The challenge of penicillin-resistant Streptococcus pneumoniae meningitis: current antibiotic therapy in the 1990s

Bacterial meningitis caused by Streptococcus pneumoniae is an important cause of neurological morbidity and mortality in both children and adults. With increasing antibiotic resistance in pneumococci and documented microbiological failure in treatment of pneumococcal meningitis with cefotaxime and ceftriaxone, the need for alternative antibiotic therapy is critical. Of the currently available options, vancomycin has shown the most promise, particularly when used in combination with ceftriaxone or cefotaxime. Rifampin, also used in combination with either ceftriaxone or cefotaxime, has demonstrated encouraging preliminary results against antibiotic-resistant pneumococci as well. Chloramphenicol has unexpectedly yielded discouraging clinical results in children with infection caused by penicillin-resistant strains. Of the investigational antibiotics currently in clinical trials for the treatment of meningitis, meropenem, a carbapenem-class antibiotic, has demonstrated increased activity against penicillin-resistant pneumococci compared with that of other beta-lactam antibiotics, while having a safety profile similar to that of the cephalosporins.

Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis

There are reports of failure of extended-spectrum cephalosporin treatment in pneumococcal meningitis. On the basis of in vitro and animal experimental studies, the addition of vancomycin or rifampin to an extended-spectrum cephalosporin has been recommended for empiric treatment of these patients. Cerebrospinal fluid (CSF) was taken from 31 children with bacterial meningitis randomized to receive ceftriaxone alone (n = 11), ceftriaxone plus rifampin (n = 10), or ceftriaxone plus vancomycin (n = 10). The CSF from children receiving ceftriaxone alone was unable to kill intermediately ceftriaxone-resistant or fully resistant strains when the concentration of ceftriaxone in the CSF was less than 5 micrograms/ml. At higher concentrations bactericidal activity was present. We have shown that vancomycin penetrates reliably into the CSF of children with acute meningitis, which is in contrast to previous studies with adults. The addition of vancomycin or rifampin to ceftriaxone resulted in significantly enhanced CSF bactericidal activity compared with that of ceftriaxone alone against these resistant strains. Our data suggest that the addition of rifampin or vancomycin to ceftriaxone may be useful for the treatment of cephalosporin-resistant pneumococcal meningitis.

Rhabdomyolysis associated with acute varicella infection

We report two cases of intense, generalized rhabdomyolysis complicating varicella-zoster virus (VZV) infections, one in an adolescent and one in a young adult male. In both cases, myoglobinuria and weakness of large muscle groups developed within 5 days of the onset of vesicular lesions. A muscle biopsy from one of the individuals showed muscle fiber necrosis in the absence of acute inflammatory infiltrates or vasculitis. Culture of the muscle biopsy specimen for VZV was negative; however, the VZV genome was detected by the polymerase chain reaction. Both patients recovered fully after treatment with hydration therapy alone.

Ceftriaxone therapy of bacterial meningitis: cerebrospinal fluid concentrations and bactericidal activity after intramuscular injection in children treated with dexamethasone

Antibiotic therapy is administered intravenously to children with bacterial meningitis to achieve the highest possible blood and cerebrospinal fluid (CSF) concentrations. However, intravenous access for the entire duration of therapy may be difficult in some children. Intramuscular therapy offers a more versatile option; however, CSF concentrations and bactericidal activity following im injection in children concurrently treated with dexamethasone have not been studied. We prospectively evaluated 37 children given an im dose of ceftriaxone on either the 3rd, 6th or 9th day of antibiotic therapy while receiving dexamethasone for the first 4 days of treatment. All children were required to have normal peripheral perfusion at the time of im injection. Four to 6 hours after im injection CSF was obtained. The average age of study patients was 28 months; Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b were responsible for 95% of all infections. All children studied had detectable CSF ceftriaxone concentrations, with mean (+/- SD) concentrations (microgram/ml) on Days 3, 6 and 9 of therapy of 5.7 +/- 5.5 (n = 12), 5.2 +/- 5.0 (n = 14) and 2.0 +/- 2.6 (n = 10), respectively. All CSF bactericidal titers for N. meningitidis, S. pneumoniae and H. influenzae type b, regardless of day of im injection, were > or = 1:64. Intramuscular ceftriaxone therapy of bacterial meningitis may be a reasonable therapeutic option for the convalescing child with good peripheral perfusion.

Outpatient parenteral antibiotic therapy. Management of serious infections. Part II: Amenable infections and models for delivery. Meningitis

Children with bacterial meningitis are ideal candidates for outpatient parenteral antibiotic therapy; most recover from the acute infection within five days and do not require skilled nursing observation of neurologic status during the entire course of therapy. Before discharge, the child should be afebrile, show a good response to therapy, and demonstrate no neurologic abnormalities.

Outpatient parenteral antibiotic therapy. Management of serious infections. Part I: Medical, socioeconomic, and legal issues. Pediatric considerations

Outpatient parenteral antibiotic therapy (OPAT) is less threatening to children than in-hospital treatment and most likely reduces the risk of nosocomial infection. Most pediatric infections can be treated in the home if patients are medically stable, parents are motivated to help with therapy, and appropriate resources, such as skilled pediatric nursing, are available. The cost of pediatric OPAT is similar to that of adult OPAT.

Single-dose pharmacokinetics and safety of HA-1A, a human IgM anti-lipid-A monoclonal antibody, in pediatric patients with sepsis syndrome

The pharmacokinetics and safety of HA-1A (Nebacumab), a human IgM monoclonal antibody with specificity for the lipid A region of endotoxin, were evaluated in a multicenter trial of pediatric patients with sepsis syndrome or septic shock. Forty-two patients received a total of 44 infusions of drug, at a dose of 3 mg/kg (maximum 100 mg). The mean age was 7 years 10 months (range, 11 months to 16 years 7 months). The pharmacokinetic behavior of HA-1A during 36 hours was best described by a one-compartment open model. Clearance (6.1 +/- 2.0 ml/kg per hour) and apparent volume of distribution at steady state (0.11 +/- 0.03 L/kg) were larger than values reported previously in adults with sepsis syndrome. Elimination half-life (14.5 +/- 6.8 hours) and plasma concentration after infusion (30.7 +/- 14.5 mg/L) were similar to adults' values. In an additional three patients studied for 72 hours after administration, a biexponential function (i.e., two-compartment open model) best described the pharmacokinetic behavior of HA-1A: clearance (1.5 +/- 1.4 ml/hr per kilogram) and apparent volume of distribution at steady state (0.2 +/- 0.02 L/kg) were different (p < 0.002) from values observed in children's blood samples during 36 hours. Within the pediatric population, no age-related differences in pharmacokinetics could be detected. Drug disposition was unaffected by renal or hepatic dysfunction. Decreased blood pressure was the most frequently reported adverse event; 4 (9%) episodes in 44 infusions were considered possibly related to the study drug. Gram-negative bacteremia was documented in 23 (55%) of 42 patients. The overall mortality rate was 31%. Enterobacter cloacae was the most common pathogen isolated. Haemophilus influenzae type b was isolated from one child with sepsis syndrome. We conclude that infusion of HA-1A in children is associated with a low incidence of side effects. The pharmacokinetic-pharmacodynamic behavior of HA-1A in children requires further study to determine whether developmental differences exist and how these differences might affect drug administration. Efficacy remains to be studied.

Once-daily ceftriaxone to complete therapy of uncomplicated group B streptococcal infection in neonates. A preliminary report

Newborn infants minimally symptomatic with non-central nervous system (CNS) infections due to Streptococcus agalactiae (group B streptococcus [GBS]) and other pathogens may not require skilled nursing care during the entire course of parenteral antibiotic therapy. In 1985, treatment guidelines were made available to private practitioners in Oregon for therapy of newborn infants at low risk of complications from their infections. In 1988, patient data were collected and analyzed retrospectively. Outpatient management during convalescence of 51 infants (21 with culture-positive infections due to GBS) was accomplished with once-daily physician follow-up examinations and IM injection of ceftriaxone. Long-term (greater than or equal to two months) follow-up data were available for 67% of GBS-infected infants, with no complication of infection or significant complication of therapy reported. Outpatient parenteral antibiotic management of selected, low-risk infants may offer the clinician an alternative to hospitalization for a portion of the duration of parenteral antibiotic therapy.

Once-daily ceftriaxone in the outpatient treatment of paediatric infections

Parenteral ceftriaxone was administered as a once-daily outpatient treatment to a selected low-risk population of neonates, infants, and children with moderate to severe bacterial infections. No incidences of treatment failure were seen in 200 children with uncomplicated infections responsive to ceftriaxone therapy. The mean period of outpatient treatment in initially hospitalized children with non-CNS infections, excluding endocarditis, was 1-3 days. Ceftriaxone outpatient management was successful in the control of organisms causing meningitis (n = 54), periorbital facial cellulitis (n = 16), sinusitis (n = 10), arthritis (n = 6), endocarditis (n = 4), and other infections.

A Monte Carlo study of tests on data originating from quadrat sampling. I: Data from a Poisson distribution

Computer simulations are used to examine the significance levels and powers of several tests which have been employed to compare the means of Poisson distributions. In particular, attention is focused on the behaviour of the tests when the means are small, as is often the case in ecological studies when populations of organisms are sampled using quadrats. Two approaches to testing are considered. The first assumes a log linear model for the Poisson data and leads to tests based on the deviance. The second employs standard analysis of variance tests following data transformations, including the often used logarithmic and square root transformations. For very small means it is found that a deviance-based test has the most favourable characteristics, generally outperforming analysis of variance tests on transformed data; none of the latter appears consistently better than any other. For larger means the standard analysis of variance on untransformed data performs well.

Hereditary nephritis in the bull terrier: evidence for inheritance by an autosomal dominant gene

A high prevalence of renal failure has been reported in bull terriers in Australia. The pattern of inheritance was analysed in a family of 33 bull terriers in which 10 dogs had renal disease manifested by proteinuria, ultrastructural abnormalities in the glomerular basement membrane, renal failure, or 'end stage' kidneys. The presence of at least one affected parent for each affected offspring, the approximately equal male/female ratio and the apparent absence of 'generation-skipping', strongly supported an autosomal dominant mode of inheritance, assuming a fully penetrant single major gene locus. Further evidence was not compatible with either an autosomal recessive or X-linked inheritance pattern. This contrasts with the X-linked inheritance shown in Alport's-type human hereditary nephritis and hereditary glomerulopathy in the samoyeds. Hereditary nephritis in the bull terrier should be a useful model for non-Alport's-type human hereditary nephritis, which is also reported to have an autosomal dominant inheritance pattern.

Exposure of health care workers to ribavirin during therapy for respiratory syncytial virus infections

Health care workers (HCW) are exposed to ribavirin aerosol during therapy of infants with respiratory syncytial virus infections. To assess the degree of HCW exposure, we analyzed air samples from patient rooms and HCW personal breathing zones during ribavirin aerosol delivery by ventilator (two samples), oxygen hood (two samples), and a new vacuum exhaust hood (four samples). HCW exposure to ribavirin during aerosol delivery by ventilator or vacuum exhaust hood system was substantially lower than HCW exposure during aerosol delivery by oxygen hood in rooms with adequate ventilation.

Predominance of T cells that express CD45R in the CD4+ helper/inducer lymphocyte subset of neonates

Neonates have an increased risk of severe infections. For several in vitro and in vivo immune responses, neonates have been shown to have significant differences when compared to normal adults. To indirectly study immune cellular defects, we compared cell surface markers on cord blood lymphocytes (CBL) from 58 term infants to peripheral blood lymphocytes (PBL) from 17 healthy adults using flow cytometry with standard as well as newly defined monoclonal antibodies (Mab) that distinguish regulatory T cells. CBL had significantly smaller percentages of lymphocytes that express the CD2 and CD8 markers (total T cells, and suppressor/cytotoxic T cells, respectively), although absolute numbers of CD2+ and CD8+ cells were comparable in neonates and adults. CBL and PBL were similar in terms of the percentage of CD4+ cells (helper/inducer T cells), although the absolute numbers of CD4+ cells were higher in CBL than in PBL. The CD4+ population was subdivided into cells bearing the virgin and memory T cell phenotypes using anti-2H4 and anti-4B4 Mab and dual parameter analysis with anti-CD4. Neonates were deficient in the percentage of CD4+, 4B4+ (3.8 +/- 2.8 vs 13.4 +/- 7.5, P less than 0.001), but equivalent to adults in the percentage of CD4+, 2H4+ T cells (21.4 +/- 9.8 vs 18.8 +/- 12.8). In absolute numbers, neonates had fewer CD4+, 4B4+ cells (178 +/- 173 vs 344 +/- 152 cells/microliters, P less than 0.001), but more CD4+,2H4+ cells (978 +/- 572 vs 542 +/- 518 cells/microliters, P less than 0.01) than adults. The predominance of 2H4+ virgin T cells in the CD4 population whose function is associated with that of the induction of suppression rather than the up-regulation of immune responses may contribute to the observed susceptibility of neonates to infection.

Assessment of an Approximate Lethal Dose Technique for Determining the Relative Susceptibility of Non-Target Species to 1080-Toxin

The susceptibility of eight species of dasyurid marsupials and five species of murid rodents from the pastoral areas of Western Australia to the toxin sodium monofluoroacetate (Compound 1080) was assessed. Both LD*5O tests and an increasing dose procedure to determine the approximate lethal dose (ALD) were used. The results ranged from a low ALD of 1.6 mg kg-1 for an island population of Pseudomys hermannsburgensis to a high of 20 mg kg-1 for a mainland population of Notomys mitchelli. Intraspecific and regional variation in sensitivity was evident: three populations of P. hermannsburgensis showed widely different ALDS, and high ALDS were found in the Millstream area relative to elsewhere in the pastoral regions. Where both ALD and LD*5O were available, the dose response curve was steep; all LDSOS were less than a factor of 1.5 above the ALD. LD*5O values and ALDS were significantly correlated for selected dasyurids and murids, using published data. A computer simulation based on sampling a standard number of animals from 10 theoretical populations differing only in their LD~O confirmed that ALD and LD*5O gave similar rankings of sensitivity, although high variance on the LD~O reduced the strength of the correlation. Actual dosing data from eight populations of Rattus fuscipes were also analysed; both LD*5O and ALD gave similar rankings of population sensitivity. Subject to assumptions about the variability of sensitivity within a population, the ALD offers an alternative to LD~O testing that requires fewer animals, and need not cause more than one death per population tested.

An Assessment of the Potential Target Specificity of 1080 Predator Baiting in Western-Australia

The potential hazard of 1080 baiting for predators to 14 species of non-target mammals in the pastoral areas of Western Australia and a further six from Western Australia's Fitzgerald River National Park, was assessed by comparing projected doses of 1080 (based on consumption of non-toxic bait by captive animals in the absence of alternative food) with the approximate lethal dose of 1080 for each species. These figures suggested that individuals from 12 species were potentially at risk from crackle baits, while only individuals from Dasyurus hallucatus, Ningaui spp., Sminthopsis crassicaudata, Planigale maculata, one population of Leggadina forresti and one population of Sminthopsis ooldea were potentially endangered by meat baits. Tests using the native mammals Zyzomys argurus and Pseudomys hermannsbergensis and laboratory mice (Mus musculus) and laboratory rats (Rattus norvegicus) showed that individuals of all species reduced their consumption of toxic bait relative to non-toxic bait, although this did not prevent three of five rats and one of three P. hermannsbergensis from being killed.

Outpatient therapy of serious pediatric infections with ceftriaxone

Convalescent outpatient parenteral antibiotic therapy with ceftriaxone was evaluated in an uncontrolled study of 101 children with documented serious bacterial infections, including meningitis. Criteria for outpatient therapy were established to assure that risks of complications from the illness were minimal at the time of discharge from the hospital. Daily physician visits and motivated, capable parents were considered essential in outpatient management. Ceftriaxone was given once daily to children with non-central nervous system infections and once or twice daily intravenously to children with meningitis. The mean durations of therapy for children with non-central nervous system infections and with meningitis were 2.4 and 4.6 days, respectively. No child enrolled in this study was readmitted to the hospital for medical or social reasons. Probable complications of treatment included diarrhea in 13% of children with meningitis and in 6% of children with non-central nervous system infections. One child with meningitis developed pseudomembranous colitis. For children who are infected with bacteria that are highly susceptible to ceftriaxone, single daily dose outpatient therapy is a reasonable option for management if a good clinical response to initial treatment is demonstrated and the risks of complications of the disease process are negligible.

The Relationship Between Prey Size and Handling Time and Prey Size and Capture Success in 3 Sympatric Species of Dasyurid Marsupials

Regressions of handling time on prey weight were determined for the dasyurids Srninthopsis hirtipes, S. ooldea and Ningaui spp. preying on grasshoppers and cockroaches in the laboratory. In all cases, a simple linear regression fitted the relationships better than logarithmic models. The slopes of the regression lines were steeper for grasshopper prey than for cockroach prey in all species, and for each prey type the slopes for the predators were ranked in order of predator weight. Capture efficiency, defined as the proportion of successful attacks, did not vary significantly between predator species and prey types, and all predators showed declining capture efficiencies with increasing prey size. Niche separation in these dasyurids does not appear to be based on different optimal prey sizes for each species.

Invasive bacterial disease in childhood: efficacy of oral antibiotic therapy following short course parenteral therapy in non-central nervous system infections

Recommendations vary considerably for duration of parenteral therapy of common bacteremic infections in children. To assess the efficacy of the current standard of practice by private pediatric practitioners in Portland, OR, we reviewed hospital and clinic records of children older than 6 months of age with non-central nervous system bacteremic disease due to Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis and Group A Streptococcus during 1981 to 1984. Diagnoses were: cellulitis (buccal/periorbital), 21; bacteremia without focus, 17; epiglottitis, 13; pneumonia, 7; and other, 4. The average duration (range) of fever (greater than 37.9 degrees C) was 1.8 days (0.5 to 21 days), that of parenteral therapy was 2.9 days (0 to 10 days) and that of oral therapy was 9.5 days (4 to 42 days). No complications of inadequate therapy assessed by clinical or microbiologic failure were reported in study patients. Our review suggests that in a private practice where compliance and accessibility of medical care are good, parenteral therapy for non-central nervous system bacteremic disease need be continued only until the child is afebrile for 24 to 48 hours; outpatient oral therapy should be provided to complete a 10- to 14-day total course of antibiotics. A lumbar puncture should be performed in bacteremic children to rule out occult meningitis.

Neonatal herpes simplex encephalitis: correlation of clinical and CT findings

Review of 31 computed tomographic (CT) scans in 15 neonates with herpes simplex encephalitis (HSE) type 2 revealed the most characteristic early findings to be patchy and widespread areas of low attenuation, primarily in white matter, with minimal contrast material enhancement in a meningeal pattern. The low-attenuation lesions increased rapidly in size and prominence during the course of the disease. This was usually accompanied by increased attenuation of cortical gray matter that persisted for weeks to months. Atrophic changes appeared rapidly, being evident in the 3d week. Late findings consisted of very extensive, diffuse, low attenuation of white matter with cortical atrophy. Calcification assumed a variety of distributions, from punctate to an extensive gyral pattern. The cerebellum was involved in nine patients. Early CT findings were not good predictors of outcome, but later serial CT scans showing progression or stability of findings were more accurate in prognosis. CT serves primarily to confirm the diagnosis of neonatal HSE.

Humoral and cell-mediated immunity in neonates with herpes simplex virus infection

Fifty-nine neonates with herpes simplex virus (HSV) infection were evaluated with use of assays for neutralizing antibody (NAb), lymphocyte transformation (LT), alpha interferon production, and virus-specific antibody (immunoblots). Infants with disseminated disease or onset in the first week of life were more likely to lack NAb. Patients treated with vidarabine were more likely than those treated with acyclovir to develop a fourfold rise in NAb titer. Infants with encephalitis showed a broader spectrum of IgG and IgM antibody reactivity against HSV proteins by immunoblotting than did those who had earlier onset of mucocutaneous illness. Only 10 of 33 infants had HSV-specific LT, compared with eight of eight adults with primary HSV. Neonates with positive LT were more likely to show a fourfold rise in NAb titer. In vitro alpha interferon production was diminished in infants, compared with values in adults.

Speech intelligibility studies in classrooms

Speech intelligibility tests and acoustical measurements were made in ten occupied classrooms. Octave-band measurements of background noise levels, early decay times, and reverberation times, as well as various early/late sound ratios, and the center time were obtained. Various octave-band useful/detrimental ratios were calculated along with the speech transmission index. The interrelationships of these measures were considered to evaluate which were most appropriate in classrooms, and the best predictors of speech intelligibility scores were identified. From these results ideal design goals for acoustical conditions for classrooms were determined either in terms of the 50-ms useful/detrimental ratios or from combinations of the reverberation time and background noise level.

Predictors of speech intelligibility in rooms

Three different types of acoustical measures were compared as predictors of speech intelligibility in rooms of varied size and acoustical conditions. These included signal-to-noise measures, the speech transmission index derived from modulation transfer functions, and useful/detrimental sound ratios obtained from early/late sound ratios, speech, and background levels. The most successful forms of each type of measure were of similar prediction accuracy, but the useful/detrimental ratios based on a 0.08-s early time interval were most accurate. Several physical measures, although based on very different calculation procedures, were quite strongly related to each other.

Toxic shock syndrome in a scald burn victim

A child with 12% total body surface area superficial and partial-thickness burns was admitted to the Oregon Burn Center. Within 48 hours of admission, signs and symptoms of toxic shock syndrome (TSS) were present including high spiking fevers, vomiting, diarrhea, hypotension, conjunctival hyperemia, and a diffuse macular erythroderma. Cultures of skin pustules and burn wounds grew Staphylococcus aureus. This strain has been shown to produce staphylococcal enterotoxin B (SEB). This case appears to be the first reported of toxic shock syndrome in a burn victim caused by staphylococcal enterotoxin B.

Neonatal infections

The spectrum of neonatal infections continues to evolve with changes in the types and antibiotic susceptibilities of bacterial pathogens and the prominent appearance of new clinical syndromes of infection in the newborn intensive care unit. Fortunately with the development of new antibiotics and thorough reevaluation of older antibiotics in the neonate, effective antimicrobial therapy is still available. With the knowledge of national and local trends of infecting organisms, it is possible to select an accurate empiric antibiotic regimen for neonatal sepsis.

Upper airway obstruction due to laryngeal coccidioidomycosis in a 5-year-old child

Laryngeal coccidioidomycosis with severe upper airway obstruction occurred in a 5-year-old boy. Diagnosis was confirmed by positive serum precipitin and complement fixation titers, pathologic demonstration of typical Coccidioides spherules in biopsy specimens from subglottic tissue and paratracheal lymph nodes, and culture of C. immitis from the subglottic tissue specimen. The child was treated successfully with tracheostomy and intravenously administered amphotericin B (total dose of 60 mg/kg).

Culling and wastage in dairy cows in East Anglia

A culling survey in 80 Friesian dairy herds in East Anglia over four years investigated the age at, and reasons for, disposal or death. Failure to conceive was the most important reason except in very old animals. Low production was the second most common reason, culling being particularly heavy in the first two lactations. Mastitis was the major disease influencing wastage and increased with age until the sixth lactation. The percentage of culls for multiple reasons increased with age. There was a high proportion of young animals in most herds and the median lactating life of cows was about three years, equivalent to three lactations. Considerable variation in herd life demonstrated that there was substantial scope for improving herd longevity. Long living herds culled fewer animals for breeding problems in the early lactations and for mastitis in the later ones, enabling more animals to be culled as surplus and for production factors.

Neutralization of herpes simplex virus by antibody in amniotic fluid

The ability of amniotic fluid to neutralize herpes simplex virus type 2 (HSV-2) was quantitated and compared with the serum neutralization titer in 158 pregnant women. Neutralizing activity was expressed as the ability of 0.1 ml of amniotic fluid to reduce the expected number of plaque-forming units (pfu) in the inoculum by 99%. All amniotic fluid samples from 32 women with serum titers of 1:40 or greater neutralized 5 pfu or more; at term, 96% of these fluid samples neutralized 50 pfu or more, 83% neutralized 500 pfu or more, and 61% neutralized 5000 pfu or more. Only 76% of the amniotic fluid samples obtained at term from women with serum titers of 1:5 to 1:39 contained detectable neutralizing activity and only 8% neutralized 5000 pfu or more. None of the amniotic fluid samples from 30 women with serum titers less than 1:5 neutralized 5 pfu or more. All neutralizing activity was removed when immunoglobulin G was removed from the amniotic fluid samples. Sera were obtained from 51 pregnant women 4 to 8 weeks prior to delivery. All women with serum titers of 1:40 or higher gave birth to infants who also had serum titers of 1:40 or higher. Therefore, it is possible to predict the neutralization titer in amniotic fluid and in the infant's serum by measuring the mother's titer in the third trimester.

Prevention of transfusion-acquired cytomegalovirus infections in newborn infants

Transfusion-acquired cytomegalovirus infections occurred in 13.5% of 74 infants of seronegative mothers who were exposed to one or more blood donors who had a CMV indirect hemagglutination titer of 1:8 or higher. None of 90 infants of seronegative mothers exposed only to donors with CMV IHA titers of less than 1:8 became infected. Ten of 41 (24%) infants of seronegative mothers who received more than 50 ml of packed red blood cells and who were exposed to at least one seropositive donor became infected. None of 23 infants of seronegative mothers who received this amount of blood but who were exposed only to seronegative donors became infected. Fatal or serious symptoms developed in 50% of the infected infants of seronegative mothers and in none of the 32 infected infants of seropositive mothers. Acquired CMV infections occurred in 15% of infants of seropositive mothers who were exposed to the red blood cells of seropositive donors and in 17.6% of infants of seropositive mothers exposed only to seronegative donors. Use of seronegative donors reduced the prevalence of excretion of CMV among hospitalized infants who were 4 weeks of age or older from 12.5 to 1.8% and eliminated acquired CMV infections in infants of seronegative mothers.

Carbon fibre reinforced epoxy as a high strength, low modulus material for internal fixation plates

A multi-axial carbon fibre/epoxy composite fracture plate has been developed. This type of plate appears to allow early consolidation of internally fixed fractures whilst avoiding the ensuing disadvantage of 'plate induced osteopoenia' which are observed with metal devices. The mechanical properties of these plates (determined 'in vitro') are reported, along with early results of implantation in sheep.