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This prospective review was designed to determine the effectiveness of a broad-spectrum health intervention program for homeless and runaway youth. Diagnosis, treatment, and counseling for drug use, sexually transmitted diseases (STDs), and other health issues were provided to all new admissions to a residential care facility during a 7 ½-year enrollment. Education was continued during a minimum follow-up period of 9 months based on the program entitled Bright Futures, previously developed and published by the National Center for Education in Maternal and Child Health. Fifty-four percent of the study residents had STDs on admission, and 9% developed new STDs after completing therapy and undergoing counseling. Drug dependence was reduced from 47% to 4%, and 46% achieved full-time or part-time employment. Sixty-three percent completed hepatitis B immunization with the 3-dose series. This experience suggests that an organized program of interventions in a residential care facility for homeless teenagers can significantly reduce drug dependence and STDs. © Elsevier Inc. All rights reserved.

Because of susceptibility to severe pneumococcal infection, children with sickle cell disease (SCD) routinely receive penicillin prophylaxis. Increasing rates of penicillin resistance have been reported throughout the world. Our objective was to assess the prevalence of nasopharyngeal colonization with Streptococcus pneumoniae and to assess the antimicrobial susceptibility of the organisms in children with SCD.Nasopharyngeal cultures for S. pneumoniae were obtained from all children with SCD attending clinics in a statewide university-based network. Background colonization rates were determined in children attending day care centers in some of the same locations. All recovered S. pneumoniae organisms were tested for susceptibility to penicillin, and all resistant strains were examined for susceptibility to other antibiotics.Overall nasopharyngeal pneumococcal colonization rates among children with SCD were 12%. Colonization was associated with age less than 2 years (p0.001) and day care attendance for more than 20 hr/wk (p = 0.00005). More than half of these strains (62%) were resistant to penicillin, 33% having intermediate resistance (minimal inhibitory concentration 0.06 to 1 microgram/ml) and 29%, high level resistance (minimal inhibitory concentrationor = 2.0 microgram/ml). Penicillin resistance was associated with penicillin prophylaxis (p0.01). Many of these organisms were also resistant to other classes of antibiotics.Although penicillin prophylaxis and pneumococcal vaccine for patients with SCD have reduced overall nasopharyngeal colonization and disease caused by S. pneumoniae (p0.001), a higher percentage of colonizing strains are now resistant both to penicillin and to other antimicrobial agents (p0.01). Newer strategies for preventing disease and early management of suspected pneumococcal infection in these children must be developed.

Fifty-three male, Caucasian, neuroleptic-treated patients with chronic schizophrenia were examined for the presence of tardive dyskinesia (TD) and were tissue typed. The group with TD (n = 25) was compared to the group without TD (n = 28). HLA-DR4 was more prevalent in the group with TD than in the group without TD, with a relative risk of 3.04 for TD with HLA-DR4 present, although this finding is not statistically significant when corrected for the number of nonparametric comparisons. Other investigations reported an association between HLA-B44 and TD, or between HLA-B44 and neuroleptic-induced parkinsonism. Potential explanations relating the findings of these investigations are discussed.

To determine the effect of operations with cardiopulmonary bypass on the immunologic function of polymorphonuclear leukocytes in infants, we studied polymorphonuclear leukocyte function and immunologic profile in 16 infants undergoing repair of congenital heart lesions. An oxygen/air/high-dose fentanyl anesthetic was used for all patients. Absolute neutrophil count increased significantly (p less than 0.05) after bypass and remained increased 48 hours afterward. Chemotaxis, random migration of polymorphonuclear leukocytes, and phagocytic index were unaffected, but bactericidal capacity decreased significantly immediately after cardiopulmonary bypass and remained decreased 48 hours later. Serum opsonizing capacity to bacterial and fungal antigens was variably altered, and complement factors 3 and 4 decreased significantly after cardiopulmonary bypass. Total hemolytic complement decreased significantly immediately after cardiopulmonary bypass and returned to normal by 48 hours. These data suggest that operations with cardiopulmonary bypass in infants significantly affect the immunologic function of polymorphonuclear leukocytes and result in consumption of complement.

To evaluate the incidence and significance of radiographic sinus opacification in infants, we performed computed tomography (CT) of the maxillary and ethmoid sinuses in conjunction with routine cranial CT in 100 infants from birth to 12 months of age. CT was performed for indications other than sinusitis. Prospective concurrent clinical history was obtained and physical examination of the upper respiratory tract was performed. Of 100 infants, 16 had hypoplasia of the maxillary sinuses; 81% (13/16) of these were less than 2 months of age. The antra showed progressive increase in size during the first year of life. Of the 100 infants, 70 had CT sinus opacification, including 67% of those without historical or physical evidence of upper respiratory tract infection. There was a positive correlation of CT findings between the maxillary and ethmoid sinuses in 80% of the infants older than 2 months of age but in only 49% of the younger infants. Radiographic sinus opacification in infants is of uncertain significance and is not diagnostic of upper respiratory tract infection, much less of sinusitis.

Fifty children with bacterial meningitis were prospectively randomized to receive cefotaxime (50 mg/kg/dose every 6 hours) or ampicillin and chloramphenicol in standard doses. Twenty-three patients received cefotaxime and 27 received standard therapy. Bacterial isolates included: Haemophilus influenzae (29), Streptococcus pneumoniae (eight), Neisseria meningitidis (eight), group B streptococci (three), and Salmonella enteritidis (two). Ten (34%) of the H. influenzae isolates were resistant to ampicillin, nine on the basis of beta-lactamase production. All strains were susceptible to cefotaxime. Clinical cure rates for the cefotaxime (100%) and standard therapy (96%) groups were similar; survival without detectable sequelae was similar, at 78% and 77%, respectively. The duration of therapy, 11.1 +/- 2.4 days (range 10 to 21 days) vs 11.9 +/- 3.9 days (range 10 to 21 days), and days to defervescence, 4.7 +/- 2.6 days (range 1 to 14 days) vs 5.6 +/- 2.9 days (range 2 to 17 days), were similar in the cefotaxime and standard therapy groups, respectively. No adverse drug reactions or side effects were noted in either group. Cefotaxime was found to be as safe and effective as standard therapy for the treatment of bacterial meningitis in children.

An 1,810-g girl born at 37 weeks of gestation had true congenital herpes simplex virus type 2 infection. The neonate was born with hypo-pigmented skin lesions, brain lesions, and old heavily pigmented retinal scars in the posterior pole. There was no active ocular disease. Viral cultures, immunoperoxidase stains, and antibody determination by enzyme-linked immunosorbent assay were all positive for herpes simplex virus. Treatment with acyclovir healed the lesions within ten days. The clinical and laboratory findings indicated that the herpetic infection probably occurred in the second trimester.

Immune modulators have exhibited some limited efficacy in the prevention or treatment of viral infection. Such agents have included transfer factor, thymosin, thymic humoral factors, levamisole, isoprinosine, immune RNA, young lymphocytes, vitamin C, and BCG. This article focuses on data that have examined clinical application of immune adjuvant therapy.

Employing a 51Cr release cytotoxicity microassay, and using both measles-and SSPE-infected target cells, four patients with documented SSPE were evaluated for specific cellular and humoral immunity. Mononuclear leukocytes from SSPE patients and control subjects exhibited comparable cytotoxicity. Serum and CSF from these SSPE patients inhibited the cellular response to SSPE-infected cells but not to measles-infected cells. Moreover, fresh whole serum alone from control donors produced significant 51Cr release from both cell lines, whereas SSPE whole serum was effective only against measles-infected cells. CSF from an additional ten patients with SSPE was examined for inhibitory activity: seven of these completely blocked and one partially blocked cell-mediated cytotoxicity to SSPE-infected cells. Preliminary characterization of the serum inhibitory factor suggested that it is IgM or antigen-antibody complexes. These data also suggest antigenic differences between the SSPE and measles viruses.

Cell-mediated autoimmune responses were studied by means of in vivo and in vitro techniques in five rhesus monkeys with spontaneous endometriosis. The results were compared with similar data obtained from five normal rhesus monkeys without endometriosis. The in vivo studies included intrademal injection of autologous antigens prepared from uterine endometrium, ectopic endometrium, or peritoneum, or injection of the mitogen, phytohemagglutinin (PHA). Skin biopsies were obtained at 48 hours and evaluated under the light microscope for perivascular lymphocytic infiltration. The mean number of lymphocytes per high-power field after injection of the autologous endometrial antigen was significantly smaller in animals affected by endometriosis than in the control group. There was no significant difference in lymphocytic response to autologous peritoneal antigens between the groups. Animals of both groups responded readily to PHA with marked perivascular lymphocytic infiltration. Lymphocyte stimulation responses to the same autologous antigens or to PHA were evaluated by means of in vitro assays and micro-methods. Lymphocyte stimulation response to autologous endometrial antigens in the group with endometriosis was significantly less than in the control group. There was no significant difference in response to the peritoneal antigens between the groups, and the response to PHA was marked in all animals of both groups. The results of this study indicate that rhesus monkeys with spontaneous endometriosis have an altered cellular immune response to autologous antigens. Although the animals were immunologically competent, as judged by responses to PHA, both in vivo and in vitro studies indicated a decrease in the cell-mediated immune response to autologous endometrial antigens. These data suggest that endometrial cells translocated from their normal location may implant only in women with specific alteration in cell-mediated immunity. New light is thus shed on the cause of endometriosis.

Dialyzable transfer factor (TF d ) prepared from a human donor and transfer factor (TF) from baboon whole cell lysates was administered to 3 species of nonhuman primates: baboons, cebus monkeys and marmosets. In vivo transfer was evaluated with in vivo skin test and in vitro blastogenic responses to multiple antigens. Transfer of cellular reactivity in all three nonhuman primate species was demonstrated with both human TF d and baboon TF. A cumulative conversion rate of 45% for skin test responses and 65% for lymphocyte blastogenesis was demonstrated following human TF d injection while conversion was 17% and 33% respectively following baboon TF. Specificity was supported by the absence of conversion to TF donor negative antigens. There were no signficant differences observed between the 3 recipient primate species.

Human dialyzable transfer factor (TF) was found capable of inducing in vivo (skin test) and in vitro blastogenesis) cellular immunity in gnotobiotic nonhuman primates. Because the animals were gnotobiotic (germ-free) and had not been skin tested previously, these data support the hypothesis that induction of cell-mediated immunity in recipients of TF does not require a “priming” exposure to specific and/or cross-reacting antigens, and that this induction may be due to an antigen-specific informational effect of TF. In addition, these results support the antigenic specificity of TF, in that recipient primates developed cellular reactivity only against donor “positive” but not against donor “negative” antigens.

Neonatal herpes simplex virus (HSV) infection is usually acquired at birth, although a few infants have had findings suggestive of intrauterine infection. We describe 13 babies who had clinical manifestations of intrauterine HSV infection, including skin lesions and scars at birth (12), chorioretinitis (eight), microcephaly (seven), hydranencephaly (five), and microphthalmia (two). All infants had combinations of these defects. Infection was proved by viral isolation in each case; all isolates were HSV-2. Two infants died during the first week of life; 10 of the surviving infants had severe neurologic sequelae, and one infant was blind. Four mothers experienced an apparent primary genital HSV infection, and one had recurrent infection, at varying times during gestation. The remaining women denied a history of symptoms of genital HSV infection. These findings indicate that intrauterine HSV infection can occur as a consequence of either primary or recurrent maternal infection and has severe consequences for the fetus.

There are some data to suggest that amniotic fluid protects the fetus from invasion by pathogenic bacteria. To examine methods by which amniotic fluid may offer such protection, quantitative antibody, complement activity, and functional opsonic capacity were measured. Immunoglobulins were measured by laser nephelometry and total hemolytic complement was determined by radial diffusion; results suggested activity adequate for bactericidal capacity. The chemiluminescence assay was used to quantitate the functional interaction between polymorphonuclear leukocytes and E. coli, group B streptococci (GBS), or zymosan particles preopsonized with amniotic fluid obtained at different stages of gestation. Results were compared to those for normal serum. Data were analyzed by evaluation of the initial slope, area under the curve, and peak chemiluminescence response. Opsonic activity of amniotic fluid for E. coli and GBS was demonstrated, with E. coli showing greater reactivity (maximum = 15,000 to 25,000 cpm) than GBS (10,000 to 20,000 cpm). Specific, as well as nonspecific, opsonic activity was demonstrated by absorption of amniotic fluid with killed bacteria. Concentration of amniotic fluid did not result in an increase in chemiluminescent activity, which demonstrates that optimal opsonic activity already exists. The classical and alternate pathways of complement were assessed for E. coli and GBS. Preterm amniotic fluid did not differ in response from that of amniotic fluid obtained from term pregnancies. This study demonstrates that amniotic fluid can provide the fetus with protection from bacterial pathogens and delineates mechanisms for such protection.

Ten patients with severe hypogammaglobulinemia received 6 monthly infusions of either native or modified intravenous immunoglobulin (IVIG) followed by 6 monthly infusions of the other product in a double-blind, crossover protocol. Clinical parameters were monitored on a daily basis and serum was obtained at 24 hours, 3 weeks, and 4 weeks after each infusion for measurement of total IgG, specific antibodies, and opsonizing antibodies against Streptococcus pneumoniae types 5, 12F, and 14. No differences between the products were seen for total IgG or antibodies against herpes simplex virus types 1 and 2, rubella, toxoplasma cytomegalovirus, diphtheria, or tetanus. Greater opsonizing antibody to the three strains of pneumococci were apparent for native IVIG until the third infusion, after which time products were equal. Clinical parameters (febrile or symptomatic days, missed work/school, time on antibiotics, culture positive infection, and hospitalizations) were equivalent during the treatment period with each preparation. This study showed equivalent efficacy of native IVIG as compared with reduced and alkylated IVIG during maintenance therapy for hypogammaglobulinemia.

A controlled clinical study compared the effectiveness of sponging with tepid water, ice water, and equal parts of 70 per cent isopropyl alcohol and water in addition to orally administered acetaminophen to reduce fever in children. More rapid reduction of fever was demonstrated when sponging was combined with the oral antipyretic drug. Sponging with ice water or with alcohol in water were equally effective and significantly superior to sponging with tepid water; however, sponging with tepid water afforded significantly better comfort during the sponging procedure.

T-lymphocyte subsets in nephrotic syndrome. T-lymphocyte subsets when measured in steroid responsive nephrotic syndrome (SRNS) have demonstrated significant variance from normal values T-cell subsets were studied by using two-color flow cytometric analysis in 32 children (9.2 ± 5 years of age) with SRNS. The children were divided into four groups: a) SRNS in acute relapse, on prednisone; b) SRNS in acute relapse, off prednisone; c) SRNS in long-term remission, off prednisone (nephrotic controls); d) patients in remission on long-term prednisone therapy; and e) 15 age-matched normal controls. Children suffering an acute relapse of SRNS showed an increase in Leu2a+/DR+ (CD8) activated lymphocytes (P < 0.05), a decrease in Leu4a+ total T-lymphocytes (P = 0.01) and a decrease in Leu3a+ (CD4) helper T-cells (P < 0.05) when compared to normal controls and nephrotic controls. Though some subset changes may represent a prednisone effect and the functional role of these lymphocytes in the disease process is unknown, this study provides additional evidence to support a role for abnormal T-cell subsets in the etiology of SRNS.

Circulating lymphocyte profiles and reactivity normally vary with age. Operation results in depression of both lymphocyte counts and blastogenesis but the relationship of age to these alterations has not been previously evaluated in the pediatric surgical patient. This report analyzes the relationship of age to lymphocyte alteration in the postoperative child. Thirty-five healthy children (age range 1 mo to 12 yr), admitted for elective herniorrhaphy, underwent perioperative lymphocyte assay. Anesthesia consisted of halothane and NO2, and operative time averaged 54 minutes. Three milliliters of heparinized whole blood was obtained at induction of anesthesia and at 2 hours postoperatively. Lymphocytes were separated by Histopaque gradient and assayed for absolute count, total T-cells, and total B-cells. Lymphocyte reactivity was determined by 3H-Thymidine incorporation during incubation with the mitogens phytohemagglutinin (PHA), pokeweed (PWM), and/or concanavalin A (Con A) and results expressed as the logarithm of scintillation counts per minute. Differences in preoperative and postoperative values were analyzed for significance by paired T-test. The same differences were evaluated for relationship to age by regression analysis. Operation resulted in significant decreases in all lymphocyte counts (absolute, T- and B-cells), and the operative-induced alteration in both absolute and total B-cell counts were significantly correlated with age (P less than .03, P less than .007, respectively). Similarly, operation resulted in significant depression of lymphocyte reactivity and alteration in B-cell response (PWM) was significantly correlated with age (P less than .008). In all instances of significant correlation, lymphocyte alterations were inversely related to age.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective clinical study was performed documenting the incidence of diarrhea, vomiting, and skin rashes relative to varied dosage schedules of orally administered ampicillin. Four hundred children were treated by randomization with one of four doses; 100 each received 50, 100, 150, or 200 mg. per kilogram per day administered in four equally divided doses, for a period of at least seven days. Vomiting or severe diarrhea was rare and was not dose related. Mild or moderate diarrhea was commonly encountered in patients regardless of dose. Erythematous maculopapular skin rashes occurred in 3 to 7 per cent of patients; there was some increase in incidence with increasing dosages but not to a significant degree. Urticarial skin rashes occurred in 1 per cent of patients and were unrelated to dose. Perineal moniliasis occurred exclusively in infants in diapers, usually with associated mild diarrhea; the incidence was significantly dose related.

Ten years ago there was just one way to treat bacterial meningitis in children. There was no debate, and few conferences included presentations on this topic. Now there are many choices - and life is certainly more enjoyable for pediatric infectious disease specialists. Subtle differences in various regimens require periodic expert analysis, and this is often the reason for consultations or hospital conferences. However, for the practicing pediatrician managing a child with bacterial meningitis, there are many alternatives to therapy, and they are all correct.

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