Background: Scrub typhus is an important differential cause of acute undifferentiated febrile illness in the pediatric age-group. Diagnosis of scrub typhus is made by evaluating a child's history of exposure, clinical spectrum, and results of serologic testing. A high degree of clinical suspicion leading to early diagnosis and timely intervention has greatly reduced mortality due to various associated complications. This study aimed to study the epidemiological profile and outcome predictors for scrub typhus in admitted children in a tertiary care academic hospital in the Indian sub-Himalayan region. Methods: It was a cross-sectional study enrolling children aged 1 month to 18 years, diagnosed with scrub typhus based on IgM ELISA between January 2019 and December 2021. Detailed history, clinical examination findings, laboratory profile, complications, and outcomes were recorded and analyzed accordingly. Results: A total of 82 children were enrolled with 63.4% belonging to the 11–18 years age-group. High admission rates were observed in the months of May to August and September to December. Common presenting symptoms were fever (100%), nausea/vomiting (35.4%), headache (25.6%), shortness of breath (25.6%), pain abdomen (18.3%), and altered sensorium (9.8%); while classical eschar was seen in only 3.7% children. On examination, children had generalized lymphadenopathy, hepatosplenomegaly, hypotension, ascites, periorbital edema, maculopapular rash, and meningeal signs. The most common associated complications were septic shock, acute respiratory distress syndrome (ARDS), myocarditis, meningoencephalitis, and multiple organ dysfunction syndrome (MODS). The median duration of defervescence after starting antimicrobial therapy was 4 days. Children presenting with shock, ARDS, MODS, and meningoencephalitis had a statistically significant unfavorable outcome. Conclusion: Pediatric scrub typhus is a common infection in sub-Himalayan terrain. Physicians should be sensitized regarding symptoms, signs, and risk factors of scrub typhus. All cases of febrile illness should be evaluated for scrub typhus. As early detection and timely management lead to a higher recovery rate and prevention of complications; the present study would help clinicians identify severe cases and manage them accordingly.

Aims and background: Measles has made an unwelcome comeback as a resurgent infection and India is one of the worst-hit countries. The present study was undertaken to study clinicodemographic profile of measles and the reason for nonvaccination due to COVID-19 lockdown as risk factor for recent outbreak of measles. Materials and methods: This was a hospital-based cross-sectional study carried out in the pediatric ward of Shardaben Hospital, which is a tertiary care center. Patients between 1 month and 12 years of age admitted to hospital between April 2022 and January 2023 were included in the study. Measles was clinically defined according to the World Health Organization (WHO) criteria. Detailed history was taken, physical examination was done, and the outcome was studied. The data was analyzed and descriptive statistics were presented using percentages. Results: It was observed that out of the total admitted cases 4,893, there were 657 cases of measles with prevalence is 13.4%. From the table, it is suggested that highest attack rate of measles is 63.92% and more in children between 9 months and 5 years. Maximum number of cases is 67.57%, found in lower and lower middle socioeconomic classes and also 76.56% in urban slums. Measles is more in people residing in overcrowding, 37.2%. Number of cases of measles peaked in October (134 cases) and declined in January (34 cases). It was found that 78.34% of cases are partially or unvaccinated. Around 21% cases had documented history of having taken two doses of measles-containing vaccine. COVID-19 pandemic and its lockdown were responsible for 67.2% of cases of nonvaccination. Other reasons not to be vaccinated are also mentioned. Postmeasles complication like pneumonia is seen in 384 patients, out of which 74.2% were unvaccinated or partially vaccinated. Majority of the patients had either moderate acute malnutrition (264 cases) or severe acute malnutrition (371 cases). Conclusion: There is an urgent need to strengthen not only our Measles–Rubella (MR) vaccine drive but also overall routine immunization; otherwise, another vaccine-preventable disease like whooping cough may stare at us in 2023 too. Clinical significance: Resurgence of measles in Ahmedabad was restricted to malnourished, unvaccinated/partially vaccinated, and poor children living in slums/chawls with overcrowding. Intensified MR vaccination campaign in these pockets seems to be a sure-shot way to prevent measles outbreaks.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in multisystem inflammatory syndrome in children (MIS-C). It manifests later in the course of SARS-CoV-2 infection and presents with higher severity. Aim: To describe the clinical spectrum of illness and to compare the clinical profile, management and outcome in two age groups; upto 5 years and >5 years. Materials and methods: Observational study. Children satisfying World Health Organization (WHO) MIS-C criteria admitted in the hospital during the study period were included in the study. Results: A total of 44 children were included in the study. The median age was 6.5 years, interquartile range (IQR) was 3.92 to 10 years. Gastrointestinal symptoms were the commonest presentation, 70.45%. Gastrointestinal symptoms and shock were seen in children of >5 years and the difference was statistically significant. Hyperferritinemia and lymphopenia were statistically significant in the older age group. Intravenous immunoglobulin (IVIG) was used in 88.24% of children up to 5 years of age group. Around 55.56% of children of >5 years were managed with steroids alone. Conclusion: The course and short-term outcome of MIS-C are generally favorable.

Introduction: Vancomycin is effective against gram-positive bacteria including staphylococcus aureus which are resistant to methicillin. Vancomycin has a narrow therapeutic range and is associated with adverse drug reactions related to iv infusion, nephrotoxicity and ototoxicity. Drug therapeutic level monitoring of this ambiguous drug is important, as a low therapeutic level will not be effective against multidrug-resistant bacteria and a higher drug level may lead to adverse drug reactions mainly renal damage. Hence therapeutic drug monitoring (TDM) of vancomycin becomes very crucial. Objective: To discuss the TDM of vancomycin guidelines. Discussion: This guideline includes indications of TDM, vancomycin target AUC/MIC (Area Under Curve over 24 hours/Minimum Inhibitory Concentration) ratio should be 400–600 mg/hour. In case of a MIC value of >1 mg/L, the guideline recommends changing the therapy. In critically ill patient loading dose can be considered. When conventional intermittent infusion fails to reach adequate therapeutic drug level continuous infusion of vancomycin is recommended. Children above the age of 3 months with suspected MRSA sepsis should receive vancomycin 60–80 mg/kg/day (should not increase >3600 mg/day) in three to four divided doses, considering they have normal renal function. Vancomycin dose should not increase >100 mg/kg/day which is more likely to surpass the threshold level. In the case of obese patients and patients on dialysis therapeutic monitoring and changing the dosage according to that is more important. Conclusion: Vancomycin has a narrow therapeutic index. Low therapeutic levels can lead to treatment failure, and a higher level can lead to adverse effects. This article stresses the need for therapeutic monitoring of vancomycin, especially in children who are critically ill, who have compromised renal function, and those receiving other renal toxic drugs.

Introduction: The acquired myasthenia gravis (MG) is an autoimmune neuromuscular junction (NMJ) disorder. Thymomas and thymic carcinomas are extremely rare in children. We are reporting a rare case of MG following the coronavirus disease 2019 (COVID-19) infection. Case description: A 10-year-old girl presented with difficulty in getting up from sitting, swallowing, and drooping of eyelids. Weakness was more in the evening. On examination, bilateral ptosis had a power of 2/5 in the proximal and 3/5 in the distal group of muscle. There was a history of COVID-19 infection 45 days ago. Investigations revealed a decremental response in repetitive nerve stimulation. The neostigmine challenge test noted improvement in ptosis and weakness. Computed tomography (CT) showed a large thymic lesion. Antibody to the acetylcholine receptor (AChR) and COVID-19 spike protein was positive. Treated with oral pyridostigmine, steroids, and thymectomy, and showed significant improvement in power. Histopathology of the excised mediastinal mass revealed type B2 thymoma. Conclusion: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can precipitate MG in the underlying thymoma.

Congenital tuberculosis (CTB) is a rare and challenging diagnosis with high mortality. As one of the many differentials for newborn sepsis, it should be considered when neonates deteriorate despite broad-spectrum antibiotics. We present a case of a day 19, full-term Indian male neonate with fever, respiratory distress, and abdominal complaints. The response to antibiotics and supportive treatment was not encouraging, so he was evaluated for CTB which revealed disseminated lesions in the lungs, liver, and spleen with abdominal lymphadenopathy. Genexpert CB-NAAT test for Mycobacterium tuberculosis (MTB) DNA was positive. The neonate responded well on antitubercular therapy (ATT). We could not find the source of infection despite extensive evaluation of close contacts including the mother. We conclude that CTB should be taken into consideration when neonates with sepsis respond poorly to antimicrobial treatment in TB-endemic areas. Diagnostic workup should include obtaining a gastric aspirate sample for the detection of MTB DNA via PCR, and a thorough evaluation of the mother.

Bacillus Calmette-Guérin (BCG) is a live bacterial vaccine of Mycobacterium bovis to prevent tuberculosis (TB). It is given at birth or as early as possible according to the national immunization schedule. Usually, BCG is well tolerated. Severe adverse events following BCG vaccinations include local abscess, ulceration, and suppurative abscess. Disseminated BCGosis is the most devastating adverse event with a high fatality rate. It is seen most commonly in infants with primary immunodeficiencies or infants born with human immunodeficiency virus (HIV) infection. Here we present a 7-month female child who presented initially with BCG adenitis and was later diagnosed with disseminated mycobacterial infection; hence investigated, and the diagnosis was confirmed as severe combined immunodeficiency (SCID).

Tuberculosis (TB) involving the musculoskeletal system is unusual. An acute and multifocal noncontiguous presentation is diagnostically challenging as it simulates various other infections, hematological malignancies, and secondaries. In this study, we report a rare record of a 14-year-old girl who presented with multiple focal swellings on her body within a short duration of 6 days. The tuberculin skin test was exaggerated and the cartridge-based nucleic acid amplification test (CBNAAT) of the granulomatous aspirate revealed rifampicin-resistant TB. Magnetic resonance imaging (MRI) showed swellings with underlying bone erosions and cultures of pus aspirate from the right shoulder region turned out to be Rifampicin and Isoniazid resistant TB.

Splenic infarct is an extremely rare complication of enteric fever in children. It could be misdiagnosed as a splenic abscess where computed tomography (CT) has to be used over ultrasonography to confirm the diagnosis. We reported a young girl who was presented with fever and abdominal pain whose diagnosis of enteric fever was made by Widal and blood culture. She had pain over the upper left abdomen; ultrasonography revealed a splenic abscess; however, the clinical course of the patient doubted the diagnosis for which CT was done, which confirmed the lesion as splenic infarct.