Background: Diagnosis of incomplete Kawasaki disease (KD) is a clinical challenge in the absence of a specific diagnostic test. Diagnosis of KD is based mainly on the typical constellation of clinical signs and symptoms. Incomplete KD is much more difficult to diagnose because they present with fewer clinical features. Hence, diagnosis and treatment are often delayed in such cases and the response to treatment with intravenous immunoglobulin (IVIg) is poor. A high index of suspicion is necessary to diagnose and manage the children presenting as incomplete KD. Objectives: To study the clinical spectrum of incomplete KD and to assess the response to IVIg therapy. Materials and methods: A retrospective cohort study of children with incomplete KD at a tertiary care hospital from January 2010 to April 2018. Diagnosis and treatment were based on American Heart Association (AHA) guidelines. Results: Fifty-four out of 94 KD cases were incomplete KD (57.4%). Most of the incomplete KD cases were in infants (48.1%). The mean duration of fever at diagnosis was 6.3 days in complete KD and 6.9 days in incomplete KD. Clinical manifestations were oral mucosal changes (79.6%), conjunctival injection (68.5%), and polymorphous exanthema (64.8%). Less common clinical manifestations were extremity changes (14.8%), cervical lymphadenopathy (33.3%), irritability (53.7%), diarrhea (31.4%), vomiting (20.3%), and Bacillus Calmette-Guerin (BCG) scar flare-up (11.1%). Coronary artery abnormality (CAA) was detected in 27 cases (50%). Forty-nine out of 54 cases showed clinical resolution to IVIg (90.7%), 5 were resistant to the first dose of IVIg, 4 responded to the second dose of IVIg, and 1 required infliximab. Conclusion: Incomplete KD is more often associated with CAA. Clinicians should have a high index of suspicion when fever persists for 5 days or more and is associated with any of the principal clinical manifestations. Few laboratory tests and echocardiography may assist in the early diagnosis and treatment. The majority of the children responded to IVIg.

Objective: Probiotics have been researched extensively over the past few years for the prevention and treatment of diarrhea in pediatric populations. In the present study, the efficacy and safety of probiotic Bacillus subtilis HU58 and probiotic Bacillus coagulans SC208 in combination were evaluated in children for the treatment of acute diarrhea. Materials and Methods: In this randomized, double-blind, parallel, placebo-controlled trial, 64 children with average age of 4.18 ± 3.0 years (mean ± standard deviation), out of which 32 children with antibiotic-associated diarrhea (AAD) and 32 children with acute infective diarrhea randomly received either syrup containing B. subtilis HU58 and B. coagulans SC208 probiotics or placebo syrup daily for a period of 7 days. Stool consistency, duration of diarrhea in days, and abdominal pain intensity during the treatment period, were assessed daily in all subjects for the improvement in clinical signs and symptoms. Also, an assessment of adverse events was done from the screening visit to the end of study visit. Result: A total of 32 subjects were screened and randomized in both cohort 1 and cohort 2. At the end of the study, that is, on day 7, B. subtilis HU58 + B. coagulans SC208 syrup-treated subjects in both cohorts showed significant improvement in stool consistency and duration of diarrhea over placebo syrup. No adverse events were observed in the study of both cohorts. Conclusion: This study's results conclude that B. subtilis HU58 and B. coagulans SC208 syrup improved the recovery and reduced the course of acute infectious diarrhea and AAD in children, with no reported adverse effects.

Study of the Immunization Status and Reasons for Incomplete Vaccination of Children Attending an Urban Hospital Introduction: Immunization is one of the main health interventions to prevent childhood morbidity and mortality. Need of the study: We noticed that the vaccination status of the children admitted in our hospital differed markedly from what was recommended by the Indian Academy of Pediatrics (IAP), despite most of the families living in the city and having access to health care. Objective:The study was conducted in order to assess the magnitude of the problem and the factors affecting the immunization status of the children. Materials and methods: Children between the age of 6 weeks to 18 years attending an urban hospital were included in study, which was conducted for a period of 9 months from September 1, 2017 to May 31, 2018. The IAP 2016 Immunization Guidelines were taken as the standard. Based on these guidelines, children were categorized as completely immunized, partially immunized, or unimmunized for their age depending on the level of immunization they had received. Result: A total of 378 children were included in the study. We found that 32.3% (122) children were completely immunized and 67.7% (256) of children were partially immunized. The most common reasons for partial/nonvaccination included (a) unawareness of the need for vaccination, followed by (b) financial constraints, (c) child being ill, and (d) postponing vaccination to another time for no apparent reason. Completion of schedule of vaccines that requires multiple doses (e.g., OPV and DPT or Pentavalent) remains a major challenge toward achieving higher full immunization coverage.

Background: Acute bronchiolitis is the commonest cause of lower respiratory tract infection in children under 2 years of age. There are no prospective studies in south India, which depict the viral epidemiology of bronchiolitis. Therefore, we undertook this prospective study of all the children <2 years who were admitted with suspected lower respiratory tract infection. Aim and objective: To determine the exact viral etiology in children aged <2 years with clinical suspicion of bronchiolitis. Design: Prospective observational study. Setting: A single-center study was conducted in Narayana Health City, Bengaluru. Fifty children aged <2 years with a clinical suspicion of bronchiolitis were included in the study and their nasopharyngeal swab were sent for multiplex PCR viral panel. The data were analyzed and results were reported. Results: Forty-six out of 50 children who were clinically suspected to have viral bronchiolitis showed positive result on nasopharyngeal swab PCR study. Among them 33 had single viral infection while 13 had multiple viral infections. Respiratory syncytial virus (RSV) was the most common virus involved followed by rhinovirus and parainfluenza virus. The clinical signs and symptoms had a good correlation with the laboratory diagnosis of viral bronchiolitis. Conclusion: There is an extremely good correlation between clinical features of acute viral bronchiolitis with their laboratory diagnosis. Good clinical history and physical examination can avoid undue use of antibiotics in children <2 years.

Kawasaki disease (KD) is a multisystemic childhood vasculitis that predominantly affects the coronary arteries. The constellation of clinical features in KD, such as, acute onset of fever, redness of lips and oral mucosa, rash, swelling over palms and feet, cervical adenopathy, and perineal peeling followed by periungual peeling suggests an infection or toxin-mediated etiology. Occurrence of cases in clusters and epidemics also support an infectious etiology for KD. Many infectious agents—bacteria, fungi, and viruses—are reported to be associated with KD. This review article gives a comprehensive overview of available literature that supports an infective etiology for KD.

Amidst increasing concerns of children presenting with multisystem inflammatory syndrome (MIS) simulating Kawasaki disease, we report a child with MIS-C presented with abdominal pain and fever. A 9-year-old child presented with acute febrile illness, abdominal pain, and later had skin rash with mild bulbar conjunctivitis, oral mucosal erythema, and posterior pharyngeal congestion. Investigations showed high inflammatory markers, leukopenia with neutrophil predominance with high CRP (205 mg/L), ESR (89), D-dimer, and ferritin. Reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative, but antibodies for SARS-CoV-2 was strongly reactive. During hospital stay, he developed arthralgia and tachypnea requiring oxygen. He was treated with oxygen, IV immunoglobulins, aspirin, steroids, and low-molecular-weight (LMW) heparin. Child has responded well, with fever and rash subsiding in 24 hours and no further complications.

Transient neonatal cholestasis (NC) is characterized by early-onset cholestasis and normalization of clinical and biochemical parameters at follow-up. The causes are multifactorial and include immature bile secretion (as in the case of prematurity) and other perinatal causes. Sepsis is responsible for 20% of cases of NC. It is mandatory to rule out other causes of NC before labeling the neonate as having transient NC. The use of ursodeoxycholic acid in cholestasis has been advocated to bring a faster decline in direct bilirubin levels in neonates. Neonates have to be evaluated early considering associated risk factors so that early intervention could prevent complications and yield better outcomes.

Pseudomonas aeruginosa is an opportunistic infectious agent, which is known to cause severe urinary tract infections (UTI) in children. As these organisms are intrinsically resistant to commonly used antibacterial and because new resistances develop while on treatment, infections caused by these organisms are difficult to treat. This case highlights the risk factors for the development of UTI by this organism, the need for periodic updation of local hospital antibiograms for this emerging infection, and suggests a revisit into recommendations for indications for invasive urinary tract procedures like micturating cystourethrogram (MCU) and UTI prophylaxis.