Advances in pediatric infectious diseases最新文献_第10页

Human ehrlichiosis. 人权观察(Human ehrlichiosis。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

M S Edwards

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Human herpesvirus-6 and exanthem subitum. 人类疱疹病毒-6和exanthem subitum

Advances in pediatric infectious diseases Pub Date : 1991-01-01

D I Bernstein

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Measles in the United States: 1989 and 1990. 麻疹在美国:1989年和1990年。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

S L Katz

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New developments in vaccines. 疫苗的新发展。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

R S Daum, B Watson, H F Clark, S A Plotkin

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Viral encephalitis. 病毒性脑炎。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

P Toltzis

{"title":"Viral encephalitis.","authors":"P Toltzis","doi":"","DOIUrl":"","url":null,"abstract":"Nonherpetic encephalitis outside the newborn period is usually a self-limited disease. The majority of patients will recover without significant sequelae, and require only supportive therapy during the acute illness. Though the underlying viral etiology frequently will escape detection, identification of the infecting agent has considerable prognostic value which can complement clinical measures of severity of disease. The most important initial task of the clinician faced with a case of presumptive viral encephalitis is to eliminate the possibility of a treatable illness. Once this has been done, the diagnosis of viral encephalitis can be supported by documenting the characteristic slow-wave background activity on EEG, and a mild lymphocellular pleocytosis in the CSF. Because viral encephalitis can be caused by such a large number of organisms, the search for an etiology can be daunting. Realizing that all the agents described above can, at times, cause encephalitis without any clue to their identity, one nevertheless may use several pieces of historical information to narrow the possibilities. Travel history, animal exposures, immunization history, and seasonality all may help to steer the search in a particular direction and, indeed, may point to a nonvirologic cause as well. In addition, detection of extraneurological signs and symptoms may strongly indicate a specific virologic diagnosis. Finally, knowledge of concurrent community epidemic patterns, and of surveillance data routinely collected by local and state health departments, can help to increase or decrease the likelihood of a given pathogen. The causative viral agent usually can be identified by serological testing and viral culture. Occasionally, single serological determinations are diagnostic: in rabies (when the patient has not received immune prophylaxis), eastern equine encephalitis, and HIV, since seropositivity is strongly associated with symptomatic illness; and in Epstein-Barr virus, if a panel of antibody determinations which can time the infection is available. In addition, high CSF: serum titers for antibody against any neurotropic agent is usually diagnostic, though the absence of a high central nervous system antibody titer does not eliminate any potential viral pathogen. With these few exceptions, a single serological determination for a given pathogen is almost always impossible to interpret; paired sera (one obtained upon diagnosis, and one obtained 10 to 14 days later, either just prior to hospital discharge or at a follow-up visit) are far more helpful. Many viruses that directly infect the central nervous system are difficult to recover from the CSF; therefore, viral isolation from the nasopharynx and stool also should be sought.(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"6 ","pages":"111-36"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12813334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current issues in burn wound infections. 烧伤创面感染的当前问题。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

D Dodd, H R Stutman

{"title":"Current issues in burn wound infections.","authors":"D Dodd, H R Stutman","doi":"","DOIUrl":"","url":null,"abstract":"As we have emphasized, the diagnosis of burn wound infections in the high-risk burned child can be difficult and depends on a very high degree of suspicion and daily clinical evaluation of the burn wound site by consistent observers. Appropriate precautions include meticulous hand-washing and the use of gloves when handling the wound site and prophylactic application of a topical antibacterial agent such as SSD cream. Wound therapy should include routine vigorous surgical débridement. Surveillance wound cultures should be done weekly to determine the emergency of colonization and aid in the selection of empiric antimicrobial regimens when these are appropriate. Wound biopsy for histological examination and quantitative culture is highly recommended in the severely ill child with an unclear etiology or site of infection. If, despite these measures, sepsis ensues, then systemic antibiotics must be started empirically as an adjuctive therapy to surgical débridement. Knowledge of the organisms colonizing a wound will prove useful in choosing an antibiotic regimen while awaiting definitive results of blood and wound biopsy cultures. Without this information, early burn sepsis therapy should focus on gram-positive organisms, while infection later in the course should raise suspicion of nosocomial pathogens such as P. aeruginosa, other enteric bacilli, and C. albicans. An initial regimen might include nafcillin plus ceftazidime or an aminoglycoside, with anaerobic coverage depending on considerations noted previously. Once the causative agent is identified, therapy must be modified accordingly. Amphotericin B and acyclovir use should be guided by positive cultures from the burn wound site along with systemic evidence of dissemination. Available studies do not yet make clear the role of empiric immunotherapy with intravenous gamma globulin in the burned child. Therefore, its use cannot be recommended at the present time, although the development of specific immunoglobulins (P. aeruginosa, S. aureus) may prove useful in the future. In view of the multiplicity of organisms that may colonize burn wounds, it is likely that passive immunization may be more useful in the treatment of infection than in its prevention. The switch from P. aeruginosa to, for example, Klebsiella pneumoniae or E. cloacae, is not apt to be particularly beneficial in most circumstances. Similarly, an increased understanding of the role of the immune system in the propensity to burn sepsis may guide the development of vaccines or immunomodulators that decrease the risk of infection in seriously burned children and adults.","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"6 ","pages":"137-62"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13210297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Skeletal infections in children. 儿童骨骼感染。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

J D Nelson

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Screening of immigrant children for infectious diseases. 对移民儿童进行传染病筛查。

Advances in pediatric infectious diseases Pub Date : 1991-01-01

K C Hayani, L K Pickering

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Pertussis and pertussis vaccine: 1990. 百日咳和百日咳疫苗:1990。

Advances in pediatric infectious diseases Pub Date : 1990-01-01

E A Mortimer