DOI: 10.5005/jp-journals-10081-1204 |
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Sanjeeva G, Varshneya K, Pavithra H, Ramesh R, Semple T, Owens CM, Sonnappa S. Bronchiectasis in Pediatric HIV Infection: An Indian Perspective. Pediatr Inf Dis 2019; 1 (2):45-51.
Background: Children with vertically acquired HIV-infection (CLHIV) surviving into adulthood are susceptible to sequelae such as chronic lung disease (CLD) including bronchiectasis. Our objective was to characterize bronchiectasis radiologically and functionally, estimate prevalence, and determine risk factors in Indian CLHIV. Meterials and methods: In this prospective cross-sectional study, CLHIV aged 5–18 years were categorized into either high-resolution computed tomography (HRCT) confirmed bronchiectasis or control groups without clinical evidence of CLD. Clinical and radiological evaluations, chart review, spirometry, and 6-minute walk test (6MWT) were performed. Baseline characteristics of both groups were compared using Mann–Whitney U or Chi-square, or t tests. Multivariable logistic regression was used to determine factors independently associated with bronchiectasis. Findings: Four hundred and eleven CLHIV with median (IQR) age 12 years (9.5–14.5) were screened. Thirty-nine (10.6%) children had bronchiectasis and 160 with no CLD were controls. Mean ± SD of zFEV1 (−2.61 ± 0.9) and zFVC (−2.0 ± 0.8) in the bronchiectasis group was significantly lower than that of control group (zFEV1 = −0.37 ± 0.87; zFVC = −0.55 ± 0.88). During 6MWT, 41% in the bronchiectasis group desaturated (Chi-square = 6.19; p = 0.01) as compared to 20% in control group and 76% covered <3rd centile distance (Chi-square = 3.95; p = 0.047) as compared to 57% in control group. Age >5 years (OR-3.39; 95% CI [1.30, 8.87]) at HIV-diagnosis and recurrent sinopulmonary infections (OR-2.37; 95% CI [1.07, 5.24]) were found to be independent risk factors for the development of bronchiectasis. Interpretation: Bronchiectasis was seen in 9.5% of our cohort of CLHIV causing significantly abnormal pulmonary function. Late HIV diagnosis (age >5 years) and recurrent sinopulmonary infections were independent risk factors for developing bronchiectasis.
The risk of exposure to HIV is high among certain populations like healthcare personnel (HCP), injection drug users (IDUs) and people engaged in unprotected sex. The timely reporting of the needle stick injury or potential exposure to HIV depends on the knowledge and understanding of PEP by the HCP. There is a delay in development of systemic infection after the initial exposure caused by the HIV replication in the dendritic cells of the skin and mucosa before spread through the lymphatic vessels. This window of opportunity can be utilized to block the replication of HIV by providing PEP. The case control study has demonstrated the reduction in acquisition of HIV by 81% after introduction of PEP among HCPs. Hence a comprehensive review on PEP among HCP, particularly with reference to Indian context is presented here.
Background:Helicobacter pylori infection is a ubiquitous gastric infection, seen in almost half of the world's population. Majority of them acquire the infection by the age of 10 years. However, only a small proportion become symptomatic. Methods: This narrative review examines the clinical features, histology, diagnostic approach and treatment options in children as per recent updated guidelines and comparison vis-à-vis with adult's guidelines at appropriate places. In brief; peptic ulcer disease (PUD) is a main manifestation in children. While in adults, in addition to PUD, it is associated with MALToma and distal gastric adenocarcinoma. There is no specific symptom of H. pylori disease; the evaluation is a part of all the diagnostic studies of upper GI symptoms. Confirmation requires histological presence of H. pylori in the biopsy sample along with atleast one biopsy based test (rapid urease test and PCR). On confirmation; PUD, MALToma, iron refractory iron deficiency anemia, chronic ITP requires treatment based on antimicrobial susceptibility. Eradication is confirmed by a noninvasive test such as stool antigen or C-13 urea breath test (13C-UBT test). Persistence of infection in a symptomatic child requires second line antimicrobials. Conclusion:H. pylori is becoming common infection in children with myriad presentations. Protocol based approach and planned treatment is necessary to eradicate and prevent complications.
Antimicrobial resistance (AMR) in gram-negative bacteria (GNB) is persisting to be a significant cause of severe infections across the world, with increasing morbidity and mortality rates. Extended spectrum beta lactamase (ESBL) rates are alarmingly increasing in Escherichia and Klebsiella species, which is about 70% and there has been an increase in the resistance to carbapenems over the past few years in India. Current scenario of rapidly growing multidrug resistant (MDR) organisms in our Indian intensive care units is posing difficulties with regard to detecting these infections and starting appropriate empirical antibiotics. A clear understanding of the epidemiological, microbiological, and pharmacological aspects of these MDR gram-negative organisms is very important. This article tries to brief the risk factors for MDR GNB infections, spectrum of MDR GNB infections, mechanisms of resistance, and beta-lactamase enzyme classification and outlines the clinically important types and the treatment considerations for these MDR gram-negative organisms.
Blood culture, Drug-resistant typhoid, Enteric fever, Indian report
DOI: 10.5005/jp-journals-10081-1205 |
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Kukreja S, Gupta T. Cephalosporin-resistant Typhoid Fever: A Report of Two Cases with a Unique Isolate from a Tertiary Care Hospital in Delhi. Pediatr Inf Dis 2019; 1 (2):70-71.
Typhoid fever is endemic in our country and is the commonest bacterial bloodstream infection in South Asia.1 Multidrug-resistant typhoid fever (MDRTF) is defined as typhoid fever caused by Salmonella enterica serovar Typhi strains (S. Typhi), which are resistant to the first-line recommended drugs, i.e., chloramphenicol, ampicillin, and trimethoprim–sulfamethoxazole. Extensively drug-resistant typhoid fever (XDRTF) is defined as Salmonella Typhi/Paratyphi resistant to first line antibiotics (ampicillin, chloramphenicol and cotrimoxazole) and also to fluoroquinolone and ceftriaxone. Pakistan has an ongoing epidemic of extensively drug resistant (XDR) typhoid, which is a cause for alarm. Prior to this XDR typhoid epidemic, which started in 2016, only 17 cases of ceftriaxone resistance were reported in the world literature. Four out of these 17 were cases of XDR typhoid reported in Iraq, Bangladesh, India, and Pakistan.2 We report two cases of cephalosporin resistant typhoid fever from North India in the pediatric age group and discuss the clinical presentation and treatment. These two isolates were resistant to four drugs (ampicillin, chloramphenicol, fluoroquinolone, and ceftriaxone) but sensitive to chloramphenicol.