Candidemia results in a mortality of > 50% among adults, but data on children with candidemia are limited. We reviewed 70 episodes of pediatric candidemia that occurred between January 1988 and October 1992. Of these episodes, 53% were caused by Candida albicans, 24% were caused by Candida parapsilosis, 16% were caused by Candida tropicalis, and 3% were caused by Candida krusei. Twenty-five percent of the patients were premature infants. Other underlying conditions included malignancy (15%); cardiac disease (14%); and short-gut syndrome (14%). A central venous catheter was in place during 61 (87%) of 70 episodes. Candiduria preceded candidemia in only 4 (8%) of 52 patients. The overall mortality rate was 19%; 36% of those with intravenous catheters that were not removed within 3 days died, whereas none of the patients from whom catheters were removed within 3 days died (P < .0001). Only two survivors had complications. Therapy with amphotericin B (with or without flucytosine) was administered to 74% of these patients. Seventeen patients were not treated medically; all were immunocompetent and survived. Of these patients, 15 were > 2 months of age; 14 had candidemia for < or = 2 days; and 15 had an intravenous catheter removed within 2 days of the onset of candidemia. No patient stopped receiving amphotericin B because of side effects. The results of this study suggest the following: that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwelling intravenous catheter usually results in a poor outcome; that candiduria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.
Legionella pneumophila can invade and grow within explanted alveolar epithelial cells. Given its potential clinical significance, an examination of the molecular basis of epithelial cell infection was initiated. The mip gene encodes a 24-kilodalton surface protein that promotes macrophage infection and virulence. To determine whether this gene is required for pneumocyte infection, we tested a strain bearing a mip null mutation for its ability to infect both explanted type II cells and type I-like cell lines. For infection of type II cells, the infective dose 50% for the Mip-strain was 25-fold higher than an isogenic Mip+ strain. Type I cell monolayers infected with the mutant for 3 days yielded approximately 50-fold fewer bacteria than did monolayers infected with the parental strain. These data indicate that Mip enhances infection of pneumocytes and that L. pneumophila employs some of the same genes (mechanisms) to infect epithelial cells and macrophages.
Changes in health care delivery have imposed more time constraints on community-based preceptors. However, this study identified underlying factors motivating physicians to volunteer as preceptors. Strategies to recruit new and retain current preceptors must be collaborative.
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