Cardiac findings in children admitted to a hospital general ward in South Africa: a comparison of HIV-infected and uninfected children.

The aim of this prospective observational study was to determine the presence of cardiac abnormalities in HIV infected versus uninfected children who were admitted to a general paediatric ward during a two-month period. HIV status was determined by antibody and p24 antigen testing. Clinical information, echocardiography and electrocardiography (ECG) were performed for all children. There were 90 HIV-infected and 118 uninfected children. The median age was 9.6 and 11.8 months for infected and uninfected children, respectively. Baseline left ventricular dysfunction, defined as a shortening fraction < or = 25%, was found in 13 (17%) of the HIV-infected children compared to 5 (8%) uninfected children (p < 0.05). Left ventricular end-diastolic enlargement above the 98th percentile for age was found in 24% of the infected and 20% of uninfected children. Pericardial effusions, although common, were sub-clinical and not different in the groups. ECG findings and resting heart rates were also similar. Left ventricular dysfunction was the most significant cardiac abnormality present in hospitalised HIV-infected children. Other abnormalities, although common, were mostly asymptomatic and found with the same frequency in uninfected children. Further studies are indicated.

Calvarial tuberculosis.

Tuberculosis of the skull is very rare. We report on two children: one presented with orbital and scalp swellings and was found to have lytic lesions on skull X-ray, while the other presented with chronic discharging scalp ulcers typical of tuberculosis of the scalp and also showed lytic skull lesions. Both patients had evidence of vertebral and lung tuberculosis.

The effect of tuberculous meningitis on the cognitive and motor development of children.

OBJECTIVE: To evaluate and compare the different degrees of cognitive and motor impairment of children surviving tuberculous meningitis (TBM), with a view to establishing areas amenable to remedial intervention. DESIGN: Neurodevelopmental testing of a previously reported cohort, performed 1-7 years after completion of 9-12 months of treatment of TBM. SETTING: Bloemfontein and environs. PARTICIPANTS: A total of 19 subjects out of a possible 25 (76%) in a geographically accessible area. MAIN OUTCOME MEASURES: Cognitive and fine and gross motor development. RESULTS: Cognitive and motor development were scored and expressed as percentages of those expected for normal children of similar age and background. The median cognitive development was 66.9% (95% confidence intervals (CIs) 59.1-73.2). The degree of impairment was similar for all 10 cognitive areas tested, ranging from 61.8% to 70.4%. The median fine motor development score was 68.6% (95% CIs 54.7-81.5). The median gross motor function score was 51.2% (95% CIs 36.4-77.1). Comparison of impairment between stage 2 and stage 3 disease showed median differences of 28.7% (95% CI 2.7-55.1) (P = 0.02) for cognitive function, 21.6% (95% CI -9.9-54.1) (P = 0.15) for fine motor function, and 35.2% (95% CI 14.2-59.6) (P = 0.01) for gross motor function. No TBM relapses had occurred. CONCLUSIONS: Our findings show the occurrence of marked generalised impairment of cognitive and motor development following TBM, with no specific areas amenable to early remedial intervention. Shortened treatment regimens of 9-12 months were effective, but prevention of TBM remains the priority.

Primary amoebic meningo-encephalitis in southern Africa.

A fatal childhood case of confirmed primary amoebic meningo-encephalitis due to Naegleria fowleri is reported. This appears to be the first such case identified in southern Africa. The diagnosis and management of this unusual and lethal infection is discussed and attention is drawn to the possible danger of swimming in contaminated warm water.

The epidemiology and outcome of childhood tuberculous meningitis. The Pelonomi Hospital experience.

A prospective study was undertaken to determine the epidemiology and outcome of tuberculous meningitis in children admitted to hospital in Bloemfontein, OFS. Over a 5-year period 75 patients were studied, and 78% of them were less than 5 years of age. The largest group of patients came from rural areas. The annual incidence in the 0-14-year-old group for the City of Bloemfontein was estimated at 3,6/100,000. Most patients were in an advanced stage of illness at the start of therapy and the mortality rate was 18%. Of those patients who survived, 26% had severe neurological sequelae. The incidence of tuberculous meningitis can be decreased by improving primary health care facilities in certain areas of the OFS.