Invasive fungal infections in a paediatric intensive care unit in a low-to middle-income country.

Background: Paediatric intensive care units (PICUs) are high-risk settings for healthcare-associated infections. Invasive fungal infection (IFI) is one of the common causes of healthcare-associated infections. Objectives: To describe the prevalence and short-term outcomes of children with IFI, and to offer a basis for the efficient prevention and treatment of IFI. Methods: A retrospective study was conducted in children under the age of 12 years over a two-year period. Participants were categorised according to pre-defined microbiology criteria into IFI if they had a positive culture from blood or other sterile sites. Data collected included demographics, invasive procedures, length of stay and mortality. Results: One thousand and forty-two children were admitted during the study period. Of the total, 56.8% (n=592) were male. Median length of stay was 18 days (mean±SE 18.6±8.9). IFI was identified in 35 cases per 1 000 admissions, with 77.7% of these infants under the age of one year. The mean length of stay was 18.6 days compared with 7.5 days for children with bacterial infections. The in-hospital mortality for invasive fungal infection was 36% compared with 16% for all admissions. Findings confirmed that colonisation was more prevalent than IFI. Conclusion: IFIs are common among infants, and these patients have a higher mortality rate and prolonged hospital stay. Therefore we recommend early diagnosis and timely treatment with high-performance antifungal drugs to improve the prognosis in children with IFI.

Pulmonary arteriovenous malformation in a child with multiple brain abscesses: A case report.

Pulmonary arteriovenous malformations (PAVMs) are caused by abnormal connections between arteries and veins, which lead to right-to-left shunting of deoxygenated blood. Here, we report an 11-year-old male who presented with signs suggestive of intracranial pathology. The patient displayed signs of a chronic illness, possibly congenital malformation that was complicated by PAVM and multiple brain abscesses. This case illustrates the importance of doing a detailed examination and investigations, especially if the history alone is not helpful in making a diagnosis.

Life after paediatric intensive care unit.

Advances in critical care medicine have led to reduced mortality but increased morbidity. Post-intensive care unit syndrome (PICS) develops after critical illness and presents as cognitive, physical and/or psychosocial impairments. PICS is prevalent in 10 - 36% of patients after discharge from paediatric intensive care unit. Multiple risk factors are associated with PICS, but there is no single causal factor. Factors range from clinical illnesses to intensive care intervention. The care plan should be aimed at prevention, early identification and post-ICU management of PICS by a multidisciplinary team.

Invasive fungal infections among critically ill children: Epidemiology, risk factors and outcomes.

Critically ill children are at high risk of developing invasive fungal infection in a paediatric intensive care unit. This is due to the vulnerability of these children and invasive nature of the care provided.

Two cases of unusual airway pathology, in which a careful history contributed to a successful diagnosis.

Lower airway obstruction commonly presents with wheezing but is not always caused by asthma. Considering the case history and course of illness is of utmost importance in determining the cause of wheezing. We present two cases admitted to the paediatric intensive care unit, in which a double aortic arch was found to be the cause of wheezing. The cases illustrate the importance of a systematic approach when investigating a patient with persistent wheeze, especially when there is a poor response to conventional therapy.