Subscribe: Journal of Tropical Pediatrics - current issue
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Journal of Tropical Pediatrics Current Issue

Published: Wed, 22 Mar 2017 00:00:00 GMT

Last Build Date: Wed, 22 Mar 2017 08:44:54 GMT


In this Issue 63/2


Preventing Neural Tube Defects


Globally, around 300 000 children are born with neural tube defects each year, though this is a condition that is preventable in the majority of cases [1]. Periconception folic acid is a primary prevention that is now well known, but implementation lags behind the basic science.



In “Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance” by Ragna S. Boerma et al., the affiliations for Cissy Kityo and T. Sonia Boender were published online incorrectly. They should be Joint Clinical Research Center (JCRC), Kampala, Uganda and Stichting HIV Monitoring Foundation, Amsterdam, the Netherlands, respectively. The affiliations have been corrected online and in print.

Interactions between Gastrointestinal Nematodes and Malaria in a Cohort of Children in an Amazonian Village


Introduction: Most studies on nematode–malaria interactions were conducted outside of the Americas. The objective of the present study was thus to study the relation between malaria and nematodes in a cohort of children in an Amazonian village. Methods: Odds ratios for intestinal nematode infections as an explanatory variable to malaria resistant vs. malaria sensitive were computed. Results: Ascaris lumbricoides was significantly more frequent in the ‘resistant’ malaria group than in the ‘sensitive’ one. Conclusions: Despite its low statistical power, the present results find that Ascaris was associated with less malaria, as observed by a number of studies.

Paratesticular Rhabdomyosarcoma Associated with Tuberculosis


We report a 16-year-old male patient diagnosed with paratesticular rhabdomyosarcoma and mediastinal tuberculous lymphadenitis. The differential diagnosis between high or early stage of rhabdomyosarcoma and tuberculosis (TB) was critical in this patient without a history of TB. Unexpected lymphadenopathies detected during the staging of patients with malignancy should be carefully evaluated, and TB should be taken into consideration in the differential diagnosis especially in underdeveloped and developing countries. Unnecessary additional treatments increase the rate of mortality and morbidity because of upstaging of cancer. Further, TB reactivation can be seen during chemotherapy because of immunosuppression.

Prediction of Bronchial Mucus Plugs Formation in Patients with Refractory Mycoplasma Pneumoniae Pneumonia


Background: We aimed to find the relationship between the clinical characteristics and mucus plug formation and developed models to predict mucus plug formation in refractory Mycoplasma pneumoniae pneumonia (RMPP) infection. Methods: RMPP patients treated with bronchoscopy were retrospectively enrolled in the study between November 2011 and November 2015. Multivariate logistic regression was performed to identify independent predictors of mucus plug formation. Results: Of the 173 RMPP patients enrolled, the mucus plug group accounted for 82 (47.4%) cases. Multivariate logistic regression analysis identified age, fever duration, C-reactive protein (CRP) and lactic dehydrogenase (LDH) as independent risk factors for mucus plug. We assigned one point for age, length of fever and CRP and two points for LDH. Using this predicted score, we identified patients with mucus plug with 71.8% sensitivity and 78.9% specificity. Conclusions: Our predictive models based on demographic and laboratory variables accurately predicted mucus plug formation in initial treatment of patients with RMPP.

Maternal Immunization with Pneumococcal Polysaccharide Vaccine: Persistence of Maternal Antibodies in Infants


Objective: To evaluate the level and the persistence of maternal antibodies in infants after maternal immunization with pneumococcal polysaccharide vaccine (Pn23V). Methods: Pregnant women were assigned to two groups, during routine low-risk pre-natal visits. The first Group (VAC) received the Pn23V vaccine shortly after enrolment at 28 weeks or later, and the second Group (NO_VAC) received no vaccine. To investigate the antibody persistence, we collected blood samples from the mothers after 1 month of delivery and from the infants at 1 and 6 months of age. Results: Antibody titers were measured for serotypes 1, 6B and 14. Geometric mean antibody concentrations of specific immunoglobulin G were significantly higher in the vaccinated group compared with unvaccinated controls for all three serotypes tested. Conclusion: Despite the antibody level’s decline, at 6 months of age, proportions  >0.35 μg/ml remained higher in the infants of vaccinated mothers than controls for all three serotypes.

Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance


Background: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.Methods: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.Results: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.Conclusions: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.

Soil-transmitted Helminth Infections in Schoolchildren of Laguna de Perlas (Nicaragua)


Soil-transmitted helminth (STH) prevalence, intensity, polyparasitism and co-infections in 425 children from 3 schools of Laguna de Perlas (Nicaragua) were investigated. Single stool samples were analysed by the formalin-ether method and the Kato-Katz. A total of 402 (94.6%) children were infected. Trichuris trichiura 308 (72.4%), Ascaris lumbricoides 115 (27.1%) and Hookworms 54 (12.7%) were the most prevalent STHs. Polyparasitism (322; 75.8%) with two species was most prevalent (109; 25.6%). T. trichiura with A. lumbricoides (19.3%) and T. trichiura with Hookworm (6.8%) were the most common combinations. Positive associations were observed between T. trichiura and A. lumbricoides and T. trichiura and Hookworm (p = 0.0001). Highest Hookworm intensities appeared when three STH co-infections occurred. Moderate- heavy STH intensities appear in up to 42.1% in trichuriasis, 57.5% in ascariasis and 11.1% in Hookworm infections. Integrated control interventions covering children need to be implemented mainly in a rural environment.

Nail Scabies: An Unusual Presentation Often Overlooked and Mistreated


Nail scabies is an interesting clinical presentation of scabies. Although it is usually found concomitant with characteristic dermatologic manifestations, it may present as an isolated finding in the immunocompromised host. This condition is commonly mistaken with other diseases such as nail dystrophy, nail psoriasis and onychomycosis. We report two cases of unusual nail presentations that provide clues to diagnosis. Also, literature on unusual nail and dermatologic presentations was reviewed to recognize dermatologist consideration for appropriate treatment options.

Screening and Primary Care Access for Newly Arrived Paediatric Refugees in Regional Australia: A 5 year Cross-sectional Analysis (2007–12)


Aim: This study aimed to determine the prevalence of health conditions in newly arrived refugee children and access to timely heath screening. Methods: Cross-sectional data from screening of refugee children in regional Australia (2007–12) were analysed for health conditions and timeliness of primary care access. Results: The health of 376 newly arrived refugee children (0–15 years) was assessed. Refugee children came from African (45%), Southeast Asian (29%) and Eastern Mediterranean (10%) regions. Access to primary care screening was present in 367 children (97% of arrivals). Completion of all recommended screening tests was 72%. Of 188 children with arrival and screening dates recorded, 88% were screened within 1 month and 96% within 6 months of arrival. Timely access of remaining children could not be assessed. Conclusion: Primary care was highly accessible to almost all newly arrived refugee children. Health screening was timely in those children with complete medical records.

Changing Epidemiology: A New Focus of Kala-azar at High-Altitude Garhwal Region of North India


Adult cases of visceral leishmaniasis (VL), predominantly males, have been reported in the past decade from natives of high altitude areas of North Indian state of Uttarakhand. We report 14 pediatric cases of VL, who were diagnosed and treated successfully over the past 7 years. All these children were born and brought up in this area and had never visited any of the endemic areas. High prevalence of pallor, splenohepatomegaly, thrombocytopenia and poor association with HIV are cardinal features of VL in this region. Although newer drugs have become available, the protozoan continues to be sensitive to sodium stibogluconate. We conclude that the transmission cycle of VL has been established in this region and VL should be considered in the differential diagnosis of any child presenting with fever and hepatosplenomegaly. However, molecular and epidemiological studies are needed to identify the ancestry, vector and animal reservoir if any in this region.

Measuring the Daily Activity of Lying Down, Sitting, Standing and Stepping of Obese Children Using the ActivPAL TM Activity Monitor


This study describes the patterns of objectively measured sitting, standing and stepping in obese children using the activPALTM and highlights possible differences in sedentary levels and patterns during weekdays and weekends. Sixty-five obese children, aged 9–11 years, were recruited from primary schools in Terengganu, Malaysia. Sitting, standing and stepping were objectively measured using an activPALTM accelerometer over a period of 4–7 days. Obese children spent an average of 69.6% of their day sitting/lying, 19.1% standing and 11.3% stepping. Weekdays and weekends differed significantly in total time spent sitting/lying, standing, stepping, step count, number of sedentary bouts and length of sedentary bouts (p < 0.05, respectively). Obese children spent a large proportion of their time sedentarily, and they spent more time sedentarily during weekends compared with weekdays. This study on sedentary behaviour patterns presents valuable information for designing and implementing strategies to decrease sedentary time among obese children, particularly during weekends.

Adherence to Childhood Tuberculosis Treatment in Mozambique


Background: There is limited literature regarding adherence rates for the treatment of tuberculosis (TB) in children. We aimed to describe TB treatment outcomes and adherence as well as to evaluate associated factors to poor adherence in Mozambican children.Methods: This is a sub-study of a community TB incidence study among children <3 years of age. Incomplete adherence included the sum of lost-to-follow-up cases plus those with a delay of > 3 weeks to treatment completion.Results: Fifty TB treatments were assessed. Forty-four (88.0%) patients completed treatment, two (4.0%) died during treatment and four (8.0%) were lost to follow-up. Incomplete adherence was observed in 31.3% (15 of 48) of cases and was associated with malnutrition or history of a migrant mother.Conclusion: Although treatment outcome is overall good, there is still a significant proportion of incomplete adherence. Further larger paediatric TB cohorts and qualitative approaches are needed to assess and confirm potential factors for non-adherence.