A total of 97 children aged 1 month to 16 years (mean 6.6 years) had upper endoscopies performed in Paediatric Institute, Kuala Lumpur Hospital between January 1997 and December 1999 for various gastrointestinal symptoms. Of these 70 children were tested for Helicobacter pylori. The four most common indications for upper endoscopy were recurrent abdominal pain, upper gastrointestinal bleeding, epigastric pain and vomiting. The overall prevalence of this infection in this heterogenous group of symptomatic children was 10% (7/70). This study shows that H.pylori positivity in a routine endoscopy population is low and does not appear to be associated with specific symptoms.
We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.