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|00000590| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 36 32 30 |nique_ID|{YRB0620|
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|000007d0| 20 63 61 72 65 20 6f 66 | 3b 0d 0a 41 6d 62 75 6c | care of|;..Ambul|
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|000007f0| 62 72 69 6c 65 20 69 6e | 66 61 6e 74 20 61 74 20 |brile in|fant at |
|00000800| 72 69 73 6b 20 66 6f 72 | 20 62 61 63 74 65 72 69 |risk for| bacteri|
|00000810| 61 6c 20 69 6e 66 65 63 | 74 69 6f 6e 7d 0d 0a 24 |al infec|tion}..$|
|00000820| 4a 6f 75 72 6e 61 6c 7b | 4a 20 50 65 64 69 61 74 |Journal{|J Pediat|
|00000830| 72 7d 0d 0a 24 56 6f 6c | 75 6d 65 7b 31 31 32 7d |r}..$Vol|ume{112}|
|00000840| 0d 0a 24 50 61 67 65 7b | 33 35 35 2d 33 36 30 7d |..$Page{|355-360}|
|00000850| 0d 0a 24 44 61 74 65 7b | 4d 61 72 63 68 20 31 39 |..$Date{|March 19|
|00000860| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |88}..$YB|Vol{1989|
|00000870| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 46 61 | Year Bo|ok of Fa|
|00000880| 6d 69 6c 79 20 50 72 61 | 63 74 69 63 65 7d 0d 0a |mily Pra|ctice}..|
|00000890| 24 43 68 61 70 74 65 72 | 7b 31 2d 31 7d 0d 0a 24 |$Chapter|{1-1}..$|
|000008a0| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 52 61 |YBEditor|{Drs. Ra|
|000008b0| 6b 65 6c 2c 20 41 76 61 | 6e 74 2c 20 44 72 69 73 |kel, Ava|nt, Dris|
|000008c0| 63 6f 6c 6c 2c 20 50 72 | 69 63 68 61 72 64 2c 20 |coll, Pr|ichard, |
|000008d0| 61 6e 64 20 53 6d 69 74 | 68 7d 0d 0a 24 54 61 62 |and Smit|h}..$Tab|
|000008e0| 6c 65 7b 7d 0d 0a 24 43 | 6f 6d 6d 65 6e 74 61 74 |le{}..$C|ommentat|
|000008f0| 6f 72 7b 43 2e 57 2e 20 | 53 6d 69 74 68 2c 20 4a |or{C.W. |Smith, J|
|00000900| 72 2e 2c 20 4d 2e 44 2e | 7d 0d 0a 0d 0a 43 6f 70 |r., M.D.|}....Cop|
|00000910| 79 72 69 67 68 74 20 28 | 63 29 20 59 65 61 72 20 |yright (|c) Year |
|00000920| 42 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |Book Med|ical Pub|
|00000930| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|00000940| 39 38 39 0d 0a 0d 0a 31 | 39 38 39 20 59 65 61 72 |989....1|989 Year|
|00000950| 20 42 6f 6f 6b 20 6f 66 | 20 46 61 6d 69 6c 79 20 | Book of| Family |
|00000960| 50 72 61 63 74 69 63 65 | 20 28 52 29 0d 0a 0d 0a |Practice| (R)....|
|00000970| 43 68 61 70 74 65 72 20 | 31 2d 2d 49 6e 66 65 63 |Chapter |1--Infec|
|00000980| 74 69 6f 75 73 20 44 69 | 73 65 61 73 65 0d 0a 0d |tious Di|sease...|
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|000009e0| 2d 2d 2d 0d 0a 41 6d 62 | 75 6c 61 74 6f 72 79 20 |---..Amb|ulatory |
|000009f0| 43 61 72 65 20 6f 66 20 | 46 65 62 72 69 6c 65 20 |Care of |Febrile |
|00000a00| 49 6e 66 61 6e 74 73 20 | 59 6f 75 6e 67 65 72 20 |Infants |Younger |
|00000a10| 54 68 61 6e 20 32 20 4d | 6f 6e 74 68 73 20 6f 66 |Than 2 M|onths of|
|00000a20| 20 41 67 65 20 43 6c 61 | 73 73 69 66 69 65 64 20 | Age Cla|ssified |
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|00000a40| 20 52 69 73 6b 20 66 6f | 72 20 48 61 76 69 6e 67 | Risk fo|r Having|
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|00000a70| 0a 44 61 67 61 6e 20 52 | 2c 20 53 6f 66 65 72 20 |.Dagan R|, Sofer |
|00000a80| 53 2c 20 50 68 69 6c 6c | 69 70 20 4d 2c 20 53 68 |S, Phill|ip M, Sh|
|00000a90| 61 63 68 61 6b 20 45 0d | 0a 28 53 6f 72 6f 6b 61 |achak E.|.(Soroka|
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|00000ae0| 69 61 74 72 20 31 31 32 | 3a 33 35 35 2d 33 36 30 |iatr 112|:355-360|
|00000af0| 2c 20 4d 61 72 63 68 20 | 31 39 38 38 0d 0a 2d 2d |, March |1988..--|
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|00000b50| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct....  |
|00000b60| 20 20 20 49 74 20 68 61 | 73 20 67 65 6e 65 72 61 |   It ha|s genera|
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|00002960| 0a 24 43 68 61 70 74 65 | 72 7b 31 2d 33 7d 0d 0a |.$Chapte|r{1-3}..|
|00002970| 24 59 42 45 64 69 74 6f | 72 7b 44 72 73 2e 20 52 |$YBEdito|r{Drs. R|
|00002980| 61 6b 65 6c 2c 20 41 76 | 61 6e 74 2c 20 44 72 69 |akel, Av|ant, Dri|
|00002990| 73 63 6f 6c 6c 2c 20 50 | 72 69 63 68 61 72 64 2c |scoll, P|richard,|
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|00002a10| 31 39 38 39 0d 0a 0d 0a | 31 39 38 39 20 59 65 61 |1989....|1989 Yea|
|00002a20| 72 20 42 6f 6f 6b 20 6f | 66 20 46 61 6d 69 6c 79 |r Book o|f Family|
|00002a30| 20 50 72 61 63 74 69 63 | 65 20 28 52 29 0d 0a 0d | Practic|e (R)...|
|00002a40| 0a 43 68 61 70 74 65 72 | 20 31 2d 2d 49 6e 66 65 |.Chapter| 1--Infe|
|00002a50| 63 74 69 6f 75 73 20 44 | 69 73 65 61 73 65 0d 0a |ctious D|isease..|
|00002a60| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00002a70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002aa0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ab0| 2d 2d 0d 0a 45 66 66 65 | 63 74 73 20 6f 66 20 43 |--..Effe|cts of C|
|00002ac0| 61 75 73 61 74 69 76 65 | 20 4f 72 67 61 6e 69 73 |ausative| Organis|
|00002ad0| 6d 20 61 6e 64 20 50 72 | 65 73 65 6e 63 65 20 6f |m and Pr|esence o|
|00002ae0| 72 20 41 62 73 65 6e 63 | 65 20 6f 66 20 4d 65 6e |r Absenc|e of Men|
|00002af0| 69 6e 67 69 74 69 73 20 | 6f 6e 20 57 68 69 74 65 |ingitis |on White|
|00002b00| 0d 0a 42 6c 6f 6f 64 20 | 43 65 6c 6c 20 43 6f 75 |..Blood |Cell Cou|
|00002b10| 6e 74 73 20 69 6e 20 43 | 68 69 6c 64 72 65 6e 20 |nts in C|hildren |
|00002b20| 57 69 74 68 20 42 61 63 | 74 65 72 65 6d 69 61 0d |With Bac|teremia.|
|00002b30| 0a 0d 0a 4b 6c 69 6e 65 | 20 4d 57 2c 20 4f 27 42 |...Kline| MW, O'B|
|00002b40| 72 69 61 6e 20 53 6d 69 | 74 68 20 45 2c 20 4b 61 |rian Smi|th E, Ka|
|00002b50| 70 6c 61 6e 20 53 4c 2c | 20 4c 6f 72 69 6e 20 4d |plan SL,| Lorin M|
|00002b60| 49 0d 0a 28 42 61 79 6c | 6f 72 20 43 6f 6c 6c 65 |I..(Bayl|or Colle|
|00002b70| 67 65 20 6f 66 20 4d 65 | 64 69 63 69 6e 65 3b 20 |ge of Me|dicine; |
|00002b80| 54 65 78 61 73 20 43 68 | 69 6c 64 72 65 6e 27 73 |Texas Ch|ildren's|
|00002b90| 20 48 6f 73 70 2c 20 48 | 6f 75 73 74 6f 6e 29 0d | Hosp, H|ouston).|
|00002ba0| 0a 4a 20 45 6d 65 72 67 | 20 4d 65 64 20 36 3a 33 |.J Emerg| Med 6:3|
|00002bb0| 33 2d 33 35 2c 20 4a 61 | 6e 75 61 72 79 2d 46 65 |3-35, Ja|nuary-Fe|
|00002bc0| 62 72 75 61 72 79 20 31 | 39 38 0d 0a 2d 2d 2d 2d |bruary 1|98..----|
|00002bd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002be0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002bf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00002c20| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00002c30| 20 54 68 65 20 77 68 69 | 74 65 20 62 6c 6f 6f 64 | The whi|te blood|
|00002c40| 20 63 65 6c 6c 20 28 57 | 42 43 29 20 63 6f 75 6e | cell (W|BC) coun|
|00002c50| 74 20 69 73 20 77 69 64 | 65 6c 79 20 75 73 65 64 |t is wid|ely used|
|00002c60| 20 69 6e 20 74 68 65 20 | 65 6d 65 72 67 65 6e 63 | in the |emergenc|
|00002c70| 79 20 64 65 70 61 72 74 | 6d 65 6e 74 0d 0a 61 73 |y depart|ment..as|
|00002c80| 20 61 20 73 63 72 65 65 | 6e 69 6e 67 20 74 65 73 | a scree|ning tes|
|00002c90| 74 20 66 6f 72 20 62 61 | 63 74 65 72 65 6d 69 61 |t for ba|cteremia|
|00002ca0| 2e 20 20 56 61 72 69 61 | 62 6c 65 73 20 74 68 61 |.  Varia|bles tha|
|00002cb0| 74 20 6d 69 67 68 74 20 | 69 6e 66 6c 75 65 6e 63 |t might |influenc|
|00002cc0| 65 20 74 68 65 20 57 42 | 43 0d 0a 63 6f 75 6e 74 |e the WB|C..count|
|00002cd0| 20 69 6e 20 62 61 63 74 | 65 72 65 6d 69 63 20 63 | in bact|eremic c|
|00002ce0| 68 69 6c 64 72 65 6e 20 | 77 65 72 65 20 61 73 73 |hildren |were ass|
|00002cf0| 65 73 73 65 64 20 62 61 | 73 65 64 20 6f 6e 20 74 |essed ba|sed on t|
|00002d00| 68 65 20 72 65 63 6f 72 | 64 73 20 6f 66 20 39 35 |he recor|ds of 95|
|00002d10| 20 62 6f 79 73 20 28 35 | 32 25 29 0d 0a 61 6e 64 | boys (5|2%)..and|
|00002d20| 20 38 37 20 67 69 72 6c | 73 20 28 34 38 25 29 20 | 87 girl|s (48%) |
|00002d30| 61 67 65 64 20 32 2d 31 | 34 34 20 6d 6f 6e 74 68 |aged 2-1|44 month|
|00002d40| 73 20 28 6d 65 61 6e 2c | 20 31 37 2e 34 20 6d 6f |s (mean,| 17.4 mo|
|00002d50| 6e 74 68 73 29 20 77 69 | 74 68 20 62 61 63 74 65 |nths) wi|th bacte|
|00002d60| 72 65 6d 69 61 20 63 61 | 75 73 65 64 0d 0a 62 79 |remia ca|used..by|
|00002d70| 20 53 74 72 65 70 74 6f | 63 6f 63 63 75 73 20 70 | Strepto|coccus p|
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|00002d90| 70 68 69 6c 75 73 20 69 | 6e 66 6c 75 65 6e 7a 61 |philus i|nfluenza|
|00002da0| 65 20 74 79 70 65 20 62 | 2c 20 6f 72 20 4e 65 69 |e type b|, or Nei|
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|00002dc0| 69 64 69 73 2e 20 20 41 | 6e 61 6c 79 73 69 73 20 |idis.  A|nalysis |
|00002dd0| 6f 66 20 63 6f 76 61 72 | 69 61 6e 63 65 20 77 61 |of covar|iance wa|
|00002de0| 73 20 75 73 65 64 20 74 | 6f 20 61 73 73 65 73 73 |s used t|o assess|
|00002df0| 20 74 68 65 20 65 66 66 | 65 63 74 73 20 6f 66 20 | the eff|ects of |
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|00002e30| 61 6e 64 20 70 72 65 73 | 65 6e 63 65 20 6f 72 20 |and pres|ence or |
|00002e40| 61 62 73 65 6e 63 65 20 | 6f 66 20 6d 65 6e 69 6e |absence |of menin|
|00002e50| 67 69 74 69 73 0d 0a 6f | 6e 20 6d 65 61 6e 20 57 |gitis..o|n mean W|
|00002e60| 42 43 2c 20 61 62 73 6f | 6c 75 74 65 20 70 6f 6c |BC, abso|lute pol|
|00002e70| 79 6d 6f 72 70 68 6f 6e | 75 63 6c 65 61 72 20 63 |ymorphon|uclear c|
|00002e80| 65 6c 6c 20 63 6f 75 6e | 74 2c 20 61 6e 64 20 61 |ell coun|t, and a|
|00002e90| 62 73 6f 6c 75 74 65 20 | 62 61 6e 64 20 63 6f 75 |bsolute |band cou|
|00002ea0| 6e 74 73 2e 0d 0a 20 20 | 20 20 20 4e 6f 20 73 69 |nts...  |   No si|
|00002eb0| 67 6e 69 66 69 63 61 6e | 74 20 61 73 73 6f 63 69 |gnifican|t associ|
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|00002ed0| 62 65 74 77 65 65 6e 20 | 61 67 65 2c 20 73 65 78 |between |age, sex|
|00002ee0| 2c 20 72 61 63 65 2c 20 | 74 69 6d 65 20 6f 66 20 |, race, |time of |
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|00002f00| 6e 20 6f 66 20 69 6c 6c | 6e 65 73 73 20 61 6e 64 |n of ill|ness and|
|00002f10| 20 6d 65 61 6e 20 57 42 | 43 20 63 6f 75 6e 74 73 | mean WB|C counts|
|00002f20| 2e 20 20 48 6f 77 65 76 | 65 72 2c 20 73 69 67 6e |.  Howev|er, sign|
|00002f30| 69 66 69 63 61 6e 74 6c | 79 20 6c 6f 77 65 72 20 |ificantl|y lower |
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|00002f50| 20 77 65 72 65 20 6e 6f | 74 65 64 20 69 6e 20 70 | were no|ted in p|
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|00002f80| 74 68 6f 73 65 20 77 69 | 74 68 6f 75 74 0d 0a 6d |those wi|thout..m|
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|00002fa0| 6e 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |n patien|ts with |
|00002fb0| 48 2e 20 69 6e 66 6c 75 | 65 6e 7a 61 65 20 74 79 |H. influ|enzae ty|
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|00002fd0| 74 68 61 6e 20 69 6e 20 | 74 68 6f 73 65 0d 0a 77 |than in |those..w|
|00002fe0| 69 74 68 20 53 2e 20 70 | 6e 65 75 6d 6f 6e 69 61 |ith S. p|neumonia|
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|00003050| 69 6e 63 6c 75 64 65 64 | 20 69 6e 20 74 68 69 73 |included| in this|
|00003060| 20 63 6f 6d 70 61 72 69 | 73 6f 6e 2e 0d 0a 20 20 | compari|son...  |
|00003070| 20 20 20 41 73 20 61 20 | 73 63 72 65 65 6e 69 6e |   As a |screenin|
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|000030a0| 6f 75 6e 74 20 69 73 20 | 6c 65 73 73 20 75 73 65 |ount is |less use|
|000030b0| 66 75 6c 20 66 6f 72 0d | 0a 63 68 69 6c 64 72 65 |ful for.|.childre|
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|00003100| 70 65 20 62 20 74 68 61 | 6e 0d 0a 66 6f 72 20 63 |pe b tha|n..for c|
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|00003130| 69 6f 6e 73 20 63 61 75 | 73 65 64 20 62 79 20 53 |ions cau|sed by S|
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|00003650| 20 61 62 6e 6f 72 6d 61 | 6c 20 77 68 65 6e 20 74 | abnorma|l when t|
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|00003670| 74 68 61 6e 20 32 35 20 | 72 65 64 20 62 6c 6f 6f |than 25 |red bloo|
|00003680| 64 20 63 65 6c 6c 73 20 | 28 52 42 43 73 29 2f 6d |d cells |(RBCs)/m|
|00003690| 6d 5e 33 20 75 6e 6c 65 | 73 73 20 74 68 65 20 70 |m^3 unle|ss the p|
|000036a0| 65 72 69 70 68 65 72 61 | 6c 20 50 4d 4e 20 63 6f |eriphera|l PMN co|
|000036b0| 75 6e 74 20 69 73 0d 0a | 75 6e 75 73 75 61 6c 6c |unt is..|unusuall|
|000036c0| 79 20 68 69 67 68 2e 20 | 20 49 66 20 74 68 65 72 |y high. | If ther|
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|000036e0| 20 61 6e 64 20 31 30 30 | 20 52 42 43 73 2f 6d 6d | and 100| RBCs/mm|
|000036f0| 5e 33 2c 20 74 68 65 20 | 70 72 65 73 65 6e 63 65 |^3, the |presence|
|00003700| 20 6f 66 20 61 73 0d 0a | 6d 61 6e 79 20 61 73 20 | of as..|many as |
|00003710| 31 30 20 50 4d 4e 73 20 | 73 68 6f 75 6c 64 20 62 |10 PMNs |should b|
|00003720| 65 20 63 6f 6e 73 69 64 | 65 72 65 64 20 6e 6f 72 |e consid|ered nor|
|00003730| 6d 61 6c 2e 20 20 49 66 | 20 74 68 65 72 65 20 61 |mal.  If| there a|
|00003740| 72 65 20 6d 6f 72 65 20 | 74 68 61 6e 20 31 30 30 |re more |than 100|
|00003750| 20 52 42 43 73 2f 0d 0a | 6d 6d 5e 33 20 74 68 65 | RBCs/..|mm^3 the|
|00003760| 20 50 4d 4e 20 63 6f 75 | 6e 74 20 73 68 6f 75 6c | PMN cou|nt shoul|
|00003770| 64 20 6e 6f 74 20 62 65 | 20 63 6f 6e 73 69 64 65 |d not be| conside|
|00003780| 72 65 64 20 76 65 72 79 | 20 75 73 65 66 75 6c 2e |red very| useful.|
|00003790| 20 20 54 68 65 20 61 75 | 74 68 6f 72 73 20 64 6f |  The au|thors do|
|000037a0| 20 6e 6f 74 0d 0a 61 64 | 64 72 65 73 73 20 74 68 | not..ad|dress th|
|000037b0| 65 20 70 72 6f 62 6c 65 | 6d 20 6f 66 20 74 68 65 |e proble|m of the|
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|000037f0| 6e 61 6c 0d 0a 66 6c 75 | 69 64 20 74 68 61 74 20 |nal..flu|id that |
|00003800| 68 61 73 20 6e 6f 20 52 | 42 43 73 2e 20 20 42 79 |has no R|BCs.  By|
|00003810| 20 69 6e 66 65 72 65 6e | 63 65 2c 20 77 65 20 73 | inferen|ce, we s|
|00003820| 68 6f 75 6c 64 20 61 73 | 73 75 6d 65 20 74 68 61 |hould as|sume tha|
|00003830| 74 20 69 74 20 72 65 70 | 72 65 73 65 6e 74 73 20 |t it rep|resents |
|00003840| 61 6e 0d 0a 61 62 6e 6f | 72 6d 61 6c 20 66 69 6e |an..abno|rmal fin|
|00003850| 64 69 6e 67 2e 2d 2d 43 | 2e 57 2e 20 53 6d 69 74 |ding.--C|.W. Smit|
|00003860| 68 2c 20 4a 72 2e 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |h, Jr., |M.D...$U|
|00003870| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 36 32 30 |nique_ID|{YRB0620|
|00003880| 33 7d 0d 0a 24 54 69 74 | 6c 65 7b 4f 75 74 70 61 |3}..$Tit|le{Outpa|
|00003890| 74 69 65 6e 74 20 54 72 | 65 61 74 6d 65 6e 74 20 |tient Tr|eatment |
|000038a0| 6f 66 20 53 65 72 69 6f | 75 73 20 49 6e 66 65 63 |of Serio|us Infec|
|000038b0| 74 69 6f 6e 73 20 69 6e | 20 49 6e 66 61 6e 74 73 |tions in| Infants|
|000038c0| 20 61 6e 64 20 43 68 69 | 6c 64 72 65 6e 20 57 69 | and Chi|ldren Wi|
|000038d0| 74 68 20 43 65 66 74 72 | 69 61 78 6f 6e 65 7d 0d |th Ceftr|iaxone}.|
|000038e0| 0a 24 41 75 74 68 6f 72 | 7b 50 6f 77 65 6c 6c 2c |.$Author|{Powell,|
|000038f0| 20 4b 52 0d 0a 4d 61 77 | 68 6f 72 74 65 72 2c 20 | KR..Maw|horter, |
|00003900| 53 44 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |SD}..$Af|filiatio|
|00003910| 6e 7b 55 6e 69 76 20 6f | 66 20 52 6f 63 68 65 73 |n{Univ o|f Roches|
|00003920| 74 65 72 7d 0d 0a 24 53 | 75 62 6a 65 63 74 7b 49 |ter}..$S|ubject{I|
|00003930| 6e 66 65 63 74 69 6f 6e | 73 2c 20 73 65 72 69 6f |nfection|s, serio|
|00003940| 75 73 2c 20 63 65 66 74 | 72 69 61 78 6f 6e 65 20 |us, ceft|riaxone |
|00003950| 69 6e 2c 20 69 6e 20 69 | 6e 66 61 6e 74 73 20 61 |in, in i|nfants a|
|00003960| 6e 64 20 63 68 69 6c 64 | 72 65 6e 3b 0d 0a 49 6e |nd child|ren;..In|
|00003970| 66 61 6e 74 2c 20 63 65 | 66 74 72 69 61 78 6f 6e |fant, ce|ftriaxon|
|00003980| 65 20 66 6f 72 20 73 65 | 72 69 6f 75 73 20 69 6e |e for se|rious in|
|00003990| 66 65 63 74 69 6f 6e 73 | 20 69 6e 3b 0d 0a 43 68 |fections| in;..Ch|
|000039a0| 69 6c 64 72 65 6e 2c 20 | 63 65 66 74 72 69 61 78 |ildren, |ceftriax|
|000039b0| 6f 6e 65 20 66 6f 72 20 | 73 65 72 69 6f 75 73 20 |one for |serious |
|000039c0| 69 6e 66 65 63 74 69 6f | 6e 73 20 69 6e 3b 0d 0a |infectio|ns in;..|
|000039d0| 43 65 66 74 72 69 61 78 | 6f 6e 65 2c 20 66 6f 72 |Ceftriax|one, for|
|000039e0| 20 73 65 72 69 6f 75 73 | 20 69 6e 66 65 63 74 69 | serious| infecti|
|000039f0| 6f 6e 73 20 69 6e 20 69 | 6e 66 61 6e 74 73 20 61 |ons in i|nfants a|
|00003a00| 6e 64 20 63 68 69 6c 64 | 72 65 6e 7d 0d 0a 24 4a |nd child|ren}..$J|
|00003a10| 6f 75 72 6e 61 6c 7b 4a | 20 50 65 64 69 61 74 72 |ournal{J| Pediatr|
|00003a20| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 31 31 30 7d 0d |}..$Volu|me{110}.|
|00003a30| 0a 24 50 61 67 65 7b 38 | 39 38 2d 39 30 31 7d 0d |.$Page{8|98-901}.|
|00003a40| 0a 24 44 61 74 65 7b 4a | 75 6e 65 20 31 39 38 37 |.$Date{J|une 1987|
|00003a50| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00003a60| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 46 61 6d 69 |ear Book| of Fami|
|00003a70| 6c 79 20 50 72 61 63 74 | 69 63 65 7d 0d 0a 24 43 |ly Pract|ice}..$C|
|00003a80| 68 61 70 74 65 72 7b 31 | 2d 34 7d 0d 0a 24 59 42 |hapter{1|-4}..$YB|
|00003a90| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 52 61 6b 65 |Editor{D|rs. Rake|
|00003aa0| 6c 2c 20 41 76 61 6e 74 | 2c 20 44 72 69 73 63 6f |l, Avant|, Drisco|
|00003ab0| 6c 6c 2c 20 50 72 69 63 | 68 61 72 64 2c 20 61 6e |ll, Pric|hard, an|
|00003ac0| 64 20 53 6d 69 74 68 7d | 0d 0a 24 54 61 62 6c 65 |d Smith}|..$Table|
|00003ad0| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00003ae0| 7b 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |{}....Co|pyright |
|00003af0| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00003b00| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00003b10| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00003b20| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00003b30| 66 20 46 61 6d 69 6c 79 | 20 50 72 61 63 74 69 63 |f Family| Practic|
|00003b40| 65 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |e (R)...|.Chapter|
|00003b50| 20 31 2d 2d 49 6e 66 65 | 63 74 69 6f 75 73 20 44 | 1--Infe|ctious D|
|00003b60| 69 73 65 61 73 65 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |isease..|..------|
|00003b70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ba0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003bb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 4f 75 74 70 |--------|--..Outp|
|00003bc0| 61 74 69 65 6e 74 20 54 | 72 65 61 74 6d 65 6e 74 |atient T|reatment|
|00003bd0| 20 6f 66 20 53 65 72 69 | 6f 75 73 20 49 6e 66 65 | of Seri|ous Infe|
|00003be0| 63 74 69 6f 6e 73 20 69 | 6e 20 49 6e 66 61 6e 74 |ctions i|n Infant|
|00003bf0| 73 20 61 6e 64 20 43 68 | 69 6c 64 72 65 6e 20 57 |s and Ch|ildren W|
|00003c00| 69 74 68 0d 0a 43 65 66 | 74 72 69 61 78 6f 6e 65 |ith..Cef|triaxone|
|00003c10| 0d 0a 0d 0a 50 6f 77 65 | 6c 6c 20 4b 52 2c 20 4d |....Powe|ll KR, M|
|00003c20| 61 77 68 6f 72 74 65 72 | 20 53 44 0d 0a 28 55 6e |awhorter| SD..(Un|
|00003c30| 69 76 20 6f 66 20 52 6f | 63 68 65 73 74 65 72 29 |iv of Ro|chester)|
|00003c40| 0d 0a 4a 20 50 65 64 69 | 61 74 72 20 31 31 30 3a |..J Pedi|atr 110:|
|00003c50| 38 39 38 2d 39 30 31 2c | 20 4a 75 6e 65 20 31 39 |898-901,| June 19|
|00003c60| 38 37 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |87..----|--------|
|00003c70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003cb0| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00003cc0| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 73 6c 6f |....    | The slo|
|00003cd0| 77 20 65 78 63 72 65 74 | 69 6f 6e 20 6f 66 20 63 |w excret|ion of c|
|00003ce0| 65 66 74 72 69 61 78 6f | 6e 65 2c 20 61 20 74 68 |eftriaxo|ne, a th|
|00003cf0| 69 72 64 2d 67 65 6e 65 | 72 61 74 69 6f 6e 20 63 |ird-gene|ration c|
|00003d00| 65 70 68 61 6c 6f 73 70 | 6f 72 69 6e 2c 20 6d 61 |ephalosp|orin, ma|
|00003d10| 6b 65 73 0d 0a 69 74 20 | 70 6f 73 73 69 62 6c 65 |kes..it |possible|
|00003d20| 20 74 6f 20 63 6f 6e 73 | 69 64 65 72 20 6f 6e 63 | to cons|ider onc|
|00003d30| 65 2d 64 61 69 6c 79 20 | 6f 75 74 70 61 74 69 65 |e-daily |outpatie|
|00003d40| 6e 74 20 74 68 65 72 61 | 70 79 20 66 6f 72 20 73 |nt thera|py for s|
|00003d50| 65 72 69 6f 75 73 20 62 | 61 63 74 65 72 69 61 6c |erious b|acterial|
|00003d60| 0d 0a 69 6e 66 65 63 74 | 69 6f 6e 73 20 74 68 61 |..infect|ions tha|
|00003d70| 74 20 74 72 61 64 69 74 | 69 6f 6e 61 6c 6c 79 20 |t tradit|ionally |
|00003d80| 72 65 71 75 69 72 65 20 | 6c 6f 6e 67 20 68 6f 73 |require |long hos|
|00003d90| 70 69 74 61 6c 69 7a 61 | 74 69 6f 6e 20 66 6f 72 |pitaliza|tion for|
|00003da0| 20 70 61 72 65 6e 74 65 | 72 61 6c 0d 0a 61 6e 74 | parente|ral..ant|
|00003db0| 69 6d 69 63 72 6f 62 69 | 61 6c 20 74 68 65 72 61 |imicrobi|al thera|
|00003dc0| 70 79 2e 20 54 68 65 20 | 72 65 63 6f 72 64 73 20 |py. The |records |
|00003dd0| 6f 66 20 35 38 20 63 68 | 69 6c 64 72 65 6e 20 77 |of 58 ch|ildren w|
|00003de0| 69 74 68 20 73 65 72 69 | 6f 75 73 20 62 61 63 74 |ith seri|ous bact|
|00003df0| 65 72 69 61 6c 0d 0a 69 | 6e 66 65 63 74 69 6f 6e |erial..i|nfection|
|00003e00| 73 20 77 68 6f 20 63 6f | 6d 70 6c 65 74 65 64 20 |s who co|mpleted |
|00003e10| 61 6e 74 69 62 69 6f 74 | 69 63 20 74 68 65 72 61 |antibiot|ic thera|
|00003e20| 70 79 20 77 69 74 68 20 | 63 65 66 74 72 69 61 78 |py with |ceftriax|
|00003e30| 6f 6e 65 20 77 65 72 65 | 20 72 65 76 69 65 77 65 |one were| reviewe|
|00003e40| 64 2e 20 4f 66 0d 0a 74 | 68 65 73 65 2c 20 32 36 |d. Of..t|hese, 26|
|00003e50| 20 28 34 35 25 29 20 63 | 6f 6d 70 6c 65 74 65 64 | (45%) c|ompleted|
|00003e60| 20 63 65 66 74 72 69 61 | 78 6f 6e 65 20 74 68 65 | ceftria|xone the|
|00003e70| 72 61 70 79 20 61 73 20 | 6f 75 74 70 61 74 69 65 |rapy as |outpatie|
|00003e80| 6e 74 73 20 61 66 74 65 | 72 20 72 65 63 65 69 76 |nts afte|r receiv|
|00003e90| 69 6e 67 20 61 74 0d 0a | 6c 65 61 73 74 20 31 20 |ing at..|least 1 |
|00003ea0| 64 6f 73 65 20 69 6e 20 | 74 68 65 20 68 6f 73 70 |dose in |the hosp|
|00003eb0| 69 74 61 6c 2e 20 50 61 | 74 69 65 6e 74 73 27 20 |ital. Pa|tients' |
|00003ec0| 61 67 65 73 20 72 61 6e | 67 65 64 20 66 72 6f 6d |ages ran|ged from|
|00003ed0| 20 31 20 64 61 79 20 74 | 6f 20 39 20 79 65 61 72 | 1 day t|o 9 year|
|00003ee0| 73 2e 0d 0a 20 20 20 20 | 20 43 65 66 74 72 69 61 |s...    | Ceftria|
|00003ef0| 78 6f 6e 65 20 64 6f 73 | 65 73 20 72 61 6e 67 65 |xone dos|es range|
|00003f00| 64 20 66 72 6f 6d 20 32 | 30 20 74 6f 20 31 32 30 |d from 2|0 to 120|
|00003f10| 20 6d 67 2f 6b 67 20 70 | 65 72 20 64 61 79 20 66 | mg/kg p|er day f|
|00003f20| 6f 72 20 6e 6f 6e 2d 43 | 4e 53 0d 0a 69 6e 66 65 |or non-C|NS..infe|
|00003f30| 63 74 69 6f 6e 73 2c 20 | 61 6e 64 20 66 72 6f 6d |ctions, |and from|
|00003f40| 20 38 30 20 74 6f 20 31 | 30 30 20 6d 67 2f 6b 67 | 80 to 1|00 mg/kg|
|00003f50| 20 70 65 72 20 64 61 79 | 20 66 6f 72 20 43 4e 53 | per day| for CNS|
|00003f60| 20 69 6e 66 65 63 74 69 | 6f 6e 73 2e 20 43 65 66 | infecti|ons. Cef|
|00003f70| 74 72 69 61 78 6f 6e 65 | 20 77 61 73 0d 0a 61 64 |triaxone| was..ad|
|00003f80| 6d 69 6e 69 73 74 65 72 | 65 64 20 69 6e 74 72 61 |minister|ed intra|
|00003f90| 6d 75 73 63 75 6c 61 72 | 6c 79 20 6f 6e 63 65 20 |muscular|ly once |
|00003fa0| 64 61 69 6c 79 20 74 6f | 20 32 31 20 63 68 69 6c |daily to| 21 chil|
|00003fb0| 64 72 65 6e 2c 20 74 77 | 69 63 65 20 64 61 69 6c |dren, tw|ice dail|
|00003fc0| 79 20 74 6f 20 33 0d 0a | 63 68 69 6c 64 72 65 6e |y to 3..|children|
|00003fd0| 20 77 69 74 68 20 6d 65 | 6e 69 6e 67 69 74 69 73 | with me|ningitis|
|00003fe0| 20 61 6e 64 20 31 20 77 | 69 74 68 20 73 65 70 74 | and 1 w|ith sept|
|00003ff0| 69 63 20 61 72 74 68 72 | 69 74 69 73 2c 20 61 6e |ic arthr|itis, an|
|00004000| 64 20 74 77 69 63 65 20 | 64 61 69 6c 79 20 65 69 |d twice |daily ei|
|00004010| 74 68 65 72 0d 0a 69 6e | 74 72 61 6d 75 73 63 75 |ther..in|tramuscu|
|00004020| 6c 61 72 6c 79 20 6f 72 | 20 69 6e 74 72 61 76 65 |larly or| intrave|
|00004030| 6e 6f 75 73 6c 79 20 74 | 6f 20 61 20 63 68 69 6c |nously t|o a chil|
|00004040| 64 20 77 69 74 68 20 62 | 72 61 69 6e 20 61 62 73 |d with b|rain abs|
|00004050| 63 65 73 73 2e 20 4f 75 | 74 70 61 74 69 65 6e 74 |cess. Ou|tpatient|
|00004060| 0d 0a 74 68 65 72 61 70 | 79 20 77 61 73 20 61 64 |..therap|y was ad|
|00004070| 6d 69 6e 69 73 74 65 72 | 65 64 20 66 6f 72 20 32 |minister|ed for 2|
|00004080| 33 35 20 70 61 74 69 65 | 6e 74 20 64 61 79 73 20 |35 patie|nt days |
|00004090| 28 72 61 6e 67 65 2c 20 | 31 20 74 6f 20 33 32 20 |(range, |1 to 32 |
|000040a0| 64 61 79 73 29 2e 20 43 | 65 66 74 72 69 61 78 6f |days). C|eftriaxo|
|000040b0| 6e 65 0d 0a 77 61 73 20 | 67 69 76 65 6e 20 65 78 |ne..was |given ex|
|000040c0| 63 6c 75 73 69 76 65 6c | 79 20 69 6e 20 74 68 65 |clusivel|y in the|
|000040d0| 69 72 20 68 6f 6d 65 73 | 20 74 6f 20 35 34 25 20 |ir homes| to 54% |
|000040e0| 6f 66 20 63 68 69 6c 64 | 72 65 6e 2c 20 69 6e 20 |of child|ren, in |
|000040f0| 74 68 65 20 70 68 79 73 | 69 63 69 61 6e 27 73 0d |the phys|ician's.|
|00004100| 0a 6f 66 66 69 63 65 20 | 6f 72 20 68 6f 73 70 69 |.office |or hospi|
|00004110| 74 61 6c 20 61 6d 62 75 | 6c 61 74 6f 72 79 20 63 |tal ambu|latory c|
|00004120| 61 72 65 20 64 65 70 61 | 72 74 6d 65 6e 74 20 74 |are depa|rtment t|
|00004130| 6f 20 33 31 25 2c 20 61 | 6e 64 20 69 6e 20 62 6f |o 31%, a|nd in bo|
|00004140| 74 68 20 73 65 74 74 69 | 6e 67 73 20 74 6f 0d 0a |th setti|ngs to..|
|00004150| 31 35 25 2e 0d 0a 20 20 | 20 20 20 54 68 65 20 70 |15%...  |   The p|
|00004160| 72 69 6d 61 72 79 20 70 | 68 79 73 69 63 69 61 6e |rimary p|hysician|
|00004170| 73 20 63 61 72 69 6e 67 | 20 66 6f 72 20 74 68 65 |s caring| for the|
|00004180| 73 65 20 70 61 74 69 65 | 6e 74 73 20 72 65 70 6f |se patie|nts repo|
|00004190| 72 74 65 64 20 6e 6f 20 | 64 72 75 67 2d 72 65 6c |rted no |drug-rel|
|000041a0| 61 74 65 64 0d 0a 63 6f | 6d 70 6c 69 63 61 74 69 |ated..co|mplicati|
|000041b0| 6f 6e 73 2c 20 6e 6f 20 | 74 72 65 61 74 6d 65 6e |ons, no |treatmen|
|000041c0| 74 20 66 61 69 6c 75 72 | 65 73 2c 20 61 6e 64 20 |t failur|es, and |
|000041d0| 6e 6f 20 69 6e 73 74 61 | 6e 63 65 73 20 6f 66 20 |no insta|nces of |
|000041e0| 72 65 6c 61 70 73 65 20 | 6f 72 20 72 65 63 75 72 |relapse |or recur|
|000041f0| 72 65 6e 63 65 2e 0d 0a | 4d 61 6e 79 20 70 61 72 |rence...|Many par|
|00004200| 65 6e 74 73 20 65 78 70 | 72 65 73 73 65 64 20 63 |ents exp|ressed c|
|00004210| 6f 6e 63 65 72 6e 20 66 | 6f 72 20 74 68 65 20 73 |oncern f|or the s|
|00004220| 75 62 73 65 71 75 65 6e | 74 20 70 61 69 6e 66 75 |ubsequen|t painfu|
|00004230| 6c 20 69 6e 74 72 61 6d | 75 73 63 75 6c 61 72 0d |l intram|uscular.|
|00004240| 0a 69 6e 6a 65 63 74 69 | 6f 6e 73 20 61 74 20 74 |.injecti|ons at t|
|00004250| 68 65 20 74 69 6d 65 20 | 6f 66 20 64 69 73 63 68 |he time |of disch|
|00004260| 61 72 67 65 20 70 6c 61 | 6e 6e 69 6e 67 2e 20 48 |arge pla|nning. H|
|00004270| 6f 77 65 76 65 72 2c 20 | 6f 6e 20 66 6f 6c 6c 6f |owever, |on follo|
|00004280| 77 2d 75 70 2c 20 6f 6e | 6c 79 20 61 20 66 65 77 |w-up, on|ly a few|
|00004290| 0d 0a 72 65 63 61 6c 6c | 65 64 20 70 61 69 6e 20 |..recall|ed pain |
|000042a0| 61 73 73 6f 63 69 61 74 | 65 64 20 77 69 74 68 20 |associat|ed with |
|000042b0| 74 68 65 20 69 6e 6a 65 | 63 74 69 6f 6e 20 6c 61 |the inje|ction la|
|000042c0| 73 74 69 6e 67 20 6c 6f | 6e 67 65 72 20 74 68 61 |sting lo|nger tha|
|000042d0| 6e 20 32 20 6d 69 6e 75 | 74 65 73 2e 20 4e 6f 0d |n 2 minu|tes. No.|
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|000042f0| 66 65 63 74 73 20 6f 66 | 20 74 68 65 72 61 70 79 |fects of| therapy|
|00004300| 20 77 65 72 65 20 72 65 | 70 6f 72 74 65 64 2e 20 | were re|ported. |
|00004310| 50 61 72 65 6e 74 73 20 | 64 65 73 63 72 69 62 65 |Parents |describe|
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|00004330| 6b 0d 0a 6c 6f 73 73 20 | 61 6e 64 20 74 72 61 6e |k..loss |and tran|
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|00004380| 74 69 65 6e 74 20 63 65 | 66 74 72 69 61 78 6f 6e |tient ce|ftriaxon|
|00004390| 65 20 74 68 65 72 61 70 | 79 20 77 61 73 20 6d 75 |e therap|y was mu|
|000043a0| 63 68 20 6c 65 73 73 20 | 63 6f 6d 70 61 72 65 64 |ch less |compared|
|000043b0| 20 77 69 74 68 20 74 68 | 65 20 73 74 61 6e 64 61 | with th|e standa|
|000043c0| 72 64 20 68 6f 73 70 69 | 74 61 6c 0d 0a 74 72 65 |rd hospi|tal..tre|
|000043d0| 61 74 6d 65 6e 74 20 6f | 66 20 61 6d 70 69 63 69 |atment o|f ampici|
|000043e0| 6c 6c 69 6e 20 61 6e 64 | 20 63 68 6c 6f 72 61 6d |llin and| chloram|
|000043f0| 70 68 65 6e 69 63 6f 6c | 2e 20 54 72 65 61 74 6d |phenicol|. Treatm|
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|00004820| 73 65 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |se....--|--------|
|00004830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004870| 2d 2d 2d 2d 2d 2d 0d 0a | 43 6f 61 67 75 6c 61 73 |------..|Coagulas|
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|00004890| 79 6c 6f 63 6f 63 63 69 | 20 61 73 20 54 72 75 65 |ylococci| as True|
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|000048c0| 41 20 43 6f 68 6f 72 74 | 0d 0a 53 74 75 64 79 0d |A Cohort|..Study.|
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|00004940| 6f 75 6e 74 20 53 69 6e | 61 69 20 48 6f 73 70 2c |ount Sin|ai Hosp,|
|00004950| 20 54 6f 72 6f 6e 74 6f | 3b 20 4d 61 69 6e 65 20 | Toronto|; Maine |
|00004960| 4d 65 64 20 43 74 72 2c | 0d 0a 50 6f 72 74 6c 61 |Med Ctr,|..Portla|
|00004970| 6e 64 2c 20 4d 65 29 0d | 0a 50 65 64 69 61 74 72 |nd, Me).|.Pediatr|
|00004980| 20 49 6e 66 65 63 74 20 | 44 69 73 20 4a 20 36 3a | Infect |Dis J 6:|
|00004990| 31 30 32 36 2d 31 30 33 | 31 2c 20 4e 6f 76 65 6d |1026-103|1, Novem|
|000049a0| 62 65 72 20 31 39 38 37 | 0d 0a 2d 2d 2d 2d 2d 2d |ber 1987|..------|
|000049b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000049d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000049f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|00004a00| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 43 |stract..|..     C|
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|00005170| 6c 73 2e 20 20 54 68 65 | 20 61 6c 70 68 61 2d 31 |ls.  The| alpha-1|
|00005180| 2d 41 47 50 20 61 6e 64 | 20 70 72 65 61 6c 62 75 |-AGP and| prealbu|
|00005190| 6d 69 6e 0d 0a 6c 65 76 | 65 6c 73 20 77 65 72 65 |min..lev|els were|
|000051a0| 20 6e 6f 72 6d 61 6c 20 | 69 6e 20 6d 6f 73 74 20 | normal |in most |
|000051b0| 69 6e 66 61 6e 74 73 20 | 6f 66 20 61 6c 6c 20 34 |infants |of all 4|
|000051c0| 20 67 72 6f 75 70 73 2e | 0d 0a 20 20 20 20 20 4f | groups.|..     O|
|000051d0| 62 6a 65 63 74 69 76 65 | 20 65 76 69 64 65 6e 63 |bjective| evidenc|
|000051e0| 65 20 69 73 20 70 72 6f | 76 69 64 65 64 20 66 6f |e is pro|vided fo|
|000051f0| 72 20 74 68 65 20 70 61 | 74 68 6f 67 65 6e 69 63 |r the pa|thogenic|
|00005200| 69 74 79 20 6f 66 20 43 | 4f 4e 53 20 69 6e 20 6e |ity of C|ONS in n|
|00005210| 65 77 62 6f 72 6e 0d 0a | 69 6e 66 61 6e 74 73 2e |ewborn..|infants.|
|00005220| 20 20 54 68 65 20 43 4f | 4e 53 20 69 73 6f 6c 61 |  The CO|NS isola|
|00005230| 74 65 73 20 6f 62 74 61 | 69 6e 65 64 20 66 72 6f |tes obta|ined fro|
|00005240| 6d 20 74 68 65 20 62 6c | 6f 6f 64 20 6f 66 20 6e |m the bl|ood of n|
|00005250| 65 6f 6e 61 74 65 73 20 | 77 68 6f 20 70 72 65 73 |eonates |who pres|
|00005260| 65 6e 74 20 77 69 74 68 | 0d 0a 6c 65 74 68 61 72 |ent with|..lethar|
|00005270| 67 79 2c 20 68 79 70 65 | 72 74 68 65 72 6d 69 61 |gy, hype|rthermia|
|00005280| 2c 20 69 6e 63 72 65 61 | 73 65 64 20 6f 78 79 67 |, increa|sed oxyg|
|00005290| 65 6e 20 72 65 71 75 69 | 72 65 6d 65 6e 74 73 2c |en requi|rements,|
|000052a0| 20 61 6e 64 20 65 6c 65 | 76 61 74 65 64 20 43 52 | and ele|vated CR|
|000052b0| 50 20 6c 65 76 65 6c 73 | 0d 0a 72 65 70 72 65 73 |P levels|..repres|
|000052c0| 65 6e 74 20 70 61 74 68 | 6f 67 65 6e 73 20 72 61 |ent path|ogens ra|
|000052d0| 74 68 65 72 20 74 68 61 | 6e 20 63 6f 6e 74 61 6d |ther tha|n contam|
|000052e0| 69 6e 61 6e 74 73 20 69 | 6e 20 6d 6f 73 74 20 63 |inants i|n most c|
|000052f0| 61 73 65 73 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |ases....|.Post-Co|
|00005300| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 4d 6f |mment...|.     Mo|
|00005310| 73 74 20 6f 66 20 75 73 | 20 68 61 76 65 20 62 65 |st of us| have be|
|00005320| 65 6e 20 74 61 75 67 68 | 74 20 74 6f 20 69 67 6e |en taugh|t to ign|
|00005330| 6f 72 65 20 73 74 61 70 | 68 20 65 70 69 64 65 72 |ore stap|h epider|
|00005340| 6d 69 64 69 73 20 61 6e | 64 20 73 69 6d 69 6c 61 |midis an|d simila|
|00005350| 72 0d 0a 22 63 6f 6e 74 | 61 6d 69 6e 61 6e 74 22 |r.."cont|aminant"|
|00005360| 20 6f 72 67 61 6e 69 73 | 6d 73 20 77 68 65 6e 20 | organis|ms when |
|00005370| 74 68 65 79 20 61 72 65 | 20 72 65 70 6f 72 74 65 |they are| reporte|
|00005380| 64 20 66 72 6f 6d 20 62 | 6c 6f 6f 64 20 63 75 6c |d from b|lood cul|
|00005390| 74 75 72 65 73 2c 20 65 | 76 65 6e 20 69 6e 20 74 |tures, e|ven in t|
|000053a0| 68 65 0d 0a 6e 65 77 62 | 6f 72 6e 2e 20 20 49 74 |he..newb|orn.  It|
|000053b0| 20 6e 6f 77 20 61 70 70 | 65 61 72 73 20 74 68 61 | now app|ears tha|
|000053c0| 74 20 74 68 69 73 20 6f | 72 67 61 6e 69 73 6d 20 |t this o|rganism |
|000053d0| 73 68 6f 75 6c 64 20 62 | 65 20 63 6f 6e 73 69 64 |should b|e consid|
|000053e0| 65 72 65 64 20 61 20 70 | 61 74 68 6f 67 65 6e 20 |ered a p|athogen |
|000053f0| 61 6e 64 0d 0a 74 72 65 | 61 74 65 64 20 61 73 20 |and..tre|ated as |
|00005400| 73 75 63 68 20 77 68 65 | 6e 20 64 69 73 63 6f 76 |such whe|n discov|
|00005410| 65 72 65 64 20 69 6e 20 | 74 68 65 20 62 6c 6f 6f |ered in |the bloo|
|00005420| 64 20 6f 66 20 61 20 73 | 69 63 6b 20 6e 65 6f 6e |d of a s|ick neon|
|00005430| 61 74 65 2e 20 20 49 74 | 20 73 68 6f 75 6c 64 20 |ate.  It| should |
|00005440| 61 6c 73 6f 2c 0d 0a 6f | 66 20 63 6f 75 72 73 65 |also,..o|f course|
|00005450| 2c 20 62 65 20 63 6f 6e | 73 69 64 65 72 65 64 20 |, be con|sidered |
|00005460| 61 20 70 61 74 68 6f 67 | 65 6e 20 69 6e 20 73 75 |a pathog|en in su|
|00005470| 73 70 65 63 74 65 64 20 | 63 61 73 65 73 20 6f 66 |spected |cases of|
|00005480| 20 73 75 62 61 63 75 74 | 65 20 62 61 63 74 65 72 | subacut|e bacter|
|00005490| 69 61 6c 0d 0a 65 6e 64 | 6f 63 61 72 64 69 74 69 |ial..end|ocarditi|
|000054a0| 73 2e 20 20 49 6e 20 6f | 74 68 65 72 20 63 69 72 |s.  In o|ther cir|
|000054b0| 63 75 6d 73 74 61 6e 63 | 65 73 2c 20 69 74 20 73 |cumstanc|es, it s|
|000054c0| 74 69 6c 6c 20 69 73 20 | 6c 69 6b 65 6c 79 20 74 |till is |likely t|
|000054d0| 6f 20 72 65 70 72 65 73 | 65 6e 74 20 61 20 73 6b |o repres|ent a sk|
|000054e0| 69 6e 0d 0a 63 6f 6e 74 | 61 6d 69 6e 61 6e 74 2e |in..cont|aminant.|
|000054f0| 2d 2d 43 2e 57 2e 20 53 | 6d 69 74 68 2c 20 4a 72 |--C.W. S|mith, Jr|
|00005500| 2e 2c 20 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |., M.D..|.$Unique|
|00005510| 5f 49 44 7b 59 52 42 30 | 36 32 30 35 7d 0d 0a 24 |_ID{YRB0|6205}..$|
|00005520| 54 69 74 6c 65 7b 4c 69 | 73 74 65 72 69 6f 73 69 |Title{Li|steriosi|
|00005530| 73 20 69 6e 20 74 68 65 | 20 55 6e 69 74 65 64 20 |s in the| United |
|00005540| 53 74 61 74 65 73 3a 20 | 20 31 39 38 30 2d 31 39 |States: | 1980-19|
|00005550| 38 32 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 43 69 65 |82}..$Au|thor{Cie|
|00005560| 73 69 65 6c 73 6b 69 2c | 20 43 41 0d 0a 48 69 67 |sielski,| CA..Hig|
|00005570| 68 74 6f 77 65 72 2c 20 | 41 57 0d 0a 50 61 72 73 |htower, |AW..Pars|
|00005580| 6f 6e 73 2c 20 53 4b 0d | 0a 42 72 6f 6f 6d 65 2c |ons, SK.|.Broome,|
|00005590| 20 43 56 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | CV}..$A|ffiliati|
|000055a0| 6f 6e 7b 43 74 72 73 20 | 66 6f 72 20 44 69 73 65 |on{Ctrs |for Dise|
|000055b0| 61 73 65 20 43 6f 6e 74 | 72 6f 6c 2c 20 41 74 6c |ase Cont|rol, Atl|
|000055c0| 61 6e 74 61 7d 0d 0a 24 | 53 75 62 6a 65 63 74 7b |anta}..$|Subject{|
|000055d0| 4c 69 73 74 65 72 69 6f | 73 69 73 2c 20 69 6e 20 |Listerio|sis, in |
|000055e0| 55 2e 53 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 41 |U.S}..$J|ournal{A|
|000055f0| 72 63 68 20 49 6e 74 65 | 72 6e 20 4d 65 64 7d 0d |rch Inte|rn Med}.|
|00005600| 0a 24 56 6f 6c 75 6d 65 | 7b 31 34 38 7d 0d 0a 24 |.$Volume|{148}..$|
|00005610| 50 61 67 65 7b 31 34 31 | 36 2d 31 34 31 39 7d 0d |Page{141|6-1419}.|
|00005620| 0a 24 44 61 74 65 7b 4a | 75 6e 65 20 31 39 38 38 |.$Date{J|une 1988|
|00005630| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00005640| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 46 61 6d 69 |ear Book| of Fami|
|00005650| 6c 79 20 50 72 61 63 74 | 69 63 65 7d 0d 0a 24 43 |ly Pract|ice}..$C|
|00005660| 68 61 70 74 65 72 7b 31 | 2d 36 7d 0d 0a 24 59 42 |hapter{1|-6}..$YB|
|00005670| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 52 61 6b 65 |Editor{D|rs. Rake|
|00005680| 6c 2c 20 41 76 61 6e 74 | 2c 20 44 72 69 73 63 6f |l, Avant|, Drisco|
|00005690| 6c 6c 2c 20 50 72 69 63 | 68 61 72 64 2c 20 61 6e |ll, Pric|hard, an|
|000056a0| 64 20 53 6d 69 74 68 7d | 0d 0a 24 54 61 62 6c 65 |d Smith}|..$Table|
|000056b0| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|000056c0| 7b 43 2e 57 2e 20 53 6d | 69 74 68 2c 20 4a 72 2e |{C.W. Sm|ith, Jr.|
|000056d0| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|000056e0| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 20 42 6f |ight (c)| Year Bo|
|000056f0| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00005700| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 38 |shers, I|nc., 198|
|00005710| 39 0d 0a 0d 0a 31 39 38 | 39 20 59 65 61 72 20 42 |9....198|9 Year B|
|00005720| 6f 6f 6b 20 6f 66 20 46 | 61 6d 69 6c 79 20 50 72 |ook of F|amily Pr|
|00005730| 61 63 74 69 63 65 20 28 | 52 29 0d 0a 0d 0a 43 68 |actice (|R)....Ch|
|00005740| 61 70 74 65 72 20 31 2d | 2d 49 6e 66 65 63 74 69 |apter 1-|-Infecti|
|00005750| 6f 75 73 20 44 69 73 65 | 61 73 65 0d 0a 0d 0a 2d |ous Dise|ase....-|
|00005760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005790| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000057a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000057b0| 0a 4c 69 73 74 65 72 69 | 6f 73 69 73 20 69 6e 20 |.Listeri|osis in |
|000057c0| 74 68 65 20 55 6e 69 74 | 65 64 20 53 74 61 74 65 |the Unit|ed State|
|000057d0| 73 3a 20 20 31 39 38 30 | 2d 31 39 38 32 0d 0a 0d |s:  1980|-1982...|
|000057e0| 0a 43 69 65 73 69 65 6c | 73 6b 69 20 43 41 2c 20 |.Ciesiel|ski CA, |
|000057f0| 48 69 67 68 74 6f 77 65 | 72 20 41 57 2c 20 50 61 |Hightowe|r AW, Pa|
|00005800| 72 73 6f 6e 73 20 53 4b | 2c 20 42 72 6f 6f 6d 65 |rsons SK|, Broome|
|00005810| 20 43 56 0d 0a 28 43 74 | 72 73 20 66 6f 72 20 44 | CV..(Ct|rs for D|
|00005820| 69 73 65 61 73 65 20 43 | 6f 6e 74 72 6f 6c 2c 20 |isease C|ontrol, |
|00005830| 41 74 6c 61 6e 74 61 29 | 0d 0a 41 72 63 68 20 49 |Atlanta)|..Arch I|
|00005840| 6e 74 65 72 6e 20 4d 65 | 64 20 31 34 38 3a 31 34 |ntern Me|d 148:14|
|00005850| 31 36 2d 31 34 31 39 2c | 20 4a 75 6e 65 20 31 39 |16-1419,| June 19|
|00005860| 38 38 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |88..----|--------|
|00005870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058b0| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|000058c0| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 67 72 61 |....    | The gra|
|000058d0| 6d 2d 70 6f 73 69 74 69 | 76 65 20 62 61 63 74 65 |m-positi|ve bacte|
|000058e0| 72 69 75 6d 20 4c 69 73 | 74 65 72 69 61 20 6d 6f |rium Lis|teria mo|
|000058f0| 6e 6f 63 79 74 6f 67 65 | 6e 65 73 20 69 73 20 61 |nocytoge|nes is a|
|00005900| 20 77 65 6c 6c 2d 6b 6e | 6f 77 6e 20 63 61 75 73 | well-kn|own caus|
|00005910| 65 20 6f 66 0d 0a 69 6c | 6c 6e 65 73 73 20 69 6e |e of..il|lness in|
|00005920| 20 72 75 6d 69 6e 61 6e | 74 73 20 61 6e 64 20 6f | ruminan|ts and o|
|00005930| 74 68 65 72 20 61 6e 69 | 6d 61 6c 20 73 70 65 63 |ther ani|mal spec|
|00005940| 69 65 73 2c 20 62 75 74 | 20 69 74 20 63 61 6e 20 |ies, but| it can |
|00005950| 61 6c 73 6f 20 63 61 75 | 73 65 20 69 6c 6c 6e 65 |also cau|se illne|
|00005960| 73 73 20 69 6e 0d 0a 68 | 75 6d 61 6e 20 62 65 69 |ss in..h|uman bei|
|00005970| 6e 67 73 2c 20 6d 6f 73 | 74 20 63 6f 6d 6d 6f 6e |ngs, mos|t common|
|00005980| 6c 79 20 69 6e 20 6e 65 | 6f 6e 61 74 65 73 2c 20 |ly in ne|onates, |
|00005990| 69 6d 6d 75 6e 6f 63 6f | 6d 70 72 6f 6d 69 73 65 |immunoco|mpromise|
|000059a0| 64 20 69 6e 64 69 76 69 | 64 75 61 6c 73 2c 20 61 |d indivi|duals, a|
|000059b0| 6e 64 0d 0a 70 72 65 67 | 6e 61 6e 74 20 77 6f 6d |nd..preg|nant wom|
|000059c0| 65 6e 2e 20 20 4c 69 73 | 74 65 72 69 61 20 6d 61 |en.  Lis|teria ma|
|000059d0| 79 20 63 61 75 73 65 20 | 61 20 6d 69 6c 64 2c 20 |y cause |a mild, |
|000059e0| 6e 6f 6e 73 70 65 63 69 | 66 69 63 20 66 65 62 72 |nonspeci|fic febr|
|000059f0| 69 6c 65 20 69 6c 6c 6e | 65 73 73 20 69 6e 0d 0a |ile illn|ess in..|
|00005a00| 70 72 65 67 6e 61 6e 74 | 20 77 6f 6d 65 6e 2c 20 |pregnant| women, |
|00005a10| 77 68 69 63 68 20 63 61 | 6e 20 6c 65 61 64 20 74 |which ca|n lead t|
|00005a20| 6f 20 73 74 69 6c 6c 62 | 69 72 74 68 2c 20 61 62 |o stillb|irth, ab|
|00005a30| 6f 72 74 69 6f 6e 2c 20 | 6f 72 20 70 72 65 6d 61 |ortion, |or prema|
|00005a40| 74 75 72 65 20 62 69 72 | 74 68 20 6f 66 20 61 6e |ture bir|th of an|
|00005a50| 0d 0a 69 6e 66 65 63 74 | 65 64 20 69 6e 66 61 6e |..infect|ed infan|
|00005a60| 74 2e 20 20 42 65 63 61 | 75 73 65 20 6c 69 73 74 |t.  Beca|use list|
|00005a70| 65 72 69 6f 73 69 73 20 | 69 73 20 6e 6f 74 20 61 |eriosis |is not a|
|00005a80| 20 72 65 70 6f 72 74 61 | 62 6c 65 20 64 69 73 65 | reporta|ble dise|
|00005a90| 61 73 65 20 61 6e 64 20 | 6c 69 74 74 6c 65 0d 0a |ase and |little..|
|00005aa0| 69 6e 66 6f 72 6d 61 74 | 69 6f 6e 20 69 73 20 61 |informat|ion is a|
|00005ab0| 76 61 69 6c 61 62 6c 65 | 20 6f 6e 20 74 68 65 20 |vailable| on the |
|00005ac0| 6d 61 67 6e 69 74 75 64 | 65 20 6f 66 20 4c 69 73 |magnitud|e of Lis|
|00005ad0| 74 65 72 69 61 20 69 6e | 66 65 63 74 69 6f 6e 20 |teria in|fection |
|00005ae0| 61 73 20 61 20 70 75 62 | 6c 69 63 0d 0a 68 65 61 |as a pub|lic..hea|
|00005af0| 6c 74 68 20 70 72 6f 62 | 6c 65 6d 20 69 6e 20 74 |lth prob|lem in t|
|00005b00| 68 65 20 55 6e 69 74 65 | 64 20 53 74 61 74 65 73 |he Unite|d States|
|00005b10| 2c 20 68 6f 73 70 69 74 | 61 6c 20 64 69 73 63 68 |, hospit|al disch|
|00005b20| 61 72 67 65 20 64 61 74 | 61 20 70 72 6f 76 69 64 |arge dat|a provid|
|00005b30| 65 64 20 62 79 20 74 68 | 65 0d 0a 43 6f 6d 6d 69 |ed by th|e..Commi|
|00005b40| 73 73 69 6f 6e 20 6f 6e | 20 50 72 6f 66 65 73 73 |ssion on| Profess|
|00005b50| 69 6f 6e 61 6c 20 61 6e | 64 20 48 6f 73 70 69 74 |ional an|d Hospit|
|00005b60| 61 6c 20 41 63 74 69 76 | 69 74 69 65 73 20 77 65 |al Activ|ities we|
|00005b70| 72 65 20 75 73 65 64 20 | 74 6f 20 6f 62 74 61 69 |re used |to obtai|
|00005b80| 6e 0d 0a 69 6e 66 6f 72 | 6d 61 74 69 6f 6e 20 6f |n..infor|mation o|
|00005b90| 6e 20 74 68 65 20 65 70 | 69 64 65 6d 69 6f 6c 6f |n the ep|idemiolo|
|00005ba0| 67 79 20 6f 66 20 6c 69 | 73 74 65 72 69 6f 73 69 |gy of li|steriosi|
|00005bb0| 73 2e 0d 0a 20 20 20 20 | 20 42 65 74 77 65 65 6e |s...    | Between|
|00005bc0| 20 31 39 38 30 20 61 6e | 64 20 31 39 38 32 2c 20 | 1980 an|d 1982, |
|00005bd0| 36 36 30 20 70 61 74 69 | 65 6e 74 73 20 77 69 74 |660 pati|ents wit|
|00005be0| 68 20 6c 69 73 74 65 72 | 69 6f 73 69 73 20 77 65 |h lister|iosis we|
|00005bf0| 72 65 20 64 69 73 63 68 | 61 72 67 65 64 20 36 37 |re disch|arged 67|
|00005c00| 31 0d 0a 74 69 6d 65 73 | 20 66 72 6f 6d 20 70 61 |1..times| from pa|
|00005c10| 72 74 69 63 69 70 61 74 | 69 6e 67 20 68 6f 73 70 |rticipat|ing hosp|
|00005c20| 69 74 61 6c 73 2e 20 20 | 4f 66 20 74 68 65 73 65 |itals.  |Of these|
|00005c30| 20 65 70 69 73 6f 64 65 | 73 2c 20 32 33 34 20 28 | episode|s, 234 (|
|00005c40| 33 35 25 29 20 6f 63 63 | 75 72 72 65 64 20 69 6e |35%) occ|urred in|
|00005c50| 0d 0a 31 39 38 30 2c 20 | 32 31 32 20 28 33 32 25 |..1980, |212 (32%|
|00005c60| 29 20 69 6e 20 31 39 38 | 31 2c 20 61 6e 64 20 32 |) in 198|1, and 2|
|00005c70| 31 34 20 28 33 32 25 29 | 20 69 6e 20 31 39 38 32 |14 (32%)| in 1982|
|00005c80| 2e 20 20 57 68 65 72 65 | 61 73 20 33 31 37 20 70 |.  Where|as 317 p|
|00005c90| 61 74 69 65 6e 74 73 20 | 28 34 38 25 29 20 68 61 |atients |(48%) ha|
|00005ca0| 64 0d 0a 4c 2e 20 6d 6f | 6e 6f 63 79 74 6f 67 65 |d..L. mo|nocytoge|
|00005cb0| 6e 65 73 20 6d 65 6e 69 | 6e 67 69 74 69 73 2c 20 |nes meni|ngitis, |
|00005cc0| 74 68 65 20 6f 74 68 65 | 72 20 33 34 33 20 68 61 |the othe|r 343 ha|
|00005cd0| 64 20 64 69 61 67 6e 6f | 73 65 73 20 6f 66 20 73 |d diagno|ses of s|
|00005ce0| 65 70 74 69 63 65 6d 69 | 61 20 61 6e 64 0d 0a 76 |epticemi|a and..v|
|00005cf0| 61 72 69 6f 75 73 20 66 | 6f 63 61 6c 20 69 6e 66 |arious f|ocal inf|
|00005d00| 65 63 74 69 6f 6e 73 2e | 20 20 54 68 65 20 69 6e |ections.|  The in|
|00005d10| 63 69 64 65 6e 63 65 20 | 6f 66 20 6c 69 73 74 65 |cidence |of liste|
|00005d20| 72 69 6f 73 69 73 20 77 | 61 73 20 65 73 74 69 6d |riosis w|as estim|
|00005d30| 61 74 65 64 20 61 74 20 | 33 2e 36 20 70 65 72 0d |ated at |3.6 per.|
|00005d40| 0a 6d 69 6c 6c 69 6f 6e | 20 70 6f 70 75 6c 61 74 |.million| populat|
|00005d50| 69 6f 6e 20 70 65 72 20 | 79 65 61 72 2c 20 77 69 |ion per |year, wi|
|00005d60| 74 68 20 61 6e 20 65 73 | 74 69 6d 61 74 65 64 20 |th an es|timated |
|00005d70| 38 30 30 20 69 6e 66 65 | 63 74 69 6f 6e 73 20 6f |800 infe|ctions o|
|00005d80| 63 63 75 72 72 69 6e 67 | 20 69 6e 20 74 68 65 0d |ccurring| in the.|
|00005d90| 0a 55 6e 69 74 65 64 20 | 53 74 61 74 65 73 20 65 |.United |States e|
|00005da0| 61 63 68 20 79 65 61 72 | 2e 20 20 54 68 65 20 70 |ach year|.  The p|
|00005db0| 72 6f 6a 65 63 74 65 64 | 20 74 6f 74 61 6c 20 6e |rojected| total n|
|00005dc0| 75 6d 62 65 72 20 6f 66 | 20 64 65 61 74 68 73 20 |umber of| deaths |
|00005dd0| 69 6e 20 74 68 65 20 55 | 6e 69 74 65 64 0d 0a 53 |in the U|nited..S|
|00005de0| 74 61 74 65 73 20 62 65 | 63 61 75 73 65 20 6f 66 |tates be|cause of|
|00005df0| 20 4c 2e 20 6d 6f 6e 6f | 63 79 74 6f 67 65 6e 65 | L. mono|cytogene|
|00005e00| 73 20 69 6e 66 65 63 74 | 69 6f 6e 20 77 61 73 20 |s infect|ion was |
|00005e10| 31 35 30 2c 20 6e 6f 74 | 20 69 6e 63 6c 75 64 69 |150, not| includi|
|00005e20| 6e 67 20 74 68 65 20 66 | 65 74 61 6c 0d 0a 6d 6f |ng the f|etal..mo|
|00005e30| 72 74 61 6c 69 74 79 2c | 20 61 73 20 73 74 69 6c |rtality,| as stil|
|00005e40| 6c 62 69 72 74 68 73 20 | 61 6e 64 20 73 70 6f 6e |lbirths |and spon|
|00005e50| 74 61 6e 65 6f 75 73 20 | 61 62 6f 72 74 69 6f 6e |taneous |abortion|
|00005e60| 73 20 77 65 72 65 20 6e | 6f 74 20 63 6f 6e 73 69 |s were n|ot consi|
|00005e70| 64 65 72 65 64 20 61 73 | 0d 0a 64 69 73 63 68 61 |dered as|..discha|
|00005e80| 72 67 65 64 20 70 61 74 | 69 65 6e 74 73 2e 20 20 |rged pat|ients.  |
|00005e90| 54 68 65 20 6f 76 65 72 | 61 6c 6c 20 72 61 74 69 |The over|all rati|
|00005ea0| 6f 20 6f 66 20 63 61 73 | 65 73 20 74 6f 20 66 61 |o of cas|es to fa|
|00005eb0| 74 61 6c 69 74 69 65 73 | 20 77 61 73 20 31 39 2e |talities| was 19.|
|00005ec0| 31 25 2c 20 77 69 74 68 | 0d 0a 74 68 65 20 68 69 |1%, with|..the hi|
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+--------+-------------------------+-------------------------+--------+--------+