Tularemia, a febrile zoonosis with six clinical types, recently has been shown to occur at an increased incidence in children compared with previous reports. Ulceroglandular and glandular tularemia are still the most common types, but pneumonic tularemia has increased in incidence. However, with these changes, an overall decline in mortality has been observed. Children exhibit fever, pharyngitis, hepatosplenomegaly, and constitutional symptoms more often than affected adults. The complication of late lymph node suppuration is found in half of the tularemia patients with lymphadenopathy. A high index of clinical suspicion and a good medical history and physical examination confirmed by specific serologic studies are the critical factors in the successful diagnosis of tularemia in children.
A high incidence of rickets among infants in t h e people; Republic of Cadham P r o v i n c i a l Laboratory, Winnipeg, Canada.China has been reoorted. etioloev unclear. The vit. D status of infants in An outbreak of Echovirus 11 i l l n e s s occurred among i n f a n t s ~ China has not bekn invkstigateY;I. The specific effect of sunshine (UV) exposure on D status in any infant is unstudied. We hypothesized that breast-fed infants in China have low vit. D status and UV exposure increases serum 250H vit. D into the normal range. 54 breast-fed term infants 1 t o 8 mos. without D supplements were randomly assigned into 2 grps. in a 2 mo. study, Sept. and Oct. (mos. of high UV exposure): controls with "usual" sun exposure; and experimental with 2 hr. sunld. Infants received only human milk, rice soup, fruit juice and mashed vegetables and exposed mostly face and forearms. A 20 nurse team monitored UV exposure with diaries and a unique infant UV dosimeter.Only 100 u1 blood samples were permissible in infants. Serum 250HD was measured by protein binding assay after chromatography. (N I1 t o 68 nglrnl). Mean maternal 250HD was 22 nglml. Infant 250HD correlated with mother's k0.48). Infant 250HD ranged 3 t o 61 nglml a t entry with 20%
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