Haemophilus influenzae: an underrated cause of vulvovaginitis in young girls

AIMS: To establish the common pathogens associated with infective vulvovaginitis in young girls in the local population and to determine current management of this condition. METHODS: A prospective laboratory based survey was carried out over 19 months. A questionnaire was then sent to local general practitioners and hospital doctors. RESULTS: One hundred and six swabs were received during the study period of which 43 (40.5%) yielded organisms recognised as causes of vulvovaginitis. The most common pathogen was group A beta haemolytic streptococcus (19), with Haemophilus influenzae the second most common (11). Candida was isolated on nine occasions. The users' questionnaire had an overall response rate of 52%. Forty one per cent of respondents nominated candida as the most common cause of this condition. Forty six per cent were aware that beta haemolytic streptococci caused juvenile vulvovaginitis, but only four (3.6%) knew that H influenzae was a possible pathogen. The most popular agent for empirical treatment of vulvovaginitis was topical clotrimazole cream, although 24 respondents (22%) prescribed antibiotics that are active against both group A beta haemolytic streptococci and H influenzae. CONCLUSIONS: Although H influenzae is the second most common infective cause of juvenile vulvovaginitis in the local population, most doctors managing these patients were unaware of its importance and may not be prescribing appropriate empirical treatment.     

Infectious gastroenterocolitides in children: an update on emerging pathogens

The recognition that bacterial infections induce signal transduction responses in infected epithelial cells also provides new avenues to consider as novel forms of therapy. For example, the chemokine interleukin-8, which attracts neutrophils to sites of mucosal infection, is produced by epithelial cells of gastric and intestinal origin in response to bacterial infection. Inhibitors of chemokine production or inhibition of the biologic effects of neutrophil chemoattractants have the potential to reduce both mucosal inflammatory responses and the attendant clinical sequelae. Eukaryotic cells also respond to infection with elevations in cytosolic second messengers, including inositol triphosphate (IP3) and calcium ([Ca2+]i). In intestinal epithelium, these second messengers can mediate the diarrheal response to infection. Calcium/calmodulin inhibitors may have a beneficial effect in treating those gastrointestinal infections mediated through changes in the level of cytosolic free calcium. DuPont and colleagues showed, for example, that oral therapy with zaldaride maleate relieves symptoms of disease and shortens the duration of diarrhea in travelers with ETEC-induced diarrhea. Evaluation of additional signal transduction responses to microbial infections should provide both new insights into the pathogenesis of gastrointestinal infectious diseases and novel approaches to consider for the prevention and therapy for these human illnesses.     

Subglottic hemangioma as the cause of laryngostenosis in young children

The amount of plasma cells synthesizing different class immunoglobulins in the gallbladder wall in 9 practically healthy people and in 19 patients with different forms of cholecystitis was studied by a complex of histological, histochemical and immunofluorescent methods. It was established that catarrhal cholecystitis was accompanied by activated production of immunoglobulins of all classes by plasmocytes of the gallbladder wall. In patients with destructive forms of cholecystitis the level of secretory immunoglobulin A was substantially decreased as well as the amount of plasmocytes synthesizing IgA. The amount of immunocytes producing IgM and IgG became disproportionally greater, there appeared immune IgM complexes and IgG and IgG in the wall of blood vessels and perivascular stroma. The author considers that local immune reactions play an important role in protection of the gallbladder mucosa and pathomorphogenesis of cholecystitis.     

Clinical outcome of invasive infections by penicillin-resistant Streptococcus pneumoniae in Korean children

One hundred six cases of invasive pneumococcal infections diagnosed from 1985 to 1996 were analyzed retrospectively. The types of infection were bacteremia without focus (45%), meningitis (19%), peritonitis (17%), pneumonia (bacteremic) (16%), and others (3%). Penicillin-nonsusceptible Streptococcus pneumoniae was first detected in 1989, and its incidence increased rapidly thereafter, reaching 89% in 1995. Initial empirical regimens were of parenteral beta-lactam antimicrobials with or without an aminoglycoside, but these were modified subsequently. Among the 72 nonmeningeal infections analyzed, a favorable response at 72 hours and death were observed in 83% and 2.5%, respectively, of 40 penicillin-susceptible infections, as compared with 86% (P = 1.0) and 7.1% (P = .45) of 14 infections due to intermediate strains and 61% (P = .07) and 11% (P = .22) of 18 due to resistant strains. The favorable-response rate and mortality among 49 patients not in initially critical condition were 92% and zero, respectively, as compared with 52% (P = .00027) and 17% (P = .008) of 23 in critical condition. The data suggest that clinical outcome of penicillin-nonsusceptible pneumococcal infection outside the CNS may be more closely related to clinical condition at presentation than to the level of resistance of the causative strain when such infection is treated with parenteral beta-lactams.     

Mucoid encapsulated Enterococcus faecalis: an emerging morphotype isolated from patients with urinary tract infections

Three strains of encapsulated Enterococcus faecalis, which produced highly mucoid coalescing colonies on routine bacteriologic media, were isolated from urine specimens of patients with urinary tract infection. Encapsulation could be demonstrated through India ink preparations. The occurrence of this unusual enterococcal colony morphotype, which resembles that of a Gram-negative bacterium, may delay true identification.     

The role of international agencies in emerging infections

Emergent and resurgent infections have no respect for national borders. Surveillance programmes, policies and practices, educational activities and control initiatives all require international leadership, multinational funding, and the ability to transcend national barriers if we are to prevent and control these infections. Society seems to expect us to organise ourselves to do this job well without building "impossible to maintain" barriers to the flow of people or goods. As a result, we must determine how international organisations, including United Nations agencies, international societies, and academic groups in universities, can work together with national organisations to achieve effective surveillance, ongoing education, important research and control initiatives to prevent infections from becoming an ever-increasing global threat to our security.     

Urethral polyps in children: an unusual cause of obstruction of the lower urinary tract

We report an unusual case of urethra polyp in a young child which caused obstruction of the lower urinary tract. Endoscopy was successful.     

Lymphocyte subset profile of young healthy children residing in a rural area: possible role of recurrent gastrointestinal infections

BACKGROUND: Lymphocyte subsets in healthy children are currently characterized by age-related standards. Because antigenic stimuli play a role in maturation of the immune system after birth, there is a question of whether cellular immune development differs in infants whose living conditions entail extensive antigenic exposure and infants growing up in a more protected environment. METHODS: Peripheral blood lymphocyte subsets were studied in two populations of children of similar age and nutritional status; children belonging to a rural population residing in proximity with farm animals and children from an economically privileged urban population. In each population, children studied included a group with an acute diarrheal episode and a healthy control group. RESULTS: Among rural population children, 65% had experienced at least one episode of gastroenteritis within the previous 3-month-period, compared with less than 10% of urban population children. In the rural population group 15% had experienced two or more episodes of gastroenteritis. The proportion of helper T cells was similar in rural population and urban population children. Among helper T cells, the proportion of CD29+ "memory" cells of the total CD4+ helper T cells was more than two times higher than those in rural population children. The proportion of CD8 cells was higher in rural population children than in urban population children, and the proportion of natural killer cells, CD56+ and CD57+, was two to three times higher in rural population children. Within each population, peripheral blood lymphocyte subsets did not differ between the healthy control group and those with acute diarrhea. CONCLUSIONS: In young children exposure to environmental pathogens and specifically to gastrointestinal antigenic stimuli is a major factor affecting development of the cellular immune response. Young children who have experienced enhanced infectious exposure have a peripheral blood lymphocyte profile similar to that of adults.     

Effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections in young children in Brazil

A beneficial effect of periodic vitamin A supplementation on childhood mortality has been demonstrated, but the effect on morbidity is less clear. We investigated the effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections (ALRI) in children from northeastern Brazil in a randomised, double-blind, placebo-controlled community trial. 1240 children aged 6-48 months were assigned vitamin A or placebo every 4 months for 1 year. They were followed up at home three times a week, and data about the occurrence and severity of diarrhoea and ALRI were collected. Any child with cough and respiratory rate above 40 breaths per min was visited by a paediatrician. The overall incidence of diarrhoea episodes was significantly lower in the vitamin-A-supplemented group than in the placebo group (18.42 vs 19.58 x 10(-3) child-days; rate ratio 0.94 [95% Cl 0.90-0.98]). The benefit of supplementation was greater as regards severe episodes of diarrhoea; the incidence was 20% lower in the vitamin A group than in the placebo group (rate ratio 0.80 [0.65-0.98]). With the standard definition of diarrhoea (> or = 3 liquid or semi-liquid stools in 24 h) the effect of vitamin A on mean daily prevalence did not reach significance, but as the definition of diarrhoea was made more stringent (increasing number of stools per day), a significant benefit became apparent, reaching for diarrhoea with 6 or more liquid or semi-liquid stools in 24 h a 23% lower prevalence. We found no effect of vitamin A supplementation on the incidence of ALRI. The reduction in severity of diarrhoea may be the most important factor in the lowering of mortality by vitamin A supplementation.     

Epiglottitis: pathology in young children?

Aqueous solubilities for some guanine derivatives were estimated by semiempirical equations developed by Yalkowsky and Valvani1 using the data for partition coefficient and melting temperature. It was shown that in the case of guanine derivatives examined in this study, the solubility values could not be estimated adequately by these equations.     

Quantitative risk assessment: an emerging tool for emerging foodborne pathogens

New challenges to the safety of the food supply require new strategies for evaluating and managing food safety risks. Changes in pathogens, food preparation, distribution, and consumption, and population immunity have the potential to adversely affect human health. Risk assessment offers a framework for predicting the impact of changes and trends on the provision of safe food. Risk assessment models facilitate the evaluation of active or passive changes in how foods are produced, processed, distributed, and consumed.     

Testing of visual acuity in young children: an evaluation of some commonly used methods

In a comparative study of screening tests for visual acuity in young children, two groups of children were presented with three different tests. In the younger group (three to five years) three single opto-type tests were compared: Sheridan's five and seven letter matching test, the Fooks test and the E card test. The Sheridan test gave the best results and the E card test was found to be unsuitable for this age-group. The Fooks is an attractive test but was less sensitive in the detection of defects than the Sheridan test. In the older group (five to seven years) a single opto-type test, the Sheridan-Gardiner test, was compared with the E chart and the Snellen chart. The Sheridan-Gardiner test was found to have limitations in the detection of defects, including amblyopia, therefore results obtained by this method should not be considered to be directly comparable with those of the Snellen chart. The E chart gave good results in the detection of defects and there was less lateral confusion than had been expected. It has disadvantages, but there is still a place for its use in the screening of normal school-age children. The Snellen chart was the most effective test in the detection of defects, but not all the children were able to co-operate in its use. It is concluded that where it is possible to use the Snellen chart it should always be the method of choice.