Meningococcal disease in infants: a potentially difficult and serious diagnosis.

Most children with meningococcal disease have apparent clinical signs of illness, but some do not initially present with clinical toxicity. These children with unsuspected meningococcal disease may potentially be discharged after outpatient evaluation and may deteriorate rapidly. We present the case of a 15-week-old infant boy who was brought to a private physician with symptoms of a common cold and was sent home. Three days later, his parents brought him to the hospital emergency department stating he was congested and crying a lot. He was again discharged. Another 2 days passed and his parents returned to the emergency department complaining that the infant was experiencing breathing problems. Following an examination, he was admitted to the hospital where symptoms worsened. Several hours after the infant was brought to the emergency room, he succumbed to what was later confirmed to be meningococcal disease.

Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment.

BACKGROUND: Respiratory syncytial virus (RSV) infection is a potentially important cause of acute respiratory illness in many populations, including military recruits receiving basic training. Understanding the full impact of RSV infection is challenging because of difficulties in diagnosis and the limitations of past epidemiologic studies. In this study, we set out to determine the prevalence and clinical characteristics of RSV infection and infection caused by other common viral agents in a population of previously healthy young adults, namely, military recruits receiving basic training. METHODS: In addition to standard viral culture techniques, we employed serologic testing and a recently described, novel, highly sensitive real-time PCR and a molecular beacon probe assay for the detection of RSV infection. RESULTS: Among 256 military trainees with respiratory symptoms, RSV infection was identified in 11% by means of serologic testing and real-time PCR. Viral culture identified adenovirus in 48% of symptomatic recruits, influenza viruses in 11%, parainfluenza virus 3 in 3%, and enterovirus in <1%. The majority of recruits with RSV infection experienced a nonproductive cough, sore throat, and nasal congestion, and almost half reported symptoms of wheeze or shortness of breath. Almost all (94%) of the recruits lost > or =1 day(s) from training because of illness. CONCLUSIONS: This study demonstrates the challenges of diagnosis and clinical significance of RSV infection in symptomatic young adults. RSV may account for 11% of clinically important respiratory illnesses in this population, which is as much as 25% of previously undiagnosed illness. These results have implications for treatment and prevention of RSV in young adults.

An outbreak of pneumococcal pneumonia among military personnel at high risk: control by low-dose azithromycin postexposure chemoprophylaxis.

In the winter of 1998-1999 an outbreak of pneumococcal pneumonia occurred among Ranger students undergoing high-intensity training. Thirty pneumonia cases (attack rate = 12.6%) were identified among a group of 239 students. Eighteen students were hospitalized; Streptococcus pneumoniae-positive cultures were detected in 11 (61.1%) of these 18 hospitalized cases. Pneumococci were also identified in throat swabs of 30 (13.6%) of 221 nonhospitalized students surveyed. Serum antipneumolysin seroconversions were detected in 30 (18.3%) of 164 students tested. An association between development of serum antipneumolysin antibody and pneumococcal pharyngeal carriage/colonization was found. Of 30 seroconverters, eight (26.7%) had S. pneumoniae-positive cultures compared with only 17 (12.7%) of 134 nonseroconverters (relative risks = 2.02, 95% confidence interval = 1.02-4.02, p = 0.05). The outbreak was controlled by administrating lowdose, oral azithromycin prophylaxis (250 mg weekly for 2 weeks) and was associated with a 69% reduction in pneumococcal carriage and a 94% reduction in pneumonia rates.