ABSTRACT
The authors describe a one-year-old girl with a fronto-ethmoidal encephalomeningocele who developed wound infection, purulent meningitis and septic shock 5 hours after operation. The patient was treated with intravenous ceftazidime and vancomycin empirically. The cerebrospinal fluid (CSF) and eye discharge grew Streptococcus pneumoniae (S. pneumoniae). The minimal inhibitory concentration (MIC) by E-test of penicillin and cefotaxime were 1.0 and 0.38 ug/ml respectively so the antibiotics were switched to cefotaxime 300 mg/kg/day. She recovered completely after appropriate treatment. Penicillin-non-susceptible S. pneumoniae should be considered as one of the causes of post-operative serious infection of the face and neck in the era of increasing prevalence of penicillin-resistant S. pneumoniae.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cefotaxime/therapeutic use , Chloramphenicol/therapeutic use , Drug Resistance, Bacterial , Female , Humans , Infant , Lincomycin/therapeutic use , Meningoencephalitis/diagnosis , Pneumonia, Staphylococcal/diagnosis , Postoperative Complications , Trimethoprim, Sulfamethoxazole Drug Combination , Vancomycin/therapeutic useABSTRACT
BACKGROUND: Multi-drug resistant HIV mutants have been reported after prolonged dual antiretroviral therapy. OBJECTIVE: To evaluate the prevalence and resistance pattern in HIV-infected children treated with dual NRTIs. MATERIAL AND METHOD: Records of HIV-infected children treated with dual NRTIs at Srinagarind Hospital, Khon Kaen University, Thailand, were reviewed for baseline data and their consensually-stored plasma were checked for the occurrence of HIV mutants by genotyping. RESULTS: Fifty-seven HIV-infected children were treated with dual NRTI regimens (27 males; 30 females). The median age and median CD4+ T-lymphocyte at genotypic testing were 83.5 months and 10.9%, respectively. The median duration of ARV therapy was 22 months. More than half the children (42) were on zidovudine and didanosine. A set of three or more nucleoside analog mutations (NAMs), conferring multi-dideoxynucleoside resistance, was found in 60% of the cases. CONCLUSION: High percentages of NAMs were found in HIV-infected children previously on dual ARV therapy for long periods. Genotypic testing was helpful in designing the second antiretroviral regimen.
Subject(s)
Anti-HIV Agents/pharmacology , Child , Drug Resistance, Multiple, Viral/genetics , Female , Genotype , HIV Infections/drug therapy , HIV Reverse Transcriptase/genetics , HIV-1/drug effects , Humans , Male , Mutation , Reverse Transcriptase Inhibitors/therapeutic use , ThailandABSTRACT
OBJECTIVE: To evaluate the efficacy and safety of CHQ in a combination treatment with ZDV/ddI in HIV-1-infected children. MATERIAL AND METHOD: Fifty five HIV-infected children were randomly enrolled into 3 treatment groups: (I) ZDV + ddI (n = 25); and (II) ZDV + ddI + CHQ (n = 21); and (III) ZDV + ddI experienced children were non-randomly added CHQ (n = 9). Weight, CD4+ T-lymphocytes and plasma HIV-RNA were measured at weeks 0, 8 and 24. RESULTS: Fifteen, 16 and 8 children from Groups I, II and III were evaluated. No significant improvement in the mean Z-score for weight in groups I and II, but a decrease occurred in group III after 6 months of therapy. In group I, II and III, the respective change in the mean CD4+ T-lymphocyte percentage was +6.7, +4.0 and -0.6. The decrease in the plasma HIV-RNA log was 0.9, 1.1 and 0.7, respectively. There was a trend for more nausea/vomiting in group II/III and more opportunistic infections in group III. CONCLUSION: 1. The addition of chloroquine in ZDV/ddI regimen provided no significant improvement in clinical, immunological and virological parameters. 2. Chloroquine induced immunosuppression and nausea complicated its use.
Subject(s)
Anti-HIV Agents/therapeutic use , Antimalarials/therapeutic use , Child , Child, Preschool , Chloroquine/therapeutic use , Didanosine/therapeutic use , Female , HIV Infections/drug therapy , HIV-1/drug effects , Humans , Male , Zidovudine/therapeutic useABSTRACT
Obscure fever is not an uncommon problem in Thailand. We studied 25 children with obscure fever admitted to Srinagarind (university) Hospital in Northeast Thailand. The etiology was identified in 52% of the cases: dengue (40%), leptospirosis (8%), and micrococcus septicemia (4%). Two cases with primary dengue infection developed dengue shock syndrome. The case with leptospirosis developed infection-associated, hemophagocytic syndrome. We found no cases of Japanese encephalitis, scrub typhus or murine typhus.
Subject(s)
Adolescent , Child , Child, Preschool , Fever of Unknown Origin/blood , Hospitals, University , Humans , Infant , ThailandABSTRACT
Kawasaki disease (KD) is a leading cause of acquired heart disease of childhood. The authors retrospectively reviewed cases of KD in major referral centers of central Northeast Thailand from July 1991 to June 2003. Seventy-three episodes occurring in 72 patients were diagnosed with KD by the American Heart Association criteria with a mean age of presentation of 27 +/- 19 months. The annual incidence was 2.2 per 100,000 children < 5 years of age. Coronary artery abnormalities (CAA) were found in 15 (20.5%) children. Nine patients (18%) who were diagnosed before 10 days were not treated with intravenous immunoglobulin (IVIG). Two (13%) of the 15 patients still had coronary lesions at the end of the follow-up period of 35.5 +/- 13.4 months. Index of suspicious should be maintained in children who had clinical signs of KD for early diagnosis and prompt treatment with IVIG.