Vincent A. Fulginiti

The association of viral and bacterial respiratory infections with exacerbations of wheezing in young asthmatic children

The relationship between exacerbations of wheezing and infection of the respiratory tract was studied prospectively in 32 young hospitalized asthmatic children. Of 139 episodes of wheezing, 58 (42 per cent) were associated with identifiable viral infections. There were 25 respiratory syncytial virus infections; wheezing occurred in 24 of these and pneumonia in 13. Parainfluenza type 2 infection appeared to be next most likely to be associated with wheezing, followed by coronavirus infection. Influenza A. (Hong Kong) was not associated with wheezing in any of the children. Infection with “pathogenic” bacteria was not statistically associated with wheezing.

Smallpox Vaccination: A Review, Part II. Adverse Events

Smallpox vaccination of health care workers, military personnel, and some first responders has begun in the United States in 2002-2003 as one aspect of biopreparedness. Full understanding of the spectrum of adverse events and of their cause, frequency, identification, prevention, and treatment is imperative. This article describes known and suspected adverse events occurring after smallpox vaccination.

Severe Eczema Vaccinatum in a Household Contact of a Smallpox Vaccinee

BACKGROUND We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The childs mother also developed contact vaccinia infection. METHODS Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts. RESULTS The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring. CONCLUSION This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.

An Anomaly of Neutrophil Morphology with Impaired Function

Abstract Neutrophils from a boy with recurrent bacterial infections since infancy were found to have unique morphologic abnormalities. The nuclei were bilobed, and the cytoplasm appeared nearly dev...

Smallpox Vaccination: A Review, Part I. Background, Vaccination Technique, Normal Vaccination and Revaccination, and Expected Normal Reactions

Because smallpox could be a factor in bioterrorism, the United States has provided guidelines for smallpox vaccination of certain members of the population, including health care workers and first responders, as well as military personnel. A plan for more extensive vaccination, if it is needed in the event of a bioterrorist attack, is being developed under the aegis of the Centers for Disease Control and Prevention. The characteristics of smallpox vaccine, the technique of administration, and the expected reactions to primary vaccination and revaccination are outlined in this article.

Disaccharidase deficiency in children with immunologic deficits

Eighteen Caucasian patients with various immunologic deficiencies had gastrointestinal manifestations such as diarrhea, steatorrhea, partial villous atrophy, and lymphoid nodular hyperplasia. The levels of IgA in the saliva and in the duodenal juice correlated well with each other and also reflected the serum levels of IgA. Determinations of the jejunal disaccharidase activity revealed an isolated lactase deficiency with normal villi in 3 of the 18 patients. Seven of the 8 patients with deficiencies of cellular immunity and one with isolated IgA deficiency and normal cellular immunity, were found to have decreased lactase, sucrase, and maltase activity despite the presence of a normal villous pattern and of intact epithelial cells.

Thymic alymphoplasia with XX/XY lymphoid chimerism secondary to probable maternal-fetal transfusion†††

Karyotypes in a 5-month-old patient with thymic alymphoplasia revealed evidence for XX/XY chimerism in peripheral blood lymphocytes. These cells showed no immunologic competence, and there was no indication of a graft-versus-host reaction (GVHR). These findings suggest that placentally transfused maternal lymphocytes may persist in an immunologically incompetent fetus without having a demonstrable effect. Additional findings included adrenal hyperplasia, possible absence of parathyroids, and lack of evidence of immunologic function after attempts at grafting fetal thymic and hematopoietic tissue.

Transmission of Vaccinia Virus and Rationale for Measures for Prevention

Currently, health care workers (HCWs) in the United States are being vaccinated against smallpox, and there is a possibility that this will be expanded to a more widespread vaccination program. Inadvertent transmission of vaccinia virus to patients with illnesses that are contraindications to vaccination is theoretically possible. Vaccinia virus is shed from the vaccination lesion of healthy primary vaccinees from approximately the third day to the end of the third week after vaccination; transmission of vaccinia virus is rare but does occur. Prudent management of the vaccination site by HCWs should virtually eliminate transmission. We recommend that vaccinated HCWs cover the site with loose gauze dressings and, when caring for patients with immunosuppression or extensive disruptive skin disorders, cover the dressings with semipermeable membranes. The evidence for respiratory spread of vaccinia virus is not compelling, and therefore droplet or airborne infection precautions should not be necessary, even for vaccinated HCWs who are caring for patients who experienced serious adverse events after smallpox vaccination in the past.

Trimethoprim-sulfamethoxazole treatment of Pneumocystis carinii pneumonitis

PNEUMOCYSTIS CARINII pneumonitis occurs almost exclusively in the debilitated or immunosuppressed individual? Mortality without therapy in this disease exceeds 50%. Treatment with pentamidine isethionate has improved the survival rate to 60 to 95%. However, pentamidine is toxic; adverse reactions occur in approximately 50% of recipients. Trimethoprim-sul famethoxazole is apparently effective and less toxic/ In this report we summarize our experience with TMP-SMZ treatment of five children with P. carinii pneumonitis, CASE REPORTS The age, sex, underlying disease, and diagnostic procedures for five patients with P. carinii infection are listed in Table I. Symptoms in four children were present for four to 21 days before starting treatment. One patient (No. 2) had easy fatiguabilitY, dyspnea, and mild cough for nine weeks; his respiratory symptoms had progressed during the last week. Such an insidious course has been recognized in P. carinii infections/All children had tachypnea, cough, and fever; three were cyanotic. At the time of diagnosis blood Pao2 was over 50 mm Hg in the three survivors and under 50 mm Hg in the two children who died subsequently. Total and differential white blood counts were not helpful in diagnosis but reflected either the underlying disease (Patient 1) or the effects of chemotherapy (Patients 2 to 5). All patients had extensive, bilateral interstitial infiltrates as demonstrated by chest radiographs?. 3 The first patient also developed a spontaneous pneumothorax. Aerobic and anaerobic bacteria, mycobacteria, fungi, and viruses were sought in all cases in smears and cultures of lung biopsy specimens; none was isolated. All lung biopsy

Recurrent Group C Streptococcal Tonsillitis in an Adolescent Male Requiring Tonsillectomy

A 15-year-old boy had repeated episodes of tonsillitis with group C strepto cocci over a four-month period. The tonsillitis cleared with antibiotic therapy but was followed by a recurrence within a few days. Tonsillectomy resulted in a permanent cure and group C streptococcus was found in the tonsils. A literature search has failed to reveal similar cases and a brief review of the existing literature is given.