Analysis of a measles epidemic.

In January, February and March of 1989 an epidemic of rubeola occurred on the campus of Texas Tech University. A vaccination programme was initiated as soon as the epidemic was confirmed. Extensive case histories of all confirmed cases were collected by the Lubbock City Health Department and given an exhaustive statistical analysis by a group from the Department of Mathematics at Texas Tech University. The data and statistical analysis were used to formulate stochastic and deterministic models of the measles epidemic based on the standard SEIR model. The analysis and the simulations indicate that in order to prevent a measles outbreak on a university campus a high rate of immunity may be required (> 98 per cent). The assumptions in the models raise some interesting questions regarding social contacts which require further investigation.

Acute gastroenteritis due to double infection with enteropathogenic Escherichia coli or Salmonella and another bacterial pathogen.

Two enteric bacterial pathogens were concomitantly isolated from the feces of 18 infants less than 6 months of age admitted to the Assaf Harofeh Medical Center over a 7-year period. In all but two patients stool cultures grew enteropathogenic Escherichia coli, six of serogroup 0119. The other organisms cultured were Shigella, Salmonella, Campylobacter jejuni and Aeromonas hydrophila. The usual clinical presentation was diarrhea, dehydration and vomiting of acute onset, and low grade fever. Patients with gastroenteritis due to a single agent compared with multiple pathogens had a milder course of disease, a milder degree of dehydration and acidosis, a lesser need for i.v. fluid treatment and shorter hospitalization.

Chorea associated with systemic lupus erythematosus in children. A case report.

In the past most cases of childhood chorea were related to rheumatic fever and were treated appropriately. With the decrease in the incidence of rheumatic fever less common etiologies of chorea should be investigated. This report demonstrates the difficulties of distinguishing between chorea associated with rheumatic fever and chorea associated with systemic lupus erythematosus.

Acute rheumatic fever in the young: changing prevalence and pattern.

Acute rheumatic fever (ARF) is rare in young people. A group of 28 patients is described who were hospitalized during the years 1960-1984. Patients were divided into two groups: children who were admitted between 1960 and 1966 and those admitted between 1966 and 1984. The annual incidence of ARF declined from 1.17 to 0.44 cases per 10,000 population at risk. The incidence of arthritis declined in parallel to the decrease in number of children presenting with ARF, whereas the incidence of carditis remained the same.

Cardiac injuries caused by blunt chest trauma in children.

Two illustrative cases with different features of cardiac injury caused by blunt chest trauma are described. The first patient had mild and obscure symptoms, detected on physical examination, and required observation only. The second patient had acute pericardial tamponade, necessitating surgical treatment. We present the different medical procedures that should be taken into consideration in management of such cases, although continuous monitoring, repeated physical examination, electrocardiograms, chest x-rays, and echocardiography proved sufficient in managing our two children. It is important that physicians who provide care to children suffering from blunt chest trauma have increased awareness of possible cardiac injuries.

Familial occurrence of typhoid acute glomerulonephritis.

Three cases of typhoid nephritis occurring in a single family are reported. A clinical similarity to poststreptococcal nephritis was noted, although no hypocomplementemia was observed. The same phage type occurred in other patients who did not exhibit nephritis. The possibility of a host factor was therefore considered to be involved, although no HLA haploid-type link was found in the patients. These cases illustrate that in certain geographical areas the possibility of typhoid fever should be considered in patients with nephritis and concomitant fever.

Tachycardia and heart failure after ritual circumcision.

Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

Recurrent abdominal and cervical pains. An unusual clinical presentation of acute rheumatic fever.

Most cases of acute rheumatic fever (ARF) present with arthritis, carditis or choreiform movements. However, a variety of clinical manifestations which are not included in the modified Jones criteria can be the presenting symptoms of the disease. We describe a case of a 10-year-old boy with ARF who presented with recurrent episodes of abdominal and cervical pain who later developed an active carditis which established the diagnosis of ARF. A high degree of suspicion and an awareness of the less common manifestations of ARF are necessary to make an early diagnosis and initiate appropriate treatment in certain cases of ARF.

Shigellosis: incidence of convulsions and resistance to antibiotics.

One hundred and ninety-three children with bacillary dysentery were admitted to the "Assaf Harofeh Hospital" during the years 1975-1980. Generalized convulsions were observed in 37 (19.2%) children. The incidence of seizures was significantly higher in children whose age ranged between 1 and 6 years when compared to those below or above this age range. Convulsions were not observed when fever was below 38 degrees C, however, higher fever was not associated with a parallel increase in their incidence. Temperature above 38 degrees C was less common in infants compared to older children. These findings suggest that convulsions in shigellosis do not differ from simple febrile convulsions in respect to age, sex, presence and degree of fever. The incidence of resistance to either ampicillin or trimethoprim-sulfamethoxazole was similar in all the various shigella strains isolated in our population.

Congenital megacolon associated with familial dysautonomia.

A 4-year-old child suffering from both familial dysautonomia (FD) and congenital megacolon (CM) is described. The possibility of a single etiology of the two conditions is discussed.