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.