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Delane Shingadia

Publications and source records attributed to Delane Shingadia.

15 recordsLinked to original sources
PubMed2007

UK malaria treatment guidelines.

Malaria is the tropical disease most commonly imported into the UK, with 1500-2000 cases reported each year, and 10-20 deaths. Approximately three-quarters of reported malaria cases in the UK are caused by Plasmodium falciparum, which is capable of invading a high proportion of red blood cells and rapidly leading to severe or life-threatening multi-organ disease. Most non-falciparum malaria cases are caused by Plasmodium vivax; a few cases are caused by the other two species of Plasmodium: Plasmodium ovale or Plasmodium malariae. Mixed infections with more than 1 species of parasite can occur; they commonly involve P. falciparum with the attendant risks of severe malaria. Management of malaria depends on awareness of the diagnosis and on performing the correct diagnostic tests: the diagnosis cannot be excluded until 3 blood specimens have been examined by an experienced microscopist. There are no typical clinical features of malaria, even fever is not invariably present. The optimum diagnostic procedure is examination of thick and thin blood films by an expert to detect and speciate the malarial parasites; P. falciparum malaria can be diagnosed almost as accurately using rapid diagnostic tests (RDTs) which detect plasmodial antigens or enzymes, although RDTs for other Plasmodium species are not as reliable. The treatment of choice for non-falciparum malaria is a 3-day course of oral chloroquine, to which only a limited proportion of P. vivax strains have gained resistance. Dormant parasites (hypnozoites) persist in the liver after treatment of P. vivax or P. ovale infection: the only currently effective drug for eradication of hypnozoites is primaquine. This must be avoided or given with caution under expert supervision in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), in whom it may cause severe haemolysis. Uncomplicated P. falciparum malaria can be treated orally with quinine, atovaquone plus proguanil (Malarone) or co-artemether (Riamet); quinine is highly effective but poorly tolerated in prolonged dosage and is always supplemented by additional treatment, usually with oral doxycycline. ALL patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h, since patients can deteriorate suddenly, especially early in the course of treatment. Severe falciparum malaria, or infections complicated by a relatively high parasite count (more than 2% of red blood cells parasitized), should be treated with intravenous therapy until the patient is well enough to continue with oral treatment. In the UK, the treatment of choice for severe or complicated malaria is currently an infusion of intravenous quinine. This may exacerbate hypoglycaemia that can occur in malaria; patients treated with intravenous quinine therefore require careful monitoring. Intravenous artesunate reduces high parasite loads more rapidly than quinine and is more effective in treating severe malaria in selected situations. It can also be used in patients with contra-indications to quinine. Intravenous artesunate is unlicensed in the EU. Assistance in obtaining artesunate may be sought from specialist tropical medicine centres, on consultation, for named patients. Patients with severe or complicated malaria should be managed in a high dependency or intensive care environment. They may require haemodynamic support and management of acute respiratory distress syndrome, disseminated intravascular coagulation, renal impairment/failure, seizures, and severe intercurrent infections including gram-negative bacteraemia/septicaemia. Falciparum malaria in pregnancy is more likely to be severe and complicated: the placenta contains high levels of parasites. Stillbirth or early delivery may occur and diagnosis can be difficult if parasites are concentrated in the placenta and scanty in the blood. The treatment of choice for falciparum malaria in pregnancy is quinine; doxycycline is contraindicated in pregnancy but clindamycin can be substituted for it, and is equally effective. Primaquine (for eradication of P. vivax or P. ovale hypnozoites) is contraindicated in pregnancy; after treatment for these infections a pregnant woman should take weekly chloroquine prophylaxis until after delivery when hypnozoite eradication can be considered. Children are over-represented in the incidence of malaria in the UK, probably because completely susceptible UK-born children accompany their overseas-born parents on visits to family and friends in endemic areas. Malaria in children (and sometimes in adults) may present with misleading symptoms such as gastrointestinal features, sore throat or lower respiratory complaints; the diagnosis must always be sought in a feverish or very sick child who has visited malaria-endemic areas. Children can be treated with most of the antimalarial regimens which are effective in adults, with appropriate dosage adjustment. Doxycycline plus quinine should not be given to children under 12 years as doxycycline is contraindicated in this age group, but clindamycin can be substituted for doxycycline, and pyrimethamine-sulfadoxine (Fansidar) may also be an effective substitute. An acute attack of malaria does not confer protection from future attacks: individuals who have had malaria should take effective anti-mosquito precautions and chemoprophylaxis during future visits to endemic areas.

Adolescent↗
PubMed2006

Multiple needle-stick injuries with risk of human immunodeficiency virus exposure in a primary school.

Twenty children received needle-stick injuries with a risk of exposure to human immunodeficiency virus type 1 during an incident in a primary school playground. All were counseled and offered human immunodeficiency virus postexposure prophylaxis. All 20 children started postexposure prophylaxis, and 19 attended for follow-up testing 3 months later. More than one-half of the children completed the full 4-week course of treatment. None of the 19 children tested seroconverted after the incident.

Adult↗
PubMed2005

Adenovirus infection after pediatric bone marrow transplantation: is treatment always necessary?

BACKGROUND: Adenovirus infections are associated with significant rates of morbidity and mortality among children after bone marrow transplantation (BMT). Many transplantation units use molecular virological methods, such as polymerase chain reaction (PCR), for surveillance for adenovirus infection and give preemptive antiviral therapy to children with evidence of disseminated adenovirus infection. This treatment strategy has never been evaluated in clinical trials. METHODS: We retrospectively tested blood samples obtained from a cohort of children who had undergone BMT before the introduction of regular weekly surveillance for adenovirus infection. A total of 273 samples collected from 26 patients between May 1998 and June 2002 were tested for adenovirus infection by quantitative PCR. Virus load was quantified for each sample yielding positive test results, and the clinical notes and virological records of each child were reviewed. RESULTS: Evidence of adenovirus infection was found in 11 children (42%), 7 of whom had not previously had positive test results. Receipt of T cell-depleted transplants was associated with a significantly higher incidence of adenovirus infection during the posttransplantation period. The 2 children who died from adenovirus disease developed infection within 2 weeks after transplantation, and both had very low absolute lymphocyte counts at the time of diagnosis. Seven of 11 children with blood samples that were found to be positive for adenovirus by PCR cleared the virus without antiviral therapy. CONCLUSIONS: Surveillance for adenovirus by PCR is better than symptomatic testing for detecting adenovirus infection. Antiviral therapy may not be necessary for all children who develop adenovirus viremia after BMT.

Adenoviridae↗
PubMed2005

BCG vaccine.

Explore the source record for details and available documents.

Animals↗
PubMed2005

Changes in laboratory features of 192 children with imported falciparum malaria treated with quinine.

Little is known about changes in laboratory values of children with imported falciparum malaria. Of 192 children, 69% had parasitemia of 2% or less and 64% had platelets <150 x 10/L. In 20%, parasite counts rose within 12-24 hours of starting treatment before falling, whereas the platelet counts dropped in 45% but returned to normal levels within 5 days. Hemoglobin values were <10 g/dL in 31% at presentation and dropped in 61% at 5-21 days after treatment, but did not fall below 6.8 g/dL in any case. Blood cultures were negative in all children. Hyponatremia (n = 16), jaundice (n = 4) and hypoglycemia (n = 0) were uncommon. Thus most children presented with abnormal laboratory values, which initially worsened in a significant proportion, but none required active intervention once therapy was initiated.

Adolescent↗
PubMed2004

Global epidemiology of paediatric tuberculosis.

Tuberculosis is one of the major infections affecting children worldwide. It causes significant morbidity and mortality, especially in infants and young children. Factors such as overcrowding, poverty and the HIV epidemic have all contributed to the resurgence of tuberculosis globally. The highest rates of tuberculosis occur in resource-poor countries and over the last decade case notifications in children have been increasing steadily, particularly in Sub-Saharan Africa. Mycobacterium tuberculosis infects millions of children worldwide every year, yet accurate information on the extent and distribution of disease in children is not available for most of the world. We describe some of the unique aspects of tuberculosis infection in children and review the epidemiology of disease in children worldwide.

Child↗
PubMed2004

Polymerase chain reaction in the management of disseminated adenovirus infection after stem cell transplantation.

We report a 20-month-old child with disseminated adenovirus infection after a haploidentical T cell-depleted stem cell transplantation. This case demonstrates the value of polymerase chain reaction surveillance for early detection of adenovirus infection and the role of quantitative polymerase chain reaction for monitoring antiviral therapy. It also emphasizes the importance of T cell immunity in controlling disseminated adenovirus infection after stem cell transplantation.

Adenovirus Infections, Human↗
PubMed2003

Adenovirus: an increasingly important pathogen in paediatric bone marrow transplant patients.

Adenovirus is increasingly being recognised as a significant pathogen in children following bone marrow transplantation. The virus is endemic in the general paediatric population, and frequently causes severe disease in immunocompromised patients, especially children. Immune responses to adenovirus infection are not fully understood but T-cell responses appear to be important for recovery. Infections can affect a variety of organs with gastrointestinal and urinary tract diseases being the most common. When disseminated infection occurs, reported mortality rates are as high as 60%. The responses to treatment in immunocompromised patients have generally been disappointing. New molecular diagnostic techniques have meant that adenoviral infections can now be detected early, often before symptoms have developed. Clinicians now screen for adenovirus infection to allow early initiation of treatment. It is hoped that this approach, together with effective antiviral therapy, will reduce the deaths from this common virus in high-risk children.

Adenoviridae↗
PubMed2003

Diagnosis and treatment of tuberculosis in children.

There has been a recent global resurgence of tuberculosis in both resource-limited and some resource-rich countries. Several factors have contributed to this resurgence, including HIV infection, overcrowding, and immigration. Childhood tuberculosis represents a sentinel event in the community suggesting recent transmission from an infectious adult. The diagnosis of tuberculosis in children is traditionally based on chest radiography, tuberculin skin testing, and mycobacterial staining/culture although these investigations may not always be positive in children with tuberculosis. Newer diagnostic methods, such as PCR and immune-based methods, are increasingly being used although they are not widely available and have a limited role in routine clinical practice. Diagnostic approaches have been developed for use in resource-limited settings; however, these diagnostic methods have not been standardised and few have been validated. Short-course, multidrug treatment has been adopted as standard therapy for adults and children with tuberculosis, with or without directly observed therapy. Compliance is a major determinant of the success of drug treatment. Although uncommon in children, multidrug-resistant tuberculosis is also increasing and treatment will often involve longer courses of therapy with second-line antituberculosis drugs. Treatment of latent infection and chemoprophylaxis of young household contacts is also recommended for tuberculosis prevention, although this may not always be carried out, particularly in high incidence areas.

Antimalarials↗
PubMed2003

Childhood malaria in East London.

OBJECTIVES: To describe the epidemiologic, clinical and laboratory features of children younger than 16 years with malaria in East London. METHODS: Retrospective case review of all children admitted to two East London hospitals with malaria identified between 1996 and 2001 with the use of notifications and hospital discharge data. RESULTS: A total of 211 children with a median age of 9 years (range, 11 to 179 months) were identified. Children living in the UK who acquired malaria while visiting a malaria-endemic country on holiday accounted for 82% of cases, whereas the rest were children visiting the UK from endemic areas. Three-fourths of children who had traveled to a malaria-endemic area were born in the UK, and 93% were of Black African ethnicity. The peak seasonal incidence was late summer/early autumn. Plasmodium falciparum acquired in Africa accounted for 91% of cases. Although 42% of children took antimalarial prophylaxis, only 15% of medications were taken according to recommended guidelines. Another family member, most often a sibling, was found to have concurrent malaria in 23% (49 of 211) of cases. On the basis of the WHO criteria, 15 children (7.1%) 15 months to 15 years of age had severe malaria, including convulsions (n = 4), acute renal failure (n = 3), jaundice (n = 4), severe anemia (n = 3) and >2% parasitemia (n = 6). CONCLUSIONS: The majority of children with malaria in this study were UK-born, school age, of Black African ethnicity and were visiting family in Africa, often with other family members. Most children had low level parasitemia and uncomplicated malaria, and they responded rapidly to antimalarial treatment.

Antimalarials↗
PubMed2002

Massive hepatosplenomegaly in a child with malaria.

Hypermalarial splenomegaly syndrome (HMS) usually occurs in adults living in malaria-endemic areas. A 7-year-old girl presented with a 7-week history of gradual distention of the abdomen and low grade fever, 8 months after traveling to Ghana, and was subsequently diagnosed with HMS. Presentation at such a young age after very brief exposure to a malaria-endemic area has not been described previously.

Age Factors↗