Aim and background: Fungal infections have emerged as a significant cause of late-onset neonatal sepsis in the last two decades. Epidemiological data on fungal sepsis in neonates especially in the Indian population is scarce. This study aims to determine the epidemiological trend of neonatal fungal infection, the organisms, and their susceptibility pattern to the different antifungal agents and additionally to look for the various risk factors, clinical features, and laboratory manifestation of fungal sepsis in neonates. Materials and methods: This is a retrospective observational study conducted in the NICU of a pediatric tertiary care hospital in Kolkata from January 2018 to December 2020. All the neonates who had a blood culture positive for Candida were included in the study. The type of organisms and susceptibility pattern to antifungal agents were noted. The clinical details like the age and sex of the neonate, gestational age at delivery, birth weight, and other predisposing risk factors like intravascular devices, mechanical ventilation, parenteral nutrition, and the laboratory parameters were noted. Results: Seventy-nine neonates whose blood culture was positive for Candida species were included in the study. Out of them, 65% were preterm (n = 52) and 67% were low birth weight (LBW). The chief presenting feature of the neonates was abdominal distension (39%), lethargy, refusal to feed (34%), respiratory distress (36%), convulsion (20%), and low-grade fever (5%). Sixty-one percent of the neonates required mechanical ventilation. Seventy-six percent (n = 60) of the babies were receiving parenteral nutrition with either peripheral or central line on the day blood culture was sent. Sixty-seven percent (n = 53) of the patients were diagnosed with fungal sepsis based on first blood culture on the day of admission (group I), whereas 33% (n = 26) were diagnosed after a few days of admission to NICU (group II). All the babies in group I were outborn and the average age of referral was day 7. In group II, 61.5% (n = 16) were outborn and 38.5% (n = 10) were inborn and the average age of positive fungal culture was day 12. Among the isolates, 43% were Candida pelliculosa, 31% were Candida parapsilosis, 8% were Candida famata, 7% were Candida tropicalis, 2.9% were Candida krusei, 5.7% Candida guilliermondii, and only 2.3% were Candida albicans. As per the culture sensitivity report, 13% (n = 10) of the Candida species were resistant to antifungal agent fluconazole but 100% were sensitive to voriconazole; 11% (n = 9) resistant to amphotericin B; 2.5% (n = 2) were intermediate sensitive, and 5% (n = 4) resistant to both caspofungin and micafungin. The general mortality rate was 32.9% (n = 26). The babies in group I had a higher mortality rate (37.7%) compared with the babies in group II (23%). Infection with C. tropicalis has the highest mortality (42.3%), followed by C. parapsilosis (30.7%) and C. pelliculosa (27%). Interpretation: Our study revealed that fungal infection in neonates is mostly due to non-albicans Candida species (97.3%), C. pelliculosa was found to be the commonest organism accounting for 43% of infection. Infection with C. tropicalis was associated with maximum mortality. Thirteen percent of the Candida species were resistant to the drug fluconazole, 11% were resistant to amphotericin B, 5% were resistant to caspofungin and micafungin, whereas all of the organisms were sensitive to voriconazole. Preterm, LBW, need for mechanical ventilation, parenteral nutrition, and broad-spectrum antibiotics play a significant role in fungal sepsis-related morbidity and mortality.

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis is a benign, usually self-limiting condition, that usually affects females under the age of 30 years. The etiology remains unknown. Methods: Analysis of all cases of KFD diagnosed at our center from January 2019 to March 2021 was carried out. A total of seven cases with KFD were included in the study. The clinical and laboratory parameters, associated comorbidities, and treatment outcomes were studied and analyzed in detail. Results: The mean age of presentation was 11 years with a female predominance. Fever and lymphadenopathy were noted in the majority; while weight loss and fatigue were noted in 5/7. One patient had a recurrence of KFD, whereas two sisters presented with familial KFD. Most patients had leukopenia and raised ESR at presentation. ANA was positive in 5/7 (71%) of patients, of which two had systemic lupus erythematous at presentation. Steroids were used in all except one patient. Conclusion: We hereby report our experience in the diagnosis and management of KFD and re-emphasize that KFD must be considered as a possibility in febrile children with lymphadenopathy.

Usage of antibiotics off-label, in neonates and children, is an important public health issue. An overwhelming number of antibiotics are marketed and prescribed without clear labeling for use in pediatrics. It presents an even larger and more complex issue in neonates, children younger than 2 years, and those with chronic and/or rare diseases due to a lack of good clinical trials in these pediatric subgroups. The purpose of off-label use is to benefit an individual patient. The article details the prevalence of off-label antibiotic use in pediatrics and the reasons for the same. An attempt is made to highlight the different recommendations for antibiotic use in two pediatric drug formularies, the non-availability of child-friendly formulations and the lack of studies on newer antibiotics in neonates and children that necessarily results in antibiotics being prescribed off-label in children.

There are very few guidelines available that focus on recommended diluents for intravenous (IV) administration of the various antimicrobial used in pediatric practices. This article attempts to detail ideal diluents for commonly used antimicrobials; the amount of diluent to be added for IV administration; analyze various methods of IV administration; explains how diluents could be reduced while treating children in whom fluid restriction improves outcome; and suggests methods of reducing wastage of costly antimicrobials and thereby economizes therapy of sick children.

We report three cases who presented with symptoms of upper airway obstruction that were secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These children showed no signs of lung parenchymal involvement initially. Our first patient presented with stridor with significant upper airway obstruction and respiratory failure and required emergency intubation followed by tracheostomy. The second child presenting as croup had only partial response to dexamethasone and adrenaline. The third child, who had presented with airway obstruction turned out to have a retropharyngeal collection, was found to be infected with SARS-CoV-2 on RT-PCR from a nasopharyngeal swab. Our cases represent the new presentation of coronavirus disease 2019 (COVID-19) in pediatric patients.

Childhood tuberculosis is a formidable problem in present times. Although the principles of diagnosis and treatment remain the same in children and adults, yet the dissimilarities in the pathology and the host bring up challenges while dealing with pediatric TB. Just as children are not miniature adults, TB in children is also not a miniature version of the adult form. Therefore, it becomes very important to be aware and highly suspicious of infection with tuberculosis especially in endemic countries like India. We present a case series of five cases of different presentations of tuberculosis in childhood. Only one among the five survived the illness and the other four succumbed to the disease. This study highlights the high prevalence and varied clinical spectrum of childhood tuberculosis in Mumbai city.

Guillain-Barré syndrome (GBS) is a common cause of acute weakness in children; in the majority of cases, a preceding infection can be identified. There is increasing evidence that coronaviruses can affect the central nervous system and present with varied neurological manifestations. The clinicians must be aware of the neuroinvasive properties of SARS-CoV-2 when caring for patients with COVID-19. We hereby report GBS in a toddler as a rare neurological manifestation of COVID-19.

Supplementary Video

Cerebrospinal fluid (CSF) study gives important clues to quick diagnosis and prompt management of neurologic disease, which is often life-threatening and disabling in young children. Following is a compilation of commonly done tests on CSF in pediatric infections or infection mimics.

Multi-dose vials are useful and economical when large numbers of patients need to be immunized. These multi-dose vials are invaluable in the National Immunization Programme vaccination days, as they save time and effort and also are economically viable. However, there could be wastage of doses of vaccines, due to uncertainty in knowing the duration of potency and effectiveness of opened vials. Hence, the open vial policy (OVP) that has been introduced by several global and Indian bodies will go a long way in reducing this wastage. The prerequisites of using the opened vials must be strictly implemented. Early audits after implementation have shown a reduction in vaccine wastage and better usage of resources