Laura T. Gutman

Tuberculosis in human immunodeficiency virus-exposed or -infected United States children

This study was designed to provide a preliminary assessment of the occurrence of tuberculosis exposure, infection and disease within a national sample of infants and children with human immunodeficiency virus (HIV) exposure or infection, and to determine the prevalence of Mycobacterium tuberculosis isolates resistant both to isoniazid and rifampin in these patients or their adult source contacts. A retrospective questionnaire survey was conducted of infants and children with HIV exposure or infection evaluated by pediatric HIV referral centers in the United States comprising the pediatric units or subunits of the Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG). Seventy of 72 sites during a mean period of 5 (range, 1 to 12) years participated in this study and had provided care for 14,038 patients. There were 75 cumulative total cases of tuberculosis disease seen since each site was established. Therapy for asymptomatic infection was given to another 40 children and for tuberculosis exposure to 71 children. Annualized case rates were 478/100,000 for sites established in 1990 to 1992, 117/100,000 for 1988 to 1989, 63/100,000 for 1986 to 1987 and 58/100,000 for 1981 to 1985 (P = 0.05, Spearmans p test for trend). By comparison, the 1992 age-specific tuberculosis case rate for all U.S. children < 5 years was 5.5/100,000. Twenty percent of isolates from PACTG patients and 15% of isolates from adult source contacts were resistant to isoniazid and rifampin.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of coexisting vaginal infections and multiple abusers in female children with genital warts

All 11 girls less than 12 years of age presenting to the pediatric clinic between 1980 and 1986 with genital warts were evaluated by the Child Protection Team for possible sexual abuse. Nine of the 11 girls had condylomata acuminata, and two had verruca vulgaris. Ten of the 11 had historical and/or physical evidence other than the warts that confirmed sexual abuse. Six girls had coexisting vaginal infections such as bacterial vaginosis and infections due to various pathogens including Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma urealyticum, and Mycoplasma hominis. These six girls were known (three) or suspected (three) of being abused by multiple perpetrators. None of the five girls with a known or suspected single abuser had coexisting vaginal infections (P = less than 0.02, Fishers exact test). We conclude that almost all genital warts in girls are sexually transmitted and that girls presenting with anogenital warts should be evaluated for other genito-vaginal infections and sexual abuse. Multiple vaginal infections in childhood, with organisms that are sexually transmitted or associated with sexual activity, may be a marker for abuse by multiple perpetrators.

Neonatal staphylococcal enterocolitis: association with indwelling feeding catheters and S. aureus colonization.

A prospective study of the clinical and epidemiologic characteristics of four newborn infants who developed staphylococcal enterocolitis is reported. The four infants were fed with an indwelling nasoduodenal or gastric-feeding catheter which was passed through a nasal or gastrostomy site which was colonized by Staphylococcus aureus . All infants in whom this occurred developed disease or excreted S. aureus in their stool. Infants not fed by nasoduodenal or gastrostomy catheter or not colonized by S. aureus at the site of the feeding catheter did not develop this disease. The first case of this unusual disease occurred in a previously asymptomatic infant in whom signs of acute disease included ileus, leukopenia, shock, and diarrhea; a culture of the stool revealed S. aureus in pure growth. S. aureus of identical phage types was recovered from both feeding orifice and stool during of four episodes, but the infected infants were each colonized by strains of S. aureus of different phage patterns. No strain produced identifiable quantities of enterotoxin A-E.