Urinary schistosomiasis-associated morbidity in schoolchildren detected with urine albumin-to-creatinine ratio (UACR) reagent strips

ObjectiveTo evaluate urine albumin-to-creatinine ratio (UACR) reagent strips for detection of urinary tract pathology (UTP) associated with urinary schistosomiasis in schoolchildren from Zanzibar.Patients and methodsSixty-six schoolchildren were examined for urinary schistosomiasis and UTP using urine reagent strips (Hemastix^®), urine microscopy and portable ultrasonography. The UACR was estimated using Microalbustix^®; univariate and logistic regression methods were used to test for statistical associations.ResultsPrevalence of egg-patent schistosomiasis was 65.2% while 77.3% had micro-haematuria and 66.1% had a least one ultrasound-identified UTP. Abnormal UACR (≥3.4 mg/mmol) was frequent (88.4%) but an unsatisfactory identifier of UTP, albeit highly sensitive: sensitivity (SS) = 100.0%, specificity (SP) = 23.8%, positive predictive value (PPV) = 71.9%, negative predictive value (NPV) = 100.0%. When only severely abnormal UACR was considered (≥33.9 mg/mmol), SS decreased while SP improved: SS = 58.5%, SP = 61.9%, PPV = 75.0%, NPV = 43.3%.ConclusionAbnormal and severely abnormal UACRs were strongly associated with egg-patent urinary schistosomiasis and UTP, although via different mechanisms: respectively, from venous blood released directly into the urine from bladder wall perforations, and from leaching sera released from chronic egg-induced lesions throughout the urinary tract. From a control perspective, Microalbustix^® reagent strips are therefore best applied in pre-screening protocols allowing selection, or rather confident exclusion, of schoolchildren with urinary schistosomiasis for more detailed investigations.     

Diagnosis and treatment of bacterial meningitis

This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.     

Aseptic meningitis: Diagnosis and management

The term aseptic meningitis encompasses all types of inflammations of the brain meninges other than that caused by pus producing organisms. It is usually a benign illness. Etiology of aseptic meningitis is very wide and includes many infections—both viral and non viral, drugs, malignancy and systemic illness. The most common cause is viral infection and enteroviruses—Coxsackie and ECHO viruses account for more than half of all cases. Clinical manifestations include headache, fever, malaise, photophobia and meningeal signs. Convulsions, neurological deficits and severe obtundation are rare except with certain non viral infectious meningitis. Diagnostic work up includes blood and cerebrospinal fluid (CSF) examination and serology for infectious meningitis. The polymerase chain reaction is a rapid and accurate method for detection of microbial DNA in CSF. Treatment is mainly supportive except for the nonviral infectious etiology.     

Diagnosis and treatment of bacterial meningitis.

This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.     

儿童隐球菌脑膜炎临床探讨

目的：介绍儿童隐球菌脑膜炎在临床诊断和治疗方面的体会,分析诊断线索及影响疗效的因素。方法：回顾性分析6例确诊为隐球菌脑膜炎患儿的诊治经过,并进行分析和评价。结果：6例患儿中2例死亡,３例治愈,1例留有后遗症。菌体计数显示1例治愈者6周内菌体计数从1 410个/mm3转为正常,而留有后遗症者3个月内菌体计数波动于150/mm3。结论：联合用药优于单药治疗,疗效与诊断早晚、药物承受能力有关;二性霉素B脂质体较二性霉素B有更好的耐受性和临床疗效;鞘内注射是行之有效且安全的治疗方法之一;菌体计数对预后的提示意义值得关注。     

School-based control of urinary schistosomiasis on Zanzibar, Tanzania: monitoring micro-haematuria with reagent strips as a rapid urological assessment

ObjectiveTo evaluate micro-haematuria, detected by Haemastix^® reagent strips, for diagnosis of urinary schistosomiasis during a 3-year period of school-based control on Zanzibar.Patients and methodsA sub-set of school children, from a total of 135,000 who were receiving treatment for urinary schistosomiasis and soil-transmitted helminthiasis, were monitored by parasitological and questionnaire methods for Schistosoma haematobium infections: at treatment baseline in 2004 (n = 2002), follow up with re-treatment in 2005 (n = 3278) and further follow up with re-treatment in 2006 (n = 3993). Standard diagnostic scores for micro-haematuria were calculated against parasitological assessment.ResultsDiagnostic scores of Haemastix^® remained strong throughout the 3-year period. In 2006, scores were: sensitivity (SS) = 0.86 (95% CI: 0.86–0.88), specificity (SP) = 0.99 (0.98–1.00), positive predictive value (PPV) = 0.90 (0.88–0.91), negative predictive value (NPV) = 0.98 (0.98–0.99) in boys; and SS = 0.84 (0.82–0.86), SP = 0.98 (0.98–0.99), PPV = 0.77 (0.75–0.79) and NPV = 0.99 (0.99–1.00) in girls. By comparison, reported blood in urine and pain upon urination were much lower and not as informative.ConclusionAt a cost of approximately £0.20/test, further use of reagent strips for monitoring of urinary schistosomiasis during ongoing control programmes should be advocated as a rapid, cost-effective and informative disease surveillance tool.     

Diagnosis and outcome of acute bacterial meningitis in early childhood

OBJECTIVE: To estimate frequency of acute bacterial meningitis (ABM) in early childhood in hospital admissions, to describe clinical and diagnostic features, and to analyze mortality, complications and long term sequelae. DESIGN: Prospective study. SETTING: Pediatric wards and Rehabilitation Center of KEM Hospital, Pune. METHOD: Study subjects between the ages of 1 months to 5 years with ABM were recruited. Clinical details were recorded. CSF was analysed by routine biochemical methods, antigen detection tests (Latex agglutination LAT) and microbiological studies on special media. Management was as per standard protocols. Survivors were followed up long term with neurodevelopmental studies and rehabilitation programmes. RESULTS: In a study period of 2 years, 54 children (1.5% of all admissions) satisfied the criteria of ABM in early childhood; 78% were below one year and 52% were under the age of six months. Chief presentation was high fever, refusal of feeds, altered sensorium and seizures. Meningeal signs were present in only 26%. CSF C-reactive protein was positive in 41%, gram stain was positive in 67% LAT in 78% and cultures grew causative organisms in 50% of the cases. The final etiological diagnosis (as per LAT and/or cultures) were Streptococcus pneumoniae 39% Hemophilus influenzae type b 26% and others in 35% The others included one case of Neisseria meningitidis and 10 who were LAT negative and culture sterile. 39% patients developed acute neurological complications during the hospital course. 31% children with ABM died in hospital or at home soon after discharge. Six were lost to follow up. Of the 31 children, available for long term follow up (1-3 years), 14 (45%) had no sequelae. The remaining had significant neurodevelopmental handicaps ranging from isolated hearing loss to severe mental retardation with multiple disabilities. CONCLUSION: ABM in early childhood has a considerable mortality, morbidity and serious long term sequelae. Neurodevelopmental follow up and therapy should begin early. Etiological diagnosis can be enhanced by LAT and good culture media. H. influenzae b and S. pneumoniae account for more than 60% of ABM in early childhood.     

The inaccuracy of venous and capillary blood glucose measurement using reagent strips in the newborn period and the effect of haematocrit

The purpose of this study was to compare the accuracy of capillary and venous reagent strip tests (RST) against a reference plasma glucose method, and to assess the impact of haematocrit. One hundred and eighty infants admitted to the Neonatal Unit had blood glucose measured by reagent strip tests using capillary and venous blood samples. Venous plasma glucose was assayed by the Hexokinase method. Each infant had a venous haematocrit performed in the Neonatal Unit. Comparable inaccuracies were noted with both capillary and venous reagent strip tests at all levels. The mean difference between capillary RST and plasma glucose was 0.058 mmol/l (S.D. 1.39). The corresponding mean venous RST plasma glucose difference was 0.138 mmol/l (S.D. 0.96). The two means were statistically different from each other (P = 0.024), but this difference disappeared if the comparison was made only in babies with a PCV of 35-55%. At higher haematocrits (PCV >55%, N= 96) the mean difference between venous RST and plasma glucose was significantly more than the mean difference between capillary RST and plasma glucose (0.018 versus 0.295. P = 0.002). Hence the higher the haematocrit the more inaccurate the venous RST. This study confirms the limited value of reagent strip tests in the assessment of blood glucose in the neonatal period. It suggests that venous RST may be more inaccurate in comparison to capillary and that high haematocrits have a greater effect on venous RST than capillary RST.     

Intussusception associated with bacterial meningitis

Despite its common association with viral illnesses, intussusception has only rarely been found in the presence of bacterial infections. Two infants are described, both of whom were admitted to hospital with bilious vomiting, drowsiness, and dehydration. Both infants required urgent intravenous volume expansion. Intussusception was confirmed, and reduction was achieved by enema in both cases. Recovery was slow, and one infant developed a seizure. Evidence of meningococcal meningitis was found in both, with septicaemia in one. Neurological outcome is normal to date, and there has been no recurrence of intussusception in either case.     

Diagnosis of tuberculous meningitis by detection of antigen and antibodies in CSF and sera

OBJECTIVE: To evaluate diagnostic potential of three immunological tests, namely, detection of H37Rv antigen of M. Tuberculosis in CSF, detection of antibodies (IgG) against H37Rv in CSF and detection of antibodies (IgG) against H37Rv in serum for diagnosis of tuberculous meningitis in children. SUBJECTS: 50 children diagnosed as patients of tuberculous meningitis were included as cases and 48 children with CNS diseases of nontubercular etiology [pyogenic meningitis (n = 31), encephalitis (n = 10), seizure disorder of unknown etiology (n = 5), brain tumor (n = 2)] served as controls. METHODS: H37Rv antigen of M. tuberculosis was detected in CSF by Dot ELISA, and antibodies (IgG) against H37Rv in CSF and serum were detected by Plate ELISA. RESULTS: Detection of H37Rv antigen in CSF was the most sensitive (90%) and specific (95.83%) with positive and negative predictive values of 95.74% and 90.19%, respectively, followed by detection of antibodies in CSF (sensitivity-74%, specificity-89.58%, positive predictive value-88.10%, negative predictive value-76.78%). Detection of antibodies in serum had low sensitivity (50%), specificity (91.67%), positive predictive value (86.21%) and negative predictive value (63.76%). CONCLUSIONS: Detection of antigen in CSF is a rapid, sensitive and specific test for diagnosis of tuberculous meningitis in children. Detection of antibody in CSF may be useful in some cases but needs further evaluation. Detection of antibody in serum does not appear to be useful for diagnosis of tuberculous meningitis.     

Treatment of pneumococcal meningitis with dexamethasone

Our aim was two compare two different dexamethasone administration schedules in pneumococcal meningitis: short course (48h) and long course (96h) treatment. We diagnosed 18 pneumococcal meningitis treated with the two different schedules. We found a statistically significant longer duration of primary fever in patients who received dexamethasone for two days. We found no differences in the appearance of secondary fever, or in the development of severe neurological handicaps, or death between the two groups. We conclude that they are no significant differences between the two treatment schedules and that there is a need for developing early prognostic markers and adjuvant therapies that improve the outcome of patients with pneumococcal meningitis.     

Bacterial meningitis concurrent with salicylism

Repetitive administration of therapeutic salicylate over 72 hours for amelioration of headache produced severe central nervous system manifestations in an adolescent. The simultaneous occurrence of bacterial meningitis was not promptly diagnosed. Treatment directed at correcting fluid and metabolic derangements of salicylism may have contributed to a morbid outcome.     

Acanthameba meningitis with successful outcome

We report a rare cause of sub acute meningitis in a 15-yr-old immunocompetent female child with successful outcome. The etiological agent was Acanthameba. The child was sucessfully treat with combination of Ketoconazole. Rifampicin, cotrimoxa zole and for a period of 9 month.     

Association of meningitis with infantile gastro-enteritis

It is the policy at the Jordan University Hospital to perform lumbar puncture on children with gastroenteritis who present with one or more of the following: age less than 1 month, convulsions, hypoactivity or marked irritability, and depressed sensorium. Review of the records of 737 children admitted with gastro-enteritis between January 1980 and October 1984 showed that lumbar puncture was performed on 351 (47.6%) children. Acute bacterial meningitis was diagnosed in only three children, two of whom had already received treatment before admission and the third had obvious meningeal signs. These findings do not justify the present policy on lumbar puncture in children with gastroenteritis and it is proposed that the procedure be reserved for children in whom abnormal CNS findings persist after initial correction of fluid and electrolyte balance or with overt signs of meningitis.