Haemophilus influenzae meningitis in Malaysia.

OBJECTIVE: To determine the pattern of postneonatal childhood meningitis in Malaysia. METHODS: Retrospective cross-sectional study involving five pediatric departments in Malaysia. RESULTS: There were 435 cases of clinical meningitis admitted to the five centers. More than 90% of the patients were <5 years old, and one-half were <6 months of age. The estimated overall incidence of childhood meningitis in the first 5 years of life was 76.7 per 100000 per year. However, of the 435 cases only 71 (16.3%) fulfilled laboratory diagnostic criteria and in only 58 of these was an organism isolated. Nearly one-half (48%) of all bacteriologically proved cases were caused by Haemophilus influenzae type b (Hib). The mortality rate was 12.5% and 21 patients (30%) suffered neurologic sequelae. CONCLUSIONS: More than one-half of all cases of culture-positive childhood bacterial meningitis were caused by Hib, although successful isolation of a pathogen occurred in only a small proportion of cases. For this reason the true incidence of Hib meningitis in Malaysia remains unknown. These findings are consistent with previous studies in Malaysia.

Recurrent headaches in children--an analysis of 47 cases.

In a retrospective analysis of paediatric referrals to a Neurology Outpatient Clinic, the largest single category of 47 patients (32%) presented with acute recurrent headache. There were 30 girls and 17 boys. Age of onset ranged from 4 to 11 years (8.35 +/- 1.98) and duration of headache from half month to 42 months (19.2 +/- 11.9). Only 6 children were unable to describe the quality of their pain. Using conventional criteria, 43 of the children could be classified as classical migraine (10), common migraine (20), basilar migraine (3), ophthalmoplegic migraine (1) and tension tension headache (9). None had any positive physical signs, and all responded to simple measures.

Lamotrigine as an add-on therapy in intractable paediatric epilepsy--the Kuala Lumpur Hospital experience.

An observational study of all children with intractable epilepsy at the Paediatric Institute prescribed Lamotrigine as an add-on therapy between January 1994 and November 1998 was conducted. A total of 30 children were recruited. Three had adverse effects to the drug and it was withdrawn. Of the remaining 27, there were 20 boys and 7 girls, ranging from 2 to 17 years. Fifteen children had generalised epilepsy, 6 had partial epilepsy, 2 had West syndrome and 4 had Lennox Gastaut syndrome. Six children (20%) became seizure free, and 14 (54%) had a greater than 50% reduction in seizure frequency. However 7 children (23%) did not respond and 3 experienced a deterioration in seizure severity. Nine children were noted to have an improvement in alertness and behaviour. Our small series suggests that Lamotrigine is useful as add-on therapy in childhood intractable epilepsy.

Acute disseminated encephalomyelitis: a report of six cases.

Six children with Acute Disseminated Encephalomyelitis (ADEM) were seen at the Penang Hospital over a two year period (July 1999-June 2001). Diagnosis was based upon typical clinical features and characteristic findings on neuroimaging. Cerebrospinal fluid examination and other investigations were done, where appropriate, to rule out other causes of central nervous system disease. Three children had a prodromal illness. The most common presenting symptoms were fever, seizures, ataxia, focal neurological deficits and labile mood. Two children presented with status epilepticus. All children had an abnormal neurological examination. Brain magnetic resonance imaging revealed hyperintense signals on T2-weighted and FLAIR sequences in the subcortical and deep white matter regions of the frontal, parietal, and temporal lobes, as well as in the thalami, cerebellum and brainstem. One child had multiphasic disseminated encephalomyelitis (three episodes). The child with multiphasic disease had only one treated episode, and has suffered mild disability. Three children were treated with either methylprednisolone or immunoglobulins, and remain well. One child received both treatments but expired as a result of severe gastrointestinal bleeding from the use of methylprednisolone. The child who was not treated has severe disability.

The effect of pesticide on the activity of serum cholinesterase and current perception threshold on the paddy farmers in the Muda agricultural development area, MADA, Kedah, Malaysia.

BACKGROUND: The aim of this study was to find out the indicator as a marker of person who are exposed to pesticides (organophospate). Up to now the serum cholinesterase is used as a marker. This new method will not taking blood vein since this be the obstacle in conducting research in a rural area. METHODS: A cross sectional study was conducted to investigate the effect of pesticide exposure on the activity of serum cholinesterase (ChE) and current perception threshold (CPT). The samples are 60 paddy farmers (exposed group) and control group taken from the office of Muda agricultural area of Kedah in 19 do not expose to pesticide. The CPT values measured using a portable constant current electric nerve stimulator, Neurometer CPT/Eagle (Neurotron Incorporated, Baltimore, USA). Assessments carried out by one examiner on the index finger (median digital nerve) and the great toe (peroneal digital nerve). The current used are 3 neuroselective frequency range 2000 Hz, 250 Hz, and 5 Hz. The serum cholinesterase activity measured spectrophotometrically using cholinesterase inhibition test kit CHE MHE 1,144729. RESULT: It was significantly evident that the serum cholinesterase activity noted reduced among the paddy farmers (p = 0.014). The CPT values were significantly elevated for the 2000 Hz frequency range for both the measurement sites (index finger p < 0.0001 and great toe p < 0.0001). For the 250 Hz frequency range CPT values were significant only for the index finger (p = 0.012). However there was no significant difference for the 5 Hz frequency range. There was also a significant correlation (negative) between CPT values and serum cholinesterase activity more for the 2000 Hz frequency range (index finger r = 0.672, p < 0.0001 & for great toe r = 0.736, p < 0.0001). The results were suggestive of subclinical impairment of distal axonopathy considering the fact only 25% of the farmer showed clinical manifestation of numbness. CONCLUSION: The selective involvement of the large diameter sensory fibres (250 Hz and 2000 Hz) were reflective of toxic peripheral neuropathy. Neurometer CPT/Eagle used as indicator for detecting the effect of pesticide instead of using cholinesterase enzyme activity.

Disseminated histoplasmosis in a non-immunocompromised child.

We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.

Childhood non-traumatic coma in Kuala Lumpur, Malaysia.

All post-neonatal children with acute non-traumatic coma admitted over an 8-month period were analysed and followed up for 18-24 months to determine the aetiology and outcome of their coma. One hundred and sixteen children, 72 boys and 44 girls, were recruited. Half the children were under 1 year of age and only 16 (14%) were more than 6 years of age. Eighty cases (69%) were due to infection, 15 (13%) to toxic metabolic causes, six (5%) to hypoxic ischaemic insults, four (3.5%) had intracranial haemorrhage, nine (7.8%) were due to miscellaneous causes and in two (1.7%) the cause was unknown. Seven cases were lost to follow-up. Of the remainder, 39 (35.7%) died, 32 (29.3%) developed permanent neurological deficit, and 38 (35%) were discharged well. The outcome was worst in the infectious group. Age of onset and sex did not significantly affect outcome. Our findings are similar to experience in Japan, where infection accounts for 74% of non-traumatic coma, but differ considerably from Western data on childhood coma where only a third of cases are due to infection.

Determinants of linear growth in Malaysian children with cerebral palsy.

OBJECTIVE: To compare the linear growth and nutritional parameters of a group of Malaysian children with cerebral palsy (CP) against a group of controls, and to determine the nutritional, medical and sociodemographic factors associated with poor growth in children with CP. METHODOLOGY: The linear growth of 101 children with CP and of their healthy controls matched for age, sex and ethnicity was measured using upper-arm length (UAL). Nutritional parameters of weight, triceps skin-fold thickness and mid-arm circumference were also measured. Total caloric intake was assessed using a 24-h recall of a 3-day food intake and calculated as a percentage of the Recommended Daily Allowance. Multiple regression analysis was used to determine nutritional, medical and sociodemographic factors associated with poor growth (using z-scores of UAL) in children with CP. RESULTS: Compared with the controls, children with CP had significantly lower mean UAL measurements (difference between means -1.1, 95% confidence interval -1.65 to - 0.59), weight (difference between means -6.0, 95% CI -7.66 to -4.34), mid-arm circumference (difference between means -1.3, 95% CI -2.06 to -0.56) and triceps skin-fold thickness (difference between means -2.5, 95% CI -3.5 to -1.43). Factors associated with low z-scores of UAL were a lower percentage of median weight (P < 0.001), tube feeding (P < 0.001) and increasing age (P < 0.001). CONCLUSION: A large proportion of Malaysian children with CP have poor nutritional status and linear growth. Nutritional assessment and management at an early age might help this group of children achieve adequate growth.

Five-year surveillance of acute flaccid paralysis in Malaysia.

OBJECTIVE: The nation-wide surveillance for acute flaccid paralysis (AFP) was implemented in Malaysia in 1995 and further intensified in 1996 as part of the World Health Organization's (WHO) certification process for polio eradication in the Western Pacific Region. Clinical data on AFP cases during a 5-year surveillance period from 1997 to 2001 were compiled and analysed. RESULTS: Based on 517 cases of AFP reported during this 5-year period, the overall rate of AFP was 1.2 per 100 000 children below 15 years old. The major clinical diagnosis associated with AFP were Guillain-Barre syndrome (30.2%), central nervous system infection (16.2%), transverse myelitis (10.6%) non-polio enterovirus infection (6.2%), and hypokalaemic paralysis (5.2%). This unusual pattern with an excess of CNS infection and non-polio enterovirus infection was attributed to the outbreak of enterovirus 71 infection nation-wide in 1997. According to the WHO virological classification, there was no case of poliomyelitis due to wild poliovirus. Three cases were 'polio compatible', there were no cases of vaccine-associated paralytic polio (VAPP), while 62 cases (12.0%) were merely classified as 'non-polio AFP'. CONCLUSION: Overall, these data suggest the absence of circulation of wild poliovirus in Malaysia from 1997 to 2001. The pattern of AFP in this study is different from other published reports.