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Severe malnutrition due to subtle neurologic deficits and epilepsy: report of three cases
1UCLA-Department of Medicine 90095-1736, USA.
Insights
Inadequate nutrition in children with chronic infections can mask underlying epilepsy. Early diagnosis and treatment of neurological conditions are crucial for children with severe protein energy malnutrition (PEM) to prevent recurrent failure-to-thrive.
Area of Science:
- Pediatrics
- Neurology
- Public Health
Background:
- Protein energy malnutrition (PEM) is prevalent in Southern and Eastern Africa, affecting children with chronic infections like tuberculosis, parasites, and HIV.
- Severe PEM often presents as a primary concern, masking other potential underlying health issues in affected children.
Observation:
- Three pediatric cases at Chikankata Salvation Army Hospital presented with life-threatening PEM requiring intensive feeding.
- Children initially gained weight in the feeding unit but later re-presented with failure-to-thrive after discharge.
Findings:
- Subtle neurologic deficits and underlying epilepsy were identified in children with recurrent failure-to-thrive.
- Epilepsy was the primary unidentified cause of PEM and failure-to-thrive in these cases.
Implications:
- Epilepsy and developmental disabilities should be considered in the differential diagnosis of severe PEM, especially when other etiologies are not apparent.
- Integrated care addressing both malnutrition and neurological conditions is essential for improving outcomes in vulnerable children.
- This highlights the need for comprehensive diagnostic approaches in pediatric malnutrition cases in resource-limited settings.
Abstract:
In southern and eastern Africa, where approximately eight per cent of households lack access to adequate food, children suffering from chronic infections such as tuberculosis, gastrointestinal parasites and human immunodeficiency virus, often present with severe protein energy malnutrition. Three cases are described of children presenting to Chikankata Salvation Army Hospital who required hospitalization and urgent feeding due to PEM. No underlying aetiology for their life-threatening PEM could initially be identified and they were all observed to gain weight while in the intensive feeding unit. After discharge, each re-presented with recurrent failure-to-thrive and were found to have subtle neurologic deficits and underlying epilepsy. Epilepsy and developmental disabilities should be considered in patients with PEM for whom other aetiologies cannot be identified.