ABSTRACT
OBJECTIVE: To provide an overview of the various treatment options available in the rational management of ITP in children. DATA SOURCE: Published original research findings and reviews. DATA SELECTION: On-line searches for published data on immune thrombocytopaenia, idiopathic thrombocytopaenia, thrombocytopaenic purpura. DATA EXTRACTION: Abstracts of selected articles were read and analysed to determine their relevance to this article. DATA SYNTHESIS: All relevant articles were read in full and necessary contribution extracted for this review. CONCLUSION: Immune thrombocytopaenic purpura is a common disorder affecting children and adults. Ongoing research into the pathogenesis is providing the basis for future treatment options. Greater consensus as to appropriate treatment strategies is needed to improve outcomes.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/therapeutic use , Purpura, Thrombocytopenic/therapy , Splenectomy , Child , Chronic Disease , Humans , Platelet Transfusion , Purpura, Thrombocytopenic/immunologyABSTRACT
Four hundred and ninety nine children (aged between one month and five years) admitted with clinical features of meningitis were recruited in cross-sectional survey of bacterial meningitis in hospitals within Nairobi. Lumbar punctures were done on all of them and the cerebrospinal fluid (CSF) analysed bacteriologically and serologically for the common causative organisms. Two hundred and fifty (50.1%) cases were diagnosed clinically as having meningitis. Of these, 132 (52.8%) had turbid CSF specimens, while 118 (47.2%) were clear. When turbid CSF specimens were cultured, 83 (62.8%) yielded three common bacterial micro-organisms namely; Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae in that order of frequency. The implications of these findings in paediatric meningitis together with the drug sensitivity patterns is presented and discussed.
Subject(s)
Hospitalization/statistics & numerical data , Meningitis, Haemophilus/microbiology , Meningitis, Meningococcal/microbiology , Meningitis, Pneumococcal/microbiology , Age Distribution , Child, Preschool , Cross-Sectional Studies , Female , Hospitals, Urban , Humans , Incidence , Infant , Kenya , Male , Meningitis, Haemophilus/cerebrospinal fluid , Meningitis, Meningococcal/cerebrospinal fluid , Meningitis, Pneumococcal/cerebrospinal fluid , Microbial Sensitivity TestsABSTRACT
A 14-year-old girl from the UK underwent volunteer unrelated donor bone marrow transplant (VUD BMT) for accelerated phase chronic myeloid leukaemia. On day +40 she became febrile, and peripheral blood smears demonstrated a 1% Plasmodium vivax parasitaemia. Although she had never been outside the UK, her male donor had documented Plasmodium vivax infection during a vacation in Papua New Guinea. Following appropriate treatment, he had been asymptomatic for 11 months before marrow harvesting. This is the first case report of malarial transmission by VUD BMT, and illustrates the potential problem of recrudescence of latent, dormant forms of Plasmodium vivax infection following transplantation into an immuno-compromised recipient. Even after appropriate therapy, malarial infection should be included in the differential diagnosis for all post-transplant febrile episodes.
Subject(s)
Bone Marrow Transplantation/adverse effects , Malaria, Vivax/etiology , Adolescent , Animals , Female , Humans , MaleABSTRACT
Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder characterised by seizures, mental retardation, cutaneous lesions and visceral harmatoma. We describe a 4 1/2-year old boy in whom in addition to the commonly described features of TSC, adult-type polycystic kidneys, a scantily reported occurrence, was an associated feature.
Subject(s)
Abnormalities, Multiple/diagnosis , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/diagnosis , Tuberous Sclerosis/complications , Tuberous Sclerosis/diagnosis , Child, Preschool , Humans , Male , Tomography, X-Ray Computed , UrographyABSTRACT
This was a cross-sectional survey in which 80 children with malignancies were studied at the Kenyatta National Hospital to determine cardiac status before and during cancer therapy. An equal number of age and sex matched subjects admitted to the surgical wards for minor procedures was recruited as a comparison group. All the subjects underwent clinical cardiac assessment. Chest radiographs, electrocardiograms (ECG), echocardiograms, haemograms and renal function tests were also performed. Overall, 13 cases (16.3%) had abnormal cardiac findings compared to 7 (8%) in the comparison group (p = 0.429). Sixteen, two and five subjects had abnormal velocity of circumferential fibre shortening, ejection fraction and pericardial effusion respectively. Three out of the five subjects with pericardial effusion were cancer patients who had not undergone treatment. Mitral valve prolapse with regurgitation was diagnosed in one cancer patient. Though not statistically significant, children with malignancies appear to have a higher frequency of acquired cardiac abnormalities than those without cancers. Since a larger proportion of the abnormalities occurred in cancer children before commencement of treatment, the pathology is more likely to have resulted from the malignancies than therapy. There was no evidence to suggest that cancer treatment contributed to cardiac morbidity. We recommend that all oncology patients undergo cardiac evaluation on admission.
