RESUMEN
We report a previously healthy 14-month-old boy who developed community-acquired Acinetobacter baumannii meningitis. He had no history of immunodeficiency, and was brought to Konan Kosei Hospital with a high fever and vomiting. His consciousness was clear, but neck stiffness was noted. Examination of the cerebrospinal fluid (CSF) revealed a cell count of 10 112/microl; protein, 216 mg/dl; and glucose, 9 mg/dl. A CSF test kit for bacterial capsular antigens (Pastorex Meningitis; Bio-Rad Laboratories) was positive for Haemophilus influenzae type b antigen. On day 3 of admission, the microorganism isolated by CSF culture was identified as A. baumannii. Therefore, his treatment was changed to meropenem hydrate from the initial therapy with panipenem/betamipron and ceftriaxone sodium hydrate. Because the CSF cell count remained elevated, meropenem hydrate was administered for a total of 19 days. The meningitis resolved with no sequelae.
Asunto(s)
Infecciones por Acinetobacter/diagnóstico , Acinetobacter baumannii/aislamiento & purificación , Meningitis Bacterianas/diagnóstico , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/inmunología , Antígenos Bacterianos/inmunología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Reacciones Cruzadas , Haemophilus influenzae tipo b/inmunología , Haemophilus influenzae tipo b/aislamiento & purificación , Humanos , Lactante , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/microbiología , Resultado del TratamientoRESUMEN
A live attenuated varicella vaccine, the Oka vaccine strain (vOka), is routinely administered to children in Japan and other countries, including the United States. vOka consists of a mixture of genotypically distinct variants, but little is known about the growth potential of each variants in vivo. We isolated varicella-zoster virus (VZV) DNA sequences from the peripheral blood mononuclear cells (PBMCs) of asymptomatic healthy children immunized with the Oka varicella vaccine. VZV gene 62 DNA fragments were detected in 5 of 166 (3.0%) PBMC samples by nested PCR within 5 weeks of the vaccination. Sequence analysis of VZV DNA from these five PBMC samples indicated that multiple viral clones in the vaccine could infect vaccinees and replicate in vivo. We also provide evidence that a nonsynonymous substitution at position 105356 may affect viral replication in vivo.
Asunto(s)
Vacuna contra la Varicela/administración & dosificación , Varicela/virología , Herpesvirus Humano 3/genética , Proteínas Inmediatas-Precoces/genética , Leucocitos Mononucleares/virología , Análisis de Secuencia de ADN , Transactivadores/genética , Proteínas del Envoltorio Viral/genética , Secuencia de Aminoácidos , Sustitución de Aminoácidos , Anticuerpos Antivirales/sangre , Secuencia de Bases , Varicela/inmunología , Varicela/fisiopatología , Varicela/prevención & control , Niño , Herpesvirus Humano 3/crecimiento & desarrollo , Herpesvirus Humano 3/aislamiento & purificación , Herpesvirus Humano 3/patogenicidad , Humanos , Proteínas Inmediatas-Precoces/química , Inmunización , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , Transactivadores/química , Proteínas del Envoltorio Viral/química , Replicación ViralRESUMEN
We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 +/- 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 +/- 2.0 years) received amoxicillin. There were no significant between-group differences in age, sex, or symptoms. Eradication was confirmed in 99% (102/103) of the cefditoren-pivoxil group and 100% of the amoxicillin group. Recurrence within 4 weeks occurred in 8 and 15 patients in the cefditoren-pivoxil and amoxicillin groups, respectively, showing no significant difference in the recurrence rate, and all isolates had the same serotypes as before. There were no clinically significant adverse reactions or complications. The 50%/90% minimum inhibitory concentrations (microg/ml) of cefditoren-pivoxil and amoxicillin for the 258 isolates were < or =0.03/< or =0.03 and < or =0.03/0.06, respectively, so all isolates were susceptible to both agents. Because the efficacy for pediatric group A streptococcus pharyngotonsillitis was similar between oral cefditoren-pivoxil for 5 days and amoxicillin for 10 days, the shorter treatment period may make the former regimen preferable.
Asunto(s)
Amoxicilina/administración & dosificación , Antibacterianos/administración & dosificación , Cefalosporinas/administración & dosificación , Faringitis/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes/efectos de los fármacos , Tonsilitis/tratamiento farmacológico , Niño , Preescolar , Esquema de Medicación , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Servicio Ambulatorio en Hospital , Faringitis/microbiología , Estudios Prospectivos , Recurrencia , Serotipificación , Streptococcus pyogenes/clasificación , Tonsilitis/microbiología , Resultado del TratamientoRESUMEN
We evaluated a kit for the rapid diagnosis of Mycoplasma pneumoniae infection and investigated the antimicrobial susceptibility of the isolates. A total of 194 otherwise healthy children, aged 0.3-14.9 years, were diagnosed as having pneumonia by chest X-ray findings between December 2003 and November 2004, and were admitted to Showa Hospital. Isolation of M. pneumoniae was attempted from a throat swab obtained on admission, and the complement fixation titer was measured in paired serum samples obtained at admission and at the convalescent stage. We also used a rapid diagnosis kit (ImmunoCard Mycoplasma) for the detection of specific immunoglobulin M antibody in paired sera. Pneumonia due to M. pneumoniae was defined by isolation of this microorganism, or by seroconversion, or a >or=4-fold increase in the antibody titer. Using each isolate, we determined the minimum inhibitory concentrations for five antimicrobial agents by the broth dilution method. M. pneumoniae pneumonia was diagnosed in 45 children (23.2%). The ImmunoCard had a sensitivity of 31.8% using admission serum and 88.6% using paired sera, while the specificity was 78.1% and 70.5%, respectively. M. pneumoniae was isolated from 14 of the 45 patients (31.1%). The 50%/90% minimum inhibitory concentration (microg/ml) of erythromycin, clarithromycin, azithromycin, minocycline, and levofloxacin was 0.006/0.012, Asunto(s)
Mycoplasma pneumoniae/efectos de los fármacos
, Neumonía por Mycoplasma/diagnóstico
, Juego de Reactivos para Diagnóstico/microbiología
, Adolescente
, Antibacterianos/farmacología
, Niño
, Preescolar
, Humanos
, Lactante
, Macrólidos/farmacología
, Pruebas de Sensibilidad Microbiana
, Mycoplasma pneumoniae/inmunología
, Mycoplasma pneumoniae/aislamiento & purificación
, Pruebas Serológicas
RESUMEN
BACKGROUND: Iron deficiency anemia is one of the treatable causes of developmental delay in infants and is therefore screened in several countries. However, in Japan, a screening program for anemia among infants has not been introduced and data on the prevalence of iron deficiency anemia and results of therapeutic trial with iron supplementation are limited. OBJECTIVE: To examine the prevalence of anemia, diagnosis was made with venipuncture blood and iron deficiency anemia was confirmed in a therapeutic trial of infants in Japanese communities. PARTICIPANTS: Six- to 18-month-old infants participated in the anemia screening program in Shinshiro city and Shitara districts, Aichi, and Fujisawa town, Iwate, Japan. METHODS: Capillary blood samples in microtubes were obtained by skin puncture, and centrifuged to measure the hematocrit. When the value was low, venipuncture blood was examined. A hemoglobin concentration under 11 g/dl was judged as a positive result. Anemic infants were referred to pediatrics for prescription of ferrous sulfate. Iron deficiency anemia was defined as a hemoglobin concentration elevated by 1 g/dl or more with a 4-week regimen of ferrous sulfate (therapeutic trial). RESULTS: Of 283 eligible infants, 161 were screened (participation rate, 57%). Mean (SD) microhematocrit by skin puncture was 35.9(2.2)%. Thirteen infants (8%, 95% Cl: 4 to 13%) were anemic, and 7 infants (4%, 95% Cl: 2 to 9%) demonstrated iron deficiency anemia in the therapeutic trial. There was no significant difference between study sites in mean microhematocrit, and prevalence of anemia or iron deficiency anemia. CONCLUSIONS: The prevalence of anemia and iron deficiency anemia among infants in the study communities is high enough to warrant considering routine screening. Further studies are needed to determine whether a high prevalence of anemia is widespread in Japan.