Maria J. Patterson

Respiratory syncytial virus infections in children with acute myeloid leukemia: A report from the Children's Oncology Group

Morbidity and mortality related to respiratory syncytial virus (RSV) in pediatric acute myeloid leukemia (AML) is not known.

Penicillin-resistant Streptococcus mitis as a cause of septicemia with meningitis in febrile neutropenic children

PURPOSE The purpose of this report is to emphasize the importance of occurrence of Streptococcus mitis meningitis in febrile neutropenic children with hematopoietic malignancy. PATIENTS AND METHODS Symptoms of meningitis and sepsis (fever, headache, changes in mental status) were seen in three patients who were severely neutropenic and undergoing cytotoxic chemotherapy for CNS relapse of their underlying malignancy (acute lymphoblastic leukemia (ALL), n = 2; Burkitts lymphoma, n = 1). Chemotherapy had included cytosine arabinoside administered 7-14 days prior to presenting with sepsis and meningitis. All three patients had buccal mucositis or sinusitis. Blood cultures and CSF cultures showed S. mitis resistant to penicillin but sensitive to vancomycin. Vancomycin, at a dosage of 60 mg/kg/day to maximize CNS levels of antibiotic, was administered to all three children. RESULTS Two of the patients recovered from S. mitis meningitis; recovery was associated with an improvement in their peripheral granulocyte counts. One patient, who remained neutropenic, died despite being treated with both intravenous and intraventricular vancomycin. CONCLUSION Physicians caring for patients who are neutropenic and febrile need to be aware of the risk of meningitis occurring with S. mitis sepsis. Early treatment with high dosages of vancomycin (60 mg/kg/day) and an attempt to limit the duration of neutropenia are important factors in the outcome of such patients.

Treatment of systemic candidiasis in a neutropenic murine model using immunoglobulin G bearing liposomal amphotericin B

Efficacy of immunoglobulin G (IgG) bearing liposomal amphotericin B (LAMB-IgG), liposomal amphotericin B without IgG (LAMB) or free amphotericin B (fAMB/Fungizone) was investigated in the treatment of systemic candidiasis in a neutropenic mouse model. Treatment with a single dose (0.6 or 0.9 mg amphotericin B per kg body weight) of LAMB-IgG resulted in a significant increase in the survival rate of neutropenic mice infected with 3×105 cfu ofCandida albicans compared to untreated controls, mice injected with IgG, or liposome alone. Survival was also better in neutropenic mice treated with LAMB-IgG than in neutropenic mice treated with the same dose of LAMB or fAMB. Moreover, 65% of all mice survived the infection after treatment with a single dose of 0.6 mg AMB of the LAMB-IgG formulation. Quantitative culture counts of organs showed that both fAMB and LABM-IgG formulations even at a dose of 0.3 mg AMB/kg, clearedC. albicans from the spleens, livers, and lungs but not from the kidneys. However, a decreasd number ofC. albicans cells was recovered from the kidneys of mice that survived the infection. Results of the study suggest that LAMB-IgG is more effective than LAMB or fAMB in the therapy of disseminated candidiasis in neutropenic mice.

Evaluation of antibody-bearing liposomal amphotericin B in the treatment of systemic candidiasis in a neutropenic murine model

The efficacy of liposomal amphotericin B bearing anticandidal antibodies (LAMB-Ab) was investigated in the treatment of systemic candidiasis in a murine model made neutropenic by an intraperitoneal injection of cyclophosphamide. Treatment with a single dose (0.6 mg amphotericin B kg-1 body weight) of LAMB-Ab resulted in an improved survival of neutropenic mice infected with Candida albicans compared to neutropenic mice treated with identical doses of liposomal amphotericin B or free amphotericin B.

Hepatitis B Surface Antigen in Urine of Renal Transplant Recipients

Excerpt Urinary hepatitis B surface antigen (HBsAg) has been shown by radioimmunoassay in 19 of 36 persistent serum HBsAg carriers on maintenance hemodialysis (1); however, data on antigenuria in t...

Intermittent hepatitis B surface antigenuria in a renal transplant recipient

Abstract It has been demonstrated that hepatitis B surface antigen (HB 8 Ag) can be detected in the urine of a majority of persistent serum carriers of HB 8 Ag undergoing hemodialysis with urinary output. Therefore we have proposed that, in this population, urine may represent a potential vehicle for nonparental transmission of hepatitis B. Described here is a renal transplant recipient with intermittent HB 8 Ag in the urine who has never been subjected to hemodialysis and who underwent bilateral nephrectomy before renal transplantation. Determinations of HB 8 Ag or antibody to HB 8 Ag (anti-HB 8 ) in serum obtained from this patient and three household contacts, as well as in serial urine samples from the patient, were performed by radioimmunoassay. The patient has consistently had HB 8 Ag in her serum (HB 8 Ag positive) (subtype ad) for at least three years. Four of five urines obtained over a four-month period also contained HB 8 Ag. Two serum samples, one year apart, obtained from the son of this index patient both contained HB 8 Ag. Serum samples from her former husband and a current cohabitant were void of HB 8 Ag, but did contain anti-HB 8 , indicating previous exposure to hepatitis B. We believe this information implicates the index patient as a potential source of hepatitis B to a number of persons. The epidemiologic consequences of HB 8 Ag positive persons receiving a renal transplant have not been adequately emphasized. Furthermore, the presence of HB 8 Ag in the urine eight years after a bilateral nephrectomy and successful renal transplantation suggests that the transplanted kidney allows passage of HB 8 Ag into the urine and that the presence of an end-stage kidney is not required for antigenuria. Finally, because successful renal transplantation results in normal urine volume and increased interaction of the recipient with the general population, the urine of HB 8 Ag carriers could have an important role in the spread of hepatitis B.

Blastomyces dermatitidis Pneumonia in an adolescent

Abstract Fungal etiology as a cause of pneumonia should be considered in children and adolescents who may be part of a family or group cluster of pneumonia. Fungi should also be considered and appropriate diagnostic studies ordered in those patients who have specific factors (such as travel, recreational or occupational exposure) for development of infections caused by fungi, such as Blastomyces, Coccidioides , or Histoplasma .

Pediatric HIV infection

Abstract Human immunodeficiency virus (HIV) infection is a major and growing threat to children. An essentially unknown disease prior to 1981, pediatric HIV infection is now one of the leading causes of death in children. The social stigma associated with the disease, the exceedingly poor ultimate prognosis for the child, and the devastating emotional toll that families suffer have only recently been recognized. This review will highlight the epidemiology, etiology, pathophysiology, and current medical treatment of HIV infection. A case study will also be presented to demonstrate the complex psychosocial issues that characterize this disease.