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Biomedical subjects

R Dagan

Publications and source records attributed to R Dagan.

At least 199 records · Page 11Linked to original sources
PubMed1992

Safety and immunogenicity of oral tetravalent human-rhesus reassortant rotavirus vaccine in neonates.

We conducted a prospective randomized double blind study to determine: (1) the safety and immunogenicity of live oral tetravalent human-rhesus rotavirus reassortant vaccine in neonates; and (2) whether a second dose at the age of 6 to 8 weeks enhances the immunogenicity. Two hundred forty healthy neonates were enrolled and received vaccine (183) or placebo (57) on the second day of life. At the age of 6 to 8 weeks 133 received placebo and 88 received a second dose of vaccine. Medical events were noted within 10 days from vaccine administration in 6 of 183 (3.3%) vaccine recipients vs. 0 of 57 placebo recipients (P = 0.34) after the first dose and in 8 of 88 (9%) vs. 4 of 133 (3%) after the second dose (P = 0.069); none was severe and all were of short duration. Seroresponse of any type (detectable IgA or 4-fold increase of titer to rhesus rotavirus was 9% for the placebo, vs. 52 and 46% for those who received one and two doses of vaccine, respectively. However, neutralizing antibodies against human serotypes 1, 2 and 3 were not raised successfully in vaccinated infants when compared with placebo recipients. The same pattern was found when geometric mean titers were compared. Vaccine take was better when cord blood titers were low. At the age of 1 year the vaccinees had more often high titers for antirhesus rotavirus antibodies (> 640) than the placebo recipients (49% vs. 0%; P < 0.001). NO difference was found between the groups in neutralizing antibodies to human serotypes 1, 2 and 3 rotavirus.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains.

Staphylococcus aureus has been consistently isolated from a high proportion of impetiginous lesions, and in several recent studies, it was present in the majority of the cases. Since recently a large proportion of S. aureus strains in our community showed erythromycin resistance, we undertook a prospective double-blind controlled study comparing topical mupirocin with oral erythromycin to determine (i) the prevalence of erythromycin-resistant S. aureus strains in impetigo and (ii) whether an increased rate of failure of erythromycin treatment was associated with such resistance. A total of 102 patients 3 to 185 months old (median = 49 months) were enrolled. Culture was positive for 97 of 102 (95%) patients, and S. aureus was present in 93% of the patients for whom cultures were positive. S. aureus was the single pathogen in 64% of these patients. Erythromycin-resistant S. aureus strains were present in 27 of 91 (28%) patients for whom cultures were positive. In all cases but one, S. aureus was resistant to penicillin, and in all cases it was sensitive to mupirocin. A marked difference was observed in favor of mupirocin in the clinical courses of the disease. However, only patients with erythromycin-resistant S. aureus strains had unfavorable courses compared with those treated with mupirocin (failure rate, 47 versus 2%, respectively). Patients with erythromycin-susceptible S. aureus strains who received erythromycin had a failure rate of 8%. In four patients, S. aureus strains initially susceptible to erythromycin became resistant during treatment. We conclude that erythromycin-resistant S. aureus strains are commonly isolated from impetigo in our region.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1992

High prevalence of Kingella kingae in joint fluid from children with septic arthritis revealed by the BACTEC blood culture system.

In an effort to improve detection of fastidious organisms, joint fluid aspirates of pediatric patients were inoculated into BACTEC 460 aerobic blood culture bottles, in addition to cultures on solid media. Culture records for the 1988 to 1991 period were reviewed to compare the performance of both methods for the recovery of pathogens. Overall, 216 children underwent a diagnostic joint tap, and 63 specimens grew significant organisms, including Kingella kingae in 14. While both methods were comparable for recovery of usual pathogens, with a single exception, K. kingae isolates were detected by the BACTEC system only. K. kingae appears to be a more common cause of septic arthritis in children than has been previously recognized. The BACTEC blood culture system enhances the recovery of K. kingae from joint fluid and improves bacteriologic diagnosis of pediatric septic arthritis.

Adolescent↗
PubMed1992

Clinical studies in pediatric respiratory-tract infections: what is desirable, feasible, or simply misleading.

In recent years, attempts have been made to make the regulatory requirements for clinical studies more uniform, and much has been discussed on the issue of good clinical practice. There is no doubt that clinical trials involving new drugs have to be conducted according to the highest standards. However, ideal design is not always feasible or ethical. The ideal design for efficacy studies demands randomization, double-blind comparisons, adequate group size, specification of the type of patients and isolated organisms. The present paper points out some difficulties regarding these points when studying cephalosporins in pediatric respiratory-tract infections, and proposes some solutions.

Anti-Bacterial Agents↗
PubMed1992

Aerobic bacteriology of chronic suppurative otitis media without cholesteatoma in children.

Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious. We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables. Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15%. Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%). The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone. The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps. We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.

Adolescent↗
PubMed1991

Infections due to gram-positive organisms in children: possible role for teicoplanin.

The disruptive effect on, and potentially hazardous exposure to nosocomial infection, together with the relative cost of hospitalization, of children favours the need for ambulatory care. An increasing proportion of infections in children are due to beta-lactam resistant Gram-positive organisms. Teicoplanin is proposed as a suitable candidate for treating paediatric patients with serious Gram-positive infections in hospital or ambulatory care. The experience acquired in children is still limited. However, over 200 paediatric patients have been treated with once or twice daily im or iv teicoplanin in daily doses of 3-10 mg/kg. The main clinical diagnoses were skin and soft tissue infections, skeletal infections and septicaemia. The drug was safe and clinical efficacy was greater than 90%. Comparative studies with defined uniform protocols are now required to assess the potential of this drug.

Anti-Bacterial Agents↗
PubMed1991

Detection and treatment of brucellosis by screening a population at risk.

Brucellosis presents a difficult diagnostic challenge in view of its protean manifestations, multiple organ involvement and variable clinical course. The purpose of the present study was to determine whether active screening of a population at risk, identified through index cases, would enhance the detection rate of brucellosis and improve treatment. During a 1-month period all 98 individuals sharing risk factors with 4 diagnosed symptomatic cases of brucellosis in one Bedouin town in southern Israel were approached and 86 agreed to undergo screening. Symptomatic brucellosis was found in 8 (9%) of the screened population and an additional 5 (6%) asymptomatic individuals were found to be seropositive. These 13 were followed for 12 months. All symptomatic cases were treated and cured. Of the 5 asymptomatic seropositive individuals 2 showed a further elevation of Brucella antibody titers. One became symptomatic, was treated and was cured. This screening program provided 53% of all reported cases from the Bedouin town during the entire year of the study. Screening a population at risk increased the detection rate of brucellosis and improved the treatment.

Adolescent↗
PubMed1991

Calves as a source of an outbreak of cryptosporidiosis among young children in an agricultural closed community.

Transmission of Cryptosporidium from animals to humans, originating mainly in calves, had been suggested previously but has remained unproved. An outbreak of cryptosporidiosis that started among calves was transmitted to multiple pediatric groups living in close contact through one family who had close contact with the calves. Eleven of 19 (58%) infants and young children ages 10 to 15 months had Cryptosporidium compared with 3 of 27 (11%) of those ages 36 to 60 months and none of those ages 16 to 35 months. None of the asymptomatic children was positive for Cryptosporidium. These data emphasize that an extensive human to human transmission does not rule out the zoonotic nature of cryptosporidiosis.

Adult↗
PubMed1991

Safety and immunogenicity of Haemophilus type b-tetanus protein conjugate vaccine, mixed in the same syringe with diphtheria-tetanus-pertussis vaccine in young infants.

As new vaccines are developed there is increasing interest in reducing the number of injections given to children by combining vaccines in one syringe. We studied the safety and immunogenicity of Haemophilus influenzae type b-tetanus protein conjugate vaccine (PRP-T) administered at ages 2, 4 and 6 months mixed in the same syringe with DTP vaccine and its effects on the seroresponse to DTP vaccine. A group of 112 healthy 2-month-old infants received DTP-PRP-T or DTP-placebo mixed immediately before immunization in the same syringe. The addition of PRP-T to DTP did not increase the rate of local or systemic reactions. After the first, second and third dose, the PRP-T recipients showed a geometric anti-PRP antibody mean of 0.13, 2.31 and 6.40 micrograms/ml vs. 0.07, 0.05 and 0.05 micrograms/ml among the DTP-placebo recipients, respectively. Of the PRP-T recipients, 94 and 98% attained antibody concentration of greater than or equal to 0.15 micrograms/ml protein after the second and third dose, respectively, and 65 and 94% attained a concentration of greater than or equal to 1.0 micrograms/ml after the second and third dose, respectively. At the age of 1 year 94 and 52% of the DTP-PRP-T recipients vs. 12% and 0% of the placebo recipients still maintained titers of greater than or equal to 0.15 and greater than or equal to 1.0 micrograms/ml, respectively. The administration of DTP in the same syringe with PRP-T did not affect significantly the antibody response to diphtheria and tetanus toxoid and to pertussis agglutinins. It is concluded that PRP-T vaccine could be administered in the same syringe as DTP.

Antibodies, Bacterial↗
PubMed1991

Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors.

The incidence and risk factors for chronic suppurative otitis media without cholesteatoma in children in Southern Israel were determined by comparing 88 children with the disease to 76 controls with similar age distribution who visited 3 clinics serving representative populations of the region. Data were collected during the child's visit to the clinic by means of a structured interview with the parents and by extracting information from medical records. The calculated yearly incidence was 39/100,000 children 0 to 15 years of age. Significantly increased risk for chronic suppurative otitis media was associated with a history of acute and recurrent otitis media, a parental history of chronic otitis media, larger families and more siblings, a higher crowding index and care in large daycare centers. The sex, parental age and education, allergy, sinusitis and recurrent upper respiratory tract infections were not associated with chronic suppurative otitis media.

Adolescent↗
PubMed1991

Pseudooutbreak of Candida guilliermondii fungemia in a neonatal intensive care unit.

During a 3-week period multiple blood cultures obtained from 14 Neonatal Intensive Care Unit infants and 3 Newborn Unit babies grew Candida guilliermondii, a yeast rarely associated with infections in humans. At the time of detection of positive cultures, most infants had been hospitalized for days or weeks for serious perinatal conditions and treated with antibiotics and intravenous hyperalimentation. Two critically ill premature infants from whom the yeast was isolated were given amphotericin B. In 7 other infants, however, yeasts were recovered on the day of birth, raising the question of pseudofungemia. Exhaustive interrogation on the blood culture practices revealed that when drawing blood for a culture from small infants, "butterfly" needles were often flushed with a diluted heparin solution to prevent blood clotting. Culture of a single lot of diluted heparin vials, prepared at the hospital pharmacy and distributed to the Neonatal Intensive Care Unit and Newborn Unit shortly before the onset of the epidemic, grew between 10,000 and 15,000 colony-forming units of Candida guilliermondii/ml. Removal of contaminated heparin vials and discontinuation of heparinization of needles used for blood cultures resulted in cessation of the epidemic. The present outbreak illustrates the difficulties in recognizing pseudoinfections in sick premature infants and the importance of intensive investigation and intervention during such an outbreak.

Blood↗
PubMed1991

[Bacterial tracheitis in children].

Bacterial tracheitis (BT) was found in 10 of 748 children (1.3%) admitted with croup during 1983-1990. 9.9% of all the 748 croup cases seen (74) were admitted to the pediatric intensive care unit (PICU) and 16 of the 74 required intubation. 10 of those intubated (62.5%) were found to have BT and had typical features of croup, including inspiratory stridor, hoarseness and cough. Airway obstruction resulted mainly from accumulated tracheal pus. After endotracheal intubation all required frequent suctioning of thick purulent secretions. In 2 children causative microorganisms were cultured from the blood, and in all 10 from the tracheal pus. All children were given antibiotic therapy but a 7 month-old girl died of secondary complications (respiratory syncytial virus infection, pneumonia and adult respiratory distress syndrome). The others recovered and were discharged from the PICU within 3-14 days. BT should be suspected when tracheal intubation is required in croup. In such cases close monitoring in a PICU and frequent tracheal suctioning after intubation is necessary; antibiotic therapy should be considered.

Anti-Bacterial Agents↗
PubMed1991

Focal encephalitis with enterovirus infections.

We report on four pediatric patients with Enterovirus infections who were admitted to the hospital with signs or symptoms of acute, focal encephalitis. All four experienced focal seizures. Each had a cerebrospinal fluid pleocytosis at the initial lumbar puncture. In all four patients the diagnosis of herpes simplex encephalitis was entertained. Each child improved spontaneously within a few days of admission to the hospital, and only one had residual neurologic abnormalities at the time of discharge. A brief review of these cases, and three additional cases from the literature, indicate that the enteroviruses, particularly the group A Coxsackieviruses, are rare causes of acute focal encephalitis in children and adolescents.

Adolescent↗