2000 Journals

Vol. 4 No.1 & No. 2 Jan-Dec 2000
CLINICAL EVALUATION OF RAPID IMMUNOCHROMATOGRAPHIC ASSAY USING THE 38 KDA ANTIGEN
FROM MY MYCOBACTERIUM TUBERCULOSIS
Araceli L. Barrientos, M.D.*, Rosalinda B. Soriano, M.D.*
Keywords: mycobacterium tuberculosis, TB immunochromatographic test

Since diagnosing childhood is a dilemma for most physician, a rapid immunochromatographic test was developed to circumvent this difficulty. It is a serological assay which detects the antibody against the 38 KDA antigen of mycobacterium tuberculosis is serum or plasma. Its clinical usefulness was evaluated in this study. One hundred nineteen patients aged 6 months to 17 years old, admitted at the service ward were categorized into Class I-IV as defined in the 1997 National Consensus of Childhood Tuberculosis were enrolled in the study. Both class I and II had 11 patients each: Class III PTB had 25 cases; Extrapulmonary TB had 28 cases and military TB had 10 cases: Class IV had 13 patients. Sixteen patients with diagnosis other than TB were included to serve as control group. Five patients were eliminated because of incomplete data and inability to complete the serial AFB smear. Complete history and physical examination were done, exposure to adults with tuberculosis was also noted. All patients underwent tuberculin testing, chest radiography, sputum/ gastric AFB smear for 3 consecutive days and ICT test. The test detected 12 out of 25 cases (48%) of PTB, 14 out of 28 cases (50%) extrapulmonary TB and 7 out of 10 patients (70%) with military TB. The sensitivity and specificity of this test in PTB patients were 48% and 94% respectively; in extrapulmonary TB 50% and 94% while in military TB 70% and 94% respectively. Positive predictive value in these groups range from 87% – 92%. Interestingly, 2 more patients outside class III had (+) ICT statistically they were not significant (pval=.0.05). The effect of the nutritional status was also evaluated and only patients who were well nourished correlated well with ICT test. In contrast, the role of previous primary booster BCG vaccination did not modify the result of this test. In conclusion, ICT test had low sensitivity and high specificity; thus, a negative result will not rule out the possibility of TB but a positive test tells us the high probability of the disease. Therefore, this test can be used as an adjunctive laboratory method that can support the existing criteria accepted in our setting. Additional studies are recommended to further validate the test.

NOSOCOMIAL INFECTIONS: A NEED FOR CONTINUED SURVEILLANCE
Maria Teresa P. Fabre, M.D.*, Maria Carmen B. Nievera, M.D.*, Thelma M. Laot, M.D.*, Ma. Ines Bettina L. Santos, M.D.*,Lulu Bravo, M.D.*
Keywords: nosocomial infection

Whenever a nosocomial infection (NI) occurs, the hospital, instead of serving as an institution where patients gets cured of their illnesses, becomes a threat to patient’s life. Thus, with the objective of determining the occurrence of NI’s among patients admitted to the pediatric wards, pediatric intensive care unit (PICU), and nursery intensive care unit (NICU), of a tertiary hospital, this one-year prospective epidemiologic study was conducted. Sensitivities of all the isolates were done using the disk infusion method. NI rates were as follows – 17% each for the two pediatric wards, 18% for PICU and 14% NICU. Except for NICU were cases of necrotizing enterocolities (NEC) ranked second, the top three diseases were sepsis, pneumonia, and urinary tract infection (UTI). Overall, the predominant organisms for sepsis were Enterobacter spp’ Candida and Pseudomonas spp. For pneumonia, as much as 56% had no identifiable pathogen. The rest were gram-negative organisms. Candida comprised a little more than half (51%) of UTI isolates. In both sepsis and UTI, only about a quarter of Candida was identified as C.albicans. The following were the antibiotics which showed favorable sensitivity patterns in general – amikacin, piperacillin-tazobactam, imipenem and ciproglaxacin. Strict adherence to infection control measures as well as more prudent and restrictive use of an antibiotic should always be practiced if a reduction in NI is to be achieved.

BRAIN ABSCESS IN CHILDREN AT THE PHILIPPINE GENRAL HOSPITAL: A PROSPECTIVE EPIDIMIOLOGIC STUDY
Clarissa Michelle Ablaza-Medalla, M.D.*, Dennis Oh, M.D.*, Annabelle Chua, M.D.*, Aida M. Salonga, M.D.,
Salvacion R. Gatchalian, M.D.*
Keywords: tuberculosis DOTS

Intracranial abscesses remain to pose a threat to the pediatric population, particularly in those with known predisposing factors in developing countries. Twenty one patients less than 18 years of age who were diagnosed to have brain abscess by CT scan, were seen at the Philippine General Hospital from February to September 1999. Seventy six percent were less than 10 years old (25% were 2 years of age). The most common presenting symptoms were fever, weakness, vomiting and headache with 67% presenting with focal neurologic deficit on admission. Ten (47.6%) had cyanotic congenital heart disease as their predisposing condition, the most common of which was due to Tetralogy of Fallot. Chronic suppurative otitis media was only seen in 28.6%. Eight (44.4%) of the 18 patients who underwent surgery yielded no growth on both aerobic and anaerobic cultures but half of these patients had previous antibiotic intake. A microbiologic diagnosis was established in 55.5% and only one patient grew an anaerobic organism (Bacteriodes spp.) on culture of the brain abscess. There was no specific organism associated with certain predisposing factor although gram negative bacteria were commonly seen in patients with CSOM (Proteus vulgaris, Proteus mirabilis, Acinetobacter anitratum, Morganella morgagni). Staphylococcus aureus was isolated in 2 patients with no known predisposing factor. All aerobic gram negative organisms and Streptococuss viridans isolated were sensitive to chlormaphenicol and Penicillin G respectively. All straphylococcus aureus isolated were sensitive to oxacillin. Thus the empiric antibiotics of choice remain to be penicillin G and chloramphenicol or metronidazole in the treatment of the brain abscess. In cases of chronic otitis media wherein gram negative acrobes are usually implicated, a third generation cephalosporin or anti-pseudomonal antibiotic recommended. Although antimicrobial therapy may play a major role in the treatment of brain abscess, surgical evacuation, either by aspiration, tube drainage or excision is essential for optimum management.

CONCISE REVIEWS OF PEDIATRIC INFECTIOUS DISEASES
EPIDEMIOLOGY AND PREVENTION OF HEPATITIS A VIRUS INFECTION
Yong Poovorawan, MD*
Keywords: Viral Hepatitis Research Unit

The prevalence of HAV infection, transmissible by oral-fecal route. reflects the standard of hygiene and socioeconomic conditions in any given country. In poor countries, the disease usually affects infants and young children among who it takes an entirely asymptomatic course leaving them with life-long immunity. India might serve as the best example for a country with high endemicity in that since 1982 near universal seroconversion has been shown to occur at a very young age. Developing countries, with sanitation and hygiene gradually improving, show moderate endemicity in that seroconversion occurs mainly among adolescents or young adults. The Philippines and Vietnam display age related seroprevalence patterns indicative of high to moderate endemicity whereas significant can be observed in Indonesia, Singapore, Thailand and Malaysia have undergone a decline in childhood and adolescent HAV seroprevalence typical of countries experiencing socioeconomic development countries, where due to good sanitation and hygiene, seroprevalence increases in direct proportion with age.

BACTERICAL MENINGITIS IN CHILDREN LESS THAN FIVE YEARS OF AGE AT A PROVINCIAL HOSPITAL IN THE PHILIPPINES
E. Abucejo, MD *, S. Lupisan, MD* B.Quiambao, MD * , L. Sombrero, MD *, M. Lucero, MD *, R. Capeding, MD *, I. Arcay, MD*,
E. Herva, MD*, P. RUUTI, MD *
Keywords: Viral Hepatitis Research Unit

To describe the clinical and laboratory profile of bacterial meningitis in children less than five years of age at a provincial hospital in the Philippines.
Methods: To increase the previously infrequent use of lumbar tap for CSF samples, a guideline based on combination of neurologic symptoms ans signs was develop. Blood and CSF samples were cultures for bacteria, and CSF samples were cultured for bacteria, and CSF agglutination was done for pnemococcus, meningococcus (A.C.) and Haemophilus influenzae type b. Clinical and laboratory date of children less than five years old were collected from January 1995 to December 1998.