Asunto(s)
Vacunas Bacterianas , Infecciones Neumocócicas/prevención & control , Vacunas Conjugadas , Formación de Anticuerpos , Vacunas Bacterianas/inmunología , Niño , Preescolar , Infecciones por Haemophilus/epidemiología , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae tipo b , Humanos , Incidencia , Lactante , Otitis Media/prevención & control , Infecciones Neumocócicas/epidemiología , Neumonía Neumocócica/epidemiología , Neumonía Neumocócica/prevención & control , Estados Unidos/epidemiología , Vacunas Conjugadas/inmunologíaRESUMEN
Vitamin A administered to children infected with the human immunodeficiency virus before influenza vaccination in a double-blind randomized study did not enhance vaccine serologic responses but did dampen the increase in the human immunodeficiency virus viral load 14 days after immunization (vitamin A, decrease of 0.13 +/- 0.09 log(10) copies/mL; placebo, increase of 0.14 +/- 0.08, P =.02).
Asunto(s)
Anticuerpos Antivirales/efectos de los fármacos , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1 , Virus de la Influenza A/inmunología , Virus de la Influenza B/inmunología , Vacunas contra la Influenza/inmunología , Carga Viral , Vitamina A/administración & dosificación , Adolescente , Anticuerpos Antivirales/sangre , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Masculino , Factores de Tiempo , Vacunas de Productos Inactivados/inmunologíaRESUMEN
OBJECTIVES: To describe the presentation, clinical course, therapeutic response, and long-term follow-up of patients with a syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). STUDY DESIGN: Patients with PFAPA (n = 94) referred over a 10-year period completed a registry form and provided medical records. Follow-up telephone calls were made in late 1997 to determine the persistence of episodes and sequelae. RESULTS: PFAPA episodes lasted 4.8 days (95% confidence interval 4.5 to 5.1) and recurred every 28 days (confidence interval 26 to 30), with a maximal temperature of 40.5 degrees C (confidence interval 40. 4 degrees to 40.6 degrees ). Of the 83 children available for follow-up, 34 no longer had episodes. In the remainder the episodes did not differ in character but recurred less frequently over time. The affected children had no long-term sequelae. Glucocorticoids were highly effective in controlling symptoms. Tonsillectomy and cimetidine treatment were associated with remission in a small number of patients. CONCLUSIONS: PFAPA is a not uncommon cause of periodic fever in children. In some children the syndrome resolves, whereas symptoms in others persist. Long-term sequelae do not develop. The syndrome is easily diagnosed when regularly recurring episodes of fever are associated with aphthous stomatitis, pharyngitis, or cervical adenitis.
Asunto(s)
Fiebre Mediterránea Familiar , Fiebre , Linfadenitis , Faringitis , Estomatitis Aftosa , Edad de Inicio , Preescolar , Fiebre Mediterránea Familiar/diagnóstico , Fiebre Mediterránea Familiar/fisiopatología , Fiebre Mediterránea Familiar/terapia , Femenino , Fiebre/diagnóstico , Fiebre/fisiopatología , Fiebre/terapia , Estudios de Seguimiento , Humanos , Linfadenitis/diagnóstico , Linfadenitis/fisiopatología , Linfadenitis/terapia , Masculino , Faringitis/diagnóstico , Faringitis/fisiopatología , Faringitis/terapia , Estomatitis Aftosa/diagnóstico , Estomatitis Aftosa/fisiopatología , Estomatitis Aftosa/terapia , SíndromeAsunto(s)
Antibacterianos/uso terapéutico , Prescripciones de Medicamentos , Resistencia a las Penicilinas , Infecciones Neumocócicas/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Streptococcus pneumoniae/efectos de los fármacos , Antibacterianos/efectos adversos , Cefalosporinas/administración & dosificación , Cefalosporinas/efectos adversos , Niño , Preescolar , Utilización de Medicamentos , Humanos , Lactante , Pruebas de Sensibilidad Microbiana , Infecciones Neumocócicas/microbiología , Infecciones del Sistema Respiratorio/microbiologíaRESUMEN
OBJECTIVE: To determine the nasopharyngeal colonization rate of penicillin-susceptible and penicillin-resistant strains of Streptococcus pneumoniae in young children, and to assess its relationship with the incidence of otitis media. DESIGN: Observational study in 215 children younger than 6 years of age who received care in the Vanderbilt Vaccine Clinic from September 1, 1992, to August 31, 1993. RESULTS: Of 842 nasopharyngeal cultures obtained, results for 44% of the cultures were positive for S. pneumoniae; 73% of the isolates were serotypes 6, 14, 19, or 23. Younger children had significantly higher rates of pneumococcal colonization than older children, with a peak at 1 year of age. By microdilution susceptibility testing, 37% of the cultures with positive results were intermediately or highly resistant to penicillin. Significantly more serotype 19 and 23 isolates were penicillin resistant than organisms of other serotypes. Children younger than 2 years of age had a twofold higher percentage of resistant isolates than those older than 2 years of age. A significant association was noted between nasopharyngeal carriage of S. pneumoniae and acute otitis media (p = 0.0002); however, the incidence of acute otitis media did not differ significantly between children colonized with penicillin-susceptible or penicillin-resistant strains. Unresolved otitis media was diagnosed more often in children who were colonized with resistant organisms than in children colonized with susceptible strains (p = 0.04). CONCLUSIONS: There was a high rate of nasopharyngeal carriage of penicillin-resistant S. pneumoniae in this population of young children. Nasopharyngeal colonization was associated with an increased incidence of acute otitis media, and penicillin resistance was associated with an increased incidence of unresolved otitis media.
Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Otitis Media/etiología , Penicilinas/uso terapéutico , Infecciones Estreptocócicas/complicaciones , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pneumoniae/patogenicidad , Enfermedad Aguda , Preescolar , Humanos , Lactante , Nasofaringe/microbiología , Otitis Media/diagnóstico , Serotipificación , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
The safety and immunogenicity of primary immunization at 2, 4 and 6 months of age with Haemophilus influenzae type b capsular polysaccharide conjugated to tetanus toxoid (PRP-T; Act-HIB) were evaluated in infants in Valencia, Venezuela. In order better to assess reactions to PRP-T, subjects received their initial PRP-T vaccine a mean of 6.5 days after their initial diphtheria-tetanus-pertussis (DTP) vaccine. The PRP-T vaccine was well tolerated. Serum was obtained at ages 2 and 7 months (before the first and 1 month after the third PRP-T dose). Antibody responses were compared with those from Nashville infants who had received PRP-T and DTP simultaneously in a previous trial. The preimmunization titers in the Venezuelan and Nashville infants did not differ. The geometric mean postimmunization titer in the Venezuelan infants was 37.9 micrograms/ml, as compared with 3.63 micrograms/ml in the Nashville infants (P < 0.00001). Possible explanations for the exceptional antibody response of these Venezuelan infants to PRP-T include carrier priming caused by prior DTP immunization, synergy associated with the specific DTP vaccine used, preimmunization immunologic experience that differed from their United States counterparts and genetic differences that altered response to the vaccines. Further studies are proposed to evaluate these possibilities.
Asunto(s)
Anticuerpos Antibacterianos/biosíntesis , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae/inmunología , Toxoide Tetánico/inmunología , Vacunación , Vacunas Conjugadas/inmunología , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Femenino , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/efectos adversos , Humanos , Esquemas de Inmunización , Lactante , Masculino , Serología , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/efectos adversos , Estados Unidos , Vacunación/efectos adversos , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/efectos adversos , VenezuelaRESUMEN
Children primed with one of four conjugate Haemophilus influenzae type b vaccines received booster immunization with their primary vaccine or with polyribosylribitol phosphate conjugated with diphtheria toxoid. The latter vaccine produced postbooster antibody levels that equaled or exceeded those produced by boosting with the original vaccine, and thus may be used as a booster irrespective of the original vaccine.
Asunto(s)
Proteínas de la Membrana Bacteriana Externa/inmunología , Vacunas Bacterianas/inmunología , Toxoide Diftérico/inmunología , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus , Haemophilus influenzae/inmunología , Inmunización Secundaria , Polisacáridos Bacterianos/inmunología , Vacunas Sintéticas/inmunología , Anticuerpos/análisis , Humanos , Lactante , Toxoide Tetánico/inmunologíaRESUMEN
We performed a double-blind, randomized trial to compare the immunogenicity and reactogenicity of four conjugate Haemophilus influenzae type b vaccines given to infants 2, 4, and 6 months of age. Adverse reactions attributable to the vaccines were few and minor. The rates of systemic reactions did not differ among the various vaccines and were similar to those seen among children receiving conventional diphtheria-tetanus-pertussis vaccine. However, the four conjugate H. influenzae type b vaccines differed markedly in ability to stimulate antibody production. Mean antibody levels after three injections of polyribosylribitol phosphate conjugated with mutant diphtheria protein (PRP-CRM) or polyribosylribitol phosphate conjugated with tetanus toxoid (PRP-T) were 3.08 micrograms/ml and 3.64 micrograms/ml, respectively, significantly higher than those after the use of polyribosylribitol phosphate conjugated with outer-membrane protein of Neisseria meningitidis (PRP-OMP) (1.14 micrograms/ml) or polyribosylribitol phosphate conjugated with diphtheria toxoid (PRP-D) (0.28 microgram/ml). Only PRP-OMP produced a clinically pertinent elevation in antibody level after two injections (0.84 microgram/ml); the third injection of PRP-OMP produced a modest but statistically significant further elevation in mean antibody level (1.14 micrograms/ml). Only 29% of infants receiving PRP-D had antibody levels of 1 micrograms/ml, compared with 55%, 75%, and 83% of those receiving PRP-OMP, PRP-CRM, and PRP-T, respectively. We conclude that all four vaccines are safe and that all but PRP-D appear appropriate for use in a primary immunization series during infancy. The unique serologic response to PRP-OMP offers both advantages and disadvantages in comparison with PRP-CRM and PRP-T.
Asunto(s)
Vacunas Bacterianas/inmunología , Vacunas contra Haemophilus , Haemophilus influenzae/inmunología , Formación de Anticuerpos , Proteínas de la Membrana Bacteriana Externa/efectos adversos , Proteínas de la Membrana Bacteriana Externa/inmunología , Proteínas Bacterianas/efectos adversos , Proteínas Bacterianas/inmunología , Vacunas Bacterianas/efectos adversos , Toxoide Diftérico/efectos adversos , Toxoide Diftérico/inmunología , Método Doble Ciego , Ensayo de Inmunoadsorción Enzimática , Humanos , Lactante , Polisacáridos Bacterianos/efectos adversos , Polisacáridos Bacterianos/inmunología , Radioinmunoensayo , Toxoide Tetánico/efectos adversos , Toxoide Tetánico/inmunología , Vacunas SintéticasRESUMEN
A syndrome of periodic fever that resembles human cyclic neutropenia in its clinical presentation has been identified in 12 children observed at two major referral centers. Attacks characterized by abrupt onset of fever, malaise, chills, aphthous stomatitis, pharyngitis, headache, and tender cervical adenopathy occur at 4- to 6-week intervals over periods of years. These episodes of illness resolve spontaneously in 4 to 5 days. Mild leukocytosis and elevation of the erythrocyte sedimentation rate during attacks are the only laboratory abnormalities. Affected children grow normally, are not unusually susceptible to infection, and exhibit no long-term sequelae. Attacks may be aborted by short courses of prednisone but do not respond to nonsteroidal anti-inflammatory agents. This syndrome is sporadic and appears to be much more common than cyclic neutropenia.