Japanese encephalitis virus remains an important cause of encephalitis in Thailand.

BACKGROUND: Japanese encephalitis virus (JEV) is endemic in Thailand and prevention strategies include vaccination, vector control, and health education. METHODS: Between July 2003 and August 2005, we conducted hospital-based surveillance for encephalitis at seven hospitals in Bangkok and Hat Yai. Serum and cerebrospinal (CSF) specimens were tested for evidence of recent JEV infection by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and a plaque reduction neutralization test (PRNT). RESULTS: Of the 147 patients enrolled and tested, 24 (16%) had evidence of acute flavivirus infection: 22 (15%) with JEV and two (1%) with dengue virus. Of the 22 Japanese encephalitis (JE) cases, 10 (46%) were aged ≤ 15 years. The median length of hospital stay was 13 days; one 13-year-old child died. Ten percent of encephalitis patients enrolled in Bangkok hospitals were found to have JEV infection compared to 28% of patients enrolled in hospitals in southern Thailand (p < 0.01). Four (40%) of the 10 children with JE were reported as being vaccinated. CONCLUSIONS: JEV remains an important cause of encephalitis among hospitalized patients in Thailand. The high proportion of JE among encephalitis cases is concerning and additional public health prevention efforts or expanded vaccination may be needed.

Hypothalamic-pituitary dysfunction in survivors of childhood brain tumors in Prasat Neurological Institute.

OBJECTIVE: To assess hypothalamic-pituitary dysfunction in childhood brain tumor survivors in Prasat Neurological Institute. MATERIAL AND METHOD: Between October 2007 and September 2008, 19 brain tumor survivor children in Prasat Neurological Institute without recurrence at least 2 years after complete treatment were included in the present study. The patients were categorized according to brain tumor location into directly (DHPA) (9 cases) and indirectly (IDHPA) (10 cases) involving hypothalamic-pituitary axis. All patients were treated by surgery. Furthermore, six cases were combined with radiation and chemotherapy and 10 cases were combined with radiation therapy only. Growth Hormone (GH) stimulation test by clonidine and/or L-Dopa, ACTH stimulation test and thyroid function test (TFT) were done. RESULTS: The mean age at diagnosis was 9.9 +/- 4.6 years old and the interval from diagnosis to study was 5.8 +/- 2.2 years. Seven DHPA (77%) and seven IDHPA patients (70%) had low peak GH with significant lower level in the former group (p < 0.05). Six of seven DHPA (85%) and one IDHPA patients (10%) had low response to ACTH stimulation test. All DHPA (100%) and 10% IDHPA patients had central hypothyroidism. By ACTH stimulation test in DHPA patients, hypocortisolism was detected in five and excluded in one who later stopped prednisolone after prolonged continuation. The central hypothyroidism was newly detected in two DHPA patients and replacement therapy was initiated GH deficiency (GHD) was detected by GH stimulation test in 73% of overall brain tumors. Growth hormone therapy would be considered in the appropriate GHD patients. CONCLUSION: With effective therapy and improving survival rates of brain tumor children, hypothalamic-pituitary dysfunction in either DHPA or IDHPA group should be regularly monitored to prevent further morbidity and improve quality of life.

Outcome of Bell's palsy in children.

Acute idiopathic facial nerve paralysis (Bell's palsy) is a non life-threatening disorder but may cause important impact. In Thailand there has been no report of the outcome of Bell's palsy in children. Eighty four children with facial palsy were treated at Prasat Neurological Institute from January 1996 to July 2001. The etiology was found in 9 children (10.7%). Seventy five children were Bell's palsy. Twenty eight children were excluded, twenty two of these were loss to follow-up after the first visit and in six the onset were more than 30 days before presentation. Forty seven children remained for study. The mean age was 8.8 years (range from 2 years to 15 years 8 months). The male to female ratio was 1:1.1. The ratio of left to right side involvement was 1.3:1. Two children had recurrent facial palsy (4.3%). The duration from onset to recurrence was 6 months to 3 years 5 months. Oral prednisolone was given in 39 children. Complete recovery was observed in 29 children (61.7%) and almost complete recovery in 18 children (38.2%). All children recovered within 7 months. The mean duration of recovery was 6.61 weeks (range from 9 days to 28 weeks). The outcome of children aged under and over six years was not statistically different. The outcome of early and late steroid treatment could not be compared in this study.