Septic arthritis caused by an unusual type of Haemophilus influenzae.

A healthy 3.5-month-old infant developed septic arthritis with Haemophilus influenzae type f isolated from the knee aspirate and blood. The patient had no obvious risk factors and immunological evaluation revealed no abnormalities. To our knowledge, there are only two reported childhood cases of septic arthritis caused by non-type b H. influenzae, but this is the first one to be reported in a child without an underlying disorder. The importance of serotyping H. influenzae isolates in the H. influenzae type b vaccine era, and the need to look for predisposing factors in paediatric patients with invasive disease caused by non-type b H. influenzae are discussed.

Cranial nerve palsies in Streptococcus pneumoniae meningitis.

Cranial nerve palsies are uncommon in nontuberculous bacterial meningitis. We report a patient with Streptococcus pneumoniae meningitis, multiple cranial nerve involvement, and cerebellar signs suggestive of basilar meningitis. Nontuberculous bacterial meningitis should be considered in the differential diagnosis of basilar meningitis.

A focus of Rocky Mountain spotted fever within New York City.

In the spring and summer of 1987, four persons acquired Rocky Mountain spotted fever within New York City, an area in which the disease had not previously been known to be endemic. Three of the four patients were residents of the Soundview area of the Bronx. All diagnoses were confirmed by indirect fluorescent-antibody tests. Environmental investigation revealed that the tick vector for Rickettsia rickettsii, Dermacentor variabilis, was present in a local park. Of the 66 specimens of D. variabilis collected, 5 (8 percent) were positive for rickettsiae from the spotted fever group. Of an additional 96 specimens of D. variabilis, 5 (5 percent) were found positive for rickettsiae by a more specific monoclonal antibody assay. Eight additional New York City parks in all five boroughs were searched for ticks. D. variabilis was found in only one other park; of the 147 ticks collected there, none were positive for rickettsiae. These findings emphasize the focal nature of Rocky Mountain spotted fever and the need to consider that disease in the differential diagnosis of any obscure acute febrile illness, even in the absence of a history of travel to known endemic areas.

Acquired immunodeficiency with reversed T4/T8 ratios in infants born to promiscuous and drug-addicted mothers.

A new syndrome of acquired immunodeficiency has been identified in seven children who were small for gestational age at birth and subsequently have exhibited failure to thrive, lymphadenopathy, parotitis, hepatosplenomegaly, interstitial pneumonia, and recurrent infections. All have a profound cell-mediated immunodeficiency with reversed T4/T8 ratios. Six are hypergammaglobulinemic and one has low IgG levels. The mothers of five of the seven children are sexually promiscuous and/or drug addicts. Three mothers have an immunodeficiency similar to that found in their infants. One of them died at age 33 years with a diagnosis of acquired immunodeficiency syndrome. In five of the children and in three of their mothers, there is evidence of a persistent Epstein-Barr virus (EBV) infection. We speculate that a perinatal or in utero transmission of EBV can induce an "infectious immunodeficiency." The clinical, histopathologic, and immunologic features resemble those described in adult homosexuals and drug addicts.

Sinusitis: induced subdural empyema.

In 17 cases of sinusitis-induced subdural empyema, all but 5 occurred in boys or men aged 13 to 33 years. Clinical features were headaches and fever (14 patients), nuchal rigidity (10), and seizures (8). Seven patients had periorbital cellulitis, and 15 had radiographic clouding of at least one sinus. Only five patients had a history of sinusitis. CT identified the empyema accurately in seven patients but failed in two patients who developed subdural empyema while being treated for sinusitis-induced cerebritis. Ten patients had specific bacteriologic etiologies determined by culture of empyema, blood, or sinuses.

Infectious agents in spinal epidural abscesses.

Of 27 cases of spinal epidural abscess, 19 were caused by bacteria, 7 by Mycobacterium tuberculosis, and 1 by Echinococcus granulosus. Blunt trauma and cutaneous infections were the most frequent preceding events in bacterial cases. Tuberculous abscess was usually the sole manifestation of reactivation of dormant tuberculosis. Drug addiction, the most common cause in young adults, was associated with gram-negative infections. Whatever the infectious agent, paraparesis for longer than 4 days led to a poor outcome. Myelography was the best diagnostic test, whereas lumbar puncture and percutaneous bone biopsy offered little specific information.

Interstitial nephritis with anti-tubular-basement-membrane antibody.

To determine the pathogenesis of interstitial nephtitis, immunopathological studies were performed with kidney and serum from a six-year-old boy. The kidney revealed linear staining of tubular basement membranes with antiserums specific for human IgG and C3; the membranes also showed fixation of heterologous complement. After incubation of the patient's serum on frozen sections from normal human kidneys, linear staining with IgG was detected by indirect fluorescence. This staining was eliminated by absorption of the serum with purified tubular basement membranes, but was unaltered by absorption with purified glomerular basement membrane. The antibody reacted with mouse, rabbit, dog, sheep, monkey, Sprague-Dawley and Lewis/Brown Norway rat tubular basement membranes, but not with that of Lewis rat or guinea pig, or with human skin, thyroid, parotid, lung, liver or pancreas. Anit-tubular-basement-membrane antibody may be involved in the pathogenesis of the patient's disease.