Invasive pneumococcal disease in a cohort of HIV-1 infected female prostitutes living in Nairobi

A cohort of predominantly HIV seropositive female prostitutes has been followed for a two year period. 54 episodes of invasive pneumococcal disease (ISpD) have been diagnosed in 41 patients; of which 28 were bacteraemic. All patients were seropositive for HIV. Pneumonia was the most common presentation in 34(64); then maxillary sinusitis in 11 (21) and occult bacteraemia in 8 (15). Nine of the patients (22) had proven recurrent disease despite appropriate therapy; most of these episodes were with different serotypes suggesting that this is reinfection rather than relapse. The mean CD4 count of first episode ISpD was 325 showing that that this is an early HIV-related problem. The estimated inicdence rate was 30/1000 person years of observation and it was the most common life-threatening problem seen in the cohort in the study period. All patients survived with standard penicillin or ampicillin treatment. The pneumococcus is an important but under-recognised cause of HIV-related disease in Africa. Presentation can be atypical but the response to appropriate therapy good

Phenobarbitone in young children with severe falciparum malaria

The mortality of cerebral malaria (CM) in children remains 10-40; and seizures have been shown to effect outcome adversely. Phenobarbitone (PB) is cheap; widely available in Kenya and reduces the incidence in adults with CM (single IM dose; 3.5 mg kg-1. Its value in children with CM is unkown. We have studied the pharmacokinetics and effect of PB in children with CM as a dose-finding exercise prior to controlled trial. 14 children entered the treatment group and 39 entered the control group. Over the first 6 h; the motor component of the coma score improved in 29 of the treatment group and 26 of the controls; was unchanged in 36 and 51; worsened in 7 and 8; and was not available in 29 and 13 respectively. The time taken to localise pain was 21 + 19 h (x+SD) in the treatment group; and 22 + 14 h in the control. There was no difference between the groups in the incidence of seizure; number of seizures during admission; incidence of neurological sequelae or mortality. Peak PB concentrations exceeded 15 mgL-1 in only 27 of patients. Prophylactic PB (10 mg/kg) has neither apparent benefit nor risk in young children with CM.; probably because of the low blood concentrations achieved