Frederick Cox

Candida albicans adherence in newborn infants

Adherence of Candida albicans to buccal epithelial cells from full-term infants was significantly lower than adherence to epithelial cells from premature infants and healthy school-age children, until the full-term infants reached 5 days of age. Adherence in premature infants (gestational age 28-39 weeks) at birth was more than twice that of term infants and remained unchanged during the first week of life. Differences in Candida adherence in premature and term newborns may be due to developmental, salivary, receptor site or other unknown factors.

Lack of toxicity of oral and intrapulmonary group B streptococcal lipoteichoic acid.

ABSTRACT: Lipoteichoic acid (LTA) was prepared from type III group B streptococci and administered by topical oral application or intravenous or intratracheal injection in weanling and adult white New Zealand rabbits. Tritiated [3H]LTA in tissues and body fluids was measured by scintillation spectrometry. Five minutes to 120 h after intravenous injection of 10 mg (17 × 106 dpm) of [3H]LTA, none was present in blood. Combined urine and fecal excretion peaked at 24 h and decreased over 5 days. There was no effect on collagen-induced platelet aggregation. [3H]LTA concentrations were greatest in colon, bone, stomach, and skin 1 day after intravenous injection. After a 5-mg oral dose (8.5 x 106 dpm) in an adult animal, fecal excretion peaked at 24 h and decreased after 4 days. No systemic absorption was noted. No [3H]LTA was found in any of seven tissues examined at autopsy 3 days after 1 to 5 mg/kg oral doses in weanling animals with normal or traumatized buccal mucosa. No effect was noted on platelet aggregation or serum complement, there was no increase in the incidence of nephrocalcinosis and the buccal mucosa remained histologically normal. Intratracheal injection of 0.5 to 2.5 mg/kg of LTA resulted in no tachypnea or alteration in blood gases. All animals remained healthy after LTA administration. The absence of toxicity and absorption in animals suggests that studies could be performed in humans to evaluate the safety and efficacy of oral LTA.

Haemophilus influenzae type b meningitis in a fully immunized 2-year-old

HISTORY OF PRESENT ILLNESS The patient is a 30-month-old, previously healthy female child who presented to the emergency department with the acute onset of fever to 102° F that evening. Her mother noted some mild, clear rhinorrhea and sneezing for several days. Shortly after the onset of fever, she vomited several times and complained of some headache. As the evening progressed, her appetite and fluid intake declined.

ADHERENCE OF GROUP B STREPTOCOCCI TO BUCCAL EPITHELIAL CELLS IN NEONATES WITH DIFFERENT GESTATIONAL AGES

Adherence of group B streptococci to buccal epithelial cells was determined in 81 neonates with different gestational ages. There was a significant curvilinear increase in adherence in premature neonates with decreasing gestational ages. Amniotic fluid did not inhibit attachment of group B streptococci to epithelial cells. Increased adherence of group B streptococci to premature neonates may explain, in part, the increased susceptibility of these infants to disease from this organism.

Ticarcillin/Clavulanic Acid Combination Treatment of Bacterial Infections in Hospitalized Children

Eighteen patients 2 months to 11 years of age with culture proven bacterial infections were treated with parenteral ticarcillin/clavulanic acid in a noncomparative study. Seven patients had pneumonia, two had tracheobronchitis, three had soft tissue abscess, two had periorbital cellulitis, three had urinary tract infection and one had purulent bursitis. Four of the 18 were bacteremic. Organisms treated included Staphylococcus aureus (6), Pseudomonas aeruginosa (5), Haemophilus influenzae (2), Branhamella catarrhalis (2), Escherichia coli (1), Streptococcus pneumoniae (1), Klebsiella pneumoniae (1), Streptococcus pyogenes (1) and Serratia marcescens (1). Thirteen of 15 (87%) organisms tested were beta-lactamase positive. Therapy was given intravenously in six doses per day at 310 mg/kg. Duration of treatment ranged from 5 to 28 (mean 11) days, with an average time of 4 days to clinical improvement. Seventeen patients (94%) were clinically cured. One patient with recurrent aspiration pneumonia due to mixed infection with multiple gram-negative enteric bacilli failed therapy. Adverse effects were minimal and transient. Notably, mild to moderate thrombocytosis occurred in four (22%) patients that resolved uneventfully. We conclude that ticarcillin/clavulanic acid is safe and effective therapy for serious infections in hospitalized children.

Nocardia asteroides brain abscess following mastoidectomy

Nocardia asteroides brain abscess occurred after mastoidectomy and tympanoplasty in a previously healthy 10-year-old boy. Combined surgical excision and trimethoprim/sulfamethoxazole therapy resulted in significant improvement.

PREVENTION OF ESCHERICHIA COLI Kl BACTEREMIA WITH TOPICAL MANNOSE IN NEWBORN MICE

An animal model of E. coli bacteremia after maternal-infant transmission was developed in newborn mice. Mid-gestation, E. coli free, Swiss-Webster mice were vaginally inoculated with 5X104 E. coli strain LH (075:K1:H3). Blood cultures were obtained from newborn mice at 3 days of age and grown in TSB broth. Surface cultures of the nape and perineum were performed on McConkey agar. Prevention of bacteremia was studied using topical vaginal mannose (25 mg/ml) (M) and a sub-inhibitory dose of gentamicin (G) (.2 ug/ml). Inhibitors or saline (S) were applied vaginally with a micropippette after colonization.Surface colonization was present at 3 days of age in 38 of 51 (74%) control mice, 14 of 56 (25%) babies born to mannose treated mothers and 7 of 52 (13%) babies where mother and infant were treated.Topical mannose may be useful in preventing colonization and/ or disease from E. coli in human infants.