The pattern of bacterial infections in kwashiorkor patients as seen in Kenyatta National Hospital
Abstract
Ninety six patients with kwashiorkor were screened for bacterial
infections. 59% of them had bacterial infections. The finding that 41%
of patients studied had no bacterial infection speaks against routine use
of antibiotics ,in the kwashiorkor patients and strongly suggests their
screening for bacterial infections before intiating treatment with
antibiotics.
Urinary tract was the commonest system involved with urinary tract
infection documented in 28% of the patients. None of the patients had
sysmptoms or signs suggestive of urinary tract infection. Thus one has
to have high index of suspicion in as far as urinary tract infection is
concerned. The commonest organ+sm isolated was escherichia coli (51.9%)
followed by klebsiella (37%). The escherichia coli was mainly sensitive
to cotrimoxazole and nitrofurantoin.
The general pattern of the bacterial infections- showed that gram
negative organisms were predominantly isolated. Escherichia coli was the
commonest organism isolated (22.9%) followed by klebsiella (21.9%).
Escherichia coli was sensitive to gentamycin (40%) and chloramphenicol
(28%). For klebsiella\' 45% of the organisms were sensitive to gentamycin,
39.9% to chloramphenicol and 5% of them to ampicillin.
The above sensitivities show that the commonly used antibiotics (penicllin
and ampicillin) are not useful and that the best antibiotics to use are
either gentamycin or chloramphenicol.
Diagnosis of tuberculosis was difficult as only four patients had positive
Mantoux test and six had chest X-ray findings suggestive of tuberculosis.
None of the children'in the study had BeG scar. One thus has to have tuberculosis
at the back of one's mind and if bronchopneumonia does not respond to
effective treatment, then one should think of tuberculosis.
Citation
Master of medicine ,University of Nairobi,1982.Publisher
University of Nairobi Medicine