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Early in my career, I remember caring for one particular family that opted not to vaccinate.
Children who are fully vaccinated can still get pneumonia, but may have a milder illness and hopefully will avoid hospitalization. The vaccines that can prevent many of the viruses and bacteria that cause pneumonia are available in the United States.
In third world nations, people cook either over a fire with no ventilation, or with stoves that leak lethal and toxic fumes into the air. February 15, 2016 Spotlight on Zika – RCSIsmj staff writer Stephanie TungNovember 15, 2015 ‘Getting your Bell rung’: Is concussion the Death Knell for Contact Sports? Here, we present a child with CHS and trisomy 21 syndrome who presented in the accelerated phase. A baby boy was born to first-degree consanguineous parents at 36 weeks’ gestation by spontaneous vaginal delivery after an uneventful pregnancy. At the age of six months, the baby boy was referred to the Salmaniya Medical Complex (SMC) with pancytopaenia, coagulopathy and cholestasis. During his hospital stay, the baby boy was diagnosed with bronchial asthma, and subsequently required several re-admissions in the following months for acute asthmatic exacerbations and an episode of pneumonia. Given these results, the boy was diagnosed with re-activation of the accelerated phase of CHS secondary to a viral infection. The diagnosis of CHS is based on the identification of abnormal neutrophil, lymphocyte and eosinophil granules on peripheral blood smears and in bone marrow aspirates.4,6 Ophthalmological findings and platelet aggregation studies may also be used. This case demonstrates the clinical course of CHS in an infant who concurrently had trisomy 21 syndrome. The patient was not a candidate for BMT as the incidence of complications and mortality following a BMT in patients with trisomy 21 syndrome is considerably high.
Today is World Pneumonia Day, a day when people all over the world come together to make people aware of the toll of pneumonia, and to promote interventions that can treat and prevent this illness. These are the pneumococcal, haemophilus influenzae type b (Hib), whooping cough, varicella (chickenpox), measles, and flu vaccines.
Dana, the developer of the Well BabyTummy Time Mat, attended Georgetown University for Medical School.
If they could get improvements in ventilation in their homes or be taught how to safely cook their food, the children would not be breathing in the fumes and getting sick.

To our knowledge, these two syndromes have never before been encountered simultaneously in the literature. He was born with dysmorphic features suggestive of trisomy 21 syndrome – low-set ears, upward slanting eyes, a short neck and a protruding tongue (Figure 1). A healed scar is evident on the left aspect of the thoracic cage – the site of surgical intervention for patent ductus arteriosus ligation.
Two years and four months after his diagnosis was confirmed, the patient presented to the Accident & Emergency Department at SMC with a two-week history of fever, poor feeding, lethargy, hypotonia and frequent bouts of dark brown-to-black diarrhoea, which was occasionally speckled with blood and mucus. The patient was commenced once again on cyclosporine and dexamethasone, and antibiotics, intravenous immunoglobulin (IVIG) and bronchodilators were added to his drug regime. In arriving at the diagnosis of CHS, other immunodeficient conditions must be considered and ruled out by a blood smear. In this patient, the accelerated lymphoproliferative phase was managed effectively at first with immunosuppressive therapy, but recurred two years later. Chediak-Higashi syndrome – a report of two cases with unusual hyperpigmentation of the face.
Clinico-haematological profile of Chediak-Higashi syndrome: experience from a tertiary care center in south India.
Chediak-Higashi syndrome with early developmental delay resulting from paternal heterodisomy of chromosome 1. Hermansky-Pudlak syndrome and Chediak-Higashi syndrome: disorders of vesicle formation and trafficking. Bone marrow transplantation for the treatment of haematological disorders in Down’s syndrome: toxicity and outcome.
Bone marrow transplantation for acute leukaemia and Down syndrome: report of a successful case and results of a national survey. Vaccinations and promotion of exclusive breastfeeding in the first few months of life are a few of the strategies that are being implemented. Death usually results from frequent and recurrent bacterial infection, haemorrhage or the development of the accelerated lymphoma-like phase.6 The key to improving patient survival is the early diagnosis of CHS by careful inspection of peripheral blood and bone marrow smears. When a child has pneumonia, he may need to use all of his extra muscles to get oxygen into his lungs.
Streptococcus pneumoniae (pneumococcus) is the number one bacterial cause of pneumonia, and influenza, parainfluenza, and respiratory syncytial viruses (RSV) are the most common viral causes of pneumonia.

On further inspection, the baby was extremely fair with silver hair, in stark contrast to his Middle Eastern parents. Examination of his oral cavity revealed gingivitis with a bleeding tendency, and hepato-splenomegaly was detected on abdominal percussion. Closer examination revealed gingivitis, a soft abdomen and an enlarged spleen 3cm below the left costal margin.
The skin under his rib cage, between his ribs, and above his collarbone will pull in as he uses all of these extra muscles to breathe. At two months, the baby underwent surgical intervention to correct a duodenal atresia and a patent ductus arteriosus (Figure 2). No lymphadenopathy or meningeal signs were detected and capillary refill was within normal limits. His parents agreed to continue palliative care and to avoid aggressive resuscitation measures. On questioning, the mother revealed that two of his half siblings died in early childhood, one of whom had been given a confirmed diagnosis of CHS.
Investigations ordered for the boy included a chest x-ray, full blood count (FBC), a peripheral blood smear and a bone marrow study. The first and second heart sounds were present, and a soft systolic murmur was appreciated at the left lower sternal edge. The FBC revealed a significant pancytopaenia, and abnormal giant granules within the neutrophils with prominent secondary granules were detected on blood smear.
The bone marrow study demonstrated pancytopaenia and evidence of haemophagocytosis (Figure 3), and it was confirmed that the patient was in the accelerated phase of CHS. The patient was commenced on an immunosuppressive regime consisting of dexamethasone and cyclosporine to control the accelerated phase of disease. BMT was ruled out for him as a therapy option due to severe psychomotor retardation secondary to trisomy 21 syndrome.
The baby boy responded well to treatment and recovered from the accelerated phase, but remained on maintenance treatment.

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