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Green RS, Sartori LF, Florin TA, Aronson PL, Lee BE, Chamberlain JM, Hunt KM, Michelson KA, Nigrovic LE. Predictors of Invasive Bacterial Infection in Febrile Infants Aged 2 to 6 Months in the Emergency Department. J Pediatr 2024; 270:114017. [PMID: 38508484 DOI: 10.1016/j.jpeds.2024.114017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Our goal was to identify predictors of invasive bacterial infection (ie, bacteremia and bacterial meningitis) in febrile infants aged 2-6 months. In our multicenter retrospective cohort, older age and lower temperature identified infants at low risk for invasive bacterial infection who could safely avoid routine testing.
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Affiliation(s)
- Rebecca S Green
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Laura F Sartori
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Todd A Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Brian E Lee
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kathryn M Hunt
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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Hunt KM, Michelson KA, Balamuth F, Thompson AD, Levas MN, Neville DN, Kharbanda AB, Chapman L, Nigrovic LE. Racial Differences in the Diagnosis of Lyme Disease in Children. Clin Infect Dis 2023; 76:1129-1131. [PMID: 36314085 DOI: 10.1093/cid/ciac863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
Black children with Lyme disease compared with children of other races were less likely to have an erythema migrans lesion diagnosed (adjusted odds ratio, 0.34; 95% confidence interval, .14-.79) but more likely to have a swollen joint (adjusted odds ratio, 3.68; 95% confidence interval, 2.13-6.36) after adjustment for age and local Lyme incidence.
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Affiliation(s)
- Kathryn M Hunt
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fran Balamuth
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy D Thompson
- Division of Emergency Medicine, Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
| | - Michael N Levas
- Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Laura Chapman
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Scott CS, Richards SJ, Sivakumaran M, Short M, Child JA, Hunt KM, McEvoy M, Steed AJ, Balfour IC, Parapia LA. Transient and persistent expansions of large granular lymphocytes (LGL) and NK-associated (NKa) cells: the Yorkshire Leukaemia Group Study. Br J Haematol 1993; 83:505-15. [PMID: 8485057 DOI: 10.1111/j.1365-2141.1993.tb04678.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A survey of 870 different adult blood samples (primarily from patients with non-haematological disorders) found that 269 (31%) had increased proportions (> 25%) and/or absolute numbers (> 1.0 x 10(9)/l) of morphologically-defined large granular lymphocytes (LGL), and/or phenotypically-defined NK-associated (NKa) cells. Of these, 112 were re-analysed at least 6 months after initial presentation and were classified as 'persistent' (92/112) or 'transient' (20/112) according to whether or not the original abnormality was still present. Lymphocyte counts in most patients with persistent abnormalities were within normal limits (18/92) or slightly increased (68/92), with only six having a lymphocytosis exceeding 10.0 x 10(9)/l. With the exception of five persistent LGL expansions in which the granular lymphocytes did not express NKa determinants (designated LGL+NKa-), the remaining 87 cases could be phenotypically grouped according to their primary abnormality as CD8+NKa+ (n = 33), CD4+ NKa+ (n = 14), CD8dim+NKa+ (n = 7) or CD8-NKa+ (n = 33). TCR genotypic studies in 58 patients showed that the 16 patients with rearranged TCR components were restricted to the CD8+NKa+ group and that, in most of these, the CD8+ fraction showed abnormal relative CD16/CD56 expression. Persistent neutropenia (n = 15) also appeared to be associated with primary abnormalities of CD8+NKa+ cells (12/15), with 10 of these additionally showing rearranged TCR genes. In contrast, persistently increased CD8dim+NKa+ and CD8-NKa+ components did not appear to phenotypically differ from their corresponding 'counterparts' in normal bloods or in patients with transient LGL/NKa+ abnormalities. This survey has therefore established that persistent LGL/NKa+ abnormalities are considerably more common than suggested in published work, that a high proportion of patients with expanded CD8+NKa+ components, with quite diverse clinical histories, show evidence of clonal lymphoid populations, and that the clonal nature of such disorders appears to be associated with abnormal NKa phenotypic patterns.
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Affiliation(s)
- C S Scott
- Yorkshire Leukaemia Diagnostic Unit, Cookridge Hospital, Leeds
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Sivakumaran M, Richards SJ, Hunt KM, Steed AJ, Bynoe AG, Morgan MM, Pyrah R, Roberts BE, Scott CS. Patterns of CD16 and CD56 expression in persistent expansions of CD3+NKa+ lymphocytes are predictive for clonal T-cell receptor gene rearrangements. The Yorkshire Leukaemia Group. Br J Haematol 1991; 78:368-77. [PMID: 1714758 DOI: 10.1111/j.1365-2141.1991.tb04450.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Phenotypic characteristics, and correlations between the expression of membrane NK-associated (NKa) determinants (CD11b, CD16, CD56 and CD57) and T cell receptor (TCR) genotypic patterns, were examined in 25 patients with persistent (greater than 6 months) expansions of CD3+WT31+NKa+ (CD8+ and CD8dim+) lymphocytes. These studies showed that distinct NKa phenotypic profiles were restricted to cases with rearranged TCR configurations and that clonal CD3+NKa+ components could be predicted in most cases by assessing relationships between membrane CD16 and CD56 expression. For all normal NKa subpopulations, there was a high correlation (P less than 0.0001; n = 31) between the expression of these two membrane determinants. Markedly increased CD16 expression by CD3+NKa+ cells, in relation to CD56 (i.e. a high CD16:CD56 ratio), was found exclusively in cases with rearranged TCR (13/16 cases); 2/3 of the remaining cases showing significantly reduced CD16:CD56 ratios and high (greater than 2.0) CD3+CD56+ absolute numbers. In contrast, 7/9 of the germline TCR cases had a normal CD16:CD56 ratio and 2/9 a decreased ratio with low (less than 1.0) CD3+CD56+ absolute numbers. A high ratio of CD16:CD56 expression by CD3+NKa+ lymphocytes was therefore informative for 82% of TCR rearrangements in this series; and analysis of CD16 and CD56 expression was predictive for germline and rearranged TCR configurations in 24/25 persistent CD3+NKa+ expansions.
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MESH Headings
- Adult
- Antigens, CD/immunology
- Antigens, Differentiation/analysis
- Antigens, Differentiation/immunology
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Differentiation, T-Lymphocyte/immunology
- CD3 Complex
- CD56 Antigen
- Clone Cells
- Gene Rearrangement, T-Lymphocyte/immunology
- Humans
- Immunophenotyping/methods
- Killer Cells, Natural/immunology
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Fc/analysis
- Receptors, Fc/immunology
- Receptors, IgG
- T-Lymphocytes/immunology
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Affiliation(s)
- M Sivakumaran
- Leukaemia Diagnostic Unit, Cookridge Hospital, Leeds
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Abstract
The treatment of primary proliferative polycythaemia (polycythaemia rubra vera) may include radioactive phosphorus (P32) in conjunction with venesection. Acute leukaemia or carcinoma can be associated with the use of P32. We present a case of primary proliferative polycythaemia treated by repeat venesection together with P32 whose follow-up was complicated by the development of malignant neuroblastoma.
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Affiliation(s)
- J K Murphy
- Department of Pathology, Bradford Royal Infirmary, West Yorkshire
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Cocks PS, Adib RS, Hunt KM. Concurrent carcinoma of penis and carcinoma-in situ of the cervix in a married couple. Case report. Br J Obstet Gynaecol 1982; 89:408-9. [PMID: 7082597 DOI: 10.1111/j.1471-0528.1982.tb05085.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ogborn AD, Hunt KM, Gordon H. Factors affecting fetal survival after intrauterine transfusion for rhesus isoimmunization. Br J Obstet Gynaecol 1977; 84:665-8. [PMID: 410430 DOI: 10.1111/j.1471-0528.1977.tb12677.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intrauterine transfusion of the fetus is described in 165 pregnancies. The overall fetal survival rose from 28 per cent in 1964 to 1969 to 42-5 per cent in 1973 to 1975. Apart from technical complications of the procedure itself, the factors most likely to affect fetal survival were the gestational age and amniotic fluid optical density difference before the first intrauterine transfusion, the birth weight and the cord blood haemoglobin level.
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Hunt KM. Doptone foetal pulse recorder. Nurs Mirror Midwives J 1968; 126:38-9. [PMID: 5184801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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