Neonates with culture proven sepsis have lower amounts and percentage of CD45RA+ T cells.

To evaluate the expression of lymphocyte subsets in newborns diagnosed as culture proven or culture negative sepsis and to investigate the differentiation. The aim of this study is to explore neonatal immunology in newborns diagnosed as culture proven or culture negative neonatal sepsis and to identify their place in the diagnosis. This prospective study was performed in newborns who were diagnosed as neonatal sepsis and hospitalized in a tertiary care hospital and who were classified as culture proven sepsis (n=12), as culture negative sepsis (n=21) and healthy (n=17). Lymphocyte subsets were obtained at time of diagnosis. Culture proven sepsis had statistically significant increase of WBC compared to culture negative sepsis and control groups (p<0.05). Significant decreases were observed of percentage of lymphocyte, when compared to culture negative sepsis and control group (p<0.05). Percentage of CD4(+) was lower in culture proven sepsis and absolute count of CD4(+) was lower in culture negative sepsis (p<0.05). Percentage and absolute count of CD45RA(+) were lower in culture negative sepsis than control and percentage of CD45RA(+) was lower in culture proven sepsis than control (p<0.05). Percentage of CD45RO(+) was higher in culture proven sepsis than control group (p<0.05). It is clear that during neonatal sepsis lymphocyte subsets are different from healthy controls. Whether the described abnormalities represent the absence of a normal maturation process, rather, pathological events is still not clear.

Effects of febrile and afebrile seizures on oxidant state in children.

No comparative studies have addressed the oxidant and antioxidant states of blood and cerebrospinal fluid. To reveal this differential state, the study was designed to identify the seizure type with the worse prognosis by determining erythrocyte arginase and erythrocyte catalase, plasma and cerebrospinal fluid malondialdehyde, and plasma and cerebrospinal fluid nitric oxide levels. Study groups were classified as febrile (group 1, n = 21), afebrile (group 2, n = 21), and control (group 3, n = 41, subdivided as 3a, febris positive, convulsion negative, and 3b, febris negative, convulsion negative). Levels of erythrocyte arginase, erythrocyte catalase, plasma malondialdehyde, cerebrospinal fluid malondialdehyde, plasma nitric oxide, and cerebrospinal fluid nitric oxide levels were determined for all groups. A difference was detected between the control and febrile seizure groups with respect to erythrocyte catalase and plasma and cerebrospinal fluid levels of nitric oxide (P < 0.05). Both febrile states and convulsions influence oxidative mechanism. Oxidative stress-generating potential differs for febrile and afebrile seizures. In afebrile seizures, greater levels of oxidative stress might affect prognosis adversely. This phenomenon can be interpreted in terms of fever as a protective factor against possible neurological damage during convulsive seizures.

Parapneumonic empyema in children: conservative approach.

Forty-nine patients, aged 3 months to 13 years, were studied to determine the clinical presentation, bacteriology, treatment and outcome of empyema complicating pneumonia in children. There were 28 (57.2%) males and 21 (42.8%) females in the study, with a male/female ratio of 1.3/1. We found malnutrition in 15 (30.6%) patients. The most common symptoms at presentation were fever (93.8%) and cough (85.7%). Radiography demonstrated minimal effusions (6 patients, 12.2%), moderate effusions (23 patients, 46.9%), and massive effusions (20 patients, 40.9%). The pleural fluid was on the right side in 26 (53.1%) cases, the left side in 17 (34.6%) cases, and bilateral in 6 (12.3%) cases. Staphylococcus aureus was the most frequently isolated microorganism in pleural fluid. No organism was recovered in 33 (67.3%) patients. Most cases were treated with a combination of intravenous antibiotics and chest tube drainage. Decortication was carried out in only two patients. The hospitalization period was 28.02 +/- 10.18 days (11 to 57 days). There was one death due to widespread Staphylococcus aureus septicemia. All patients who were followed-up showed complete or near complete resolution of the chest radiography at six months, regardless of severity of disease or treatment modality. Children with pleural empyema can be successfully treated with appropriate antimicrobial therapy and adequate closed chest tube drainage. Further surgical intervention is rarely required.

Interleukin-8 levels in children with bacterial, tuberculous and aseptic meningitis.

OBJECTIVE: lnterleukin-8 (IL-8) is produced in monocytes and vascular endothelial cells in response to stimulation with bacteria or lipopolysaccharides, and is released from these cells into blood stream or tissue fluid. METHODS: Cerebrospinal fluid (CSF) levels of interleukin-8 in 56 children with nonbacterial, bacterial and tuberculous meningitis (TBM), and in 15 control subjects were analyzed to evaluate the involvement of this cytokine in the pathogenesis acute bacterial meningitis and their discriminative value between different etiologies of meningitis. The kinetics of IL-8 concentrations during the course of bacterial meningitis was also evaluated in patients. IL-8 levels were significantly higher in bacterial and TBM than in aseptic meningitis and in control subjects (p < 0.0001). RESULTS: There was no difference in the levels of IL-8 between the non-bacterial meningitis and control groups. The analysis of the kinetics of production of IL-8 in patients with bacterial meningitis showed that the SSF concentrations of this cytokine decreased to undetectable values in recovery stage. Conversely in patients with TBM the concentrations of IL-8 were elevated in two weeks after beginning the specific treatment. CONCLUSION: The results suggest that determining IL-8 levels may be useful in the differential diagnosis.