55% of a sample of patients in a rural
community, and 76% of a sample of patients and
staff in the local district hospital were found to
be nasal carriers for Staphylococcus aureus. The
in vitro antibiotic susceptibility patterns of 46
strains of S. aureus isolated in nasal carriers as
well as of 43 strains in community-acquired skin
infections were characterised. High levels of
resistance were expressed to penicillin (73%),
cephalexin (64%) and tetracycline (46%).
Resistance to erythromycin (18%) was moderate.
A few strains showed resistance to methicillin
(5 isolates), vancomycin (4), [usidic acid (3),
cotrimoxazole (1), and none to gentamicin.
Penicillin can no longer be recommended for
treating community-acquired S. aureus infections.
Bacterial skin infection was studied in 239 children between the ages of 1 and 12 years in an urban squatter area in Kuala Lumpur over a period of three months (January - March 1983). 62 children presented with dermatological problems, 33 of which were clinically diagnosed as pyoderma. Microbiological examination of swabs from the lesions yielded mixed growth from 54.5% (18/33) specimens. Beta-haemolytic streptococci were isolated from 63.6% (21/33) and Staphylococcus aureus from 54.5% (18/33) specimens. All streptococcal isolates were grouped with a commercial kit, the Streptex (Wellcome). 81% (17/21) belonged to Lancefield's group A, 90% of which were not M or T typable by the standard international set of antisera. Urine analysis, pharyngeal swab culture and determination of anti-streptococcal antibody titre were also performed for children with positive skin cultures for group A streptococcus. 6% (2/33) of children with impetigo developed acute glomerulonephritis, requiring hospitalization.
Study site: Growth and nutrition clinic, squatter area, Kuala Lumpur, Malaysia
Bullous impetigo is a highly contagious skin infection commonly affecting children due to epidermolytic toxins of bacteria Staphylococcus sp. This presentation described a case of a 3 year-old Indian girl with bullous lesion around the peri-oral region. The lesion was initially thought to be of viral origin and was treated symptomatically. However, the lesion progressed without any resolution with more vesicles at distant sites. The patient was also having fever and refused any oral intake. At this point, a probable diagnosis of bacterial skin infection was considered and the patient was admitted. Intra-venous fluid was administered to rehydrate the patient and she was treated with topical antibiotic and antipyretic. The lesion resolved within 14 days without scarring. As dental practitioners, we should be aware of bacterial infection around the peri-oral region and consider it as part of a differential diagnosis so that an appropriate treatment can be given.
Malaysia is a rapidly developing country with a very young population, about 36% of which are below the age of 15 years. The standard of child health has improved greatly. However, there are great changes in the morbidity and mortality patterns of childhood diseases relating mainly to an improved standard of living; availability of safe water supply and adequate sanitary latrines; a higher literacy rate; rapid industrialisation and urban migration. The infant mortality rate has droppedfrom 50.1 per 1,000 livebirths in 1986 to 10.4 in 1995, and similar trends apply also to neonatal, perinatal and toddler mortality rates. Nevertheless, current major child health problems are those relating to events in the perinatal period and to infections. Despite improvements in the standard of neonatal care with the use ofhigh technology, the commonest cause of certified deaths still occur in the neonatal period. A rapid and inexpensive screening test for G6PD deficiency, a disease present in 2-3% of the population, is now widely available and, together with the use of phototherapy is largely responsible for the declining incidence of kernicterus in the country. Infections remain an important cause of morbidity and mortality although their patterns have changed. The very high (>95%) WHO-EPI-vaccines coverage rate is linked to the great reduction in the incidence of diphtheria, pertussis, tetanus, poliomyelitis and measles. Childhood tuberculosis is less common now, with about 250 - 300 reported cases per year and TB meningitis is rare with about 30-40 reported cases/year. The hepatitis B carrier rate is high (5%) and the introduction of routine newborn hepatitis B vaccination in 1989 is expected to have a positive impact as is the immunisation of young girls against rubella introduced in 1985 in reducing the incidence of congenital rubella syndrome. The incidence of malaria has declined but remains prevalent in the interiors of PeninsularMalaysia and in Sabah and Sarawak. Filariasis is largely under control. Unfortunately, despite great efforts at mosquito control, dengue virus infection remains a major problem with thousands of cases reported every year. Children are most susceptible to dengue haemorrhagic fever with many dying from the shock syndrome. The incidence of acute gastroenteritis has also dropped with most cases being due to a viral aetiology. Acute respiratory infections, mostly viral in origin, account for most attendances at paediatric outpatient services. Although staphylococcal and streptococcal impetigo and pneumonia are common, the incidence of streptococcal related diseases like rheumatic fever and acute glomendonephritis is rapidly declining. The nutritional status of children has improved in tandem with the rise in the standard of living, but subclinical malnutrition is prevalent, particularly among urban squatters and the rural poor. There is a disturbing decline in breastfeeding among urban working mothers. Poor weaning practices and food habits are responsible for the common occurrence of nutritional anaemia (5%) among infants and young children. Greater prosperity, rapid industrialisation and urbanisation have resulted in changes in the childhood disease pattern where non-communicable diseases assume greater importance as the problems of malnutrition and infection are gradually overcome. Road traffic accidents are a major killer and home accidents, largely preventable, are an important cause of morbidity and mortality. Childhood cancer, with about 550 new cases a year, is an important cause of death beyond infancy. Major congenital malformations, with a 1% prevalence rate, cause much ill-health. Thalassaemia is a particularly common genetic disease with fl thalassaemia gene frequency of about 5%. The prevalence of asthma is increasing, with a rate of 13.9% in the Kiang Valley but the prevalence of asthma-related symptoms is much higher. Physical, sexual child abuse and neglect, abandoned babies, substance abuse are but signs of stress of modern city living and peoples inability to cope with it. Although the general standard of child health has greatly improved, there are several states where it is still not satisfactory. In Sabah where there is a large illegal immigrant population, the infant mortality and infection rates are relatively high. In Kelantan and Trengganu, it is common for parents to refuse permission for a lumbar puncture required to treat meningitis. Other still deeply entrenched, culturally-related adverse health practices include : a fatalistic attitude to illness; a preference for traditional practitioners of medicine resulting in late treatment; and 'doctor-hopping' with unrealistic expectations of 'instant cure'. Childhood illnesses that are uncommon in Malaysia include: cystic fibrosis, coeliac disease, ulcerative colitis, Crohns disease, Sudden Infant Death Syndrome, Encopresis, enuresis and epiglottitis due to Haemophilus Influen:ae.