RESUMO
OBJECTIVES: To evaluate the risk for infantile hypertrophic pyloric stenosis (IHPS) among infants prescribed systemic erythromycin, infants prescribed a course of erythromycin ophthalmic ointment, and infants whose mothers were prescribed a macrolide antibiotic during pregnancy. STUDY DESIGN: Retrospective cohort study of infants born at an urban hospital from June 1993 through December 1999. RESULTS: Of 14,876 eligible infants, 43 (0.29%) developed IHPS. Infants prescribed systemic erythromycin had increased risk of IHPS, with the highest risk in the first 2 weeks of age (relative risk = 10.51 for erythromycin in first 2 weeks, 95% CI 4.48, 24.66). Erythromycin ophthalmic ointment for conjunctivitis was not associated with increased risk of IHPS. Maternal macrolide antibiotics within 10 weeks of delivery may have been associated with higher risk of IHPS but the data were not conclusive. CONCLUSIONS: This study confirms an association between systemic erythromycin in infants and subsequent IHPS, with the highest risk in the first 2 weeks of age. No association was found with erythromycin ophthalmic ointment. A possible association with maternal macrolide therapy in late pregnancy requires further study. Systemic erythromycin should be used with prudence in early infancy.
Assuntos
Antibacterianos/efeitos adversos , Eritromicina/efeitos adversos , Troca Materno-Fetal , Estenose Pilórica/induzido quimicamente , Feminino , Humanos , Hipertrofia , Recém-Nascido , Masculino , Gravidez , Estenose Pilórica/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Between April 1982 and June 1983 four children 3 to 24 months of age were referred for evaluation of neurologic abnormalities found to be compatible with vaccine-related poliovirus infection, which had not been suspected by referring physicians. Patients were epidemiologically unrelated residents of Indiana, and none had prior symptoms suggestive of immunodeficiency. All had received poliovirus vaccine orally (first dose in three, fourth dose in one) and a diphtheria-tetanus-pertussis injection in the left anterior thigh within 30 days of symptoms. A vaccine-like strain of poliovirus was isolated from each patient, and each had symptoms (left leg paralysis in three; developmental regression, spasticity, and progressive fatal cerebral atrophy in one) persisting for at least 6 months. Immune function was normal in two with poliovirus type 3 infection, and abnormal (hypogammaglobulinemia, combined immunodeficiency) in two with type 1 and type 2 infection, respectively. The incidence of observed vaccine-related poliovirus infection in Indiana recipients of orally administered poliovirus vaccine was 0.058 per 100,000 per year, significantly greater (P less than 0.001) than predicted.
Assuntos
Poliomielite/etiologia , Vacina Antipólio Oral/efeitos adversos , Atrofia , Encéfalo/patologia , Pré-Escolar , Humanos , Síndromes de Imunodeficiência/etiologia , Lactente , Masculino , Atrofia Muscular/etiologia , Paralisia/etiologia , Poliomielite/microbiologia , Poliovirus/isolamento & purificaçãoRESUMO
Metabolic acidosis has previously been described in the gray baby syndrome, but has not been documented as a presenting feature. Four seriously ill children (bronchiolitis, hypoaldosteronism, dysautonomia, Reye syndrome), ages 4 months to 11 years, received chloramphenicol (CAP) intravenously. After initial stabilization, unexplained metabolic acidosis occurred 40 to 81 hours after beginning CAP. Serum CAP concentrations were 84, 62, 80, and 30 micrograms/ml, respectively, when acidosis was recognized. Hypotension, hypothermia, and abdominal distension occurred a mean of 23 hours after the onset of acidosis. Acidosis resolved and signs of the gray baby syndrome cleared with the decrease in serum CAP concentrations. Metabolic acidosis should be considered an early sign of CAP toxicity, and CAP should be used in reduced doses in severely ill patients, especially those with liver dysfunction.
Assuntos
Acidose/induzido quimicamente , Cloranfenicol/efeitos adversos , Bronquiolite Viral/tratamento farmacológico , Criança , Pré-Escolar , Disautonomia Familiar/tratamento farmacológico , Feminino , Humanos , Hiperaldosteronismo/tratamento farmacológico , Lactente , Síndrome de Reye/tratamento farmacológicoRESUMO
The differentiation of mediastinal masses caused by lymphoma from those caused by histoplasmosis may require thoracotomy. We reviewed the medical records of 37 children undergoing initial evaluation for anterior or middle mediastinal masses. Sixteen had biopsy-proved lymphoma, and 21 had histoplasmosis; seven with histoplasmosis underwent thoracotomy. Age, sex, fever, weight loss, duration of illness, anemia, erythrocyte sedimentation rate, nonspecific reactants, and lung infiltrates and calcifications were similar in both groups. Masses were in the middle mediastinum in all patients with histoplasmosis and in 69% with lymphoma. Masses were in the anterior mediastinum in one of 21 (5%) with histoplasmosis and 13 of 16 (81%) with lymphoma. Among patients with lymphoma, histoplasmal complement fixation antibody titers were less than 1:8 in 14 of 15 (93%); a single patient had a titer of 1:16. The CF titers were greater than or equal to 1:32 in 14 of 21 (67%) with histoplasmosis. In children with middle mediastinal masses, a histoplasmal CF yeast or mycelial titer greater than or equal to 1:32 is strongly suggestive of acute histoplasmosis and biopsy is not required. Children not fulfilling these criteria should undergo diagnostic biopsy.
Assuntos
Histoplasmose/diagnóstico , Linfoma/diagnóstico , Neoplasias do Mediastino/diagnóstico , Adolescente , Anticorpos Antifúngicos/análise , Criança , Pré-Escolar , Testes de Fixação de Complemento , Diagnóstico Diferencial , Feminino , Histoplasmose/diagnóstico por imagem , Histoplasmose/patologia , Humanos , Imunodifusão , Lactente , Linfoma/diagnóstico por imagem , Linfoma/patologia , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , RadiografiaRESUMO
Spontaneous bacterial peritonitis should be considered in the evaluation of any patient with acute abdominal complaints, especially in the presence of preexistent ascites. Paracentesis is indicated in all suspected cases of spontaneous peritonitis in order to obtain necessary studies, including microbial cultures. Broad-spectrum antibiotic coverage has become necessary because of the increasing incidence of gram-negative isolates. Ascitic pH and lactate may provide accurate information in the evaluation of spontaneous peritonitis, although increased clinical awareness remains the key to proper diagnosis.