Background: Childhood tuberculosis (TB) is an important cause of morbidity and mortality in the developing countries. In 2014, the World Health Organization (WHO) recommended the use of GeneXpert as the initial diagnostic test for detecting all cases of pediatric TB. Only limited data are available on the utility of GeneXpert in the diagnosis of pediatric TB. The present study was done to evaluate the efficacy of GeneXpert as diagnostic tool for pediatric TB detection. Objectives: To understand the utility of GeneXpert for detecting Mycobacterium tuberculosis and rifampicin resistance in pediatric TB. Materials and methods: This was a prospective cross-sectional study done in a tertiary care teaching hospital over a period of 1 year. After obtaining consent, sputum/induced sputum (IS)/gastric aspirate (GA)/fine needle aspiration cytology (FNAC)/cerebrospinal fluid (CSF)/pleural tap samples were obtained and subjected for cartridge-based nucleic acid amplification test (CBNAAT) and Mycobacterium growth indicator tube (MGIT) culture, respectively. Results: Based on the inclusion criteria, 128 children with presumptive TB were enrolled; of which 76 children were diagnosed with TB [30 with pulmonary TB (PTB) and 46 with extrapulmonary tuberculosis (EPTB)]. In EPTB, lymph node TB was most commonly seen in 37.0% subjects. In pulmonary TB, GeneXpert sensitivity and specificity were 85.71% (95% confidence interval, CI 62.64–96.23%) and 77.7% (95% CI 40.19–96.05%), respectively. Observed positive predictive value (PPV) and negative predictive value (NPV) of GeneXpert were 90% (95% CI 66.87–98.24%) and 70% (95% CI 35.36–91.90%), respectively. Sensitivity and specificity in EPTB was observed to be 50% (95% CI 28.80–71.19%) and 83.33% (95% CI 61.81–94.52%) with PPV of 73.33% (44.82–91.08%) and NPV of 64.51% (45.38–80.17%), with an overall sensitivity and specificity of GeneXpert of 67.39 and 92.68%, respectively, and PPV and NPV of 83.78 and 83.51, respectively. All the recruited subjects were found to be rifampicin sensitive. Conclusion: GeneXpert is a very useful test with a high sensitivity and specificity for diagnosing pediatric TB and for detection of rifampicin resistance in a short period of time.

Respiratory infections are caused by a vast number of pathogens including bacteria, viruses, and fungi. Many of these have nonspecific symptoms and do not have a final diagnosis in resource-limited settings—due to either economic reasons or lack of diagnostic facilities. A good understanding of the tests available would be of immense help, especially in critically ill patients in whom knowing the exact causative organism is mandatory to shift from empirical treatment to a more specific treatment plan. There are even rapid test formats which have good sensitivity for common respiratory infections encountered in outpatient set-up.

Mimics of sepsis are a common cause of misdiagnosis in the emergency department. Studies have shown that more than 50% of patients identified and treated for severe sepsis have negative culture results. Of the patients identified with a sepsis syndrome at presentation, 18% have a noninfectious disease that mimics sepsis. Hence, it is important to differentiate sepsis from several noninfectious diseases that may closely mimic sepsis. Conditions such as diabetic ketoacidosis (DKA), Kawasaki disease (KD) shock syndrome, pancreatitis, and inborn errors of metabolism (IEM) mimic the clinical presentation of sepsis, while anaphylaxis, adrenal insufficiency, hemorrhage, pulmonary embolism, and spinal cord injury mimic the hemodynamic parameters of sepsis. Due to a significant overlap in the clinical, hemodynamic, as well as laboratory parameters, sepsis and its mimics are often not distinguishable on the initial assessment. Unresolving sepsis with appropriate fluid resuscitation and antimicrobials may be a clue that it is not sepsis alone. High index of suspicion combined with a systematic approach and prompt therapy is important as many can be progressive and fatal. Nonetheless, sepsis is still the commonest. Beware mimics are there but rare!!

Hepatitis A, a waterborne endemic disease, is an important cause of acute viral liver disease in Indian children. Although self-limiting in most cases, hepatitis A can rarely cause life-threatening acute hepatic failure. It is the most common attributable cause for acute liver failure in children in countries of high endemicity. Changing epidemiology of hepatitis A in India has resulted in the coexistence of heterogeneous pockets of exposed and unexposed individuals in different social classes and regions. Epidemiological transition has also resulted in higher risk of hepatitis A infection and complications in older children and adults. Vaccines are the time tested and effective measures for prevention of hepatitis A infection; however, despite available vaccines, hepatitis A remains an important public health problem in India because of low vaccination coverage. Currently, two types of vaccines are available for prevention of hepatitis A: live attenuated vaccine and killed/inactivated vaccines. Live vaccine provides robust and long-term immunogenicity due to both humoral and cellular responses, unlike mostly humoral response with killed vaccines. Differences also exist in the schedule and route of administration of these vaccines. Live attenuated vaccine is administered subcutaneously and offers several advantages over killed vaccine including convenience, potential for better compliance, less cost due to single-dose administration and less pain. In patients with bleeding disorder, subcutaneous administration can result in less chances of bleeding when compared with intramuscular administration. Moreover, published long-term immunogenicity data in Indian subjects are available only with live vaccine. In this article, we discuss the clinician's perspective on the use of hepatitis A vaccine in Indian children.

The World Health Organization (WHO) recently reviewed the scientific advancements in the area of rabies prophylaxis and in 2018 issued new guidelines for consideration of the national governments for implementation. Following this, a Government of India (GoI) expert group met in January 2019 in Delhi and examined these WHO recommendations for implementation in India. In this article, the author has reviewed both the WHO and GoI recommendations and provides expert interpretation and opinion to both service providers in government institutions and private medical practitioners.

Typhoid fever continues to ravage across the globe. It affects young children and causes higher morbidity and mortality in them. The Diseases of the Most Impoverished (DOMI) study has added invaluable data regarding the disease incidence. The bacteria had developed resistance to the first generation of antimicrobials. Fluoroquinolones and recently third-generation cephalosporins have been found to be ineffective and extremely drug resistance typhoid had surfaced in certain regions. Vaccines are an important tool in the ongoing fight against typhoid fever.

This article reviews few trials assessing the use of newer antibiotics in the neonates and children. Published data show that more studies are conducted in the adult population (50 times) when compared to children with respect to the testing of newer antibiotics. The figures are approximately 177 and 580 times more as compared to neonatal and preterm babies, respectively. Although there is paucity of data in the pediatric domain, carbavance (meropenem + vaborbactam) and solithromycin deserve special mention, as they are currently being used in pediatric clinical trials.

Background: A rare case of atypical Steven–Johnson syndrome secondary to mycoplasma infection. Case description: An eight-year-old boy presented with a history of fever and cough of 7 days with recent-onset redness and purulent discharge of eyes with multiple oral ulcers for the past 3 days. He was febrile, toxic looking with bilateral conjunctival congestion, multiple painful ulcers in the mouth, and severe mucositis. Because of cefpodoxime ingestion before the onset of ulcers and redness of eyes, possibility of Steven–Johnson syndrome considered and history of respiratory infection in the absence of skin involvement, atypical Steven–Johnson syndrome secondary to mycoplasma infection (Fuchs syndrome) kept in mind. mycoplasma serology was sent which was reported as positive. Other routine investigations and chest X-ray were normal. Intervention: He was started on IV pulse methylprednisolone for 7 days. He becomes afebrile after the first dose of methylprednisolone. Eye lubricants and topical anti-inflammatory agents continued. A significant reduction in mucositis observed. Later oral corticosteroid continued and tapered and stopped over 2 weeks. Message: Severe mucositis with the background of respiratory infection, Fuchs syndrome should be considered as a differential.