Tuberculous cold abscess

A tubercular cold abscess secondary to adjoining bone involvement is a well-known entity. However, a primary cold abscess with no bony involvement in children is very rare. We present such a case.     

Renal abscess in infancy

Renal abscess is a rare occurrence in infancy. Its differentiation from an infected renal cyst may be difficult, especially if a perinephric abscess develops. This report illustrates a hitherto unrecorded unusual presentation of renal abscess as a tumour arising from the left lumbocostal region in an infant.     

Posterior perineal hernia presenting in infancy as a gluteal mass

Perineal hernias are extremely rare at any age but particularly in children. This case illustrates the presentation of a posterior perineal hernia in a newborn infant, with clinical presentation as a gluteal mass.     

Tuberculous splenic abscess in a neonate with thrombocytopenia

We present a case of a premature neonate who presented with anemia and persistent thrombocytopenia. The patient was ultimately diagnosed with disseminated tuberculosis. Initial sonographic evaluation of the abdomen revealed a heterogeneous but predominately hypoechoic spleen; there was subsequent evolution of a splenic abscess. The patient was treated medically with anti-tubercular drugs. Follow-up post-treatment sonograms of the spleen showed diminution of the abscess and the evolution of multiple calcifications compatible with calcified granulomas. This case is an unusual presentation of tuberculosis in an infant with splenic abscess associated with thrombocytopenia and anemia.     

Acute lacrimal abscess in infancy: a report of 22 cases

Twenty-two cases of acute lacrimal abscess in infancy seen between 1959 and 1976 have been presented. Twelve of them had more han one attack at the time of reporting to this hospital. Initial treatment of the condition was medical, utilizing local and systemic antibiotics. If this did not produce a prompt response, incision and drainage of the abscess was done. The cases showed a preponderance of infections by mixed organisms. In three cases, blocked lacrimal passages opened up spontaneously while on medical treatment. In the remaining 19 cases, probing in an attempt to remove the obstruction in the nasolacrimal duct was performed as soon as the acute inflammation was controlled. Reprobing was needed in nine cases. Only two cases eventually required surgery to achieve a cure. The study indicates that early probing is successful in a high percentage of cases of acute lacrimal abscess including those coming with recurrent attacks.     

Tuberculous meningitis in children

Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings. These data were discussed by means of literature knowledge. Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients. There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05). In addition, there was also a significant relationship between prognosis and HC (P < 0.05). However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).     

Tuberculous meningitis in children

Summary Ninety cases of tuberculous meningitis have been analysed with special reference to some prognostic factors such as the age of the patient, duration of symptoms before treatment, C.S.F. picture and type of treatment. 78·8 per cent. of cases were males and 84·4 per cent. below the age of 5 years. The peak incidence was below 3 years, 21·1 per cent. of cases occurring below the age of 1 year, the youngest patient being 4 months old. History of contact could be obtained in 27·78 per cent. of cases. X-Ray chest showed evidence of intrathoracic tuberculous foci in 74·4 per cent. of cases, with miliary lesions in 15·5 per cent., hilar lymphadenopathy in 33·3 per cent., bronchopneumonic infiltration in 21·1 per cent., fibrosis in 3·3 per cent. and thickened pleura in 1·1 per cent. of cases. Out of 90 cases, 35 expired, another 35 left the hospital in an unsatisfactory state, and only 20 cases recovered, giving a satisfactory response in 22·2 per cent. of cases. The combined figures for mortality and unsatisfactory results were 82·9 per cent., 77·2 per cent. and 64·3 per cent. between the age groups 0 to 2, 2 to 5 and above 5 years respectively. 84·2 per cent. of cases with coma and/or fits either proved fatal or had severe neurological sequelae. Low cerebrospinal fluid sugar and chlorides and raised proteins affected the prognosis adversely. Treatment under “Category I, II and III” showed satisfactory response in 29·3, 50 and 11·65 per cent. of cases respectively. Steroid therapy did not seem to favourably influence the results in cases picked up at random. From the Department of Pediatrics, Medical College, Amritsar