Floyd W. Denny

Epidemiology of Acute Lower Respiratory Disease in Children

RESPIRATORY infections are the major cause of morbidity due to acute illnesses in the United States.1 Children may experience six to eight acute respiratory illnesses per year,2 3 4 many of which, ...

Prophylaxis of acute rheumatic fever: By treatment of the preceding streptococcal infection with various amounts of depot penicillin☆

Abstract The prevention of acute rheumatic fever by penicillin therapy of acute streptococcal respiratory infections was attempted in this study. Procaine penicillin G in oil containing 2 per cent aluminum monostearate was injected intramuscularly according to one of three dosage schedules in 1,178 patients with exudative tonsillitis or pharyngitis while 1,162 patients remained untreated and served as controls. There was a total of ten patients who had received penicillin and forty-two patients who received no treatment in whom an illness classified as definite or possible rheumatic fever subsequently developed. Data collected on rheumatic subjects showed that reinfection with a new type of streptococcus frequently occurred when the interval between the onset of the observed attack of exudative tonsillitis or pharyngitis and the onset of rheumatic fever was prolonged. Excluding those cases of rheumatic fever developing after a forty-five-day interval between the two diseases results in two cases of rheumatic fever in the treated group and twenty-eight in the control patients. These data indicate that penicillin therapy of acute streptococcal infections almost completely prevents the subsequent occurrence of acute rheumatic fever. Penicillin therapy was also found to eradicate the streptococcus from the oropharynx of the majority of individuals and to inhibit the formation of antistreptolysin. The most marked inhibition of antibody was that obtained by three injections of penicillin over a ninety-six-hour period totaling 1,200,000 units in comparison to the suppression of antistreptolysin by either a single injection of 600,000 units or two injections of 300,000 units each given seventy-two hours apart.

Invasive Group A Streptococcal Infections in North Carolina: Epidemiology, Clinical Features, and Genetic and Serotype Analysis of Causative Organisms

During 1994 and 1995, an increase in the number and severity of group A streptococcal (GAS) infections was noted in North Carolina. Ninety-six patients had GAS recovered from blood and other sterile body fluids, abscesses, and soft tissue. The overall case fatality rate was 11% but was much higher in patients with toxic shock syndrome (55%) and necrotizing fasciitis (58%). Recent invasive GAS isolates were compared with pre-1994 invasive isolates and temporally related pharyngeal isolates by M protein serotyping, pulsed field gel electrophoresis (PFGE), and polymerase chain reaction amplification of the streptococcal pyrogenic exotoxin A gene. Serotypes M1 and M3 accounted for 50% of recent invasive isolates (1994-1995) and 58% of pharyngeal isolates (1994). The latter isolates demonstrated PFGE patterns that were identical to invasive M1 and M3 strains, suggesting that pharyngeal infections may have served as a reservoir for virulent GAS clones.

Effect of penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis

Abstract A controlled evaluation of penicillin and aureomycin therapy in 475 patients with streptococcal exudative tonsillitis and pharyngitis studied by clinical, bacteriologic and immunologic methods is reported. Aureomycin was found to be somewhat more effective than penicillin in lowering the fever and causing rapid subsidence of symptoms. Both drugs exhibited slight action on the abnormal physical signs. They were equally effective in inhibiting antibody formation. Penicillin usually eradicated the carrier state whereas aureomycin failed to influence the incidence of convalescent carriers. Earaches seldom developed in patients treated with these drugs. With either drug early treatment is required if the disease process is to be materially shortened.

The effect of penicillin prophylaxis on streptococcal disease rates and the carrier state.

CRITICAL situations arise in the armed forces during periods of mobilization when the incidence of streptococcal pharyngitis and tonsillitis reaches such levels as to interfere seriously with military training and operations. Complete information about the most feasible method for preventing or terminating these epidemics is lacking. This report presents the findings of several field trials conducted at an Air Force base for the purpose of evaluating penicillin as an agent for prophylaxis of epidemic streptococcal disease. The observations are divided into two parts: pilot studies comparing the effects of several regimens of penicillin on the carrier state in small selected .xa0.xa0.

FLUORESCENT-STAINABLE ANTIBODIES TO THE EATON AGENT IN HUMAN PRIMARY ATYPICAL PNEUMONIA TRANSMISSION STUDIES

The etiology of those cases of nonbacterial pneumonia that cannot be associated with the viruses of psittacosis and influenza, adenoviruses, or other well delineated agents, and in which cold hemagglutinins or streptococcus MG agglutinins often develop, has been a controversial subject. The possible role in this disease of an agent isolated by Eaton, Meiklejohn, van Herick and Talbot in 1941 from patients with primary atypical pneumonia (1) has been difficult to evaluate because of the agents limited host range and technical problems in performing specific serologic tests with it. Eatons agent can be propagated in embryonated hens eggs, as demonstrated by production of pneumonia on passage to cotton rats (2), but produces no apparent pathologic change in the chick embryo (2, 3). Using a modification of the fluorescent antibody technique of Coons and Kaplan (4), Liu, Eaton and Heyl have provided both a means of localizing the antigens in the chick embryo and a method by which sera can le examined for fluorescent-stainable antibodies to Eatons agent (3, 5). Additional isolations of Eatons agent from patients and demonstrations of fluorescent-stainable antibodies to it have been reported by Cook (6) and Chanock (7) and their associates, confirming and extending the observations of Eaton and Liu. The specificity of this fluorescent antibody reaction in terms of the etiology of the disease has been questioned (8), however, since patients with primary atypical pneumonia may develop a number of nonspecific

The streptococcus saga continues.

The report by Gray et al. in this issue of the Journal adds another chapter to the amazing saga of the return of virulence of the group A streptococcus (Streptococcus pyogenes).1 Recent reports of ...

Can Hemophilus infections be prevented

Infections due to Hemophilus influenzae are a major problem in people of all ages. In children, H. influenzae type b is the leading cause of meningitis, the primary cause of epiglottitis, and an im...

Acceptance of the 1995 John Howland Award

Thank you very much, Jud, for those kind remarks. Dr. Scriver and friends, I want to express my sincerest appreciation to the officers, the council, and the members of the American Pediatric Society for bestowing on me the Howland Award. This is by far the most important and prestigious professional honor to come to me, and I am very grateful to all of you who made it possible. I thought long and hard about what else I could or should say at this time, in addition to expressing my appreciation for this honor. My first thought was to tell you some of the exciting things that are going on with the streptococcus and rheumatic fever. Putting this aside, I then turned to my great concern

575 CHILDHOOD SARCOIDOSIS

A wide range of clinical and laboratory manifestations have been reported in childhood sarcoidosis. We are presenting the findings from a review of the largest series reported to date. Sixty patients were diagnosed with sarcoidosis by biopsy (47) or chest x-ray (CXR) and clinical course (13). Fifty-four percent were male, 72% black, 88% lived on the coastal plain of N.C., 75% presented in the winter or spring, and the average age was 13.3 yrs. Common symptoms were weight loss (54%), cough (53%), and fatigue (48%). Common physical findings included peripheral lymphadenopathy (58%), eye changes (54%), and skin changes (42%). All but 1 had an abnormal CXR. Frequently abnormal laboratory tests included an elevated ESR (74%), eosinophilia (45%), increased gamma-globulins (88%), hypercalcemia (31%), hypercalciuria (67%), and pulmonary function tests (50% with restrictive changes). Distinctive features not emphasized fully in the past were the prominence of eye involvement, hypercalcemia/hypercalciuria, skin involvement and the multisystem involvement. After an average of 4.7 yrs, of follow-up, there was considerable improvement in clinical manifestations, CXR findings, and pulmonary function; however, there was 1 death, 35% had continued physical abnormalities, and 47% had CXR findings. Because children treated with adrenocorticosteroids had more severe disease, evaluation of therapy could not be done. Due to the larger number of children in this series, the clinical manifestations are clarified and knowledge of the distinctive features should improve the management of childhood sarcoidosis.