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Bacterial meningitis is frequently diagnosed in children below the age of five years. Recently our understanding of the pathophysiology of meningitis has been enhanced by several innovative studies. In addition the development and future application of conjugate vaccines against H. influenzae, N. meningitidis, and S. pneumoniae will result in a substantial reduction of morbidity and mortality in patients with meningitis caused by these microorganisms. This review will discuss the current status on the epidemiology, pathophysiology, prevention and treatment of meningitis.

Cytokines are relatively small polypeptides that are essential components of inflammatory reactions and immunologic processes. They are produced by a great variety of cells. The molecular biology revolution of the seventies and eighties has enabled investigators to elucidate the structure of cytokines and to unravel their spectrum of activity. Cytokines play a central role in the pathogenesis of infectious diseases and in the regulation of the immune system. Tumor necrosis factor (TNF) and interleukin-I (IL-I) were found to be responsible for most of the symptoms of infectious diseases, from fever to septic shock. In addition, TNF and IL-I are probably indispensable for repair of tissue damage. IL-2 is the pivotal cytokine for the regulation of the immune system; it is produced by CD4-positive T-cells and essential for the proliferation of T-lymphocytes in general and crucial for the induction of cytotoxic T-cells. Studies to define the therapeutic possibilities of cytokines are in progress.

Typhoid fever is an uncommon disease in the Netherlands. Acquisition occurs mainly during holidays in an endemic area. The history of three children, admitted in the summer of 1985, will be discussed, in one of them the disease had a complicated course. A short review of the literature is given, especially regarding pathogenesis, diagnosis and treatment. Cultures of blood, faeces and bone-marrow are essential for diagnosis. Bone marrow culture remains the most effective method for recovery of the causative agent, especially in children who previously were treated with antibiotics. Chloramphenicol still is the drug of choice in treatment. Vaccination with the oral typhoid vaccine of children who intend to visit an endemic area is recommended.

Many cephalosporins are presently available for clinical use. Although the cephalosporins are excellent antimicrobial agents for many infectious diseases in childhood, they have not replaced the older antibiotic regiments. In fact they offer the pediatrician a broader range of choices in treatment. This article gives a review on microbiological and pharmacokinetic properties of cephalosporins and an indication for the use of cephalosporins in pediatric therapy.