Rifampin Effects on Tuberculous Meningitis in Children

Fifty nine patients of tuverculous menigiis who were admitted to the Pediatric department of Seoul Red Cross Hospital during the period from March, 1976 to December 1977 were treated with rifampin in addition to isoniazid and streptomycin injection, and Compaired with 135 cases of tuberculous meningitis who were admitted during the period from January, 1971 to December, 1975. The contrast group was composed of 21 cases who obtained as folows. 1) Out of 59 patients givern rifampin, only 5 patients died resulting in lower motality rate (8.5%) whereas 20 patients died out of 135 cases given PAS regimen showing 14.8% of motality rate. 2) Seven cases on each stage of PAS regimen group and 10 cases of stage I, 9 cases of stage II and III of rifampin group were reviewed for the respects of defeveration, durratio of disappearance of meningeal irritation signs, improvements of conciousness and neurological defects and self feeding ability. It was very hard to conclude the superiority on one group because of the similarity of days needed for the improvement. However, superior results with rifampin regimen could be mentioned among the patients with second and third stage of tuberculous meningitis for the clinical improvements. 3) Serial examination of cerebrospinal fluids of the cases in 3 stage revealed no direct relationship either for the clinical improvements or the for ultimate outcome of the patients themselves. C. S. F. improvements were observed in average within one to three weeks. 4) Side effects of fifampin ; the level of SGOT, SGPT and bilirubin at the time of of admission wrer all normal. Twenty-one cases out of 41 patients showed the impairment of liver function after the first to second week of treatment with the dosage of 15-20mg/kg/day. In 3 out of 21 cases, the drug had to be discontinued, owing to the futher elevation of SGOT and SGPT but in 18 out of 21 cases, liver function was gradually normalized within one to two weeks after the dosage of rifampin had been reduced down to 10mg/kg/day. There was no evidence of impairment of liver function on the follow-up evaluation from 4 to 10 months later. And there were no significant changes in Hb, Hct, platelet counts during the course of the therapy. The hepatitis, the well known side effects such as hemolytic anemia, skin rashes and G-I tract disturbance were not observed during the course of treatment. Bases on the above observations that rifampin reduced the motality and shortened the duration of clinical manifestation without the serious side effects except for transient hepatitis, rifampin plus isoniazid would seem to be preferred for the patients who are seen at the late stage of the disease. We know that the number of cases of this study is not enough to draw the definite conclusion of the superiority of rifampin, however, the of these prelininary observations seemed to cast a bright light for the futher trial and follow up observations.

A Caes of Congenital Nephrotic Syndrome

Nephrotic syndrome occurs infrequentiy prior to the second year of life. When nephrotic syndrome does develop during the first year, the course differs from that of older children with nephrotic sydrome, being characterized by an extremely poor prognosis and an almost complete refractoriness to therapy. Despite its low incidence congenital nephrotic syndrome is important, not only because of the severity and the disorder itself but also because the occurrence of nephrotic syndrome in this age group rasies question regarding the etiology of the disease. We experienced one case of congenital nephrotic syndrome which was confirmed by autopsy. The patient was born as a premature infant with body weight 1,400gm and 37weeks of gestational age, to a toxemic mother, gravida 3 and parity 3 in Obsteric Department of Seoul Red Cross Hospital. The patient had an uncomplicated nursery staying even though routine weekly urinalysis did show up various degree of proteinuria and microscopic hematuria without any obvious edema till the age of 50 days with body weight 2,400gm on the discharge. He was lost to be followed at Out Patient Department untill the age of 4months when he was brought to admission because of respiratory distress in generalized edematous state. He died at 7 months of age following progressive down-hill cours, despite treatment with prednisolone and cyclophosphamide for 2 months. At autopsy, almost all of the glomeruli (99%) were sclerotic with occassional creascent formation and tubules showed mircocystic dilataions. It is considered that this case was the first one which was presented on literature in Korea.