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Biomedical subjects

C Y Chong

Publications and source records attributed to C Y Chong.

At least 19 recordsLinked to original sources
PubMed2006

Ecthyma gangrenosum: a manifestation of Pseudomonas sepsis in three paediatric patients.

Pseudomonas aeruginosa sepsis rarely occurs in healthy children. In immunocompromised children, it usually carries a high mortality rate. Ecthyma gangrenosum is a known cutaneous manifestation of Pseudomonas septicaemia. Three paediatric cases of Pseudomonas aeruginosa septicaemia with ecthyma gangrenosum were retrospectively reviewed. The three patients were aged seven years, seven months, and five months, respectively. An underlying disease of hypogammaglobulinaemia was present in the oldest patient. Blood cultures grew Pseudomonas aeruginosa in all three patients. All underwent repeated wound debridement and received intravenous ceftazidime and an aminoglycoside for a minimum of two weeks. One needed colostomy and subsequent posterior sagittal anorectoplasty as a result of complete obliteration of the anal canal from the ecthyma. There was no mortality. In conclusion, Pseudomonas aeruginosa sepsis should be treated early. Recognition of ecthyma gangrenosum as a manifestation of this problem can allow early institution of the appropriate antibiotics before culture results.

Agammaglobulinemia↗
PubMed2004

Pelviureteric junction obstruction as sequelae of Kawasaki disease.

We present a 7-year-old boy who was admitted with a history of cough for a week, neck pain with associated swelling for 4 days, fever, and vague periumbilical pain. He was diagnosed with Kawasaki disease, and subsequently developed vasculitis of the ureter and stricture of the ureteric lumen at the level of the pelviureteric junction.

Child↗
PubMed2004

Varicella screening and vaccination for healthcare workers at KK Women's and Children's Hospital.

INTRODUCTION: Varicella is a highly contagious disease with significant morbidity and mortality, especially in adults. It can lead to nosocomial transmission with dire consequences, especially in a healthcare facility where children and pregnant women form the majority of patients. At KK Women's and Children's Hospital, we embarked on a programme in 2 phases, between 1997 and 1999, to screen healthcare workers (HCWs) for varicella immunity and to offer varicella vaccination to those who tested negative for antibody. MATERIALS AND METHODS: HCWs were initially screened via a questionnaire; those with no previous history of chickenpox underwent a blood test for varicella zoster antibody. Varicella vaccine was offered to those who tested negative for antibody and they were monitored for adverse reactions. RESULTS: Of the HCWs surveyed, 14.7% and 26.9% in phases 1 and 2, respectively, had no previous history of chickenpox. Of these, 55.3% in phase 1 and 26.1% in phase 2 tested negative for antibodies. Thus, the overall seronegativity of all HCWs surveyed was between 6.5% and 7.6%. Among those who tested negative for antibodies, 42.9% in phase 1 and 74% in phase 2 were vaccinated. Hence, the overall vaccination rate in HCWs was 3.2% and 4.8% in phases 1 and 2, respectively. Adverse reactions were observed in 2 (22.2%) HCWs in phase 1 and in 9 (9.3%) in phase 2, consisting mostly of maculopapular rashes or vesicles around the injection site. CONCLUSIONS: Our study shows that 26% to 55% of HCWs with no history of chickenpox and who tested negative for antibody against varicella required vaccination. Hence, in healthcare facilities, varicella screening and vaccination should be offered to all HCWs.

Adult↗
PubMed2003

Treatment of urinary tract infection with gentamicin once or three times daily.

AIM: To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI). METHODS: This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment. RESULTS: 210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence. CONCLUSION: OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.

Adolescent↗
PubMed2003

Clinical characteristics of an outbreak of hand, foot and mouth disease in Singapore.

BACKGROUND: We experienced a hand, foot and mouth disease (HFMD) outbreak in late year 2000 in Singapore. Between 14 September 2000 and 14 November 2000, a total of 3526 cases of HFMD were notified. There were 652 patients clinically suspected to have HFMD, who were seen at the Children's Emergency department of KK Women's and Children's Hospital of Singapore. OBJECTIVE OF THE STUDY: To study the clinical profile and virologic isolates of children admitted with HFMD during the outbreak. STUDY DESIGN: A prospective observational study. METHODS: Analysis of clinical features and virologic studies of 129 selected cases of HFMD and herpangina. RESULTS: The median age was 25 months with a range of between 4 months and 11 years. The majority were less than 5 years old (87%). The male-to-female ratio was 1.3:1. The median numbers of day of illness to presentation to the hospital was 3 days. Poor feeding and loss of appetite accounted for 76.7% of the admissions. Symptoms of vomiting were present in 37.2% of the cases. Oral ulcers were found in 96.1%, rashes over hands in 87.6%, over feet in 86.8% and over buttocks in 54.3%. Only 4.7% exhibited no rashes other than oral ulcers and were labelled as herpangina. The median duration of fever was 3 days, ranging from 2 to 7 days. An intravenous drip was required in 68.2% due to poor feeding. Viral cultures were sent in 89.1% of patients of whom 61.7% of patients were positive for viruses. Of the positive cultures, types of viruses isolated were EV71 (enterovirus 71) in 59/71 (83%), Coxsackievirus (A16, A24, A2 B3, B4) in 6/71 (8.4%), EV Untypable in 4/71 (5.6%) and mixed [EV71, echo25, cytomegalovirus (CMV)] in 2/71 (2.8%). EV71 was isolated mostly from stool samples followed by vesicle fluid culture and throat swabs. Two siblings aged 14 months and 2.5 years died during this period at day 5 of illness, their post-mortem examinations showed interstitial pneumonitis of the lungs. EV71 was isolated from the brain, heart, tonsils, intestines, throat and rectal swabs. A raised total white cell count of 14,000/L versus 12,000/L was significantly associated with complicated HFMD (P = 0.04). There was no difference in clinical characteristics of EV71 versus non-EV71 infections. Other viral illnesses, e.g. measles and CMV, may be mistaken for HFMD in the outbreak setting. CONCLUSIONS: HFMD tends to occur in younger children less than 5 years old due to low herd immunity. Poor feeding due to mouth ulcers accounts for admission to hospital requiring intravenous drip. EV71 accounted for the majority (75%) of the positive isolations, followed by coxsackievirus and untypable EV, mixed infection of echovirus or CMV. The yield of virus isolation was highest from stool, followed by vesicles and throat swabs. There is no difference in clinical characteristics of EV71 and non-EV71 virus infections. Enterovirus can cause mild symptoms to fatal death. Two infants died of interstitial pneumonitis and encephalitis.

Child↗
PubMed2003

Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases.

AIM: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD-related deaths and after the epidemic, another three HFMD-related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. METHODS: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n = 7) and non-fatal controls (n = 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n = 4) and non-fatal controls (n = 63) were also compared. RESULTS: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non-fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right-sided pneumonia, Haemophilus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin-related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p = 0.0006), raised total white cell count (p = 0.0128), vomiting (p = 0.0116) and absence of mouth ulcers (p = 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis. CONCLUSION: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.

Child↗
PubMed2001

Prevention of human immunodeficiency virus (HIV) transmission from mother to child--a cohort study in Singapore.

INTRODUCTION: The landmark Paediatric AIDS Clinical Trials Group (PACTG) trial 076 showed in 1994 that antiretroviral therapy (ART) was effective in reducing maternal-child transmission of human immunodeficiency virus (HIV). This trial included antenatal oral zidovudine (ZDV), intrapartum intravenous ZDV, 6 weeks of oral ZDV to the babies and no breastfeeding. MATERIALS AND METHODS: This study is an on-going, prospective, open-label trial conducted from 1995 in which we enrolled HIV-infected pregnant women using the above strategy. Since 1997, the antenatal component of the regimen was modified to include lamivudine with ZDV. All babies had serial HIV polymerase chain reaction (PCR) and antibody tests including enzyme-linked immunosorbent assay (EIA), particle agglutination (PA) and Western blot (WB) at day 1, 1 week, 1, 2, 3, 6, 12 and 18 months. RESULTS: A total of 16 out of 19 eligible women were recruited from 1995 to 1999. The median age was 26 years (range 22 to 38 years), 38% were Singaporeans, median CD4 was 421 cells/mL (range 18 to 713 cells/mL) and median baseline gestational age was 23.5 weeks (range 8 to 32 weeks). None of the 16 children was infected as evidenced by 2 negative HIV PCRs including 1 done > 4 months old with a follow-up of 6 months to 2 years. There was a statistically significant difference between the 3 HIV antibody tests at 12 months of age (P = 0.003), there being more negative results with WB as compared to PA (P = 0.02). However, the difference between the 3 tests at 18 months was not statistically significant. No long-term side effects in these children were seen. CONCLUSION: Although the number of patients in this study is small, the absolute prevention of transmission (95% confidence intervals 0%-17%) in this cohort supports the recommendation of antenatal HIV screening and treatment of those infected.

Adult↗
PubMed2000

Salmonella typhimurium: a rare cause of colonic ulceration and perforation in infancy.

A rare case of a healthy infant with colonic ulcers caused by Salmonella typhimurium infection that presented with colonic perforation, hypovolemic, and septicemic shock is discussed. It stresses the importance of considering an infective process such as salmonellosis in the differential diagnosis of colonic ulceration in an infant and illustrates the unique histologic finding of colonic inflammatory changes with sparing of the small intestine.

Colonic Diseases↗
PubMed1999

Hydatidiform mole in Kandang Kerbau Hospital--a 5-year review.

BACKGROUND: This is a 5-year review of hydatidiform mole in a major maternity hospital. PATIENTS: A total of 75 patients were studied, with 35 cases of complete hydatidiform mole and 40 cases of partial hydatidiform mole. RESULTS: The annual incidence of hydatidiform mole was between 1 in 1,601 deliveries and 1 in 721 deliveries. The racial distribution was higher among the Malay and Indian population. Pre-operative diagnosis was made in 53.3% of the cases. Per vaginal bleeding was the main presenting complaint in 89.3% of cases. All patients were treated with vacuum aspiration. All patients with partial hydatidiform mole had spontaneous remission after vacuum aspiration. Three patients with complete mole required chemotherapy. Methotrexate was used. There was a significant number of patients who did not practise contraception in the initial remission period after vacuum aspiration. CONCLUSION: Education of these patients is necessary. Prognosis of patients with hydatidiform mole is good with proper follow-up. Setting up of a National Trophoblastic Centre is recommended.

Adolescent↗
PubMed1998

Lack of acceptance of guidelines for prevention of disseminated Mycobacterium avium complex infection in infants and children infected with human immunodeficiency virus.

BACKGROUND: Disseminated Mycobacterium avium complex (DMAC) infection occurs in HIV-infected children and adults with advanced immunosuppression. Prophylactic therapy has been shown to prevent this infection in adults with low CD4 cell counts. The United States Public Health Service and the Infectious Disease Society of America recently published guidelines (USPHS/CDC guidelines) for the prevention of opportunistic infections, including DMAC infection, in children and adults with HI infection. These guidelines incorporate age-specific CD4 counts at which DMAC prophylaxis should be used. OBJECTIVES: To determine (1) the extent to which the USPHS/CDC guidelines are being followed and (2) current practices for the prevention and management of DMAC infection in HIV-infected children. METHODS: A questionnaire was sent to 65 centers that specialize in the care of HIV-infected children. RESULTS: Forty-one of 65 centers responded to the questionnaire. A strikingly low rate of adherence to age-specific criteria for DMAC prophylaxis was found for the age groups < 1 year and 1 to 2 years (34 and 39%, respectively), in contrast to good adherence for the age groups 2 to 6 years (80%) and >6 years (93%) (<0.0001). Reasons for lack of adherence to the guidelines included a perception of low risk of DMAC in the youngest age groups and difficulty administering additional medications to these patients. The survey also documented substantial variability in DMAC prophylactic and treatment regimens and in susceptibility testing of M. avium complex isolates.

AIDS-Related Opportunistic Infections↗
PubMed1998

Complicated varicella zoster infection in 8 paediatric patients and review of literature.

BACKGROUND: This is a study of complicated varicella zoster infection in paediatric patients. AIM: To find out the number of patients with such complications, the types of complications and their outcome. METHOD: This involved a retrospective review of the case records of 8 patients who presented to our unit over a 12-month period (Jan-Dec 96). All patients were previously well without any underlying immunodeficiency. Varicella zoster (VZ) infection was confirmed by VZ immunofluorescence from vesicular fluid. RESULTS: CMS complications accounted for 6 of the 8 cases. Of these, 3 presented with encephalitis, 2 with cerebella ataxia and 1 with aseptic meningitis and cerebella ataxia. Of the non-CNS cases, 1 presented with glomerulonephritis with superimposed staphylococcus infection of skin ulcers; the other had disseminated VZ infection with haemorrhagic vesicles, hepatitis, ileus with mesenteric adenitis and disseminated intravascular coagulation. OUTCOME: The patient with disseminated VZ infection and multiple organ involvement died 5 days after a stormy course. One patient with encephalitis who had status epilepticus for 2 hours had behavioural problems and poor memory. The remaining 6 patients had no sequelae. CONCLUSION: VZ infection usually a minor illness, can result in serious life-threatening complications in previously healthy patients.

Cerebellar Ataxia↗
PubMed1998

Infections in acute lymphoblastic leukaemia.

We did a retrospective study of all acute lymphoblastic leukaemia (ALL) patients on United Kingdom ALL protocol who were admitted for febrile neutropenia. The aim of the study was to document the types of infections and aetiological agents associated with febrile neutropenia and to document the factors affecting mortality. Over the 8 1/2-year period from 1986 to June 1995, there were 77 episodes in 32 children with a mean of 2.4 episodes. Morbidity due to infection was 61%; unknown causes of fever contributed 39%. Of the microbiologically documented infections, majority were Gram-negative bacteraemia. There were 7 deaths (22%) during the study period, 3 (9%) of which were due to overwhelming sepsis, with 4 contributed by the relapse status of the leukaemia. Mortality was increased by prolonged neutropenia, relapse of the leukaemia and invasive fungal infection.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

The changing trend in the pattern of infective etiologies in childhood acute lower respiratory tract infection.

The etiologic agents causing acute lower respiratory tract infection (LRTI) in hospitalized children were compared for 1995 and 1988. Between May 1994 to April 1995, 397 children were admitted to Tan Tock Seng Hospital for acute LRTI compared to 240 children in 1988. The following criteria for LRTI were used: (i) age less than 12 years with a community-acquired LRTI; (ii) presence of cough or fever of less than 2 weeks' duration; and (iii) presence of tachypnea, chest retractions or pulmonary infiltrates on chest X-ray. Sputum cultures were considered suitable for culture if there were less than 25 epithelial cells per low power field. Moraxella catarrhalis was considered only if heavy growth of more than 3+ was seen. Etiological agents were found in about 70% of patients in both studies. Viruses constituted 41.3% of the etiologic agents in 1995 but constituted only 28% in 1988; 36% had a bacterial etiology in 1995 compared to 15% in 1988. The most common bacteria in 1995 was M. catarrhalis (34.7%) followed by non-type B Haemophilus influenzae (33%). In contrast, in 1988, Mycoplasma (33%) was the predominant organism followed by H. influenzae (17%) and M. catarrhalis (11.4%). The increased incidence of M. catarrhalis could be due to antibiotic selection. A mixed viral-bacterial etiology was found in 12.3% of the 1995 cohort. The majority of the bacteria were positive by sputum cultures; only 4 (3.3%) had positive blood cultures. No penicillin resistance was detected in 1988; however, in 1995, penicillin resistance was found in 17% of the Streptococcus pneumoniae, 38.5% of H. influenzae and 83% of M. catarrhalis. It was also found that 30% of the S. pneumoniae were also resistant to erythromycin, and 23% were resistant to sulfamethoxaxole-trimethoprim; 5% of the H. influenzae had multiple resistance to erythromycin, sulfamethoxazole-trimethoprim and chloramphenicol. Among those patients with antibiotic resistance, 30% had received prior antibiotics of which 18% had had two or more antibiotics, frequently erythromycin or amoxycillin/ampicillin. Judicious use of antibiotics is required to check the rising trend of antibiotic resistance.

Child↗
PubMed1997

Case report and review of Chromobacterium sepsis--a gram-negative sepsis mimicking melioidosis.

Chromobacterium violaceum has recently been recognised as a pathogen which can cause life-threatening disease. It is the only Chromobacterium species which is pathogenic to humans. Due to its unfamiliarity, clinicians often do not appreciate its importance when it is isolated in sterile cultures and may dismiss it as a "containment". It is therefore important for us to be aware of this infection and its clinical spectrum since it is a disease of the tropics. We report a paediatric case of documented Chromobacterium sepsis in Singapore who presented like septicaemic melioidosis associated with diminished T-cell numbers. A review of both fatal and non-fatal Chromobacterium, infections is also included.

Child↗
PubMed1996

Childhood fever.

Childhood fever is a common symptom, reflective of multiple causes. As the child is often unable to express himself, the physician must rely on parents' observations and the physical examination. The majority of febrile children have non-bacterial upper respiratory tract infection and indiscriminate use of antibiotics is inappropriate, ineffective and leads to drug-resistance such as the emergence of Penicillin-resistant Streptococcus pneumoniae. In this article, we attempt to identify the possible causes of fever by a simple approach using the presence or absence of associated or localising symptoms. Infants less than 3 months constitute a unique group as the fever may be related to perinatal events and as serious bacterial infections can still occur despite unremarkable physical findings. Management of fever needs to take into account the toxicity, immune status and age of the patients as well as the source of the infection. Zealous overprescription of antipyretics needs to be avoided with attention directed to the cause of the fever, the child's capacity to cope with the illness and parental education.

Analgesics, Non-Narcotic↗