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Pyomyositis is a purulent infection of skeletal muscle caused predominantly by Staphylococcus aureus. Although not often encountered in the continental United States, pyomyositis is frequently seen in tropical areas. Pyomyositis is difficult to diagnose as it may mimic other diseases. Delay in diagnosis may lead to septicemia, shock, and death. Recently, two cases of patients with pyomyositis and acquired immune deficiency syndrome were reported. We report a case of pyomyositis in a 7-week-old premature infant who subsequently tested positive for anti-HIV antibodies. A brief review of the topic is included.

Biopsy and/or autopsy material from lymphoreticular and other organs was studied in 8 children with suspected acquired immune deficiency syndrome (AIDS). One or both parents of each of these children had one or more of the recognized risk factors for AIDS, such as intravenous drug abuse, prostitution, Haitian origin. The following histologic patterns were noted in the lymph nodes: (1) follicular hyperplasia with normocellular paracortex, (2) follicular hyperplasia with depletion of paracortex, and (3) atrophy of follicles with depletion of paracortex. Lymphoid interstitial pneumonitis (LIP), a previously unreported lesion in AIDS, was present in 4 cases. It is suggested that the pulmonary lymphoid lesion may be part of a more generalized lymphoid hyperplasia involving B cells. The gross and microscopic features of the thymus, available in 2 of the 8 cases, indicated that the immunologic defect in these children was not of congenital type. Pathologic findings can be helpful in the diagnosis of the syndrome when correlated with clinical and immunologic features of suspected cases and of the pulmonary lesion. The latter is of importance in deciding the type of therapy to be given for the pulmonary disease process.

Six children with the acquired immunodeficiency syndrome (AIDS) and 12 of their household contacts were investigated serologically for evidence of infection with human T-lymphotropic virus/lymphadenopathy-associated virus (HTLV-III/LAV), the presumed etiologic agent of AIDS. All six children had antibody against HTLV-III/LAV, as measured by enzyme-linked immunosorbent assay, in each specimen tested. Of the two mothers studied both were seropositive; one was diagnosed with and died from AIDS. Four of the remaining 10 household members were seropositive, including three adults in groups at high risk for the development of AIDS and one sibling who was younger than the child with AIDS. Among the seronegative household contacts were four foster mothers or grandmothers of the children with AIDS, three of whom had cared for the children since infancy. Household contact with children with AIDS may include persons in groups at high risk for AIDS who have been infected with HTLV-III/LAV. However, the negative findings in household contacts without risk factors for AIDS suggest that horizontal transmission of the virus within households by means other than sexual contact must be infrequent.

Experimental studies suggest that IGIV therapy can be highly effective in the prevention and treatment of infectious diseases in a number of different patient groups. Several intravenous immune globulins are available in the United States (Table 5). For the most part, these preparations are well tolerated, but adverse reactions have been observed. They may be due to a rapid rate of infusion, the presence of circulating immune complexes, or the production of anti-IgA by IgA-deficient individuals. With respect to HIV transmission, clinical experience strongly suggests that IGIV preparations are safe.

Lung tissue and tissue from the lymphoreticular system obtained at open biopsy and/or autopsy were studied in ten children with the acquired immunodeficiency syndrome (AIDS). One or both parents of nine of the children had AIDS or risk factors for AIDS. The remaining child had hemophilia. The following pulmonary lesions were seen: 1) diffuse alveolar damage (DAD), 2) Pneumocystis carinii and/or cytomegalovirus pneumonitis, 3) lymphoid interstitial pneumonitis (LIP), and 4) desquamative interstitial pneumonitis (DIP). Combinations of such factors as mechanical ventilation, oxygen therapy, and opportunistic infection played a role in the pathogenesis of DAD. Opportunistic infections were related to the defective cell-mediated immunity in these children. The clinical, epidemiologic, immunologic, and pathologic features of the thymuses of these patients indicate that the immune deficiency was unlikely to have been of congenital origin. The immunologic abnormalities may also have been related to the pathogenesis of LIP and DIP. Neither LIP nor DIP has been described in adults with AIDS. Open lung biopsy is of practical importance in the diagnosis and treatment of pulmonary disease in children with AIDS.

Plasma copper and zinc concentrations were measured in 58 patients with a laboratory-confirmed primary or secondary immunodeficiency. Patients with severe combined immunodeficiency, collagen vascular disease with depressed cell-mediated immunity, and acquired or congenital acrodermatitis enteropathica had mean plasma zinc concentrations substantially below the lower limit of normal. In contrast, patients with primary humoral and polymorphonuclear leukocyte defects had normal plasma zinc concentrations. Patients with primary polymorphonuclear leukocyte defects had a mean plasma copper concentration substantially above the upper limit of normal. Those subjects with primary humoral immunity defects also had significantly elevated plasma copper concentrations in comparison to controls. Plasma copper concentrations in patients with severe combined immunodeficiency or acrodermatitis enteropathica were normal. Cutis laxa patients had low plasma zinc and copper concentrations. These data demonstrate that zinc and copper homeostasis are altered in come immunodeficiency disorders and may be important factors in host defenses. Since it is known that cellular immunity is impaired by zinc deficiency, patients with primary and secondary immunodeficiency states with appropriately documented mild or severe zinc deficiency should receive zinc supplements.

Thymic biopsy was done at the time of open lung biopsy in 11 children with acquired immunodeficiency syndrome (AIDS). Precocious involution, involution mimicking dysplasia designated as dysinvolution, and thymitis characterized by lymphomononuclear or plasmacytic infiltration, medullary lymphoid follicles, or medullary multinucleated giant cells were seen. Thymic biopsy is helpful in distinguishing AIDS from certain congenital immunodeficiency disorders. The three different types of thymic lesions may represent progression and/or different expressions of thymic epithelial injury in children with AIDS.

To investigate a possible protective role of HTLV-III neutralizing antibodies in individuals exposed to the virus, sera of children with acquired immunodeficiency syndrome or acquired immunodeficiency syndrome-related complex were analyzed for neutralizability of HTLV-IIIB infectivity. Twelve pediatric patients (nine acquired immunodeficiency syndrome, three acquired immunodeficiency syndrome-related complex) were clinically stable and had survived more than 2 yr postonset. Their predominant clinical problems included lymphocytic interstitial pneumonia, candidiasis, recurrent bacterial infections, failure to thrive, and lymphadenopathy. Twelve additional children (all acquired immunodeficiency syndrome) were classified as clinically poor; 10 of them had died. Their median length of survival was less than 2 yr, and their disease spectrum included progressive encephalopathy, thymic depletion or atrophy, and Pneumocystis carinii pneumonia in addition to many of the clinical features of the stable children. All (100%) of the stable patients possessed serum neutralizing antibody in contrast to only one of the 12 (8%) clinically poor patients. A simple decline in immunologic reactivity to HTLV-III antigens with disease progression did not account for this difference, since HTLV-III antibody titers of the clinically poor cases (1 X 10(2) to 1 X 10(7)) ranged as high as those of the stable cases (1 X 10(4) to 1 X 10(7)) when measured by the ELISA technique. Although stable cases possessed a higher geometric mean titer (2.8 X 10(5)) by ELISA than the poor cases (4 X 10(4)), this difference was not statistically significant. Serial serum samples from stable children exhibited continual neutralizing antibody activity while two of three clinically poor cases lacked neutralizing activity in serial specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Opportunistic infections (OI) were diagnosed by histology and culture of biopsy and autopsy material in 15 children with the acquired immune deficiency syndrome (AIDS). The opportunistic pathogens included Pneumocystic carinii, Toxoplasma gondii, Candida species, Aspergillus species, Mycobacterium avium-intracellulare, cytomegalovirus, and herpes simplex virus. Seven of 15 patients also had multiple systemic infections with common pathogenic bacteria. Accurate diagnosis of OI in AIDS is of importance in the decision regarding the choice of appropriate antimicrobial therapy. Careful histologic assessment of the biopsy specimens; awareness of unusual features such as paucity of organisms and inflammatory reaction, "histoid" variety of reaction, lack of granuloma formation, and resemblance to Whipple's disease in certain OI; and demonstration of causative organisms by appropriate special stains and/or culture are essential in the evaluation of these patients.

Gaucher's disease is an uncommon lipid storage disease sometimes associated with bone pain that can mimic an acute pyarthrosis or osteomyelitis. A case report with two incidences of pseudo-osteomyelitis with two-year follow-up is presented along with a literature review. Recommendations for evaluation and differentiation from a true infection are given. In general a needle biopsy for culture is preferable to any open biopsy or drainage if the diagnosis is in doubt.

Recent reports in the literature have presented results showing a decrease in blood zinc levels accompanied by an increase in blood copper levels during acute infection. The purpose of this study was to determine possible shifts in whole blood lead as well as whole blood zinc and copper during such a stress state. The total survey population of 73 was divided into 21 children with non-infectious diseases, 40 children with acute infections and 12 asymptomatic lead poisoned children admitted for elective chelation therapy. No differences between whole blood lead levels for acute and non-infectious groups were determined. Zinc levels for controls were significantly greater than those in both the infected and the asymptomatic lead intoxicated groups. Copper levels were elevated in the infected group compared to controls but this elevation was significant only when associated with temperatures over 102 F.