Harry T. Wright

Imipenem/cilastatin treatment of bacterial meningitis in children.

The safety and efficacy of imipenem/cilastatin were evaluated in 21 children, ages 3 to 48 months, with bacterial meningitis. Eradication of bacteria from the cerebrospinal fluid was demonstrated within 24 hours of antibiotic therapy in all but 2 patients who had Haemophilus influenzae type b meningitis and ultimately achieved bacteriologic cure after 2 to 3 days of imipenem/cilastatin therapy. Cerebrospinal fluid penetrations of imipenem and cilastatin were determined at various times after drug administration with mean cerebrospinal fluid: serum ratios of 14 and 10% for imipenem and cilastatin, respectively. The study was terminated when 7 (33%) patients developed seizure activity after antibiotic therapy was administered. The usefulness of imipenem/cilastatin for the treatment of bacterial meningitis in children may be limited by a possible increased incidence of drug-related seizure activity.

Epidemic measles in the postvaccine era: evaluation of epidemiology, clinical presentation and complications during an urban outbreak.

A total of 440 cases of measles were seen at a single childrens hospital during an epidemic in a large urban center. These cases were retrospectively analyzed for demographic characteristics, exposure histories, risk factors for and incidence of complications, outcome and financial consequences. More than 90% of children were <5 years of age and 56% were <15 months of age. Ninety-four percent were of Hispanic or African-American ethnic background. A visit to a medical facility was the only source of infection for 83 of the 115 patients for whom exposure histories were available. Four patients with underlying immunodeficiency were among those nosocomially exposed and one died of pulmonary complications. Of the 440 patients 195 (44.3%) required hospitalization for measles complications. The mean age of hospitalized patients, 1.9 ± 2.4 years, was not different from those not admitted (2.1 ± 2.5 years; P < 0.25). The most frequent indications for admission were respiratory tract complications (pneumonia and/or croup) seen in 161 patients and dehydration in 25 patients. Fourteen required intensive care and 11 required intubation and mechanical ventilation. Three children died, all of pulmonary involvement. Total hospital and medical charges for care of these patients was more than

Human Cytomegalovirus. Morphology by Negative Staining.

1.7 million dollars.

Nosocomial measles infection in a pediatric hospital during a community-wide epidemic

Abstract Human cytomegalovirus grown in cultures of human fetal skin-muscle cells was examined by high resolution electron microscopy using the phosphotungstate method for negative contrast. The virus particle shows evidence of icosahedral shape and consists of a capsid (960 A diameter) composed of 162 elongated hollow capsomeres (135 A × 95 A) and an inner core (750 A diameter). Some particles are surrounded by an envelope, and some cores apparently contain a “ringlike” substructure. Varicella, herpes simplex, and human cytomegaloviruses appear to be indistinguishable by the described morphological criteria.

The incidence of cytomegaloviruria and postmortem cytomegalic inclusions in children with acute leukemia.

From Jan. 1, 1988, through Dec. 31, 1988, a total of 89 cases of measles were observed at Childrens Hospital of Los Angeles, and 37 patients were admitted to the hospital. Of the 37 patients, six were not initially thought to have measles, which resulted in exposure of 107 patients and 24 personnel. Of the exposed patients, measles developed in four. One nosocomially infected infant died of pneumonia. Another exposed patient was subsequently admitted to another hospital with unrecognized measles, which led to exposure of an additional eight patients. Of seven employees in whom measles developed, two required hospitalization because of pneumonia. Two hundred eleven employee days were lost because of measles exposure or infection. Infection control interventions included prophylaxis of exposed patients, employee education, and measles immunization for susceptible personnel. Of 1103 hospital personnel considered susceptible to measles, 800 received monovalent measles vaccine. No secondary cases of measles occurred in hospital personnel who received appropriate prophylaxis. We conclude that infection control programs aimed at mandating measles immunity in hospital employees at risk should be instituted.

A fatal case of inclusion body pneumonia in an infant infected with adenovirus type 3

Summary Attempts were made to detect cytomegaloviruria in 97 children with acute leukemia. Two of these patients (2 per cent) yielded cytomegalovirus, whereas none of 50 control patients yielded cytomegalovirus. Review of autopsy material from 82 leukemic children revealed 2 cases (3 per cent) with disseminated cytomegalic inclusions. These studies demonstrate the infrequent ocurrence of cytomegalovirus infection in children with leukemia in the population studied. The incidence was too low to have a meaningful correlation with their clinical state; however, both patients with cytomegaloviruria were receiving immuno suppressive therapy and had neutropenia.

An infant fatality associated with Coxsackie B1 virus

This report describes the clinical, roentgenologic, pathologic, and virologic findings in a 91/2-month-old girl who died after an illness characterized by severe respiratory distress and fever. Microscopic examination of the tissues revealed acute necrotizing pneumonitis characterized by intranuclear inclusion-bearing cells, perifollicular necrosis of the spleen, and enteritis. Adenovirus type 3 was isolated in high concentration from a suspension of the lung and also “unmasked” from lung tissue cultivated in vitro. No previous report of such “unmasking” of an adenovirus from lung tissue has come to our attention.

Bacteriologic relapse during ampicillin treatment of Hemophilus influenzae meningitis

The clinical, pathologic, and virologic findings of a 10-day-old infant who died after a rapid fulminating illness are described. The most significant postmortem findings were evidence of myocarditis and meningoencephalitis. Coxsackie B 1 virus was isolated from throat washings and urine obtained before death and from necropsy specimens of liver, lung, kidney, and brain. Thus, Coxsackie B 1 virus is added to the group of known Coxsackie B viruses associated with myocarditis and severe generalized disease in infancy.

Hepatic dysfunction after renal transplantation in children

A v t P I c I L L I N is a safe and effective agent in the t r ea tmen t of Hemophilus influenzae meningitis . 1-~ No strains of Hemophilus influenzae which are resistant to ampicil l in have been isolated in the extensive studies by Wehr le and associates. 4, 5 However, 3 instances of bacter iologic relapse in HemophiIus influenzae meningit is t rea ted with ampici l l in have been r epor t ed2 -s I n one case of meningit is t rea ted by the oral route, 6 relapse was a t t r ibu ted to inadequa te concent ra t ion of ampici l l in in the cerebrospinal fluid. In ano ther pat ient , s relapse was also a t t r ibu ted to inadequa te concent ra t ion of the ant ibiot ic in the cerebrospinal fluid. I n a th i rd repor t 7 relapse was a t t r ibu ted to sequestra t ion of organisms at a site (cellulitis or e thmoidi t is) inaccessible or only par t ia l ly accessible to the drug; the second lumbar punc tu re in this last pa t ien t revealed ne i ther cells nor organisms. T h e following is the case repor t of an addi t ional infant who had a bacter iologic re-

Cytomegalic inclusion disease in newborn twins

Nine of 63 (14 per cent) recipients of renal allografts developed clinical and/orbiochemical evidence of hepatic dysfunction. The etiology was considered to be azathioprine toxicity in eight children and cytomegalovirus hepatitis in one. Evidence of hepatic dysfunction abated in seven of eight children after lowering the dosage of or temporarily discontinuing the drug; the cytomegalovirus hepatitis remitted spontaneously without adjustment in immunosuppressive therapy. One patient died from fungal septicemia with persistent hepatic dysfunction despite discontinuation of azathioprine for 50 days. The data indicate the need for frequent surveillance of hepatic function in pediatric allograft recipients in order to determine the need for adjustment in azathioprine dosage.