{"title":"Superantigens and their role in infectious disease.","authors":"R Schafer, J M Sheil","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although the exact mechanisms by which superantigens may contribute to the pathogenesis of diseases are unknown, it seems increasingly likely that they have a role in the induction and pathogenesis of disease. The studies described here demonstrate that in several different diseases either bacterial or viral superantigens can be isolated from patients. There is also a preferential expansion of particular V beta T-cell subsets, which is a common feature of superantigen stimulation. From the work that has been done to date it can be hypothesized that superantigens may act in several ways. They may stimulate and activate T cells that are autoreactive and lead to the induction or exacerbation of autoimmune disease, as in RA. Alternatively, they may lead to the depletion of T-cell subsets based on V beta expression, thereby resulting in the severe reduction in lymphocytes in certain immunodeficiency diseases such as AIDS. But perhaps the most likely contribution of superantigens to disease pathogenesis is seen indirectly by their effect on the immune system-particularly the stimulation of large numbers of T lymphocytes expressing the same V beta domain. Thus it is likely that the direct effect of various T-cell-derived inflammatory mediators (i.e., interleukins and other cytokines) released by these activated T lymphocytes is the primary cause of disease pathology via response to superantigen stimulation. In addition to the diseases discussed here, there are a number of other diseases in which a potential role for superantigens is being studied. These include autoimmune diseases seen after group A streptococcal infections in which the streptococcal M protein has been postulated to act as a superantigen such as scarlet fever, rheumatic heart disease, and poststreptococcal glomerulonephritis. Other diseases being studied include psoriasis, lupus-like disease, and lymphoproliferative diseases (reviewed in Kotzin et al.). In the coming years the exact role of superantigens and the specific mechanisms by which they contribute to disease should be more clearly defined. Our understanding of these molecules could also lead to new therapies for the treatment of these diseases.</p>","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"10 ","pages":"369-90"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18719213","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}
{"title":"Atypical pneumonias in children.","authors":"M R Hammerschlag","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The major agents responsible for atypical pneumonia in children include a wide variety of organisms, one Mycoplasma species, two Chlamydia species, a rickettsia, and one fastidious bacterium. Mycoplasma pneumoniae and C. pneumoniae together may be responsible for over 40% of these infections. Recognition of the role that these agents play in pneumonia is important since many of the diagnostic methods used to detect these organisms are not available in most hospital microbiology laboratories. If you don't look, you won't find. Epidemiologic factors can provide valuable clues, especially with the less frequently encountered infections, since it is almost impossible to make a clinical diagnosis on which to base treatment. A reliable history of avian exposure should suggest psittacosis, exposure to sheep or pregnant cats suggests Q fever, and children with underlying malignancy or immunodeficiency or those receiving systemic steroids may have legionnaires' disease. None of these organisms are susceptible to beta-lactam antibiotics. Sometimes the diagnosis is not considered until after the child has failed to respond to a penicillin or a cephalosporin and routine bacteriology is negative. In view of the role played by M. pneumoniae and C. pneumoniae, a macrolide may be the first-line antibiotic for atypical pneumonia in children.</p>","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"10 ","pages":"1-39"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18719281","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}
{"title":"Neonatal necrotizing enterocolitis: current concepts and controversies.","authors":"R G Faix, J T Adams","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115598","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}
{"title":"Lyme disease and babesiosis.","authors":"P J Krause, H M Feder","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"183-209"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115602","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}
{"title":"Immunomodifiers applicable to the prevention and management of infectious diseases in children.","authors":"T R La Pine, H R Hill","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Attempts to augment immune function in infants or children with overwhelming sepsis or immune deficiency have focused on recombinant cytokines and interferons. Although early in their clinical use, the proinflammatory and antiinflammatory effects of the interleukins show promise in regulating the acute inflammatory response. The hematopoietic growth factors have demonstrated considerable clinical effect, especially in individuals with distinct hematopoietic disorders and in patients receiving immunosuppressive chemotherapy. The interferons gamma and alpha have received considerable attention over the last decade as potential immunomodulators. The stimulatory effects of INF-gamma on human neutrophils suggest its therapeutic usefulness in children with specific neutrophil dysfunction, and INF-alpha has shown broad clinical application both as an antitumor as well as an antiviral agent. The most recent studies of the integrins and selectins implicate their potential role in regulating a number of infectious disease states. As we learn more about the complexity of interactions and the delicate balance these molecules have in regulating the immune response, we will be better able to implement their use in regulating disease states in infants and children.</p>","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"37-58"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115607","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}
{"title":"Lower respiratory viral infections in immunocompetent children.","authors":"K J Henrickson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Viral lower respiratory disease causes a heavy burden on our society. Better understanding of the epidemiology of these viruses combined with new rapid diagnostic techniques will provide more rapid and more reliable diagnosis of these agents in the future. Two agents not commonly thought of as causes of LRI in children (rhinoviruses, coronaviruses) should now be added to an already long list. Effective drugs exist for prophylaxis against influenza virus type A and therapy for influenza virus type A, type B, and RSV. While no new antiviral drugs are near clinical use at this time, new antiviral agents are constantly being tested and developed. High-titer, specific antiviral IVIG appears promising for both therapy and prophylaxis. Over the next decade, improved influenza virus vaccines and safe and effective vaccines against HPIV and RSV are expected. Adenoviral vaccines for use in immunocompromised patients are possible, but a generally available vaccine for all children is less likely. Although the basic clinical epidemiology of these viruses has been well investigated over the last 30 years, new molecular techniques are greatly expanding our understanding of these agents. Antigenic and genetic variation is being found in many viruses previously thought homogeneous. The exact role and biologic significance of this variation is just beginning to be explored, but already there is evidence of differences in pathogenicity and immunogenicity in many of these substrains. All of this information will have an impact on future vaccine and antiviral drug development.</p>","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"59-96"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115481","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}
{"title":"Pelvic inflammatory disease in adolescents.","authors":"E R Wald","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"161-81"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115601","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}
{"title":"Genital herpes simplex virus and human papillomavirus infection.","authors":"J M Ellen, A B Moscicki, M A Shafer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"97-124"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115482","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}
{"title":"The role of newer oral cephalosporins, fluoroquinolones, and macrolides in the treatment of pediatric infections.","authors":"W J Rodriguez, B L Wiedermann","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76980,"journal":{"name":"Advances in pediatric infectious diseases","volume":"9 ","pages":"125-59"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19115600","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}