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Neurologic manifestations of human immunodeficiency virus infection in children
33 Infectious Diseases Newsletter 6(4) April 1987 (continued from page 28 )
Table 1. Factors Predisposing to Catheter Related Infection Length of time catheter is in place Poor preparation and insertion technique Pre-existing Infection Surgical placement Local catheter care and dressing changes Frequent manipulation lmmunocompromised host Multi-lumen catheters present and invasive cannulation is still necessary, a new site should be selected for access. Daily dressing changes and local catheter care with application of neomycin-bacitracinpolymixin ointment is standard care for prevention of infection. When C R I are diagnosed, removal of the indwelling percutaneous catheter and administration of antimicrobial agents based on culture and suscep-
tibility tests constitutes appropriate therapy.
Bibliography Applefeld J J, Caruthers TE, Reno D J, et al: Assessment of the sterility of long-term cardiac catheterization using the thermodilution Swan-Ganz catheter. Chest 74:377-380, 1978. Band JD, Maki DG: Infections caused by arterial catheters used for hemodynamic monitoring. Am J Med 57:735-741, 1979. Dahlberg P J, Yutuc WR, Newcomer KL: Subclavian hemodialysis catheter infections. Am J Kid Dis 7:421-427, 1986. Gertner J, Herman B, Pescio M, et al: Risk of infection in prolonged central venous catheterization. Surg Gynecol Obstet 149:567-570, 1979. Hiemenz J, Skelton J, Pizzo PA: Perspective on the management of catheter-related infections in cancer patients. Ped Inf Dis 5:6-11, 1986. Maki DG, Weise CE, Sarafin HW: A semiquantitative culture method for identifying intravenous-catheter-
related infection. New Engl J Med 296:1305-1309, 1977. Michel L, Marsh M, McMichan JC, et al: Infection of pulmonary artery catheters in critically ill patients. JAMA 245:1032-1036, 1981. Pemberton LB, Lyman B, Lander V, et al: Sepsis from triple-vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch Surg 121:591-593, 1986. Pinilla JC, Ross DF, Martin T, et al: Study of the incidence of intravascular catheter infection and associated septicemia in critically ill patients. Crit Care Med 11:21-25, 1983. Samsoondar W, Freeman JB: Colonization of intravascular monitoring devices. Crit Care Med 13:753-755, 1985. Schuman ES, Winters V, Gross GF, et al: Management of Hackman catheters sepsis. Am J Surg 149:627-628, 1985. Singh S, Nelson N, Acosta E, et al: Catheter colonization and bacteremia with pulmonary and arterial catheters. Crit Care Med 10:736-739, 1982.
C O M M E N T S ON C U R R E N T P U B L I C A T I O N S Epstein LG, Sharer LR, Oleske JM, et al: Neurologic manifestations of human immunodeliciency virus infection in children. Pediatrics 78:678-687, 1986. Among 36 children with human immunodeficiency virus (HIV) infections, progressive encephalopathy developed in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with A I D S related complex (ARC), and one of three asymptomatic seropositive children. Neurologic abnormalities were often detected early, and worsened with progression of the immunodeficiency. Progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. Incubation periods ranged from 2 months to 5 years from initial HIV infection in the perinatal
period to the onset of progressive encephalopathy. Synthesis of HIV specific antibodies within the central nervous system (CNS) was demonstrated in 8 of 14 children with A I D S or ARC, indicating active brain infection with HIV. Unique neuropathologic findings in children who died with HIV infection suggested that the progressive encephalopathy was a result of primary and persistent infection of the brain with HIV.
and in one child still asymptomatic but seropositive. Brain infection in these children probably occurred early and was persistent. The presence of the virus within the brain has therapeutic implications, ie, an effective anti-HIV agent will need to cross the blood brain barrier unless it is administered before CNS involvement has occurred. LKP []
Comment Acquired immunodeficiency syndrome, in both adults and children is frequently accompanied by neurologic dysfunction. Epstein et al. report that progressive encephalopathy occurred in more than 50% of children with HIV infection. Most of the children also had AIDS, although the encephalopathy also developed in children with ARC,
© 1987 Elsevier Science Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
Edwards KM, Lawrence E. Wright PF: Diphtheria, tetanus, and pertussis vaccine: A comparison of the immune response and adverse reactions to conventional and acellular pertussis components. Am J Dis Child 140:872-876, 1986. Lewis K, Cherry J D , Holroyd J, et al: A double-blind study comparing
Table 1. Factors Predisposing to Catheter Related Infection Length of time catheter is in place Poor preparation and insertion technique Pre-existing Infection Surgical placement Local catheter care and dressing changes Frequent manipulation lmmunocompromised host Multi-lumen catheters present and invasive cannulation is still necessary, a new site should be selected for access. Daily dressing changes and local catheter care with application of neomycin-bacitracinpolymixin ointment is standard care for prevention of infection. When C R I are diagnosed, removal of the indwelling percutaneous catheter and administration of antimicrobial agents based on culture and suscep-
tibility tests constitutes appropriate therapy.
Bibliography Applefeld J J, Caruthers TE, Reno D J, et al: Assessment of the sterility of long-term cardiac catheterization using the thermodilution Swan-Ganz catheter. Chest 74:377-380, 1978. Band JD, Maki DG: Infections caused by arterial catheters used for hemodynamic monitoring. Am J Med 57:735-741, 1979. Dahlberg P J, Yutuc WR, Newcomer KL: Subclavian hemodialysis catheter infections. Am J Kid Dis 7:421-427, 1986. Gertner J, Herman B, Pescio M, et al: Risk of infection in prolonged central venous catheterization. Surg Gynecol Obstet 149:567-570, 1979. Hiemenz J, Skelton J, Pizzo PA: Perspective on the management of catheter-related infections in cancer patients. Ped Inf Dis 5:6-11, 1986. Maki DG, Weise CE, Sarafin HW: A semiquantitative culture method for identifying intravenous-catheter-
related infection. New Engl J Med 296:1305-1309, 1977. Michel L, Marsh M, McMichan JC, et al: Infection of pulmonary artery catheters in critically ill patients. JAMA 245:1032-1036, 1981. Pemberton LB, Lyman B, Lander V, et al: Sepsis from triple-vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch Surg 121:591-593, 1986. Pinilla JC, Ross DF, Martin T, et al: Study of the incidence of intravascular catheter infection and associated septicemia in critically ill patients. Crit Care Med 11:21-25, 1983. Samsoondar W, Freeman JB: Colonization of intravascular monitoring devices. Crit Care Med 13:753-755, 1985. Schuman ES, Winters V, Gross GF, et al: Management of Hackman catheters sepsis. Am J Surg 149:627-628, 1985. Singh S, Nelson N, Acosta E, et al: Catheter colonization and bacteremia with pulmonary and arterial catheters. Crit Care Med 10:736-739, 1982.
C O M M E N T S ON C U R R E N T P U B L I C A T I O N S Epstein LG, Sharer LR, Oleske JM, et al: Neurologic manifestations of human immunodeliciency virus infection in children. Pediatrics 78:678-687, 1986. Among 36 children with human immunodeficiency virus (HIV) infections, progressive encephalopathy developed in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with A I D S related complex (ARC), and one of three asymptomatic seropositive children. Neurologic abnormalities were often detected early, and worsened with progression of the immunodeficiency. Progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. Incubation periods ranged from 2 months to 5 years from initial HIV infection in the perinatal
period to the onset of progressive encephalopathy. Synthesis of HIV specific antibodies within the central nervous system (CNS) was demonstrated in 8 of 14 children with A I D S or ARC, indicating active brain infection with HIV. Unique neuropathologic findings in children who died with HIV infection suggested that the progressive encephalopathy was a result of primary and persistent infection of the brain with HIV.
and in one child still asymptomatic but seropositive. Brain infection in these children probably occurred early and was persistent. The presence of the virus within the brain has therapeutic implications, ie, an effective anti-HIV agent will need to cross the blood brain barrier unless it is administered before CNS involvement has occurred. LKP []
Comment Acquired immunodeficiency syndrome, in both adults and children is frequently accompanied by neurologic dysfunction. Epstein et al. report that progressive encephalopathy occurred in more than 50% of children with HIV infection. Most of the children also had AIDS, although the encephalopathy also developed in children with ARC,
© 1987 Elsevier Science Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
Edwards KM, Lawrence E. Wright PF: Diphtheria, tetanus, and pertussis vaccine: A comparison of the immune response and adverse reactions to conventional and acellular pertussis components. Am J Dis Child 140:872-876, 1986. Lewis K, Cherry J D , Holroyd J, et al: A double-blind study comparing