Salmonella enteritidis ventriculitis

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis

Extra cellular volume imaging of left ventricular walls in children with congenital heart diseases and impaired ventricular function

Background/Hypothesis: In children with congenital heart diseases, myocardial fibrosis is a possible long term complication with impairment of left ventricular function. Extra-Cellular Volume (ECV) imaging of left ventricular (LV) walls using Cardiac Magnetic Resonance Imaging (CMR) offers early detection of fibrosis before late gadolineum enhancement (LGE) changes are seen. Aim of the study was to determine ECV of a cohort of children with congenital heart diseases and any association with their left ventricular function. Materials and Methods: 19 children with congenital cardiac conditions who had undergone CMR from March to December 2016 at Birmingham Children’s Hospital UK were included in the study. All subjects underwent CMR (Siemens Avanto 1.5 T scanner) to assess LV function, measurement of ECV on T1- mapping (MOLLI sequence) and standard late gadolinium enhancement (LGE) imaging. ECV values were determined from 5 different LV wall segments on short axis images (inter-ventricular septum, anterior, antero-lateral, inferio-lateral, inferior segments). Results: 4 children (age 10.9 ±3.9 years old) had impaired LV ejection fraction (44.5±6.0%) and increased LV end diastolic volume indexed (82.2± 14.5 ml.m2). One of the children had LGE changes seen on the inter-ventricular septum. ECV parameters of the inter-ventricular septum were higher in children with impaired LV function (38.6±7.0% vs 30.0±3.5%, p= 0.002). No significant difference were found in the ECV of LV free walls (32.2± 5.2% vs 28.7 ±5.7%, p =0.279). Conclusions: ECV technique has promising possibility in detection of myocardial fibrosis in children with impaired LV function, similar as adult studies. In those with poor LV function, there is a strong possibility that area of fibrosis is in the inter-ventricular septum. However, normal ECV parameters will need to be determined first in children before comparing with those with cardiac illnesses

Traditional Jones criteria: limitation in the diagnosis of rheumatic fever in patients with mitral valve repair

The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheumatic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta hemolytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and administration of secondary prophylaxis to prevent progression to severe valvular disease

Reversible posterior leukoencephalopathy syndrome in post streptococcal glomerulonephritis

Reversible Posterior Leukoencephalopathy syndrome (RPLS) is a uncommon neurological disorder among pediatric population. Clinical features started with decreased alertness and activity, and associated with headache, visual changes, altered mental status such as seizures, confusion and abnormal behavior. Radio imaging findings commonly present typical changes in the white matter located in the posterior regions of the cerebral hemisphere and cerebellum. This syndrome commonly associated with hypertension, ecclampsia, renal failure or the used of some immunosuppression medications especially cyclosporine and tacrolimus. We describe a previously healthy 9-year-old boy who presented with acute post-streptococcal glomerulonephritis, and he developed neurological symptoms of posterior leukoencephalopathy syndrome with hypertensive crisis. His CT scan shows typical changes of non enhancing white matter with hypodensities at the occipital and parietal temporal areas. He had a rapid resolution of neurological symptoms with adequate treatment of hypertension. He was discharged well after 14 days in the ward