Clinical Manifestations of Eosinophilic Meningitis Due to Infection with Angiostrongylus cantonensis in Children

Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

Cerebrospinal Fluid Shunt Infections in Children in Srinagarind Hospital

 The   most  widely  used  VP  shunt  for  the  treatment  of  hydrocephalus  is  Pudenz  shunt  but  the  cost  is  expensive.  The  Neurosurgery  Unit  of  Seinagarind  hospital  had  used  silastic  shunt  instead  of  Pudenz  shunt  for  many  years.  The  objectives  of  this  study  were  to  compare  infection  rates  between  pudnz  shunt  and  silastic  shunt,  to  study  the  demographic  and  clinical  data  and  to  identify  risk   factors  of   VP  shunt  infection.  Two  hundred  and  six  VP  shunt  procedures  performed  in  147  children  during  the  period  of  5  years  and  4  months  were  retrospectively  reviewed.  The  infection  rate  was  7.8%.  The  most  common  organisms  were  gram  negative  rods  (37.5%). The  most  common  sign  of  shunt  infection  was  fever.  The  majority  of  patients  were   infected  within  2  weeks  postoperatively  (87.5%).  No  statistically  significant  relationships  have  been  found  between  infection  rate  and  1)  age,  2)  type  of  shunt,3)  etiology  of  hydrocephalus,  4)  shunt   revision,  5)  ventriculostomy   prior  to  VP  shunt  insertion,  6)  antibiotic  prophylaxis  ,  and  7)  duration  of  operation.  Usage  of  silastic  shunt  and  Pudenz  shunt  resulted   in  similar  infection  rat  (8.6%  VS  0.0%).  Taking  into  the  account  the  infection  rate  only,  silastic  shunt  could  be  used  instead  of  Pudenz  shunt. 

Duchenne muscular dystrophy in northeastern Thai children: a retrospective study

Background: Duchenne muscular dystrophy (DMD) is the most common hereditary neuromuscular disease. No curative treatment for DMD is known. Prednisone therapy is the first medical treatment that alters the course of DMD. Several studies about the doses and administrations of prednisone or prednisolone had been reported. Objectives: To review clinical features, laboratory findings, and the result of treatment of DMD. Methods: DMD patients who came to Srinagarind Hospital, Thailand from January, 1995 to January, 2007 were retrospectively analyzed. Results: Sixty-two patients fulfilled the study criteria. All patients were male (100 %). Mean age at onset was 4.9 years. Family history was found in 10 families (16 %). The most common symptoms were weakness, standing difficulty, and gait abnormality (100, 97, and 93 % respectively). The most common clinical signs were calf hypertrophy, weakness, and Gower sign (100, 100, and 94 % respectively). Serum creatine kinase (CK) was raised in all of the patients with mean serum CK 13,026 IU/L. Fifty patients received prednisolone. Twelve received only supportive treatments. The overall outcomes of prednisolone treatment were better, same, and worse in 37, 51, and 12 % respectively. Mean age at wheel chair was 10.8 years. Three patients with associate diseases; adult respiratory distress syndrome (ARDS), Sturge Weber syndrome, and autism were presented. To the best of our knowledge, this is the first report about DMD concomitant with ARDS and DMD with Sturge-Weber syndrome. DMD with autism, a very rare occurrence, is presented. Conclusion: Clinical features, laboratory findings, and the outcomes of treatments of 62 DMD patients were presented. Prednisolone treatment had some beneficial effects and had significant side effects. Starting with a low dose, and then increasing to high dose in the no response patient is recommended.