Lyme disease.

Lyme disease is a newly recognized disease with diverse but characteristic inflammatory manifestations that involve the skin, joints, heart, and CNS. The illness develops following the bite of the Ixodes tick and is caused by a Treponema-like spirochete. This article reviews the causal, epidemiologic, clinical, and laboratory features of this illness. Since a large number of patients described with this treatable disease have been children and the disease may be confused with other more serious illnesses, Lyme disease is worthy of the pediatrician's awareness.

Neonatal herpes simplex infection in the absence of mucocutaneous lesions.

Six infants with disseminated HSV had no mucocutaneous lesions at any time during the course of the illness. These infants presented with lethargy, poor feeding, apnea, acidosis, and hepatomegaly. The diagnosis of HSV was made by culturing the infant's oropharynx and blood, and the maternal cervix. Eight infants with HSV encephalitis had no skin, eye, or mucous membrane lesions. These infants presented with lethargy and low-grade fever, followed within 24 hours by the onset of focal partial motor seizures. The seizures were refractory to anticonvulsant therapy. The mean CSF white cell count was 131 cells/mm3;the glucose and protein concentrations were in the normal range. Brain biopsy was required for the early diagnosis of HSV encephalitis. These 14 cases presented 70% (14/20) of all infants with neonatal HSV diagnosed during the study period. HSV infection should be considered in infants with no mucocutaneous lesions who have signs usually associated with bacterial sepsis or who develop focal seizures during the first three weeks of life.

Comparison of oral penicillinase-resistant penicillins: contrasts between agents and assays.

We observed the comparative serum levels and mean peak serum antistaphylococcal activity in eight fasting adults who received 500 mg each of dicloxacillin, cloxacillin, oxacillin, and nafcillin. Dicloxacillin achieved higher and more prolonged serum levels and greater peak serum antistaphylococcal titers than the other drugs studied. The higher degree of protein binding of dicloxacillin was reflected in a greater disparity between the peak antistaphylococcal activity observed when dilutions were done in serum compared to broth. The lesser protein-bound penicillins showed less disparity, but this effect was offset by the higher serum levels obtained by dicloxacillin. The higher protein binding of dicloxacillin did not prevent its having equal or superior antistaphylococcal activity in serum when the drugs were given in equal doses.

Epidemic occurrence of neonatal necrotizing enterocolitis.

In case-control studies of three epidemics of neonatal necrotizing enterocolitis (NEC) in three different high-risk nurseries in three states, no particular risk factor was associated with affected infants or their mothers. Epidemic cases had higher birth weights and Apgar scores and fewer perinatal difficulties than those previously reported for sporadic cases. Seven infants fed primarily breast milk were not protected against disease. Early antibiotic therapy was associated with a significantly decreased risk of disease in one outbreak. In two hospitals, affected infants who received antibiotic therapy during the first three days of life had a significantly later disease onset. The occurrence of the disease in epidemics and the decreased risk or modification of disease with antibiotic therapy support an infectious etiology for NEC.

Type A2 influenza viral infections in children.

We retrospectively reviewed the manifestations of influenza A2 in 83 hospitalized young children. Our purpose was to define the spectrum of clinical illness in this age group. Findings included fever (91%), vomiting or diarrhea (49%), pharyngitis (34%), pneumonitis (29%), otitis media (24%), conjunctivitis (13%), croup (13%), and bronchiolitis (6%). Neuromuscular manifestations occurred in 16 patients (19%) and included seizures, apnea, opisthotonos, and myositis. Three children had cerebrospinal fluid pleocytosis. Children younger than 3 months of age had fever less often and gastrointestinal symptoms more often than older children. Threee children died of progressive pneumonitis. We conclude that influenza A2 may cause a wide range of respiratory and neurologic findings in infancy and early childhood.

Apnea associated with respiratory syncytial virus infection in young infants.

The hospital charts of 274 infants under 6 months of age with culture-proved respiratory syncytial virus infections were reviewed. Fifty-six infants (20.4%) demonstrated apnea in association with RSV infection. Predisposing factors significantly correlated with apnea included premature birth and young chronologic age at the time of virus infection. The clinical implications of this association are discussed.

Respiratory syncytial virus in early infancy. Circulating antibody and the severity of infection.

Forty-one children less than 6 months of age from whom respiratory syncytial virus (RSV) was isolated were divided into groups of varying severity of illness. No relationship was demonstrated between severity of illness and the complement fixation titer to RSV in cord sera, acute sera, or convalescent sera. An increase in IgM level of greater or equal to 15 mg/100 ml in association with the RSV infection was seen more frequently in infants who had higher IgM levels in their acute sera than in infants who had lower levels.

Mucocutaneous lymph node syndrome in Denver.

Four children with acute febrile mucocutaneous lymph node syndrome (MLNS) were hospitalized in Denver over a two-year period. The children had most of the principle features of this recently described syndrome, including prolonged fever unresponsive to antibiotics, an erythematous rash, conjunctivitis, pharyngitis, and nonsuppurative cervical lymphadenitis. Three of the children exhibited characteristic desquamation from the fingertips or toes during convalescence. None developed clinical or electrocardiographic evidence of coronary thromboarteritis, the most serious complication of the disease. Additional cases undoubtedly will be reported in the United States as physicians become famililar with this new syndrome and learn to distinguish it from the other acute febrile exanthems.

Severe Haemophilus influenzae infections.

From May 1973 thorugh April 1974, a total of 83 children with severe Haemophilus influenzae infections were treated in three Denver pediatric hospitals. Although meningitis was the most common clinical manifestation (45 cases), other foci of infection were also noted (pneumonia, 12 cases; cheek cellulitis, eight cases; epiglottitis, eight cases; empyema, seven cases; pericarditis, three cases; arthritis, one case; periorbital cellulitis, one case; and abscess, one case). Nine children had positive blood cultures with H influenzae without an initial detectable focus of infection. Two patients developed clinically apparent sites of infection (osteomyelitis and scalp abscesses).