Episodio Hipotonía-Hiporreactividad posterior a la inmunización con vacuna combinada con pertussis de células enteras. Reporte de un caso / Hypotonic-Hyporesponsive Episode after immunization with whole-cell pertussis combination vaccine. Clinical Case Report

Resumen Introducción: El Episodio Hipotonía-Hiporreactividad (EHH) es un efecto adverso tras la vacuna ción, asociado principalmente a vacunas anti-pertussis de células enteras. Se caracteriza por un inicio súbito de flacidez muscular, reducida respuesta a estímulos y palidez cutánea o cianosis. Aunque el EHH es infrecuente, está considerado como un efecto adverso severo. Objetivo: Reportar un caso de EHH posterior a la administración de la vacuna combinada pentavalente con: difteria, tétanos, pertussis celular, hepatitis B y Haemophilus influenzae tipo b (DTwP-HB-Hib), que está incluida en el Programa Nacional de Inmunizaciones (PNI) de Chile, con la finalidad de difundir esta infrecuente complicación de evolución benigna, auto-limitada y de carácter no recurrente. Caso clínico: Lactante de 6 meses de edad, 3 h post-vacunación con la tercera dosis de vacuna DTwP-HB-Hib, presentó compromiso del estado de conciencia interpretado como convulsión atónica y que finalmente se consideró como EHH. El lactante evolucionó favorablemente después de 2 h y fue dado de alta tras 24 h de vigilancia clínica; se cambió el esquema de inmunización del lactante con vacunas anti-per tussis acelulares como medida preventiva. Conclusiones: El desconocimiento sobre el EHH puede desalentar la inmunización infantil. Por lo tanto, es importante que el personal médico informe a los padres de los pacientes sobre este evento benigno, autolimitado y no recurrente. En estos casos, se re comienda continuar con el programa de inmunización del lactante con formulaciones que contengan componentes anti-pertussis acelulares.

Abstract Introduction: Hypotonic-Hyporesponsive Episode (HHE) is an adverse event after vaccination, mainly associated with whole-cell pertussis vaccines. It is characterized by a sudden onset of muscle flaccidity, reduced response to stimuli and pallor or cyanosis. Although the HHE is infrequent, it is considered a severe adverse event. Objective: To report a case of HHE following the administration of the whole-cell pertussis combination vaccine (DTwP-HB-Hib), which is included in National Im munization Program (PNI) of Chile, and to contributing to the knowledge of this adverse event in the country. Case report: A 6-month-old infant, 3 hours post-vaccination with the third dose of DTwP-HB-Hib vaccine, presented a decreased level of consciousness that was interpreted as atonic seizure but finally considered as EHH. The infant progressed favorably after 2 hours of clinical observation and was discharged 24 hours later. Parents were suggested to continue the immunization schedule of the infant with acellular pertussis vaccines as a preventive measure. Conclusions: The lack of knowledge about the EHH may discourage childhood immunization. Therefore, it is important for the medical staff to inform parents of the patients about this benign, self-limited and non-recurrent adverse event. In these cases, it is recommended to continue the immunization schedule of the infant with acellular pertussis vaccines.

Scurvy

Scurvy is a condition caused by a lack of vitamin C [ascorbic acid] in the diet. It is extremely rare in industrialized societies but still exists in higher risk groups including economically disadvantaged populations with poor nutrition. We are reporting a case of 4 year old Asad who presented to our department with this condition

Passive malaria surveillance in a low endemic area of India: validation of a clinical case definition.

BACKGROUND: In India, 2.55 million cases of malaria were reported during 1997; roughly one-third were due to Plasmodium falciparum. Malaria cases are identified by passive and active surveillance and all patients with fever are treated with chloroquine (10 mg/kg body weight). Since all fevers are not malaria, this results in overtreatment and has a bearing in terms of the parasites developing resistance. We aimed to test the validity of a clinical algorithm for passive malaria surveillance by primary care doctors (fever with pallor or splenomegaly) in a low endemic, Plasmodium vivax-predominant area of Ballabgarh block in Faridabad District, Haryana. METHODS: Passive surveillance was carried out at the general and paediatric outpatient departments (OPDs) of Ballabgarh hospital. All persons with fever attending the OPD were examined for the presence of fever, pallor and splenomegaly by the treating doctor. A blood smear was prepared and examined in all these cases. RESULTS: A total of 3119 slides for malaria were made at Ballabgarh hospital but clinical details in the requisition form were available for only 2616 patients who form the subjects of this analysis. A total of 59 malaria cases (30 P. vivax cases and 29 P. falciparum) were diagnosed. The presence of fever with pallor or splenomegaly had a sensitivity of 28.8% (95% CI: 18.1-42.3); specificity of 88.6% (95% CI: 87.3-89.8), positive predictive value of 5.5% (95% CI: 3.3-8.8) and negative predictive value of 98.2% (95% CI: 97.5-98.7). CONCLUSION: The algorithm did not have sufficient sensitivity to detect malaria cases by passive surveillance.

Leucemia linfoblástica aguda: características al diagnóstico en 100 niños / Acute lymphoblastic leukaemia: characteristics at diagnosis in 100 patients

Objetivo: El objetivo es comunicar los hallazgos al diagnóstico en niños con LLA, describiendo las formas de presentación que permiten sospechar esta entidad. Pacientes y método: revisión retrospectiva de las fichas clínicas de 100 niños tratados en el Hospital Roberto del Río entre enero 1992 y junio 1998. Resultados: 62 por ciento varones, incidencia peak entre 1-6 años (60 por ciento). El tiempo medio antes del diagnostico fue 2,5 semanas. Los sintomas más frecuentes son compromiso del estado general (81 por ciento), palidez (66 por ciento), dolor óseo (30 por ciento) y púrpura (24 por ciento). Los hallazgos más comunes en el examen físico: hepatomegalia (71 por ciento), adenomegalia (71 por ciento), esplenomegalia (24 por ciento). El hemograma es siempre anormal con anemia (90 por ciento), trombocitopenia (72 por ciento), neutropenia (62 por ciento) y/o linfoblastos (67 por ciento). Muchos pacientes debutan con una mezcla de síndromes (anémico, febril, tumoral, dolor óseo) y sólo 23 fueron monosintomaticos ( todos con neutropenia). Conclusión : Una anamnesis y examen físico detallados, junto a una adecuada interpretación del hemograma, permiten al pediatra sospechar esta enfermedad, la que actualmente tiene alta probabilidad de curación

Clinical case definition of malaria at a secondary level hospital in northern India.

Malaria has re-emerged as a major public health problem in India. At present, under the National guidelines; all fevers are presumed to be due to malaria and chloroquine is given as presumptive treatment. This results in overtreatment. We did a pilot study to see whether some clinical predictors of malaria could be identified in the Indian setting. This case control study was done in a secondary level hospital. All those with fever who were smear positive for malaria were enrolled as cases and other patients fever who were smear negative for malaria served as the controls. All the factors under study were ascertained by a history or detailed clinical examination. A total of 41 cases and 95 controls were enrolled. Of the 41 cases, 35 were positive for P. vivax and six were positive for P. falciparum. After multivariate analysis, only splenomegaly (OR = 2.11; 95% CI = 1.27-3.50) and pallor (OR = 2.01; 95% CI = 1.16-3.48) were significantly associated with malaria. It appears that history of fever along with one or both of these two signs can be a useful predictor of malaria in a secondary level hospital in India. The utility and feasibility of a similar approach in a field setting needs to be studied further.

Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma.

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Episódio hipotônico-hiporresponsivo após imunizaçäo com vacina tríplice (DPT) em criança portadora da forma heterozigota da doença falciforme: relato de caso / Hypotonic-hyporesponsive episode following diphteria-tetanus-pertussis immunization on a child with heterozygous sickle cell desease: case report

Os autores apresentaram um caso raro de complicaçäo após vacinaçäo com DPT em lactente de cor parda, posteriormente identificada como portadora de traço falciforme