Annals of Tropical Paediatrics

Harlequin ichthyosis (HI) is a very rare severe form of autosomal recessive congenital ichthyosis, usually associated with stillbirth and early neonatal death. A newborn girl with HI is described. She presented in a critical condition with severe universalis hyperkeratosis, diffuse scales and deep erythematous fissures. She received preventive systemic antibiotics and hygienic nursing with skin and eye care, feeding and appropriate hydration. She was discharged at 28 days in good general condition.

BACKGROUND: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy. AIM: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations...

BACKGROUND: Rapid diagnosis of typhoid fever is very important in the timely initiation of therapy. OBJECTIVES: To evaluate the sensitivity and specificity of the Enterocheck WB(®) test. METHODS: In a prospective study, the sensitivity and specificity of Enterocheck WB(®) that detects IgM antibodies to Salmonella typhi were compared with blood culture using BacT/Alert. RESULTS: Four hundred and fifty patients with suspected typhoid fever were assessed both by blood culture and Enterocheck WB(®); 100 of them were either Enterocheck WB(®)-positive or blood culture-positive or both for S...

UNLABELLED: Although hypovitaminosis D has been reported in the neonatal period and infancy, there is currently little information on the longitudinal changes in vitamin D status throughout early infancy. AIM: To estimate, in Al Ain, UAE, the prevalence of vitamin D deficiency and longitudinal changes and risk factors in infants between birth and 6 months of age. METHODS: Serum 25-OH-vitamin-D levels were measured after birth and 6 months later in 27 infants of mothers of Middle Eastern or Asian origin who were pregnant between the months of September and November 2007...

BACKGROUND: No studies have assessed the diagnostic accuracy of clinical signs of electrolyte disturbances in children with dehydrating diarrhoea. AIMS: To assess the diagnostic accuracy and reliability of clinical signs previously reported to be associated with plasma sodium and potassium disturbances in children. METHODS: A cross-sectional analytical study of 476 children aged 6 weeks to 2 years, admitted to a rehydration unit in Cape Town, South Africa...

OBJECTIVES: Colorectal polyps are important causes of rectal bleeding but they have been infrequently reported in Egyptian children. The prevalence and characteristics of colorectal polyps in a consecutive cohort of Egyptian children with rectal bleeding are presented. METHODS: A total of 174 children aged 2-12 years [mean (SD) 6.4 (3.7)] with fresh rectal bleeding were enrolled prospectively. Rectal examination, laboratory investigations and fibre-optic colonoscopy were performed in all patients...

BACKGROUND: Early childhood diarrhoea is a major cause of infant morbidity and mortality in developing countries. Recurrent and persistent diarrhoea affect growth and cognition in children as young as 6 years. OBJECTIVES: To evaluate the effect of early childhood cryptosporidial and giardial diarrhoea on growth and development in children in a semi-urban slum in India. This is the first report of such assessment at 3 years of age. METHODS: This study was undertaken on 116 children who were part of an ongoing birth cohort study (n=452) of rotaviral and cryptosporidial diarrhoea between June and December 2005...

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As child mortality declines globally, neonatal mortality (death in the 1st month of life) has become an increasingly important cause of under-5 deaths. Emerging evidence showing the effectiveness of low-cost community-based interventions proves that expensive hospital interventions are not needed to make progress with newborn survival in low-income countries where the vast majority of deaths occur. This paper discusses the use of two approaches to community-based interventions: home visits by community health workers and participatory women's groups...

Congenital measles is a well recognised but uncommon transplacental infection in the post-vaccine era. A 4-day-old infant is described who presented with uncomplicated congenital measles during the 2010 South African measles outbreak. Clinicians working in regions affected by measles outbreaks should be mindful of waning vaccine-induced measles immunity where infections among pregnant women may result in a resurgence of congenital measles.

Long considered a benign infection, Plasmodium vivax is now increasingly recognised as a cause of severe and fatal malaria. Various atypical presentations of vivax malaria have been reported. This report highlights the occurrence of acute glomerulonephritis in a 7-year-old girl who presented with fever and vomiting. Peripheral smear examination demonstrated ring forms of P. vivax. OptiMAL test was positive for P. vivax and negative for Plasmodium falciparum. She was managed with antimalarial and antihypertensive drugs and made an uneventful recovery...

Orbital myositis in children is uncommon. Recurrence is a major challenge in management. An 11-year-old Malay girl who presented with bilateral orbital myositis with recurrent attacks of diplopia is reported.

In Crimean-Congo haemorrhagic fever (CCHF), haemorrhagic manifestations are usually petechiae and ecchymoses on mucous membranes and skin. Rarely, there is bleeding from the nose, gingiva, gastro-intestinal tract, genito-urinary tract, brain and lungs. A 13-year-old boy with CCHF presented with gastro-intestinal bleeding and developed peritoneal and pleural effusion. He made a complete recovery with supportive treatment and ribavirin, without requiring chest or peritoneal fluid drainage. To our knowledge, this is the first report of CCHF associated with peritoneal and pleural fluid...

Intra-abdominal calcification is uncommon in newborns and has several causes of which meconium peritonitis is the most frequent. Three neonates with intra-abdominal calcification as a complication of meconium peritonitis are presented. The types of meconium peritonitis were cystic, meconium pseudocyst and meconium ascites. Two required surgical intervention. Meconium peritonitis should be considered in newborns with intra-abdominal calcification.

A 3.5-year-old child with influenza B virus pneumonia developed pneumomediastinum and subcutaneous emphysema on the 3rd day of illness. Bronchoscopy demonstrated obstruction of the left main bronchus by mucopurulent sputum. Culture of the broncho-alveolar lavage yielded Stenotrophomonas maltophilia. After the respiratory complications resolved (11 days), the patient developed neurological symptoms and was diagnosed as acute disseminated encephalomyelitis (ADEM). Stenotrophomonas maltophilia was probably a factor in the development of pneumomediastinum...

A woman presented with polyhydramnios at 22 weeks of gestation with a structurally normal fetus and placenta. Biochemical analysis of amniotic fluid detected a very high level of chloride (582 mmol/L), which led to the diagnosis of Bartter syndrome. With serial amniocentesis and indomethacin therapy, the pregnancy continued to 36 weeks. Neonatal and subsequent investigations further supported the diagnosis of Bartter syndrome. The infant was well at birth and now, at 5 months of age, is gaining weight normally on indomethacin...

Alternating hemiplegia of childhood (AHC) is a rare neurological disorder which usually presents before 18 months of age and is characterised by recurrent alternating episodes of hemiparesis. A single effective treatment for this condition is yet to be established; flunarizine is currently the most widely used but with varying degrees of success. An 18-month-old child presented with AHC and treatment with a combination of topiramate and flunarizine made a significant difference in controlling the frequency and severity of the attacks...

Menetrier's disease is a rare cause of protein-losing gastropathy characterised by hypertrophy of the gastric folds. Three cases are reported. Helicobacter pylori was detected by culture and CLO test in two cases and on follow-up gastroscopy in the other. The first two patients were given eradication therapy and hypertrophic gastropathy resolved whereas in the third the disease remitted prior to the eradication treatment. Typical sonographic features were thickened gastric wall with preservation of the wall stratification...

A retrospective review of ten patients (8 girls, 2 boys) admitted over a 9-month period with haemophagocytic lymphohistiocytosis (HLH) is presented. Presenting features included fever and hepatosplenomegaly (10), bleeding manifestations (7), lymphadenopathy (4), skin rash (4), shock (4), jaundice (3), CNS disorder (3), renal failure (2) and arthritis (2). Three infants had familial HLH (FHL) while the other seven patients had acquired (secondary) HLH. Two patients with FHL had very low perforin levels (0 and 0...

BACKGROUND: Acute kidney injury (AKI) is one of the commonest manifestations of end-organ damage associated with birth asphyxia. OBJECTIVE: To evaluate glomerular and tubular dysfunction in neonates with moderate to severe birth asphyxia. DESIGN: Prospective cohort study. SETTING: Neonatal unit of a teaching hospital. METHODS: Subjects were inborn neonates of ≥34 completed weeks of gestation with an APGAR score <7 at 1 min after birth...