[Cat-scratch disease in children].
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Biomedical subjects
Publications and source records attributed to J Ströder.
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Compound GO 10213, a 5-nitroimidazole substituted at the 2 position, is more active against aerobic, microaerophilic, and anaerobic bacteria than metronidazole. The MICs for Salmonella typhimurium (2 to 128 micrograms/ml), Campylobacter spp. (0.06 to 16 micrograms/ml) and Bacteroides spp. (0.03 to 0.25 micrograms/ml) are definitely lower than those of metronidazole. Niridazole, a 5-nitrothiazole, is still more active.
The antibacterial activities of different nitroheterocyclic compounds were assessed by an agar dilution method against aerobic, microaerophilic, and anaerobic bacteria. Nitronaphthofurans inhibited the multiplication of aerobic bacteria at low concentrations (MIC for 50% of strains tested [MIC50], 1 mg/liter). Under anaerobic growth conditions the MICs were found to be even lower. The rough, DNA repair-deficient mutants of Salmonella typhimurium were more susceptible, whereas nitroreductase-deficient strains were resistant. Microaerophilic campylobacter isolates could be divided into two groups, one of which was as susceptible as aerobic bacteria (MIC50, 1 mg/liter) and the other of which was more highly susceptible (MIC50, 0.015 mg/liter). All anaerobic bacteria tested were susceptible to nitronaphthofurans (MIC50, 0.125 mg/liter). Nitrothiazole exerted antibacterial activities similar to those of the nitronaphthofurans. Metronidazole, a nitroimidazole derivative, and nitrofurans were definitely less active. Nitrobenzofurans showed relatively high MICs.
The immunization of mice with sheep erythrocytes served as model for the materno-fetal transfer of specific antibodies. It could be shown that passively transferred antibodies are able to induce a long-lasting suppression of the primary and secondary immuno-response in the offspring. This holds true both for active immunization before pregnancy and for passive immunization shortly before term. As it can be supposed that similar effects also apply to the human organism, this phenomenon must be considered for the vaccination during pregnancy as well as for the first immunization of children.
199 children with acute hepatitis hospitalized between 1968 and 1978 were tested for serological markers of hepatitis A and B infection. In 24 out of 28 HBsAg-positive patients, hepatitis B infection was diagnosed because of the disappearance of the antigen during convalescence. The histories of the 171 HBsAg-negative children suggested acute hepatitis A infection in 69% of the patients. This diagnosis could be confirmed in 110 of the 116 tested cases (95%) by a more than fourfold increase in the anti-HAV titer or by detection of anti-HAV of the IgM class. In the 55 HBsAg-negative patients without epidemiological clues as to the type of hepatitis, 40 children exhibited anti-HAV which could be related to acute A infection in 21 out of 22 tested cases. At least 11 patients had to be classified as having nonn A--non B infection. The results indicate that a combination of evaluation of the patient's history and selected serological tests will permit a fast preliminary diagnosis. This is important in the clinical management of patients and protection of contacts with immunoglobulin.
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The phagocytic and NBT reduction indices of 94 preterm and underweight babies, divided into 7 groups and two weight classes, were observed over a period of six weeks while they were observed over a period of six weeks while they were given four commercial baby foods (Humana 0, Meb, Multival, Pomil). In all groups the mean values of both parameters were always within the standard range with only slight differences. In all test subjects, phagocytic activity decreased continuously during the first five weeks, and NBT reducing capacity during the first six weeks. Correlations could not be established between phagocytic or NBT reduction rate and birth weight or gestational age. As compared with the other groups there was a distinct lowering of the phagocytic indices in both Meb groups, which we think is nutrition-dependent and can be interpreted as the result of interaction between nutrition and immunological parameters.
The principles of treatment of diphtheria are discussed: in the present epidemic situation, diphtheritic children must be admitted to a pediatric hospital. The children need at least 3 to 4 weeks, to a large extent strict, bed rest. The basic concepts of the treatment of both peripheral circulatory weaknesses and of myocardial damage are communicated. Glucocorticoids have proved their value in myocarditis. Prophylactic digitalization is to be rejected. Confirmed heart failure is a binding indication for digitalization. A causal therapy for para- and metadiphtheritic paralysis does not exist. All forms must be treated with antibiotics nowadays. In croup, tracheotomy must not be delayed too long. The nursing must be left the best staff only and requires, in addition to a fundamental knowledge of the disease picture, an exceptional empathy in the particular, especially psychic, situation of the sick children.
The history of a 13-year old boy is reported who suffered from frequent bacterial, enteroviral, and protozoal infections since late infancy. A decrease in the serum levels of IgG2, IgG3, IgA, a neutrophil dysfunction, and a partial cellular immune deficiency could be demonstrated. A deficiency of folic acid produced a pancytopenia which enhanced the patient's susceptibility to infections. The combined substitution of gammaglobulins and folic acid only was able to break this vicious cycle.
IgG-subclass concentrations were determined in cord sera from 47 premature, 59 full-term, and 29 small-for-dates babies of varying gestational age. In permature and full term babies the relative percentages of all four subclasses were in the range for normal adult values. However, in small-for-dates babies significantly lowered IgG1-levels were found.
In in vitro studies vitamin D3 proved inhibitory on strains of Staphylococcus aureus, Streptococcus pyogenes, Klebsiella pneumoniae. Escherichia coli, and Candida albicans. In the presence of 5x10(4)-9x10(4) IU/ml vitamin D3 the organisms were killed or reacted with a marked growth inhibition.
In 23 subjects of different ages with Down's syndrome a number of parameters of non-specific defense of humoral and cellular immunity were investigated. While in all age groups complement factors C3, C4 and C5 as well as phagocytosis and NBT indices were in the normal range, a dysgammaglobulinaemia increasing with age with a hyperglobulinaemia of the IgG, IgA and IgD types was found, sparing immunoglobulins IgM and IgE. In addition the transformation capacity of peripheral blood lymphocytes decreased with age. This is understood as the consequence of premature aging of the thymus-dependent immune system.
The basic features of diphtheria, especially clinical aspects, differential diagnosis and therapy are set out insofar as they are important for the general practitioner. The doctor, not the bacteriologist, must make the diagnosis. Serotherapy must be begun as rapidly as possible, and in adequate dosage. The patients must be carefully watched over in the interests of early detection of possible complications. Rest in bed is required in every case for at least 3 to 4 weeks, longer if possible. Even mild "localized" forms can lead to toxic damage during the course or subsequently. In infants, diphtheria may run its course as the well-defined clinical picture of "diphtheria intoxication" of infants.
The investigation of a number of parameters of nonspecific and specific defense in 13 purulent and 18 mumps meningitides gave no indication of underlying primary immunodeficiencies. Only in the acute phase of mumps meningitis did we find a temporary suppression of cellular immune reactions measured as diminished rate of incorporation of thymidine by phytohemagglutinin-stimulated peripheral blood lymphocytes.