Intestinal parasitic infections among human immunodeficiency virus-infected and -uninfected children hospitalized with diarrhea in Bangkok, Thailand.

A prospective observational study was conducted to determine the prevalence and the clinical impact of intestinal parasitic infections in diarrheal illness among HIV-infected and HIV-uninfected children hospitalized with diarrhea in Bangkok, Thailand. Stool samples were examined for intestinal parasites using a simple smear method, a formalin-ether concentration method, a modified acid-fast stain and a modified trichrome stain. Intestinal parasites (IP) were identified in the stool specimens of 27 of 82 (33%) HIV-infected and 12 of 80 (15%) HIV-uninfected children (p=0.01). Microsporidia and Cryptosporidium were the most common IP found. Eighty-two percent of HIV-infected and 97% of HIV-uninfected groups presented with acute diarrhea and 76% of each group had watery diarrhea. Pneumonia was the most common concurrent illness, found in 22%. Clinical findings were unable to differentiate children infected with IP. Sixty-three percent of HIV-infected and 83% of HIV-uninfected children who had IP made a satisfactory recovery without specific anti-parasitic therapy. However, 9 children (7 HIV-infected and 2 HIV-uninfected) with persistent diarrhea who also had cryptosporidiosis and/or microsporidiosis did not respond to azithromycin and/or albendazole respectively. HIV-infected children with cryptosporidiosis were older and had more advanced HIV infection than those with microsporidiosis. Routine stool examination for IP should be considered due to the absence of clinical markers. The lack of effective therapy for the major IP found underscores the importance of preventive measures.

Penicilliosis-associated hemophagocytic syndrome in a human immunodeficiency virus-infected child: the first case report in children.

Infection-associated hemophagocytic syndrome (IAHS) has been found in many systemic infectious conditions with a high mortality rate. Disseminated Penicillium marneffei infection is a common opportunistic condition among HIV-infected patients in many regions in Southeast Asia. We report the first case of IAHS caused by penicilliosis in an HIV-infected child who presented with cytopenias and recovered promptly after antifungal and intravenous immunoglobulin therapy.

Nosocomial bloodstream infection in pediatric patients: Siriraj Hospital, Bangkok; 1996-1999.

A retrospective study on nosocomial bloodstream infection (NBSI) in pediatric patients hospitalized at Siriraj Hospital from January 1996 to December 1999 was performed. Of the 18,087 blood specimens sent for culture, 533 (3%) were positive for organisms after 72 hours of hospitalization and were defined as NBSI. The rate of NBSI detected in blood culture specimens was highest among neonates (5.2%). Gram-positive cocci and gram-negative rods caused NBSI in an equal proportion (46% and 44% respectively) and Candida caused 10 per cent of NBSI. Coagulase-negative staphylococci was the most common pathogen followed by K. pneumoniae and Enterobacter. Antibiogram showed that 15 of the 35 (43%) S. aureus identified were methicillin-resistant. Only 35-38 per cent of Enterobacteriaceae were sensitive to cefotaxime or ceftazidime. Cefoxitin was still effective against 95 per cent of K. pneumoniae. Compared with other third generation cephalosporins, combination of cefoperazone and betalactamase-inhibitor (sulbactam) possessed an increased in vitro efficacy against K. pneumoniae, Enterobacter, E. coli, Acinetobacter and non-fermentative gram-negative rods. Resistant rate of amikacin among all gram negative rods was 25-69 per cent. Ciprofloxacin sensitivity varied from 62-100 per cent among all gram-negative rods. Imipenem was excellent against all gram-negative rods with the sensitivity of 80-100 per cent. Epidemiological data of this study is important for the decision of the appropriate empirical antimicrobial treatment in our hospital.

Perinatal asphyxia: multivariate analysis of risk factors.

Perinatal asphyxia contributes greatly to neonatal mortality and morbidity. In developing countries, the need for risk assessment in perinatal asphyxia is obvious because of the high birth rate and limited perinatal resources. OBJECTIVE: To determine the incidence and risk factors of perinatal asphyxia in infants who were delivered from mothers with high-risk conditions. STUDY DESIGN: A prospective study over a 5-year period from 1993 to 1997 was performed at a tertiary level, referral hospital. PATIENTS AND METHOD: Nine hundred and sixty-one infants who were delivered from 878 high-risk mothers were recruited. All of the risk factors that might have contributed to asphyxia were identified and recorded. Univariate and stepwise multiple logistic regression analysis was performed to identify significant factors that might have contributed to asphyxia, the odds ratios and 95 per cent confidence interval were computed. RESULTS: Abnormal fetal heart rate pattern, thick meconium stained amniotic fluid, and premature delivery, were three common risk factors for asphyxia. The mean gestational age was 37.6 +/- 3.5 weeks, 10.5 per cent (101/961) were infants less than 33 weeks. The incidence of asphyxia was 9.7 per cent and was highest (26.7%) in infants less than 1000 g. By univariate analysis, significant relationships between perinatal factors and asphyxia were found among birth weight, gestational age, premature and breech delivery but stepwise multiple logistic regression analysis revealed that only birth weight was significantly associated with perinatal asphyxia. CONCLUSION: In countries where resources are limited, a neonatal resuscitation team should be available for very low birth weight infants, premature and breech delivery.

Evaluation of susceptibility status of invasive pneumococcal isolates to various antibiotics and risk factors associated with invasive penicillin-nonsusceptible pneumococcal infection: Bangkok 1997-1998.

The antibiotic susceptibility pattern of Streptococcus pneumoniae isolated from specimens of invasive infections was examined at Siriraj Hospital, a tertiary care center in Bangkok, during December 1996 April 1998. The percentage of S. pneumoniae isolates intermediate and resistant to various antibiotics were: penicillin, 25% and 21%; amoxicillin-clavulanate, 24% and 0%; cefuroxime, 6% and 36%; cefotaxime, 6% and 1.4%; ceftibuten, 5% and 42%; imipenem 22% and 0%; co-trimoxazole, 6% and 41%; chloramphenicol, 2% and 26%; erythromycin, 12% and 16%; azithromycin, 0% and 30%; and roxithromycin 0% and 33%. Most of the penicillin-nonsusceptible S. pneumoniae (PNSP) were also nonsusceptible to other antibiotics except cefotaxime, and imipenem. The isolates from respiratory specimens have a higher rate of resistance to all antimicrobial agents with a significant rise in MIC50 of beta-lactam antibiotics. There was no difference in the outcome of infections caused by penicillin-susceptible and -nonsuscetible S. pneumoniae. The only identifiable risk factor associated with PNSP infection was prior use of antibiotic within 3 weeks.

A randomized clinical trial comparing the efficacy of ranitidine and famotidine on intragastric acidity in critically ill pediatric patients.

We examined the efficacy of intravenous ranitidine and famotidine on raising intragastric pH in each of 10 critically ill pediatric patients. The severity of illness was assessed by using the modified zinner index score. The study had 3 phases and each phase took 24 hours. Intragastric pH was measured by continuous pH monitoring digitrapper for 72 hours. In phase 1 and 3, the patients did not receive any H2 blockers. In phase 2, they were randomized to receive intravenous ranitidine or famotidine. The majority of cases had intragastric pH < 4 in day 1 (base line). Ranitidine and famotidine increased total time of intragastric pH > or = 4 from the base line during day 2, 38.2 +/- 16.9 per cent and 60.3 +/- 24.8 per cent respectively (P0.004), but there was no statistical difference between the 2 medications in both Zinner index score 1 and score greater than 1 group (P 0.08, 0.45). Three cases in the famotidine group had successful prophylaxis with total time pH > or = 4 more than 80 per cent. Famotidine appeared to have a trend toward increasing intragastric pH in critically ill pediatric patients.

Use of serum gamma glutamyl transpeptidase to differentiate between extrahepatic biliary atresia and neonatal hepatitis.

The differentiation between extrahepatic biliary atresia (EHBA) and neonatal hepatitis (NH) was studied in 53 Thai infants (39 males, 14 females) with obstructive cholangiopathy at the Department of Pediatrics, Siriraj hospital. Prevalence of EHBA was 25 per cent (13 of 15) overall. A higher prevalence of EHBA was found in females (8 of 13) while a higher prevalence of NH occurred in males (34 of 40). No difference was demonstrated in serum conjugated and total bilirubin, SGOT or alkaline phosphatase between EHBA and NH groups. The EHBA group had a significantly higher mean serum GGTP (184 +/- 77 IU/L) than the NH group (58 +/- 40 IU/L). The diagnostic usefulness of GGTP was confirmed, but variation in laboratory measurements could limit its generalizability.

Height and weight of Thai children: high socioeconomic group of the some selected urban population.

A total of 4,371 high socioeconomic children, 2,220 boys and 2,151 girls, from Bangkok Metropolis, from 1985 to 1986 was studied. The height and weight were computed according to sex and age, height and weight for age, and weight for height were calculated in different percentiles (P5, P25, P50, P75 and P95). It was found that height and weight for age of a selected population of children are generally higher, they are taller and heavier than the children of previous studies. At 18 years of age, the average boy is 171 cm and 58 kg, while the average girls is 157.5 cm and 47 kg. The growth rate of Thai adults should be better with socioeconomic improvement in the standards of living in the future. Weight for height is not different from the previous studies, this is a more reliable and better parameter to evaluate the growth of children.

Disappearance of measles antibody in Thai infants after birth.

A seroepidemiology of measles hemagglutination inhibition antibody was studied in infants at birth to 8 months of age. It was found that at birth the antibody was greater than 1:8 in 56 of 64 newborns. At 2 and 4 months of age, 9 of 21 and 12 of 21 respectively had measles antibody titer less than 1:8, while at 8 months of age, only 1 of 6 had the antibody titer greater than 1:8. It shows that the maternal measles antibody can protect the infant at young age and the decrease in antibodies occur as the child grows. The measles vaccine should be given when the maternal passive immunity of measles disappears. This study indicates that the optimal age to recommend measles vaccination should be at the age of 9 months.

Cerebrospinal fluid lactate level in childhood purulent meningitis.

Cerebrospinal fluid lactate was determined in 54 pediatric patients by means of enzymatic method of Marbach and Weil. The mean value of cerebrospinal fluid lactate in 13 purulent meningitis patients was 80.4 mg/dl, in 9 clinical purulent meningitis patients was 72.7 mg/dl, in 18 non-purulent meningitis patients and 14 controls were 17.0 and 11.8 mg/dl respectively. The present study demonstrated that a cerebrospinal fluid lactate level of 35 mg/dl may be used as a cut off point to differentiate bacterial from non-bacterial infection of the central nervous system. It should served as a supplementary aid to clinical examinations and conventional methods to diagnose bacterial meningitis.