Protective efficacy of neonatal Bacillus Calmette-Guérin vaccination against tuberculosis.

This matched case-control study was performed in two hospitals in Bangkok to evaluate the protective efficacy of neonatal Bacillus Calmette-Guérin (BCG) vaccination in Thai children and to find factors that might explain the reported variation in estimates of the protective efficacy of BCG. Cases were defined as children 3 months to 14 years of age who had tuberculosis and controls consisted of one to four children who were born in the same year and had the same district of residence as the case. A matched analysis with a variable number of controls per case was performed on 75 cases and 207 controls. Conditional logistic regression was performed to adjust for the potential confounding effects of household tuberculosis exposure and socioeconomic status. Forty-eight percent of cases had nonrespiratory tuberculosis. Laboratory-confirmed evidence for tuberculosis was found in 48% of cases. The adjusted protective efficacy of neonatal BCG vaccination was 83% (95% confidence limits, 35%, 96%). It was 96% (95% confidence limits, 66%, 100%) when only 36 matched sets of laboratory-confirmed cases were analyzed. Subgroup analyses and literature reviews indicated that the accuracy of tuberculosis diagnosis, types of tuberculosis, duration after vaccination and household tuberculosis exposure contribute to variation in the reported protective efficacy of neonatal BCG vaccination.

The role of ketotifen in children with recurrent bronchitis.

The efficacy and safety of ketotifen in the treatment of recurrent bronchitis were studied in twenty Thai children with an average age of 5.3 years. Symptoms studied were cough, hypersecretion and wheezing and 4-point rating scores were assigned to each of the symptoms with regard to their frequency, severity and duration. Score per dose of the symptomatic agents used was also given. The symptoms and the use of symptomatic agents were recorded during a full year prior to ketotifen treatment and during a further full year study period. PEFR measurement was performed in the children above the age of 6 years at 2-weekly intervals under the supervision of the authors at the clinic. Assessment of efficacy was done by comparing monthly symptom scores and medication scores during the study period with the mean value of the previous year. Thirteen children received ketotifen for the whole year while seven children who were almost symptom-free after 4 months ketotifen treatment, were then only observed for a further 8 months. At the end of the study period, ketotifen treatment was rated very good and good in 85% of children, satisfactory in 10% and poor in 5%. Drowsiness was the only side-effect reported in a few cases but then only initially. There were no abnormalities in any laboratory parameters studied.

Obstructive sleep apnea syndrome in Thai children diagnosed by polysomnography.

Overnight polysomnography was conducted in 39 Thai children with clinically suspected obstructive sleep apnea syndrome (OSAS) during the years 1994 to 1996. Eighty-five percent of these children met the polysomnographic criteria of pediatric OSAS, 42.4% among whom had severe OSAS. Male : female ratio of children with OSAS was 4.5:1. The peak age at the time of diagnosis was 3 to 4 years. The most common predisposing factor was adenoidal and tonsillar hypertrophy. Adenoidectomy and/or tonsillectomy was the most effective therapeutic option. Recovery of symptoms was observed following surgery and nasal continuous positive airway pressure.

Risk factors associated with morbidity and mortality of pneumonia in Thai children under 5 years.

ARI is the most common cause of illness and death in children under 5 years of age. Pneumonia is the leading cause of death. This prospective study was part of an ARIC project conducted to identify risk factors associated with mortality and morbidity of community acquired pneumonia in Thai children younger than 5 years of age. Study subjects were 267 moderately severe pneumonia who were admitted to hospital. Fifteen percent required a ventilator and were categorized as severe cases. Nine patients (3.4%) died and were categorized in the fatal group. From univariate analysis only, risk factors of fatal pneumonia were lower body weight (p = 0.04), paternal age less than 35 year (OR = 6.1, p = 0.01), underlying heart disease (OR = 12.1, p = 0.0000) and protein energy malnutrition (OR = 7.9, p = 0.0087). Predictors on admission to predict fatal outcome were rapid respiratory rate > 50/minute (OR = 4.1, p = 0.03), gallop rhythm (OR = 11, p = 0.04), enlarged liver (OR = 13.2, p = 0.001), and cyanosis (OR = 12, p = 0.0006). Significant factors associated with severe pneumonia after multiple logistic regression were underlying heart disease (OR = 4.04, 95% CI 1-15.4), enlarged liver (OR = 4.31, 95% CI 1.2-15.2) and cyanosis (OR = 5, 95% CI 0.8-28.7). This information should create awareness in physicians who are responsible for young children with pneumonia. Early recognition and intervention may prevent deaths and complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary and platelet function in mild form of Hb H disease.

Pulmonary function abnormality, arterial hypoxemia and platelet hyperaggregation were commonly seen in severe or moderately severe thalassemic patients. In previous studies, these abnormalities were found in beta-thalassemia, beta-thalassemia/Hb E disease and Hb H disease in 62, 40 and 52%, respectively. However these functional abnormalities in mild form of Hb H disease have not yet been reported. Pulmonary function test by using standard spirometry, platelet aggregation and arterial blood gases were performed in 23 children with mild form of Hb H disease, whose age ranged from 6-18 years (average 11 years), and hematocrit status was 30-40%. Mild to moderate degree of restrictive lung disorder was found in 48% of these patients, 5% had mild platelet hyperaggregation and none of these had arterial hypoxemia. This study showed that a pulmonary function defect was noted as one significant finding in thalassemic patients, being noted even in the very mild form and early age of life. This information will lead to further exploration of the pathogenesis of pulmonary function defects as well as their role is the patients' future health and prognosis.

Haemophilus influenzae and Streptococcus pneumoniae in children with acute respiratory infection.

The incidence of Haemophilus influenzae and Streptococcus pneumoniae in children with acute respiratory infection (ARI) under 5 years was carried out by throat swab culture, blood culture, body fluid or tissue culture in 688 patients from a community, 744 patients from a teaching hospital in Bangkok, 766 normal children from the community and 303 children from a hospital well baby clinic. H. influenzae was found in the throats of 15-20% of patients and in the throats of 4-6% of normal children (p less than 0.001 for both hospital and community patients). Only 12/332 strains (3.6%) of H. influenzae were type b. The rest of H. influenzae were non type b. The most common biotype of H. influenzae non type b was biotype II. S. pneumoniae was found in hospital patients in highly significant numbers compared to the controls (12% vs 4%). No significant difference was observed in strains from the community patients.

Incidence of Mycoplasma pneumoniae, Chlamydia trachomatis, and viral infections in pneumonia cases under six months of age, Bangkok, Thailand.

The incidence of infections by Mycoplasma pneumoniae, Chlamydia trachomatis and respiratory viruses was investigated in 76 pneumonic patients aged under 6 months who attended Ramathibodi and Siriraj Hospitals in Bangkok during two study periods. M. pneumoniae infection was not found in any case from either hospital by serological diagnosis. By the isolation method, C. trachomatis infection was found in 7(16.7%) of 42 patients from Ramathibodi Hospital and 5(21.7%) of 23 patients from Siriraj Hospital with the average male:female ratio of 2.6:1; and 91.7% of the infected cases were under 3 months old. Laboratory diagnosis of respiratory virus infection was performed by indirect immunofluorescence (IIF), isolation, and by antibody detection. Data from Ramathibodi Hospital showed that 11 (24.4%), 4 (8.9%), 3 (6.7%) of the 45 patients were infected by respiratory syncytial virus (RSV), adenoviruses, parainfluenza virus type 3, and some other viruses, respectively; infection rates of 10 (32.3%), 4 (12.9%), 1 (3.2%) and 1 (3.2%) by those viruses respectively, were observed in the 31 patients from Siriraj Hospital.

Randomized controlled trial of dexamethasone in infectious croup.

Infectious croup is a common and an important cause of upper airway obstruction in young children. Despite its frequency and potentially serious nature, there is still no definite conclusion regarding the beneficial effect of corticosteroid. A randomized controlled study on the effects of dexamethasone in infectious croup was conducted at the Department of Pediatrics, Ramathibodi Hospital between January 1985 and September 1986. Thirty-two patients, 2-37 months old, were included in this study. Fourteen patients received dexamethasone (0.5 mg/kg/dose daily for 3 days) and eighteen patients were the control group. The dexamethasone group had significantly lower croup scores at 48 hour (p < 0.05), shorter hospital course (p < 0.005) and lower incidence of endotracheal intubation (p < 0.05) than the control group. Five patients in the control group required endotracheal intubation. Complications included four episodes of pneumonia, one episode of sepsis, and one bacterial tracheitis. Pneumonia and sepsis occurred only in the control group. We concluded that dexamethasone therapy decrease the severity of infectious croup and the risk of complications.

Correlation of roentgenologic diagnosis and etiologic agents of pneumonia in thai children under 5 years of age.

An attempt to distinguish between viral and bacterial pneumonia from radiographs is usually difficult unless there is a pathognomonic type of infiltration such as parahilar peribronchial infiltration commonly seen in viral pneumonia which can be usually be differentiated easily from that of bacterial pneumonia. Percentage of agreement of roentgenographic diagnosis for bacterial pneumonia, viral pneumonia and mixed infection is about 53, 73.3 and 63.9 per cent respectively.

Pulmonary function and exercise challenge test in Thai children: 10 years post respiratory syncytial virus infection.

OBJECTIVE: To report the occurrence of asthma, pulmonary function and exercise challenge test abnormalities found in Thai children, who 10 years earlier had lower respiratory tract infection caused by respiratory syncytial virus (RSV-LRI). PATIENTS AND METHODS: 37 children, with RSV-LRI admitted at Ramathibodi Hospital during January 1986 through December 1987, were contacted, of whom 13 patients responded and completed history-review-questionnaires. Pulmonary function measurements at pre- and post-exercise and testing for bronchodilator response were performed. RESULTS: The occurrence of physician-diagnosed asthma in the patients with and without family history of allergic diseases was 75 per cent and 40 per cent, respectively. Of 11 patients who performed spirometry, 45 per cent had concave flow-volume curves, 36 per cent showed decreased ratio of forced expiratory flow in the first second (FEV1) to forced vital capacity (FVC) and 27 per cent showed either decreased forced expiratory flow between 25-75 per cent of FVC (FEF25-75%) or peak expiratory flow rate (PEFR). Of 8 patients who completed exercise challenge tests, 87.5 per cent showed markedly decreased PEFR at post exercise challenge tests and 37.5 per cent had markedly decreased FEV1. 62.5 per cent and 25 per cent showed markedly increased PEFR and FEV, respectively, after inhalation of bronchodilators. CONCLUSION: This study suggests that the occurrence of asthma in children, who had previous RSV-LRI, is relatively high compared with that reported in general Thai children. Baseline pulmonary function tests showed evidence of airway obstruction as demonstrated by concave-shaped flow-volume curves, decreased FEV1/FVC ratio, FEF25-75% and PEFR. The presence of bronchial hyperreactivity to exercise challenge test and positive response to bronchodilators confirms the evidence of exercise-induced bronchospasm in children with history of RSV-LRI.

Cyanide poisoning, 2 cases report and treatment review.

Two patients, a 4-year-old girl and her brother 1 1/2 year-old, with cyanide poisoning are reported. They vomited and became comatose 9 hours after ingestion of boiled cassava. At a community hospital, they were intubated and given ventilatory support. The girl was transferred to Ramathibodi Intensive Care Unit. At 19 hours after ingestion, sodium nitrite and sodium thiosulfate were given as well as other supportive treatment. She recovered with normal breathing on the next day. The boy was referred to Ramathibodi 4 hours later. On arrival, he appeared normal except for the bitter almond breathe. Only supportive treatment was given. Their blood cyanide levels on arrival were 0.56 and 0.32 microgram/ml (normal value < 0.3 microgram/ml) respectively confirming the diagnosis of cyanide poisoning. Other abnormal laboratory findings included metabolic acidosis and lactic acidemia. The pathogenesis and management of cyanide poisoning are reviewed.

Pulmonary involvement in childhood systemic lupus erythematosus.

Twenty-four children (aged 6-15 years, M:F = 1:11) with systemic lupus erythematosus (SLE), who had respiratory symptoms, were retrospectively reviewed. Chest radiographs obtained from all patients revealed pleural effusion in 13, alveolar infiltration in 9, pericardial effusion and cardiomegaly in 6, interstitial infiltration in 4, hilar adenopathy in 3, lung abscess in 2 and pneumatocele with pneumothorax in 1. Etiologic organisms were identified in 7 cases; (3 cases of nocardia isolated from pleural effusion and sputum, 2 cases of tuberculosis, 1 case with staphylococcus aureus septicemia and 1 case with salmonella septicemia). All except one patient improved with medical treatment. One patient died from pneumonitis. Although pulmonary involvement is increasingly recognized in children with SLE, neither roentgenogram nor clinical findings were specific. The differentiation of pulmonary infiltrates caused by lupus lung disease from pulmonary infection should be carefully evaluated.