Atypical pompholyx presentation of secondary Staphyloccoccus and Klebsiella infections in a patient with premorbid Ebstein anomaly: A case report

Rationale: Pompholyx refers to pruritic vesicles or bullous rash that mainly distribute on the palms and lateral surfaces of the fingers. It is less common among Asians, and in a severe condition, secondary bacterial infection of pompholyx can happen and result in pain, swelling and pustules. Patient concerns: A 15-year-old girl complained of progressive wound and small bumps containing yellowish pus and crusts on her hands and feet for over 6 months and worsened in the last month before admission. She also had Ebstein anomaly. Diagnosis: Atypical pompholyx with secondary Staphylococcus and Klebsiella infections. Interventions: Wound care with wet dressing and applying moisturizer on crusts, application of antibiotics for Gram positive and negative bacteria and giving nutritional support with reckoning of proper calories. Outcomes: Skin lesions were completely healed and the patient was discharged after 10 days of hospitalization. Lessons: Atypical manifestation of pompholyx makes it hard to diagnose. The diagnosis can be confirmed with meticulous history-taking and physical examination. Wound caring and controlling of the infection should be done to earn an optimal outcome.

Case report: Diazepam in severe tetanus treatment.

The causes of death in tetanus are muscle spasms and spasm of the larynx, which are caused by blocking the release of inhibitory neurotransmitters in the spinal synapses, causing the uncontrolled spread of impulses. Diazepam controls the spasms by blocking the polysynaptic reflexes, working peripherally, without depressing the cortical center and has no cardiovascular or endocrine effects. High dose diazepam had been used and proved to be a good muscle relaxant. Diazepam seems to work better with tetanus than pancuronium bromide, but both drugs need mechanical ventilation. In cases where the dose exceeds 240 mg per day in a child, a ventilator should be on hand, and if the dose required is more than 480 mg per day, other drugs should be considered. In three cases of severe tetanus presented here, the first two were managed by diazepam and pancuronium bromide and the last case by high dose diazepam only. In the first case, the dose of diazepam was up to 480 mg/day. By using high dose diazepam in severe tetanus, management of the clinical manifestations of autonomic nerve involvement and the weaning process become easier. Most complications of severe tetanus became more manageable.

Progress and challenges toward poliomyelitis eradication in Indonesia.

Poliomyelitis is one of few diseases that can be eradicated. The virus cannot survive outside the body and effective vaccine is available to protect children and stop transmission. Today, there are 3 million children each year saved by the oral polio vaccine (OPV) and globally the reported cases have declined from 50,000 to 7,000 in 1999. At present, 20 countries may remain at risk of continued transmission, mostly in Africa and Asia. In the region of SEARO, wild poliovirus is still transmitted in India, Nepal and Bangladesh. Efforts to eradicate polio had been made in Indonesia, through a four-pronged strategy; routine immunization, National Surveillance Days (NIDs), surveillance of Acute Onset of Flaccid Paralysis (AFP) cases, and supplementary immunizations. No polio cases have been detected in Indonesia since 1995, but some problem will remain until the whole SEARO region is certified polio-free. Filling the immunization gap and revitalizing the AFP surveillance program are among the highest priority activities.