Use of the directigen latex agglutination test for detection of Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis antigens in cerebrospinal fluid from meningitis patients.

Cerebrospinal fluid specimens from 257 persons were tested for the presence of bacterial antigens by counterimmunoelectrophoresis and the Directigen meningitis test (Hynson, Westcott & Dunning, Div. Becton Dickinson & Co., Baltimore, Md.). The specimens were obtained from 162 patients with meningitis caused by Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis serogroups A and C and from 95 patients without bacterial meningitis or meningitis caused by other bacterial agents. Directigen detected H. influenzae type b antigen in 83% (69 of 83) of the specimens obtained from patients with H. influenzae disease, pneumococcal antigen in 77% (30 of 39) of the specimens from patients with pneumococcal disease, and N. meningitidis antigen in 93% (37 of 40) of the specimens from patients with disease caused by N. meningitidis serogroups A and C. The comparable figures for counterimmunoelectrophoresis were 66% (55 of 83), 79% (31 of 39), and 78% (31 of 40), respectively. No false-positive reactions were reported with the Directigen reagents. Nonspecific reactions (agglutination with more than one of the four Directigen latex reagents) were noted with five specimens. The nonspecific reactions were resolved in four of the five specimens by heating (100 degrees C for 3 min). The accumulated data demonstrate that the sensitivity of the Directigen meningitis test is better than or at least equivalent to the sensitivity of counterimmunoelectrophoresis for the detection of antigens in cerebrospinal fluid.

Primary peritonitis due to Haemophilus influenzae type b in a previously healthy child.

A case of primary peritonitis caused by Haemophilus influenzae type b biotype 2 in a 3-year-old child is described. The organism was isolated from peritoneal fluid. This is the first case of documented peritoneal infection due to this species in a patient who showed no evidence of being immunocompromised.

Clinical spectrum of pharyngeal gonorrhea in children and adolescents: a report of sixteen patients.

Pharyngeal gonorrhea in children and adolescents is probably increasing. During a 1-year period, 16 patients were diagnosed and treated for pharyngeal gonorrhea. This was the result of a search among a high-risk group, consisting of victims of sex abuse, patients suspected of homosexual practices, and adolescents with symptoms or signs suggestive of sexually transmitted diseases. Of the 16 positive throat cultures, 75% represented pharyngeal colonization while only 25% had clinical symptoms. Pharyngeal gonorrhea was found to be a marker in screening for psychosocial pathology, leading in two-thirds of the cases to the discovery of instances of incest, sexual abuse, chaotic family situations, or severe depression, all of which had been previously denied, ignored, or neglected. The purpose of this article is to alert health care providers to the clinical spectrum of pharyngeal gonorrhea in children and adolescents.

Haemophilus influenzae biotype III infections in children and report of three unusual cases.

Three hundred thirty seven Haemophilus influenza isolates from infections in children were studied to determine the relationship between H. influenza, biotype III, and specimen source. Eighteen per cent (60) of the isolates were H. influenza biotype III. Of these, 70% were from the eye, 18% from the respiratory tract, 7% from the ear and 2% from blood. Although conjunctivitis was the most common clinical condition associated with H. influenza biotype III, three cases of systemic infection with this organism are presented: a 10-month-old female with pneumonia, a 17-year-old male with sepsis, and a 7-year-old male with endophthalmitis. This organism may be a significant pathogen depending on the clinical setting. Increased awareness of its importance will lead to more reports of its isolation.

Ampicillin-resistant Hemophilus influenzae type B septic arthritis in children.

Three cases of ampicillin-resistant Hemophilus influenzae type B septic arthritis are described. These patients presented over a four-month period (November 1978 to February 1979). All were less than 18 months of age, all had positive blood and joint aspirate cultures, and counter-current immunoelectrophoresis (CIE) on serum positive for Hemophilus influenzae type B. The ampicillin minimum inhibitory concentration (MIC) for all three isolates was 6.25 microgram/ml or greater. All patients recovered uneventfully with intravenous chloramphenicol therapy. We suggest that chloramphenicol be considered in the initial therapy of children under 18 months of age who present with septic arthritis, at least in geographic areas where the incidence of ampicillin resistance is high.

Lactic acid in urine of children with lower and upper urinary tract infection and renal obstruction.

Preliminary evidence suggests that the concentration of lactic acid in urine may be a good means of distinguishing lower urinary tract infection (cystitis) from upper urinary tract infection (pyelonephritis) and may be helpful in detecting urinary tract obstruction. To test this hypothesis the lactic acid concentrations in 291 urine samples from 250 children were tested. Sixty-four patients had no bacterial infection and served as the control group. A second group (153 patients) had cystitis, and the third group (24 patients) showed radiologic, clinical, and laboratory evidence of pyelonephritis. A fourth group of nine patients who had prolonged urinary tract retention was also analyzed. Patients in the control group, as well as those with cystitis, showed relatively; low concentrations of urinary lactic acid. All levels were less than 2 mg/dl; (mean, 0.8 mg/dl; range, 0.1-2 mg/dl). Patients who had clinical pyelonephritis had lactic acid concentrations of 3.3 mg/dl (mean, 11.4 mg/dl; range, 3.3 mg/dl-40.5 mg/dl). There was no overlap in lactic acid concentrations between the two groups. Furthermore, lactic acid concentrations in urine from patients who had pyelonephritis gradually declined after the initiation of therapy, attaining a level of less than 1 mg/dl by the end of the treatment. Recurrence of the pyelonephritis was consistently documented by a renewed increase of urinary lactic acid concentration. Lactic acid levels were also elevated in urine samples collected immediately after relief of obstruction in the nine patients who had urethral obstructions, showing a mean concentration of 15.8 mg/dl (range, 4.2-37.2 mg/dl).

Anaerobic bacteremia in children.

Twenty-nine anaerobic isolates were recovered from 28 pediatric patients with anaerobic bacteremia: 14 Bacteroides sp (11 in the B fragilis group); four anaerobic Gram-positive cocci; four Clostridium sp; four Propionibacterium acnes; and three Fusobacterium sp. No aerobic bacteria were isolated from these patients. The gastrointestinal tract was the possible portal of entry in 13 instances, eight of which were due to Bacteroides organisms, four to Clostridium sp, and one to F nucleatum. The ear, sinus, and oropharynx were probable portals of entry in seven instances, four of which were due to Peptococcus sp and two to Fusobacterium sp. Five patients (18%) died; four had bacteremia caused by B fragilis group, and one had bacteremia caused by P acnes. The average duration of antimicrobial therapy was 20 days (range, seven to 72 days). The early recognition and rapid institution of appropriate antimicrobial and surgical therapy are of utmost importance in improving the outcome of these patients.

Complications of sinusitis in children.

Eight patients (6 to 15 years of age) who had periorbital cellulitis and other complications of sinusitis were studied. Both ethmoid and maxillary sinusitis were present in four patients, frontal sinusitis in two, and ethmoid sinusitis and pansinusitis in one patient each. Subdural empyema occurred in four patients, in one case accompanied by cerebritis and brain abscess and in another by meningitis. Periorbital abscess was present in two children who had ethmoiditis. Alveolar abscess in the upper incisors was present in two children whose infection had spread to the maxillary and ethmoid sinuses. Anaerobic bacteria were isolated from the infected sinuses in all the patients. These were seven isolates of Bacteroides sp, four Fusobacterium sp, three microaerophilic streptococci, three Gram-positive anaerobic cocci, and two Veillonella sp. There was only one aerobic isolate recovered, a group F beta-hemolytic. Streptococcus. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in all patients. The role of anaerobic bacteria in sinus infection and its subsequent complication is discussed. Given the possible serious complications of this disease, the early recognition of sinusitis in children and the institution of appropriate antimicrobial and surgical therapy are of great clinical importance.

Arizona hinshawii bacteraemia and meningitis in a child: a case report.

An 8-week-old infant presented with Arizona hinshawii meningitis and bacteraemia. The child responded well to the administration of parenteral ampicillin and chloramphenicol. However, chloramphenicol was discontinued after one day of therapy, and A. hinshawii was recultured from the cerebrospinal fluid on the fifth day. Chloramphenicol therapy was restarted and the patient had an uneventful recovery. This report is the first description of A. hinshawii meningitis and should alert clinicians to the possible occurrence of this infection in endemic areas.

Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children.

Aspirates of pus from pilonidal abscesses in 25 children were studied for aerobic and anaerobic bacteria. A total of 76 isolates (63 anaerobic and 13 aerobic) were recovered from the patients, accounting for 2.52 anaerobes and 0.52 aerobes per specimen. Anaerobic organisms were recovered from all the specimens, and in eight cases (32%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides sp (36 isolates, including ten B fragilis group and ten B melaninogenicus group), Gram-positive anaerobic cocci (16). Fusobacterium sp (five), and Clostridium sp (four). The predominant aerobic organisms were Escherichia coli (four) and group D streptococci, alpha-hemolytic streptococci, and Proteus sp (two of each). We believe this study is the first to demonstrate the mixed anaerobic and aerobic bacteriology of pilonidal cyst abscesses in children.

Gonococcal scalp abscess in a newborn.

We have described a 6-day-old male infant who presented with Neisseria gonorrhoeae conjunctivitis and a scalp abscess. Delivery was complicated by rupture of the membranes 24 hours before delivery and fetal monitoring for four hours. The rare scalp abscesses caused by gonococci cleared with penicillin therapy.

Meningitis in typhoid fever: an unusual complication.

A case of Salmonella typhi meningitis in a 15-month-old child was manifested only by organisms in the CSF, emphasizing the need for spinal tap in children with typhoid fever. The infection responded satisfactorily to special drug therapy.

Yersinia enterocolitica enteritis in children.

Five patients were admitted to Children's Hospital National Medical Center with manifestations of Yersinia enterocolitica infections. Four of five had primarily enteric illness, while the fifth had associated ocular and joint involvements. In three of five cases, the disease was self-limiting. Two of the patients (No. 1 and 2) may have had their disease improved by antibiotic therapy. Increased alertness to the potential of Y enterocolitica to cause a variety of syndromes is necessary to make an accurate bacteriologic diagnosis and to expedite medical treatment.

Lactic acid levels in cerebrospinal fluid from patients with systemic lupus erythematosus.

Cerebrospinal fluid (CSF) samples from 22 patients with systemic lupus erythematosus (SLE) and 20 samples from normal controls were studied for lactic acid levels. Ten samples were obtained from SLE patients with active central nervous system (CNS) involvement and 12 from SLE patients with inactive CNS disease. The mean CSF lactic acid level in patients with SLE was 17.24 +/- 1.25 mg/dl (range 31-10.2 mg/dl) which was not statistically different to the normal control mean of 14.75 +/- 0.9 mg/dl (range 9-28 mg/dl). Thus, lactic acid levels in active or inactive CNS disease of SLE appear to be normal. Due to the fact that lactic acid levels are elevated in the CSF of patients with bacterial meningitis, lactic acid levels can be of potential value in the differentiation between bacterial meningitis and CNS involvement of SLE.