Annals of Tropical Paediatrics最新文献

This case report highlights the course of two healthy unrelated children with an encephalopathy characterised by dyskinesia, seizures, hemiparesis and behavioural change associated with recent human parvovirus B19 infection. The cases are compared with a previously described case of childhood chorea encephalopathy associated with human parvovirus B19 infection.

An 8-month-old boy was diagnosed with visceral leishmaniasis in the Ukraine, a non-endemic area. His mother had been treated for visceral leishmaniasis at 28-32 weeks gestation whilst working in Alicante, Spain and delivered her infant at 38 weeks gestation by elective caesarean section in Ukraine. It is presumed that the infant's infection was as a result of vertical transmission.

Background: Swine-origin influenza A H1N1 (S-OIV) has not been systematically studied in Indian children.

Objectives: To study the clinical characteristics, morbidity and mortality pattern in children with S-OIV infection.

Methods: This prospective study was conducted during the 'containment phase' of the pandemic in New Delhi from 10 June to 5 August 2009. All children suspected of being infected by S-OIV were admitted to the isolation wards and clinically evaluated according to WHO guidelines. Nasal and throat swabs were collected immediately for real-time reverse transcriptase polymerase chain reaction (RT-PCR). Haemoglobin, total leucocyte and platelet counts and chest radiography were undertaken in all patients. Those who tested positive for S-OIV infection were treated with oseltamivir for 5 days in isolation wards.

Results: Thirty-seven children fulfilled the inclusion criteria. Twenty-one tested positive for S-OIV by RT-PCR and 16 tested negative. Comparison of the clinical characteristics of the two groups showed that duration of cough was longer in children with S-OIV (p<0.03). Total leucocyte and lymphocyte counts were significantly less in the S-OIV group (p<0.001 and , 0.02, respectively). Oseltamivir-related gastritis was seen in 38% of children. All improved and were discharged.

Conclusion: S-OIV infection in Indian children had features similar to those of seasonal influenza. Lymphopenia is an important feature of S-OIV.

A male fetus was extruded from the uterus following multiple lower abdominal stab wounds to the mother. He was brought to the emergency room at 8 hours of age. He had sustained a compound skull fracture with brain contusion. There was no neurological deficit. Debridement and primary wound closure were undertaken. His mother had multiple lacerations to the uterus and a laceration of the fundus of the bladder. Following resuscitation, she had repair of the uterus and bladder and made an uneventful recovery. At 3 years of age, the boy is developing normally.

We describe a 7-year-old boy with staphylococcal toxic shock syndrome who presented with acute respiratory distress and cor pulmonale. We wish to highlight this unusual presentation as the diagnosis of toxic shock syndrome depends chiefly on a high degree of clinical suspicion. Early diagnosis and prompt institution of appropriate therapy will significantly reduce morbidity and mortality.

A 13-year-old girl with controlled coeliac disease who had been on a gluten-free diet for the past 3 months was admitted with respiratory distress and hypoxia for the past week. Chest radiograph and CT scan showed bilateral widespread alveolar shadowing suggestive of a hypersensitive pneumonitis. There was a dramatic radiological and clinical response to oral corticosteroids. Bronchial lavage was suggestive of recurrent aspiration and histology of a transbronchial biopsy showed pulmonary haemosiderosis. We conclude that pulmonary haemosiderosis may occur in children with coeliac disease who are on a gluten-free diet.

Paediatrician and specialist in tropical child health. Born 5 November 1926 in Cape Town, South Africa, died 6 May 2010 in Heswall, Wirral, England, aged 83.

Background: The primary genetic marker associated with coeliac disease (CD) is the HLA-DQ2 molecule, encoded by the DQA1*0501 and DQB1*0201 genes.

Aim: To investigate the frequency of HLA-DQA1*0501 and DQB1*0201 alleles in Jordanian patients with CD and their first-degree relatives.

Methods: An allele-specific DNA-based PCR-sequence-specific primer was used to investigate DQA1*0501 and DQB1*0201 alleles in 44 CD patients, 47 first-degree relatives and 53 healthy controls.

Results: The mean age of the patients at the time of diagnosis was 13.5 years (range 1-39) and at the time of the study was 19.3 years (range 5-42). The DQA1/B1 (0501; 0201) haplotype was present in 80% of patients and 66% of first-degree relatives compared with 32% of controls (p<0.0001 and <0.01, respectively). The remaining 20% of CD patients who were negative for the DQ2 molecule carried the DQB1*0201 allele only. A statistically significant difference was detected in the DQ2 hetero-dimer frequency between CD patients, their first-degree relatives and controls with a higher frequency in the patients group (p<0.001).

Conclusion: The significant differences in the frequency of DQA1*0501, DQB1*0201 alleles in CD patients and their first-degree relatives compared with the control group demonstrated the important role of these alleles in the development of CD in the Jordanian population.

Aim: To report on the management of plasma sodium and potassium disturbances, identified by routine electrolyte testing in children.

Methods: A prospective cohort study of patients admitted to the Diarrhoea Rehydration Unit of Red Cross Children's Hospital, Cape Town, South Africa. The patients were 530 children aged 6 weeks to 2 years with a primary diagnosis of diarrhoea.

Results: For plasma sodium levels <125 mmol/L (3.4%, 95% CI 2.0-0 5.3), 48 patients (95% CI 30-116) needed testing for one to receive a change of management. For plasma potassium levels <3 mmol/L (31.6%, 95% CI 27.6-35.6), fewer patients (6, 95% CI 5-7) needed testing for one to receive a change of management.

Conclusion: Electrolyte abnormalities were detected and clinical management changed, but large numbers of patients needed to be tested for each change of management.

A newborn girl with a haemangioma of the liver failed to respond to cortico-steroid therapy. Ultrasonic evidence of the haemangioma disappeared after 2 months of treatment with propranolol. Propranolol, a non-selective beta-blocker, is a promising therapy in the management of haemangiomas.