Biomedical subjects
Publications and source records attributed to D Isaacs.
Antibiotic use selects for antibiotic resistant bacteria. This is an example of rapid Darwinian natural selection in action. It occurs in neonatal intensive care units with the use of parenteral antibiotics, and in the community with oral antibiotic use. A 10 point plan is put forward to reduce antibiotic resistance in neonatal units.
OBJECTIVES: To study the epidemiology of early onset neonatal bacterial meningitis (EONBM) in Australasia. DESIGN: Prospective surveillance study, 1992-2002, in 20 neonatal units in Australia and New Zealand. EONBM was defined as meningitis occurring within 48 hours of delivery. RESULTS: There were 852 babies with early onset sepsis, of whom 78 (9.2%) had EONBM. The incidence of early onset group B streptococcal meningitis fell significantly from a peak of 0.24/1000 live births in 1993 to 0.03/1000 in 2002 (p trend = 0.002). There was no significant change over time in the incidence of Escherichia coli meningitis. The rate of EONBM in very low birthweight babies was 1.09/1000 compared with the rate in all infants of 0.11/1000. The overall rate of EONBM was 0.41/1000 in 1992 and 0.06 in 2001, but this trend was not significant (p trend = 0.07). Case-fatality rates for EONBM did not change significantly with time. Birth weight <1500 g (odds ratio (OR) 7.2 (95% confidence interval (CI) 4.8 to 10.9)) and Gram negative bacillary meningitis (OR 3.3 (95% CI 2.2 to 4.9)) were significant risk factors for mortality. Sixty two percent of the 129 babies who died from early onset sepsis or suspected sepsis did not have a lumbar puncture performed. CONCLUSION: The incidence of early onset group B streptococcal meningitis has fallen, probably because of maternal intrapartum antibiotic prophylaxis, without a corresponding change in E. coli meningitis. Gram negative bacillary meningitis still carries a worse prognosis than meningitis with a Gram positive organism.
OBJECTIVES: To describe the epidemiology, clinical features and outcome of Mycoplasma pneumoniae infection in children presenting to a tertiary children's hospital. METHODS: Sixty-three month retrospective review of serologically diagnosed M. pneumoniae infections. RESULTS: There were 76 children, 42 boys and 34 girls, mean age 6.3 +/- 3.5 years. The age group most commonly affected was 5-9 years, followed by children 1-5 years. More than half of the patients had failed to respond to antibiotics before referral. The commonest presentation was with cough and fever. Coryza, diarrhoea, vomiting, tachypnoea and recession were significantly more common in children less than 5 years than in children 5-15 years. Hospitalized patients were more likely than non-hospitalized patients to have respiratory distress with recession and wheeze. Radiographic findings were non-specific. Thrombocytosis was found in 29 (41.4%) of 70 children studied. CONCLUSION: The clinical features of M. pneumoniae infection were different in children less than 5 years than in children aged 5-9 years. The presence of thrombocytosis in 40% of the cases has not previously been reported in children.
BACKGROUND: Recurrent parotitis (RP) of childhood is a rare condition of unknown aetiology, probably immunologically mediated. OBJECTIVE: To review the clinical presentation, diagnosis and management of RP of childhood. METHODS: Retrospective study from 1983 to 2004 of children diagnosed with RP of childhood at a tertiary children's hospital. RESULTS: We identified 53 children, 37 (70%) male and 16 (30%) female. The age of onset was biphasic, with peaks at 2-5 years of age and at 10 years. The commonest symptoms were swelling (100%), pain (92.5%) and fever (41.5%). Symptoms usually lasted 2-7 days with a median of 3 days. The mean frequency was 8 episodes per year. The diagnosis was often delayed, >1 year in 70% of patients, maximum 8 years. The most common diagnoses, before the definitive diagnosis of RP, were mumps (21%), 'infection' (15%) and stones (11%). Sialogram (57%) and/or ultrasound (41%) showed sialectasis in 81% of patients. Over half the patients (54%) were given antibiotics at least once to treat the parotitis. Two children had hypogammablobulinaemia, one child had human immunodeficiency virus infection, and one child had Sjogren's syndrome. Two children had high titre antinuclear antibodies. CONCLUSIONS: Recurrent parotitis had a biphasic age distribution. The major clinical features that distinguish it from other causes of parotid swelling are the lack of pus and recurrent episodes. A clinical diagnosis can often be confirmed by ultrasound. Antibiotics do not have a role in treatment. Affected children should be screened for Sjogren's syndrome and immune deficiency.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Routine childhood immunizations are compulsory in a small number of countries, including the United States of America. Arguments used to justify making immunizations compulsory include enhancing the health of the community and treating as paramount the rights of the child to be protected against vaccine-preventable diseases. But compulsory immunization infringes the autonomy of parents to make choices about child rearing, an autonomy which we generally respect unless doing so seriously endangers the child's health. We present a historical review and ethics discussion on whether routine childhood immunizations should be compulsory. We conclude that, for both ethical and practical reasons, routine immunization should not be compulsory if adequate levels of immunization can be achieved by other means.
OBJECTIVE: To study the incidence and outcome of systemic infections with methicillin sensitive (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) infections in Australasian neonatal nurseries. METHODS: Prospective longitudinal study of systemic infections (clinical sepsis plus positive cultures of blood and/or cerebrospinal fluid) in 17 Australasian neonatal nurseries. RESULTS: The incidence of early onset sepsis with S aureus, mainly MSSA, was 19 cases per 244 718 live births or 0.08 per 1000. From 1992 to 1994, MRSA infections caused only 8% of staphylococcal infections. From 1995 to 1998, there was an outbreak of MRSA infection, in two Melbourne hospitals. The outbreak resolved, after the use of topical mupirocin and improved handwashing. Babies with MRSA sepsis were significantly smaller than babies with MSSA sepsis (mean birth weight 1093 v 1617 g) and more preterm (mean gestation 27.5 v 30.3 weeks). The mortality of MRSA sepsis was 24.6% compared with 9.9% for MSSA infections. The mortality of early onset MSSA sepsis, however, was 39% (seven of 18) compared with 7.3% of late onset MSSA infection presenting more than two days after birth. CONCLUSIONS: S aureus is a rare but important cause of early onset sepsis. Late onset MRSA infections carried a higher mortality than late onset MSSA infections, but babies with early onset MSSA sepsis had a particularly high mortality.
AIMS: To examine the frequency of and risk factors for bacteraemia in children hospitalised with respiratory syncytial virus (RSV) infection; and to determine current use of antibiotics in hospitalised children with RSV infection. METHODS: Retrospective study of all children, aged 0-14 years, admitted to a tertiary children's hospital with proven RSV infection over a four year period. Children with concurrent bacteraemia and RSV infection were identified, and risk factors examined for bacteraemia. The case notes of a randomly selected comparison sample of 100 of these RSV infected children were examined to assess antibiotic use and population incidence of risk factors for severe RSV infection. RESULTS: A total of 1795 children had proven RSV infection, and blood cultures were sent on 861 (48%). Eleven (0.6%) of the 1795 RSV positive children had bacteraemia. RSV positive children had a significantly higher incidence of bacteraemia if they had nosocomial RSV infection (6.5%), cyanotic congenital heart disease (6.6%), or were admitted to the paediatric intensive care unit (2.9%). Forty five (45%) of the random comparison sample of RSV infected children received antibiotics. CONCLUSIONS: Bacteraemia is rare in RSV infection. Children with RSV infection are more likely to be bacteraemic, however, if they have nosocomial RSV infection, cyanotic congenital heart disease, or require intensive care unit admission.
The charge sister has an essential role to play in combating the spreading of the HIV in the environment of the nursing unit. The HIV/AIDS dilemma is a reality in the health care environment. On a daily basis nurses is treating patients with the HIV. Through the basic conceptual framework of the management process, the charge sister can play her part and contribute in keeping the disease under control in her work environment. An explorative, descriptive study was done through a structured questionnaire with four open questions. This study was aimed at developing and formulating guidelines to be included in a policy to be used in the combating of spreading of HIV in the health care unit by the charge sister and her staff. The results indicate the absence of policy regarding the prevention of the spreading of the HIV, necessary for orientation and in service training of staff.
Respiratory syncytial virus (RSV) infection, one of the most common causes of hospitalization of children in developed countries, has been implicated as a cause of asthma. We aimed to characterize the cytokine profile in nasopharyngeal aspirates (NPAs) taken from infants during upper respiratory tract infection to investigate whether RSV induced a unique immune response as compared with other viruses. Additionally, we sought to determine whether this profile was influenced by the infants' atopic status. A prospective birth cohort of babies at high risk of atopy was recruited. Ratios of a T-helper 1 (Th1) cytokine, interferon gamma (IFN-gamma) and a T-helper 2 (Th2)-like cytokine, interleukin-10 (IL-10), in NPAs were determined during episodes of respiratory tract infections in the first year. The viral aetiology of the respiratory tract infections was determined using polymerase chain reaction (PCR), culture and immunofluorescence. Atopic status was ascertained at 1 year of age using skin prick tests. Participants were recruited antenatally and subsequently followed in the community. Sixty babies with one or both parents atopic were enrolled into the study. IFN-gamma : IL-10 ratios in NPAs during upper respiratory tract infections and their correlation with viral aetiology and atopic status were the main outcome measures. The mean IFN-gamma : IL-10 ratio was significantly lower (due to lower IFN-gamma) during RSV infections than during infections with other viruses (P = 0.035). The cytokine ratio, however, did not differ between infants with or without wheeze during URTIs (P = 0.44), or between infants who were atopic or non-atopic (P = 0.49). This study suggests that RSV is associated with lower IFN-gamma production in young babies, regardless of their atopic status, compared to upper respiratory tract infections where either another virus is detected or where no viral identification is made.
An infant is reported who presented with Pneumocystis carinii pneumonia, secondary to HIV infection, diagnosed at 3 months of age, and who had concurrent paravertebral neuroblastoma. Although neuroblastoma cell lines support the growth of HIV in vitro, this is the first report of a clinical association between HIV infection and neuroblastoma. Although we do not think the conditions are causally linked, we report the case to raise awareness of a possible association between HIV and neuroblastoma. The case also raises the importance of starting antiretroviral treatment with three drugs.
Explore the source record for details and available documents.
Various pathogenic bacteria have coats of polysaccharide, many with repeating epitopes. Though polysaccharide vaccines have been available for some time, they induce mainly IgM production, and are only moderately protective in adults and ineffective in young children. It was originally shown in 1931 that the immunogenicity of polysaccharides could be enhanced by conjugating to a protein. The last two decades have witnessed the production and clinical testing of polysaccharide-protein conjugates specific for at least four different bacteria which normally cause considerable mortality and morbidity, especially in young children. In some cases, immunizing children from 4 months of age, with a booster early in the second year, has resulted in remarkably high success rates in protecting them from disease. For one pathogen, Haemophilus influenza type b, the success rate has been sufficiently high (> 95%) to suggest that this disease might, in time, be globally controlled in this way. The results of immunization with conjugate vaccines to Streptococcus pneumoniae, Neisseria meningiditis and Salmonella typhi are also very encouraging. More conjugate preparations are under development.