Pediatric Infectious Disease

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2023 | July-September | Volume 5 | Issue 3

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Original Article

Keyur D Mahajan, Rajan Joshi

Correlation of Laboratory Profile and Clinical Features in Dengue Viral Illness in the Pediatric Population: A Retrospective Analysis

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:8] [Pages No:71 - 78]

Keywords: Clinical features in pediatric dengue, Dengue fever, Laboratory profile in pediatric dengue, Serum ferritin in dengue

   DOI: 10.5005/jp-journals-10081-1395  |  Open Access |  How to cite  | 

Abstract

Objective: To study the correlation between laboratory profile and clinical features in dengue viral illness in the pediatric population. Materials and methods: A retrospective study was conducted on pediatric patients, ranging from 0 to 16 years old, diagnosed with dengue viral illness and admitted to the pediatric care unit between January and December of 2022. The outcome of interest measured was the correlation between laboratory profile and clinical features of dengue patients. Depending on data distribution, appropriate tests were applied for analysis. Data were collected from hospital software records according to the set pro forma. The medical notes and the Laboratory Information System were evaluated using a tool for standard assessment. Conclusion: The presentation of dengue viral illness can vary, and it is crucial to diagnose it early for effective patient management. Upon admission, common clinical presentations include fever, nausea, vomiting, abdominal pain, body ache, leg pains, and retro-orbital pain. However, there was no association between presenting complaints and progression to severe illness. Although all five patients who died from the disease were females, it is inconclusive if sex is a significant risk factor for severe disease. Likewise, the patient's age has no association with the progression to severe disease. Platelet count, serum (Sr) albumin, Sr glutamic-oxaloacetic transaminase (SGOT)/Sr glutamic pyruvic transaminase (SGPT), prothrombin time (PT) international normalized ratio (INR), and Sr ferritin levels are all excellent predictors of prognosis for severe dengue. Peak Sr ferritin levels indicating the highest immune response were seen on day 5 of illness and were not affected by the age or sex of the patient.

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Original Article

Purbasha Gupta, Subhojit D Sarkar, Mohini Bhelo, Anurag Mondal, Priyankar Pal

Analysis of Clinicopathological Characteristics and Treatment Modalities in Multisystem Inflammatory Syndrome in Children: An Eastern Indian Cohort

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:5] [Pages No:79 - 83]

Keywords: Intravenous immunoglobulin, Methylprednisolone, Multisystem inflammatory syndrome in children, Myocarditis, Pediatric inflammatory multisystem syndrome, Post-coronavirus disease 2019 hyperinflammation

   DOI: 10.5005/jp-journals-10081-1396  |  Open Access |  How to cite  | 

Abstract

Aim: Document and analyze our experiences from eastern India pertaining to multisystem inflammatory syndrome in children (MISC), which is a novel disease entity with variable presentations and varying treatment guidelines. Materials and methods: Observational cohort study on children diagnosed with MISC by the World Health Organization (WHO) criteria at the Institute of Child Health (ICH) Kolkata from July to December 2020. History, clinical findings, laboratory investigations, including imaging, and response to different therapeutic modalities were noted, and postdischarge follow-up data for 6 months were recorded and subsequently analyzed. Results: A total of 75 children with a median age of 11 years [interquartile range (IQR): 3 years] were included. All presented with fever. 86% had erythematous maculopapular rashes. Gastrointestinal complaints were present in about 30%. Central nervous system (CNS) affection varied from extreme irritability in 63% to drowsiness in 18%. Around 42.67% needed intensive care, and 28% required inotropic support. Cardiac affection was detected in 57.74%, mostly as myocarditis, and 27% had coronary artery dilatations (CAAs). About 20% required respiratory support, and four had to be ventilated. Significant laboratory investigations included neutrophilia, very high C-reactive protein (CRP) (mean 186.8 mg/L), and pro B-type natriuretic peptide (NT-proBNP) (mean 10370 pg/mL). Coronavirus disease 2019 (COVID-19) immunoglobulin (IgG) was positive in 91%. A total of 90.6% received intravenous Ig (IVIg), and 57.3 received methylprednisolone (MP) + IVIg. The dosage of MP varied from 2 to 30 mg/kg; doses were individualized depending on the clinical severity. All of the patients survived and had normalization of cardiac lesions on follow-up. Conclusion: Multisystem inflammatory syndrome in children (MISC) is a hyperinflammatory disease with variable presentations, often requiring intensive care management. Early identification and immediate administration of steroids/IVIg revert the stormy progression, usually without significant residual morbidity.

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REVIEW ARTICLE

Keyur D Mahajan

“Prevention of Group B Streptococcus by Vaccination,” Will It Transform Maternal and Neonatal Health?

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:6] [Pages No:84 - 89]

Keywords: Antenatal immunization, Group B Streptococcus, Immunization against group B Streptococcus, Intrapartum antibiotic prophylaxis

   DOI: 10.5005/jp-journals-10081-1399  |  Open Access |  How to cite  | 

Abstract

Objective: Group B Streptococcus (GBS) is a leading cause of sepsis, leading to neonatal mortality and morbidity all over the world. Intrapartum antibiotic prophylaxis is the current main modality for the prevention of perinatal transmission of GBS infection. We want to discuss whether antenatal vaccination is an intervention that can help to reduce the GBS burden and improve maternal and neonatal health. Conclusion: The GBS vaccine given during pregnancy is undoubtedly the key to lowering newborn mortality, but we must exercise extreme caution while using it. More study is required to fill in the knowledge gaps and better understand the numerous components of prenatal immunization for improving both mother and baby's health.

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CASE REPORT

Vinitha Arjula, Mounica Adari, Sudharshan Raj Chitgupikar

A Rare Case of Congenital Syphilis Presented with Pneumonia alba

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:3] [Pages No:90 - 92]

Keywords: Case report, Congenital syphilis, Intrauterine growth retardation, Pneumonia alba, Treponema pallidum

   DOI: 10.5005/jp-journals-10081-1401  |  Open Access |  How to cite  | 

Abstract

Congenital syphilis is an infectious disease primarily caused by the hematogenous transmission of Treponema pallidum, a spirochete bacterium, from an infected mother to the fetus through the placenta during pregnancy. In the present era, congenital syphilis manifests as prematurity intrauterine growth retardation (IUGR) and can develop as acute systemic illness (Pneumonia alba, nonimmune hydrops), bone deformities, developmental disabilities, blindness, or deafness immediately or later in life. We report an infant diagnosed with congenital syphilis with IUGR and pneumonia at birth. This case reveals that there is an incidence of missed prevention and the importance of awareness and maternal screening for syphilis in the antenatal period.

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CASE REPORT

Keerthana Menon, Swati Narasimhan, Shruthi Natarajan, Padmasani V Ramanan

A Case Report on Pneumococcal Sepsis with Incomplete Kawasaki Disease

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:7] [Pages No:93 - 99]

Keywords: Immunization, Incomplete Kawasaki disease, Pneumococcal infection

   DOI: 10.5005/jp-journals-10081-1392  |  Open Access |  How to cite  | 

Abstract

Background: Kawasaki disease (KD) is a multisystem vasculitis which occurs due to various infectious triggers causing an abnormal immunological response. There are very few case reports on KD with pneumococcal infection. We report a case of pneumococcal sepsis associated with KD. Case description: A 11-month-old girl was referred to our hospital with a history of fever and cough for 10 days and one episode of seizure on day 1 of fever. She had not been immunized with the pneumococcal conjugate vaccine (PCV). On examination, she was irritable and tachypneic and had crepitations on the left infrascapular and infra-axillary regions on auscultation. A diagnosis of pneumonia was made. Chest X-ray revealed left lobar consolidation. Blood culture showed Streptococcus pneumoniae 19A growth. In view of the history of seizures and the child's irritability, an magnetic resonance imaging (MRI) brain with contrast was done to rule out intracranial infection and was found to be normal. In view of persistent fever, no response to antibiotics, marked irritability, and investigations showing leukocytosis, anemia, thrombocytosis, elevated inflammatory markers, incomplete KD was suspected. Echocardiogram (ECHO) showed left main coronary artery dilatation. She was treated with intravenous immunoglobulin (Ig) and aspirin. The fever resolved within 24 hours, and the child became playful. She was discharged on oral amoxicillin and aspirin. Clinical significance: We emphasize the need for pneumococcal vaccination (PCV13) for all children to prevent infection and infection-triggered complications.

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CASE REPORT

Ravi Chirag, Bharath Jayachandra, Thirunavukkarasu Arun Babu

Necrotic Lymphadenopathy in a 12-year-old Boy with Enteric Fever: An Uncommon Presentation

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:2] [Pages No:100 - 101]

Keywords: Case report, Enteric fever, Lymphadenopathy, Necrotic, Pediatric, Salmonella

   DOI: 10.5005/jp-journals-10081-1400  |  Open Access |  How to cite  | 

Abstract

This case report describes a 12-year-old boy who presented with high-grade fever, joint pain, abdominal pain, and general weakness. The Widal test showed positive results with ‘O’ and ‘H’ antibody titers of 1:320. Additionally, the blood culture report confirmed the growth of Salmonella typhi, leading to the diagnosis of enteric fever. An abdominal ultrasound (USG) was performed due to severe abdominal pain, revealing the presence of multiple discrete necrotic lymph nodes in the right subhepatic and right iliac fossa, with the largest node measuring 1.6 cm. The child was treated with ceftriaxone (1 gm twice daily) and azithromycin (20 mg/kg), resulting in a gradual improvement of symptoms. To the best of our knowledge, this is the first reported case of necrotic lymphadenopathy in enteric fever confirmed by abdominal imaging in the pediatric population.

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Immunology Corner

Neha Singh, Sagar Bhattad

Lymphoproliferation: How do You Evaluate for an Immune Deficiency?

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:3] [Pages No:102 - 104]

Keywords: Immune dysregulation, Inborn errors of Immunity, Lymphoproliferation

   DOI: 10.5005/jp-journals-10081-1397  |  Open Access |  How to cite  | 

Abstract

Lymphoproliferation (LP) refers to the excessive proliferation of lymphocytes, causing nodal and extranodal infiltration triggered by infection, malignancy, and inflammation. LP in patients with inborn errors of immunity (IEI) could have different connotations based on the type of IEI. When LP is the presenting complaint, the diagnosis of IEI is often delayed. In this article, we discuss LP as the key manifestation in patients with IEI and present a few clinical cases highlighting the different patterns of LP in IEI.

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Journal Watch

MIS-C and More

[Year:2023] [Month:July-September] [Volume:5] [Number:3] [Pages:4] [Pages No:105 - 108]

Keywords: Extended-spectrum beta-lactamase-producing Enterobacteriaceae, Multisystem inflammatory syndrome in children, Neonatal infections, Tuberculosis preventative therapy, Viral-only diarrhea

   DOI: 10.5005/jp-journals-10081-1398  |  Open Access |  How to cite  | 

Abstract

This PID journal watch provides valuable insights into various aspects of infectious diseases and antibiotic resistance. It highlights the need for continued research, improved diagnostic strategies, and targeted interventions to effectively combat these national and global health challenges. The findings from these journal articles contribute to the growing body of knowledge in the field and can inform clinical practice and public health policies.

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