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4.
Ann Pharmacother ; 31(10): 1146-9, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9337438

ABSTRACT

OBJECTIVE: To report a case of renal toxicity associated with administration of indinavir sulfate in a pediatric hemophiliac with HIV infection. CASE SUMMARY: A 16-year-old white hemophiliac boy with HIV infection secondary to tainted coagulation factor VIII was treated with indinavir sulfate. The patient developed gross hematuria, proteinuria, pyuria, abdominal pain, increased bilirubin, an elevated serum creatinine (SCr) of 1.2 mg/dL (baseline 0.9-1.0), and symptoms of renal colic within 1 month of starting indinavir sulfate therapy. Approximately 2 months later the patient developed a low-grade fever with a further increase in SCr. He was prescribed a 10-day course of cefpodoxime proxetil for a possible urinary tract infection. One week later, the patient developed fever, chills, nausea, vomiting, decreased appetite, sterile pyuria, nasal congestion, and an elevated SCr of 1.3-1.7 mg/dL. Indinavir sulfate and cefpodoxime proxetil were discontinued and the patient was suspected of having tubulointerstitial nephritis secondary to indinavir sulfate. The patient's nephritis resolved and the SCr decreased to 1.1 mg/dL within 1 month of discontinuing indinavir sulfate. CONCLUSIONS: This case demonstrates the potential for renal toxicity with the use of indinavir sulfate in HIV-infected hemophiliacs.


Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Hemophilia A/complications , Indinavir/adverse effects , Nephritis, Interstitial/chemically induced , Adolescent , Factor VIII/adverse effects , HIV Infections/complications , HIV Infections/etiology , Hemophilia A/therapy , Humans , Male
5.
J Pediatr ; 129(2): 245-50, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8765622

ABSTRACT

OBJECTIVE: To evaluate whether pediatric patients infected with human immunodeficiency virus (HIV) can mount appropriate delayed-type hypersensitivity (DTH) skin responses to recall antigens and whether these responses can be correlated with clinical or immunologic parameters. DESIGN: Prospective evaluation of DTH responses in HIV-infected children. Uninfected children born to HIV-infected mothers served as control subjects. Antigens used for yearly DTH testing included Candida albicans (1:100, 1:10); mumps virus; Trichophyton; purified protein derivative of tuberculin; and tetanus toxoid (1:100, 1:10). At the time of each DTH test, patients were staged according to two Centers for Disease Control and Prevention pediatric HIV classification systems, and T-cell subsets were obtained. RESULTS: Twenty-seven HIV-infected patients with a median age at entry of 74.1 (range, 12 to 156) months were followed. Forty-four DTH skin tests in 21 symptom-free HIV-infected patients (PI) and 18 tests in 10 HIV-infected patients with symptoms (P2), as well as 43 DTH skin tests in 18 patients who had either mild or moderate clinical symptoms or immunosuppression and 19 tests in 13 patients with severe symptoms or immunosuppression, were evaluated. Sixteen DTH skin tests were performed in 14 uninfected patients. HIV-infected patients tended to have fewer DTH responses to antigens and of smaller size than did uninfected patients. When controlled for age, few differences in DTH responsiveness were seen between HIV-infected and uninfected patients. Anergy was associated with symptomatic disease, evidence of advanced clinical or immunologic disease, and low CD4+ percentages (p <0.05). CONCLUSIONS: HIV-infected children are able to mount antigen-specific cell-mediated immune responses that are qualitatively similar to those of age-matched control subjects. Loss of DTH responsiveness correlates with both clinical and immunologic evidence of HIV disease progression.


Subject(s)
HIV Infections/immunology , Hypersensitivity, Delayed/immunology , Skin Tests , Skin/immunology , Adolescent , Age Factors , Antigens/immunology , Antigens, Fungal/immunology , Antigens, Viral/immunology , CD4 Lymphocyte Count , Candida albicans/immunology , Case-Control Studies , Child , Child, Preschool , Follow-Up Studies , Humans , Immunocompromised Host , Immunologic Memory , Infant , Lymphocyte Count , Mumps virus/immunology , Prospective Studies , T-Lymphocyte Subsets/pathology , Tetanus Toxoid , Trichophyton/immunology , Tuberculin
6.
J Pediatr ; 129(2): 275-8, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8765627

ABSTRACT

OBJECTIVE: To determine the minimum volume of blood and the absolute number of organisms required for detection of bacteremia and fungemia by an automated colorimetric blood culture system (BacT/Alert, Organon Teknika). DESIGN: Common neonatal pathogens, Escherichia coli, Streptococcus agalactiae (group B streptococcus (GBS): one American Type Culture Collection (ATCC) strain and one clinical isolate), Staphylococcus epidermidis, and Candida albicans, were seeded into blood to produce bacteremia or fungemia with low colony counts (1 to 3 colony-forming units (CFU) per milliliter) and ultra-low colony counts (<1 CFU/ml). For each organism, 96 culture bottles were inoculated with either 0.25, 0.5, 1.0, or 4.0 ml of the two seeded blood concentrations. Blood culture bottles were incubated in the BacT/Alert device for 5 days, and time to positivity was noted when applicable. All bottles were subcultured on plated media. DATA ANALYSIS: The Poisson statistic was used to calculate the probability of finding at least one viable CFU per inoculated culture bottle. The fraction of culture bottles with positive findings per group was divided by the probability of one or more organisms present to give the positivity index. RESULTS: Plated subculture identified no growth of organisms not detected by the colorimetric detection system. The false-positive rate for the automated device was less than 1%. The positivity index for the GBS clinical isolate was 1.13, for the GBS ATCC isolate 0.96, for S. epidermidis 0.94, for C. albicans 0.97, and for E. coli 0.95. There was a statistically significant difference with time to positivity and inocula volume (p <0.01), but the difference was not clinically important. CONCLUSIONS: If one or two viable colony-forming units are in the blood inoculated into culture media, the BacT/Alert system will detect growth rapidly. Because there appears to be a sizable subset of neonates who are at risk of sepsis with a colony count less than 4 CFU/ml, then a 0.5 ml inoculum of blood into the culture media is inadequate for sensitive and timely detection of bacteremia. One to two milliliters of blood should increase microorganism recovery in the face of low-colony-count sepsis.


Subject(s)
Bacteremia/blood , Fungemia/blood , Infant, Newborn/blood , Bacteremia/microbiology , Candida albicans/isolation & purification , Candidiasis/blood , Colony Count, Microbial , Colorimetry , Culture Media , Escherichia coli/isolation & purification , Escherichia coli Infections/blood , False Positive Reactions , Fungemia/microbiology , Humans , Poisson Distribution , Probability , Risk Factors , Sepsis/microbiology , Staphylococcal Infections/blood , Staphylococcus epidermidis/isolation & purification , Streptococcal Infections/blood , Streptococcus agalactiae/isolation & purification
7.
Clin Infect Dis ; 21(2): 352-60, 1995 Aug.
Article in English | MEDLINE | ID: mdl-8562744

ABSTRACT

Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD). Cases of B. henselae-related disease were collected from September 1991 through November 1993. Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B. henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations. In addition to three previously described cases, 23 patients with R. henselae-related infection were identified. The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B. henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1). A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia. Tissue cultures were positive for B. henselae in three recent cases of adenitis. Twenty-two patients were exposed to cats. This series further demonstrates the similarities between B. henselae-related diseases and CSD and identifies several new syndromes due to B. henselae.


Subject(s)
Bartonella henselae/isolation & purification , Cat-Scratch Disease/diagnosis , HIV Infections/complications , HIV-1 , Lymphadenitis/diagnosis , Meningitis, Aseptic/diagnosis , Optic Neuritis/diagnosis , Retinitis/diagnosis , Adolescent , Adult , Aged , Animals , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Bacteremia/veterinary , Cat Diseases/drug therapy , Cat Diseases/microbiology , Cat-Scratch Disease/drug therapy , Cat-Scratch Disease/microbiology , Cat-Scratch Disease/veterinary , Cats , Child , Child, Preschool , Female , Fundus Oculi , Humans , Immunocompetence , Lymphadenitis/drug therapy , Lymphadenitis/microbiology , Male , Meningitis, Aseptic/drug therapy , Meningitis, Aseptic/microbiology , Middle Aged , Optic Neuritis/drug therapy , Optic Neuritis/microbiology , Retinitis/drug therapy , Retinitis/microbiology
8.
J Clin Microbiol ; 33(1): 193-8, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7699040

ABSTRACT

Latex particle agglutination (LPA) testing for antigen to group B streptococcus (GBS) has been useful in the diagnosis of GBS sepsis in newborns. However, recent reports have demonstrated that the sensitivity of LPA assays may be as low as 27 to 54%. The purposes of the present study were to directly compare the abilities of four urine antigen assays to detect GBS antigen with clinical urine samples from neonates with GBS bacteremia and to evaluate the effect of the urine concentration on the sensitivities and specificities of these assays. Urine samples were collected serially from neonates with blood cultures positive for GBS or on admission from healthy full-term infants. One milliliter of urine was removed, and the remainder was concentrated to a volume of 1 ml. Unconcentrated samples were serially diluted with normal saline and were assayed to determine the highest dilution which would produce a positive test result. The Wellcogen, Bactigen, and Directigen LPA tests and ICON immunoassay were directly compared by using concentrated and unconcentrated urine specimens and urine specimens with known titers. A total of 94 urine specimens, including 61 concentrated and 75 unconcentrated specimens, from bacteremic infants were available for sensitivity testing, and 220 urine specimens from uninfected infants were available for specificity testing. There were significant differences in sensitivity among the four assays when they were performed on concentrated urine specimens, as follows: Directigen, 98%; Bactigen, 92%; ICON, 89%; Wellcogen, 68%. When the assays were performed on unconcentrated urine specimens, the Directigen (84%) and Bactigen (76%) assays were each significantly more sensitive than the ICON (59%) or Wellcogen (43%) assay. All four assays were significantly more sensitive in detecting GBS antigen in concentrated than in unconcentrated urine. The Directigen assay detected antigen in higher dilutions (geometric mean titer, 1:5) than the ICON (1:3), Bactigen (1.2), or Wellcogen (1:1) assay. The specificity was 99.5% for all four assays when concentrated urine was used and for the Bactigen, Directigen, and ICON assays when unconcentrated urine was used; the Wellcogen assay was 100% specific when unconcentrated urine was used. We conclude that there are significant differences in sensitivity but not specificity among the commercially available assays for the detection of GBS antigenuria when concentrated and unconcentrated urine specimens are tested. These differences in sensitivity may affect the abilities of clinicians to accurately diagnose GBS sepsis before culture results are available.


Subject(s)
Antigens, Bacterial/urine , Immunoassay , Latex Fixation Tests , Streptococcal Infections/diagnosis , Streptococcus agalactiae/immunology , Bacteremia/microbiology , Female , Humans , Infant, Newborn , Male , Prospective Studies , Reagent Kits, Diagnostic , Sensitivity and Specificity , Time Factors
14.
Clin Pediatr (Phila) ; 32(8): 467-71, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8403745

ABSTRACT

Although blood cultures remain the most specific indicator of Group B streptococcus (GBS) sepsis, a potentially life-threatening infection in neonates, test results may not be available for 24 to 48 hours. Detection of GBS antigen in the urine by latex particle agglutination (LPA) may speed diagnosis. This study analyzed the sensitivity of the GBS urine LPA assay under clinical conditions. The urine of neonates with early-onset GBS bacteremia was analyzed for GBS antigen over a three-year period at six military medical centers. Overall, 53.5% (38/71) of infants with positive blood cultures had a positive urine LPA test. Only one medical center routinely followed manufacturer's recommendations to concentrate urine specimens before testing. These data suggest that the sensitivity for the urine LPA assay, when performed on unconcentrated urine, is lower than previously reported. Clinicians should insist that the laboratory maximize sensitivity by concentrating urine prior to GBS LPA testing.


Subject(s)
Antigens, Bacterial/urine , Bacteremia/immunology , Latex Fixation Tests , Streptococcal Infections/immunology , Streptococcus agalactiae/immunology , Antigens, Bacterial/blood , Bacteremia/classification , Bacteremia/urine , False Negative Reactions , Female , Humans , Infant, Newborn , Latex Fixation Tests/methods , Male , Risk Factors , Sensitivity and Specificity , Streptococcal Infections/blood , Streptococcal Infections/classification , Streptococcal Infections/urine
15.
Clin Infect Dis ; 17(1): 123-5, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8102556

ABSTRACT

Values for CD4+ lymphocytes are reported to vary by age. We evaluated an ethnically diverse population of healthy children at risk for human immunodeficiency virus infection to establish normal ranges for age-adjusted CD4+ lymphocyte parameters. We identified a threshold of approximately 30% CD4+ lymphocytes which corresponded to a 5th percentile for all ages. It is important that no significant differences in absolute CD4+ lymphocyte counts on the basis of ethnic group were found.


Subject(s)
CD4-Positive T-Lymphocytes/immunology , Age Factors , CD4-CD8 Ratio , Child , Child, Preschool , HIV Infections/etiology , Humans , Infant , Leukocyte Count , Reference Values , Risk Factors
16.
J Perinatol ; 13(3): 212-6, 1993.
Article in English | MEDLINE | ID: mdl-8345385

ABSTRACT

Early-onset group B streptococci (GBS-EOS) sepsis may be prevented by intrapartum antibiotics administered for GBS maternal colonization, premature labor, or prolonged rupture of membranes. We sought to identify cases of neonatal GBS sepsis after apparent failure of intrapartum chemotherapy and to determine the factors associated with failure of intrapartum antibiotics in these cases. We identified 96 GBS blood culture-positive infants at five military medical centers from 1987 to 1990. Eighteen (18.7%) of these infants had mothers who had received intrapartum antibiotics; 16 of 18 cases were early-onset disease, 15 of which initially had symptoms at less than 1 hour of age. Two infants had late-onset disease develop at 3 weeks of age. At least one perinatal risk factor (prematurity, prolonged rupture of membranes > 12 hours, maternal fever) was present in each of the 16 cases. Indications for intrapartum antibiotics were suspected chorioamnionitis (13 cases), GBS colonization and prolonged rupture of membranes or prematurity (3), and GBS colonization alone (2). Maternal antibiotics included ampicillin (14 cases), cephadyl (1), vancomycin (1), clindamycin (1), and gentamicin alone (1). The median number of doses of ampicillin before delivery was 1 (range, 1 to 21), which was administered at a median of 4 hours (range, 1 to 84) before birth. The mean dose of ampicillin was 1.8 gm/dose (range, 1 to 2 gm/dose). Two of 16 (12.5%) infants with GBS-EOS died as a result of GBS sepsis. In our population of neonates with GBS-EOS, 18.4% (16 of 87) of the infants had positive blood cultures despite intrapartum antibiotics. Intrapartum antibiotics may fail to prevent GBS sepsis in a number of infants born to mothers colonized with GBS or to those with acute chorioamnionitis.


Subject(s)
Ampicillin/therapeutic use , Chorioamnionitis/drug therapy , Fetal Membranes, Premature Rupture/drug therapy , Labor, Obstetric , Streptococcal Infections/prevention & control , Streptococcus agalactiae/isolation & purification , Ampicillin/administration & dosage , Female , Humans , Infant, Newborn , Pregnancy , Risk Factors , Streptococcal Infections/epidemiology , Treatment Failure
17.
J Pediatr Surg ; 28(4): 627-9, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8483081

ABSTRACT

A patient with terminal osteogenic sarcoma and catheter-related coagulase-negative staphylococcal bacteremia was treated with vancomycin and blood cultures were positive for 4 days documented with quantitative colony counts. Urokinase therapy was initiated and was associated with a transient bacteremia with markedly increased colony counts of coagulase-negative Staphylococcus prior to eradication of the catheter-related infection. We feel that the combination of urokinase and appropriate antibiotics may be an effective method to eradicate line-associated coagulase-negative staphylococcal infection in selected patients.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacteremia/drug therapy , Bacteremia/etiology , Catheterization, Central Venous/adverse effects , Staphylococcal Infections/drug therapy , Urokinase-Type Plasminogen Activator/administration & dosage , Adolescent , Female , Humans , Osteosarcoma/drug therapy , Staphylococcal Infections/etiology
18.
J Acquir Immune Defic Syndr (1988) ; 6(3): 241-4, 1993 Mar.
Article in English | MEDLINE | ID: mdl-8450398

ABSTRACT

Fifteen sets of seroreversal serum samples (i.e., an initial specimen confirmed as anti-human immunodeficiency virus, HIV, positive and a 2-4-week follow-up specimen that is anti-HIV negative) were identified from 711,684 military members tested by the U.S. Army HIV screening program from January 1990 to May 1991. We utilized the Miragen Antibody Fingerprinting Assay to determine what proportion of these seroreversals was caused by different or discordant patient samples as opposed to laboratory testing errors. Forty-two percent of these seroreversals demonstrated substantially discordant immunoblot strips representing serum samples from different patients. We recommend utilization of this antibody fingerprinting assay to help determine the etiology of HIV seroreversal specimens.


Subject(s)
Autoantibodies/analysis , False Positive Reactions , HIV Antibodies/analysis , HIV Seropositivity/diagnosis , Military Personnel , Algorithms , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , HIV Seropositivity/immunology , Humans , Immunoblotting , United States
20.
Diagn Microbiol Infect Dis ; 15(6): 499-503, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1424502

ABSTRACT

We reviewed our experience with paired quantitative and standard blood cultures in the evaluation of children with suspected central-line sepsis with the hypothesis that by employing both systems we would increase our yield of pathogenic isolates. A total of 913 paired cultures were reviewed, representing 267 pathogenic isolates and 58 individual episodes of sepsis. The isolates were analyzed for recovery rates for each system and by combining both systems. The Isolator system proved to be equal to the BACTEC system for the recovery of all groups of pathogenic isolates. The combined use of both the quantitative and the standard culture systems demonstrated a statistically significant advantage (p less than 0.001) for the recovery of pathogens as compared with either system alone. The use of either system alone would have missed 15% of the total pathogenic isolates. Quantitative colony counts were helpful in identifying the line as the source of infection in 35 to 58 episodes of sepsis and were often beneficial in the clinical management central venous line infection. We recommend the use of the Isolator 1.5 ml combined with a conventional broth-bottle system in selected pediatric patients to enhance the recovery of pathogenic organisms.


Subject(s)
Bacteremia/microbiology , Bacteria/isolation & purification , Candida/isolation & purification , Catheterization, Central Venous , Fungemia/microbiology , Blood/microbiology , Child , Child, Preschool , Colony Count, Microbial , Humans
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