Spinal gnathostomiasis resembling an intrinsic cord tumor/myelitis in a 4-year-old boy.

A 4-year-old boy presented with fever, myalgia followed by progressive quadriparesis and urinary retention. Spinal fluid from a lumbar puncture showed 42 WBC/microl with 100% lymphocytes, no RBC, a glucose of 54 mg/dl (blood glucose 107 mg/dl), and a protein of 39 mg/dl. The cerebrospinal fluid culture was negative. His white blood cell count was 10,860 cells/microl with a normal differential count. An MRI of the brain was negative. An MRI of the whole spine showed fusiform dilatation of the cervical cord from the cervicomedullary junction to the T4 level. The tentative diagnosis was acute hemorrhage of an intrinsic cord tumor versus acute myelitis. Intravenous dexamethasone was administered which resulted in a slight improvement in strength. One week later, he deteriorated precipitously and became flaccidly quadriplegic. Since the patient deteriorated rapidly and no definitive diagnosis was made, the patient underwent cervical cord biopsy. Intraoperatively, after the cervical cord had been opened, a living Gnathostoma spinigerum was found in the spinal cord parenchyma. The nematode was removed. Following the operation the patient was placed on albendazole 400 mg/d and metronidazole 250 mg three times per day for 3 weeks. He gradually improved over the next several weeks.

Dual infection: dengue hemorrhagic fever with unusual manifestations and mycoplasma pneumonia in a child.

We report a case of pneumonia caused by Mycoplasma pneumoniae in an 8-year-old Thai girl. She had a dual infection with dengue hemorrhagic fever with unusual manifestations; liver failure. The diagnoses were based on relevant clinical findings and laboratory confirmations of both infections.

Rectal prolapse associated with cytomegalovirus pseudomembranous colitis in a child infected by human immunodeficiency virus.

We report a newly recognized presentation of cytomegalovirus (CMV) enterocolitis in a 4-year-old girl with newly diagnosed HIV disease who presented with rectal prolapse. Gross findings showed multiple whitish punctate lesions. An endoscopic examination revealed multiple shallow ulcers and pseudomembranes along the colon. A biopsy from colonic tissues demonstrated CMV-like inclusion bodies. A direct immunofluorescence assay using specific CMV monoclonal antibody was positive for CMV-infected cells in specimens from the rectal smear.

Seroprevalence of cytomegalovirus infection in children born to HIV-1 infected women.

Cytomegalovirus (CMV) is a frequent opportunistic infectious agent in children infected with human immunodeficiency virus type 1 (HIV-1). It has been implicated as a factor in the progression of HIV-1 disease. The aim of the present study was to evaluate the prevalence of CMV infection in Thai children born to HIV-1 infected women. The prevalence of CMV infection was 13, 89 and 84% in HIV-infected children and 9, 61 and 75% in HIV uninfected at age ranges of 0-12, 13-36 and 37-79 months, respectively. The prevalence of CMV infection was significantly different between HIV infected children (89%) and HIV uninfected (61%) at the age of 13-36 months (p < 0.05). The presence of CMV IgM in some children of age < 1 year suggested that CMV infection could occur early in life. Early co-infection may be important as they remain a risk factor for reactivation of latent CMV infection throughout the course of the HIV diseases. Clinical monitoring and appropriate work up may be of benefit in the early diagnosis and treatment of CMV disease.