Aim and objective: The study was designed to detect Mycobacterium tuberculosis (M.tb) in buccal swab specimens using cartridge-based nucleic acid amplification test (CBNAAT) in children suffering from pulmonary tuberculosis (TB) and to compare with CBNAAT results with gastric aspirate (GA) and sputum specimen. Materials and methods: This observational study included children ≤15 years of age attending Department of Pediatrics of a tertiary care hospital diagnosed as presumptive pulmonary TB. Gastric aspirate/induced sputum (IS) sample and buccal swab were collected from all the study subjects and subjected to CBNAAT. Acid-fast bacilli (AFB) microscopy was also performed on GA/IS samples. Results: Fifty presumptive cases of pulmonary TB were enrolled in the study. Fifteen (30%) buccal swab samples and 41 (82%) GA/IS samples were positive for CBNAAT. Gastric aspirate was positive in 23/24 (98%) subjects which was significantly higher as compared to buccal swab results (p = 0.0001). Induced sputum was positive in 18/26 (69.2%) samples which was comparable to buccal swab results (p < 0.092). AFB microscopy was positive in only 10 (5%) subjects. Rifampicin resistance was demonstrated in 9 (18%) subjects on GA/IS and 4 (8%) cases on buccal swab detected by CBNAAT. Conclusion: Buccal swabs can be used to detect M.tb in children with pulmonary TB. The results were statistically comparable to IS but inferior to GA specimen. It can serve as simple and convenient alternative method.

Aim and objective: Periodic surveillance of causative organisms of acute meningitis in children is helpful. Cerebrospinal fluid (CSF) findings characterize the type of meningitis and guide therapy to improve the outcome. We aimed to analyze clinical features, CSF characteristics, causative organisms, and the outcome of meningitis in children. Materials and methods: Children aged from 1 month to 18 years admitted to a teaching hospital with a provisional diagnosis of meningitis were studied retrospectively. Clinical data, CSF analysis, and complications of meningitis were retrieved from medical records. Meningitis was further classified depending on laboratory findings into acute bacterial meningitis (ABM), probable bacterial meningitis (APBM), and aseptic meningitis (ASM). Results: Among 50 children with meningitis, 9 (18%) had ABM, 34 (68%) had APBM, and 7 (14%) had ASM. The causative bacteria included Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterobacter cloacae, Streptococcus viridians, Brucella, and Salmonella typhimurium. Important clinical features included fever (96%), seizures (50%), headache (44%), vomiting (70%), altered sensorium (56%), neck stiffness (56%), cranial nerve palsy (16%), and focal neurological deficits (10%). The median CSF WBC levels in ABM, APBM, and ASM groups were 310, 125, and 140 cells/mm³, respectively. The mean CSF glucose and protein levels in the same groups, respectively, were 29.5 ± 23.1, 51.2 ± 23.8, and 51.7 ± 8.7 mg/dL; and 441.5 ± 546.9, 99.1 ± 79.1, and 100.1 ± 82.6 mg/dL. Complications among 43 bacterial meningitis included hydrocephalus (8, 18.6%), hearing loss (4, 9.3%), visual impairment (3, 6.9%), brain abscess (3, 6.9%), subdural effusion (1, 2.3%), and infarct (1, 2.3%). Conclusion: The present study has explored the causative bacteria in acute meningitis in children. Furthermore, the study explored the characteristics of CSF and identified the important complications.

Aim and objective: To study clinical presentation and complication in diphtheria in pediatric age-group. Materials and methods: Retrospectively 33 clinical diphtheria cases who got admitted to the isolation unit of Niloufer hospital from August 2019 to July 2020 were taken for this study. The epidemiological details, vaccination status, clinical profile, routine blood investigations along with SGOT, ECG, treatment given, and interventions done with outcome were studied. Results: The common symptoms observed were throat pain seen in 26 cases (79%), fever seen in 25 cases (76%), dysphagia seen in 24 cases (75%), bull neck seen in 18 cases (55%), and palpitations seen in 06 cases (18%). Of the 33 patients, 4 (12%) patients had completed vaccination, 29 (88%) cases were either unimmunized or partially immunized as per their age. The complications observed were cardiac involvement evident through elevated serum transaminase and ECG changes seen in 06 cases (18%), neurological involvement seen in 05 cases (15%), renal failure seen in 04 cases (12%), thrombocytopenia seen in 02 cases (6%), and bleeding seen in 01 case (3%). Tracheostomy due to airway compromise required in six cases. A total number of nine (29%) patients died with complications. Conclusion: Diphtheria incidence is relatively more in the age-group >5 years. The common symptoms are throat pain followed by fever, dysphagia, and bull neck. Common complications observed are myocarditis associated with high mortality, palatal palsy, renal failure, and thrombocytopenia. An increase in vaccination coverage is an effective preventive measure to reduce the incidence of diphtheria.

Aim and objective: To assess parental perceptions of COVID-19 vaccination in children. Materials and methods: An anonymous survey on COVID-19 vaccination in children was sent to 3,900 parents. Parents were divided into three groups and compared. Results: Over two-thirds of parents (70.7%) were willing to vaccinate their child immediately which changed to 94.1% if clinical trials were completed and results were published. Half of the parents said they would be willing to send their child to school in person, after a successful vaccination rollout. Further measures required by other parents included maintaining proper social distancing, mandatory masks, and those schools would be run in a hybrid (part online, part offline) manner. 91.7% of parents were willing to pay for their child to be vaccinated. Hospitals and clinics were preferred sites by parents to have their children vaccinated. Conclusion: Clinical trials involving children are important for a successful COVID-19 rollout in children. It is also seen that most parents would require extra measures to be implemented even after vaccination to be comfortable in sending their child to school.

Skin and soft tissue infections (SSTIs) are common in the pediatric age-group in developing countries, where the risk factors are commonplace. These SSTIs may be classified for ease of management, into uncomplicated (uSSTI) and complicated SSTIs (cSSTI). Folliculitis, furuncles, impetigo, ecthyma, and erysipelas are grouped under uSSTI, whereas abscess, carbuncle, and cellulitis come under cSSTI. Most of them are secondary to Staphylococcus aureus and group I beta-hemolytic Streptococci. Antibiotic treatment must be based on antimicrobial sensitivities and local community resistance patterns. Antibiotics like beta-lactams, first-generation cephalosporins, trimethoprim-sulfamethoxazole, and clindamycin are effective in most patients. However, methicillin-resistant Staphylococcus aureus (MRSA) is a serious concern in cases worldwide, including India. Newer molecules like dalbavancin, telavancin, tigecycline, ceftaroline, and tedizolid are emerging.

Background: Diphtheria is a vaccine-preventable disease despite universal immunization programs, outbreaks are reported from many Indian states with low immunization coverage since the last decade. Timely intervention and administration of diphtheria antitoxin (DAT) is the mainstay of treatment. Aim material, and methods: In Uttarakhand state, an outbreak of diphtheria in the Bageshwar district was reported in August 2020 which resulted in high mortality due to limited resources, complications, and non-availability of DAT. Here, we describe the clinical-laboratory profile, the outcome of four patients admitted in our hospital who received DAT since October 2020, and also the intervention done by district and state authorities for prevention and early detection of diphtheria outbreaks along with to review the efficacy of the immunization program in the district. Conclusion and significance: Diphtheria is still prevalent in our state; strict epidemiological surveillance for case detection and strengthening of immunization is needful. Timely management with empirical antibiotics with DAT results in a favorable prognosis.

Background: Fungal paranasal sinusitis most commonly observed infection in immunocompromised hosts or patients with uncontrolled diabetes mellitus. In immunocompromised hosts like patients with leukemia on chemotherapy, it can become life-threatening infection. Case description: We present a case report of a 6-year-old male child who presented as a case of febrile neutropenia. Diagnosis of invasive paranasal sinusitis by Aspergillus fumigatus was made and treatment with voriconazole commenced. But due to underlying refractory leukemia the child succumbed. Conclusion: A high index of suspicion of invasive aspergillosis (IA) should be kept in the mind with careful clinical examination should be done in acute lymphoblastic leukemia (ALL) patients with prolonged duration of neutropenia. Clinical significance: Importance of early diagnosis of fungal sinusitis and early initiation of treatment in leukemic patients.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon life-threatening hypersensitivity drug reaction characterized by fever, rash, lymphadenopathy, and internal organ involvement occurring 2–8 weeks after the initiation of the offending drug. It is a clinical diagnosis and management involves the prompt withdrawal of the drug. We report a 2 years 7 months old child who presented with DRESS syndrome after the introduction of multiple antibiotics and improved after withdrawal of all the antibiotics and initiation of systemic corticosteroid.

Enteric fever is a community-acquired generalized bacteremic infection of the topical countries where health infrastructure and hygienic conditions are compromised to a great extent due to poor public health facilities and low socioeconomic status. It is associated with the involvement of the reticuloendothelial system, intestinal lymphoid tissue, and even the gallbladder. Ever-increasing antimicrobial resistance, increasing number of cases in younger children, and increasing paratyphoid cases are the current challenges. Though the management of typhoid fever is straight forward, it poses a number of diagnostic challenges and dilemma due to many reasons which include lack of sensitivity and specificity of clinical features and CBC parameters, overreliance on serology despite its limitations, non-feasibility of culture methods, underutilization of blood culture despite its availability, and poor yield due to prior antibiotic therapy. Classic presentation may not be always there. CBC has more of a negative predictive value. Blood culture is the gold standard but may not always be feasible and results are available by day 4. A rapid, point-of-care test with very good sensitivity and specificity is needed to detect acute cases as well as carriers.