This case control study was conducted to determine the frequency of nutritional rickets among hospitalized infants and to assess their relation to respiratory diseases. All infants between the age of 3 months and 2 years admitted to the pediatric ward of Queen Alia Military Hospital during the period February–October 2001 were examined and investigated to rule out nutritional rickets. Children admitted for the first time to hospital for acute illnesses were only included in the study. A special data collection sheet was designed for this study which includes information on the age sex causes of admission family size the rank of the child in the family family monthly income outdoor clothing habit of the mother and the mode of feeding. Data were collected from the infant charts and/or by interviewing the child’s mother or guardian. Clinical signs of rickets were also recorded including rosary beads craniotabes wide anterior fontanel delayed dentition widening of epiphysis bowing of the legs and double malulous. Blood sample was collected for calcium phosphorus alkaline phosphatase and hemoglobin level. Those infants with any clinical sign of rickets and/or abnormal chemical results had a wrist X-ray to confirm the diagnosis of rickets. The rachitic group (cases) was compared for statistical significance with the remaining non-rachitic infants (controls) for the data collected. Rachitic infants received intramuscular 600 000 I of vitamin D; a follow-up wrist X-ray and blood sample for calcium phosphorus and alkaline phosphatase was arranged 3 weeks later. Forty-seven infants (10.6 per cent) out of the 443 included in the study were found to have nutritional rickets. Forty (85.1 per cent) of the rachitic infants were admitted due to lower respiratory tract diseases compared with 30 per cent of the control group and the difference was statistically significant (p < 0.01). Duration of hospital stay in the rachitic infants was also significantly more prolonged than the non-rachitic control group (9.5 days vs. 7.4 days p = 0.002). Rachitic infants were breastfed in 82.9 per cent ranked second or more in the family in 87.2 per cent and had mothers who wore head cover outdoors in 80.8 per cent compared with 60.8 40.1 and 60.3 per cent respectively in the non-rachitic group (p < 0.01). High alkaline phosphatase hypocalcemia hypophosphatemia and anemia was found in 100 19 50 and 78.7 per cent respectively in the rachitic group compared with 9.8 2 1.2 and 43.7 per cent respectively in the control group (p < 0.001). Nutritional rickets seems to be a common problem among infants in Jordan. Further studies at national level are needed to determine the prevalence of rickets in Jordan. Rachitic infants are commonly hospitalized due to lower respiratory tract infections thus there is a high index of suspicion for rickets among hospitalized infants with lower respiratory tract diseases. (authors)

The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases.

Background : Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare, even in areas where tuberculosis is endemic. In the literature, only few case series of calvarial tuberculosis have been reported. Aim : To report a case series of 11 patients with calvarial tuberculosis, and discuss their presentation and management. Materials and Methods : This study is a retrospective analysis of case records of 11 patients with calvarial tuberculosis treated between 2001 and 2005 in a tertiary hospital. Clinical features, radiological findings, surgical and medical management, and outcomes were reviewed. Results : Of the 11 patients, seven were male and the age ranged between 1 and 25 years (mean 15.09 years). The mean duration of symptoms was 2.9 months (range 1-5 months). The most common presenting features were scalp swelling, discharging sinus, and pain. Computed tomography (CT) scan of brain showed punched out bony defect, with a peripherally enhancing extradural collection in most of the cases. Ten patients underwent surgical excision of necrotic bone and granulation tissue with primary closure of the scalp flap and antituberculous therapy. One patient is being managed with antituberculous therapy only. Of the 10 patients treated surgically and with antituberculous therapy, nine recovered well and one died of tuberculous meningitis and hydrocephalus. The patient being treated with antituberculous therapy is under follow-up. Conclusion : A high index of suspicion and knowledge is required for early diagnosis of calvarial tuberculosis. Surgery and antituberculous therapy remains the mainstay of treatment.

/pdf/calvarial-tuberculosis-a-report-of-eleven-patients-50prnhitvz.pdf

Calvarial tuberculosis: A report of eleven patients

Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare and only a few cases have been reported. In a review of the literature, we found only six cases of calvarial tuberculosis reported with computed tomographic findings. We report a series of seven patients with calvarial tuberculosis, and we discuss their presentations and treatments.The patients were studied with respect to age and sex prevalences, previous histories of trauma and tuberculosis, and presenting complaints. Plain cranial x-ray films and computed tomographic scans were used for diagnoses. All patients underwent surgery and antituberculous chemotherapy.Of the presenting patients, 71.42% were less than 20 years of age. There was a female predominance, with a male/female ratio of 1:6. Painless swelling and discharging sinuses over the scalp were the most common presenting features. One patient presented with osteomyelitis and sinus formation, with associated meningitis. All patients recovered well after surgery and antituberculous chemotherapy, except for one patient who discontinued drug treatment.Although calvarial tuberculosis is rare, the possibility of this disease should be considered when patients report previous histories of tuberculosis or are from areas in which the disease is endemic. Surgery is indicated in cases with associated neurological deficits or sinus formation. Antituberculous therapy should be continued for 18 months. 

Calvarial Tuberculosis

Tuberculosis osteitis is mainly observed as a late complication of the pulmonary infection. We describe a 9-mo-old Japanese infant who became infected with Mycobacterium tuberculosis even after receiving Bacillus Calmette-Guerin (BCG) vaccination at 3 mo of age. This is the first report that the sternum is the localizatio n for tuberculou s osteitis in infants. He developed a localized tumor in the sternum without any respiratory symptom. Mycobacterium tuberculosis complex was detected by means of nucleic acid amplification test. Gastric aspirates also yielded Mycobacterium tuberculosis. The source of the infection was unclear. Conclusion: Tuberculous osteitis should be excluded in infants with undiagnosed bone lesions, even if they have been vaccinated with BCG. ±BCG vaccination, infant, Mycobacterium tuberculosis, sternum, tuberculous osteitis

Sternal tuberculosis in a 9-month-old infant after BCG vaccination.

Objective and importance Many types of neurotuberculosis have been described; the most common intracranial forms are tuberculous meningitis and tuberculomas. We report a unique and as yet unreported form of neurotuberculosis, which is an intracranial tuberculous subdural empyema. Clinical presentation A 59-year-old man who had been previously treated for pulmonary tuberculosis (TB) presented at our institution with a long-standing history of headaches. General and neurological examinations revealed no abnormalities. Radiography of the chest confirmed fibrotic lung changes caused by healed pulmonary TB. A cranial computed tomographic scan revealed a hypodense extra-axial collection with mass effect as well as adjacent osteitis and scalp swelling. Intervention The patient underwent craniectomy of the osteitic bone and drainage of 50 ml of fluid pus located subdurally. Microscopic examination of the bone and pus revealed tuberculous granulation tissue with numerous acid-fast bacilli identified using Ziehl-Neelsen stain. Mycobacterium TB bacillus was cultured from the pus at 42 days. The patient required two further operative procedures as well as a protracted course of anti-TB therapy. Conclusion The patient eventually achieved a good recovery. We recommend surgical drainage of tuberculous subdural empyema to relieve mass effect and to obtain microbiological confirmation. Furthermore, surgical treatment should be combined with an 18-month course of anti-TB chemotherapy, during which period patient compliance should be closely monitored.

Intracranial Tuberculous Subdural Empyema: Case Report

A 13-year-old girl of Pakistani origin presented with a non-tender, fluctuant swelling over her left parietal area and an underlying skull defect. At the apex of the swelling there was a sinus. Cultures of the discharge were positive for Mycobacterium tuberculosis. We present a case report of tuberculosis of the skull and review of the literature. We highlight the difficulty which still exists in establishing a diagnosis of tuberculosis in countries where it is uncommon.

Tuberculous osteitis of the skull: a case report and review of the literature

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Tuberculous osteitis of the skull: a case report and review of the literature