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.

Epidemiology of acute respiratory infections in young children from Thailand.

A prospective evaluation of the epidemiology and presentations of acute respiratory infections in children younger than 5 years of age admitted to Children's Hospital Bangkok (1988 to 1989) was supported by the World Health Organization. There were 226 patients with the inclusion criteria: 1 to 5 years of age; duration of illness less than 2 weeks; no prior antibiotic therapy; and low socioeconomic status. The disease categories included: croup, 19 cases; bronchiolitis, 60 cases; and pneumonia, 147 cases. Pathogens isolated were: respiratory syncytial virus (40); parainfluenza III (1); influenza B (1); and adenovirus (1); bacterial infections were proved in 23 cases. No significant differences in clinical features between bacterial and viral pneumonia were found. Interstitial radiographic patterns were more common in viral pneumonia whereas alveolar patterns were more common in bacterial pneumonia. However, 91% of mixed radiographic patterns (interstitial and alveolar) in chest films were from viral pneumonia.

Intensive short course chemotherapy for tuberculous meningitis.

This nonrandomized, open clinical investigation of tuberculous meningitis evaluated 53 children with Stage I (n = 8), Stage II (n = 29) and Stage III (n = 16) disease. The overall mortality was 20.8% (11 of 53) with a rate of sequelae of 35.7% (15 of 42) in survivors reflecting the advanced stages of children at diagnosis. Various combinations of standard antituberculous drugs including isoniazid, rifampin, pyrazinamide, streptomycin and ethambutol were given. Three treatment durations used during various time periods were evaluated: 12, 9 and 6 months with only the 6-month regimen receiving pyrazinamide (PZA). This prospective evaluation demonstrated that: (1) severe disease at presentation is highly associated with early mortality (P less than 0.05), regardless of drug regimen; and (2) intensive short course chemotherapy (6 months) with PZA, regardless of stage of disease at presentation, is more efficacious than longer course therapy (9 or 12 months) without PZA in preventing total negative outcomes and sequelae (P less than 0.05). This study demonstrates that a 6-month regimen containing PZA can be used in treating children with tuberculous meningitis.

Oral electrolyte therapy for acute diarrhea in infants.

PIP: The treatment of diarrheal diseases involves replacement of water and electrolytes lost. This is done by nasogastric and intravenous routes in severe cases but can be done successfully by oral administration of fluid electrolytes in mild to moderately severe cases. The ORS formula (a WHO-developed formula containing 90 mEq/1 of sodium, 20 mEq/1 of potassium, 80 mEq/1 of chloride, 30 mEq/1 of bicarbonate with 2% of glucose), hospital-prepared solutions, and home-made salt/sugar solutions are possibilities. 3 studies using the ORS showed that the solution is effective in replacing fluid and electrolyte loss in acute diarrhea in infants. Results from a study with 30 patients under 2 showed that the amount of oral electrolyte intake is sufficient to correct dehydration. Weight gain was 3.8 +or- 3/3% in 24 hours. When edema developed in a 2nd study with 16 patients under 6 months, it was concluded that the ORS intake should be restricted to the amount lost through diarrhea. This strategy was tried with 18 infants under 6 months and was successful. Although weight gain with oral rehydration is lower than with intravenous therapy, it can reduce the need for intravenous therapy in more than 80% of cases.^ieng

Perinatal mortality at Children's and Rajvithi Hospitals in 1983-1987.

In the period between 1983-1987, there were 101,056 births at Rajvithi hospital. Out of these, 6,158 sick newborn were transferred to Children's hospital for further care. The incidence of low birth-weight infants was 9.42 per cent. Average perinatal mortality was 14.49 per 1,000 births, ranging from 13.44 to 15.52 per 1,000 births. The major causes of early neonatal death were perinatal asphyxia, respiratory distress syndrome (RDS), immaturity (less than 1,000 g), congenital anomalies, and infection. Beyond this period (7-28 days of age) the causes of death were infection, congenital anomalies, bronchopulmonary dysplasia, necrotizing enterocolitis, apnea and others. Asphyxia and RDS are still the major causes of death that could be further reduced.

PIP: This study reveals the perinatal and neonatal mortality between 1983 and 1987 at Children's and Rajvithi Hospitals, Bangkok, Thailand, and the causes of death with the leading early neonatal (END) cause being asphyxia and respiratory distress syndrome (RDS). The late neonatal (7-28 days) and the post natal cause was infection. A decline in perinatal mortality from 28/1,000 births in 1978 to 13.7 in 1987 was due to 1980 improvements in obstetrics and early neonatal care, reflecting a general trend in decreasing perinatal mortality. There was no major cause of late fetal death, however one-third were macerated, and 15% of stillbirths were congenital anomalies including over 60% from anencephaly and other central nervous system defects. 101,056 births were recorded at Rajvithi with Children's Hospital transfers of those who were sick or weighed less than 2000 grams. 9.42% were low birth weight with males more than females. 30% died within the first 24 hours of life. Mortality was 14.49/1000 births. 4.67% of ENDs were low birthweight, while only .19 for a full-sized infant. The author attributed quality of care at Children's and the low socioeconomic (SES) status of the population to the presence of sepsis and nocosomial infections and asphyxia and RDS. Ramathibodi Hospital with better care and a higher SES reports the leading cause of death between 1979 and 1983 as congenital anomalies; death due to asphyxia and RDS is no longer a significant cause of death. The author urges better prenatal care and hospital conditions.

Surveillance of antimicrobial resistance of Streptococcus pneumoniae and Hemophilus influenzae in Thailand.

Resistance patterns of S. pneumoniae and H. influenzae to standard antibiotics in Thailand is not on the rise when compared to previous reports. There is no need at present to change standard antibiotic therapy recommendations for pneumonia by the National ARI. The use of antibiotics for the treatment or prophylactic purposes should be judicious to limit the spread of antimicrobial resistance. This study is the main part of a National surveillance for antimicrobial resistance of S. pneumoniae and H. influenzae. The surveillance programme should be continued to evaluate trends in order to up-date guidelines for the selection of antibiotics of the ARI programme in the future.

Otogenous tetanus: a sequelae of chronic ear infections.

Eight patients had bacteriologically confirmed otogenous tetanus and all survived, suggesting that this may be a less severe form of the disease. Clostridium organisms most probably secondarily infect the purulent ear discharge after contamination by dirty cloth or fingers. Since most cases of tetanus are seen first by pediatricians or family physicians, they should be familiar with this potential source. Adequate tetanus immunization predisposed to chronic otorrhea.

Detection of bacterial antigen in pleural fluid by counterimmunoelectrophoresis.

Pleural fluid specimens from 87 patients were studied using counterimmunoelectrophoresis with pneumococcal, staphylococcal, and Hemophilus influenza b antisera. This method compared favorably with traditional bacteriologic methods and in addition provided a presumptive etiologic diagnosis in more than half of the specimens with negative bacterial cultures. One cross-reaction between H. influenza b antiserum and a pleural fluid specimen with an Escherichia coli isolate was observed.