Infectious Diseases and Developmental Immunology

Infectious
Diseases and Developmental Immunology

   

• B
  Jonsson, M Rylander, (Karolinska Hosp, Stockholm)
  
  
  Ureaplasma urealyticum, Erythromycin and Respiratory
  Morbidity in High-Risk Preterm Neonates.
  
  
  Acta Paediatr 87: 1079-1084, 1998.
  
    
  
  
  Ureaplasma urealyticum (Uu) often colonizes the
  lungs of very premature infants (less than 30 weeks’
  gestation). The relationships between Uu
  colonization and respiratory morbidity or chronic
  lung disease (CLD) in very premature infants were
  studied; whether Uu treatment with erythromycin
  would have an effect on morbidity was also assessed.
  
    
  
  
  Findings: Compared with infants without Uu
  colonization, infants colonized with Uu were
  significantly younger (25 vs 26 weeks’ gestation),
  and their mothers were significantly more likely to
  have premature rupture of membranes (PROM 48% vs
  12%), chorioamnionitis (46% vs 17%), and vaginal
  delivery (71% vs 29%). Use of supplemental oxygen at
  36 weeks’ postconceptual age was also significantly
  more common in the colonized infants.
  
    
  
  Conclusion : Ureaplasma urelayticum colonization was
  related to immaturity, PROM, chorioamnionitis, and
  vaginal delivery. However Uu colonization was not a
  significant independent predictor of the need for
  supplemental oxygen at 36 weeks’ postconceptual age.
  Similarly, treatment of colonized infants with
  erythromycin tended to eradicate their infection but
  had no effect on their supplemental oxygen needs.
  Thus, if Uu does play an important role in the
  development of chronic lung disease in very
  premature infants, its influence probably occurs
  very early in lung development and would have to be
  treated early, possibly in utero.
  
    
  
  
  Editorial comments: Uu is somehow related to
  prematurity and chorioamnionitis but should not
  necessarily be implicated in chronic lung disease.
  Furthermore, administration of erythromycin reduces
  colonization but not duration of oxygen therapy.
  
     
  

• TA
  Joseph, SP Pyati, (Cook County Children’s Hosp,
  Chicago; Finch Univ, North Chicago; Univ of
  Illinois, Chicago)
  
  
  Neonatal Early-Onset Escherichia coli Disease: The
  Effect of Intrapartum Ampicillin.
  
  
  Arch Pediatr Adolesc Med 152: 35-40, 1998.
  
    
  
  
  One of the most organisms responsible for sepsis
  during the newborn period is E.coli. Ampicillin has
  been increasingly used by obstetricians for
  intrapartum chemoprophylaxis for group B
  streptococcal disease. However the consequences of
  this practice are unknown. The clinical
  characteristics and outcomes associated with
  early-onset neonatal E.coli disease were delineated,
  and the effect of increased use of intrapartum
  ampicillin during recent years on the rate of early-onet
  E.coli infection and case fatalities was assessed.
  
     
  
  
  
  Methods: Intrapartum ampicillin use increased since
  1988 and infection and case fatality rates were
  compared before 1988 and afterwards.
  
    
  
  
  
  Results: Early-onset E.coli infection was diagnosed
  in 30 of the 61498 liver births, and the infected
  neonates had a clinical syndrome that was
  indistinguishable from early-onset group B
  streptococcal infection. The single most frequent
  finding in 73% of the infected neonates was
  respiratory distress.
  
    
  
  
  Ampicillin resistant infection was found in a higher
  proportion of neonates born to ampicillin treated
  women. In mothers with sensitive organisms and
  resistant organisms, the difference between the
  prevalence of intrapartum fever was significiant in
  proportionate cases. Ampicillin resistant organisms
  caused all 6 early onset E.coli related deaths; of
  these 4 of the 6 mothers received intrapartum
  ampicillin.
  
    
  
  
  
  Conclusion : There has been a shift of early-onset
  E.coli infection from a less fulminant disease
  caused by ampicillin-sensitive organisms to a more
  fulminant disease caused by organisms that are
  resistant to ampicillin.
  
    
  
  
  Editorial comment: The concern that attempts to
  eradicate the group B streptococcus (GBS) will
  result in the reemergence of resistant gram-negative
  organisms may be well justified. 
  
    
  
  
  Towers et al have also written on this particular
  subject and they observed that the incidence of
  early-onset neonatal sepsis with group B
  streptococci decreased during their study periods,
  whereas the incidence of early-onset sepsis with
  non-group B streptococcal organisms, especially
  E.coli, increased. It is important that the
  recommendations for the use of intrapartum
  penicillin G, rather than ampicillin, for
  prophylaxis against group B streptococci be
  followed.
  
    
  

• M
  Adhikhari, T Pillay, DG Pillay (Univ of Natal,
  Kwa-Zula Natal, South Africa)
  
  
  Tuberculosis in the Newborn: An Emerging Disease.
  
  
  Pediatr Infect Dis J 16: 1108-1112, 1997.
  
    
  
  
  Introduction: Despite the global increase of
  tuberculosis, which has been fueled, in part, by the
  HIV infection pandemic, it is rare to see
  tuberculosis in the perinatal period.
  
    
  
  
  Methods: Seventy-seven neonates, with a differential
  diagnosis of tuberculosis, were studied during a
  1-year period in a province with epidemics of
  tuberculosis and HIV infection. For neonates with a
  confirmed diagnosis of tuberculosis, the clinical
  profiles, short-term outcome, and relationship to
  maternal tuberculosis and HIV infection were
  determined.
  
    
  
  
  The clinical characteristics of tuberculosis and HIV
  coinfection in the adult have been well
  characterized. In contrast to immunologically normal
  patients, in whom tuberculosis infection remains
  subclinical in the overwhelming majority, HIV
  infected patients develop a clinical disease much
  more frequently. There is a marked predilection for
  extra pulmonary spread of the mycobacteria,
  particularly to the lymph nodes, central nervous
  system, bone marrow, and genitourinary and
  gastrointestinal tracts.
  
    
  
  
  Conversely, it also has been noted that tuberculosis
  can accelerate clinical deterioration in the
  HIV-infected patient independent of the morbidity
  caused by the tuberculosis infection itself.
  
    
  
  
  The cause for this deterioration are speculative,
  but cytokines produced after M tuberculosis
  infection, particularly tumor necrosis factor and
  interleukin-1, promote HIV replication in vitro and
  may do so in vivo as well.
  
    
  
  
  In the United States there is aggressive screening
  for HIV infection among tuberculosis clinic
  patients, and tuberculosis screening among HIV
  clinic patients; this results in early diagnosis and
  treatment of both. Moreover, intragestational
  prophylaxis to prevent vertical transmission of HIV
  to the newborn is highly effective and has resulted
  in a dramatic diminution in the number of neonates
  born with HIV and its resultant severe immunologic
  impairment.
  
    
  

• ME
  O’Connor, W Schmidt, et al (Case Western Reserve
  Univ, cleveland, Ohio)
  
  
  Relaxation Training and Breast Milk Secretory IgA
  
  
  Arch Pediatr Adolesc Med 152:1065-1070, 1998.
  
    
  
  
  A study was undertaken to determine whether
  relaxation training and suggestion to breast feeding
  women would increase the secretory IgA (sIgA) levels
  in their breast milk to improve the immunity of
  breast-fed infants.
  
    
  
  
  It was concluded that breast milk sIgA levels were
  increased with self-reported stress. sIgA levels
  were inversely related to success at relaxation in
  the group learning to relax.
  
    
  
  
  Editorial comments: However, as all new mothers are
  sleep deprived and stressed, it should be of some
  comfort and consolation for them to learn that this
  is beneficial for their babies.