High dose methylprednisolone therapy in children with onyalai

Methylprednisolone at 30 mg/kg i.v. for 3 days followed by 20 mg/kg for 4 days was given to eight children who had been referred to Windhoek State Hospital with onyalai. The history of previous attacks, change in platelet count over 7 days, blood transfusion requirement and length of clinical bleeding were compared with similar parameters in a historical control group of 21 untreated children who had been observed in hospital. All the treated patients demonstrated a rise of at least 25 x 10(9)/l in the platelet count and the mean count increased from 16 x 10(9)/l on admission to 161 x 10(9)/l on day 8. In the untreated control group, 38% of children did not demonstrate a rise in platelet count of 25 x 10(9)/l (p < 0.05) and the mean platelet count increased from 21 x 10(9)/l to 100 x 10(9)/l on day 8. The average duration of bleeding was 3.1 days in the controls versus 1.5 days in the treatment group. One-third of the children in both groups needed a blood transfusion. Total blood use amounted to 0.9 unit per child for controls and 0.5 unit per child in the treatment group. The average cost of treatment (drug only) was $US 44 per patient. High dose methylprednisolone therapy reduced the morbidity of onyalai in children in this series.