Asunto(s)
Bronquiolitis Viral/complicaciones , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/complicaciones , Antivirales/uso terapéutico , Bronquiolitis Viral/diagnóstico , Bronquiolitis Viral/tratamiento farmacológico , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Recurrencia , Ruidos Respiratorios/fisiopatología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate the safety, tolerance, and efficacy of palivizumab in children with hemodynamically significant congenital heart disease (CHD). STUDY DESIGN: A randomized, double-blind, placebo-controlled trial included 1287 children with CHD randomly assigned 1:1 to receive 5 monthly intramuscular injections of 15 mg/kg palivizumab or placebo. Children were followed for 150 days. The primary efficacy end point was antigen-confirmed respiratory syncytial virus (RSV) hospitalization. RESULTS: Palivizumab recipients had a 45% relative reduction in RSV hospitalizations (P=.003), a 56% reduction in total days of RSV hospitalization per 100 children (P=.003), and a 73% reduction in total RSV hospital days with increased supplemental oxygen per 100 children (P=.014). Adverse events were similar in the treatment groups; no child had drug discontinued for a related adverse event. Serious adverse events occurred in 55.4% of palivizumab recipients and 63.1% of placebo recipients (P<.005); none were related to palivizumab. Twenty-one children (3.3%) in the palivizumab group and 27 (4.2%) in the placebo group died; no deaths were attributed to palivizumab. The rates of cardiac surgeries performed earlier than planned were similar in the treatment groups. CONCLUSIONS: Monthly palivizumab (15 mg/kg IM) was safe, well-tolerated, and effective for prophylaxis of serious RSV disease in young children with hemodynamically significant CHD.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antivirales/uso terapéutico , Cardiopatías Congénitas/epidemiología , Hospitalización/estadística & datos numéricos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Anticuerpos Monoclonales Humanizados , Comorbilidad , Método Doble Ciego , Cardiopatías Congénitas/cirugía , Humanos , Palivizumab , Respiración Artificial , Infecciones por Virus Sincitial Respiratorio/terapia , Factores de RiesgoRESUMEN
OBJECTIVES: To assess the prevalence of superantigen secreting bacteria in children with acute Kawasaki disease (KD) relative to control patients. STUDY DESIGN: Bacterial cultures were obtained in a blinded fashion from the throat, rectum, and groin of 45 patients with untreated acute KD and 37 febrile control patients from 6 centers in the United States. Cultures were processed for the presence of superantigen-producing bacteria at a central laboratory. RESULTS: Staphylococci or streptococci that produced superantigens (TSST-1, SEB, SEC, SPEB, SPEC) were isolated from 25 of 45 patients with KD (56%) as compared with 13 of 37 (35%) control patients (P =.078). Because SEB- and SEC-producing Staphylococcus aureus have not been associated with KD and because they do not induce a Vbeta2+ T-lymphocyte response, we analyzed the difference between groups relative to superantigens TSST-1 or SPEB/SPEC production. TSST-1 secreting S aureus or SPEB/SPEC producing group A streptococci were isolated from 20 of 45 (44%) patients with KD compared with 7 of 37 (19%) control patients (P =.019). CONCLUSIONS: The overall isolation rates of superantigen (TSST-1, SPEB, SPEC, SEB, SEC) producing bacteria between patients with KD and febrile control patients were not statistically significant. However, future studies should further examine the potential role of Vbeta2-stimulatory superantigens (TSST-1 and SPEB/SPEC) in KD.
Asunto(s)
Antígenos Bacterianos/aislamiento & purificación , Toxinas Bacterianas , Enterotoxinas/inmunología , Enterotoxinas/aislamiento & purificación , Síndrome Mucocutáneo Linfonodular/microbiología , Staphylococcus aureus/inmunología , Staphylococcus/inmunología , Superantígenos , Proteínas Bacterianas/inmunología , Proteínas de Unión al Calcio/inmunología , Niño , Preescolar , Cisteína Endopeptidasas/inmunología , Femenino , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
In laboratory studies, the Argentine ant, Linepithema humile (Mayr), and the odorous house ant, Tapinoma sessile (Say), avoided aromatic cedar mulch as a nesting substrate. Both ant species were killed when confined with fresh aromatic cedar mulch in sealed containers. However, when confined with cedar mulch that had been aged outdoors for up to 140 d, mortality of L. humile was complete regardless of mulch age, whereas T. sessile mortality declined significantly over the mulch-aging period. Argentine ant susceptibility to aromatic cedar mulch was also greater than that of the odorous house ant when colonies were restricted to mulch in open trays. In addition, commercial aromatic cedar oil was lethal to both ant species. Our results suggest that aromatic cedar mulch may serve as an effective component of a comprehensive urban ant management program.
Asunto(s)
Hormigas , Control de Insectos/métodos , Repelentes de Insectos , Juniperus , Estructuras de las Plantas , Animales , ArgentinaRESUMEN
OBJECTIVE: To examine the effectiveness of respiratory syncytial virus immune globulin administered intravenously (RSV-IGIV) in reducing hospitalization for treatment of RSV in children with congenital heart disease (CHD). METHODS: Children younger than 4 years of age were randomly assigned to a treatment group receiving RSV-IGIV, 750 mg/kg, monthly or to a control group not receiving infusions. Surveillance for respiratory tract infections was carried out and management decisions were made by physicians blinded to treatment group. RESULTS: Hospitalization for treatment of an RSV infection occurred in 32 of 214 (15%) of control children and 21 of 202 (10%) of the children receiving RSV-IGIV, a 31% reduction (P = .16). However, in infants younger than 6 months of age at study entry, 20 of 82 (24%) in the control group and 10 of 96 (10%) in the RSV-IGIV group had RSV hospitalizations (58% reduction, P = .01). The incidence of hospitalization for any respiratory tract symptomatology was lower in the RSV-IGIV group (34 of 202, 17%) than in the control group (57 of 214, 27%; P = .02). There was a significantly higher frequency of unanticipated cyanotic episodes and of poor outcomes after surgery among children with cyanotic CHD in the RSV-IGIV group (22 of 78, 28%) than in the control group (4 of 47, 8.5%; P = .009). CONCLUSION: RSV-IGIV should not be used for prophylaxis of RSV disease in children with cyanotic CHD. RSV-IGIV did not reduce RSV hospitalization in all children with CHD, but it was effective in preventing RSV hospitalization in infants younger than 6 months of age. Further studies in these children are indicated.
Asunto(s)
Cardiopatías Congénitas/complicaciones , Inmunoglobulinas Intravenosas/uso terapéutico , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/prevención & control , Virus Sincitiales Respiratorios , Factores de Edad , Preescolar , Cianosis/complicaciones , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/rehabilitación , Método Simple CiegoRESUMEN
OBJECTIVE: To estimate the economic costs and benefits of routine childhood vaccination against varicella infection. DESIGN: Decision-analytic model of the incidence and costs of chickenpox in children assumed to receive varicella vaccine at age 15 months in conjunction with the measles-mumps-rubella vaccine, or not to be vaccinated against varicella. PATIENTS: Hypothetical cohort of 100,000 children. MAIN OUTCOME MEASURES: Costs of vaccination, cumulative incidence of chickenpox to age 25 years, and related disease costs, including medical treatment and work loss. RESULTS: Vaccination of 100,000 children against varicella at age 15 months would cost $4,812,000. The expected number of cases of chickenpox to age 25 years would be reduced from 95,400 to 4800; costs of medical treatment and work loss would correspondingly decline by $1,678,000 and $9,781,000, respectively. On balance, vaccination is estimated to yield net economic benefits of $6,647,000, or $66.47 per vaccinee. CONCLUSION: Vaccination against varicella infection is cost-effective and should be part of the routine immunization schedule for U.S. children.
Asunto(s)
Varicela/prevención & control , Vacunación/economía , Adolescente , Adulto , Varicela/economía , Niño , Preescolar , Estudios de Cohortes , Análisis Costo-Beneficio , Humanos , Lactante , Modelos Teóricos , Estados UnidosRESUMEN
The single most important respiratory pathogen in infancy and early childhood is respiratory syncytial virus (RSV). Approximately 40% of primary RSV infections in children result in lower respiratory tract disease. Approximately 1% of RSV-infected children require hospitalization. Especially in high-risk children, primary RSV infection results in significant morbidity and, sometimes, death. This high-risk group includes children with bronchopulmonary dysplasia, children with congenital heart disease, premature infants less than 6 months of age, and children with immunodeficiency diseases. It has been estimated that, in the United States, 14,000 infants with chronic lung disease and 16,400 infants with heart disease will be identified by 12 months of age. More than 91,000 children are hospitalized annually with lower respiratory tract disease caused by RSV, and 4500 deaths occur. In 1985 a report from the Institute of Medicine calculated that the annual hospitalization costs attributable to RSV infection were $300 million. Data collected at the New England Medical Center in 1991 show that the average cost of hospitalization of a child with RSV was $808 each day. Because of difficulty in developing a safe and effective RSV vaccine, attention is now focused on passive immunization using an RSV immune globulin. On the basis of a recently completed multiinstitutional trial, RSV immune globulin appears to be a safe and cost-effective option for prevention of severe RSV disease in high-risk children.
Asunto(s)
Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Infecciones del Sistema Respiratorio , Preescolar , Enfermedad Crónica , Cardiopatías Congénitas/complicaciones , Hospitalización/economía , Humanos , Huésped Inmunocomprometido , Inmunoglobulinas/uso terapéutico , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades Pulmonares/complicaciones , Infecciones por Virus Sincitial Respiratorio/economía , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/etiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/prevención & control , Factores de RiesgoRESUMEN
One week after treatment with intravenously administered immune globulin and aspirin, a child with Kawasaki disease had persistent fever and an increase in coronary artery diameter to greater than 3 mm. Two additional doses of immune globulin were given intravenously. Rapid hemolysis occurred, followed by disseminated intravascular coagulation and serum sickness. Clinicians should be aware that immune globulin preparations contain antibodies to blood-type antigens that may cause significant hemolysis and disseminated intravascular coagulation.
Asunto(s)
Coagulación Intravascular Diseminada/etiología , Hemólisis/inmunología , Inmunoglobulinas Intravenosas/efectos adversos , Síndrome Mucocutáneo Linfonodular/terapia , Enfermedad del Suero/etiología , Sistema del Grupo Sanguíneo ABO/inmunología , Aspirina/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , MasculinoRESUMEN
Over a 3-week period, 20 of 34 (59%) infants in a newborn nursery developed nosocomial viral respiratory tract disease. Either respiratory syncytial virus (seven infants) or parainfluenza virus type 3 (five) or both (two) were demonstrated in respiratory secretions from 14 of the 20 symptomatic patients. Symptoms in the 20 infants included rhinitis (15 infants), cough (14), apnea (eight), pulmonary infiltrates (seven), and fever (six). There were no differences in symptoms between children infected with respiratory syncytial virus alone, with parainfluenza virus alone, or with both viruses concurrently. Patients were clustered in the nursery by agent: infants with the same virus tended to share contiguous bed spaces, supporting the concept that parainfluenza virus as well as respiratory syncytial virus can be transmitted from patient to patient. In addition to this risk for contiguous bed spaces, the presence of a nasogastric tube was associated with risk of illness (P less than 0.05). In the presence of a nursery outbreak of respiratory tract disease, more than one virus may circulate concurrently, and an individual patient may be infected simultaneously by more than one virus.