Subject(s)
Wolman Disease/pathology , Female , Fever/etiology , Humans , Infant , Jaundice/etiology , Vomiting/etiology , Wolman Disease/complicationsABSTRACT
The aim of this study was to evaluate the utility of a volume-modified blood culture system to diagnose bacteremia in newborns and infants. A total of 793 paired blood cultures, obtained from 464 patients (173 newborns and 291 infants), were analyzed. Vacutainer tubes containing 18 ml supplemented peptone broth sodium-polyanethol-sulfonate were used as the gold standard, in comparison with a blood micro-culture system containing 1.8 ml of the broth. Prior to antibiotic treatment, 2.2 ml of blood was obtained from each patient; 0.2 ml was inoculated in a blood micro-culture tube and 2 ml in a routine tube. Sensitivity, specificity and predictive values were calculated. Microorganisms were isolated in 153 standard blood culture tubes and 151 blood micro-culture tubes. The sensitivity of the blood micro-culture system was 95%, specificity 99% and positive and negative predictive values 96% and 99% respectively. The sensitivity and specificity of blood micro-culture in neonates and infants is high. We recommend that this system be used for the diagnosis of bacteremia in newborns and infants in laboratories where manual systems are still in use.
Subject(s)
Bacteremia/diagnosis , Bacteriological Techniques , Bacteremia/blood , Bacterial Typing Techniques , Blood/microbiology , Blood Specimen Collection , Culture Media , Humans , Infant , Infant, Newborn , Sensitivity and SpecificityABSTRACT
In this work we compare the sensitivity, specificity and predictive values of hemagglutination inhibition (HI), immunofluorescent assay (IFA), biotin-streptavidin immunofluorescent assay (B/SA-IFA), enzyme-linked immunosorbent assay (EIA) and plaque neutralization test (PN). This study includes serum samples from children taken before and after vaccination, children with clinically diagnosed measles and household contacts. EIA were the most specific and better serological diagnostic test. HI and IFA had high sensitivity but low specificity. An alternative to EIA is B/SAIFA, which is cheaper than EIA and can be used in the study of small outbreaks or in isolated cases.
Subject(s)
Immunoglobulin G/blood , Measles virus/immunology , Measles/blood , Child , Humans , Predictive Value of Tests , Sensitivity and Specificity , Serologic Tests/methodsABSTRACT
A randomized clinical trial was performed in children with cancer, fever and neutropenia, to evaluate the efficacy of amikacin once daily versus thrice daily dosing plus carbenicillin in both groups. Fifty patients were included, 25 patients in group A who received amikacin once daily and 25 in group B who received amikacin thrice daily. No intergroup differences were observed, i.e., fever diminished in a median of 6 days (2-8 days) vs. 7 days (3-12 days) in groups A and B respectively (p = 0.37);clinical improvement was observed in a median of 6 days (3-10 days) vs 7 days (2-14 days) (p = 0.68). One patient in group A and two in B died. The peak levels of amikacin on the 7th day of treatment were 10-60 and 7-25 micrograms/mL in groups A and B respectively, and the serum creatinine levels were 0.3 - 0.7 for group A and 0.2 - 0.8 mg/dL for group B; none of the patients presented a creatinine above 40% of the basal value. Three patients of group A had amikacin levels higher than 40 micrograms/mL without increasing the creatinine levels; our observations do not suggest that toxicity is higher. We conclude that the administration of aminoglycoside once daily seems to be as effective as the traditional dosing.
Subject(s)
Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Fever/drug therapy , Neutropenia/complications , Bacterial Infections/etiology , Child , Child, Preschool , Drug Administration Schedule , Female , Fever/etiology , Humans , Immunocompromised Host , Male , Treatment OutcomeABSTRACT
In order to have a diagnostic test for invasive candidiasis, an immunofluorescent assay (IFA) in buffy coat was developed and evaluated. This test was compared to buffy coat culture and blood culture. The study was divided into two parts: evaluation of the diagnostic test in a rabbit model, and for diagnosis in patients at high risk for invasive candidiasis. Part I: Rabbits were experimentally infected. Of 13 rabbits with disseminated candidiasis blood was drawn from central venous catheter and from peripheral veins. From catheters, Candida was detected in 13/13, 10/13 and 8/13, by buffy coat culture, IFA, and blood culture, respectively. From peripheral veins, Candida was detected in 10/10 by buffy coat cultures, in 6/10 by IFA and in 3/10 by blood cultures. The gold standard was histopathological diagnosis; sensitivity for IFA was 60% with peripheral blood and 76% with catheter blood samples. Part II: IFA and blood cultures were compared in clinical samples from hospitalized children. Forty patients were included. Candida was isolated from blood cultures in four patients whereas IFA detected Candida in 22 patients. Differences were statistically significant (p < 0.05). We conclude that IFA in buffy coat smears is a reliable test to detect candidemia, and would be a useful tool to help physicians with treatment decisions with amphotericin B.
Subject(s)
Candidiasis/diagnosis , Fluorescent Antibody Technique, Indirect , Animals , Bacteremia/diagnosis , Candidiasis/blood , Child , Cross-Sectional Studies , Humans , Leukocytes/chemistry , Male , Predictive Value of Tests , Prospective Studies , Rabbits , Time FactorsABSTRACT
Visceral leishmaniasis is a rare parasitosis in our country; in a 30 year period only exists the report of five cases, three in the state of Puebla and two in the state of Guerrero. Now it has been identified another two cases in the state of Chiapas. In these patients the common presentation of the disease were fever, hepatosplenomegaly, hypergammaglobulinemia and pancytopenia. The parasite can be found in liver, spleen, lymph nodes and bone marrow macrophages. A definitive diagnosis depends on the demonstration of the parasite in tissue; spleen biopsy is the most useful because it is positive in 98% of the cases, in other tissues the amastigotes are seen in 50-80% of the cases. Negative PAS-stained smears maintains the diagnosis until another more specific method as electronic microscopy or culture is available. Pentavalent antimonial compounds are the drugs of choice and as an alternative or in case of failure amphotericin B can be used.
Subject(s)
Leishmaniasis, Visceral/diagnosis , Female , Humans , Infant , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/parasitology , Male , Mexico/epidemiologyABSTRACT
We report a case of a female infant, from Acapulco Guerrero, Mexico. She had been sick for 45 days, with diarrhea and general malaise, fever during the last 20 days; at physical examination she was pale, with abdominal distention and hepatosplenomegaly. She had leukopenia, thrombocytopenia and anemia. The microscopic findings in the bone marrow sample were intracytoplasmic and extracellular bodies. Both bone marrow and blood cultures were positive for Histoplasma capsulatum. Seventy three pediatric cases of diseminated histoplasmosis have been described in the medical literature since 1934 to 1988. It is know that only about 1% of the persons that become infected will develop a diseminated disease.
