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.

Neonatal inguinoscrotal hematocele.

Neonatal inguinoscrotal lesion, or hematocele of neonates, is attributed to trauma from the plastic clamp used to ligate the umbilical cord immediately after delivery. The pathogenesis is thought to be related to two factors: incorrect clamping technique, in which the clamp is eccentric or too distal, and the infant's position, lying over the clamp. This is a rare event that usually appears on the 2nd day of life, with very few reports recorded in the literature. The lesion does not have any complications, but may be easily confused with testicular torsion. We present two cases and review the literature.

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.

[Castleman's pseudotumor in children. Apropos of an unusual case]. / La pseudo-tumeur de Castleman chez l'enfant. A propos d'un cas rare.

A case of abdominal pseudo-tumor of Castleman disease is reported in a nine year-old boy. The patient is well without evidence of recurrence three years following resection. Castleman's disease is a benign disorder of lymph nodes that occurs rarely in children. Since the first description by Castleman in 1954, 286 other cases have been published and we could find only four cases in the 10 year and younger age group in the literature and only one case in the same group with anemia, hypergammaglobulinemia fever and weight loss. The management requires surgical resection of the enlarged nodes both for diagnosis and therapy, since the enlarged nodes can mimic malignant tumors of the lymphoid system. After surgical excision no recurrences have been reported.

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.

Hepatotoxic reactions in children with severe tuberculosis treated with isoniazid-rifampin.

The incidence and degree of liver injury was prospectively evaluated in 44 children, ages between 4 months and 14 years (mean age, 4.5 years) treated for tuberculosis with 15 to 20 mg isoniazid/kg/day and 15 mg rifampin/kg/day (INH-RIF). None of the patients had hepatic dysfunction before initiation of treatment. Elevation of the serum alanine aminotransferase (ALT) concentration (greater than 100 units) occurred in 36 patients (82%). One patient with an increase in the ALT value had coincidental infection with hepatitis B. The incidence of hepatotoxicity did not correlate with the patients' age or sex. Fifteen of the 36 patients developed clinical hepatitis with jaundice. In 7 patients liver enlargement and prolongation of the prothrombin time were also observed. In all but one patient liver dysfunction was recognized 6 to 30 days (mean, 14 days) after start of treatment. Biochemical signs of hepatic injury in the 35 surviving patients regressed completely without alteration of the INH-RIF regimen in 22 patients. These facts suggest the possibility that hepatocellular damage may be due to the effect of tubercle bacilli products liberated in the liver after their destruction by antituberculous drugs. However, the high rate of hepatotoxic reactions warns that the dose of 10 mg INH/kg/day should not be exceeded when that drug is combined with RIF.

Sequential computed tomography in tuberculous meningitis in infants and children.

Clinical and serial CT findings in 9 children, mainly infants with advanced tuberculous meningitis are presented. Hydrocephalus, tuberculomas and brain infarction were common findings in the acute stage of the disease. CT scan, allowing the detection and follow-up of cerebral manifestations of tuberculosis, proved to be an accurate and effective diagnostic method, which should be used in all cases of tuberculous meningitis.

Neonatal tetanus--long-term residual handicaps.

Thirty-eight survivors of neonatal tetanus were assessed, 5 to 12 years after recovery, for neurological sequelae, physical growth, and maturation. Apart from appreciable handicaps (cerebral palsy, mental deficit, behavioural disturbances) in 4 cases, no harmful effect on physical growth or development was found. The fact that affected patients had frequent and prolonged bouts of spasms and apnoea suggests that anoxia was the main cause of brain damage.

Virological and serological study in children hospitalized for acute hepatitis (detection of HBsAg, HAAg, anti-HAV and specific IgM-anti-HAV).

Serological methods were used to detect different markers of hepatitis A and B infection in a series of 36 children aged 3.5-13 years with acute viral hepatitis, hospitalized from August 1978 to October 1978. Hepatitis A was verified serologically in 30 patients (83.3%) with the demonstration of specific IgM-anti-HAV. Hepatitis B infection was serologically confirmed in only 2 patients (5.5%). After exclusion of hepatitis A and B as well as of hepatitis due to cytomegalovirus, leptospira and Epstein-Barr virus, 3 patients (8.3) were classified to have post-transfusion non-A non-B hepatitis, and 1 patient (2.5%) showed a sporadic non-A non-B hepatitis. The finding of HBsAg in 5 of 30 patients with hepatitis A suggests that the presence of HBsAg during the acute icteric phase of viral hepatitis is not sufficient for a diagnosis of HB. The presence of HAAg in one of 30 patients with HA confirms previous studies that faecal shedding of HAV stops with the appearance of jaundice. Finally, the above results establish the value of the new radioimmunoassay technique for detection of specific IgM-anti-HAV, which appears to be the best diagnostic test for hepatitis A.

[Evaluation of the criteria used for the interruption of treatment in bacterial meningitis (persistent pleocytosis and hyper-cervicospinal fluid proteins (author's transl)]. / Evaluation des critères de l'interruption du traitement dans la méningite microbienne (pléiocytose et hyperprotéinorachie persistantes).

Among 809 patients with bacterial meningitis persistent pleocytosis greater than 60 white blood, cells/mm3, after 10 days or more of therapy, was found in 25 patients and persistent hypercervicospinal fluid proteins greater than 70 mg/dl in 24. In 14 patients there was an association of these disturbances. All cases, except one, were adequately treated. Persistent pleocytosis and hyper-cervicospinal fluid proteins, uncommon inmeningococcal meningitis, were frequent in pneumococcal and more frequent in Haemophilus influenzae meningitis. In pneumococcal and Haemophilus influenzae meningitis the incidence of neurologic sequelae was greater in patients with persistent pleocytosis and hyper-cervicospinal fluid proteins than without them. In adequately treated patients, persistent pleocytosis or hyper-cervicospinal fluid proteins alone cannot be used as an indication of prolonging or changing therapy of bacterial meningitis.

Anthrax in children: a long forgotten, potentially fatal infection.

After a brief account of anthrax morbidity in northern Greece in recent years, 4 cases in 1977 of cutaneous anthrax in 10 to 13-year-old children are presented. Two had an atypical cutaneous lesion. In 1 of these, a 13-year-old girl, the disease was complicated by severe, eventually fatal meningitis. Death ensued despite intensive treatment with high doses of penicillin and hydrocortisone. This case is the first report of anthrax meningitis in a child in Greece and the third reported in the last 15 years. We stress the diagnostic difficulties in atypical cases of cutaneous anthrax and the need for early diagnosis and treatment to avoid spread of infection and appearance of complications such as the usually fatal meningitis.

Immunological studies in children with acute viral hepatitis.

Sera from 116 consecutive unselected cases of sporadic acute viral hepatitis in children were examined for hepatitis B antigen (HBAg), smooth-muscle autoantibodies (SMA), other autoantibodies and immunoglobulins, and skin tests were performed with dinitrochlorobenzene (DNCB). HBAg was detected in twenty-one and SMA in ninety-eight out of 116 sera that had been obtained during the 1st or 2nd week from the onset of jaundice. Hepatitis B antigen was present in seventeen out of the eighteen SMA negative patients (94-4%) and in only four out of the ninety-eight SMA-positive patients (4-1%). The presence of SMA was not related to the sex and age of the patients or to the serum bilirubin and transaminase levels. SMA did not persist for more than 6 weeks from the onset of jaundice in most of the cases. In twenty-eight out of forty-one sera which were tested the IgM level was found to be elevated during the acute phase of illness and within normal limits during the recovery stage. A negative correlation between the presence of SMA and the elevated serum IgM level and the presence of HB Ag in the same patients was observed. The DNCB skin test was found to be positive in all fifty-two patients who did not have HBAg in their serum and in twenty out of the twenty-one patients who had circulating HbAg. From these findings there appears to be no gross impairment of cell-mediated immunity in acute viral hepatitis, and hepatitis A is associated with SMA production and an increase in serum IgM levels, when compared to hepatitis associated with HBAg.