Pediatric Infectious Disease

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Volume 6, Number 2, April-June 2024
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EDITORIAL

Vijay Yewale, Bhaskar Shenoy

Yes! We Can End TB

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/pid-6-2-iv  |  Open Access | 

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Original Article

Dipti V Patel, Zeel Patel, Snehal V Patel, Pooja Gandhi, Gayatri Parmar, Param S Patel

Resurgence of Mumps among Lower Socioeconomic Class of Children in Ahmedabad: A Cross-sectional Study of 115 Cases in a Tertiary Care Center

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:37 - 39]

Keywords: IAP, Mumps, Measles–mumps–rubella, National Immunization Schedule, Orchitis

   DOI: 10.5005/jp-journals-10081-1424  |  Open Access |  How to cite  | 

Abstract

Aims and background: Mumps has seen a resurgence in the lower socioeconomic regions of Ahmedabad. The present study was undertaken to study the clinical pattern among mumps patients and their vaccination status. Materials and methods: A hospital-based cross-sectional study was carried out in the Department of Pediatrics at Shardaben General Hospital (NHL Municipal Medical College), a tertiary care center located in Saraspur, Ahmedabad, from September to December 2023. All patients 12 years of age who were clinically diagnosed with mumps on an outpatient department (OPD) basis and those admitted to the pediatric ward with mumps and its complications were included in the study. All patients belonged to the lower socioeconomic class of Ahmedabad. Informed consent was obtained from patients’ relatives. Detailed history in the form of demographic data, clinical presentation, vaccination status for measles–rubella (MR)/measles–mumps–rubella (MMR), reasons for nonvaccination, and history related to complications. A detailed physical examination was performed, and the data was tabulated in an Excel sheet. An appropriate statistical analysis using percentage calculation was performed. Results: It was observed that out of a total of 115 patients who were clinically diagnosed with mumps, the highest occurrence (71.3%) was observed among the 6–10 years age-group. No patient was fully vaccinated for mumps. Out of the 15.6% (18 patients) admitted, two patients (1.7%) suffered from mumps complication of orchitis. Around 24.3% of mumps patients had no contact history, whereas the rest, 75.6%, had either a classroom or household contact history with a mumps patient. Mumps also resulted in increased hospital burden and school absenteeism. Conclusion: It is high time that the Indian Academy of Pediatrics and the Government of India join hands to include MMR in place of MR in the National Immunization Schedule (NIS) and conduct a mass campaign for the MMR vaccine, although three doses of MMR in the 2023 Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) recommendation. Clinical significance: Mumps is a public health problem in India. Though a benign disease, it has the potential for multiple complications. Effective vaccines are available to prevent the disease. So why not protect our future generations from it?

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Original Article

Tanu Singhal, Shyam Kukreja, Jaydeep Choudhury, Vijay Yewale, Balasubramanian Sundaram, Jagdish Chinnappa, Suhas Prabhu, Balaji Veeraraghavan, Camilla Rodrigues, Vidya Krishna, Winsley Rose, Samir Bhargava

Expert Consensus on the Management of Acute Otitis Media in India: A Delphi Study

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:9] [Pages No:40 - 48]

Keywords: Acute otitis media, Antibiotics, Expert consensus, India, Otitis media with effusion

   DOI: 10.5005/jp-journals-10081-1426  |  Open Access |  How to cite  | 

Abstract

Aim and background: Acute otitis media (AOM) and otitis media with effusion (OME) are common childhood ear infections. The changing epidemiological landscape in India and growing concerns about antimicrobial resistance underscore the need for evidence-based, updated guidance on management. This expert consensus using the Delphi methodology was undertaken to deliberate and consolidate statements to guide the management of AOM and OME in India. Methods: A panel of 12 experts comprising pediatric infectious disease specialists, clinical microbiologists, and ear, nose, and throat (ENT) specialists participated in a three-step modified Delphi study conducted between April 2023 and January 2024. Overall, 101 statements were derived from an extensive literature search and shared with the experts for their response in the form of “yes” or “no” during round 1. Statements lacking consensus (predefined as <80% agreement) in round 1 were reevaluated in round 2, following a similar process for reaching consensus. Statements pending consensus in round 2 were then discussed in a virtual meeting (round 3). Results: A total of 83/101 (82.2%) statements in round 1 and 15/18 (83.33%) statements in round 2 achieved consensus (≥80% agreement) among the experts. A few statements were revised and updated based on the inputs from the experts, and 23 statements were deliberated in the virtual discussion during round 3. Finally, experts agreed to include 67 statements pertaining to risk factors, resistant strains, conservative and symptomatic management, and antibiotic treatment algorithms for AOM and OME. Conclusion: The consensus recommendations provide systematic guidance to clinicians on the appropriate management of AOM and OME. Clinical significance: These recommendations encompass stepwise interventions and address initial treatment as well as potential scenarios of treatment failure or recurrence in AOM and OME.

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Original Article

Utkarsh Singh, Suhas Prabhu, Deepak Phalgune

Similarities and Differences between Coronavirus Disease 2019-related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease in Indian Patients

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:6] [Pages No:49 - 54]

Keywords: Coronavirus disease 2019, Kawasaki disease, Multisystem inflammatory syndrome in children

   DOI: 10.5005/jp-journals-10081-1420  |  Open Access |  How to cite  | 

Abstract

Background: There is a marked overlap of clinical and laboratory features of multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD); resulting in a diagnostic dilemma. Studies comparing MIS-C and KD in Indian children are limited. The present study was conducted to describe the similarities and differences between MIS-C and KD which may help in diagnosis. Materials and methods: This prospective observational and retrospective study was conducted between April 2022 and March 2023. A total of 82 children <18 years of age were included; 41 with MIS-C and 41 diagnosed as KD admitted in the same hospital as controls. The primary objectives were to compare the gastrointestinal manifestations between the two groups, whereas the secondary objectives were to compare the mucocutaneous and cardiac manifestations. Results: The mean duration of fever was significantly longer in children with KD compared to those with MIS-C. Gastrointestinal manifestations were notably more prevalent in the MIS-C group, whereas mucocutaneous signs were more frequently observed in the KD group (KDG). Evidence of shock, the use of inotropes, and the need for respiratory support were significantly higher in the MIS-C group than in the KDG. Myocardial dysfunction and pericardial effusion/regurgitation were also more prevalent in the MIS-C group, whereas coronary dilatation/aneurysm was significantly lower compared to the KDG. Mean white blood cell (WBC) count, percentage of lymphocytes, absolute lymphocyte count (ALC), and platelet count were notably higher in the KDG compared to the MIS-C group. Liver function tests (LFTs), renal function tests (RFTs), and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were comparable between the two groups. Conclusion: There were vast similarities between KD and MIS-C, suggesting that they lie along the same clinical spectrum. However, there are several differences between the two disease entities.

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REVIEW ARTICLE

Harshini T Reddy, Bhaskar Shenoy

C-Tb Skin Test: A Step Toward Tuberculosis Eradication

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:2] [Pages No:55 - 56]

Keywords: C-Tb, Culture filtrate protein 10, Early secretory antigenic target 6, Interferon γ-release assay, QuantiFERON gold in tube test, Tuberculin skin test

   DOI: 10.5005/jp-journals-10081-1423  |  Open Access |  How to cite  | 

Abstract

C-Tb is a novel diagnostic test for latent tuberculosis (TB) infection. It is a skin test based on the principle of tuberculin skin test containing early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10). It is important to understand newer diagnostics for TB in order to move towards the goal of eradication of TB. This test helps in early diagnosis and treatment of latent TB infection in high-risk individuals who can develop active TB. It is field-friendly and cost-effective, which comes with the ease of tuberculin skin test and the accuracy of interferon γ-release assay (IGRA).

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CASE REPORT

Madhuri Kadam

Common Tropical Illness Due to Uncommon Species

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:57 - 59]

Keywords: Case report, Fowl typhoid, Poultry, Salmonella Gallinarum

   DOI: 10.5005/jp-journals-10081-1421  |  Open Access |  How to cite  | 

Abstract

Aim and background: This case report details a rare instance of Salmonella Gallinarum infection in a human with a history of exposure to poultry. Case description: A 12-year-old boy presented with fever, respiratory symptoms, and leukopenia, diagnosed with Salmonella Gallinarum, likely contracted from contact with poultry. Ceftriaxone and azithromycin were effective, leading to clinical improvement. Family members, especially the child caring for animals, received education on hand hygiene and improved animal care practices to prevent future zoonotic exposures. Follow-up blood cultures confirmed Salmonella Gallinarum clearance. Conclusion: The case underscores the importance of considering zoonotic sources in febrile illnesses and highlights the role of comprehensive hygiene measures in preventing such infections, especially in households with diverse animal exposure. Clinical significance:Salmonella Gallinarum infections in humans are rare, and the symptoms are generally consistent with those of salmonellosis caused by other Salmonella serotypes. The infection typically occurs due to close contact with infected birds, particularly poultry.

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CASE REPORT

Kruti N Shah, Shwetal Bhatt, Vaishali Chanpura

Nonimmune Hydrops Fetalis and Early Skeletal Changes in Congenital Syphilis: Case Series and Review of Literature

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:4] [Pages No:60 - 63]

Keywords: Case report, Congenital syphilis, Early skeletal changes in congenital syphilis, Hydrops fetalis

   DOI: 10.5005/jp-journals-10081-1427  |  Open Access |  How to cite  | 

Abstract

Aim and background: Syphilis remains the most common congenital infection in the world. During pregnancy, syphilis is associated with numerous findings, including placentomegaly, hepatomegaly, polyhydramnios, fetal nonimmune hemolytic anemia, and hydrops fetalis. Typically, hepatomegaly and placentomegaly precede signs of hydrops fetalis on ultrasound. Abnormal antenatal ultrasound findings are associated with poor outcomes and a higher risk of neonatal treatment failure. In severe cases, syphilis infection during pregnancy leads to prematurity, low birth weight, and stillbirth. Some cases also present with early skeletal changes, and hence, skeletal radiographs expedite the clinical decision-making process and direct further management of neonates. The signs of neonatal syphilis, including hepatic and bone dysfunction, and fetal hemolytic anemia, do follow complete recovery with penicillin treatment. We hereby report two such cases of congenital syphilis presenting with nonimmune hydrops fetalis (NIHF) and early skeletal changes and aim to initiate early diagnosis and treatment based on clinical evidence. Case description: We report two cases of congenital syphilis with varied presentations. The first case presented as antenatally diagnosed hydrops fetalis with nonimmune hemolytic anemia and thrombocytopenia without any antenatal maternal diagnosis of syphilis. The baby also had features of neurosyphilis with early bony sclerotic changes. The patient responded to penicillin treatment. The other case was also an antenatally undiagnosed case of congenital syphilis with fetal anemia, thrombocytopenia, and hydrops fetalis, along with facial deformity and bony changes of sclerosis, addressing early syphilis but succumbed to death within 24 hours, accounting for hemodynamic instability and pulmonary hemorrhage. Conclusion: Congenital syphilis can remain undiagnosed in the antenatal period and, when left untreated, can present with life threatening complications. Due to varied clinical signs and presentations of congenital syphilis, it becomes imperative to diagnose it postnatally for early initiation of treatment. Long bone radiographs aid in the diagnosis of congenital syphilis in neonates of seronegative mothers. Clinical significance: Congenital syphilis may present with varied clinical presentations, such as hydrops fetalis, fetal growth restriction, anemia, thrombocytopenia, purpura, hepatosplenomegaly, meningitis, sclerotic bony changes, facial deformities, etc. Familiarity with the radiographic findings of early congenital syphilis can assist clinicians in making appropriate treatment decisions, especially in equivocal cases and prevent postnatal life-threatening events. Early treatment has been observed to reverse life-threatening complications. Repeat screening for syphilis in the later part of pregnancy is a prudent measure to avoid vertical transmission of syphilis.

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NOTES FROM LAB

Nivedhana Subburaju

Molecular Tools for Diagnosis of Pediatric Infectious Diseases

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:3] [Pages No:64 - 66]

Keywords: 16S ribosomal ribonucleic acid, 18S ribosomal ribonucleic acid, Culture-negative infections, Molecular diagnostics, Quantitative polymerase chain reaction

   DOI: 10.5005/jp-journals-10081-1422  |  Open Access |  How to cite  | 

Abstract

Molecular techniques constitute valuable tools to improve the diagnosis of bacterial infections in children when cultures remain negative, etiologies of which would otherwise go nondocumented. The clinical utility of such tests could be optimized by systematic prescription by the pediatricians after consulting the microbiologist.

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Journal Watch

Vikram S Kumar

Lifelong Learning in Pediatric Infectious Diseases

[Year:2024] [Month:April-June] [Volume:6] [Number:2] [Pages:6] [Pages No:67 - 72]

Keywords: Antiretroviral, Early-onset neonatal sepsis, Hemophagocytic lymphohistiocytosis, Malaria, Methicillin-resistant Staphylococcus aureus, Probiotic, Procalcitonin, Sinusitis

   DOI: 10.5005/jp-journals-10081-1429  |  Open Access |  How to cite  | 

Abstract

Pediatric infectious diseases pose significant challenges to global health, necessitating a thorough understanding of their epidemiology, diagnosis, treatment, and prevention strategies. This article provides a concise yet comprehensive overview of various aspects of pediatric infectious diseases. It highlights the burden of common pathogens in children, including respiratory viruses, gastrointestinal pathogens, and vaccine-preventable diseases. Additionally, it touches upon emerging infectious threats, antimicrobial resistance patterns, and the impact of infectious diseases on child health outcomes. Overall, this article serves as a valuable resource for healthcare professionals and researchers seeking insights into the dynamic landscape of pediatric infectious diseases.

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