Spread of rotavirus within families: a community based study

The spread of rotavirus infection was studied over four weeks in a sample of 28 families exposed to a child with rotavirus infection. The results showed a high incidence of intrafamilial infection, with 46% of members of these families developing rotavirus infections compared with none in another series of 18 families. Children in the families with an index case were more frequently affected than adults: 75% of the children developed rotavirus infection but only 33% of the adults. Children tended to suffer the infection in a more severe form. Intrafamily contact is clearly important in transmitting rotavirus infection, and preventive measures should aim at reducing the likelihood of such cross infection.

Acute respiratory infection in childhood: the factors which influence hospital admission

A study of 100 children admitted to hospital with acute respiratory infection revealed that general practitioners remain the major referral source. Changing financial factors do not appear to have influenced this process. Sixty percent of children had a mild illness, requiring a short period hospital stay, but their referral was on a medical rather than a social basis.

General practitioner prescribing practices for childhood respiratory infection

Prescribing practices for respiratory infection during the first three years were studied in a birth cohort of Christchurch children. Of the 5630 consultations studied 39 percent were treated with antimicrobial therapy only, 23 percent by antimicrobials supplemented by other medication, 22 percent by other medication only and 16 received no medication. There were only 27 return consultations because of the iatrogenic effects of medication prescribed for respiratory infection and all of these involved adverse reactions to antimicrobial treatment. However, in no case did these reactions require further treatment other than withdrawing or changing the child's medication. The implications of the high rate of antimicrobial prescribing present for this sample are discussed.

Bone marrow transplantation for acute leukaemia and severe marrow aplasia: an analysis of five patients

Five patients, three with severe aplasia and two with acute leukaemia have been treated by bone marrow transplantation (BMT). Four are alive and well with excellent graft function. One showed engraftment but died of acute graft-versus-host disease (GVH); this patient and his donor were hepatitis B antigen positive. Three show evidence of mild chronic GVH, two patients requiring control by immunosuppressive therapy. Bone marrow transplantation (BMT) has now become an established method of treatment in severe aplasia and in acute leukaemia and our results serve to emphasise this. The clinical and organisational problems associated with BMT are discussed.

Pituitary gigantism in a 31 month old girl: endocrine studies and successful response to hypophysectomy

A case of pituitary gigantism occurring in a 31 month old female child is reported. Growth records indicate that the disorder began early in the second yr of life. Apart from her size and history of excessive sweating, there were no characteristic clinical features of endocrinopathy. Elevated and autonomous secretion of GH (60-109 microgram/l) and prolactin were corrected by the removal of an eosinophilic pituitary adenoma. In the subsequent 6 yr, despite the presence of immunoreactive GH (4.6-17.3 microgram/l), plasma somatomedin was subnormal and the patient showed growth failure which responded normally to exogenous GH therapy. This case, which appears to be the youngest example of verified pituitary gigantism on record, illustrates that a successful outcome can be achieved by surgical ablative therapy.

Right atrial catheters for long-term venous access

Thirty-two Hickman central venous catheters were placed in patients suffering mainly from blood disorders. The catheters remained in situ for an average of 64 days. In 20 patients the catheters were removed either because they were no longer needed (14) or at death (6). In five patients they are still in position. Complications in seven patients led to the catheter being removed and these included four patients with catheter related sepsis. The use of these catheters allows safe long-term access to the venous circulation even in the neutropenic, immunosuppressed patient.

Transient leukemoid proliferation of the cytogenetically unbalanced +21 cell line of a constitutional mosaic boy

A newborn without any signs of Down's syndrome was found to have an acute proliferation that remitted without drug therapy. Chromosomal analysis of blood, bone marrow, and skin cells revealed that the child was a constitutional mosaic with normal cells and a low number of cells in which one no. 21 chromosome was replaced by a probably isochromosome for the no. 21 long arm: 46,XY/46,XY,i(21q). The abnormal cell line of the mosaic appeared to be selectively involved in this proliferation.

Bone marrow transplantation for severe aplastic anaemia

An eight-year-old girl with severe acquired aplastic anaemia received a bone marrow transplant from her 11-year-old brother. The bone marrow graft is firmly established, but the patient has mild chronic graft versus host disease affecting liver and skin. The indications for bone marrow transplantation in aplastic anaemia are discussed.

Amoxycillin and co-trimoxazole in presumed viral respiratory infections of childhood: placebo-controlled trial

A double-blind randomized controlled trial of amoxycillin, co-trimoxazole, and placebo was conducted on 197 children presenting with presumed viral respiratory infections. Routine throat swabs were taken to exclude streptococcal diseases. The three disease categories studied--nasopharyngitis, pharyngotonsillitis, and bronchitis (including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment. Nevertheless, seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment. Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn. Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary. Thus the return consultation rate in children receiving placebo therapy was 15% compared with 4% for those receiving antimicrobial treatment. Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment. Placebo treatment allowed an earlier return to normal activity. There was a high incidence of possible side effects on all regimens including placebo. It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal, and they should not be routinely prescribed for these conditions.

Treatment of urinary-tract infection with a single dose of amoxycillin

31 patients with a urinary infection were treated with a single oral dose (3 g for adults and 100 mg/kg for children) of amoxycillin; 23 (74%) were cured. 20 women and 26 children were then randomly allocated to either a single dose of amoxycillin of a 5- to 7-day conventional course of the same antibiotic. The results of both treatment regimens were comparable. Single-dose therapy for the treatment of urinary-tract infections was simple, effective and well tolerated. Patients preferred taking their treatment in this manner. Failure of single-dose therapy to eradicate bacteriuria may indicate which patients require subsequent investigations of their urinary tract.

Neonatal bacteriuria: a prospective study in 1,460 infants

In a prospective study of 1,460 virtually consecutive neonates 14 (1%) were found to have bacteriuria, established by bladder puncture. Eleven were boys and three girls. Five of the infants with bacteriuria had symptoms suggestive of infection and were treated with antibiotics. The remaining nine were asymptomatic and remained so during a period of observation-five cleared their urine of bacteria without treatment, and four received antibiotics. Only one infant with bacteriuria had bacteraemia. Six infants had more than 10 white blood cells per mm(3) in the bladder puncture urine and three had proteinuria. The blood urea was slightly raised in only two of the infants. The intravenous pyelogram was normal in all infants with bacteriuria but eight had slight or moderate vesicoureteric reflux when examined by micturating cystourethrography.

Bacteriuria in pregnancy and infection in amniotic fluid and infant

Women with asymptomatic bacteriuria during pregnancy had sterile amniotic fluid at the time of delivery. There was no evidence that maternal urinary infection was associated with infection in the infant.

Transient asymptomatic bacteriuria in infancy

Spontaneous clearing of bacteriuria occurred in three infants during the neonatal and early infancy period. In all cases, the presence of bacteria was confirmed by bladder puncture, no signs of clinical infection were present, and no treatment was given. The same host defence mechanisms as exist in adults were probably responsible for this phenomenon.