Varicella in immunocompromised children at the Philippine General Hospital: A six-year review

Objective: This research aims to describe the profile, clinical course, treatment and outcome of varicella in immunocompromised children at the Philippine General Hospital from January 1999 to December 2004.Study Population: All immunocompromised patients less than 19 years of age with a clinical diagnosis of varicella admitted at the Philippine General Hospital during the study period were included. Method: A review of medical records and monthly census reports of the Pediatric Infectious Disease and Hematology-Oncology Services was conducted. Results: Out of 26 immunocompromised patients who developed varicella during the study period, only 22 charts were available for review. Of these patients, 13 were male and 9 were female. The highest incidence occurred from 0 to 5 years old (41%). Twenty patients had an underlying malignancy in the form of leukemia (14%) and solid organ tumors (6%). Two patients were on chronic steroid therapy (Prednisone) for more than a month due to Nephrotic Syndrome and Myelodysplastic Syndrome with Stevens-Johnson Syndrome. The most common presenting symptom was a rash (68%), with an associated fever seen in 54% of the cases. Majority were treated with acyclovir for an average of 7 days with good response. Nine patients developed complications: mainly, pneumonia and sepsis. Recovery rate was 82%; however, fatality rate was 13.6%. Conclusion: Varicella in immunocompromised children is associated with increased morbidity and mortality. Our patients responded well to sequential intravenous and oral acyclovir. Vaccination of targeted populations such as close household contacts of immunocompromised patients, as well as, healthcare workers may be a good strategy to protect high-risk children from developing the disease and its complications.

Rotavirus acute gastroenteritis among Filipino children

This is a prospective study aimed to determine the clinical profile of pediatric patients less than 5 years old with rotavirus diarrhea seen at the Philippine General Hospital from August 1-September 15, 2001. Ninety-one patients with acute diarrhea were included in the study. Of these 39 patients (42.9 percent) had rotavirus antigen in the stool as detected by the ELISA method. The mean age of the patients was 11.5 months with 61.5 percent of the patients belonging to the 7-12 months of age, mostly well-nourished. The stools were described as watery (74.4 percent), yellow in color (84.7 percent), with no pus, red blood cells or parasite. Average duration of diarrhea prior to consultation was 2.5 +/- 1.8 days with 7 episodes per day. Vomiting, fever and concomitant upper respiratory tract infection were noted in 76.9 percent, 64 percent and 23.7 percent of the patients respectively. A comparison of the rotavirus versus bacterial etiology of diarrhea showed fever and vomiting to be more predominant in rotavirus while dehydration was noted in bacterial isolates. Antibiotic was noted to be given to 38.5 percent rotavirus cases. Increased awareness of rotavirus diarrhea, regarding its high incidence and clinical profile, will help guide physicians in their rational use of antibiotics for patients with acute diarrhea

The effect on various treatment methods on the disinfection of artificially contaminated water

Since waterborne diseases are still an important cause of morbidity and mortality in the Philippine setting, it is evident that the quality of water supplies cannot always be assured, and remedial measures are required to provide consumers with safe drinking water. Boiling is a proven household disinfection method, but doubt regarding its efficacy has led to a search for alternatives. This study was thus performed to compare the efficacy of various methods of water treatment, and to perform a cost analysis for each method Sterile water was seeded with E. Coli ATCC 25922 to a concentration of 10 exponent 5 cfu/ml. Equal amounts were then disinfected by:(1) boiling for 10 minutes; (2) passage through an ultraviolet (UV) light water treatment device (UV Waterworks TM); (3) reverse osmosis (RO). Three replicates were done for each procedure, and for each replicate five aliquots were obtained for (1) immediate testing: (2) testing after 24 hours in room temperature; (3) testing after 24 hours at a temperature of 2-8 degrees C; (4) testing after 48 hours in room temperature; and (5) testing after 48 hours at a temperature of 2-8 degrees C, Samples were analyzed using the spread-plate method on MacConkeys agar. For all samples taken, no growth was seen after 24 hours of incubation Taking into account the cost of consumables for each method, UV disinfection has the advantage of being 200 times less expensive than boiling, which in turn is less costly by 50 percent compared to RO. The increased cost of RO is due to large amount of water discarded during processing. An advantage offered by methods such as RO and UV disinfection is its time-saving aspect. However, households without access to UV or RO units should consider boiling a cost-effective option, so long as manpower and fuel resources are available. (Author)