Neonatal astrovirus gastroenteritis during an inborn nursery outbreak.
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Astroviridae Infections↗
Biomedical subjects
S Sirinavin
Publications and source records attributed to S Sirinavin.
Systemic nontyphoidal Salmonella infection in normal infants in Thailand.
BACKGROUND: The relative paucity of information about systemic nontyphoidal Salmonella (NTS) infection in infants without an underlying disease prompted this study. METHODS: Infants without an underlying disease, who had positive cultures for NTS from their normally sterile sites during 1978 through 1998, were included. Their medical records were reviewed. RESULTS: The study included 75 eligible infants; 68 (91%) had positive blood cultures. The spectrum of disease included transient bacteremia (5), bacteremia without localized infection (37), bone and joint infection (5) and meningitis (28); 53 and 88% of infants were < or =3 and < or =6 months old, respectively. All infants with localized infection were < or =7 months old, and infants with meningitis were 3.35+/-1.87 (mean +/- SD) months old. In bacteremic infants risks for localized infection and meningitis were 30 and 24%, respectively. Abnormal neurologic findings were the only predictor for meningitis. Relapse of meningitis occurred in two infants despite treatment with cefotaxime for 4 and 6 weeks. Severe neurologic deficit occurred in 21% of infants with meningitis. Of 11 infants with meningitis who received early treatment at this tertiary care center, 1 died but none had severe neurologic deficits; whereas of 17 referred cases, 2 died and 6 had severe neurologic abnormalities. No death occurred in infants without meningitis. CONCLUSION: Systemic NTS infection in normal infants has a variable disease spectrum. Infants 0 to 6 months of age are at high risk for localized infection, especially meningitis.
Age Distribution↗
Antibiotics for treating salmonella gut infections.
BACKGROUND: Antibiotic treatment of salmonella infections aims to shorten illness and prevent serious complications. There are also concerns about increasing antibiotic drug resistance. OBJECTIVES: The objective of this review was to assess the effects of antibiotics in adults and children with diarrhoea who have salmonella. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Science Citation Index, African Index Medicus, Lilacs, Extra Med and reference lists of relevant articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing antibiotic therapy with placebo or no antibiotic therapy for salmonella infections in symptomatic or asymptomatic adults or children. Typhoid and paratyphoid salmonella infections were excluded. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data were extracted independently by two reviewers. MAIN RESULTS: Twelve trials involving 778 participants (with at least 258 infants and children) were included. There were no significant differences in length of illness, diarrhoea or fever between any antibiotic regimen and placebo. The weighted mean difference for length of illness was -0.07 days, 95% confidence interval -0.55 to 0.40; diarrhoea -0.03 days, 95% confidence interval -0.53 to 0.48; fever -0.45 days, 95% confidence interval -0. 98 to 0.08. Antibiotic regimens resulted in more negative cultures during the first week of treatment. Relapses were more frequent in those receiving antibiotics, and there were more cases with positive cultures in the antibiotic groups after three weeks. Adverse drug reactions were more common in the antibiotic groups (odds ratio 1.67, 95% confidence interval 1.05 to 2.67). REVIEWER'S CONCLUSIONS: There appears to be no evidence of a clinical benefit of antibiotic therapy in otherwise healthy children and adults with non-severe salmonella diarrhoea. Antibiotics appear to increase adverse effects and they also tend to prolong salmonella detection in stools.
Adult↗
Semiquantitative human immunodeficiency virus antibody tests in diagnosis of vertical infection.
OBJECTIVE: This study evaluated the roles of semiquantitative anti-HIV antibody tests for early diagnosis of vertical HIV-1 infection in infants. METHODS: The study included 0- to 18-month-old children of HIV-1-infected mothers. They were regularly followed up, and blood was obtained for semiquantitative anti-HIV tests using a particle agglutination (PA) test and a microparticle enzyme immunoassay (MEIA). RESULTS: One hundred forty-six children of HIV-1-infected mothers, including 104 infected and 42 uninfected infants, were studied. Using anti-HIV titer of < or = 1:100 by PA and optical values of < or = -3 by MEIA for diagnosis of not being infected, approximately 69 and 53% of the uninfected cases at age 7 to 8 months, 76 and 67% at age 9 months and 100% at age 12 months could be diagnosed. By comparison with the diagnosis by qualitative tests the figures were 16%, 8 and 11%, 70 and 74% at the same ages. All asymptomatic HIV-infected cases had persistently high PA titers and MEIA values of at least 1:5000 and 6, respectively, but 7 cases with AIDS-related manifestation at the time of tests had low anti-HIV titers. One severely ill, HIV-infected infant had a transient negative anti-HIV test at the age of 7 months. Two asymptomatic infected children, who had been breast-fed, had transient decrease in anti-HIV titers after the age of 6 months, and transient seroreversion occurred in one. CONCLUSION. Semiquantitative anti-HIV tests between the age of 6 to 12 months were very useful in diagnosis of HIV-1 infection in infants born of HIV-1-infected mothers. Interpretation must be accompanied by information about AIDS-related manifestation and history of breast-feeding.
AIDS Serodiagnosis↗
Clinical and prognostic categorization of extraintestinal nontyphoidal Salmonella infections in infants and children.
The study included 172 patients, aged 0-15 years, for whom at least 1 nonfecal, nonurinary specimen was culture-positive for nontyphoidal Salmonella. Ninety-five percent had positive blood cultures. Immunocompromising diseases were found in 19% of 74 infants and 77% of 98 children. Associations between the study factors and outcomes, as localized infection or death, were assessed by logistic regression analysis. Thirty-three patients had localized infections. An adjusted risk factor for development of localized infections was an age of <12 months (P=.003). There were 17 deaths. The case-fatality rates were 43% and 10% for immunocompromised and 5% and 0% for nonimmunocompromised infants and children, respectively. Adjusted risk factors for death were age of <12 months (P=.006), inappropriate antimicrobial therapy (P=.014), meningitis or culture-proven pneumonia due to nontyphoidal Salmonella (P=.004), and immunocompromised status (P<.001). The clinical courses and prognoses for infants and children with extraintestinal infection due to nontyphoidal Salmonella can be categorized into 4 groups according to the characteristics of age (infants vs. children) and host status (immunocompromised vs. nonimmunocompromised).
Adolescent↗
Disseminated intravascular coagulation findings in 100 patients.
A retrospective study of 100 patients with disseminated intravascular coagulation from 1993 to 1997 is reported. Forty-five patients were neonates with a mean age of 12.6 days and 55 patients were infants, children and adolescents with a mean age of 6 years and 3 months. Most of them (91.5%) had complicated underlying conditions which included congenital anomalies, prematurity, malignancy, hematological and various diseases. Additionally, every patient had triggering conditions commonly identified as gram-negative septicemia. Bleeding and thromboembolic manifestations were found in 59.4 per cent and 19.8 per cent, respectively. The laboratory findings revealed red blood cell fragmentation, 89.6 per cent and thrombocytopenia, 85.8 per cent. Natural anticoagulants were studied in a few cases and revealed low levels of antithrombin III and protein C. The prompt effective management included treatment of underlying diseases, identification and relief of triggering conditions, correction of thrombocytopenia and coagulopathy, and fully supportive care. The overall case-fatality rate was 41.6 per cent which was not correlated with age, underlying diseases, triggering conditions, manifestation of bleeding, thromboembolism or shock, and exchange transfusion. However, a significant lower case-fatality rate was found in patients with positive culture (25%) as compared to those with sepsis and negative culture (51.7%) (p = 0.044). In addition, the febrile neutropenic patients, who showed good response to the administrated granulocyte-colony stimulating factor (G-CSF), survived from the DIC.
Adolescent↗
Maternal and umbilical cord serum zidovudine levels in human immunodeficiency virus infection.
The aim of this study was to determine the maternal and umbilical cord serum ZDV levels at delivery in HIV-1 infected parturients treated with a short-course ZDV regimens in late pregnancy and labour. Serum ZDV and its metabolite were measured by high-performance liquid chromatography. Concentrations of ZDV and its metabolite in umbilical cord blood appeared similar to maternal concentrations. There was a significant positive correlation between serum ZDV and its metabolite in maternal and umbilical cord concentrations. At delivery, maintenance of optimal virustatic ZDV concentration with oral antenatal and oral intermittent intrapartum ZDV dosage regimen can be achieved in only 53% of cases. The regimens used in this study were useful but not as effective as the ACTG 076 regimen with an intravenous dose intrapartum plus the oral administration to the infants for 6 weeks.
Adult↗
Effect of antibiotic order form guiding rational use of expensive drugs on cost containment.
New injectable antimicrobial agents are generally costly and broad-spectrum. Overusage results in unnecessary economic loss and multi-drug resistant organisms. Effective strategies for decreasing costs without compromising patient care are required. This study aimed to evaluate the economic impact of a system using an antimicrobial order form to assist rational usage of expensive antimicrobial agents. The study was performed during 1988-1996 at a 900-bed, tertiary-care, medical school hospital in Bangkok. The target drugs were 3 costly, broad-spectrum antibacterial drugs, namely imipenem, vancomycin, and injectable ciprofloxacin. The restriction of these 3 drugs was started in 1992 and was extended to netilmicin and ceftazidime in 1995. A filled antimicrobial order form (AOF) was required by pharmacists before dispensing the drugs. The AOF guided the physicians to give explicit information about anatomic diagnosis, etiologic diagnosis, and suspected antimicrobial resistance patterns of the organisms. It also contained information about indications of the restricted drugs. The filled forms were audited daily during working days by the chairman of The Hospital Antibiotic Committee. Feedback was given to the prescribers by infectious disease specialists at least twice a week. The strategy was endorsed by the executive committee of the hospital. Impact of AOF without endorsement, audit and feedback, was evaluated in 1996. The expenditures of the drugs were adjusted to the average admitted patient-days per fiscal year of the study period. The system with endorsement was well accepted and could be maintained for 4 years. The adjusted expenditures per year of the 3 restricted antibiotics were 1.41-1.87 million baht less (22-29%) in 1992-1994 than the pre-intervention year 1991. The cost reduction of imipenem and injectable ciprofloxacin could also be maintained for 1995 but not vancomycin for which use increased. The costs of these 3 restricted drugs increased very sharply (69%) in 1996 when there was loss of endorsement and capacity to perform auditing and feed back by infectious disease specialists. The system did not work with ceftazidime which was commonly used for febrile neutropenia and nosocomial infections.
Anti-Bacterial Agents↗
Effect of zidovudine treatment in late pregnancy on HIV-1 in utero transmission.
In Thailand, the prevalence of paediatric HIV-1 infection has increased rapidly through vertical transmission. According to the ACTG 076 trial regimen, zidovudine treatment in HIV-infected pregnancy can reduce vertical transmission. However, this treatment is complex and costly. It is not applicable for developing countries. We conducted a study to evaluate the effect of zidovudine treatment in late pregnancy on HIV-1 in utero transmission. Fifty cases of asymptomatic HIV-1 infected-women were voluntarily enrolled to the study. Zidovudine 250 mg orally twice a day was given to these patients from gestational age 36 weeks until labour. The newborns were evaluated at birth by a neonatologist and peripheral blood was tested for HIV genome by PCR technique within 48 hours of birth. The study revealed that no HIV genome was detected from the peripheral blood of newborns. It is suggested that zidovudine treatment in late pregnancy could reduce HIV-1 in utero transmission.
AIDS Serodiagnosis↗
Randomized controlled trial of dexamethasone in infectious croup.
Infectious croup is a common and an important cause of upper airway obstruction in young children. Despite its frequency and potentially serious nature, there is still no definite conclusion regarding the beneficial effect of corticosteroid. A randomized controlled study on the effects of dexamethasone in infectious croup was conducted at the Department of Pediatrics, Ramathibodi Hospital between January 1985 and September 1986. Thirty-two patients, 2-37 months old, were included in this study. Fourteen patients received dexamethasone (0.5 mg/kg/dose daily for 3 days) and eighteen patients were the control group. The dexamethasone group had significantly lower croup scores at 48 hour (p < 0.05), shorter hospital course (p < 0.005) and lower incidence of endotracheal intubation (p < 0.05) than the control group. Five patients in the control group required endotracheal intubation. Complications included four episodes of pneumonia, one episode of sepsis, and one bacterial tracheitis. Pneumonia and sepsis occurred only in the control group. We concluded that dexamethasone therapy decrease the severity of infectious croup and the risk of complications.
Airway Obstruction↗
Naegleria meningomyeloencephalitis.
A case of primary amebic meningoencephalitis (PAM) with severe spinal cord involvement was documented in a 12 year-old boy from Samut Prakan Province, Thailand. This is the first reported case of Naegleria meningomyeloencephalitis in Thailand. He had a history of swimming in the canal nearby his house prior to the fever, headache and convulsion which rapidly progressed into a comatose state. PAM was only detected at post-mortem. The findings included suppurative exudates and necrosis of the olfactory bulbs and the basal parts of the frontal, temporal lobes, pons, cerebellum, medulla and the spinal cord. Numerous Naegleria trophozoites were present in the brain and spinal cord. Foci of neuronal degeneration and demyelination were noted.
Amebiasis↗
Transfusion-transmitted AIDS with blood negative for anti-HIV and HIV-antigen.
A four-year-old boy who was diagnosed with Glanzmann's thrombasthenia received supportive treatment and desmopressin for his bleeding episodes. He seldom received blood components, except for platelet concentrates, due to severe bleeding. He was exposed to 18 routine donors and 2 plateletpheresis donors who were negative for human immunodeficiency virus (HIV) antigen and anti-HIV upon screening. At the age of 3 years and 9 months (4.5 months after the transfusion of platelet concentrate), he developed full-blown AIDS and died from circulatory failure 3 months later. The source of HIV transmission was identified as I donor who developed anti-HIV 3 months after the last donation. The rather short incubation time of AIDS in this case was attributed to a large inoculum of HIV virus in the 'window period' of infectivity of the newly infected donor. This case illustrates transfusion-transmitted HIV leading to AIDS, even though HIV antigen and anti-HIV screening tests were negative.
Acquired Immunodeficiency Syndrome↗
Routine voluntary antenatal anti-HIV screening in Bangkok, Thailand.
The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for AZT administration to the seroconverted pregnant women for reduction of perinatal transmission. 4. There should be available the appropriate back up services for seropositive pregnant women such as: (i) C--Choice. Having been appropriately counselled the pregnant women should be able to terminate or continue with the pregnancy. (ii) H--High-risk pregnancy concept. The pregnant women should be treated as high-risk cases. Throughout their pregnancy and delivery only experienced personnel should manage them. (iii) I--Integrated services. From our experience it would be reasonable to integrate the care of seropositive pregnant women with any other high-risk cases. Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.
Adolescent↗
Disseminated Burkitt's lymphoma in a child with AIDS.
Rarity of HIV-associated disseminated lymphomas in children initiated this report. The patient was an 18-month-old girl who had a history of chronic cervical lymphadenopathy since 6 months of age. She was first seen because of rapid enlargement of an inguinal lymphnode. The bone marrow aspirate was compatible with Burkitt's lymphoma, L3 cell-type. She was treated with chemotherapy without satisfactory success. She developed neurological involvement of lymphoma. Accidental sharp injury which contaminated her blood, in a medical personnel leaded to having her blood tested for anti-HIV and it was found positive. Her mother had positive anti-HIV presumably acquired from blood transfusion after an abortion in early 1988. It occurred before the donated blood was compulsively tested for anti-HIV. She died at the age of 24 months.
Burkitt Lymphoma↗
Hepatopathy-thrombocytopenia vs infection-induced hemophagocytic syndrome in Wilms' tumor: a case report.
A 3-year-old boy with Wilms' tumor, post operative left nephrectomy stage, had HTS on day 99 of the combined chemotherapy which lasted for more than 20 days. He had severe respiratory distress due to a moderate amount of ascites and marked pleural effusion. Because of high fever, thrombocytopenia and marked hemphagocytosis in the bone marrow, he received IVIG for 2 days. Normal platelet count and markedly decreased pleural fluid were attained within 3 days. He subsequently tolerated full doses of combined chemotherapeutic agents with an additional one (doxorubicin). In cases of HTS, IAHS should be suspected. The bone marrow should be done and treatment accordingly so that there is no need to decrease, the dosage of chemotherapeutic agents afterwards.
Child, Preschool↗
An unusual case of listeria meningitis.
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Child↗
An outbreak of Salmonella urbana infection in neonatal nurseries.
An outbreak of neonatal infection with Salmonella urbana in three neonatal wards of a teaching hospital in Bangkok, Thailand is described. The outbreak lasted for 5 days. Fifty-seven neonates had gastrointestinal infection, 37 had diarrhoea, and three had bacteraemia. The attack rates were 43% for infection, 29% for diarrhoea, and 2.3% for bacteraemia. Epidemiological evaluation suggested that a contaminated wash basin in the labour nursery was the source of infection. Delay in controlling this outbreak occurred because the staff assumed that person-to-person transmission was the mode of spread, thus ignoring epidemiological data that would have led to the identification of the source of infection.
Cross Infection↗
Protective efficacy of neonatal Bacillus Calmette-Guérin vaccination against tuberculosis.
This matched case-control study was performed in two hospitals in Bangkok to evaluate the protective efficacy of neonatal Bacillus Calmette-Guérin (BCG) vaccination in Thai children and to find factors that might explain the reported variation in estimates of the protective efficacy of BCG. Cases were defined as children 3 months to 14 years of age who had tuberculosis and controls consisted of one to four children who were born in the same year and had the same district of residence as the case. A matched analysis with a variable number of controls per case was performed on 75 cases and 207 controls. Conditional logistic regression was performed to adjust for the potential confounding effects of household tuberculosis exposure and socioeconomic status. Forty-eight percent of cases had nonrespiratory tuberculosis. Laboratory-confirmed evidence for tuberculosis was found in 48% of cases. The adjusted protective efficacy of neonatal BCG vaccination was 83% (95% confidence limits, 35%, 96%). It was 96% (95% confidence limits, 66%, 100%) when only 36 matched sets of laboratory-confirmed cases were analyzed. Subgroup analyses and literature reviews indicated that the accuracy of tuberculosis diagnosis, types of tuberculosis, duration after vaccination and household tuberculosis exposure contribute to variation in the reported protective efficacy of neonatal BCG vaccination.
Adolescent↗