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Biomedical subjects

E D Shapiro

Publications and source records attributed to E D Shapiro.

At least 37 records · Page 2Linked to original sources
PubMed1997

Lyme disease in children.

Neurologic manifestations of Lyme disease are common in children, among whom the incidence of Lyme disease is higher than among adults. Cranioneuropathies, in particular palsy of the facial nerve, occur in approximately 3-5% of children with Lyme disease, followed in frequency by meningitis (1% of symptomatic children). Children with only non-specific symptoms such as headache, arthralgia or fatigue commonly are misdiagnosed as having Lyme disease. Although such non-specific symptoms often accompany more specific signs and symptoms (e.g., erythema migrans, arthritis) in children with Lyme disease, very rarely are non-specific symptoms the sole manifestation of Lyme disease. A number of carefully conducted follow-up studies have indicated that the prognosis is excellent for children with Lyme disease who have been treated with standard antimicrobial regimens.

Adult↗
PubMed1997

Fever without apparent source on clinical examination, lower respiratory infections in children, other infectious diseases, and acute gastroenteritis and diarrhea of infancy and early childhood.

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. Jean Klig reviews recent literature about lower respiratory tract infection in children. Jeffrey Kahn and Eugene Shapiro discuss literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood.

Acute Disease↗
PubMed1996

Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group.

BACKGROUND: Although the incidence of Lyme disease is highest in children, there are few prospective data on the clinical manifestations and outcomes in children. METHODS: We conducted a prospective, longitudinal, community-based cohort study of children with newly diagnosed Lyme disease in an area of Connecticut in which the disease is highly endemic. We obtained clinical and demographic information and performed serial antibody tests and follow-up evaluations. RESULTS: Over a period of 20 months, 201 consecutive patients were enrolled; their median age was 7 years (range, 1 to 21). The initial clinical manifestations of Lyme disease were a single erythema migrans lesion in 66 percent, multiple erythema migrans lesions in 23 percent, arthritis in 6 percent, facial-nerve palsy in 3 percent, aseptic meningitis in 2 percent, and carditis in 0.5 percent. At presentation, 37 percent of the patients with a single erythema migrans lesion and 89 percent of those with multiple erythema migrans lesions had antibodies against Borrelia burgdorferi. All but 3 of the 201 patients were treated for two to four weeks with conventional antimicrobial therapy, which was administered orally in 96 percent. All had prompt clinical responses. After four weeks, 94 percent were completely asymptomatic (including the two patients whose parents had refused to allow antimicrobial treatment). At follow-up a mean of 25.4 months later, none of the patients had evidence of either chronic or recurrent Lyme disease. Six patients subsequently had a new episode of erythema migrans. CONCLUSIONS: About 90 percent of children with Lyme disease present with erythema migrans, which is an early stage of the disease. The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents.

Adolescent↗
PubMed1996

Fever without apparent source on clinical examination, lower respiratory infections in children, other infectious diseases, and acute gastroenteritis and diarrhea of infancy and early childhood.

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. Jean Klig reviews recent literature about lower respiratory tract infection in children. Eugene Shapiro discusses recent developments in the literature concerning several infectious diseases commonly facing practitioners in the office. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood.

Acute Disease↗
PubMed1996

Evaluations of enzyme-linked immunosorbent assay procedure for determining specific Epstein-Barr virus serology and of rapid test kits for diagnosis for infectious mononucleosis.

Using the results of Epstein-Barr virus-specific immunofluorescence serology as the "gold standard," we found that the sensitivities of the five rapid test kits varied from 78 to 84% and specificities varied from 89 to 100%. Enzyme-linked immunosorbent assay-determined specific Epstein-Barr virus antibody profiles had a sensitivity and specificity of 98.6 and 95.5%, respectively.

Antibodies, Viral↗
PubMed1996

Forensic DNA analysis and the United States Government.

All three branches of the United States Government are, directly or indirectly, promoting the use and judicial acceptance of forensic DNA analysis. In addition, the establishment of a US national DNA databank has been authorized. The US Congress has passed the 'DNA Identification Act of 1994', which provides, inter alia, funding to the states for developing and/or improving forensic laboratories capable of conducting DNA analysis, and also creates a framework for federal supervision of forensic DNA technology. Specifically, the Executive Branch, through the Department of Justice and particularly its Federal Bureau of Investigation, has been directed to develop standards and practices in order to speed the admissibility of forensic DNA analysis as scientifically acceptable evidence in US courts. Finally, the federal judiciary has been ordered by the US Supreme Court to abandon or modify the 70-year-old Frye standard, which the Federal courts previously used to determine whether scientific evidence is deemed admissible, a move that will directly impact the judicial acceptance of forensic DNA analysis in all federal courts and undoubtedly will affect the admissibility of DNA evidence in many American state courts.

Criminal Law↗
PubMed1995

Lyme disease in children.

Lyme disease is the most common vector-borne disease among children in the United States; the incidence of Lyme disease is higher among children than among adults. Extensive publicity in the lay press about the effects of Lyme disease has led to widespread anxiety about this illness that is out of proportion to the actual frequency of severe consequences, especially among children. The problem is exacerbated by the difficulty of documenting the diagnosis (or more often of ruling out the diagnosis in children with vague symptoms), especially when the diagnosis depends on serologic tests that are often inaccurate. This caveat applies particularly to commercial laboratories using prepackaged kits, which often give inaccurate results that should not be relied on by themselves to make a diagnosis. Careful prospective studies have found that nearly 90% of children with Lyme disease have erythema migrans. Although there has been great concern about congenital Lyme disease, no data suggest that it is a significant problem, nor has transmission of Lyme disease through breast milk been documented. Virtually all children will respond well to treatment for any stage of Lyme disease. Misdiagnosis is the most common reason for treatment failure. Long-term follow-up studies indicate that the prognosis for children with Lyme disease is excellent.

Adolescent↗
PubMed1995

Recombinant outer surface protein C ELISA for the diagnosis of early Lyme disease.

To compare the sensitivity of a new ELISA for IgM antibodies to Borrelia burgdorferi that uses a recombinant outer surface protein C (rOspC) with those of a whole cell (WC) ELISA and an immunoblot assay for the diagnosis of early Lyme disease, serum specimens from 82 consecutive patients with physician-documented erythema migrans were analyzed. To compare the specificities of the three assays, serum specimens from 50 patients without a history of Lyme disease and from an area in which B. burgdorferi is not endemic were analyzed. The sensitivities of the WC ELISA, immunoblot assay, and IgM rOspC ELISA were 28%, 29%, and 46%, respectively, while the specificities were 100%, 100%, and 98%, respectively. The IgM rOspC ELISA is a convenient, readily automated, easily standardized serologic test that is significantly more sensitive for the diagnosis of early Lyme disease than either WC ELISA or immunoblot assay.

Adolescent↗
PubMed1995

Risk factors for a first febrile seizure: a matched case-control study.

We conducted a matched case-control study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixty-nine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (+/- 6 months), site of routine pediatric care, and date of visit (+/- 2 weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected pre- and perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a first- or in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.

Acetaminophen↗
PubMed1995

Fever without apparent source on clinical examination, lower respiratory infections in children, bacterial infections, and acute gastroenteritis and diarrhea of infancy and early childhood.

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. David Bachman reviews recent literature about lower respiratory tract infection in children and focuses on community-acquired lower respiratory infections and respiratory syncytial virus. Eugene Shapiro discusses literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest: the hemolytic-uremic syndrome and enterohemorrhagic Escherichia coli. Streptococcus pneumoniae resistant to penicillin, infections in day care centers, and new antimicrobial drugs. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood and discusses diagnosis, complications, pathogenesis and physiology, epidemiology, and treatment.

Bacterial Infections↗
PubMed1994

Serotypes responsible for invasive Streptococcus pneumoniae infections among children in Connecticut.

Active prospective surveillance to identify the serotypes of Streptococcus pneumoniae responsible for invasive infections among children in Connecticut was conducted from July 1984 through March 1993. S. pneumoniae isolates (722) recovered from normally sterile sites (98% from blood, 7% from both blood and cerebrospinal fluid) were serotyped by the Quellung reaction; 70% of the isolates were from children < 2 years old. Serotype 14 caused 29% of the infections. Seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) were responsible for 84% of the invasive infections overall and for 86% of the invasive infections among children < 2 years old. Formulations of polysaccharide-protein conjugate pneumococcal vaccines designed to prevent invasive infections in children in the United States should include these commonly isolated serotypes.

Adolescent↗
PubMed1994

The risk of acquiring Lyme disease or babesiosis from a blood transfusion.

To determine the risk of acquiring Lyme disease or babesiosis from blood transfusion, serum was collected before and 6 weeks after patients received multiple transfusions during cardiothoracic surgery and antibodies to Borrelia burgdorferi and Babesia microti were measured. Of 155 subjects, 149 received 601 total units of packed red blood cells (PRBC) and 48 received 371 total units of platelets. No patient developed clinical or serologic evidence of Lyme disease; 1 (who received 5 units of PRBC) developed clinical and serologic evidence of babesiosis. The risk of acquiring Lyme disease from a transfused unit of PRBC was 0 (95% confidence interval [CI], 0-0.5%) and from a transfused unit of platelets was 0 (95% CI, 0-0.8%); the same risks for babesiosis were 0.17% (95% CI, 0.004%-0.9%) and 0 (95% CI, 0-0.8%), respectively. The risk of acquiring either Lyme disease or babesiosis from a blood transfusion in Connecticut is very low.

Aged↗
PubMed1994

Lyme disease.

Explore the source record for details and available documents.

Lyme Disease↗