Posted in
Volume 16 -
Number 3
ABSTRACT | Full Text PDF
OBJECTIVE:To determine the clinical pattern of infections in admitted malnourished children.
METHODS:It is a cross-sectional study conducted at department of Paediatrics Dow University of Health Sciences and Civil Hospital Karachi from April 2008 to December 2009. Patients between 3 to 60 months of age admitted in the nutritional rehabilitation ward were graded for nutritional status according to WHO guidelines as mild (weight for height ratio between -1SD to -2SD), moderate (-2SD to -3SD) and severe malnourished (weight for height ratio <-3SD of NCHS/WHO reference values). These patients were clinically examined for weight, height/ length, sign and symptoms of infections and micronutrient deficiencies. Relevant investigations including CBC, Urine D/R, and Blood culture were done to confirm the clinical diagnosis. The collected data was analyzed and presented as frequencies and percentages.
RESULTS:A total of 112 admitted malnourished children with various types of infections were included in the study. Majority of these patients (58%) were between 12 to 36 months of age, females were fifty nine and males were fifty three with male to female ratio of 1:1. There were hundred severely malnourished, eleven moderate and one case of mild malnutrition. Common infections found were acute gastroenteritis (44.6%), acute respiratory tract infections (24%), enteric protozoal and helminthic infections (23%) and sepsis (16%). Blood Culture was positive in 11.6% cases and common pathogens isolated were staphylococcus aureus (60.23%), gram negative organisms, including klebsiella pneumoniae (23%), E-coli (9.2%) and salmonella typhi in (7.6%) of cases whereas urine and stool culture revealed predominantly E-coli. Most of these organisms were sensitive to ciprofloxacin (100%), vancomycin (88.8%), co-amoxiclav (22.2%) and amikacin (33.3%) and showed resistant to most of the first line drugs including chloramphenicol ampicillin, gentamicin and co-trimaxazole. Co-existing micronutrient deficiencies were rickets (35.7%), vitamin A deficiency (18.7%) while (80%) children had iron deficiency anemia.
CONCLUSION: Common infections found in malnourished children were acute gastroenteritis, acute respiratory tract infections, protozoal, helminthic infections and sepsis. Staphylococcus aureus and gram negative organisms were common pathogens found in blood, urine and stool cultures of malnourished children. These pathogens were sensitive to ciprofloxacin, co-amoxiclav, amikacin and 3rd generation cephalosporins but resistant to all first line drugs recommended by WHO including co-trimaxazole, gentamicin, penicillin, chloramphenicol.
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