GOLDEN ANNIVERSARY OF FELLOWSHIP PROGRAM In 1963 Kenneth C. Haltalin became the first Fellow in Pediatric Infectious Disease at the University of Texas Southwestern Medical School in Dallas. Edgar Ledbetter followed in 1965 and since that time we have had 3 to 5 Fellows in training during each calendar year. The grand total of bright, sometimes brilliant, young people who have trained with us is more than 100, most of whom completed the standard Fellowship period, but a few (especially foreigners) spent only 1 to 2 years with us because of limitations of their governments or medical schools. In the early years it became apparent that Pediatric Infectious Disease was not a recognized subspecialty in most countries, so we put a focus on trainees from foreign countries. During the past 50 years we have trained Fellows from 27 countries that span the globe. CENTRAL AND SOUTH AMERICA: Chile, Costa Rica, Colombia, Argentina, Panama, Mexico, Venezuela. EUROPE: Switzerland, Greece, Spain, Finland, France, Germany, Estonia, Italy. MIDDLE EAST: Jordan, Israel, Qatar. ASIA: Thailand, Japan, Pakistan, Taiwan, Philippines, Singapore. AFRICA: South Africa. NORTH AMERICA: Canada, Mexico. Most of the foreign Fellows have returned to their native countries to apply their skills and knowledge locally. We trust that everyone benefits from international cooperation. We appreciate the opportunity to have contributed to the education of so many fine physicians. From a selfish standpoint, we have learned a lot from them.
INFANT WITH A RASH Dr. Albert Karam, an experienced pediatrician in Dallas, TX, called to ask whether we knew of an association between receipt of hepatitis B vaccine and Gianotti-Crosti syndrome. He had recently seen an 18 month old Caucasian female with a rash. She had received her third hepatitis B and first hepatitis A vaccines three days before and now had a papulosquamous eruption that involved the cheeks, extremities, and to a lesser extent the trunk and diaper area. There was no fever, itching or other symptoms. Examination showed a happy playful child who had a completely normal physical examination other than the rash. There was no mucous membrane involvement. A presumptive diagnosis of Gianotti-Crosti syndrome was made by Dr Karam. The rash spontaneously resolved within 48 hours of onset and there were no sequelae. Papular acrodermatitis or Giannoti-Crosti syndrome was described in the mid-1950s and thought at that time to be principally associated with hepatitis B infection. The syndrome is now less frequently seen in those countries providing routine immunization with hepatitis B vaccine and associated with other viral infections, such as CMV, EBV, enteroviruses and many others. It also occurs after administration of certain vaccines like influenza vaccine, MMR and hepatitis A and B vaccines. It is a self-limited condition as illustrated by Dr Karam’s patient.
OH NO! For one of us nothing tops peanut butter, almost no matter how and on what it is eaten. Imagine the queasy feeling when I read the Morbidity and Mortality Weekly Report of February 15, 2013 about the cluster of Salmonella enterica Serotype Bredeney infections in 41 individuals who consumed peanut butter manufactured by Sunland, Inc of Portales, New Mexico as Trader Joe’s Creamy Salted Valencia Peanut Butter. I checked my opened, often sampled jar of the product I snack from daily and it was another manufacturer and tasted great. I decided not to culture it. It is going to take more than that to stop this culinary habit.
QUESTION OF THE DAY For several years we have been receiving by email an excellent publication entitled “Medical Microbiology Question of the Day”. Clicking on the link provides access to a teaching tool formatted as questions and answers on topics pertaining to medical microbiology and infectious diseases. It is prepared three times weekly by Carey- Ann Burnham, PhD, D(ABMM) F(CCM), Assistant Professor Pathology & Immunology and Pediatrics, Washington University School of Medicine, Medical Director of Microbiology, Barnes Jewish Hospital, St Louis, MO and Christopher Doern Ph.D. D(ABMM), Assistant Professor of Pathology, University of Texas Southwestern Medical Center Director of Microbiology, Children’s Medical Center of Dallas, Dallas, TX. Check it out by clicking on http://PathQuestions.com where you can find a description of the publication, examples of past questions on various topics, a list of contributing authors and how to subscribe free of charge. You will be glad that you did.
MANAGEMENT OF EMPYEMA Recently we helped manage several children with empyema caused by Staphylococcus aureus. The guidelines for drainage of parapneumonic effusions have changed in our combined experience. In the 1970s and 1980s tube thoracostomy was usually performed for empyema with tubes left in place for 7-10 days, or longer and hospitalization routinely exceeded 2-3 weeks. That approach gave way to video-assisted thorascopic surgery (VATS) often accompanied by short-term chest tube drainage. Hospitalization was shortened to 7-10 days and recovery was more rapid because of earlier mobility of the children. In the past several years chemical rather than operative debridment has emerged as the preferred management because hospitalization can be further shortened and recovery completed more rapidly. In the United States tissue plasminogen activator (tPA) is the chemical agent most frequently used whereas urokinase or streptokinase are often employed elsewhere. Improved outcome has also been facilitated by the advance in radiologic techniques where nowadays ultrasonograhy often coupled with chest computed tomography delineate the extent of the pulmonary parenchymal and pleural space disease and the presence and location of loculations. Needless to say, routine use of the conjugate vaccines for Haemophilus influenza type b and Streptococcus pneumonia has been critical in preventing many of these infections.
A FAMOUS MAN YOU NEVER HEARD OF Nevin S. Scrimshaw, Ph.D., M. D. died in February 2013 at 95 years of age, an event that was heralded by an extensive, laudatory obituary in The New York Times. The work that earned him these plaudits had gone virtually unnoticed to the medical world and to the general public during his lifetime even though the World Food Prize Foundation in 1991 honored him for his “revolutionary accomplishments” that had “improved the lives of millions”. In 1945 the U.S. Army assigned Dr. Scrimshaw to the Gorgas Hospital in the Panama Canal Zone where he developed an interest in the interrelationships between poor nutrition and infections. In 1949 he founded the Institute of Nutrition of Central America and Panama, which was known by the acronym INCAP. He concocted a mixture of corn, cottonseed and sorghum that was nutritionally equivalent to milk, which he dubbed Incaparina (from INCAP and harina, the Spanish word for flour). Mothers would cook it for 15 minutes with water and flavoring (e. g. cinnamon, vanilla) and feed it to weanling infants at the cost of 1 penny a glass. Incaparina became standard fare throughout Central America. He later devised a similar product in India. Improved nutrition in babies undoubtedly had a major impact on infectious diseases. Dr. Scrimshaw worked effectively with many governments and agencies to provide nutritional supplements in many countries. We had the pleasure of encountering him in Guatemala many years ago and can attest to his kind, selfless humanitarianism. His name lives on at the Nevin Scrimshaw International Nutrition Foundation at Tufts University.