No abstract

Severe acute lower respiratory infection is common in developing countries and is a major cause of mortality. Studies from some developing countries indicate a high prevalence of bacteria in the aetiology of pneumonia in hospitalised children

Zimbabwe SUMMARY Eleven children under 16 years of age with purulent pericarditis were seen in one hospital in one year. The condition was always secondary to a septic focus elsewhere, usually staphylococcal pneumonia; its incidence after pneumonia was 0-64%, but this may be an underestimate. Clinical diagnosis can be difficult in patients with pneumonia as the heart is not always enlarged. Persistent or progressive liver enlargement was an important diagnostic feature. The presence of excess pericardial fluid was easily confirmed by echocardiography. Early diagnosis and drainage followed by continuous irrigation with 0-1% povidone iodine solution usually resulted in rapid recovery, but two patients died.

The management of 25 children with empyema thoracis in Zimbabwe is discussed. The method adopted in 21 of these children using simple drainage and continuous irrigation with 0.1% solution of povidone iodine compared well with more aggressive methods. The method can be carried out easily in a rural environment. 2 of these 21 children died, one because of aspiration. The results among the survivors were good - excellent in 14 of the 21 children and fair in 2. There were no side effects attributable to the povidone iodine. The method failed in 3 patients who had to be dealt with surgically. Staphylococcus aureus was the commonest organism responsible for empyema.

From July 1992 to May 1993 a study was performed of the relationship between bacteraemia, nutritional status and HIV status in 212 out of 334 consecutive infants and children aged 0-5 years, who had died at home in Bulawayo, Zimbabwe. The remaining 122 children were excluded because the time period between death and arrival at the hospital was over 3 h. A pathogen was isolated from 92 (43%) children and Klebsiella species were most commonly isolated. A positive HIV-1 serology was found in 122 (58%) children and 110 (52%) children were malnourished. Malnutrition was significantly associated with bacteraemia at death after adjustment for the confounding effect of age and HIV status (odds ratio 4.28; 95% CI 2.27-8.07; P < 0.001). No association was found between either HIV serostatus or proven HIV infection and bacteraemia, which could not be attributed to nutritional status. Conclusion. Bacteraemia, in particular with Gram-negative bacteria, is an important cause of death in malnourished children in Zimbabwe regardless of their HIV-1 antibody status.