Neonatal Haemophilus influenzae infections

Article Abstract:

The incidence of Haemophilus influenzae infection in newborns has increased over the past decades, particularly among premature, low birth weight infants. It is characterized by the early development of symptoms and rapid course of disease. The infection may start during pregnancy and contribute to premature birth. H. influenzae infection of the blood (septicemia) is associated with a high death rate among newborns. Newborns tend to be infected by the non-encapsulated strains of H. influenzae, whereas older children are usually infected by the capsular type b forms. The biotype IV strains of H. influenzae infect newborns and the female genital tract, whereas the biotypes I or II tend to be of the type b capsule form. A national surveillance of invasive infections in children in Finland was started in 1985 to determine the effectiveness of the vaccine against H. influenzae capsular type b. The five-year findings of this study and clinical and bacteriological characteristics of nine cases of H. influenzae infection in newborns are discussed. The incidence of H. influenzae was 2.8 per 100,000 live births, and H. influenza infection accounted for 1.6 percent of all cases of septicemia in newborns. The disease developed from birth to six hours of age. Of the nine infants, seven were premature and three died, resulting in a death rate of 33 percent. H. influenzae was detected in the blood of seven infants, and several surface sites and the placenta in two newborns. Of the eight strains isolated, only one was identified as H. influenzae capsular type b. All mothers had evidence of H. influenzae infection at birth or shortly after delivery, and H. influenzae was isolated from the blood in one mother, and placenta, or cervix, the opening of the uterus, in four cases. Two mothers used an intrauterine device during their pregnancies, which may have contributed to the development of H. influenzae infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Reports, Pediatric diseases, Diseases, Infants (Newborn), Neonatal diseases, Infection in children

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Paediatric bone marrow transplantation using donors other than HLA genotypically identical siblings

Article Abstract:

Allogenic bone marrow transplantation is the transplantation of bone marrow from genetically different individuals of the same species. It can be performed using a bone marrow graft from a sibling who has a similar tissue type. The tissue type is determined by the human leukocyte antigens (HLA), which are genetic elements that can provoke an immune response. Allogenic bone marrow transplantation using HLA genotypically identical sibling donors (ID-BMT) is used to treat childhood cancers involving the hemopoietic cell system (blood cell-producing). Before transplantation, the patient is treated with radiation or chemotherapy to destroy their bone marrow cells. The drugs used to eliminate the patient's bone marrow include busulfan and cyclophosphamide. Unlike total body radiation, these two agents do not adversely affect growth and development. However, both total body radiation and chemotherapy cause infertility. ID-BMT should be performed before the development of complications and before the cancer becomes resistant to standard treatment. The procedure is usually reserved for patients in their second remission. The use of bone marrow transplantation to treat cancers of the hematopoietic system and bone marrow failure in children without an HLA identical sibling is discussed. The role of using partially HLA-matched bone marrow transplants to treat leukemia, severe aplastic anemia, congenital immune deficiencies and osteopetrosis (the excessive calcification of the bone) is assessed. The limitations of mismatched related bone marrow transplantation are presented. Issues concerning unrelated bone marrow donors, such as HLA matching, patient selection, and the difficulty of finding matched unrelated donors, are reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Analysis, Genetic aspects, Bone marrow, Bone marrow transplantation, HLA antigens, Organ transplantation, Pediatric surgery, Blood diseases, Hematologic diseases, Transplantation of organs, tissues, etc. in children, Histocompatibility antigens

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Haemophilus influenzae infections in siblings: the need for prophylaxis

Article Abstract:

Although guidelines for the use of vaccination and prophylaxis against Hemophilus influenzae B are established in the United States, no such guidelines currently exist in Britain. Two recent cases illustrate the importance of developing such guidelines. A 33-month-old boy was diagnosed as having epiglottitis, and cultures from the trachea (windpipe) yielded an erythromycin and ampicillin resistant strain of Hemophilus influenzae B. The child was intubated and treated with chloramphenicol; his recovery was uneventful. However, 12 days after this admission, the patient's eight-month-old brother was admitted and found to have bacterial meningitis caused by a strain of Hemophilus influenzae B identical to that isolated from the elder brother. The infant was treated with chloramphenicol, and made a gradual recovery. In cases of Hemophilus infection, The American Academy of Pediatrics recommends prophylactic antibiotic treatment with rifampicin for household contacts when there is another child in the family under the age of four. In the case of these two brothers, such a policy may well have prevented a life-threatening infection of bacterial meningitis. Roughly half of British physicians now follow the American guidelines. Until the day when all children are immunized against Hemophilus influenzae B, prophylactic antibiotics (preventive) therapy for the family of an infected child seems to be an appropriate and useful measure for preventing further infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Prevention, Rifampin

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