Pneumocystis infection has proven difficult to study partly due to the lack of reliable culture system for the organism. 7 The mode of transmission is not firmly established but airborne human to human transmission is likely. Infections are almost always limited to the lungs and cannot be cultured reliably outside the lungs. 7,8 Clinical signs and symptoms are non-specific and confirmation is hampered by inability to reliably perform in vitro culture. 5 Definitive diagnosis in resource limited ABSTRACT Pneumocystis pneumonia (PJP), initially thought to be rare in this part of the world, has over the years, been diagnosed and treated in our center. PJP should be considered in a young child 3 to 6 months of age with very severe pneumonia, known or suspected to be HIV infected. It should be suspected when severity of illness is out of proportion with the chest findings and chest x-ray is normal or shows minimal or bilateral interstitial infiltrates. Treatment is oral or intravenous high dose cotrimoxazole given 6-8 hourly for 3 weeks and the addition of prednisolone. The objective of this report is to describe the presentation, challenges of diagnosing and management of PJP in children in a developing country. Report of 3 cases aged 3, 4 and 41/2 months, exposed to the HIV. All developed severe pneumonia characteristic of PJP and all responded to treatment with high dose cotrimoxazole and Prednisolone. A high index of suspicion is needed to diagnose PJP in a resource poor setting like ours. It is common in HIV positive children but can also occur in HIV negative individuals as shown by these case reports. A presumptive diagnosis can be made in a young child, usually below 6 months of age, very ill with severe pneumonia and minimal chest findings who responds to cotrimoxazole. Addition of prednisolone has been found to improve the outcome. Antibiotics should continue to cover for co-existing bacterial pneumonia.

Aim: Increasing cases of Cryptococcus laurentii infection are being reported globally possibly due to advances in medicine, the use of immunosuppressants and invasive therapies such as endotracheal intubation, parenteral nutrition, central vascular catheters and exposure to broad-spectrum antimicrobial agents. Cryptococcus species are ubiquitously distributed in the environment, abundant in contaminated soil and bird droppings. Four cases of Cryptococcus laurentii fungemia have been described in neonates, all were premature low/very low-birth-weight. Our case is likely the 5th reported globally and the 1st from Nigeria and Africa across all age groups. Case Presentation: The patient presented at 34 hours of life with complaints of fever and multiple convulsions after delivery in a traditional birth attendant facility. Mother drained liquor for 5 days with poor cord care. A diagnosis of severe birth asphyxia with sepsis was made and baby received antibiotics (ceftriaxone and genticin) in addition to the management of severe birth asphyxia but showed no improvement. Blood culture yielded cream-colored smooth colonies, identified by Vitek 2 (bioMerieux, France) as Cryptococcus laurentii. Baby was treated with fluconazole, had good recovery and was discharged home. Conclusion: Our case report emphasizes the need for high index of suspicion for non-bacterial organisms (fungi) as possible causes of sepsis in newborns. Improved fungal diagnosis and timely commencement of antifungal medications will improve clinical outcomes.

No abstract

Introduction Pulmonary tuberculosis (PTB) is one of the rare pulmonary infections causing hyponatremia (serum sodium ˂135 mmol/L) and severe hyponatremia (serum sodium ˂125 mmol/L). Although the major cause of hyponatremia in TB patients is syndrome of inappropriate antidiuretic hormone (SIADH) secretion, cerebral salt wasting syndrome (CSWS) can occur and requires evidence of inappropriate urinary salt losses and reduced arterial blood volume. Adrenal insufficiency (AI) is rare in TB with scanty literature describing it. The two reported cases highlight three possible causes of severe symptomatic hyponatremia in TB pleural effusion and disseminated TB, their treatment modalities, and the need to increase the index of suspicion to diagnose TB hyponatremia in children. Case Report Case 1: a 10-year-old girl with TB pleural effusion who developed recurrent hyponatremia in the first few weeks of anti-TB treatment which was responsive to sodium correction. Case 2: an 8-year-old girl presenting to our facility with presumptive TB. She deteriorated over several months and progressed to disseminated TB with AI. Discussion Early diagnosis and prompt and correct treatment of TB hyponatremia cannot be overemphasized, as AI, SIADH secretion, and CSWS, each require different therapeutic regimens, most especially AI on its own poses a huge clinical challenge. Conclusion A high index of suspicion, with intensified case finding at all levels of care, is necessary to identify and manage children with TB hyponatremia because early diagnosis and prompt treatment is lifesaving.