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* Abbreviations: ICP = : intracranial pressure • LP = : lumbar puncture • CT = : computed tomography • OP = : opening pressure • CSF = : cerebrospinal fluid Cerebral edema and resulting elevated intracranial pressure (ICP) is a well-known complication of acute pyogenic meningitis.1 ,2 A diagnostic lumbar puncture (LP) may then precipitate herniation or coning of the brain, often with fatal outcome.3–8 A computed tomography (CT) scan of the brain is therefore recommended before LP whenever raised ICP is suspected, particularly if the possibility of a mass or space-occupying lesion exists.9–11 We describe a 15-year-old adolescent with bacterial meningitis with a normal CT scan who developed signs of herniation immediately after a subsequent LP. To the best of our knowledge this is the second documented report of herniation found at postmortem examination in a child with a normal CT scan. A previously healthy 12-year-old white boy presented to a community hospital emergency department with a 1-hour history of single generalized tonic-clonic seizure and a 2-day complaint of fever, headache, vomiting, and increasing somnolence. He received acetaminophen at home with no resolution of his symptoms. There was no trauma, drug abuse, or alcohol abuse. Family history was noncontributory. On initial evaluation at the emergency department, the patient was lethargic with a temperature of 101.8°F, pulse of 124 beats per minute, respiratory rate of 18 breaths per minute, and a blood pressure of 104/64 mm Hg. Meningeal signs were present; he flexed his limbs in response to painful stimuli and had normal plantar responses and pupillary reflex to light. Fundoscopy was normal with no evidence of papilledema. Clinically, bacterial meningitis was suspected. An emergent unenhanced CT scan of the brain was obtained, that was interpreted as normal after which a diagnostic LP was performed. The opening pressure (OP) was not measured at the time of LP. A blood culture was obtained and subsequently, intravenous ceftriaxone (3.8 g every 8 hours) and vancomycin (850 mg every 8 …

An outbreak of chickenpox, involving three patients and one nurse on a pediatric ward, necessitated rapid identification of susceptible employees in conjunction with standard epidemiologic intervention in order to prevent spread to other high-risk patients. Of 46 hospital personnel 15 (33%) gave a negative or unknown history of prior disease. Response to a varicella-zoster skin test was compared with antibody determination as measured by fluorescent antibody to membrane antigen. Correlation of these two screening methods was absolute. Of 46 hospital personnel four (9%) were susceptible to infection (negative skin test and antibody < 1:4) requiring their removal from the ward. All those with positive histories for prior disease with the virus and 11/15 (73%) with negative or unknown histories were immune as indicated by both tests. A readily available varicella zoster skin test would be an extremely useful epidemiologic tool for screening hospital personnel.

Three patients with histories of recurrent bacterial meningitis were previously examined with skull and sinus radiographs, routine cranial computed tomography, intrathecal radioisotope tracer studies, and immunologic evaluation. None of these studies were diagnostic. Pneumococcal vaccine and prophylactic penicillin therapy were ineffective in preventing recurrent episodes in two cases. Thin-section (2-mm) direct coronal computed cranial tomography demonstrated anatomic defects in all three patients. The use of metrizamide cisternography was not necessary to diagnose the defects. All patients had basiethmoidal encephaloceles which were repaired surgically. Direct coronal computed tomography offers a relatively easy noninvasive method for delineating anatomic abnormalities in patients with recurrent meningitis.

Neutrophil chemotaxis and random migration were studied in 11 infants with active cow's milk and/or soy protein intolerance and in an additional four infants following clinical recovery. Results were compared to 15 age-matched control subjects. Infants with active intolerance exhibited depressed chemotaxis and enhanced random migration. The four recovered infants had values similar to those of control subjects.

Children with acute otitis media were treated with oral esters of erythromycin in doses of 12.5 mg/kg at 6-hour intervals for 24 hours (50 mg/kg/day). Two hours after the last dose serum and middle ear exudates obtained by needle aspiration were assayed for erythromycin levels. Gram stained smears and cultures of the middle ear exudates were obtained and correlated with the levels of erythromycin found in the exudates. Concentrations of the drug were found in middle ear exudates sufficient to be effective against essentially all strains of D. pneumoniae and Lancefield Group A beta hemolytic streptococci. These results may explain why erythromycin is highly effective in the treatment of acute otitis media due to these organisms. Penetration of erythromycin into middle ear exudates may not be sufficient in some cases to eradicate all strains of H. inflenzae and therefore otitis media due to this organism may not respond as readily to therapy with this agent.

Chronic thoracic duct drainage in the experimental animal has been employed to deplete thymic dependent lymphocytes with resultant cellular immune deficiency.1-3 The human clinical correlate is the patient with chylothorax or even more analogous, chronic chyluria. The most common cause of chyluria worldwide is filariasis. Other causes include trauma, tuberculosis, neoplasms, infections, lymphactic aneurysm, and thoracic duct stenosis.4 We recently evaluated a child with this defect, giving us the opportunity of evaluating the effect of chronic T-cell depletion on immune reactivity. CASE REPORT J.K. is a 6-year-old Korean boy who was adopted at 2 years of age. Family history is unknown.