Hemolytic Group Research Articles

Impact of identification of Streptococcus dysgalactiae subspecies equisimilis from throat cultures in an adult population

Streptococcus dysgalactiae subspecies equisimilis (SDSE) are isolated from the throat of patients with pharyngitis, although the clinical significance remains debated. We sought to determine the incidence and association with pharyngitis of SDSE in an adult veteran population. Organisms were phenotypically identified to subspecies and Lancefield group, with selective 16S rRNA gene sequencing. From 833 throat cultures, the overall frequency of SDSE was 3.4% (64% group C and 36% group G) as compared to 8.6% for S. pyogenes (GAS). SDSE was described as a large colony in only 29% of the original culture evaluations by bench technologists, and clinical symptoms were similar for GAS and SDSE. Laboratory algorithms that are limited to identification of only GAS or are based on Lancefield group or visual identification of “large-colony type” β hemolytic Lancefield group C and G streptococci may be missing or misidentifying SDSE along with Anginosus group streptococci.

Biocompatibility of chitosan used in vas deferens fertility control

Objective To evaluate the biocompatibility of the chitosan used in the vas deferens fertility control.Methods In 60 4-month-old male Wistar rats,acute and subacute toxicity test,hemolysis and the vas deferens plantation test were used to explore the biocompatibility of chitosan.Results In acute toxicity test,there was no significant difference in body weight between experimental group and control group (P ＞ 0.05).In subacute toxicity test,the body weight,HB,WBC,lymphocytes and neutrophils ratios in experimental group were (252.0 ± 16.1) g,(13.80 ± 1.37) g/dL,(8.68 ±0.36) x 109/L,(76.60 ± 6.81) ％ and (8.60 ± 3.64) ％,showing no significant differences from control group (P ＞0.05).Tissue and cell degeneration,and necrosis were not seen.The hemolytic rate in hemolytic experimental group was 0.37 percent,less than accepted 5.00 percent.Vas deferens plantation experiment showed a minor inflammatory response.Conclusion Chitosan using in the vas deferens fertility control has good biocompatibility. Key words: Chitosan; Biocompatibility; Fertility control

Evaluation of the validity of high serum antistreptolysin o titre only, as an indication for tonsillectomy.

Serum Antistreptolysin O (ASO) titre is raised when there is infection of any organ of the body, by Group A beta haemolytic streptococci (GABHS), Group C or Group G streptococci [1]. Increased serum ASO titre should not be the only deciding criterion for tonsillectomy if GABHS is not present in the palatine tonsils. In this study, we evaluate the rationality of performing tonsillectomy in raised serum ASO titre only, in absence of GABHS in palatine tonsil. The study was designed as a prospective cohort study in which the main out come measure is to find out: The main outcome measure is to find out whether only the raised serum ASO titre is to be considered to perform tonsillectomy or not. Fifty consecutive patients (both children and adults) clinically diagnosed to have chronic tonsillitis were included in this prospective cohort study. Throat swab culture, tonsilar core tissue culture and Serum ASO titre tests were performed in all the patients. The results showed that out of the 50 patients 45 had raised ASO titre and 5 patients had normal ASO titre. GABHS was found in 5 cases (10%) in throat swab culture and 8 cases (16%) in FNA of tonsil core culture. The sensitivity of throat swab culture as compared to FNA Tonsil core culture was 62.5% and positive predictive value was 100%. The sensitivity of ASO titre as compared to core culture was 100% and positive predictive value was 17.8%. Specificity was only 12%. From the results of this study, it is evident that FNA culture of the tonsil core is a valid and a reliable test for the diagnosis of bacterial micro flora in recurrent tonsillitis. One should perform throat swab culture and FNA culture from tonsil core along with ASO titre before doing tonsillectomy in absence of any other indications. Identifying GABHS in the tonsil by FNA test and/or in the throat swab culture along with high serum ASO titre may be one of the ideal indications for tonsillectomy.

Prevalence of Heart Disease in School Children of Islamabad

Material and Methods: Islamabad is the new capital of Pakistan and is about 18 years old with the population of 150,000. It is situated 330 36’N, 72-50’S and 73°-24’ East of Greenwhich at the foot of Margala Hills at the altitude of 503-610 meters. The temperature varies from a maximum of 42°C in Summer to a minimum average of 3.4°C in Winter. Aortic systolic murmur was deemed signif icant if it was graded 3 or above and was conducted to the neck and the aortic component of the second sound was relatively soft. Results: A Total number of 15,100 children were examined out of’ which 8,607 (57%) children were male and 6,943 (43%) children were female. The age distribution of the cases is given as below:— Age 05—-07 08—- 10 11 - 13 14—15 Total Number of cases 12 14 17 7 50 2% complained of undue dyspnoca on exertion. 60% children belonged to the families with monthly income of less than Rs. 625/-. 17.2% of the Throat Swab Cultures were positive for Beta Hemolytic group A Streptococci and A.S.O. Titre were 200 units and above in 29% of the cases. Discussion: Our figures for rheumatic heart disease(1 . 52) per thousand are comparable to those of Abbasi et al., from Karachi, Miller et al., from USA and Stuckey et al., from Australia. Otherreports from Pakistan, India, Iran, Morocco, Egypt 23 show a very high prevalence rate which may be due to selection of slums and overcrowded areas in the survey. Acknowledgements: This paper was previewed by Dr. T. Strasser of W.1-1.O. Geneva for which we are most grateful. We wish to acknowledge our thanks National Science Foundation Islamabad which provided us the funds to carry out this study.

RESEARCH ON CLINICAL MANIFESTATIONS AND AEROBIC BACTERIA OF ACUTE TONSILITIS IN HUE CENTRAL HOSPITAL AND HUE UNIVERSITY HOSPITAL

Objective: To study the paraclinical and clinical mannifestations, aerobic bacteria and antibiogramme of acute tonsilitis. Materials and method: A cross-sectional study was conducted upon 34 patients with acute tonsilitis at Hue Central hospital and of Hue University Hospital. Results: Clinical and paraclinical characteristics: odynophagy 94.1%, tonsillar hyperaemia 88.2%. Having treatment with antibiotics before hospitalization 50%. White blood cells >10-15.109/l (58.8%). Positive bacteria culture is 67.6% in which streptococcus β hemolytic group (A) 25%, streptococcus α hemolytic 25%, hemophilus influenzae 25%. Antibiogramme: Sensitization: gentamycin 100%, cefuroxim 100%, ceftriaxone 93.8%, cefalexin 90.9%, vancomycin 86.7%; Resistance: Tetracyclin 85.7%, erythromycin 69.2%, ofloxacin 42.9%, ampicillin 33.3%, ciprofloxacin 33.3%. Consclusions: The priority of antibiotic prescription for acute tonsilitis should be based on the frequency of bacteria found in bacteria culture and depending on antibiogramme to choose appropriate antibiotics.

Placental Inflammatory Changes and Bacterial Infection in Premature Neonates with Respiratory Failure

Objective: to reveal a relationship of placental inflammatory changes to bacterial infection in premature neonates with respiratory failure. Material and methods. Bronchoalveolar aspirate was bacteriologically studied in 157 premature neonates with respiratory distress syndrome (NRDS); the total and differential leukocyte counts were measured in their peripheral blood. The levels of the cytokines IL-1^3, IL-4, IL-6, and TNF-a were studied in different biological fluids of mothers and their babies; the placentas were also morphologically examined. Results. An analysis of bacterial cultures from the tracheobronchial tree revealed no growth of bacterial microflora in 61.8% of cases, Enterococcus faecalis and Staphylococcus epidermidis were isolated in 6.4 and 8.3% of the infants, respectively; Staphylococcus haemolyticus, Staphylococcus capitis, Enterobacter agglomerans, and hemolytic group A Streptococcus were seen in 1.9% each; moreover, 1.3% of the newborn infants were found to have Bacillus spp., Staphylococcus aureus, Escherichia coli, Acinetobacter spp., and Serratia marcescens. Other microorganisms and a microbial association were encountered in 8.9% of cases. Placental morphological examination revealed different inflammatory changes concurrent with chronic and acute placental insufficiency. The investigation demonstrated that the maternal peripheral plasma levels of IL-1^, IL-4, IL-6, and TNF-a were within the physiological range at the end of the first period of delivery. The amniotic fluid displayed elevated IL-6 and TNF-a concentrations and normal IL-4 and IL-1e levels, suggesting that there was an intrauterine inflammatory process. Conclusion. Premature birth is associated with various placental inflammatory changes, which causes intrauterine stimulation of macrophages in the chorionic villi. Specific immune defense mechanisms that prevent the development of a fetal infectious process, i.e. the maternal infectious process, may induce preterm birth, but fail to lead to fetal and neonatal diseases. The investigation has shown that NRDS is a major disease in premature neonatal infants. Key words: intrauterine infection, premature neonates, cytokines, neonatal res piratory distress syndrome.

Glomérulonéphrites aiguës postinfectieuses

Acute postinfectious glomerulonephritis are defined by an acute nonsuppurative inflammatory insult predominantly glomerular. Its current incidence is uncertain because of the frequency of subclinical forms. The most common infectious agent involved is beta hemolytic streptococcus group A. Acute postinfectious glomerulonephritis is uncommon in adults, and its incidence is progressively declining in developed countries. Humoral immunity plays a key role in the pathogenesis of kidney damage. Complement activation by the alternative pathway is the dominant mechanism, but a third way (lectin pathway) has been recently identified. The classic clinical presentation is sudden onset of acute nephritic syndrome after a free interval from a streptococcal infection. Treatment is essentially symptomatic and prevention is possible through improved hygiene and early treatment of infections.

Virulence Characteristics and Genetic Affinities of Multiple Drug Resistant Uropathogenic Escherichia coli from a Semi Urban Locality in India

Extraintestinal pathogenic Escherichia coli (ExPEC) are of significant health concern. The emergence of drug resistant E. coli with high virulence potential is alarming. Lack of sufficient data on transmission dynamics, virulence spectrum and antimicrobial resistance of certain pathogens such as the uropathogenic E. coli (UPEC) from countries with high infection burden, such as India, hinders the infection control and management efforts. In this study, we extensively genotyped and phenotyped a collection of 150 UPEC obtained from patients belonging to a semi-urban, industrialized setting near Pune, India. The isolates representing different clinical categories were analyzed in comparison with 50 commensal E. coli isolates from India as well as 50 ExPEC strains from Germany. Virulent strains were identified based on hemolysis, haemagglutination, cell surface hydrophobicity, serum bactericidal activity as well as with the help of O serotyping. We generated antimicrobial resistance profiles for all the clinical isolates and carried out phylogenetic analysis based on repetitive extragenic palindromic (rep)-PCR. E. coli from urinary tract infection cases expressed higher percentages of type I (45%) and P fimbriae (40%) when compared to fecal isolates (25% and 8% respectively). Hemolytic group comprised of 60% of UPEC and only 2% of E. coli from feces. Additionally, we found that serum resistance and cell surface hydrophobicity were not significantly (p = 0.16/p = 0.51) associated with UPEC from clinical cases. Moreover, clinical isolates exhibited highest resistance against amoxicillin (67.3%) and least against nitrofurantoin (57.3%). We also observed that 31.3% of UPEC were extended-spectrum beta-lactamase (ESBL) producers belonging to serotype O25, of which four were also positive for O25b subgroup that is linked to B2-O25b-ST131-CTX-M-15 virulent/multiresistant type. Furthermore, isolates from India and Germany (as well as global sources) were found to be genetically distinct with no evidence to espouse expansion of E. coli from India to the west or vice-versa.

Phlegmon peri-amygdalien aspects diagnostiques et thérapeutiques

Introduction : The Peritonsillar abscesse (PTA) is a suppurated complication of the face and the neck often met as a matter of urgency ENT. He can raise diagnostic and therapeutic problems and be life-threatening. The objective of this study is to specify the epidemiological and clinical particularities of this affection and to revise the therapeutic possibilities from a review of the literature. PATIENTS AND METHODS : This retrospective study concerning 75 patients hospitalized for PTA in the Department of Otolaryngology-Head and Neck Surgery of the Hospital of Nabeul over a period of 7 years (in January 2001 to December 2007). The study of files allowed us to find all the clinical and therapeutic data. Our drop is of two years. RESULTS : The average age of our patients was of 26 years with a sex ratio of 1. The classic set of three of the PTA was complete only in 49 % of the cases. All the patients were the object of a needle aspiration, it was positive in 74 % among which 92 % benefited from a drainage under local anesthetic. A germ was identified in 16 cases with a Streptococcus â- hemolytic group A in 13 cases. The clinical and biological cure was noticed on average in the tenth day. Forty-seven patients underwent tonsillectomy at a later date after an interval from 2 to 6 months. No emergency tonsillectomy was realized. CONCLUSION : The Peritonsillar abscesses is a frequent urgency in ENT. The diagnostic is clinical. The practicable of needle aspiration in every case allows to confirm the diagnosis in the incomplete forms. The treatment is medical and surgical. KEYWORDS : Peritonsillar abscesses, diagnostic, treatment

Rheumatisches Fieber

Rheumatic fever and rheumatic heart disease are caused by an auto-immune reaction that occurs following a Group A streptococcal infection. Prevalence of rheumatic fever and rheumatic heart disease has notably decreased in industrialised countries in the past 50 years. Both diseases mainly affect children and adolescents. The exact pathomechanism is not yet known. Following an infection with haemolytic Group A streptococcals typical signs and symptoms occur which can be divided into major and minor criteria after Jones. Major criteria include carditis, polyarthritis, Sydenham's chorea, erythema marginatum, and subcutaneous nodules. Minor criteria include fever, arthralgia, raised erythrocyte sedimentation rate and C reactive protein as well as leukocytosis. Rheumatic fever can be treated with anti-inflammatory medications such as salicylic acid. It is recommended to treat streptococcal infections with antibiotics within 9 days in order to prevent rheumatic fever and rheumatic heart disease.

Prevalence of Beta Hemolytic Group Streptococci Among Elementary School Children in Zanjan

Prevalence of Beta Hemolytic Group Streptococci Among Elementary School Children in Zanjan

Microbiology of otitis externa in the secondary care in United Kingdom and antimicrobial sensitivity

Introduction Otitis externa is one of the most common conditions seen in the otolaryngology clinics. There are no recently published studies that have looked at the causative pathogens of the otitis externa seen in secondary care in the United Kingdom and their antimicrobial sensitivities. We present results of a prospective study to determine the current bacteriology of the condition. Methods Swabs were taken from the external auditory canals of the patients who presented to the otolaryngology emergency clinic with symptoms of otitis externa. These were analysed using microscopy, culture and sensitivity testing in one laboratory. The samples were cultured on blood agar, chocolate agar, Sabouraud agar, fastidious anaerobes agar with neomycin and staph/strep agar. Antimicrobial sensitivities of isolated pathogens were tested on iso-sensitest and blood agars using the BSAC disc diffusion template program. Results The most commonly identified pathogen was Pseudomonas aeruginosa (45.1%), followed by Staphylococcus aureus (9%), anaerobes (6.3%), β haemolytic Streptococcus group G (2.8%), β haemolytic Streptococcus group A (1.4%), Streptococcus pneumoniae (0.7%), methicillin resistant S. aureus (0.7%), Candida species (9.7%), Aspergillus species (4.2%) and Absidia corymbifera (0.7%). One hundred percent resistance of Pseudomonas isolates to neomycin, chloramphenicol, trimethoprim and amoxicillin was observed while most were sensitive to ciprofloxacin (100%), polymixin B (100%) and gentamicin (98.5%). S. aureus isolates were sensitive to gentamicin and flucloxacillin (100%). 92.3% were sensitive to neomycin and chloramphenicol. Resistance to penicillin and amoxicillin is observed. All isolates anaerobes were sensitive to metronidazole. Conclusion Polymixin B, gentamicin or ciprofloxacin topical preparations should be used as first line treatment of otitis externa. If the infection does not settle swab results should be used to guide further treatment.

Brote de síndrome de shock tóxico estreptocócico en una guardería de Cantabria en 2006

Beta hemolytic group A streptococcus only exceptionally produces aggressive disease with high lethality. Even more uncommon is the occurrence of an outbreak. In Spain, no outbreak in child care center has been previously described. Descriptive study of an outbreak of streptococcal toxic shock syndrome (3 cases, one lethal) in a child care center, which motivated the health care intervention with chemoprophylaxis, the closure of the child care center and the study of contacts. We analyzed the determinants of infection in the invasive and non-invasive cases, and the results of the pharyngeal culture of contacts. We identified 3 invasive and 14 non-invasive cases between 40 children attending the child care center (attack rate 42.5%). We studied 19 possible determinants of the infection, finding only an association with being over the age of 24 months and the assistance to the handouts classroom (that of the oldest children). It was not associated with chickenpox. All children attending the child care center, its staff (4 women) and 258 contacts were microbiologically investigated. In 12 children the emm 4 strain was isolated, including 2 of 3 cases with invasive disease. In 13 of 258 contacts other strains of beta hemolytic group A streptococcus were isolated, but in none of them the strain responsible of the outbreak was found. Azytromicin chemoprophylaxis was implemented for all children and contacts, and in those with a positive isolation, the culture was repeated until negative. The invasive strain circulated only in the child care center. Azytromicin chemoprophylaxis eradicated effectively the infection.

Cellulites cervicales extensives et médiastinite descendante nécrosante

Objectives To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis. Materials and methods A Retrospective study (1995–2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search. Results Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus β haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died. Conclusions The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.

Liver Abscess as a Complication of Esophgeal Balloon Dilation

Purpose: Despite the increase use of upper endoscopy, the complication rate has remained low. Infectious complications of EGD include transmission of infection by contaminated endoscopes or ancillary equipment, bacteremia and aspiration pneumonia. Here, we are reporting a liver abscess followed a routine upper endoscopy dilation in patient with gastric bypass. Methods: A 59 year old patient with history of gastric bypass 19 years ago presented with intermittent dysphagia has been going on for the last few months. Her upper endoscopy was remarkable for schatzki ring and gastric pouch contained undigested food. The gastrointestinal anastomosis was patent. The schatzki ring was dilated using CRE balloon 15–18 mm with evidence of breaking the mucosa at 16.5 and 18 mm. Her other past medical history was significant otherwise for thyroid cancer, thyroidectomy 20 years ago, tobacco and ETOH abuse. Patient presented with right upper quadrant pain 2 days after the EGD to outside facility. She was treated symptomatically. Pain returned and patient developed fever and chills. CT scan of the abdomen performed at our facility 2 weeks after the EGD showed left hepatic lobe abscess. US guided drainage grew Candida Albicans, streptococcus Solivarius, and Beta Hemolytic Strep Group B. Esophagogram failed to show any leak or perforation. The abscess resolved with IV antibiotic and percutaneous drainage without the need for surgery. Results: The timing between the onset of her symptoms and the EGD suggest causal relationship. This is most likely related to transient bacteremia secondary to the dilation. Her altered anatomy, gastroparesis and ETOH intake, probably predisposed her for the bacteremia and the immune suppression status. Conclusion: Esophageal dilation has the highest incidence of bacteremia of all gastrointestinal endoscopic procedures, occurring in approximately 45 percent of cases. In spite of this, complications of bacteremia such as endocarditis are rare. The most common reported complication is endocarditis, and less frequently meningitis. Antibiotic prophylaxis is not warranted in most patients undergoing esophageal dilation except for those at high risk. People with immunosupressed status or altered anatomy might need to be considered for prophylaxis.

A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital

Fusobacterium necrophorum is an obligate anaerobe believed to be a member of the normal flora of the human oropharangeal and urogenital tract. It has been associated with deep-seated infections and was first described in 1936 by Lemierre, a French microbiologist. There is now strong evidence to suggest that it is also a cause of recurrent sore throat and persistent sore throat syndrome (PSTS) without leading to full systemic infection. It is considered to be the second most common cause of sore throat after group A β-haemolytic streptococci. This study was performed over a six-month period (October 2004 to March 2005) at the Eastbourne District General Hospital. All throat swabs received in the laboratory are cultured routinely for haemolytic group A streptococci and pathogenic Corynebacteria spp. During the study period an extra fastidious anaerobic blood agar plate with neomycin was inoculated, with a 30 µg vancomycin disc placed at the junction of the second and third streaks. This was examined after 48 h for the presence of F. necrophorum. A total of 1157 swabs were processed during the study period: 156 were positive for haemolytic group A streptococci, 57 were positive for F. necrophorum, 47 for group C haemolytic streptococci, nine for group G haemolytic streptococci, and one was positive for C. ulcerans. Patient age ranged from less than a year old to 88. The majority of F. necrophorum isolates were from patients in the 11–25 age group, with an isolation rate of 9.48% (44/464). This age group accounted for 40% (464/1157) of the swabs received during the study period and 77% (44/57) of these were positive for F. necrophorum. Group A haemolytic streptococci showed an overall isolation rate of 13.5%, with peaks of 23% in the 0–10 and 26–35 age ranges. Together, these two organisms were responsible for 18.4% (213/1157) of all throat infections in this study. The results presented here indicate that F. necrophorum is second to group A haemolytic streptococci as a cause of sore throat, especially in the young adult, and introduction of routine culture should be considered.

Neurodevelopmental Outcome of Severe Neonatal Hemolytic Hyperbilirubinemia

We recruited 128 neonates with hyperbilirubinemia over a 5-year period (1995-2000) to study the short- and long-term effects of hemolytic hyperbilirubinemia on the auditory brainstem pathway and neurodevelopmental status. These children were divided into two groups: (1) a hemolytic group (n = 29; ABO incompatibility [n = 19], Rh incompatibility [n = 1], glucose-6-phosphate dehydrogenase deficiency [n = 8] and both ABO incompatibility and glucose-6-phosphate dehydrogenase deficiency [n = 1]) and (2) a nonhemolytic group (n = 99). All received phototherapy. Exchange transfusions were performed for four (13.8%) in the hemolytic group and three (3%) in the nonhemolytic group. The brainstem auditory evoked potential was recorded at a mean age of 3.2 months in the hemolytic group and 3.1 months in the nonhemolytic group. Serial brainstem auditory evoked potential assessments were performed until 2 years of age (3 in the hemolytic group and 18 in the nonhemolytic group). All had regular physical, neurologic, visual, and auditory evaluation until 3 years of age. The rate of exchange transfusion was significantly higher in the hemolytic group than in the nonhemolytic group (P < .05). Brainstem auditory evoked potential abnormalities at the initial assessment occurred in three (10.4%) in the hemolytic group (all related to ABO incompatibility) and nine (9.1%) in the nonhemolytic group. At 2 years, the brainstem auditory evoked potential returned to normal except in three cases with a slightly increased hearing threshold (one [3.5%] in the hemolytic group at 60 dB nHL and two [2%] in the nonhemolytic group at 50 dB nHL]). There were no significant differences in the rate of brainstem auditory evoked potential abnormalities at the initial or subsequent assessments between both groups. All except five cases had a normal neurodevelopmental outcome at 3 years (three [two with ABO incompatibility and one with glucose-6-phosphate dehydrogenase deficiency] in the hemolytic group [10.4%] and two [2%] in the nonhemolytic group). All had mild motor delay and hypotonia, which returned to normal at 3 years. The rate of abnormal neurodevelopmental outcome was higher in the hemolytic group than in the nonhemolytic group, although with no significant difference between both groups (P = .08). All five cases in both groups with abnormal neurodevelopment had a normal brainstem auditory evoked potential at the initial assessment. There was no relationship between the abnormal initial brainstem auditory evoked potential and the final neurodevelopmental outcome. The toxic effect of hyperbilirubinemia on the auditory brainstem pathway and neurodevelopmental status in our cohort was transient. The prognosis of neonatal hemolytic hyperbilirubinemia in our Chinese cohort is excellent, possibly owing to an aggressive early-intervention approach.

Encefalomielitis aguda. Experiencia de un hospital terciario español

To describe the epidemiological, clinical, microbiological, neuroimaging and laboratory features, treatment, and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM). Retrospective chart review was performed of children with a diagnosis of ADEM over a 23-year period in a tertiary hospital in Spain. Twelve cases were identified. Ten cases (83%) occurred after 1992. Nine patients (75%) presented between April and September. The mean age was 6 years. Nine patients (75%) were male. Fifty percent of the patients had a history of infectious disease or vaccination. The most frequent nonspecific symptom was fever in 75%. The most frequent neurological manifestations were motor deficits and altered consciousness in 75%. Cerebrospinal fluid abnormalities were found in 83%. All patients had at least one brain scan and one brain magnetic resonance imaging (MRI) scan. Three patients underwent spinal MRI. The sensitivity of MRI was greater than that of the scanner in the diagnosis of ADEM. An etiologic diagnosis was made in four patients: Mycoplasma pneumoniae, beta hemolytic streptococcus group A, Epstein-Barr virus and measles-mumps-rubella vaccination. Eleven patients were treated with corticosteroids and one was treated with intravenous immunoglobulin therapy. One patient died while 75 % of the patients had a good outcome. ADEM is in an infrequent disease in children. The clinical features are similar to those of infectious encephalitis. Etiologic diagnosis is difficult to establish but this entity is usually preceded by an infection. The neuroimaging test of choice to establish the diagnosis is MRI. In most patients, the prognosis is good.

A Case-Control Study of Acute Respiratory Tract Infection in General Practice Patients in The Netherlands

Background. Acute respiratory tract infections (ARTIs) are responsible for considerable morbidity in the community, but little is known about the presence of respiratory pathogens in asymptomatic individuals. We hypothesized that asymptomatic persons could have a subclinical infection and thus act as a source of transmission. Methods. During the period of 2000–2003, all patients with ARTI who visited their sentinel general practitioner had their data reported to estimate the incidence of ARTI in Dutch general practices. A random selection of these patients (case patients) and an equal number of asymptomatic persons visiting for other complaints (control subjects) were included in a case-control study. Nose and throat swabs of participants were tested for a broad range of pathogens. Results. The overall incidence of ARTI was 545 cases per 10,000 person-years, suggesting that, in the Dutch population, an estimated 900,000 persons annually consult their general practitioner for respiratory complaints. Rhinovirus was most common in case patients (24%), followed by influenza virus type A (11%) and coronavirus (7%). Viruses were detected in 58% of the case patients, β-hemolytic streptococci group A were detected in 11%, and mixed infections were detected in 3%. Pathogens were detected in ∼30% of control subjects, particularly in the youngest age groups. Conclusion. This study confirms that most ARTIs are viral and supports the reserved policy of prescribing antibiotics. In both case and control subjects, rhinovirus was the most common pathogen. Of bacterial infections, only group A β-hemolytic streptococci were more common in case patients than in control subjects. Furthermore, we demonstrated that asymptomatic persons might be a neglected source of transmission.

Non‐protein‐bound iron and free radical damage in fetuses with rhesus haemolytic disease: influence of intrauterine transfusions

To determine iron-induced free radical damage in fetal rhesus haemolytic disease (RHD) before and after repeated intrauterine red blood cell transfusions and its relation to hydrops fetalis. Prospective, observational study. Department of Obstetrics, Leiden University Medical Centre, the Netherlands. Fifty anaemic fetuses, including 13 hydropic ones, 9 preterm and 12 term neonates and 8 female non-pregnant adults. Venous blood plasma samples were collected from 50 fetuses suffering from RHD preliminary to the first, and if appropriate, subsequent intrauterine red blood cell transfusions for determination of iron status including non-protein-bound iron (NPBI) and iron-binding primary antioxidant proteins, total plasma anti-oxidant capacity and its contributing secondary antioxidants (e.g. vitamin C, uric acid, sulphydryl groups and peroxidation products). Results were compared with values of healthy preterm and term neonates directly at birth and adult controls. Within the fetal haemolytic group, 13 hydropic fetuses were analysed as a separate group. Non-protein-bound iron, antioxidants, total antioxidant capacity and peroxidation products. Sub analysis of the outcome measures of the hydropic fetuses. RHD fetuses had at initial cordocentesis a significantly higher NPBI level and a significantly lower total plasma antioxidant capacity than control babies and adults. Their vitamin C tended to be more oxidised but lipid peroxidation had not increased, when compared with preterm babies. The repeated intrauterine red blood cell transfusions had a positive effect on the total antioxidant capacity of plasma and did not increase the concentration of NPBI. The hydropic fetuses, who had higher NPBI concentrations and lower plasma protein concentrations and total antioxidant capacity, did not show more peroxidation products in plasma than the non-hydropic fetuses. Fetuses without reversal of hydrops despite intrauterine transfusions showed decreasing levels of proteins with subsequent transfusions but peroxidation products remained constant. Repeated intrauterine red blood cell transfusions do not lead to free radical damage in the fetus in utero. Iron-induced free radical activity does not appear to play a causative role in the proceeding of hydrops fetalis in RHD.