Pediatric malaria in Houston, Texas.

We retrospectively reviewed the medical records of all infants and children (< 18 years of age) with the discharge diagnosis of malaria who were admitted to the four major pediatric teaching hospitals in Houston, Texas from January 1988 through December 1993. Thirty-four cases of pediatric malaria were identified in three newborns, 22 travelers, and nine recent immigrants. The travel destination was West Africa in 68%, Central America in 14%, India in 14%, and unknown in 4%. The location of the child's and parents' birthplace was available in 77% of the travel-related cases and in all cases the destination of travel was the parents' country of origin. The peak incident of the travel-related cases was late summer and early January corresponding to return from summer or Christmas vacation. Sixteen (75%) of the 22 travel-related cases had received either no prophylaxis (12 of 22) or inadequate (4 of 22) chemoprophylaxis. Half of the patients who were given appropriate chemoprophylaxis admitted to poor compliance. The clinical presentation was usually nonspecific. Fever was the most common symptom (97%) and was paroxysmal in one-third. Splenomegaly was the most common physical finding (68%). The malaria species identified included Plasmodium falciparum (56%), P. vivax (23%), P. malariae (3%), and unidentified (18%). Moderate anemia (hemoglobin level = 7.0-10 g/dL) occurred in 38% and severe anemia (hemoglobin level < 7.0 g/dL) in 29%. Three patients required transfusion. There were no end-organ complications. In summary, pediatric malaria in Houston was primarily seen in immigrants or children of immigrants who returned to their native country. Education and preventive strategies should target these families and should be part of the routine well child care of these children.

Clinical and public health aspects of tuberculous meningitis in children.

To define the clinical and public health aspects of tuberculous meningitis, we conducted a 10-year retrospective review of patients with central nervous system (CNS) tuberculosis, investigated health department records of contact investigations involving our patients, and assessed prospective follow-up of patients. Thirty-one cases of CNS tuberculosis (8.6% of all pediatric patients with tuberculosis) were reviewed. Three patients had tuberculomas, 23 had meningitis, and five had both. Cranial nerve involvement, basilar meningitis, and hydrocephalus were common clinical and radiographic findings. Sixty-eight percent had been examined by a physician in the preceding month, and 13% had been hospitalized. Symptoms related to tuberculosis averaged 17 days before admission. For 15 patients (47%) there was no initial family history of tuberculosis, but an adult with tuberculosis was discovered after the child's symptoms became evident. Tuberculosis had been diagnosed in an adult in close contact with nine of the patients (38%) before the child became ill. Eight of these adult source cases already had been reported to the health department, and more rapid examination of contacts may have prevented meningeal tuberculosis in the child. The diagnosis of CNS tuberculosis should be considered in all children with neurologic signs and symptoms of, and risk factors for, tuberculosis.