Ceftriaxone Therapy of Bacterial Meningitis in Children

Twenty-nine children, age 3 months to 11 years, admitted with the clinical diagnosis of bacterial meningitis to the Department of Child Health, were included in a prospective treatment study of ceftriaxone (RocephinHoffmann- La Roche AG Bas/e, Switzerland). Ceftriaxone was used as the only antibiotic agent in single daily dose of 100 mg/kg body weight given intravenously for a minimum of 10 days. Of these 29 patients, 25 (86.2%) recovered, 3 (10.3%) died and 1 (3.4%) no respond to treatment. Among fatal cases, two patients had subdural empyema and one had a cerebral abscess. The microorganisms isolated from cerebrospinal fluid were: Streptococcus pneumoniae (5), Pseudomonas sp. (4), Proteus sp. (2), Salmonella typhi (1), Escherichia coli (1), Clostridium sp. (1), Pseudomonas aeruginosa (1), Staphylococcus aureus {1), and Streptococcus haemolyticus (1). In 12 patients (41,4%), organisms were not identified. The diagnosis was made based on clinical symptoms, Gram staining, cell count. ~!·tease, and protein in the CSF. In all patients, repeated spinal fluid cultures had no bacterial growth at 24 hours after initation of intravenous therapy. No evidence of clinical important drug toxicity was observed. Three p'Oiients, however, had lightly elevated hepatic transaminase levels, and one patient had rnild neutropenia. These clinical and bacteriological results suggested that ceftriaxone is reasonably safe and effective in the treatment of bacterial meningitis caused by the most common pediatric pathogens in Indonesian children over one month of age.

Ultrasound findings in dengue haemorrhagic fever

The ultrasound examination of 29 children, aged between 2 to 13 years with clinical and serological proven dengue haemorrhagic fever were reviewed and correlated with the findings in the literature. Ultrasound findings consisted of: (1) ascites, (2) pleural effusion, (3) abnormal gallbladder wall and (4) abnormal liver parenchyma. Ascites is common in DHF. Pleural effusion was found on the right and on bilateral pleural spaces. There was no isolated left pleural effusions. The abnormal gallbladder wall has never been mentioned before in the literature and the abnormal liver parenchyma might be due to intraparenchymal and subcapsular haemorrhages.

Congenital toxoplasmosis in a 15 day-old infant. A case report

A case congenital toxoplasmosis in a 15-day old infant was reported, citing the difficulties encountered in establishing the diagnosis due to the wide range of the disease's clinical spectrum. Congenital toxoplasmosis was suspected after finding hydrocephalus, cerebral calcification, and chorioretinitis. Serology tests with the ELISA technique were highly positive for antibodies against IgG, whereas anti-IgM was negative. The patient died before the second serological analysis was done. The final diagnosis of congenital toxoplasmosis was eventually established at autopsy, based on the detection of T. gondii in the brain, testicular, liver, spleen and striated muscle tissues.

Dengue haemorrhagic fever and Japanese B encephalitis in Indonesia

Dengue haemorrhagic fever (DHF) was first recognized in Indonesia in the cities of Jakarta and Surabaya in 1968, 15 years after its recognition in the Philippines. During the 1968 outbreak, a total of 58 clinical cases with 24 deaths were reported. The number of reported cases since then has increased sharply, with the highest number of cases recorded in the years 1973 (10,189 cases), 1983 (13,668 cases), and 1985 (13,588 cases). Outbreaks of the disease have spread to involve most of the major urban areas, as well as some of the rural areas. In 1985, the disease had spread to 26 of 27 Provinces and 160 of 300 regencies of municipalities. At present, the disease is endemic in many large cities and small towns. Interestingly, DHF has not been reported in some cities, even though dengue virus transmission rates in those cities are high. The epidemic pattern of DHF for the country as a whole has become irregular. Since 1982, the intensity and spread of DHF has created an increasing public health problem in Indonesia, particularly in Java where 60% of the total population of the country resides. Java contributed about 71% of all cases occurring in the country in 1982, 84% in 1983, and 91% in 1984. The peak monthly incidence of DHF was frequently reported during October through April, months which coincide with the rainy season. The morbidity rate for Indonesia, estimated from reported cases over five years (1981-1985), ranged between 3.39 to 8.65 per 100,000 population. The overall case fatality rate has steadily declined from 41.3% in 1968 to 3% in 1984.(ABSTRACT TRUNCATED AT 250 WORDS)

Protection against marked plasma leakage in dengue haemorrhagic fever by infusion of carbazochrome sodium sulfonate (AC-17)

Patients diagnosed clinically as having grade II dengue haemorrhagic fever, and confirmed serologically to have been recently infected by dengue virus were randomly assigned to two groups, to assess suppression of plasma leakage by intravenous administration of carbazochrome sodium sulfonate(AC-17). The double-blind prospective study over three successive epidemic periods included 39 patients in the placebo group, and 38 in the AC-17 group. The effects of the administration were evaluated with respect to pleural effusion of the chest X-ray films. A clear difference between the two groups was found in the numbers of patients with pleural effusion and severity of the pleural effusion thus the administration of AC-17 may be useful in eliminating the risk factors of severe bleeding and shock in dengue haemorrhagic fever.