Introduction: Candidemia has emerged as one of the life-threatening causes of invasive infection in both adults and children worldwide.
Materials and methods: We performed a retrospective study of children (≤16 years) with candidemia diagnosed in our center in 2010 to 2019. Demographics, comorbidities, Candida species distribution, antifungal susceptibility, and outcomes were analyzed.
Results: A total of 96 children were identified in the last 10 years. The predominant species identified were C. tropicalis (23%), C. parapsilosis (15.6%), C. pelliculosa (15.6%), C. albicans (13.6%), C. krusei (7.3%), and C. haemulonii (5.2%). Male to female ratio was 2:1. The most common risk factor was found to be congenital malformations (27%), followed by hematological malignancy in 13.5%. Candidemia was diagnosed while being admitted in the intensive care unit in 74%, 14.5% in wards, and 11.5% in outpatients. The overall mortality rate was found to be 31.3%. C. tropicalis was found to be sensitive to fluconazole in 95.5%, flucytocine in 95.2%, and 100% susceptible to amphotericin B, voriconazole, and caspofungin.
Conclusion: Invasive candidiasis occurs frequently in hospitalized patients and is associated with high mortality rates. C. tropicalis was the most frequently isolated species. We have observed a shift in Candida spp. with an increasing isolation of C. pelliculosa. The occurrence of azole resistance is a matter of concern.
Clinical significance: This type of data analysis is needed to track trends of serious infection and to develop guidelines for infection control strategies and antimicrobial stewardship program.
DOI: 10.5005/jp-journals-10081-1283 |
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Sawant SP, Rudraraju S, Amin AS. Predictive Model to Differentiate Dengue Fever from Other Febrile Illnesses in Children—Application of Logistic Regression Analysis. Pediatr Inf Dis 2021; 3 (1):9-14.
Background: Diagnosis of dengue fever (DF) is challenging in the initial stage of illness. Early diagnosis and adequate management are important to reduce the complications associated with dengue.
Objectives: This study aims to identify the clinical and laboratory features to predict DF from other febrile illnesses (OFI).
Materials and methods: A observational analytical study was undertaken in an urban referral hospital in Mumbai, India. Eighty-seven children (up to 14 years of age) presenting with acute fever of >24 hours and <7 days without any evident or suspected focus on clinical examination were included. Clinical features and laboratory parameters at the time of presentation were used to build a predictive model for DF by multivariate logistic regression analysis. A rapid, qualitative immunochromatographic test for the detection of dengue non-structural protein-1 (NS1) antigen and IgG and IgM antibodies to dengue virus was done as a screening test for DF in all children. A serological test including the dengue IgM (MAC ELISA) test or its seroconversion after 2 weeks was considered as a diagnostic test for DF.
Results: Dengue fever was diagnosed in 51.7% of children. Myalgia was an independent predictor of DF amongst the clinical features. A model including clinical and laboratory features demonstrated myalgia, leukopenia, and raised liver aspartate transaminase (AST) to be significant predictors of early DF. This model was internally validated, had high accuracy with an area under curve (AUC) of 0.93 (95% CI 0.88–0.98) with sensitivity 86.7% (95% CI 72.5–94.4), specificity 83.3% (95% CI 68.0–92.4), positive predictive value 84.78% (95% CI 70.51–93.16), and negative predictive value 85.4% (95% CI 70.13–93.9).
Conclusion: We constructed a predictive model for the diagnosis of DF in an earlier stage of presentation. Validation of this model in a larger population and different regions should be attempted.
Pneumonia has remained the leading cause of morbidity and mortality in children. Timely diagnosis and prompt treatment can avert many deaths; however, diagnosis of pneumonia in children still remains a challenge. Chest radiography has been widely used worldwide to diagnose pneumonia in children; however, in recent times, lung ultrasound (LUS) is emerging as a useful tool to diagnose pneumonia. The ease of performing LUS, its bedside availability, no exposure to ionizing radiation, and allowance of real-time monitoring of patients make LUS an attractive tool for the intensivists. In this article, we would elaborate the ultrasound equipment, the technique, normal artifacts, and various sonographic patterns of pneumonia in children. The LUS features of various complications of pneumonia like pleural effusion and pneumothorax will also be discussed. This article also summarizes the current evidence of using LUS in the diagnosis of pediatric pneumonia along with the strengths and limitations of this technique.
Fungal infections in pediatric practice are too common and yet often not discussed. Superficial fungal infections are primarily due to a poor personal hygiene. They are easy to treat provided a prompt diagnosis is made and prolonged topical antifungals are used, occasionally requiring oral antifungals. Systemic fungal infections are assuming great importance because of rampant antibiotic use, increasing intensive care centers and a big subsection of survivors in oncology, primary, and acquired immunodeficient states. The key to a successful management rests on a high index of suspicion in the vulnerable population, laboratory evidence and selecting the appropriate antifungal drug based on the local epidemiology.
The laboratory plays a crucial role in diagnosing fungal infections that are often underdiagnosed. Identifying invasive fungal infections in the immunocompromised population requires a high index of suspicion and choice of diagnostic methods is of utmost importance. This article aims to describe the various methods in a nutshell and hence explain how an integrated approach helps in accurate diagnosis which will benefit the patient. It also illustrates a few interesting case reports along with their laboratory findings.
Antifungal therapy for neonates, children, and adolescents, especially in those with primary or secondary immunodeficiencies having invasive fungal infections, is possible today due to the advent of newer antifungals. Studies of antifungals in the pediatric age-group are limited to those for cutaneous fungal infections. Although there are a few studies on the pharmacokinetics and safety, these drugs are used off-label, and most dosage recommendations are extrapolated from the adult data. A review of the use of antifungals other than amphotericin B for treatment of invasive fungal infections in pediatrics is the focus of this article.
Subhajit Dey Sarkar,
Prabhas P Giri,
Kawasaki disease is a systemic vasculitis, sometimes presenting atypically in infancy, often leading to a late diagnosis, and resulting in devastating consequences. We report a 2-month-old baby presenting with fever of unknown origin. Echo showed giant aneurysms in all three coronary arteries with intraluminal thrombus in one artery that required thrombolysis and anticoagulation.
DOI: 10.5005/jp-journals-10081-1290 |
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Al-Masqari M, Al-Maani A, Ramadhan F. Gastrointestinal Basidiobolomycosis: An Emerging Fungal Infection of the Gastrointestinal Tract, the Royal Hospital (Sultanate of Oman) Experience. Pediatr Inf Dis 2021; 3 (1):46-49.
Aims and objectives: In this study, we aimed to examine the epidemiology, clinical characteristics, histopathology findings, management, and ancillary techniques which are important for diagnosis, management, and outcome of an uncommon manifestation caused by the Basidiobolus ranarum.
Materials and methods: This is a case series of five interesting cases of gastrointestinal basidiobolomycosis (GIB). This study was conducted in the histopathology department at the Royal hospital which is a tertiary care institution. Cases diagnosed with all types of fungal gastrointestinal disease between 2008 and 2015 were reviewed. Cases with morphological features of basidiobolomycosis were retrieved and the diagnosis was confirmed by a senior pathologist.
Results: Five cases were identified. Out of five patients, four were misdiagnosed with other types of fungal infections which resulted in high morbidity and mortality. This case series revealed that the majority of patients identified are pediatrics (60%). Further, (60%) were from the same region (Ad Dakhiliyah). All patients presented with unspecific gastrointestinal symptoms that clinically mimic serious diseases. Additionally, all patients shared similar radiological findings and laboratory investigations.
Conclusion: Diagnosis of GIB requires a high index of suspicion, increased awareness of this rare disease aid in early diagnosis and promote an early start of treatment. Since there is a resemblance in the clinical features of inflammatory and neoplastic bowel disease, GIB should be considered in the differential diagnosis.