Pediatric AIDS.
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Biomedical subjects
Publications and source records attributed to E Connor.
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HIV infection in pediatric patients is a multisystem chronic disease that manifests as a clinical spectrum from asymptomatic infection through symptomatic infection with opportunistic infections and malignancies. The hematopoietic system is involved early in the systemic manifestations of this disease. The hematologic abnormalities seen are most probably a reflection of persistent viral infection, inflammation, and immune dysregulation, and may be complicated by secondary infections, chronic disease, drug toxicities, and nutritional deficiencies. Anemia and lymphopenia are commonly found in adult AIDS patients. Although both are also seen in pediatric patients, lymphopenia is much less common. Atypical lymphocytes with plasmacytoid characteristics have been identified in both adults and children. Pediatric bone marrow evaluation has shown an increase in plasma cells and plasmacytoid lymphocytes. Besides these findings, adult marrow findings include an increase in reticulum and lymphocytes appearing in a diffuse or aggregate pattern.
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.
Imipenem is the first of a new class of beta-lactam antimicrobial agents with potent in vitro activity against most bacterial pathogens that cause infections in children. We studied, prospectively, the clinical efficacy and toxicity of imipenem/cilastatin in 40 children with proved or suspected bacterial infection. A dose of 100 mg/kg/day of imipenem was given to children younger than 3 years of age, while children older than 3 years of age received 60 mg/kg/day. Twenty-nine organisms were isolated from 26 patients. Infections treated included cellulitis, osteomyelitis, septic arthritis, lymphadenitis, renal infections, wound infections, and pneumonia. Bacteria isolated included Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Pseudomonas aeruginosa. All patients responded favorably to treatment, with defervescence and improvement of symptoms. All of the infecting bacteria were susceptible to imipenem. Imipenem/cilastatin was well tolerated, with no serious side effects, and appeared to be an effective and safe antimicrobial agent in the treatment of the population studied.
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Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days. Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis, we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls. Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms, fever, and erythrocyte sedimentation rate. Fifty-four girls (ages 1 to 12 years) with two positive urine cultures (greater than 10(5) CFU/ml E. coli) were assigned by a table of random numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly. Six of 23 patients (26%) in the amikacin group and four of 21 (19%) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy. This difference was not statistically significant (P greater than 0.5). This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls. Additional potential advantages of single-dose therapy are fewer side effects and less toxicity, excellent compliance, and reduced potential for selecting resistant organisms.
A total of 42 strains of Haemophilus influenzae type b isolated from pediatric patients were sensitive in vitro to temocillin (90% minimal inhibitory concentration = 0.25 microgram/ml). No difference in mean minimal inhibitory concentration between beta-lactamase producer (0.25 microgram/ml) and nonproducer (0.23 microgram/ml) strains was found. Various dosages of ampicillin or temocillin for the treatment of infant rats with ampicillin-resistant H. influenzae bacteremia and meningitis yielded no difference in cure rates. These results suggest that temocillin may not be as effective as other new cephalosporins for the treatment of H. influenzae type b infections.
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A simple, normobaric hypoxic chamber constructed of easily obtainable parts is described. Important features include small size, low cost, simple construction, and easy maintenance. The chamber accommodates 50 mice and can be used for rats as well. Although designed to provide animals for the in vivo bioassay of erythropoietin, it is also useful for experimental studies requiring the acute induction of hypoxia.
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