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1. Higher doses of amoxicillin for the treatment of otitis media. During the last year, it has been suggested by different investigators that by using higher doses of amoxicillin (70-90 mg/kg/day) the middle ear fluid concentrations for this antibiotic can be equal or higher than the MIC for intermediate resistant strains of Streptococcus pneumoniae. A study by French investigators suggests that the use of even higher doses may be beneficial in some cases.

(Roger G et al. Management of otitis media caused by resistant pneumococci in infants. Pediatr Infect Dis J, 1998;17:631-38.).

2. Pulmonary hemorrhage in infants linked to Stachybotrys atra. An epidemiological investigation performed on the homes of  10 infants who developed pulmonary hemorrhage and hemosiderosis in Cleveland OH, revealed that the likelihood of finding this organism in the homes of the affected infants was higher than in homes of controls. It is hypothesized that S.atra produces mycotoxins which could be linked to the development of pulmonary hemorrhage.

(Etzel RA et al. Acute Pulmonary Hemorrhage in infants associated with exposure to Stachybotrys atra and other fungi. Archives of Pediatrics and Adolescent Medicine, 1998; 152:757-762.).

3. Study highlights the importance of respiratory viruses in children with otitis media. Using  reverse transcriptase polymerase chain reaction, researches determined the frequencies of  human rhinovirus (HRV), respiratory syncytial virus (RSV) and coronavirus (HCV) infection in middle ear fluid (MEF) and nasopharyngeal aspirates of children with acute otitis media. Viral RNA for any of the viruses studied was detected in 48% of MEF samples.

(Pitkaranta A et al. Detection of rhinovirus, respiratory syncytial virus and coronavirus infections in acute otitis media be reverse transcriptase polymerase chain reaction. Pediatrics, 1998; 102: 291-295. * A  commentary of this study by Dr. Robert  Pass is included on the same issue (pages 400-401)).

4. A vaccine against Lyme Disease. Two different double-blind placebo controlled  trials in which recombinant Borrelia burgdorferi outer-surface lipoprotein A was used to immunized  individuals against this organism showed efficacy of 76% and 92% in the second year after a third injection was given. Although neither trial included children both trials showed that this type of vaccine is safe and effective in the prevention of most  adult cases of Lyme disease.

(*  Steere A et al. Vaccination against Lyme disease with recombinant Borrelia burgdorferi outer-surface lipoprotein A with adjuvant. NEJM 1998; 339: 209-215.  * Sigal L et al. A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease. NEJM 1998; 339: 216-222).  click here

5.  Emerging Infectious Diseases: Influenza. A description of the the epidemiology of influenza, as well as  the index case and characterization of the virus in the Hong Kong outbreak is presented in a very informative manuscript. This manuscript also presents  possible ways of preventing future pandemics.

(Webster R. Influenza: an emerging disease. Emerging Infectious Diseases 1998; 4: 436-441.) full text

6. Human granulocytic ehrlichiosis (HGE) in a neonate. Horowitz and colleagues describe the case of and infant perinatally infected with the agent of HGE. The infant’s mother was diagnosed and successfully treated 5 days after delivery. The infant became ill on her ninth day of life.  Polymerase chain reaction for this agent was performed on blood specimens of  both, the infant and her mother showing identical restriction fragment length polymorphism.

(Horowitz HW et al. Perinatal transmission of the agent of human granulocytic ehrlichiosis. NEJM 1998; 339: 375-378.) click here

7. Measles, mumps and rubella antibodies after treatment for leukemia. In a recent study, investigators have shown that  after receiving treatment for acute leukemia, the group of children studied had an antibody decline against measles, mumps and rubella of 13%, 18% and 21% respectively.

(Feldman S et al. Decline in rates of seropositivity for measles, mumps and rubella antibodies among previously immunized children treated for acute leukemia. CID 1998; 27: 388-390).

8. Mortality among children with hand foot mouth disease. Earlier this year about 90,000 cases of children with hand-foot-mouth disease where reported  to the Taiwan Ministry of Public Health, many of them developed aseptic meningitis and 55 were reported dead.

(CDC MMWR 1998; 47: 30 click here).

9. Should we screen more frequently for Chlamydia trachomatis?. It is currently recommended that in sexually active adolescents screening for C.trachomatis should be performed every year.  A recent study performed among inner city adolescents suggests that because of the high incidence of this infection (28 cases per 1000) screening in sexually active adolescent females should be performed every six months.

(Burstein GR et al. Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA 1998;280: 521-526. click here ). 

10. Global increase in vector-borne diseases. An increase in this type of infections has been observed during recent years. It is suggested that related factors are changes in public health policy, insecticide and drug resistance, demographic and societal changes as well as genetic changes among pathogens.

(Gubler DJ. Resurgent vector-borne diseases as a global health problem. Emerging Infectious Diseases 1998; 4: 442-450.
 full article).

WHAT’S THE BUG?

A 10 year old female with Fanconi’s anemia presents with 3 days history of fever and malaise. He has been admitted multiple times in the past for fever and neutropenia. Her temperature at admission is 102 F, she looks pale. Her exam reveals a 0.5 cm ulcer on her tongue. She has hepatomegaly and splenomegaly  Upon admission her absolute neutrophil count is 100. Twenty four hours after admission the microbiology laboratory reports the growth of a Gram negative anaerobe rod from two cultures obtained one day before. The species reported  was  formerly known as Dysgonic Fermenter 1 and 2  (DF-1 and DF-2).

What is the current name for this bacteria? (Click here for the answer).
 

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Benjamin Estrada, M.D.
Assistant Professor of Pediatrics,
Division of Pediatric Infectious Diseases,
Department of Pediatrics and Adolescent Medicine,
University of South Alabama (*)

Last update August, 1998