The use of TORCH titers.

Of 603 patients undergoing serologic tests for Toxoplasma, syphilis, rubella, cytomegalovirus, and herpes simplex (TORCH tests) during a 4-year period, 381 (63%) were infants younger than 6 months and 110 (18%) were either the mothers of those infants or pregnant women. The remaining 112 (19%) were older infants and children, male adults, or nonpregnant female adults. Of 381 infants less than 6 months of age who were tested, 323 (85%) had only a single TORCH test. Of 35 (9%) infants who had follow-up titers, 16 (46%) had a specific titer requested whereas in 19 (54%) the entire TORCH battery was repeated. Follow-up titers were infrequently (25%) requested when initial titers were elevated. Infection with a TORCH agent was not confirmed serologically in any of the 603 patients. The pattern of TORCH test use has a poor diagnostic return.

Suppurative thrombophlebitis in childhood.

Thrombophlebitis in children is almost always related to intravenous therapy. In most cases the inflammatory reaction is self-limited and resolves when the intravenous catheter or needle is removed. In some cases contamination may result in suppurative thrombophlebitis, a potentially life-threatening complication of intravenous therapy. This report describes two-6-year-old children with suppurative thrombophlebitis that was successfully treated by drainage of periphlebitic abscess and excision of the infected vein. Early recognition and prompt surgical management should reduce morbidity and prevent mortality in these cases.

Maternal oral herpes: isolation policy.

Current official recommendations are that parents and personnel with oral herpes lesions be isolated from newborn infants. A survey of 110 neonatal centers, 50% of them replying, showed that most centers do not isolate mothers with oral herpes from their newborn infants. A review of the literature suggest that exposure of infants to personnel or family with oral herpes lesions might occasionally result in disseminated neonatal herpes simplex virus disease. Since the separation of a mother from her newborn infant up to 1 week of ages is a decision that should not be taken lightly, more information is urgently needed to decide whether or not to isolate mothers and hospital personnel with oral herpes lesions from newborn infants. Recommendations to obtain more information concerning these infants are provided.

Unusual manifestations of histoplasmosis in childhood.

Nine previously healthy children were seen with unique, and in several instances, unreported manifestations of acute histoplasmosis. Presenting manifestations included: obstructive airway disease; subacute parotitis; unilateral cervical lymphadenopathy; anterior mediastinal mass-simulating neoplasm; immune hemolytic anemia; a cutaneous lesion with regional lymphadenopathy; mediastinal mass and pericardial effusion; pulmonary infarction; and a symptom complex of cervical lymphadenopathy, CSF pleocytosis, arthritis, and interstitial nephritis. In eight children histoplasmosis was not initially considered, and the correct diagnosis was made only after complex, and sometimes invasive, diagnostic evaluation and considerable delay. All patients recovered fully without antifungal therapy. Reports of uncontrolled trials of new antifungal agents for treatment of histoplasmosis in immunocompetent hosts should be cautiously evaluated.

Should linen in newborn intensive care units be autoclaved?

The American Academy of Pediatrics' Standards and Recommendations for Hospital Care of Newborn Infants recommends that linen in newborn intensive care, intermediate care, continuing care and admission observation areas be autoclaved. Questionnaires sent to 269 directors of newborn intensive care units (69% returned) showed that 74% of the respondents do not autoclave linen used in their newborn intensive care unit. There were 284 linen cultures performed in our newborn intensive care unit where linen is not autoclaved; 68% of the cultures were positive, but only 2.5% had a colony count greater than 20 colonies per plate. The most common organisms obtained were Staphylococcus epidermidis, diphtheroids, and Micrococcus species. Two cultures grew Staphylococcus aureus, one colony and two colonies per plate. Three-factor analysis of variance showed that the location of the linen in the top of the pile exerted a statistically significant effect on the bacterial contamination rate. The fact that three fourths of neonatal intensive care centers in this country do not autoclave nursery linen, the lack of reports in the literature relating linen contamination to nosocomial infections, and the microbiologic results of this study suggest that the recommendations of the American Academy of Pediatrics merit further study and reevaluation.

The Histoplasma capsulatum antigen assay in disseminated histoplasmosis in children.

Progressive disseminated histoplasmosis is often fatal without treatment and requires rapid and accurate laboratory diagnosis. Radioimmunoassay for Histoplasma capsulatum var. capsulatum antigen has been established as a sensitive and accurate diagnostic technique for disseminated histoplasmosis in adults; this study examines the radioimmunoassay in children. The clinical and laboratory records of 26 patients 18 years old or younger in whom H. capsulatum antigen was detected in urine by radioimmunoassay and at least one other positive corroborative standard test were evaluated. Twenty-two (85%) had disseminated disease, and 4 (15%) had self-limited pulmonary disease. Positive corroborative tests included serologic tests in 17 of 22 (77%) patients tested, tissue stains in 5 of 9 (56%) and fungal cultures in 16 of 24 (67%). Patients with disseminated histoplasmosis had a greater degree of antigenuria than those with self-limited infection. In 20 patients with progressive disease treated with amphotericin B, antigen levels declined, and the decrease in antigenuria correlated with clinical improvement. The radioimmunoassay for H. capsulatum antigen in urine is an important test in the diagnosis of disseminated histoplasmosis and is useful for assessing the efficacy of treatment. The presence of urinary antigen is strong evidence for progressive disease that requires treatment.

Importance of a regular source of medical care among the elderly.

In recent years health services researchers have become increasingly aware of the importance of a regular doctor to whom the patient usually goes when sick or in need of advice about health, as a means of providing a point of entry to needed medical care. For example, persons who have a regular source of care seem more likely to receive an annual physical examination, to experience continuity of care when needed, and to be satisfied with the care received. Yet, despite the importance of an established tie to a regular treatment source, evidence is scanty with respect to the aged. To address the issue, this study employs data from a national probability sample of 11,619 persons, of whom 1,506 were aged 65 or older. The findings indicate that several factors (e.g., sex, race, education, and community size) which traditionally have served as important indicators of the use of health services fail to emerge as strong determinants regarding the regular source of care among the aged. The consequences of these findings and implications for future research are discussed.

Adaptation of a commercially available indirect fluorescent antibody slide test for measuring measles-specific immunoglobulins.

A commercially available indirect fluorescent antibody (IFA) test was evaluated for the determination of measles-specific immunoglobulins G and M (MIgG, MIgM). The IFA test detected fourfold rises of MIgG in 34 of 35 (97%) cases of measles confirmed by complement fixation or hemagglutination inhibition. In determining immune status, MIgG-IFA correlated with hemagglutination inhibition in 22 of 23 (96%) cases. The IFA test detected MIgM in only 11 of 34 acute-phase sera collected within 5 days of the reported onset of rash and in the convalescent specimens of another 13 of the 35 specimens. The IFA test is an effective method for the conventional diagnosis of measles and for determining immune status. This IFA test has a limited role as a rapid diagnostic test for measles when used to detect measles-specific MIgM in acute-phase sera obtained from patients with suspected measles.

Rapid diagnosis of measles using enzyme-linked immunosorbent assay for measles immunoglobulin M.

An enzyme-linked immunosorbent assay (ELISA) for measles-specific immunoglobulin M (MIgM) was developed for use as a rapid diagnostic test for acute measles. A titer greater than or equal to 1:20 in both the acute and convalescent sera was present in 100% of patients with measles and was diagnostic of acute measles infection in children. Interference by rheumatoid factor (RF) was avoided by pretesting sera for RF and absorption with aggregated gamma globulin. Ion exchange separation of IgM and IgG should eliminate RF interference. The ELISA MIgM assay can easily be used in any laboratory for the serologic confirmation of measles infection.

Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis.

Thirteen infants with compartmentalization of the lateral ventricles diagnosed by air encephalography, computerized tomography, or autopsy are reported. In each case, the body of one or both lateral ventricles was completely divided by a membrane posterior to the foramen of Monro. Recognition of this entity is important from both therapeutic and prognostic standpoints.

Acute disseminated encephalomyelitis presenting as a neurodegenerative disease in infancy.

An infant with acute demyelinating encephalomyelitis resulting from California virus infection presented with a neurodegenerative clinical picture. The clinical course was complicated by infantile spasms which responded to treatment with corticotropin. Acute demyelinating encephalomyelitis should be included in the diagnostic evaluation of patients who present with subacute regression of developmental milestones.

LaCrosse viral encephalitis mimics herpes simplex viral encephalitis.

Temporal lobe abnormalities, findings commonly associated with herpes simplex virus encephalitis, were observed in a male 10 years of age found to have LaCrosse virus encephalitis. Diagnostic features included magnetic resonance imaging revealing abnormal signal intensity in the bilateral frontotemporal regions, and left-sided periodic lateralizing epileptiform discharges. LaCrosse virus encephalitis should be included in the differential diagnosis of viral encephalitis associated with structural and electrographic temporal lobe lesions, represented by periodic lateralizing epileptiform discharges. The recently developed LaCrosse RNA polymerase chain reaction for cerebrospinal fluid may enable rapid diagnosis, prevent the need for treatment with acyclovir, and give parents an encouraging prognosis.

Primary Hemophilus influenzae lung abscesses with bronchial obstruction.

A primary lung abscess due to non type B Hemophilus influenzae was diagnosed in three children who failed to improve after prolonged antibiotic treatment for dense, pneumonic infiltrates. In each instance percutaneous aspiration yielded pure cultures of Hemophilus influenzae, one of which was ampicillin resistant. Because of bronchial obstruction, operative drainage was necessary to effect cure in each case. Hemophilus influenzae has not previously been recognized as a cause of primary pulmonary abscess in childhood.

Support for the medical profession among the aged.

National survey data are utilized to delineate areas of confidence among the aged in the medical profession. Four key specifying variables were used in the analysis-race, sex, socioeconomic status, and size of community. Findings indicate that confidence in medical leaders is lowest among that group which in past studies has been found to visit the doctor most often: the elderly of low socioeconomic status. This finding suggests that improvement in the medical care received by the aged could be an important first step in restoring the elderly's confidence in medical leaders.

Recent U.S. trends in the age decrement in health satisfaction: preliminary findings.

One of the most salient components of older patients' mental disposition involves satisfaction with health. Low health satisfaction has been observed to be associated with anomia, unhappiness, high body concern, poor adjustment to the environment, low activity, and depression. Yet a number of issues in the area remain under-investigated. One such issue involves change over time in the elderly populace's general level of contentment with health. The present study utilizes data from the National Opinion Research Center at the University of Chicago to investigate this subject. The preliminary findings suggest that the extent to which the aged are highly satisfied with their health has been declining, particularly in comparison to that of their younger counterparts.