Extramembranous nephropathy in black South African children

Membranous nephropathy is the most frequent histological category among black children with nephrotic syndrome. In this study 31 African children with this condition are described. There were more boys than girls and the peak age was four to 11 years. The incidence of this histological category and clinical outcome in the African children were similar to these features in adults with membranous nephropathy. During a follow-up period of up to six years there was spontaneous remission in a third of patients, persistent proteinuria in just over a third (37.5%) and persistent relapse in under a third (29.2%). Hypertension occurred more frequently (19.3%) and spontaneous remission less often (33.3%) than in children with membranous nephropathy elsewhere. Hypertension, the lower remission rate and persistence of proteinuria during the course of the disease were similar to the disease seen in adults. Renal failure was not encountered in any patients. Steroids were of little value in the treatment of these children. Five children (16.2%) had associated infections. HBsAg was present in three of six children tested.     

Infective endocarditis in black South African children: report of 10 cases with some unusual features

Ten black South African children with infective endocarditis seen over a 2-year period are reported. In five cases, including two neonates, the infection was nosocomial and in five cases it occurred in children with previously normal hearts. Of the bacteria isolated from nine cases, five were Staphylococcus aureus (all from nosocomial cases), one was Haemophilus influenzae and three were corynebacteria. The unusual aspects of this series are discussed, with an emphasis on preventing nosocomial cases and on making the diagnosis in children without underlying heart disease.     

Bacteremia in hospitalized black South African children. A one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children

During a one-year period, 315 of 5,397 children admitted to the general pediatric wards of a hospital had bacteremia. The commonest causative organisms were Streptococcus pneumoniae, Salmonella enteritidis, Hemophilus influenzae, and Escherichia coli. Most episodes of bacteremia were associated with gastroenteritis, pneumonia, or meningitis. Seventy-eight episodes occurred in children with severe protein-energy malnutrition, and 46 episodes were hospital acquired. The overall case fatality rate was 23.2%, being highest in children with severe malnutrition and in those with other underlying conditions. The high proportion of bacteremias due to S pneumoniae and S enteritidis possibly reflects infections occurring in a lower socioeconomic group living in a temperate climate in crowded conditions. The most appropriate antimicrobial therapy for children who have suspected bacteremia in association with gastroenteritis or severe malnutrition is a combination of ampicillin sodium and gentamicin sulfate.     

Antibiotic-resistant pneumococcal disease in South African children.

OBJECTIVE--To determine the incidence of antibiotic-resistant pneumococcal disease and to compare the presentation and outcome of penicillin-resistant infections with penicillin-susceptible infections. DESIGN--Patient series. SETTING--General community hospital. PATIENTS--Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 children with penicillin-susceptible pneumococcal bacteremia or meningitis. SELECTION PROCEDURES--Consecutive patients admitted between 1989 and 1991. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--Forty percent of community-acquired isolates and 95% of hospital-acquired isolates were resistant to penicillin. Eighty-three (82%) of 101 penicillin-resistant infections were community acquired. Resistance to chloramphenicol, tetracycline, and erythromycin occurred in 9%, 12%, and 4% of all isolates, respectively. The proportion of penicillin-resistant pneumococci with cefotaxime minimum inhibitory concentrations greater than or equal to 0.5 micrograms/mL increased from 0% in a 1986 study to 21.5% in this study. The sites of infection, underlying diseases, and mortality of patients with penicillin-resistant infections outside the central nervous system did not differ significantly from those of penicillin-susceptible infections. CONCLUSIONS--The resistance of Streptococcus pneumoniae to beta-lactam antibiotics has increased alarmingly in South Africa. Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.     

Nutritional status and HIV in rural South African children

Background  

Achieving the Millennium Development Goals that aim to reduce malnutrition and child mortality depends in part on the ability of governments/policymakers to address nutritional status of children in general and those infected or affected by HIV/AIDS in particular. This study describes HIV prevalence in children, patterns of malnutrition by HIV status and determinants of nutritional status.     

医院儿童感染性肺炎

医院感染性肺炎 (nosocomialpneumonia ,NP)是指患者在住院 4 8h后所获得的肺实质炎症。其患病率占医院内感染的首位 ,达 3%～ 16 % ,病死率达 2 0 %～ 6 0 %。由于NP的高患病率、高病死率和高医疗资源消耗 ,已给社会经济发展带来沉重负担 ,并已成为临床上的突出问题。1　病原学及危险因素1 1　病原学　近年来随着医学科学的发展 ,侵入性诊疗操作、放疗、化疗的广泛应用导致患者免疫功能下降 ,由于抗菌药物的滥用 ,使医院感染性肺炎的病原菌趋向多重耐药株发展。其中 90 %以上为条件致病菌 ,且主要是革兰阴性菌 ,需氧杆菌占6 0 %以上。据…     

Chronic liver disease in black children in Durban, South Africa

In a prospective study of 130 South African black children with chronic liver disease, it was found that the aetiology differed from that reported from developed countries. The most common cause of chronic liver disease (CLD) was HBsAg (33 of 55 with cirrhosis and 24 of 28 with chronic active hepatitis) and Schistosoma mansoni infestation (41 children). Inherited, auto-immune, iatrogenic and cryptogenic disorders, which are the usual causes in the developed world, were less common. The majority of children seen in this series were in an asymptomatic compensated state in contrast to reports from some developed countries. It is concluded that because infection is a common cause of CLD in the Third World it may be preventable in many cases.     

Nosocomial infections in pediatric intensive care units

Nosocomial infections are a significant problem in pediatric intensive care units. While Indian estimates are not available, western PICUs report incidence of 6–8%. The common nosocomial infections in PICU are bloodstream infections (20–30% of all infections), lower respiratory tract infections (20–35%), and urinary tract infections (15–20%); there may be some differences in their incidence in different PICUs. The risk of nosocomial infections depends on the host characteristics, the number of interventions, invasive procedures, asepsis of techniques, the duration of stay in the PICU and inappropriate use of antimicrobials. Most often the child had endogenous flora, which may be altered because of hospitalization, are responsible for the infections. The common pathogens involved areStaphylococcus aureus, coagulase negativestaphylococci, E. coli Pseudomonas aeruginosa, Klebsiella, enterococci, andCandida. Nosocomial pneumonias predominantly occur in mechanically ventilated children. There is no consensus on the optimal approach for their diagnosis. Bloodstream infections are usually attributable to the use of central venous lines; use of TPN and use of femoral site for insertion increase the risk. Urinary tract infections occur mostly after catheterization and can lead to secondary bacteremia. The diagnostic criteria have been discussed in the review. With proper preventive strategies, the nosocomial infection rates can be reduced by up to 50%; handwashing, judicious use of interventions, and proper asepsis during procedures remain the most important practices.     

Nosocomial Gram-positive bacterial infections in children: Results of a 7 year study

BACKGROUND: The aim of the present paper was to determine the rate of culture-proven nosocomial infections and evaluate the episodes of nosocomial Gram-positive (GP) bacterial infections in pediatric patients. METHODS: The data of children with positive culture, who were diagnosed as having nosocomial infection on the Centers for Disease Control and Prevention criteria, were examined and only the patients with nosocomial GP bacterial infections were included in the study. RESULTS: Between January 1997 and January 2004 a total of 836 episodes of nosocomial GP bacterial infections were observed. The most frequently seen nosocomial GP bacterial infections were primary bloodstream infections (BSI; 43%), ventriculoperitoneal shunt infections (18%), and nosocomial pneumonias (11%). Coagulase-negative staphylococci (CONS; 46%) were the most common nosocomial GP bacteria isolated, followed by Staphylococcus aureus (33%). Methicillin resistance rates for CONS and S. aureus were 85% and 25.2%; respectively. The mortality rate was 4% of all children with nosocomial GP bacterial infections in the present study. CONCLUSION: In the present patients primary BSI were the most common nosocomial GP bacterial infections and CONS were the most frequent GP pathogen isolated. Antimicrobial resistance in GP isolates is an increasing problem.