Gerard P. Rabalais

Renal candidiasis in neonates with candiduria.

BACKGROUND Candida species commonly cause urinary tract infection in infants admitted to neonatal intensive care units. The purpose of this study was to describe the natural history of renal candidiasis as evidenced by sonography in infants with candiduria. METHODS The medical records of all infants who developed candiduria during their neonatal intensive care hospitalization between 1982 and 1993 were reviewed. Candiduria was defined as the isolation of Candida from (1) one or more specimens obtained by bladder catheterization or suprapubic aspiration, (2) one or more voided specimens and concurrent positive cultures from another sterile body site or (3) one or more voided specimens and changes on renal ultrasound consistent with renal candidiasis. Renal ultrasounds were retrospectively reviewed by one pediatric radiologist. Nonshadowing echogenic foci were considered evidence of renal fungus balls. RESULTS Forty-one infants with candiduria were identified. Thirty-six infants underwent 1 or more renal imaging studies (ultrasonography, 35; computerized tomography, 1). The incidence of renal candidiasis in neonates with candiduria, defined as renal fungus balls or renal fungal abscess, was 42%. Of the 13 patients who had sonographic abnormalities suggestive of renal fungus balls, 7 had abnormalities on the first ultrasound obtained after the discovery of candiduria, whereas 6 patients developed abnormalities between 8 and 39 days later. CONCLUSIONS Serial renal ultrasounds are required to reliably detect late appearing renal fungus balls in neonates with candiduria. Complications requiring surgical intervention, like urinary tract obstruction, were uncommon.

Invasive candidiasis in infants weighing more than 2500 grams at birth admitted to a neonatal intensive care unit.

BACKGROUND Because invasive candidiasis in newborn infants admitted to a neonatal intensive care unit (NICU) occurs most frequently in very low birth weight infants, the incidence of invasive candidiasis and its clinical features in infants > 2500 g birth weight have not been well-described. METHODS We retrospectively reviewed the medical records of all infants with birth weight > 2500 g admitted to our NICU from 1986 through 1993 who developed invasive candidiasis during their hospitalization. RESULTS Seventeen of 3033 (0.6%) infants with birth weights > 2500 g admitted to the NICU developed invasive candidiasis. All 17 infants had a condition that required prolonged NICU hospitalization; 13 of 17 (76%) had a major congenital malformation. CONCLUSION The incidence of invasive candidiasis in infants with birth weights > 2500 g requiring admission to a NICU was much less than has been reported for very low birth weight infants. This review points out that in infants with birth weights > 2500 g who develop invasive candidiasis, major congenital malformations are the most frequent underlying conditions responsible for prolonged NICU hospitalization.

Successful medical treatment of presumed Candida endocarditis in critically ill infants

Few infants have been reported who survived fungal endocarditis; all have required both surgical and intensive antifungal therapy. We describe three infants, two weighing less than 1000 gm, who survived Candida endocarditis without surgery. Two had Candida parapsilosis, an agent not previously reported as a cause of neonatal endocarditis. All three infants were treated with amphotericin B and 5-flucytosine. Despite administration of 44, 38, and 48 mg/kg amphotericin B, respectively, no nephrotoxicity was noted; 5-flucytosine therapy was stopped in one infant because of thrombocytopenia. One infant died of an unrelated cause 6 months later; there was no evidence of Candida or endocarditis at autopsy. The other two infants are thriving 2 and 3 years after the completion of antifungal therapy; no remaining evidence of endocarditis is present on echocardiography. We conclude that antifungal therapy without surgery is an option for Candida endocarditis in critically ill infants.

Measles-Mumps-Rubella Immunization of Susceptible Hospital Employees during a Community Measles Outbreak: Cost-Effectiveness and Protective Efficacy

OBJECTIVE To determine cost-effectiveness and protective efficacy of a program to identify and immunize susceptible hospital employees during a measles outbreak. DESIGN A cost analysis was made of blind measles-mumps-rubella (MMR) immunization versus directed MMR immunization based on 2,000 employees born after December 31, 1956. A directed MMR immunization program for susceptible employees was instituted. Actual costs of the program were calculated at the conclusion of the program. SETTING A medical center complex with more than 4,000 employees, two acute care community hospitals, and a tertiary care childrens hospital. RESULTS A directed MMR immunization program was projected to be less expensive than blind immunization (

Cytomegalovirus Seroprevalence in Women Bearing Children in Jefferson County, Kentucky

23,106 versus

Antibody Responses of Healthy Infants to Concurrent Administration of a Bivalent Haemophilus influenzae Type b-Hepatitis B Vaccine with Diphtheria-Tetanus-Pertussis, Polio and Measles-Mumps-Rubella Vaccines

70,720). MMR vaccine was administered to 169 of 188 susceptible employees. Actual cost of the directed MMR immunization program was

West Nile Virus Encephalitis in a Child with Left-Side Weakness

25,384. CONCLUSIONS The directed MMR immunization program was cost-effective and prevented secondary cases among hospital employees during a community measles outbreak.

Emergence and control of methicillin-resistant Staphylococcus aureus in a children's hospital and pediatric long-term care facility

Symptomatic congenital cytomegalovirus (CMV) disease occurs almost exclusively in infants born to seronegative mothers who acquire the virus during pregnancy. This study sought to determine patterns of CMV immunity in women of childbearing age at one center participating in a national study. Cord blood specimens from 100 consecutive deliveries at each of three hospitals were tested for CMV-specific IgG. Mean age of women in this sample was 25.7 years; 76% were white, 60% were from middle and upper socioeconomic status, 64% were married, and 57% had other living children. Overall seroprevalence rate was 62%. Univariate analysis showed strong associations between seropositivity and lower socioeconomic status, non-white race, and age younger than 25 years (odds ratios, 4.4, 3.9, and 2.5, respectively). Stratification by socioeconomic status and race eliminated the effect of age. Stratification by socioeconomic status markedly reduced the effect of race, whereas stratification by race only moderately reduced the effect of lower socioeconomic status, which was the strongest predictor of seropositivity (odds ratio, 3.4). Seroprevalence was lowest among older white women of middle and upper socioeconomic status (47% seropositive). Development of longitudinal regional seroprevalence data will facilitate interpretation of data generated by the National CMV Registry.

Evaluation of a commercially available latex agglutination test for rapid diagnosis of group B streptococcal infection.

AbstractObjective: To confirm that children given a bivalent Haemophilus influenzae type b-hepatitis B vaccine (bivalent Hib-HB vaccine; COMVAX™) concurrently with priming doses of diphtheria-tetanus-pertussis vaccine (DTP), a booster dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP), inactivated or oral polio vaccine (IPV or OPV) and measles-mumps-rubella vaccine (M-M-R®II) have satisfactory antibody responses to all antigens. Design: 126 healthy 2-month-old infants were scheduled to receive bivalent Hib-HB vaccine concurrently with DTP (2 and 4 months of age), OPV or IPV (random allocation to OPV or IPV at 2 months of age; OPV at 4 and 14 to 15 months of age), DTaP and M-M-R®n (14 to 15 months of age). A response was judged ‘adequate’ if the lower bound of the 95% confidence interval on the proportion of vaccinees having a critical antibody level was <10 percentage points below prediction. Result: Antibodies to hepatitis B virus surface antigen, H. influenzae polysaccharide, diphtheria toxin, tetanus toxin, pertussis agglutinogens, pertussis toxin (as measured by enzyme immunoassay but not by Chinese hamster ovary cell assay), pertussis filamentous haemagglutinin after a booster dose of DTaP, poliovirus type 2, measles virus, and mumps virus all equalled or exceeded expected levels. Antibodies to rubella virus and pertussis filamentous haemagglutinin (after priming doses of DTP) fell slightly, and in the case of rubella significantly, below predicted levels. Antibodies to poliovirus types 1 and 3 were also below expectation after 2 doses of polio vaccine but were adequate following a third dose of vaccine. Conclusion: Concurrent administration of bivalent Hib-HB vaccine with priming doses of DTP, a booster dose of DTaP, OPV, IPV, or M-M-R®II was well tolerated and, with the possible exception of rubella, did not substantially impair the antibody response to any antigen.

Rapid detection of influenza-B virus in respiratory secretions by immunofluorescence during an epidemic

West Nile virus typically causes self-limited fever with flulike symptoms; pediatric cases are rare. We report a unique case involving a 7-year-old girl with left-side weakness and focal temporal lobe findings resembling herpes encephalitis.