Use of OM-85 BV in children suffering from recurrent respiratory tract infections and subnormal IgG subclass levels

BACKGROUND

Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels.

METHODS

This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment.

RESULTS

IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 1.4 (mean SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 1.5 ARTIs (-2.4 [3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients.

CONCLUSION

This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV.

Cytomegalovirus infection in patients with solid-organ transplant. Recently reviewed immunologic response and pathogenicity mechanisms

Cytomegalovirus (CMV) infection in immunocompromised host is an important cause of morbidity and mortality. The protective immunity against the virus is both humoral and cellular. Immunologic mechanisms in rejection as in the immune response against CMV infection are similar but there is difficult to separe as histologic and clinically independent events. At least eight different genes of CMV are homologous to human proteins related to the immune response. The potential role of these genes with homology to human genes can be at different levels. The relevance that immunodominant antigens have on the natural control of CMV infection, suggests that the future design of a vaccine directed to protecting from disease those susceptible to primary infection, in an immunocompromised state, should involve a combination of antigens that include pp65, IE1-exon 4 and gB as a recombinant proteins.

Clinical outcome of invasive infections in children caused by highly penicillin-resistant Streptococcus pneumoniae compared with infections caused by penicillin-susceptible strains

BACKGROUND

In this report based on data from the Institutional Surveillance System during 1994-1998, we document the continuing emergence of drug-resistant Streptococcus pneumoniae strains at the Hospital Infantil de Mexico Federico Gómez in Mexico City.

METHODS

We evaluate the clinical course of 49 invasive pneumococcal infection outside the central nervous system (CNS) by a number of factors including the site, severity, and place where the infection was acquired, the underlying health of the patient, and the adequacy of antimicrobial therapy.

RESULTS

An underlying illness was present in 21 of 49 (43%) patients, 37 (75%) patients had taken previous antimicrobial therapy, and 25% of the infections were nosocomially acquired. Overall, 25 of 49 (51%) of the pneumococcal strains tested were pencillin-resistant; strains with the highest resistance to penicillin were also resistant to cephalosporins. Twenty-two percent of all strains were considered to be multidrug-resistant. Eleven of 25 penicillin-resistant strains were identified as multidrug-resistant, i.e., to erythromycin, TMP/SMX, and chloramphenicol. Ten serotypes accounted for 88% of the isolates, the most frequent serotypes being 23F, 14, 19V, 6A, and 6B. The overall case-fatality rate was 37% (18 of 49), with most deaths occurring within 3-5 days after antibiotic therapy was initiated. There was no difference in the case fatality rate between children with penicillin-nonsusceptible and penicillin-susceptible pneumococcal infections; instead; case-fatality rate correlated with severity of illness on admission and presence of underlying disease.

CONCLUSIONS

Characterizing groups at risk for invasive pneumococcal disease could aid in the development of preventive programs and increase the benefits from wide use of future conjugated vaccines.

[Antimicrobial resistance characteristics of clinical isolates of Streptococcus pyogenes]

OBJECTIVE

To determine the antibiotic susceptibility of recent isolates of Streptococcus pyogenes and to evaluate the prevalence of macrolide-resistant phenotypes.

MATERIAL AND METHODS

In 1999, we conducted a cross-sectional study at Mexico Children's Hospital "Federico Gomez", to analyze one hundred strains of S. pyogenes isolated from 1992 to 1998, in children with uncomplicated pharyngotonsillitis. Strains were frozen at the bacteriology lab until they were analyzed. Strains were tested for susceptibility against some beta-lactams, macrolides and clindamycin. Double-disk testing was carried out to evaluate erythromycin-resistant phenotypes. Data are presented using central tendency measures.

RESULTS

All tested strains were not resistant to beta-lactams and clindamycin; 16% of the strains were resistant to macrolides and all of them belonged to phenotype M.

CONCLUSIONS

Susceptibility testing is recommended to identify possible changes in antibiotic resistance to streptococci.

[Clinico-microbiological characteristics of meningitis caused by penicillin-resistant Streptococcus pneumoniae]]

OBJECTIVE

To evaluate the susceptibility to antibiotics of Streptococcus pneumoniae isolated from cerebrospinal fluid of children with meningitis. To describe and compare the clinical and microbiological characteristics, treatment and outcome among children infected with strains either susceptible or resistant to penicillin and cephalosporin.

MATERIAL AND METHODS

A total of 38 children with pneumococcal meningitis were prospectively enrolled in the Institutional Surveillance Program for Pneumococcal Infections during 1994-1998. Clinical and laboratory data were collected by chart review.

RESULTS

Of the 38 children, 24 (63%) were less than 2 years of age, 11 (28.9%) had drug-resistant S. pneumoniae, 18.4% had intermediate resistance, 10.5% high level resistance and 2.6% also showed high level resistance to cefotaxime. The only associated factors (by Fisher's exact test) associated to resistance were: previous use of antibiotics (p = 0.2), underlying disease (p < 0.001). Course of illness and clinical course were similar for children infected with penicillin or cefotaxime susceptible, vs. non-susceptible strains.

CONCLUSIONS

Current levels of S. pneumoniae resistance to penicillin and cephalosporin are not associated to an increase in mortality in children with meningitis.

[Epidemic outbreak of viral meningitis caused by type 30 ECHO virus]

The clinical records of 15 children admitted to Hospital Infantile de México Federico Gómez with diagnosis of viral meningitis were reviewed. They were part of 19 patients admitted with this diagnosis during a 5 week period (March 22 to April 30, 1992) and represent a significant increase of aseptic meningitis compared with the same periods of previous years at Hospital Infantile de Mexico and in Mexico City where there is an ongoing epidemic outbreak of this entity. All the patients studied had spinal fluid findings consistent with viral meningitis and in 4 of them on ECHO virus type 30 was isolated at the Enterovirus Section of the CDC, Atlanta Georgia USA.

[Antimicrobial sensitivity profile of Staphylococcus aureus at a pediatric hospital: prevalence of resistance to methicillin]

Methicillin-resistant Staphylococcus aureus (MRSA) has become a significant cause of nosocomial infections. In efforts to delineate the magnitude of this problem, we determined the prevalence of MRSA in community acquired (n = 382) and nosocomial strains (n = 207) of S. aureus isolated between Jan 1986 and March 1989. Antimicrobial susceptibility was evaluated using an agar dilution method (Muller-Hinton agar supplemented with 4% NaCl incubated to 35 degrees C for 24 h) and MIC breakpoints were determined according to NCCLS standards. We detected (24.2%) MRSA in nosocomial strains and (5%) MRSA in community acquired strains (P less than 0.05), with a global prevalence of 11.7%. The susceptibility of community acquired S. aureus was 90% or higher for dicloxacillin, cephalothin, sulbactam/ampicillin (S/A), clindamycin, rifampicin and amikacin; 85% for cefotaxime and SMX/TMP and only 75% for erythromycin. The susceptibility pattern of the nosocomial strains was consistent with the prevalence of MRSA but the susceptibility for cephalothin, amikacin and sulbactam/ampicillin was 84.4%, 89.4% and 86.5% respectively, significantly higher than for methicillin (P less than 0.05). Although the increased susceptibility for cephalothin and amikacin has been reported for MRSA before, the published reports using these antibiotics in the treatment of MRSA infections are controversial. The increased susceptibility of MRSA to S/A could be explained in part if the MR was mediated by "acquired MR" attributable to B-lactamase production. Our data provide a perspective on the magnitude of MRSA as a problem in a pediatric teaching hospital in Mexico. Moreover, if taken at face value, the in vitro susceptibility data point to various potential treatment options which warrant clinical evaluation.

[Actinomycosis of the bladder in a girl]

Abdominal actinomycosis is a rare finding in pediatric patients and its location in the urinary bladder is exceptional. On the other hand, immunodepression can be found in several disorders including that of actinomycosis. The purpose of this study was to report a case of urinary bladder actinomycosis seen in a seven year old girl. No risk factors were found. It was diagnosed as an abdominal tumor which was successfully surgically removed and treated with penicillin. During her recovery, she suffered from a transitory cell-mediated depression of her immune system which later returned to normal once treatment as installed. The pathogenesis of actinomycosis is presented and a review of the literature is cited. Actinomycosis; immunodepression; bladder.