Pharynx Of Children Research Articles

CHANGES IN THE MICROBIOME OF THE SKIN AND PHARYNGEAL MUCOSA IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES

Background. According to the data from a World Health Organization report for 2022, the prevalence of diabetes among children under the age of 18 has increased by 21.1% over the past 5 years. Often, these patients have a number of concomitant systemic conditions, in particular diseases caused by skin or mucosa microbiome changes (usually chronic tonsillitis and pustular skin lesions) due to dysregulation of carbohydrate metabolism and increased lipid peroxidation. Therefore, the study is relevant.
 Aim: to determine the quantitative and qualitative composition of the microbiological community of the skin and throat in children with type 1 diabetes in comparison with the control group.
 Materials and methods. 20 children of the control group (CG) and patients with type 1 diabetes mellitus (DM), on insulin therapy, aged 8-17 years, were involved in the study. The skin washes and throat swabs were delivered to the laboratory within 2 hours after collection and immediately cultured on sterile nutrient mediums: Endo, YSA, blood agar and Saburo. The nature of the growth of microorganisms on the medium was evaluated and microscopy of Gram-stained micropreparations was performed after cultivation within 1-2 days in a thermostat at a temperature of 37°C. The photos of every colony on the medium were taken with further quantitative and qualitative analysis. Statistical analysis of the obtained results was conducted. Comparisons between control and patient groups were done using the Mann-Whitney U-test. A result of p<0.05 was considered statistically sufficient.
 Results. As a result of our study, St. aureus was detected on the skin in 80.0% of patients with diabetes and in 55.0% of subjects in CG. St. epidermidis was isolated in 90.0% of patients with DM and in 70.0% of cases in CG. β-hemolytic streptococci were also more frequently observed in patients with DM (60.0% and 35.0% in CG). Nonhemolytic streptococci were revealed in 40.0% of patients with diabetes and only in 10.0% of children in CG. Candida were observed in 25.0% of the cases with DM and no one in CG. The number of colony-forming units in 1 ml (CFU/ml) of all detected microorganisms was higher in patients with diabetes (p<0.05) in general.
 In addition, the microflora of the mucous membrane of the pharynx was studied. Colonization with St. aureus was more often observed in patients with DM (65.0% and 45.0% in CG). St. epidermidis were detected in 90.0% of patients with DM and 85.0% of patients with CG. Carrier of β-hemolytic streptococci was revealed in 70.0% of patients of the experimental group and 55.0% in CG. Nonhemolytic streptococci were found in all patients from the general sample. The number of CFU/ml of all above mentioned microorganisms was higher in patients with diabetes (p<0.05).
 Conclusion. Thus, our study revealed a pattern of increasing the number of pathogenic (Staphylococcus aureus, hemolytic streptococci) and opportunistic microflora (Candida) on the skin and mucous of the pharynx in children with type 1 diabetes and on insulin therapy, in comparison to the control group. However, the trend of increasing the frequency of pathogens in the study group was not statistically confirmed. An increase in the number of microorganisms in the diabetic patients can lead to various complications: purulent-septic (furunculosis, tonsillitis) and fungal diseases caused by Candida. Therefore, such children should be advised to avoid diseases of the nasopharynx, damage to the skin and, if necessary, to use antimicrobial agents.

Efficacy and safety of adenotomy in children with persistent allergic rhinitis

Introduction. This article analyzes the effectiveness and safety of complex treatment of children with diseases of the lymphoepithelial pharyngeal ring against the background of persistent allergic rhinitis.Objective. Study the efficacy and safety of adenotomy in children with persistent allergic rhinitis.Materials and methods. 124 children participated in the study. Two groups were formed: a control group of children receiving medical treatment and a main group – complex (medical and surgical treatment). When contacting the polyclinic, an examination was carried out by an otorhinolaryngologist. An allergist-immunologist confirmed the diagnosis of persistent allergic rhinitis, assessed the quality of life of children, using a questionnaire for patients with allergic diseases in pediatrics PRQLQ together with an otorhinolaryngologist. The condition of the dental system was evaluated by a pediatric dentist. A pediatrician conducted a physical examination of all children one, three and six months after the start of the study.Results and discussion. After comprehensive (surgical and drug) treatment, children experienced a significant decrease in nasal obstruction, a decrease in the incidence of respiratory diseases, as well as increased physical activity and improved emotional status, inflammatory phenomena in the pharynx and nasopharynx decreased by 70.9% according to visual analog scales compared to the day of discharge from the hospital. Analysis of the results of the study showed that conservative treatment in combination with surgical intervention on the lymphoid structures of the pharynx in the presence of indications in patients with persistent allergic rhinitis is safe and more effective than using only a therapeutic approach.Conclusions. Thus, the preliminary results of the observed period demonstrate the effectiveness and safety of surgical intervention on the lymphoid structures of the pharynx in children with persistent allergic rhinitis. The complex method of treatment of combined pathology is safe and effective and has a beneficial effect on the somatic status and quality of life of children.

Features of the pathology of the lymphoid ring of the pharynx in children during the COVID-19 pandemic

Introduction. For many years, one of the problems in medicine that attracted the attention of specialists from different areas of medicine was herpes virus infection. There are many reasons for this, including the often persistent nature of the course, a wide variety of clinical manifestations and routes of transmission, and many target organs of this infection. The disease can proceed in different ways, it has both asymptomatic, mild and rather severe course. For otorhinolaryngologists, Epstein-Barr virus (EBV), cytomegalovirus (CMV) and herpes virus 6 (HHV-6) are the most relevant and important in the context of the treated site of the pathological process. Since the end of 2020, humanity has faced a new, previously unexplored viral infection – a new coronavirus infection. And just like the previously studied herpes virus infection, COVID-19 has a large number of clinical manifestations and affects a huge number of organs and organ systems.Aim. To determine the types of interplay between COVID-19 and herpesviruses (EBV, CMV, HHV-6) in children of different ages with abnormalities of the lymphoid ring of pharynx.Materials and methods. In the course of the study, a comprehensive examination was carried out and the results of examination of children with pathology of the lymphoid ring of the pharynx who had herpes virus infection and COVID-19 were analyzed.Results. The results of the study obtained in the course of the work are consistent with the data that the virus carrier. The presence of an infectious agent triggers the production of macrophages and leads to clonal selection of T and B cells. Further, lymphocytes are transformed into lymphoblasts, which are capable of division and their transformation into plasma and B-memory cells occurs. As a result of this process, hypertrophy of the lymphoid tissue occurs and its reactive activity increases. (persistent herpesvirus infection) is one of the important causes of lymphoid proliferation in children. The combination of antigenic load and immaturity of the immune system in children is accompanied by an increase in the activity of lymphoid tissue and its compensatory activity.Conclusions. Past mild and asymptomatic COVID-19 can contribute to the reactivation of lymphotropic herpesviruses, first of all EBV, in 55-65% of children of preschool and school age.

THE EFFECTIVENESS OF PHARMACOLOGIC TREATMENT FOR REGRESSION OF CLINICAL SYMPTOMS AND INDICATIONS FOR SURGICAL TREATMENT OF CHRONIC NASOPHARYNGITIS ASSOCIATED WITH EPSTEIN-BARR VIRUS

Chronic nasopharyngitis (CNP) associated with Epstein-Barr virus (EBV) is etiopathogenetically based on the virus-induced chronic inflammation of the pharyngeal tonsil. Studies using immunological methods have shown that EBV is involved in the hypertrophy of the lymphoid tissue of the pharynx in children and adolescents, since the lymphoid tissue of the pharyngeal tonsil is the site of primary infection and persistence of the virus. The surgery does not often resolve the problem in 19-26% of patients. Therefore, there are many questions regarding the choice of the adequate therapy that would show its effectiveness.
 Objective: to evaluate the effect of treatment of CNP associated with Epstein-Barr virus with the phytoneering extract BNO 1030 on the dynamics of the main clinical symptoms and associated indications for surgery.
 Material and methods. A total of 108 outpatients divided into two groups: experimental (n-54) and control (n-54). Verification of EBV was carried out according to the ELISA reaction profile: IgM-VCA/IgG-EA/IgG-EBNA. All the patients were prescribed a background treatment and the experimental group additionally received BNO 1030. The evaluation of the effectiveness of treatment was based on the analysis of the dynamics of clinical symptoms, the degree of hypertrophy of the pharyngeal tonsil, and the existence of indications for surgical treatment. Symptom assessment was performed on V1 (day 0), V2 (day 51), V3 (day 101), V4 (day 141). Indications for surgical intervention (adenotomy) were determined on V4 together with the patient's parents.
 Results. Clinical symptoms of CNP include runny or stuffy nose, postnasal drip, nasal voice, posterior cervical lymphadenopathy. Symptoms were rated, on average, from 0 to 3 points on a 4-point MSS scale that corresponds to the moderate course of CNP. At V1, both groups showed comparable symptom scores.
 The use of the phytoneering extract BNO 1030 in addition to background therapy in patients of the main group proved its clinical efficacy. At V3 and V4, in patients of the main group, there was observed a clinically significant decrease in the severity of nasal congestion, nasality, enlarged cervical lymph nodes (p<0.05). There was insignificant difference between the groups in the dynamics of nasal discharge and postnasal drip symptoms at all visits (р> 0,05).
 The analysis of the dynamics of indicators of pharyngeal tonsil hypertrophy in both groups of patients was carried out before the operation. There are significant differences between hypertrophy indicators between V1 and V4 (p<0.05). After eliminating the operated patients, there were no differences between the groups in the degree of hypertrophy (p> 0.05). The need for surgery decreased in patients of the main group. A 14.8% decrease in adenotomy rate was observed: from 53.7% in the control group to 38.9% in the main group (p<0.05). Conservative treatment was prolonged in 61.1% of patients in the main group and 46.3% of patients in the control group.
 No patient developed side effects.
 Conclusions: the adequate pharmacologic treatment of CNP associated with EBV has improved clinical symptoms and reduced the indications for surgical treatment in 61.1% of patients.

Inflammatory diseases of the pharynx in children

Introduction. Inflammatory diseases of the lymphoid ring of the pharynx in children are widespread and account for more than 30% in the structure of ENT pathology. Lymphoid tissue, especially the palatine tonsils, largely determines the formation of local and general protective reactions of the child’s body.The aim of this work is to assess the efficacy and safety of using topical bacterial lysate in chronic tonsillitis of streptococcal and herpes viral etiology in frequently ill children.Materials and methods. The study was conducted on a sample of 31 children aged 7–17 who were treated in the pediatric department of the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech inpatiently or outpatiently, which were divided into 2 groups. Group 1 consisted of 15 children with decompensated chronic tonsillitis of streptococcal etiology, who were prescribed tonsillectomy according to indications. Group 2 consisted of 16 children with chronic compensated tonsillitis, who, after an acute respiratory infection, showed signs of acute pharyngitis in the form of pain and discomfort in the throat, perspiration, low-grade body temperature. In both groups children were prescribed to take topical baclerial lysates.Results. A subjective pain relief of sore throat in patients (groups 1 and 2) was observed from day 2–3 of administration of the topical bacterial lysate. The clinical therapeutic effect resulted in decreased intensity of inflammation of the posterior pharyngeal wall, reduction in size and tenderness of regional lymph nodes from day 4–5 of administration of the drug. The clinical recovery from acute pharyngitis in children of both groups was observed in 98% of cases at visit 3.Conclusion. The persistence of pathogenic viruses and bacteria contributes to the development of secondary immunodeficiency states and participates in the formation of a kind of “vicious circle” In these causes prescription of topical baclerial lysates may be an effective conservation therapy as well as antibiotics and antiviral drugs. The drug showed its efficacy in the treatment of acute and chronic diseases of the pharynx in children of both viral and bacterial etiology.

RESULTS OF CREATION AND INITIAL APPLICATION QUESTIONNAIRE FOR THE DIAGNOSIS OF GASTROESOPHAGEAL REFLOX IN COMBINATION WITH LARYNGEAL PATHOLOGY AND THROATS IN CHILDREN IN VOLGOGRAD

Gastroesophageal reflux (GER) is a disease that associated with the passage of gastric retention into the esophagus, with or without regurgitation and vomiting, characterized by a variety of clinical picture of squashed and external manifestations. At children true prevalence of gastroesophageal reflux disease is still a question, that is due to the difficulties of early suppuration. In the article provides an overview of the available literature on the topic of the influence of GER on the state of the laryngeal pathology and throats in children, as well as examined aspects creation of questionnaire for doctors for early detection of patient with GER associated with pathologies of the larynx and pharynx in children.

Etiological aspects of chronic pathology of the lymphepithelial pharyngeal ring in children at the present stage

The lymphoepithelial pharyngeal ring is located in the entrance gate and is constantly exposed to infectious agents. Currently, chronic pathology of the lymphoepithelial pharyngeal ring remains one of the most common problems in the practice of a pediatric doctor. Hypertrophy of the pharyngeal tonsil, chronic adenoiditis, which occurs in 35.3% of children under the age of 7 years, and chronic tonsillitis, which occurs in 15-63% of cases, are among the most common diseases of childhood. Taking into account the wide range of infectious microbiota that contributes to the development of chronic pathology of the lymphoepithelial pharyngeal ring, the issue of differential diagnosis of the etiology of the disease and the selection of adequate treatment regimens remains relevant. In most cases, at the present stage, the approach to the treatment of patients with chronic inflammation of the lymphoid ring of the pharynx in children is reduced to replacing the surgical method with a conservative one with the appointment of immunocorrective and immunomodulatory drugs. The lack of a positive effect of the ongoing conservative treatment, clinical and laboratory signs of persistent streptococcal infection say us about the need for surgical treatment. At the same time, a group of frequently ill children requires special attention with the development of new regimens of the immunocorrecting and immunomodulating drugs usage.

A Clinical Analysis of Pharyngeal Bronchogenic Cysts in the Pharynx of Children.

Objective: This study was designed to summarize the clinical characteristics, diagnosis and treatment of pharyngeal bronchogenic cysts in children to help in making the correct diagnosis and developing an appropriate treatment plan.Methods: The clinical data of 13 children with bronchogenic cysts in the pharynx, who were treated in otolaryngology head and neck surgery department between September 2013 and July 2019, were analyzed retrospectively. The clinical characteristics were evaluated, and the related factors for diagnosis and treatment were analyzed. Clinical characteristics and imaging features of three cases whose lesions located in the nasopharyngeal, oropharynx, and laryngopharyngeal were demonstrated.Results: All 13 children were male, the youngest being 4 days old, the oldest 6 years and 6 months, and the median age being 1 year and 4 months. Eight patients were diagnosed during a physical examination, and five patients visited the doctor with different degrees of upper airway obstruction. The mass was located in the nasopharynx in one patient, in the oropharynx in eight patients, and in the laryngopharynx in the other four patients. Computed tomography (CT) scanning, which is helpful for a topical diagnosis, showed a dense homogeneous mass. Electronic nasopharyngoscopy showed cystic masses of different sizes in the pharynx. All the children underwent cyst resection under general anesthesia, and the postoperative pathology result was a bronchogenic cyst. One child was lost to follow-up, but the remaining 12 children were followed up for between 6 months and 6 years, during which no recurrence of a cyst was found.Conclusion: Bronchogenic cysts are a rare cyst of the head and neck, and the most common site of the cyst is the oropharynx. The impact on airway obstruction depends on the location and size of the cyst. CT scanning is of great significance for diagnosis. Surgical treatment should be carried out as soon as possible after diagnosis, as surgery is the most effective way to treat bronchogenic cysts. Follow-ups should be carried out regularly to prevent cyst recurrence.

Microorganisms causing respiratory diseases in children in relation to age and diagnosis

Community-acquired pneumonia (CAP) in children is still one of the leading causes of morbidity and mortality, especially in developing countries. The World Health Organization (WHO) has reported that pneumonia accounts for 15% of all deaths of children under 5 years old. The aim of the present study was to find out the predominance of microorganisms in the respiratory tract in children. 334 strains of microorganisms were isolated: Gram-positive – 293 strains, Gram-negative – 41. From the pharynx 183 strains were isolated, from the nose – 94, from sputum – 57. Among Gram-positive microorganisms the following were isolated: Staphylococcus aureus 44 strains of microorganisms, S. epidermidis – 75, Group A β-hemolytic streptococci – 39, viridans streptococci – 55, Streptococcus pneumoniae – 34, Enterococcus faecalis – 2, Candida spp. – 38, Corynebacterium pseudodiphthericum – 6. Among Gram-negative microorganisms the following were isolated: Escherichia coli 4 strains of microorganisms, Klebsiella pneumoniae – 13, Pseudomonas aeruginosa – 6, Haemophilus influenzae – 11, Enterobacter cloacae – 7. Children were divided by age and diagnosis into four groups: I group – children with acute bronchitis (0–5 years of age), II group – children with acute bronchitis (5–18 years of age), III group – children with CAP (0–5 years of age), IV group – children with CAP (5–18 years of age). Materials used in the research – nasal swabs, throat swabs and sputum. Microorganisms were isolated and identified using standard microbiological methods. S. aureus was the predominant microorganism isolate from the pharynx in children with bronchitis (0–5 years). Group A β-hemolytic streptococci were isolated most often from the pharynx in children with bronchitis older than 5 years and in children with CAP less than 5 years of age. S. pneumoniae was most often isolated from the pharynx in children older than 5 years of age with CAP. S. aureus was the main microorganism, isolated from the nose in children with bronchitis in all age groups; in patients with CAP it was the predominant microorganism in children older than 5 years of age. S. aureus was the predominant microorganism, isolated from sputum in children with bronchitis older than 5 years. S. pneumoniae was the predominant microorganism, isolated from sputum in children with CAP older than 5 years. The research showed that S. pneumoniae is still one of the main pathogens that cause CAP in school aged children.

The role of group A β-hemolytic streptococcus in the etiology of acute inflammatory pathology of the pharynx in children and adolescents

Determine the incidence of GABHS in children with catarrhal symptoms (rhinorrhea, cough) and without them. 69 children with signs of acute tonsillopharyngitis (ATP) in the first 2 days of the disease were examined. Patients were divided into 2 groups depending on the presence or absence of rhinorrhea and cough. All patients underwent a comprehensive otorhinolaryngological examination and bacteriological examination of smears from the surface of the posterior pharyngeal wall and lacunae of the tonsils. Obtained data was processed by basic statistical methods. Incidence of GABHS in children with ATP without catarrhal symptoms was 9.5%, with rhinorrhea and cough - 3.7%. Median age for the detection of GABHS in patients with ATP was 5.6 years. A statistically significant symptom of GABHS-positive patients in our study was the enlargement of the anterior cervical lymph nodes; plaques on the tonsils were found only in 20% of cases. GABHS is predominant in patients with ATP without catarrhal phenomena, however, the presence of rhinorrhea and coughing in a patient does not exclude the possibility of the presence of GABHS infection, therefore, patients with ATP should undergo an objective examination for GABHS.

The foundation of treatment of otitis media in children on the modern stage

The pathological inflammatory process in the Eustachian tube, as well as the catarrhal stage of acute otitis media, are the most common conditions in the practice of a pediatric otolaryngologist. The article presents literature data on acute pathology of the middle ear, epidemiology, etiology and standard conservative therapy. The fact of the influence of persistence of herpes virus infection on the development of hyperplastic processes in the lymphoid ring of the pharynx in children is described. It was noted that there are few data on the conduct of etiotropic and pathogenetic therapy in patients with acute middle ear pathology infected with pathogens of latent infections in the literature. The article presents a clinical case of successful treatment of the patient with acute otitis media and timely identified markers of an active infection process. Also the determination of clear indications and the timing of the specific conservative treatment of acute otitis media in children, based on an analysis of the etiological aspects of the development of this disease, the duration and somatic condition of the patient allowed to reduce the percentage of complications and relapses in the development of acute otitis media. When selecting adequate therapy for acute otitis media in children, it is necessary to consider the etiology of the disease in each individual patient. In the presence of acute lymphoproliferative syndrome in combination with middle ear inflammation, it is necessary to verify the causative factor with a laboratory examination (diagnosis by polymerase chain reaction and enzyme-linked immunosorbent assay with antibody detection) for herpes virus infection (Epstein-Barr virus, cytomegalavirus, herpes simplex virus 6 type), with further selection of specific therapy and observation of an otolaryngologist and infectious disease specialist.

Infections of the Neck and Pharynx in Children

To review the current literature and determine noteworthy updates in the evaluation and management of infections of the neck and pharynx in children. To better understand the role of initial surgical intervention versus medical management in children with retropharyngeal, parapharyngeal, or peritonsillar abscess. The risk of airway compromise continues to be important in the evaluation of children with infections of the pharynx. Debate persists on the optimal initial treatment, medical, or surgical. Surgical intervention is recommended for children with signs of airway compromise, prevalence of complications of deep neck space infections, absence of clinical improvement after 48 h of intravenous antibiotics, abscess greater than 2.2 cm on CT imaging, age less than 4 years, or ICU admission secondary to the deep neck space infection. Based on the clinical pathway followed, newer studies show statistically significant differences in length of stay and hospital charges. In regard to PTA, transcervical ultrasound is now being used for initial evaluation to help determine which patients will benefit from incision and drainage. Aside from a few identifiable risk factors, there is still a lack of consensus as to the role and timing of surgical intervention for deep neck space infections. Future, potentially multicenter, research studies are needed to better determine the optimal treatment of pediatric deep neck space infections for both health and economic outcomes.

Persistence of non-typeable Haemophilus Influenzae in the pharynx of children with adenotonsillar hypertrophy after treatment with azithromycin.

This study was performed in children with adenotonsillar hypertrophy to evaluate the effect of azithromycin (AZT) on the presence of NTHi in monocyte/macrophages (CD14(+) cells) of adenoids/tonsils and the persistence of NTHi after adenotonsillectomy. A total of 36 pediatric patients participated in the study: 20 children were treated with AZT before adenotonsillectomy, and 16 children did not receive the antibiotic prior to surgery. NTHi were identified by culture and PCR in swabs and tissue samples. NTHi was detected in the lysates of CD14(+) cells by fluorescence in situ hybridization (FISH) and by culture. The molecular typing was used to cluster NTHi isolates from each child. The intracellular NTHi was found in 10 (62.5%) untreated patients and was identified in three (15%) azithromycin-treated patients (P = 0.003). The proportion of the persistent NTHi strains was similar in both groups. AZT treatment followed by adenotonsillectomy did not completely eliminate NTHi from pharynges; however, it significantly reduced the risk of carriage of Haemophilus influenzae inside the CD14(+) cells.

Diagnosis and management of children with streptococcal pharyngitis.

Physicians must be aware that rheumatic fever can no longer be considered a disease of the past and be prepared to diagnose and treat promptly children with streptococcal pharyngitis. Although the rapid diagnostic kits for detecting Group A streptococci in pharyngeal swabs are not perfect, they can be useful to the practitioner if positive because the specificity of the test is excellent. Thus, a child with pharyngitis who has a positive rapid test should be treated immediately to shorten the period of morbidity and to reduce the risk of nonsuppurative sequelae. Upon completion of a 10-day treatment course there is usually no reason to reculture the pharynx if the child is asymptomatic. Recurrence of symptoms is an indication to perform another culture and to retreat with either benzathine penicillin G or erythromycin depending on compliance of the patient and the agent used initially for therapy. Eradication of Group A streptococci from the pharynx of children who are carriers is usually a difficult and unnecessary task. When eradication is indicated, such as when the carrier has had contact with a person who had rheumatic fever, rifampin should be added to the penicillin regimen (Table 4).

Group A hemolytic Streptococci detected in Nemuro, Hokkaido--changes in types and variations in sensitivity to drugs over a period of approximately seven years

Four hundred eighty-two strains of group A hemolytic streptococci were isolated from the pharynx of children with acute inflammation in the upper airways treated at the Department of Pediatrics, Municipal Nemuro Hospital, during the approximately seven-year period between february 1978 and December 1984. On the other hand, 44 strains of group A hemolytic streptococci were isolated from the pharynx in healthy elementary school children in Nemuro in 1978 and 1985.Typing of these isolated strains was carried out according to T agglutination in order to investigate the changes in the types of strains isolated during the above period. Of these strains, 368 were also examined for variations in sensitivity to drugs.Among the various types, type 12 was most frequent, followed by type 4. The two types, type 12 was most frequent, followed by type 4. The two types were regularly present during the seven years, and their incidences alternately reported increase and decrease in a cycle of three or four years. Other relatively frequent types were types 6, 28 and B3264. These types repeated appearing and disappearing in their particular cycles.These isolated group A hemolytic streptococci were examined for sensitivity to six antibiotics, i. e., PC-G, AB-PC, CET, MINO, EM and CP. The sensitivity to PC-G was highest, followed by those to ABPC and CET. With MINO and EM, a two-peak pattern was occasionally noted in the sensitivity distribution. The sensitivity to CP was relatively invariable. Among the antibiotics, resistance to EM alon was found in some strains; there was no multiple drug resistance in any strain.

Ineffectiveness of isolation of patients as a method of preventing the spread of mumps. Failure of the mumps skin-test antigen to predict immune status.

Abstract During an outbreak of mumps all susceptible children on an open ward were infected despite the fact that cases were isolated at the first sign of parotid swelling. The ineffectiveness of isolation could probably be attributed to the finding that virus was recovered from the pharynx of children before the onset of parotid swelling. Moreover, only nine of 13 mumps infections were manifested by parotitis. Mumps skin-test reactions of children who did not get mumps were less than 10 mm in four, 15 mm or more in one and intermediate in one. Reactions of children in whom mumps subsequently developed were 15 mm or more in four, less than 10 mm in five and intermediate in three. All nine of the children who did not have detectable serum antibody and none of the six who had antibody at the time of exposure subsequently contracted mumps. The neutralizing-antibody test, in contrast to the mumps skin test, proved to be a reliable method for predicting immunity to mumps.

Skin reactions to pneumococci and streptococci

Bruin and Vedder isolated pneumococci from the pharynx of children suffering from respiratory diseases, killed the resulting cultures by heating to 65'C and prepared vaccines, containing from 6 to 20 million cultures per cm3.