Pneumocystis carinii pneumonia in South African children infected with human immunodeficiency virus.

Background: Pneumocystis carinii pneumonia (PCP) has been regarded as uncommon in HIV-infected patients in Africa, but diagnostic difficulties and geographic variability may partly account for this. There is little information on the incidence of PCP in HIV-infected children in Africa.

Aim: To investigate (1) the incidence and associated features of PCP in African HIV-infected children and (2) the usefulness of sputum induction and nasopharyngeal aspirates (NPAs) for diagnosis of PCP.

Respiratory syncytial virus infection in children hospitalised with acute lower respiratory tract infection.

Background: Data are lacking on respiratory syncytial virus. (RSV) respiratory tract infections in children from developing countries.

Objective: To determine the importance of RSV as a cause of acute lower respiratory tract infection (ALRTI) in Cape Town children.

Twice weekly vs. daily chemotherapy for childhood tuberculosis.

Background: Treating childhood tuberculosis places a large burden on health services, and ways of lessening this were sought.

Methods: A randomized controlled trial was conducted to determine the effectiveness of fully intermittent twice weekly treatment for intrathoracic childhood tuberculosis and its effect on adherence to treatment, in comparison with daily (weekday) treatment. The setting was a district of Cape Town, South Africa, an area of high incident tuberculosis.

Sputum induction for the diagnosis of pulmonary tuberculosis in infants and young children in an urban setting in South Africa.

Background: Bacteriological confirmation of pulmonary tuberculosis is difficult in infants and young children. In adults and older children, sputum induction has been successfully used; this technique has not been tested in younger children.

Aims: To investigate whether sputum induction can be successfully performed in infants and young children and to determine the utility of induced sputum compared to gastric lavage (GL) for the diagnosis of pulmonary tuberculosis in HIV infected and uninfected children.

Doctors' attitudes to the care of children with HIV in South Africa.

A descriptive survey was conducted on the attitudes of medical staff to caring for HIV-infected children, in three teaching hospitals in Cape Town, South Africa. The study was designed to determine whether the knowledge of a patient's HIV-positive status affects the doctor's attitude and management, to determine doctors' perceived competence with regard to the management of paediatric AIDS and to identify their major concerns in the management of paediatric patients with HIV infection. The response rate was 86%, including 89% of consultants, 81% of registrars and 87% of medical officers employed at the hospitals during the period July/August 1996.

Immunological manifestations of HIV-infected children.

This cross-sectional study of stable HIV-infected children was designed to document the immunological manifestations of paediatric HIV infection and to determine whether inexpensive markers of immunosuppression could be identified. Investigations included lymphocyte count and subset analysis, levels of total protein, albumin, immunoglobulins, beta-2 microglobulin and neopterin. The median age of the 74 children studied was 16.

Primary staphylococcal pneumonia in young children: a review of 100 cases.

Staphylococcus aureus (S. aureus) is responsible for a small proportion of acute respiratory infections in children. Nevertheless a high index of suspicion is required because of the potential for rapid progression, the need for antibiotics different to those routinely administered in the treatment of pneumonia, and the high incidence of complications.

Risk factors for meningococcal disease in Cape Town.

Objective: To determine the risk factors associated with meningococcal disease among children living in Cape Town.

Design: A case-control study was conducted from October 1993 to January 1995.

Setting: The study population consisted of all children under the age of 14 years who were resident in the Cape Town metropolitan region.

Plasma-soluble CD30 in childhood tuberculosis: effects of disease severity, nutritional status, and vitamin A therapy.

Plasma-soluble CD30 (sCD30) is the result of proteolytic splicing from the membrane-bound form of CD30, a putative marker of type 2 cytokine-producing cells. We measured sCD30 levels in children with tuberculosis, a disease characterized by prominent type 1 lymphocyte cytokine responses. We postulated that disease severity and nutritional status would alter cytokine responses and therefore sCD30 levels.

Survival of children in Cape Town known to be vertically infected with HIV-1.

Objective: To determine the survival patterns of children in Cape Town known to be vertically infected with HIV.

Design: Retrospective record review of children diagnosed with symptomatic HIV infection during the period 1 December 1990-31 May 1995.

Setting: Hospitals in the Cape Town metropolitan area.

Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children.

Background: When available, chest radiographs are used widely in acute lower-respiratory-tract infections in children. Their impact on clinical outcome is unknown.

Methods: 522 children aged 2 to 59 months who met the WHO case definition for pneumonia were randomly allocated to have a chest radiograph or not.

Vitamin A status and therapy in childhood pulmonary tuberculosis.

Low plasma vitamin A levels (mean, 18.1 +/- 10.3 micrograms/dl, 62% below normal) were demonstrated in South African children with pulmonary tuberculosis.

Vitamin A status, other risk factors and acute respiratory infection morbidity in children.

Objective: This study evaluated the association between vitamin A status and the severity of acute respiratory infections (ARIs) in children, controlling for the influence of other known ARI risk factors.

Design: Case control study.

Setting: Ambulatory and hospital-based study.

Epidemiology of post-neonatal bacterial meningitis in Cape Town children.

Bacterial meningitis is a major cause of childhood morbidity and mortality in South Africa. However, comprehensive regional or national epidemiological data, essential for rational public health interventions, are lacking. The purpose of this 1-year prospective study, from 1 August 1991 to 31 July 1992, was to define the magnitude of the problem of childhood bacterial meningitis in Cape Town.

Clinical problems in measles case management.

Measles remains one of the leading causes of childhood morbidity and mortality in developing countries. The World Health Organization has identified effective case management as one of the specific strategies to reduce the burden of this disease. The purpose of this article is to review the aetiology, natural history, treatment and outcome of the common clinical problems associated with measles with a view to identifying possible deficiencies in case management.