interesting cases

Cancrum oris

Cancrum Oris (Noma) occurs in areas of extreme poverty and is relatively common in sub-saharan Africa. Common in early infancy it can affect any age and is associated with measles, leukaemia, malaria TB and other co-existing diseases that see the immune system weakened, exacerbated by poor nutrition and living conditions. The erosion of soft tissues by a mixed bacterial infective process can be treated with good results though reconstructive surgery can be required for dental and bony involvment. With muscles affected, the patient can often not eat and eventually breathing can be compromised, and most untreated cases prove fatal.

SPINA BIFIDA / meningocoele

The spinal cord is encased within the vertebral bones of the spine. In this condition there is a deformity from birth..A meningocoele is a cystic cavity, lined with meninges but devoid of neural tissue, and protruding from the unfused spine. It usually arises in the lumbosacral area. It has a good prognosis if operated on early.The outcome of the disease depends critically upon the type of lesion, the timing of any surgical intervention, and the motivation of the child and / or their parents. About one third of children whose myelomeningocoele was not operated upon early will survive to enter school 5 years later. About one-third of survivors will be wheelchair bound, or have their mobility severely constrained. About 85% will be incontinent of urine, and by the age of 16, will have severely compromised upper renal tract function. Their IQ may be borderline or subnormal. Patients who undergo early surgery, may have a near normal life expectancy. Sadly this will not be an option in this childs case

 

resus technique

The unconcious patient always causes concern. Techniques such as rubbing the breast bone hard, or pinching the pinna of the ear, or pressing the pulp of the finger nail bed are commonplace in the west as means to revive a patient (besides obviously clinically assessing the cause for decreased conciousness and treating appropriately). In the delta camps we often see severe bites to the toe in patients who have convulsed or lost conciousness.  In this example there was a partial amputation by a more zealous assistant to the patient.

fetish protection

The use of padlocks to anchor the children to the earth and afford them divine protection against all illness and indeed bad fortune. Inevitably these children can present late in illness when belief in the charms has been superceded by the reality of the childs deterioration. Note the padlocks both around the necks and ankles.

 marasmus

Marasmus is seen in infants up to one year. In developing countries this is often associated with maternal inadequacy of diet, poor lactation, or in cases of underweight at birth and chronic disease, often affecting the bowel.The child exhibits of more than 50% weight loss, though usually has a normal appetite. In a region where there is adequate food , maternal education underpins treatment.

 

kwashiokor

This small boy has been exclusively fed  Eba, a starchy carbohydrate, and suffers from chronic malnutrition and protein deficiency.  He has been cut extensively by local witch doctors when simple nutritional education would have prevented this probably fatal , and avoidable disease. He presented with the classic advance signs of wasting, swollen abdomen, loss of pigmentation and drowsiness.

Albinism in a case of twins

Albinism is a relatively rare inherited condition affecting both sexes. The condition results from a genetic inheritance that can affect both the eyes and the skin.The lack of pigmentation makes the skin very susceptible to the damaging affects of ultraviolet light, resulting in a high risk of developing skin cancer in hot climates. In one study no albinos over 20 years of age in Nigeria were free of malignant or premalignant skin changes.Blindness, retinal damage, involuntary ocular movements (nystagmus) fissured skin, cancers and inflammatory changes are all common. Besides these there is a large social stigma that both alienates and can victimise the individual. Support needs to be both physical, to provide emollients, and sunscreens, education to include the individual into society, support for the parents,and health education to avoid the effects of sun exposure, and to identify skin lesions that warrant further investigation.