RESUMO
To determine whether Pneumocystis carinii is associated with clinical illness in the competent host, 107 normal, healthy infants were enrolled in a 2-year prospective cohort study in Chile. P. carinii was identified by specific stains and nested--deoxyribonucleic acid (DNA) amplification of the large subunit mitochondrial ribosomal ribonucleic acid gene of P. carinii f. sp. hominis, and seroconversion was assessed by enzyme-linked immunosorbent assay of serum samples drawn every 2 months. P. carinii DNA was identified in nasopharyngeal aspirates obtained during episodes of mild respiratory infection in 24 (32%) of 74 infants from whom specimens were available for testing. Three (12.5%) of those 24 infants versus 0 of 50 infants who tested negative for P. carinii had apnea episodes. Seroconversion developed in 67 (85%) of 79 infants who remained in the study by 20 months of age and occurred in the absence of any symptoms of disease in 14 (20.8%). The study indicates that P. carinii DNA can be frequently detected in healthy infants, and it raises the hypothesis that they may be an infectious reservoir of P. carinii in the community. Further investigation is needed to identify whether P. carinii causes overt respiratory disease in infants.
Assuntos
Portador Sadio/diagnóstico , Infecções por Pneumocystis/diagnóstico , Pneumocystis/isolamento & purificação , Infecções Respiratórias/diagnóstico , Portador Sadio/epidemiologia , Chile/epidemiologia , DNA Fúngico/análise , Humanos , Lactente , Recém-Nascido , Pneumocystis/genética , Infecções por Pneumocystis/epidemiologia , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Testes SorológicosRESUMO
To delineate clinical and histological features of the first Pneumocystis carinii infection affecting the immunocompetent host, P. carinii-specific histological stains were performed on autopsy lung specimens from 534 consecutive pediatric patients (those with AIDS and malignancies were excluded) in Santiago, Chile. P. carinii clusters were found in 4 (25%) of 16 infants who died of no apparent cause at arrival to the emergency department, and in 10 (2.9%) of 342 infants who died of multiple conditions at the hospital (P=.002, Fisher's exact test). This prompted us to analyze additional series of infants with sudden infant death syndrome (SIDS). In 161 additional SIDS cases, 47 (35.1%) of 134 infants from Chile and 4 (14.8%) of 27 infants from Oxford, United Kingdom, were found to have P. carinii clusters in the lungs. The quantity of P. carinii cysts was small compared with the numbers seen in immunocompromised hosts with P. carinii pneumonitis. This study provides histological evidence that primary P. carinii infection is associated with SIDS.
Assuntos
Infecções por Pneumocystis/epidemiologia , Morte Súbita do Lactente/epidemiologia , Autopsia , Chile/epidemiologia , Histocitoquímica , Humanos , Lactente , Recém-Nascido , Pulmão/microbiologia , Pulmão/patologia , Pneumocystis , Infecções por Pneumocystis/microbiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Morte Súbita do Lactente/patologiaRESUMO
The opportunistic fungal pathogen Pneumocystis carinii is a frequent cause of pneumonia in immunocompromised hosts. In this study, we have compared the DNA sequences of a portion of the mitochondrial large-subunit rRNA gene of P. carinii (an informative locus showing up to 27% differences among isolates of P. carinii from human-, rat-, mouse-, ferret-, rabbit-, and horse-infected lungs) obtained from human-derived isolates from widely disparate geographical areas, including Britain, the United States, Brazil, and Zimbabwe. A single-base polymorphism which varied among samples was identified. Apart from this nucleotide, the DNA sequences of all samples were identical. The sequences of the British samples were shown to be stable over a period of 4 years. These data suggest that there is relatively low genetic diversity among isolates of human-derived P. carinii from different global regions.
Assuntos
Variação Genética , Pneumocystis/genética , RNA Fúngico/genética , RNA Ribossômico/genética , RNA/genética , Sequência de Bases , Brasil , Humanos , Hospedeiro Imunocomprometido , Dados de Sequência Molecular , Pneumocystis/isolamento & purificação , RNA Mitocondrial , Análise de Sequência de DNA , Reino Unido , Estados Unidos , ZimbábueRESUMO
Two children with cancer received azithromycin for Cryptosporidium-associated diarrhea that was unresponsive to supportive care. One child had choleriform diarrhea requiring daily fluid replacement of up to 65% of his total body weight; the other had protracted diarrhea and wasting. In both cases, administration of azithromycin was followed by prompt clinical improvement.
Assuntos
Criptosporidiose/tratamento farmacológico , Diarreia Infantil/tratamento farmacológico , Diarreia/tratamento farmacológico , Eritromicina/análogos & derivados , Neoplasias do Mediastino/complicações , Neuroblastoma/complicações , Infecções Oportunistas/tratamento farmacológico , Sarcoma/complicações , Administração Oral , Azitromicina , Pré-Escolar , Terapia Combinada , Criptosporidiose/etiologia , Diarreia/etiologia , Diarreia Infantil/etiologia , Avaliação de Medicamentos , Eritromicina/administração & dosagem , Hidratação , Humanos , Lactente , Masculino , Infecções Oportunistas/etiologiaRESUMO
We report the hematologic changes in 90 black children who were randomized to receive a 10-day course of either trimethoprim-sulfamethoxazole (TMP-SMZ) or amoxicillin as therapy for acute otitis media. Absolute neutrophil counts less than 1500/mm3 developed at least once during the 23-day evaluation in 28 (57%) of the 49 children given TMP-SMZ and in 22 (54%) of the 41 who received amoxicillin. Incidence of leukopenia, thrombocytopenia, and anemia was negligible in both groups. Pancytopenia did not occur in any child. Absolute neutrophil counts had increased to greater than 1500/mm3 by the end of the study period in all of the patients but six, whose recovery required an additional 1 to 63 days. Decreased neutrophil counts in antibiotic-treated subjects remained within the range of findings for healthy black children, suggesting that a count less than 1500/mm3 may be an inappropriate criterion for an adverse drug effect. Neither TMP-SMZ nor amoxicillin produced hematologic effects that would detract from their continued use in children with infections caused by antibiotic-susceptible organisms.
Assuntos
Amoxicilina/uso terapêutico , Otite Média/sangue , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Amoxicilina/efeitos adversos , Ensaios Clínicos como Assunto , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Lactente , Contagem de Leucócitos , Leucopenia/induzido quimicamente , Masculino , Neutrófilos , Otite Média/tratamento farmacológico , Distribuição Aleatória , Fatores de Tempo , Combinação Trimetoprima e Sulfametoxazol , Infecções Urinárias/sangue , Infecções Urinárias/tratamento farmacológicoRESUMO
Hematogenous (disseminated) histoplasmosis occurred in 31 of 4158 children with cancer or immune deficiency disorders. Approximately half of the 31 patients had pulmonary lesions, reacted to the histoplasmin skin test, and generated complement-fixing antibodies to Histoplasma capsulatum. In a comparative study delayed hypersensitivity to histoplasmin was demonstrated in 36 (5.7%) of 634 children at the time of diagnosis of cancer. Patients with cancer who were reactive to histoplasmin before treatment were at no greater, and possibly less, risk for hematogenous histoplasmosis than were nonreactors. All of the 27 patients who received treatment for greater than 1 day recovered; three had recurrences that responded to treatment.
Assuntos
Histoplasmose/imunologia , Terapia de Imunossupressão , Adolescente , Anfotericina B/uso terapêutico , Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Feminino , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Lactente , Cetoconazol/uso terapêutico , Masculino , RiscoRESUMO
We have evaluated a commercially available latex agglutination system for the detection of C-reactive protein in CSF by a prospective study of 56 patients with CSF pleocytosis. On initial lumbar puncture, C-RP was detected in 100% (24/24) of patients with culture-proven bacterial meningitis, compared to 6% (2/32) of patients in the nonbacterial group (chi 2 c = 44.8, P less than 0.0001). C-RP in CSF had a sensitivity of 1.0 and a specificity of 0.94 for detecting culture-positive, bacterial meningitis. It was a more sensitive test for differentiating bacterial from nonbacterial meningitis on initial CSF examination than was the number of CSF leukocytes, the absolute number of CSF polymorphonuclear leukocytes, CSF glucose concentration, CSF protein concentration, or Gram staining of CSF. Detection of C-RP by latex agglutination may prove to be a practical and reliable method for differentiating bacterial from nonbacterial meningitis.
Assuntos
Infecções Bacterianas/líquido cefalorraquidiano , Proteína C-Reativa/líquido cefalorraquidiano , Meningite/líquido cefalorraquidiano , Adolescente , Líquido Cefalorraquidiano/citologia , Proteínas do Líquido Cefalorraquidiano/análise , Criança , Pré-Escolar , Humanos , Lactente , Testes de Fixação do Látex , Contagem de Leucócitos , Meningite Viral/líquido cefalorraquidiano , Estudos ProspectivosAssuntos
Síndromes de Imunodeficiência/epidemiologia , Pneumocystis/imunologia , Pneumonia/epidemiologia , Quimioterapia Combinada , Humanos , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/tratamento farmacológico , Lactente , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Sulfametoxazol/uso terapêutico , Inquéritos e Questionários , Trimetoprima/uso terapêutico , Estados UnidosRESUMO
We developed a sensitive enzyme radioisotopic assay for the measurement of beta-lactamase, an enzyme produced by a number of pathogenic bacteria. This ERIA was 100-fold more sensitive than the commonly used iodometric or spectrophotometric assays for the measurement of beta-lactamase and, unlike these other assays, the ERIA was not significantly influenced by serum proteins or unlabeled penicillin. Clinical specimens consisting of blood, peritoneal, pleural, and cerebrospinal fluids from patients infected with beta-lactamase-producing organisms yielded positive ERIA tests; fluids from uninfected patients were negative. The ERIA takes approximately 90 minutes to perform, and offers great potential for the rapid diagnosis of serious bacterial infections caused by bacteria which produce beta-lactamase.
Assuntos
Infecções Bacterianas/diagnóstico , Ensaios Enzimáticos Clínicos/métodos , Penicilinase/análise , Radioisótopos , beta-Lactamases/análise , Enterococcus faecalis/isolamento & purificação , Escherichia coli/isolamento & purificação , Haemophilus influenzae/isolamento & purificação , Humanos , Neisseria gonorrhoeae/isolamento & purificação , Penicilinase/sangue , Penicilinase/líquido cefalorraquidiano , Pseudomonas aeruginosa/isolamento & purificação , Serratia marcescens/isolamento & purificação , Staphylococcus aureus/isolamento & purificaçãoAssuntos
Antígenos de Bactérias/líquido cefalorraquidiano , Contraimunoeletroforese/métodos , Haemophilus influenzae/imunologia , Imunoeletroforese/métodos , Meningite por Haemophilus/líquido cefalorraquidiano , Eletroforese em Gel de Poliacrilamida/métodos , Humanos , Meningite por Haemophilus/imunologiaRESUMO
Fifty patients with P. carinii pneumonitis were randomized to receive either pentamidine isethionate or trimethoprim-sulfamethoxazole therapy. Those not responding favorably to the first drug after three or more days of therapy were changed to the alternate drug. Of the 26 patients initially treated with TMP-SMZ, 20 recovered (0.77)-17 after TMP-SMZ alone and three of nine who were crossed over to pentamidine. Of the 24 patients initially treated with pentamidine, 18 recovered (0.75)-14 of 15 who received only pentamidine and four of nine who were crossed over to TMP-SMZ. Abnormal values for blood urea nitrogen, creatinine, or glucose; inflammation at injection sites; or combination of these effects occurred in 14 of the 15 patients treated with pentamidine alone. Only one of the 17 patients treated with TMP-SMZ alone developed any of these abnormalities. This study shows that TMP-SMZ is as effective as pentamidine in the treatment of PCP, and that it offers the advantages of minimal adverse effects, oral administration, and ready availability.
Assuntos
Amidinas/uso terapêutico , Pentamidina/uso terapêutico , Pneumonia por Pneumocystis/tratamento farmacológico , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Administração Oral , Criança , Combinação de Medicamentos , Humanos , Pentamidina/efeitos adversos , Sulfametoxazol/administração & dosagem , Sulfametoxazol/efeitos adversos , Trimetoprima/administração & dosagem , Trimetoprima/efeitos adversosRESUMO
Leukocyte and urine cultures were done at monthly intervals in 36 children with acute lymphocytic leukemia known to be excreting cytomegalovirus in their or saliva in order to determine the relationship of viremia to clinical cytomegalic inclusion disease. Eleven of 36 (30.5%) patients had viremia. Viremia was related to clinical disease in only three patients; two with chorioretinitis and one with a CMV monomucleosis syndrom. However, the presence of viremia did not serve as a useful means to determine active CID. Viremic patients with CID all had elevated serum levels of IgM and multiple episodes of viremia. Viremia was not related to the duration, type or number of drugs used in immunosuppression, nor to the hematologic status of leukemia. Viremic patients received more blood transfusions than noviremic patients, but the administration of blood products could not be related to the acquisition of infection. Leukopenia, neutropenia, total lymphocyte count, fourfold rise or fall in complement-fixing titer, and viruria had no consistent relationship to viremia or clinical CID.