Invasive Pseudomonas infection in two healthy children following prolonged bathing.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
S S Long
Publications and source records attributed to S S Long.
Simultaneous administration of a diphtheria and tetanus toxoids and acellular pertussis vaccine with measles-mumps-rubella and oral poliovirus vaccines.
OBJECTIVE: To compare the safety and immunogenicity of Lederle Laboratories' (Pearl River, NY) diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine with diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine when administered simultaneously with measles-mumps-rubella (MMR) vaccine and trivalent oral poliovirus (OPV) vaccine at 15 to 16 months of age. DESIGN: Randomized and double-blind. SETTING: Two general pediatric practices. PARTICIPANTS: Ninety-seven infants, aged 15 to 16 months, who had received three previous DTwP immunizations. SELECTION PROCEDURES AND INTERVENTIONS: Healthy children received the DTaP or DTwP vaccine. Infants received the MMR vaccine at a separate site and the OPV vaccine concurrently. Blood was obtained on day 0 and at 6 weeks. Adverse events were recorded by parents at specified times after immunization. MEASUREMENTS/RESULTS: Within 3 days of immunization, DTaP vaccine recipients had less fever, drowsiness, and irritability (P = .01, .04, .01, respectively). They also experienced less tenderness, erythema, and induration (.001, .001, and .002, respectively). There was no difference in the frequency of adverse reactions 6 to 14 days after immunization. Enzyme-linked immunosorbent assays were used to determine all antibody values. Antibody responses to filamentous hemagglutinin and pertussis toxoid were significantly greater in the DTaP group (P = .0001 and .02, respectively). Immune responses to the other measured antigens were similar. CONCLUSIONS: Simultaneous administration of the Lederle DTaP with MMR and OPV vaccines did not interfere with antibody response to pertussis antigens measured or measles, mumps, or rubella viruses and was associated with fewer local and systemic adverse events during the first 3 days following immunization when compared with the simultaneous administration of the DTwP, OPV, and MMR vaccines. We conclude that the DTaP vaccine can be administered at 15 months of age concurrently with the MMR and OPV vaccines.
Anorexia↗
Antibody persistence four years after primary immunization of infants and toddlers with Haemophilus influenzae type b CRM197 conjugate vaccine.
Explore the source record for details and available documents.
Antibodies, Bacterial↗
Prolonged bacteremia with catheter-related central venous thrombosis.
Infection of a central venous thrombus is a serious but rarely recognized complication of the use of central venous catheters in children. We report the cases of seven children with persistent bacteremia or fungemia in which central venous thrombosis was demonstrated by ultrasonography after removal of the catheter. All patients had signs and symptoms of infection, but only one had clinical evidence of central venous stasis. Bacteremia persisted from 6 to 35 days. Infection did not resolve in any patient prior to catheter removal, and five patients had positive blood cultures for 5 or more days after removal of the catheter. Six patients, including all who survived, were treated parenterally with antibiotics for more than 28 days. Two patients died; neither death was directly attributable to infection. Central venous thrombosis should be suspected in patients with persistent catheter-related bacteremia. Optimal treatment of this problem is not yet known.
Adolescent↗
Impact of treatment guidelines on use of ribavirin.
During the 1987 through 1988 seasonal peak of respiratory syncytial virus (RSV), 177 courses of ribavirin were administered at St Christopher's Hospital for Children, a tertiary care medical center in Philadelphia, Pa. Charts were reviewed on 100 treated patients with proved or suspected RSV disease to determine adherence to American Academy of Pediatrics treatment guidelines. Ninety-four percent fulfilled criteria for the risk of significant morbidity: cardiac, pulmonary, or immunodeficiency conditions (38%); an age of 6 weeks or younger (35%); or severe illness (21%). Severe illness was defined as hypoxemia, hypercapnia, or marked tachypnea. Of those treated because of underlying conditions, 71% had RSV documented, as did 71% of patients aged 6 weeks or younger and 81% of patients with severe disease. A study of 80 consecutive patients who were hospitalized with illness compatible with RSV infection revealed that 56% of patients were treated with ribavirin. Adherence to guidelines led to ribavirin use in half of the hospitalized patients with suspected RSV infection. The majority of these patients received therapy because of underlying conditions or very young age.
Drug Prescriptions↗
Widespread silent transmission of pertussis in families: antibody correlates of infection and symptomatology.
Four children with pertussis and their 18 family members were subjects of a 1-year study to detect infection and antibody responses to Bordetella pertussis. Attack rate for pertussis infection in contacts was 83%. Two-thirds of cases in these immunized contacts were subclinical. All infected family contacts had diagnostically elevated serologic tests for pertussis at the time the index case was diagnosed. Culture identified only 20% of infected contacts. Infected individuals had a mean of 5.5 of 10 antibody tests diagnostic for recent infection. ELISA assay for IgG to pertussis toxin and assay for IgA to filamentous hemagglutinin on serum and nasal secretions were the most discriminating diagnostic tests. Index cases and immunized contacts had different type and timing of antibody responses, making a single assay or sampling unable to identify all infected individuals. Symptomatic infection was characterized by higher magnitude of pertussis toxin antibody response and asymptomatic infection by filamentous hemagglutinin. After pertussis immunization, immunity to disease is greater than is protection from infection.
Antibodies, Bacterial↗
Serologic evidence of subclinical pertussis in immunized children.
Incidental to a vaccine study involving 783 immunized children conducted at two study sites, inner city children had significantly higher geometric mean pertussis agglutinin titers compared with suburban children just before the fourth dose of diphtheria-tetanus-whole cell pertussis vaccine (47 vs. 25; P less than 0.001). Higher titers in the inner city were correlated with residence in census tracts where cases of pertussis were reported. Three hundred thirty-two children in a placebo arm of the study who were clinically observed and had paired serum samples taken during a 2- to 4-month period were analyzed for evidence of natural Bordetella infection. Twelve (11%) inner city children and three (1.3%) suburban children had spontaneous 4-fold or greater rises in at least two different pertussis antibodies measured (agglutinin, antitoxin or enzyme-linked immunosorbent assay for IgG to pertussis toxin, IgG and IgA to filamentous hemagglutinin). Eighty percent of these children had IgA to filamentous hemagglutinin. Nine of 12 inner city children with serologic evidence of pertussis lived within 6 blocks of a case of pertussis reported within 1 month of the observed antibody rise in study subjects; none had a household member with pertussis and none had symptomatic disease.
Agglutination Tests↗
Longitudinal study of adverse reactions following diphtheria-tetanus-pertussis vaccine in infancy.
A prospective study of immunogenicity and adverse effects of 1553 doses of diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP) was performed in 538 children observed longitudinally from 2 months to 20 months of age. Subjects were randomized to the standard four-dose immunization schedule or to a three-dose schedule (with a saline injection substituted for DTP at 6 months of age). The three-dose schedule could not be recommended on the basis of serologic data. Compliance for completing a clinical observation form in the 48 hours following injections was greater than 99%. Fever, local reactions, or adverse behavioral effects were described in association with 96% of DTP doses and 36% of placebo injections. Contraindications to DTP immunization developed in 3% of study children. No convulsion, hypotonic hyporesponsive episode, encephalopathy, or temperature greater than 40.5 degrees C occurred. Behavioral and local inflammatory effects occurred maximally in the first 6 hours following vaccine but fever peaked later. There was no interrelationship between occurrence of local reaction and fever. Data suggest that age has more effect on the type and rate of adverse clinical events than does vaccine dose number. Existing antibody levels to vaccine components, lot of vaccine, breast-feeding, or gestational age did not affect rate or type of clinical reactions. Neither occurrence of reactions nor the use of acetaminophen affected antibody response to vaccine.
Acetaminophen↗
Outbreak of pertussis in a residential facility for handicapped people.
An outbreak of pertussis was recognized and investigated in a home for neurologically impaired people. Of 66 residents, 44 (67%) had evidence of recent pertussis infection, although only 12 (27%) had respiratory symptoms. Pertussis was diagnosed by culture, direct fluorescent antibody testing of nasal secretions, agglutinating antibody titer, pertussis antitoxin titer, IgG antibody to pertussis toxin, IgA antibody to pertussis toxin, IgA antibody to filamentous hemagglutinin, or IgG antibody to filamentous hemagglutinin. No single test identified more than 66% of people with pertussis. Of those with positive serologic findings, 95% had a positive test result for IgA antibody to filamentous hemagglutinin or for IgG antibody to pertussis toxin or for both. Pertussis occurred in both immunized and unimmunized residents. Seven carriers were identified; these residents had positive cultures or positive direct fluorescent antigen test results but negative serologic findings. Treatment of residents and caretakers with erythromycin halted the outbreak.
Adolescent↗
Simultaneous administration of measles-mumps-rubella vaccine with booster doses of diphtheria-tetanus-pertussis and poliovirus vaccines.
The safety and efficacy of simultaneous administration of measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), and trivalent oral poliovirus (OPV) vaccines in a test group of 405 children were compared with the safety and efficacy of sequential administration of the same vaccines in a control group of 410 children given MMR followed by booster doses of DTP and OPV 2 months later. The study was double blind and placebo controlled with respect to DTP and OPV. Seroconversion rates to measles, mumps, and rubella exceeded 96% in both groups. Geometric mean titers to measles (P = .05) and rubella (P = .004) were higher in the test group, and titers of antibodies to the other seven antigens were similar in both groups. Clinical reaction data were analyzed in 248 of 405 test children and 249 of 410 control children. The rates of serious vaccine-associated reactions were low and similar in the two groups. Some minor side effects were reported more frequently in the test group, but these differences were judged to be related to study design rather than to differences in the safety of the two vaccine schedules. The results indicate that the safety and serologic efficacy of administering MMR simultaneously with reinforcing doses of DTP and OPV in the second year of life is equivalent to the safety and efficacy observed after administering these antigens separately.
Antibodies↗
Effect of imipenem-cilastatin therapy on fecal flora.
Alteration of fecal flora was prospectively studied in 21 children receiving imipenem-cilastatin therapy under protocol for therapy of infections. Although no profound reduction in facultative or anaerobic flora was observed, qualitative and quantitative increases in organisms which were resistant or less susceptible to imipenem occurred. Of 21 patients, 13 (62%) had increases in counts of Enterococcus spp. of at least 10(3) organisms per g (wet weight) of stool, and 7 (33%) had acquisition of or similar increases in counts of Candida species. No change in susceptibility of isolates to imipenem was demonstrable during therapy. However, the MICs for 50 and 90% of the strains of Enterococcus spp. (2 and 8 micrograms/ml, respectively) were higher than those previously reported.
Adolescent↗
Clostridium difficile in patients with cystic fibrosis.
One hundred seven patients with cystic fibrosis (CF) and 54 other patients with risk factors for Clostridium difficile-associated disease were entered into a bacteriologic study to compare the rate of recovery of C difficile and cytotoxin in feces with occurrence of diarrhea and to investigate potentially protective or permissive relationships of fecal flora. Toxigenic C difficile was recovered from 22% of CF patients and 11% of patients with other diagnoses. Unlike the latter group, the majority (12/15) of CF patients who had cytotoxin recovered had formed stools and no history of diarrhea. Explanations for the lack of symptoms are speculative. Stool flora of CF patients was significantly more likely to include several bacteria with known inhibitory effects on C difficile. Recovery of C difficile and cytotoxin, however, was not associated with the decrease in rate of recovery or the mean bacterial count of any bacterium of fecal flora.
Adolescent↗
Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania.
Forty-four cases of botulism occurred in infants in Southeastern Pennsylvania between 1976 and 1983. Forty-three were caused by Clostridium botulinum type B. Progressive weakness necessitated ventilatory support in 39 infants. Complications during hospitalization included otitis media in 13 patients and aspiration pneumonia in 11. Eight infants developed the syndrome of inappropriate secretion of antidiuretic hormone and two developed adult respiratory distress syndrome. One infant died of progressive bradycardia despite adequate control of ventilation. Manifestations of autonomic nervous system dysfunction recognized on admission to the hospital were constipation, distention of the urinary bladder, and decreased salivation and tearing. During hospitalization, some infants had unexpected fluctuations of skin color, blood pressure, and heart rate. Infants' strength improved despite persistent intestinal elaboration of toxin. C botulinum was isolated from seven of nine home or work environments sampled. All 44 infants were white and were receiving breast milk at the time of onset of symptoms. The majority had first feedings of nonhuman food substances within 4 weeks prior to onset of symptoms. Delineation of fecal flora in seven infants revealed predominance of enterobacteriaceae. Perturbations of intestinal flora during infancy, especially at weaning, may cause transient permissiveness to colonization by C botulinum.
Botulinum Toxins↗
Epidemiologic study of infant botulism in Pennsylvania: Report of the Infant Botulism Study group.
The majority of the almost 400 confirmed cases of infant botulism in the United States have occurred in California, Pennsylvania, and Utah. In Pennsylvania, 44 of 53 (83%) cases occurred within a geographic area of Southeastern Pennsylvania which represents one tenth of the Commonwealth's area and one third of the population at risk for infant botulism. In Southeastern Pennsylvania, a map of the residences of cases circumscribes a discrete ring around Philadelphia. A case-control study performed to seek host-related risk factors, identifies the significant associations of botulism with infants who are white, breast-fed, and born at term into two-parent families with hospitalization insurance. County control studies were performed to identify differences in host-related factors between areas of high and low prevalence of botulism. Although some "protection" could be afforded Philadelphia infants by their feeding and family characteristics, the differences in case rates between Philadelphia and the botulism "ring counties" cannot be explained entirely by host-related factors. Further, the absence of botulism in counties just outside of the botulism "ring," where infants were found to have identical potential risk factors, suggests that an uneven distribution of botulinal spores in the environment is the most significant determinant of case rate.
Botulism↗
Clostridium difficile cytotoxin in a pediatric population.
Assays for cytotoxin of Clostridium difficile were performed on stool samples submitted to the laboratory for routine microbiologic study. Cytotoxin was recovered from 8.6% of 208 pediatric patients studied. Cytotoxin was identified significantly more often in younger patients (median age, 11 months) and in those with hospital-associated illness (17%) and antibiotic-associated illness (18%). Hospitalization and antibiotic use were significant independent risk factors. Clinical diagnoses in patients with C difficile cytotoxin included classic pseudomembranous colitis, acute self-resolving diarrheal syndrome, chronic diarrhea with failure to thrive, infant botulism, and asymptomatic carriage.
Adolescent↗
Herpetic whitlow. Epidemiology, clinical characteristics, diagnosis, and treatment.
Herpetic whitlow is a herpes simplex virus infection of a distal phalanx. It is characterized by pain, swelling, erythema, and nonpurulent vesicle formation. Herpetic whitlow follows direct inoculation (exogenous or autogenous) or reactivation of latent virus. In children, it most frequently occurs following a primary oral herpes infection. In adolescents, herpetic whitlow is commonly associated with genital herpes infections. In adults, it frequently occurs in medical personnel who have contact with patients' oral secretions or is associated with genital herpes infections. The diagnosis of herpetic whitlow is readily confirmed by Tzanck test and culture. It is important to distinguish herpetic whitlow from bacterial felon or paronychia, as herpetic whitlow is a self-limited infection for which surgical incision is not indicated. We described herpetic whitlow in five children, one adolescent, and two pediatric residents.
Adolescent↗
Treatment of acute pneumonia in infants and children.
Explore the source record for details and available documents.
Acute Disease↗