Pediatric Infectious Disease最新文献

Background

Cutaneous tuberculosis is an important infectious public health problem in India. The increasing incidence of childhood cutaneous tuberculosis is a marker of active transmission of the disease in the community.

Materials and methods

All cases of cutaneous tuberculosis in patients ≤14 years of age were included in the study. After a thorough history taking and examination, the patients were subjected to necessary investigations. They were categorised into different type of cutaneous tuberculosis and were started on anti-tubercular therapy (ATT) accordingly.

Results

A total of 128 cases of cutaneous tuberculosis were identified within the study period. The clinical types identified in children in decreasing order of frequency were, lupus vulgaris, lichen scrofulosorum, tuberculosis verrucosa cutis, scrofuloderma, tuberculous gumma, miliary tuberculosis and papulonecrotic tuberculid. Multiple clinical types were seen in 7 patients.

Conclusion

A proper diagnosis of cutaneous tuberculosis is very important, as it responds very well to ATT and early diagnosis decreases the chances of complications.

Bronchiolitis is a lower respiratory infection caused commonly by RSV in the initial 2 years of life. It is responsible for a large number of hospitalizations. Pulse oximetry plays an important role in monitoring the progression of disease. Supplemental oxygen administration is not recommended at saturation levels above 90%.

Improvement in CD4 counts in children with human immunodeficiency virus (HIV) has been reported with some infections. We present an 11-year-old HIV-infected boy who developed acute myeloid leukemia that showed spontaneous remission along with improvement in CD4 counts with documented Demodex mite infestation. The child presented with fever without localization during course of illness, and developed crusted lesion at angle of mouth. Direct microscopy of skin biopsy revealed Demodex mite infestation. The child was continued on highly active antiretroviral treatment along with single dose of ivermectin and local application of permethrin. The crusted lesion improved within a weeks’ time. His CD4 counts improved from baseline of 534/μL to 1674/μL over a period of 4 weeks.

We are reporting a 5-year-old male child of empyema thoracis, who developed acute glomerulonephritis as a complication. Post-infectious glomerulonephritis in children commonly follows group A β-hemolytic streptococcal infections. Development of nephritis in empyema is rare in children.

The incidence of Staphylococcus aureus infections is increasing worldwide. Apart from localized infections, it can cause life-threatening disseminated disease. Community-associated staphylococcal infections are difficult to recognize early unless there is awareness of its varied presentation. We present two previously healthy adolescent boys with methicillin-sensitive S. aureus sepsis, highlighting its invasive nature and specific treatment considerations.

Background

Neurological manifestations in patients with Rickettsial diaseases are increasingly being reported from various parts of India but still Rickettsial diseases as a cause of central nervous system (CNS) infections are underdiagnosed.

Aim

Main objective of this case series is to report neurological manifestations in patients of Rickettsial diseases so as to increase awareness amongst pediatricians.

Methods

Study design was a retrospective analysis of children (birth to 16 years) hospitalized in Smile Institute of Child Health and Orbit Children Hospital, which are secondary referral centres catering to children in five districts of central India, with diagnosis of Rickettsial disease from August 2014 to July 2015. Diagnosis of Rickettsial infections was made by clinical features, IgM antibodies by ELISA, prompt response to Doxycycline and exclusion of differential diagnoses.

Results

Out of 62 patients, who were diagnosed as having Rickettsial diseases, 51 patients had neurological involvement. Out of 51 patients with diagnosis of Rickettsial disease having symptomatic neurological involvement, 21 (41%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of Rickettsial diseases too along with neurological manifestations. Youngest patient was 23 days old neonate. Various neurological manifestations seen were headache (90%), irritability (61%), meningeal signs (21%), altered mental status (23%), seizures (17%), papilloedema (6%), focal neurological deficits (13%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (35%).

Conclusions

Myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in Rickettsial infections and should have high index of suspicion for Rickettsial diseases in febrile patients having neurological features specially in endemic areas.

Aim

To describe the clinico-laboratory profile of scrub typhus diagnosed in a tertiary care institution in northern India.

Materials and methods

All cases of febrile illness diagnosed as scrub typhus over a period of 6 months were analyzed retrospectively. Diagnosis was based on positive IgM ELISA.

Results

Forty-four cases of scrub typhus were seen over a period of 6 months (July 2013 and December 2013). Common clinical features were fever (100%), lymphadenopathy (68.18%), hepatomegaly (56.82%), splenomegaly (47.73%), vomiting (38.64%), signs of meningeal irritation (38.64%), abdominal pain (31.82%), hypotension (31.82%), pedal edema (29.54%), rash (20.45%), and cough (11.36%). Eschar was seen in 10 (22.73%) cases. Common laboratory findings were thrombocytopenia (68.18%), increased liver enzymes (40.9%), meningitis (34.1%), leucocytosis (34.1%), and azotemia (22.73%). Multiple organ dysfunction syndrome (MODS) was present in 24 (54.54%) patients, shock in 15 (34.1%), meningitis in 15 (34.1%), ARDS in 11 (25%), hepatitis in 11 (25%), and azotemia in 10 (22.73%) patients. A total of 3 (6.82%) patients died.

Conclusion

Scrub typhus has emerged as an important cause of febrile illness with multisystemic involvement and high rate of MODS.