Pediatric emergency medicine in Laos when horses turn to zebras

Transcription

1 Pediatric emergency medicine in Laos when horses turn to zebras

2 "When you hear hoofbeats, think of horses not zebras Capital: Vientiane Currency: Lao kip Population: 6.77 million (2013) Official language: Lao Spoken languages Lao Hmong Khmu Ethnic groups 55% Lao 11% Khmu 8% Hmong 26% other Unless.. You are in Africa..

3 Luang Prabang

4 Just another case of pleural effusion 7 y.o boy Unremarkable PMHx 1 month of non productive cough without fever Mild anorexia and weight loss No night sweats Physical examination is remarkable for reduced air entry to the Rt lung and dullness on percussion No lymphadenopathy or HSM WBC W.N.L.

5 So what is your differential diagnosis?? In Israel. Malignancy Pneumonia Tuberculosis Pulmonary embolism Fungal infection Pancreatic pseudocyst Intra-abdominal abscess In Laos Paragonimiasis Pneumonia Tuberculosis Malignancy

6 What would you do next? A chest drain was placed with copious purulent discharge being drained. On microscopy eosinophilic predominance was noticed

7 And back to the differential diagnosis in Laos Microscopy revealed roundworms in the pleural effusion. Consultation with Prof Eli Schwartz suggested Strongyloides stercoralis as the culprit pathogen. Treatment with Albendazol wad commenced PCR for Strongyloides stercoralis done from a dried specimen of the pleural effusion was negative.

8 Clinical manifestations : Gastrointestinal symptoms Pulmonary manifestations Dermatologic manifestations Strongyloides stercoralis Migration of the larvae through the lungs produces a pneumonitis that resembles Loeffler syndrome. Strongyloidiasis can also produce a clinical syndrome that mimics either asthma or pneumonia. Pulmonary complications include the following: Asthma or exacerbation of preexisting obstructive pulmonary disease Pneumonitis Respiratory failure, [33] acute respiratory distress syndrome (ASDS) Alveolar hemorrhage Pleural effusion Granulomatous lung disease

9 Paragonimus westermani

10 Just another case of bronchiolitis 3 m.o Fever up to 38.1 and difficulty in breathing. On admission : Moderately Increased work of breathing. Saturation : 83% RA, 87% HFNC. HR = 187 Physical examination : bilateral lung crepitation's, no heart murmur, Hepatomegaly.

11 Beri Beri and taboo diet

12 Beriberi refers to a cluster of symptoms caused primarily by thiamine (vitamin B1) deficiency. Beriberi has conventionally been divided into three separate entities, relating to the body system mainly involved (peripheral nervous system or cardiovascular) or age of person (like infantile). According to the Oxford English Dictionary, the term 'beriberi' comes from a Sinhalese phrase meaning "weak, weak" or "I cannot, I cannot", the word being duplicated for emphasis. Beri Beri and taboo diet

13 Infantile thiamine deficiency This occurs in various forms and typically affects breastfed infants whose mothers had beriberi. Early on, the infant is constipated, crying, restless, and has emesis. Three forms are recognized: The pure cardiologic or pernicious form is common in infants aged 1-3 months. They present with cyanosis and features of acute cardiac failure. Infants usually die within 2-4 hours, but this type of deficiency responds very rapidly to thiamine. The aphonic form is seen in infants aged 4-6 months. This milder form causes loss of voice due to paralysis of the vocal cords. The pseudomeningitic form is encountered in infants aged 7-9 months. It presents with clinical signs of meningitis, but cerebrospinal fluid findings exclude infection. Vomiting, sweating, and seizures may be present. Beri Beri and taboo diet

14 Take home message.