Publications by authors named "Kavinda Dayasiri"

37 Publications

Review on Pneumococcal Infection in Children.

Cureus 2021 May 9;13(5):e14913. Epub 2021 May 9.

Paediatrics, Base Hospital, Mahaoya, LKA.

Childhood pneumococcal infection is a growing concern among paediatricians especially, in countries where there is no routine vaccination program against . The disease is associated with significant morbidity and mortality in young children particularly those who are under the age of two years. Its main virulent factors include polysaccharide capsule, autolysin, pneumolysin, choline-binding Protein A, the higher chance for genetic transformation, and the presence of pilli that facilitate enhanced binding of bacteria to host cellular surfaces. More severe and invasive pneumococcal infections are seen in children with immunodeficiencies, hypofunctional spleen, malnutrition, chronic lung disease and nephrotic syndrome. The disease spectrum includes a range of manifestations from trivial upper respiratory tract infections to severe invasive pneumococcal disease (PD). The basis of diagnosis is the isolation of bacteria in the culture of body fluids including blood. Antibiotics are best guided by sensitivity patterns and the emergence of resistance is a growing concern.
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http://dx.doi.org/10.7759/cureus.14913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189266PMC
May 2021

Effect of Prior Symptomatic Dengue Infection on Dengue Haemorrhagic Fever (DHF) in Children.

J Trop Med 2021 2;2021:8842799. Epub 2021 Jun 2.

Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.

Pathogenesis of dengue haemorrhagic fever is not fully understood, but it is thought that there is antibody enhancement during the secondary infection, which causes severe dengue haemorrhagic fever (DHF). Therefore, patients who have DHF should have a documented history of symptomatic dengue infection in the past. A retrospective descriptive-analytical study was conducted at the University Paediatric Unit at Lady Ridgeway Hospital for Children, Colombo, Sri Lanka. All children who had fulfilled the criteria for DHF admitted to the unit from April 2018 to September 2018 were recruited into the study. Relevant data were collected from bed head tickets. One hundred and eighty-four children were included in the final analysis. Thirty-three (17.9%) had a past history of documented symptomatic dengue infection, while 82.1% did not have a documented dengue infection. Twelve patients had dengue shock syndrome, and none of them had previously documented symptomatic dengue fever. Dextran was used in 96 patients in the critical phase. Twelve (42%) patients with past documented symptomatic dengue fever needed dextran while 84 (54.9%) patients without a documented past history of dengue fever needed dextran. In our clinical observation, we noticed that children with DHF mostly did not have a documented symptomatic prior dengue infection, while those with a documented symptomatic prior infection had a milder subsequent illness. In fact, the majority (82.1%) of patients with DHF did not have documented previous symptomatic dengue infection. It was also observed that the clinical course of subsequent dengue infection was less severe in patients with previously documented symptomatic dengue fever. This finding should be further evaluated in a larger scale study minimizing the all-confounding factors. This fact is more important in selecting recipients for vaccines against the dengue virus, which are supposed to produce immunity against the virus without causing the severe disease.
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http://dx.doi.org/10.1155/2021/8842799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192182PMC
June 2021

Retrospective Study of Clinico-Aetiological Factors of Chronic Urticaria Among Children Attending a Tertiary Care Paediatric Centre in Eastern Province of Sri Lanka.

Cureus 2021 May 4;13(5):e14848. Epub 2021 May 4.

Paediatrics, Paediatric Professorial Unit, Teaching Hospital, Batticaloa, LKA.

Introduction Chronic urticaria is one of the growing problems worldwide and the prevalence is increasing. Around 2% of children have been shown to be affected with chronic urticaria. Objectives To evaluate demographic, clinical and aetiological factors related to chronic urticaria in children and to assess investigations and treatment. Method: A retrospective study was done from January 2018 to December 2019 on 40 children aged 1-14 years who presented with chronic urticaria to the paediatric clinic, University Paediatric Unit, Batticaloa Teaching Hospital. Detailed information including demographic factors, duration of illness, main reasons for clinic attendance, treatment received from the out-patient department, caregiver reported allergens, family history of atopy and complications such as secondary bacterial infection were retrieved from clinic-based records. Information regarding laboratory investigations was also retrieved. Data were analysed using SPSS version 19.0 (IBM Corp., Armonk, NY). Results Forty children were available for the analysis. The most common age category was four to eight years and 25 (62.5%) were females. Seventy percent of children had urticaria for one or more years. Thirty-six (90%) children had a family history of allergies such as allergic rhinitis, eczema, food allergies, medication allergies and bronchial asthma. The common precipitating factors were foods in 12 (30%) cases and insect bites in 10 (25%) cases. The main reasons for seeking medical advice were severe itchiness in 40 (100%) and sleep disturbances in 24 (60%). Only a limited number of investigations had been performed and they included white cell counts (differential eosinophil counts) and thyroid functions. Almost all had normal thyroid functions whilst 45% had eosinophilia. ConclusionsThe majority of children with chronic urticaria had symptoms for over the one-year duration and reported a family history of allergy. All children reported severe itchiness as the main symptom and sleep was disturbed in the majority. The common precipitating factors were food and insect bites.
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http://dx.doi.org/10.7759/cureus.14848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176063PMC
May 2021

Postdengue chronic fatigue syndrome in an adolescent boy.

BMJ Case Rep 2021 Jun 7;14(6). Epub 2021 Jun 7.

Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Chronic fatigue syndrome (CFS) is often preceded by a viral illness and has recurrent 'flulike' symptoms which include a wide spectrum of musculoskeletal and neurological clinical features. The condition is also known as myalgic encephalomyelitis and systemic exertional intolerance syndrome. CFS has been reported following dengue among adult patients. We report the case of an 11-year-old boy who developed CFS following recovery of dengue haemorrhagic fever (DHF). The reported child was initially managed as for DHF and was clinically asymptomatic on post-discharge day 3. He was re-admitted after 3 weeks with severe joint pains, myalgia and unbearable headache. As his symptoms persisted, he was investigated in-depth. All investigations were normal except mild elevation of liver functions. The diagnosis of CFS secondary to DHF was made by exclusion of differential diagnosis. At 1-year follow-up, patient continues to have symptoms after treatment with physiotherapy and nutrition counselling.
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http://dx.doi.org/10.1136/bcr-2020-238605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186546PMC
June 2021

Clinical Profile, Risk Factors and Outcomes of Children With Cutaneous Larva Migrans Infection: A Hospital-Based Study.

Cureus 2021 Apr 11;13(4):e14416. Epub 2021 Apr 11.

Internal Medicine-Pediatrics, Base Hospital, Mahaoya, LKA.

Background Cutaneous larva migrans (CLM) is a neglected parasitic skin disease caused by hookworm larvae such as and . It is more common in tropical and subtropical countries. Evidence regarding clinical profiles, risk factors and outcomes of children with CLM in the Eastern province of Sri Lanka is scarce. Aim The aim of this study was to evaluate demographic profile, risk factors, clinical manifestations and outcomes associated with CLM in children who presented to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka.  Method A retrospective study was conducted over three years from January 2017 to December 2019 among children who presented with CLM infection to paediatric and dermatological clinics of the Teaching Hospital, Batticaloa, Sri Lanka. Twenty-eight children who were aged between 1 and 14 years were recruited for the study. Detailed information including demographic factors such as age, sex, residence and mother's education, risk factors for infection, main reason for clinic visit, duration of illness, site of lesions, number of lesions, treatment received from out-patients department and/or general practitioner, duration of treatment, associated secondary bacterial infection, family history of similar infections and laboratory investigations were extracted from clinical records. Data were analyzed using SPSS version 19.0 (IBM Corp., Armonk, NY). Results Among 28 children recruited for this study, 19 (67.9%) were male children and 9 (32.1) were female children. The majority of children were below 6 years (n=25, 88.3%). Twenty-six (92.9%) children had residence in rural areas and also belonged to low socioeconomic class. Most cases were detected in Valaichenai (32.1%) and Kattankudy (21.4%) 'Medical Officer of Health' (MOH) regions. The majority of mothers were educated only up to ordinary level or below (n=19, 67.8%). All patients had pets either dogs or cats at home and no pets had been dewormed. Almost 92.9% of children acquired disease whilst playing on the infected soil The main reason for clinic visit had been itchiness and this presentation accounted for 60.7% (n=17). Skin infection accounted for 25% of presenting problems. Majority of them presented late to the clinic with the lesions of more than three weeks of duration (n=17, 60.7%). Single lesion was noted in the majority (n=27, 96.4%) except one child who had three lesions. Buttock lesions were observed in 35.7%, feet in 25%, and 10.7% in legs. Investigations revealed eosinophilia in 50% (n=14) of patients and neutrophil leukocytosis was seen in five patients (17.9%). All patients received treatment either from the general practitioner or outpatient department for variable duration without success before attending the specialist clinic. Fifty percent of patients needed treatment with Albendazole and antihistamine for more than three weeks to achieve complete cure. It was also observed that overall occurrence had been declining over the past three years. Conclusion CLM is a common and unreported disease in Eastern province, Sri Lanka. The majority of children presented from low socio-economic backgrounds. The common risk factors were the presence of dewormed pets at home and contamination with infected soil. The majority of children had a single lesion on presentation. Fifty percent of children needed more than three weeks of treatment to achieve a good response.
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http://dx.doi.org/10.7759/cureus.14416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112287PMC
April 2021

Early-Onset Multiple Sclerosis With Frequent Relapses: A Challenging Diagnosis With a Less Favorable Prognosis.

Cureus 2021 Mar 18;13(3):e13963. Epub 2021 Mar 18.

Paediatrics, Base Hospital Mahaoya, Mahaoya, LKA.

Pediatric multiple sclerosis (MS) is a rare demyelinating disease of the brain, spinal cord, and optic nerve caused by immune modulators mediating against the neuronal axons of the central nervous system. MS is usually characterized by a series of neurological events, without any features of encephalopathy, separated in time and space. The complications arise from the permanent degeneration of the nerves. This condition can be diagnosed based on International Pediatric Multiple Sclerosis Study Group diagnostic criteria, and there is no definitive treatment for MS. We report the case of a male child who was diagnosed with MS at the age of six years when he presented with right hemiparesis and visual impairment. Subsequently, he had multiple relapses with varied neurological presentations, and each relapse was treated with methylprednisolone.
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http://dx.doi.org/10.7759/cureus.13963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052520PMC
March 2021

A Study on Digit Sucking Among Children Presented to a Tertiary Care Paediatric Clinic in Sri Lanka.

Cureus 2021 Feb 12;13(2):e13306. Epub 2021 Feb 12.

Paediatrics, Base Hospital, Mahaoya, Mahaoya, LKA.

Background Sucking habits are common among children, especially in early childhood. There is, however, controversy about its prevalence probably due to under-reporting. The objective of this study is to analyze the demographic factors, reasons for clinic attendance, and treatment options chosen by parents and health care providers to control digit sucking. Material and methods A retrospective cross-sectional study was conducted including 82 children presented to the paediatric clinic, Teaching Hospital, Batticaloa, with digit sucking over a period of three years from November 2017 to October 2020. The data was analyzed using SPSS version 19.0 (IBM Corp., Armonk, NY, USA). Results Eighty-two children were enrolled in this study. The majority (n=29, 35.4%) of them presented between seven months to two years, and very few (n=3, 3.6%) presented after five years. Female children outnumbered males (50: 32). Only 24 (29.3%) mothers had been working and away from home during the daytime whilst the rest were housewives and were available to their children most of the time of the day. About 70 (85.4%) children had been given exclusive breastfeeding while the rest had either formula alone or formula with breastfeeding during the first six months of their age. Around 62 (75.6%) children had used their right hand for sucking. Sixty-six children (80.5%) had been using the thumb. Most children (n=56, 68.3%) were sucking since birth. The most common reason (n=68, 82.9%) for clinic attendance was that parents were scared about the future occurrence of mal-alignment or malocclusion of teeth. Thirty-one parents (37.8%) did nothing to stop digit sucking while 25 (30.5%) applied bitter oil and the majority tried pacifier without success. All children were referred to the dental surgeon for further management of digit sucking and amongst them, 78 children (95.1%) attended the appointment. All 78 children had been reassured that the habit eventually disappears before permanent teeth will appear and explained that digit fixing therapy would be offered for persisting habitual digit sucking. Four children did not visit the dental department.  Conclusions The majority of children presented to the clinic were below three years and females outnumbered males in all age groups. A greater number of children had been using their right hand and thumb. Most of them had the habit of sucking since birth and most of the parents anticipated mal-alignment of teeth due to consequences of sucking. None of them succeeded in stopping the habit of digital sucking with various remedies performed at home by their parents.
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http://dx.doi.org/10.7759/cureus.13306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956008PMC
February 2021

Child with dengue haemorrhagic fever complicated by ileocaecal intussusception.

BMJ Case Rep 2021 Mar 16;14(3). Epub 2021 Mar 16.

Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK

Dengue fever is one of the most common neglected tropical diseases with an increasing trend seen in Sri Lanka and many other tropical countries. A number of unusual presentations and complications of dengue fever have been reported, and acute abdomen is one such presentation. However, intussusception as the cause of acute abdomen in a patient with dengue haemorrhagic fever has not been previously reported. The authors report a child who was diagnosed to have intussusception during the critical phase of dengue haemorrhagic fever while having a platelet count of 15×10/cumm. The child had initial point-of-care ultrasound followed by detailed ultrasound of the abdomen by the radiologist, and the diagnosis of ileocaecal intussusception was confirmed. Intussusception was relieved by saline reduction and without needing laparotomy. Early diagnosis and non-operative management prevented emergency laparotomy.
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http://dx.doi.org/10.1136/bcr-2020-237697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970290PMC
March 2021

Multiple aplasia cutis congenita type V and fetus papyraceous: a case report and review of the literature.

J Med Case Rep 2021 Mar 4;15(1):110. Epub 2021 Mar 4.

Dermatology, Teaching Hospital, Batticaloa, Sri Lanka.

Background: Aplasia cutis congenita is regarded as congenital focal absence of skin in the newborn, and occurrence of more than three similar skin defects is rare. The etiology is thought to be multifactorial, and precise etiopathogenesis is unknown.

Case Presentation: A 13-day-old newborn Sri Lankan Tamil girl was referred to the dermatologic clinic with multiple skin defects at birth. There were six lesions on the body, and two of them had healed during intrauterine period, leaving scars. This was a second twin of her pregnancy. Her first twin fetus had demised before 19 weeks of pregnancy and was confirmed to be fetus papyraceous based on ultrasound-guided fetal assessment. The said child was thoroughly investigated and found to have no other congenital abnormalities. Chromosomal studies yielded normal findings. She was treated with tropical antibacterial ointment, and all lesions resolved spontaneously within 4 weeks, leaving scars. Physiotherapy was commenced to prevent contracture formation, and follow-up was arranged in collaboration with the plastic surgical team.

Conclusions: Aplasia cutis congenita is a rare condition of uncertain etiology, but consanguinity may play a role. This report described a newborn with type V cutis aplasia congenita in whom the diagnosis was confirmed based on clinical features and revision of antenatal history. The management depends on the pattern, extent, location, severity, underlying causes, and associated anomalies.
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http://dx.doi.org/10.1186/s13256-021-02662-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931332PMC
March 2021

PHACE Syndrome Presenting With Retinal Degeneration, Cortical Dysplasia, Microphthalmia, and Atrial Septal Defect in a South Asian Boy.

Cureus 2021 Jan 26;13(1):e12928. Epub 2021 Jan 26.

Clinical Sciences, Faculty of Health Care Sciences, Eastern University, Batticaloa, LKA.

PHACE syndrome is a rare disorder of vasculogenesis that occurs during the first trimester of pregnancy. The disorder commonly presents with posterior fossa brain anomalies and coarctation of aorta/arterial anomalies and is predominantly seen in female patients. Herein, we report a male child with PHACE syndrome who had several less common features such as cortical dysplasia, retinal degeneration, and microphthalmia. The diagnosis of PHACE syndrome was confirmed based on revised diagnostic criteria and by the presence of one major criterion and two minor criteria in addition to >5 cm haemangioma. Further, the reported child had atrial septal defect as the only cardiac abnormality, and this has been rarely described in patients with PHACE syndrome.
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http://dx.doi.org/10.7759/cureus.12928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907719PMC
January 2021

Exome sequencing detected an extremely rare case of foetal onset familial haemophagocytic lymphohistiocytosis type 5 presenting with hydrops foetalis.

BMC Med Genomics 2021 02 16;14(1):50. Epub 2021 Feb 16.

Department of Clinical Sciences, Faculty of Health Care Sciences, Eastern University of Sri Lanka, Chenkaladi, Sri Lanka.

Background: Familial hemophagocytic lymphohistiocytosis (FHL) is a genetically heterogeneous autosomal recessive hyper-inflammatory syndrome which needs early accurate diagnosis and appropriate treatment to prevent complications and early mortality. Recently, it was reported that mutations in STXBP2 gene are linked to FHL type 5 (FHL-5).

Case Presentation: We report a Sri Lankan neonate who presented with low Apgar scores at birth, abdominal distension, and hepatosplenomegaly, followed by lethargy, poor sucking and rapid decompensation with wide spread activation of inflammation within 48 h of birth. Her elder sibling also had a similar presentation during early neonatal period and deceased at two weeks of age with no diagnosis. Unfortunately, the index case deceased at 14 days of age following multi-organ dysfunction and severe metabolic acidosis. Targeted gene panel followed by reflex exome sequencing revealed a novel likely pathogenic homozygous variant in the STXBP2 gene (NM_001272034.1:c.1141-2A > G) which confirmed the diagnosis of autosomal recessive FHL-5.

Conclusion: Early diagnosis of FHL type 5 using genetic analysis and timely treatment are difficult in the absence of family history due to a wide spectrum of clinical manifestations. However both early diagnosis and treatment doesn't alter the long term prognosis. So genetic counselling would be the better option.
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http://dx.doi.org/10.1186/s12920-021-00897-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885387PMC
February 2021

Primary Hypertension as the Presenting Feature of Laurence-Moon-Bardet-Biedl Syndrome: A Report of Two Children.

Cureus 2021 Jan 11;13(1):e12617. Epub 2021 Jan 11.

Paediatrics, Base Hospital, Mahaoya, LKA.

Laurence-Moon-Bardet-Biedl syndrome (LMBBS) is a rare ciliopathic genetic multisystem disorder. It has several primary and secondary clinical features, which include central obesity, retinitis pigmentosa, mental subnormalities, polydactyly, and renal dysfunction. The majority of children may not show all clinical features at birth, and clinical features can develop progressively over the years. The authors report two children who were followed up for obesity at the pediatric clinic in the local hospital and the ophthalmology clinic at the tertiary care center, respectively, without a diagnosis, and were referred for specialist pediatric evaluation of hypertension detected on their routine checkup and for further management. Both children were investigated and found to have satisfied criteria for LMBBS in association with primary hypertension. Both children were diagnosed late as LMBBS at 12 years and four years of their age although both of them had enough features to have a suspicion of this syndrome.
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http://dx.doi.org/10.7759/cureus.12617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873780PMC
January 2021

Subgaleal Abscess Following Staphylococcal Cellulitis in a 10-Month-Old Child: A Diagnostic Challenge for the Clinician.

Cureus 2021 Jan 9;13(1):e12591. Epub 2021 Jan 9.

Pediatrics, Mahaoya Base Hospital, Mahaoya, LKA.

Subgaleal abscess is an extremely rare and unusual presentation of head and neck infections and has been reported to occur following scalp infections, head trauma, sinusitis, septicemia, scalp monitoring, and surgical interventions. We report a 10-month-old child who presented with cellulitis around a pustule on the right forehead of three days duration. It was initially treated with oral cloxacillin for five-days. However, the child went on to develop a high continued fever on the day of discharge and remained febrile and unwell for seven days until a subgaleal abscess was identified and surgical drainage was performed. Pus cultures grew Staphylococcus aureus, which was sensitive to flucloxacillin. Following drainage of the abscess and change of antibiotics to intravenous flucloxacillin, fever completely subsided and the child made a complete clinical recovery. This report highlights the importance of having a high clinical suspicion of this rare complication in children with continuing high spikes of temperature following skin infections in the head region.
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http://dx.doi.org/10.7759/cureus.12591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869907PMC
January 2021

Paroxysmal kinesigenic dyskinesia: a diagnostic challenge.

BMJ Case Rep 2021 Feb 5;14(2). Epub 2021 Feb 5.

Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

A 10-year-old girl presented with a month long history of episodic limb movements. She had a normal neurological examination and after thorough investigation, she was thought to have possible tics. Anxiety was reported as being a trigger. Unusually, these 'tics' were not directly witnessed during hospital visits. Eighteen months after the initial presentation, the clinician observed dystonic posturing after the child stood up from having been seated during a consultation. Paroxysmal kinesigenic dyskinesia (PKD) was then suspected and confirmed on genetic testing. She was successfully treated with carbamazepine. In hindsight, it became apparent that her anxiety was related to a fear of uncontrolled movements, rather than it being a trigger. The abnormal involuntary movements in PKD are precipitated by sudden voluntary movement. Lack of recognition of this typical feature, normal examination and/or features such as coexisting anxiety can lead to misdiagnosis or delayed diagnosis of this easily treatable condition.
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http://dx.doi.org/10.1136/bcr-2020-235112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871216PMC
February 2021

Cutaneous larva migrans in a young child following circumrotation as a cultural ritual.

BMJ Case Rep 2021 Jan 25;14(1). Epub 2021 Jan 25.

Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK

Cutaneous larva migrans is an acquired, self-limited infestation caused by cat hookworm, , and dog hookworm, The disease is acquired by direct contact with contaminated soil. Circumrotation is a religious ritual practised by devotees of Hinduism as a fulfilment of vows taken at the shrine and involves rolling over with uncovered upper body on the sand over a distance of up to 600 m. It is a reported mode of acquisition of cutaneous larva migrans infestation. The authors report a 10-year-old boy who acquired cutaneous larva migrans on his right forearm after circumrotation. The forearm is an unusual site for this infestation, and most reported cases had lesions on the feet, thighs and buttocks following either sitting or playing on contaminated soil. The child made complete recovery following treatment with albendazole for 1 week.
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http://dx.doi.org/10.1136/bcr-2020-237204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839857PMC
January 2021

Adolescent Pregnancy and Outcomes: A Hospital-Based Comparative Study at a Tertiary Care Unit in Eastern Province, Sri Lanka.

Cureus 2020 Dec 14;12(12):e12081. Epub 2020 Dec 14.

Pediatrics, Base Hospital, Mahaoya, LKA.

Background Adolescent pregnancy is a high-risk condition that can potentially lead to adverse perinatal and obstetric outcomes. It is a growing concern in developing countries including Sri Lanka. The main objective of this study was to evaluate obstetric and perinatal outcomes amongst adolescent pregnancies and compare them with outcomes of pregnancies of average maternal age (AMA) women. Method This was a prospective, cross-sectional study conducted at a tertiary care hospital in the Eastern province of Sri Lanka. A total of 795 primigravidae who had singleton pregnancies and delivered their live babies over a period of three months from February to April 2019 were selected for the study. The data were retrieved from Bed Head Tickets (BHTs) of those patients upon discharge from the postnatal ward. Results The majority of primigravida was AMA women and accounted for 83.4% (n=663) of the study population while primiparous adolescents comprised 16.6% (n=132). Among the 132 adolescent pregnancies, 81.1% (n=107) were associated with complications and the remaining 18.9% (n=25) were uncomplicated. The most common risk associated with adolescent pregnancy was the low birth weight (LBW; n=24, 18.2%), followed by preterm labour (n=10, 7.6%). An adolescent mother had a 1.3 times higher possibility of delivering an LBW baby than an AMA mother and the risk was statistically significant (p=0.04). The likelihood of delivering an intrauterine growth restriction (IUGR) baby was higher in adolescent mothers (6%) than in AMA mothers (5%). Adolescent mothers had a 1.2 times higher chance of delivering newborns with IUGR compared to AMA mothers; however, the difference of IUGR was not statistically significant (p>0.05). The incidence of foetal distress was less among adolescent mothers compared to AMA mothers. The majority of the babies (n=126, 95.5%) of adolescent pregnancies were healthy. Only 4.5% (n=6) babies needed neonatal intensive care unit (NICU) admissions; of those, four babies had very LBW and prematurity and the other two babies depressed at birth and developed respiratory distress. Conclusion Adolescent pregnancy carries a significant risk of obstetric complications including LBW and prematurity that should draw public and healthcare providers' attention. The effectiveness of a comprehensive antenatal and community-based program to prevent adolescent pregnancy and related adverse outcomes should further be evaluated.
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http://dx.doi.org/10.7759/cureus.12081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805495PMC
December 2020

Trichotemnomania in an Adolescent Girl: A Case Report of an Asian Child and Literature Review.

Case Rep Dermatol Med 2020 8;2020:6615250. Epub 2020 Dec 8.

Department of Psychiatry, Base Hospital, Valaichenai, Sri Lanka.

Trichotemnomania (TT) refers to cutting or shaving of one's own hair as a compulsive act. This condition is reported rarely and may be indicative of an underlying obsessive-compulsive disorder. TT may be misdiagnosed with trichotillomania or other disorders such as alopecia areata, tinea capitis, and postinflammatory scars. The diagnosis of trichotemnomania is confirmed by dermoscopic assessment, histopathological changes of hair, and correlation of these findings with clinical history. A fourteen-year-old adolescent girl presented with focal hair loss over forehead for duration of two-weeks and periodic abnormal breathing and poor sleep for 2-month duration. Besides, she had also lost some of pubic hair and hair on the forearm over preceding 24 hours. This patient was assessed by a team including a paediatrician, gynecologist, dermatologist, and psychiatrist to gather focused medical history and to perform physical examination, laboratory investigations, and dermoscopic assessment. It was revealed that she used to shave or cut regularly following stressful situations across various aspects of her life and hyperventilate as a means of relieving her stress. Eventually, she was diagnosed to have trichotemnomania and was started oral sertraline 50 mg/day for one month. Clinical features and her behaviour improved with regular cognitive behavioural therapy, and hairs were demonstrated to grow up normally with change in behaviour. Currently, she does well at school and is off medications and being followed up at the child guidance clinic. Trichotemnomania is a very rare disorder which is characterised by cutting or shaving of one's own hairs as a compulsive habit. The condition needs careful and detailed assessment by a team of specialists to identify coexisting psychiatric disorders and offer treatment.
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http://dx.doi.org/10.1155/2020/6615250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787842PMC
December 2020

Focal Status and Sub-Ependymal Tumor as Features of the First Presentation in a Child With Tuberous Sclerosis.

Cureus 2020 Dec 1;12(12):e11816. Epub 2020 Dec 1.

Paediatrics, District General Hospital Ampara, Ampara, LKA.

Tuberous sclerosis (TS) is an autosomal dominant inherited disorder that affects multiple organ systems. Usually, children with TS present either with neurocutaneous stigmata or seizures during the early years of life. The mortality and morbidity are related to refractory epilepsy, giant cell astrocytoma and related complications, and multiple angiomyolipomas. The authors have reported an eleven-year-old child in whom focal status and sub-ependymal tumor were the features of the first presentation of tuberous sclerosis. The report further highlights the importance of early identification of cutaneous features by primary care providers and parents to enable early comprehensive multi-disciplinary management.
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http://dx.doi.org/10.7759/cureus.11816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781495PMC
December 2020

Cutaneous Larva Migrans Infestation Over Buttocks and Perineal Region: A Case Series of Five Toddlers From Sri Lanka and Literature Review.

Cureus 2020 Nov 5;12(11):e11335. Epub 2020 Nov 5.

Pediatrics, Base Hospital, Mahaoya, LKA.

Cutaneous larva migrans (CLM) is a cutaneous infestation caused by a hookworm larva. We report five toddlers who presented to the pediatric clinic with characteristic cutaneous lesions of CLM over the buttock and perianal region over periods of variable duration. Lesions of four children were typical and linear and one child had an atypical lesion. All were diagnosed as cutaneous larva migrans based on clinical history and examination. Complete recovery in all five children was achieved following treatment with oral albendazole.
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http://dx.doi.org/10.7759/cureus.11335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720901PMC
November 2020

Dengue Fever Associated Haemophagocytic Lymphohistiocytosis: A Report of Two Children.

Cureus 2020 Oct 29;12(10):e11232. Epub 2020 Oct 29.

Pediatrics, Base Hospital Mahaoya, Mahaoya, LKA.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, fatal complication of dengue infection and often leads to multi-system involvement and failure. Early recognition is crucial in improving the outcome. We report two children who developed secondary haemophagocytic lymphohistiocytosis following dengue fever. A 14-year-old girl who was diagnosed with beta-thalassemia major presented with dengue hemorrhagic fever and developed a continuous very high fever, persistent thrombocytopenia, and anemia despite several transfusions of blood and blood products. The other child was a 12-year old girl who, following initial confirmation of dengue fever, presented with persistent fever and hepatosplenomegaly. The diagnosis of HLH in both children was confirmed by clinical and laboratory features supported by the demonstration of haemophagocytes in the bone marrow. Both children were treated with steroids and supportive care and made a gradual recovery with treatment. Second-line immune-suppressive treatment was not needed. Whilst sepsis is a priority differential diagnosis in children with persistent fever following recovery from dengue fever, HLH should always be suspected early in these patients. Early, appropriate immunosuppressive treatment is likely to improve long-term outcomes and prevent mortality.
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http://dx.doi.org/10.7759/cureus.11232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704164PMC
October 2020

Refractory Kawasaki Disease Presenting With Erythema at Bacille Calmette-Guérin Inoculation Site: A Paediatric Case Report.

Cureus 2020 Oct 13;12(10):e10928. Epub 2020 Oct 13.

Internal Medicine: Paediatrics, Base Hospital, Mahaoya, LKA.

Kawasaki disease (KD) is an autoimmune disease that generally affects children under the age of five years. It has a variety of clinical manifestations which may be either specific or nonspecific. Intravenous immunoglobulin and aspirin are the mainstays of treatment. There are unusual circumstances where patients are resistant to conventional treatment. We report a one-year-old girl who presented with a 12-day history of fever in association with erythema at the site of Bacille Calmette-Guérin (BCG) scar. She did not respond successfully to conventional treatment although she was diagnosed to have Kawasaki disease. Eventually, she responded to intravenous methylprednisolone and was diagnosed as having refractory Kawasaki disease.
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http://dx.doi.org/10.7759/cureus.10928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659888PMC
October 2020

Sucking Pads: A Report of Two Newborns.

Cureus 2020 Oct 11;12(10):e10904. Epub 2020 Oct 11.

Paediatrics Department, Base Hospital, Mahaoya, LKA.

The sucking pad is a hyperkeratotic thickening of the lips of a neonate. It might present either at birth or develop later in the neonatal period. It indicates that the child has effective sucking. We present two babies who developed the peeling of the lips during the neonatal period. It was mistreated as various conditions. Ultimately, it was diagnosed as a sucking pad, and the parents were reassured that it was a benign lesion.
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http://dx.doi.org/10.7759/cureus.10904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657316PMC
October 2020

Clinical and Radiological Characterization of an Infant with Caudal Regression Syndrome Type III.

Case Rep Neurol Med 2020 26;2020:8827281. Epub 2020 Oct 26.

Department of Radiology, Base Hospital Mahaoya, Maha Oya, Sri Lanka.

Caudal regression syndrome is a rare disorder of developmental failure of lumbosacral vertebra and corresponding spinal cord during notochord formation. The severity varies from absent coccyx to complete absence of lumbosacral vertebra and caudal spinal cord. Both genetic and environmental factors are believed to play roles in aetiopathogenesis of caudal regression. The authors report a two-month-old child born to a diabetic mother, in whom the diagnosis of caudal regression syndrome type III was confirmed based on clinical and radiological characteristics. The child was managed by the multidisciplinary team to continue supportive care and screen and monitor for long-term complications. The long-term prognosis for mobility was less favourable given the presence of bilateral hip dysplasia and involvement of lumbar vertebra in addition to sacral agenesis.
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http://dx.doi.org/10.1155/2020/8827281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641678PMC
October 2020

Combined liver and kidney transplantation in children and long-term outcome.

World J Transplant 2020 Oct;10(10):283-290

Department of Clinical Nutrition, Lady Ridgeway Hospital for Children, Colombo 0094, Sri Lanka.

Combined liver-kidney transplantation (CLKT) is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual (usually a cadaver) to the same recipient during a single surgical procedure. Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1. Atypical haemolytic uremic syndrome, methylmalonic academia, and conditions where liver and renal failure co-exists may be indications for CLKT. CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft; however, liver survival has no significant impact. Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries, acute complications are not uncommon. Bleeding, thrombosis, haemodynamic instability, infections, acute cellular rejections, renal and liver dysfunction are acute complications. The long-term outlook is promising with over 80% 5-year survival rates among those children who survive the initial six-month postoperative period.
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http://dx.doi.org/10.5500/wjt.v10.i10.283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579435PMC
October 2020

Invasive Streptococcus Pneumoniae Septicemia Complicated with Hemolytic Uremic Syndrome and Meningitis.

Cureus 2020 Sep 25;12(9):e10644. Epub 2020 Sep 25.

Internal Medicine: Pediatrics, Base Hospital, Mahaoya, LKA.

Streptococcus pneumoniae-associated hemolytic uremic syndrome (SpHUS) is an uncommon cause of hemolytic uremic syndrome (HUS). The diagnosis and treatment of Streptococcus pneumoniae-associated HUS is often difficult and associated with high long-term morbidity and mortality. The authors report a five-year-old child who developed HUS following an invasive Streptococcus (S.) pneumoniae infection. The child initially presented with fever, cough, and difficulty in breathing for three days duration and was clinically and radiologically diagnosed as having right middle lobe pneumonia. Blood culture grew Streptococcus pneumoniae. The cerebrospinal fluid analysis also showed Streptococcus pneumoniae. He was initially treated with intravenous cefotaxime. As the child had a poor response to cefotaxime with ongoing fever, antibiotics were changed to ceftriaxone and vancomycin. Although fever started to subside subsequently, the child deteriorated with reduced urine output and developed generalized body swelling. The hematological and biochemical evaluation confirmed hemolytic uremic syndrome. He needed continuous renal replacement therapy for five days and antibiotics were given for 14 days. He had no long-term sequelae on follow-up.
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http://dx.doi.org/10.7759/cureus.10644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586376PMC
September 2020

Pulmonary tuberculosis presenting as lung abscess in a 10-month-Old infant.

Respir Med Case Rep 2020 16;31:101229. Epub 2020 Sep 16.

Consultant Paediatrician, Base Hospital, Mahaoya, Sri Lanka.

Tuberculosis in infants although less common compared to older children and adults, is associated with a high risk for milliary tuberculosis, tuberculosis meningitis and overall higher mortality. Lung abscess commonly presents following severe community acquired bacterial infections and is extremely rare in infants with tuberculosis. This report presents the case of a 10-month-old infant who had an unusual presentation of pulmonary tuberculosis with no cough, poor growth or documented temperature >38 C despite extensive right lung involvement with lung abscess formation and pleural effusions. Inflammatory markers were minimally deranged. The diagnosis of pulmonary tuberculosis was confirmed based on positive tuberculosis polymerase chain reaction test. The child made a successful clinical and radiological recovery upon completion of anti-tuberculosis drug regimen for six months. This report brings to light that it is crucial for clinicians to have a high index of suspicion of tuberculosis irrespective of age of the patient, presenting symptoms and low prevalence since delayed diagnosis of tuberculosis in infants is associated with poor outcomes.
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http://dx.doi.org/10.1016/j.rmcr.2020.101229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516287PMC
September 2020

Homozygous autosomal recessive hypercholesterolaemia in a South Asian child presenting with multiple cutaneous xanthomata.

Ann Clin Biochem 2021 03 7;58(2):153-156. Epub 2020 Oct 7.

Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Australia.

Autosomal recessive hypercholesterolemia (ARH; OMIM #603813) is an extremely rare disorder of lipid metabolism caused by loss-of-function variants in the LDL receptor adapter protein 1 () gene, which is characterized by severe hypercholesterolaemia and an increased risk of premature atherosclerotic cardiovascular disease. We report the case of an 11-year-old girl who presented with multiple painless yellowish papules around her elbows and knees of two-year duration. She had been reviewed by several general practitioners, with some of the papules having been excised, but without a specific diagnosis being made. The child was referred to a paediatric service for further evaluation and treatment of the cutaneous lesions, which appeared xanthomatous in nature. A lipid profile showed severe hypercholesterolaemia. Next generation sequencing analysis of a monogenic hypercholesterolaemia gene panel revealed homozygosity for a pathogenic frameshift mutation, c.71dupG, p.Gly25Argfs*9 in . Her parents and brother, who were asymptomatic, were screened and found to be heterozygous carriers of the variant. There was no known consanguinity in the family. She was commenced on the HMG-CoA reductase inhibitor, atorvastatin, to good effect, with a ∼76% reduction in LDL-cholesterol at a dose of 50 mg per day. At six-month follow-up, there had been no obvious regression of the xanthomata, but importantly, no enlargement of, or the development of new papular lesions, have occurred. In summary, we report a child who presented with multiple cutaneous xanthomata and was confirmed to have ARH by the presence of a homozygous novel pathogenic frameshift variant in .
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http://dx.doi.org/10.1177/0004563220961755DOI Listing
March 2021

A case report of dengue hemorrhagic fever complicated with diabetic ketoacidosis in a child: challenges in clinical management.

BMC Pediatr 2020 08 26;20(1):403. Epub 2020 Aug 26.

Base Hospital, Mahaoya, Sri Lanka.

Background: Diabetic ketoacidosis (DKA) is a common presentation of type 1 diabetes mellitus (T1DM) precipitated by various bacterial and viral infections. Dengue infection is no exception for this and can be a precipitating factor for DKA. The presentation of DKA with dengue haemorrhagic fever (DHF) has been reported in adults. However, it is very rarely observed in children.

Case Presentation: We present the case of a paediatric patient who was previously healthy and subsequently, developed polyuria (above 3 ml/kg/hour), irritability and high blood glucose (724 mg/dl) during the critical phase of DHF. DKA was diagnosed with DHF and managed successfully with insulin and intravenous fluids. He recovered without complications and discharged home with follow up being arranged at the endocrinology clinic.

Conclusions: When both DHF and DKA present together in a patient, meticulous monitoring of glycaemic control as well as fluid management is required to reduce the potential risk for severe complications of both conditions. Since there are no similar paediatric case reported in the literature, this case report might inspire paediatricians to anticipate the possibility of DKA in children with DHF.
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http://dx.doi.org/10.1186/s12887-020-02300-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448987PMC
August 2020

Accidental and Deliberate Self-Poisoning with Medications and Medication Errors among Children in Rural Sri Lanka.

Emerg Med Int 2020 3;2020:9872821. Epub 2020 Aug 3.

Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.

. Pharmaceutical products are the leading cause accidental poisoning in middle- and high-income countries. Patterns of poisoning with medicinal drugs change across different geographic regions and over decades owing to variability in prescription practice, sociocultural factors, safe storage of medicines, and free availability of over the counter medications. . This multicentre descriptive study was conducted over a seven-year period (February 2007 to January 2014) to assess patterns and trends of medicinal drug-related poisoning among children less than 12 years of age in thirty-six hospitals across rural Sri Lanka. Children with both accidental and deliberate medication poisonings and medication errors were recruited to the study. Data on poisoning events and medication errors were gathered via patient/parent interviews using multistructured questionnaires that assessed demographic factors, first aid measures, location and circumstances of poisoning, clinical management, and complications. In addition, focus group discussions were performed on all children and their families who had deliberate poisoning events and medication errors. . Among 1621 children presented with acute poisoning over seven years of age, 410 children had acute poisoning with medications. Male children (225, 54.9%) outnumbered female children. Paracetomol (137, 35.6%), salbutamol (55, 14.3%), and chlorpheniramine (35, 9.1%) were the most commonly poisoned medications. Prospective data at Anuradhapura teaching hospital ( = 112) revealed that unsafe first aid measures were practiced on 22 (19.6%) children. Although the majority of children remained asymptomatic (61, 54.5%), neurological symptoms (34, 67%) were predominantly seen in symptomatic children. The majority of poisonings took place within home premises (76, 67.9%). There were 16 reports of medication errors (14.2% of acute poisoning events) either due to erroneous administration by caregivers or erroneous issue of medicines by health workers. The current study did not observe mortality following medication poisonings. This study brings to light the burden of medicinal drug-related poisoning morbidity among children in rural Sri Lanka. Potentially, interventions such as community educational initiatives, written safety warnings, increased use of child resistant containers, and enforcement of laws to bring down accidental medication poisonings need to be implemented, and their effectiveness should be evaluated.
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http://dx.doi.org/10.1155/2020/9872821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422222PMC
August 2020

Dengue hemorrhagic fever as a rare cause of chronic immune thrombocytopenic purpura-a pediatric case report.

Trop Med Health 2020 20;48:59. Epub 2020 Jul 20.

Base Hospital Mahaoya, Mahaoya, Sri Lanka.

Background: Dengue is a common mosquito-borne infection in tropical countries. Dengue incidence in Sri Lanka is generally showing a rising trend. Both chronic immune thrombocytopenia purpura (ITP) children and chronic ITP triggered by dengue fever in the pediatric age group are rarely reported. This unusual presentation is a diagnostic challenge to clinicians. The authors have reported a pediatric patient who presented with chronic ITP following recovery from dengue hemorrhagic fever.

Case Presentation: A 14-year-old previously healthy boy was initially managed as for dengue hemorrhagic fever. Following initial detection of persistent thrombocytopenia at 2 weeks post-discharge, his parents defaulted follow-up for 1 year as he remained asymptomatic. However, 1 year after initial admission, the child re-presented with ecchymotic patches and a platelet count of 30 × 10/cumm. Review of serial blood counts performed during previous hospital admission and by his parents themselves revealed persistent thrombocytopenia over preceding 12 months. Subsequently, the child had an in-depth evaluation. The diagnosis of ITP was confirmed by ruling out differential diagnosis and he was managed as for chronic ITP. His platelet counts showed good response to oral corticosteroids and he is currently being followed up at the pediatric hematology clinic.

Conclusion: While reporting, a 14-year-old boy who developed chronic ITP following dengue hemorrhagic fever, this report highlights importance of frequent monitoring of blood counts to accurately detect and manage critical phase of dengue fever. The report also highlights the value of monitoring platelet counts in post-recovery phase to ensure they have normalized.
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http://dx.doi.org/10.1186/s41182-020-00248-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370471PMC
July 2020