Pediatric Infectious Disease最新文献

Rickettsial diseases are a group of infections caused by obligate intracellular Gram-negative bacilli and transmitted to man by arthropod vectors. They are prevalent in many parts in India and are characterized by microvasculitis, causing microinfarcts in various organs.¹ Complications of rickettsial infection include pneumonias, renal failures, and neurological involvement. Neurological complications, such as meningitis and meningoencephalitis, are commonly seen.² Other neurological manifestations are infrequent and rickettsial infection presenting as cerebrovascular stroke is extremely rare. Here, we report a child presenting with prolonged fever, maculopapular rash, and acute onset left-sided hemiplegia. Child was toxic, and had dorsal edema and pallor. His investigations revealed microcytic hypochromic anemia and aseptic meningitis. MRI brain showed infarct over right corona radiata, right basal ganglia, right frontal gyri, insular cortex, and right anterior temporal lobe. Weil–Felix test showed rising titers for OX19 suggesting typhus group of rickettsia. Child responded rapidly to doxycycline. This case highlights the possibility of rickettsial infection in cerebrovascular stroke.

Rickettsial diseases are caused by arthropod-borne obligate intracellular parasites. One such rickettsial infection is scrub typhus, which is an important cause of fever of unknown origin. Spectrum of presentation is variable. There are reports of scrub typhus with CNS complication, like meningoencephalitis, in adolescents and adults from various parts of India but not from Delhi. There are recent case reports of scrub typhus without CNS involvement in adults from Delhi. Its occurrence in the form of hemorrhagic fever with meningoencephalitis is rarer in children and is not so far reported from the state of Delhi. We present a case of a 4-year-old child from Delhi presenting with hepatosplenomegaly, thrombocytopenia, and altered sensorium, whose timely diagnosis and management saved her life, and this brings to our notice the emergence of scrub encephalitis in children.

Scrub typhus commonly presents with rash, lymphadenopathy, and nonspecific symptoms after a prodrome of 4–5 days. CNS complications are known associations with it, but presenting with neurological symptoms is an uncommon presentation, especially in children. We report a rare case of scrub typhus presenting with refractory seizures in a 9-year-old child, not previously reported in children from India.

Rickettsial diseases are one of the re-emerging diseases in India. Non-specific signs and symptoms along with lack of availability of highly sensitive and specific test have led to underdiagnosis of rickettsial diseases. Significant mortality and morbidity are caused due to failure to diagnose rickettsial infections early in their course. Rickettsial infections respond dramatically to easily available and inexpensive antimicrobials if diagnosed early. High index of suspicion of possible rickettsial infection and utilisation of various diagnostic methods plays a vital role in the early diagnosis of rickettsial infections. This article addresses the various diagnostic tools available for its diagnosis.

Infection with parvovirus B19 is common in children and typically causes mild illness. However it is occasionally associated with severe diseases such as acute myocarditis. We report here the case of a 3-year-old girl who developed myocarditis secondary to parvovirus B19 virus. Diagnosis of PVB19 infection was made with serological tests. The outcome was favorable after immunoglobulins.

Background

Tuberculosis is one of the most serious health problems in our country.

The association between tuberculosis and malnutrition is well recognized. Tuberculosis can lead to malnutrition, and malnutrition may predispose to tuberculosis. The micronutrient status in tuberculosis is affected significantly. Among the micronutrients, zinc plays a very important role as far as cell-mediated immunity is concerned. Limited data are available on the relationship between zinc levels and tuberculosis in childhood.

Aim

The present study was designed to estimate the serum zinc levels in children with tuberculosis and in children with malnutrition, and to compare the serum zinc levels between them.

Methods

Our study was conducted on 100 children in the age group of 6 months–12 years reporting to Department of Pediatrics, Rajindra Hospital, Patiala, out of which 50 children were those affected by tuberculosis and 50 children were those with malnutrition without tuberculosis. 50 age- and sex-matched children were taken as control.

Results

It was observed that the mean serum zinc levels in TB were 45.18 ± 10.05 μg/dl, in PEM were 53.04 ± 7.13 μg/dl while in controls they were 86.84 ± 15.92 μg/dl. It was seen that serum zinc levels were significantly low in children with TB as compared to controls (p < 0.0001). Serum zinc levels were found to be significantly low in children with PEM (but without TB) as compared to controls (p < 0.0001). Also, serum zinc levels were significantly low in children with TB when compared to children with PEM (without TB) (p < 0.05).

Conclusion

Serum zinc levels are significantly affected in tuberculosis.

Sepsis poses a great threat to the newborns and different approaches are in practice to tackle this problem. The signs and symptoms of neonatal sepsis are nonspecific and this makes accurate diagnosis difficult. Commonly used biomarkers, such as acute-phase reactants and cytokines, have not been completely conclusive though they have shown some promise. Newer approaches, such as flow cytometry and real-time PCR, could be valuable tools for the timely diagnosis and management of neonatal sepsis. Proteomic biomarkers, such as S100 proteins in the amniotic fluid, could also be used for the early prediction of neonatal sepsis. Antibiotics and supportive care are the mainstay of treatment at present. Antibiotics only act against the pathogen but not against the inflammatory process, which continues to surge. Complete inhibition of cytokines may not be the correct approach for treatment, but to achieve the right balance of pro- and anti-inflammatory cytokines should be the target. So an ideal treatment should include not only antimicrobials but also anti-inflammatory drugs to neutralize the surging inflammatory cascade and the subsequent ‘cytokine storm’ in neonatal sepsis.

Though only 0.1% of acute viral Hepatitis A complicated as acute hepatic failure, Hepatitis A has been detected as the most common aetiology of acute hepatic failure in India. Any co-existence morbidity like G6PD deficiency certainly makes it more complicated. Here we present a case where a 10 year old boy admitted with Acute Hepatic Failure with grade 3 encephalopathy with severe hyperbilirubinemia and haemolytic anemia with features of acute tubular necrosis and later on found to be G6PD deficient.