Assessment of cord blood IL-6 levels as an indicator of neonatal sepsis.

Based on the recognition that interleukin-6 (IL-6) is produced early in infection, IL-6 determinations have been used to identify infants with early onset bacterial sepsis. This study intended to assess the value of IL-6 in maternal, cord and infant peripheral blood as an index of sepsis, and examine the relationships of its values in mother and infants. The population consisted of 17 mother/infant pairs at high risk for neonatal infection. Eight of these infants had clinical signs of possible sepsis. Cord blood IL-6 levels in infants of mothers considered to be noninfected were lower than those born to women with chorioamnionitis. There was also a positive correlation between maternal and cord blood IL-6 values. There were no differences in maternal blood IL-6, whether they had infections or not. Also, peripheral infant blood obtained after birth did not differentiate between those born to women with or without chorioamnionitis, nor did it correlate with maternal blood IL-6 levels. Clinical symptoms of the infants did not correlate with either cord or peripheral blood IL-6 values. Although maternal prepartum treatment with antibiotics and/or steroids may influence their own and their infants' blood IL-6 levels, there is insufficient evidence to consider low infant blood IL-6 level a reliable predictor to rule out early newborn sepsis.

Streptococcus pneumoniae bacteremia in children infected with HIV: presentation, course, and outcome.

OBJECTIVE: To examine the presentation, course, and outcome of pneumococcal bacteremia in children infected with human immunodeficiency virus (HIV). METHODS: A retrospective series of HIV-infected children less than 18 years of age with Streptococcus pneumoniae bacteremia from four urban, tertiary care hospitals was evaluated. The main outcome measures included persistent bacteremia, the development of a focal infection, and death. RESULTS: Seventy-two episodes of pneumococcal bacteremia were identified in 59 patients. Fifty-four first episodes were included; 26/54 were occult. Mean temperature was 39.8 degrees C. In patients with bacteremia, white blood cells (WBCs) > or = 15,000 and > or = 10,000 had sensitivities of 40% and 75%, respectively. At the time of bacteremia, age >3 years old was associated with a lower mean WBC count compared with episodes occurring in patients <3 years old (11.2 vs 16.1, P < 0.05). Patients with occult bacteremia who were discharged with antibiotics (12 i.m., 7 p.o.) were less likely than patients without antibiotic treatment to have persistent bacteremia at a return visit within 72 hours (0/19 vs 2/5, P < 0.05). No patient with occult bacteremia died, progressed to clinical meningitis, or had other sequelae. Two of fifty-four patients died as a result of their first episode of invasive pneumococcal disease. Both patients who died had meningitis and appeared ill on initial presentation. CONCLUSIONS: Neither a WBC count > or = 15,000 nor > or = 10,000 is a sensitive indicator of pneumococcal bacteremia in HIV-infected children. Empiric antibiotics are useful to decrease the risk of persistent bacteremia. Children infected with HIV who have occult pneumococcal bacteremia appear to do well with appropriate antibiotics. Patients who are afebrile and well appearing on reevaluation may be safely treated as outpatients.

Efficacy and safety of dapsone prophylaxis against Pneumocystis carinii pneumonia in human immunodeficiency virus-infected children.

Dapsone (4,4'-diaminodiphenylsulfone) is recommended as an alternative agent for prophylaxis against Pneumocystis carinii in children with human immunodeficiency virus infection. We reviewed our experience over the past 100 months with 20 children (age range, 2 months to 13 years) who received dapsone and examined the safety and efficacy of this regimen. Dapsone was taken for an average of 7.33 months/patient or a total of 4410 days by those children in whom safety could be assessed. Three of the 20 patients had an adverse reaction to dapsone. One had mild elevation of blood methemoglobin values (5.6%) and transient elevation of serum transaminases that resolved without discontinuing drug. The other two developed allergic skin rashes which necessitated discontinuation. Efficacy of dapsone in preventing P. carinii pneumonia (PCP) was assessed in 16 children at high risk for developing PCP (defined by CD4 counts or prior PCP infection). These 16 children took dapsone for an average of 6.88 months and a total of 3300 days. Two of the 16 high risk children, one who had had a previous P. carinii pneumonia, developed PCP while taking dapsone. Both had CD4 counts < or = 200 cells/mm3 and were taking dapsone for > or = 12 months before developing PCP. Dapsone is well-tolerated in children and appears to be as effective in preventing PCP in children with human immunodeficiency virus infection as it is in adults.

Bacteremia due to Pseudomonas aeruginosa in children with AIDS.

Six episodes of Pseudomonas aeruginosa bacteremia in five children with AIDS were reviewed to characterize further the disease caused by this pathogen. Hypotension occurred in five episodes, and two children died. Bacteremia was associated most frequently with new pulmonary infiltrates and skin lesions, but additional sites of infection were also observed (the middle ear, an abdominal abscess, and the CNS). None of the children had catheter-associated infection, and only three were neutropenic. P. aeruginosa should be considered as a cause of sepsis in children with AIDS.