Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh

Background: Acute meningoencephalitis is an important cause of morbidity and mortality around the globe. The objective of this study was to examine the distribution of acute meningoencephalitis and its aetiological agents among children admitted to a tertiary hospital in southern Bangladesh. Methods: This prospective study was carried out in Khulna Medical College Hospital from 2007 to 2009. All of the admitted children between 1 month and 12 years of age were enrolled over a 2-year period if they met the inclusion criteria of having an acute onset of fever (≤ 14 days) and any of the following 3 signs: neck stiffness, convulsion, or altered mental status. Cerebrospinal fluid (CSF) was collected within hours and sent to the laboratory for cytological and biochemical analyses. CSF was examined by Gram staining and a latex agglutination test to detect common bacteria. Serum and CSF were also tested for Japanese encephalitis virus antibodies. Results: A total of 140 children were included in the study, which accounted for 2.5% of admissions between 2007 and 2009. The number of acute meningoencephalitis cases was relatively higher (37.9%) during the monsoon season. The CSF report revealed a pyogenic form in 24 (18.5%) and a viral form in 13 (10.0%) cases. Altered mental status was significantly less frequent (P < 0.001) in cases of pyogenic meningoencephalitis (62.5%) than in cases of non-pyogenic meningoencephalitis (93.4%). Bacterial causes were identified in 11 (8.5%) children; the causative agents included Streptococcus pneumoniae (n = 8), Neisseria meningitides (n = 2), and Haemophilus influenzae (n = 1). Three (2.3%) patients were positive for Japanese encephalitis virus. Conclusion: S. pneumoniae was the most common bacteria causing acute meningoencephalitis among the study subjects, and Japanese encephalitis virus was present in few patients.

Outcome of Neonatal Hyperbilirubinemia in a Tertiary Care Hospital in Bangladesh

Background: Kernicterus occurs in infants around the world. This study examined the outcomes of various treatments for neonatal hyperbilirubinemia (NH) used in the Khulna Medical College Hospital in Bangladesh. Methods: All of the jaundiced newborns in the neonatal ward between 2005 and 2008 were included in the study. Total serum bilirubin and fractional levels were measured in all cases, regardless of the degree of jaundice. NH was classified as mild, moderate or severe depending on the bilirubin level; mild NH was treated with a sunbath, moderate NH was treated with phototherapy, and severe NH was treated with exchange transfusion. Results: Of 1981 neonates, 426 (22%) were diagnosed with NH. Physiological jaundice (26.7%) was most common, followed by the jaundice of prematurity (20.9%). Haemolytic jaundice was primarily caused by ABO incompatibility (11.3%) and Rh incompatibility (5.4%). Exchange transfusion (ET) was performed in 22 patients; four (18.2%) died as a result of hazards that could have been avoided with skilled monitoring. Twelve (2.8%) individuals with jaundice died. Kernicterus developed in nine (2.1%) children, four of whom survived with neurological sequelae. Conclusion: ABO incompatibility is twice as common as Rh incompatibility. The majority of kernicterus patients died in the acute phase.

Neonatal sepsis and use of antibiotic in tertiary care hospital

Neonatal infections currently cause 1.6 million deaths in developing countries. Resistance to commonly used drug is emerging as the most important problem globally. Therefore rational use of antibiotic is a priority to reduce the burden of treatment failure. To evaluate the magnitude of neonatal infections in the neonatal ward of a medical institution and pattern of antibiotic use in these cases. This was a cross sectional retrospective study. All the cases of neonatal infections admitted between October 2003 to September 2005 were included in the study. Relevant informations like age, sex, birth weight, investigations, diagnosis, antibiotic use and outcome were noted in the predesigned proforma. Infection within first week of birth was regarded as the early onset infections and infections thereafter were considered as late onset infections. Eleven hundred and ninety six cases got admitted in the neonatal ward during the 24 months of study period. Three hundred and thirty four neonates with sepsis constituted 27.8% of the total cases. Majority of these cases were early onset infections [70.7%]. Septicemia was the commonest [34.6%] major infections followed by pneumonia [19.5%]. The dominant minor infections were umbilical sepsis [10.5%] and pyoderma [6.9%]. The most frequently used antimicrobial agent was third generation cephalosporin [36.2%] and next in order was the combination of ampicillin and gentamycin [18.9%]. Regarding outcome 78.1% cases recovered well. Among the rest of the cases with unsatisfactory progress, 12.3% died in the hospital. Neonatal sepsis constituted nearly one third of the health problem in neonatal ward and majority of them are early onset infections. Septicemia is the most frequently encountered infections and costly third generation cephalosporin topped the list of antibiotic use