Chlamydia pneumoniae infection among healthy children and children hospitalised with pneumonia in Greece.

Chlamydia pneumoniae has been recognized as a cause of respiratory tract infection in humans, and its prevalence has been shown to vary among different age groups and populations. The prevalence of Chlamydia pneumoniae antibody was determined by serological investigation in 343 healthy children and in 77 children consecutively hospitalised for pneumonia in southwestern Greece. Seventy-eight (22.7%) healthy children had IgG Chlamydia pneumoniae titers > or =1/8. The prevalence of Chlamydia pneumoniae antibody in the age groups 6 months-5 years, 6-9 years and 10-15 years was 7.9%, 11.4% and 36%, respectively. One child hospitalised for pneumonia had serological results consistent with acute Chlamydia pneumoniae infection. The results of the present study suggest a low prevalence of Chlamydia pneumoniae antibody among preschoolers in Greece, followed by a steep rise in children 10-15 years of age. Chlamydia pneumoniae is not a common etiologic agent of childhood pneumonia requiring hospitalisation.

Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection.

BACKGROUND: During the first 3 months of life febrile infants are subjected to sepsis workup, which includes evaluation for urinary tract infection (UTI) and meningitis. We investigated the existence of concomitant meningeal inflammation in infants younger than 90 days old affected with UTI. METHODS: We reviewed the medical records of all infants younger than 90 days old, who were hospitalized for UTI from January, 1990, to January, 2001. For the diagnosis of sterile cerebrospinal fluid (CSF) pleocytosis, the child's age, the CSF total white blood cell (WBC) count and the CSF absolute neutrophil count were taken into consideration. CSF pleocytosis was defined as the presence of > or = 35, > or = 21 and > or = 15 WBC/mm3 of CSF during the first, second and third month of life, respectively. The CSF Gram-stained smear, latex agglutination test and bacterial culture were negative. RESULTS: Sterile CSF pleocytosis was found in 15 (12.8%) of 117 infants with UTI who had had a lumbar puncture included in their initial laboratory evaluation. The 15 infants had a median age +/- semiinterquartile range of 40 +/- 25 days (range, 4 to 75 days). In these infants the median CSF WBC count +/- semiinterquartile range was 55 +/- 125/mm3 (range, 21 to 1,270/mm3). CONCLUSIONS: Sterile CSF pleocytosis was found in 12.8% of infants younger than 90 days old with UTI. The pathogenesis of this meningeal inflammation is not fully understood. Although bacterial infection of the subarachnoid space, with low bacterial seeding, cannot be excluded, at least in some cases, it is possible that CSF pleocytosis in some of the infants with UTI is mainly caused by the endotoxin of Gram-negative or other inflammation-inducing molecules of Gram-positive urine pathogens.

Correlation of leucocyte count and erythrocyte sedimentation rate with the day of illness in presumed bacterial pneumonia of childhood.

We investigated the effect of the duration of illness on the white blood cell (WBC) and total neutrophil counts and the erythrocyte sedimentation rate (ESR) in untreated children with clinical and roentgenographic findings compatible with bacterial pneumonia. According to the duration of illness before admission, the patients were divided into: Group I, 48 patients ill for < 24 h; Group II, 39 patients ill for 24-48 h; Group III, 21 patients ill for 48-72 h; and Group IV, eight patients ill for 72-96 h. In children with presumably bacterial pneumonia the number of the WBC was greater during the first 2 days of illness. Thereafter, the leucocyte count declined, reaching the lowest levels on the fourth day. A similar course was followed by the absolute number of total neutrophils. During the second day of illness, 92% and 72% of the patients had leucocyte counts > 10,000 and > 15,000/mm3, respectively, whereas on the fourth day of illness only half of the patients had > 10,000 and one-quarter > 15,000 WBC/mm3. The ESR followed an opposite course to that of the WBC. During the first day of illness it was normal or mildly elevated, increasing steadily thereafter. The validity of the WBC and total neutrophil counts in conjunction with the ESR in the evaluation of bacterial pneumonia is augmented when the day of illness is taken into consideration.