Lack of pneumococcal antigenuria in infants immunized with heptavalent pneumococcal conjugate vaccine.

The incidence and duration of pneumococcal antigenuria were determined in 21 infants who received the first dose of pneumococcal conjugate vaccine. Urine specimens collected from the study participants at 1, 3, 6 and 9 days after immunization did not reveal the presence of pneumococcal antigen.

Hepatitis B prevention strategies among pediatric hemodialysis centers.

We surveyed pediatric hemodialysis centers (PHDCs) concerning their hepatitis B virus (HBV) prevention strategies. One hundred thirty-one patients were being dialyzed in these PHDCs in December 1996. Although all centers immunized HBV-susceptible hemodialysis patients and had infection control policies to curtail the spread of HBV infection, most centers were not in compliance with all of the Centers for Disease Control and Prevention recommendations for isolating hepatitis B surface antigen-positive patients.

Suspected foreign body aspiration in a child with endobronchial tuberculosis.

Endobronchial tuberculosis is a form of pulmonary tuberculosis, thought to result from rupture of an infected node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. With the presence of multidrug resistant isolates of TB, and its incidence in an increasing number of foreign-born persons immigrating to the US, otolaryngologists must be aware of its often subtle presentation. The following case is an unusual presentation of endobronchial tuberculosis initially diagnosed as an airway foreign body.

Neonatal hepatic abscess.

Neonatal liver abscess is a rare entity. There are no published reports of neonatal liver abscess in the radiology literature in the past 15 years. We recently encountered a premature infant in whom a hepatic abscess was diagnosed solely based on abnormal radiographic studies. We report this case to illustrate the unusual clinical and radiographic abnormalities seen with neonatal solitary hepatic abscess.

Infantile cortical hyperostosis and facial nerve palsy.

Facial nerve palsy was diagnosed in a 13-month-old child with infantile cortical hyperostosis. Facial palsy preceded the roentgenographic evidence of mandibular hyperostosis but there was concurrent evidence of hyperostosis of multiple other bones. This case exemplifies the importance of maintaining a high index of suspicion for infantile cortical hyperostosis in infants and children presenting with facial swelling and facial nerve palsy.

Aeromonas-associated diarrhea in children.

In a 27-month prospective study, Aeromonas spp. were isolated from 7.3% of children with diarrhea and from 2.2% of controls. In 32 patients with diarrhea, ranging in age from 1 to 27 months old, Aeromonas spp. were the only potential bacterial enteropathogens isolated. Principal symptoms of Aeromonas-associated diarrhea were vomiting, fever and bloody stools. Diarrhea was often self-limiting and lasted for 10 days or less in 90% of patients. No secondary spread of diarrhea among close contacts was observed and no clear-cut seasonal patterns of Aeromonas isolation were found. Aeromonas caviae was the most frequently isolated species in fecal samples of patients (24 of 29 isolates) as well as controls (5 of 7 isolates). Cholera toxin cross-reactive cytotoxic enterotoxin was produced by a vast majority of Aeromonas isolates, as compared to a non-cholera toxin cross-reactive cytotonic enterotoxin. In addition no significant correlation was observed between severity of the diarrheal disease and different Aeromonas or the quantity of enterotoxins produced. In our geographic area Aeromonas spp., and A. caviae in particular, seem to be an important and frequent cause of diarrhea in young children.

A widespread epidemic of mild necrotizing enterocolitis of unknown cause.

Within a 28-day period, necrotizing enterocolitis (NEC) developed in 20 of 38 infants (53%). Patients with NEC were compared with the remaining 18 infants hospitalized at the same time who did not acquire the disease. Complications of pregnancy and labor-delivery and infant care practices did not differ between groups. Mean chronologic age was significantly different between patients with NEC and those without, 29 days v 77 days. Mean postconceptional age at the time of the outbreak was also significantly different, 33.4 weeks v 42.3 weeks. None of the cultures demonstrated a specific common pathogen. The low mortality (5%) and the large number of infants affected suggest an atypical out-break of NEC. We could not isolate a causative agent despite extensive epidemiologic investigation, and suggest that postconceptional age delineates those at risk.