Staphylococcal scalded skin syndrome in a breast-fed infant.
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Adult↗
Biomedical subjects
E R Wald
Publications and source records attributed to E R Wald.
Nasal colonization with Haemophilus and immunization status.
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Bacterial Capsules↗
Branhamella catarrhalis conjunctivitis.
Eleven cases of Branhamella catarrhalis conjunctivitis have been reported. In four recent studies that examine the microbial etiology of ophthalmia neonatorum, B catarrhalis was identified only twice in 1,299 cases. However, diagnosis by Gram stain in some and previous antibiotic therapy in others may have resulted in underdiagnosis of B catarrhalis and inaccurate diagnosis as gonococcal ophthalmia.
Conjunctivitis, Bacterial↗
Rapid detection of group B streptococci directly from vaginal swabs.
Duplicate vaginal swabs were obtained from patients who attended obstetric or gynecologic clinics affiliated with the Magee Womens Hospital in Pittsburgh. One swab was cultured semiquantitatively on 5% sheep blood agar to detect group B streptococci (GBS). The other swab was subjected to a rapid method (25 min) for antigen detection and micronitrous acid exposure to extract the GBS antigen, followed by latex particle agglutination. A total of 464 swabs were evaluated by direct plating. Fifty-two swabs (11.2%) were found to contain GBS. Overall, the rapid method detected 21 of 52, or 40.4%, positive specimens. The sensitivity of the rapid method for identifying the most heavily colonized samples was 85.7%. This method can be used to identify maternity patients who are heavily colonized with GBS and are at high risk of delivering septic infants.
Antigens, Bacterial↗
Haemophilus disease after rifampin prophylaxis.
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Child↗
Acute rheumatic fever in western Pennsylvania and the tristate area.
Acute rheumatic fever is reported to have declined and perhaps be vanishing. Prompted by the occurrence of 17 cases of acute rheumatic fever in an 18-month period in 1985 and 1986, we reviewed the records of 243 children with acute rheumatic fever who were cared for at Children's Hospital of Pittsburgh or Mercy Hospital between 1965 and 1986. Acute rheumatic fever was diagnosed using the modified Jones criteria and cases were classified by major criteria as arthritis, arthritis and carditis, carditis alone, carditis and chorea, chorea alone, and arthritis and chorea. Among the 17 recent patients, 59% had carditis, 30% had chorea, and 24% had arthritis alone. The proportion of children who had particular major manifestations was similar in the last two decades and in 1985 to 1986. The recent children with acute rheumatic fever ranged in age from 6 to 13 years with a mean and median age of 10 years. There were 16 white children and one Asian child. Only four children lived in an urban setting. When demographic features of the children were contrasted with those in the previous two decades, a decrease in the proportion of children who lived in urban areas and who were black was noted. Four children had a history of preceding sore throat but only three sought medical care; nine children had no memorable illness and four had either a nonrespiratory illness or a respiratory infection without sore throat. This resurgence of rheumatic fever serves as a reminder that a diligent approach to the diagnosis and therapy of streptococcal infections remains essential.
Acute Disease↗
Use of rifampin in Haemophilus influenzae type b infections.
Based on evidence that patients with infections due to Haemophilus influenzae type b (HIB) remain colonized after therapy, recommendations for chemoprophylaxis of susceptible contacts have included providing rifampin for patients themselves. However, these recommendations have been made with neither definitive advice concerning the timing of rifampin administration nor any supporting data of efficacy and safety in patients. Our data suggest that rifampin given concurrently with therapeutic antimicrobials is as effective-89% (17/19)--as when given following therapeutic antimicrobials-95% (18/19)--in eradicating pharyngeal HIB. Colonization of the pharynx by HIB was also determined before and during therapy. Almost all patients were colonized before beginning therapy; most were heavily colonized. The density of colonization diminished rapidly during the first 15 to 20 hours of therapy. However, 28% of patients, primarily those who had HIB diseases other than meningitis or did not receive any chloramphenicol, still had detectable colonization after four to six days of antimicrobial therapy.
Cellulitis↗
Risk factors for development of bacterial meningitis among children with occult bacteremia.
To identify risk factors for the development of bacterial meningitis, we compared clinical characteristics in children with occult bacteremia who did and those who did not subsequently develop bacterial meningitis. The estimates of risk were adjusted for the possible confounding effects of other characteristics by using logistic regression. Of 310 children (median age 15 months) who had occult bacteremia with Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis at either Yale-New Haven Hospital or Children's Hospital of Pittsburgh, bacterial meningitis subsequently developed in 22 (7%). Compared with the risk associated with occult bacteremia with S. pneumoniae, the adjusted relative risk for bacterial meningitis was 85.6 (P less than 0.0001) and 12.0 (P = 0.0001) for N. meningitidis and H. influenzae type b, respectively. By contrast, the adjusted relative risk associated with a lumbar puncture at the initial visit was only 1.2 (P = 0.78). The development of bacterial meningitis in children with occult bacteremia is strongly associated with the species of bacteria that causes the infection, but not with a lumbar puncture or with other clinical characteristics identifiable at the initial visit.
Anti-Bacterial Agents↗
The incubation period necessary for detection of bacteremia in immunocompetent children with fever. Implications for the clinician.
The authors determined the time required for blood cultures to be detected as positive for the common bacterial pathogens in immunocompetent infants and children with fever who had no apparent source of infection. Records of the bacteriology laboratory were reviewed retrospectively from 1981 to 1984 for blood cultures that were positive for Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, Salmonella species, and group B streptococcus. Blood culturing by a conventional technique and a radiometric method were compared sequentially. Only four (1.5%) of 268 specimens were detected as positive after the second day of incubation; in each case that detection of bacteremia was delayed there was an identified source of infection. For H. influenzae, but not S. pneumoniae, significantly more bacteremias were detected earlier by the radiometric method. Discontinuation of empiric antibiotic therapy in immunocompetent children with suspected bacteremia and without focal infection appears warranted when blood cultures have been sterile for at least 48 hours.
Anti-Bacterial Agents↗
Haemophilus influenzae type b colonization in household contacts of infected and colonized children enrolled in day care.
Strategies for management of children attending day-care facilities after a case of Haemophilus influenzae type b disease are controversial. The success of chemoprophylaxis in preventing subsequent cases has been variable. Failure of rifampin prophylaxis as currently recommended may result from usage limited to direct contacts of the index patient. This prospective study was designed to ascertain the extent of colonization in household contacts of colonized children attending day-care facilities with an index case of H influenzae disease. Outer membrane protein analysis was used to determine similarity between strains isolated from contacts and index patients. Of children attending six day-care facilities, 15% were colonized with subtypes of H influenzae identical with those of their respective index patients, and 7% of children were colonized with different subtypes. Colonization with identical outer membrane protein subtypes in children from day-care homes was more frequent than in the larger day-care centers (91% v 8%, P less than .00001). Within families of children with identical outer membrane protein subtypes, 25% of household members (17% of parents and 44% of siblings) were colonized despite lack of direct contact with the index patients. This colonization rate was comparable to that of household contacts of index patients (26%). Among household contacts of index patients, especially siblings, colonization with H influenzae tended to be lower if the patient attended day care than if the patient did not attend day care (17% v 73%; P = .05 for siblings). We have found that household contacts of colonized day-care children are a reservoir of H influenzae.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Long-term outcome of group B streptococcal meningitis.
Group B Streptococcus is a common cause of neonatal sepsis and meningitis. The purpose of this study was to evaluate the neurologic, psychologic, and academic status of children who had group B streptococcal meningitis and to compare these children with their siblings. Seventy-four children who acquired group B streptococcal meningitis between one day and 6 months of life formed the study population. Survivors were 3 to 18 years old at the time of their follow-up evaluations. Twenty children (27%) died, two were institutionalized, one severely affected child died at age 2 years, 15 were assessed by phone interview, and two were lost to follow-up. Thirty-four children and 21 siblings were comprehensively evaluated with physical and neurologic examinations, hearing tests, and tests of intellectual, perceptual-motor, and behavioral-adaptive functions. Of the total population, nine children (12%) had major neurologic sequelae (spastic quadraplegia, profound mental retardation, hemiparesis, deafness, or blindness). Six children had acute hydrocephalus; two were doing well after shunt placement. In general, those children surviving group B streptococcal meningitis without major sequelae appeared to be functioning normally or comparably to their sibling in intellectual, social, and academic matters.
Achievement↗
Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial.
This study compared the relative effectiveness of two antimicrobial preparations, amoxicillin and amoxicillin-clavulanate potassium (Augmentin), in the treatment of acute maxillary sinusitis in children 2 to 16 years of age. Of 171 children with persistent (ten to 30 days' duration) nasal discharge or daytime cough or both, 136 (80%) had abnormal maxillary sinus radiographs. These children were stratified by age and severity of symptoms and randomly assigned to receive either amoxicillin, amoxicillin-clavulanate potassium, or placebo. After the exclusion of 28 children with throat cultures positive for group A Streptococcus and 15 who did not complete their medication, the remaining 93 children were evaluated: 30 received amoxicillin, 28 received amoxicillin-clavulanate potassium, and 35 received placebo. Clinical assessment was performed at three and ten days. On each occasion, children treated with an antibiotic were more likely to be cured than children receiving placebo (P less than .01 at three days, P less than .05 at ten days). The overall cure rate was 67% for amoxicillin, 64% for amoxicillin-clavulanate potassium, and 43% for placebo.
Acute Disease↗
Risk factors for osteomyelitis.
An approach that is useful in classifying the risk factors for the development of acute osteomyelitis is the same as one commonly employed to discuss the mechanisms responsible for pathogenesis: hematogenous dissemination, direct inoculation, and contiguous spread from an adjacent area of soft tissue infection. Acute hematogenous osteomyelitis is predominantly a disease of children. Factors that favor the development of acute bone infection are those that predispose to bacteremia. These include indwelling intravascular catheters, distant foci of infection, and intravenous drug abuse. The distant sites of focal infection that are most commonly associated with acute osteomyelitis include the skin as well as urinary and respiratory tracts. Two patient groups with an usual susceptibility to acute skeletal infections are those with sickle cell anemia and chronic granulomatous disease. The second major mechanism for the development of acute osteomyelitis is by direct inoculation. Injuries due to penetrating bites and puncture wounds of the food may serve to infect bone directly. Diagnostic procedures (lumbar puncture, fetal monitoring electrodes, suprapubic aspiration, and heel sticks) may result inadvertently in the inoculation of a neighboring osseous structure. Surgical procedures such as internal fixation of long bone fractures and skeletal traction may cause an infection of the bone. Osteomyelitis may develop as a consequence of contiguous spread of infection from adjacent soft tissue, particularly if vascular insufficiency complicates the clinical picture. Infection of the mandible, maxilla, and frontal or mastoid bones may result from persistent or neglected infection of the teeth, paranasal sinuses, or middle ear cavity, respectively. The major risk factor for chronic infection of bone is inadequate or delayed management of acute osteomyelitis or completely unrecognized bone infection.
Acute Disease↗
Evaluation of the febrile neonate.
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Blood Sedimentation↗
Oral trimethoprim/sulfamethoxazole for prevention of bacterial infection during the induction phase of cancer chemotherapy in children.
We conducted a randomized, double-blind, placebo-controlled study to evaluate the efficacy of oral trimethoprim/sulfamethoxazole (TMP/SMX) in the prevention of bacterial infections in children with cancer. Sixty-three patients with acute leukemia were studied during the induction phase of chemotherapy; 28 patients with solid tumors who were starting intensive chemotherapy were also enrolled and treated for 2 months. There was no significant difference in the frequency of febrile episodes between the 43 children receiving trimethoprim/sulfamethoxazole and the 48 receiving placebo. However, when the group of 74 children who experienced granulocytopenia (absolute granulocyte count less than 500/microL) was analyzed separately, significant reductions in the frequencies of confirmed bacteremia (2.6% v 20.0%, P = .02) and febrile episodes (35.9% v 65.7%, P = .01) were observed in the trimethoprim/sulfamethoxazole group. Furthermore, life table analysis showed that children with leukemia receiving trimethoprim/sulfamethoxazole had significantly more days without fever and without bacteremia. No benefits from prophylaxis were recognized in the subgroup with solid tumors. Although the frequency of oral thrush was greater (P = .02) in the trimethoprim/sulfamethoxazole group (25.6%) than in the placebo group (6.3%), invasive fungal infection did not occur. Although the mean duration of granulocytopenia was greater among those receiving trimethoprim/sulfamethoxazole (13.7 v 9.0 days, P = .05), this did not appear to increase the overall risk for bacterial infection. These data suggest that trimethoprim/sulfamethoxazole reduces the frequency of bacteremia and febrile episodes in granulocytopenic children undergoing induction chemotherapy for acute leukemia.
Adolescent↗
Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor.
Maxillary sinus aspiration and quantitative culture of the aspirate were performed in 50 patients, ranging in age from 1 to 16 years, with clinical and radiographic evidence of acute sinusitis. Of 79 sinuses aspirated, at least one was found to be infected in 35 (70%) children. Streptococcus pneumoniae, Branhamella catarrhalis, and Haemophilus influenzae were the most common organisms recovered. All H. influenzae were nontypeable. Twenty percent of the H. influenzae and 27% of the B. catarrhalis organisms were beta-lactamase positive and amoxicillin resistant. The subjects received either amoxicillin or cefaclor at a dose of 40 mg/kg/day in three doses for 10 days. The clinical cure rate with amoxicillin was 81%, compared to 78% with cefaclor. Radiographic improvement was similar in both treatment groups. Antibiotic therapy failed in four patients; three had been given amoxicillin, and one cefaclor. In three of these, a beta-lactamase-positive antibiotic-resistant bacterial species was recovered from the maxillary sinus aspirate; the fourth aspirate was sterile.
Acute Disease↗
Isolated uvulitis due to Haemophilus influenzae type b.
Infections of the uvula are infrequently recognized and have been previously described only in association with group A streptococcal pharyngitis or Haemophilus influenzae type b epiglottitis. Three cases of H influenzae type b bacteremic uvulitis are described. In suspected cases of H influenzae type b uvulitis, a lateral neck radiograph should be performed and parenteral antibiotics initiated.
Arthritis, Infectious↗