ABSTRACT
We report a case of a 16-year-old female patient with sickle-cell disease with a liver abscess secondary to methicillin-resistant Staphylococcus aureus (MRSA). She had initially presented with jaundice and abdominal pain and subsequently underwent endoscopic retrograde cholangio-pancreaticography followed by laparoscopic cholecystectomy for removal of gallstones. However, post-cholecystectomy she presented with generalized abdominal pain and computed tomography scan of the abdomen revealed a liver abscess. A pigtail catheter was inserted into the abscess and culture of the aspirate yielded MRSA (susceptibility pattern of the organism was compatible with community-acquired MRSA). She was treated with intravenous clindamycin for 6 weeks with complete resolution of the abscess.
Subject(s)
Anemia, Sickle Cell/complications , Drug Resistance, Bacterial , Liver Abscess/etiology , Methicillin , Staphylococcal Infections/etiology , Staphylococcus aureus/growth & development , Adolescent , Anemia, Sickle Cell/diagnostic imaging , Anemia, Sickle Cell/microbiology , Anti-Bacterial Agents/administration & dosage , Cholecystectomy, Laparoscopic , Clindamycin/administration & dosage , Female , Humans , Infusions, Intravenous , Liver Abscess/diagnostic imaging , Liver Abscess/drug therapy , Liver Abscess/microbiology , Radiography , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purificationABSTRACT
Cerebrospinal fluid shunt systems are used to treat hydrocephalus in infants and children; unfortunately, some shunt systems become infected. We sought to define the epidemiology of shunt infections and shunt survival prior to infection at our institution. We identified 268 shunt procedures performed from January 1990 to June 1996 in 145 patients. There were 29 episodes of shunt infection for an incidence of 10.8% per procedure and 13.1% per patient. Staphylococcus epidermidis was the most common isolate recovered. The probability of shunt infection was highest during the first 8 weeks after a shunt procedure and subsequent infection was less likely after 28 weeks.
Subject(s)
Cerebrospinal Fluid Shunts/mortality , Gram-Negative Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Adolescent , Alabama/epidemiology , Anti-Bacterial Agents/administration & dosage , Cerebrospinal Fluid/microbiology , Child , Child, Preschool , Drainage , Female , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , Humans , Hydrocephalus/surgery , Incidence , Infant , Infant, Newborn , Injections, Intravenous , Male , Probability , Risk Factors , Survival Rate , Treatment Outcome , Urban PopulationABSTRACT
A previously healthy 4-year old male, born in India and residing in Mobile, Alabama since October 1996 came to the emergency department in April 1997 because of general malaise, fever and vomits of 5 days duration. A peripheral smear of the complete blood count revealed the presence of malarial parasites within the erythrocytes. Plasmodium vivax was later identified in serial thin peripheral smears. He defervesced after initial treatment with oral quinine and pyrimethamine-sulfadoxine, followed by primaquine for 14 days.
Subject(s)
Malaria, Vivax , Alabama , Child, Preschool , Humans , Malaria, Vivax/diagnosis , Malaria, Vivax/drug therapy , MaleABSTRACT
Arthropod-borne virus (arbovirus) infections in humans are primarily central nervous system infections, but other clinical manifestations include febrile illness and fever with hemorrhagic diathesis. In the genus Bunyavirus there are several viruses that cause disease in humans, especially in North America; these include LaCrosse, Jamestown Canyon, trivittatus, and snowshoe hare viruses. The disease seen mainly in children is California encephalitis (usually of the LaCrosse subtype); this infection is widespread in the United States but is most prevalent in the upper Midwest, especially in rural areas. We present the first reported case of California encephalitis in rural Alabama; the patient was a 7-year-old boy who came to us with fever and seizures in the summer of 1994. This report stresses the importance of including California encephalitis in the differential diagnosis when children have fever and altered sensorium after exposure to mosquitoes during summer months.
Subject(s)
Encephalitis, California/diagnosis , Alabama , Animals , Child , Culicidae , Diagnosis, Differential , Encephalitis, California/virology , Fever/virology , Humans , Insect Vectors , La Crosse virus/isolation & purification , Male , Rural Health , Seizures/virologyABSTRACT
Croup is an acute infectious illness usually occurring in children; it is characterized by brassy cough and stridor. The main pathogens include mainly parainfluenza and influenza viruses. Recently there have been reports of prolonged croup caused by the herpes simplex viruses. We report two cases of prolonged croup due to herpes simplex types 1 and 2. We also review and summarize the reported pediatric cases of herpetic croup.
Subject(s)
Croup/diagnosis , Herpes Simplex/diagnosis , Herpesvirus 1, Human , Herpesvirus 2, Human , Biopsy , Child, Preschool , Croup/pathology , Female , Herpes Simplex/pathology , Herpes Simplex/virology , Herpesvirus 1, Human/isolation & purification , Herpesvirus 2, Human/isolation & purification , Humans , Infant , Larynx/pathology , MaleABSTRACT
OBJECTIVE: To estimate the perinatal HIV transmission rate and describe the natural history of infant HIV infection in a situation in which HIV status is known in more than 95% of delivering women. DESIGN: A cohort of HIV-exposed infants born between 7 July 1987 and 30 June 1990, whose mothers were identified by routine voluntary universal HIV testing, were followed using clinical and laboratory measures. SETTING: Grady Memorial Hospital, a major health-care site for individuals of lower socioeconomic status in Atlanta, Georgia, USA, with approximately 7000 deliveries per year. PATIENTS: HIV-exposed infants (n = 165), 98% of whom were African American. RESULTS: Annual maternal HIV seroprevalence increased from 0.58 to 0.86%. The annual proportion of HIV-positive women having a second delivery increased from 4.3 to 25%. Clinical outcome was known for 132 out of 165 infants (22 infected and 110 uninfected), the transmission rate was 17% (confidence interval, 11-24%). The rate declined to 11% by the third year of the study. Gestational growth, prematurity and mode of delivery were unrelated to infant outcome. There was a trend for intravenous drug use to be more common in mothers of infected infants (P = 0.08). After 35 months median follow-up of infected infants, eight out of 22 (36%) had an opportunistic infection (seven Pneumocystis carinii pneumonia); three out of 22 (14%) had lymphocytic interstitial pneumonia, and 10 out of 22 (45%) were asymptomatic or had only nonspecific symptoms. Cumulative mortality in infected infants was 9, 32 and 32% by 1, 2 and 3 years of age, respectively. CONCLUSION: In this cohort of HIV-exposed infants, perinatal HIV transmission was 17% overall. Factors affecting the transmission rate and possible future changes in the rate require further study.
Subject(s)
HIV Infections/transmission , Maternal-Fetal Exchange , AIDS-Related Opportunistic Infections/epidemiology , Child, Preschool , Cohort Studies , Female , Georgia/epidemiology , HIV Infections/mortality , HIV Seroprevalence , Humans , Infant , Infant, Newborn , Male , Pregnancy , Pregnancy Outcome , Prospective Studies , Risk FactorsABSTRACT
Thirteen children with human immunodeficiency virus infection acquired perinatally and with varicella were identified. Clinical and epidemiologic information, including the use of varicella immune globulin and acyclovir, was obtained and testing for antibodies to varicella-zoster virus was done. The 13 children infected with human immunodeficiency virus had an uncomplicated clinical course, and many had a significant antibody response to varicella-zoster virus.