Paediatrics and International Child Health最新文献

Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.Abbreviations: AIS: arterial ischaemic stroke; ANA: anti-nuclear antibody; APA: anti-phospholipid antibody; APTT: activated partial thromboplastin time; CAD: carotid artery dissection; CCAD: cranio-cervical artery dissection; CRP: C-reactive protein; CT: computed tomography; CTA: computed tomography angiography; dsDNA: double-stranded DNA; ESR: erythrocyte sedimentation rate; ICA: internal carotid artery; LA: lupus anticoagulant; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MTHFR: methylenetetrahydrofolate reductase; PT INR: prothrombin time international normalised ratio.

Congenital tuberculosis (CTB) is the transmission of Mycobacterium tuberculosis infection from mother to infant during the intrauterine period or delivery. An 82-day-old infant presented to Nilratan Sircar Medical College and Hospital, Kolkata, with a history of persistent fever from Day 15 of age. Over the course of more than 2 months, there were pneumonia, hepatosplenomegaly and endophthalmitis which were unresponsive to a range of antibiotics, and there had been several admissions to local hospitals. On this admission, his chest radiograph and contrast-enhanced computed tomography (CECT) of the thorax demonstrated bilateral nodules and enlarged mediastinal lymph nodes. Ultrasound and CECT of the abdomen demonstrated hepatosplenomegaly with multiple hypodense enhancing lesions. GeneXpert of a gastric lavage on Day 2 of this admission detected M. tuberculosis without rifampicin resistance. The infant was diagnosed with tuberculosis (TB) complicated by caseating hepatic granulomas, which fulfilled Cantwell's diagnostic criteria for CTB. Magnetic resonance imaging of the orbit demonstrated focal heterogeneous lesions involving the anterior portion of the left ocular bulb and vitreous, suggesting panophthalmitis, which was unresponsive to intravitreal antibiotics. Following commencement of standard anti-TB therapy from Day 90 of life, there was clinical and radiological recovery of endophthalmitis. The mother had a cachectic appearance owing to weight loss, and she had attended only one antenatal appointment. She had a positive acid-fast bacilli sputum stain but was unwilling to allow a genital tract smear. In the spectrum of CTB, TB panophthalmitis is an extremely rare presentation, and, as far as we are aware, it has not been reported in a child.Abbreviations: AFB: acid-fast bacilli; ATT: anti-tuberculous therapy; CTB: congenital tuberculosis; CECT: contrast-enhanced computed tomography; CSF: cerebrospinal fluid; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; TB: tuberculosis; MRI: magnetic resonance imaging; USG: ultrasonogram.

Background: Rabies is a fatal disease caused by the rabies virus, usually transmitted by a bite by an infected animal. Because there is no effective treatment, prophylaxis is crucial. The aim of the study was to analyse the circumstances of exposure, characterise the animals that were a potential source of infection and evaluate the frequency of post-exposure prophylaxis in children.

Methods: This was a retrospective analysis of the medical records of 494 children who had been bitten, scratched or salivated on by an animal and were seen consecutively between 2015 and 2019 in the Department of Paediatric Infectious Diseases, Medical University of Warsaw.

Results: The study group was children aged 10 months to 17 years 11 months. The animals most commonly involved were dogs (347/494, 70.24%), cats (81/494 (16.40%) and squirrels (10/494, 2.02%). The contact was mainly with tame but unfamiliar animals (359/494, 72.67%, p < 0.001). The most common type of exposure was a bite (457/494, 92.51%). Surgical wound care was required most often after exposure in a town (64/90, 71.11%). A total of 412 children (80.83%) received post-exposure vaccination, including 333/412 using the Essen regimen. In 13/412 cases, the vaccination schedule (3.16%) was not completed because of an absence of signs of disease during veterinary observation of the animal. Anti-rabies immunoglobulin was administered to 13/412 (3.16%).

Conclusion: Most children who are referred after being bitten by an animal require post-exposure prophylaxis. Children are usually bitten by tame dogs with which they are unfamiliar, mostly on the hand. Surgical wound care is needed more often for urban patients than others.

Accidental foreign body aspiration in children is a leading cause of childhood morbidity. Prompt recognition and timely management reduce complications, some of which are potentially fatal. A previously well 2-year-old girl presented with recurrent episodes of cough, fever and tachypnoea with chest indrawing for the previous 7 months. The first episode lasted almost 4 weeks. There was no history of choking. She was underweight (Z-score -2 to -3) with initially normal height. The chest radiograph demonstrated opacities in the left lung first, but subsequently there were lesions in both lungs. Computerised tomography confirmed the chest radiograph findings. Bronchoscopy demonstrated pus and granulomatous tissue in the left main bronchus, but no foreign body was detected and she was treated with antibiotics. Over the following 18 months she had several outpatient and four inpatient treatments for the same complaint. There was progressive weight loss, stunting and she developed finger clubbing. During her fourth admission, a repeat bronchoscopy again demonstrated granulomatous tissue with pus in the left main bronchus and remnants of a migratory peanut and signs of early bronchiectasis. Following removal of the peanut, her health began to recover, and, at follow-up a year later, her chest radiograph was normal, her growth had caught up and she was in normal health.

Background: Despite its associated benefits which include better long-term pulmonary and neurodevelopmental outcome, the use of caffeine for apnoea of prematurity (AoP) has been limited in low- and middle-income countries (LMIC).

Aim: To better understand current caffeine use, the barriers and facilitators to its use and perceptions and practices in LMIC which have a disproportionately high burden of prematurity.

Methods: An anonymous online global survey was conducted, targeting healthcare providers working and training in paediatrics and/or neonatology in LMIC.

Results: A total of 181 respondents in 16 LMIC were included in the analysis; most were physicians working in publicly-funded urban tertiary hospitals. Most had received training in the use of caffeine for AoP (77%), reported expertise (70%) and confidence (96%) in its use, and had access to caffeine (65%). Caffeine availability was reported to be the greatest barrier (48%) and the greatest facilitator (37%). Other common barriers included cost (31%), access (7%) and policies or guidelines on caffeine use (7%); other common facilitators included policies or guidelines on caffeine use (11%), access (10%), staff/other providers' acceptance of caffeine as an appropriate treatment (9%) and the availability of staff to administer caffeine (8%). Most (79%) noted that access to caffeine was important, 92% agreed that caffeine improves quality of care, and 95% agreed that caffeine improves patient outcome.

Conclusion: Improving availability and access to low-cost caffeine will be key to increasing caffeine use in LMIC.

Abbreviations: AoP: Apnoea of Prematurity; LMIC: low- and middle-Income countries; REDCap: Research Electronic Data Capture.

Rhizobium radiobacter is an aerobic, motile, oxidase-positive, non-spore-forming Gram-negative tumorigenic plant pathogen which rarely infects humans. A 46-day-old girl was admitted to hospital with a 10-day history of fever and cough. She had pneumonia and liver dysfunction owing to infection by R. radiobacter. After 3 days of treatment with ceftriaxone, (compound glycyrrhizin and ambroxol), her body temperature returned to normal and the pneumonia improved, but liver enzyme levels continued to rise. After treatment with meropenem (glycyrrhizin and reduced glutathione), her condition stabilised and she recovered with no liver damage, and was discharged after 15 days. R. radiobacter has low virulence and antibiotics are highly sensitive, but, rarely, severe organ dysfunction can occur and result in multi-system damage in vulnerable children.

Background: The outcome of perinatal hypoxic-ischaemic encephalopathy (HIE) in middle-to-low-income countries varies between regions.

Objectives: To determine the mortality and morbidity, and factors influencing the deaths of infants with perinatal HIE.

Methods: A retrospective study was conducted at Chiang Mai University Hospital, Thailand. Perinatal HIE infants of >35 weeks gestation, birthweight ≥2000 g and admitted during 2005-2019 were reviewed. Baseline Characteristics, clinical course and outcome at discharge were compared between the period before and after initiation of therapeutic hypothermia (TH). Risk of death in HIE infants who underwent TH was identified.

Results: A total of 162 HIE infants were included. Compared to the period before TH initiation, the mortality rate was significantly decreased in the TH period. (27% vs. 12.8%, p=0.04) Among 100 HIE infants who underwent TH, the mortality rates was 14%(14/100), of whom 2.5% (2/76) and 50% (12/24) were in the moderate and severe HIE groups. Apgar score at 5 mins ≤1, severe HIE, seizures, hypoglycaemia, organ involvement ≥ five sites, ammonia ≥100 umol/L, lactate ≥14 mmol/L, and requirement for two or more inotropic drugs were risks of death. Multivariate analysis demonstrated that severe HIE (aOR 732.8, 95% CI 4.7-114643, p=0.01) and a need for two or more inotropic drugs (aOR 45.7, 95% CI 1.5-1040, p=0.029) were significant factors for mortality.

Conclusion: In the period of TH, perinatal HIE infants had decreased mortality. Severe HIE and a need for two or more inotropic drugs were associated with death in the infant with HIE who underwent TH.Abbreviations: AED: anti-epileptic drug; BW, birthweight; CI: confidence interval; CMU: Chiang Mai University; EEG: electro-encephalogram; GA: gestational age; HIE: hypoxic-ischaemic encephalopathy; IQR: interquartile range; NICU: neonatal intensive care unit; SD: standard deviation; TH: therapeutic hypothermia.

A 3-month-old female infant with meningo-encephalitis caused by Salmonella enterica Paratyphi B var. Java is described. The aetiological agent was confirmed in six CSF samples; however, none of the blood or faecal samples was positive for the same pathogen. The presence of the bacteria was confirmed in the CSF by culture, serology and Multiplex PCR assay. The infant developed dilated subarachnoid spaces and right-sided hemiparesis associated with the persistent bacterial meningo-encephalitis. She was re-admitted 2 weeks after recovery and initial discharge from hospital owing to recurrence of S. enterica Paratyphi B bacteria in the CSF and the development of large bilateral subdural effusions in the brain. Computed tomography and the clinical course confirmed dynamically progressive meningo-encephalitis. Following further parenteral antibiotics and symptomatic treatment, the child's condition improved. After a total of 24 days in the PICU, she was sufficiently improved to be discharged with a residual right-sided hemiparesis. However, sadly she died a week after discharge.Abbreviation: ALT: alanine aminotransferase; API: analytical profile index 20 E-test; AST: aspartate aminotransferase; CRP: C-reactive protein; CSF: cerebrospinal fluid; CT: computed tomography; EUCAST: European Committee on Antimicrobial Susceptibility Testing; MDCT: multi-detector computed tomography; PCR: polymerase chain reaction; PICU: paediatric intensive care unit; RBC: red blood cells; VITEK: automated instrument for identification/antimicrobial susceptibility testing; WBC: white blood cells.

Varicella infection can present with a variety of neurological manifestations, the most common of which are cerebellitis and encephalitis. A 12-year-old girl presented with headache, altered sensorium, blurring of vision and status epilepticus 2 weeks after she developed varicella lesions. Imaging demonstrated cerebral venous sinus thrombosis involving the left transverse sinus, sigmoid sinus and internal jugular vein with a haemorrhagic infarct in the left parieto-occipital region. Measures were taken to decrease the intracranial pressure, and she was commenced on anti-convulsants (phenytoin) and heparin infusion, following which she improved and was discharged after 2 weeks. Repeat imaging undertaken 3 months later demonstrated a resolving thrombus, and a pro-coagulant work-up at follow-up did not show any underlying pro-thrombotic state. Neurological complications post varicella are rare, with encephalitis and ataxia being the most common. Cerebral sinus venous thrombosis secondary to varicella is very rare with only one case reported in a child.