An outbreak of aseptic meningitis involving 36 children is described. Enterovirus type 71, a recently recognized cause of central nervous system and systemic illness in children, was found to be the responsible agent. On initial lumbar puncture, cerebrospinal fluid (CSF) polymorphonuclear (PMN) cell predominance was seen in 64%, and greater than 200 CSF white blood cells (WBC)/mm3 was seen in 25% of these patients. Fifty-four per cent of the patients subjected to repeat lumbar puncture and a significant rise in the number of CSF WBC/mm3, the majority with the maintenance of a PMN cell predominance. The CSF white blood cell findings of individual patients did not allow for differentiation from patients concurrently seen with bacterial meningitis. Both initial and serial measurements of CSF lactic acid dehydrogenase reliably distinguished these two groups of patients.
We were interested to read of Dr. DeNicola's experience with ultrasound in a patient with orbital cellulitis. We have no personal experience with this technique and know of no studies using it for this particular clinical problem. It does seem, however, that orbital sonography should define proptosis and displacement of the globe and establish the presence of any sizeable intraorbital mass (abscess). However, we doubt that sonography has the resolution to provide the detailed information about sinus disease and its relationship to orbital disease that computed tomography (CT) can.
e c t i o n i s an e s t a b l i s h e d cause o f m o r b i d i t y and m o r t a l i t y i n r e n a l t r a n s~l a n t r e c i~i e n t s . CMV-I--I seronegative (SN) r e c i b i e n t s o f a l l o g r a f t s from k e r o p i s i t i v e do nors appear t o be p a r t i c u l a r l y v u l n e r a b l e t o c l i n i c a l l y apparen p o s t -t r a n s p l a n t CMV disease. Since CMV s e r o p o s i t i v i t y i n c r e a s e w i t h age, p e d i a t r i c t r a n s p l a n t candidates a r e a l o g i c a l populat i o n i n whom t o c o n s i d e r establishment o f p r e -t r a n s p l a n t imnuni t y through v a c c i n a t i o n . R e s u l t s o f a p r e l i m i n a r y vaccine t r i a l i n 5 SN a d u l t t r a n s p l a n t candidates imnunized w i t h CMV Towne 12 an a t t e n u a t e d s t r a i n , a r e r e p o r t e d here. Antibody t o CMV was detected by IFA 2-4 weeks a f t e r v a c c i n a t i o n i n a l l p a t i e n t s . N CMV was recovered from any p a t i e n t , d e s p i t e l a t e r imnunosuppres sion. No v a c c i n e -a t t r i b u t a b l e c l i n i c a l o r l a b o r a t o r y abnormal i t i e s have occurred. C u r r e n t s t a t u NONE V a c c i n a t i o n may o f f e r a s a f e means o f p r o d u c t i o n o f CMV a n t ibody i n r e n a l t r a n s p l a n t candidates a t r i s k f o r CMV i n f e c t i o n . RS v i r u s produces y e a r l y epidemics o f l i f e -t h r e a t e n i n g bronch i o l i t i s i n i n f a n t s under 6 months o f age. Other workers have t h e o r i z e d t h a t imnunopathologic processes i n v o l v i n g maternal antibody o r s e n s i t i z a t i o n may enhance t h e s e v e r i t y o f these i n f e c t i o n s . Prospective s t u d i e s o f i n f a n t s i n Houston have n o t supported these t h e o r i e s ; i n f a c t , a p o s t i v e c o r r e l l a t i o n (p<.05 has been found between t h e l e v e l o f maternal antibody and t h e age o f i n f a n t s a t t h e t i m e o f i n f e c t i o n suggesting a r e l a t i v e p r o t e c t i o n o f i n f a n t s by h i g h l e v e l s o f maternal antibody. Furthermore, t h e mean maternal antibody t i t e r o f 37 i n f a n t s w i t h i n f e c t i o n was s i g n i f i c a n t l y lower than t h a t o f over 200 random c o r d sera.Of 70 i n f a n t s f o l l o w e d from b i r t h , o n l y 14 (20%) were i n f e c t e w i t h RS v i r u s d u r i n g t h e f i r s t 6 months o f l i f e , b u t 4 had lower r e s p i r a t o r y i n f e c t i o n s and 2 were h o s p i t a l i z e d . The i n f e c t i o n r a t e increased s h a r p l y a f t e r 6 months o f age and almost a l l were i n f e c t e d by age 2 years. R e i n f e c t i o n s , which were m i l d o r inapparent. accounted f o r 15 o f 70 t o t a l RS v i r u s i n f e c t i o n s . Our s t u d i e s do not support any o f t h e hypotheses o f imnunopathology f o r RS v i r u s disease; i n f a c t , t h e p r e v i o u s l y impugned maternal f a c t o r s appear t o be r e l a t i v e l y p r o t e c t...
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