Seroprevalence of hepatitis B, hepatitis C and HIV among multiply transfused thalassemic children treated at Tawam Hospital

The management of children with beta-thalassaemia major is based upon regular blood transfusions and prevention of iron overload. Blood transfusions, however, carry a definite risk of transmitting blood-borne viruses such as hepatitis B [HBV], hepatitis C [HCV] and human immunodeficiency virus [HIV]. This study was undertaken to determine the prevalence of HBV, HCV and HIV as well as the success rate of the immune response to HBV vaccine in 16 multiply-transfused children with beta-thalassemia major. None of our patients were hepatitis B surface antigen positive, and none were anti-HIV positive. Only 3 [18.75%] patients were anti-HCV positive. In spite of the administration of a full course of HBV vaccine to all patients, only 2 out of 16 patients responded. These patients, however, will require more booster doses of vaccine or a higher dose of vaccine

Cryptosporidium as a cause of diarrhoea

We herein describe 8 children [4 immunocompetent and 4 undergoing chemotherapy for acute lymphoblastic leukaemia] with severe diarrhoea and dehydration which was identified using modified Ziehl-Neelsen stain caused by Crytosporidium. The four immunocompetent children were treated with intravenous hydration only without specific antimicrobial therapy and they responded well. The other four immunocompromized children received intravenous hydration and antimicrobial chemotherapy. Two of them received paromomycin and responded well. One patient was started on paromomycin for 10 days, and although there was clinical improvement, his stool examination continued to be positive for Cryptosporidium. He then received azithromycin for 14 days to which he responded well and his stools became negative for Cryptosooridium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered as a causative organism in children, especially those who are immunocompromized, and who present with severe or prolonged nonbloody diarrhoea. The organism is not seen in a routine 'ova and parasite' examination and the lab should be notified of its possibility in the differential diagnosis for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompetent children with cryptosporidiosis will respond to intravenous hydration without specific antimicrobial therapy while immunocompromized children may benefit from paromomycin or azithromycin therapy. We wish to increase the awareness of this condition and its management in clinicians and microbiologists