Ciprofloxacin in treatment of nosocomial meningitis in neonates and in infants: report of 12 cases and review.

Twelve cases of neonatal and infant nosocomial meningitis treated with intravenous ciprofloxacin in doses of 10 to 60 mg/kg/day are described. Four neonates were 21 to 28 days old and eight infants were 2 to 6 months old. Six presented with Gram-negative meningitis: Escherichia coli (2), Salmonella enteritidis (1), Acinetobacter calcoaceticus (1), two with two organisms, and (H. influenzae plus Staphylococcus epidermidis, Acinetobacter spp. plus S. epidermidis), and six were attributable to Gram-positive cocci (four S. aureus and two Enterococcus faecalis). Ten cases were cured. In two cases, reversible hydrocephalus appeared that responded to intraventricular punctures. In seven children, no neurologic sequellae appeared after a 2- to 4-year follow-up. One neonate had relapse of meningitis 3 months later and was ultimately cured, but developed a sequellae of psychomotoric retardation. Follow-up varied from 27 months to 10 years. Current published case reports from Medline on quinolone use in meningitis in neonates and infants are reviewed.

Nosocomial meningitis in children after ventriculoperitoneal shunt insertion.

This study reviews 33 cases of ventriculoperitoneal shunt (VPS) meningitis among 415 children after 540 shunt insertions within 8 y, in 9 paediatric intensive care units from 5 centres in Slovakia. The incidence of VPS meningitis was 6.3% per insertion. The most common organisms isolated from cerebrospinal fluid (CSF) and shunt were coagulase-negative staphylococci (52.8%), followed by Staphylococcus aureus (13.1%) and Pseudomonas aeruginosa (7.5%). Seven of 15 assessed risk factors were significantly associated with VPS meningitis, compared with non-VPS meningitis: prior meningitis with hydrocephalus (15.1 vs 1.5%, p < 0.015), perinatal pathology (51.1 vs 1.5%, p < 0.001), very low birthweight (66.6 vs 16.2%, p < 0.001), polymicrobial nosocomial meningitis (30.3 vs 5.9%, p < 0.002), S. aureus (21.2 vs 7.3%, p < 0.05), coagulase-negative staphylococci (84.8 vs 30.9%, p < 0.001) and P. aeruginosa and Acinetobacter calcoaceticus (30.3 vs 4.5%, p < 0.001) in aetiology.

Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis.

PURPOSE OF THE STUDY: To assess efficacy and safety of fluconazole in neonates with Candida fungemia. STUDY DESIGN: Multicenter prospective protocol of all fungemias appearing between January 1, 1993, and December 31, 1997, in four major university hospitals. RESULTS: Forty neonates, 28 of them with very low birth weight (<1500 g; 30.5 median gestation week), with documented Candida albicans fungemia were treated with intravenous fluconazole in a daily dosage of 6 mg/kg once daily for 6 to 48 days. Thirty-four received fluconazole as monotherapy and 6 received it in combination with amphotericin B. Thirty-two (80%) were cured; 4 of them relapsed despite at least 14 days of therapy, but they were ultimately cured without sequelae. Eight other neonates died, 4 because of fungal infection and 4 because of prematurity or hemorrhage or lung failure, with fungemia (20% overall and 10% attributable mortality). Two neonates had elevated liver enzymes during fluconazole therapy and 2 others had elevated serum creatinine during fluconazole monotherapy. In none of them did these abnormalities necessitate discontinuation of antifungal therapy. In 8 neonates fungal meningitis developed as a complication of fungemia. All but 3 fungemias were C. albicans; 3 were Candida parapsilosis. CONCLUSIONS: Fluconazole was safe and effective antifungal therapy even in complicated or Candida fungemia in neonates and in infants with very low birth weight.

Prospective study of nosocomial fungal meningitis in children--report of 10 cases.

Within an 8-year period, 10 cases of fungal nosocomial meningitis in children 0-13 y old were prospectively identified, 3 caused by yeasts other than Candida spp. (Rhodotorula rubra, Aureobasidium mansoni, Clavispora lusitaniae) and 7 by Candida albicans. Seven patients survived. whereas 3 neonates with fungal meningitis (all due to C. albicans) died. Risk factors for fungal nosocomial meningitis included cancer (2 children), previous neurosurgery (2 children), cranial trauma (1 case) and prematurity with low birthweight (5 cases). All patients except 1 had received broad-spectrum antibiotics before onset of meningitis. In addition to yeasts, bacteria were isolated from CSF of 4 children. One child had additional fungaemia. Univariate analysis was used to compare 10 cases of fungal to 91 cases of bacterial nosocomial meningitis. Except for concurrent bacteraemia, (60 vs 25.3%, P < 0.03), which was more frequently observed among fungal meningitis, there were no significant differences in risk factors, sequelae or outcome (mortality) between patients with fungal vs bacterial meningitis. A review of fungal meningitis reported within the last 20 y is included.

[Toxocara infections in childhood in relation to reactive arthritis]. / Toxokarová infekcia v detskom veku vo vzt'ahu k reaktívnej artritíde.

Reactive arthritis belongs to a group of rheumatoid diseases known as seronegative spondylarthritis or spondarthropathies. Of many reactive arthritis-evoking agents, the authors focused on larval toxocarosis. The authors describe a child with high anti-Toxocara antibody and circulating antigen titres in combination with acute Chlamydia infection, which may have caused reactive arthritis in this immunologically impaired organism. This is evidence of the coincidence of different pathological factors manifested by reactive affection of the knee joint.

Fimbriation, surface hydrophobicity and serum resistance in uropathogenic strains of Escherichia coli.

A total of 80 Escherichia coli strains were examined for expression of P-fimbriae, mannose-sensitive haemagglutination (MSHA) and mannose-resistant haemagglutination (MRHA) of human group A erythrocytes and guinea pig erythrocytes, cell surface hydrophobicity and resistance to serum bactericidal activity. Isolates were obtained from urine of children and adults, either with acute pyelonephritis (n = 15 and n 12) or lower urinary tract infection (UTI) (n = 30 and n = 23, respectively). Results obtained showed that, in E. coli strains isolated both from children and adults with lower UTI, significant differences were not found concerning the incidence of P-fimbriae, cell surface hydrophobicity and serum resistance. In pyelonephritogenic E. coli isolated from children and adults, the incidence of P-fimbriae and cell surface hydrophobicity was associated more frequently with the former (87% vs. 42% and 100% vs. 67%, P < 0.05), while serum resistance was associated with the latter (47% vs. 67%, P < 0.05).

Virulence-associated factors in Escherichia coli strains isolated from children with urinary tract infections.

One hundred and sixty-eight strains of Escherichia coli were isolated from cases of pyelonephritis (24) and lower urinary tract infections (UTI) (144) from hospitalised and outpatient children up to 2 years old. These strains were investigated for the expression of P fimbriae (PF), mannose-resistant and mannose-sensitive haemagglutination, cell-surface hydrophobicity, serum resistance and the production of alpha-haemolysin (AH), colicins and aerobactin. PF, AH, aerobactin production and serum resistance were significantly more frequent amongst strains expressing mannose-resistant haemagglutination. PF and AH production was significantly more frequent in pyelonephritogenic strains than in lower UTI strains. Serotypes O6 and O112 were isolated most frequently and plasmids were found in the majority of strains tested.

[Increased immune response in broilers after administration of natural food supplements]. / Zvýsení obranyschopnosti brojleru po podávání biologických krmných doplnku.

The trial involved broilers from the 4th to the 56th day of life. The first group P1 (n = 30) received commercial mashes with supplements of 0.5% biomass of freshwater algae (Chlorella vulgaris). The second group P2 (n = 30) received 0.9% dried cow's colostrum and 0.9% dried brewer's yeasts in addition to the algae (0.2%). All the ingredients came from fluid-bed drying at temperatures maximally 50 degrees C. Control group K (n = 30) consisted of broilers which received commercial mashes only. At the age of 21, 33 and 56 days, 10 birds of each group were killed, and basic hematological values were determined in the blood samples and phagocytic activity of leucocytes was determined. Samples of the thyme, bursa Fabricii, spleen, ileocecal valve, Meckel's diverticulum, gonads, suprarenal glands and Harder's gland were subjected to histological examination. 22-day chickens of all three groups were vaccinated with Newcastle disease (the vaccine Avipest, Mevak Nitra) and the levels of specific antibodies in blood serum were determined on days 33, 46 and 56. 0.5% alga supplement to feed ration increased the live weight of experimental broilers at the end of the second week of life only (p < 0.05). On the 21st and 33rd day of life, phagocytic activity of leucocytes increased significantly (p < 0.01) in these individuals, while in the second month of life development of the intestinal lymphatic tissue and Harder's gland was largely stimulated. Combination of algae with other biological additives did not significantly influence the live weight of broilers, but it enhanced the above-mentioned effect on the phagocytic activity and lymphatic tissue development.(ABSTRACT TRUNCATED AT 250 WORDS)

[Present possibilities of improving the diagnosis of glomerular erythrocyturia]. / Súcasné moznosti zlepsenia diagnostiky glomerulovej erytrocytúrie.

Examination of glomerular erythrocyturia which proved useful in the differential diagnosis of haematuria faces in practice two serious problems--the necessity to examine fresh urine and differences as regards the interpretation of criteria of glomerular erythrocyturia (from 10 to 80%). The authors examined therefore the morphology of erythrocytes in urine of 65 children with different causes of haematuria, incl. 35 patients with different forms of glomerulonephritis. They found that adding 25 mg thimerasol to 10 ml urine preserves urinary elements, incl. morphologically altered red cells for a period of 72 hours or longer. This makes it possible to examine the red cells under a phase microscope after dealing with ambulatory patients. Among various morphological forms of red cells in urine of 31 patients with glomerulonephritis in urine acanthocytes were found in a concentration above 5%, and in the majority above 20%. Acanthocyturia above 5% was not present only in 4 patients with glomerulonephritis, whereby all four suffered from mild erythrocyturia. The authors consider therefore acanthocyturia above 5% as the most reliable evidence of glomerulonephritis, in case of erythrocyturia above 10 Ery in the visual field. The criteria of acanthocyturia in children are thus lower than in adults.

[Are dietetic and non-immunologic therapies becoming deciding factors in the treatment of autoimmune diseases?]. / Stáva sa diétna a neimunologická liecba rozhodujúcim faktorom v terapii autoimúnnych chorôb?

Authors call attention to non-immunological therapy and its determining role for fate and final prognosis in patients with autoimmune diseases. A stress importance of the timely and rigorous antihypertensive and antiinfectious treatment. From the dietary measures is best known favourable effect of the low protein diet and pharmacological limitation of the phosphorus supply. A new therapeutical aspect is the influence of the lipids on the autoimmune diseases activity and efficiency of the omega-3 unsaturated fatty acids. Non-immunological methods of the treatment are particularly valuable for the general practitioners and pediatricians, because enable them essentially to influence the course of the autoimmune diseases.

[New views on the pathophysiology of the nephrotic syndrome]. / Nové pohl'ady na patofyziológiu nefrotického syndrómu.

The authors draw attention to new pathophysiological aspects of some symptoms of the nephrotic syndrome (NS), in particular proteinuria, hypoalbuminaemia and oedema. In proteinuria they focus attention on the formation of a new population of heteropores in severe morphological forms of NS with penetration of high molecular proteins into urine. In hypoalbuminaemia the authors emphasize the importance of an inadequately increased albumin synthesis in the liver. In case of oedema in the majority of patients hypovolaemia is not present, as was assumed so far. In the pathogenesis of oedema primary Na retention in the kidneys is important caused by the glomerulonephritic process. New findings in the pathophysiology of NS lead to changes of several clinical approaches. The authors draw attention e.g. to the need of dietary protein restriction in NS, on altered effects of drugs in NS, new approaches to diuretic treatment etc.