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Biomedical subjects

R Dagan

Publications and source records attributed to R Dagan.

At least 217 records · Page 12Linked to original sources
PubMed1991

Cryptosporidium in Bedouin and Jewish infants and children in southern Israel.

We conducted a 1-year prospective study in two clinics and a hospital in the Negev region of southern Israel to determine the epidemiological and clinical patterns of Cryptosporidium diarrhea among Jewish and Bedouin infants and children living in the same geographical area. A total of 612 episodes were studied: 398 in Bedouins and 214 in Jews, of which 449 occurred in patients with diarrhea and 164 in controls. Cryptosporidium was detected in 13 of 382 patients (3.4%) with diarrhea and in 1 of 138 controls (0.7%) (P = 0.078). In 5 of 13 Cryptosporidium-positive patients (38%) another pathogen was detected. No significant difference in Cryptosporidium detection rates was observed between Jews and Bedouins or between hospitalized or nonhospitalized patients. The frequency of Cryptosporidium detection did not differ significantly when three age-groups were compared (less than 6 months old, 7-12 and 13-36 months old). The rate of Cryptosporidium detection was similar among malnourished and well-nourished patients, as determined by weight-for-height percentiles. Cryptosporidium was detected more frequently during the summer months (8.3%) than during the rest of the year (1.2%) (P less than 0.001). Patients with Cryptosporidium diarrhea did not differ clinically from patients with other causes of diarrhea. However, they were characterized by the absence of fecal leukocytes. Cryptosporidium is not a rare cause of diarrhea in southern Israel. It is more prevalent during the hot and dry season and can be detected in a relatively high prevalence among very young infants. Its clinical features are indistinguishable from those of patients with non-cryptosporidial diarrhea.

Child, Preschool↗
PubMed1990

Medical management of chronic suppurative otitis media without cholesteatoma in children.

To determine whether systemic administration of antibiotics may eliminate or reduce the need for tympanomastoid surgery in chronic suppurative otitis media without cholesteatoma, we undertook a randomized, prospective study comparing three regimens: (1) daily suction and débridement, with intravenous administration of mezlocillin until 3 days after the discharge stopped, (2) daily suction and débridement, with intravenous use of ceftazidime until 3 days after the discharge stopped, and (3) daily suction and débridement without antibiotics. No topical antimicrobial agents were used during the study. Fifty-one patients were included, and 48 children completed the study. The duration of discharge from the ear before treatment was 2 to 123 months (median 20 months). In 26 patients (51%), the disease was bilateral. Aerobic cultures, obtained with the Alden-Senturia middle ear aspirator, yielded Pseudomonas aeruginosa in 98%, enteric gram-negative bacilli in 33%, staphylococci in 25%, and Haemophilus influenzae in 12%. The first 33 patients were randomly assigned to one of the three regimens. In the 21 patients treated with suction and antibiotics (either mezlocillin or ceftazidime), the discharge stopped completely, versus in only 1 (8%) of 12 patients in the suction-only regimen (p less than 0.01). Therefore the following 18 patients were randomly assigned to one of only two groups, which included the two suction-and-antibiotic regimens. In all patients treated initially with antibiotics, discharge stopped after 4 to 18 days (mean 12.0 days), but 25% needed treatment for greater than 14 days. Amoxicillin prophylaxis was administered to 27 (56%) of the patients after completion of therapy. All patients were followed for 6 months. Drainage recurred in 12 (25%) patients during the first 3 months after the study. The recurrence rate was not affected by the antibiotic regimen, the patient's age, the duration of drainage before initiation of antibiotic therapy, or prophylaxis. We conclude that intravenous wide-spectrum antibiotic therapy in conjunction with daily suction and débridement is efficacious for the treatment of chronic suppurative otitis media without cholesteatoma.

Adolescent↗
PubMed1990

Rotavirus diarrhea in Jewish and Bedouin children in the Negev region of Israel: epidemiology, clinical aspects and possible role of malnutrition in severity of illness.

We conducted a 1-year prospective study in the Negev region of southern Israel to determine the epidemiologic and clinical patterns of rotavirus diarrhea. A total of 605 patients were studied, 392 Bedouins and 213 Jews, 441 of whom had diarrhea (449 episodes) and 164 did not. Rotavirus was the most common organism detected in children with diarrhea (63 of 444; 14%) but was rarely found in controls (3 of 163; 2%) (P less than 0.001). In 22% (12 of 54) of the rotavirus-positive patients, at least one other organism was also detected. The rate of rotavirus detection decreased as age increased, from 18% in the first year to 8% in the third year of life. Hospitalization with rotavirus diarrhea occurred more frequently in the summer. However, during winter, when diarrhea was less prevalent in the community, the proportion of cases associated with rotavirus was higher. Compared with controls, malnourished children were more likely to be hospitalized. However, rotavirus was detected in similar proportions among well-nourished and malnourished cases with diarrhea. The most prevalent rotavirus serotype was type 1 (in 69%), followed by types 4 and 2 (18 and 13%, respectively). We estimated that during the study period, approximately 2% of all Bedouin infants vs. only 0.2% of Jewish infants were hospitalized with rotavirus disease in their first year of life. Clinical signs and symptoms and stool appearance were not useful in predicting rotavirus detection. Malnutrition seems to be an important indicator of disease severity, which may explain why the toll of rotavirus-associated morbidity and mortality is particularly high among children in developing countries.

Acute Disease↗
PubMed1990

Epidemiology of invasive Haemophilus influenzae type b infections in Bedouins and Jews in southern Israel.

We report the epidemiology of invasive Haemophilus influenzae type b disease requiring hospital intervention in Southern Israel, an area that contains two ethnic populations, Bedouins and Jews. The study is based on 107 blood or cerebrospinal fluid culture-positive cases during the years 1984 to 1988. The annual incidence rate among children younger than 5 years of age was 51/100,000 (48/100,000 for Jews and 58/100,000 for Bedouins). Thirty-nine percent of patients had meningitis, 32% had pneumonia and 31% had otitis media. Epiglottitis was present in only one case (less than 1%). The median age was 8 months. Twenty-six percent of the cases were 6 months old or younger, 75% were 1 year old or younger and 87% were 18 months old or younger. Ninety-five percent of all meningitis cases occurred during the first 18 months of life. A projected number of 2938 hospitalization days and 9.8 deaths/year for a population in which 100,000 births occur yearly was calculated. The major impact of invasive H. influenzae type b infections and the very young age involved justify initiation of H. influenzae vaccine studies in our region.

Age Factors↗
PubMed1990

The use of prophylactic furazolidone to control a nosocomial epidemic of multiply resistant Salmonella typhimurium in pediatric wards.

The nosocomial spread of enteric pathogens is often difficult to control in overcrowded pediatric wards. During 1983 and 1984, despite cohorting of patients and enforced hand washing, more than 200 cases of nosocomial multiply resistant Salmonella typhimurium phage type R-9 were observed on two adjacent pediatric wards. Most cases occurred during the summer months. After 19 new cases were detected early in the summer of 1985, oral administration of furazolidone throughout their entire hospital stay (2.5 mg/kg twice daily) was recommended for all subsequently hospitalized infants. Among the 114 (65%) infants who were appropriately treated, only one additional case (1%) was detected. In contrast 11 (19%) cases occurred among the 59 infants who were inappropriately treated: 5 of 35 (14%) of those who were not treated and 6 of 24 (25%) in whom treatment with furazolidone was delayed greater than 24 hours (P less than 0.001 between the appropriately and inappropriately treated groups). In pediatric wards where infection control measures cannot be optimally applied, prophylactic furazolidone administration may be helpful in preventing the spread of enteric pathogens.

Cohort Studies↗
PubMed1990

Risk factors for infantile hypothermia in early neonatal life.

Hypothermia in infancy is not uncommon among the low socioeconomic population in various parts of the world. It is prevalent in Israel and is associated with severe morbidity and mortality. We tried to identify neonates at risk among the population of the Negev district of Israel. Ninety-one infant hospitalized with infantile hypothermia (IH) during the years 1974 to 1981 were identified. The neonates belonged to two distinct ethnic groups, Bedouins and Jews, and were compared with 120 healthy controls of similar background. Our data show that premature infants and babies with low birth weight born during the cold season to young (inexperienced) mothers of lower socioeconomic strata and who sustained perinatal morbidity are at risk for IH. It is suggested that parents of infants at risk should be approached while the baby is till in the nursery, be advised about the possibility of hypothermia, and institute the appropriate preventive measures.

Birth Weight↗
PubMed1989

Comparison of amoxicillin and clavulanic acid (augmentin) for the treatment of nonbullous impetigo.

We undertook a prospective double-blind controlled study to compare the efficacy of a drug that usually has no antistaphylococcal activity (amoxicillin trihydrate) with the efficacy of the same drug with an addition of a beta-lactamase inhibitor (amoxicillin plus clavulanic acid [Augmentin]) in the treatment of nonbullous impetigo. Fifty-one culture-positive patients, aged 6 months to 9 years, were included, 26 in the amoxicillin group and 25 in the Augmentin group. The study groups were clinically and bacteriologically comparable at the start of the study. Staphylococcus aureus was isolated from all patients and beta-hemolytic streptococcus from 14 (29%). All staphylococci were sensitive to Augmentin but resistant to amoxicillin. Forty-nine patients completed the study. The clinical response was significantly better among the Augmentin recipients (marked improvement in 71% and 95% of patients after 2 and 5 days, respectively; no new lesions during the treatment course) than among the amoxicillin recipients (marked improvement in 44% and 68% of patients after 2 and 5 days, respectively; new lesions appeared in 20% of patients). Recurrence within 3 weeks occurred in 12 (26%) of 49 patients, and no difference was observed between the two groups. We conclude that S aureus is common in nonbullous impetigo, and that at least in some cases it plays an important role in the course of the disease that can be altered by specific therapy.

Amoxicillin↗
PubMed1989

Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities.

The association of penicillin-tolerant streptococci with reported epidemics of streptococcal pharyngitis in Israel was studied. The streptococcal strains had been isolated during 11 epidemics of community-acquired pharyngitis and 6 food-borne epidemics of pharyngitis occurring in the last 15 years. Strains were stocked lyophilized. Isolates were defined as tolerant if the MBC/MIC ratio for penicillin was greater than or equal to 32. All 122 group A streptococcal strains isolated during the epidemics of community-acquired infection showed tolerance to penicillin. In contrast, none of the 52 strains from food-borne epidemics (24 group A, 18 group C and 8 group G) was tolerant.

Disease Outbreaks↗
PubMed1989

Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis.

A prospective study was conducted to determine the frequency and distribution of bacterial and viral pathogens in infants hospitalized with suspected sepsis and to evaluate the potential of virus detection for improving patient management. A causative organism was detected in 157 (67%) of 233 previously healthy infants less than 3 months of age, who had been hospitalized for suspected sepsis: 19 (8%) had bacterial infections, 135 (58%) had viral infections, and 3 (1%) had mixed viral-bacterial infections. Viral infections occurred in a seasonal pattern: enteroviruses were responsible for most of the hospitalizations during summer and fall (65/110; 63%) and respiratory syncytial and influenza A viruses were responsible for most of the infections during winter (44/81; 55%). In contrast, bacterial infections were not seasonally distributed. Virus was detected in 33% of the 138 infected infants within 24 hours, and in 64% within 3 days. We conclude that viral infections are prevalent among infants hospitalized for suspected sepsis, and most can be detected early enough to influence patient management.

Bacterial Infections↗
PubMed1989

Virus-specific IgA in serum, saliva, and tears of children with measles.

Measles-specific IgA antibody titres were determined by radioimmunoassay (RIA) for serial serum, saliva and tear samples obtained from 21 children with measles infection, from onset of rash until up to 14 months later. Serum IgA titres rose rapidly after onset of illness and remained detectable throughout the follow-up period. Virus-specific salivary IgA titres peaked at 4 to 7 days after onset of rash and decreased thereafter. Measles-specific lacrimal fluid IgA antibodies remained elevated for long periods of time; however, secretory component-bearing measles-specific antibodies in tears became for the most part undetectable by 1 month after onset of rash. These data raise anew the question of whether some form of viral latency is associated with the presence of virus-specific IgA antibody, or whether such antibody is simply a reflection of immune memory.

Adolescent↗
PubMed1989

Bacterial meningitis with initial normal cerebrospinal fluid findings.

Seven pediatric patients with bacterial meningitis but with initial normal cerebrospinal fluid (CSF) findings are presented. They represent 6.5% of all cases with bacterial meningitis seen at our medical center during a 5-year period. In all cases, the duration of symptoms before the initial lumbar puncture was short (6-24 h). The case-fatality rate was 3/7 (43%) compared with 10/100 (10%) among children with abnormal initial CSF, despite early initiation of antibiotics. Bacterial meningitis with an initial normal CSF finding is not rare and may be associated with poor outcome.

Bacterial Infections↗
PubMed1988

Methaemoglobinaemia in young infants with diarrhoea.

Seventeen infants under 2 months of age are described who presented with methaemoglobinaemia and acute diarrhoea during a period of 2 years. No infants beyond this age presented with such characteristics. In none of them was one of the known mechanisms of methaemoglobin formation found. All infants recovered with conventional therapy. Methaemoglobin associated with diarrhoea relapsed in three infants before they were 2 months old. Twenty-six similar cases have been reported in the literature. The mechanism of methaemoglobinaemia in these infants is unclear.

Acidosis↗
PubMed1988

Acute ascites accompanying hepatitis A infection in a child.

A seven-year-old child developed ascites when recovering from hepatitis A infection. Accumulation of intraperitoneal fluid was confirmed by ultrasonic study. The clinical course was otherwise uneventful and the ascites disappeared after a few days with no treatment, and did not recur for five years. Ascites may exceptionally accompany hepatitis A infection. Its appearance, however, does not indicate an unfavorable outcome.

Acute Disease↗