Pediatric Infectious Disease

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2024 | January-March | Volume 6 | Issue 1

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EDITORIAL

Vijay Yewale, Bhaskar Shenoy

Mumps Outbreak—Another Challenge?

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:2] [Pages No:iv - v]

   DOI: 10.5005/pid-6-1-iv  |  Open Access | 

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Original Article

Pankaj V Deshpande

Long-term Conservative Follow-up in Children with High-grade Vesicoureteral Reflux and an Abnormal Dimercaptosuccinic Acid Scan

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Circumcision, Dimercaptosuccinic acid scan, Micturating cystourethrogram, Prophylaxis, Vesicoureteral reflux

   DOI: 10.5005/jp-journals-10081-1417  |  Open Access |  How to cite  | 

Abstract

Aim: High-grade vesicoureteral reflux (VUR) with an abnormal dimercaptosuccinic acid (DMSA) scan is considered to be a high risk for recurrent urine infections (UTIs) and advised surgery in most parts of India to prevent the high risk of UTIs and renal damage. In this retrospective study, we looked at 82 children with high-grade VUR and abnormal DMSA, having conservative follow-ups, to determine if they had recurrent UTIs and what their renal function and growth were at the end of follow-ups. Materials and methods: Records of 82 children who were being followed up conservatively for high-grade VUR and an abnormal DMSA were seen for the number of UTIs, present kidney function and urine protein/creatinine ratio, and growth at follow-up, reason for micturating cystourethrogram (MCUG) and if circumcision had been done. The follow-up period was 3–19 years. Results: Only two children had developed UTIs amongst the 82 after stopping prophylaxis. All the children had normal growth, kidney function, blood pressure, and urine protein/creatinine ratio at follow-up. A total of 59 children (39 boys and 20 girls) (72%) had MCUG done after UTI while 20 (19 boys and one girl) (24%) children had it done for antenatal hydronephrosis (four of whom had developed UTI immediately after MCUG but had remained free of UTIs thereafter). Conclusion: Conservative management of high-grade VUR, either unilateral or bilateral, in children with an abnormal DMSA does not lead to recurrent severe UTIs. Prophylaxis can be stopped after a period of 6 months to 1 year, even in high-grade VUR. Repeated MCUG or DMSA scans seem unnecessary. Almost all boys remained well with no UTI without circumcision. All children have normal growth, kidney function, urine protein/creatinine ratio, and blood pressure at present. (15 years follow-up in 17 children). Clinical significance: Conservative follow-up in high-grade VUR with abnormal DMSA is not associated with recurrent UTIs in all patients and does not affect renal function or growth adversely.

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Original Article

Divya Priyadharshini, Mobill Clinton, Nandini Sethuraman, Mathrubootham Sridhar, Vidya Krishna

Clinical Profile and Prescription Patterns in Culture-proven Enteric Fever in Children

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:4] [Pages No:6 - 9]

Keywords: Culture-proven enteric fever, Drug susceptibility in enteric fever, Enteric fever in children, Prescription patterns in enteric fever, Salmonella typhi and paratyphi in Indian children

   DOI: 10.5005/jp-journals-10081-1408  |  Open Access |  How to cite  | 

Abstract

Aim: We aimed to study the clinical profile of enteric fever in children at an urban tertiary care children's hospital in South India. Materials and methods: We carried out a retrospective study of culture-proven enteric fever in children aged 0–18 years between January 2018 and March 2023. We included 128 children in total; 109 inpatients (85.2%) and 19 outpatients (14.8%). Results: Enteric fever accounted for 4.9% of nonrespiratory febrile admissions (n = 2,204). A total of 98 (76.5%) had Salmonella typhi (S. typhi), while 30 (23.5%) had Salmonella paratyphi (S. paratyphi) A in their blood. Leukopenia occurred in 28 (21.8%) patients. The average inpatient fever defervescence time was 4.62 days (range: 1–28 days). A total of 26 children (20.3%) experienced fever defervescence after 5 days. The mean C-reactive protein (CRP) was 58.2 mg/dL in the group with fever defervescence in <5 days and 63.3 mg/dL for >5 days (p = 0.540). Single antibiotic was used in only 25 children (19.5%). Mean fever defervescence time was 4.8 days in the single antibiotic group and 4.5 days in the combination group (p = 0.47), and in typhoid vs paratyphoid, it was 4.8 vs 3.3 days (p = 0.04). Conclusion: Salmonella paratyphi (S. paratyphi) caused 23.5% of culture-proven enteric fever cases. Most cases had normal leukocyte counts, eosinopenia, and elevated CRP. CRP does not predict fever defervescence. Fever typically resolved in 4–5 days, with paratyphoid fever resolving earlier. Combination therapy was used in over two-thirds of cases. Clinical significance: Salmonella paratyphi (S. paratyphi) is a significant cause of enteric fever in children. There seems to be no clear benefit for combination therapy from our small retrospective data, but study limitations preclude drawing accurate conclusions. Future areas of research interest will include an effective vaccine for paratyphoid fever and a randomized clinical trial on single vs combination therapy in enteric fever.

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Original Article

Apurva Kawdiya, Swati Bhalse, Gaurav Mogra, Kewal K Arora

Neonatal Intensive Care Unit Apocalypse—Rise of the World Health Organization Priority Pathogens

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:4] [Pages No:10 - 13]

Keywords: Antibiotic resistance, Neonatal sepsis, World Health Organization priority pathogens

   DOI: 10.5005/jp-journals-10081-1415  |  Open Access |  How to cite  | 

Abstract

Background: With higher neonatal survival, increasing neonatal intensive care unit (NICU) admissions, and rampant use of antibiotics, highly resistant organisms have become a major hurdle in the path of intact survival of neonates. In 2017, a list of World Health Organization (WHO) global priority pathogens (GPP) was released. Identifying the burden of these organisms in NICU will pave the way for devising further antibiotic strategies in their management. Aims and objectives: Primary objective was to study the burden of WHO GPPs and their antibiotic sensitivity pattern. Secondary objective was to assess their virulence by studying their outcome. Materials and methods: Retrospective data of positive blood cultures was collected for a period of 1.5 years (April 2022 to September 2023) from neonates admitted to the level three NICU of a medical college. Antibiotic sensitivity patterns and final outcome were noted. Results: A total of 105 positive blood cultures were analyzed. Of these, 64% (n = 68) amounted to WHO GPPs. These pathogens were more commonly associated with late-onset sepsis 63% (n = 43) and hence more likely to be nosocomial. Most of these (89%) were gram-negative. Of these, Klebsiella pneumoniae (carbapenem/third-generation cephalosporin-resistant) was the most commonly isolated organism found in 28% (n = 30). Colistin, tigecycline, and cotrimoxazole were some of the antibiotics to which these strains were sensitive variably. Acinetobacter baumannii (carbapenem-resistant) was found to be the most virulent, with a fatality rate of 62%. Among gram-positive organisms, Enterococcus faecium was found in five cases, and all were sensitive to linezolid and tigecycline. Conclusion: Burden of drug-resistant organisms in NICU is increasing at an alarming rate. They are not only difficult to treat but are also associated with poor outcomes. This study highlights the alarming increase of resistant organisms in the NICU.

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Original Article

Kunal Kumar, Sangita Yadav, Raghvendra Singh, Archana Thakur

Immunogenicity of Two Fractional Inactivated Poliovirus Vaccine Doses vs Single Intramuscular Inactivated Poliovirus Vaccine Dose in Infants of Low- and Middle-income Countries: A Prospective Case-control Study

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:14 - 18]

Keywords: Inactivated poliovirus vaccine, Mean antibody titers, Seroconversion, Seroprotection

   DOI: 10.5005/jp-journals-10081-1418  |  Open Access |  How to cite  | 

Abstract

Aims and background: Despite the support of the Global Alliance for Vaccines and Immunization, developing countries still struggle to afford inactivated polio vaccine (IPV). This study was undertaken to evaluate and compare the serological status of infants being offered two doses of intradermal fractional inactivated polio vaccine (ID-f-IPV) vs a single full dose administered intramuscularly (IM-SD-IPV) in conjunction with routine bivalent oral poliovirus vaccine (bOPV). Materials and methods: This prospective cross-sectional study was conducted in an Indian tertiary care healthcare center. The study consisted of 80 participants, with 40 in each group. The study measured the levels of antibodies using human poliovirus (PV) antibody immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) kits and identified seroprotection as the presence of antibody >1:8 dilution. Seroconversion was described as a fourfold rise in antibody titers after 4 weeks. Results: Pre- and postimmunization mean antibody titers (MAT) in pg/mL against types I, II, and III PVs in the ID group were 192.26 ± 49.5, 162.96 ± 34.1, 131.32 ± 38.4, and 1743.58 ± 391.6, 1272.10 ± 341.3, 1105.71 ± 331.1, respectively. However, in the IM group, they were 523.83 ± 102.5, 209.47 ± 57.3, 426.57 ± 61.7, 2101.32 ± 282.1, 1033.08 ± 226.1, and 1381.04 ± 308.3, respectively. Around 100% of participants in both groups were seroprotected at pre- and postimmunization levels. Seroconversion against types I, II, and III serotypes in the ID-f-IPV group was 100% each, while in the IM-SD-IPV group, it was 62.5, 87.5, and 55%, respectively. Conclusion: The seroconversion rates of f-IPV were superior to the full dose IPV and may be a cost-effective choice for low- and middle-income countries.

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Original Article

Sudhir V Sane, Jayashree R Balip, Satish S Mali

A Cross-sectional Study to Understand the Reasons for Failure to Vaccinate Eligible Children with Measles-containing Vaccine among the Clinically Diagnosed Measles Cases during the Outbreak (2022) in a District of Maharashtra

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:19 - 23]

Keywords: Measles, Measles vaccine, Outbreak, Reasons for unvaccination, Vaccination

   DOI: 10.5005/jp-journals-10081-1414  |  Open Access |  How to cite  | 

Abstract

The measles outbreak occurred in many parts of India, including Maharashtra, in the second half of 2022. We noticed that almost all of these patients were either completely unvaccinated or partially vaccinated for measles. This study was initiated to study reasons for inadequate vaccination in these children. Materials and methods: Patients suffering from measles who had missed vaccination for a period of at least 1 month were included. The caretakers were interviewed, and their responses were recorded. Results: A total of 99 patients were included, with a mean age of 46.667 months. Of these, 38 were completely unvaccinated. The geographical penetration and knowledge of the vaccination program were good. Recurrent illness was the most common reason, followed by coronavirus disease of 2019 (COVID-19) and worry about side effects. The reasons were not measles-containing vaccines (MCV)—specific. Two patterns emerged while analyzing responses: antivaccine sentiments or situational issues. Parents’ responses to nonvaccination were independent of their education. Parents who never visited vaccination centers or who did not give vaccines to any child in the family expressed more antivaccine sentiments. Parents who visited the center at least once or who gave the vaccine to at least one child in the family expressed more situational issues. Conclusion: In children suffering from measles, various factors resulted in nonvaccination. Understanding the causes would lead to ways to improve vaccination coverage.

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REVIEW ARTICLE

Niti Gor, Devesh Joshi

BioFire FilmArray Blood Culture Identification (BCID) Panel and Clinical Usefulness: A Systematic Review

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:5] [Pages No:24 - 28]

Keywords: BioFire FilmArray, Blood culture identification panel, Clinical usefulness

   DOI: 10.5005/jp-journals-10081-1419  |  Open Access |  How to cite  | 

Abstract

Introduction: In the critical care of septic patients, timely and accurate diagnosis is paramount. Molecular diagnostic studies that offer rapid and precise results are lacking. The BioFire blood culture identification (BCID) panel, a multiplex polymerase chain reaction (PCR) technique, enables earlier species identification, potentially influencing clinical decision-making. Materials and methods: This systematic review follows Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, utilizing online databases such as PubMed and Google Scholar to assess the clinical utility of the BioFire BCID panel. A total of 654 articles were initially identified, narrowed down to 20 relevant articles after eliminating duplicates and less pertinent ones. A total of 11 articles were meticulously reviewed and analyzed. Results and discussion: BioFire demonstrated a remarkable ability to identify organisms within 9.5 hours, significantly faster than conventional methods taking around 16 hours. In approximately one-third to one-fourth of cases, the BCID panel contributed to earlier decision-making. The available evidence suggests that the BCID panel substantially reduces the time needed for optimal antibiotic administration and enhances the accuracy of empirical antibiotic selection. Despite its cost, the statistical utilization of the BCID panel can render it a cost-effective investigation. However, there is a risk of missing organisms not covered by the panel, emphasizing the need for increased awareness among physicians regarding the panel's limitations. Conclusion: In conclusion, the judicious use of the BCID panel, coupled with background knowledge, facilitates early decision-making in antibiotic selection. This tool proves valuable for antibiotic stewardship, aiding in the cessation of unnecessary antibiotic use. Increased physician awareness and proper utilization are crucial for maximizing the potential benefits of the BioFire BCID panel.

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COMMENTARY

Abubakr Yosufi, Hedayatullah Ehsan, Ali Maisam Eshraqi, Abdul Majeed Momeni

Measles Outbreaks in Afghanistan

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:3] [Pages No:29 - 31]

Keywords: Afghanistan, Coronavirus disease 2019 pandemic, Humanitarian crisis, Measles, Measles eradication, Measles outbreaks

   DOI: 10.5005/jp-journals-10081-1413  |  Open Access |  How to cite  | 

Abstract

Afghanistan has been facing multiple measles outbreaks recently. As Afghanistan is currently witnessing a severe humanitarian crisis, controlling measles outbreaks has become very challenging due to the country's nearly collapsed health infrastructure. Even though there have been years of efforts to eliminate measles such as measles vaccination and campaigns, multiple outbreaks and dozens of fatalities are reported every year. Lately a widespread measles vaccination campaign was held in 2022, but still, thousands of measles cases were reported afterwards. Severe widespread poverty, decades of civil unrest, armed conflict, and recently coronavirus disease 2019 (COVID-19) pandemic, and lack of funding have been a huge obstacle to curb the disease. To eliminate the disease and prevent its spread to measles-free countries through migration, Afghanistan needs immediate global support. Purpose: This paper aims to comment on the measles outbreak challenges amid the current severe humanitarian crisis in Afghanistan, along with recommendations to overcome the persistent outbreaks.

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Journal Watch

Vikram S Kumar

Journal Watch Updates

[Year:2024] [Month:January-March] [Volume:6] [Number:1] [Pages:4] [Pages No:32 - 35]

Keywords: Chikungunya, Congenital rubella, Multisystem inflammatory syndrome in children, Multiplex polymerase chain reaction, Respiratory syncytial virus, Scrub typhus

   DOI: 10.5005/jp-journals-10081-1416  |  Open Access |  How to cite  | 

Abstract

Updates in the field of pediatric infectious disease.

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