following respiratory symptoms, have rarely been described. (1,2) Herein, we present a previously healthy child who developed pneumococcal AGN following submandibular and cervical lymphadenitis complicated with respiratory problems, and in whom AGN was confirmed on blood culture. We also review the relevant literature. CA S E R E PO RTA previously healthy four-year-old boy presented to Hospital Kuala Lumpur, Malaysia, with a one-week history of fever and neck swelling. Two days prior to admission, he developed high fever, vomiting and diarrhoea, with poor oral intake and reduced urine output. On examination, the boy was lethargic, febrile (temperature at 39.9°C) and appeared ill. His pulse rate was 120 bpm, respiratory rate was 30 bpm and blood pressure was 98/46 mmHg (50th percentile for age, gender and height at 93/50 mmHg). The patient was noted to have bad dental penicillin (50,000 unit/kg/dose) and cefotaxime (50 mg/kg/dose) were commenced. Over the following 48 hours, the patient developed periorbital and leg oedema, with tea-coloured urine.The patient was subsequently treated for acute nephritis with fluid restriction, and put on a low-salt diet and close monitoring of daily fluid intake/urine output. His blood pressure remained stable throughout the course of hospitalisation.Despite being administered antibiotics, the patient's fever remained unresolved. After two weeks of hospitalisation, he developed bronchopneumonia with left pleural effusion that was confirmed on repeat chest radiography. A left pleural tap did not grow any organisms, but the effusion did not deteriorate.Pneumococcal glomerulonephritis in a healthy child: a case report and literature review ABSTRACT Pneumococcal glomerulonephritis is rarely described in the literature. We report a four-year-old boy who developed acute glomerulonephritis following pneumococcal bacteraemia and submandibular lymphadenitis, and review the published literature. Two weeks after developing acute glomerulonephritis, the patient developed bronchopneumonia with left pleural effusion. However, by the fourth week of admission, his renal function had normalised and lung involvement resolved.

Congenital pneumonia is one of the common causes of respiratory distress at birth, with significant morbidity and mortality in neonates, especially among preterm infants, and particularly in developing countries. The etiological agents are many and vary between the developed and underdeveloped parts of the world. Group B streptococci have been attributed as the most common organisms causing severe pneumonia, particularly in developed countries. Human immunodeficiency virus (HIV) is now an increasing risk in underdeveloped countries such as Zimbabwe. Ureaplasma spp. have been highlighted as an important cause of congenital pneumonia in recent years. Clinical manifestations are often nonspecified, and majority of infections appear within the first 48 hours of life. Establishing the microbial diagnosis of congenital pneumonia is challenging. Molecular diagnosis using polymerase chain reaction has an extremely improved diagnostic yield as compared with other conventional detection methods. However, it is often associated with a high level of contamination and may not be available in most hospitals. Management of congenital pneumonia is multifaceted and the most vital is towards eliminating the possible incriminating agent. This review updates the current knowledge on congenital pneumonia and discusses its etiology, diagnosis, preventive strategies, and management.

We would like to thank Dr Sakallioglu for his insightful comments on our report (1) and the opportunity to clarify a number of points. Firstly, the patient presented with a seven-, and not nine-, day history of fever and neck swelling. It was also highlighted that the fever was of a high grade, and associated with vomiting and diarrhoea for two days before, and not after, admission.Secondly, although a renal biopsy may have been diagnostically helpful, it was deferred due to the patient's improving renal functions, and clinically, the patient was not deteriorating. After three weeks of hospitalisation, his urine output was consistent at > 1 mL/kg/hr, and at four weeks, his renal function normalised. Furthermore, renal biopsy is not generally performed in cases of poststreptococcal acute glomerulonephritis or acute glomerulonephritis following pneumococcal bacteraemia because of rapid clinical improvement. Other case reports reviewed in our paper(1) did not state the histological type of acute glomerulonephritis; only three cases had renal biopsies performed -two complicated cases in adults with rapidly increasing creatinine levels beyond four weeks (2) and who required dialysis,and one paediatric case for the purpose of academic exercise.(4) As with other case series of children with pneumococcal glomerulonephritis previously summarised in our report,(1) our patient had a good prognosis for both renal and lung involvements -the recovery of renal functions was observed to be achieved within 11 days to 8 weeks following disease onset.Finally, Streptococcus pneumoniae (S. pneumoniae) is known to present with a wide range of symptoms, including diarrhoea (5) and cervical lymphadenopathy. Our case highlighted these unusual presentations of S. pneumoniae.(1) After two weeks of hospitalisation, the unresolved fever complicated with bronchopneumonia and pleural effusion was attributed to the pathogenesis of pneumococcal glomerulonephritis. The possibility of nosocomial infections was ruled out by subsequent cultures, which were negative. We also performed a workup for autoimmune and immunodeficiencies causes, which were all negative. The patient was found to respond to the antibiotic treatment the following week.(1)

Background: The term early onset neonatal septicaemia (EONS) refers to invasive bacterial infections that primarily involve the blood stream of neonates during the first 3 days of life. Although early onset neonatal septicaemia is relatively uncommon, it may be associated with case fatality rates of 15-30% and substantial morbidity in surviving infants.Objectives: This study describes an unusual septicaemia cases with Janthinobacterium lividum in neonatal Intensive Care Units.Methods: Bacterial causes of early onset neonatal sepsis in Kuala Lumpur Hospital Malaysia were investigated using broad range 16S rDNA PCR and sequencing. The bacterial DNA was isolated directly from blood without pre-incubation. All samples collected were equally cultured and incubated in automated BACTEC system.Results: Two hundred and fifty two neonates were recruited in this study with mean (SD) gestational age of 35.9. Neonates with J. lividum infection lacked microbiological evidence of septicaemia as their blood culture yielded no bacterial growth. However, the PCR analysis of these samples yielded 1100bp corresponding to bacteria species.Conclusion: This study demonstrates the value of PCR in detecting bacteria where special growth requirement is involved.Keywords: Janthinobacterium lividum, neonatal septicaemia, neonatal intensive care units.