Acute poisoning in a paediatric intensive care unit in Harare

A CAJM clinical report on acute poisoning of infants studied at a hospital children ward in Harare, Zimbabwe.Forty two cases of acute poisoning were studied retrospectively over a two year period (1990 to 1991, inclusive) in the paediatric Intensive Care Unit (ICU), at Parirenyatwa Hospital in Harare. This formed 8,6 pc of the total admissions into the unit over the same period. The four commonest types of poisons were organophosphates, 38,1 pc; paraffin, 26,2 pc; traditional medicines (muti), 14,3 pc and miscellaneous drugs, such as chloroquine, aspirin, chloropromazine, diazepam and gama-benzene, 9,5 pc. The results suggest poor living conditions, local beliefs, customs and ignorance of the dangers of chemicals, as the risk factors associated with acute poisoning. Eighty eight pc of all admissions were children below the age of five years. The mortality rate in this series was 21 pc. Compared to the overall mortality rate of all ICU admissions of 30,9 pc over the same period, death due to acute poisoning was 1,8 pc of all ICU deaths

Antibiotic use in infants hospitalised with HIV-related pneumonia in Harare, Zimbabwe

A CAJM journal article.Objective: To describe the clinical features of infants admitted with HIV-related pneumonia and to describe antibiotic use in relation to recommended treatment guidelines. Design: Case series. Setting: Paediatric medical wards of two University Teaching Hospitals, Parirenyatwa and Harare Central Hospitals. Subjects: 100 infants aged one to 12 months admitted with HIV-related pneumonia Main Outcome Measures: Mortality and antibiotic use in the two hospitals. Methods: Records of 100 infants admitted for 48 hours or more with features of HIV-related pneumonia were analysed for clinical features and antibiotic use. Results: 77% of patients were in the first six months of life with a peak age of two months and a median of four months (Q1 = 2, Q3 = 6). The median age of children admitted to Parirenyatwa hospital was 5.5 months (Q1 = 3, Q3 =7) and in Harare hospital it was three months (Q1 = 2, Q3 = 6). The difference was statistically significant, p=0.035. Fifty four percent of cases received penicillin, aminoglycoside and cotrimoxazole and overall only 30% of prescriptions complied with Essential Drug List of Zimbabwe (EDLIZ) recommendations for treatment of severe pneumonia in children with HIV infection. The overall mortality was 27.0%. The mortality in Harare Central Hospital was 40.4% and 15.7% in Parirenyatwa. The difference was statistically significant p= 0.005. Conclusion: The difficulties in establishing the cause of the pneumonia in infants with HIV infection was a contributory factor to lack of adherence to standard treatment guidelines. In countries with a high prevalence of HIV infection and with limited resources, a clinical case definition for Pneumocystis carinii pneumonia (PCP) is required as a measure to provide treatment for infants with HIV related pneumonia which is evidence based. This approach will also promote rational antibiotic prescribing and will contain cost

Rhabdomyosarcoma of the orbit in a four months old infant in Zimbabwe: a case report

Rhabdomyosacoma, as a medical condition, observed in a four month old infant at a Zimbabwe hospital.Infants younger than one year of age with Rhabdomyosacoma appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome.. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Call is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma

Giant pyogenic granuloma of the thigh: a case report

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T-helper 1 versus T-helper 2 lymphocyte immunodysregulation is the central factor in genesis of Burkitt lymphoma: hypothesis

<p>Abstract</p> <p>Background</p> <p>The HIV epidemic has challenged our previous understanding of endemic Burkitt's lymphoma. Despite the strong association of Burkitt's lymphoma and HIV infection in the Developed world, and against previous postulations that the cancer is due to immunosupression among African children, the HIV epidemic in the Malaria belt has not been associated with a corresponding increase in incidence of childhood Burkitt's lymphoma. Even outside the context of HIV infection, there is substantial evidence for a strong but skewed immune response towards a TH2 response in genesis of Burkitt lymphoma.</p> <p>Presentation of the hypothesis</p> <p>Rather than a global and/or profound immunosupression, the final common pathway in genesis of Burkitt's lymphoma is the dysregulation of the immune response towards a TH2 response dominated by B-lymphocytes, and the concomitant suppression of the TH1 cell-mediated immune surveillance, driven by various viral/parasitic/bacterial infections.</p> <p>Testing the hypothesis</p> <p>Case control studies comparing TH2 and TH1 immune responses in Burkitt lymphoma of different etiological types (sporadic, HIV-related, endemic and post-transplant) to demonstrate significant dominance of TH2 immune response in presence of poor CMI response as a common factor. Immunological profiling to evaluate differences between immune states that are associated (such as recurrent Malaria infection) and those that are not associated (such as severe protein-energy malnutrition) with Burkitt lymphoma. Prospective cohorts profiling chronology of immunological events leading to Burkitt lymphoma in children with EBV infection.</p> <p>Implications of the hypothesis</p> <p>The dysregulation of the immune response may be the missing link in our understanding of Burkitt lymphomagenesis. This will provide possibilities for determination of risk and for control of development of malignancy in individuals/populations exposed to the relevant infections.</p

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

<p>Abstract</p> <p>Background</p> <p>Immunodeficient persons with persistent vaccine-related poliovirus infection may serve as a potential reservoir for reintroduction of polioviruses after wild poliovirus eradication, posing a risk of their further circulation in inadequately immunized populations.</p> <p>Methods</p> <p>To estimate the potential for vaccine-related poliovirus persistence among HIV-infected persons, we studied poliovirus excretion following vaccination among children at an orphanage in Kenya. For 12 months after national immunization days, we collected serial stool specimens from orphanage residents aged <5 years at enrollment and recorded their HIV status and demographic, clinical, immunological, and immunization data. To detect and characterize isolated polioviruses and non-polio enteroviruses (NPEV), we used viral culture, typing and intratypic differentiation of isolates by PCR, ELISA, and nucleic acid sequencing. Long-term persistence was defined as shedding for ≥ 6 months.</p> <p>Results</p> <p>Twenty-four children (15 HIV-infected, 9 HIV-uninfected) were enrolled, and 255 specimens (170 from HIV-infected, 85 from HIV-uninfected) were collected. All HIV-infected children had mildly or moderately symptomatic HIV-disease and moderate-to-severe immunosuppression. Fifteen participants shed vaccine-related polioviruses, and 22 shed NPEV at some point during the study period. Of 46 poliovirus-positive specimens, 31 were from HIV-infected, and 15 from HIV-uninfected children. No participant shed polioviruses for ≥ 6 months. Genomic sequencing of poliovirus isolates did not reveal any genetic evidence of long-term shedding. There was no long-term shedding of NPEV.</p> <p>Conclusion</p> <p>The results indicate that mildly to moderately symptomatic HIV-infected children retain the ability to clear enteroviruses, including vaccine-related poliovirus. Larger studies are needed to confirm and generalize these findings.</p

Rhabdomyosarcoma of the orbit in a four months old infant in Zimbabwe: A case report

Infants younger than one year of age with RhabdomyosarcTJmrr'appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome.. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Cal 1 is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma