Treatment of chickenpox in immunocompromised children.

In Hungary since 1981, 98 immunocompromised children have been treated with intravenous acyclovir for varicella zoster virus infections. They were treated in an open study or a double-blind study. Results of both are discussed briefly. Overall, five of 74 patients with varicella died, whereas all 24 patients with herpes zoster recovered. Treatment failures occurred in patients in whom treatment started late and in those with severe lymphocytopenia. In some children, varicella zoster virus-specific antibodies failed to develop by the end of treatment, and a proportion of these suffered recurrent episodes of varicella.

Oral acyclovir to prevent dissemination of varicella in immunocompromised children.

Twenty-five immunocompromised children with varicella were treated with oral acyclovir 800 mg, five times daily for 7 days. Two patients were transferred from the oral to the intravenous route: one had signs of varicella pneumonitis on routine X-ray, the other had continuing new lesion formation on day 4 of oral treatment. The disease healed in all patients, with no other evidence of dissemination. In an historical placebo treated group, 12 of 25 patients were transferred to intravenous acyclovir. The reduction to two of 25 is statistically significant (P < 0.01). The mean peak plasma acyclovir concentration in these patients was 6.56 mumol/l. Mild, self-limiting diarrhoea in nine patients was the only adverse event considered to be related to acyclovir. It is concluded that immunocompromised children with varicella can be treated safely and effectively with oral acyclovir. All patients should be observed closely by a physician.

[Incidence and characteristics of childhood suppurative meningitis in Hungary in 1983-87]. / A gyermekkori gennyes meningitis magyarországi elöfordulása és néhány jellemzöje az 1983-87. években.

Data of 1208 infants and children hospitalized for purulent meningitis were analysed. The incidence of the disease was closely age related: morbidity calculated for 100,000 children was found 97.5 under one year of age; 15.6 in 1 to 5 and 2.2 in 6 to 14 years of age. Incidence of newborn meningitis cases was 3.7 per 10,000 live-borns. The disease was caused by N. meningitidis in 278 (23%), H. influenzae in 171 (14%), S. pneumoniae in 157 (13%), E. coli in 74 (6%), B-group streptococcus in 61 (5%), other bacteria (altogether 17 species) in 107 (9%) cases, while in 360 cases (30%) the etiology remained unknown. Overall case fatality was 19.6 per cent. When compared to international data mortality was especially high among the newborns (53%) and in meningitis cases due to S. pneumoniae (29%), E. coli (48%), B-group streptococcus (37%) and "other bacteria" (41%). Neurologic sequelae were found in 17 per cent of the patients at discharge however, in newborns it was 54 per cent. Since the antibacterial therapy was appropriate in all cases, authors try to reveal the possible causes of the relatively high mortality and make recommendations for reducing it.

[Significance of varicella zoster infection in pregnancy and labor]. / A terhesek és szülönök varicella-zoster vírusinfekciójának jelentösége.

The authors observed 25 pregnant or delivering women with varicella and their offsprings from 1986 to 1991. The course of varicella of the pregnant and delivering mothers was generally benign, only one progressive case was observed with pneumonitis after delivery; this woman also recovered upon acyclovir treatment. All but one woman delivered on term, in one case the varicella developed on the 27th gestational week; this woman gave birth to a premature baby of 1180 g who died from a cerebral and lung hemorrhage. No sign of varicella-zoster virus infection was found at the autopsy. No congenital varicella syndrome was observed during the investigation period. Varicella-zoster immunoglobulin was given to 21 newborn babies, immediately after birth. Eight of the newborns developed varicella, the course of the disease was mild in seven cases. One baby who was given no varicella-zoster immunoglobulin and developed progressive varicella recovered after acyclovir therapy. During the investigation period the authors observed three cases of zoster in infants whose mothers had had varicella during pregnancy. The authors discuss the possibilities of prevention of varicella-zoster virus infection of newborns and infants.

[Hearing loss resulting from purulent meningitis in the light of adjuvant dexamethasone therapy]. / A purulens meningitist követö halláskárosodás az adjuváns dexamethason kezelés tükrében.

Results of objective audiometry of 109 infants and children after purulent meningitis are presented. Among them 17 patients got dexamethasone as a supportive therapy. There was no statistically significant difference in hearing loss between the dexamethasone-treated and the control group. (41 vs 43% sensorineural hearing loss respectively). Authors do not contraindicate the dexamethasone therapy in purulent meningitis because of its harmlessness and useful effect to the course of the disease but further investigations are needed for avoidance of hearing loss following meningitis.