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Biomedical subjects

F Shann

Publications and source records attributed to F Shann.

At least 109 records · Page 6Linked to original sources
PubMed1985

The aetiology of purulent meningitis in highland children: a bacteriological study.

Of 155 highlands children with purulent culture-positive meningitis studied from March 1980 to September 1984, 84% were aged twelve months or less and 92% were infected with either Haemophilus influenzae, Streptococcus pneumoniae or both organisms. Other pathogens were Neisseria meningitidis (8 isolations), Streptococcus pyogenes (2 isolations) and Streptococcus agalactiae and Klebsiella species (1 of each). Among H. influenzae isolates, serotype b strains predominated (83%) and most (96%) belonged to biotype I or II. Infections due to non-b haemophili included serotype a (9 strains), serotype f (1 strain) and non-serotypable variants (3 strains). Of 67 S. pneumoniae strains 22% were resistant to benzylpenicillin, with minimal inhibitory concentrations of 0.1-1.0 micrograms/ml. The commonest serotypes were types 5 (11 isolates), type 7 (9 isolates) and types 2, 6 and 46 (6 of each). No resistance to chloramphenicol was detected in either H. influenzae or S. pneumoniae and only one of 56 strains of H. influenzae was insensitive to betalactam antibiotics. The known case fatality rate in this study was 37%. More children with pneumococcal infection died (46%) than those with haemophilus infection (30%), though the difference was not statistically significant; 79% of all deaths occurred in children aged less than twelve months. There is an urgent need for H. influenzae and S. pneumoniae vaccines that are effective in young children.

Age Factors↗
PubMed1984

Aetiology of pneumonia in children in Goroka Hospital, Papua New Guinea.

To determine the aetiology of pneumonia in 83 children admitted to Goroka Hospital, Papua New Guinea, lung aspirates and blood were cultured for bacteria. Haemophilus infuenzae, Streptococcus pneumoniae, or both, were isolated from 43 (52%) of the children, other bacteria from 8 (10%), and no bacteria from 32 (39%). Of the 32 strains of H influenzae tested, 18 (56%) were non-serotypable, 8 (25%) were serotypes other than type b, and only 6 (19%) were type b. Viruses were isolated from lung or nasopharyngeal aspirates from 18 (29%) of the 62 children for whom viral cultures were done. It seems that, although viruses may initiate infection, death from pneumonia in children in developing countries is often due to H influenzae, S pneumoniae, or both. Antibiotic therapy would prevent many of these deaths. There is an urgent need for vaccines, effective in children less than 6 months old, that protect against all strains of H influenzae, and S pneumoniae.

Biopsy, Needle↗
PubMed1984

Penicillin in the treatment of skin sores in children.

Skin infections are a common cause of morbidity in children, particularly in tropical areas. Cultures from such lesions often grow both penicillin-resistant staphylococci and penicillin-sensitive streptococci. In a controlled trial of the treatment of septic skin lesions in 227 paediatric outpatients at Goroka Hospital, sequential analysis of the response to treatment showed that washing plus the intramuscular administration of procaine penicillin was more effective than washing plus placebo (P less than 0.05) after the 25th preference had been decided. When the amount of healing in the two groups was compared, washing plus penicillin was again more effective than washing plus placebo (P less than 0.001; Wilcoxon's rank-sum test). Because it eradicates beta-haemolytic streptococci, penicillin is a safe and effective agent for the treatment of large, multiple, or badly infected skin sores, even in countries such as Australia and Papua New Guinea in which most staphylococci are resistant to penicillin.

Bacterial Infections↗
PubMed1984

Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission.

Acute lower respiratory tract infections are a common cause of morbidity and mortality in children in the less developed countries. Considering the urgent need for rational protocols for the management of these infections in children and how little is known about the clinical signs that might predict the need for antibiotic therapy in a primary health care setting, a prospective study of the clinical signs in 200 paediatric outpatients presenting with a cough, 100 age-matched controls without cough, and 50 children admitted to hospital with pneumonia was carried out.In children with cough, a respiratory rate greater than 40 or 50 per minute (or a qualitative impression of tachypnoea) is probably the best indicator of the need for starting antibiotic treatment by primary health workers. The presence of fever appeared to be a poor guide to the need for antibiotic therapy. The presence of chest indrawing is, however, a reliable indication that a child with cough should be admitted to a health centre or a hospital. Further prospective studies are needed to determine the ability of these clinical signs to predict the course of these infections.

Acute Disease↗
PubMed1984

The bacteriology of skin sores in Goroka children.

The bacteriology of infected skin lesions was studied in paediatric outpatients. Thirty-nine untreated lesions were studied: 37 (95%) grew beta haemolytic streptococci (46% group A, 3% group B, 23% group C, 26% group G), 21 (54%) grew Staphylococcus aureus and 13 (33%) grew Corynebacterium haemolyticum. No attempt was made to selectively isolate Corynebacterium diphtheriae in this study. Vincent's organisms were seen in 13 (37%) of 35 gram stains from untreated lesions, including eight (73%) of 11 tropical ulcers. Twenty-three (92%) of the 25 strains of S. aureus isolated from untreated sores were resistant to penicillin.

Child↗
PubMed1981

Treatment of bacterial meningitis in children without intravenous fluids.

It would be easier and cheaper, and there would be less risk of cerebral oedema, if bacterial meningitis could be adequately treated without the intravenous administration of fluid. Fifty children with bacterial meningitis were treated with intramuscular injections of benzyl penicillin, probenecid given orally and chloramphenicol palmitate suspension given orally, and the outcome was evaluated prospectively. Seven (14%) of the 50 children died. In a control group of 50 children with bacterial meningitis treated with the intravenous administration of benzyl penicillin and chloramphenicol sodium succinate, the outcome was determined retrospectively. Twelve (24%) of the 50 children died. The difference in mortality rate was 10% +/- 15.7% (+/- 2 SE), which is not significant. Except in the rare case of a child with shock or persistent vomiting, bacterial meningitis can be effectively treated with six-hourly intramuscular injections of penicillin, and probenecid and chloramphenicol given orally.

Administration, Oral↗
PubMed1979

Prevention of necrotising enteritis in Papua New Guinea by active immunisation.

Necrotising enteritis (pig-bel) caused by Clostridium welchii type C is a major cause of illness and death in the Highlands of Papua New Guinea. In a controlled trial of active immunisation with a clostridial toxoid prepared from type-C cultures the incidence of pig-bel in over 2500 immunised children within 24 months of immunisation was less than an eighth of that in a control group. Necrotising enteritis in Papua New Guinea is now a preventable disease.

Adolescent↗
PubMed1979

The prevention of pig-bel in Papua New Guinea.

In many Highlands hospitals pig-bel is the commonest cause of death in children over 12 months of age. In a double blind controlled trial in Sina Sina we have shown that Clostridium welchii type C beta toxoid (beta toxoid) protects against pig-bel (p < 0.02). Of 2,538 children given beta toxoid, two developed pig-bel in the following two years. Seventeen of 2,532 control children vaccinated with tetanus toxoid developed pig-bel. We suggest that beta toxoid be given to Highlands children at two, four and six months of age. Boosters may be needed. Health services in the Highlands need to be improved so that this vaccine can be effectively delivered.

Adolescent↗
PubMed1979

The medical management of enteritis necroticans (pigbel).

Pigbel is the commonest cause of death in children over 12 months of age at Goroka Hospital. The clinical features are described. The medical management of pigbel includes intravenous fluids, nasogastric suction, penicillin and chloramphenicol. The development of dehydration, anaemia, hyponatraemia, hypokalaemia and hypoalbuminaemia must be prevented. In severe pigbel prolonged starvation may result in malnutrition that impairs wound healing and increases mortality. Intravenous feeding is therefore desirable in some cases.

Acute Disease↗