At a Glance Commentary: Our data provide evidence for the new Cystic Fibrosis Foundation guideline that advises people with CF to wear a surgical mask in healthcare

A 5-day-old male infant was admitted to hospital with a history of poor feeding and fever. He was born at term to a 22-year-old woman (gravida 1, para 0). The delivery took place at home and was uncomplicated. The birth weight was 3300 g. On admission, a child with mild respiratory distress and tachypnoea was seen. The rectal temperature was 37.5 ~ C. There was an oxygen demand of 25%. Laboratory tests included haemoglobin 12.5 mmol/1, haematocrit 0.60 1/1, platelet count 306 x 109/1, WBC count 10.9 x 109/1 with 8% band forms, 33% neutrophils and 58% lymphocytes, serum CRP level 56 rag/1 and capillary blood gas analysis pH 7.28, PCO2 9 kPa, bicarbonate 32.1 mmol/l, base-excess +3.3 retool/1. A chest radiograph showed a lobar infiltrate in the right upper lobe. Bacteriological cultures of blood, sputum and CSF remained negative. The infant was treated with intravenous ampicillin and cefotaxim. When his clinical condition did not improve intravenous erythromycin was added. A new chest radiograph at day 11 showed complete consolidation of the right lung (Fig. 1). The child was subsequently transferred to our hospital. On admission a moderately ill child was seen with tachypnoea (respiratory rate: 60/min) and oxygen demand (46%). The rectal temperature was 36.7 ~ C. Auscultation of the right lung revealed decreased breathsounds and rhonchi. Laboratory results included haematocrit 0.52 1/1, platelet count 79 x 109/1, WBC count 14.6 x 109/1 and CRP level 56 rag/1. Capillary blood gas analysis revealed pH 7.39, PCO2 7.3 kPa, base-excess +7 mmol/1. CSF analysis showed 12 cells/3 mm 3, glucose and protein levels 2.5 mmol/1 and 84 mg/100 ml respectively. A bronchoscopy with broncho-alveolar lavage was performed on day 11. Purulent secretion was seen in the right upper lobe. Treatment was started with amoxicillin/clavulanic acid (25/2.5 mg/kg qid), tobramycin (3 mg/kg once daily) and erythromycin (5 mg/kg qid) intravenously. At the age of 14 days the patient developed an erythematous rash, which disappeared spontaneously after 1 day. Bacterial cultures remained negative. On day 19 results of viral cultures were obtained.

Bacterial infections continue to be a major cause of morbidity and mortality in preterm infants admitted to neonatal intensive care units [1]. Nosocomial infections including septicemia, meningitis, pneumonia or urinary tract infection occur in approximately 18% of neonates with a very low (<1500 g) birth weight. Major pathogens responsible for bacterial infections during the first month of life are Staphylococcus aureus, coagulase-negative staphylococci, en- terococci, group B streptococcus, Escherichia coli, klebsiella, enterobacter, pseu- domonas and other gram-negative bacteria. The combination of prolonged hospitalization, multiple invasive procedures, prolonged positive pressure ventilation, parenteral nutrition, and an impaired host defence is largely responsible for the increased susceptibility of preterm infants for bacterial, viral and fungal infections.

In the US and northern Europe, the prevalence of pregnant syphilitic women is estimated at .1-.6%, while in South Africa it was 7.6% in 1982. In 1978, there 108 cases in the US which increased to 268 reported cases in 1985. The increase of congenital syphilis (CS) by 25% from 1985 to 1988 was attributed to the spread of crack cocaine in the US. The rate was 10.5 cases/100,000 live births in the US during this period, a 21% increase. In contrast, in the Netherlands there were 2.5 cases/100,000 live births during 1982-85. Clinical symptoms appear 3 weeks after birth, but some are present at birth such as hepatosplenomegaly, bloated abdomen, cutaneous lesions, and nasal discharge turning into purulent rhinitis. Anemia occurs in 90% of children with CS. Generalized lymphadenopathy, splenomegaly with hepatomegaly, and syphilitic hepatitis may also occur. Syphilitic skeletal abnormalities include osteochondritis, periostitis, osteomyelitis, and osteitis. Meningovascular syphilis produces nervous system effects. CS complications include nephrotic syndrome and acute glomerulonephritis. Ocular abnormalities are caused by treponemes found in the cornea, sclera, uvea, retina and the optic nerve. Chorioretinitis and iridocyclitis are common ocular lesions. The pathogen Treponema pallidum can be diagnosed by dark field microscopy, by immunofluorescence, or by histopathological examination of silver-stained preparations. Pregnancy women with syphilis are treated with penicillin although failures have been reported after single or 2 or 3 in administrations of 2.4 MU benzathine penicillin and after giving tetracycline in 3rd trimester pregnancy. The CDC recommendation for treating infants with CS is iv 50,000 U/kg penicillin G every 8-12 hours for 10-14 days or im 50,000 U procaine penicillin once daily for 10-14 days. Single administration of 50,000 U/kg benzathine penicillin is recommended for newborn children whose mothers have been treated with erythromycin.

Clinical, morphological, ultrastructural and immunological studies were performed in a case of congenital self-healing non-Langerhans cell histiocytosis. The patient showed several aspects that have not been published before: a large nodule in the vulvar region, vesiculobullous elements and pneumonia (asymptomatic). The relationship of the vesicles and pneumonia to the histiocytic disorder is not clear. Ultrastructurally, worm-like (comma-shaped) particles, dense bodies and Birbeck granules were not found. Histiocytes were Leu-6 negative, and S100 (partly), Leu M3 and HLA-DR positive. Positive reactions were also obtained with anti-lysozyme and non-specific esterase. Several aspects of this case and of others described previously are discussed.

Antibiotics are administered to cystic fibrosis patients for chronic endobronchial infection complicated by frequent exacerbations. Agents active against Staphylococcus aureus, Pseudomonas aeruginosa or both are administered. Serum antibiotic concentrations were measured in cystic fibrosis patients in an effort to optimise antibiotic dose and frequency. This led to the observation that cystic fibrosis subjects had (in general) a larger Vd and increased total body clearance of β-lactams and aminoglycosides than non-cystic fibrosis subjects. The larger Vd is mainly due to the increased amount of lean body mass per kg bodyweight, although increased tissue binding may also account for part of this. The increased total body clearance of β-lactams appears to be due to increased renal elimination, particularly tubular secretion. Decreased tubular reabsorption and increased non-renal clearance contribute to the increased total body clearance of metabolised β-lactams and aminoglycosides. However, the lack of concomitant controls in many studies make these generalisations tentative.