Browsing by Author "Jumanne, Shakilu"

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    A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature
    (University of Malawi, 2019) Jumanne, Shakilu; Nyundo, Azan
    Background: Necrotizing pneumonia and hyperleukocytosis, to the extent of that seen in leukaemia, is a rarely reported presentation. The commonest trigger of such a presentation is an inflammatory process caused by an overwhelming infection which leads to bone marrow irritation. However, the misdiagnosis of this clinical entity as leukaemia should be avoided at all costs so as to avoid the anxiety associated with a diagnosis of cancer, both to the patients and their families. Case presentation: Here, we report the case of a 22-month-old boy who was referred to our Pediatric Oncology Unit (POU). Owing to a high total leukocyte count (TLC) of 98,000 cells/μl, there was a strong suspicion of leukaemia. The boy had been reviewed at another hospital where he presented with fever and cough refractory to the commencement of tuberculosis medications as a result of chest radiography findings. Laboratory investigations performed on admission in the POU were negative for leukaemia and other myeloproliferative disorders. A chest computer tomography (CT) scan was performed to delineate opacification in the right middle lobe. This revealed multiple necrotic and emphysematous foci in line with a diagnosis of necrotizing pneumonia. Subsequently, the patient responded well to a course of piperacillin- tazobactam. The TLC normalized and the cough and fever resolved over a period of 2 weeks. Conclusion: Here, we describe a particularly rare case of leukaemoid reaction with a massive leukocyte count. Such patients can be easily misdiagnosed as having leukaemia or other myeloproliferative disorders, especially in settings with limited diagnostic availability. Such misdiagnosis can cause undue stress on the patient and their families. Thus, it is important that patients presenting with these symptoms should undergo a thorough review of history, physical examination and a structured workup.
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    Case report: Xanthogranulomutouspyelonephritis presenting as "wilms’ tumor"
    (BioMed Central, 2016) Jumanne, Shakilu; Meda, John; Hokororo, Adolfine; Leshabari, Kelvin
    Background: Xanthogranulomatous pyelonephritis (XGP) is a rare renal tumor that arises as a complication of chronicobstructive pyelonephritis of uncertain etiology. It is primarily an adult tumor seen occasionally in children associated with urinary tract obstruction due to congenital urological anomalies, nephrolithiasis, and recurrent urinary tract infections. Radiologically, it may show neoplastic features such as those seen in common pediatric renal malignancies like Wilms ‘tumor and renal cell carcinoma. This overlap in radiological manifestation frequently leads to misdiagnosis and delay inappropriate intervention. We report a case of a 3 years old boy who presented with history of recurrent urinary tractinfections and a left renal mass initially thought to be Wilms ‘tumor. Case presentation: We present a case of a 3 years old boy admitted to the Pediatric oncology unit at Muhimbli National Hospital in Dar es Salaam, Tanzania with one year history of recurrent fever and urinary tract infection signs and symptoms refractory to antibiotic therapy. He was eventually found to have a left kidney mass detected at the District hospital by abdominal ultrasound performed to evaluate a flank mass that was felt by his mother. He was then referred to our unit for a suspicion of Wilms ‘tumor which finally turned out to be a left kidney Xanthogranulomatous pyelonephritis. He underwent a successful left nephrectomy and was discharged from hospital in a stable clinical condition and remains asymptomatic at the time of submission of this case report. Conclusion: This case report underscores the need for clinicians attending a febrile child with a renal mass that can be confused with common pediatric renal malignancies such as Wilms ‘tumor to broaden their differential diagnosis. The case also underlines the significance of individualized patient evaluation because this patient would have otherwise received preoperative chemotherapy under the International Society of Pediatric Oncology (SIOP) guidelines if the diagnosis of Wilms tumor was not ruled out.
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    Clinical predictors of malaria, acute bacterial meningitis and treatment outcomes among febrile children admitted with altered mental status in Northwestern Tanzania
    (Oxford University Press, 2017) Jumanne, Shakilu; Meda, John; Hokororo, Adolfine; Leshabari, Kelvin
    Background: Malaria and acute bacterial meningitis (ABM) are the leading infectious causes of febrile encephalopathy in malaria endemic settings. The clinical distinction of the two conditions is complicated by overlap in clinical features. Objective: To determine the clinical predictors for malaria, ABM and treatment outcome in febrile children aged 2 months to 12 years with altered mentation at two tertiary hospitals in Northwestern Tanzania. Methods: Prospective study of 103 children to document demographic data and physical examination findings, such as level of consciousness and meningeal irritations. Laboratory results for cerebrospinal fluid, hemoglobin, malaria and HIV were also evaluated. Results: Age>60 months and hemoglobin 5 g/dl were independent predictors of malaria; (p¼0.013 and 0.004, respectively). HIV infection was the only predictor of meningitis, p¼0.037, and mortality was high if the diagnosis was unconfirmed. Conclusions: Children with febrile encephalitic are more likely to have malaria than ABM if they have severe anemia.
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    Evaluation and outcome of central nervous system involvement in pediatric acute lymphoblastic leukemia in Dar es Salaam, Tanzania
    (PubMed, 2016) Cohler, Cheryl; Jumanne, Shakilu; Kaijage, Jane; DuBois, Steven G.; Scanlan, Patricia; Matthay, Katherine K.
    BACKGROUND: Outcomes for acute lymphoblastic leukemia (ALL) in low-income countries lag far behind high-income countries (HIC). We explored the impact of central nervous system (CNS) involvement on outcome of pediatric patients with ALL in Tanzania. PROCEDURE: Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric patients with ALL at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013. RESULTS: One hundred fifty-six patients with confirmed ALL had accessible data, and 128 initiated therapy. Sixteen percent of 156 patients had a documented cerebral spinal fluid analysis by cytospin. Seventy patients (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen patients presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one patients (16%) experienced CNS relapse, three of whom had CNS disease at diagnosis. Median event-free survival (EFS) for all patients was 7.9 months and estimated EFS at 24 months was 31%. For the patients with CNS involvement at diagnosis, the estimated EFS at 24 months was 45%. Only three of 21 patients with CNS relapse were still alive with a median follow up of 3 months. CONCLUSIONS: The rate of CNS disease in patients with ALL in Dar es Salaam at diagnosis and relapse was higher than that reported in HIC, and overall survival was lower. Improving outcomes will require further advances including consistent CNS prophylaxis and may include targeting high-risk patients with additional IT treatments.
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    High incidence of poor in-hospital outcomes of term newborns with hypoxic–ischaemic encephalopathy admitted at a regional referral hospital in Dodoma, Tanzania
    (Wiley Online Library, 2022) Mwatonoka, Joyce F; Jumanne, Shakilu; Nyundo, Azan; Kruger, Carsten
    Hypoxic–ischaemic encephalopathy (HIE) is one of the leading causes of neonatal deaths and neurological impairment with the highest impact in resource-limited settings. This study aimed to determine the incidence of poor in-hospital outcomes and related factors among newborns with HIE in Tanzania. Methods A prospective observational study in which 170 newborns with HIE (diagnosed using the Thompson clinical score) were followed from 1 September 2020 to 28 February 2021 at the neonatal ward of Dodoma Regional Referral Hospital in Dodoma, central Tanzania, until discharge or death. Clinical parameters were recorded. Multinomial logistic regression analysis was applied to determine factors associated with adverse outcomes. Results Out of 170 newborns, 44.7% (76/170) had poor outcomes (death 27.1% (46/170); neurological deficits 17.6% (30/170)). Severe HIE (Thompson score > 14) (p < 0.0001), history of aspiration (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI) [1.170, 8.014], p = 0.0226) and 5th-min APGAR of <7 (AOR = 2.88, 95% CI [1.133, 7.310], p = 0.0262) were associated with mortality. Severe HIE, delivery at other facilities (AOR = 3.106 CI [1.158, 8.332], p = 0.0244) and abnormal heart rate (<100 or ≥160 beats/min) on admission (AOR = 3.469 [1.200, 10.030], p = 0.0216) predicted neurological impairment at discharge. Conclusion Hypoxic–ischaemic encephalopathy is associated with a high incidence of poor outcomes in resource-limited settings. To improve outcomes newborns with severe HIE, history of aspiration, referred from other facilities, 5th-min APGAR score of <7 and abnormal heart rate need improved quality of neonatal care.
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    Prevalence and factors associated with renal dysfunction among children with sickle cell disease attending the sickle cell disease clinic at a tertiary hospital in Northwestern Tanzania
    (Plos One, 2019) Kimaro, Fransisca D.; Jumanne, Shakilu; Sindato, Emmanuel M.; Kayange, Neema; Chami, Neema
    Background: Little is known on how the interaction between Sickle Cell Disease (SCD) and renal insults caused by other coexisting conditions in Sub-Saharan Africa such as urinary schistosomiasis, malnutrition and HIV affect the prevalence of Renaldas function in children with SCD.ObjectivesTodeterminetheprevalenceandfactorsassociatedwithrenaldysfunctionamongchil-drenwithSCDaged6 months to 12yearsattendedat a tertiary hospital in Northwestern Tanzania. Methods: A cross sectional hospital-based study with a short follow up component of 3 months for153 children with SCD was done to document demographics, clinical characteristics and features of Renaldas function including urine dipstick albuminuria (>20mg/l) and eGFR (<60ml/ml/min/1.73m2). Other potential renal insults such as HIV infection and Schistosomiasis were also evaluated. Results At enrollment, 48/153(31.37%) children had renal dysfunction declining to 31(20.3%) at 3 months follow up. Acute chest syndrome (OR3.04,95%CI[1.08–8.96],p = 0.044), severe anemia (OR0.44,95%CI[0.26–0.76], p= 0.003), urinary schistosomiasis (OR7.43,95%CI[2.10–26.32]p<0.002) and acute malnutrition (OR4.92,95%CI[1.29–18.84],p = 0.020). Were associated with renal dysfunction. Conclusion: Where prevalent, urinary schistosomiasis and acute malnutrition increase the risk for renal dysfunction in children with SCD. Were commend albuminuria routine screening in children with SCD especially those presenting with acute chest syndrome, severe anemia and features of acute malnutrition for early detection of renal dysfunction among children with SCD.