Pyomyositis in a child with acquired immunodeficiency syndrome

Article Abstract:

Pyomyositis, a bacterial infection of the skeletal muscle, is rare in the United States with only 50 reported cases. This infectious disease passes through three stages and is often difficult to diagnose because early symptoms are similar to many, less serious conditions. Initially, the affected area feels firm, but is not inflamed and warm. If treatment is delayed, pyomyositis becomes life-threatening. The causative organism is usually the bacteria Staphylococcus aureus. One case of pyomyositis has been reported in an adult patient with acquired immunodeficiency syndrome (AIDS). This is the first reported case of pyomyositis in an infant who had been diagnosed with AIDS. A three-and-a-half-month-old black infant became ill at one month of age; he developed swelling of the liver, jaundice (yellowed-skin) and thrush (candida infection in the mouth). The infant and the mother subsequently tested positive for human immunodeficiency virus (HIV), the virus responsible for acquired immunodeficiency syndrome (AIDS). The jaundice and liver swelling were assumed to be AIDS-related and the patient was discharged home. At three months of age fever and diarrhea developed and the infant was hospitalized. A small mass (1.2 inches by 0.8 inches) near the base of the spine, hardly noticeable during rest, became obvious when the infant cried. Since the area was not warm to the touch it was thought that the lesion was not an abscess. However, when the lesion was opened, a large amount of thick, yellow non-smelling pus was obtained and subsequent laboratory analysis identified the bacteria Staphylococci aureus. The patient received intravenous and oral antibiotic therapy and was sent home. However, he returned two days later with evidence of either disseminated intravascular coagulation, a blood clotting complication which can occur after bacterial infection, or liver dysfunction. Despite intensive treatment, the infant died shortly thereafter. Pyomyositis should be included in the list of bacterial infections that may affect children with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Infection, Diagnosis, Muscles, Myositis

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Elevated serum levels of tumor necrosis factor are associated with progressive encephalopathy in children with acquired immunodeficiency syndrome

Article Abstract:

Tumor necrosis factor (cachectin), is a protein produced by immune cells, known as macrophages, when the body responds to toxins. Tumor necrosis factor (TNF) can be beneficial or toxic to cells. Levels of (TNF) are increased in patients with cancer, parasitic infections, and in adults with acquired immunodeficiency syndrome (AIDS, which is caused by human immunodeficiency virus, HIV). Cell cultures from symptomatic HIV-positive patients produced seven times more TNF than cells from uninfected individuals. These TNF levels were also much greater than those reported in asymptomatic HIV-positive patients. Children with AIDS often develop progressive encephalopathy, a condition causing brain degeneration. It is thought that TNF can cause the destruction of oligodendrocytes, a type of nerve cell in the brain. In pediatric AIDS patients, astrocytes, another type of nerve cell, may be stimulated to produce TNF. Therefore, HIV-infected cells may be involved in damaging brain tissue. Wasting (cachexia), a common manifestation of AIDS, may also be caused by TNF. Levels of TNF were measured in the cerebrospinal fluid (CSF, which is in the brain and spinal cord) of 26 children with AIDS, and in the blood of 31 pediatric AIDS patients. High blood levels of TNF were found in 15 out of 19 children (79 percent) who had progressive encephalopathy, and 1 out of 12 (8 percent) pediatric AIDS patients without brain involvement. Encephalopathy occurred in 15 out of 16 (94 percent) pediatric patients with high blood levels of TNF, and in 8 children without high blood levels of TNF. These results indicate that there is an association between high blood TNF levels and encephalopathy in children with AIDS. CSF levels of TNF were not correlated with encephalopathy in these patients. There was no relationship between blood or CSF levels of TNF and the degree of wasting. TNF circulating in the blood may be responsible for the nerve damage caused by HIV-induced progressive encephalopathy in children with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, HIV (Viruses), HIV, Tumor necrosis factor, Cachexia

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Neurologic sequelae of open-heart surgery in children: an 'irritating question'

Article Abstract:

Many of the recent improvements in cardiac surgery techniques have been applied to infants. Babies with congenital heart disease often require surgical correction during infancy. In 1985, more than 37,000 open-heart operations were performed in the US on children less than 15 years of age. Although the mortality of this group has dropped, adverse neurological consequences of cardiac surgery may occur. Most infants are not affected by serious complications, however, a small but significant number suffer permanent neurologic injuries including seizures, motor disorders, mental retardation, and learning disabilities. A survey of six large pediatric cardiac surgery units was performed between 1988 and 1989 to obtain information on how diagnosis of neurologic adverse effects of open-heart surgery in infants is made and subsequently treated. All the units that were surveyed reported the incidence of neurologic symptoms in some patients following cardiac surgery. Diagnostic imaging techniques revealed hypoxic encephalopathy (brain damage due to lack of oxygen), cerebral atrophy (deterioration of the brain), and subdural hematoma (mass of blood, often a clot, between the brain and dura membrane). The causes of these abnormalities may be attributed to the congenital heart condition or may be a result of damage sustained during the surgical procedure. Altered blood flow and metabolism during heart vessel bypass procedures, and postoperative blood clots and low cardiac output may be contributing factors. The mechanisms of these injuries need to be carefully examined to minimize and prevent neurologic injury, and to provide the best possible outcome for these children. Neurologic damage may create lifelong disability and impair the overall quality of life of these children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surveys, Surgery, Postoperative complications, Heart, Heart surgery, Coronary care units

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