SummaryWe conducted a field study of a rapid test (Brugia Rapid) for detection of Brugia malayi infection to validate its sensitivity and specificity under operational conditions. Seven districts in the state of Sarawak, Malaysia, which are endemic for brugian filariasis, were used to determine the test sensitivity. Determination of specificity was performed in another state in Malaysia (Bachok, Kelantan) which is non-endemic for filariasis but endemic for soil-transmitted helminths. In Sarawak both the rapid test and thick blood smear preparation were performed in the field. The rapid test was interpreted on site, whereas blood smears were taken to the district health centres for staining and microscopic examination. Sensitivity of Brugia Rapid dipstick as compared with microscopy of thick blood smears was 87% (20/23; 95% CI: 66.4-97.2) whereas the specificity was 100% (512/512). The lower sensitivity of the test in the field than in laboratory evaluations ( ‡95%), was probably due to the small number of microfilaraemic individuals, in addition to difficulties in performing the test in remote villages by field personnel. The overall prevalence of brugian filariasis as determined by the dipstick is 9.4% (95% CI: 8.2-0.5) while that determined by microscopy is 0.90% (95% CI: 0.5-1.3) thus the dipstick detected about 10 times more cases than microscopy. Equal percentages of adults and children were found to be positive by the dipstick whereas microscopy showed that the number of infected children was seven times less than infected adults. The rapid dipstick test was useful as a diagnostic tool for mapping and certification phases of the lymphatic filariasis elimination programme in B. malayi-endemic areas.keywords Brugia malayi, rapid test, field validation

Purpura fulminans is a rapidly progressive thrombotic disease that has been described during both severe bacterial and viral infections. Disseminated intravascular coagulation (DIC), antiphospholipid antibodies and acquired or congenital C and S protein deficiency are thought to play a role in its pathogenesis. Here we report the case of a 4-yearold girl who developed gangrene of all her fingers and toes following dengue shock syndrome complicated by DIC and also discuss its management.

Objective: To evaluate the preoperative status of children admitted for renal transplantation, and their supportive care, complications and outcomes during the immediate postoperative period in the intensive care unit (ICU).

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Background: Prognostic scoring systems are increasingly used to predict risk of mortality by assessing severity of illness on the day of admission. Paediatric risk mortality III (PRISM III) score is commonly used among paediatric critical care units. Objectives:To assess the severity of illness using PRISM III score in all paediatric medical intensive care unit (MICU) admissions within the first 24 hours and to find the relationship between PRISM III score and the mortality rate.Method: This was a prospective study conducted at MICU, Sirimavo Bandaranaike Specialized Children Hospital, Peradeniya, from July 2016 to April 2017. PRISM III score of each patient was calculated from abnormal physical and laboratory variables according to scoring system on admission day and the patients followed up for their outcome. Results:The sample size was 105 with 51 males and 54 females. There were 23 deaths and 82 discharges from MICU. There was significant positive correlation with death and provision of mandatory ventilation or usage of any number of inotropes. The average PRISM III score among the sample was 8.1. The PRISM III scores among the deaths and survivals were 14.6 and 6.3 respectively. Conclusions:PRISM III score is a good predictor of mortality and it is a good indicator of severity of illness on the day of admission.