Ebola and Marburg Fever

The incubation period for Ebola virus is between 3 and 21 days and for Marburg virus between 3 and 9 days. In contrast to Lassa fever, the onset of VHF caused by these viruses is abrupt, with onset of a prodrome lasting less than 7 days. This comprises non-specific symptoms including fever, chills, severe headache, malaise, myalgia and a maculopapular rash (onset day 2 to 7 typically on the face, neck, trunk and arms). This is followed by a rapid and progressive deterioration with severe,...

Recommendations for the Use of Antibiotic Prophylaxis

Current clinical guidelines regarding the use of antimicrobial prophylaxis for recurrent UTIs in children highlight the uncertainty that surrounds their efficacy. For example, the American Academy of Pediatrics currently recommends the use of prophylactic antibiotics for all children with UTIs in whom documented VUR exists American Academy of Pediatrics, 1999 , whereas Swedish guidelines limit prophylaxis to high grades of reflux 4-5 only Jodal and Lindburg, 1999 . We know that UTIs may be...

The Role of the Pharmaceutical Industry

By the year 2015 each of the 191 United Nations member states have pledged to meet a set of Millennium Development Goals for global health and human rights Table 3.4 . Considering the NTDs probably impact on more of these goals than any other single entity it is astonishing that the NTDs still retain their neglected status. The global pharmaceutical industry failure to invest in new drugs for these diseases has produced particularly serious consequences. Of the 1,233 drugs commercialized...

NTM Lymphadenitis

Lymph node disease is the most common manifestation of NTM infection in children and has been extensively described Schaad et al., 1979 Colville, 1993 Hazra et al., 1999 Saggese et al., 2003 Panesar et al., 2003 Mandell et al., 2003 Haverkamp et al., 2004 . There are many retrospective case series making comparisons of different surgical treatments in children with significant lymphadenopathy. However, evidence on appropriate drug treatment is confined to small case series. Most NTM isolated...

References

Barzilay, E.J., O'Brien, K.L., Kwok, Y.S., Hoekstra, R.M., Zell, E.R., Reid, R., Santosham, M., Whitney, C.G., Feikin, D.R. 2005 . Could a single dose of pneumococcal conjugate vaccine in children be effective Modeling the optimal age of vaccination. Vaccine Sep 30 Epub . Black, S., Shinefield, H., Fireman, B., Lewis, E., Ray, P., Hansen, J.R., Elvin, L., Ensor, K.M., Hackell, J., Siber, G., Malinoski, F., Madore, D., Chang, I., Kohberger, R., Watson, W., Austrian, R., Edwards, K. 2000 ....

Impaired T Helper 1 Function

Numerous studies have demonstrated decreased Th1 function in neonatal CD4 T cells Adkins, 1999 Ehlers and Smith, 1991 Gasparoni et al., 2003 Pirenne-Ansart et al., 1995 Trivedi et al., 1997 Wu et al., 1993 In part, these findings reflect the increased numbers of differentiated memory T cells of the Th1 subset in adult blood compared to neonatal blood. Na ve CD45RAhighCD45R0low cells comprise approximately 60 of the CD4 T cells in most adults while they represent nearly 90 of cells in infants...

T Helper 1 Cells

Cd154 Into Cd40

Th1 immunity is essential to control infection by certain intracellular bacteria e.g., Mycobacteria, Salmonella, Listeria reviewed in Picard and Casanova 2004 , viruses e.g., herpesviruses , fungi e.g., Candida, Pneumocystis , and protozoa e.g., Toxoplasma, Plasmodium . A typical primary Th1 immune response to an intracellular pathogen, such as Mycobacterium tuberculosis, begins when a myeloid dendritic cell takes up cellular material that includes pathogen proteins and loads peptides from...

Introduction

Streptococcus pneumoniae, pneumococcus, is one of the major bacterial pathogens of childhood. Infections caused by this organism range from the very severe e.g., meningitis and septicaemia , to non-bacteremic pneumonia and to less severe upper respiratory tract infections such as acute otitis media and sinusitis. The spread of HIV infection has increased the incidence of pneumococcal disease, especially in many resource poor countries where anti-HIV treatment is not readily available. It is...

Prehospital Management

Once infected by P. falciparum, without prompt diagnosis and appropriate treatment, progression to severe malaria is likely in a non-immune child. This should always be assumed even for children raised in malaria-endemic areas but now residing in non-malarious areas. Immunity requires years of repeated infection and rapidly wanes when the person is no longer exposed to infective mosquito bites. When a child presents with a possible travel-associated or tropical illness it is important to take a...

The Current Generation of Vaccines

The problem of intussusception from the rhesus vaccine changed the way that the next generation of rotavirus vaccines would have to be tested. The rhesus vaccine had demonstrated that live oral vaccines could be highly effective and protect children against severe rotavirus diarrhea. However, new vaccines also had to jump the hurdle of safety and demonstrate greater safety than Rotashield. While trials of several thousand children were adequate to demonstrate vaccine efficacy, trials exceeding...

Diagnostic Specimens

Many screening tests for C. trachomatis require appropriately handled samples containing columnar epithelium from mucosal sites e.g., endocervix, urethra, or conjunctiva rather than exudate the adequacy of specimens should be verified by periodic cytologic evaluations. The discomfort caused by obtaining a urethral swab in males has precluded its widespread use in asymptomatic men. A dipstick test for leukocyte esterase LE performed on the first portion of a voided urine is a cost-effective and...

Clinical Evidence for Deficiencies of TCell Mediated Immunity in the Neonate

Cytomegalovirus CMV is a ubiquitous herpes virus that ultimately infects 50-90 of the population. For the vast majority of children and adults, infection, which usually occurs after mucosal contact with bodily secretions, is either asymptomatic or results in a self-limited non-specific viral syndrome characterized by fever, hepatosplenomegaly, leukopenia, and myalgias Gandhi and Khanna, 2004 . During active infection, virus is shed from mucous membranes and is detectable in both urine and...

Community Awareness Education and other Control Measures

Education, particularly in concert with the support of local traditional healers and religious leaders, has proven a valuable component of outbreak control in the African setting as some cultural and traditional practices can be counterproductive, particularly those associated with certain burial practices. After death, cadavers should be buried or burned immediately and sheets, gloves and clothing that have been in contact with patients also need to be burned CDC, 2005c . Finally, an integral...

Assessment and Triage of Children with Severe Malaria

As for any other sick child presenting to hospital the initial management of a child with suspected malaria should be guided by a rapid, structured, triage assessment, aimed at identifying emergency and priority signs 1997 Group, 2001 Box 2.1 . The sequence of clinical assessment should remain 1 the early recognition of impending respiratory failure 2 the detection of shock and 3 a neurological assessment. This approach, will guide early management towards the complications that are the most...