ID/01(P) AUDIT OF ANTIMICROBIAL PRESCRIPTIONS FOR HOSPITALISED CHILDREN IN
A TERTIARY CARE CHILDREN’S HOSPITAL.
Sripradha S, K.R.Aparna, S. Balasubramanian
Kanchi Kamakoti CHILDS Trust Hospital,12-A, Nageswara Road, Nungambakkam, Chennai – 34.
Introduction: There is paucity of data on antimicrobial prescribing practices in pediatric hospital setting in
India especially in private sector. Aim: To describe and investigate the prescribing pattern of antimicrobials
for pediatric inpatients in a tertiary care setting. Design: Retrospective descriptive study Setting and
Methods: Case records of 1000 children from 1 month to 18 years of age hospitalised and treated between
August 1st 2004 to 30th July 2005 in a single paediatric unit were analysed for the following antimicrobial
used or not indication & details of the same type of antimicrobial Justification of antimicrobial use
Results: A total no. of 420 children received antimicrobial agents (42%). More no. of children in age group
of 1-5 years 65% (273) received antimicrobial agents when compared to infants and children above 5 years.
The following are the indications in decreasing order for antimicrobial prescriptions. WALRI-15.71%(66)
Enteric Fever-14.29%(60) Others-13.57%(57) UTI-12.86%(54) URI-11.67 %(49) Pneumonia-8.81%(37)
Meningitis-5.48%(23) Skin / Skeletal infection-9.05%(17) Dysentery-3.57%(15) AGE-2.86%(12)
Leptospirosis-2.86%(12) LRI-2.14%(9) Sepsis-2.14%(9) The most frequently used antimicrobials were as
follows: Amoxyicillin / Amoxyclav-40.24% (169) Cephalosporins I Generation - 0. 71% (3) II
Generation- 8.33% (77) III Generation - 12.86% (54) Others - 27.86% (117) Conclusion: More
preschool children tend to receive antimicrobial agents when compared to infants. Inspite of application of
guidelines for using antimicrobial therapy appropriately, nearly 1/10 of the children who received
antibiotics did not require the same as per established guidelines. Our observations emphasize the need for
National guidelines for appropriate antimicrobial prescription practice in the Indian context.
ID/02(P) A NEW FOCUS OF PEDIATRIC SCRUB TYPHUS IN NORTHERN INDIA
Sanjay Mahajan,Naveen Sankhyan,R K Kaushal
Indira Gandhi Medical College,Shimla,HP,171001
Objective: To study, the clinical profile of Scrub Typhus occurring in children of this hilly state. Methods:
Clinical profile of five cases of acute febrile illness presenting in rainy season, and showing positive
serology to Orientia tsutsugamushi on Microimmunofluorescence assay are detailed. Results: Four males
and one female with age range 3-15 were studied. Fever (5), chills and rigors (2), headache (1), vomiting
(5), pain abdomen (1), altered sensorium (1), seizures (1), facial puffiness(2),generalized lymphadenopathy
(5), hepatomegaly (1) and splenomegaly (1), were main presenting features. Abnormalities of liver function
tests (2) & renal function tests (1) were main biochemical abnormalities noted. Two had titers 1:160; one ≥
160 & two ≥320 to Proteus OXK antigen, 4 had 1: 40-80 titers to Proteus OX2 & 19 antigens. On
Microimmunofluorescence assay, all 5 patients showed titers (IgG and IgM) to Orientia tsutsugamushi (O.
Kato and O. Kawasaki strains) and serology to Spotted Fever Group Rickettsioses was negative. The exact
characterization of strains, prevalent in our area, is on by PCR. Four of the 5 were treated with
Azithromycin and one with Doxycycline. Time to defervesence ranged from 18-96 hrs after commencing
therapy. Four children improved after treatment and 1 died.Conclusion: In hills of northern India, Scrub
typhus should be considered in febrile children, especially during rainy season.
ID/03(P) AN UNUSUAL ASSOCIATION OF THROMBOCYTOPENIA WITH PLASMODIUM
VIVAX MALARIA CASES
Sunil Gomber, Manish Kumar. Department of pediatrics, University College of
Medical Sciences and Guru Teg Bahadur Hospital, Delhi-95, India.
Most of the complications associated with malaria are known to occur with Plasmodium falciparum
infection. Anemia and thrombocytopenia has been uncommonly reported with Plasmodium vivax infection.
We report three such cases of vivax malaria that presented with thrombocytopenia. The first case presented
in shock, the condition not reported earlier with vivax malaria. The other two cases presented with anemia,
thrombocytopenia and splenomegaly. All the patients were treated with choloroquine and discharged
successfully. Thrombocytopenia improved and regression in spleen size was noted at discharge. Cause of
thrombocytopenia is not exactly known. However one study has shown increased platelet associated IgG
(PAIgG) leading to thrombocytopenia. The message is that thrombocytopenia does occur with vivax
malaria and one should consider the possibility of vivax malaria in cases of fever with thrombocytopenia.
ID/04(O) A PROSPECTIVE CLINICOBACTERIOLOGICAL STUDY OF TYPHOID FEVER IN
DELHI
Deepti Chaturvedi,Devendra Mishra,Vikas Manchanda, Mukta Mantan, Ds Chauhan, Manoja Das
Department of Pediatrics and Laboratory Medicine, Chacha Nehru Bal Chikitsalaya [Maulana Azad
Medical College], Geeta Colony, Delhi-110031
Objective:1.To study the clinical profile and sensitivity pattern of enteric fever in children.
2.To
correlate the clinical features with the drug sensitivity pattern in patients with MDRST and non-MDRST.
Design and Setting: Prospective study, Government Pediatric hospital attached to a medical college
Methods: All culture positive typhoid patients diagnosed between 27th January to 26th September2005 (8
months) were studied .The presenting features, clinical findings, hospital course, complications,
bacteriological profile and response to therapy were entered in a pretested structured proforma. Results:
There were 52 children treated as typhoid fever of which 23(44 %) were culture positive and 43(83%) were
Widal positive. Out of these culture positive cases, 4(17 %) were MDR typhoid. The age varied from 7
months to 12 years. Maximum number of children belonged to age group 5 to 10 yrs with an average age of
6.25 yrs. Out of the 23 culture positive cases 7 (30 %) were males and 16 (70 %) were females. The mean
duration of fever at presentation was 16 days with a wide range from 5 to 60 days. The other important
presenting complaints were pain in abdomen (77%), decreased oral acceptance (25%), bowel complaints
(56%),cough (19%),urinary complaints(13%),hepatomegaly (65%), splenomegaly (48%). The mean period
of defervescence of fever was 4 days. The complication rate was (6%). The resistance pattern would be
discussed in detail. Conclusions: The duration of fever at presentation (18 days vs. 15 days) and mean time
to defervescence (9day vs.4 days) were longer in MDRST. The overall complication rate was low (6 %)
and not different between the two groups. There is a resurgence of non-MDRST in the community in our
area, and this information needs to be considered when deciding empiric antibiotics for suspected enteric
fever in the community.
ID/05(O) ASSESSMENT OF YALE OBSERVATION SCALE (YOS) TO PREDICT BACTEREMIA
IN FEBRILE CHILDREN AGED 3 TO 36 MONTHS.
Akash Bang, Pushpa Chaturvedi
Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences and Kasturba Hospital,
Sevagram. 442102. Dst. Wardha.
Fever in children aged 3-36 months, even in absence of localizing signs, may be due to bacteremia.
Untreated bacteremia can cause serious complications including death. In absence of culture facilities in
rural India, observational scales like YOS gain prime importance in prediction of bacteremia. Design:
Prospective hospital based study. Methods: 219 consecutive febrile inpatients aged 3-36 months were the
subjects. Before giving antipyretics, rectal temperature was recorded. YOS scores were assessed by 2
independent blinded residents. History, clinical examination and investigations followed. Blood cultures
were taken in all children before antibiotics. Point estimates and 95%confidence intervals were calculated
for sensitivity, specificity, positive & negative predictive values and likelihood ratios for use of YOS as a
diagnostic test in prediction of bacteremia. The best cut off value for a positive YOS test was established by
calculating these statistical values separately for a cut off YOS score of 8, 10 and 12 and plotting ROC
curve. Reliability of YOS was assessed by the inter-observer agreement through kappa statistics. Results:
Study population (n=219) had 59.36% males and a mean age of 15.24 months. 28.16% subjects had
bacteremia. Mean YOS scores were significantly higher in bacteremic children (14.9 vs 8.78 in nonbacteremic, p=0.00001) Sensitivity, specificity, PPV, NPV, LR+ and LR- of YOS score >10 to predict
bacteremia were 87.93%, 83.78%, 68.00%, 94.66%, 5.42 and 0.14 respectively. Those of YOS score >8
were 96.55%, 65.54%, 52.34%, 97.98%, 2.80 and 0.05 respectively and of a YOS score >12 were 48.28%,
91.22%, 68.29%, 81.82%, 5.5 and 0.5 respectively. ROC curve showed YOS score >10 to be the best cut
off for prediction of bacteremia. Area under ROC curve was 0.9001. The chance corrected inter-observer
agreement (kappa) was 0.7919. Conclusions: YOS is a simple, easy to administer, cost-effective and useful
test to predict bacteremia in a febrile child aged 3-36 months due to its high sensitivity and reproducibility.
ID/06(P) BRUCELLOSIS IN ADOLESCENT FEMALE-A CASE STUDY
Renuka Mohanty, Subhranshu Sekhar Kar, amarendra Mahapatro
Hi-Tech Medical College,Bhubaneswar-10
Introduction- Brucellosis is a zoonosis transmitted to the humans from infected animals. It continues to be a
major health problem worldwide. Humans are accidental hosts and acquire this disease from direct contact
with an infected animal or consumption of infected products. Case report- A 14 year old female child of
middle socio economic family was brought to the hospital with chief complaints of fever (remittent) for 8
days, multiple joint pains for 6days & severe headache with maculopapular rashes for 3 days. The past
history, family, immunization developmental history was uneventful. In dietary history, it was found that
she was taking milk from household cattles & goats from her village. On examination, the child was toxic
looking with maculopapular rashes, hepatosplenomegaly and fundoscopy revealing mild blurring of disc
margins (both eyes) indicating early papilledema. There was mild neck stiffness but no focal neurologic
deficit. So provisionally she was diagnosed as complicated malaria with septicaemia. InvestigationsComplete blood count, urine & stool exam were normal. ICT-P.f.,P.v.-(-ve),ASOtitre > 1:200I.U.(+ve),
CXR(PA)-NAD, Blood & Urine C/S-NO growth, C.S.F. analysis & CT Scan-NAD and serum
agglutination test (SAT) for Brucella revealed titres of B. abortus > 1:160 and B. melitensis > 1:320
indicating strongly positive result. SAT after 7 days of treatment revealed Brucella titres of 1:160 but
shows a declining trend. Treatment- She was treated with Ceftriaxone, Quinine, Falcigo, Linezolid and
Treonam. On third day with negative MP report Falcigo & Quinine were omitted. Dexamethasone and
Mannitol were added for papilledema. Regimen for Brucella was started after getting SAT report and other
antibiotics were omitted. Thus the child was treated with Cap Doxycycline 200 mg/day for 4-6 weeks and
inj. Gentamicin 5 mg/kg/day & Tab Rifampicin 600 mg/day for 4-6 months. The child responded
dramatically to the treatment protocol. Conclusion- As the clinical features are not disease specific, often
diagnostic dilemma occurs and it is confused with malarial or typhoid fever. Hence proper history
pertaining to ingestion of infected products from animals gives a clue for diagnosis.
ID/07(O) BACTERIAL SEPSIS IN CHILDREN WITH CEREBRAL MALARIA
Sudhir Mishra, Sarala Sunder, DP Patra, PK Gupta
Department of Pediatrics, Tata Main Hospital, Jamshedpur- 831001
Introduction: Cerebral malaria is a common killer disease of children in this part of the world. Some
children were noted to be blood culture positive. Aims and Objective: To study the frequency of sepsis in
children with cerebral malaria and compare it with falciparum malaria without cerebral involvement.
Material and Methods: Children diagnosed as cases of falciparum malaria either on smear or a card test
were included in this study conducted over a period of two years. Uncomplicated cases were excluded from
the study. Pre-designed and pre-tested proforma was used to record clinical details, investigations results,
treatment given and outcome. All children with cerebral malaria received antibiotic therapy in addition to
antimalarial(s) and supportive care. Results: A total of 331 children – 193 with cerebral malaria and 138
with other complications were included in this study. Multisystem involvement was seen in 66.3% children
in cerebral malaria group. Gastro-intestinal bleeding (44.4%) and acute renal failure (11.4%) were other
common complications seen in children with cerebral malaria. Gastro-intestinal bleeding (81.1%) and
acute renal failure (32.6%) were the common complications seen in children without cerebral involvement.
Bacteremia was found in 21.7% children in cerebral malaria group and 7.9% in children without cerebral
involvement. Mortality was 1.55% in cerebral malaria cases. There was no death in children with other
complications during the period of study. Conclusion: Data from this study suggests that sepsis in cerebral
malaria is found with a frequency that demands routine evaluation and use of broad spectrum antibiotic(s)
for improved survival.
ID/08(O) MALARIA-PRESENT TREATMENT SCENARIO-NATIONAL ANTIMALARIAL
PROTOCOL-A PARADOX
Radha Tripathy, Leena Das, Arakhita Swain, Sailajanandan Parida, Arun Agrawalla, Aswini Kumar
Mohanty
SVP PG Institute of Pediatrics and SCB Medical College, Cuttack, Orissa
Design: Prospective study. Setting: Tertiary care Teaching Hospital. Period: June 2004 to May 2005.
Objective:To evaluate the present antimalarial chemotherapy received by patients before hospitalization
and how far the present scenario of antimalarial chemotherapy is helpful in promoting DRUG
RESISTANCE ?? Materials and Methods: 268 hospitalized children aged between 2 month to 14 years
with diagnosis of Falciparum malaria (Slide and/or ICT +ve) were evaluated for the history of taking
antimalarial chemotherapy prior to hospitalization. Evaluation was based on history of drug intake
(adequacy, dosage, duration) and whether self-medicated / prescription by health care providers. Later, the
cases were treated as per the WHO protocol. Outcome in terms of mortality was compared and analyzed.
Results: Out of 268 slide and/or ICT +ve falciparum malaria cases, only 113(42.2%) received antimalarial
chemotherapy before hospitalization. Out of these 113 cases, 105 (93%) received monotherapy
(Chloroquine, Quinine, α,β arte-ether, Sulfadoxin-Pyrimethamin (SP), Arteether and Artesunate (40%,
24%,20%, 1%, 3.5% and 4% respectively) and 8 (7%) received combination (Artesunate + Quinine,
Arteether + Quinine and Chloroquine + SP in 3.5%, 2.7% and 1% respectively) antimalarial chemotherapy.
50 children (44%) received antimalarial chemotherapy in proper dosage whereas 63(56%) received
improper dosage. In respect to monotherapy, inadequate dosing was observed in 22% in Chloroquine
group, 85% in Quinine group and 70% in Artemesinin derivatives. All combination antimalarial
chemotherapy were administered in improper dosage excepting lone case of Chloroquin +SP. 10% cases of
Chloroquine was self-medicated whereas other antimalarial drugs were administered by health providers.
Mortality was much higher among the children receiving no antimalarial drugs(17.4%) in comparision to
those who received antimalarial chemotherapy (6.2%). Mortality was much lower in the group receiving
proper dosage of Chloroquine in comparision to newer Artemesinin derivatives which was received in
improper doses (75%). Summary and Conclusion: Pre-Hospital Chemotherapy against Malaria should not
only be rationalized but also the awareness and availability of the same drugs should be ensured at
minimum cost to the users. Use of antimalarial chemotherapy with under-dosing, and/or failure to comply
full course of treatment (particularly the newer Artemesinin derivatives) have a significant adverse effect.
ID/09(O) MULTIDRUG - RESISTANT TYPHOID FEVER IN HOSPITALISED CHILDREN
Rajiv Kumar, Nomeeta Gupta, Shalini
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Objective: To study the epidemiological pattern, clinical picture, sensitivity patterns, and therapeutic
response of ofloxacin and ceftriaxone in multidrug-resistant (MDR) typhoid. Material & Methods: The
present prospective randomized controlled parallel study was conducted on 93 children upto 12 years
admitted in our hospital between May 2002 and April 2004 with typhoid fever supported by positive blood
culture for Salmonella typhi. All children initially received chloramphenicol. Mid-course modification was
done after sensitivity report. All MDR cases were randomized to treatment with ofloxacin or ceftriaxone.
Results: Of 93 culture-proven children, 62(66.6%) were MDR typhoid. 24 cases were below 5 years, 26
between 5-10 years and 12 were above 10 years. Male to female ratio was 1.85: 1. Majority of cases came
from lower middle socio-economic classes with poor personal hygiene. Fever was the main presenting
symptom. Other features were diarrhea (74%), abdominal pain (63%), vomiting (61%), headache (55%),
cough (32%), constipation (14%) and chills and rigors (10%). Hepatomegaly and splenomegaly was
present in 88% and 46% cases respectively. Serum bilirubin was raised in 21% cases. SGPT was elevated
in 13% cases. Sensitivity and specificity of Widal test were 68.57% and 37.08% respectively. In vitro
resistance to ampicillin, co-trimoxazole and chloramphenicol were 66% - 74%. Ofloxacin and ceftriaxone
were resistant to 7.6% and 2.1% isolates respectively. 19(30.6%) cases developed complications: hepatitis
(14.5%), intestinal bleeding (4.8%) and pleural effusion (1.6%). Mean defervescence time with ceftriaxone
and ofloxacin was 4.258 and 4.968 days respectively. Clinical response was good. All children recovered
completely and none had clinical relapse. Conclusions: MDR typhoid is still emerging as serious public and
therapeutic challenge. Ceftriaxone is well-tolerated and effective drug for MDR typhoid in children but
expensive. Ofloxacin is safe, cost-effective and therapeutic alternative in treatment of MDR typhoid with
comparable efficacy to ceftriaxone.
ID/10(P) SPECTRUM OF CLINICAL PRESENTATION OF JAPANESE ENCEPHALITIS IN AN
ENCEPHALITIS ENDEMIC REGION
V V Tewari, P L Prasad
Deptt. of Pediatrics, Military Hospital Namkum, Ranchi - 834010, Jharkhand
Japanese encephalitis occurs with endemic frequency in and around Ranchi . 11 children with Japanese
encephalitis were encountered in a service hospital, over a period of observation of 1 year. Design:
Prospective design. Material and Methods: 11 children, wards of serving and retired defence personel were
admitted at Military Hospital Namkum, Ranchi, Jharkhand over a period of 1 year. The age, sex, socioeconomic status, educational status of the parents, clinical presentation, progression of neurological status
at day 3, day 7, day 14 and day of discharge, with CSF evaluation, Fundus examination, and requirement
for mechanical ventilation were recorded. On follow - up, evolution of the neurological signs , patterns of
seizures occuring as a sequelae to the primary insult, and apparent recovery of the neurological deficit were
analysed. Results: Age group with maximum number of cases was between 3 - 6 years. Boys were equally
involved as girls in this age group. However in the 6 - 9 years age group boys were affected more than girls
probably because of greater degree of mobility. Almost all the cases came from the lower socio - economic
status where father was the sole bread earner and mother was a housewife and more involved with the care
of a younger sibling. At best educational status of a parent was graduation and at iits worst till Class 5.
Clinical presentation ranged from altered state of conciousness (ASC) with fever and generalized seizures
as the commonest with Hemiplegia with partial seizures being seen in 1 case. Progression to hypertonia by
day 3, features of raized intracranial tension manifesting as breathing difficulty by day 5, requirement of
ventilation from the day 4 - 7, appearance of decortication or decerebration by day 6 - 7, generalized
hypotonia by day 14, were the hallmarks of the neurological evolution. 2 cases showed persistent
hypertonia and early appearance of extra-pyramidal signs.1 case resulted in a fatal outcome. CSF IgM
capture ELISA was used to confirm the illness in 7 out of the 11 cases. Serial Fundus examination was
done to pick - up raized ICP, but was not able to predict requirement for ventilation. Seizures, intellectual
deterioration, extra-pyramidal signs (EPS), loss of speech and motor milestones, were most commonly
observed on follow - up.
ID/11(P) SEROPREVALENCE OF ANTIBODIES TO HEPATITIS A VIRUS (HAV) IN URBAN
INDIAN CHILDREN
Bindu Shrivastava, Nomeeta Gupta, Sisir Paul, Rajiv Kumar
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Hepatitis A is more frequent among children. Most children in endemic areas acquire immunity through
subclinical infections. IgM antibody appears early in the illness and persists for 90 days. IgG appears more
slowly and persists for many years. Objective: To study the seroprevalence of antibodies to hepatitis A in
children aged less than 10 years in urban Indian population and to evaluate the modes of transmission and
feasibility of Hepatitis A vaccine. Material & Methods: The present prospective study was conducted on
150 children less than 10 years of age of urban Indian population attending the Pediatric OPD of Batra
Hospital and Medical Research Centre, New Delhi. Sera were tested for qualitative detection of antibody to
HAV. Results: The overall seroprevalence of antibodies to HAV was found to be 62.7% indicating most
individuals are infected early in childhood mainly through subclinical infection. The change in
seroepidemiology increased significantly with increasing age. The seropositivity among males was 61%
and females 65%. There was decreasing seroprevalence rate with increasing socioeconomic strata of the
children in 2-10 years of age group. The better living condition and hygiene status decreases exposure to
virus in higher socioeconomic strata. Majority of individuals from high socioeconomic strata lacks natural
immunity and remains at constant risk of infection. The seroprevalence was 65% in South Delhi, 65.2% in
other parts of Delhi and 57.4% in non capital residents. The children drinking municipal water were more
seropositive (82.1%) than with drinking tap water (27.5%) and well water (50%). Those who used
purification method had definitely decreased seroprevalence (38.2%). The children using common toilet
were more seropositive (96.7%) than those using private 54.9%. Majority of population belonged to middle
and upper lower socioeconomic classes and the susceptible population to HAV is more so in upper
socioeconomic classes. So only such group of children should be offered Hepatitis A vaccination as these
are at high risk. Conclusions: The overall seroprevalence of Hepatitis A is declining in India but still
majority of the children are immune by early childhood through subclinical infections. Seroprevalence of
Hepatitis A increases with increasing age. Seroprevalence of Hepatitis A declines with improving
socioeconomic strata making the individuals from high socioeconomic strata more susceptible for HAV
infection.
ID/12(O) SHORT-COURSE AZITHROMYCIN FOR THE TREATMENT OF UNCOMPLICATED
TYPHOID FEVER IN CHILDREN
Rajiv Kumar, Nomeeta Gupta, Shalini
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Typhoid fever is distressingly prevalent in developing countries, where it remains a major endemic health
problem among children. A number of therapeutic strategies have been employed in the treatment of
uncomplicated typhoid fever in children including broad-spectrum cephalosporins, quinolones and
azithromycin. Objective: To study the therapeutic response of short-course azithromycin for the treatment
of uncomplicated typhoid fever in children. Material & Methods: The present prospective randomized
controlled study was conducted on 149 children up to 12 years of age with clinical typhoid fever in the
department of Paediatrics, Batra Hospital & Medical Research Centre, New Delhi during the period May
2003 and April 2005. All cases were randomized to treatment with either oral azithromycin (20 mg/kg/day)
or intravenous ceftriaxone (75 mg/kg/day) daily for 5 days. The clinical course was closely monitored and
the period of defervescence was recorded. The blood and stool samples were obtained for culture before
the initiation of therapy and were repeated on days four and eight of treatment. The isolation of Salmonella
typhi from the initial culture was required for inclusion in the final analysis. Results: Salmonella typhi was
isolated from 68 patients, 32 of whom were receiving azithromycin. The clinical cure was achieved in 30
(94%) of patients in the azithromycin group and in 35 (97%) of patients in the ceftriaxone group. The mean
defervescence time was longer in azithromycin group than in ceftriaxone group. No patient who received
azithromycin had a clinical relapse, compared with 6 patients who received ceftriaxone. Conclusions: A 5day course of azithromycin was found to be an effective treatment for uncomplicated typhoid fever in
children.
ID/13(P) SEROLOGICAL ASPECTS OF DENGUE FEVER AND ITS CORRELATION WITH
CLINICAL FEATURES IN A RECENT FABRILE OUTBREAK.
T.K.chatterjee, S Chaterjee, B.Garai, Kaustav Nayak, S Som, N Chaudhuri, B. Mukhopadhaya.
Kantapukur Lane, Laxmipur Mat, Burdwan 713 101
Objective : To study correlation between serology of dengue fever and the changing Pattern of clinical
features in the recent spell. Materials and Methods : Study was carried at Burdwan Medical College and
included samples from surrounding districts. After clinical examination, blood sample for laboratory
parameters and serum for IgM antibodies were collected. Samples processed by Enzyme Imuno Assay,
supplied from M/s.Omega Diagnostics Ltd. In this study, out of 139 cases 80 males and 59 females were
of different age groups starting from <1 year to >60 years. Results : Age and sex distribution were M:F.
56.4:43.6, and vulnerability is mostly observed between 1 to 20 years, sharing 61.3% of the total. After 40
years and below 1 year cases were negligible. Maculopapular rash was observed in only 3 cases. Bleeding
manifestations observed in 3 cases. None of the cases were seen to have respiratory manifestations.
Neurological manifestations was not observed and DSS was not observed at all. In some cases fever
continued for 30 days. IgM antibodies which were detected in different age groups have not appeared
according to usual usual rule of appearance. Very few patients have biphasic temperature. Fever and
severity of symptoms have not any particular correlation. Neither the antibody titre can point towards
severity of the disease. Discussion : In this recent spell of fever blood of the patients have been examined
by IgM EIA for Dengue, 44.6% have been identified. The correlation between duration of illness and
optical density is r= 0.41 (p<0.01). Interestingly it was noticed that the fever other than Dengue also
exhibited similar symptoms excepting significantly less optical density density which suggests the
possibility of Chikungunya fever.
ID/14(O) KNOWLEDGE AND ATTITUDE OF QUALIFIED V/S UNQUALIFIED MEDICAL
PRACTITIONERS REGARDING IMMUNIZATION AGAINST VACCINE PREVENTABLE
DISEASES IN MEERUT, NORTHERN INDIA
Dharmendra Kumar Gupta, S.P Goel, Ram Asare
Department of Pediatrics, L.L.R.M. Medical College and associated S.B.V.P Hospital Meerut, 250004
Objective - To assess overall knowledge of practitioners in respect to immunization schedule, diagnosis,
management and prevention of vaccine preventable diseases. This is the only study of this kind conducted
in northern India. Method - In urban and rural areas of Meerut, total 210 medical practitioners (85 qualified
and 125 unqualified) were interviewed using standard WHO 30 cluster sampling method. Results - Out of
85 qualified practitioners 49% possessed correct knowledge and 38.5% had partial knowledge about
vaccine preventable diseases. In unqualified group out of 125, 10% had correct knowledge and about 56%
had partial knowledge. Qualified practitioners having knowledge of measles, polio, diphtheria and
tuberculosis were 97%, 98.8%, 68% & 97% respectively while among unqualified practitioners this was
21%, 16%, 52%, and 76% respectively. One-third of total practitioners had knowledge regarding routine
immunization in mild illness; about 52.3% had correct knowledge of avoiding immunization in high-grade
fever and infectious diseases and very few knew about immunization in children of cerebral palsy,
convulsion and malnutrition. The knowledge of cold chain among qualified and unqualified was 63.2% and
8.1% respectively. Conclusions – Although the qualified doctors in Meerut district possessed knowledge
and had attitude, it was not up to the mark in regard to immunization against vaccine preventable diseases.
While unqualified practitioners have very little knowledge. Both the groups do not follow proper guidelines
for vaccine preventable diseases and this needs upgrading.
ID/15(P) JAPANESE ENCEPHALITIES VACCINATION AND ITS OUTCOME
Sabyasachi Som, A.K.Dutta, K.L.Barik, Nabendu Chaudhury, B.Mukherjee.
Department of Pediatrics, Burdwan Medical College, Burdwan.
Introduction : Burdwan district is highly prevalent for Japanese Encephalitis since 1973. Different aspects
of JE have been studies including the vaccination programme. First phase study conducted with 1 lac 38
thousand subjects. Next phase study included 5 to 10 tears. Later extended to 25 years age, & 6,72,567
subjects incorporated. The efficacy of vaccine studies on aspects, like antibody production, antibody titre
rise, then clinical survey in vaccinated area. Aims : Government of India may start JE vaccination. Age
group benefited by vaccination needs to be ascertained before incorporation in the routine schedule. The
facts need to be elucidated as follows : (1) Age group to be vaccinated. (2) Timing of vaccine (3) Area to
be covered. (4) Immunological response. Methodoloty : The area of study has been selected on previous
epidemiological reports. The area of occurrence, persistence of disease, vector density and seasonal
variation are taken into account. After having surveillance the vaccination programme has been conducted.
Nakayama NIH strain manufactured by CRI, Kasuli was used (Dose : 1 ml SC) 2nd dose : at 7-14 days
Results :
District
Block
Year
Age group
Number
Burdwan
Jamalpur
1990
5-25 years
138969
Kalna
1990
5-25 years
7256
Memari
1993-95
5-10 years
17276
BDN sadar
1993-95
5-10 years
55404
Primary
5-10 years
9000
School
Bankura
Chhatna
1992-93
5- 25 years
260198
Gangajalghani
1992-93
5-15 years
48072
Ranibandh
1996-99
5-10 years
55766
Khatra
1996-99
5-10 years
10817
Birbhum
Mahammed
1995
5-10 years
39882
Midnapur
bazaar
Salboni
Kharagpur
5-10 years
5-10 years
65060
58912
The efficacy of the vaccine was judged by : A) Evidence of seroconversion : a) By HI 68% b) NT 99%
B) Rise of antibody titre a) By HI 100%, b) NT 100%. Grand total vaccines given were 6,72567 3 rd dose
given 19866 Conclusion : Study showed the importance of J.E.Vaccination.
ID/16(P) TO STUDY THE ENCEPHALITIS EPIDEMIC AT UCMS TEACHING HOSPITAL AT
BHAIRHAWA, NEPAL.
Jha P.K, Sharma Daya
UCMS, Bhairhawa, Nepal
Introduction: Japanese Encephalitis Cause Lot Of Death Toll Every Year, After Causing Disease In
Epidemic Form In Western Up when it come to Nepal we planed to do a systemic study of this epidemic
with an aim to decrease mortality of patient. we formulated a guideline which was followed strictly in all
the patient and we got excellent result inspite of lot of inadequacy in infrastructure. Aim: To study the
encephalitis epidemic at UCMS teaching hospital at bhairhawa,Nepal. Jha P.K, Sharma Daya Material and
methods: all the patient with suspected encephalitis were given emergency treatment and sample were
collected for confirming the case.they were started on the supportive treatment as formulated by us. the
result of various parameters were analysed later. Observation : Total 52confirmed patient of Japanese B
encephalitis were admitted in our hospital,all the case underwent CBC,S.Electrolyte examination,
immunological study and CSF study. all the patient were treated on the basis of guidelines formulated by us
after consulting relevant data. All the patient received full ration of fluid and amino acid supplement. our
mortality rate is only 6% much below the reported rate of 20-30%. Conclusion: mortality in JE can be
decreased by giving adequate fluid with appropriate nutrition and proper care of patient.
ID/17(O) JAPANESE ENCEPHALITIS IN CHILDREN—A FIVE YEAR CLINICOEPIDEMIOLOGICAL SYUDY
P. Chakraborty, M. Hazarika, D.K. Patgiri
Assam Medical College, Dibrugarh, (ICMR) Regional Medical Research Centre, Dibrugarh
Japanese encephalitis is an endemic zoonotic disease in our country, however few studies are available.
OBJECTIVE:1)To analyse the probable epidemiological factors. 2) To study the clinical spectrum of
seropositive and seronegative cases. METHOD: Over a period of five years(2001 to 30/09/2005), all
children upto 12years presenting with Suspected Japanese Encephalitiss were systematically examined and
serological diagnosis was done by MAC-ELISA from ICMR. RESULT:A total of 521 cases of suspected
Japanese encephalitis were admitted; every year, cases were reported from the month of June and continued
till September. The majority of patients were between 4-8 year age(72.5%) with slight male
preponderance.87.5% cases were from low socio-economic status,mainly tea-garden workers.
Most children had mild to moderate malnutrition and were associated with livestock[ Cattle70%,
Chicken52%,
Pig39%
&Duck20%
]
Use
of
mosquitonets
was
rare.
55% patients reported to the hospital between 4-7 days of onset of illness with ubiquotus clinical
presentation of fever and impaired consciousness, followed by convulsion (71%),
headache(61%),vomiting(41%),abnormal behavior (15%) with hemiplegia (5%). Nervous system
examination revealed 11% unarousable coma, 55% with extensor plantar & 45% had Glasgow coma score
5-8 with exaggerated deep tendon reflexes. Neck rigidity & kernig sign were positive in 45% &25.5%
respectively with papilledema in one third cases. Cerebro-spinal fluid analysis revealed raised opening
pressure in 85% cases with maximum showing lymphocytic pleocytosis. Mortality was 25%,while almost
half of the survivors developed sequelae during hospital stay in the form of cognitive impairement, motor
aphasia,
dystonia,
cranial
neuropathy
and
hemiparesis.
There was no difference in morbidity, mortality or sequelae between seropositive & seronegative cases.
CONCLUSION: Japanese encephalitis shows seasonal variation, affecting mostly rural children of 4-8 year
age from poor families. Clinical diagnosis has high accuracy,and cases can be managed with basic health
care facilities without serology or neuroimaging. Early sequelae and mortality being high, Japanese
encephalitis vaccination, patient education ( IEC) and mosquito control measures are a must during premonsoon.
ID/18(O) FALCIPARUM MALARIA WITH RENAL DYSFUNCTION A HOSPITAL BASED
PROSPECTIVE STUDY
N.K. Panigrahy, R. Tripathy, G.C. Samal, S.K. Satpathy
Room # 14 Pg Hostel –I, Mkcg Medical College, Berhampur, Berhampur 760004
Objective : To assess demography, association and outcome of renal involvement in severe falciparum
malaria in children. Methods : This prospective study conducted between January 03 to July 05 at
department of pediatrics M.K.C.G. Medical College, Berhampur. 610 cases of confirmed severe falciparum
malaria (WHO criteria) in the age group 0 –14 years were followed up. 113 children with renal dysfunction
were taken up in the series. Observation : Out of 610 cases 113 (18.5%) had renal involvement. The mean
age of children having renal dysfunction had a higher mean age of affection 8.6  3.1 compare to that in
other types of complications (5.3  2.8). No sex predilection was observed. There was a significant
association of malarial hepatopathy (53.1%) and cerebral malaria (49.5%) with renal dysfunction compared
to their association with other complication. Case fatality among renal dysfunction cases was 23.9%
mortality was comparative higher in above 5 age group and in female sex (33.3%), and cases who deed not
receive any prehospitalisation antimalarial therapy (19.8% verses 39.3%). Case fatality higher in renal
dysfunction along with either cerebral malaria (31.1%), hepatopathy (28.3%), multi organ failure (34%).
Conclusion : Renal dysfunction is not an un common complication in children with severe falciparum
malaria. Early detection in batter facilities for referral and supportive may be of utility to reduce the large
mortality.
ID/19(P) UNSUAL CASE OF FATAL RABIES
Sharma Anita, Kalra Veena, Banerjee Bidisha, Kamate Mahesh, Gulati Sheffali, Kabra Madhulika, Sharma
M.C.
Department of Pediatrics, Division of Neurology, All India Institute of Medical Sciences, Ansari Nagar,
New Delhi 110 029
Aims & objective-To address a diagnostic dilemma & failure of rabies prophylaxis. Case -5-year boy
presented with 3-d h/o fever, headache, irritability and altered sensorium of 12 hrs (Rapid deterioration).
20-days back unprovoked, stray dog bite on face; wound washed, stitched, No Rabies immune
immunoglobulin given Inj Rabipur taken (0,3,7,14) No seizures, hydrophobia, aerophobia, difficulty in
swallowing, drooling, rash, trauma Dog was alive & no H/o change in its behavior. Examination Category III Punctured wound on face, no pooling of secretions. Tone & Reflexes - normal, Plantar b/L
mute, Possibilites considered -Herpes Simplex Encephalitis, Rabies encephalitis, Japanese B Encephalitis,
Acute Disseminated Encephalitis(ADEM ). Pyogenic Meningitis & Cerebral Malaria. CT scan normal.
CSF-PCR for HSV, rabies antibody & Japanese encephalitis negative. Serology for HSV-1 negative. IgM
for Jap B positive. Antemortem - Corneal impression, serum & CSF antibody negative for rabies. Child
continued to be in shock & died 18 days after admission. Post mortem- Brain biopsy, Skin biopsy, Partial
- numerous Negri bodies.
Immunohistochemistry –
prophylaxis failure were -Lack of local treatment of bite wound, failure to give RIG locally, wound
Stitching, poor potency drug or virus deposition into nerves directly. Conclusion- High index of suspicion
of rabies in cases of bite. Stress on local wound care & local immunoglobulin infiltration. Delay in
identification resulted in non isolation and vaccination requirement for over 56 exposed staff members.
Despite vaccination failures though uncommon should figure in differential diagnosis, and patient
management.
ID/20(P) CEFIXIME: AN ORAL OPTION IN MDR ENTERIC FEVER IN CHILDREN
Rajiv Kumar, Nomeeta Gupta, Shalini
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Enteric fever is a serious public health problem in India, where multidrug-resistant salmonellosis causes
enteric fever with increased morbidity and mortality. Costly parenteral therapy and lack of an established
safety profile for the use of quinolones in children necessitate evaluation of an oral treatment option.
Cefixime is an oral third-generation cephalosporin. Objective: To assess the efficacy, safety and cost
effectiveness of an oral cefixime in the treatment of multidrug-resistant enteric fever in children. Material
& Methods: The present prospective and open randomized study was conducted on 85 children up to 12
years of age with culture-proven enteric fever in the Department of Pediatrics, Batra Hospital & Medical
Research Centre, New Delhi during the period between August 2003 and July 2004. All children were
randomly assigned to two treatment groups. Group A (n = 41) received cefixime at a dosage of 10
mg/kg/day in two divided doses. Group B (n = 44) received chloramphenicol at a dosage of 75 mg/kg/day
in four divided doses. Both groups were treated for at least 7 days. Results: In group A, 39(95%) of the
patients receiving cefixime responded well, whereas in group B, 14 (31.8%) responded to chloramphenicol.
Out of 44 patients in group B, 31(68.2%) patients were not cured and they were treated successfully with
cefixime. Overall, cefixime was well tolerated. The subsequent antibiogram data showed an overall
multidrug-resistance rate of 78%. Conclusions: Cefixime is a safe, well tolerated, effective and cheaper oral
option for the treatment of multidrug-resistant enteric fever in children. However, further studies are
needed to validate our observation.
ID/21(P) CEFEPIME IN MULTI-DRUG RESISTANT TYPHOID FEVER : A NEW HOPE ?
Ashish K Roy, Asit Mishra,Raj Kumar Mittal.
Tata Main Hospital, Jamshedpur- 831001, Jharkhand.
Introduction: Lately, there have been a high percentage of treatment failure with ceftriaxone in Multi drug
resistant Typhoid fever. Is it time to try something new ? Objective : A study was carried out to find out the
efficacy of Cefepime in the treatment of culture positive Multidrug resistantTyphoid fever in comparison to
ceftriaxone. Design : Prospective, controlled trial. Setting : Pediatrics ward of a referral hospital. Subjects :
52 children aged 5-12 years, suffering from culture positive MDR typhoid fever. Method: 27 children were
included in the Cefepime group, and treated with cefepime IV 50-75 mg/kg/dy. 25 childrenor Widal were
in the ceftriaxone group treated with ceftriaxone 75 mg/kg/dy. Duration of treatment was 7-10 days with
Cefepime and 10-14 days with Ceftriaxone group. Fever clearence time, treatment failures and relapses
were observed. Results : Cefepime group became afebrile in 66+/-18 hours compared to the 120+/- 36
hours of Ceftriaxone group. There was 1 treatment failure in the Cefepime group, compared to 6 out of 25
in the Ceftriaxone group. There were 3 relapses in the Cefepime group and 5 in the Ceftriaxone group.
Conclusion: Cefepime is more efficacious in the treatment of multidrug resistant Typhoid fever with early
defervesence and fewer relapses. Declaration: This is an independent study with no help from any outside
agencies . There is no commercial interest involved.
ID/22(P) CLINICAL FEATURES AND ANTIMICROBIAL SUSCEPTIBILITY OF VIBRIO
CHOLERAE (INABA) IN CHILDREN IN DELHI
K. Rajeshwari, Ashish Gupta, A.P. Dubey, Beena Uppal
Deparment of Pediatrics and Microbiology ,Maulana Azad Medical College ,New Delhi 110002
Introduction: Outbreaks of cholera are associated with shifts in serogroups and serotypes of the organism.
This study describes the clinical profile of pediatric cholera cases due to inaba serotype seen in Lok Nayak
Hospital, New Delhi during the period April to August 2005. Aims and Objectives: To study clinical
profile, serogroups, serotypes and antimicrobial susceptibility pattern of cholera patients presenting to
pediatric Diarrhea Treatment Unit (DTU). Material and Methods: Case records of children aged 0 – 12
years with culture proven cholera, who were treated at Lok Nayak Hospital, between April and August
2005 were retrospectively analyzed. Results: During this period 1205 patients were admitted to DTU. 106
children were suspected to have cholera out of which 40 were stool culture positive for Vibrio Cholerae.
Most (67.5%) children presented within 24 hours of the onset of illness. History of rice water stools could
be obtained in only 8 (20%) cases. Dehydration was present in 90% of children, with severe dehydration in
60% cases. Out of 40 cases, 37 (92.5%) were Vibrio Cholerae 01 Inaba. Antimicrobial susceptibility of the
organism to Gentamicin, Cefotaxime, Tetracycline, Norfloxacin, Nalidixic acid and Amoxycillin was
100%, 92.5 %, 81.6%, 75%, 5% and 5% respectively. All children recovered without any complications.
Conclusions: Published reports on clinical profile and antimicrobial spectrum on pediatric cholera due to
inaba serotype are scanty. This study highlights the spectrum of illness due to Vibrio Cholerae inaba in LN
Hospital. The strains isolated were mostly resistant to Amoxycillin and Nalidixic acid which is in contrast
to previously published data.
ID/23(P) CLINICAL PROFILE OF 50 CASES OF IGM +VE DENGUE FEVER IN A HOSPITAL
IN KOLKATA
Asha Mukherjee, Dilip Mukherjee, Anindya Kr.Saha, Koushik Mondal, Arpan Agarwal, Saradindu Sarkar
Ramakrishna Mission Seva Pratishthan-Vivekananda Institute Of Medical Sciences, 99, Sarat Bose Street.
Kolkata-700026
Introduction: Kolkata has recently experienced an insurgence of Dengue fever during the month of AugustSeptember2005.Few lives including children had to succumb to this illness.RKSMP is a general hospital
with 100 beded ped unit.Numbers of suspected Dengue cases attended OPD and emergency during this
period ,admitted, thoroughly investigated including detecction of anti Dengue antibody by ELISA.The
clinical profile ,management and outcome of IgM+ve Dengue cases forms the basis of this study. Aims
&Objective:1) To study clinical spectrum of Dengue fever. 2)Management of the cases and their
complications are analysed. 3)To formulate/ propose the remedial measures to identify and prevent the
catastrophy of Dengue. Materials and Methods: 1) 50 cases of IgM+ve Dengue fever were included,studied
and analysed accoding to following criteria: Age of Presentation ,duration of fever before
admission,presence
of
bodyache
,headache,irritability,vomiting,pain
abdomen,
skin
rash,hepatosplenomegaly,polyserositis,anasarca, bleeding manifestation without shock, DHF, DSS. 2) Lab
investigation done using standard methods by the dept of pathology, immunology,
microbiology,biochemistry, radiology in this hospital: blood for complete hemogram,MP,malaria
antigen,,Widal test, culture&sensivity, sodium, potassium,liver enzymes,urea,creatinine, anti Dengue
antibody (IgM &IgG)by elisa,urine for RE&C/S,chest xray and USG when needed. 3)Statistical analysis of
the data. Result: Age of presentation:1 month to 12 yrs., M:F= 1.27:1, Duration of fever at admission=5
days to 10 days. Incidence of various findings as follows: Irritability-70%, bodyache &backpain-60%
headache-60%,vomiting-30%,epigastric pain-50%,skinrash -70%,hepatosplenomegaly-20%,polyserositis20%,anasarca-10%,+ve tourniquet test-4%,petechie-4%, GI bleeding without shock-12%, hypotension25%,altered sensorium-2%,convulsion-2%,shock with myocarditis-2%,DHF-2%,DSS-4%,leucopenia36%,thrombocytopenia-32%,atypical lymphocytes-10%, increased SGPT-2%,IgG anti Dengue antibody48%,Vivax MP-12%,Widal+-8%,Protinuria-4%. blood and urine C/S +ve—NIL Conclusion: 50 cases of
IgM+ve Denguecases thus analysed .The result shows that besides fever in all cases there aresignificant
association of anasarca(10%)
ID/24(P) CUTANEOUS LARVA MIGRANS: A CASE REPORT
Rajiv Kumar, Nomeeta Gupta, Anil Vaishnavi, Bindu Shrivastava, Sandeep Patel, Asif Siddiqui, Praveen
Gupta
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Cutaneous larva migrans is a parasitic skin infection characterized by tortuous migratory skin lesions
caused by hookworm larvae. It presents as an erythematous, serpiginous, pruritic, cutaneous eruption
caused by percutaneous penetration and subsequent migration of larvae of various nematode parasites. It is
also known as ‘creeping eruption’ or ‘sandworm eruption’ or ‘ground itch’. It is characterized by tortuous
migratory skin lesions caused by hookworm larvae creeping eruption as once infected; the larvae migrate
under the skin's surface and cause itchy red lines or tracks. It is seen in tropical and subtropical areas. Case
Report: A 4-year-old male child came with history of pruritic, erythematous, single-track linear and
serpiginous lesions on his leg and buttock of 2 months' duration. He was afebrile. Clinical examination
revealed multiple wavy serpentine tracts and fork like lesions He was treated with antihistamines but
without any clinical response. Cutaneous examination revealed multiple erythematous papules, plaques and
wavy serpentine tracts on the back and posterior aspect of legs. The baseline laboratory parameters were
normal, with a raised absolute eosinophil count of 3800 cell/mm3. A biopsy from the lesion showed only
spongiosis with exocytosis. Based on the history and clinical findings a diagnosis of cutaneous larva
migrans was considered. Treatment with albendazole 400 mg once daily for a week led to incomplete
resolution of lesions on the his leg and buttock. Then oral ivermectin 150-200 µg / kg as a single dose were
given. Human hookworm infestation can be prevented by practicing good personal hygiene, deworming
pets, and not allowing children to play in potentially contaminated environments.
ID/25(O) CHANGING PATTERN AND EMERGING RESISTANCE IN CULTURE POSITIVE
TYPHOID FEVER
Jain R, Mehra S, Sibal A, Mahajan A, Trehan P, Dubey Pn
Apollo Centre for Advanced Pediatrics, Mathura road, New Delhi
Objectives: Multi drug-resistant (MDR) typhoid in India is an escalating problem. MDR isolates of
Salmonella Typhi are on rise and are becoming a challenge for optimal treatment. The present study was
conducted to find the changing trends in the clinical pattern, sensitivity pattern and therapeutic response of
drugs in emerging MDR typhoid Methods: The present prospective study was carried from Feb’03- July’05
in department of pediatrics and microbiology, at a tertiary level hospital. All blood culture positive cases
were included for analysis. Results: A total of 158 had positive cultures for Salmonella Typhi during this
period. Age distribution was, 52 (< 5 years), 75 (5-10 years), 31(>10 years). Male to Female ratio was
1.07:1. Fever was the main presenting feature (100%), followed by abdominal pain (63.3%), diarrhea
(50.6%), vomiting (49.3%), headache (47.5%), cough (19.6%). Hepatomegaly was present in (62%) and
splenomegaly (39.2%). Neutropenia was observed in (7.6%), elevated SGPT in (20%) and S Widal was
positive in (88.6%). In vitro resistance to ampicillin was 82.27%, co-trimoxazole 93.6% and
chloramphenicol 59.81%. 13.2% were resistant to fluroquinolones. Sensitivity to third generation
cephalosporins was 100%. In our study ceftriaxone alone was used in 67%, ofloxacin in 13% and both the
drugs in 20%. Mean time to defervescence was 3.5 days with ceftriaxone and 4.8 days with ofloxacin.
Complications developed in 9 as encephalopathy in 2, severe transaminitis in 5 .Two patients were unusual
presentations, as hematuria and pancytopenia in one and Hemophagocytic Lymphohistiocytosis(HLH) in
another, both had positive bone marrow cultures. There was no mortality or relapse. Conclusions: MDR
typhoid is a major problem in India. However third generation cephalosporins and quinolones are currently
sensitive in majority of the cases. Re-emergence of Chloramphenicol sensitivity and decreased in vitro
resistance was observed in this study.
ID/26(P) CEFPROZIL IN ACUTE OTITIS MEDIA IN CHILDREN
Nomeeta Gupta, Rajiv Kumar, Shalini, Sandeep Patel,
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi, India.
Introduction: Respiratory tract infections are the leading cause of children’s visit to pediatricians. Young
children contract as many as six to eight upper respiratory tract viral infections per year, and these
infections frequently lead to secondary bacterial infections such as acute otitis media (AOM) and sinusitis.
AOM is an extremely common and frustrating medical problem in children. Prompt treatment of AOM is
desirable in order to relieve the child’s immediate discomfort. Cefprozil is an orally active third generation
cephalosporin with excellent antibacterial activity against the Gram-positive organisms, Strept. pyogenes,
Strept. pneumoniae and Staph. aureus. Objective: To study the efficacy and safety of cefprozil in the
treatment of AOM in children. Materials & Methods: The present prospective, open, non-comparative
study was conducted on 167 children aged 6 months through 12 years in Pediatric OPD of our hospital with
clinical symptoms and tympanic membrane signs of AOM. All children received cefprozil 30 mg/kg/day in
two divided doses for at least 7 days. Results: 167 children comprised 104 males and 63 females. All
children had pretreatment symptoms of AOM; the most frequent were earache (45.5%), irritability (39.2%),
lethargy (14.6%), infections (20.3%) and exudation (19.1%). All children had abnormal otoscopy findings;
the most frequent were bulging tympanic membrane (31.4%), erythema (36.5%) and loss of light reflex
(25.4%). Fever was present in 38.9% cases while cough, vomiting and diarrhea was seen in 26.6% cases.
Clinical cure was obtained in 96.6% patients. There was failure of therapy in 1% patient. There was no
need for any rescue medication any change in antibiotic in any patient. A satisfactory bacteriological
outcome was seen in 95% of patients. The twice-daily regimen of cefprozil was acceptable to most patients
and compliance was also good. Cefprozil was well tolerated by our study population. No patient withdrew
from the study due to adverse effects. Gastrointestinal side effects were the only side effects seen.
Conclusion: Cefprozil is a well-tolerated and effective drug for AOM in children. Moreover, its expanded
spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing,
and proven tolerability suggest that it is a better alternative to agents conventionally used in AOM.
ID/27(P) CLINICAL AND BIOCHEMICAL PROFILE OF CHILDREN WITH DENGUE
HAEMORRAGHIC FEVER (DHF) IN DELHI
M.M.A Faridi, Manish Kumar, Anju Aggarwal, Abedin Sarafrazul .
Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi
–95
Introduction: DHF is a mosquito borne, arboviral disease which affects all organ systems and usually
occurs in epidemics. Clinical and biochemical profile differs in various epidemics. Aim: To study the
clinical and biochemical profile of DHF in children during 2003 epidemic. Study design: Prospective
observational study. Subjects: Children hospitalized with DHF from September 2003 to December 2003
were studied. All patients were diagnosed, managed and monitored according to a standard protocol.
Results: Of the 34 patients who fullfilled the WHO criteria for DHF were 22(64.6%) were males and 12
(35.4%) were females. Majority were in age group of 10-12 years (52.9%) ,were 23.5% between 7-9 years
and 23.5% were less than 6 years. All paitents presented with fever. Hepatomegaly was seen in all ,
splenomegaly in 11(29.4%) ascites in 6(17.6%) and pleural effusion in 3(8.8%). Bleeding manifestations
were seen in 12 (35.3%) children, of which 7 had epistaxis, 2 had gum bleed, 2 had petechiae and 1 had
hematemesis. Majority had a platelet count between 20,000/mm3 and 50,000/mm3 (56%), 14(41%) had
platelet count >50,000/mm3 and 1(3%) less than 20,000/mm3. Bleeding manifestations were not related to
platelet count (P>0.05). SGPT > 40 IU/L was seen in 22 (64.6%) patients, alkaline phosphate > 400 IU/L in
12 (35.4%), serum bilirubin > 1mg% in 3 (8.8%). Dengue serology was positive in 68.5% cases .There was
no significant difference in LFT’s, haematocrit and platelet count with age and sex (P >0.05).Conclusion –
Clinical features were different from previous epidemics. Liver function tests are altered in DHF.
ID/28(O) CLINICO-BACTERIOLOGICAL PROFILE OF ACUTE PYOGENIC MENINGITIS IN
CHILDREN
Gurdeep S. Dhooria, (Brig) C. H. Gidvani, Praveen C. Sobti
Deptt of Pediatrics, Dayanand Medical College and Hospital, Ludhiana 141012
The study was conducted to evaluate the clinical and bacteriological profile of bacterial meningitis.
Methods: 50 cases aged between 1month and 12years with signs of meningitis admitted in the Pediatric
Department of Pravara Medical College, Loni, were studied. A detailed history and thorough clinical
examination was done. CSF was examined for Gram stain, cytology, biochemistry and culture. Results:
Maximum cases were constituted by children less than 3 years of age (62%), of which 34% were in 1month
-1 year age group. Common signs and symptoms included fever (84%), altered sensorium (72%),
convulsions (62%) and meningeal signs were present in 46%. The commonest foci of infection were otitis
media and bronchopneumonia (52%) . Gram stain was positive in 21 cases (42%). CSF Culture was
positive in 18 cases (36%). The organisms isolated were 5 cases each of Escherichia coli and Klebsiella
species, 3 cases each of Streptococcus pneumoniae and Staphylococcus aureus, and 1 each of Coagulase
negative Staphylococcus and Citrobacter diversus. In children less than 1 year, of the total 10 CSF culture
positive cases, Escherichia coli was the commonest (4cases) followed by Klebsiella species (2 cases) and
Staphylococcus aureus (2 cases). Mortality was noted in 7 cases (14%), and at discharge 8 cases (16%) had
neurological sequelae . Conclusions: In the study it was observed that fever (84%), altered sensorium
(72%), convulsions (62%) and meningeal signs (46%) were common signs and symptoms. Highest culture
positivity was seen in children less than 1 year, where Gram negative bacilli were the commonest.
ID/29(P) EPIDEMIC OF VIRAL ENCEPHALOPATHY IN BAGHPAT & NEIGHBOURING
AREAS OF UTTAR PRADESH.
Sanjay Verma, Piyush Gupta.
Department Of Pediatrics, Ucms & G.T.B.Hospital, Delhi.
INTRODUCTION: During the months of September to November 2004, sudden increase in number of
cases was noticed with diagnosis of encephalitis/encephalopathy, admitted in our hospital from Baghpat
and neighboring districts of Western Uttar Pradesh. AIMS & OBJECTIVES: To study the clinicobiochemical profile & outcome of these admitted patients. MATERIAL & METHODS: Retrospective
analysis RESULTS: 42 (22 males, 20 female) patients were admitted [Baghpat(21), Muzaffarnagar(9),
Ghaziabad(7), Bulandshahr(5)]. 30(71.4%) were between 2-5 years, majority were poor presented with a
short history. Main symptoms were history of fever(97.6%), vomiting(54.8%), abnormal behavior(95.2%),
seizures(47.6%), bleeding manifestations(11.9%) and jaundice(9.5%) while examination revealed signs of
raised ICT(40.5%), brisk DTR(54.8%), extensor planter(71.4%), coma(57.1%) and hepatomegaly(7.1%)..
Investigations revealed hypoglycemia in 28(66.7%), while slightly raised liver enzymes in 7/21(33.3%)
cases. CSF examination was normal in most of them while arboviral serology was positive for JE virus
only in 1 case, out of 11 samples send. Most striking feature was a very high mortality, as 31(73,8%)
expired, majority 23/31(74.2%) within 24 hour of admission. DISCUSSION: Considering the clinical
pattern, probable viruses could be considered in etiology, other then JE virus include Nipah virus,
Chandipura Virus, Enerovitus-71 and West Nile virus. This clinical picture could be correlated with
encephalopathy like Reye's syndrome. This disease entity in this region of Western Uttar Pradesh is being
reported since 1998, our study probably a continuation of the same. CONCLUSION: We are reporting an
epidemic of encephalitis/encephalopathy from this area having a very high fatality rate. More planned
epidemiological study is needed urgently to find the causative agent, so that these patients could be
managed batter.
ID/30(P) EPIDEMIOLOGICAL STUDY OF JAPANESE ENCEPHALITIS AT BURDWAN
MEDICAL COLLEGE.
Sabyasachi Som, K.Nayek, A.K.Dutta, Nabendu Choudhuri, B Mukherjee,
Department of Pediatrics, Burdwan Medical College, Burdwan
Introduction : The state of West Bengal is known for its constant endemicity for Japanese Encephalitis
since 1973, From that time till today the total number of cases of JE is more than 5000. It is one the area
where there is continuous occurrence, but in other state it is declining. Aim: A detailed epideminological
study for mortality and morbidity of subjects, animal who are amplifier of JE virus, vectors with effect of
insecticides on them, seasonal variation of vectors and preventive measures. Methodology : All the cases
admitted in BMC are totally evaluated for clinical profile, living habits relation with animals, test for JE
antibodies and vector density study, Identification of vectors, susceptibility to insecticides and its
resistance are also studies and longitudinal approach of benefits of preventive aspects on subsequent house
visits. Results & Analysis : The case fatality rate was 23-58%. Case fatality is gradually declining and
morbidity part is also decreasing. As because of growing resistance of vectors to insecticides, the use of
mosquito net and repellents are more useful. The study has reflected the occurrence of disease is due to
different types of Culex vismi. Conclusion : This epidemiological study has definitely found out the cause
of propagation of disease and its intimate relationship with the animal who are amplifier of the disease and
theraby helping to control this disease in Burdwan and surrounding districts.
ID/31(O) ETIOLOGICAL AGENTS OF ACUTE WATERY DIARRHEA
Panchmahalkar As, Patel Ab, Dibely Mj, Kulkarni Lr
Indira gandhi government college, Nagpur
Objectives: To determine etiological microbes in acute diarrhea, their antibiotic sensitivity and the baseline
risk factors of bacillary dysentery and rota virus diarrhea. Design: Cross-sectional study. Setting: Teaching
hospital. Methods: Baseline socio-demographic, clinical and nutritional status of 300 children aged 6-59
months with acute watery diarrhea was studied. The etiologic agents and their sensitivity were determined.
Results: Mean age 18 months; mean maternal education was 6.7 years, only 31% of mothers were using
soap for washing their hands before feeding child, and only 70% were using close container for drinking
water. 45% of population was from slum area. About 55% of children were malnourished. Clinical watery
diarrhea was in 77% of cases and microscopically 53% showed red cells. Ova and cysts were in 16%,
Giardia in 1.6%, and, Rotavirus in 19% of cases. The commonest bacterial agent was E.coli (49%)
followed by Klebsiella (35%), Shigella (2%) and Salmonella (1%). E.coli had 44% sensitive to
Chloramphenicol and 33% to Cefuroxime. The predictors of Rota virus were younger age group[OR:94,
CI:0.91-0.98], with increased frequency of vomiting [OR: 1.01, CI: 1-1.03] and those using open container
for water storage[OR: 0.5, CI:0.26-0.96]. Bacillary dysentery was more common with increasing age [OR:
1.03, CI:1-1.05] and in population not residing in slums[OR: 0.58, CI: 0.35-0.97] with better wealth
index[OR: 2.72 CI: 1.02-7.28]. Conclusions: Malnutrition was present in high proportion of children with
bacillary dysentery. Therefore even children of acute watery diarrhoea with malnutrition should be
routinely assessed for bacterial dysentery and treated with appropriate antimicrobial therapy, which in this
study was Chloramphenicol.
ID/32(O) DENGUE VIRUS ENCEPHALOPATHY IN CHILDREN
J.J. Tambe, R. Kumar, V.L.Nag, K.L. Srivastava
Department of Paediatrics, K.G.M.U., Lucknow
OBJECTIVE: Acute febrile encephalopathy is a common problem leading to childhood hospital admission
in Lucknow. In the previous years, many patients were admitted in our wards with Acute febrile
encephalopathy along with hemorrhagic manifestations. Some of them were proven to be dengue viral
infections. The present study was therefore aimed to define the role of dengue viral infection as a cause of
Acute febrile encephalopathy. METHOD: A total of 123 cases of AFE were enrolled in study conducted
between August 2003 to July 2004. A detailed history, clinical examination and relevant investigations
including cerebrospinal fluid examination, packed cell volume, liver function tests, platelet counts was
done. We also performed serology for Japanese Encephalitis and Dengue and detected IgM antibody by
haemagglutination test (HI) and IgM antibody capture ELISA. RESULT: The maximum number of cases
were admitted to the hospital in the month of September (45.0%). Out of 123 cases, twenty cases were
confirmed cases of Dengue viral infection. Tourniquet test, was positive in only 10%of cases. Seventeen
cases had two or more criteria of DHFout of them seven patients had evidence of vascular leak. In this
study, three cases showed pleocytosis and thrombocytopenia in 2 cases. CONCLUSION: Dengue viral
infection is a cause of acute febrile encephalopathy in children in this region. Tourniquet test though
considered an important diagnostic parameter, is infrequently seen in our patients with DHF
ID/33(O) DENGUE FEVER - A SCORING SYSTEM FOR ASSESSING SEVERITY OF THE
DISEASE
Gopala Setty B .R , Sneharoopa Baseganni , Ramesh . H , C.R.Banapurmath.
JJM Medical College , Davangere.
Objectives: Dengue fever is a killer disease with fatal outcome. Early diagnosis is a key factor in the
management. This study was taken up to assess the severity and outcome by using a scoring chart.
Methods: Seventy five children suffering from dengue fever who were IgM positive between six months to
fifteen years formed the study group. Twenty parameters which included clinical, hematological,
biochemical and radiological findings were identified and accorded score 0, 1, 2, 3, depending upon
absence, presence, increase or decrease level of each parameter. A total score of 37 was given. Results:
Out of seventy five children, nineteen cases belonged to dengue fever (DF), thirty to dengue hemorrhagic
fever (DHF) and twenty six to dengue shock syndrome (DSS) group. DF group had no scores whereas DHF
and DSS group had higher scores. Mortality occurred in 6 (8%) cases who had higher scores.These scores
were found statistically significant as per Spearman's Rak conversion and Kandal's taub conversion table.
Conclusion: The study had shown by using above scoring system, severity can be assessed more efficiently.
ID/34(O) PULMONARY MANIFESTATIONS OF HIV-1 INFECTION
STUDY OF 42 CASES.
L.Braja Mohon Singh, L.Ranbir Singh, Ch.Shyamsunder Singh, Y.Tomba Singh
Department of Pediatrics, Institute of Medical Sciences (RIMS), Imphal, Manipur
IN CHILDREN - A
Background: Pulmonary complications are a major cause of morbidity and mortality in children with HIV1 infection. Of the important pulmonary manifestations encountered in clinical practice are recurrent
serious bacterial pneumonias, tuberculosis (TB), Pneumocystis carinii pneumonia (PCP) and Lymphoid
interstitial pneumonitis (LIP) and other opportunistic viral and fungal infections. Diagnosis of these
complications needs awareness and a high index of suspicion among treating doctors. Often empirical
therapy is required for some pulmonary conditions in resource poor settings where the health
infrastructures are inadequate. We describe our experience in the problem of diagnosis and management
from a state with a high HIV sero-prevalence rate of 1.7% among antenatal mothers. Objectives: To
describe the prevalence, type of pulmonary manifestations, clinical profile, investigation variables,
problems in diagnosis and management, morbidity and mortality and associated factors affecting the
outcome of management of HIV-1 infected children with pulmonary manifestations. Design: Prospective
observational study. Setting:Tertiary Medical Care Teaching Hospital. Materials and Methods:42 HIV-1
infected children (1½- 12 yrs) with pulmonary manifestations admitted in the Pediatric ward of the
Regional Institute of Medical Sciences Hospital, Imphal, during January 2000 and December 2004 were
studied. Clinical data were recorded and relevant investigations performed in all the cases. Diagnosis of
HIV infection was based on the criteria laid down by National AIDS Control Organization (NACO).
Diagnosis of Pneumocystis carinii pneumonia (PCP) was based on clinical signs and symptoms and sputum
examination. Tuberculosis (TB) was diagnosed as per the IAP guidelines. LIP was diagnosed from the
clinical history, radiological findings and by method of exclusion as none of the patients gave consent for
lung biopsy. Other relevant investigations were performed wherever indicated. The various constraints in
diagnosis of pulmonary conditions and their management are assessed and analyzed. Result : Of the 42
children with perinatally acquired HIV-1 infection(ARV naïve),15 (35.7%) were rapid
progressors,27(64.3%) slow progressors. Mean age of rapid progressors was 22 months and that of slow
progressors 4½ years. Of the 15 rapid progressors, 4 (26.7%) had PCP, 9 (60%) had recurrent serious
pneumonias and 2(13.3%) had TB. Of the 27 slow progressors, TB was observed in 13(48.1%) children,
bacterial pneumonias in 5(18.5%)cases, PCP in 2(7.4%) cases and LIP in 3(11.1%). There were 4 (14.8%)
children with chronic pulmonary symptoms and signs (rales) in which we could not arrive at a conclusive
diagnosis. Of the 13 TB cases 7(25.9%) had progressive primary complex, TB 5 (38.5%)cases of TB had
Mx test ≥5 mm induration, and none of them had >10mm. induration. PCP had its peak at 4-6 mo with
acute onset of tachypnea, dyspnea and marked hypoxia, and chest radiographs showed diffuse alveolar
disease in 1 case, interstitial infiltrates in 2 and nodular lesion in 1 case. LIP was seen after 3 years and
presented with insidious onset of progressive hypoxemia and cough with minimal rales and steroid was
useful in relieving the symptoms. None of the children with LIP was associated with parotitis.
Management of PCP was difficult as co-trimoxazole IV was not available. Problem encountered in
children presenting with respiratory illness or pulmonary infiltrates was in distinguishing between bacterial
pneumonias and PCP or LIP. TB management was done as per the IAP guidelines. It was complicated by
HIV co-infection, severe malnutrition and other OIs. Sputum examination of suspected PCP in older
children is a useful tool in diagnosis and it was positive in 2 cases. Because of the subacute onset we had
difficulty in clinically suspecting PCP in older children.There were 4 (9.5%) deaths, 3 were due to PCP
among rapid progressors and 1 due to miliary TB. Delayed diagnosis and treatment, severe malnutrition
and advanced HIV disease and co-infection with other OIs were responsible for the mortality. Cotrimoxazole prophylaxis helps in reducing the number of episodes of recurrent bacterial pneumonias in
children with HIV infection. Conclusion: Although recurrent pneumonias are commonest among small
children with rapid progressors ,TB is emerging as one of the important OIs and its diagnosis difficult because of
the clinical overlap with HIV disease. A high index of suspicion is required for its diagnosis. PCP is a major fatal
disease among rapid progressors and its prompt diagnosis and treatment with IV co-trimoxazole is crucial for
salvaging these infants. Among slow progressors, LIP is another chronic pulmonary condition which needs critical
evaluation and management with corticosteroid therapy. The importance of co-trimoxazole chemoprophylaxis is
emphasized for PCP.
ID/35(P) DISSEMINATED CRYPTOCOCCUS INFECTION: A CASE REPORT
Anand VK, Sardana Kabir, Choudhary Mw
Deptt of Pediatrics, Kalawati Saran Children’s Hospital, Lady Hardinge Medical College, New Delhi,
110001
Introduction: Cryptococcosis, is a fungal disease of humans and animals caused by Cryptococcus
neoformans, a yeast-like encapsulated fungus. Infection is thought to be acquired by inhalation of fungus
into lungs mostly where the infection goes unnoticed and it has strong prediliction for the central nervous
system The disease primarily presents as a subacute or chronic meningitis, though other organs like liver,
spleen, skin, lymph node, eye, bones, adrenals and ears involvement is variably seen. Case Report: We here
in report an 8-year-old girl
who presented with fever, cough, headache, lymphadenopathy,
hepatosplenomegaly and cutaneous lesions. Lymph node biopsy revealed multiple granulomas composed
of histiocytes and epitheliold cells along with numerous yeast forms of cryptococcus. Cultures of CSF,
sputum and urine yielded cryptococcus neoformans. Surprisingly, the immune function in terms of T-cell
number, CD4: CD8 ratio, serum immunoglobulins and HIV serology was normal. After the diagnosis of
disseminated cryptococcosis was established, the patient was treated with 5-fluorocytosine (100
mg/kg/day) for initial two weeks and amphotericin B (1 mg/kg/day) for 13 weeks. Patient responded well
to the treatment with disappearance of presenting symptoms, cutaneous lesions, and lymphadenopathy,
though she still had hepatosplenomegaly, which also decreased. Unfortunately, she developed loss of vision
in 10th week of therapy. The patient was discharged on oral fluconazole (6 mg/kg/day) and no recurrence
was found during the follow-up period of more than 9 months.
ID/36(P) PROFILE OF PEDIATRIC HIV PATIENTS AT AN ANTI RETROVIRAL THERAPY
(ART) CENTRE
Ajay Kumar, Peeyush Jain, K Rajeshwari, AP Dubey
Deptt. of Pediatrics, Maulana Azad Medical College & assoc. Lok Nayak Hospital, New Delhi-2
Limited Indian data is available on pediatric HIV infections. In this report demographic details, clinical
features, diagnostic parameters, details of management and follow-up of HIV-infected children registered
at ART center at Lok Nayak Hospital, New Delhi set up in April 2004, are being presented. Forty-nine HIV
positive children, median (range) age at presentation 5 yrs (1-11yrs) and M:F being 1.58:1 (M=30, F=19)
are presently under follow up. Of the parents fathers in 29 (59%), mothers in 32 (65%) and both in 28
(57%) were HIV positive. Various reasons for referral included: HIV positive parents in 19 (39%), HIV
positive subjects in 13 (26%) and already on ART in 10 (20%) cases. Signs and symptoms at presentation
included fever, malaise, weight loss, diarrhea, cough and lymphadenopathy. Candidiasis and pyogenic
infections were the main opportunistic infections seen. Fifteen (30.6%) of these patients were administered
free Antiretroviral therapy as per NACO guidelines. Of these, 8 children (53%) also had tuberculosis.
Seven (20.5%) children who did not require ART also had TB. Three (20%) patients required change in
ART regimen due to intractable side effects. In patients on ART, at presentation CD4 counts (mean+s.d.)
were 375+298 /mm3, CD4/CD8 counts (mean+s.d.) 0.27+0.26 which improved after 6 months of therapy
to 579+474 /mm3 and 0.59+0.33 respectively. Eight (53%) children on ART were also put on
Cotrimoxazole prophylaxis. All the patients on ART are alive and are under regular follow up.
ID/37(P) PSEUDOTUMOR CEREBRI FOLLOWING MEASLES VACCINATION.
Ritu Gupta, Ravinder K. Gupta
Child Care Centre, Nai Basti, Jammu Cantt. (J&K)
Two infants aged 9 months each of opposite sex presented in private pediatric OPD with bulging anterior
fontenelle. Detailed history did not reveal any evidence of infection, otitis media, recent trauma, drug
intake including vitamin A or previous such ailment in each infant. There was no history of any viral illness
in the family in recent past. There was history of measles vaccination about 3 days back. Both infants were
given measles vaccine by two different persons at two different places. Both measles vaccines had two
different batch numbers. Thorough clinical examination did reveal well nourished children. There were no
signs of rickets, vitamin A deficiency and anemia. There was no maculopapular skin rash. Both infants
were afebrile and had bulging anterior fontanelle at relaxed state. A search for focus on infection
particularly in the ENT area was done and did not reveal any thing abnormal. Cranial examination
particularly for suture, skull circumference, shape of cranium and any other abnormality and fundus
examination did not reveal any thing unremarkable. Each child was investigated with a view to find out the
cause of ICP and its effects. These investigations comprised of complete hemogram, urinalysis and stool
examination. Special investigation included cranial ultrasonography through open anterior fontenelle,
guarded lumber puncture for CSF analysis and CT scan of head which were however within normal limits.
Serology was not done because of lack of facility. Both the mothers were reassured and within 3 days
anterior fontenelle were at normal levels. The children were followed for six months and found to be
normally. Conclusion: Association of pseudotumor cerebri after measles is definitely a rare observation.
Measles being a live attenuated vaccine and its possibility of acting directly or through allergic
manifestation of this virus couldnot be a possible hypothesis, though it was a circumstantial evidence. It
needs further study. To conclude pseudotumor cerebri can also be seen following measles vaccination.
ID/38(O) TREATMENT OF KALA- AZAR IN NEW MILLENNIUM
Arun Shah, Shyam Sundar
Aala –Azar medical research centre Rambagh Raod, Muzaffarpur& Institute of Medical science, Banaras
Hindu University, Varanasi
Children from about 40-50 % of Patient with Kala-azar in India and this proportion is steadily increasing.
Effacacy of Sodium Stibogluconate has declined significantly with the result that only 30-38% patient and
cured with in North Bihar. Through, pentamidine pass used initially for antomoney unresponsive, serious
toxicity and declining efficacy led to stoppage of its use. Amphotericin B infusions, although highly
effective, are expensive toxic and require prolonged hospitlisation. Lipid formulations of amphotericin B
have low toxicity and treatment can be delivered in short courses, even in a single dose, the cost is
prohibitive, recently first oral antileishmanial drug miltefosine ( 2.5 mg/kg for 28 days) has been approved
for treatment of Kala-azar including in children, cure rates in children was 94%, and mild gastrointestinal
side- effect was seen with 21(26%) and 20 (25%) of children had vomiting and diarrhea, respectively,
Recently paromomycin, an aminoglycocide side is undergoing a phase III trail, In this study 500 patients
with 40% children have been treated with paromomycin (15/kg intramiuscular for 21 days ), and the
preliminary result are extremely encouraging with no nephrotoxicity and hearing loss. Reversible
ototoxicity in high frequency was observed in 0.6%. Contrary to previous era, therapeutic horizon for
leishmaniasis is expanding and to protect the newly developed drugs, it is advisable that multi drug therapy
with short courses be used to improved compliance and prevent resistance.
ID/39(P) PREDICTION OF SERIOUS ILLNESS AND MORTALITY RISK IN FEBRILE
CHILDREN AGED 3-36 MONTHS USING YALE OBSERVATION SCALE (YOS).
Akash Bang, Pushpa Chaturvedi
Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences and Kasturba Hospital,
Sevagram. 442102. Dst. Wardha.
In absence of investigational facilities and more so when localizing signs are absent, proper assessment and
triage of febrile children is very important. For this, observational scales like Yale Observation Scale(YOS)
need validation and assessment as they use observational items that can be judged by even non-specialists.
Design: Prospective hospital based study. Methods: 219 febrile inpatients aged 3-36 months were
consecutively recruited. Before giving antipyretics, rectal temperature was recorded. YOS scores were
assessed by 2 independent blinded residents. History, clinical examination and investigations followed. A
serious illness was defined as a positive blood or urine culture OR a chest roentgenogram or cerebrospinal
fluid finding consistent with an infective disease process. Point estimates and 95%confidence intervals
were calculated for sensitivity, specificity, positive & negative predictive values and likelihood ratios for
use of YOS in prediction of serious illness and of mortality. Results: Study population (n=219) had a mean
age of 15.24 months and had 59.36% males. 49.77% patients had a serious illness with a mean total YOS
score of 13.64, that was significantly higher (p<0.000001) than the mean total YOS score (8.09) of the
50.23% patients with a non serious illness. Sensitivity, specificity, PPV, NPV and LR+ of YOS score >10
to predict a serious illness were 64.49%, 87.04%, 83.13%, 71.21%, 4.98 and 0.41 respectively. Mean YOS
score for the 24 patients who succumbed (22.33) was significantly higher (p<0.0001) than those discharged
(9.49). Sensitivity, specificity, PPV, NPV and LR+ of YOS score >16 to predict mortality were 100%,
95.26%, 72.72%, 100% and 21.1 respectively. Conclusions: YOS is a simple, easy to administer, costeffective and useful test to predict a serious illness and mortality risk in a febrile child aged 3-36 months.
Normal YOS scores rule out a serious illness and further mortality with reasonable accuracy whereas high
scores need further workup.
ID/40(P) HEPATITIS A WITH THROMBOCYTOPENIA: A CASE REPORT
Rajiv Kumar, Nomeeta Gupta
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Case Report: A 11 year old girl admitted in our institution with history of low grade fever, malaise, nausea
and loss of appetite for 7 days followed by hematemesis and purpura for 2 days. On examination, she was
sick, toxic-look; weight was 30 Kg and height was 140cm. The pulse rate was 124/min, respiratory rate was
32/min and BP was 74/50 mmHg. She had mild jaundice, severe pallor and purpuric spots over the face and
extremities. There was no lymphadenopathy or bony swelling and tenderness. Systemic examination
revealed hepatosplenomegaly and other systems were essentially normal. A slit lamp examination excluded
presence of Kayser Fleischer ring. Laboratory investigations revealed Hb 4.8 gm%, TLC 8200/cmm with
53% neutrophils, 39% lymphocytes, 6% monocytes, 2% eosinophils, ESR 16 mm in 1st hour and platelet
count 45000/cmm, and no evidence of abnormal cells on peripheral smear. M.P. was negative. PT was
prolonged while PTT was normal. Total serum bilurubin was 8.3 mg/dL and conjugate bilurubin of 2.5
mg/dL. SGOT was 2156 U/L, SGPT 1860 U/L and alkaline phosphatase 398 U/L. Serum urea, creatnine,
albumin, glucose and electrolytes were normal. Abdominal ultrasound revealed hepatosplenomegaly but no
evidence of biliary tree dilatation, ascitis or space occupying lesion. Serum IgM for anti-Hepatitis A
antibody was strongly positive though it was negative for Hepatitis B and Hepatitis C. She was transfused
with packed red blood cells, platelet concentrates and other supportive therapy which included IV fluids, IV
antibiotics, ranitidine and vitamin K. Over a period of 7 days of hospital stay, her general condition
improved and her liver function tests and platelet count returned to normal. Conclusion: The clinical profile
and serology associated with normal peripheral smear made us conclude that the thrombocytopenia was
indeed a result of HepatitisA infection. Thrombocytopenia as a result of HAV infection in children has
rarely been reported. The pathogenesis of thrombocytopenia has been postulated to be caused as a result of
deposition of immune complexes on the platelet surface or to the development of anticardiolipin antibodies.
ID/41(O) HEPATITIS EPIDEMIC IN CENTRAL
EPIDEMIOLOGICAL STUDY
Siby Joseph, M. M. Sosamma, S. Latha
Institute of Child Health. Govt Medical College. Kottayam.
TRAVANCORE
2004-2005
AN
Objectives : To determine the aetiology of acute viral hepatitis epidemic in central Travancore from
September 2004 to March 2005 and to determine the risk factors clinical profile and demographic pattern
of distribution of cases.Study design: This was a prospective study involving 68 of the 82 viral hepatitis
patients admitted in Institute of Child Health, Kottayam for 7 months from September 04 to March 05.
Methods: There were a total of 82 cases admitted during this period. 68 cases were included in this study.
Detailed physical examination,clinical profile recordings and investigations including serum markers for
HAV and HBV were done and all the parents and children were interviewed. USG Abdomen was done in
almost all cases. Investigations for HEV, HCV, Leptospirosis and Dengue fever were done wherever
necessary. .14 out of the 82 cases could not be interviewed or serum markers were not done and so avoided
from the study.Result: 60 of the 68 patients studied were found to have viral hepatitis A.40 of the 60
hepatitis A patients reported direct contact with a case of hepatitis A either in family, school or
neighborhood. 36 of the 60 reported poor personal hygiene in the form of improper washing of hands
before food and after toilet, which is the second important risk factor identified. 30 of the 60 children where
in the age group of 5 to 10 yrs. In the clinical profile study 59of the 60 had jaundice,50 had high colored
urine,55 had anorexia,13 had diarrhea and 10 had pale feaces which were comparable with other studies.
Fever(58),nausea/vomiting(50), abdominal pain (44)and fatigue (56) where seen in more cases when
compared with other studies.Outcome.Of the 60 cases studied there was one mortality. Of the other 59
cases 51 where treated and discharged without any complications. There where 9 cases with significant
complications. 1 case had ADEM, 2 cases went to early hepatic failure,2 cases had pleural effusion ,3
cases had ascites and 1 case had relapse after one month of recovery . All these 9 children also responded
to adequate treatment and discharged and were followed up till liver function was normal. Conclusion: Our
findings confirm that Hepatitis A was the causative organism for this epidemic. Contact with a case of
hepatitis A was the most important risk factor identified. Age group of 5-10 yrs was identified as the
highest affected group.A rare complication of ADEM was also seen.
ID/42(P) HIV SEROPOSITIVITY IN SEVERELY MALNOURISHED CHILDREN
S.Manazir Ali, Syed Javed Hasan Zaidi, Tabassum Shahab,Abida Malik
Department of Pediatrics & Microbiology, Jawahar Lal Nehru Medical College, AMU, Aligarh 202002.
Malnutrition is one of the clinical features of HIV infection in paediatric age group which is evident from
the studies on HIV seropositivity in Nigeria, Tanzania, Zambia. However, on study on the prevalence of
HIV seropositivity in severely malnourished children is available in India. Hence, this study was carried
out to determine the HIV seropositivity in severely malnourished children in the Department of Pediatrics
in collaboration with Microbiology of Jawahar Lal Nehru Medical College, AMU, Aligarh with effect from
October 2003- May 2005. 300 severely malnourished children (Weight/Age <60%, IAP) (Weight/Height
<70%, WHO) were studies. There was predominance of males over females with a M:F ratio of 2.33:1
These malnourished children were screened for HIV seropositivity after obtaining detailed history,
examination and routine investigations. 46.66% of malnourished children were in the age group of o-17
months followed by 31.33% in the age group 36-60 months belonging to Muslim (55.67%). Upper-lower
socio economic status (76.33%) (Kuppuwamy Scale ) Low immunization status (< 30%) was seen. Low
awareness of mode of HIV transmission(<10%) was found and the commonest presentations of severely
malnourished children were anemia 97%, followed by fever 59%amprexoa (42%), diarrhoea (38%)altered
sensorium (29.77%) and lymphadenopathy (11.33%). After selection of severely malnourished children, 4
ml of venous blood was collected by aseptic manner and transported to Microbiology Department for
ELISA for detection of HIV antibodies in serum by Microlisa HIV. The Hiv positivity of all 300 severely
malnourished children was found to be zero% which is probably low risk of HIV seropositivity in this
region i.e. Uttar Pradesh. Therefore more studies preferably community based with multiple risk factors
are needed so that yield of HIV seropositivity may be increased. Hence clinically directed selective
screening is the need of the hour to diagnose paediatric HIV infection in a resource poor country like India.
ID/43(P) SAFETY AND REACTOGENICITY OF A BOOSTER FORMULATION DIPHTHERIATETANUS-ACELLULAR PERTUSSIS VACCINE IN INDIAN CHILDREN
A.P. Dubey, A. Bose, D.J. Gandhi, A. Pandit, M.B. Raghu, P. Raghupathy, I. Rao, P.V. Verghese, S.K.
Datta, H.L. Bock
Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi
Introduction: Pertussis disease in adults and adolescents has been a long recognised and growing public
health problem. Acellular pertussis vaccines, especially when combined with diphtheria and tetanus in
reduced booster concentrations, offer an opportunity to boost older children, adolescents and adults safely
and efficiently. A study to ascertain the tolerability and acceptability of such a vaccine in Indian pre-school
children was undertaken to facilitate local registration. (Trial: dTPa-036) Methods: After full review of the
protocol by the Regulatory Authorities (DCGI) and the individual Institutional Ethics Committees,
GlaxoSmithKline's booster dose reduced-antigen-content combination diphtheria-tetanus-acellular pertussis
(dTpa) vaccine was administered to 347 children aged 4-6 years in 7 centres across India, after documented
parental consent. All children were subsequently followed up for one month for safety and reactogenicity.
Results: 345 subjects completed the study, with only 2 subjects lost to follow-up. Only 1 serious adverse
event (head injury) was reported, which was unrelated to vaccination. Otherwise, all subjects were in good
health. Related to vaccination, no subjects developed fever >39 °C (axillary) and only 3 subjects (0.9%)
reported transient general symptoms (such as irritability and drowsiness), which prevented normal activity.
Only 5 subjects (1.4%) reported pain spontaneously or when the limb was moved, resolving shortly. There
were no other severe local reactions including large injection site reactions. Conclusion: The reduced
antigen-content combined dose dTpa vaccine is safe and well tolerated in Indian children and offers a
potential vehicle to boost pertussis in older age groups.
ID/44(P) IMMUNOGENICITY AND SAFETY OF COMBINED DIPHTHERIA-TETANUSWHOLE CELL PERTUSSIS-HEPATITIS B/HAEMOPHILUS INFLUENZAE TYPE B VACCINE
IN INDIAN INFANTS PREVIOUSLY PRIMED AT BIRTH WITH HEPATITIS B VACCINATION
S.B. Bavdekar, P.P. Maiya, S.D. Subba Rao, , S.K. Datta, H.L.Bock
Seth G.S. Medical College and K. E. M. Hospital, Parel, Mumbai-400 012
Introduction: This study of the combined diphtheria-tetanus-whole-cell pertussis-hepatitis B and
Haemophilus influenzae type B (Hib) vaccine investigated the immune responses against the hepatitis B
and Hib components and evaluated the reactogenicity of the vaccine. The study had full ethical approval
and was conducted according to ICH GCP guidelines. (Trial: DTPw-HBV-Hib-021) Methods: 225 healthy
infants, who had received HBV at birth were enrolled in 3 centres across India and received 3 doses of the
study vaccine at 6, 10 and 14 weeks of age. Serum anti-HBs and anti-PRP antibody levels were measured
upon recruitment and one month after completion of the vaccination course. Solicited local and general
symptoms were actively assessed for 4 days, using diary cards; and unsolicited adverse events for 30 days
following each vaccine dose. Serious adverse events (SAE) were recorded during the entire study period.
Results: 219 subjects completed the study; 6 subjects were withdrawn. One month after the third
vaccination, all subjects had seroprotective anti-PRP antibody concentrations (>= 0.15 µg/ml); 98.6% had
concentrations >= 1 µg/ml; the anti-HBs seroprotection rate (>= 10 mIU/ml) reached 99%. Two SAE were
reported, neither were considered to be related to vaccination by the investigators. Redness and swelling >
20 mm was 2.7% and 11.5%, respectively; and grade “3” pain (cried when limb was moved/spontaneously
painful) was only 3.6%. Over all doses, the incidences of grade "3" solicited general symptoms and
unsolicited symptoms (symptoms that prevented normal activity) were 1.3% and 0.4% respectively.
Conclusion: The combined DTPw-HBV-Hib vaccine is immunogenic (for the antigens tested), safe and
well-tolerated in Indian infants.
ID/45(O) CLINICAL MANIFESTATIONS OF FALCIPARUM MALARIA AND EFFICACY OF
ARTISUNATE DERIVATIVE IN TREATING FALCIPARUM MALARIA
M.Veerashankar, Shantala C.R., Arun Kooli, Nasima Banu
Pediatrics Department, VIMS, Bellary.
INTRODUCTION :- Malaria although a rural problem in Karnataka has re-emerged as a major public
Health problem diversified into various types like Urban Malaria, Malaria in project area etc. Bellary a
North Karnataka district, reported as one of Malaria endemic region. OBJECTIVE :- To study the cases of
Plasmodium Farciparum malaria in infants and children – their presentation, complications and to study
usefulness of Artimisinen derivatives in treatment of severe and resistant malaria. DESIGN :- Prospective
study from Sept 2004 – Sep 2005. MATERIALS AND METHODS :- Parasitologically confirmed 100
cases of malaria in children aged less than 12yrs old. Peripheral smear study, routine investigations in all
cases Blood Urea, Serum Creatinine, Serum Bilirubin, SGPT, Chest X-ray, CSF, Serum electrolytes levels
in needed cases. Treatment outcome with parenteral artesunate derivative in complicated cases of
plasmodium falciparum malaria in recommended doses. RESULTS :- Most common age groups 3 – 5 yrs
(44%), Males predominant (64%), Low socio economic status (82%). More in the months of August to
October (14%). Commonest signs-fever (94%), Pallor (86%), Splenonmegaly (54%). Commonest
complication encountered is Cerebral Malaria (34%), Severe Anemia (18%), Hypoglycemia (20%), CCF
(11%). In cerebral malaria fever in 100% cases, convulsion 70.5% and headache in 67.6% cases.
Artesunate Derivatives are very effective in treating severe Falciparum Malaria and Resistant Malaria. 91%
cure crate, No Recrudescence, Rapid Fever clearance time (48 hrs). Rapid Parasite clearance time (90% in
24 hrs, 98% in 48 hrs, 72 hrs in 100%). Rapid recovery from coma (36 hrs). No adverse reaction with
Artesunate derivations. Overall mortality 9% cerebral malaria was commonest cause (66% deaths more rate
17.6%). Neurogical sequare in cerebral malaria was 14.7% at 1mm after discharge. CONCLUSION :Complicated (severe) malaria is common in Plasmodium Falciparum Malaria child. Artesunate derivatives
are highly effective and safe in treating with severe PF malaria. Currently it is appropriate to preserve drugs
for serious and life threatening infections & multidrug resistant Plasmodium Falciparum infection.
ID/46(P) A STUDY ON CLINICAL AND BIOCHEMICAL CORRELATES IN HEPATITIS A
Amit Gupta, Monika Garg, Anjoo Bhatnagar, Vikas Goyal
Escorts Hospital and Research Centre, Faridabad.
Study : Retrospective study in a tertiary care urban hospital. Period : 1-10-04 to 31- 08-05 Inclusion criteria
: patients admitted to the department of Pediatrics with a confirmed serological diagnosis of hepatitis A.
Exclusion : patients with associated infections, congenital syndromes or enzyme deficiency. 53 such
subjects were enrolled in the study and their clinical and biochemical profile noted. The data thus collected
was analysed. Results: 1.vomiting was seen in 8/14 children within age <=5 years against 30/31 in age >
5years which was significantly less than counterparts (p<0.01). 2.jaundice and fever had no significant
difference in different age groups.3.vomiting was found to be less common in subjects with PT
derangements. 4.PT derangements were significantly more common in the patients with SGPT> 2000 IU
(11/27 against 18/21) but a PT > 20was not found to be significantly correlated to level of SGPT. 5.out of
21 patients who received one or more doses of vit. K, none had a change of >3 sec on repeat PT
evaluationdone on an average 4 days later.6.clinical symptoms like fever, vomiting and pain in
abdomenwere not found to be statisticallydifferent in patient group with SGPT<2000 IU & >2000 IU but
reduced appetite was significantly (p<0.05) more common in subjects with higher SGPT (18/20 against
19/31).7.it was seen that presence of bile salts and bile pigmentsin urine was not related to level of s.
bilirubin or to its direct fragment. This may signify a differential excretion of bile salt and bile pugments
and bilirubin from hepatocytes. Conclusions: 1.Vomiting is the most consistent feature in Hepatitis A in
age group >5 years 2. The role of Vitamin K in acute Hepatitis A is at best doubtful 3.Presence /absence
ofUrinary Bile Salts and Bile pigments is not a direct function of level of serum bilirubinand hance not
much value in diagnosis, prognosis and treatment