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Experts Check Into Rash of U.S. Child Flu Deaths

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    Posted: February 01 2007 at 5:02pm
Experts check into rash of U.S. child flu deaths
01 Feb 2007 22:59:16 GMT
Source: Reuters
 
 
 
Maggie Fox, Health and Science Editor

WASHINGTON, Feb 1 (Reuters) - Nine children have died of flu this season in Alabama, an unusually high number that has some experts worried, a pediatrician said on Thursday.

Dr. Richard Whitley of the University of Alabama at Birmingham said he had sent samples from the children to the U.S. Centers for Disease Control and Prevention for analysis.

"Nine children and we are a state of 4 million people," he said.

They were all affected with the regular seasonal flu, Whitley said in an interview, but were unusually ill with it.

"We have tried extravagant things (to save them)."

"These kids are presenting with an ARDS-like syndrome," he said. Acute respiratory distress syndrome usually only occurs with severe infections, and is not normally a symptom of influenza.

Normal seasonal influenza does kill children every year, even previously healthy children. Public health officials are watching flu more closely than before because of fears the H5N1 bird flu virus, a strain found primarily in birds but that has killed 164 people since 2003, might mutate into a fast-spreading and lethal pandemic form.

"Unfortunately, it is not unusual for there to be pediatric deaths in any flu season," CDC director Dr. Julie Gerberding told reporters.

It takes years sometimes to get good estimates, but 153 children died in the 2003-2004 flu season, according to CDC figures. This year so far the CDC had reported eight deaths among children, but its statistics are usually several weeks old.

Whitley said his hospital started filling up with cases, mostly children, in December. The U.S. flu season normally runs from October to March.

"Our hospital has been at 115 percent occupancy," Whitley told reporters.

"We are not seeing influenza in our adult populations."

Most of the 36,000 Americans who die of flu and flu-related pneumonia in an average year are elderly.

Whitley said the annual flu wave was now starting to peter out in Alabama, but increased activity had been reported east, in South Carolina, and north in Illinois. The CDC says flu activity in the United States has not reached epidemic levels.

"We do know that the majority of virus circulating in this flu season is a strain that is an excellent match to the vaccine," Gerberding said. Every year, the flu vaccine is reformulated with three strains of flu that match the most common types in circulation.

The CDC now recommends that most people in the United States get flu vaccines every year, including young children, people over the age of 50, health care workers and people with chronic conditions such as diabetes.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote GreenTeam Quote  Post ReplyReply Direct Link To This Post Posted: February 01 2007 at 5:31pm
A child died from influenza here in Minnesota this week, the first child influenza death in two years. The child ended up with bacterial pneumonia.
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GreenTeam sorry to hear of that...
..........................................................................
 
 
in regards to....
 
"These kids are presenting with an ARDS-like syndrome," he said. Acute respiratory distress syndrome usually only occurs with severe infections, and is not normally a symptom of influenza.
 
......................
 
 
 
A lot of ARDS I read about is also associated with Dengue....
 
 
 
ARDS  
 
called by a few names...
 
 ...................................................................................................
 
Acute respiratory distress syndrome (ARDS), also known as respiratory distress syndrome (RDS) or adult respiratory distress syndrome
 
ARDS has gradually shifted to mean acute rather than adult.
 
 
"...usually requires mechanical ventilation and admission to an intensive care unit...."
 
 
 
..................................................................
 
 
Should they be treating the children as if they had....
.........
 

Dengue shock syndrome (DSS).

 
DSS is reversible if appropriately treated with fluids and plasma infusion

to reverse the osmotic permeability gradient due to hypoalbumenaemia. Severe pulmonary oedema

causes adult respiratory distress syndrome (ARDS). The lung effusions and hypotension must be

differentiated from other causes of shock and pulmonary oedema.

Correction of acid-base balance and

internal bleeding if present, recognition and appropriate treatment of septicaemia and pneumonia, and

avoiding fluid overload usually result in recovery. Nosocomial and mycoplasma pneumonias, not

uncommonly, complicate severe ARDS. Fatalities are often from these unrecognized infections.

 

From......

 

A Guide to DHF/DSS Management –

The Singapore Experience

by

Oon Chong Teik*

Tropical Medicine & Infectious Diseases, Mt Elizabeth Hospital, Singapore 228510

 
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153 children died in the 2003-2004 flu season,
 
..............................................................................
 
this was one of our more severe seasons....03-04
...............................................................................
 
 
 
OBJECTIVE. The 2003–2004 influenza season
 
was marked by both the emergence of a new drift "Fujian" strain of influenza A virus and prominent reports of increased influenza-related deaths in children in the absence of baseline data for comparison.
 
In December 2003, the California Department of Health Services initiated surveillance of children who were hospitalized in California with severe influenza in an attempt to measure its impact and to identify additional preventive measures.
.................................................
 
 
 
This season was characterized by the predominance of a drifted influenza A strain, A/Fujian/411/2002-like (H3N2), that was not included in the 2003-2004 influenza vaccine. 
 
 
 
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"We are not seeing influenza in our adult populations."

This can not be true. I know of several who had the flu and know of one 24 year old young lady who died from complications of it.
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a lot of influenza B here...  may what state are you?
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Influenza virus detections continue to increase in Europe
http://www.eiss.org/cgi-files/bulletin_v2.cgi?display=1&code=211&bulletin=211
Summary: Influenza virus detections are currently increasing in Europe. The total number of positive specimens has steadily increased from less than 100 in week 50/2006 to 626 positive specimens in week 03/2007. Countries with increased levels of influenza activity are Greece, Luxembourg, the Netherlands, Northern Ireland, Scotland, Spain and Switzerland. In Scotland consultation rates for influenza-like illness peaked in week 02/2007 and now appear to be on the decline.

Epidemiological situation - week 03/2007: For the intensity indicator, the national network level of influenza-like illness (ILI) and/or acute respiratory infection (ARI) was medium in Greece, Luxembourg, the Netherlands, Northern Ireland, Scotland, Spain and Switzerland*, whilst it remained low in 18 other countries.

For the geographical spread indicator, regional activity was reported in four countries (the Czech Republic, Norway, Scotland and Spain), local activity in seven countries, sporadic activity in 12 countries and no activity in three countries (Hungary,Confused Lithuania and Poland). Definitions for the epidemiological indicators can be found
here.
http://www.google.com/search?sourceid=navclient&ie=UTF-8&rls=ADBS,ADBS:2006-36,ADBS:en&q=H3N2+europe+2007     H3N2 -----Europe more reading ,,,
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AnnHarra,
"a lot of influenza B here... may what state are you?"

+++++++++++++++++++++++++++++++++++++++++++++++++++++++
I live in Alabama 50 miles from the hospital where 9 children were on life surport. There are a lot of conflicking reports out there.
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CORRECTED: U.S. experts check into severe child flu cases
Fri Feb 2, 2007 5:40pm ET

    http://tinyurl.com/2wbfc8
(Corrects headline, initial paragraphs with revised information from Dr. Whitley that one child died, while nine more had life-threatening illnesses) By Maggie Fox, Health and Science Editor
-snip-
WASHINGTON (Reuters) - An unusually high number of children have suffered severe illnesses from influenza in Alabama this year, which has some experts worried, a pediatrician said on Thursday.
-snip-
He said half the children were hospitalized for at least two weeks, and some as long as four weeks. One remains in the hospital.



    
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dlugose Quote  Post ReplyReply Direct Link To This Post Posted: February 02 2007 at 10:13pm
For the country as a whole we are not having a bad flu year, even among children.  The latest of CDC's weekly reports, week ending 1/27, says
"During week 4, 7.1% of all deaths were reported as due to pneumonia or influenza. This percentage is below the epidemic threshold of 7.8% for week 4.

No influenza-associated pediatric deaths were reported during week 4. Since October 1, 2006, CDC has received seven reports of influenza-associated pediatric deaths that occurred during the current season."

report at http://www.cdc.gov/flu/weekly/
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia
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Wonder if there were any updates on this.
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flu report... Insert your zip
 
 
.................................................
 
 
 
seems to me they may be classing these two
 
RSV and human metapneumovirus
 
as similar/same ?
 
because CDC only shows....
 
RSV and influenza A
....................................
 
for their stats. on flu Report
 
 
site link for flu A and RSV  ... http://www.hhs.state.ne.us/flu/report.htm
 
 
it shows that.....
 
RSV and Influenza A are hitting people in similar numbers in Nebraska
 .........................................................
        flu A ....  487        RSV....  370
 
..........................................................................................................
 
they are not testing for a difference between
 
RSV and human metapneumovirus....  which they call "similar"
..................................................................................................................
 
 
The spectrum of disease (human metapneumovirus)and the epidemiology of this RNA virus seem to closely resemble those of RSV.
 
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Human metapneumovirus is the first described mammalian species of Metapneumovirus/Turkey rhinotracheitis virus.
.................................................................
 
 
 
most infections are due to respiratory syncytial virus (RSV) (2).

In June 2001, Osterhaus and colleagues reported the discovery of a “new” human respiratory virus (Pneumovirinae subfamily, Paramyxoviridae family) (3).
 
RSV is in the genus Pneumovirus,
 
and the new virus
 
(human metapneumovirus (hMPV),
 
although related to RSV,
 
is more closely related to
 
avian pneumovirus serotype C
 
(previously known as
 
turkey rhinotracheitis virus) (4),
 
the only other member of the Metapneumovirus genus.
...............................................
 
turkey rhinotracheitis virus/human metapneumovirus
 
The virus seems to be distributed worldwide and to have a seasonal distribution with its incidence comparable to that for the influenza viruses during winter.
...................
as you see above post it is included with stats for seasonal flu.
 
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Is RSV infection an emerging infectious disease?

Yes.

 ....................................................

A big problem with these viruses now is that they are so prevelant...that
 
they co-circulate in humans... (2 viruses at once)
.............................................................................................................

Folks...it's another virus we get from "Birds"

They found it (Human metapneumovirus) in children

in the Netherlands in 2001...

These different yet similar avian viruses can ***co-circulate in humans...

So do not wonder why some years you are SO DARN ILL....
.............................................................................................................

Human metapneumovirus is the first described

mammalian species

of Metapneumovirus/Turkey rhinotracheitis virus.


and.....

ducks don't show it....


but they SPREAD it...  AVP ....(was turkey rhinotracheitis virus)


**Ducks inoculated with APV of turkey origin may not develop clinical signs of disease, but they are suspected to play a role as nonclinical carriers of APV.

...............................................................................................................

*http://www.emedicine.com/med/byname/human-metapneumovirus.htm

**http://avmajournals.avma.org/doi/abs/10.2460/ajvr.2001.62.991?cookieSet=1&journalCode=ajvr

****http://en. w i k  ip e d i a .org/*****/Metapneumovirus

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newly discovered human pneumovirus isolated from young

children with respiratory tract disease

BERNADETTE G. VAN DEN HOOGEN1, JAN C. DE JONG1, JAN GROEN1, THIJS KUIKEN1, RONALD DE

GROOT2, RON A.M. FOUCHIER1 & ALBERT D.M.E. OSTERHAUS1

1Departments of Virology and 2Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands

Correspondence should be addressed to A.D.M.E.O.; email: osterhaus@viro.fgg.eur.nl

From 28 young children in the Netherlands, we isolated a paramyxovirus that was identified as a

tentative new member of the Metapneumovirus genus based on virological data, sequence homology

and gene constellation. Previously, avian pneumovirus was the sole member of this recently

assigned genus, hence the provisional name for the newly discovered virus: human

metapneumovirus. The clinical symptoms of the children from whom the virus was isolated were

similar to those caused by human respiratory syncytial virus infection, ranging from upper respiratory

tract disease to severe bronchiolitis and pneumonia.

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SYMPTOMS
..................

The Flu


If you get infected by the flu virus, you will usually feel symptoms 1 to 4 days later. You can spread the flu to others before your symptoms start and for another 3 to 4 days after your symptoms appear. The symptoms start very quickly and may include
  • Body aches
  • Chills
  • Dry cough
  • Fever
  • Headache
  • Sore throat
  • Stuffy nose
.................................................................................................................
 
 
 
RSV
 
 

RSV – Pathophysiology:

• RSV causes inflammation primarily in the bronchioles of the lung. Therefore, it causes necrosis and

sloughing of the epithelium of the small airways with resultant edema, mucus formation, and finally

obstruction of air flow.

• It can cause a wide variety of clinical features, ranging from URI symptoms, to cough and pneumonia

RSV – Clinical features:

• In adults, RSV often goes undiagnosed and unsuspected. In most labs, it can now be diagnosed by a

panel of tests for respiratory viruses (DFA, ELISA); sensitivity and specificity > 90%.

• Because RSV causes obstruction of small airways, classic clinical findings include hyperinflation,

atelectasis, and wheezing.

• However, RSV can cause a wide variety of clinical features, ranging from URI symptoms, to cough and

pneumonia symptoms, to severe respiratory failure, ARDS, and death.

• Histologic resolution begins within days of onset of symptoms, but the new epithelial cells lack cilia

which makes clearing debris for the airways difficult.

• Clinical resolution typically takes 4-8 weeks.

RSV – Treatment and prevention:

• Ribavirin has been used in children, and has improved oxygenation and symptom scores in some studies.

However, these studies haven’t shown a mortality benefit. In adults, ribavirin has not been shown to be

effective.

• Bronchodilators can help, but steroids have no role unless the patient has concomitant asthma.

• No vaccine available because immunity wanes (even after natural infection) and dominant strains shift

yearly.

• Preventive measures: hand washing and avoiding little kids is key!

..................................................................................................................
 
We may see more extreme illness in children because their systems can not handle these coinfection loads .... 
 
Another reason they want to Vac little ones...
 
How many is that now?
 
Is there a build up of anything from all these Vac's?
 
Anything they use in the manufacture?
 
Tiny bodies need the best... parents are good to ask questions.
 
It's ok to ask.... whatever your concerns.
 
...............................
 
Who said to hell with the darn chickens?
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Coinfection
..................
 
 

In virology, coinfection describes the simultaneous infection of a single cell by two or more virus particles.
........................................

http://www.medscape.com/viewarticle/530540_print


In 18 patients with coinfections, clinical characteristics were indistinguishable from those with single infections. When 51 patients with hMPV single infections were compared with 88 patients with human RSV single infections, recurrent wheezing was more frequent in hMPV patients, but all other variables tested were similar in both groups.


.........................................

http://en.*****pedia.org/*****/Glandular_fever


In a small percentage of cases, mono infection is complicated by co-infection with streptococcal infection in the throat and tonsils (strep throat). Penicillin or other antibiotics should be administered to treat the strep throat, but are not effective against EBV.

................................................

http://www.lymeinfo.net/coinfections.html


LYME DISEASE COINFECTIONS
The following is information on diseases known to be transmitted by ticks. Multiple infections may be transmitted at one time by a single tick.

http://mypage.uniserve.ca/~ron-anne/co-in.htm
It has also been proven that one tick bite can transmit multiple pathogens. In North America they are: Lyme disease, Ehrlichiosis, Babesiosis, Relapsing Fever, Rocky Mountain Spotted Fever, Colorado Tick Fever, Bartonella, Tularemia, Q-Fever, Tick-Borne Encephalitis and Tick-Borne Paralysis. In 2001, viral meningitis was found to co-infect with Lyme disease. All may present singly or as co-infections.

Co-infections can be problematic to diagnose due to an overlapping of symptoms. It is known that co-infections may heighten the severity and duration of illness.

.............................................................................................................................

http://www.co-cure.org/Nicolson.pdf

Multiple co-infections (Mycoplasma, Chlamydia, human
herpes virus-6) in blood of chronic fatigue syndrome patients:
association with signs and symptoms

............................................................................................

http://www.fda.gov/cdrh/oivd/tips/rapidflu.html


Some of these limitations that apply for seasonal human influenza and most likely for an outbreak with a new influenza A virus are:

When influenza activity is low, positive results should be confirmed by immunofluorescence DFA testing, viral culture, or RT-PCR as false positive test results are more likely. Additionally, a positive test does not rule out at any time, the possibility of co-infections with other pathogens. 9

...................

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Two more MN children die of flu

Associated Press
Published Thursday, February 08, 2007

ST. PAUL (AP) - The Minnesota Department of Health is reporting two more deaths of children from influenza.

That brings to three the number of children in Minnesota who have died from the flu this season.

 
 
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2nd post here today
 
Feb 8, 5:24 PM EST

Girl dies of flu complication

By ANNE KIMAssociated Press Writer

=0

SEATTLE (AP) -- A 7-year-old girl has died of a rare complication of the flu, and a high school shut down Thursday because of a high percentage of absentees due to illness, but public health officials say it's still a typical flu season.Sarah Horner, of Kent, died Monday of myocarditis due to influenza, according to the King County Medical Examiner.Myocarditis, an inflammation of the heart muscle, is a rare complication of the flu, said Jeffrey Duchin, chief of the communicable disease section for Public Health-Seattle & King County. The condition can cause the heart muscle to not pump effectively, decreasing blood flow to the brain and other organs, causing the body to shut down, he said.

Sarah was the first child under the age of 15 who has died in King County due to flu-related causes since 1999, he said.

But this is not an indication of an unusual strain of the flu causing severe illness in children, said James Apa, a spokesman for the health agency.

"This death appears to be an uncommon reaction to a common virus in the community," he said.

"We're not seeing any superbugs in the community," he said. "What we're seeing is a typical flu virus."

Bishop Blanchet High School, a private Catholic school in Seattle, was closed Thursday and is rescheduled to open Monday.

The school had about 30 percent of its students sick, and based on the information he has now, the culprit is probably a mixture of the flu and a gastrointestinal infection, Duchin said.

Duchin said this was the first time since 1995 that he had heard of a school in King County closing due to the flu.

As of Monday, 33 schools in King County had greater than 10 percent absenteeism, a marked increase from the week before, when only five schools reported an absentee rate of more than 10 percent, according to the health agency.

That number and the number of people infected are typical when compared to past flu seasons, Duchin said.

Statewide, there have been fewer cases of the flu so far this year as compared to other years, said Tim Church, spokesman for the state Department of Health.

February and March are usually the peak of the flu season, he said. Until the past couple of weeks, there hadn't been many cases of the flu, he said.

"We're certainly starting to see a few more now," he said.

The death of the 7-year-old girl "reminds us that influenza is a really serious illness and sometimes even in healthy people can be fatal," Duchin said.

"People who haven't become ill yet should seriously consider getting vaccinated," Duchin said.

People tend to think that if they don't get their flu shots by October or November, it's not worth getting, Church said.

"That's absolutely not true," he said. "It's not too late.

©http://hosted.ap.org/dynamic/stories/W/WA_FLU_SEASON_WAOL-?SITE=PAREA&SECTION=HOME&TEMPLATE=DEFAULT 2007 The Associated Press

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Kansenshogaku Zasshi. 1990 Dec;64(12):1566-71. < =1.2> < =1.2> Links

[A case having initial onset of bronchial asthma, probably induced by prolonged mycoplasmal infection, accompanied with concurrent highly suspicious chlamydial infection]

[Article in Japanese]

First Department of Internal Medicine, Kurume University School of Medicine.

A 37-year-old man who had had no allergic history was admitted to our hospital complaining of high fever, a dry hacking cough and dyspnea.

Mycoplasma and Chlamydia mixed infection was diagnosed because of increased antibody titers to simultaneous Mycoplasma pneumoniae and Chlamydia psittaci,
 
however only the Mycoplasma pneumoniae antibody titer was not decreased during the over six months. One month after the onset, bronchial asthma was diagnosed subsequently from for the clinical symptoms of wheeze and cough.
 
Clinical studies of the dual infection and the possibility of Mycoplasma pneumoniae as the probable antigen of bronchial asthma were discussed.

PMID: 2127423 [PubMed - indexed for MEDLINE]

.....................................................................................................
Kansenshogaku Zasshi. 1996 Jan;70(1):87-92. < =1.2> < =1.2> Links

[An adult case of pneumonia due to Mycoplasma pneumoniae and Chlamydia psittaci]

[Article in Japanese]

Department of Medicine, Kawasaki Medical School.

A 18-year-old male was admitted to another hospital complaining of his chest X-ray. After transfer to our hospital, increased serum antibody titers to simultaneous M. pneumoniae and C. psittaci were noted. These antibody titers decreased after about four months. Positive results for M. pneumoniae was obtained by Polymerase chain reaction in the right pleural effusion. Based on these findings, this case was diagnosed as M. pneumoniae and C. psittaci pneumonia. A transbronchial lung biopsy and a bronchial biopsy revealed rare histological findings, including histiocytic intra-alveolar pneumonia with palisaded granuloma and small foci of necrosis in the left upper lobe and eosinophilic bronchitis in the right middle bronchus. His chest X-ray and chest CT showed a nodular shadow, obstructive pneumonia and pleural effusion which are rare in M. pneumoniae and C., psittaci pneumonia.

PMID: 8822057 [PubMed - indexed for MEDLINE]

..............................................................................

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17001543&itool=iconfft&query_hl=12&itool=pubmed_docsum

Chlamydia and Mycoplasma serology in respiratory tract infections of children.

Department of Children's Health and Diseases, Faculty of Medicine Dokuz Eylul University, Izmir, Turkey.

One of the challenges in planning the treatment of respiratory tract infection in children is identifying the causative agent. The objective of the present study was to investigate the incidence of Mycoplasma and Chlamydia in the etiology of respiratory tract infections of children.

The present study included 100 children, three months to 12 years of age, admitted to the outpatient department of pediatrics with such respiratory symptoms as fever, cough and respiratory distress. Following a detailed clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, peripheral blood smear and chest X-ray were obtained from each patient.
 
 At admission, IgG and IgM for Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci were determined serologically.
 
Positive antibody titer was found for Chlamydia and Mycoplasma in 18 (18%) of the patients. It was found that 2% of the patients had acute C. pneumoniae infection. When the subjects who had infections in the past or had re-infection were also considered; 6% were infected with C. pneumoniae, 3% with C. trachomatis, 1% with C. psittaci and 8% with M. pneumoniae.
 
The presence of eosinophilia (> or = 4%) or the presence of siblings in the house were considered as factors favoring Chlamydial infections. High antibody titers for M. pneumoniae and C. pneumoniae were found more frequently after the age of two. Patients older than two years should be evaluated carefully for antibiotic treatments against atypical agents in pediatric lower respiratory tract infections.

PMID: 17001543 [PubMed - indexed for MEDLINE]

......................................
 
 
 
 Nihon Kokyuki Gakkai Zasshi. 2002 Dec;40(12):960-4
 

[A case of pneumonia due to coinfection by Mycoplasma pneumoniae and Chlamydia pneumoniae]

[Article in Japanese]

Second Department of Internal Medicine, Akita University School of Medicine.

Few cases of Mycoplasma pneumoniae and Chlamydia pneumoniae coinfection in pneumonia have been reported in adults. We report a case of such a double infection in a young adult. A 16-year-old boy was admitted to our hospital with dry cough and fever. Laboratory findings revealed elevated serum GOT and GPT levels. The patient had been administered a beta-lactam antibiotic before admission to our hospital. Antibodies to M. pneumoniae were significantly elevated. Titers of IgM and IgG specific for C. pneumoniae titer were high, as measured by the enzyme-linked immunosorbent assay method. The patient was treated with clarithromycin and discharged after a satisfactory recovery. M. pneumoniae and C. pneumoniae may act as cofactors in community-acquired pneumonia. Further studies are needed to clarify the relationships of these pathogens to community-acquired pneumonia.

PMID: 12692948 [PubMed - indexed for MEDLINE]

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