Background: Certain biochemical markers have been found useful in monitoring the progress and predicting the severity of dengue. Serum lactate dehydrogenase (LDH) is one such potential biomarker.
Aim and objective: To study the serum LDH levels in critically ill patients of dengue with warning signs and severe dengue and its relationship with severity of illness.
Materials and methods: Retrospective analytical study.
Results: Sixty patients with severe dengue and dengue with warning signs were included. Mean duration of fever at admission was 4 ± 1.6 days and the mean age was 9.6 ± 5.06 years. Male:female ratio was 1:1. Half the children were above 10 years. The median LDH value was 1,133.5 IU [interquartile range (IQR) 640–1,732]. The mean LDH value was significantly higher in patients with severe dengue (2,986.65 ± 3,638.54) as compared to dengue with warning signs (1,209.87 ± 1,370.20) (p—0.047). The majority (70%) of patients with severe dengue had LDH >1,000 IU and complications like severe bleeding, pleural effusion, ARDS, and shock were higher in this group. Mean hospital stay in patients with LDH >1,000 was 14.685 ± 5.993 days and in those with LDH <1,000 was 8.732 ± 3.312 days (p = 0.000). Mean platelet count was significantly lower in severe dengue (56,405.00 ± 49,918.74) as compared to dengue with warning signs (922,257.50 ± 71,235.44) (p value 0.028) and there was a weak negative correlation between LDH and platelet count which was non-significant (r = Karl Pearson coefficient −0.055; p value 0.676). The case fatality rate was 9%. The mean LDH (4,783 ± 5,131) in non-survivors was much higher than survivors (1,531.1 ± 1,986) though this was not statistically significant.
Conclusion: Serum LDH level at admission was significantly raised in severe dengue as compared to dengue with warning signs. Similarly, mean LDH values were higher in survivors as compared to non-survivors. There was a weak negative correlation between LDH and platelet count.
Clinical significance: Lactate dehydrogenase can be used early in the disease to identify those who may progress to severe dengue and predict mortality. This will help optimize resource allocation and more effective care in a disease-endemic country like India.
Mycoplasma pneumoniae is an important cause of community-acquired pneumonia in school-aged children and adults and the incidence is also increasing in other age groups. It has a varied presentation and apart from respiratory system involvement, it also involves many other systems of the body. In children, central nervous system involvement is very common followed by dermatological, hematological, and other systems. Extrapulmonary manifestations can even cause long-term sequel. Since this organism does not have a cell wall, the diagnosis is always difficult and a strong possibility has to be kept in mind so that the treatment can be started early. The choice of antibiotics is limited, as beta-lactam antibiotics (which act on the cell wall) do not act on it. In this article, we have reviewed the up-to-date knowledge of M. pneumoniae infection in children.
In viral myocarditis, viral invasion of the heart can lead to direct and indirect inflammatory destruction of the myocardium. Various etiological agents, ranging from enterovirus to adenovirus can cause myocarditis. The clinical presentation is heterogeneous and can end up in a dilated cardiomyopathy phenotype, leading to major mortality, morbidity, and years lost in children. Early recognition and diagnosis with echocardiogram, endomyocardial biopsy, and cardiac MRI is important. Treatment options include with immunosuppression and immunomodulation in the early phases and may require cardiac transplantation in end-stage heart failure.
How to cite this article:
Nagaraju K, Shah R, Ganapathy S, Roy S, Bhatia R, Kumar PS, Kanaujia S, Karadkhele A, Muchhala S, Rathod R, Suvarna V. Practical Approach for the Diagnosis, Prevention, and Management of Recurrent Upper Respiratory Tract Infection in Children: Report from an Expert Closed-group Discussion. Pediatr Inf Dis 2021; 3 (3):105-112.
Respiratory tract infections (RTIs) are one of the most common infections in childhood. Due to the weaning of maternal immunity during the first year of life and relative immaturity of the immune system, children in the age group of 6 months to 6 years are predisposed to RTIs. Several guidelines are available from western countries on the diagnosis and management of RRTIs. However, owing to the economic, nutritional, environmental, geographic, and social diversity of India, the practical approach to RRTIs, especially, the recurrent URTIs, is likely to differ warranting the need for local guidelines. This expert consensus offers a practical guide for the diagnosis, prevention, and management of recurrent URTIs in pediatric outpatient settings in India.
Savita G Krishnamurthy,
Kanchamaranahalli L Madhura,
How to cite this article:
Krishnamurthy SG, Indumathi C, Madhura KL, Kulkarni R. Invasive Pulmonary Aspergillosis and Nocardiosis in a Child with Possible Hyperimmunoglobulin E Syndrome. Pediatr Inf Dis 2021; 3 (3):113-115.
Aim and objective: To highlight the importance of looking for rare opportunistic as well as coinfections in children with primary immunodeficiency.
Background: Opportunistic infections are often seen in children with primary immunodeficiency. Infections like nocardiosis and aspergillosis often mimic tuberculosis. So far, a single case of nocardiosis in hyperimmunoglobulin E syndrome (HIES) has been reported but none with coinfection with aspergillosis. Here we report a child with possible HIES presenting with nocardiosis and invasive pulmonary aspergillosis.
Case description: A 3-year-old boy with recurrent abscesses and pneumonia presented to us with persistent fever and cough for 5 months, unresponsive to antitubercular therapy. Considering the suggestive history, characteristic facies, and elevated immunoglobulin E levels, HIES was diagnosed based on the NIH (National Institute of Health)-HIES score. High-resolution CT chest revealed mediastinal lymphadenopathy with right-sided nodular infiltrates and bilateral bronchiectasis. A positive serum galactomannan assay and growth of Aspergillus in bronchoalveolar lavage confirmed invasive aspergillosis. Mediastinal lymph node aspirate showed acid fast bacilli on smear and culture grew Nocardia species.
Conclusion: It is important to look for rare opportunistic as well as coinfections in children with primary immunodeficiency. To the best of our knowledge, ours is the first report of pulmonary aspergillosis and nocardiosis in a child with HIES.
Clinical significance: Albeit much rarer, aspergillosis and pulmonary nocardiosis can be close mimics of tuberculosis. Nonresolving pulmonary symptoms in the immunocompromised host must raise a suspicion of opportunistic infections including nocardiosis as early diagnosis and treatment may alter outcomes.
Tuberculosis (TB) has always been a burden in developing nations like India. Both pulmonary and extrapulmonary manifestations of TB have been seen widely in the pediatric age group with the specific age-wise distribution. We hereby report a case of a 15-month-old male child who was brought with complaints of localized pain in the left knee and was initially diagnosed to have juvenile-onset oligoarthritis. As the symptoms progressed and a cystic swelling was observed in the left popliteal fossa, he was investigated and aspiration of the cyst was done. Mantoux test done in the child was strongly positive and pus aspirated from the cyst was positive on cartridge-based nucleic acid amplification testing (CBNAAT) for Mycobacterium tuberculosis with rifampicin sensitivity. He was promptly started on 4 drug anti-TB therapy. The pus grew acid-fast bacilli in a culture medium which confirmed the diagnosis. Very young age (15 months) of presentation with cystic lesion from a joint is an unusual presentation of tubercular arthritis.
Pseudomonas is considered to be an unusual organism in urinary tract infections. Most of the time, predisposing factors are present, which makes its colonization easier. In our case report, we conclude the possibility of asymptomatic colonization of Pseudomonas aeruginosa in urine even without any risk factors for its growth. So far, Pseudomonas urinary infection has been associated in children with urologic abnormalities or those who were hospitalized or catheterized or used any prior antibiotics. Following this case report, clinicians should note its unusual occurrence without any causative factors.
As per the latest data from World Health Organization, in the year 2019, a total of 10 million people fell ill with tuberculosis, of which 1.2 million were children, while 1.4 million people died due to tuberculosis. There are 30 high burden countries that are responsible for 87% of new TB cases. Eight countries account for two-thirds of the total, with India leading, followed by Indonesia, China, the Philippines, and four more countries. An important cog in the wheel of tuberculosis progression is the risk of TB infection progressing to TB disease. To break this wheel, active intervention is essential. A vaccine given to all children can help to confer protection, especially against severe disease forms. Currently, the role of the available BCG vaccine is limited to protection against disseminated TB and miliary TB. Currently, there are at least 15 candidate vaccines at different stages of clinical trials, while one vaccine has entered phase III. These newer vaccines have the potential of combating the disease as we forge ahead to end TB.
Pediatric-onset IBDs (PIBDs) are a group of genetically heterogeneous diseases with variable severity. Depending on the age of onset, inflammatory bowel disease (IBD) can be classified as pediatric-onset (<17 years), early-onset (<10 years), very early-onset (<6 years), infant/toddler-onset (0–2 years), and neonatal-onset IBD (<28 days). Due to the advancement of molecular science and sequencing technologies, several monogenic defects have been identified in very early-onset IBD (VEO-IBD) over the last few decades. Inflammatory bowel disease manifesting at a very young age is more likely to be a monogenic defect. Pediatric-onset IBDs have been found to be associated with as many as 60 monogenic defects with most presenting below 6 years of age and some presenting before 1 year of age. The current article discusses early-onset IBD in detail with new concepts and a clinical and laboratory approach to these patients has been provided.