Measles associated diarrhea and pneumonia in south India.

A prospective study was undertaken from April 1988 to April 1989, to assess the diarrheal and respiratory complications of measles. Standard definitions were used for the cases, Measles Associated Diarrhea (MAD) and Measles Related Pneumonia (MRP). Children with diarrhea not related to measles were recruited for comparison for MAD. There was a total of 454 cases, measles 53 (11.7%), measles associated diarrhea (MAD) 113 (24.9%), measles related pneumonia (MRP) 186 (41.0%) and MAD with MRP 102 (22.5%). Children under 10 months and 24 months were 11% and 51.5%, respectively. Altogether 215/401 (53.6%) and 288/401 (71.8%) had diarrhea and pneumonia. Children who had been measles vaccinated were 8.4%. The overall case fatality was 4.2%. Case fatality in pneumonia was 1.1%. There was no statistically significant difference between the MAD and diarrhea in relation to religion, water supply, the method of excreta disposal, nutritional status and immunization status other than measles vaccination. There was significant difference in the nature of stools between the two groups, the stools of MAD were more of dysenteric in nature (p < 0.005). Vitamin A deficiency as evidenced by eye signs, was significantly more in MAD than in diarrhea (p < 0.001). It is recommended that Vitamin-A be given to all children with measles, complication due to diarrhea be promptly and adequately treated and to consider measles vaccination earlier than 9 months.

Bacterial meningitis: diagnosis by latex agglutination test and clinical features.

To know the usefulness of Latex Agglutination Test (LAT) for the diagnosis of bacterial meningitis (BM), it was performed in all the 114 consecutive samples of CSF with polymorphs from 114 prospectively recruited children aged 2 months to 11 years. Definite diagnosis of BM based on culture and/or LAT was evident in 55. Among the 46 LAT positive, culture was positive in 3 only. Major organisms identified by LAT were H. influenzae B (HiB) in 28 and S. pneumoniae (SP) in 15. Ninety per cent of HiB and 67% of SP bacterial meningitis were under one year of age. Fever > 7 days prior to admission was not uncommon (38%) and 26% had received prior antibiotics. Meningeal signs were present in 64%. CSF cells were < 500/mm3 in 24% and sugar was > 50% of blood level in 23%. There was no significant difference in the immediate outcome between HiB and SP meningitis. The case fatality was 22% and was significantly high in cases who had altered level of consciousness on admission (p = 0.02). It is concluded that LAT is very useful for rapid diagnosis of BM.

Intramuscular injection as a provoking factor for paralysis in acute poliomyelitis. A case control study.

In order to identify the role of intramuscular injection (IM) as a provoking factor for poliomyelitis, a case control study as done at the Institute of Child Health, Madras from May 1988 to May 1989. The case was defined as acute poliomyelitis if he had acute asymmetric flaccid paralysis of lower motor neurone type without objective sensory disturbance following a short episode of fever. Controls were taken from children attending outpatient department for fever. Two controls matched for aged and sex were recruited for each case. Recruitment, data collection and clinical examination were done by a single pediatrician. IM injection received within 30 days prior to onset of paralysis or illness was considered to be the risk factor. The total number of cases and controls recruited were 257 and 515, respectively. Among cases, 172 (66.9%) out of 257 and among controls 252 (48.9%) out of 515, received IM injection within one month earlier to onset of paralysis or illness. The overall risk of paralysis, estimated for IM injection, was increased [odds ratio (OR) 2.1 (95% CI, 1.5-3.0)]. The maximum risk for paralysis was observed to be 2 weeks preceding the illness; the ORs for < 7 days was 2.2 (95% CI, 1.6-3.2) and for 7-13 days 3.2 (95% CI, 1.8 to 5.8). The risk of paralysis associated with IM injection was similar for unimmunized and immunized cases (OR 2.4 and 2.2). Multiple injections were not associated with a higher risk of developing paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)