The Center for Disease Control, an immunofluorescent antibody titer of 1:64, consistent with the diagnosis of carinii. Because of his steadily improving respiratory and nutri¬ tional status, it was not thought justifiable to obtain tissue for examination. He was not treated with pentamidine isethionate. He has continued to thrive.
mocystis.
Atlanta, determined
Pneumocystis carinii in Vietnamese
a
Foundling
Recently, Pneumocystis carinii pneumonitis has been reported in two
Vietnamese foundlings.1,2 Therapy consisted of pentamidine isethionate and correction of the malnourished condition; one child died.1 We wish to describe another example of P carinii pneumonitis in a Vietnamese found-
ling.
a Case.\p=m-\A Vietnamese boy born in April 1974. His Vietnamese records disclosed multiple episodes of cellulitis, cough, and fever in July 1974. A chest roentgenogram at that time was reported to show "air bronchograms behind the heart." On arrival in this country (September 1974), he was hospitalized because of persistent rhinitis, cough, and clinically apparent pneumonitis. He was malnourished (3.75 kg [8.25 lb]) and had multiple cutaneous abscesses, scabies, and hepatomegaly. There were prominent interstitial markings in the right upper lobe. The scabies were topically treated and the abscesses were drained and treated with antibiotics. Tuberculin tests were negative, examinations of the stool showed no ova and parasites, and culture of tracheal aspirates for bacterial pathogens were negative. Shortly after admission, the child developed pro¬ fuse diarrhea that was responsive to for¬ mula modification. He began to gain weight in mid-October, but had persistent coryza and cough. Because of a report from the orphanage of two other foundlings with carinii and because of the persistence of respiratory symptoms, the child was examined at the University of Iowa Hospitals. At that time, he was 6 months old and weighed 5.1 kg (11.2 lb). Examination showed a resting respiratory rate of approximately 36/min; he had diffuse rhonchi and a few basilar rales. There was evidence of healing impetiginous lesions and abscesses. Chest roentgenogram was within normal limits, and analysis of the arterial blood gases with the patient breathing room air showed a pH of 7.36, an oxygen pressure of 76 mm Hg, and a carbon dioxide pressure of 28 mm Hg. Methenamine silver stains of trachea! aspirates showed no Pneu-
Report of
was
Comment.—The "epidemic form" of carinni was first recognized in cen¬ tral Europe in the late 1930s, and epi¬ demics continued until about 1960 when the nutritional status of the in¬ volved countries improved.'1 This form of carinii pneumonitis usually oc¬ curs in children 6 weeks to 4 months old who are malnourished and fre¬ quently premature, and after an incu¬ bation period of one to two months. The course is usually insidious and may continue for as long as two to three months. Treatment with pen¬ tamidine isethionate reduces the mor¬ tality from 50% to about 3%.4 In con¬ trast, the so-called sporadic form of carinii pneumonitis occurs almost ex¬ clusively in immunologically compro¬ mised patients."' These patients often have an abrupt onset with spiking fe¬ vers, cough, and tachypnea, and the course is generally rapid with death the usual outcome in the untreated patient and about 50% in treated pa¬ tients." Most cases of the sporadic va¬ riety do not develop elevated anti¬ body titers.7 However, most infants with the epidemic variety of carinii do develop elevated antibody titers,'·4·7 exemplified by this case and the two previous case reports.1- Our case demonstrates that recovery may occur spontaneously with improved nutritional status alone in children with this form of the disease. JAMES NORDIN, MD MARTIN G. MYERS, MD Division of Pediatric Infectious Diseases University of Iowa Hospitals Iowa City, IA 52242 ROLLIE PERKINS, MD 4217 Utica Ridge Rd Bettendorf, IA 52274
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Manitoba User on 06/16/2015
1. Eidelman A, Nkongo A, Morecki R: Pneucarinii pneumonitis in Vietnamese infant in U.S., abstracted. Pediatr Res 8:424, 1974. 2. Redman JC: Pneumocystis carinii pneumonia in an adopted Vietnamese infant. JAMA 230:1561-1563, 1974. 3. Gajdusek DC: Pneumocystis carinii: Etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 19:543-565, 1957. 4. Ivady G, Paldy L, Koltay M: Pneumocystis carinii pneumonia. Lancet 1:616-617, 1967. 5. Burke BA, Good RA: Pneumocystis carinii infection. Medicine 52:23-51, 1973. 6. Western KA, Perera DR, Schultz MG: Pentamidine isethionate in the treatment of Pneumocystis carinii pneumonia. Ann Intern Med 73:695-702, 1970. 7. Norman L, Kagan IG: A preliminary report of an indirect fluorescent antibody test for detecting antibodies to cysts of Pneumocystis carinii in human sera. Am J Clin Pathol 58:170\x=req-\
mocystis
176, 1972.
Scrotal Mass in a Neonate: Testicular Abscess
We would like to report the case of infant found to have epididymoorchitis and a testicular abscess. an
Report of a Case.\p=m-\A2,600-gm (5.7-lb) inby low forceps to a 16-year-old, VDRL-negative primigravida appeared fant born
normal at birth. Circumcision was performed on the second day of life, and the genitalia were observed to be normal. On the third day of life the infant fed poorly and became visibly jaundiced. A distended abdomen with active bowel sounds and
periumbilical erythema without discharge were noted. Suspecting sepsis, blood, urine, and cere-
brospinal fluid cultures were obtained, and the infant was treated intravenously with antibiotics. The following day the blood culture yielded a Gram-negative rod, later
identified as Escherichia coli. On the 14th day of life, a firm, tender mass measuring 2 cm in diameter was found in the right scrotum. The mass, which seemed to include the right testicle,
was not erythematous or warm to palpation, was not transilluminable, and was not
continuous with the abdominal cavity. The left testicle was normal to palpation. Re¬ sults of urinalysis were normal, and re¬ peated urine cultures were sterile. An in¬ travenous
pyelogram
was
unremarkable,
calcifications were seen in the scro¬ tum or abdominal cavity. At operation, the right scrotum was ex¬ plored and found to contain an enlarged, and
no
mocystis.
Atlanta, determined
Pneumocystis carinii in Vietnamese
a
Foundling
Recently, Pneumocystis carinii pneumonitis has been reported in two
Vietnamese foundlings.1,2 Therapy consisted of pentamidine isethionate and correction of the malnourished condition; one child died.1 We wish to describe another example of P carinii pneumonitis in a Vietnamese found-
ling.
a Case.\p=m-\A Vietnamese boy born in April 1974. His Vietnamese records disclosed multiple episodes of cellulitis, cough, and fever in July 1974. A chest roentgenogram at that time was reported to show "air bronchograms behind the heart." On arrival in this country (September 1974), he was hospitalized because of persistent rhinitis, cough, and clinically apparent pneumonitis. He was malnourished (3.75 kg [8.25 lb]) and had multiple cutaneous abscesses, scabies, and hepatomegaly. There were prominent interstitial markings in the right upper lobe. The scabies were topically treated and the abscesses were drained and treated with antibiotics. Tuberculin tests were negative, examinations of the stool showed no ova and parasites, and culture of tracheal aspirates for bacterial pathogens were negative. Shortly after admission, the child developed pro¬ fuse diarrhea that was responsive to for¬ mula modification. He began to gain weight in mid-October, but had persistent coryza and cough. Because of a report from the orphanage of two other foundlings with carinii and because of the persistence of respiratory symptoms, the child was examined at the University of Iowa Hospitals. At that time, he was 6 months old and weighed 5.1 kg (11.2 lb). Examination showed a resting respiratory rate of approximately 36/min; he had diffuse rhonchi and a few basilar rales. There was evidence of healing impetiginous lesions and abscesses. Chest roentgenogram was within normal limits, and analysis of the arterial blood gases with the patient breathing room air showed a pH of 7.36, an oxygen pressure of 76 mm Hg, and a carbon dioxide pressure of 28 mm Hg. Methenamine silver stains of trachea! aspirates showed no Pneu-
Report of
was
Comment.—The "epidemic form" of carinni was first recognized in cen¬ tral Europe in the late 1930s, and epi¬ demics continued until about 1960 when the nutritional status of the in¬ volved countries improved.'1 This form of carinii pneumonitis usually oc¬ curs in children 6 weeks to 4 months old who are malnourished and fre¬ quently premature, and after an incu¬ bation period of one to two months. The course is usually insidious and may continue for as long as two to three months. Treatment with pen¬ tamidine isethionate reduces the mor¬ tality from 50% to about 3%.4 In con¬ trast, the so-called sporadic form of carinii pneumonitis occurs almost ex¬ clusively in immunologically compro¬ mised patients."' These patients often have an abrupt onset with spiking fe¬ vers, cough, and tachypnea, and the course is generally rapid with death the usual outcome in the untreated patient and about 50% in treated pa¬ tients." Most cases of the sporadic va¬ riety do not develop elevated anti¬ body titers.7 However, most infants with the epidemic variety of carinii do develop elevated antibody titers,'·4·7 exemplified by this case and the two previous case reports.1- Our case demonstrates that recovery may occur spontaneously with improved nutritional status alone in children with this form of the disease. JAMES NORDIN, MD MARTIN G. MYERS, MD Division of Pediatric Infectious Diseases University of Iowa Hospitals Iowa City, IA 52242 ROLLIE PERKINS, MD 4217 Utica Ridge Rd Bettendorf, IA 52274
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Manitoba User on 06/16/2015
1. Eidelman A, Nkongo A, Morecki R: Pneucarinii pneumonitis in Vietnamese infant in U.S., abstracted. Pediatr Res 8:424, 1974. 2. Redman JC: Pneumocystis carinii pneumonia in an adopted Vietnamese infant. JAMA 230:1561-1563, 1974. 3. Gajdusek DC: Pneumocystis carinii: Etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 19:543-565, 1957. 4. Ivady G, Paldy L, Koltay M: Pneumocystis carinii pneumonia. Lancet 1:616-617, 1967. 5. Burke BA, Good RA: Pneumocystis carinii infection. Medicine 52:23-51, 1973. 6. Western KA, Perera DR, Schultz MG: Pentamidine isethionate in the treatment of Pneumocystis carinii pneumonia. Ann Intern Med 73:695-702, 1970. 7. Norman L, Kagan IG: A preliminary report of an indirect fluorescent antibody test for detecting antibodies to cysts of Pneumocystis carinii in human sera. Am J Clin Pathol 58:170\x=req-\
mocystis
176, 1972.
Scrotal Mass in a Neonate: Testicular Abscess
We would like to report the case of infant found to have epididymoorchitis and a testicular abscess. an
Report of a Case.\p=m-\A2,600-gm (5.7-lb) inby low forceps to a 16-year-old, VDRL-negative primigravida appeared fant born
normal at birth. Circumcision was performed on the second day of life, and the genitalia were observed to be normal. On the third day of life the infant fed poorly and became visibly jaundiced. A distended abdomen with active bowel sounds and
periumbilical erythema without discharge were noted. Suspecting sepsis, blood, urine, and cere-
brospinal fluid cultures were obtained, and the infant was treated intravenously with antibiotics. The following day the blood culture yielded a Gram-negative rod, later
identified as Escherichia coli. On the 14th day of life, a firm, tender mass measuring 2 cm in diameter was found in the right scrotum. The mass, which seemed to include the right testicle,
was not erythematous or warm to palpation, was not transilluminable, and was not
continuous with the abdominal cavity. The left testicle was normal to palpation. Re¬ sults of urinalysis were normal, and re¬ peated urine cultures were sterile. An in¬ travenous
pyelogram
was
unremarkable,
calcifications were seen in the scro¬ tum or abdominal cavity. At operation, the right scrotum was ex¬ plored and found to contain an enlarged, and
no
