Aim and objective: To monitor the causative pathogens, serotype distribution, and antimicrobial resistance patterns for pediatric invasive pneumococcal disease (IPD). Background: In India, IPD is a major contributing factor to the high under-five mortality rate, but surveillance-based studies are scarce on the subject, although vaccines are available for prevention. Case descriptions: We present a case series of IPD among Indian children aged ≤12 years attending a pediatric specialty hospital in Bengaluru, South India, over 5 years. Nine IPD cases were seen between June 2014 and July 2019 including both immunized and unimmunized children. The clinical presentation included pneumonia that progressed to sepsis, empyema, and pleural effusion in seven children and febrile seizures in one patient. Streptococcus pneumoniae was isolated from all the blood and pleural fluid cultures. The serotypes isolated were 19F, 19A, 2, 14, 9V/A, 6A/6B, and 3, which were all vaccine-preventable. Three cases were susceptible to all antibiotics, while others showed antimicrobial resistance to cotrimoxazole, benzylpenicillin, erythromycin, and clindamycin. All but one patient recovered uneventfully. Conclusion: Continued surveillance for IPDs and serotyping of pneumococcal isolates is important to study the effects of vaccination and monitor the emergence of non-vaccine-preventable serotypes. Clinical significance: Although IPD-causing pneumococcal serotypes have been documented in the Indian scenario, data are scarce on the emergence of non-vaccine-preventable serotypes, particularly in Indian children with IPD. Since the availability of pneumococcal vaccine (PCV) in India, this is possibly the first case series of IPD in Indian immunized children. The case series reveals that IPD-causing pneumococcal serotypes in Indian children are mostly vaccine-preventable and susceptible to standard antibiotics.

Aims and objectives: The worldwide prevalence of pediatric coronavirus disease-2019 (COVID-19) infections has risen from 1–5% in early part of 2020 to 8–9% in later half of 2020. Though clinical features of pediatric COVID-19 are well researched, its correlation with biochemical parameters and outcome is less evaluated. Materials and methods: A retrospective evaluation of records of a cohort of 45 children with RT-PCR confirmed COVID-19. We collected information on clinical, laboratory features, and their outcome in all children (age <18 years) admitted between March 1, 2020, and December 31, 2020. Results: The mean age of the study population was 11.7 ± 4.83 years. The average duration of hospital stay of patients was 7.8 ± 2.51 days. The majority of COVID-19 positive children were asymptomatic (20, 44.4%), 12 (26.6%) had upper respiratory tract features while only 4 (8.8%) had features of lower respiratory tract infection. Five children had nonspecific manifestations. The abnormal chest X-ray findings, the RFT, LFT, and inflammatory markers like C-reactive protein (CRP) (>1 mg/dL), lactate dehydrogenase (LDH) (>450 IU/L), serum ferritin (>300 ng/mL), and D-dimer values of >1,000 ng/mL, in ICU and non-ICU patients were highly significant. Conclusion: Coronavirus disease 2019 in Indian children seems to affect the older age group. In India, COVID-19 is more associated with comorbidities like chronic kidney disease and chronic infection like tuberculosis rather than congenital heart disease and other acute respiratory illnesses in western studies. Inflammatory markers correlate well with the severity of illness but TLC, DLC, and NL ratio showed variable results and does not correlate with severity of illness.

Vaccines have made an enormous contribution to the health and well-being of all. However, persistent disparities still exist in the adoption of new vaccines and sustained vaccination rates because some people still question or doubt vaccines’ value and importance in both developed and developing countries. Therefore, a potential contributor to the success of vaccination programs is vaccine acceptance, and thus understanding the complex mix of factors that determine individual and collective vaccination behavior is key to design effective vaccination policy, programs, and target interventions. With vaccine confidence being a relatively new concept in understanding vaccine acceptance, one determinant of vaccine confidence that is consistently shown to correlate with vaccination behavior is a recommendation from a healthcare professional (HCP), who is always the most trusted voice on vaccines. Consistent with a large body of research, the World Health Organization (WHO) confirmed the important role of HCP as the cornerstone of public acceptance of vaccination. And, perhaps most importantly, the foundation of vaccination acceptance is public trust, trust in vaccine and vaccine producers in the HCPs and the health authorities and government. It is thus essential to recognize that confidence now plays a central role in vaccine acceptance, and investments and efforts are needed to ensure that high levels of trust exist in recommended vaccines, the healthcare workers who provide them, and the entities and processes involved in vaccination policies and recommendations.

Aim and objective: To evaluate the effectiveness of low-dose amoxicillin in otitis media. Materials and methods: All children presenting to our outpatient clinic with signs and symptoms suggestive of otitis media and need of antibiotics according to AAP criteria were enrolled. Intervention: A 10-day course of oral amoxicillin at 40 mg/kg/day in three divided doses. Main outcome: Symptomatic relief after 48 hours and normal tympanic membrane at the end of therapy. Results: There were 201 cases. One hundred and sixty-one out of these completed a 10-day course of amoxicillin. One hundred and forty-six (90.68%. 95% CI 86.17–95.18%) responded to amoxicillin. On follow-up of these 67.44% had normal tympanic membrane whereas 33.56% had persistent middle ear fluid. Conclusion: Amoxicillin remains the first-line therapy in the treatment of acute otitis media (AOM) in children.

Aim and objective: To describe the management and outcome of an isolated pulmonary granuloma due to subclinical Histoplasma infection in a pediatric patient. Background: Fungal infections can lead to variable presentations and include isolated organ involvement or disseminated disease. Histoplasmosis is an infection caused by the fungus Histoplasma and is particularly endemic to the Ohio and Mississippi river valleys. Case description: A 16-year-old male presented with shortness of breath and pleuritic chest pain for a 1-year duration. He lived in a home that was occupied by bats. Chest X-rays and computed tomography revealed a right paratracheal calcification. The patient underwent esophagoscopy and right thoracoscopic hilar mass resection. On pathology, the sections showed necrotizing granulomata with giant cells, but no organisms were identified despite full pathological workup. Histoplasma yeast titers were subclinical at 1:8. No further medical management was pursued, and the patient demonstrated resolving symptoms on follow-up. Conclusion: Management of isolated granulomatous disease in pediatric patients is poorly characterized. The most common cause of necrotizing granulomatous inflammation are infections including mycobacteria and fungal infections, but organisms may not be seen on pathological workup. The exact cause of the granuloma may be idiopathic. Treatment is reserved for patients with a severe disease process and degree of symptoms. Practitioners in areas endemic to Histoplasma should suspect it as a cause of isolated lung nodules in the right clinical setting. Clinical significance: Workup of pulmonary granulomas requires a detailed history and physical exam, and isolated pulmonary granulomas in the pediatric population are rare. Practitioners are encouraged to consider infectious etiologies and consider surgical consultation for diagnosis and treatment.

Scrub typhus is a common infection in tropical countries affecting mainly the pediatric population. It is caused by Orientia tsutsugamushi with characteristic pathological change being focal or disseminated vasculitis. Main clinical symptoms involve fever, rash, headache, myalgia along with edema of the face and limbs. Lobar pneumonia is not a common manifestation of scrub typhus infection. Here, we discuss a case of a girl who presented with unilateral neck swelling with lobar pneumonia who turned up to be positive for scrub typhus infection.

A hitherto unusual case of community-acquired Aeromonas hydrophila gastroenteritis causing obstructive hydrocephalus in a patient recovering well after a craniotomy is presented. Earlier cases of A. hydrophila causing septicemia and meningitis in neonates, postoperative wound infections after neurotrauma, and after spinal surgery have been reported in the literature.

In invasive fungal infections, early initiation of treatment within the day of symptom onset is related with a significantly reduced mortality. Early initiation of treatment and specifically treatment initiation within the day of symptom onset and blood culture draw is related to a significantly reduced mortality. However, automated blood culture methodologies, which are routinely used for the diagnosis of candidemia, take up to 2–5 days to grow and lead to a crucial delay in treatment initiation. Therefore, a highly sensitive, specific, and rapid diagnostic method is expected to allow early initiation of antifungal therapy and subsequently improve outcomes. Rapid diagnostic methods for fungal infections are long-awaited and are expected to improve outcomes through early initiation of targeted antifungal therapy. T2 Candida panel is a novel qualitative diagnostic platform that was recently approved by the US Food and Drug Administration (FDA) for diagnosis of candidemia with a mean time to species identification of <5 hours. Technological advances in the field of nanotechnology coupled with the proven applications of magnetic resonance have recently presented a rapid, fully automated, qualitative, sensitive, and specific diagnostic platform, the “T2 Candida panel”. The introduction of this technology in diagnostic algorithms will increase the cost per patient tested, but it is expected to provide an economically self-supporting policy if savings from shorter hospital stays and termination of excess empiric antifungal treatment are taken into account. Expected benefits in terms of morbidity, mortality, and costs remain to be confirmed in clinical practice. The T2 Magnetic Resonance (T2MR) assay can detect and speciate the five most common Candida spp.; namely, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, in approximately 5 hours. The five detectable Candida spp. are responsible for >95% of the total Candida infections. T2 Magnetic Resonance demonstrated a sensitivity and specificity of 91.1 and 98.1%, respectively. The utility of T2MR in candidemia depends on the prevalence of the disease in each clinical setting. In intensive care units and other high-prevalence settings, the incorporation of T2MR in diagnostic algorithms is very appealing. T2 Magnetic Resonance is expected to allow timely initiation of antifungal therapy and help with antifungal stewardship. In low-prevalence settings, the positive predictive value of T2MR might not be enough to justify the initiation of antifungal treatment in itself.

Eczematous dermatitis, also known as atopic dermatitis (AD), is a chronic inflammatory skin disease. It globally affects 15–20% of children and 1–3% of adults. Patients with eczema are more prone to develop allergic manifestations like allergic rhinitis, asthma, and 80% usually develop either of them or both. Children and adults with primary immune deficiencies (PIDs) are not only prone to infections, but they develop allergies, autoimmunity, and malignancies also. Eczematous dermatitis is a common finding among several PIDs and many of these patients first present to a dermatologist. Primary immune deficiencies that can present with eczema are hyper-IgE syndrome, Wiskott–Aldrich syndrome, IPEX, etc. Recognizing the warning signs of an underlying PID can help clinicians in the early diagnosis of an underlying immune deficiency. In this paper, we discuss in detail the pathomechanism of eczema in PID and provide a simple approach to PIDs presenting with eczema.