Factor influencing case-fatality rate of septicemic children.

One hundred and fourty episodes of septicemic children seen at Songklanagarind Hospital during a period of two years were reviewed to determine factors related to mortality. One hundred episodes (70.4%) of septicemia were hospital-acquired in which 98 (69%) were caused by gram negative bacilli, with Pseudomonas being the most common agent. Thirty episodes were from gram-positive cocci and eight were from polymicrobial infections. The remainder were caused by Candida species. The overall case-fatality rate was 28.6%. Using a logistic regression model, appropriateness of antibiotic use and host status (being newborn or a compromised host compared to a normal host), but not neutropenia and acquisition of infection were the only statistically significant risk factors. The exact odds ratio of inappropriate use of antibiotic adjusted for host status was 13.6 (95% confidence limits = 5.7-32.3). Percentages of inappropriate usage among the premature and full term newborn, compromised host and normal were 50, 11, 28 and 24, respectively. Inappropriate antibiotic use was the major cause of case-fatality in the study population. It was more common among the premature newborn and compromised hosts.

Pseudomonas pseudomallei in southern Thailand.

The distribution of Pseudomonas pseudomallei was studied in soil and water from various sources of Songkla province, Southern Thailand. P. pseudomallei was isolated from the surface soil of rubber plantations (60.9%) and from the bottom sediments of rice fields (78.1%). Farmers and plantation workers will have a greater risk of contracting melioidosis.

Kawasaki disease in Songkla, Thailand.

Four cases of Kawasaki disease hospitalized in Haadyai Hospital, Songkla, during 1978-1983 are summarized. All four patients had clinical features, the principal signs and symptoms set forth in the guidelines for the diagnosis of mucocutaneous lymphnode syndrome (Kawasaki disease) including other associated features such as diarrhea, arthritis, mild jaundice, pneumonia, subconjunctival hemorrhage, proteinuria and leukocytosis. All four patients survived the acute illness, without evidence of cardiac complications. The cases were followed-up for over one year.

Hemorrhagic diphtheria.

Two cases of hemorrhagic diphtheria, a rare entity and severest form are reported. Both of them have been mildly ill for more than 3 days and did not seek medical attention, suddenly developed bleeding episodes with clinical evidence of diphtheria in association with severe thrombocytopenia. Inspite of antitoxin, antibiotics therapy and supportive care one died on the third day. The second case was given additional steroid therapy to the regimen and survived with diphtheria myocarditis.