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We report the use of 16S ribosomal RNA gene amplification and sequencing to diagnose culture-negative intracerebral abscesses in younger patients. These 3 cases demonstrate the optimal application of gene sequencing from direct specimens for patients with negative culture results compromised by antibacterial therapy but histories highly suggestive of acute bacterial infection.

Facial nerve palsy was diagnosed in a 13-month-old child with infantile cortical hyperostosis. Facial palsy preceded the roentgenographic evidence of mandibular hyperostosis but there was concurrent evidence of hyperostosis of multiple other bones. This case exemplifies the importance of maintaining a high index of suspicion for infantile cortical hyperostosis in infants and children presenting with facial swelling and facial nerve palsy.

Hydrops fetalis is a condition of diverse etiologies. An association between hemophagocytic lymphohistiocytosis (HLH) and hydrops fetalis has not been reported in the English literature. We describe an intrauterine case of HLH in an infant who presented with hydrops fetalis at 32 weeks gestation. We suggest that HLH should be considered in the differential diagnosis of nonimmune hydrops fetalis, especially in the presence of cytopenias.

Drug-induced immune hemolytic anemia (IHA) is rare but is being reported with increasing frequency. The most commonly cited cause of drug-induced IHA has been receipt of second and third generation cephalosporin antibiotics. We report the first case of IHA associated with cefuroxime administration.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in frequency and are an emerging problem among pregnant women and newborn infants. 1 The incidence of MRSA vaginal colonization among pregnant women usually ranges from 0.5% to 3.5%. 2,3 However, in a recent study from Tennessee, 10.5% of genital swabs from pregnant women submitted for routine Group B beta

Methicillin-resistant Staphylococcus aureus (MRSA) infections have increased significantly over the last decade. Increased prevalence and concern for nosocomial spread has led many states to mandate screening for nasal MRSA carriage. In December 2007, our institution implemented universal surveillance of all admitted patients. Nasal MRSA colonization rates and the role of universal surveillance in prevention and control of MRSA transmission in pediatric wards is not well characterized. The objectives of our study were to determine the incidence of nasal MRSA colonization, the concordance between nasal MRSA colonization and culture-proven MRSA disease at admission, and the impact of universal surveillance on MRSA transmission among children admitted to our pediatric ward. Loyola University Medical Center is an academic center with a pediatric hospital within the larger hospital. Of the 123 pediatric beds, 34 are ward beds. All children admitted from December 1, 2007, through June 30, 2010, were screened for nasal MRSA colonization, using the Cepheid GeneXpert system (Cepheid), and they were identified through the Epic electronic medical record system (Epic Systems). Contact isolation precautions were instituted if a polymerase chain reaction test or a clinical culture was positive. Microbiology laboratory data were used to identify patients with a positive nasal screen or MRSA cultures. Data on hospitalization within the previous 12 months, presence of an indwelling device, and site of the positive MRSA culture were collected. Recent antibiotic use and family history of MRSA disease were not analyzed because these data could not be reliably ascertained from charts. Antimicrobial susceptibilities of MRSA clinical isolates against oxacillin, gentamicin, cefazolin, rifampin, tetracycline, clindamycin, erythromycin, trimethoprim-sulfamethoxazole, and vancomycin were recorded. Isolates were considered to be community-associated MRSA (CA-MRSA) if they were resistant only to b-lactams erythromycin. Resistance to other antibiotics tested was considered to indicate healthcareassociated MRSA (HA-MRSA). Infection control data were reviewed to determine nosocomial MRSA cases in the pediatric ward. Four thousand and eighty-four patients were admitted to the pediatric ward, and 3,934 were screened for nasal MRSA colonization during the study. Of these, 234 patients (5.7%) were colonized, and 99 had culture-proven MRSA disease (2.4%). MRSA nasal colonization and disease rates were uniform throughout the study period. MRSA colonization and disease were highest among young children; 8.4% of infants less than 1 year old were colonized versus 5.2% of children 1 or more years old ( ). MRSA disease was more P p .004 prevalent in children 5 years old and under, 3.6% versus 1% in those more than 5 years old ( ). The incidence of P ! .002 nasal colonization markedly decreased in older age groups (Table 1). Most pediatric patients with MRSA colonization or disease had no identifiable risk factors; 9% had an indwelling catheter, and 39% were hospitalized in the year before. Most positive MRSA cultures (89%) were from skin and soft tissue sites, and 84% were CA-MRSA. Bacteremia was noted in 5 patients, 3 of whom had concurrent osteomyelitis. Only 54% of patients admitted with MRSA disease had a positive nasal screen. The use of MRSA nasal colonization to predict MRSA disease on admission had a sensitivity of 54% and a specificity of 96%. The positive predictive value was 24%, and the negative predictive value was 99%. Nosocomial MRSA infections were infrequent in our pediatric ward. There were 2 cases in the 2 years before universal surveillance and 1 during universal surveillance. The overall cost of universal screening of pediatric ward patients for the institute for the study period was $204,200, at $50 per test. Nasal MRSA colonization rates vary by geographic area and have increased over the last decade from less than 1% to 10%. Nasal MRSA colonization rate in admitted children was 5.7%, which is similar to the rate in our adult population (∼7%). The majority of colonized or infected children had no risk factors for HA-MRSA (!60%). Skin and soft tissue infections, mainly due to CA-MRSA, comprised the bulk of MRSA disease. Concerns for nosocomial spread of CA-MRSA have led many states to mandate screening of hospitalized patients and to observe contact precautions of identified carriers. While absence of MRSA nasal colonization is highly predictive of absence of disease, we found poor concordance between

The incidence and duration of pneumococcal antigenuria were determined in 21 infants who received the first dose of pneumococcal conjugate vaccine. Urine specimens collected from the study participants at 1, 3, 6 and 9 days after immunization did not reveal the presence of pneumococcal antigen.

Endobronchial tuberculosis is a form of pulmonary tuberculosis, thought to result from rupture of an infected node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. With the presence of multidrug resistant isolates of TB, and its incidence in an increasing number of foreign-born persons immigrating to the US, otolaryngologists must be aware of its often subtle presentation. The following case is an unusual presentation of endobronchial tuberculosis initially diagnosed as an airway foreign body.

All patients admitted to our tertiary care hospital from 1 December 2007 to 10 June 2008 were screened for methicillin (meticillin)-resistantStaphylococcus aureus(MRSA) nasal colonization, and the isolates were tested for mupirocin susceptibility by using Etest. Mupirocin resistance (MR) was noted to occur in 3.4% of MRSA carriers, and high-level MR was noted to occur in 0.62% of carriers.

Neonatal liver abscess is a rare entity. There are no published reports of neonatal liver abscess in the radiology literature in the past 15 years. We recently encountered a premature infant in whom a hepatic abscess was diagnosed solely based on abnormal radiographic studies. We report this case to illustrate the unusual clinical and radiographic abnormalities seen with neonatal solitary hepatic abscess.

do not shave, use depilatories, wax, or apply lotion on leg(s)/hip(s) prior to surgery. Educate patients about personal hand hygiene, inform patient not to touch dressing or incisions unless absolutely necessary, instruct patients to shower the evening before and the morning of surgery using chlorhexidine gluconate (CHG) for 2 days, distribute literature regarding patient education If patient is MRSA/ MSSA positive, instruct patient to shower with CHG for 5 days and use Mupirocin nasal ointment 5 days pre-op. Dressing Protocol: Use silver or specialty dressings, remove after 5 days, if excessive drainage occurs, nursing will change dressing. Discharge Assessment, Teaching and Follow-up: Review home care orders to reinforce understanding regarding physical therapy, medications, and signs and symptoms of infection. RESULTS: Quarterly standardized infection ratios (SIRs) were developed and presented for the system, hospitals, and individual orthopedic surgeons. Overall system and hospitals’ SIRs are reflected graphically. LESSON LEARNED: Due to numerous preventive interventions, total knees’ and total hips’ SIRs decreased below 1.0 during the last four current quarters. Continuation of monitoring compliance with practices in OR with staff is occurring. Feedback of SIRs with orthopedic surgeons happens on a quarterly basis. Opportunities for improvement, including sharing information with infection prevention committees and surgical teams, is ongoing.

We read with interest the article titled “Streptococcal infections in Patients with Chronic Granulomatous Disease” by Falcone et al in August issue of the journal. We would like to report a case of lymphadenitis and pneumonia in a 14 year-old boy with chronic granulomatous disease due to Streptococcus constellatus a member of the Streptococcus anginosus group. This 14 year-old patient presented to our clinic with history of an enlarging neck mass for one week and two days of mild nonproductive cough. He did not have any constitutional symptoms. His physical examination demonstrated a 2×4 cm non-fluctuant and non-tender mass in the left anterior cervical area. The ultrasound of neck revealed conglomerated nodes without any suppuration. His chest xray demonstrated a left upper lobe consolidation. He underwent biopsy of the lymph node and bronchial alveolar lavage washings. Tissue cultures revealed alpha hemolytic colonies after 72 h on sheep blood agar, with a distinctive butterscotch smell. The API 20 Strep system (bioMerieux, Inc. Hazelwood, MO) did not yield an acceptable identification score. Matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF MS) using a MALDI-TOF MicroFlex LT mass spectrometer (Bruker Daltonics, Billerica, MA) identified Streptococcus constellatus with high score (∼2.0). We did not test our isolate for production of hydrogen peroxide. Histology of the node revealed acute and chronic inflammation and bronchial alveolar lavage washings yielded no growth. The patient is being treated with high dose amoxicillin and his clinical symptoms have improved. Our case not only extends the observations of Falcone et al but also records lymphadenitis due to Streptococcus anginosus group which is uncommon and has not been previously reported to our knowledge in CGD patients. It is however unclear in the few published cases of S.viridans infections in CGD , if further speciation was attempted or not. Our case not only illustrates the rarity of lymphadenitis due to S.anginosus group but also underscores the importance of observing the cultures for longer than 72 h.

In a 27-month prospective study, Aeromonas spp. were isolated from 7.3% of children with diarrhea and from 2.2% of controls. In 32 patients with diarrhea, ranging in age from 1 to 27 months old, Aeromonas spp. were the only potential bacterial enteropathogens isolated. Principal symptoms of Aeromonas-associated diarrhea were vomiting, fever and bloody stools. Diarrhea was often self-limiting and lasted for 10 days or less in 90% of patients. No secondary spread of diarrhea among close contacts was observed and no clear-cut seasonal patterns of Aeromonas isolation were found. Aeromonas caviae was the most frequently isolated species in fecal samples of patients (24 of 29 isolates) as well as controls (5 of 7 isolates). Cholera toxin cross-reactive cytotoxic enterotoxin was produced by a vast majority of Aeromonas isolates, as compared to a non-cholera toxin cross-reactive cytotonic enterotoxin. In addition no significant correlation was observed between severity of the diarrheal disease and different Aeromonas or the quantity of enterotoxins produced. In our geographic area Aeromonas spp., and A. caviae in particular, seem to be an important and frequent cause of diarrhea in young children.

• Within a 28-day period, necrotizing enterocolitis (NEC) developed In 20 of 38 infants (53%). Patients with NEC were compared with the remaining 18 infants hospitalized at the same time who did not acquire the disease. Complications of pregnancy and labor-delivery and infant care practices did not differ between groups. Mean chronologic age was significantly different between patients with NEC and those without, 29 days v 77 days. Mean postconceptional age at the time of the outbreak was also significantly different, 33.4 weeks v 42.3 weeks. None of the cultures demonstrated a specific common pathogen. The low mortality (5%) and the large number of Infants affected suggest an atypical outbreak of NEC. We could not isolate a causative agent despite extensive epidemiologic investigation, and suggest that postconceptional age delineates those at risk. ( AJDC 1984;138:979-983)

We have previously reported that approximately 7% of childrer who present for medical care with common respiratory illnesses are already being treated with unprescribed antibiotics. The purpose of the present study is to determine the incidence of antibiotic abuse(self-medication with unprescribed antibiotics) in children with more serious febrile illnesses. It is anticipated that we will have 400 patients by 4/85. To date we have collected information and urine samples at the time of admission from 104 febrile patients. 8 of 104 (7.69%) children were found to have antibacterial activity in the urine as determined by bioassay. Of the 8 positive specimens only 2 were from children whose care takers admitted to antibiotic abuse. One received erythromycin and the other penicillin. Sources of antibiotic were sibling's erythromycin and amoxicillin from a previous illness. Data related to 1) duration of illness, 2) patient age, 3) symptom categories (URI, Pneumonia, Asthma, Gastroenteritis, Sepsis, Fever), 4) similar illness in the past, 5) presence of siblings, 6) primary care taker's marital status, 7) and employment were analyzed statistically. The incidence of abuse was significantly higher in the asthmatics (P .01) and no correlation was demonstrated to incidence of abuse and other mentioned variables. We conclude that antibiotic abuse is a significant problem and questioning was not a reliable abuse direction technique. The incidence of abuse in this study is similar to previously reported incidence in outpatients from a different geographical area.