trimethoprim--sulfamethoxazole-drug-combination and Infant--Premature--Diseases

Pneumocystis jiroveci (P. jiroveci) is the etiological agent of pneumocystis pneumonia (PCP) in immunodeficient patients. The increased interest of clinicians in this particular pathogen during the past decade was prompted by rising numbers of patients with immunosuppression caused by AIDS, chemotherapy, or organ transplantation. Premature, seriously ill infants at intensive care units constitute a potential risk group for infection with P. jiroveci. Recent advances in medical sciences, owing mainly to developments in molecular biology, permitted the verification of the taxonomic position of pathogens and contributed to a better understanding of new aspects of pathophysiology and pathogenesis of PCP. It has been demonstrated that the genus Pneumocystis represents a heterogeneous group of opportunistic fungi exhibiting narrow host specificity. Pneumocystis jiroveci is the species which is specific for humans. The present paper outlines the clinical symptoms of PCP in infants, currently used diagnostic methods, and treatment procedures in PCP.

Topics: Anti-Infective Agents; Antifungal Agents; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care, Neonatal; Pentamidine; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Neonatal brucellosis following blood transfusion has not previously been reported. A premature male infant born at 24 weeks gestation developed low grade fever and decreased activity and showed poor weight gain at 45 weeks post-menstrual age. Blood culture grew Brucella melitensis and the brucella antibody titre was positive. He received a 6-week course of septrin and rifampicin and made a full recovery. The infant had received a blood transfusion 5 days prior to his illness. The blood donor had symptoms suggestive of brucellosis, and it was suspected that the blood transfusion was the source of infection but this could not be confirmed as the donor was not traceable. It is suggested that, in areas endemic for brucellosis, prospective blood donors should be questioned about symptoms of brucellosis, and serological tests to screen for brucellosis might be indicated.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Brucella melitensis; Brucellosis; Erythrocyte Transfusion; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In a community-based intervention trial to reduce childhood mortality from pneumonia the intervention area included 58 villages (6176 children aged 0-4 years) and the control area 44 villages (3947 children) in Gadchiroli, India. The interventions included mass education about childhood pneumonia and case-management of pneumonia by paramedics, village health workers, and traditional birth attendants (TBAs) who were trained to recognise childhood pneumonia and treat it with co-trimoxazole. Parents sought treatment, and coverage was 76% without active case-detection efforts. The case-fatality rate among the 612 cases treated by health workers was 0.8%, compared with 13.5% in the control area. After a year of intervention pneumonia-specific childhood mortality was significantly lower in the intervention than in the control area (8.1 vs 17.5 deaths per 1000 children under 5 years); the difference between the areas was greatest in children under 1 year. The differences in infant mortality (89 vs 121 per 1000) and total under-5 mortality (28.5 vs 40.7 per 1000) were highly significant. Mortality from other causes remained similar in the two areas but neonatal mortality due to birth injury and prematurity was significantly lower in the intervention area, presumably owing to the combination of better maternal and neonatal care by the TBAs trained in the project and the availability of treatment for pneumonia. The cost of co-trimoxazole was US $0.025 per child per year ($2.64 per child saved).

Topics: Administration, Oral; Age Factors; Birth Injuries; Cause of Death; Child, Preschool; Community Health Services; Community Health Workers; Drug Administration Schedule; Evaluation Studies as Topic; Female; Health Education; Hemorrhage; Humans; India; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Pilot Projects; Pneumonia; Rural Health; Sampling Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bacteremia; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Trimethoprim, Sulfamethoxazole Drug Combination