Disseminated nocardiosis masquerading as abdominal tuberculosis

A 32-year-old patient was admitted with a communityacquired pneumonia. She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis. While in the ward she developed an acute abdomen necessitating laparotomy; at which a diagnosis of abdominal tuberculosis was made. Sputum and intraoperative pus specimens grew a multiresistant Nocardia brasiliensis. Microbiological investigations for tuberculosis were negative. The patient died after a short ICU admission from multiple organ dysfunction syndrome

A descriptive study of HIV-infected long-term surviving children in Barbados--a preliminary report / Estudio Descriptivo de Niños Infectados por el VIH Sobrevivientes a Largo Plazo en Barbados Un Informe Preliminar

OBJECTIVES: To describe the clinical and immunologic characteristics of human immunodeficiency virus type-1 (HIV-1)-infected children surviving to more than eight-years of age (long-survivors) before the introduction of antiretroviral therapy. METHODS: This report is based on all the long-term survivors from a prospective cohort of HIV-infected children born to HIV-positive women in Barbados during 1986-1995. Infants born to HIV-infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV exposure in the postnatal period and followed-up at regular intervals. RESULTS: From a cohort of 44 HIV-infected children, 17 (38.6%) children survived to the age of eight years and beyond and were classified as long-term survivors. Median age of the sixteen long-term surviving children alive at the time of this report was 12 years (age range 8 - 16.7 years). At the age of 8 years, 17.6% of these children remained asymptomatic. Nine (52.9%) children had no immunodeficiency (CD4 counts >500 cells x 10(6)/L). Of the 16 long-term surviving children who were alive and had a median follow-up of 4.1 years (range 0.1 year to 8.5 years) after their eighth birthday, 37.5% had a CD4 cell count greater than 500 cells x 10(6)/L and had either no symptoms or only mild symptoms of HIV infection and were therefore categorized as the long-term non-progressors. CONCLUSIONS: In a small cohort of HIV-infected children, in the absence of antiretroviral therapy, only about one-third survived beyond eight years of age. On further follow-up of these long-term surviving children, over one-third had a slow rate of disease progression

OBJETIVOS: Describir las características clínicas e inmunológicas de niños infectados por el VIH-1, que lograron sobrevivir hasta más de ocho años de edad (sobrevivientes a lago plazo) antes de la introducción de terapia antiretroviral. MÉTODOS: Este informe se basa en todos los sobrevivientes a largo plazo de una cohorte prospectiva de niños infectados por el VIH nacidos de mujeres VIH positivas en Barbados, durante los años 1986-1995. Los niños nacidos de mujeres infectadas por el VIH fueron enrolados en esta cohorte al nacer o en el momento de diagnóstico de exposición al VIH en el periodo postnatal, y seguidos a intervalos regulares. RESULTADOS: De una cohorte de 44 niños infectados por el VIH, 17 niños (38.6%) sobrevivieron hasta los ocho años de edad y más, clasificándoseles por ende como sobrevivientes a largo plazo. La edad media de los 16 niños sobrevivientes a largo plazo, aún vivos en el momento en que se hace este informe, fue de 12 años (rango de edad 8 ­ 16.7 años). A la edad de 8 años, el 17.6% de estos niños permanecían asintomáticos. Nueve de los niños (52.9%) no tenían inmunodeficiencia (conteos CD4 >500 células x 106/L). De los 16 niños sobrevivientes a largo plazo que estaban vivos y tuvieron un seguimiento de 4.1 años (en un rango de 0.1 año a 8.5 años) después de su octavo cumpleaños, 37.5% tuvo un conteo CD4 mayor de 500 células x 106/L, y bien no presentaban síntoma alguno de infección de VIH o se trataba sólo de síntomas leves, por lo cual fueron categorizados como no progresores de largo plazo. CONCLUSIONES: En una pequeña cohorte de niños infectados por el VIH, en ausencia de la terapia del antiretroviral, sólo aproximadamente un tercio logró sobrevivir más allá de ocho años de edad. Un seguimiento posterior de estos últimos niños sobrevivientes a largo plazo, mostró que más de un tercio presentaba un ritmo lento de progresión de la enfermedad

Mortality among HIV-infected paediatric patients in Barbados

Since the onset of the HIV epidemic, AIDS has become the leading cause of mortality in the paediatric age group in many developing countries. The main objective of this study was to review the mortality in HIV-infected paediatric patients in Barbados. It is a retrospective analysis of the hospitalization course of HIV-infected paediatric patients aged < 16 years who died during a 15-year period of surveillance. Using a specific database, information pertaining to number and duration of hospitalizations, and cause of death were analyzed. There were 39 (65) deaths among 60 HIV-infected patients diagnosed during the period of study. Twenty-one (54) were male and 18 (46) were female. Twenty-seven (69) case records were retrieved for analysis. The highest mortality (56) was among patients aged < 1 year and between 1989 and 1995. Hospitalizations averaged three per patient. No patient received anti-retroviral therapy. Nineteen (70) patients died during hospitalization on the paediatric ward. Lower respiratory tract infections suspected to be Pneumocystis carinii, gastroenteritis and septicaemia were the most frequent diagnoses at the time of death. The annual mortality ranged between 0 and 1.7 (mean 0.7) per 1000 live births. The overall mortality rate was high among HIV-infected paediatric patients, with lower respiratory tract infections being implicated as a major contributing cause of death. Results of this study definitely indicate a need for improved resources in the management of paediatric HIV/AIDS cases, especially focussing on the availability and administration of anti-retroviral therapy

Leptospirosis occurring in two children after fresh water immersion

Leptospirosis is relatively uncommon in children. Two cases of severe leptospirosis occurred in teenaged boys who shared a common exposure via immersion in fresh water. While both patients had laboratory-confirmed leptospirosis, their symptoms differed in many respects.

Childhood gastroenteritis in Barbados: occurrence of Campylobacter and Rotavirus

Four hundred children with diarrhoea whose ages rangedfrom 3 months to 6 years were investigated to determine the aetiology of childhood gastroenteritis in Barbados. Rotavirus (11%) was the most frequently identified pathogen, followed by Shigella (7%). enteropathogenic E. coli (4%), Salmonella (3%) and C. jejuni (1.3%) with 2% of patients having multiple pathogens. No pathogens were identified in the remaining cases studied. The ages of the patients with C. jejuni enteritis ranged between 4 months and 2 years (mean 1.3 years). tje male/female ratio was 2:1. The most frequent synptoms were fever (66%) and blood diarrhoea (66%). The duration of stool excretion ranged between 1 and 7 weeks. The organisms were unifromly sensitive to antibiotic tests aginst erythromycin, tetracycline, chloramphenicol, gentamicin an nitrofuratoin. In contrast, the ages of patients with rotavirus enteritis ranged between 3 months and 4 years (mean 1.3 years) with a male/female ratio of 1:1, and the most frequent symptoms were diarrhoea (80%), vomiting (70%) and upper respiratory infections. In 60% of patients, hospitalisation was necessary. All patients had an uneventful recovery

Bed utilization study in paediatric medical patients at the Queen Elizabeth Hospital, Barbados

Details of a bed utilisation study of 1,654 paediatric medical ward admissisons to the Queen Elizabeth Hospital, Barbados, during 1983 ara analysed. Forty-one per cent of admissisons had a respiratory problem, 14% had infections diseases, 9% central nervous system conditions, and 36% had diseases of other systems. Analysis of hospital stay revealed that 20% of patients spent less than 24 hours and these mostly for bronchial astma (31%), repiratory tract infections (15%), and gastroenteritis (10%). Most long-stay patients had either congenital heart disease (12%), social problems (11%) or diabetes mellitus (10%).. We recommend that the establishment of a short-stay unit could eliminate 20% of admissions, spent less than 24hours. A further 21% (poisoning and gastroenteritis) could be significantly reduced with good health education