preliminary study on the prevalence of parasitic Infections in immunocompromised children

Parasitic infections might become life threatening in immuno-compromised children' The study assessed the parasites' prevalence in different groups of Immuno-compromised children. It was conducted on 120 children of whom 90 were inpatients in Tanta University Pediatric Hospital and were divided into 6 groups. GI: malignant diseases, GII: renal diseases, GIII: aggressive corticosteroid therapy, GIV: malnourished, GV: diabetic and GVI: miscellaneous. GVII comprised healthy children as control. Each child was subjected to history taking, clinical examination and examination of 3 stool samples by direct wet smear and a concentration technique. Coproculture and smear staining by a special stain, as well as examination of one blood sample for anti-Toxoplasma antibodies were done. The diagnostic efficacy of an immuno-chromatographic test for Giardial Cryptosporidiurn coproantigen was also assessed. The results revealed parasitic infections in 62.2% of the children in the test groups. Cryptosporidium was the most prevalent [33.3%]. Cryptosporidium and Microsporidia were significantly prevalent in GI, Giardia was significantly high in GII, and Strongyloides stercoralis was detected in GIII. Coproantigen detection test showed 100% sensitivity, 87.5% specificity and 95% accuracy for Giardia; and 13.3%, l00%, 35% for Cryptosporidium respectively

Assessment of left ventricular cardiac function using doppler tissue imaging and serum cardiac troponin I in Egyptian children with rheumatic carditis

With the progress of Doppler echocardiography, many new findings have been accumulated concerning changes in valvular morphology and hemodynamics of rheumatic mitral valve disease. This study aimed to evaluate the ventricular function in children with rheumatic carditis, particularly in cases of silent carditis. The present study was carried out on thirty children suffering from rheumatic fever. Their ages ranged from 5-15 years [8.96 +/- 2.49]. They were 19 males and 11 females. They were selected from children who were admitted into Pediatric department and who were attending the Pediatric Cardiology Outpatient clinic of Tanta University Hospital during the period from September 1, 2000 to March 1, 2002. These children were classified into 2 groups based on the presence or absence of clinically heard organic murmurs. Group I included 20 children with clinical signs of carditis, evidenced by presence of organic murmurs, congestive heart failure, or pericarditis with or without other manifestations of rheumatic fever. Group II included 10 children with rheumatic fever but with no clinical signs of cardiac involvement [they were proved to have valvular lesions after examination by echocardiography, i.e., silent carditis. All children included in the present study were subjected to: 1] thorough histoiy taking and complete clinical examination with emphasis on cardiovascular system evaluation, 2] chest and heart X-ray, 3] routine laboratory investigations: ESR, ASOT, CRP, complete blood count, blood urea and serum creatinine, 4] determination of serum cardiac troponin-l [cTi] by sandwich immunoassay immediately at the time of diagnosis, 5] routine echo-Doppler evaluation, 6] Doppler tissue imaging [DTI] to evaluate ventricular diastolic function and compare it with transmitral flow pattern by conventional pulsed echo-Doppler. We concluded that children with rheumatic fever may present with carditis but with no clinically heard murmurs, i,e, silent carditis, and the use of echocardiography helps in detecting such cases. The use of DTI, a noninvasive technique, is considered as a great advance in evaluation of systolic and diastolic functions of the heart in children with rheumatic carditis to help planning for a perfect management of these children. It was also concluded that serum cTi, which is considered as a marker for myocardial cell injury significantly correlates with the degree of diastolic function [i.e., e/a ratio detected by DTI] of the left ventricle

Cardiac troponin-T as a diagnostic marker in children with rheumatic carditis

Rheumatic carditis is the most serious major manifestation of acute rheumatic fever in children. Cardiac Troponin-T [cTnT] is established as a new specific marker of myocardial damage or injury. The present work was carried out to study the value of cTnT as a diagnostic marker of myocardial injury in children with rheumatic carditis, and to compare it to established parameters of myocardial injury such as creatine kinase [CK] and its MB isoenzyme. Forty-five children with acute rheumatic fever were enrolled in the study; classified into 3 groups: group [A]: 15 children with rheumatic carditis without cardiomegaly, group [B]: 15 children with rheumatic carditis and cardiomegaly and group [C]: 15 children with other rheumatic presentations. Fifteen normal healthy children were enrolled as a control group. All children included in the study were subjected to diagnostic laboratory and radiological investigations, including serum total CK, CK-MB isoenzyme% [using electrophoresis] and cTnT [by immunoassay test]. Our results showed significant elevation of cTnT, total CK and CK-MB isoenzyme in children with rheumatic carditis [groups A and B], as compared to the control group [P < 0.05]. These values were significantly higher in group [B] children [with cardiomegaly], as compared to group [A] children [P<0.05]. Also, the ideal cut-off point for cTnT was found to be 0.1 micro g/L with a sensitivity 100%, while the sensitivity for CK-MB was 86.7% and that for total CK was 53.3%.we conclude that cardiac troponin-T [cTnT] can be used as a diagnostic marker of myocardial injury in children with rheumatic carditis, with a higher sensitivity than CK and its MB isoenzyme

Echo-Doppler study in children with rheumatic mitral stenosis [prediction of severity]

The diagnosis of mitral stenosis is well settled with the advantage of echocardiogram. However, assessment of the severity of the disease is still unimproved. The purpose of this study is to evaluate the specific role of echo-Doppler. ECG, and X-ray findings in predicting the severity of rheumatic mitral stenosis. Ten children with isolated rheumatic mitral stenosis, proved clinically and by investigations were studied with echo-Doppler. ECG, and X-ray. The mitral valve areas determined by planimetery correlated closely with Doppler derived areas. [r = 0.981]. Severe mitral stenosis was defined by a valve area <1 cm2. Two-dimensional echocardiographic analysis of the pliability, thickening and doming of anterior mitral leaflet was valuable in assessing the severity of mitral stenois. Absence of pericardial effusion and calcification of mitral valve was recorded in all our patients. Also, correlation between mitral valve areas and m-mode findings [left atrium/aortic ratio, end-diastolic dimensions, and shortening fraction] was good as the X-ray findings [heart volume]. In contrast ECG findings [width of P wave and R/S in V1] correlated poorly with the severity of mitral stenosis. Therefore, the most useful predictor of severity of mitral stenosis is echo-Doppler study and X-ray with ECG are considered as complementary methods