Annals of Tropical Paediatrics最新文献

Despite the high prevalence of tuberculosis in adults and children, congenital and perinatal forms of tuberculosis are rare. Four patients with perinatal tuberculosis are described. Diagnosis was made by demonstration of acid-fast bacilli (AFB) on broncho-alveolar lavage (BAL) specimens (two cases), gastric aspirate smear (one case) and lymph node fine-needle aspirate (one case). All of the above specimens were subsequently positive on culture. Two infants died of progressive pulmonary failure, and one of the mothers died, despite the institution of anti-tuberculous therapy. BAL specimen examination for AFB is useful in the diagnosis of perinatal tuberculosis, especially in infants with smear-negative gastric aspirate.

A 7-month-old Myanmar boy was admitted with a 3-day history of fever. He was markedly pale and his temperature was 38·2°C. Peripheral blood smear demonstrated Plasmodium vivax infection with spherocytosis and auto-agglutination of red blood cells. Haematocrit was 16% and reticulocyte count 14·9%. Direct and indirect antiglobulin tests were positive. Antibody analysis was positive for auto-antigen I. P. vivax malaria with auto-immune haemolytic anaemia (AIHA) was diagnosed. He was treated with chloroquine and primaquine for the P. vivax infection, and oral prednisolone for the AIHA. Because of the clinical symptoms of anaemia and mild dyspnoea, blood with the least incompatible red blood cells was transfused. The clinical symptoms and signs improved. At follow-up 3 and 7 weeks after treatment, his haematocrit, reticulocyte count and peripheral blood smear results were within normal limits. Prednisolone was then tapered and stopped. The patient has since been well with no detectable recurrence of AIHA.

A 14-year-old professional basketball player developed symptoms of influenza which was subsequently confirmed to be caused by influenza A (H3N2). He was given a 5-day course of oseltamivir. Two days after completing the course, he resumed basketball and developed rhabdomyolysis associated with acute renal failure and disseminated intravascular coagulation. This appears to be the first report of exercise-induced rhabdomyolysis associated with influenza A (H3N2).

Background: Rheumatic heart disease (RHD) is an important contributor to cardiovascular disease in children and adults in Yemen. This is the first report to determine the prevalence of RHD among school-children in the city of Aden.

Methods: A cross-sectional case-finding survey of RHD was conducted in 6000 school-children aged 5-16 years. Echocardiography was undertaken in those with clinical signs of organic heart disease.

Results: The prevalence of RHD was 36·5/1000 school-children, which is one of the highest reported among school echocardiography surveys in the world. RHD was more common in 10-16-year-old students. RHD was diagnosed in more than one member of the families of 53 (24·2%) of the children. Mitral regurgitation (MR) was detected in 49·8%, 26·6% had MR with mitral valve prolapse and 17·8% had combined MR and aortic regurgitation. Fifty-eight children were diagnosed with congenital heart disease (CHD), representing a prevalence of 9·7/1000. The main types of CHD were mitral valve prolapse, patent ductus arteriosus, atrial septal defect, pulmonary stenosis and aortic stenosis. Congenital mitral valve prolapse found in 36 children was three times more common in males than females. Children with RHD were more likely to be from low-income families with poor housing and greater overcrowding (49·3%, 39·3% and 64·8%) than children with CHD (44·8%, 32·8% and 48·3%, respectively).

Conclusions: The high prevalence of RHD is a major public health problem in Yemen. Urgent screening surveys and an RHD prophylactic programme of appropriate management of group A β-haemolytic streptococcal pharyngotonsilitis are required.

Background: The relationship between Helicobacter pylori and gastro-oesophageal reflux disease (GORD) in children is controversial.

Aim: To determine the role of H. pylori infection and GORD in children living in a region which is endemic for H. pylori infection.

Methods: A cross-sectional study was undertaken in 263 children aged 3-18 years, all of whom had symptoms of GORD and underwent upper gastro-intestinal endoscopy. H. pylori status was determined by conventional rapid urease test and Giemsa staining of antral and cardiac biopsies. Biopsies of the oesophagus and gastric mucosa were obtained from the lower oesophagus, the antrum and cardia according to standard protocol.

Results: Of the 263 patients, 81 (31·5%) had GORD and 162 (61·5%) had gastritis. There were 59 H. pylori-infected patients (22·4%) and 204 were uninfected. H. pylori infection was detected in 52 (88·1%) of the antral and 10 (1·9%) of the cardiac biopsies. Three (5·1%) of the biopsies revealed infection of both antrum and cardia and in seven (11·8%) only the cardia was infected. The prevalence of H. pylori infection among patients with GORD (13/83, 15%) was significantly lower than in those without GORD (46/180, 26%) (OR 0·54, CI 0·27-0·93, p<0·05). The prevalence of H. pylori infection among those with gastritis (48/162, 30%) was significantly higher than in those without gastritis (11/101, 10·8%) (OR 3·44, CI 1·69-7·015, p<0·001).

Conclusion: H. pylori infection might protect against GORD.

Hypereosinophilic syndrome in children is rare and is characterised by sustained over-production of eosinophils. An 11-year-old boy was diagnosed with hypereosinophilic syndrome as per standard criteria. He was treated initially with intravenous methylprednisolone, followed by oral prednisolone, to which he showed a limited response. The highest absolute eosinophil count was 27.0×10(9)/L. He was commenced on imatinib mesylate but, because of no response, he was switched to hydroxyurea combined with low-dose prednisolone to which he showed improvement with decreasing levels of eosinophils.

Background: Anaemia is a significant global public health problem in developing countries with adverse health effects on young children. Household food insecurity, which reflects a household's access, availability and utilisation of food, has not been well characterised in relation to anaemia in children.

Objective: To examine the relationship of household food insecurity with anaemia (Hb <11 g/dl) in children.

Methods: In a cross-sectional study of 4940 rural households participating in the Indonesian Nutrition Surveillance System, household food insecurity was measured using a modified 9-item food security questionnaire and related to anaemia in children aged 6-59 months.

Results: The proportion of households with an anaemic child was 56·6%. In households with and without anaemic children, the mean (SD) food insecurity score was 1·82 (1·72) vs 1·55 (1·54) (p<0·0001), respectively. In a multivariate logistic regression model, food insecurity score was related to anaemia in children (odds ratio 0·77, 95% confidence interval 0·63-0·95, p=0·01) when the highest quintile of food insecurity score was compared with the lowest quintile, adjusting for potential confounders.

Conclusion: A higher household food insecurity score is associated with greater prevalence of anaemia in children in rural families in Indonesia.

Background: Iron chelation is an important component of management of transfusion-dependent patients with thalassaemia major. Deferasirox is a relatively new oral iron chelator and experience of its use in children is limited.

Aim: To report experience with deferasirox in north Indian children with β-thalassaemia major.

Methods: This prospective study included 40 patients with transfusion-dependent β-thalassaemia major. The patients were receiving deferiprone alone (37 patients) or deferiprone and desferrioxamine combination (three patients) before commencing deferasirox. Patients were clinically monitored every month. Information on side-effects including gastro-intestinal symptoms, skin rash or discoloration, jaundice and complaints regarding vision and hearing were obtained from patient records. Laboratory investigations included complete blood count and renal and liver function tests estimated at baseline and then every month. Serum ferritin level was estimated at baseline and then every 3 months. The initial dose of deferasirox was 20 mg/kg/body weight and was increased to 25 mg/kg if serum ferritin remained unchanged or increased 3 months after deferasirox therapy.

Results: Therapy with deferasirox in 40 children was well tolerated. Gastro-intestinal symptoms were the most common side-effects. Nausea, vomiting and abdominal pain were observed in 25%, 20% and 15% patients, respectively. Skin rashes were seen in 5% cases. We observed greyish-brown pigmentation of the skin in four (10%) children which has not been described before. A non-progressive rise in serum creatinine was observed in 16 (40%) patients. In the majority, however, serum creatinine remained within the normal range. Leucopenia, neutropenia and thrombocytopenia were not observed. None of the side-effects necessitated cessation of the drug therapy. Serum ferritin levels fell in 24 of 32 patients (75%) who received deferasirox for over 1 year from a mean (SD) 6323·37 (2756·5) μg/L to 5458·91 (2301·2) μg/L (p<0·05).

Conclusions: Therapy with deferasirox is safe in paediatric patients with thalassaemia major. However, they should be carefully monitored for side-effects.