[Relapsing fever in children in the northern Negev].
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Child↗
Biomedical subjects
R Dagan
Publications and source records attributed to R Dagan.
[Acute adrenal insufficiency complicating anticoagulant therapy].
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Acute Disease↗
The need for intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study).
Serious bacterial infections occurred in ten children (1.4%) of 710 patients with croup admitted to the Soroka Medical Center during the years 1983-1989. Sixty-four patients (9% of all croup patients) were admitted to the pediatric intensive care unit (PICU), and 13 of them (20%) required intubation. Bacterial infections were noted in nine of the 13 intubated patients, in none of the other 51 PICU patients who did not require intubation and in one of the 646 patients (0.2%) who were not admitted to the PICU (p less than 0.0001). There was no difference in age, ethnic origin, or body temperature on arrival between the two PICU groups. Causative microorganisms were isolated from blood samples (three cases) and tracheal pus (eight cases). All intubated PICU patients were seriously ill: eight had bacterial tracheitis and one supraglottitis. Patients with bacterial tracheitis required frequent suctioning of the trachea for copious purulent secretions. The single patient with bacterial infection who was not admitted to the PICU had transient bacteremia. We conclude that the need for intubation in croup patients was an indicator for the presence of a serious bacterial infection.
Anti-Bacterial Agents↗
Parenteral fluoroquinolones in children with life-threatening infections.
The new fluoroquinolones have not been tested in children despite their wide spectrum of in vitro activity and efficacy, because of an observed damage to cartilage in young animals. However, in some cases they may be life-saving. We present three pediatric patients with life threatening infections in whom the fluoroquinolones were used when other antibiotics failed: A seven-year-old boy with meningitis due to multiresistant Acinetobacter calcoaceticus, a three-year-old boy with Job's syndrome with line sepsis due to Staphylococcus epidermidis and a four month-old boy with agammaglobulinemia with mixed infection due to Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. All three children were cured of their infections.
Body Temperature↗
Ventriculitis caused by Klebsiella pneumoniae successfully treated with pefloxacin in a neonate.
Pefloxacin was applied to a newborn suffering from ventriculitis caused by Klebsiella pneumoniae after failure of routine antibiotics. Treatment was successful. Blood and CSF levels were high, thus documenting good CSF penetration. In addition to this case report, a review of the literature regarding seven neonates with CNS infection treated with fluoroquinolones and from whom CSF levels were obtained, is presented. In conclusion, due to their excellent activity against gram-negative microorganisms, fluoroquinolones may be considered in the treatment of neonatal CNS infections if the pathogen is resistant to routinely used antibiotics. Only limited experience is available with fluoroquinolones in pediatric patients given their potential for cartilage toxicity in young animals.
Cerebral Ventricles↗
Prolonged meningoencephalitis due to Epstein-Barr virus with favorable outcome in a young infant.
We present a case of meningoencephalitis due to EBV in a 2-month-old infant, without mononucleosis, which persisted for more than 5 months. Evidence for persistence of the infection was provided by a convulsive disorder and prolonged CSF pleocytosis, combined with persistent moderate anemia. Despite the persistence of the infection, the child continued to develop normally. This case demonstrates that EBV meningoencephalitis occurring in young patients may present with only subtle clinical findings and may have a favorable prognosis.
Female↗
Decline of hepatitis A antibodies during the first 7 months of life in full-term and preterm infants.
In a previous study we have shown that transplacental transfer of hepatitis A antibodies to preterm infants does not differ from that observed in full-term infants. This follow-up study was designed to investigate the decline of hepatitis A virus (HAV) antibodies during the first 7 months of life in full-term and preterm infants, in an endemic region for hepatitis A. Two hundred and fifty newborn infants--147 full-term and 103 preterm infants--were enrolled. Blood samples from the infants were taken at birth, and at 3 and 7 months of age. Anti-HAV titers were determined by ELISA. A concentration of > or = 1:20 mlU/ml was considered protective. Protective hepatitis A antibodies were present at birth in 48.3% of all full-term and 49.5% of all premature infants. By the age of 7 months only 13% of full-term and 21.7% of preterm infants still had protective titers. For the seropositive full-term infants the geometric mean titers (GMT) were 15,698, 6,107 and 345 at birth, 3 months and 7 months, respectively, and for preterm infants, 10,378, 2,307 and 225 at birth, 3 months and 7 months, respectively. Significant differences in GMT between preterm and full-term infants were found at birth and at 3 months of age (P < 0.05). In a region endemic for hepatitis A, low levels of anti-HAV at 7 months of age may justify trials on infant vaccination since this is the most effective way to eliminate hepatitis A from circulation.
Enzyme-Linked Immunosorbent Assay↗
Dynamics of interleukin-1 production in middle ear fluid during acute otitis media treated with antibiotics.
In an ongoing prospective study, IL-1 concentrations were measured in 78 children (aged 3-36 months) with acute otitis media receiving antibiotics. Middle ear fluid IL-1 concentrations were determined using ELISA kits. Ninety-eight middle ear fluid samples were obtained by tympanocentesis at enrollment (day 1) and 43 samples were collected on days 4-5. Ninety-two pathogens were isolated in 77/98 samples obtained on day 1: 55 Haemophilus influenzae, 34 Streptococcus pneumoniae, 2 Moraxella catarrhalis and 1 Streptococcus pyogenes. Among 37 paired samples initially culture-positive, eradication of the pathogen was achieved on day 4-5 in 20 while pathogens were still present in 17. On day 1, IL-1 was detected in 61/77 (79%) culture-positive samples vs 9/21 (43%) culture-negative ones (P = 0.003). The mean +/- SD middle ear fluid concentration of IL-1 on day 1 was significantly higher in culture-positive (316 +/- 508 pg/ml) than in culture-negative samples (111 +/- 245 pg/ml) (P = 0.01). When paired samples were evaluated, IL-1 decreased on days 4-5 in 13/20 (65%) ears where bacterial eradication was achieved, but also in 11/19 (58%) with persistent or new infection. The mean IL-1 concentrations decreased on days 4-5 in the 20 samples from ears where bacterial eradication was achieved (330 +/- 460 vs 118 +/- 294 pg/ml, P = 0.1) but also in the 17 samples where it was not (465 +/- 660 vs 232 +/- 289 pg/ml, P = 0.02). No significant differences were found between day 1 and days 4-5 in the mean IL-1 concentrations measured in patients with H. influenzae vs S. pneumoniae or concomitant H. influenzae and S. pneumoniae. It was concluded that: 1) IL-1 was detected in the middle ear fluid of most patients with acute otitis media; 2) significantly higher IL-1 concentrations were found in patients with culture-positive than in those with culture-negative acute otits media; 3) IL-1 concentrations decreased on days 4-5 of antibiotic therapy, whether the pathogen was eradicated or not.
Acute Disease↗
Positive blood cultures for coagulase-negative staphylococci in neonates: does highly selective vancomycin usage affect outcome?
The implication of highly-selective vancomycin usage on the outcome for infants with positive blood cultures for coagulase-negative staphylococci (CONS) was assessed retrospectively. The analysis was performed on partly prospective collected data from infants under 3 months of age with a least one CONS-positive blood culture in the neonatal intensive care unit at the Soroka University Medical Center between 1990 and 1996. During the study period, 239 episodes of CONS-positive blood cultures were identified from among 64,226 live births (3.7 per 1,000). Vancomycin was administered in 22 (9%) episodes, in all cases only after identification of the bacteria. The remaining 217 episodes were managed either without antibiotics or with continuation or initiation of empiric antibiotic therapy (usually ceftazidime +/- ampicillin) for suspected sepsis. Severity of the initial illness, subsequent morbidity and mortality were low regardless of the treatment administered. Only a single case of a blood-borne vancomycin resistant gram-positive organism was observed during the study period. The approach to CONS-positive blood cultures in neonates used here was associated with low morbidity and mortality. These findings support a policy of highly selective vancomycin usage in an era of emerging vancomycin resistance.
Anti-Bacterial Agents↗
Hospitalization for primary varicella-zoster virus infection and its complications in patients from Southern Israel.
BACKGROUND: We conducted this study to determine the impact of chickenpox on two different ethnic populations in southern Israel: Jews and Bedouins. METHODS: Hospital records of 113 patients discharged from the Soroka Medical Center with the diagnosis of varicella during a 4.5-year period were reviewed. RESULTS: Mean age was 9.2 years and the average hospital stay was 5.4 days. Bacterial skin or soft tissue infections were the most common complications (30%), followed by pneumonia (17%) and central nervous system complications (11.5%). There were no fatal cases throughout the study period. The calculated hospitalization rate for varicella was one in every 319 cases. Major differences between Jews and Bedouins included an older mean age of Bedouin patients (13.9 years versus 4.5 years); higher hospitalization rate (relative risk [R.R.]: 2.8, 95% confidence interval: 1.9-4.2), and higher risk for complicated varicella (R.R.: 2.1, 95% confidence interval: 1.3-3.4). CONCLUSION: Hospitalization of patients with varicella in southern Israel is common and varicella infection in Bedouins is associated with greater morbidity compared with that in Jews in southern Israel.
Adolescent↗
Placental transfer of maternal poliovirus antibodies in full-term and pre-term infants.
This study was designed to investigate the placental transfer of maternal poliovirus antibodies in full-term and pre-term infants. Two hundred healthy, Israeli born mothers and their infants, were enrolled immediately after birth. The study population comprised two groups: a full-term group of 150 mothers and their infants, and a pre-term group of 50 mothers and their infants (gestational age < 35 weeks). Maternal and umbilical cord blood samples were taken in all cases. Antibody titers against the three poliovirus serotypes and a polio virus type 1 strain that caused an outbreak in 1988 (epidemic strain 1) were measured by a microneutralization system. The proportion of individuals with protective titers against each of the poliovirus types tested was slightly lower in the infants compared with their mothers. When protection to all strains combined was tested, the difference between mothers and infants was significant (P < 0.05). Transplacental transfer to epidemic strain 1 was less effective--12% of the premature infants were not protected against it at birth. The geometric mean titers against poliovirus types 1, 3 and epidemic type 1 strain were significantly lower in the pre-term group than in the full-term group. In both the full-term and pre-term groups there were significant linear correlations between the maternal and neonatal antibody titers for each of the polio viruses tested. For all poliovirus types, the transfer of maternal antibodies to the full-term infant was significantly higher than the transfer of maternal antibodies to the pre-term infant (P < 0.001). Owing to diminished transfer of maternal antibodies, pre-term infants are at greater risk of poliovirus infection.
Adult↗
A program of outpatient parenteral antibiotic therapy for serious pediatric bacterial infections.
A program set up in the Soroka University Medical Center, Beer Sheva, Israel, offers outpatient parenteral antibiotic therapy (OPAT) for children with serious bacterial infections. The following criteria must be met before a child is placed in this program: OPAT must be a suitable form of treatment for the infection, an appropriate drug must be available, the parents must be cooperative and well-informed, and 24-hour-a-day telephone communication and transportation between the home and hospital must be available. With use of ceftriaxone administered im, the OPAT program has shown positive results: a cure rate of 98.5% and an estimated savings of 1,334 hospital days for 140 patients over a 17-month period.
Adolescent↗
Neutralizing antibodies to non-polio enteroviruses in human immune serum globulin.
Neutralizing antibodies to selected non-polio enteroviruses were found in three lots of human immune serum globulin (ISG) prepared from the sera of persons from different geographic regions. Reciprocal titers to coxsackieviruses B3 and B4 ranged from 400 to greater than or equal to 2000, whereas titers to coxsackievirus A9 and ECHO viruses 5 and 9 ranged from 100 to 400 in all three lots of ISG. The presence of neutralizing antibodies to commonly occurring (coxsackieviruses B1 to B5 and A9 and ECHO viruses 3, 4 and 9) and infrequently encountered (ECHO viruses 5 and 13) serotypes, coupled with the increasing evidence that antibodies are an important factor in preventing illness, support recommending the administration of ISG to those at high risk for serious disease.
Antibodies↗
Influenza A virus infection imitating bacterial sepsis in early infancy.
Clinical and laboratory data of 12 previously healthy infants under 3 months of age hospitalized for suspected sepsis and subsequently diagnosed as suffering from influenza A viral infection were obtained prospectively during two epidemics of influenza A/Bangkok/H3N2 epidemics. The onset of the illness was generally acute, and the infants presented with high fever, lethargy often alternating with irritability, anorexia and signs of upper respiratory tract infection. History of contact with at least one person with signs and symptoms consistent with viral disease was present in all infants. White blood cell counts were within normal limits. Only one child had pneumonia and all had normal cerebrospinal fluid findings. Viral diagnosis was made by immunofluorescent testing of nasopharyngeal specimens within several hours of admission in 7 of the 9 infants tested and was isolated within 5 days from admission in 6 of 10 infants. Increasing awareness of the possible viral etiology of acute fever along with a greater availability of rapid viral diagnosis should result in better management of these young infants.
Acute Disease↗
Severe diffuse adenovirus 7a pneumonia in a child with combined immunodeficiency: possible therapeutic effect of human immune serum globulin containing specific neutralizing antibody.
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Adenoviridae Infections↗
In vitro activity of novel fluoroquinolones against Streptococcus pneumoniae isolated from children with acute otitis media.
BACKGROUND: In recent years, novel fluoroquinolones with improved activity against gram-positive organisms have been introduced into clinical practice. These drugs may be of potential benefit for the treatment of pneumococcal otitis media, including infections caused by organisms resistant to conventional drugs. METHODS: In vitro activity of 6 fluoroquinolones against 77 pneumococcal isolates from middle-ear fluid was determined by the E test. RESULTS: Resistance to penicillin, co-trimoxazole, erythromycin, clindamycin, and tetracycline was present in 59 (76.6%), 47 (61.0%), 19 (24.7%), 11 (14.3%), and 17 (22.1%) isolates, respectively. Fluoroquinolone MIC(50) and MIC(90) (in microg/ml) were as follows: ciprofloxacin: 1.0 and 3.0, levofloxacin: 0.75 and 1.0, sparfloxacin: 0.25 and 0.38, grepafloxacin: 0.25 and 0.38, trovafloxacin: 0.094 and 0.125, and moxifloxacin: 0.19 and 0.25, respectively. CONCLUSIONS: Novel fluoroquinolones and especially trovafloxacin and moxifloxacin appear to be of potential value for the treatment of acute otitis media caused by pneumococci resistant to traditional antibiotics.
Anti-Infective Agents↗
Development of a chemiluminescent optical fiber immunosensor to detect Streptococcus pneumoniae antipolysaccharide antibodies.
A chemiluminescent-based optical fiber immunosensor was developed for the detection of antipneumococcal antibodies. This was accomplished by developing a different chemical procedure utilizing 3-aminopropyl trimethoxysilane and cyanuric chloride to conjugate pneumococcal cell wall polysaccharides to the optical fiber tips, and by improving the sensitivity of the photodetection system. The lowest titer of antipneumococcal antibodies detected by the optical fiber was at a 1:819,200 dilution. The lowest corresponding value by standard enzyme-linked immunosorbent assay was at a 1:98,415 dilution. It was concluded that the optical immunosensor system is an accurate and sensitive method to detect antipneumococcal antibodies and may be an adequate tool to monitor antibodies in specimens such as saliva and urine.
Antibodies↗
Population-based study of invasive Kingella kingae infections.
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Adult↗