Mycoplasma pneumonia in young children, 2-5 years of age.

BACKGROUND: Mycoplasma pneumoniae is one of the most common causes of childhood community-acquired pneumonia (CAP), particularly in school-age children. Information regarding this infection in pre-school age children is lacking. OBJECTIVE: To determine the prevalence of M. pneumoniae in young children aged under 5 years with CAP. MATERIAL AND METHOD: This prospective study was conducted at Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand between December 2001 and November 2002. We enrolled children aged 2 to 5 years with a clinical and radiological diagnosis of CAP. Acute and convalescent sera were collected and measured by using a particle agglutination test. Polymerase chain reaction (PCR) assay for M. pneumoniae was detected from nasopharyngeal secretions. Criteria for diagnosis were defined as > or = 4-found rising of mycoplasma antibody or titer > or = 1:160 with positive PCR. RESULTS: Thirteen out of 113 CAP patients were diagnosed as mycoplasma pneumonia. Three of them were diagnosed by > or = 4-fold rising of mycoplasma antibody while another 10 patients were diagnosed by mycoplasma titer > or = 1:160 with positive PCR for M. pneumoniae. Clinical symptoms and signs of these 13 mycoplasma pneumonia in young patients were fever (85%), cough (92%), dyspnea (85%), diarrhea (15%), rales (85%), wheezing or rhonchi (46%), and skin rash (15%). Leucocytosis (wbc > 15,000/cumm) was found in 46%. Chest x-rays revealed interstitial infiltration (71%), patchy infiltration (29%) and no pleural effusion was detected. Choices of antibiotic were erythromycin (31%), beta lactam antibiotics (61%), and antibiotic was not prescribed in one patient (8%). Sixty-nine percent of the patients improved, while 31% did not, possibly due to the use of beta lactam antibiotics, or non use of antibiotics. CONCLUSION: Mycopalsma pneumonia is not uncommon in children aged 2-5 years with CAP. Clinical signs, symptoms and radiological findings are non-specific and cannot be differentiated from other causes of CAP.

Prevalence and clinical features of mycoplasma pneumoniae in Thai children.

OBJECTIVE: To determine the prevalence and clinical features of mycoplasma pneumoniae in Thai children with community acquired pneumonia (CAP). MATERIAL AND METHOD: Diagnosis of current infection was based on > or = 4 fold rise in antibody sera or persistently high antibody titers together with the presence of mycoplasma DNA in respiratory secretion. The clinical features were compared between children who tested positive for M pneumoniae, and those whose results were negative. RESULTS: Current infection due to M. pneumoniae was diagnosed in 36 (15%) of 245 children with paired sera. The sensitivity and specificity of polymerase chain reaction (PCR) in diagnosing current infection in the present study were 78% and 98% respectively. The mean age of children with mycoplasma pneumoniae was higher than CAP with unspecified etiology. The presenting manifestations and initial laboratory finding were insufficient to predict mycoplasma pneumoniae precisely, the presence of chest pain and lobar consolidation on chest X-ray, however, were significant findings in children with mycoplasma pneumoniae. CONCLUSION: The present study confirms that M. pneumoniae plays a significant role in CAP in children of all ages. Children with this infection should be identified in order to administer the appropriate antibiotic treatment.

Factors effecting the outcome of acute respiratory distress syndrome in pediatric patients treated with high frequency oscillatory ventilation.

OBJECTIVES: To evaluate the survival rate and factors affecting the outcome of pediatric patients treated with high-frequency oscillatory ventilation (HFOV) for diffuse alveolar disease (DAD) compatible with acute respiratory distress syndrome (ARDS). METHOD: A cohort study was conducted at the pediatric intensive care unit of Queen Siritkit National Institute of Child Health from 1st January 1999 to 31st December 2001. Children who suffered from DAD compatible with ARDS were enrolled. Inclusion criteria were PaO2/FiO2 < 200 and oxygenation index (OI) > 10. High-frequency oscillatory ventilator (3100A Sensor Medics Corp, Yorba Linda, Calif) was used applying high volume strategy of treatment. Patients were weaned to conventional ventilation (CV) once clinical improvement occurred. Demographic data, duration of CV mode before changing to HFOV, duration of HFOV, ventilator parameters and gas exchange variables from beginning and during the course of HFOV were recorded, so patient data could be compared between surviving and non-surviving groups. RESULTS: A total of 21 children were enrolled during the 3 year period. There were 4 patients with simultaneous air leak syndrome and a total of 10 male patients. The average age was 3.58 +/- 3.9 years. There were 11 surviving patients (52.4%). Data of ventilator parameters and gas exchange variables after changing to HFOV for 4-6 hours for the two groups, FiO2 was higher (0.99 +/- 0.32 vs 0.84 +/- 0.18; p = 0.02) and alveolar arterial oxygen gradient [P(A-a)O2] was lower (448.5 +/- 140.8 vs 562.7 +/- 99.9 mmHg; p = 0.047) in the surviving group than in the non-surviving group. Concerning mean airway pressure (Paw), oxygenation index (OI), P(A-a)O2 and PaO2/FiO2 at initiation and during the course of HFOV with comparison of the surviving and non-surviving groups: Paw and OI decreased in the surviving group and was significantly different at 36 and 24 hours respectively. P(A-a)O2 was statistically significantly lower at 6 hours after HFOV initiation in the surviving group. PaO2/FiO2 was statistically significantly increased at 24 hours in the surviving group. CONCLUSION: Implement of HFOV is useful in patients with DAD, ARDS and air leak syndrome from the initial phase of illness which fulfill criteria for decreasing ventilator induced lung injury and thus decrease the mortality rate from ARDS. Predisposing survival factor showing statistically significant differences was lower Paw during CV before changing to HFOV, lower Paw at 36 hours, lower OI at 24 hours, lower P(A-a)O2 at 6 hours and higher PaO2/FiO2 at 24 hours. These parameters are good indicators for the prognosis of ARDS for patients responding or not responding to HFOV.

Medication errors at Queen Sirikit National Institute of Child Health.

BACKGROUND: In the past two years, medication errors have been recognized as having been unacceptably high among hospitalized patients. OBJECTIVE: To determine the incidence and type of medication errors, severity of events, patient outcomes and categories of drugs involved in the largest pediatric hospital in Thailand over a fifteen-month-period. PATIENTS AND METHOD: Retrospective review of in-patient medication errors documented in standard reporting forms from September 2001 to November 2002. Main outcome measure was the incidence of errors reported. RESULTS: Medication errors occurred in 1 per cent of admissions (322 errors of 32,105 admissions). The most common error type was prescription error (35.40%). The majority of errors were detected and prevented before the drugs were administered (76.71%). There was only one case of permanent brain damage; no deaths occurred in the study period. The most common group of drugs involved in medication errors was antibiotics and the most common route of administration was oral. CONCLUSION: Medication errors are not uncommon. There is a need to change the behaviors of recognizing and acknowledging clinical errors, including drug errors. Careful review of errors highlights the many opportunities to change how drug errors are addressed and to make them less likely.