Pneumonia with pneumatocele formation caused by Mycobacterium tuberculosis: report of one case

Pneumatoceles are usually characteristic of staphylococcal pneumonia. They are rarely formed as one of the complications of Mycobacterium tuberculosis pneumonia. We report a 1-year-and-5-month old male child with pneumonia who was confirmed to have the rare complication, pneumatocele formation, by chest radiography and computed tomography. Since the patient did not respond to empiric antibiotic therapy, gastric larvage through a nasogastric tube was performed on three consecutive mornings and, as a result, acid fast rods were found on the three specimens. The cultures subsequently yielded M. tuberculosis. He was finally cured with a 6-month course of antituberculous chemotherapy. We conclude that tuberculosis should be considered in infants or young children with pneumonia that presents radiologically as pneumatocele formation, especially in whom there has been no response to empiric antibiotic therapy.

Oral acyclovir prophylaxis of varicella after intimate contact

OBJECTIVES

Whether oral acyclovir (ACV) given in late incubation can prevent clinical varicella or not.

MATERIALS AND METHODS

Twenty-seven healthy infants and children susceptible to varicella received oral ACV (40 mg/kg daily in four divided doses) for 5 days, starting 9 or 11 days after exposure from the index case in the family (2 in the classroom). The clinical features were compared with 13 control children who did not receive ACV. Enzyme-linked immunoassay was used to detect varicella-zoster virus (VZV) antibody and, in follow-up immunologic studies, lymphocyte proliferative response was added. In some cases, blood culture and polymerase chain reaction with Southern hybridization were used for detection of viremia.

RESULTS

Among the 27 children in the treatment group, two (7.4%) developed the disease and seroconversion was observed in 17 subjects (63%). Follow-up immunologic studies in 12 of these 17 seroconverted subjects 30 months later showed persistent cellular and/or humoral immunity to VZV. Only one subject, bled 11 days after exposure, had positive VZV DNA and blood culture for VZV. On the other hand 10 of 13 (77%) control subjects developed clinical varicella.

CONCLUSIONS

Oral ACV administration to healthy susceptible subjects at the beginning of secondary viremia in the late incubation period (9 days after exposure) can effectively prevent or modify clinical varicella.

Specific immune response in adult medical personnel immunized with acellular pertussis vaccine with special emphasis on T helper cell response

Recent epidemiologic data have indicated that adults are the most important reservoir that transmit pertussis to children. However, conventional whole cell pertussis vaccine is contraindicated in adults and children over 7 years of age because of the unacceptably high rate of adverse reactions. The aim of this study is to evaluate the specific cellular immune responses and adverse reactions to a less reactogenic acellular pertussis vaccine in adult volunteers. Eighty healthy medical personnel in Chang Gung Children's Hospital were enrolled. Volunteers in each group received: (1) Td + full strength acellular pertussis vaccine (PT, 1 microgram/0.5 ml; FHA, 4 micrograms/0.5 ml); (2) Td + half strength acellular pertussis vaccine; (3) Td alone. Lymphocyte phenotypic analysis, antigen-specific antibody titers, antigen-specific proliferative response and cytokine levels were evaluated before and 1 month after vaccination. Our data revealed: (1) the adverse reactions were minimal; (2) phenotypic analysis showed no non-specific activation of helper T or memory T cell after vaccination; (3) both PT and FHA-specific antibody titers increased significantly after vaccination, (4) PT antigens had a mitogenic effect on cord blood mononuclear cells and peripheral blood mononuclear cells of the adult volunteers; (5) FHA-specific T cell proliferative responses significantly increased after vaccination; (6) the cytokine production pattern showed predominant activation of Th 1 cells as reflected in increased production of gamma-IFN after vaccination. Acellular pertussis vaccine can effectively induce both humoral and cellular immune response in adults.

Acetaminophen overdose in children and adolescents

From 1982 to 1997, 12 Chinese children were admitted to Chang Gung Memorial Hospital with acetaminophen overdose. Six subjects (one young child, and five adolescents) developed liver damage which was severe in three cases (AST > 1000 IU/L). Acetaminophen-induced liver function abnormalities were characterized by elevation of transaminase levels with ALT higher than AST(6/6), coagulopathy(5/6), thrombocytopenia (1/6), but absence of jaundice(6/6). Fortunately, none of the six patients with liver damage developed fulminant liver failure, and all recovered completely. Acetaminophen overdose can cause significant morbidity in children and adolescents. Caretakers should be well instructed to give the drug correctly. So far, acetaminophen is still considered as the drug-of-choice for antipyresis in pediatric practice. However, multicentered collaborative study is necessary to determine whether acetaminophen intoxication causes less hepatic failure in Chinese children than in Western children.

Isolation and expression of a porcine lactoferrin gene

OBJECTIVE

To elucidate the spatial and temporal expression of a porcine lactoferrin (LTF) gene.

ANIMALS

4 female and 4 male Large White pigs.

PROCEDURES

We examined LTF expression in various organs excised from the pigs, using northern blot hybridization with a porcine LTF cDNA probe. Antibodies against porcine LTF were raised in rabbits and were used along with immunohistochemical staining to localize the LTF protein.

RESULTS

High amounts of porcine LTF mRNA were detected in the secreting mammary gland and epididymis. This distribution is consistent with that of porcine LTF examined by immunohistochemistry. In female pigs, porcine LTF mRNA concentration increased remarkably in the ductal cells of the lactating mammary gland then significantly decreased at day 21 after parturition. Furthermore, specific staining for LTF was observed in the epithelial cells of the gastrointestinal tract of female pigs, but not in the uterus, ovaries, spleen, kidneys, pancreas, muscles, heart, brain, lungs, or liver of postpartum female pigs, or in the testes of male pigs.

CONCLUSIONS

Gene expression of porcine LTF is closely related to lactation in the mammary gland. Distribution of LTF in the epididymis suggests that LTF may have a regulatory role in development of the reproductive tract of male pigs.

Fatal Haemophilus influenzae pneumonia: two cases report

Haemophilus influenzae is a common cause of acute childhood pneumonia. Most Haemophilus pneumonia generally follow a benign course with occasional complications of pleural effusion, pneumothorax or pneumatocele. Deaths following invasive Haemophilus pneumonia have rarely been reported in children older than 3 years of age. We report 2 deaths in children presenting with fulminant pneumonia, complicated by sepsis and adult respiratory distress syndrome despite vigorous antibiotic therapy and full resuscitative measures.

Salmonella typhimurium brain abscess in a six-month-old infant: a case report and review of the literature

We report the case of a six-month-old male infant with brain abscess caused by Salmonella typhimurium. Upon admission, he was suffering from fever, diarrhea, drowsiness and convulsion. Salmonella meningitis was identified by CSF examination. Following failure of antibiotic therapy to control his fever, brain computerized tomography (CT) was ordered 5 days later and revealed a brain abscess. He received surgical excision of the abscess and recovered completely after receiving ceftriaxone therapy for 8 weeks. The case of our patient, together with 11 cases of Salmonella brain abscess from the English literature are reviewed. There was a male preponderance among these patients (male: female = 2.67 : 1) and the majority were less than one year old. Salmonella typhimurium, typhi, and enteritidis occurred most frequently. Fever, seizure, signs and symptoms of increased intracranial pressure and change in mental status were the most common clinical features. Purulent meningitis was a major predisposing factor. Successful treatment was associated with early identification, prompt surgical intervention, high dose, long-term antibiotic therapy, and close follow-up for possible recurrence and to determine the presence of neurological sequelae.

Hepatitis C and G virus infections in polytransfused children

The prevalence of hepatitis C virus (HCV) and a newly identified hepatitis G virus (HGV) and their clinical significance were studied in 42 polytransfused Taiwanese children. Serological assays for antibodies against HCV (anti-HCV) and polymerase chain reaction for serum HCV ribonucleic acid (RNA) and HGV RNA were performed. The prevalence of anti-HCV and HGV RNA was 17% and 14%, respectively in 42 polytransfused children. Anti-HCV seropositives had a significantly higher mean age, peak serum transaminase level, and longer transfusion duration than seronegatives, while children with HGV infection usually had no or only mild hepatitis activities. The prevalence of anti-HCV dropped sharply after implementation of anti-HCV screening, however the prevalence of HGV viraemia remained unchanged.

CONCLUSIONS

HGV infection is not uncommon in polytransfused Taiwanese children and the virus does not cause significant hepatitis compared to HCV infection. Current blood donor screening for anti-HCV can effectively protect polytransfused children from HCV infection but the impact of additional screening for HGV markers awaits further studies.

Unusual manifestations in children with Kawasaki disease

Between January 1983 and December 1992, the medical records of 187 patients (116 boys and 71 girls) with Kawasaki disease (KD) who were admitted to the hospital in the acute phase were retrospectively reviewed. Of these, 175 patients (93.6%) were under 4 years of age. Among the six principal symptoms of KD, the incidence of cervical lymphadenopathy (41.2%) was relatively low. Additionally, we found some unusual features including intussusception in a 4-month-old female, transient thrombocytopenia in seven children (3.7%) and isolated azotemia in five. KD is a systemic disease of unknown etiology. The diverse associated features make KD puzzling and difficult to diagnose. In caring for children with KD, physicians should be alert to the principal symptoms as well as the unusual associated manifestations.

A pilot study of seven days of ceftriaxone therapy for children with Salmonella enterocolitis

BACKGROUND

The most effective therapy for non-typhoid Salmonella enterocolitis is still unknown. Traditionally, unless extraintestinal complications are present, antimicrobial drugs are not recommended, since earlier trials have shown that antibiotics such as ampicillin, chloramphenicol, or co-trimoxazole, do not shorten the duration of diarrhea and may even prolong convalescent fecal carriage of the bacteria. However, the recently-developed third generation cephalosporin ceftriaxone has been used successfully in the treatment of typhoid fever and other systemic salmonellosis. A controlled, pilot study was therefore undertaken to evaluate the efficacy of intravenous ceftriaxone in the treatment of children with non-typhoid Salmonella enterocolitis.

METHODS

Fifteen children with Salmonella enterocolitis and bacteremia who were eligible for antibiotic therapy were given ceftriaxone intravenously for 7 days and 15 children with enterocolitis but without bacteremia who were admitted for supportive treatment during the study period were selected as the control group. Available stool samples collected on days, 7, 14, and 30 after the completion of the drug therapy were checked for the presence of the bacteria using polymerase chain reaction (PCR) and culture methods.

RESULTS

The result showed that the duration of diarrhea was not significantly affected by ceftriaxone treatment. However, the difference in the rate of clearance of Salmonella from stools, as defined by negative stool cultures and PCR, was statistically significant between the two groups on posttreatment days 7 and 14. Only one patient given ceftriaxone was shown to have recrudescence of the bacteria in feces on day 14. One month after therapy, PCR was positive in two of the ten cases tested and one of these two experienced a relapse of diarrhea, whereas bacterial carriage was maintained in 63% of the control patients.

CONCLUSION

A prompt eradication of Salmonella in feces was observed in most of the patients treated with ceftriaxone in this study. If further studies confirm the efficacy of this therapy and the risk of inducing drug resistance is minimal, the epidemiologic problem created by convalescent fecal bacterial carriage may justify a short-course of ceftriaxone therapy for children with Salmonella enterocolitis.

Endocarditis due to Neisseria sicca: report of one case

Many species of the Neisseria, which are respiratory commensals in humans, have been regarded as being nonpathogenic or as causing disease in only immunocompromised hosts. We report a case in which Neisseria sicca was the cause of infective endocarditis in a child with a ventricular septal defect and review the literature on endocarditis due to N. sicca infection. Most of these patients had an underlying heart disease. Dental caries and poor oral hygiene may be two factors that predispose patients to the infection. N. sicca endocarditis usually results in a subacute onset of symptoms and, if not diagnosed early and treated, is associated with a high rate of embolic complications.

Microbiologic and histologic diagnosis of histoplasmosis in Taiwan

Histoplasmosis is one of the most common opportunistic fungal infections in immunocompromised patients in endemic areas. We report the first two microbiologically documented cases of histoplasmosis in Taiwan. The first patient, with acquired immunodeficiency syndrome and a depleted CD4+ lymphocyte count, presented with a history of prolonged fever, papular skin rashes, pancytopenia and elevation of liver enzymes. He was diagnosed and treated initially for systemic toxoplasmosis, but the microbiologic and pathologic findings of the autopsied specimens disclosed disseminated infection caused by Histoplasma capsulatum. The second patient, an elderly man receiving corticosteroids for adrenal insufficiency, manifested with laryngeal histoplasmosis and was successfully treated with ketoconazole.

Early echo-guided percutaneous aspiration of peripheral lung abscesses in children: report of two cases

A 9 year-old boy and a 7 year-old girl suffered from fever and chest pains before they were brought to Chang Gung Children's Hospital. Chest radiographs and computed tomography scans showed lung abscesses with pleural attachment, and using echo-guidance, percutaneous aspirations were done which confirmed the growth of Fusobacterium sp, and Veillonella parvula respectively, both of which are susceptible to penicillin G. The fever and chest pains subsided within 24 hours after the procedure. We suggest using early percutaneous aspiration of peripheral located lung abscesses soon after admission, rather than after a 10-14 day trial of antibiotic therapy: it can be a safe and cost-effective procedure to shorten the duration of the parenteral antibiotic treatment and hospitalization.

Tuberculosis of the long bone in children

From 1985 to 1994, there were 24 cases of long bone solitary tuberculosis. They were 18 boys and 6 girls with an average age of 18 months. All of the patients were treated by open biopsy and curettage and antituberculosis therapy (isoniazid and rifampin) for 6 months. Two patients had incomplete administration of the drug therapy. The lesions were in the metaphysis. Epiphyseal involvement was not significant. The tuberculin skin test was negative in 3 children and the culture was negative in 17 cases. After 2 years and 8 months' followup, there was radiographic evidence of good bone remodeling. Although there uncommonly is not a delay in diagnosis of skeletal tuberculosis despite prolonged symptoms, diagnostic biopsy with curettage of the lesion is indicated for isolated lesions, especially when the diagnosis is in doubt. It is significant that surgical debridement can shorten the duration of antituberculosis therapy and lead to improved results.

The arc index in evaluation of Class III malocclusion

Lateral cephalometric radiographs were obtained for 46 individuals (18 men and 28 women) aged 20 to 30 years. The sample consisted of Taiwanese with Class III malocclusions and prognathic facial profiles. A modification of the Sassouni arch analysis was used to evaluate this group. All parameters were compared with the norms for adult Taiwanese. The facial pattern of the Class III group was similar to that reported in other studies. The maxilla was in a retrusive position; the lengths of the maxilla and the mandible were significantly different from those in the normal group; the mandibular central incisor was retroinclined; and the total gonial angle, upper gonial angle, and lower gonial angle in the Class III group were significantly different from those angles in the normal group in both sexes. The arc index represented the maxillomandibular positional relationship. There was a statistically significant difference between the mean arc indexes of the Class III and the normal groups. The results indicated that the more negative the arc index, the greater the Class III tendency.

Double-blind placebo-controlled study of oxatomide in the treatment of childhood asthma

Oxatomide is an orally active H1-histamine receptor antagonist. It has been demonstrated to have therapeutic efficacy in the treatment of allergic diseases in adults. The aim of this study was to evaluate the efficacy and safety of oxatomide in the treatment of asthma in children. Sixty-four asthmatic children of both sexes, aged between 5 and 16 years, were enrolled in this double-blind, placebo-controlled trial with a duration of 4 months. Patients were randomized chosen to receive either oxatomide with a daily dose of 1 to 2 mg/kg body weight or a placebo twice daily. Clinical evaluations including pulmonary function tests and immunological studies. The patients' impression on the effect of treatment also were recorded during the study. The effects of bronchodilatation and normalizing pulmonary function were observed 2 months after oxatomide treatment. The levels of eosinophil cationic protein and total asthma symptom scores were significantly reduced during treatment with oxatomide. There was no significant change in total IgE or IgG4 before or after treatment in either the treatment or control groups. During the study, two (5.8%) oxatomide treated patients reported slight drowsiness and one (2.9%) reported body weight gain. Routine laboratory tests showed no significant alterations. In conclusion, oxatomide was generally well tolerated in this study and may have the potential of being an effective treatment for childhood asthma.

Identification of febrile neonates unlikely to have bacterial infections

OBJECTIVE

A prospective study was undertaken to evaluate the usefulness of low risk criteria for identifying febrile neonates unlikely to have bacterial infections, particularly bacteremia and meningitis. Using these criteria we wished to check whether these low risk neonates can be safely managed as inpatients under close observation but without receiving empiric antibiotic therapy.

STUDY DESIGN

We conducted a prospective study of 250 consecutive infants 28 days of age or less (range, 4 to 28 days) who had rectal temperatures of at least 38 degrees C. After a complete history, physical examination and sepsis workup, the 131 febrile neonates with clinical and laboratory findings indicating low risk for bacterial infections were hospitalized, closely observed and not given antibiotics. The low risk criteria used to identify these neonates included well appearance; absence of physical signs of an ear, eye or soft tissue infection; a white blood cell count of 5000 to 15,000/mm3, a neutrophil band form count of < 1500/mm3, a spun urine specimen that had < 10 white blood cells per high power field on microscopy and a C-reactive protein value of < 20 mg/l. The remaining 119 febrile neonates who did not meet the low risk criteria were hospitalized and given empiric antibiotics pending culture results.

RESULTS

The overall incidence of bacterial infections in the 250 febrile neonates was 16.4% (41 neonates) with bacteremia and/or meningitis occurring in 4.4% (11 neonates). Of the 131 low risk neonates only one (0.8%) had a bacterial infection (urinary tract infection) compared with 40 (33.6%) among the 119 who did not meet the criteria (P < 0.05). The negative predictive value of these criteria for excluding bacterial infections was 99.2% (95% confidence interval, 97.7% to 100%). For bacteremia and meningitis this figure became 100%. However, the positive predictive value and specificity of the criteria were too low to identify all febrile neonates with bacterial infections. Among the low risk group 58 (44.3%) were reclassified on the second or third hospital day, because of continued fever (35), poor activity (14) and white blood cell count > 15000/mm3 on a repeat blood test (9). They were given antibiotics, but only 1 had a urinary tract infection. This patient was then treated with a 7-day course of antibiotics. All low risk neonates recovered uneventfully with no relapses observed during their hospital stay or at the time of minimum 1-week outpatient follow-up visits.

CONCLUSION

By the low risk criteria a substantial number of febrile neonates at low risk for bacterial infections can be identified and managed safely as inpatients without antibiotic therapy.

Ileal perforation caused by congenital or perinatal cytomegalovirus infection

Enteritis developed in a 42-day-old female infant, and during hospitalization ileal perforation occurred unexpectedly. Serologic data, urinary viral culture, and pathologic studies of the resected ileal segment all suggested cytomegalovirus infection. Gastrointestinal involvement in congenital or perinatal infection with this virus may be relatively more common than previously recognized.

Invasive Haemophilus influenzae diseases and purulent meningitis in Taiwan

We conducted a 3-year Taiwan-wide hospital-based survey of invasive Haemophilus influenzae infections in children less than 15 years of age. From January 1992 to December 1994, 105 cases (57 boys, 48 girls) were reported. Seventy-three patients (69.5%) had meningitis and 32 patients had other diseases (12 pneumonia, 10 sepsis, 7 cellulitis, 3 arthritis). Fourteen patients (13%) died, all of whom had meningitis or sepsis. Among the 63 patients who survived meningitis, 17 (27%) had neurologic sequelae and eight (47%) had hearing impairment. The number of cases of H. influenzae meningitis (30%) and other H. influenzae diseases (29%) peaked in children between 6 and 12 months of age. Patients with invasive infections (82%) and meningitis (73%) were younger than 24 months of age. Only 12 patients (11%) were older than 5 years of age and four had underlying diseases. The annual incidence of invasive H. influenzae infections in children less than 5 years old was 1.9 per 100,000 per year. During the same period a survey of purulent meningitis in children younger than 15 years of age was also conducted in 20 hospitals. A total of 198 patients, in whom the causative organisms were identified, were included; 94 patients were 2 months of age or under and the most frequent pathogen was group B streptococci (35 cases, 37%). Among the 104 patients who were older than 2 months of age, H. influenzae was the leading cause (38 cases, 37%). In conclusion, invasive H. influenzae type b (Hib) diseases exist in Taiwan but have an incidence lower than in Western countries. Hib meningitis is still the most common cause of purulent meningitis in children in Taiwan and is an important cause of mortality and morbidity. Continuous active surveillance of invasive H. influenzae infections is suggested to determine the best time to introduce an Hib conjugate vaccine in Taiwan.

Diagnostic value of C-reactive protein in children with perforated appendicitis

The diagnostic value of serum C-reactive protein (CRP) levels in children with perforated appendicitis was prospectively studied in 78 consecutive patients with histologically confirmed appendicitis. The patients were divided into two groups: group A included 56 patients with perforated appendicitis and group B consisted of 22 patients with simple appendicitis. Serum CRP level and leucocyte count were assayed in all and abdominal ultrasonography was performed in 75. The mean age group A patient was significantly lower than that of group B patients (7.5 vs. 10.4 years, P < 0.001). Group A patients had a significantly higher mean serum CRP levels than group B patients (92 vs. 31 mg/l, P < 0.001), while the mean leucocyte count was comparable in the two groups. Of 75 examined patients, 73 (97%) had a pre-operative sonographic diagnosis of appendicitis.

CONCLUSION

Perforation is a common complication in children with appendicitis, especially in those of young age and with prolonged pain duration. Greatly increased serum CRP levels (> or = 50 mg/l) and abdominal ultrasonography are important diagnostic aids in such patients.

Responses to primary and a booster dose of acellular, component, and whole-cell pertussis vaccines initiated at 2 months of age

A second generation acellular pertussis vaccine (component pertussis vaccine) containing purified pertussis toxin (PT) and filamentous hemagglutinin (FHA) was tested for its immunogenicity and safety in 2-month-old infants in comparison with first-generation acellular and whole-cell pertussis vaccines. At the ages of 2, 4, 6, and 18 months, respectively, 350 subjects were inoculated one dose of pertussis vaccine, which was combined with diphtheria and tetanus toxoids. Both acellular and component vaccines elicited significantly much fewer local and systemic reactions than whole-cell vaccine did. Besides, although not reaching statistical significance, the component vaccine was less reactogenic than the acellular vaccine. After each dose of the primary immunization, antibodies against PT and FHA were much higher in acellular and component pertussis vaccinees than in whole-cell vaccinees. However, at 18 months of age, just before the booster dose, both anti-PT and anti-FHA declined very close to, or even lower than, the prevaccination levels in all three groups and then responded rapidly to a booster dose to attain high levels. The booster responses were also significantly higher (P < 0.01) in acellular and component groups than in whole-cell group. Component and acellular vaccines induced similar levels of anti-FHA but the former induced higher anti-PT than the latter (P < 0.01). Our results indicate that both in primary immunization and as a booster, acellular and component pertussis vaccines are much more immunogenic for PT and FHA and much less reactogenic than whole-cell vaccine. However, the persistence of anti-PT and anti-FHA was not as good as one can expect from other protein antigens without giving a booster dose. A long-term follow-up of the vaccinees has been underway to understand the persistence of these antibodies after the first booster.

The structure and expression of an hsc70 gene from Lycopersicon esculentum

A tomato hsc70 genomic clone (Lehsc70-3; Lycopersicon esculentum heat-shock cognate 70-3) was obtained by screening a genomic library with the tomato Lehsc70-2 cDNA. Two restriction fragments of 2.6 and 5 kb, which compose the Lehsc70-3 gene, were subcloned into pBluescriptIIKS+ and analyzed. Transcript mapping reveals that the mature Lehsc70-3 mRNA contains a 122-nt 5' untranslated region (UTR), a coding region of 1956 nt corresponding to a polypeptide of 651 amino acids, an intron of 717 nt and a 3' UTR. Analysis of genomic DNA indicates that Lehsc70-3 is present as a low-copy-number gene. We note that the sequence upstream from the coding region of Lehsc70-3 shares common features with a number of hsc/hsp genes. High-temperature treatment (37 degrees C) caused a twofold increase in the level of the Lehsc70-3 mRNA. However, Lehsc70-3 has also been expressed at substantial levels in tomato vegetative tissues, suggesting a general function of this hsc70 gene in L. esculentum.

Congenital anomalies following maternal varicella infection during early pregnancy

We report a typical case of congenital varicella syndrome following a maternal varicella infection during the 10th week of pregnancy. The presenting symptoms in the small gestational age baby were: cicatricial skin lesion, Horner's syndrome,dysphagia with resulting aspiration pneumonia and delayed developmental milestones. Serologic studies revealed persistence of varicella zoster virus IgG for at least 10 months. Although congenital varicella syndrome is rare, it should be kept in mind when counseling families where maternal varicella infection has occurred during the first 20 weeks of gestation. A maternal history of varicella infection, typical manifestations and serologic proof are crucial in the diagnosis of congenital varicella syndrome.

Evaluation of chronic atelectasis in children using chest computed tomography and bronchoscopy

A heterogeneous group of 11 children with atelectasis persisting longer than one month were investigated for the causes using chest computed tomography and fiberoptic bronchoscope. Four young infants had right upper lobe (RUL) posterior segmental atelectasis simulating RUL lobar collapse in plain chest films; all had only two visible segmental bronchi by bronchoscopic examination. Intraluminal obstruction in the central airway was not a common cause of pediatric chronic atelectasis in this small series of patients. Only one obstructive atelectasis caused by dilated pulmonary arteries was detected in this study. Two patients with pre-existing neuromuscular diseases showed multiple atelectasis. The atelectatic lobes do not spontaneously re-inflate following flexible bronchoscopy. Investigations involving a larger number of cases are needed to substantiate the etiologies and to guide specific therapy for those children with chronic atelectasis.