Evaluation of oral erythromycin and local isoniazid instillation therapy in infants with Bacillus Calmette-Guerin lymphadenitis and abscesses

A randomized placebo-controlled prospective trial was conducted to evaluate the efficacy of erythromycin therapy in 69 patients affected with Bacillus Calmette-Guerin lymphadenitis. When patients who developed subsequent regional abscesses were excluded, erythromycin caused significantly earlier resolution of lymphadenitis (5.1 months vs. 5.7 months for placebo; p < 0.001) compared with placebo. There was no significant difference in the proportion of patients who developed subsequent regional abscesses between the 2 groups (47 percent for erythromycin, 60 percent for placebo, p = 0.14). When the entire group of 69 patients was evaluated for "duration to heal" (regardless of subsequent abscess formation), erythromycin therapy (4.1 +/- 1.5 sd months) did not differ significantly from the placebo group (3.5 +/- 1.3 months, p = not significant). Patients who develop subsequent abscess (n = 36) along with those with B. Calmette-Guerin regional abcesses at presentation (n = 27) were further studied to compare oral erythromycin therapy with that of single dose 50-mg intranodal isoniazid instillation. Local isoniazid therapy caused significantly earlier resolution of the abscesses (3.9 months) compared with erthromycin therapy (5.2 months; p < 0.001). (AU)

Outbreak of Bacillus Calmette-Guerlin-associated lymphadenitis and abscesses in Jamaican children

An outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerlin (BCG) vaccination (Pasteur Paris, Batch N5122) occurred in 139 Jamaican children between January and July, 1988. The overall rate of this complication was 0.95 percent. The attack rate was 1.92 percent among the 0- to 6 week age group and 0.6 percent in the 7- to 52-week age group. Of 139 patients there were 77 males and 62 females and the mean age at presentation was 4 months. The mean size of the BCG scar, duration of healing and Mantoux reaction size differed significantly in patients compared with those of control infants (P less than 0.01). Mycobacterium bovis was isolated from 11 patients. Immunologically index patients and controls differed significantly only with respect to T lymphocyte subpopulation percentages and concanavalin A stimulation indices. Evaluation of the BCG vaccine did not reveal either increased potency or microbial contamination. We conclude that increased susceptibility to the Pasteur strain of BCG might have contributed to the increased incidence of complications in these Jamaican children and hence caution should be exercised in switching one vaccine for another as is often done in the developing countries. (AU)

Evaluation of oral erythromycin and local instillation of INH therapy, in infants with BCG lymphadenitis - abstract

The most common adverse effect of BCG vaccination is regional lymphadenitis, but the treatment of this complication is controversial. A group of 69 patients, with BCG adenitis following vaccination were randomly assigned to receive either "no therapy" or oral erythromycin for one month. Systemic erythromycin therapy caused earlier resolution of the lymph node but failed to prevent progression to abscess formation. Patients who developed subsequent abscesses (36) and another group who had abscess at the time of presentation (27) showed more rapid resolution when treated with single instillation of isoniazid (50mg) into the abscess cavity, compared to oral erythromycin therapy (AU)

Subacute sclerosing panencephalitis in Jamaica

The clinical features, outcome, electroencephalographic (EEG) and laboratory findings in 12 children with subacute sclerosing panencephalitis are described. The diagnosis was made on the clinical features, the characteristic EEG pattern and the detection of measles complement-fization antibodies in the spinal fluid and serum. The autopsy findings in 2 of 6 patients who died were typical of subacute sclerosing panenecephalitis. This report suggests that the incidence of the condition is high in Jamaica. It is recommended that strenuous efforts be made to improve the measles immunisation status of children and that a registry for the disease be established in the island (AU)

Oral rehydration using high and low sodium and potassium solutions in dehydrated Jamaican children with diarrhoea - abstract

The indications and pathophysiological principles underlying the use of glucose electrolyte solutions for treating diarrhoea with dehydration are well understood. The exact composition for the Caribbean is disputed, because the WHO recommended solution which contains 90mmols/L of sodium was developed for cholera and may produce hypernatremia. To establish the value of this solution in Jamaican children, we studied 84 cases of diarrhoea in children aged 5 to 18 months attending Bustamante Children's Hospital, Kingston. The children were assessed clinically and body weight, blood samples, urine and stool samples were studied at 0, 6 and 24 hours. Treatment was with oral rehydration solution given at a rate of 200 mls per hour. Cases were divided at random into two groups, one given a solution containing 90 mmols Na, the other, 60 mmols of Na. In both groups, clinical and biochemical indices improved rapidly, weight increased, serum specific gravity fell and bicarbonates rose. In the high sodium group, 5 cases developed hypernatremia at 6 hours and persistence of hyponatremia was seen in a few cases in the low sodium group. In a second study, 25 children were given standard GE solution, but the potassium was increased from 20 to 35 mmols/1 and the cases divided randomly into high and normal potassium groups. The GEsol was given as 2 volumes of solution to 1 of water. In this study the high potassium group showed no cases of hypokalemia whereas 19 - 33 percent of the low potassium group had this problem at 24 hours. It was concluded that the standard oral rehydration fluid containing 90 mmols/1 of sodium, given as 2 volumes of water to 1 of water is safe and effective in the cases seen in Jamaica and that a higher potassium concentration of 35mmols/1 would be more effective in correcting hypokalaemia than the present 20 mmol/1 solution. This regime is now standard practise in both Bustamante Children's Hospital and at the University Hospital of the West Indies and has led to dramatic reductions in hospitalization rates, use of drip sets and of intravenous therapy (AU)

Reye's syndrome - a case report

A single case fulfilling the clinical and pathological criteria of Reye's syndrome is reported. The possible aetiology of the syndrome, the diferential diagnosis with special reference to toxic hypoglycaemia induced by ackee and renta yams, and the treatment of the disease are discussed. This report represents to our knowledge the first case of Reye's syndrome thus documented in Jamaica (AU)

Jamaican vomiting sickness: biochemical investigation of two cases

We identified methylenecyclopropylacetic acid, a known metabolite of hypoglycin A, in the urine of two patients with Jamaican vomiting sickness. Excretion of unusual dicarboxylic acids such as 2-ethylmalonic, 2-methylsuccinic, glutaric, adipic and dicarboxylic acids with eight and 10 carbon chains were also detected in both patients. The amounts of these dicarboxylic acids were 70 to 1000 times higher than normal. These metabolities have also been identified in urine of hypoglycin-treated rats. This evidence links hypoglycin A to Jamaican vomiting sickness as its causative agent. Urinary excretion of short-chain fatty acids was also increased up to 300 times higher than normal. These results indicate that, despite their clinical and histological similarities, the cause and biochemical mechanisms of Jamaican vomiting sickness differ distinctly from those of Reye's syndrome in which these abnormal urinary metabolities are not appreciably increased.(AU)

Identification of ethylmalonic acid in urine of two patients with the vomiting sickness of Jamaica

Large amounts of ethylmalonic acid have been identified in urines from two patients with the vomiting sickness of Jamaica. The amounts were 178 and 882æg per mg creatinine which are 70 and 350 times, respectively, over control values. Other short and medium chain dicarboxylic acids including glutaric and adipic acids and those with eight and ten carbon chain, saturated and cis-unsaturated, were also detected in large quantities as in the case of hypoglycin treated rats' urine. However, the large increase of urinary ethylmalonic acid in these two human cases is in a sharp contrast to the findings in hypoglycin treated rats in which urinary ethylmalonic acid increased only 3 times over control. It appears that ethylmalonic acid is produced in the cases with the vomiting sickness of Jamaica by carboxylation of n-butyryl-CoA which is not oxidised further due to the inhibition by hypoglycin A. In case of hypoglycin-treated rats, n-butyryl-CoA is mainly conjugated with glycine or deacylated to free butyric acid.(Summary)