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Infectious disease emergencies are those in which delays in diagnosis or treatment may lead to untoward harm. Recent developments in the field offer few new therapies, but rather emphasize familiar infections in new guises or clarify approaches to troublesome entities. An enduring concern for the legal risks implicit in the care of infected children has recently received new attention.
The immediate management of three kinds of emergencies in childhood-unconsciousness, convulsions and acute respiratory failure-is discussed. First of all and in any case it is necessary to assess and reestablish vital, especially cardiorespiratory functions. Most common causes of unconsciousness in young children are dehydration states and acute poisoning, followed by febrile convulsions. Differential diagnosis and first management of subglottic laryngitis and peracute epiglottitis, two severe acute respiratory failures in childhood, are also demonstrated.
To avoid misinterpretations one should substitute the ambiguous notion of 'new disease' with 'emerging disease'. A disease can be classified emergent in at least five different historical situations; 1) it existed before it could be first identified but was overlooked from a medical point of view because it could not be conceptualized as a nosological entity; 2) it existed but was not noticed until a quantitative and/or qualitative change in its manifestations; 3) it did not exist in a particular region of the world before its introduction from other regions; 4) it never existed in a human population but only in an animal population; 5) it is completely new--the triggering germ and/or necessary environmental conditions did not exist prior to the first clinical manifestations. A series of historical examples illustrate this classification.
Infectious diseases are the cause of the majority of pediatric emergency visits, although only a minority constitute true emergencies. Progress in identifying the true emergencies continues.
We studied 2561 cases of otolaryngologic emergencies in the Far Eastern Memorial Hospital from January 1, 1985, to December 31, 1989, looking for the distribution and epidemiology of these emergency diseases. Our conclusions were as follows: 1. Total emergency otolaryngologic cases [otologic cases and pharyngolaryngologic cases] demonstrated a tendency to increase from year to year. 2. Acute otitis media and foreign bodies of the nose also showed an increase from year to year. 3. The "top five" emergency otolaryngologic diseases in order of frequency were: epistaxis (22.7%), foreign bodies of the throat (18.7%), acute tonsillitis (11.4%), acute otitis media (7.7%), and foreign bodies of the ear (6.4%). 4. Patients admitted to the emergency department (7.2%) ranked in order of frequency were: epistaxis (29%), acute tonsillitis (24.5%) and esophageal foreign bodies (14.1%). 5. Emergency visits occurred most frequently between 20-24 o'clock (26.5%) daily; the least from 4-8 o'clock (9.3%).
Unexplained serum creatine phosphokinase (CPK) elevation is not a rare clinical problem, especially in emergency diseases. We studied hypercreatine phosphokinasemia (hyper-CPK-emia) in 161 cases of emergency diseases. Correlations between CPK and various laboratory data, various conditions were investigated. The hyper-CPK-emia was found to obtain no correlations with GPT, GOT, LDH, creatinine and body temperature. For this reason, we could not discover the unknown factors of which contributed to elevate the serum CPK. The sources of the serum CPK in these diseases were concluded to be the skeletal muscle. This is based on the facts that CPK MM (muscle type) is specifically increased among the CPK isozymes. The elevation of serum CPK activity in emergency diseases was considered to result from muscle hypoxia due to severe stress and general circulatory failure.
The point of view presented in this work is not that of the epidemiologist interested in the etiology of diseases and their specific effect on mortality rates; but rather the view of the demographer who attempts to establish the influence that diseases have on evolution and population dynamics. It is not until the 19th century that the 'unification microbienne' of the world is reached and one has clinical and statistical data on the major diseases. Consequently, it is not possible to have an exact demographic picture of infectious diseases in their emerging phase. To understand globally this effect one may create a conceptual framework capable of integrating all the aspects of mortality rates: genetic, socio-biological and human. The scheme proposed here allows for a description and at the same time an evaluation of a given historical situation, how a population achieves protection from lethal diseases and what are the factors determining receptivity or resistance to a disease. This approach serves to study the interdependent relations that link all elements involved in a given morbid process.
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The evolution, in recent years, of concepts of inflammatory bowel disease in part reflect improved methods of defining disease, especially with modern microbiologic methods, endoscopy and mucosal biopsy. Although clinicians have focused on idiopathic ulcerative colitis and Crohn's disease, a host of new entities are now becoming recognized. Many of these are bacterial, such as Yersinia- or Campylobacter-associated enterocolitis. Thus, a "new" group of inflammatory bowel diseases has recently emerged, some with newly described pathologic features and others reflecting improved methods of detection with newer microbiologic methods. With evolving methods of recognition, other entities will likely be described as causes of inflammatory bowel disease.
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Callitrichid hepatitis is an arenavirus infection that recently emerged as a highly fatal disease of New World primates in the Callitrichidae family. As we previously reported, these primates develop hepatitis after contact with mice that are infected with variants of LCMV (LVMCCH), recently determined to have 86% identity with GC-P gene of the Armstrong and Western strains of LCMV. Here, we describe the histopathological lesions and tissue localization of viral antigens in confirmed cases of callitrichid hepatitis from recent outbreaks in two U.S. zoos. The liver in marmosets and tamarins with fatal infections consistently showed degeneration, necrosis, and inflammation, with variable involvement of the spleen, lymph nodes, adrenal glands, intestine, pancreas, and central nervous system. Lymphocytic choriomeningitis virus antigens were identified immunohistochemically in necrotic foci in these organs as well as in nondegenerating areas in lungs, kidney, urinary bladder, brain, and testes. The multi-organ tropism and histological pattern of LCMV infection in marmosets and tamarins are similar to those reported for the highly virulent arenavirus that causes Lassa fever in humans. Comparative studies of callitrichid hepatitis and Lassa fever would therefore be mutually beneficial for human and nonhuman primate medicine.
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