Management of contacts of children in day care with invasive Haemophilus influenzae type b disease.
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Biomedical subjects
Publications and source records attributed to B Dashefsky.
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It is necessary to systematically anticipate and sympathetically address a number of both emotional and physical problems with which Indochinese refugees commonly enter our society. Their infectious medical problems are generally common rather than exotic, although unusual diagnoses must occasionally be considered. If diagnosed, they are generally amenable to treatment. They pose little risk to the public health, and the little danger that they do represent can largely be obviated by attention to principles of infection control, personal hygiene, and public sanitation. Table 9 summarizes the screening and management recommendations appropriately applied to clinical care of this population.
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The incidence of sepsis among neonates born in the United States varies from less than one to more than eight per 1,000 live births. Bacterial meningitis occurs in about one-third of infants with sepsis and is more frequent during the first month of life than during any subsequent period. The clinical diagnosis of sepsis in newborn infants is difficult since signs are subtle and nonspecific. Because of the difficulty of diagnosis, many infants receive treatment although few significant bacterial infections are subsequently documents; approximately 5%-10% of neonates born in the United States receive parenteral antibiotics. The choice of antimicrobial agents for treatment of bacterial infections in neonates is based on knowledge of the responsible organisms and their patterns of antimicrobial susceptibility. Group B Streptococcus and Escherichia coli are currently the bacterial pathogens most often responsible for sepsis and meningitis in the United States. A penicillin and an aminoglycoside are the drugs usually used for initial therapy in infants with suspected sepsis. Present regimens are not optimal, however; mortality from sepsis and meningitis varies from 10% to 50%. Many survivors have significant sequelae. In addition, dose-related toxicity of the aminoglycosides is a concern. New beta-lactam antibiotics with increased efficacy against gram-negative enteric bacilli and with minimal or no dose-related toxicity warrant careful evaluation in newborn infants.