Detection of adenovirus infection in children in Jordan.

Between November 1997 and May 1998, 350 nasopharyngeal aspirates (NPA) were obtained from children admitted to the Respiratory Disease Unit at Princess Rahma Hospital, northern Jordan who were clinically diagnosed as suffering from respiratory tract infections. NPA were investigated for the presence of adenovirus using shell vial (SV) culture assay, conventional culture (CC) assay, and direct immunofluorescence assay (DFA). Of the 350 NPA, adenoviruses were detected in 54 (15.4%) by the combined techniques used. SV identified 34 (63%), CC 48 (89%) and DFA 30 (56%). Most virus isolations were in children aged 1-< 5 years old and were associated with pneumonia in 39% and bronchopneumonia in 32%. SV assay showed a sensitivity and specificity of 68.8% and 99.7%, respectively, for detecting adenovirus from NPA. These results emphasize that CC assay is still important for the diagnosis of adenovirus, although SV and DFA are superior diagnostic assays.

Bacterial, viral and parasitic enteric pathogens associated with acute diarrhea in hospitalized children from northern Jordan.

To determine the etiology of acute diarrhea in Jordanian children under 5 years of age, we examined stool samples from 265 children admitted to the pediatric ward at Princess Rahma Hospital for Children, Irbid, Jordan, for parasites, rotavirus and enteric bacteria. Using both traditional and molecular diagnostic techniques, we detected enteropathogens in 66.4% of patients with diarrhea. A single enteric pathogen was detected in 50.9% of the children, and multiple pathogens were detected in 15.5%. The prevalence of enteropathogens identified was as follows: rotavirus (32.5%), enteropathogenic Escherichia coli (12.8%), enteroaggregative E. coli (10.2), enterotoxigenic E. coli (5.7%), Shigella spp. (4.9%), Entamoeba histolytica (4.9%), Salmonella spp. (4.5%), Campylobacter jejuni/coli (1.5%), Cryptosporidium spp. (1.5%), enteroinvasive E. coli (1.5%), eae-, Ehly-positive E. coli (0.8%), Giardia lamblia (0. 8%) and Yersinia enterocolitica (0.4%). No Vibrio cholerae, Shiga toxin-producing E. coli, microsporidia, adenovirus or small round virus were detected. Findings from this study demonstrate that rotavirus and several types of diarrheagenic E. coli, which are not screened for during routine examinations of stool samples in public health laboratories, were the most frequently detected enteropathogens in these children. Our findings highlight the value of using a combination of traditional and molecular techniques in the diagnosis of diarrheal disease in this population.

The limitations of carotid sonography: interpretive and technology-related errors.

OBJECTIVE: This study compared carotid artery sonography with angiography to determine, in retrospect, which types of sonographic errors arose from incorrect interpretation of sonographic images and which errors could be ascribed to the limitations of sonographic imaging. MATERIALS AND METHODS: A review of all patients who underwent carotid artery sonography and angiography between 1993 and 1997 at our institution revealed 66 patients with complete sets of studies, yielding 132 examinations (right or left). Studies were not reinterpreted and angiography was considered to be the gold standard. Only stenoses of 60% or greater were included in our study. If the degree or location of stenosis differed on the two imaging studies, they were reviewed together to classify the type of sonographic error. RESULTS: We found complete agreement of sonography and angiography in 115 cases (87%) and discrepancies in 17 (13%). Thirteen of 17 sonographic errors were false-positive interpretations and three were false-negative interpretations. One was an error in location. Retrospective review showed seven interpretive errors. In all these cases, the color Doppler image better revealed the degree of stenosis. Other complicating factors included inconsistencies between absolute velocities, velocity ratios, and waveforms obtained while a patient was being treated with an intraaortic balloon pump. In the other 10 discrepancies, the sonographic interpretation was accurate. Seven of these cases were false-positive interpretations in patients with contralateral occlusions or stenoses. The other three cases in this group showed long segments of stenosis, ulcerations, or tortuous vessels on angiography. CONCLUSION: Our study suggests that increased accuracy can be achieved in the interpretation of carotid artery sonography by meticulous attention to the color image. When color Doppler sonography is technically limited by tortuosity or ulceration, or if significant contralateral disease is present, misinterpretation is more likely.

Prevalence of parainfluenza and influenza viruses amongst children with upper respiratory tract infection.

OBJECTIVE: The objective of this study was to determine the prevalence of Parainfluenza and Influenza causing upper respiratory tract infections and to evaluate shell vial culture assay and direct immunofluorescence assay. METHODS: A retrospective study during the period between November 1997 and May 1998. A total of 350 nasopharyngeal aspirates were obtained from children suffering from respiratory tract infections. Nasopharyngeal aspirates were investigated for the presence of Parainfluenza 1, 2 and 3, Influenza A and B using shell vial culture assay, conventional culture assay and direct immunofluorescence assay. RESULTS: Parainfluenza 1 were identified in 3%, Parainfluenza 2 in 5% and Parainfluenza 3 in 6%. Influenza A were identified in 4% and Influenza B in 2%. Parainfluenza 1, 2 and 3 were isolated in children less than 5 years old. Most of Parainfluenza cases were associated with other upper respiratory infections. Shell vial assay showed a sensitivity of 90-93% and specificity of 99-100% for detecting Parainfluenza 1, 2 and 3. CONCLUSION: These results emphasize that shell vial assay is important for the diagnosis of Parainfluenza and Influenza, although direct immunofluorescence assay is the superior diagnostic assay.

Molecular typing of multiresistant Klebsiella pneumoniae isolated from children from northern Jordan.

Twenty-nine clinical isolates of community acquired Klebsiella pneumoniae obtained from 17 children with malnutrition were characterized by antibiotic susceptibility, plasmid analysis, and random amplified polymorphic DNA (RAPD) techniques. Disc diffusion methodology was used to test the susceptibility of the isolates to 13 antibiotics: amoxycillin, cephapirin, ceftazidime, cefoxitin, cefotaxime, aztreonam, gentamicin, ciprofloxacin, chloramphenicol, erythromycin, nalidixic acid, trimethoprim and amoxycillin-clavulanic acid. All the isolates showed multiresistance patterns (15 patterns) ranging from resistance to two antibiotics to resistance to 10 antibiotics. All isolates were resistant to amoxycillin and erythromycin. Ten K. pneumoniae isolates producing extended-spectrum beta-lactamases (ESBLs) as evidenced by the double-disc diffusion synergy test were isolated sporadically from six patients. Six of these 10 isolates were hyperproducers of ESBL, which resulted in increased resistance to the beta-lactam-beta-lactamase inhibitor combination amoxycillin-clavulanic acid. Plasmid analysis showed plasmid ranging in size from 48 kilobases (kb) to 1.4 kb. All the 29 isolates shared the same plasmid 26 kb. There was a consistent relationship between antibiotype and plasmid profiles for each pair of isolates obtained from five individual patients. RAPD analysis using a single (10-mer) primer demonstrated that the isolates that have the same antibiotype and the same plasmid profile had different RAPD fingerprint patterns. These results demonstrate that the RAPD technique is better than antibiotype characterization and a plasmid analysis profile for typing K. pneumoniae as well as for revealing strain differences.

Respiratory syncytial virus infection in infants hospitalized with respiratory illness in northern Jordan.

During the winter seasons of 1993 and 1994, a total of 256 nasopharyngeal aspirates (NPA) from infants aged less than 1 year old admitted to the pediatric ward of Princess Rahma Hospital, northern Jordan, with bronchiolitis and/or pneumonia, were tested for the presence of respiratory syncytial virus (RSV) using direct immunofluorescence assay (DFA) and cell culture (CC). Of the 256 specimens, 129 (50 per cent) were found positive by both DFA and CC, whereas 24 specimens (9 per cent) and 16 specimens (6 per cent) were found positive by DFA and CC, respectively. In an evaluation of the collected NPA specimens detected by DFA, a sensitivity of 89 per cent and a specificity of 78 per cent were demonstrated. These data suggest that virus isolation in CC is still important for the diagnosis of RSV, although DFA is a valuable, rapid diagnostic assay.

Viral gastroenteritis among young children in northern Jordan.

During the summer months of 1992 and 1993, a total of 439 diarrhoeatic fecal specimens from infants and young children less than 3 years of age admitted to the pediatric ward of Princess Basma Teaching Hospital, northern Jordan were tested for the presence of viruses using direct electron microscopy (EM) and enzyme-linked immunosorbent assay (ELISA) for rotavirus. EM revealed rotaviruses in 83 (18.9 per cent) of cases, adenoviruses in five (1.1 per cent) cases, and small round viruses in three (0.68 per cent) cases. In contrast, the ELISA assay detected rotaviruses in 174 (39.6 per cent) of cases. In an evaluation of the collected diarrhoeatic fecal samples for rotavirus detected by ELISA, a sensitivity of 95.2 per cent and a specificity of 73.3 per cent was demonstrated.

Autosomal recessive lamellar ichthyosis and acute lymphoblastic leukemia.

Autosomal recessive lamellar ichthyosis (ARLI) is a congenital disorder of keratinization, the gene of which has been mapped to chromosome 14q11. This band is also the breakpoint in various chromosomal rearrangements in T cell acute lymphoblastic leukemia (ALL). We describe a patient with ARLI who developed ALL at the age of 2.5 years. High resolution banding showed no abnormality or rearrangement involving chromosome 14. To our knowledge, this is the first description of the occurrence of the two conditions in one patient.

Shigellosis in Jordanian children: a clinico-epidemiologic prospective study and susceptibility to antibiotics.

During a 2-year prospective study of children hospitalized with gastroenteritis, shigellosis was detected in 66 cases (9 per cent of 726 admissions). The age group for peak shigella incidence was 1-4 years. The incidence increased from 8 per cent in 1991, to 11 per cent in 1992. Shigella flexneri was the most common isolate (65 per cent), followed by Shigella sonnei (17 per cent), Shigella boydi (11 per cent), and Shigella dysenteriae (7 per cent). At presentation, 44 per cent had watery diarrhoea, followed by dysentery during hospitalization in the majority of cases. Seizures occurred in 27 per cent of cases and preceded diarrhoea in 15 per cent. Most Shigella flexneri and dysenteriae strains were resistant to co-trimoxazole, ampicillin, tetracyclin, and chloramphenicol. Nalidixic acid, gentamicin and cefotaxime were the most effective antibacterial agents. Case fatality was 3 per cent associated with strains resistant to the antibiotics used initially in the treatment.

Metabolic responses to exercise in patients with heart failure.

Metabolic and hemodynamic responses to exercise were evaluated in 10 patients with chronic congestive heart failure. We utilized an exercise protocol in which the work rate was increased continuously and oxygen uptake (VO2) kinetics were characterized by linear, first-order dynamics. VO2 at peak exercise (VO2max) was depressed at 12.8 +/- 2.3 ml/min/kg and the anaerobic threshold occurred at 63 +/- 10% of the VO2max. A significant correlation was observed between the VO2 at the anaerobic threshold and the resting cardiac index (r = .74, p less than .05). Ventilation-perfusion relationships improved during exercise, despite the presence of a widened alveolar-arterial gradient in oxygen tension and elevation of the physiologic dead space/tidal volume ratio. At peak exercise, a large breathing reserve (maximal voluntary ventilation-minute ventilation), a decline in arterial carbon dioxide tension, and a slight increase in arterial oxygen tension were observed. Plasma epinephrine levels at peak exercise correlated directly with VO2max (r = .74, p less than .05). Thus, although disturbances in ventilation-perfusion relationships occur in association with heart failure, exercise is not limited by an impairment in pulmonary function. The glycogenolytic action of epinephrine may play an important role in determining peak exercise capacity since glycogen stores are increasingly utilized at work rates above the anaerobic threshold.

Effects of long-term therapy with oral piroximone on resting hemodynamics, peak aerobic capacity, and the anaerobic threshold in patients with heart failure.

Piroximone (MDL 19205), a new imidazole derivative with positive inotropic and vasodilating properties, was administered to 10 patients with congestive heart failure. After acute intravenous (0.90 +/- 0.12 mg/kg, mean +/- SEM) and oral (1.41 +/- 0.18 mg/kg) administration, cardiac index and stroke volume index increased and were accompanied by a decline in systemic vascular resistance, pulmonary capillary wedge pressure, and right atrial pressure. Mean arterial pressure was unchanged, but heart rate increased modestly after intravenous piroximone. An increase in premature ventricular contractions was documented in four patients after drug administration. Seven of the 10 patients completed 12 weeks of therapy with piroximone; one patient withdrew after 8 weeks because of deterioration in clinical status; one developed severe ventricular arrhythmias and died after 5 days of treatment; and a drug-induced hepatitis was documented in one subject at 4 weeks. No significant improvement in oxygen uptake at peak exercise and the anaerobic threshold was observed after long-term treatment (assessed at 6 and 12 weeks). Hemodynamic responsiveness to piroximone was sustained in five patients who underwent repeat evaluation at 12 weeks. Thus, long-term treatment with piroximone was not associated with an improvement in maximal and submaximal exercise capacity in patients with congestive heart failure. Serious adverse effects were observed with the administration of this drug.

Unusual vascular reactions to albuterol.

Two patients experienced previously undescribed vascular reactions to albuterol sulfate inhalation. Features of the first reaction suggest mast-cell degranulation and were reversed by epinephrine. The second patient experienced severe postural hypotension corresponding to albuterol's duration of action. Vasoactive mediators or unusual vascular sensitivity to beta 2-drugs may be implicated in these reactions.