Infertility, in vitro fertilization and congenital tuberculosis.

Congenital tuberculosis (CTB) due to maternal genitourinary (GU) TB infection is a rare occurrence, as infection of the genital tract in women generally leads to infertility. Increasing availability of assisted reproductive technology creates the potential for CTB to emerge as a significant problem. We describe five infants (two sets of twins and a singleton birth) conceived by in vitro fertilization who developed CTB. All five infants were born to mothers who had immigrated to the United States from India and none had GU TB diagnosed before the birth of their infected infants.

Use of arbitrarily primed polymerase chain reaction analysis to type disease and carrier strains of Neisseria meningitidis isolated during a university outbreak.

Disease and carrier isolates of Neisseria meningitidis from two regions of the United States were typed by the arbitrarily primed polymerase chain reaction (PCR), or random amplified polymorphic DNA (RAPD), method. This technique generates strain-specific arrays of amplified DNA fragments using low-stringency PCR with single, arbitrarily chosen primers. Each of 3 disease isolates and 7 of 11 carrier isolates from an outbreak at the University of Connecticut were indistinguishable using each of 4 primers. In contrast, 22 other isolates (the remaining 4 carrier isolates plus 18 disease and carrier isolates from Connecticut, Illinois, and Missouri) were divided into 18 sets using the same 4 primers. This outcome supports the view that disease isolates from an outbreak may reflect sporadic invasive progression by a strain that also frequently causes asymptomatic colonization. Our results show that RAPD tests provide a sensitive and efficient means of distinguishing genetically different meningococcal strains and that they should facilitate clinical, epidemiologic, and population genetic studies of this important pathogen.

Toxic shock syndrome complicating influenza A in a child: case report and review.

Despite extensive literature on toxic shock syndrome, reports of its manifestations in children remain relatively uncommon. Similarly, toxic shock syndrome in association with influenza B or influenza-like illness has been reported in 12 patients, but it has been reported to occur following influenza A in only two patients to date. We report a third case of toxic shock syndrome in a child with influenza A and review the association between epidemic influenza and toxic shock syndrome ("the Thucydides syndrome").

Operative intervention in active endocarditis in children: report of a series of cases and review.

We describe in detail 14 children (age, less than or equal to 19 years) who underwent operative intervention during active infection of the heart and/or great vessels. The series included five children less than 6 years old, who constitute 10% of all such cases reported in this age group to date. We also review the 132 published reports in which children underwent operative intervention during active endocarditis. We found the following: (1) The survival rate for all cases was 77%. (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antibiotic treatment. (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation. (5) The perioperative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old. (8) Staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.

Molecular cloning, expression, and primary sequence of outer membrane protein P2 of Haemophilus influenzae type b.

The structural gene for the porin of Haemophilus influenzae type b, designated outer membrane protein P2, was cloned, and the DNA sequence was determined. An oligonucleotide probe generated by reverse translation of N-terminal amino acid sequence data from the purified protein was used to screen genomic DNA. The probe detected a single EcoRI fragment of approximately 1,700 base pairs which was cloned to lambda gt11 and then into M13 and partially sequenced. The derived amino acid sequence indicated that we had cloned the N-terminal portion of the P2 gene. An overlapping approximately 1,600-base-pair PvuII genomic fragment was cloned into M13, and the sequence of the remainder of the P2 gene was determined. The gene for P2 was then reconstructed under the control of the T7 promoter and expressed in Escherichia coli. The N-terminal sequence of the purified protein corresponds to residues 21 through 34 of the derived amino acid sequence. Thus, the protein is synthesized with a 20-amino-acid leader peptide. The Mr of the processed protein is 37,782, in good agreement with the estimate of 37,000 from sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Lipopolysaccharide gel profiles of Haemophilus influenzae type b are not stable epidemiologic markers.

Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of lipopolysaccharide (LPS) was performed to assess the usefulness of this technique for the epidemiologic analysis of Haemophilus influenzae type b isolates. LPS samples were prepared from isolates which had been passaged either in vitro or in infant rats. Preparations from paired isolates from a number of epidemiologically related clinical situations also were examined. The gel patterns of LPS prepared on different occasions from an individual isolate were stable. However, the LPS gel patterns changed in 5 of 14 (36%) of the passaged isolates, and differences in gel patterns also were observed among epidemiologically related isolates. The variability in LPS electrophoretic patterns of individual isolates indicated that this technique is not useful for the epidemiologic analysis of H. influenzae type b disease.