Aims and background: Accurate identification of Candida species and their antifungal susceptibility (AFS) profiles, especially in neonates, is important in the era of emerging pathogens like Candida and the growing resistance to commonly used antifungal agents. This study aimed to accurately identify Candida species using automated identification systems, specifically matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Additionally, we assessed the AFS patterns of these isolates using the automated VITEK 2 Compact system. Materials and methods: This prospective study was conducted in the Department of Microbiology at SMS Medical College, Jaipur, Rajasthan, from April 2023 to August 2023. Blood culture samples were processed using the automated BacT/Alert system, followed by Gram staining and inoculation onto blood agar and MacConkey agar. Gram results were communicated to the clinicians on the same day. Smears showing budding yeast cells were further analyzed using MALDI-TOF MS for species identification, and their minimal inhibitory concentrations (MICs) were determined using the VITEK 2 Compact system. Results: Among 161 Candida isolates, Candida krusei emerged as the most prevalent species (35%), followed by C. tropicalis (20%) and C. glabrata (15%). Male children constituted 69% of the total cases. Voriconazole demonstrated the highest sensitivity (86%), followed by micafungin (84%), caspofungin (79%), and amphotericin B (78%). Conversely, 5-flucytosine exhibited the lowest susceptibility (35%), along with fluconazole (49%). Conclusion: Identification of yeasts from blood culture by automated systems like MALDI-TOF and VITEK 2 is a fast, reliable technique, offering clinicians timely and precise information crucial for prompt patient management and targeted treatment strategies. Clinical significance: C. krusei has emerged as the most prevalent species in neonates amid the increasing trend of C. tropicalis over the past few years. We have adopted technologies like MALDI-TOF MS and VITEK 2 systems for prompt identification of Candida species, thereby speeding up the diagnosis and providing early reports to clinicians, ultimately saving the lives of neonates.

Objectives: The primary outcome was to study the utility of lumbar puncture (LP) in neonatal sepsis, and the secondary outcome was to study the clinical profile of the neonates with sepsis in a comparison of practices between two units. Methods: This is a retrospective comparative study conducted at two tertiary neonatal intensive care units (NICUs) during the period from January 2017 to January 2020. All neonates with C-reactive protein (CRP)-positive sepsis admitted to the NICU were included. Those with suspected sepsis but CRP-negative were excluded. The eligible medical records were reviewed, and data were recorded into a structured pro forma at both centers. The data from both units were analyzed. Results: Data from a total of 252 neonates were analyzed. Unit 1 (U1) had 29% blood culture-proven sepsis, of which 69% were late-onset, whereas at unit 2 (U2) it was 17.1%, of which 85% were late-onset and the remaining were early-onset. The incidence of meningitis was 3% in U1 and 1.9% in U2. Of these, 83% were associated with late-onset sepsis and only 17% with early-onset sepsis. Most of these neonates had the same organism in blood and cerebrospinal fluid (CSF). In those with meningitis, the highest CRP was <100 mg/L in 67% and >200 mg/L in 43% in U1, while all had a CRP <100 mg/L in U2. A receiver operating characteristic (ROC) curve plotted for CRP and culture-positive meningitis showed a CRP cutoff >80 mg/dL with a specificity of 84.9% and sensitivity of 66.7% for considering LP in sepsis. Conclusion: Lumbar puncture, being an invasive procedure, could be reserved only for those babies with culture-positive sepsis or with symptoms of meningitis or severe sepsis. This study suggests a CRP >80 mg/L as an indication for LP in neonatal sepsis.

Background: The Bacille Calmette–Guerin (BCG) vaccine is a live attenuated vaccine that is a part of the National Immunization Program in India. It protects infants and children from tubercular meningitis and disseminated tuberculosis. It is usually a safe vaccine but can cause mild and severe adverse reactions including suppurative lymphadenitis as well as osteitis. BCG vaccine-induced regional lymphadenitis can be easily misdiagnosed and can lead to unnecessary therapeutic as well as surgical interventions. Fine needle aspiration cytology (FNAC) in such cases is a minimally invasive procedure for not only making an early and accurate diagnosis but can also have a curative role. Aim: To study the utility of FNAC in BCG lymphadenitis and to create awareness regarding this entity. Materials and methods: This study has been conducted for 3 years (December 2021 to December 2023). We analyzed 16 cases of BCG lymphadenitis diagnosed on FNAC. Their clinical presentation, cytomorphological features, and clinical outcomes were studied. Results: Of all the 16 cases, 10 patients were males and 6 were females. The minimum age for the presentation was 5 months and the maximum was 2 years. The majority had left-sided axillary lymph node enlargement without any constitutional symptoms. FNAC yielded pus aspirates in 80% of cases. Cytological examination showed inflammatory cells (62.5%), reactive lymphoid cells (37.5%), and epithelioid cell granulomas with necrosis (18.7%), along with giant cells in 12.5% of cases. Ziehl–Neelsen staining for acid-fast bacilli was positive in 13 cases. On follow-up, lymphadenitis regressed in most of them within a few months of diagnosis. Conclusion: Bacille Calmette–Guerin lymphadenitis is a benign condition that remits spontaneously within a few weeks without any treatment in most cases. A high index of suspicion, clinical history, and FNAC play an important role in its detection and management.

Background: Klebsiella is an important causative organism of neonatal sepsis (NS), particularly in developing countries. This study aimed to analyze the demographic and clinical laboratory features of a fatal outbreak of Klebsiella spp. that occurred in a neonatal intensive care unit (NICU), identify the source of the infections, and propose infection control measures to prevent future occurrences. Methods: We performed a retrospective analysis of the medical records and investigative reports of sepsis cases caused by Klebsiella pneumoniae admitted to the neonatal units of a tertiary care teaching hospital in western India from May to August 2022. Results: Among the 26 neonates with Klebsiella sepsis, those born at <28 weeks and 28–32 weeks of gestation were the most affected group. The mortality rate was high (n = 21, 80%). The C-reactive protein (CRP) level was used to assess the severity and prognosis of the infection. The platelet count (PLT) decreased significantly from day 1 to 15 (p < 0.001) as the condition worsened. Elevated CRP levels (>100 mg/L) were also observed on the 5th day of admission (p < 0.001). We found unsatisfactory hand hygiene practices, and K. pneumoniae grew on surface swab sampling of wash basins and overhead water tanks. Thorough decontamination of the source of infection and strengthening of infection control practices was performed. Conclusion: Carbapenem-resistant Klebsiella strains led to substantial morbidity and mortality during an outbreak in neonates.

Aims and background: Respiratory infections are fairly common in pediatric age group, and respiratory syncytial virus (RSV) is a frequently encountered etiological agent. It is known to occur as seasonal outbreaks. This study was conducted to know the profile of the kids admitted with RSV during a probable outbreak in Kerala, India. Materials and methods: This was a retrospective descriptive study of data from the electronic medical record (EMR) of children admitted from September 1 to October 31, 2023 to one of four pediatric units of our hospital when the institute had a peak in the number of admissions for respiratory illnesses. Data of all children who had been tested with QIAstat respiratory panel and were positive for RSV were analyzed for their clinical presentation, laboratory investigations, and treatment. Results: An etiological agent was identified in 32 out of 35 cases for whom the viral respiratory panel was tested (91%). RSV was detected in 23 cases. It was more common among infants. Approximately 79% of them had fever, and 21% had respiratory distress. Thrombocytosis and elevated C-reactive protein (CRP) were seen in 21% and 52% of cases, respectively. Around 17% required oxygen via nasal prongs, and 9% required high-flow nasal cannula (HFNC). Only one case with septicemia was treated with antibiotics. All children with RSV infection had an uneventful recovery. Conclusions: Identification of viral agent during outbreaks of respiratory infections would reduce the unnecessary use of antibiotics and oseltamivir.

This case study presents the comprehensive evaluation and management of a 4-year-old male patient with phimosis who presented with fever, anorexia, weakness, and burning micturition. Upon admission, bilateral multiple renal abscesses and cystitis were diagnosed through ultrasound examination, prompting initiation of intravenous (IV) piperacillin–tazobactam combination and IV vancomycin. Due to concerns of red man syndrome, vancomycin was closely monitored, and a multidisciplinary approach involving specialists in pediatric infectious diseases and surgery was adopted. Sensitivity testing revealed Escherichia coli infection resistant to multiple antibiotics, leading to a switch to IV meropenem. Additional investigations for suspected mumps yielded negative results, emphasizing the importance of thorough evaluation. The patient's condition improved with appropriate antibiotic therapy, as evidenced by decreasing abscess size and resolution of symptoms. This case underscores the significance of tailored antibiotic therapy, close monitoring, and multidisciplinary collaboration in managing complex pediatric infectious cases, ensuring optimal patient outcomes. Additionally, the patient's complete vaccination highlights the potential for atypical mumps presentations. Resurgence factors include secondary vaccine failure, reduced vaccine effectiveness (85–90%), and lack of natural boosting from wild-type virus.

Human adenovirus (HAdv) infections are very common in children under 5 years of age and can present with varied manifestations including respiratory, gastrointestinal, neurological, cardiac, hematologic, and genitourinary symptoms. We report a 12-year-old boy with HAdv pneumonia who experienced fever remission by the 3rd week of illness. However, he subsequently developed a relapse of fever spikes along with left hypochondriac pain. Upon evaluation, he was found to have splenic infarction (SI). To the best of our knowledge, this is the first case report of adenoviral infection associated with SI.

Aim and background: Staphylococcus pseudintermedius is an emerging zoonotic pathogen of the Staphylococcus group, mostly found in the skin and soft tissue of domestic animals, especially dogs. Ever since the first human infection was described in 2005, a few other reports have described this in association with skin and other superficial infections in humans, but invasive bloodstream infection has rarely been reported. Case description: We describe the case of a 10-month-old male baby presenting with fever, irritability, convulsions, and bulging fontanelle diagnosed as acute pyogenic meningitis due to S. pseudintermedius. Conclusion: S. pseudintermedius is an emerging pathogen of concern. Clinical significance: This is probably the first case report of S. pseudintermedius causing invasive infection in an infant from India. Awareness of the possibility of this pathogen causing invasive infections is crucial for timely detection and successful treatment with appropriate antibiotics.