Necrotizing pneumococcal pneumonia in childhood.

We describe the rare complication of necrotizing pneumonia and invasive pneumococcal infection in 3 previously healthy pediatric patients. Lobar consolidation and pleural effusions appeared initially, followed within several days by the appearance of multiple small lucencies in the area of consolidation. In one case, necrosis progressed to a large abscess cavity. Surgical intervention was limited to treatment of pleural space complications. There were no deaths. Pulmonary parenchymal residual was limited to a thin-walled cavity in one case.

Genital Chlamydia trachomatis infection in pregnant adolescents in east Tennessee: a 7-year case-control study.

STUDY OBJECTIVE: To examine the prevalence, symptomatology, risk factors, and other infections associated with urogenital chlamydial infection in pregnant teenagers. DESIGN: Retrospective case-control study by medical record review. SETTING: Prenatal care clinic for adolescents at University of Tennessee Medical Center, Knoxville, Tennessee. PARTICIPANTS: Pregnant adolescents younger than 19 years of age who were diagnosed with chlamydial infection on the first prenatal visit from 1988 to 1994 were studied. Pregnant adolescents of similar age and socioeconomic background who came in the same day for the first prenatal visit, but were not infected, made up the control group. INTERVENTION: Routine prenatal questionnaires regarding personal and medical histories, and routine prenatal screening, including pelvic examination with Papanicolaou (PAP) smear and laboratory investigations for common genital infections and sexual transmitted disease (STDs), were obtained. MAIN OUTCOME MEASURES: Analyzed the prevalence of chlamydial infection and compared the infected group to the control group with regard to race, behavioral factors, symptoms, prenatal screening results, other concurrent genital infections, and histories of STDs. RESULTS: Of a total population of 596 pregnant teenagers, 67 (11.24%) were infected with Chlamydia trachomatis. In multivariate analysis, black race (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.74-9.23; p = 0.001) and greater gestational age at first prenatal visit (OR = 1.11; 95% CI = 1.04-1.18; p = 0.001) were independently associated with chlamydial infection. Age, marital status, number of pregnancies, smoking, alcohol abuse, drug abuse, age at first intercourse, and multiple sex partners were not associated with the infection. Likewise, the symptom of vaginal discharge (a complaint of > 70% in each group), other genital co-infections (found > 50% in each group, mainly candidiasis and bacterial vaginosis), abnormal PAP smears (found > 60% in each group) and histories of STDs or previous chlamydial infection were not significantly different between case and control groups. Human papillomavirus infection, trichomonal infection, and dysplasia or atypia were found more often in patients infected with chlamydia, but were not statistically significant. CONCLUSION: Pregnant adolescents in east Tennessee were at risk for chlamydial infection as well as for other genital infections and abnormal PAP smears. Routine prenatal chlamydial screening is warranted because of a lack of specific symptoms.

Acute renal failure in a child associated with acyclovir.

A 9-year-old boy developed acute renal failure following intravenous acyclovir (30 mg/kg per day) administered for 6 days to treat herpetic encephalitis. Physical findings and urine output were normal, except for increasing blood urea nitrogen (BUN), serum creatinine and mild proteinuria. Acyclovir was discontinued. However BUN and serum creatinine continued to increase and peaked on the following day at 8.6 mmol/l of urea (24 mg/dl) and 194 mumol/l (2.2 mg/ml), respectively. Conservative treatment and hydration were carried out. The kidney function returned to normal within 1 week. The use of acyclovir when necessary in renal failure patients is discussed.

Neonatal enterovirus infection.

A neonate who had a nonfatal echovirus 11 infection with severe hepatitis, hepatic necrosis, disseminated intravascular coagulation, and thrombocytopenia was seen at the University of Tennessee Medical Center (UTMC) in Knoxville. Clinical data from this neonate were examined and compared with clinical data from histories of 8 other cases of neonatal enteroviral infections seen at UTMC, Knoxville, during a 3-year period. The purpose of our study was to increase awareness of the clinical presentations of neonatal enteroviral infections, especially in summer months. The patients in our study presented with various clinical manifestations of disease, including overwhelming systemic infection characterized by severe hepatic dysfunction and coagulopathy with possible disseminated intravascular coagulation and central nervous system infection. Myocarditis was sometimes manifested as well. In agreement with findings from other studies, our study concluded that most enteroviral infections in neonates resulted from perinatal transmission during delivery where the mothers had experienced recent, febrile, viral-like illness prior to or during delivery. One uncommon finding in our study was that the cases were strikingly seasonal, with 8 of the 9 infants hospitalized during late summer or early fall (July through September).

Factor influencing case-fatality rate of septicemic children.

One hundred and fourty episodes of septicemic children seen at Songklanagarind Hospital during a period of two years were reviewed to determine factors related to mortality. One hundred episodes (70.4%) of septicemia were hospital-acquired in which 98 (69%) were caused by gram negative bacilli, with Pseudomonas being the most common agent. Thirty episodes were from gram-positive cocci and eight were from polymicrobial infections. The remainder were caused by Candida species. The overall case-fatality rate was 28.6%. Using a logistic regression model, appropriateness of antibiotic use and host status (being newborn or a compromised host compared to a normal host), but not neutropenia and acquisition of infection were the only statistically significant risk factors. The exact odds ratio of inappropriate use of antibiotic adjusted for host status was 13.6 (95% confidence limits = 5.7-32.3). Percentages of inappropriate usage among the premature and full term newborn, compromised host and normal were 50, 11, 28 and 24, respectively. Inappropriate antibiotic use was the major cause of case-fatality in the study population. It was more common among the premature newborn and compromised hosts.

Evidence for the polymorphic oxidation of debrisoquine in the Thai population.

Debrisoquine polymorphism has been studied extensively in Caucasian populations. The prevalence of the poor metaboliser phenotype is 3-10% in European and American Caucasian populations but appears to be very low in Asian populations. This study was carried out to determine the metabolic oxidation status in 173 Thai subjects. Phenotyping was performed using the metabolic ratio (MR) calculated as the 0-8 h urinary output of debrisoquine/0-8 h urinary output of 4-hydroxydebrisoquine after oral administration of 10 mg debrisoquine hemisulphate. Two subjects (1.2%) were phenotyped as poor metabolisers; they had MR values of 13.17 and 92.04. The incidence of the poor metaboliser phenotype of debrisoquine oxidation of 1.2% seems to be lower in the Thai population compared with that in various Caucasian populations.

Effects of cimetidine and ranitidine on the pharmacokinetics of quinine.

The pharmacokinetics of orally administered quinine were determined in six normal volunteers before and after a 7-day course of cimetidine (1 g day-1) or ranitidine (300 mg day-1). Peak plasma quinine concentration and the time of peak concentration were not altered after cimetidine or ranitidine pretreatment. After cimetidine pretreatment there was a significant reduction in the apparent oral clearance of quinine, from 0.182 +/- 0.063 (mean +/- s.d.) to 0.133 +/- 0.055 1 h-1 kg-1 (P less than 0.05). This was reflected in a 49% (range 17 to 90%) increase in the mean elimination half-life from 7.6 +/- 1.3 to 11.3 +/- 3.7 h (P less than 0.05). In contrast to cimetidine, ranitidine had no significant effect on the clearance or half-life of quinine. The apparent interaction between quinine and cimetidine may have therapeutic implications. Special care should be taken in patients taking these two common drugs concomitantly. Additionally, to avoid unnecessary risks due to drug interaction, the use of ranitidine may be preferable in the patients in whom it is desirable to administer an H2-receptor antagonist together with quinine.

Kawasaki disease in Songkla, Thailand.

Four cases of Kawasaki disease hospitalized in Haadyai Hospital, Songkla, during 1978-1983 are summarized. All four patients had clinical features, the principal signs and symptoms set forth in the guidelines for the diagnosis of mucocutaneous lymphnode syndrome (Kawasaki disease) including other associated features such as diarrhea, arthritis, mild jaundice, pneumonia, subconjunctival hemorrhage, proteinuria and leukocytosis. All four patients survived the acute illness, without evidence of cardiac complications. The cases were followed-up for over one year.

Pseudomonas pseudomallei in southern Thailand.

The distribution of Pseudomonas pseudomallei was studied in soil and water from various sources of Songkla province, Southern Thailand. P. pseudomallei was isolated from the surface soil of rubber plantations (60.9%) and from the bottom sediments of rice fields (78.1%). Farmers and plantation workers will have a greater risk of contracting melioidosis.

Hemorrhagic diphtheria.

Two cases of hemorrhagic diphtheria, a rare entity and severest form are reported. Both of them have been mildly ill for more than 3 days and did not seek medical attention, suddenly developed bleeding episodes with clinical evidence of diphtheria in association with severe thrombocytopenia. Inspite of antitoxin, antibiotics therapy and supportive care one died on the third day. The second case was given additional steroid therapy to the regimen and survived with diphtheria myocarditis.

Oral v topical erythromycin therapies for chlamydial conjunctivitis.

Results of oral and topical erythromycin therapy in 41 infants under 4 months of age with chlamydial conjunctivitis were evaluated in randomized clinical trial. After three weeks of treatment, relapse or reinfection of the eye occurred in four of 19 patients (21%) in the topical therapy group and in three of 22 patients (13.6%) in the oral therapy group (p less than .69). In the topical therapy group, chlamydiae were isolated from nasopharyngeal cultures of eight patients (42%) during or after therapy. Chlamydiae were eradicated from the nasopharynx of the six colonized patients treated with oral erythromycin. All relapses responded to a course of oral erythromycin therapy. We conclude that both modes of therapy are comparable for treatment of chlamydial conjunctivitis, but that oral therapy has the advantage of eradicating nasopharyngeal colonization.

Pharmacokinetics and bacteriological efficacy of N-formimidoyl thienamycin in experimental Escherichia coli meningitis.

The pharmacokinetics and bacteriological efficacy of N-formimidoyl thienamycin were determined in rabbits infected with Escherichia coli K1. After a single intravenous dose of 25 mg/kg, a peak N-formimidoyl thienamycin concentration in cerebrospinal fluid (CSF) of 2.5 micrograms/ml was attained at 45 min. The penetration into CSF was calculated to be 31%. In animals that received continuous intravenous infusions of the drug for 9 h, the mean CSF concentration was 8.2 microgram/ml, and the CSF bactericidal titers against the E. coli K1 strain were from 1:16 to 1:32. This infusion produced a reduction in the numbers of E. coli in the CSF of 4 log10 colony-forming units per ml. N-Formimidoyl thienamycin might prove to be useful for therapy of meningitis caused by E. coli and other susceptible bacteria.