Approach to recurrent respiratory infections.

Rational approach to diagnosis and management of recurrent respiratory infections is needed, or else the child is subjected to unnecessary investigations and multiple drugs. Repeated respiratory symptoms do not mean a respiratory infection. A diagnosis of viral infection does not justify prescription of an antibiotic. Recurrent viral infections are part of the growing up process of any child. Giving antibiotics at every episode to cover "so-called superadded bacterial infections" will lead to "recurrent antibiotics" and adverse effects on growth. Systematic approach should be used to find the underlying cause. An otoscopic examination of a child should form part of a pediatric examination in all cases of respiratory infections. Antibiotics should be judiciously chosen depending on age, socioeconomic status, severity of infection and the type of organism expected and always given in adequate doses and proper duration. Treatment should be specific and symptomatic. Adequate drainage of the sinuses is an important adjuvant therapy. Use of cough syrups with various combinations should be avoided. Efforts should be made to diagnose and treat manifestations of hyperactive airway or allergy, role of CEA (cough equivalent asthma) and WLRI (Wheeze associated lower respiratory infections). Investigations are needed in recent lower respiratory infections and adverse effect on growth, school performance, abnormal physical findings. CBC, CRP, ESR, nasal smear, appropriate cultures, tests for TB, X-Rays, barium studies, milk scan, ultra sound, CT, MRI, bronchoscopy in selected cases.

Clinical profile of measles--a prospective study of 150 hospital based children.

The clinical profile of 150 hospital based cases (6 months-7 yrs) of measles presenting between May 1986 to May 1987 was analyzed. Nearly a quarter (28%) were less than 1 yr; 60% belonged to 1-3 yrs age group, 8.6% were 3-5 yrs old and 2.6% were in the 5-7 yrs age group. The male:female ratio was 1.2:1. Nearly half (53.3%) were well nourished, 36.6% had Grades I-II PEM and 9.9% had Grades III-IV PEM. About half (47%) showed no complications; 53% had some complications of which 15% had more than one system involvement. Respiratory complications were seen in 50%, nutritional deterioration in 17.3%, gastrointestinal and neurological in 14.6% each and cardiac in 1.3%. The respiratory complications included pneumonia (16%), bronchitis (12.6%), activation of TB (10.66%), otitis (7.3%) and miliary tuberculosis (4%). CNS complications were encephalitis in 8%, meningitis in 3.3%, convulsions -2.6% and limb paresis in 0.6%. Children below 1 yr had a greater incidence of complications and multisystem involvement. Children between 3-5 yrs had respiratory and GI system involvement and children greater than 5 yrs showed respiratory system involvement only. No complications were seen in the well nourished group while early grades of PEM had mild complications. Severe degree of malnutrition had higher incidence and severity of complications. The need for large coverage of measles vaccine in our country especially amongst the malnourished group is obvious.

Epidemiology of streptococcal infection with reference to rheumatic fever.

Antistreptolysin antibodies were estimated in 787 normal children and young adults by latex test. This test detects titres of 200 IU/ml and above, which is the western cut off point, for diagnosis. Children below one year showed no antibodies. Unlike western studies where no antibodies are detected below the age of 3 years, our study revealed that 7.9% children between 1-3 years had significantly elevated antibodies. This epidemiological pattern is well reflected in the different clinical profile of younger children developing rheumatic heart disease in our country. Antibodies progressively increased with age--11.8% in 4-8 years group to 15.8% in 9-12 years age group. All these were from the lower socio-economic group. ASO was positive in 16.7% of young adults from lower socio-economic status while it was positive only in 9.2% in the upper socio-economic status. A total of 522 patients of rheumatic carditis were studied. Only 23.4% had no antibodies or less than 200 IU/ml, and 77% were positive (26.9% had greater than 400 IU/ml and 49.7% had 200 IU/ml). Throat swab culture and ASO antibodies were done simultaneously in 76 outdoor patients, clinically diagnosed as acute bacterial pharyngitis. Group A beta hemolytic streptococci were isolated in 64% and significant antistreptolysin antibodies were seen in 62%. School health records were scanned in more than 50,000 school children. Point prevalence of rheumatic heart disease was estimated to be 0.17% in lower and 0.05% in upper socio-economic groups. Age and socio-economic factors are important variables in epidemiology of streptococcal infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of cryptosporidium in children with acute diarrhea.

Cryptosporidium is an intestinal protozoa known to cause diarrhea in animals and more recently has been recognised as a cause of diarrhea in humans. The present study was designed to determine the prevalence of cryptosporidium as a cause of diarrhea in children. Faecal samples of 180 children admitted to the hospital for acute gastroenteritis and from 100 normal children were analysed. Eight out of 180 (4.4%) stools from children with acute diarrhea and none from normal showed cryptosporidi. We conclude that this parasite does play a role in the etiology of human diarrhea.