Neuroblastoma is a neurogenic tumor, derived from primordial neural crest cells. It has varied presentations, and this depends on the location of tumor. Flaccid paralysis of the both lower extremities in infants can be the presenting feature of neuroblastoma. We are reporting here a case of posterior mediastinum neuroblastoma in a 5-month-old infant who presented with spinal cord compression as oncological emergency.
{"title":"Posterior mediastinal neuroblastoma presenting with spinal cord compression as oncoemergency","authors":"Payal Bargujar, Jitendra Upadhyay, H. Pahadiya","doi":"10.4103/jpcc.jpcc_6_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_6_23","url":null,"abstract":"Neuroblastoma is a neurogenic tumor, derived from primordial neural crest cells. It has varied presentations, and this depends on the location of tumor. Flaccid paralysis of the both lower extremities in infants can be the presenting feature of neuroblastoma. We are reporting here a case of posterior mediastinum neuroblastoma in a 5-month-old infant who presented with spinal cord compression as oncological emergency.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48947034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mechanical ventilation is a lifesaving support for patients suffering with acute respiratory distress syndrome. This modality is likely to cause ventilator-induced lung injury if not used judiciously and appropriately. Lung protective ventilation strategy is routinely practiced in adult and pediatric intensive care units. Positive end-expiratory pressure (PEEP) and recruitment maneuvers (RMs) are used in “Open Lung Ventilation” strategy and to keep the lung open. PEEP is applied to recruit collapsed alveoli to improve oxygenation, compliance, reduce tidal stress, and strain on the lungs and to promote homogenous lung ventilation. There is no agreement on methods to set “Best PEEP” for a particular patient. There are many approaches described in published literature to optimize PEEP. PEEP titration may be done with PEEP/FiO2 grid, targeted compliance, driving pressure, by using pressure-volume curve and stress index. Esophageal manometry and measurement of end-expiratory lung volume may be used if special equipment, machines, and expertise are available. No single method of PEEP titration has been shown to improve outcome. RM is characterised by sudden transient increase in transpulmonary pressure. Different RMs including high-frequency oscillator ventilation and prone position ventilation have been studied in adults and pediatric patients with very conflicting results and inconsistent survival benefits. Serious complications, hemodynamic instability, air leak syndrome, transient, or no improvements in oxygenation are reported. In this narrative review, we have discussed different methods of PEEP titration and RMs and available evidence for each especially in children.
{"title":"Use of positive end-expiratory pressure titration and recruitment maneuvers in pediatric intensive care unit – A narrative review","authors":"A. Sachdev, Pradeep Kumar, Mohammed Ashif","doi":"10.4103/jpcc.jpcc_52_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_52_23","url":null,"abstract":"Mechanical ventilation is a lifesaving support for patients suffering with acute respiratory distress syndrome. This modality is likely to cause ventilator-induced lung injury if not used judiciously and appropriately. Lung protective ventilation strategy is routinely practiced in adult and pediatric intensive care units. Positive end-expiratory pressure (PEEP) and recruitment maneuvers (RMs) are used in “Open Lung Ventilation” strategy and to keep the lung open. PEEP is applied to recruit collapsed alveoli to improve oxygenation, compliance, reduce tidal stress, and strain on the lungs and to promote homogenous lung ventilation. There is no agreement on methods to set “Best PEEP” for a particular patient. There are many approaches described in published literature to optimize PEEP. PEEP titration may be done with PEEP/FiO2 grid, targeted compliance, driving pressure, by using pressure-volume curve and stress index. Esophageal manometry and measurement of end-expiratory lung volume may be used if special equipment, machines, and expertise are available. No single method of PEEP titration has been shown to improve outcome. RM is characterised by sudden transient increase in transpulmonary pressure. Different RMs including high-frequency oscillator ventilation and prone position ventilation have been studied in adults and pediatric patients with very conflicting results and inconsistent survival benefits. Serious complications, hemodynamic instability, air leak syndrome, transient, or no improvements in oxygenation are reported. In this narrative review, we have discussed different methods of PEEP titration and RMs and available evidence for each especially in children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43931914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediredla Karunakar, R. Rameshkumar, M. Chidambaram, C. Delhikumar, T. Selvan, S. Mahadevan
Background: Pediatric acute central nervous system (CNS) infections are associated with severe neuromorbidity. This study aimed to study the effect of glucose variability on clinical outcomes in comatose children due to acute CNS infections admitted in pediatric intensive care unit (PICU). Subjects and Methods: A prospective cohort study enrolled comatose children aged 1 month to 12 years due to acute CNS infection. Within 6 h, continuous glucose monitoring was started (Freestyle Libre Pro, Abbott). The unit practice was targeting blood glucose (BG, mg/dL) of <140–145. The hyperglycemic index was calculated to estimate the relative time spent above BG of >126, >140, >180, >200, and <60. Glucose variability was defined as BG fluctuation, with both hypoglycemia (<60) and hyperglycemia (>126). The primary outcome was new-onset organ dysfunction. The secondary outcomes were organ support, length of mechanical ventilation, hospital (including PICU) stay, and 90-day composite poor outcome (mortality or severe neurodisability). Results: Total BG values measured were 27,792 from 66 patients (mean [standard deviation (SD)] 421.1 [212.6] values per patient). The mean (SD) BG was 103.2 (37.7) (minimum: 42.1; maximum: 228.8). The new-onset organ dysfunction has occurred in 83.3% (n = 55/66), and no difference was noted among normoglycemic and abnormal glycemic groups (84.4% vs. 80.9%; relative risk = 1.09, 95% confidence interval: 0.67–1.76). The median (interquartile range) PICU stay (days) was higher in the normoglycemic group (7, 5–14 vs. 4, 3.5–8.5; P = 0.014). No difference was noted in other outcomes. Conclusions: Glucose variability was not significantly associated with new-onset organ dysfunction and poor outcome in comatose children due to acute CNS infections.
{"title":"A prospective cohort study on glucose variability and clinical outcomes in comatose children due to acute central nervous system infections admitted in the pediatric intensive care unit","authors":"Pediredla Karunakar, R. Rameshkumar, M. Chidambaram, C. Delhikumar, T. Selvan, S. Mahadevan","doi":"10.4103/jpcc.jpcc_31_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_31_23","url":null,"abstract":"Background: Pediatric acute central nervous system (CNS) infections are associated with severe neuromorbidity. This study aimed to study the effect of glucose variability on clinical outcomes in comatose children due to acute CNS infections admitted in pediatric intensive care unit (PICU). Subjects and Methods: A prospective cohort study enrolled comatose children aged 1 month to 12 years due to acute CNS infection. Within 6 h, continuous glucose monitoring was started (Freestyle Libre Pro, Abbott). The unit practice was targeting blood glucose (BG, mg/dL) of <140–145. The hyperglycemic index was calculated to estimate the relative time spent above BG of >126, >140, >180, >200, and <60. Glucose variability was defined as BG fluctuation, with both hypoglycemia (<60) and hyperglycemia (>126). The primary outcome was new-onset organ dysfunction. The secondary outcomes were organ support, length of mechanical ventilation, hospital (including PICU) stay, and 90-day composite poor outcome (mortality or severe neurodisability). Results: Total BG values measured were 27,792 from 66 patients (mean [standard deviation (SD)] 421.1 [212.6] values per patient). The mean (SD) BG was 103.2 (37.7) (minimum: 42.1; maximum: 228.8). The new-onset organ dysfunction has occurred in 83.3% (n = 55/66), and no difference was noted among normoglycemic and abnormal glycemic groups (84.4% vs. 80.9%; relative risk = 1.09, 95% confidence interval: 0.67–1.76). The median (interquartile range) PICU stay (days) was higher in the normoglycemic group (7, 5–14 vs. 4, 3.5–8.5; P = 0.014). No difference was noted in other outcomes. Conclusions: Glucose variability was not significantly associated with new-onset organ dysfunction and poor outcome in comatose children due to acute CNS infections.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41661474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Updates on pediatric respiratory critical care: Part II","authors":"F. Shaikh","doi":"10.4103/jpcc.jpcc_55_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_55_23","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44353330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mechanical ventilation, while life-saving, can be associated with risks of exacerbating existing lung injury or causing new injury. An understanding of how mechanical ventilation can injure the lung and other systems is important to develop an optimal ventilatory approach. Over the past 70 years, different mechanisms that can cause lung injury have been described with putative suggestions for lung protection. Which mechanisms are operating in a particular patient is difficult to ascertain at the bedside. Guidelines have been formulated for both adults and children for the management of patients on mechanical ventilation with acute respiratory distress syndrome. Lung protection is the main objective of these guidelines. Lung disease is not homogeneous within the lung, and between patients with the same diagnosis. Response to ventilatory parameters also differs based on the distribution of injured and uninjured lungs, being beneficial in some but harmful in others. The impact of mechanical ventilation on the cardiovascular system and other systems is also variable. It is important to understand that these guidelines are one-size-fits-all therapeutic suggestions. While guidelines are useful, it is important to personalize mechanical ventilation based on the patient's lung mechanics and their response to adjustments of the ventilatory parameters. This chapter will review the current knowledge of the factors that contribute to injury to the lungs from mechanical ventilation. At the end of the review, I have formulated a personalized approach to lung protection during invasive mechanical ventilation for patients with parenchymal lung disease – a consensus of one.
{"title":"Personalized lung-protective ventilation in children – Is it possible?","authors":"S. Venkataraman","doi":"10.4103/jpcc.jpcc_51_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_51_23","url":null,"abstract":"Mechanical ventilation, while life-saving, can be associated with risks of exacerbating existing lung injury or causing new injury. An understanding of how mechanical ventilation can injure the lung and other systems is important to develop an optimal ventilatory approach. Over the past 70 years, different mechanisms that can cause lung injury have been described with putative suggestions for lung protection. Which mechanisms are operating in a particular patient is difficult to ascertain at the bedside. Guidelines have been formulated for both adults and children for the management of patients on mechanical ventilation with acute respiratory distress syndrome. Lung protection is the main objective of these guidelines. Lung disease is not homogeneous within the lung, and between patients with the same diagnosis. Response to ventilatory parameters also differs based on the distribution of injured and uninjured lungs, being beneficial in some but harmful in others. The impact of mechanical ventilation on the cardiovascular system and other systems is also variable. It is important to understand that these guidelines are one-size-fits-all therapeutic suggestions. While guidelines are useful, it is important to personalize mechanical ventilation based on the patient's lung mechanics and their response to adjustments of the ventilatory parameters. This chapter will review the current knowledge of the factors that contribute to injury to the lungs from mechanical ventilation. At the end of the review, I have formulated a personalized approach to lung protection during invasive mechanical ventilation for patients with parenchymal lung disease – a consensus of one.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41408660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Streptococcus pneumoniae is a major pathogen in the pediatric population causing life-threatening infections ranging from pneumonia and meningitis to sepsis, and it is now a vaccine-preventable infection. Recently, pneumococcus is emerging as a cause of multidrug-resistant infection, resistant to ≥3 classes of antibiotics. Here, we discuss a case of ventricular empyema in a toddler due to S. pneumoniae. He was not vaccinated against pneumococcus. He had ventriculitis, ventricular empyema, and obstructive hydrocephalus. He was managed with external ventricular drainage of pus, followed by a ventriculoperitoneal shunt, and received 6 weeks of intravenous antibiotics, followed by oral antibiotics. He recovered with residual neurological sequelae and showed an improvement on follow-up visits.
{"title":"Ventricular empyema presenting as a complication of pneumococcal meningitis in a toddler","authors":"Parthasarathi Muthusamy, Madhumitha Subramaniam, Ayyammal Palaniappan, Ponnusamy Shanmugam, Balasenthilkumaran Rabindranath, Balavinoth Ramakrishnan, R. Ramalingam","doi":"10.4103/jpcc.jpcc_26_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_26_23","url":null,"abstract":"Streptococcus pneumoniae is a major pathogen in the pediatric population causing life-threatening infections ranging from pneumonia and meningitis to sepsis, and it is now a vaccine-preventable infection. Recently, pneumococcus is emerging as a cause of multidrug-resistant infection, resistant to ≥3 classes of antibiotics. Here, we discuss a case of ventricular empyema in a toddler due to S. pneumoniae. He was not vaccinated against pneumococcus. He had ventriculitis, ventricular empyema, and obstructive hydrocephalus. He was managed with external ventricular drainage of pus, followed by a ventriculoperitoneal shunt, and received 6 weeks of intravenous antibiotics, followed by oral antibiotics. He recovered with residual neurological sequelae and showed an improvement on follow-up visits.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48433678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EborJacob G. James, R. Sanketh, Balaji Sankar, Jolly Chandran
Ventilator-associated pneumonia (VAP) has traditionally been defined as pneumonia in patients with mechanical ventilation for at least 48 h. Despite advancements in critical care, VAP remains to be a complication resulting in huge financial burden to patients. The limitations to the criteria have resulted in an urge to redefine VAP by the Centers for Disease Control and Prevention. Ventilator-associated event (VAE) has been well categorized in adult population; however, in pediatric cohort, while surveillance enhances the detection of infectious and noninfectious complications which can influence patient outcomes, there are many gaps in its classification and management. Establishing a diagnosis of VAP/VAE is crucial in management of a critically ill patient. The role of clinical criteria in concordance with laboratory evidence of inflammatory markers along with chest X-ray helps in supplementing the diagnosis. The presence of culture positivity aids in diagnosis with minimally invasive bronchoalveolar lavage providing a reasonable and safe method. Early empiric antibiotic treatment in suspected patients is beneficial. The role of antibiotic stewardship will help in prevention of antimicrobial resistance in treatment of VAP. More emphasis on VAP prevention measures with multidisciplinary approach is the way forward in overcoming this morbid condition in the intensive care units.
{"title":"Ventilator-associated pneumonia","authors":"EborJacob G. James, R. Sanketh, Balaji Sankar, Jolly Chandran","doi":"10.4103/jpcc.jpcc_49_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_49_23","url":null,"abstract":"Ventilator-associated pneumonia (VAP) has traditionally been defined as pneumonia in patients with mechanical ventilation for at least 48 h. Despite advancements in critical care, VAP remains to be a complication resulting in huge financial burden to patients. The limitations to the criteria have resulted in an urge to redefine VAP by the Centers for Disease Control and Prevention. Ventilator-associated event (VAE) has been well categorized in adult population; however, in pediatric cohort, while surveillance enhances the detection of infectious and noninfectious complications which can influence patient outcomes, there are many gaps in its classification and management. Establishing a diagnosis of VAP/VAE is crucial in management of a critically ill patient. The role of clinical criteria in concordance with laboratory evidence of inflammatory markers along with chest X-ray helps in supplementing the diagnosis. The presence of culture positivity aids in diagnosis with minimally invasive bronchoalveolar lavage providing a reasonable and safe method. Early empiric antibiotic treatment in suspected patients is beneficial. The role of antibiotic stewardship will help in prevention of antimicrobial resistance in treatment of VAP. More emphasis on VAP prevention measures with multidisciplinary approach is the way forward in overcoming this morbid condition in the intensive care units.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70814552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endotracheal intubation (ETI) is a common intervention performed in a pediatric emergency. The pediatric laryngeal anatomy creates a challenge and requires an expertise for this procedure. Tracheal injury is a rare but serious complication that can occur during ETI. The stylet, if used improperly, can lead to this life-threatening complication. Here, we present a case of tracheal injury in an infant that happened during ETI with stylet use.
{"title":"Iatrogenic tracheal injury in an infant due to endotracheal intubation: Beware of the stylets","authors":"S. Solanki, Amit Pandey, S. Dogra, R. Kanojia","doi":"10.4103/jpcc.jpcc_38_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_38_23","url":null,"abstract":"Endotracheal intubation (ETI) is a common intervention performed in a pediatric emergency. The pediatric laryngeal anatomy creates a challenge and requires an expertise for this procedure. Tracheal injury is a rare but serious complication that can occur during ETI. The stylet, if used improperly, can lead to this life-threatening complication. Here, we present a case of tracheal injury in an infant that happened during ETI with stylet use.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43118287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Chugh, N. Talwar, Manish Kori, K. Mohite, M. Mohite
Flexible bronchoscopy (FB) is a very rewarding procedure in the evaluation and management of appropriately selected children with respiratory issues in pediatric intensive care unit (PICU). An understanding of the alterations in respiratory physiology (airway resistance, compliance, and air exchange) during FB is absolutely essential for the safety of the child. To reduce discomfort and other side effects of FB it is necessary to optimize the condition of the child including sedation, analgesia, paralysis, ventilator settings, and cardiovascular status. With advancements in technology and instrumentation many interventional procedures can be performed safely and effectively using access to the airway through the endotracheal tube, tracheostomy tube, or Laryngeal Mask Airway (LMA). Close monitoring during and after FB minimizes complications.
{"title":"Flexible bronchoscopy in pediatric intensive care unit","authors":"K. Chugh, N. Talwar, Manish Kori, K. Mohite, M. Mohite","doi":"10.4103/jpcc.jpcc_35_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_35_23","url":null,"abstract":"Flexible bronchoscopy (FB) is a very rewarding procedure in the evaluation and management of appropriately selected children with respiratory issues in pediatric intensive care unit (PICU). An understanding of the alterations in respiratory physiology (airway resistance, compliance, and air exchange) during FB is absolutely essential for the safety of the child. To reduce discomfort and other side effects of FB it is necessary to optimize the condition of the child including sedation, analgesia, paralysis, ventilator settings, and cardiovascular status. With advancements in technology and instrumentation many interventional procedures can be performed safely and effectively using access to the airway through the endotracheal tube, tracheostomy tube, or Laryngeal Mask Airway (LMA). Close monitoring during and after FB minimizes complications.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44750699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shraddha Sunthwal, Sagar S. Lad, Ankita Malpani, Ramdas Bangar, A. Jindal
Rickettsia is a common zoonotic disease causing fever, malaise, rash, and eruption changing to eschar with lymphadenopathy. Very few cases of Rickettsia disease with Kawasaki syndrome (KS) have been reported. We report a case of a 4-year-old girl with rickettsial disease presented with acute renal failure, shock, and features of KS. She was treated successfully with doxycycline, ceftriaxone, and intravenous immunoglobulins along with supportive management.
{"title":"A rare presentation of Rickettsia disease with Kawasaki syndrome: A case report","authors":"Shraddha Sunthwal, Sagar S. Lad, Ankita Malpani, Ramdas Bangar, A. Jindal","doi":"10.4103/jpcc.jpcc_9_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_9_23","url":null,"abstract":"Rickettsia is a common zoonotic disease causing fever, malaise, rash, and eruption changing to eschar with lymphadenopathy. Very few cases of Rickettsia disease with Kawasaki syndrome (KS) have been reported. We report a case of a 4-year-old girl with rickettsial disease presented with acute renal failure, shock, and features of KS. She was treated successfully with doxycycline, ceftriaxone, and intravenous immunoglobulins along with supportive management.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42046508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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