Hypokalemic periodic paralysis due to CACNA1S gene mutation.

Hypokalemic periodic paralysis (HypoPP) is a relatively rare but treatable disorder caused by mutations in the CACNA1S gene. HypoPP patients may experience paralytic episodes associated with hypokalemia and, infrequently, may develop late-onset proximal myopathy. The paralytic attacks are characterized by reversible flaccid paralysis and, in most cases, spare the respiratory muscles and heart. We report a case of CACNA1S periodic paralysis precipitated by vigorous exercise in a 14-year-old boy who presented with sudden-onset paralysis of both his upper and lower extremities. Laboratory evaluation revealed a markedly low serum potassium level. The patients symptoms resolved after correction of the potassium abnormality, and he was discharged with no neurological deficits. Although rare, HypoPP must be differentiated from other causes of weakness and paralysis so that proper treatment can be promptly initiated to ensure good outcomes.

Prevalence, Aetiological Agents, and Antimicrobial Sensitivity Pattern of Bacterial Meningitis Among Children Receiving Care at KCMC Referral Hospital in Tanzania.

BACKGROUND: Bacterial meningitis is an inflammation of the meninges that occurs in response to bacteria, causing a significant number of morbidity and mortality worldwide, especially in newborns and people living in low-income countries. Diagnosis of bacterial meningitis combines a high index of clinical suspicion and laboratory confirmation through cerebrospinal fluid (CSF) analysis. Despite antibiotic treatment, mortality remains high and many children end with long-term consequences, which include neurological deficits, hearing loss, and cognitive impairment. OBJECTIVE: To determine prevalence, aetiological agents, and antimicrobial sensitivity pattern among children aged less than 13 years with bacterial meningitis at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. METHODS: This was a hospital-based cross-sectional study carried out in the KCMC paediatric ward from December 2013 to May 2014 and from June 2015 to April 2016. In total, 161 children aged less than 13 years suspected of having meningitis were consecutively recruited. Each child submitted to a lumber puncture and CSF collected for microscopy, cultures, antimicrobial sensitivity testing, a latex agglutination test, and a polymerase chain reaction (PCR) test. PCR was run on 129 of the selected CSF samples. Data were collected using structured questionnaires and laboratory data sheet. Aetiological agents were identified, and antibiotic sensitivity was tested. Analyses were performed using SPSS version 20.0. RESULTS: Overall, 24 children had confirmation of having acute bacterial meningitis. Of the 161 participants, Gram stain and culture identified 4 (2.5%) children; whereas, of the 129 samples tested using the PCR, infection was confirmed in 24 (18.6%) children. Escherichia coli (n=18) was the most common organism isolated followed by Listeria monocytogenes (n=3), Streptococcus pneumonia (n=1), Group B Streptococcus (n=1), and Klebsiella species (spp.) (n=1). With the exception of Klebsiella spp., the isolated organisms were sensitive to the following commonly used antibiotics: ampicillin, chloramphenicol, gentamycin, and cephalosporin. CONCLUSION: PCR yielded more organisms. E. coli was the most common organism and was sensitive to the empirically used antibiotics for treatment of bacterial meningitis tested in our study.

Prevalence, Aetiology, and Antimicrobial Susceptibility Patterns of Urinary Tract Infection Amongst Children Admitted at Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

BACKGROUND: Urinary tract infections (UTIs) in the paediatric population are well recognised as a cause of acute morbidity and chronic medical conditions, such as hypertension and renal insufficiency later in adulthood. Although antimicrobial treatment of UTIs is simple, the disease is still largely misdiagnosed and mismanaged. Moreover, increasing resistance to conventional antimicrobials is eroding the success of empiric therapy. OBJECTIVE: To determine prevalence, aetiological agents, and antimicrobial sensitivity patterns of UTIs amongst children admitted at Kilimanjaro Christian Medical Centre (KCMC). METHODOLOGY: A cross-sectional, hospital-based study was conducted at the KCMC Department of Paediatrics and Child Health between December 2013 and April 2014. All children ages 2 months to 14 years who were admitted in the paediatric ward during the study period and fulfilled study criteria were enrolled. Data were collected by structured questionnaires. A urine dipstick test was done to detect the presence of nitrites and leucocytes, and to perform microscopic analysis of leucocytes and bacteria. All positive cases with the urine dipstick were cultured to determine bacterial species and antimicrobial susceptibility. Urine culture is considered the gold standard to confirm UTI. RESULTS: A total of 343 children enrolled in the study. Of these, 208 (60.6%) were male and 135 (39.4%) were female. The urine dipstick test was positive for leucocyte esterase and nitrate in 87 (25.4%) and 33 (9.6%), respectively, and urine microscopy showed leucocytes and bacteria by microscope in 38 (11.1%) and 24 (7.0%) samples, respectively. UTI was confirmed by culture in 11.4% (39/343) of the samples. Female children and children less than 24 months old had a higher prevalence of UTI (17% and 15.8%, respectively). Female sex (odds ratio [OR] 2.46, 95% confidence interval [CI], 1.25-4.86), presence of leucocytes esterase (OR 32.20, 95% CI, 12.03-86.19), and nitrate in urine dipstick (OR 5.87, 95% CI, 3.44-3.65) were associated with UTI. Leucocyte esterase, nitrite, microscopic leucocyte, and bacteria were positive in 34 (87.2%), 24 (61.5%), 30 (78.9%), and 23 (59%) samples, respectively, using culture as a gold standard. Antimicrobial sensitivity of nitrites, leucocyte esterase, microscopic leucocyte, and bacteria was 38.1%, 87.2%, 97.4%, and 59.0%, respectively, and specificity was 94.1%, 82.6%, 82.2%, and 99.7%. The most common bacterial species isolated were Escherichia coli 46.2% (18/39) and Klebsiella pneumoniae 30.8% (12/39); both exhibited low susceptibility to ampicillin, co-trimoxazole, and clindamycin, but they were susceptible to ciprofloxacin, nalidixic acid, and ceftazidime. CONCLUSIONS: UTIs are common conditions affecting children admitted at KCMC. The prevalence is higher in infants and children younger than 24 months. E coli and K pneumoniae were the most common isolated organisms with low susceptibility in commonly used antibiotics. Antimicrobials, such as ciprofloxacin, ceftriaxone, and gentamicin, are more likely to be successful for empirical treatment of UTIs.

TORCH Antibodies Among Pregnant Women and Their Newborns Receiving Care at Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

BACKGROUND: Toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19, and hepatitis B), rubella, cytomegalovirus (CMV), and herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) - known by the acronym TORCH - is a group of infections affecting both mothers and their unborn babies with adverse short- and long-term outcomes. The majority of infected mothers are asymptomatic, which leaves only speculation as to the probable cause of many congenital anomalies, stillbirths, prematurity, and death resulting from TORCH infections. The main objective of this study was to investigate previous exposure to TORCH infections by measuring the seroprevalence of TORCH antibodies in pregnant women and their newborns receiving care at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. METHODS: This was a cross-sectional, hospital-based study conducted at KCMC from December 2013 to April 2014. Of 350 pregnant women enrolled in the study, we tested 347 pregnant women attending the antenatal clinic and who opted to deliver at KCMC. Cord blood was collected and analysed for 309 of their newborns. To identify immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in mothers and IgM antibodies in newborns, we used enzyme-linked immunosorbent assay testing. A structured questionnaire was used to collect data of mothers and their newborns. Data analysis was done using SPSS version 20. RESULTS: The seroprevalence of IgG antibodies to TORCH infections among pregnant women was 154 (44.4%) for toxoplasmosis, 311 (89.6%) for rubella, 343 (98.6%) for CMV, and 346 (99.7%) for HSV-1 and HSV-2; 141 (40.6%) had been exposed to all 4 infections. For HSV-1 and HSV-2, the IgM antibodies were found in 137 (39.5%) of the 347 pregnant women included in this study. Age above 35 years (OR 6.15; 95% CI, 1.22-31.1; P=.028) and multiparity (OR 1.63; 95% CI, 1.01-2.62; P=.045) were associated with higher risk of being exposed to all TORCH infections. A total of 11 newborns had IgM antibodies to HSV-1 and HSV-2 giving a seroprevalence of 3.6%, and one newborn had IgM antibodies to rubella, giving a seroprevalence of 0.3%. None of the newborns had antibodies to toxoplasmosis and CMV. CONCLUSION: Exposure to TORCH infections was high among pregnant women in our population. Older age and multi-parity were associated with a higher risk of being exposed to all TORCH infections. Seroprevalence to HSV-1 and HSV-2 was high in newborns. The higher IgM antibodies to HSV-1 and HSV-2 among pregnant mothers and their newborns may disturb maternal, fetal, and neonatal health, and therefore we recommend establishing treatment protocol to support management of pregnant women and newborns who are seropositive for IgM antibodies.