Haemophilus influenzae epiglottitis has virtually disappeared in the United States, along with other invasive H. influenzae type b infections. Pediatrie tuberculosis is also on the wane in the United States, except in a few limited areas. Serious pediatrie pneumococcal infections have become more and more infrequent. However, the article by Dr. Heather Zar in this issue highlights the very different nature of pediatrie lower respiratory tract infections in South Africa and in other areas of the developing world, with the combination of human immunodeficiency virus (HIV) infection and tuberculosis being particularly deadly in much of the world. Indeed, almost 7,000 individuals worldwide die of tuberculosis every day!1
Nevertheless, despite all the progress in developed countries, in recent weeks we have cared for a substantial number of children with significant lower respiratory tract infections. These have included a Mexican immigrant teenager with severe advanced pulmonary tuberculosis; a 3 year old with cavitary bacterial pneumonia; a developmentally delayed 12 year old with severe aspiration pneumonitis; a 2 year old who developed pneumococcal pneumonia and bacteremia while visiting family in India and then developed nosocomial gram-negative pneumonitis requiring chest tube drainage while in an Indian hospital; and a 10-year-old bone marrow transplant recipient with impressive fungal pneumonitis.
Despite major medical advances, lower respiratory tract infections continue to lead to children's admissions to hospitals in the United States, albeit with a spectrum of clinical circumstances somewhat different from that seen in developing countries or here in previous decades. The change, in great measure, is a testament to the great efficacy of our modern vaccination policies, a side of the vaccine "debate" that does not receive anything close to sufficient publicity.
In keeping with our tradition at Pediatrie Annals (dating all the way back to last month), I am dipping into my infectious disease stamp collection, this time to highlight Robert Koch (1843-1910), one of the true pioneers of bacteriology. Koch received the Nobel Prize in 1905 for his discovery of the etiologic agent of tuberculosis in 1882 and, of course, is also recognized for Koch's postulates, which outline the requisites for concluding that an agent is the etiology of a specific illness.
Koch's initial work, completed in 1876, established that the anthrax bacillus was the cause of the disease about which we have heard so much in recent months. He developed the first culture plates and perfected steam sterilization. Koch's major scientific error was his claim that tuberculin, derived from the tubercle bacillus, was effective treatment for tuberculosis. This proved not to be the case, although tuberculin was (and continues to be) highly valuable for the diagnosis of tuberculosis in the form of skin tests to assess the presence of delayed hypersensitivity to this substance.
The olive green and light blue 1982 stamp is from the German Democratic Republic (East Germany) and portrays Koch alongside the first page of his 1882 article entitled (in German) "The Etiology of Tuberculosis." Each of the other three stamps/ from three different African countries, portrays the microscopic appearance of "red snappers/' acid-fast bacilli in tissue. Each commemorates the 100th anniversary of Koch's landmark discovery.
1. Dye C, Scheele S, Dolin P, et al. Consensus statement: WHO Global Surveillance Monitoring Project. JAMA. 1999;282:677-686.