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Pseudomonas injection developed at the suture line of an aortic graft in a patient 13 years after the operation. The site of the infection was localized by quantitative blood cultures taken with the aid of selective arterial catheterization. This technique may be of great help in localizing the source of endovascular infection in difficult cases.

Seven hundred twenty-two pregnancies were studied in a private-practice setting to determine the natural history of colonization by group B streptococcus(GBS) over time. The colonization rate remained constant at 7% to 8% in each trimester, with 19% of the women colonized at some time during pregnancy. The organism was lost spontaneously at some time during pregnancy in 51%. Treatment of third-trimester pregnant women and their husbands with penicillin G resulted in a significant reduction in GBS colonization at delivery as compared to an untreated control group. If other factors are considered, however, routine culturing for GBS in pregnant women and treatment of those harboring the organism with penicillin G are not recommended.

A majority of pediatric patients and rare adult patients with the acquired immunodeficiency syndrome (AIDS) develop a chronic respiratory disorder referred to as "lymphocytic interstitial pneumonitis" (LIP). Efforts to identify an infectious agent responsible for this process so far have failed. In this study, frozen sections of lungs from patients with AIDS and pulmonary disease were tested by in situ molecular hybridization for the presence of cells infected with human T-cell lymphotropic virus type III (HTLV-III) and expressing viral RNA. In the case of an infant with LIP, a relatively high frequency (0.1 %) of cells in the lung were found to be positive for HTLV-III RNA. This number is the lower limit of total cells infected since the in situ hybridization technique as applied in this study depends on expression of HTLV-III genes, and previous evidence indicates that a proportion of cells infected with HTLV-III may not express viral RNA. Moreover, this degree of infection of the lung is likely limited to LIP, since in ten patients with AIDS and pulmonary diseases other than LIP, only 0% to 0.002% of cells in lung were positive for viral RNA expression. Thus, HTLV-III may play a direct causal role in the development of LIP in infected patients, implicating its involvement in yet another of the diverse clinical diseases associated with this virus.(JAMA 1986;256:2356-2359)

Approximately 18,000 cases of bacterial meningitis are identified in children under the age of 5 years in the United States annually. In this age group, Haemophilus influenzae type b, Diplococcus pneumoniae, and Neisseria meningitidis are responsible for 87% of those cases in which the etiologic agent is demonstrable.1 A total of 43% to 50% of these patients receive some form of antimicrobial therapy before a diagnostic lumbar puncture is performed.2-6 The question is frequently asked: does pretreatment with small doses of antimicrobials significantly alter cerebrospinal fluid (CSF) findings in bacterial meningitis? A related problem is the differentiation of aseptic from bacterial meningitis when clinical and CSF findings do not clearly distinguish the two. EFFECTS OF ANTECEDENT THERAPY Several studies have suggested that prior treatment with antimicrobials may alter CSF findings, leading to an erroneous diagnosis of aseptic meningitis.2,7,8 More recently, other investigators3-6 have presented data

• The potential consequences of bacteremia are considerable in all infants but particularly in those from 3 to 24 months of age with temperatures of 38.3 °C or more. Physicians have been advised to scrutinize these patients carefully with a variety of diagnostic tests and to treat their conditions vigorously if bacteremia is seriously considered or proved. We undertook to determine how often primary care pediatric practitioners encounter such patients "at risk" for bacteremia. Among the practices of nine pediatricians in Monroe County, New York, involving 220 practice days throughout 1977 and 4,151 patient visits, we found 145 instances of potential bacteremia. Depending, then, on the season of the year, practitioners may face this diagnostic and management dilemma as often as once each day. Therefore, laboratory means for determining those infants at highest risk for bacteremia or for rapidly diagnosing bacteremia will need to be readily available to practitioners.(Am J Dis Child 133:1017-1019, 1979)

Pharmacokinetics of aminoglycoside antibiotics vary both within and between different age groups. To determine proper dosing level and interval for children, sequential pharmacokinetics were studied in 10 patients (age = 8.7 yrs). All children had normal renal function. Mean weight and surface area were 29.5 kg and 0.99 m2respectively.A dose of 7.5 mg/kg was administered IM q12h. Utilizing an acetyl transferase radioenzymatic assay, sequential serum levels were determined and were as follows (μg/ml ± SD) : Oh=0; ½h=13.0 ± 4.0; 1h=12.2 ± 3.3; 2h=8.9 ± 3.3; 4h=3.1 ± 1.8; 6h=1.5 ± 1.3; 8h=< 1.0. Drug was undetectable in serum after 8 hrs. No accumulation was observed. Mean peak serum: mean urine (0-12h) ratio was 1:20. There was no evidence of toxiclty.Utilizing this dosage regimen, the t½ in our patients (1.7h) was 23% shorter than that in adult subjects (2.2h). The mean peak serum level (13μg/ml) was 35% lower than in adults (20μg/ml).These data suggest that children require larger doses of amikacin administered at more frequent intervals than those utilized in this study.

Over the years, Dr John Nelson and his colleagues at the University of Texas Southwestern Medical School at Dallas have made important contributions to our understanding of the pharmacology of antimicrobials in infants and children. With complementary clinical studies, they have helped to place pediatric usage of antibiotics on a rational base. This handbook is an attempt to draw together some of these data in making recommendations for antibiotic usage in "quick-reference" form for pediatricians.It is an easily carried booklet divided into nine sections, all of which have the clinician very much in mind. Recommendations for antimicrobial therapy are made according to both clinical syndrome and specific pathogens. Dosages are provided in both sections and in a separate line-listing of antibiotics. Recommendations for antifungal and antiparasitic therapy are also given. In addition, there is a very helpful, alphabetized table of trade and generic names. The introductory section on antibiotics

Three structurally and antigenically similar capsular polysaccharides, two derived from group C Neisseria meningitidis (O-acetyl-positive and O-acetyl-negative variants) and one from Escherichia coli K92, which cross-reacts with polysaccharide from group C N. meningitidis, were compared for their ability to induce anticapsular and bactericidal antibodies to group C N. meningitidis in adult volunteers. All three vaccines elicited group C-specific serum antibodies. The vaccine derived from the 0acetyl- negative variant was the most immunogenic of the three vaccines. With use of radiolabeled O-acetyl-positive group C N. meningitidis polysaccharide antigen, the geometric mean titers of antibody in serum were 41.7 µg/ml to the O-acetyl-negative variant, 22.8 µg/ml to the O-acetyl-positive variant, and 7.1 µg/ml to E. coli K92. Antibodies induced by all three vaccines were bactericidal for both of the group C N. meningitidis polysaccharide variants. An inverse relation between the comparative immunogenicity of the O-acetyl-negative polysaccharide and the virulence of group C N. meningitidis was found.

Pediatricians are intimately familiar with Hemophilus influenzae as a cause of meningitis, pyogenic arthritis, and epiglottitis in infants and children. This organism is responsible for an estimated 7,000 cases of meningitis annually in the United States with a resulting 700 deaths per year and a morbidity that leaves the majority of its survivors with disabling neurologic residua.The book by David C. Turk, DM (Oxon), MRCP (Lond), MCPath, and J. Robert May, MD (Cantab), FCPath, H. influenzae: Its Clinical Importance, published in 1967, provided a review of the epidemiology, immunology, and clinical importance of this organism. Since that time, there has been a resurgence of interest in H influenzae, in part due to the development of a polysaccharide vaccine that provides the potential of preventing meningitis due to this organism. Hemophilus influenzae, edited by Sarah H.W. Sell, MD, and David T. Karzon, MD, is a report of the proceedings of