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1. New strategy in the prevention of RSV. The report of a recent multicentric study shows that a humanized monoclonal antibody against the fusion protein of RSV is effective in the prevention of severe lower respiratory infection in premature infants and children with bronchopulmonary dysplasia. This strategy requires monthly intramuscular injections od the antibody during the RSV season.
(The IMpact Study group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high risk infants. Pediatrics 1998; 102: 531-537).
2. Rotavirus vaccine approved. The food and drug administration has approved an oral vaccine against rotavirus. The vaccine is approved for administration to young infants at ages 2, 4 and 6 months. It is estimated that it will prevent one million cases of rotavirus diarrhea per year.
3. Thymic dysfunction predicts mortality in HIV infected infants. A recent study shows that thymic dysfunction (TD) evidenced by a decrease of CD4 and CD8 cells can be predictive of mortality in HIV infected infants. According to this study, infants with TD infected in utero had higher mortality than those infected intrapartum.
(Nahmias AJ et al. Thymic dysfunction and time
of infection predict mortality in human immunodeficiency virus infected
infants.
JID 1998; 178: 680-685).
4. Diagnosis of toxoplasmosis in CSF. Wallon and collaborators recently suggested that when trying to make the diagnosis of toxoplasmosis the cytochemical examination of the CSF does not significantly contribute to the diagnosis of congenital infection. Instead, is is suggested that the limited amount of CSF should be used to perform more specific such as polymerase chain reaction.
(Wallon M et al. Value of cerebrospinal fluid cytochemical examination for the diagnosis of congenital toxoplasmosis at birth in France. Pediatr Infect Dis J 1998; 17: 705-710).
5. Emerging infectious diseases. A DNA virus called “Transfusion-Transmitted virus” similar to members of the Parvoviridae has been found in high prevalence in different areas of the world ranging from 16% in Pakistan to 83% in Gambia.
(Prescott L, Simmonds P. Global distribution of Transfusion-Transmited virus. NEJM 1998; 339: 776-777. click here)
6. Guidelines for prevention of HIV perinatal transmission proven effective. The PHS published guidelines for zidovudine use and HIV counseling and voluntary testing of pregnant women have been proven to be effective in four states in which they have been implemented. HIV perinatal transmission dropped 43% between 1992 and 1996.
(CDC. Success in implementing Public Heath Service Guidelines to reduce perinatal transmission of HIV Louisiana, Michigan, New Jersey and South Carolina 1993, 1995 and 1996. MMWR 1998; 47: 888-891. click here)
7. New development in the suppression of genital herpes. Daily administration of oral famciclovir has been proven to be effective in the suppression of recurrent genital herpes. The median time recurrence for those patients treated with famciclovir was 212 to 336 days compared with 47 days for those treated with placebo. The proportion of patients remaining free of HSV recurrences was 3 times higher in the famciclovir group.
(Diaz-Mitoma F et al. Oral famciclovir for the
suppression of recurrent genital herpes. JAMA 1998; 280:887-892 click
here).
WHAT’S THE BUG?
A six year old female presents with history of fever for 4 weeks. Her mother states that her febrile episodes began 1 month ago when she developed a “red papule” on her right arm. She has been previously healthy with no significant past medical history. Lives at home with her parents, one dog and two kittens one of which is infested with fleas. On physical exam she is febrile (102 F) and i slightly pale her physical exam is otherwise normal, she does not have lymphadenopathy, hepatomegaly nor splenomegaly. Her initial laboratory work up includes a CBC, U/A, urine culture, blood culture, PPD and a CXR all with negative results except for her erythrosedimentation rate reported to be 48 mm/hr. You order a serological test which gives you the diagnosis.
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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 September, 1998