Clinical manifestations of early childhood dengue virus infection in Thailand.

INTRODUCTION: Clinical manifestations of dengue infection has a wide spectrum. This study aimed to describe and compare the clinical aspects of dengue infection in early childhood and those in older children. MATERIALS AND METHODS: All dengue patients hospitalised at King Chulalongkorn Memorial Hospital, Bangkok, Thailand during 1987-2008 and aged 0-15 years were included. All parameters were compared between patients in two groups: aged 0-2 years and >2-15 years. RESULTS: Of the 2,221 children who were diagnosed with dengue, 179 were children aged 0-2 years compared with 2,042 children aged >2-15 years. The early childhood group presented significantly more frequently with hepatomegaly, drowsiness, diarrhoea, rash, convulsions, splenomegaly, and unusual manifestations. Dengue fever (DF) was more common in the early childhood group and dengue haemorrhagic fever (DHF) was less common. The mortality rate of the early childhood group was 1.67%, which was significantly higher than that of the comparative group. Approximately 65% of study subjects were serologically proven to have primary infection, compared to 9.8% of older children. CONCLUSIONS: Clinical manifestations of dengue infection in early childhood are different in some aspects from those of dengue infection in older children, and mortality is higher. To effectively prevent dengue infection morbidity and mortality in children, it is essential that clinicians correctly recognize and diagnose dengue infection, particularly in early childhood.

Clinical features and antibiotic susceptibility of Salmonella gastroenteritis in children: A ten-year review.

INTRODUCTION: Salmonella is a common organism, causing intestinal and extraintestinal infections among Thai children, especially infants, and leading to overwhelming antibiotic use. MATERIALS AND METHODS: In this retrospective review, data collected during 2006-2015 from the medical charts of patients with evidence of infection, caused by any Salmonella serogroup or clinical form, were examined. We aimed to assess the clinical manifestations, antibiotic susceptibility, and antibiotic use in children with Salmonella gastroenteritis over the ten years' period. RESULTS: A total of 419 patients had non-typhoidal Salmonella infection. Four-hundred (95.5%) patients were diagnosed with acute gastroenteritis, which was common in children aged <12 months (72.3%). The clinical features of patients with gastroenteritis included fever (74.5%), diarrhoea with bloody mucus (60.5%), watery diarrhoea (39.5%), and vomiting (19.8%). Serogroup B was most commonly detected in the stool specimens. The susceptibility of non-typhoidal Salmonella to ampicillin, norfloxacin, and co-trimoxazole was 36.3%, 98.0%, and 80.5%, respectively. Serogroup B was the most resistant strain, which was sensitive to ampicillin in only 21.6% of specimens, while it showed high susceptibility to norfloxacin and co-trimoxazole (98.1 and 84.0%, respectively). Third-generation cephalosporin and fluoroquinolone were most commonly prescribed. CONCLUSIONS: Acute gastroenteritis is the most common form of Salmonella infection. Gastroenteritis caused by serogroup B is still the most common infection, which mostly occurs among infants under one year of age. The majority of stool specimens were still susceptible to antimicrobial agents, especially fluoroquinolone and cotrimoxazole; however, there was an overuse of antibiotics without proper indications.

Dengue associated haemophagocytic lymphohystiocytosis: An often-missed complication of a common infection.

Hemophagocytic lymphohistiocytosis (HLH) is a severe and life-threatening condition causing multisystem involvement such as cytopenia, hepatosplenomegaly, and death. Dengue infection is one of the leading causes of HLH. We reviewed three cases of children at HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand, with dengue fever who subsequently developed HLH, based on the HLH-2004 diagnostic criteria. Following treatment with dexamethasone and intravenous immunoglobulin, there was a dramatic response including defervescence and improvement of cytopenia, hyperfibrinogenemia, and hyperferritinemia. Key features for diagnosis of dengue fever complicated by HLH include a history of prolonged fever exceeding seven days, splenomegaly, and worsening cytopenia. Early recognition and treatment are crucial for a successful outcome.