Prevalence of human immunodeficiency virus infection in children with tuberculosis.

This prospective study was carried out in the pediatric ward and outpatient department of a tertiary care centre to estimate the prevalence of HIV seropositivity in children with tuberculosis. Two hundred and fifty consecutive children below 12 years of age with (pulmonary and extrapulmonary) tuberculosis diagnosed between March 1999 and July 2000 were screened for HIV infection. A patient was labeled as HIV positive if two consecutive ELISA tests were found positive using different antigen/principle. Supplemental western blot test was also done. Parents of seropositive children were also screened for HIV infection and tuberculosis. Total 5 cases were HIV positive giving a seroprevalence of 2%. All the five patients had disseminated tuberculosis. We suggest regular screening of children with disseminated/miliary tuberculosis for HIV co-infection.

A comparative clinical trial of artemether and quinine in children with severe malaria.

OBJECTIVE: To compare the efficacy of artemether and quinine in the treatment of severe malaria in hospitalized children. STUDY DESIGN: Open randomized trial. SETTING: Pediatric ward of a tertiary care center. METHODS: All children admitted with clinical manifestations of severe malaria (as per WHO criteria) and asexual forms of Plasmodium falciparum demonstrated on peripheral smear were randomized to receive either artemether or quinine. Their clinical status and smears for parasite count were assessed every 12 hours until two successive blood films were negative. The primary end point of the study was death in the hospital and residual damage to the organ involved. The secondary end points were clearance of parasites and fever, length of time of recovery from coma and normal functions of the involved system. RESULTS: Forty-six cases completed the study protocol, 23 assigned to each drug group. Cerebral malaria was the commonest manifestation (76.1%). Mean age in artemether versus quinine group (6.6 +/- 3.5 and 5.8 +/- 2.4 years) as well as degree of parasitemia at admission (55,800 and 60,300 per microlitre) were comparable. The overall mortality rate was 23.9% with no significant difference between the two groups. Twenty six cases (56.5%) presented with more than one manifestations of severe malaria. The mortality rate was 100% with four coexisting manifestations of severe malaria. Fever clearance time in artemether and quinine group was 44.5 and 45.9 hours respectively (P >0.05). Parasite clearance time was significantly shorter in artemether group (40.9 vs. 51.9 hours; P<0.001). Recovery from coma was shorter in artemether group (34.8 vs. 38.1 hours; P<0.05). CONCLUSION: Cerebral malaria is the most common manifestation of severe malaria in children. Artemether is a good alternative drug to quinine for P. falciparum malaria. Mortality rate is directly proportional to the number of coexisting manifestations of severe malaria.

Spontaneous pneumothorax in children--a review of 95 cases.

We reviewed the records of 95 consecutive patients with spontaneous pneumothorax. The children, 75 boys and 20 girls, ranged in age from newborn to 12 years. The average duration of symptoms, cough, chest pain and breathlessness, was 5 days. Pyogenic lung infection (74.8%) and pulmonary tuberculosis (21%) were the commonest underlying causes of pneumothorax. All children underwent tube thoracostomy drainage along with supportive treatment. Five died owing to sever infection present at the time of admission. Except for the five (5.21%) who died, all children (94.79%) had full relief of pneumothorax. We conclude that pyogenic pulmonary infection and pulmonary tuberculosis are still the commonest causes of pneumothorax in the tropics. Tube thoracostomy drainage is very successful and thoracotomy in selected patients is safe.

Management of Empyema thoracis in children--a study of 65 cases.

Sixty-five cases of pleural empyema (50 boys and 15 girls) were seen between January 1983 and June 1986. Fifty-three of these 65 children were below 10 years of age. Pulmonary infection was the commonest underlying cause. Cough with or without expectoration (98%) and fever (95%) were the commonest symptoms followed by breathlessness (85%) and chest pain (83%). Staphylococcus aureus was isolated from pus and blood in 61% and 18% of cases, respectively, while pseudomonas was grown in 8% and 3%. Most of the children (88%) were treated with antibiotics and tube thoracostomy drainage. Decortication was needed in 12% of cases. There were four deaths in this study. The overall success rate was 94%.

Clinical profile of malaria in children--a prospective study from Aligarh (N. India).

In a prospective, hospital-based study in North India, malaria accounted for 1.5% of paediatric outpatient attendances during 1 year. A marked increase in the prevalence of malaria was noted during the post-monsoon months. Plasmodium falciparum was the causative species in 44.4% of cases, contrary to previous reports of low prevalence of this parasite in the area. Pyrexia with or without chills or rigor, vomiting, pallor and hepatosplenomegaly were the common presenting clinical features. Splenic and hepatic enlargement were seen more frequently with P. vivax than P. falciparum infections (P less than 0.001 and P less than 0.01, respectively). Convulsions were present in 20% of cases.