How reliable is the history of chickenpox? Varicella serology among children up to 14 years of age.

OBJECTIVES: The aim of this study was to assess the seroprevalence of antibodies to varicella-zoster virus (VZV) in children of northern Greece and to estimate the reliability of varicella history. METHODS: A serosurvey of 632 children, aged 13 months to 14 years (median 5.2 years), was conducted between April 1999 and July 2001. Serum samples were tested by enzyme-linked immunosorbent assay (ELISA) for IgG antibodies to VZV (IgG Genzyme Virotech GmbH). A history of varicella in these children was obtained from the parents of all these patients. Also, a check of state health cards of the patients was done. RESULTS: Two hundred and forty-eight (39%) of the children were seropositive for VZV. Two hundred and thirty (36%) of the 632 children claimed to have had previous varicella infection; 87.8% were seropositive, and 12.2% lacked antibodies to VZV. One hundred and seven of the 230 children with a history of varicella had the information about the disease confirmed, as it was reported on their state health card by a pediatrician; 10.2% were seronegative for VZV. Absence of history of varicella was reported in 402 (63.6%) of the 632 children; 88.6% of those were seronegative, and 11.4% were seropositive. The percentage of incorrect negative history ranged from 6% (13-60 months of age) to 48% (120-168 months of age). CONCLUSIONS: A large proportion of the study group (61%), mainly below 7 years of age, is susceptible to varicella. The positive predictive value of a history of varicella is 87.8%, whereas the negative predictive value of a negative history is 11.4%, which means that there is an 88.6% probability of a negative history being correct. Varicella serology may be reasonable prior to vaccination in children >10 years old with a negative chickenpox history. However, if one excludes cost considerations, it is also reasonable to vaccinate all children, irrespective of serostatus.

Shigellosis of childhood in northern Greece: epidemiological, clinical and laboratory data of hospitalized patients during the period 1971-96.

The aim of this study was to evaluate epidemiological, clinical and laboratory data of shigellosis in children from northern Greece, hospitalized in our department during the period 1971-96. In total, 422 cases of shigellosis, aged 1 month to 14 y (238M, 184F) were hospitalized during the study period. The annual distribution was approximately stable until 1990, the mean number of cases per year being about 20. During the last 4 y the incidence significantly decreased. Shigella was serotyped in 138/422 cases. Seventy six of the strains were S. flexneri (55%) and 56 S. sonnei (40%). In the majority of cases the clinical picture was mild. Severe dehydration was seen in only 6 patients. Ninety four patients (22%) had extra-intestinal manifestations. Most common of these were convulsions (16%) and, less frequently, disturbances of consciousness (n = 26), rash (n = 9), shock and disseminated intravascular coagulopathy (n = 2), nerve paralysis (n = 2), severe anaemia (n = 2) and haemolytic-uraemic syndrome (n = 1). Nine patients had acute encephalopathy of 12 h to 12 d duration. It is important to note that all these cases recovered completely with no residual neurological deficit, except for 1 girl who developed temporal epilepsy 8 y later. Spinal fluid was normal in all 42 examined patients. Antibiotics were given to 212 of 422 patients, mainly during the first half of the study period. Shigella resistance to antibiotic was significant for cotrimoxazole (24%) and ampicillin (16%). All patients were cured. Shigellosis is a mild disease in our area, with a decreasing prevalence.

Listeria meningitis in children: report of two cases.

We report two cases of meningitis caused by Listeria monocytogenes in children. The first patient was a healthy 14-month-old boy and the second patient a 3-year-old girl with Byler disease which, however, is not reported as a predisposing factor for listeriosis. We present these cases because Listeria infection, although common in neonates, is extremely infrequent during infancy and childhood.

Outbreak of varicella in a pediatric oncology unit.

BACKGROUND: Varicella-zoster virus (VZV) infection is usually benign but immunocompromised patients are at great risk for visceral dissemination and fatal outcome. During a nationwide varicella outbreak, several of our patients contracted the disease. We undertook studies of the epidemiology and the efficacy of antiviral treatment and immunoprophylaxis. PROCEDURE: During a 9-month period, 52 patients were exposed to cases of active varicella. Twenty-seven of these children were reexposed to active varicella > 1 month after their initial exposure. The exposure concerned 7 VZV waves of varying intimacy. In all cases, prophylaxis with intravenous immunoglobulin (IVIG), varicella zoster globulin (VZIG), or both was given. The spread of the disease was limited and only 6 patients (all immunosuppressed) developed varicella (7.6%). Three of 6 had been given IVIG and 3 VZIG + IVIG. All patients with varicella received acyclovir 30 mg/kg/day for 14 days. The disease was mild and all patients were ultimately cured. RESULTS: Our results show that prophylaxis was not 100% effective, but appearance to reduce the rate of spread. The differences in incidence among the regimens used were not significant. CONCLUSIONS: For the moment, immunoprophylaxis and acyclovir administration appear to be quite satisfactory in managing immunocompromised children exposed to VZV. This may change with the wider use of the varicella vaccine.

Increased activity of lysosomal acid hydrolases in the cell-free cerebrospinal fluid of bacterial meningitis.

Because inflammation could affect lysosomal enzyme trafficking, resulting in increased enzyme release from the cells, tissue necrosis, or altered blood- and the brain-cerebrospinal fluid (CSF) barrier, the activity of four lysosomal enzymes in the cell-free CSF of 34 patients with bacterial meningitis, 20 with aseptic meningitis, and 39 control subjects was measured. Activities are expressed in nanomoles of 4-methylumbelliferone mL/h. The median beta-hexosaminidase A activity in bacterial meningitis was 313, in aseptic meningitis it was 173, and in the control subjects it was 175, the median beta-hexosaminidase B activity was 417, 165, and 120; the median alpha-mannosidase activity was 171, 124, and 113; and the median beta-glucuronidase activity was 133.7, 14.3, and 10.0, respectively. The difference of the activities of the four enzymes measured between the bacteria meningitis and the controls is significant (p < 0.000). Also significant is the difference between bacterial and aseptic meningitis (p = 0.005 to < 0.000), but it is not significant between aseptic and control subjects. Both the sensitivity and specificity of the beta-glucuronidase activity between bacterial meningitis and control subjects were 100%, whereas the corresponding values between bacterial and aseptic meningitis were 100% and 90%, respectively. No significant correlation was observed between the activities of the enzymes measured and the number of the polymorphonuclear leukocytes or other laboratory characteristics of the CSF. The increased lysosomal enzyme activities in the CSF of patients with meningitis may result from diffusion across the blood-CSF or the brain-CSF barrier or from enzyme leakage through the cell membranes.

Long-term sequelae of pneumococcal meningitis in children.

The purpose of this study was to assess the long-term effects of pneumococcal meningitis in children. From 1967 to 1988, a total of 90 children were admitted to the Hospital for Infectious Diseases, Thessaloniki, Greece, with the diagnosis of pneumococcal meningitis. Sixteen patients died in the hospital as a direct result of meningitis. Eleven others were excluded from the study (neurologic deficits prior to onset of meningitis, two; death subsequent to hospitalization, two; recurrent meningitis, seven). Of the remaining 63 survivors, we were able to evaluate 47 patients (75%). Evaluation was performed 4 to 23 years (mean 12.3 +/- 5.8 years) after discharge. Forty patients returned to hospital for evaluation, and seven were evaluated by their primary physicians, who sent information by a standardized questionnaire. The following examinations were carried out: history, physical and neurologic examination, ophthalmologic and hearing evaluation, and psychometric testing. Fourteen patients (30%) had at least one neurologic handicap; nine (19%) had mental retardation, eight (17%) hearing loss, seven (15%) seizure disorder, five (11%) motor defects, and one each (2%) behavioral problems and visual impairment. The presence of coma was the strongest predictor of increased morbidity. The high frequency of long-term sequelae observed in our study supports the need of an effective vaccine.

Non-typhoid Salmonella meningitis.

The epidemiological, clinical and laboratory findings in 8 cases of meningitis due to non-typhoid salmonella were analyzed. Seven out of 8 patients were infants < 12 months old, 2 of whom died, 2 presented with recurrent meningitis. Three infants had reversible neurological sequelae on discharge, not found during follow-up in any. Conversely, one 2-month-old patient who was considered normal on discharge developed severe growth and mental retardation during follow-up.

Treatment of childhood bacterial meningitis with ceftriaxone once daily: open, prospective, randomized, comparative study of short-course versus standard-length therapy.

Fifty-two children were included in this study to evaluate and compare short- versus standard-length ceftriaxone therapy for bacterial meningitis. The duration of the short-course regimens was 4, 6 and 7 days for Neisseria meningitidis, Hemophilus influenzae and Streptococcus pneumoniae, respectively. The standard-length regimens were twice as long. On the basis of a computer-generated randomization list, 26 children were assigned either to the short- or to the standard-treatment regimen. Ceftriaxone was given intravenously once daily in a dose of 60 mg/kg after an initial loading dose of 100 mg/kg. The population characteristics, the severity of disease and the cerebrospinal fluid (CSF) findings were similar in the two study groups at admission. Bacteriological and clinical response were comparable. There were no significant differences in the incidence of neurological complications, prolonged fever (greater than or equal to 10 days), persistent pleocytosis and side effects between the two groups. Hearing loss occurred in 3 patients in the standard-length group and in no patients in the short-course group. Diarrhea was the only side effect and occurred in 14% of the patients. The results of the study indicate that the short-duration regimen was adequate for the treatment of meningitis caused by the three major meningeal pathogens. However, the small number of patients do not justify the adoption of the short-course regimen for all children with meningitis. At present, prolongation of ceftriaxone therapy or discontinuation of the drug under strict clinical observation of the patient should be considered in some cases.

Incidence of aplastic anemia in viral hepatitis in children.

During the 20-year period 1967-1986, 5,500 children (aged 2 months-14 years) with viral hepatitis were hospitalized in a Thessaloniki pediatric department. In 4 children (0.07%) hepatitis was complicated with aplastic anemia. All 4 patients died. The mean duration of survival after the onset of aplastic anemia was 20.9 +/- 24.8 weeks. The results of the serologic tests, performed in the last 2 patients, suggest that aplastic anemia was associated with non-A, non-B hepatitis agents.