Bone marrow invasion by aspergillus specie in a sickle cell trait patient with invasive aspergillosis: a fatal case in association with disseminated intravascular coagulation

Background: Invasive aspergillosis has been predominantly associated with pulmonary infection, particularly amongst immunocompromised individuals. Extrapulmonary infections with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, haematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. The most frequently involved specie is Aspergillus fumigatus that constitutes over 90% of cases, followed by Aspergillus flavus, usually associated with a primary skin infection. Haematogenous spread to the bone causing osteomyelitis is the commonest form of disseminated aspergillosis and a surprisingly high proportion of these patients have no immunosuppression. We present a rare case of bone marrow invasion by Aspergillusspp. in a 3-year-old patient with sickle cell trait and chronic Aspergillosis. Case report: A 3-year-old patient with sickle cell trait was brought to the paediatric unit with recurrent diarrhoea, abdominal distention, weight loss and persistent cough. The child was severely wasted with generalised peripheral lymphadenopathy. She had marked respiratory distress and hepatosplenomegaly but no demonstrable ascites. Haematologic examination revealed leukaemoid reaction (leukocyte count of 44.0 x 109/L) with monocytosis (10%) and thrombocytopenia (platelet count of 97,000/mm3); no blast cells were seen on blood film. The bone marrow was hypercellular with a myeloid/erythroid ratio of 20:1, consistent with infection. Bone Marrow culture yielded Aspergillus spp. and other results of sepsis work up were negative. Conclusion: Cases of extrapulmonary invasive aspergillosis have been reported rarely in both immunocompetent and immunocompromised patients. Haematogenous spread to the bone is the commonest form of disseminated disease

Vitamin A Status of Steady State Sickle Cell Anaemia Patients Compared to Normal Control in Maiduguri North Eastern Nigeria.

Sickle cell anaemia is an inherited disorder of haemoglobin characterized by sickled red blood cells and increased destruction of these cells. Antioxidants protect cells from the damaging effects of free radicals. The aim of this study was to determine antioxidant vitamin A in steady state sickle cell anaemia patients and that of controls in Maiduguri, Borno state North-Eastern Nigeria. The study was carried out at UMTH Maiduguri. Sixty sickle cell anaemia patients were compared with sixty controls, aged ranged 1 year 3 months to 33 years of age, using HPLC for vitamin A status. The mean vitamin A in sickle cell patients according to age ranged between 0.047±0.002 to 0.053±0.002 mg/ml, while that of controls is 0.053± 0.001 to 0.091±0.001 mg/ml. The maximum mean serum vitamin A (0.053±0.001 mg/ml), in SCA was found in the business and children groups while the minimum vitamin A (0.039±0.001 mg/ml) was recorded in the un-employed SCA patients. The study showed the antioxidant vitamin A was found to be lower in the SCA subjects than in normal control in all age groups. Level of education also plays a role in the level of antioxidant vitamins in the blood.

Significance of pyuria in the diagnosis of urinary tract infection in children with sickle cell anaemia in Maiduguri, Nigeria

Urinary tract infection (UTI) is a significant cause of morbidity and mortality in children; especially in those with sickle cell disease; who are at higher risk of infections. It will be useful to have a simple test which can be used in resource limited health facilities as a means of screening such children for UTI with the view to instituting prompt treatment. This study is carried out to determine the usefulness of significant pyuria in detecting UTI in febrile children with sickle cell anaemia (SCA). Two hundred and fifty febrile children with sickle cell anaemia that attended State Specialist Hospital and University of Maiduguri Teaching Hospital (UMTH) were prospectively studied with their consent. Urine sample was collected using standard procedure; examined for pus cells and was cultured at the Microbiology laboratory of UMTH. The study showed UTI prevalence of 26. Significant pyuria was found to have sensitivity of 55.4; specificity of 77.8; the efficacy of the test was 72.0and the test has low positive predictive value of 46.8in detecting bacteriuria in SCA patients. The significant pyuria observed in this study support its usefulness in the diagnosis of UTI among children with SCA especially in communities having limited facilities or personnel for carrying out urine culture

Diethylene glycol poisoning in Nigerian children

Clinical and pathological features in 23 children who developed acute renal failure from what was subsequently proven to be diethylene glycol poisoning are presented. Symptoms of cases included anuria; fever; diarrhoea and vomiting. Eighteen (78.3) had hepatomegaly; 11(47.8) had evidence of respiratory distress and 7 (30.4) had acidotic breathing. Seven (30.4) of the children were dehydrated on physical examination. Alteration in the level of consciousness was observed in 13 (56.5) children. The major biochemical abnormalities were acidosis and elevated blood urea nitrogen. Although serum bilirubin was normal in those in whom it was determined; the liver enzymes were elevated in the 2 patients in whom they were determined