Journal of Pediatric Infectious Diseases - Volume 5, issue 4

Authors: Ogundele, Michael O. | Ayyash, Hani F.

Article Type: Research Article

Abstract: The hemolytic uremic syndrome (HUS) is characterized by the triad of thrombocytopenia, micro-angiopathic hemolytic anemia and acute renal failure. This review provides a comprehensive overview of the existing literature on the epidemiology, etiology, pathogenesis, clinical presentation, diagnosis and management of HUS. The ongoing controversy regarding the role of antibiotics during the acute enteric phase of the classical HUS and the challenges involved in the management of the atypical diseases are highlighted. The most common …cause of HUS is systemic uptake of toxins, and develops in 5–10% of children exposed to verocytotoxin-producing Escherichia coli O157:H7. Children below the age of 5 years are the most susceptible hosts and the main route of spread is by fecal-oral transmission. Other infective agents and complement genetic abnormalities are responsible for 10% of cases, referred to as atypical HUS. The characteristic pathologic findings in HUS are renal endothelial swelling, thrombi in the arterioles and capillaries, and subendothelial fibrin deposits. After 30 years of discovering Shiga toxins and over 15 years after associating it with the development of HUS, there are neither specific predictive factors to identify the most susceptible patients after an infection with E. coli 0157:H7 nor specific treatment for HUS once it has become established. Treatment of HUS is mainly supportive. The introduction of specific toxin neutralizing agents has proven disappointing in clinical practice. Recent trials of E. coli O157:H7 O-specific conjugated polysaccharide vaccines appear promising in preventing the development of HUS. Show more

Keywords: Hemolytic uremic syndrome, E. coli, thrombotic thrombocytopenic purpura, thrombotic microangiopathy, verotoxin

DOI: 10.3233/JPI-2010-0268

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 309-320, 2010

Authors: Byrd, Kathy K. | Bruden, Dana L. | Bruce, Michael G. | Bulkow, Lisa R. | Zanis, Carolyn L. | Snowball, Mary M. | Homan, Chriss E. | Hennessy, Thomas W. | Williams, James L. | Dunaway, Eitel | Chaves, Sandra S. | McMahon, Brian J.

Article Type: Research Article

Abstract: We conducted a 10–15 years follow-up to a long-term prospective cohort study on the immunogenicity of inactivated hepatitis A vaccine in Alaska Native children, who were initially vaccinated between 3–6 years of age. Children received three vaccine doses (320 E.U.) and were randomized into the following vaccination schedules: A (0, 1, 2 months); B (0, 1, 6 months); and C (0, 1, 12 months). Sera were collected every 2 years and tested for hepatitis A virus …(anti-HAV). Levels ⩾ 20 mIU/mL were considered protective. Anti-HAV geometric mean concentrations were compared by vaccination schedule at 10, 12 and 14 years of follow-up, using ANOVA. Antibody decline over the entire 15-year follow-up period was also analyzed. While none of the inter-schedule comparisons differed significantly from each other at the 10, 12 and 14-year periods, schedules B and C had significantly higher anti-HAV levels than schedule A over the entire 15 years of the study (P < 0.01). All schedule B and C children maintained seroprotective levels in all follow-up periods. Fourteen percent of schedule A children fell below seroprotective levels at 14 years. Our model estimated that anti-HAV geometric mean concentrations would fall below seroprotective levels at 26, 30 and 32 years for schedules A, B and C, respectively. The data indicate that hepatitis A immunity lasts at least 15 years after vaccination in children and that a booster dose is not needed during that time. However, continued monitoring is necessary to assess the need for a booster dose later in the second and third decade after receipt of the primary series. Show more

Keywords: Hepatitis A, inactivated hepatitis A vaccine, immunogenicity

DOI: 10.3233/JPI-2010-0269

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 321-326, 2010

Authors: Rocha, Gustavo | Pissarra, Susana | Silva, Gorett | Guimarães, Hercília

Article Type: Research Article

Abstract: Since April 2009 in Mexico, a novel influenza virus A (H1N1) of swine origin has emerged as a cause of disease in humans, and has rapidly spread worldwide, declared a pandemic on June 11. Oseltamivir is the only anti-viral agent available for influenza virus in young children, with no proven efficacy and safety in infants and newborns. The authors report their experience with oseltamivir use for term and preterm neonates, during an outbreak of influenza virus …A (H1N1) in a level III neonatal intensive care unit, from November 28 to December 7, 2009. Fifteen hospitalized high risk neonates of non-vaccinated mothers, 6 males and 9 females; gestational age 34 weeks (24–40 weeks); birth weight 1873 g (530–3310 g); 12 became infected with influenza virus A (H1N1); two were (17%) symptomatic. Infection control measures were adopted and oseltamivir was administered after parental consent; for prophylactic use in three (3 mg/kg once a day, 10 days); and therapeutic use in 12 (3 mg/kg twice a day, 5 days). No fatal cases occurred. No adverse effects were reported. The outcome was favorable and the outbreak controlled. The majority of patients infected with influenza virus A (H1N1) were asymptomatic, and no fatal cases were documented. Oseltamivir was not associated with evident short-term adverse effects, and it may have helped to control the epidemic and lessened the severity of illness in affected infants. Show more

Keywords: Newborn, oseltamivir, influenza virus A (H1N1)

DOI: 10.3233/JPI-2010-0270

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 327-331, 2010

Authors: Ahmad, Qazi Iqbal | Choh, Suhil Ahmad | Charoo, Bashir Ahmad | Ahmad, Sheikh Mushtaq | Ali, Wajid | Chaudhary, Javed

Article Type: Research Article

Abstract: Congenital toxoplasmosis is a known cause of morbidity and mortality in infants. We investigated seroprevalence and incidence of primary toxoplasmosis in pregnant women, its vertical transmission and incidence of congenital toxoplasmosis. In a hospital-based 2-year study, pregnant women from the antenatal clinic were screened for toxoplasmosis. Women with primary toxoplasmosis were followed up until delivery and their babies were screened for congenital toxoplasmosis. Another 5,000 randomly selected newborn babies were screened for …congenital toxoplasmosis and all Toxoplasma positive babies were followed up for 1 year. The study revealed 27% serological prevalence of toxoplasmosis in pregnant women, 1.1% incidence of primary toxoplasmosis during pregnancy, 43.2% rate of vertical transmission and 0.5% incidence of congenital toxoplasmosis. Toxoplasmosis in pregnant women remains under-diagnosed and leads to a higher number of infants with congenital toxoplasmosis. Toxoplasmosis is a significant health problem in the mother-child population in this region, and needs attention. Show more

Keywords: Maternal toxoplasmosis, vertical transmission, congenital toxoplasmosis

DOI: 10.3233/JPI-2010-0264

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 333-337, 2010

Authors: Vivanco-Muñoz, Nalleli | Talavera, Juan Osvaldo | Juanico-Enríquez, Antonio | Clark, Patricia

Article Type: Research Article

Abstract: Nosocomial infections at pediatric intensive care units (PICUs) often lead to substantial morbidity, mortality, and prolonged hospital stays in children who have open-heart surgery. Little is known about the risk factors in this population. Our aim was to identify the incidence and clinical factors associated with infections at the PICU in children with congenital heart disease after surgery. Clinical records of patients ⩽ 3-year-old with congenital heart disease, admitted for surgery, were evaluated for clinical, …nutritional, and other risk factors. Infection was determined during the patient's stay at the PICU. Two hundred eighty-nine patients were included in the study. Factors related to overall infection were: higher risk adjustment for congenital heart surgery, age > 1-year-old, cyanotic cardiac anomaly, parenteral or mixed nutrition support, more than 5 days of fasting, and mechanical ventilation ⩾ 48 . Factors related to pneumonia were higher risk adjustment for congenital heart surgery, cyanotic cardiac anomaly more than three inotropics infused during surgery, parenteral or mixed nutritional support, more than 5 days of fasting, and mechanical ventilation ⩾ 48 h. Factors related to mediastinitis and sepsis were: age > 1-year-old, aortic clamp ⩾ 120 min, parenteral or mixed nutritional support, more than 5 days of fasting, and mechanical ventilation ⩾ 48 h. In the multivariate survival analysis, parenteral or mixed nutrition and mechanical ventilation ⩾ 48 h increased the risk for overall infection (relative risk 1.949, 95% confidence interval 1.108–3.43, P=0.021 and relative risk 25, 95% confidence interval 2.53–246.19, P =0.006 respectively). Early enteral nutrition after surgery and early weaning from mechanical ventilation (less than 48 h) will reduce infection incidence. Show more

Keywords: Congenital heart disease, surgery, pediatric intensive care unit, nutrition support, infection

DOI: 10.3233/JPI-2010-0265

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 339-345, 2010

Authors: El Sayed Zaki, Maysaa

Article Type: Research Article

Abstract: Patients with chronic hemolytic anemia are at high risk of developing acute erythroblastopenia following infection by parvovirus B19 (PB19). The objective of the present study is to evaluate the clinical and hematological effects of recent and old PB19 infections in Egyptian children with chronic hemolytic anemia. This study included 90 pediatric patients. Twenty healthy subjects with matched age and sex were included as controls. Patients were classified as patients with chronic hemolytic anemia with acute …aplastic crises and patients with chronic hemolytic anemia without aplastic crises. Full hematological and clinical studies were performed for each patient. Virological studies for PB19 were applied with measurement of specific IgM and IgG and real time polymerase chain reaction. Recent PB19 infection in patients with chronic hemolytic anemia with acute aplastic crises was associated mainly with fever (77.8%) followed by pallor and hepatosplenomegaly (38.9% for each). Recent PB19 infection was associated by significantly lower levels of mean hemoglobin (Hb) (P1= 0.001, P2 < 0.001) compared to patients with past PB19 and in patients with no markers of infection in patients with aplastic crises respectively. In patients with chronic hemolytic anemia without aplastic crises it was observed that recent PB19 infection was associated with significantly lower levels of the mean Hb compared to patients with past PB19 infection and patients without markers of infection (P=0.026). In patients with chronic hemolytic anemia without aplastic crises there was significant neutropenia in recent infection compared to patients with past infection and in patients without markers of infection (0.039) and lymphocytosis in recent infection compared to patients with past infection and in patients without markers of infection (P=0.001). We can conclude that recent PB19 infection in patients with chronic hemolytic anemia usually presents with low Hb levels associated with fever and hepatosplenomegaly. Even in patients with evidence of past PB19 infection, the finding was lower Hb level. Show more

Keywords: Chronic hemolytic anemia, parvovirus infection

DOI: 10.3233/JPI-2010-0266

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 347-352, 2010

Authors: Cáceres, Paola | Montes, Soledad | Vega, Natalia | Cruchet, Sylvia | Brunser, Oscar | Gotteland, Martin

Article Type: Research Article

Abstract: Acute respiratory infections (ARI) are one of the main health problems in children, particularly in those under 5 years of age. The aim of this study was to evaluate whether the regular intake of the probiotic Lactobacillus rhamnosus HN001 affects the frequency, severity or duration of ARI in children attending day care centers during the winter season. A double-blind, placebo-controlled trial was carried out in 398 children (1 to 5 years old) who were randomized into …two groups to receive daily for 3 months either 100 mL of a product containing HN001 (10^{10} bacteria/day) or a control without the probiotic. ARI episodes and symptoms, absenteeism and antibiotic administration were registered. In a sub-group of children, oropharyngeal and fecal samples were obtained to detect pathogens, total Lactobacillus counts and secretory IgA, respectively. When comparing groups, neither the number nor the duration of the ARI, nor the days of absenteeism or antibiotic administration were statistically different. No differences between the groups in the detection rates of Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes in the oropharyngeal samples were observed along the study. Fecal Lactobacillus counts as well as sIgA levels increased significantly during the study in the HN001 group, compared to the control (P=0.027 and P=0.048, respectively). In the conditions in which this study was carried out, the regular intake of L. rhamnosus HN001 modulated the intestinal immune responses without affecting the frequency or severity of ARI in children. Show more

Keywords: Probiotics, functional foods, acute respiratory infections, secretory immunoglobulin A, immune response

DOI: 10.3233/JPI-2010-0267

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 353-362, 2010

Authors: Giraldo Rios, Diana | Sant'Anna, Clemax Couto | March, Maria de Fátima B. Pombo | Abreu, Thalita Fernandes | Ferreira, Sidnei | Bomfim, Márcia | Parente, Ana Alice Ibiapina | Jackson, Morgan N.

Article Type: Research Article

Abstract: From November 2007 to April 2008, 196 patients were admitted to the Short Stay Unit and/or Intensive Care Unit of the Instituto de Puericultura e Pediatria Martagão Gesteira with clinical presentations suggesting dengue fever. Included in this retrospective case series are 181 patients who had laboratory confirmation of dengue fever; 51.9% (94/181) had classical dengue fever and 48.1% (87/181) had dengue hemorrhagic fever. Patients ranged from 4 months to 15 years of age; the median age …being 9 years (mean ± SD; 8.5 ± 3.6 years). There were 90 cases with pleuropulmonary manifestations: 30 of 94 cases with classical dengue fever and 60 of 87 cases with dengue hemorrhagic fever. In descending order, the changes found were pleural effusion, elevation of the diaphragm, and pleural opacity. Radiological manifestations appeared a median of 6 days after hospitalization (range, 3 to 11 days). In 89/90 (98.9%) cases with pleuropulmonary manifestations, early therapeutic approaches resulted in resolution of clinical and radiologic findings. Show more

Keywords: Dengue fever, hemorrhagic, classical dengue fever, chest radiography, adolescents

DOI: 10.3233/JPI-2010-0281

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 363-367, 2010

Authors: Al-Otaibi, Fawzia Eida | Bukhari, Elham Essa

Article Type: Research Article

Abstract: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a serious problem in the community setting, primarily as a cause of skin and soft tissue infections. The incidence of CA-MRSA infections in children has increased dramatically over the past decade. The objectives of this retrospective study were to report the frequency of CA-MRSA isolates, to describe the spectrum of disease observed in children infected with CA-MRSA and to compare the type of infections and antibiotic …susceptibility patterns of CA-MRSA and community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA). A retrospective review was conducted of the medical records of children 0 to 18 years old with S. aureus infection including CA-MRSA isolated by the microbiology laboratory at King Khalid University Hospital between 2005 and 2008. Between January 2005 to December 2008, S. aureus was isolated from 285 children. Of these children 85 (29.8%) had CA-MRSA. The percentage of community-acquired S. aureus isolates that were methicillin-resistant increased from 18.8% (15 of 80 isolates) in year 2005 to 40.5% (34 of 84 isolates) in year 2008 (P =0.0253). Among the CA-MRSA isolates, 75 (88.2%) were obtained from children with skin and soft-tissue infections, and eight (9.4%) were obtained from children with invasive infections. Overall, 45.9% of children with CA-MRSA isolates and 17.5% of children with CA-MSSA were admitted to the hospital (P = 0.0001). Patients without identifiable risk factors comprised 55 CA-MRSA infections (64.7%). Risk factors for acquisition of MRSA including allergic skin disease (eczema), chronic diseases, previous health care contact, antibiotic treatment and intrafamilial spread were identified in 30 of the 85 (35.3%) CA-MRSA patients. CA-MRSA infections tended to occur at younger ages (infant < 1-year, P =0.0001). Compared to CA-MSSA isolates, CA-MRSA isolates were more resistant to erythromycin, clindamycin, tetracycline, gentamicin and rifampin (P < 0.05). CA-MRSA isolates account for an increasing percentage and number of infections among children seen and managed at our hospital. More surveillance and epidemiologic studies to evaluate the magnitude of infection caused by CA-MRSA infection in our community is warranted. Show more

Keywords: CA-MRSA, Saudi Arabia, children

DOI: 10.3233/JPI-2010-0278

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 369-376, 2010

Authors: Sarrell, E. Michael | Meyerovitch, Joseph

Article Type: Research Article

Abstract: The aim of the study was to investigate the utility of combining inhaled epinephrine with bromhexine, a mucolytic agent, for the management of viral bronchiolitis in an outpatient setting. A randomized double blind, placebo-controlled parallel-group design was used. Three hundred thirty patients aged 1–14 months with respiratory syncytial virus bronchiolitis attending two primary pediatric community clinics were randomly assigned to receive treatment (wet nebulized aerosol) with single-isomer epinephrine diluted (1:1000) in either …2 mL or 2.5 mL (by age) 0.9% saline (control group) or 2 mL or 2.5 mL bromhexine (study group), or 2 mL or 2.5 mL 0.9% saline only (placebo group) (n=110 each). Treatment was administered three times daily for 7 days. Primary outcome measures were changes in bronchiolitis caregiver diary score and pulse oximetry results; secondary outcome measures were emergency department visits/hospitalization and illness-related loss of daycare (patient) or work (parent) days. Baseline background and clinical characteristics were similar in all groups. The study group had significantly lower bronchiolitis caregiver diary scores than the control and placebo groups at all time points (P< 0.0001), significantly greater improvement in pulse oximetry results on days 2 and 4 (P=0.034 and 0.003 respectively), and fewer days missed from daycare/ work. There were no significant differences in hospital admissions, but the risk reduction was lowest in the study group. In children with bronchiolitis, treatment with nebulized epinephrine and bromhexine appears to lead to more rapid clinical improvement than epinephrine alone, thereby reducing the burden of care. Show more

Keywords: Bromhexine, bronchiolitis, epinephrine, infants, multicenter randomized control trial, nebulized inhalation, RSV

DOI: 10.3233/JPI-2010-0273

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 377-384, 2010

Authors: Nandi, Madhumita | Mondal, Rakesh | Chakravorti, Swati | Sarkar, Uday N.

Article Type: Research Article

Abstract: We describe an 8-year-old male who presented with persistent lung abscess. The boy was subsequently found to be having congenital broncho-esophageal fistula. This condition has been reported rarely worldwide in children. It is probably the first case of congenital broncho-esophageal fistula presenting as persistent lung abscess from India.

Keywords: Broncho-esophageal fistula, recurrent lung abscess

DOI: 10.3233/JPI-2010-0275

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 385-387, 2010

Authors: Gupta, Soham | Patil, Santosh | Muralidharan, Sethumadhavan

Article Type: Research Article

Abstract: Elizabethkingia meningoseptica is known to cause meningitis in premature neonates and severe infections in immunocompromised adults. It may cause a therapeutic dilemma as it often shows discrepancies between various methods of antimicrobial susceptibility testing. Here, we present a case of multi drug resistant E. meningoseptica meningitis and sepsis in a premature baby, which caused a therapeutic challenge. The strain was susceptible to piperacillin, piperacillin-tazobactam and trimethoprim/sulfamethoxazole by disk diffusion method. On the …other hand the minimum inhibitory concentration values for these antibiotics were much higher to be interpreted as resistant by VITEK 2C (bioMérieux). This case showed significant clinical improvement with combination therapy of piperacillin-tazobactam and amikacin, and the same drugs were continued. Relying on the clinical outcome in this case, we observe that VITEK 2C may be less accurate than disk diffusion method for detection of antimicrobial resistance in this organism. Show more

Keywords: Elizabethkingia meningoseptica, meningitis, sepsis, premature neonate, disk diffusion, VITEK 2C

DOI: 10.3233/JPI-2010-0276

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 389-391, 2010

Authors: Crispim, João Núncio | Dâmaso, Catarina | Marques, José Gonçalo | Miguéns, José | Valente, Paula

Article Type: Research Article

Abstract: We present a case of a 6-month-old boy admitted with hydranencephaly, cranial hypertension, prolonged fever and malnutrition. Cerebrospinal fluid culture identified Burkholderia cepacia meningitis, which was controlled with ceftazidime plus amikacin after a protracted course. This is the only case of B. cepacia meningitis reported in the medical literature the last 20 years. Previous cases were successfully treated with co-trimoxazole or the third generation cephalosporins.

Keywords: urkholderia cepacia, meningitis

DOI: 10.3233/JPI-2010-0272

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 393-396, 2010

Authors: van den Akker, Machiel | Greenberg, David | Harush, Miriam Ben | Fruchtman, Yariv | Kapelushnik, Joseph

Article Type: Research Article

Abstract: In immunocompromised patients, Cryptosporidium disease can present as a severe, prolonged and potentially life-threatening diarrhea. We present three case reports of children with cancer and a cryptosporidiosis infection who were treated successfully with nitazoxanide either alone or in combination with azithromycin. These case reports show that the clinician should be alert in diagnosing Cryptosporidium infection in oncology children with severe or prolonged diarrhea, a possible life threatening condition, and the combined treatment …of nitazoxanide and azithromycin can be a possible strategy to resolve the infection and eradicate Cryptosporidium. Additional studies should be performed to confirm this observation. Show more

Keywords: Cryptosporidium, cryptosporidosis, pediatric oncology patients, nitazoxanide, azithromycin

DOI: 10.3233/JPI-2010-0271

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 397-400, 2010

Authors: Rigelman-Hedberg, Natalie E. | Bjur, Kara A. | Banerjee, Ritu | Fischer, Philip R.

Article Type: Research Article

Abstract: Staphylococcus aureus is a ubiquitous pathogen responsible for a wide range of pathology, including toxic shock syndrome (TSS). We report a rare case of TSS in an otherwise healthy 16-year-old female with recent history of cellulitis at the site of umbilical piercing. The described case is an important reminder for physicians to consider TSS in the differential diagnosis of septic-appearing patients, including those with history of cutaneous infections near body piercing sites.

Keywords: Toxic shock syndrome, taphylococcus aureus, umbilicus, piercing

DOI: 10.3233/JPI-2010-0277

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 401-403, 2010

Authors: Koh, Carline | Yau, Eric Kin Cheong | Chung, Fong Nai | Wo, Hui Yim

Article Type: Research Article

Abstract: Kawasaki disease (KD), a condition primarily affecting infants and young children, is commonly encountered by physicians nowadays. However, large retropharyngeal swelling in the presence of KD is rarely reported in literature. In this report, we present a 9-month-old female with KD mimicking retropharyngeal abscess, with review of seven previously published case reports.

Keywords: Kawasaki disease, retropharyngeal abscess, retropharyngeal infection

DOI: 10.3233/JPI-2010-0279

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 405-409, 2010

Authors: Morrison, Ryann E. | Naktin, Jaan P. | Neas, Denise

Article Type: Research Article

Abstract: Rhodococcus equi is an emerging pathogen among immunocompromised hosts. Increased incidence has been described in the human immunodeficiency virus/acquired immune deficiency syndrome population, patients immunocompromised due to organ transplantation and in those receiving chemotherapy. Features associated with this case included a sustained bacteremia and delay in recognition of the clinical syndrome due to the intermittent positivity of the blood cultures and initial mis-identification of the organism as a "coryneform" contaminant. The patient …was successfully treated with an oral antibiotic regimen after removal of the central catheter. Show more

Keywords: Rhodococcus equi, catheter-associated bacteremia, oral antibiotics

DOI: 10.3233/JPI-2010-0274

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 411-414, 2010

Authors: Bhat, Deepak

Article Type: Research Article

Abstract: Acute disseminated encephalomyelitis (ADEM) is a rare central nervous system manifestation of dengue hemorrhagic fever. We report a 14-year-old male who presented to the emergency department with complaints of fever, vomiting and headache for last 6 days and altered sensorium for last 1 day. On general physical examination, he had multiple petechial spots over the trunk. In central nervous system examination child was having neck stiffness, intermittent decerebrate posturing, brisk deep tendon reflexes, hypertonia in …all the limbs, bilateral plantars extensors and sluggishly reacting small pupils. His initial investigations revealed hemoglobin of 12 g/dL, total white cell count 7.500 cells/mm^{3} , platelet count 70,000 cells /mm^{3} , urea 59 mg/dL, creatinine 0.9 mg/dL, calcium 9.1 mg/dL, sodium 140 mEq/L, potassium 4.6 mEq/L and a positive dengue IgM (39.4 panbio units, normal < 11 panbio units) by capture enzyme-linked immunosorbent assay method (PAN BIO KIT, Australia). In view of fever, petechial spots, shock, low platelet counts and a positive dengue serology, a diagnosis of dengue hemorrhagic fever was kept. Magnetic resonance imaging report showed symmetrical hyperintensities on T2-weighted and fluid-attenuated inversion recovery images involving bilateral cerebellar hemispheres, bilateral middle cerebellar peduncles, brain stem, bilateral thalami, hypothalamus and periventricular deep and subcortical white matter, suggesting ADEM. Previously only two cases of ADEM in dengue fever have been reported. Show more

Keywords: Dengue hemorrhagic fever, child, central nervous system, complication, ADEM

DOI: 10.3233/JPI-2010-0280

Citation: Journal of Pediatric Infectious Diseases, vol. 5, no. 4, pp. 415-417, 2010