David P. Ascher

Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants

Oral thrush is a common condition in young infants. Nystatin treatment is associated with frequent recurrences and difficulty in administration. Fluconazole was compared with nystatin for the treatment of oral candidiasis in infants. Thirty-four infants were randomized to either nystatin oral suspension four times a day for 10 days or fluconazole suspension 3 mg/kg in a single daily dose for 7 days. Clinical cures for nystatin were 6 of 19 (32%), and those for fluconazole were 15 of 15 (100%), P < 0.0001. In this small pilot study fluconazole was shown to be superior to nystatin suspension for the treatment of oral thrush in otherwise healthy infants.

Delayed–type hypersensitivity skin testing in human immunodeficiency virus–infected pediatric patients

OBJECTIVE To evaluate whether pediatric patients infected with human immunodeficiency virus (HIV) can mount appropriate delayed-type hypersensitivity (DTH) skin responses to recall antigens and whether these responses can be correlated with clinical or immunologic parameters. DESIGN Prospective evaluation of DTH responses in HIV-infected children. Uninfected children born to HIV-infected mothers served as control subjects. Antigens used for yearly DTH testing included Candida albicans (1:100, 1:10); mumps virus; Trichophyton; purified protein derivative of tuberculin; and tetanus toxoid (1:100, 1:10). At the time of each DTH test, patients were staged according to two Centers for Disease Control and Prevention pediatric HIV classification systems, and T-cell subsets were obtained. RESULTS Twenty-seven HIV-infected patients with a median age at entry of 74.1 (range, 12 to 156) months were followed. Forty-four DTH skin tests in 21 symptom-free HIV-infected patients (PI) and 18 tests in 10 HIV-infected patients with symptoms (P2), as well as 43 DTH skin tests in 18 patients who had either mild or moderate clinical symptoms or immunosuppression and 19 tests in 13 patients with severe symptoms or immunosuppression, were evaluated. Sixteen DTH skin tests were performed in 14 uninfected patients. HIV-infected patients tended to have fewer DTH responses to antigens and of smaller size than did uninfected patients. When controlled for age, few differences in DTH responsiveness were seen between HIV-infected and uninfected patients. Anergy was associated with symptomatic disease, evidence of advanced clinical or immunologic disease, and low CD4+ percentages (p <0.05). CONCLUSIONS HIV-infected children are able to mount antigen-specific cell-mediated immune responses that are qualitatively similar to those of age-matched control subjects. Loss of DTH responsiveness correlates with both clinical and immunologic evidence of HIV disease progression.

False-Negative Urine Latex Particle Agglutination Testing in Neonates With Group B Streptococcal Bacteremia A Function of Improper Test Implementation?

Although blood cultures remain the most specific indicator of Group B streptococcus (GBS) sepsis, a potentially life-threatening infection in neonates, test results may not be available for 24 to 48 hours. Detection of GBS antigen in the urine by latex particle agglutination (LPA) may speed diagnosis. This study analyzed the sensitivity of the GBS urine LPA assay under clinical conditions. The urine of neonates with early-onset GBS bacteremia was analyzed for GBS antigen over a three-year period at six military medical centers. Overall, 53.5% (38/71) of infants with positive blood cultures had a positive urine LPA test. Only one medical center routinely followed manufacturers recommendations to concentrate urine specimens before testing. These data suggest that the sensitivity for the urine LPA assay, when performed on unconcentrated urine, is lower than previously reported. Clinicians should insist that the laboratory maximize sensitivity by concentrating urine prior to GBS LPA testing.

International adoptions by military families: A reexamination

The adoption of foreign-born children by U.S. families is an increasingly common occurrence, having tripled in the past 15 years. The demographic features of international adoption have changed dramatically over the same time period. Todays foreign-born adoptees originate from a myriad of nations and cultures and present challenging medical and social problems to the practitioners faced with caring for these children and advising their adoptive families. Military families, cosmopolitan and often stationed overseas, adopt a large proportion of these children from foreign lands. Consequently, military health care providers require a familiarity with the special needs of international adoptees and the unique aspects of international adoption, as practiced by military families. We previously reported on this topic more than a decade ago. Much has changed since then, prompting this update.

Salmonella cholerasuis Infections in Childhood

Observation de 6 cas generalement associes a une pneumonie. Guerison avec antibiotiques appropries