Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris

Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation. Management and Outcome: Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi. Discussion: Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Wilms' Tumour in a Child with Horse Shoe Kidney seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto- A Case Report

Background- Occurrence of Wilms' tumour in patients with horseshoe kidney is an unusual presentation, with incidence being higher than in the general population. Hence, it can lead to diagnostic and management challenges.Objective- To report a case of Wilms' tumour that occurred in a child with horse shoe kidney in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Case report- UA an 18 month old boy presented with a six weeks history of progressive painless abdominal swelling. Abdominal examination revealed a huge right sided abdominal mass extending from the hypochrondium to the iliac fossa. Ultrasound revealed a huge heterogenous mass occupying the right hemi-abdomen extending from the right hypochondrium to pelvis. It crossed the midline to the contralateral side with multiple cystic portions and calcifications. The right kidney was not demonstrated while the left kidney was normal. Computed tomography (CT) scan showed a huge heterogeneously enhancing isodense mass occupying most part of the right lumbar region extending to the pelvis and crossing the midline. The mass was continuous with normal renal parenchyma on the inferomedial aspect consistent with Wilms' tumour. The inferior poles of both kidneys were merged in the midline in keeping with horse shoe kidney. Chemotherapy was commenced however he deterioratedand died after 2 courses.Conclusion- Wilms' tumour can occasionally occur in a child with horse shoe kidney. Hence, patients with horseshoe kidney should therefore be closely monitored for the possibility of co-existing Wilms' tumour.Key words- Horse shoe kidneys, Wilms' tumour, Child, diagnostic challenge

Nationwide survey of the availability and affordability of asthma and COPD medicines in Nigeria

Objective(s): To determine the availability and affordability of asthma and COPD medicines across Nigeria