Spread of varicella in hospitalized children having no direct contact with an indicator zoster case and its prevention by a live vaccine

Varicella spread from a child with zoster to a total of 3 susceptible infants in another room in a children's ward, although they had been strictly isolated. To prevent spread of the disease, the staffs and patients were doing their own washing and no source of natural infection could be found. The cases indicate that it is difficult to predict nosocomial varicella infection or to prevent spread of the disease simply by isolation in a children's ward. A total of 11 other children without history of varicella in the ward were given live varicella vaccine before or immediately after this event. None of these children developed symptoms of varicella and all the susceptible children who were vaccinated showed an antibody response.     

The effect of various adjuncts on the surgical treatment of carpal tunnel syndrome secondary to chronic tenosynovitis.

A series of 22 patients with carpal tunnel syndrome secondary to chronic tenosynovitis was divided into two groups. The first group was treated by transverse carpal ligament release alone. The second group was treated by transverse carpal ligament release, external neurolysis of the median nerve, flexor synovectomy, and intraoperative corticosteroid instillation. Both groups were comparable preoperatively as to symptoms, signs, and electrophysiological data. At two years postoperatively there were no statistically significant differences in the symptoms, signs, and electrophysiological data in the two groups. The only difference was that patients undergoing release alone were able to return to work earlier than those patients who had the adjunctive procedures.     

Acute myelopathy associated with primary infection with human immunodeficiency virus.

A 29 year old white homosexual man presented with a two and a half week history of severe sore throat, fever, and extreme fatigue. His symptoms did not respond to antibiotics. He had mild bilateral conjunctivitis, a rash over his chest and back, and enlarged lymph nodes, but examination of the nervous system yielded normal results. He had low total white cell and platelet counts. The results of enzyme linked immunosorbent assay for human immunodeficiency virus (HIV) were equivocal when HIV IgM was detected in serum. Despite treatment with ampicillin his temperature remained high and he developed abnormal neurological signs, including a paraparesis and hyperreflexia of the arms. HIV was isolated from lymphocytes from blood and cerebrospinal fluid. Over the next six weeks the patient improved and was discharged. Two months later abnormal neurological signs persisted in his legs. Although various neurological syndromes associated with seroconversion to HIV have been described, this is probably the first report of a patient with myelopathy at the time of seroconversion.     

Suppurative thyroiditis caused by Salmonella enteritidis

Bacterial thyroiditis is a rare disease, and one of which the clinical symptoms and signs are frequently misleading. On the other hand, prompt diagnosis is crucial for successful treatment. We report the case of an 82 year-old man with diabetes mellitus type 2 and a history of steroid treatment who presented with severe odynophagia and dysphagia associated with fever, chills, sore throat and right ear pain. Based on the clinical picture, radiological studies, thyroid cytology, blood and thyroid aspirate culture, suppurative thyroiditis caused by Salmonella enteritidis was diagnosed. The patient was successfully treated with antibiotics and surgical drainage.     

Clinical application of a live varicella vaccine (Oka strain) in a hospital

A total of 239 children, including 22 high-risk children and 55 non-high risk diseased children have been immunized with a live varicella vaccine (Oka strain) since June, 1978. No clinical reaction attributable to the vaccine has been observed. Of these children, 87 received emergency vaccination. Of 47 children receiving emergency vaccination because they had been in contact with varicella patients either in hospital, school or a playground, only 5 developed varicella and their symptoms were mild. Of 40 children receiving emergency vaccination because of exposure to varicella in their home, 10 developed mild varicella and 30 were protected. Clinical symptoms of varicella when seen seemed to be due to incomplete protection because the vaccine was given too late rather than to clinical reactions to the vaccine. During follow-up period of 6 to 66 months after vaccination, 8 children showed very mild rashes without fever as the result of exogenous varicella infection.     

Direct Fluorescent-Antibody Method for the Diagnosis of Pneumocystis carinii Pneumonitis from Sputa or Tracheal Aspirates from Humans

A direct fluorescent antibody (DFA) method was applied to sputum or tracheal aspirate from 68 patients with clinical or radiological evidence suggesting Pneumocystis carinii pneumonitis, and to 50 control patients. P. carinii was detected by DFA in specimens from 33 of the 69 clinical cases and 3 of the 50 controls. Specimens of lung from 11 of 33 DFA-positive cases were examined histologically, and 9 were positive. Four of 35 DFA-negative cases were examined histologically, and all were negative. Sputa or tracheal aspirates from 6 patients who were positive by both DFA and histological examination were examined also by methenamine silver staining; none could be diagnosed conclusively by this method. The results indicate that the DFA method is a sensitive and dependable procedure for the laboratory diagnosis of P. carinii pneumonitis in man.     

Evaluation of varicella vaccine in childhood leukemia. Observation over 6 years

Since 1977, we have used a live attenuated varicella vaccine to immunize 10 children with acute leukemia. 8 patients had no adverse clinical reaction but 2 patients developed mild fever and papulovesicular rash after vaccination. All 9 tested children became seropositive after the vaccination. Also in all 3 children who were observed for more than 4 years, persistence of neutralizing antibody was detected. Most of the recipients were prevented from developing symptoms of varicella in spite of contact exposure. Two patients developed varicella when they were in severe immunosuppressive states but their symptoms were mild. None of the children developed herpes-zoster during the 6 year follow-up period. The results suggest that the varicella vaccine is effective in children with acute leukemia, and that long-term effectiveness can be expected.     

IgG subclass distribution among antibodies to varicella-zoster virus in human varicella/zoster immunoglobulin preparations and the corresponding donor plasma

IgG subclasses to varicella-zoster virus (VZV) were detected in plasma from different sources used for the production of varicella/zoster immunoglobulin (VZIG). IgG1 and IgG3 were the principal virus antibodies in plasma from healthy donors as well as from convalescents after primary and reactivated disease. Anti-VZV IgG3 antibodies were predominant among varicella convalescents while IgG1 antibodies dominated among zoster convalescents. IgG4 antibodies were present in zoster convalescents and healthy donors but were rarely detected in varicella convalescents. Antiviral IgG2 antibodies were found only in a few cases. Studies of plasma samples collected from one varicella convalescent during a period of seven months following an outbreak of disease, demonstrated a rapid fall in antiviral IgG1 and IgG3, while IgG4 increased to reach a maximum six months after the onset of symptoms. The relative distribution of VZV-specific subclasses in a plasma pool was conserved during a fractionation procedure combining polyethyleneglycol 6000 precipitation with ion exchange chromatography, thus suggesting that the protective efficacy is maintained in the resulting immunoglobin preparations.     

老年性肺炎的临床特点及病原学分析

目的调查分析老年肺炎的危险因素、病原学特点及临床特征。方法收集2005年1月至2009年3月呼吸内科住院的72例老年肺炎患者病例,统计并分析其临床特点及细菌培养结果。结果本组资料显示大部分患者有基础疾病及易感因素,临床表现不典型;共检出病原菌108株,其中革兰阴性杆菌63株（58.3%）;混合感染35例,占48.6%,二重感染13例,占18.1%。结论提高对老年肺炎的诊断率,根据其病原学特征合理使用抗生素,并建议对老年肺炎患者采用降阶梯疗法,以提高治愈率。     

Abcès rénal et périrénal chez l'enfant.

One child with a pure perinephric abscess and three with renal abscesses, one of which had perinephric extension, are described. All presented with a long course of subacute infection leading to localizing symptoms or signs in the flank. The diagnosis was confirmed by radiologic examination. All the abscesses were surgically drained at various intervals after diagnosis, while the patients were receiving antibiotic therapy. Salvage of renal function was possible in all cases. A rational approach to the diagnosis and management of such abscesses is emphasized.     

Salmonellose chez les enfants: Etude de 95 cas à l'H?pital Ste-Justine,Montréal,en 1963-1964

A retrospective study was done in children in whom salmonellosis was confirmed by laboratory findings with the aim of reviewing etiology, epidemiology, clinical manifestations and therapy. The 15 serotypes most frequently isolated from stool, and in exceptional cases from urine, are discussed. If patients with typhoid fever are excluded, only one patient (who subsequently died) had a blood culture positive for Salmonella, specifically S. enteritidis.No seasonal or other peaks of incidence were noted. Age appeared to be important; of 81 patients with gastroenteritis, 30 were less than 6 months old.Two children in the older age group developed complications; one with appendicitis required surgery.Ten strains of Salmonella out of 23 tested by the disc method showed in vitro resistance to ampicillin on primary isolation.Acquired in vitro resistance to one or more antibiotics appeared to develop with six Salmonella strains reisolated from patients after or during antibiotic treatment.In several children the stool cultures remained positive after clinical signs had disappeared. These findings strongly suggest that, even though antibiotic therapy may improve the symptoms of Salmonella infection, it does not decrease the number of carriers during the convalescent period.     

老年嗜麦芽窄食单胞菌院内肺炎92例临床分析

目的：分析和总结老年嗜麦芽窄食单胞菌医院获得性肺炎的临床特点及对抗生素耐药情况。方法：对92例老年嗜麦芽窄食单胞菌医院获得性肺炎的临床资料进行统计、分析。用VITEK－AMS微生物自动鉴定仪鉴定细菌,并用其配套GNS－KI或GNS－201卡测定该菌体外药敏及MIC50、MIC90。结果：92例患者均有基础疾病,以恶性肿瘤（占27．2％）最常见,其次为COPD伴呼吸衰竭（占23．9％）、脑血管意外（占17．4％）及糖尿病（占14．1％）。其中重症监护病号（ICU）病房患者占72％（66／92）。不合理使用广谱抗生素、激素使用、气管切开、意识障碍、化疗、放疗等为本病高危因素。临床表现：发热（97．8％）;咯嗽、咳痰（53．3％）;肺部影像学显示,89％患者表现为双下肺斑片状阴影。药敏试验,该菌耐药严重。结论：老年嗜麦芽窄食单胞菌医院获得性肺炎多发生在有各种基础疾病、免疫功能低下者,各种高危因素又促成本病发生,临床表现危重,复杂。该菌耐药率高,合理治疗有赖于药敏结果。     

A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi)

Background

Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is increasingly recognized as an important cause of fever in Asia, with an estimated one million infections occurring each year. Limited access to health care and the disease’s non-specific symptoms mean that many patients are undiagnosed and untreated, but the mortality from untreated scrub typhus is unknown. This review systematically summarizes the literature on the untreated mortality from scrub typhus and disease outcomes.

Methodology/Principal Findings

A literature search was performed to identify patient series containing untreated patients. Patients were included if they were symptomatic and had a clinical or laboratory diagnosis of scrub typhus and excluded if they were treated with antibiotics. The primary outcome was mortality from untreated scrub typhus and secondary outcomes were total days of fever, clinical symptoms, and laboratory results. A total of 76 studies containing 89 patient series and 19,644 patients were included in the final analysis. The median mortality of all patient series was 6.0% with a wide range (min-max) of 0–70%. Many studies used clinical diagnosis alone and had incomplete data on secondary outcomes. Mortality varied by location and increased with age and in patients with myocarditis, delirium, pneumonitis, or signs of hemorrhage, but not according to sex or the presence of an eschar or meningitis. Duration of fever was shown to be long (median 14.4 days Range (9–19)).

Conclusions

Results show that the untreated mortality from scrub typhus appears lower than previously reported estimates. More data are required to clarify mortality according to location and host factors, clinical syndromes including myocarditis and central nervous system disease, and in vulnerable mother-child populations. Increased surveillance and improved access to diagnostic tests are required to accurately estimate the untreated mortality of scrub typhus. This information would facilitate reliable quantification of DALYs and guide empirical treatment strategies.     

Comparison of 4 serological tests--complement fixation, neutralization, fluorescent antibody to membrane antigen and immune adherence hemagglutination--for assay of antibody to varicella-zoster (V-Z) virus.

Four tests for antibody to varicella-zoster (V-Z) virus were compared; these were tests of complement fixation (CF), neutralization (NT), fluorescent antibody to membrane antigen (FAMA) and immune adherence hemagglutination (IAHA). Fifty-two sera from patients with varicella and zoster and from recipients of live varicella vaccine were examined by the 4 tests. The CF test was least sensitive, but the antibody titers by the NT, FAMA and IAHA tests were roughly comparable. The IAHA test was the simplest and fastest to perform, and appeared suitable for routine serological assay to V-Z virus. The correlation between the IAHA antibody titer and susceptibility of individuals to clinical varicella was investigated retrospectively using sera obtained during 2 outbreaks of varicella in an institution for children, where all the unvaccinated children had developed varicella symptoms. Most of the 25 pre-exposure sera from unvaccinated children examined by the IAHA test had tiers of less than 1:2. In contrast, all the 23 sera from vaccinated children who did not develop varicella had detectable antibody titers of 1:2 to 1:64. These results indicate that the IAHA titer reflects the susceptibility or resistance of individuals to clinical varicella.     

Modeling the effects of varicella vaccination programs on the incidence of chickenpox and shingles

Two possible dangers of an extensive varicella vaccination program are more varicella (chickenpox) cases in adults, when the complication rates are higher, and an increase in cases of zoster (shingles). Here an age-structured epidemiologic—demographic model with vaccination is developed for varicella and zoster. Parameters are estimated from epidemiological data. This mathematical and computer simulation model is used to evaluate the effects of varicella vaccination programs. Although the age distribution of varicella cases does shift in the simulations, this does not seem to be a danger because many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the simulations, zoster incidence increases in the first three decades after initiation of a vaccination program, because people who had varicella in childhood age without boosting, but then it decreases. Thus the simulations validate the second danger of more zoster cases.     

A five-year immunological follow-up study of the institutionalized handicapped children vaccinated with live varicella vaccine or infected with natural varicella

Twenty-two institutionalized handicapped children who were susceptible to varicella were vaccinated with live varicella vaccine of the Oka strain and their immune status was followed for 5 years under conditions without exposure to natural varicella. Simultaneously, 7 children infected with natural varicella were followed. Of the 22 vaccinees, 16 showed sero-positive conversion by the fluorescent antibody to membrane antigen (FAMA) test, the other 6 remaining seronegative during 5 years of observation period. All the 16 cases showing seroconversion had detectable antibody for 5 years after vaccination, and 14 of them gave a positive reaction in the varicella skin test. All the 7 cases after natural varicella gave positive reactions in both the FAMA and skin test. These results suggest that immunity conferred by the vaccination would persist long even in the absence of exposure to natural varicella, though further follow-up studies are needed.     

Clinical aspects of cytomegalovirus infection after allogenic bone marrow grafts

CMV infection is one of the major infection after bone marrow transplantation. CMV viremia was systematically studied in 66 patients with aplastic anemia or leukemia undergoing BMT. 57% patients had CMV viremia with a frequency peak between 7 and 9 weeks after transplant. Clinical symptoms found during viremia were pancytopenia, fever, cytolytic hepatitis. Interstitial pneumonitis was found only in 4 cases. In 3 cases, viremia was not associated with clinical symptoms. Survival was identical to the group of patients without viremia. Viremia was positively associated with the presence of high anti-CMV antibody titer in donor or recipient before transplant, or to a lymphocyte proliferative response against CMV antigens in donor or recipient before BMT. Granulocyte transfusions increased the frequency of CMV viremia. CMV infection was significantly associated with acute and chronic graft versus host disease. The relation showed between these parameters and viremia provides a basis for an accurate diagnosis of CMV infection and a better background for the study of prophylactic or curative treatment of CMV infection.     

Acute symptomatic gastritis due to Helicobacter heilmannii

Helicobacter heilmannii is a Gram-negative spiral-shaped organism predominantly associated with zoonotic infection. Human pathology has also been described, but acute symptoms with complete resolution have been infrequently reported. We present a 50-year-old man in whom H. heilmannii gastritis presented as an acute febrile illness and was successfully treated with antibiotics and proton pump inhibitor. Epidemiology, diagnosis, and treatment of similar cases are reviewed.     

Clinical and Diagnostic Significance of Enteroclysis Through Nasointestinal Decompression Intubation

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20–100 ml meglumine diatrizoate 76 % and 50–200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn’s disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.