Prevalence and Implications of Cerebrospinal Fluid Leukocytosis in Papua New Guinean Children Hospitalized with Severe Malaria

Cerebrospinal fluid (CSF) leukocytosis in severe malaria was assessed in 87 children in Papua New Guinea participating in a detailed longitudinal observational study who had undergone lumbar puncture for further investigation of altered consciousness and/or convulsions. After rigorous exclusion of non-malarial infection, 16 (20.5%) of 78 children with Plasmodium falciparum monoinfection but 0 of 9 with P. vivax/mixed-species malaria had a detectable CSF leukocytosis, which was unrelated to prior, including complex, seizures. There were eight children with a CSF leukocyte density > 10 cells/μL (9.2% of the total sample), half of whom had cerebral malaria (4 of 22, 18.1%). Cerebrospinal fluid leukocytosis is infrequent in severe pediatric malaria, especially in children with P. vivax infections, and it is generally mild. Its presence in a blood slide–positive child should prompt consideration of alternative diagnoses and empiric antibiotic therapy.Studies reporting cerebrospinal fluid (CSF) leukocytosis in cases of pediatric cerebral malaria have been conducted mainly in sub-Saharan Africa where Plasmodium falciparum monoinfections predominate. Approximately 10% of children with cerebral malaria and no bacteriologic evidence of acute bacterial meningitis have CSF pleocytosis of > 10 cells/μL in this setting.¹ Plasmodium vivax is increasingly recognized as a cause of severe malarial illness in Oceania and parts of Asia and South America.There is limited evidence that CSF leukocytosis can also be found in patients with P. vivax malaria and altered consciousness,^2,3 but these studies did not rigorously exclude co-infections with bacterial and, as in studies in Africa of cerebral malaria caused by P. falciparum,¹ viral, or fungal pathogens. Febrile seizures caused by non-malarial infections may also cause CSF leukocytosis in some children⁴ and are a common feature of pediatric severe malaria, thus further exacerbating diagnostic uncertainties when a severely ill child seeks treatment in a malaria-endemic setting. Therefore, there is a need for a prospective study that determines whether severe pediatric malaria caused by P. falciparum or P. vivax can cause CSF leukocytosis after other infective causes of encephalopathy have been excluded and after taking prior febrile seizures into account.We studied hospitalized children in Papua New Guinea who were enrolled in a detailed observational study of severe pediatric infections conducted in coastal Madang Province where there is transmission of multiple Plasmodium species. The study was approved by the Papua New Guinea Institute of Medical Research Institutional Review Board and the Medical Research Advisory Committee of Papua New Guinea (MRAC 10.08), and parental written consent was obtained before recruitment in all cases. To rule out acute bacterial meningitis in children in Papua New Guinea, routine lumbar puncture is usually performed if a child has impaired consciousness or after febrile seizures but has no clinical evidence of increased intracranial pressure.⁵ Cerebrospinal fluid leukocytes at presentation were quantified by microscopic examination using the Neubauer improved chamber (BoeCo, Hamburg, Germany). When erythrocytes were present, an adjusted leukocyte count calculated as leukocytes – [erythrocytes/100] was used⁵ (

Eye findings of diffuse unilateral subacute neuroretinitis and multiple choroidal infiltrates associated with neural larva migrans due to Bbaylisascaris procyonis

PURPOSE: To report childhood infection with Baylisascaris procyonis (raccoon round worm) manifesting as diffuse unilateral subacute neuroretinitis (DUSN) and choroidal infiltrates in association with neurologic disease (neural larva migrans).METHOD: Observational case series, one with eye manifestations of DUSN, the other with choroidal infiltrates, both with severe neurologic degeneration. RESULTS: Indirect immunofluorescence assays on serum and cerebrospinal fluid were positive for B. procyonis in one and serially positive and increasing in the other. Both children had a history of pica and raccoon exposure. CONCLUSIONS: Baylisascaris procyonis infection is associated with two cases of severe neurologic degeneration with ocular lesions: DUSN and choroidal infiltrates. Although B. procyonis is known to cause DUSN, these cases indicate that concomitant ocular migration may accompany neural larva migrans. These are the third and forth cases in the US literature of neural larva migrans due to B. procyonis with eye findings.     

Selenium-mercury interaction during intestinal absorption of 75Se compounds in chicks

The effects of inorganic (HgCl2) and organic (CH3HgCl) mercury on the intestinal absorption of Se compounds [Na2(75)SeO3, Na2(75)SeO4, L-[75Se]methionine ([75Se]Met)] were determined in 3-wk-old White Leghorn cockerels by the in vivo ligated duodenal loop procedure. The intraduodenal dose contained 0.05 microCi 75Se, 0.01 mM Se, 150 mM NaCl and 0-1.0 mM Hg. In the presence of 1 mM inorganic Hg in the intraduodenal dose, the absorption of the inorganic 75Se compounds was only about 65% of that in the control group, whereas only a slight inhibitory effect on [75Se]Met absorption was observed. Methylmercury had no effect on [75Se]selenite absorption. Precipitation of the 75Se-selenite in the intestinal lumen partly explained the direct interaction between inorganic Hg and Se compounds. Absorption of [75Se]Met and [75Se]selenite was also determined in chicks fed after hatching a purified diet supplemented with varying amounts of Hg (0-500 mg/kg) and Se (0-4 mg/kg). Dietary Hg significantly reduced the transfer of [75Se]selenite to body by enhancing the accumulation of the isotope in the intestinal tissue. Dietary Hg did not affect the absorption of [75Se]Met, but altered the whole-body distribution of this Se compound. Because interaction between Se and Hg was observed mainly between the inorganic compounds and with use of a manyfold excess of Hg over Se, the data suggest that intestinal interaction between these metals is not of great nutritional importance.     

Exposure to refractory ceramic fibres in the metal industry

Refractory ceramic fibres (RCF) are used in thermal isolation in the metal industry where high temperatures are regularly employed. Asbestos materials were earlier commonly used for these purposes. In this work, two Finnish steel plants, three foundries and a repair shop were studied for the ceramic fibre exposure of their workers under normal production and during the replacement of oven insulation. Personal and stationary sampling was used together with a novel nasal lavage sampling for the evaluation of personal exposure. Fibres were counted with optical and electron microscopy and they were identified using an energy-dispersive X-ray analyser. Ceramic fibres were found in most production phases [range <0.01-0.29 fibres per cubic centimetre (f cm(-3))]. Considerably higher fibre counts were obtained during the maintenance work (range <0.01-14.2 f cm(-3)). Nasal sampling was found to correlate with the airborne fibre concentrations at the group level. The mean fibre concentrations varied from 34 to 6680 f ml(-1) of lavage liquid. Use of personal respiratory protectors diminished the exposure on the average as analysed in the lavage specimens, but the effect of respirator use did not appear clearly in the results. Because of the heat conditions, the workers used the respirators for a strict minimum period. A considerable exposure to RCF occurs in the studied plants. Its risk should be evaluated and managed more closely in view that the material is carcinogenic. Use of personal respiratory protectors should be encouraged. Their effective use could be verified by the nasal sampling for fibres after the work shift.     

Headache children with temporomandibular disorders have several types of pain and other symptoms

The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13–14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.