Brain Abscess in children

To find out the clinical presentation, radiological characteristics, various underlying predisposing conditions and causative organisms of brain abscess in children in our setup. Descriptive study. The Children's Hospital and the Institute of Child Health, Lahore, over two years from September 2001 to August 2003. All children [<16 years] presenting with brain abscess were included to study demographic, clinical and radiological features. In addition, attempts were made to find out underlying predisposing conditions and causative organisms. Twenty-five children with brain abscess were managed over 2 years. The mean age was 7.8 years [range 9 months to 16 years]. Male to female ratio was 2.1:1. Most patients [43%] presented with 4 weeks history of illness, with mean duration of illness at presentation of 29.3 days. Main presenting complaints were fever [72%], vomiting [48%], headache [44%] and convulsions [32%]. Five patients [20%] had papilledema at presentation, another 4 [16%] had paresis/paralysis and 3 [12%] had cranial nerve palsies. Majority [64%] had solitary abscess, located in parietal, temporal, frontal and occipital lobes in order of frequency. No underlying predisposing condition was identified in 8 [32%] cases; while 8 [32%] had cyanotic congenital heart disease, 5 [20%] patients had otic infection [mastoiditis], 2 [8%] were postoperative cases and one each developed brain abscess secondary to ventriculo-peritoneal [VP] shunt infection and pulmonary tuberculosis. Causative organisms were isolated in 40% cases, which included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcal species, Klebsiella, E.coli and Proteus. Awareness of predisposing factors, early recognition of clinical features and understanding of the prevalent microbial profile is imperative for better management of children with brain abscess

Respiratory infections

Acute gastroenteritis [29%] and respiratory infections [11%] were responsible for forty percent of children ward admissions and eighty percent of total ward deaths during 1980. Respiratory infections ranked equal to gastroenteritis in a poor locality survey both entities being responsible for causing 79% of the total illness in children in the community. Younger children developed serious lower respiratory infections more commonly than older children the winter peaks involving younger children and summer peaks affecting older children are recorded. Gram negative bacilli are frequently isolated [33%] from upper respiratory secretions in hospitalized children