatal infections. A novel method for evaluation of hearing loss is distortion product otoacoustic emission (DPOAE). Physiologic acoustic energy-emission produced by sound stimulus in the inner ear is detected by DPOAE. Existing acoustic emission indicates the functional integrity of the inner ear. DPOAE was performed in 19 newborns treated with netilmicin for different infections. Serum netilmicin levels did not exceed 12 mg/l; renal functions were normal. Existence of emission was detected in 15 newborns. There was no emission found in 4 newborns unilaterally, which was fully restored in 2 months. In conclusion, aminoglycosides have no considerable ototoxic side effects. DPOAE is thought to be an objective, fast, and non-invasive method for hearing screening in the newborn period.

Changes in mental condition, hyperkinesias and biochemical parameters after withdrawal of chronic neuroleptic treatment.

Neuroleptics were withdrawn abruptly from 14 hospitalized chronic schizophrenics. For 12 weeks the patients were observed from the aspect of psychic change and the development of withdrawal dyskinesia. Serum prolactin level, plasma dopamine-beta-hydroxylase activity, cerebrospinal fluid homovanillic acid and norepinephrine levels were measured on the day prior to withdrawal and on day 14 of the study. Psychic deterioration showed no association with any of the tested biochemical parameters. The decrease in the CSF HVA and NE levels of the patients displaying symptoms of withdrawal dyskinesia was significantly smaller than in those displaying no dyskinesia.

Dexamethasone suppression test as an aid for selection of specific antidepressant drugs in patients with endogenous depression.

The dexamethasone suppression test (DST) and response to two different antidepressant drugs (maprotiline as a specific noradrenergic, and amitriptyline as a predominantly serotoninergic drug) were investigated in 44 endogenously depressed female inpatients. The more anxious and/or agitated patients were mostly treated with amtiriptyline, the non-anxious and retarded patients with maprotiline. It was found that among maprotiline responders (N = 15) there were significantly more abnormal DSTs and postdexamethasone serum cortisol levels were significantly higher than among amitriptyline responders (N = 16). On the other hand, DST abnormalities among amitriptyline non-responders (N = 10) were similar to those among maprotiline responders. The results confirm earlier reports by Brown et al. (1980), Ettigi et al. (1983) and Fraser (1983) and indicate that abnormal DST may identify the "noradrenergic" subtype of endogenous depression and that the DST represents a good way of selecting a specific antidepressant drug for the treatment of endogenously depressed patients.

The dexamethasone suppression test in psychotic versus non-psychotic endogenous depression.

The authors investigated the dexamethasone suppression test (DST) in 93 female patients with primary (endogenous) major depression; in 20 female paranoid schizophrenics, and in 17 healthy females. Depressed patients had a significantly higher rate of abnormal DST response and significantly higher post-dexamethasone serum cortisol levels than schizophrenics and normal controls. The unipolar and bipolar depressives showed a similar profile of DST abnormalities. Depressed patients with psychotic features had a significantly higher rate of positive DST results than non-psychotic patients.