Introduction: Dengue viral infection presents with a highly complex pathophysiological, economic, and ecologic problems. Through this study we aim to analyze the changing epidemiology and seasonal clustering of dengue fever cases. Also, we aim to analyze the clinical presentation, biochemical parameters, treatment given, and determine whether they have any association with the disease severity and outcome. Materials and methods: The present cross-sectional, observational study was conducted over a period of 1½ years including a total 255 patients of probable dengue, confirmed dengue, and dengue-like illness (DLI). Statistical association of various qualitative and quantitative parameters of the disease was made with both disease severity and disease outcome. Results: There were 27.8% patients in the age group 10–12 years and 11% infants in our study. Maximum patients were admitted in the post-monsoon months. Fever was the most common symptom and abdominal tenderness was the most common sign. Leucopenia was the most frequent hematological abnormality noted in our study. Mean day of appearance of hematological derangements corroborated with the onset of critical phase of dengue. The NS1 antigen test was found to be most useful for diagnosis with maximum percentage positivity, rapid results, ease of availability, and cost-effectiveness. Mean day of illness for NS1 positivity was 4.6 ± 2.9 days. Ultrasound abdomen was a sensitive test to predict early signs of plasma leakage. Substantial number of patients could be managed with oral fluids only; however, a few required an intravenous (iv) crystalloid bolus at the time of presentation. Blood products were sparingly used in our study. Antibiotic use did not alter disease course and outcome, hence is not recommended. Very few patients needed intensive care unit (ICU) admission. There were 13 deaths (mortality rate of 5.1%) during the study period. The rate of development of complications and also mortality was quite considerable in the DLI group. Hence, from the present study we emphasize that the DLI group should not be alienated from the continuum of spectrum of dengue viral infections. Conclusion: Presence of bleeding, encephalopathy, clinical/radiological signs of plasma leakage, hypotension, hepatomegaly, coagulopathy, deranged liver function test (LFT), and hemoconcentration with thrombocytopenia are indicative of a severe dengue disease and can also be used as surrogate markers for poor prognosis.

Dengue virus infection (DVI), a tropical disease, caused by the bite of female Aedes aegypti and Aedes albopictus mosquitoes. The four distinct virus serotypes of the Flaviviridae family, DENV-1, DENV-2, DENV-3 and DENV-4, cause DVI. Dengue virus infection presents in different ways, ranging from a relatively innocuous flu-like dengue fever to severe dengue. Severe dengue fever is often associated with renal injury ranging from a mild and transient elevation of serum creatinine (SCr), proteinuria, erythrocyturia, dyselectrolytemia, glomerulonephritis, nephrotic syndrome to acute kidney injury (AKI). Acute kidney injury, an infrequent complication of dengue, is usually associated with hypotension, rhabdomyolysis, or hemolysis. Sadly, the existence of renal injury in DVI and its role in the outcome is rarely recognized in clinical practice. This review is to remind ourselves to this overlooked entity of renal manifestations of dengue infection in the tropics.

The hepatitis B virus (HBV) and hepatitis C virus (HCV) in most children remain asymptomatic, but have the potential to progress to chronic hepatitis, cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Vertical transmission is a unique feature seen with both these viruses and plays an important role in the natural history and management. Since prevention is better than cure, every effort should be made to prevent these diseases as significant transmission occurs during the perinatal period. Therefore, it is very essential that all pediatricians/gastroenterologists treating children with HBV and HCV infections be aware of the details relating to the viruses before considering therapy.

Protracted bacterial bronchitis (PBB) is a common cause for chronic wet cough in children. Protracted bacterial bronchitis is defined by persistent productive cough in a child lasting for more than 4 weeks duration in the absence of symptoms or signs of other causes of chronic wet cough and which resolves following a 2–4-week course of an appropriate oral antibiotic. The microbiological criteria in certain situations include a positive bronchoalveolar lavage (BAL) culture. The most common organisms responsible for PBB are non-typable Hemophilus influenzae (NTHi) (47–81%), Streptococcus pneumoniae, and Moraxella catarrhalis. Human adenovirus (HAdV) is a known viral pathogen. The pathophysiology is an initial viral insult to the respiratory tract that disrupts the normal morphology and mucociliary function that leads to chronic inflammation and formation of biofilms that reduce the antibiotic penetration. Persistent neutrophilic inflammation, caused by the presence of capsulated organisms in the respiratory tract results in a loss of ciliary function, increased mucus production and bacterial stasis, resulting is a vicious cycle of chronic inflammation and infection and eventually bronchiectasis. Protracted bacterial bronchitis can be associated other chronic conditions with impaired mucociliary clearance and large airway malacias. It is most common in the preschoolers aged between 10 months and 4.8 years. These children appear generally healthy with normal growth and development and lack signs of chronic suppurative lung disease such as clubbing, chest deformities, or crepitations. A child with PBB typically presents with history of prolonged wet cough that is more at night and with postural changes. They can also present with shortness of breath and noisy breathing. The symptoms can also be aggravated with viral infections, resulting in exacerbations during these acute episodes. All these symptoms may be similar to asthma, and hence PBB is commonly misdiagnosed and treated as asthma. Chest radiography in PBB shows occasional perihilar changes due to peribronchial wall thickening. A computed tomography (CT) scan is indicated only if there is a recurrence, treatment failure, or suspicion of bronchiectasis. Flexible bronchoscopy with BAL is reserved in recurrent PBB and in those with treatment failure, as it is not easily available in most settings. Protracted bacterial bronchitis, which is not treated adequately, can predispose to bronchiectasis and chronic suppurative lung disease. Protracted bacterial bronchitis typically responds to a 2–4-week course of appropriate antibiotics. The antibiotic of choice is amoxicillin-clavulanate followed by macrolides, trimethoprim-sulfamethoxazole, or cephalosporins in select patients.

Varicella is an infection perceived to be a benign disease. But if adults get the disease, especially if pregnant mother gets chicken pox, it could be fatal or could cause disease in the unborn baby varying from fetal varicella syndrome to neonatal varicella—both causing significant morbidity and mortality. Understanding of the disease is very important, especially at what age it can cause problems. Unlike many other viral infections, varicella during pregnancy can cause different problems at different gestations.

Carbapenems are an important class of drugs very much useful in the therapy of multidrug-resistant gram-negative pathogens. Though these are available for the past 30 years, they can be administered only parenterally, which can reduce the compliance. Tebipenem-pivoxil (TBPM-PI; Orapenem), a prodrug, is the first oral carbapenem. It has been a promising drug in the therapy of drug-resistant respiratory infections and complicated urinary tract infections. It will also be useful in reducing the incidence of central line associated blood stream infections (CLABSI) and improving the rate of treatment completion.

Fever is a common symptom encountered in the clinical practice. This can provide vital clues about the underlying condition. This is a brief report on the role of serological investigations in a patient with fever.

Dengvaxia is a live recombinant tetravalent dengue vaccine, licensed from December 2015 for individuals from endemic area in the age-group of 9–45 years. This update gives the recent recommendations for dengue vaccination and also provides information on the newer dengue vaccines in the pipeline.

Primary immune deficiency diseases (PIDs), better known as inborn errors of immunity (IEIs), are a group of heterogeneous diseases with increased susceptibility to infections, autoimmunity, allergy, and malignancies, caused by a defect in the immune system. The latest classification on IEI by International Union of Immunological Societies (IUIS) has described around 416 IEIs. “Predominant antibody deficiencies” contribute to the largest group of IEIs in most of the published cohorts worldwide. B-cell defects/antibody deficiencies would be discussed in this paper, and the reader would be provided with a simplified clinical and immunological approach to these diseases.

The community-acquired methicillin-resistant Staphylococcus aureus of skin and soft tissue infection is commonly seen in neonates. Here, we present a neonate with the empyema thoracis. He was managed successfully with respiratory support, antibiotics, and surgical intervention and discharged home on full feeds.