Measles in Thai adults: three case reports and management of contact cases.

We report on three adults (one nurse and two medical students) diagnosed as having measles. All the patients presented with fever, cough, conjunctival injection and rash. They contracted measles from pediatric patients who had been treated at Chulalongkorn Hospital in the previous two weeks. Physical examination revealed Koplik's spots on the oral mucosa and typical maculopapular rash. The diagnosis was confirmed by viral isolation. Measles IgG antibodies were measured in 36 medical students who were in close contact with patient 2 and measles vaccines were given. Thirty-three specimens had positive measles IgG, two had equivocal results and one had negative result. The student with negative measles IgG eventually developed measles (patient 3). Except for patient 2 and 3, no further cases of measles were seen among the contacts.

Typhoid glomerulonephritis in a child: a rare complication of typhoid fever.

We report a child with typhoid glomerulonephritis who presented with fever, gastrointestinal symptoms, edema, hypertension and abnormal urine findings including microscopic hematuria and proteinuria. Salmonella typhi resistant to ampicillin and cotrimoxazole was isolated from a blood culture. Renal biopsy was not performed. The child successfully treated with ceftriaxone.

Seroprevalence of hepatitis A virus antibody among children and young adults in Bangkok.

OBJECTIVE: To determine the prevalence of hepatitis A virus (HAV) antibodies in various age groups of healthy children and young adults who have not received the hepatitis A vaccine. METHOD: Blood samples were collected from 825 volunteers aged 1-30 years from a well baby clinic and five academic institutions in the Don Mueang area from 1998 to 1999. Serum samples were assayed for specific HAV IgG antibodies using a commercial enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: The seropositivity rate (12.4% overall) in each age group was as follows: 1-3 years, 7.7 per cent; 4-7 years, 6.6 per cent; 8-11 years, 12.4 per cent; 12-15 years, 10.7 per cent and 16-30 years, 25.9 per cent. CONCLUSIONS: In the Don Mueang area of Bangkok, the majority of children (< 16 years) do not have natural immunity against HAV. The use of hepatitis A vaccine for this population should be considered. Pre-vaccination serologic screening for HAV IgG in children may not be worthwhile.

Primary dengue infection: what are the clinical distinctions from secondary infection?

To determine the magnitude of the problem posed by primary dengue infection in children and the distinctive clinical clues that may differ from those with secondary infection, 996 children serologically diagnosed with dengue infection and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand between 1988 and 1995 were retrospectively reviewed. One hundred and thirty-nine cases (14.0%) were serologically proved to be primary dengue infection. Of these, 72 were males and 67 were females, with a mean age of 4.8 years. Common manifestations by order of frequency included fever (97.8%), hepatomegaly (71.9%), vomiting (59.0%), decreased appetite (55.4%), coryza (52.5%), drowsiness (39.6%), diarrhea (34.5%), rash (33.8%), abdominal pain (23.0%) and seizure (15.8%). The mean duration of fever before admission was 4.6 days. Common sites of bleeding were skin (41.7%), mucous membrane (14.4%) and the gastrointestinal tract (12.2%). Clinical diagnosis was categorized into dengue fever (22.3%), dengue hemorrhagic fever (60.4%) and dengue shock syndrome (17.3%). Three patients (2.2%) died. Compared with the children with secondary dengue infection (n=139), children with primary dengue infections tended to be younger, presented more commonly with coryza, diarrhea, rash and seizure; and less commonly with vomiting, headache and abdominal pain (p < 0.05). The maximal hematocrit level, the mean difference between maximal and minimal hematocrit values and the maximal percentage of neutrophils were significantly lower in the study group, whereas the maximal percentage of lymphocytes was significantly higher. Dengue fever was more common and dengue shock syndrome was less common in the study group (p < 0.05). This study has emphasized that primary dengue infection is not uncommon and is less severe than secondary infection. Clinical presentations and laboratory findings are somewhat different between the two conditions.

Invasive pneumococcal infection and drug-resistant Streptococcus pneumoniae in Thai children.

Sixty-eight children with systemic Streptococcus pneumoniae infection were identified by hospital chart review between 1986-1997. The age distribution varied from 2 days to 15 years, with a mean age of 3.3 years. There were 35 boys and 33 girls. Four clinical entities included 30 cases of meningitis, 20 cases of pneumonia, 10 cases of peritonitis and 8 cases of septicemia/bacteremia. Forty patients (58.8%) had underlying diseases. Seventeen patients (25.0%) developed early complications and the mortality rate was 8.8 per cent. The percentage of susceptible isolates to penicillin, chloramphenicol, cefotaxime/ceftriaxone, ciprofloxacin, imipenem and vancomycin were 69.6, 91.3, 100.0, 87.2, 100.0 and 97.1 per cent, respectively. There were six cases of drug-resistant S. pneumoniae (DRSP) infection; 3 cases of meningitis, one case of pneumonia, one case of infective endocarditis and one case of purpura fulminans. Our data indicate that S. pneumoniae infection is relatively serious and life-threatening. There is a trend of increasing prevalence of invasive pneumococcal and DRSP infections.

Seroprevalence of Epstein-Barr virus antibody among children in various age groups in Bangkok, Thailand.

There are no current data on previous Epstein-Barr virus (EBV) infections in different age groups of Thai children. This study was conducted to determine the prevalence of anti-EBV IgG antibody in healthy children of various age ranges in Bangkok, Thailand. Between June and December 1998, blood samples were collected from 425 volunteers aged 6 months to 15 years who attended a well baby clinic in the northern suburban part of Bangkok, Thailand. Serum samples were assayed for specific anti-EBV IgG antibodies using a commercial enzyme-linked immunosorbent assay kit. The percentage of children with positive anti-EBV IgG antibody increased with advancing age. The overall seropositivity rate was 72.7%. Children with anti-EBV IgG antibody were significantly older than those without the antibody. Seronegative children were reared at home significantly more frequently than seropositive children. These seroopidemiologic data will guide calculation of the appropriate age for administration of an EBV vaccine to children, when it becomes available.

Neurological manifestations in dengue patients.

To determine the frequency and the natural history of neurological manifestations of dengue infection in Thai children, 1,493 children diagnosed with dengue infection by serology and admitted to the Department of Pediatrics, Chulalongkorn Hospital, Bangkok, Thailand from 1987 to 1998 were reviewed from prospectively recorded medical charts. There were 80 children identified with neurological manifestations, an incidence of 5.4% of all dengue patients. Of these, there were 41 males and 39 females, with ages ranging from 3 months to 14 years. They were categorized into 20 cases of dengue fever, 26 cases of dengue hemorrhagic fever and 34 cases of dengue shock syndrome. All cases experienced the neurological manifestations during the febrile stage of the illness. The patients were classified into an encephalitic group (called "dengue encephalopathy") (42), a seizure group (35) and a miscellaneous group (3). Encephalitic patients presented with alteration of consciousness (83.3%), seizure (45.2%), mental confusion (23.8%), nuchal rigidity (21.4%), spasticity of limbs (9.5%), positive clonus (4.8%), hemiplegia (2.4%) and positive kernig (2.4%), and were older than those in the other groups. Patients in the seizure group presented with seizure (100%) and positive clonus (2.9%). Abnormal laboratory findings included hyponatremia, abnormal liver enzymes and CSF pleocytosis. Dengue IgM and dengue PCR were not demonstrated in 16 CSF specimens. An autopsy finding of a child in the encephalitic group showed histologic evidence of encephalitis, the only case of confirmed dengue encephalitis in this study. One patient with encephalitic symptoms suffered from long-term neurological sequelae. The overall mortality rate was 5%. In conclusion, neurological manifestations including seizure and encephalopathy in children with dengue are not uncommon whereas dengue encephalitis is a rare entity.

Childhood cryptococcosis: an increasing problem in the era of AIDS.

The authors reported 8 children with cryptococcosis from King Chulalongkorn Memorial Hospital from 1991 to 2000. Five patients were older than five years. The two common underlying diseases were HIV/AIDS (5 cases) and systemic lupus erythematosus (2 cases). Seven cases had been observed in the past four years, four of these in 2000. One patient developed disseminated disease and two patients died. In the era of HIV/AIDS and due to the fact that HIV-infected children are tending to live longer, we may encounter a higher occurrence of this opportunistic fungus in children.

Seroprevalence of Epstein-Barr virus infection in Thai children.

A hospital-based cross-sectional survey was conducted in Bhumibol Adulyadej Hospital, Bangkok, Thailand between January and December 1997 to study the seroprevalence of anti-EBV IgG antibody in previously healthy hospitalized children aged 0-15 years. Of 589 cases, there were 327 boys and 262 girls with a mean age of 3.9 years. The seroprevalence of EBV infection was 50.4, 72.8, 92.3, 96.6 and 97.6 per cent in children at the age range of 0-2, 3-5, 6-8, 9-11 and 12-14 years, respectively. After excluding infants below 6 months of age, the total seroprevalence rate was 68.4 per cent. The age of children with positive anti-EBV IgG antibody was significantly higher than that of children with negative antibody. Children who were reared at home had lower seroprevalence rates. In conclusion, seroprevalence of EBV infection increased with advancing age and reached 90 per cent or more after 6 years of age.

Seroprevalence of anti-human herpes virus-6 IgG antibody in children of Bangkok, Thailand.

The prevalence of HHV-6 infection was surveyed by determining the presence of anti-human herpesvirus-6 IgG (Anti-HHV-6 IgG) using an ELISA method. Two hundred and ten sera collected from healthy Thai children aged between 0 to 12 years (mean +/- standard deviation = 3.35+/-3.33) indicated the prevalence of HHV-6 infection was 88.10% (185/210). Samples were classified into 7 groups, 30 samples each, according to their ages, ie, group 1: 0 - < 6 months; group 2: 6 - < 12 months; group 3: 12 - < 18 months; group 4; 18 - < 24 months; group 5: 2 - < 5 years; group 6: 5 - < 8 years and group 7: 8-12 years. The prevalence of HHV-6 infection was 63.33%, 70%, 96.67%, 93.33%, 100%, 100% and 93.33%, respectively. The mean level of anti-HHV-6 IgG among those positive for HHV-6 infection (185 samples) increased from 0 < 6 months old (17.47+/-6.32 units) to 27.57+/-8.42 units in 6 - < 12 months old, with the highest value found in the 18 - < 24 months old group (33.08+/-8.64 units). The level declined thereafter. A statistically significant difference of the mean level of anti-HHV-6 IgG among positive groups was found (p-value < 0.05). The important factor associated with HHV-6 infection was age (p = 0.002), while sex, socioeconomic status, number of children in the family and child rearing place did not show any association.

Epidemiology of invasive meningococcal disease in 13 government hospitals in Thailand, 1994-1999.

This study was conducted to elucidate the magnitude of problem and the clinical course of invasive meningococcal infection from 13 government hospitals in Thailand between 1994 and 1999. Thirty-six strains of Neisseria meningitidis were isolated from 16 blood and 24 cerebrospinal fluid specimens; 4 patients had positive culture in both blood and CSF. Of the 16 strains, 9 (56.3%) were serogroup B. Seventy-one and eighty-four percent of the isolates were susceptible to penicillin and cefotaxime/ceftriaxone respectively. Five out of six penicillin-nonsusceptible strains were found to be relatively resistant to penicillin with the MIC of 0.125 microg/ml. Of 33 patients whose medical records were available, 21 were males and 12 were females, with a mean age of 11.2 years. Fifteen patients (45.5%) presented with meningococcemia and 18 patients (54.5%) presented with meningococcal meningitis. Hypotension and purpura were found in 24.2% and 33.3% of patients respectively. The overall mortality rate was 9.1%. In conclusion, meningococcal disease is not common in Thailand, meningococcemia is a life-threatening condition whereas meningococcal meningitis is much less severe. The prevalence of meningococci relatively resistant to penicillin seems to be increasing.

Causes of fever in children with first febrile seizures: how common are human herpesvirus-6 and dengue virus infections?

This study was conducted to evaluate the etiologies of pyrexia in children with first febrile seizures using a prospectively recorded medical protocol, bacterial culture, and serologic tests for human herpesvirus-6 (HHV-6), dengue virus and Japanese B encephalitis (JE) virus. Of 82 children with first febrile seizures, who were between 3 months and 3 years old and had been admitted to Bhumibol Adulyadej Hospital between January 1997 and December 1998, 41 were boys and 41 were girls, with a mean age of 14.7 months. The average maximal body temperature was 39.7 degrees C. Approximately 70% of the children developed seizures on the first day of fever and the duration of the seizures varied from 1 to 30 minutes. In addition to fever and seizure, common symptoms and signs included coryza, diarrhea, vomiting, inflamed tympanic membranes and rash. The causes of fever documented upon discharge were, in order of frequency, upper respiratory tract infection, nonspecific febrile illness, diarrhea, urinary tract infection, viral infection, pneumonia, herpangina, measles, pneumococcal bacteremia and dengue fever. Serologic tests for HHV-6 IgM were positive in seven children (8.5%), and serologic tests for dengue and JE viruses were negative in all cases.

A dengue shock patient with negative serology and polymerase chain reaction (PCR) tests.

A 6-month-old Thai girl presented with clinical manifestations of dengue shock syndrome (DSS) with encephalopathy and urinary tract infection. Serology and PCR tests were negative whereas dengue virus type 2 was isolated. In cases of highly suspected dengue infections, viral isolation should be done even when serological and PCR tests are negative.

Seroprevalence of cytomegalovirus infection in children.

A hospital-based cross-sectional survey was conducted in Bhumibol Adulyadej Hospital between February and May 1997 to study the seroprevalence of cytomegalovirus (CMV) infection in hospitalized infants. Of 83 cases, 46 were boys and 37 girls, with the mean age of 11.87 months. The seroprevalence of CMV infection was 80.95, 61.90, 80.95 and 70.00% in infants at the age range of 0-6, 6-12, 12-18 and 18-24 months respectively. After excluding infants below 6 months of age, the seroprevalence rate was 70.97%. The family income of infants with positive CMV antibody was significantly lower than that of infants with negative results. There were no statistical correlations between seroconversion and age, sex, number of children in family and place of child rearing.