ID/2 (P) STUDY ON CLINICO -LABORATORY PROFILE OF CHILDREN WITH
SCRUB TYPHUS; IN UTTRAKHAND: NOT AN UNCOMMON.
Neeraj Jain, Vibha Jain, Sheiba Garg
Himalyan Hospital Himalyan Institute of Medical Sciences (Medical College) Jolly Grant
Dehradun
Email: ishu12002@yahoo.com
Abstract: Scrub typhus is an acute, febrile, infectious illness caused by Orientia (formerly
Rickettsia) tsutsugamushi,an obligate intracellular gram-negative bacterium. Humans are
accidental hosts in this zoonotic disease.The present retrospective study describes clinical
profile of the children hospitalized in hospital with Scrub Typhus infection during period
2010-2011. 19 hospitalized children with clinical features suggestive of Rickettsial disease
(fever, generalized rash) who tested ELISA positive for IgM against Scrub Typhus were
included in the present study between the age of 1 years and 15 years. All children presented
with fever (100%) . 42.10% had lymphadenopathy, 47.36% had Eschar and 57.89% patients
had Cough. 26.31, 21.05%, 10.52%, had hepatomegaly , pain abdomen ,and Respiratory
distress and gastrointestinal bleed respectively. All of the children were investigated and
treated with as per protocol. None of them died. We think that Rickettsial infection is not
quite common in this region but study showed that it is not an Uncommon entity and thus,
high degree of suspicion, knowledge of geographical distribution and clinical features of
Rickettsial disease helps in its early diagnosis and treatment.
ID/3 (P) JOB SYNDROME (HIE SYNDROME, OR HYPER-IGE SYNDROME)
CHARACTERIZED
BY
RECURRENT
"COLD"
STAPHYLOCOCCAL
INFECTIONS
Sandeep Aggarwal, Shallu Aggarwal
Consultant Child Specialist at Civil Hospital, Amritsar, Punjab-143001
Email: drsandeep222@yahoo.co.in
Objective: To create awareness about job syndrome (hyper-IgE syndrome). Introduction:
Job's syndrome is a rare disease characterized by recurrent skin and/or lung abscesses,
dermatitis, and bone and tooth defects, in addition to significantly increased serum IgE levels.
Davis et al. in 1966 named the disease after the biblical character Job, whose body was
covered with boils by Satan. Case report: A six years old female presented with recurrent
abscesses on face that lack the typical signs of infection like pain, heat, or redness and appear
as fluctuant masses. There was history of recurrent bronchitis, eczema on buttocks and back
and oral thrush. On examination, there was coarse facial features, a prominent forehead,
deep-set eyes, a broad nasal bridge, a wide, fleshy nasal tip. There were retained primary
teeth and no eruption of permanent teeth. On work up prominent finding was eosinophilia
and later significantly increased serum IgE levels. Due to this, job syndrome was suspected.
Culture of the abscesses showed growth a S. aureus and S. epidermidis, the patient was
treated with vancomycin and ceftriaxone. Discussion: Job's syndrome is one of the
presentations of the hyper IgE syndromes, and it is caused by a mutation in the STAT3 gene
on chromosome 17q21 with a dominant autosomal inheritance. From the description of two
girls with recurring cold skin abscesses, Davis et al. postulated a degree of deficiency in
resistance to staphylococcal infection and alluded to the biblical character Job, whose body
was "covered with pustules". Typically, it presents as persistent cutaneous abscesses , and a
history of recurring pneumonias, pneumatoceles, hypereosinophilia, elevated serum levels of
IgE (> 2,000 IU.mL-1), and craniofacial and bone growth changes. The objective of this
report was to present a case of a rare disease and its management.
ID/4 (P) PROFILE AND OUTCOME OF CHILDHOOD TUBERCULOSIS TREATED
WITH DOTS-AN OBSERVATIONAL STUDY
Pushpa Panigatti, V.H. , Madhu P.K, T.A.Shepur
Associate Professor, KIMS-Hubli-580021, Karnataka
E-mail: ratageri@rediffmail.com
Abstract: Background: Childhood tuberculosis (TB) continues to be a significant child health
problem in India. Yet there is no gold standard test for diagnosis of pediatric TB. However
various professional bodies have published standardized treatment of various types of TB in
children
according
to
clinical
manifestation direcly observed treatment short
course(DOTS) is efficacious against adult TB. However there is paucity of literature on
efficacy of DOTS in children. Aims and Objectives: Primary objective: To study the clinical
profile and outcome of childhood TB treated with DOTS regimen. Secondary objective:To
study the side effects of anti-tubercular treatment(ATT). Material and Methods: Prospective
hospital based observational study conducted at Pediatric Department at
KIMS Hospital,
Hubli over a period of 1 year.Inclusion criteria:i)All newly diagnosed cases of tuberculosis
from 0- 12 years of age.ii)Children with relapse, treatment failure or defaulter. Exclusion
criteria:Children with tuberculosis on Antitubercular treatment (ATT) other than DOTS
regimen A detailed history including demographic profile and clinical examination were
carried out for each case as outlined in the proforma. Diagnosis was made based on
WHO/RNTCP guidelines. All those diagnosed children were categorized and treated(DOTS
regimen) and outcome measures were defined according to WHO/RNTCP guidelines.
Statistical analysis: Data was analyzed using SPSS 17.Statistical methods used were
descriptive statistics means, percentages and test of significance like chi square test. Results:
Total number of children enrolled in the study was 93. Mean age of the children was 6 years
and median age was 6 years. Male to female ratio was 0.9:1. Extra pulmonary tuberculosis
was common (62.4%) than pulmonary tuberculosis (37.6%). BCG scar was absent in eleven
(11.8%) and absent BCG vaccination was most commonly associated with neurotuberculosis.
The most frequently seen symptoms/signs were fever (83.8%%), cough (46.2%),
convulsion(17.2%), loss of appetite(11.8%) and pallor (75.3%), lymphadenopathy (18.3%),
Hepatomegaly (9.7%) and splenomegaly (6.5%). Mantoux test was positive in 59 (63.4%)
children. Isolation of AFB was possible only in 13(14%) children in various fluid/histological
specimen. Prevalence of HIV infection in children with TB was 7.5%. Among 93 children
94.6% of the study population completed treatment and declared cured, four children have
lost to follow up and one child died. There were no side effects due to ATT. Seventy
four(84%) children gained weight at the completion of treatment, of which more than 10%
weight gain found in 55(62.5%) children Conclusion: EPTB was common than pulmonary
TB. Fever and cough were most common symptoms, pallor and lymphadenopathy most
common signs. Cure rate in our study was 94.6%. Key words: Childhood TB, Profile,
DOTS, Outcome
ID/5 (P) A CASE OF RABIES AFTER SQUIRREL BITE
P. Leela Kumari, K.Raja Mohanan
Department of Paediatrics, SAT Hospital, Medical College, Trivandrum
E mail: leela_suresh2005@yahoo.co.in
Abstract:- A 7 year old boy presented with fever, cough, difficulty in taking oral feeds and
anxiety and aggressive behaviour on giving oral feeds of 2 days duration. Past history of
squirrel bite 2 months back and he was treated in local hospital with injection tetanus toxoid
and local wound management no antirabies vaccine was taken. No history of any other
animal bite in the past. On examination the child was anxious, aggressive, Aerophobia and
Hydrophobia was present and he died due to sudden cardio respiratory arrest few hours after
admission. Corneal impression smear fluorescent antibody test was positive for rabies. Rabies
death due to bite of small rodents like squirrel is not reported from India. Hence we are
reporting this case. Key words: rabies, squirrel bite, aerophobia, hydrophobia
ID/6 (P) ATYPICAL TROPICAL SPLENOMEGALY SYNDROME- CASE REPORT
Ajay k. Tiwari, Dinesh Jain, Arvind Sabharwal
Senior Consultant, Department of Pediatrics, Mata Chanan Devi Hospital, New Delhi110058, INDIA
E-mail: ajaytiwari06@yahoo.com,
Introduction: Malaria is caused by bites of infected mosquitoes, with Plasmodium, in human
body. Tropical splenomegaly syndrome is seen in malaria endemic regions because of
exaggerated response of human body to malarial parasite. TSS is diagnosed after excluding
other causes of massive splenomegaly. Malnutrition and genetics play the major role for
above condition. Case Report: A 14-year male child presented with complaints of fever8days, pain abdomen and fullness with decreased appetite for 6days. Physical examination
revealed severe pallor, cervical lymph nodes, fever, hepatomegaly and splenomegaly up to
umbilicus. Investigations showed following results- Hb-7.2gm, TLC-4140, DLC-N32, L63,
E01, M04, PCV-21.5, Platelet count-1-6lakhs/cumm, FNAC-Cervical lymph nodes-reactive
lymphadenitis, Malarial serology negative for P.Falciparum/Vivax/Ovale/Malaria,
Ultrasound Abdomen-Gross Splenomegaly, Hepatomegaly and peripancreatic and periportal
lymph nodes, X-ray chest-normal, Widal-negative, Blood culture-sterile, Mx test-negative,
Urine bile salt and pigments negative, P/S for MP-negative, LFT-normal except ALK
Phosphate-increased, S.LDH-increased, Bone Marrow examination-Dimorphic anemia, Bone
Marrow biopsy-hyper cellular marrow space with adequate representation by all three-cell
lines, upper GI endoscopy-normal. Child was started with antibiotics and supportive care. On
review of all reports with clinical hematologist, antimalarial treatment was started on day 5,
patient showed clinical improvement in form of decrease in fever and spleen size
significantly. After 10 days of hospital stay, child was discharged on oral hematinics and
antimalarial drugs. Discussion: Atypical form of Tropical Splenomegaly Syndrome showing
improvement with antimalarial drugs is suggested. Oral Iron with Folic acid is improving the
Hb level of the child. More research on this area is required.
ID/7 (O) CONGENITAL CMV WITH LAD TYPE 1 WITH NK CELL DEFICIENCYA RARE CASE REPORT
Neha Thakur, NarendraRai
Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran
Children Hospital, New Delhi, India
Email Id: nehaimsbhu@gmail.com
Abstract: Introduction: Cytomegalovirus (CMV), measles and HIV are the main human
pathogens known to induce immunosuppression. Unlike measles and HIV, and despite the
availability of a well-studied animal model, little is known about the mechanisms that control
CMV-induced immunosuppression. Leucocyte adhesion deficiencies (LADs) are a group of
primary immunodeficiencies in which the leucocytes are unable to migrate from the
circulation towards the areas of inflammation. LAD-1 affects about one per 10 million
individuals and is characterized by recurrent bacterial and fungal infections and depressed
inflammatory responses despite striking blood neutrophilia. Children with severe disease
present in infancy with recurrent, indolent bacterial infections. Definitive treatment for LAD
is stem cell transplantation. Case Presentation: We report a rare case of congenital CMV who
was subsequently diagnosed as LAD type 1 with NK cell deficiency. The clinical course was
complicated by severe CMV pneumonitis during the newborn period, recurrent skin
infections without pus formation, otitis media and pneumonitis since 3 months of age.
Neutrophil chemotaxis studies showed a decrease in directed chemotaxis. Neutrophils were
dyspoetic and non-functional lacking HLA DR, CD11c and CD 18. Lymphocytes were
polyclonal but lacked CD56, CD 16 and surface membrane immunoglobulin. Coclusions:
Post stem cell transplantation patients can develop CMV infection; interestingly this case had
congenital CMV infection
ID/8 (P) CLINICO-SEROLOGICAL AND EPIDEMIOLOGICAL PROFILE OF
INFECTIVE CAUSES OF HEPATITISIN CHILDREN
Nidhi Soni, Savitri Thakur, Kabeer Ahmad Khan, Shrish Bhatnagar, Vineeta Mittal
Junior Resident, Era’s Lucknow Medical College, Lucknow, UP
Email: nidhisoni_6@yahoo.co.in
Abstract: Introduction. Clinico-serological and epidemiological profile of infective causes of
hepatitis in children. Aims & Objectives: A prospective study ►To find out the prevalence of
different infections in jaundiced patients of pediatric age group. ►To correlate the clinical
and epidemiological factors with hepatitis. Material & Methods: The study was done in
Department of Pediatrics and Microbiology, Era’s Lucknow Medical College, Lucknow, UP.
All patients aged between 1and 18 years in the last 10 months with at least threefold rise in
transaminases demonstrated in two samples, taken 24 hours apart were included in the study.
46 Cases were examined as a part of ongoing study. Serology (Hepatitis A, B, C and E,
leptospirosis, dengue, malaria, typhoid) and blood cultures (septicaemia) were performed on
samples. Results: Mean age of presentation was 4 years. Male to Female ratio was 1.2:1. The
infective causes with their incidences were HAV (17/46) 36.9%, HBV (9/46) 19.5%, HCV
(0/46) nil, HEV (4/46) 8.6%, Malaria (4/46) 8.6%, Typhoid (6/46) 13%, Leptospira (2/46)
4.3%, Dengue (2/46) 4.3%, Mixed (5/46) 10.8%, Others (8/46) 17.3%. Out of 5 mixed
infections 2 were malaria and dengue, another 2 were malaria and HAV, and 1 was HEV and
Typhoid. There were 7 cases of fulminant hepatic failure, out of which most common was
HEV (4/7). Conclusions: Acute infective hepatitis has varied aetiology. In our study
Hepatitis A is the most common casual agent of it. However fulminant hepatic failure was
most commonly associated with Hepatitis E.
ID/9 (P) ACUTE ICTERIC EBV HEPATITIS – A RARE CONSTELLATION OF
SYMPTOMS
R.Praveen, Sandipan Shringi
GD SPL Paediatrics, Dept of Paediatrics, 92 BH, C/O 56 APO
Email: praveen.army@gmail.com
Abstarct: Epstein-Barr virus infection (EBVI) in children is usually asymptomatic with
seroconversion. The most common manifestation and best known clinical syndrome caused
by EBV is acute infectious mononucleosis. Liver involvement is nearly universal in healthy
persons with Epstein - Barr virus (EBV) infection-induced infectious mononucleosis.
Acute hepatitis with icterus is a rare clinical manifestation; it is usually mild, undetected
clinically and resolves spontaneously. Jaundice is distinctly uncommon and may reflect either
more severe hepatitis or an associated hemolytic anemia. Acute acalculous cholecystitis may
occur during the course of acute EBV infection especially with cholestasis or underlying
genetic hepatic diseases. We report a rare case with unique conglomerate of symptoms with
EBV infection – Icterus, Acalculous cholecystitis and epididymitis in an immunocompetent
child with no known co morbidities.
ID/10 (O) AWARENESS REGARDING ORAL REHYDRATION SOLUTION
AMONG HEALTH WORKERS AND MOTHERS AFTER THE GOLDEN JUBILEE
OF THE INVENTION OF THE LIFE SAVING SOLUTION
N.L Phuljhele, RiteshWalmik
Dr. B.R. Ambedkar Hospital, Raipur, C.G.
Email: drnsph@gmail.com.
Introduction: According to a latest report by UNICEF the under 5years mortality rate is
highest in India with 15.55 lakhs children dying within a year. Diarrhoea and dehydration
leading to malnutrition is the major cause of under 5 mortality. Every day around 19,000
children under 5 years have lost their life in last 1 year. The majority of deaths caused by
dehydration are preventable with the use of Oral Rehydration Solution (ORS). However the
awareness about the use of ORS is not widespread and varies in various states of India. Aim:
To asses the knowledge, awareness and practice (KAP) about ORS in health worker (HW)
and mothers of children suffering with diarrhoea. Method:This was a crossectional,
observational, questionnaire based study wherein mothers of consecutive children admitted in
our hospital were included. Health workers of primary health centre were also included in the
study. Result:One hundred & thirty one mothers & 113 HW were interviewed. Twenty one
per cent of mothers & 96% of HW preferred ORS as the fluid for diarrhoea, whereas 34% &
4% of HW preferred sugar-salt solution. Only 8% of mothers while 99% of HW believed that
ORS should be given as soon as diarrhoea starts. Banana & rice water was the choice of food
for 23% of mothers & 95% of HW; and 7% of mothers &38% HW acknowledged that child
requires more feed during diarrhoea. Only 39% of mothers while all HW had seen ORS; 70%
of mothers were not aware of source for procuring ORS. Only 15% of mothers knew correct
method of preparation of ORS; 23% knew method of preparing home made ORS. Twenty
percent of mothers & 88% of HW knew about quantity of ORS required after each episode of
diarrhoea; and 83% of mothers & 99% of HW knew the amount of ORS required at a time.
Conclusion:Even after 66 years of advertisement through various media there appears a lack
of KAP about ORS among mothers. There is need of reinforcement in promotion of ORS to
increase the awareness about the utility of the drug that reduces the childhood morbidity and
mortality.
ID/11 (P) CLINICO-LABORATORY PROFILE AND OUTCOME OF RICKETTSIA
IN CHILDREN: HUBLI (KARNATAKA) EXPERIENCE
Vinod H.Ratageri, Sindhu M V, Madhu P K, T.A.Shepur
Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli-580021, Karnataka
E mail: ratageri@rediffmail.com
Background:Rickettsial diseases have been reported from various parts of India. The clinical
presentation of these infection are notoriously non specific and often mimic benign viral
illness. Aims and Objectives: To study the clinical and laboratory profile and outcome of
rickettisial disease in children in the age group of 0-12years. Materials and Methods:
Prospective hospital based study conducted at department of pediatrics, Karnataka Institute of
Medical Sciences, Hubli from June 2011 to December 2011. Inclusion criteria: All children
in the age group of 0-12years having fulfilled following criteria (i)Children with history of
fever, rash, headache, myalgia, vomiting, edema with (ii)Positive Weil-Felix test
and/or(iii)exposure/presence of tick /or mite /or louse on body Exclusion criteria:(i)children
who are positive for dengue serology (ii) Suspected other viral (measles, enteroviral
exanthems, dengue, infectious mononucleosis), protozoal (malaria), bacteria
(meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever) and collagen
vascular (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions. A detailed
clinical history, physical examination was carried out in all those children who were enrolled
in the study. Complete haemogram, Electrolytes and radiological examination like USG
abdomen and chest X-ray were done whenever required. All children received doxycycline
2.2mg/kg/dose every 12th hourly orally till 5-7 days or till 3 days following the afebrile
period. Results: Total number of children enrolled during the study was 36. Male:Female
ratio was 1:1(18:18). The mean age of presentation was 5.6 years (range 5 months to 12
years). The most common clinical symptoms/signs were fever 36 (100%), rash20 (55%)
hepatomegaly 25 (69%), splenomegaly 18 (50%), pallor 18 (50%), pedal edema14 (38%) and
ascities 6 (16%) Among the laboratary profile mean Hb was 9.27g/dl. Leucopenia was
noticed in 3 cases (8.33%) and leucocytosis was seen in 14 cases (38.8%). Thrombocytopenia
was seen in 10 cases (27.77%). Sodium level was done in 14 cases of which 10 cases were
having hyponatremia (71.4%).No mortality was present in this series. Conclusion:Rickettisia
is a re emerging disease.The most clinical manifestation were very non specific.High index of
clinical suspecion is needed to make diagnosis.
ID/12 (P) RECENT DENGUE EPIDEMIC IN WEST BENGAL: EMERGING
TRENDS IN CHILDREN
Madhumita Nandi, Sumantra Sarkar, Suman Sarkar, Supratim Datta
Department of Pediatrics, Institute of Post graduate Medical Education and Research,
Kolkata
E-mail- madhumitabanik@rediffmail.com
Introduction: Since the first report of dengue from India in 1956, the disease has been
endemic with explosive outbreaks every 4-5 years. In the recent outbreak in West Bengal
which occurred after a gap of 5 years, many of the sufferers were children who showed
certain novel trends. Aims and Objectives: To study the profile of children hospitalized with
‘dengue with warning signs’ in a tertiary care institute during the recent epidemic. Materials
and Methods: Prospective study carried out from July 2012 to September 2012 at a tertiary
care teaching hospital in Kolkata. Results: A total of 56 children having ‘Dengue with
warning signs’ were admitted. M:F ratio was 1.3:1. 57.14% children were from urban area.
There was nearly equal incidence of primary (n=27, 48.21%) and secondary cases (n=29,
51.78%). The common warning signs were persistent vomiting(n=32 ,57.14%),abdominal
pain or tenderness(n=22 ,39.28%) , mucosal bleed(n=5 ,8.92%),liver enlargement(n= 28
,50%) and localised or generalised lymphadenopathy (n= 20,35.71).The common
manifestations of severe Dengue were shock(n= 8 ,14.28%),severe bleeding(n=7 ,12.5%),
organ involvement(n=6 ,1071%), pleural effusion(n=9,16.07%), and ascites(n=10 ,17.85%).
Dengue encephalopathy was documented in 4 subjects. Interestingly, severe dengue was
noted more number of primary cases (n=6) than secondary cases which is contrary to the
traditional teaching. Six patients needed admission to PICU. Three patients with severe
dengue died .The commonest cause of death was multi organ failure due to shock.
Conclusions: This study demonstrated certain novel trends of dengue infection in children.
Presence of lymphadenopathy, severe manifestation like encephalopathy even in absence of
shock or severe hemorrhage and occurrence of shock (DSS) even in cases of primary Dengue
were some of them.
ID/13 (P) PULMONARY KOCHS PRESENTING WITH INSULIN RESISTANCE
Jaikumar S Patel , Ashwini Kundalwal, Nitin Lingayat
Room 313 New Pg Hostel, Srtr Medical College & Hospital, Ambajogai, Beed, Maharashtra
Email: jay12_686@yahoo.co.in
Background: Insulin resistance is commonly seen in bacterial infection,here is a case of
insulin resistance in a patient of Pulmonary T.B. This is a case report of a 9 month old female
child 2nd by birth order born of nonconsanginous marriage brought to department with
complaints of fever and cough since 7 days and increase respiratory movements since 1 day
and altered sensorium and refusal to feed since 5 hours .Patient had no significant past history
and birth history.Patient was exclusively breast fed till date.Patient had history of Kochs
contact(Grandmother open case of Pulmonary TB).Present weight 6kg (below
3rd centile).Height 66cm (between 3rd and 15th centile).On examination patient was drowsy,
had moderate grade fever with H.R of 168/min,R.R 72/min and signs of dehydration were
present.On respiratory system examination patient had b/l crackles with intercostal
retractions.Other system examination were normal.On investigation BSL 438mg% ,USL
3+,UK large.ABG showed features of metabolic acidosis with increase anion gap.Xray chest
showed B/L patchy opacities.On CBC, Hb% was 9.8 gm%,TLC 12000 cumm,Lymphocyte
predominant, ESR 54 at the end of 1st hr.,Mauntox test was 11mm(+ve).CSF study was
normal. LFT normal with BUL 48mg% & creatinine normal. Patient was started on
MILWAKUEE regimen as used for DKA.Patients BSL became normal and USL &UK
negative within 12 hours and level of consciousness improved and on stopping Insulin drip
patients BSL was constantly monitored which was WNL.Patient was discharged with AKT
started 4 days later.This case shows insulin resistance (stress hyperglycemia) in Pulmonary
Kochs.
ID/14 (P) ACUTE RENAL FAILURE WITH PLASMODIUM VIVAX MALARIA IN
A10 YEAR OLDCHILD: A RARE COMPLICATION.
Amol S. Murkute, K.C.Patra
ESI- PGIMSR and Model Hospital, Andheri (E), Mumbai – 93
Email: drkailashcp@yahoo.co.in
Introduction: Malaria is one of the leading cause of acute renal failure (ARF) in South-east
Asia. Inspite of being predominant malarial parasite, complications are rare with P.vivax.
Renal complications too including ARF are more common with P. falciparum than P.vivax.
We report a case of 10 yr old female with horse shoe kidney who developed ARF in vivax
malaria. Presentation : A 10 yr old female presented to us with fever of 3 days duration which
was high grade and intermittent. There was no dysuria, rash, cough or bleeding
manifestations. On examination, she was febrile, had tachycardia ( HR-128/min), with
hypotension (BP-90/60). she also had hepatosplenomegaly. Other systems were normal.
Course In Hospital : Investigations showed Hb of 10.6 gm% with WBC count of
6800/mm3(P-80, L-10), platelet count of 61000/mm3, peripheral smear showing ring forms
of P.vivax with normal RFT. After 3 days of chloroquine , child became afebrile for a day
again started spiking high grade fever ; this time with hypertension and cola colored urine.
Repeat smear showed persistent ring forms of P.vivax with Hb of 6.1gm%. S.creatinine
was1.3 mg %. Urine examination showed 3+ albuminuria with field full of RBCs.Blood
culture did not grow any organism.Leptospiraand Dengue serology were negative. Coomb’s
test was negative. Her serum electrolytes were normal. USG Abdomen revealed
splenomegaly and incidental finding of horse shoe kidney. She was treated with Artesunate +
Clindamycin therapy, platelet and whole blood transfusions. Hypertension came under
control with oral methyldopa and furosemide.The child recovered within a week with
hematuria susbsided spontaneously later and renal parameters became normal. She was given
14 days of primaquine after ruling out G6PD deficiency. Discussion: P. vivaxwas reported to
cause acute renal failure (ARF) 3 patients in an Indian study from Mumbai1 in which
P.falciparum and mixed infections were reported in 16 and 5 patients with ARF respectively.
Ahmed et al2 reported vivax in 33% cases of malaria where remaining was due to falciparum.
Our patient presented with fever, thrombocytopenia, splenomegaly, hematuria,
initialhypotension and later hypertension.so, other possible diagnoses such as leptospirosis,
dengue, post-streptococcal glomerulonephritis, falciparum infection and sepsis had to be
ruled out. He was then treated as complicated vivax according to WHO guidelines3. She had
an uneventful recovery which further substantiated our diagnosis. Conclusion: Even in a case
of Vivax malaria in children, careful monitoring and vigilance is necessary ; any
complication if detected , should be treated aggressively as a case of complicated malaria.
ID/15 (P) PLASMODIUM VIVAX MALARIA WITH SEVERE MANIFESTATIONS
Mehndiratta S, Rajeshwari K, Dubey AP.
Department of Pediatrics, Lok Nayak Hospital, New Delhi, India
Email: drsmehndiratta@gmail.com; drsmehndiratta@rediffmail.com
Introduction: Plasmodium vivax malaria is increasingly being recognized as a cause of severe
and complicated malaria and does not have a benign course as initially envisaged. Aims and
Objectives: To study the profile of patients with complicated Plasmodium vivax malaria.
Material and Methods: Records of complicated Plasmodium vivax malaria cases admitted
over a period of the last 18 months (April 2011-September 2012) were retrieved and
reviewed. Results: There were total 12 cases of complicated malaria that were positive for
Plasmodium vivax malaria and negative for Plasmodium falciparum (diagnosed on basis of
peripheral smear or RDT). The ages ranged from 1½ yrs – 12 yrs and there were 7 males and
5 females. Fever and hepatosplenomegaly were present in all cases. The severe
manifestations were severe anemia (8/12), severe thrombocytopenia (9/12), gastrointestinal
bleeding (3/12), peripheral gangrene (1/12), epistaxis (1/12), hepatic dysfunction (3/12), renal
failure (1/12), gross hematuria (1/12) and cerebral malaria (1/12). The patients were treated
with the standard protocol of Artemesinin combination therapy. 8 patients required blood
product transfusion and 1 patient required hemodialysis. The duration of hospital stay was
ranged from 9 days-30 days. One patient expired and the rest of the patients recovered
completely. Discussion: There is a change in epidemiological pattern in plasmodium vivax
infection. Varying spectrum of severe manifestations is evident and is associated with
significant morbidity and mortality. The exact cause of these severe manifestations is still
unclear. In endemic countries, clinicians must be aware of the unusual manifestations and life
threatening complications of Plasmodium vivax infection. Artemesenin combination therapy
(ACT) is recommended for treatment in such cases. Emphasis must be placed on strict
control and preventive measures to curb the burden of this disease.
ID/16 (P) PEDIATRIC EMPYEMA THORACIS: WHAT HAS CHANGED OVER A
DECADE?
Suresh Kumar, Rakesh Kumar, Devi Dayal, Joseph L. Mathew, Meenu Singh
Department of Pediatrics, Advanced Pediatric Centre, Postgraduate institute of Medical
Education and Research, Chandigarh, India
Email: sureshangurana@gmail.com
Abstract: Introduction: Empyema thoracis is associated with significant morbidity and
mortality in children and appropriate management is still controversial. Over a last decade,
infection with Methicillin resistant Staphylococcus aureus (MRSA) has been recognized as a
significant problem and availability of CT scan has greatly modified the treatment and
outcome of pediatric empyema thoracis. Aims and objectives: To study the clinical profile,
bacteriology, and treatment outcome of childhood empyema thoracis and to identify any
change with special reference to microbiology and treatment modalities over a decade.
Methods: A total of 205 patients (aged 1 month-12 years) with diagnosis of empyema
thoracis admitted over a period previous 5 years were reviewed retrospectively. Results: Fifty
two patients (25.3%) were less than 1 year and 145 (70.7%) were males. Duration of
symptoms varied from 2 to 30 days (mean: 12.2 days). 42 patients (20.5%) underwent
intercostal drainage tube placement in referring hospitals before admission to our institute.
Bacterial cultures were positive in 82 (40%) patients from whom 87 isolates were obtained.
Staphylococcus aureus was the commonest organism isolated (65.5%; 57/87) and 6 (10.5%)
isolates were community acquired MRSA. Majority of patients (190) initially started on
combination of Ceftriaxone, Amikacin and Cloxacillin and rest received Crystalline
Penicillin in addition to Amikacin and Cloxacillin. The antibiotics were altered depending on
culture sensitivity and clinical response. Total duration of antibiotics was 28.7 (±6) days.
CECT chest was done in 95 (46.3%) patients. Intercostal drainage tube (ICDT) was inserted
in 200 patients (97.5%) for mean duration of 14.8 (±7.6) days. Out of these, 57 (28.5%)
patients didn’t responded and required decortication on day 9.4 (±4.3) of admission. Twenty
patients (9.7%) received intrapleural Streptokinase. Average duration of hospital stay was
22.5 (±11 days). Eight (3.9%) patients died due to various complications of empyema.
Conclusions: Over a decade, there is increase in incidence of empyema caused by MRSA,
availability of CT scan modified the management, and more patients are subjected to early
decortication which leads to early recovery.
ID/17 (P) PROBIOTIC USE AND INCIDENCE OF CANDIDEMIA AND
CANDIDURIA IN A PEDIATRIC INTENSIVE CARE UNIT
Suresh Kumar, Sunit Singhi, Arunloke Chakrabarti, Arun Bansal, M. Jayashree.
Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical
Education and Research, Chandigarh, India, 160012.
Email: sureshangurana@gmail.com
Abstract: Objective: To compare the incidence of candidemia and candiduria in Pediatric
Intensive Care Unit (PICU) before and after the introduction of routine use of probiotics in
children receiving broad spectrum antibiotics. Method: Retrospective study conducted in a
PICU of a tertiary care hospital in north India over a period of 18 months i.e. 9 months prior
(February 2007- October 2007) and 9 months after (November 2007- July 2008) the
introduction of routine use of probiotics in all patients who received broad spectrum
antibiotics for ≥48 hours. 344 children admitted after November 2007 served as ‘probiotic
group’ and received one sachet twice a day of probiotics (EUGI® containing L. acidophillus,
L. rhamnosum, B. longum, B. bifidum, S. boulardi, and S. Thermophilus) for 7 days. 376
children admitted before that period served as historical ‘controls’. Blood culture was sent for
fungal cultures if clinically indicated as per unit’s protocol and urine was submitted for
fungal culture twice a week. Primary outcome measure was growth of Candida in blood
(candidemia) and secondary outcome was growth of Candida in urine (candiduria) and. Data
was collected till the time patients were discharged form PICU or death of patient. Results:
Candidemia was seen in 1.2% (4 of 344) patients in probiotic group and 3.7% (14 of 376) in
control group (RR: 0.31; 95% CI: 0.10-0.94; p=0.03). Candiduria was noted in 10.7% (37 of
344) patients in probiotic group and 22% (83 of 376) in control group (RR: 0.48; 95% CI:
0.34-0.7; p=0.0001). A trend towards lower incidence of nosocomial blood stream infection
(20.3% vs. 26%; p=0.07) and urinary tract infection (14.2% vs. 19.1%; p=0.08) in probiotic
group was noted. Conclusion: Routine use of probiotics in patients receiving broad spectrum
antibiotics in PICU can help in reducing incidence of candidemia and candiduria.
ID/18 (P) SENSITIVITY OF ANTIMICROBIALS IN RESPIRATORY TRACT
INFECTIONS
N.L Phuljhele, Arun SR
Dr. B.R. Ambedkar Hospital, Raipur, C.G.
Email: drnsph@gmail.com.
Introduction: The rationale use of antibiotics is becoming more and more important today
especially in view of emergence of resistance to antimicrobials in several pathogenic bacteria.
The time tested cheaper antibiotics are being neglected and we are entering a post antibiotic
era with a reduced capability to combat microbes. Aim: To study the culture profile and
antibiotic sensitivity of common respiratory tract infections in our wards. Methods: This was
a cross section observational study about patients of 1 month to 15 years of age admitted in
Paediatric wards of our hospital, with respiratory tract infection. Detailed history and clinical
examination was done. All standard investigations were obtained. Weight of the patient was
obtained at the time of admission and grading of malnourished patients was done according
to IAP classification. Results: Out of 300 patients admitted with infective aetiology during a
period of 10 months, 48% had respiratory tract infections. Majority (87%) of patients were
from rural area and low socio-economic status. Malnourishment was present in 70% of
patients; 27.6% grade I, 26% gradeII, 11% grade III and 5.3% grade IV. Empyema,
pyopneumothorax, pneumonia and TB had 78%, 74.5%, 67%, 80% incidence of malnutrition
respectively. Septicaemia had 50% incidence of malnutrition. History of prior use of
antibiotics was present in 21.6% of cases. Use of ceftriaxone, gentamicin, erythromycin, and
amoxicillin was present in 11%, 26%, 2.6% and 2.6% respectively. In pneumonia 60% of
culture were sterile and 30% showed staphylococci which was against the observation made
by M.L. Maghotra et al, R.K. Puri et al & Broor etal. Gram negative bacilli were identified in
10% of cases which was comparable to Pulmar DL et al and Kumar KG et al. Al the isolates
of staphylococci showed sensitivity to vancomycin which is similar to that reported by Mehta
eta and Annuprabha et al. Sensitivity to ciprofloxacin was seen in 57% of cases. In empyema
and pyopneumothorax 90.4% of patients received ceftriaxone followed by cloxacillin and
amikacin.
ID/19 (P) HAV IgG SEROPREVLANCE IN CORD BLOOD OF URBAN WOMEN OF
DELHI
Namita Agrawal, M.M.Gupta, Vyom Aggarwal
Tirath Ram Shah Hospital Delhi
Email: namita_shini06@yahoo.co.in
Introduction: Hepatitis A virus remains the most common cause of infectious hepatitis in the
childhood. Prevalence and severity of infection directly relates to socio-economic status and
age. When acquired early in life, the infection leads to subclinical illness and confers lifelong
immunity, while if acquired in later life, it leads to significant morbidity and mortality. The
timing of infection and its trend has important implications for deciding the utility and most
appropriate age of Hepatitis A vaccination. Aims & Objectives: To qualitatively estimate anti
HAV IgG antibodies in the cord blood. To compare prevalence of seropositivity with various
socio-economic parameters and age. Material & Methods: This cross-sectional study was
conducted in the Department of Pediatrics of the Tirath Ram Shah Hospital from July 2011 to
July 2012. 285 consecutive women in reproductive age group were enrolled and segregated
into five age groups ≤ 25, 26-30, 31-35, 36-40, ≥41years and relevant social history like
source of water supply, use of water purifier, educational level, occupation and monthly
income were recorded. Exclusion criteria included previous Hepatitis A vaccination, long
term steroid therapy and known immune-compromised or malnourished state. Cord blood
sample was collected in a plain vial and transferred to lab. After separation of serum by
centrifugation, qualitative estimation of HAV IgG level was done using ELISA KIT (MBS
Italy) and result was read by ELISA Reader. Results- Out of total 285 samples 280 (98%)
belonged to Delhi. All enrolled women were of socioeconomic status 1 and 2. Among 285,
260(91.2 %) tested positive for anti HAV IgG antibodies. Using binomial test, p value was
<.000 making this difference highly significant statistically. Though the positivity showed
increasing trend with increasing age, with p=0.56 this was not statistically significant. Chi
square test applied to compare seropositivity between mothers belonging to Kuppuswamy’s
SES grade 1 and 2 , those using purifiers & those using direct MCD water supply, those
getting admitted in deluxe rooms compared to lower rent rooms , and the job
profile(government versus private), showed no difference statistically. Application of t- test
showed no statistical difference between seropositivity and age of mother and birth weight of
the baby. Conclusion: Cord blood seroprevalance (indirect indicator of adult seropositivity)
continues to be high in India. There may be pockets of susceptibility which need to be
identified. Seroprevlance is similar in both socioeconomic status I and II women. Universal
vaccination at age at 1 year seems to be appropriate.
ID/20 (P) CLINICAL AND EPIDEMIOLOGICAL PROFILE OF CHILDREN
ADMITTED WITH SEVERE MALARIA IN A TERTIARY HEALTH CARE
CENTRE
Virender Kumar Gehlawat, Vandana Arya, Jaya Shankar Kaushik, Geeta Gathwala
Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak,
Haryana, India-124001
Email: jayashankarkaushik@gmail.com
Abstract: Introduction: Malaria continues to be a major public health problem in most
tropical countries, with a high mortality in untreated severe forms of malaria. Moreover,
plasmodium vivax has emerged as a major cause of morbidity and mortality in children with
malaria. Objectives: To assess the clinical and epidemiological profile of children admitted
with severe malaria. Methods: A cross sectional study was conducted in Department of
Pediatrics at a tertiary care hospital of North India. Children aged 1 m- 14 y diagnosed with
severe malaria and treated as per the WHO guidelines were enrolled in the study. The
demographic and clinical characteristics including laboratory parameters were recorded. The
clinical and laboratory parameters were compared between cases of severe malaria caused by
P. vivax and P. falciparum. Results: A total of 23 children with mean (SD) age of 7.6 (4.3)
years admitted with severe malaria were enrolled in the study. Nine patients (39.1%)
presented with seizures and altered sensorium (cerebral malaria), 10 (43.5%) had severe
anemia (Hb<5g/dl) and 14 (60.9%) had thrombocytopenia (plc <1 lac) out of which 2 (8.7%)
had bleeding manifestations. Majority of cases of severe malaria [12 (52%)] were infected by
P. vivax, 8 (34.8%) were infected by P. falciparum and rest 3 patients (13%) tested positive
for both species. Four patients (17.4%) were complicated with hepatitis, 3 (13%) had renal
failure and 2 (8.7%) were complicated with shock and metabolic acidosis. Proportion of
children infected with P. falciparum having severe anemia was significantly more when
compared to those infected with P.vivax (p=0.02). Although the two (P. Falciparum and
P.vivax) were comparable in terms of duration of illness (p=0.279), CNS complications
(p=0.842). Conclusion: In addition to P.Falciparum, P. vivax could also be implicated as a
cause of severe malaria, with almost similar clinical presentation but lesser chances of severe
anemia.
ID/21 (O) PERCENTAGE OF CHILDREN IN WHOM ANTIBIOTICS ARE NOT
INDICATED AT FIRST OPD VISIT AND THEIR OUTCOME
Ashank Airan, Arun Kumar
C/O Airan Dental Clinic 693 Purvawali Station Road Roorkee, Hardwar, Uttarakhand
E-mail: drashank@yahoo.com
Introduction In spite of the recommendations to use when indicated, antibiotics are still
widely used injudiciously. Aims and Objectives: To find the outcome of children not
receiving antibiotics when not indicated in a busy OPD. Material & Method The study was
conducted from 15th August to 10th September 2012 in a busy OPD at a private hospital in
North India. One thousand children suffering from URTI/Gastroenteritis were mostly treated
symptomatically initially (without antibiotics unless indicated) and outcome noted over the
coming days. Out of them 951 (729 with URTI, 132 with gastroenteritis, 88 with both
URTI/gastroenteritis and 02 with viral hepatitis) were not prescribed any antibiotics at the
first visit and 49 were prescribed antibiotics at the first visit (29 with dysentery, 10 with
furuncles, 04 with ASOM, 01 with Tonsillitis, 04 with diarrhea greater than 10 days and 01
with fever greater than 14 days). Out of the 951 children not prescribed any antibiotics at first
visit 17 were prescribed antibiotics on follow up (10 with diarrhea had blood in stools , 04
with URTI came with symptoms suggestive of Pneumonia, 01 with URTI had significant
lymphadenopathy and 02 with URTI had prolonged fever lasting greater than 10 days). Also
these presented on follow up with non serious complications and could be managed on OPD
basis again. Result: 1. Antibiotics were not indicated in more than 95% OPD cases at first
visit. 2. Out of the cases in which antibiotics were not indicated /prescribed at the first visit,
only 1.79% required antibiotics subsequently and could be managed without admission.
Conclusion: It is possible to be judicious in prescribing antibiotics (on clinical basis) even in
most busy OPD. A very low percentage of OPD represents on follow up with indications to
start antibiotics if not started initially.
ID/22 (P) STUDY OF LIPID AND GLUCOSE ABNORMALITIES IN HIV INFECTED
CHILDREN AND EFFECT OF ANTIRETROVIRAL THERAPY
Brig SK Jatana, Maj Amit Pathania, Col Rakesh Gupta
Department of Pediatrics, Command Hospital & A F M C Pune
Email: suniljatana@hotmail.com
Introduction: With the universal availability of highly active antiretroviral therapy (HAART),
HIV is increasingly recognized as a chronic, rather than terminal illness. But the cost of
longevity has resulted in to various metabolic abnormalities, mainly lipids and glucose. These
metabolic abnormalities could be due to the HIV disease itself or due to the effects of
HAART and data on their prevalence is limited in pediatric population. Objectives: To study
the abnormalities of glucose & lipid profile in HIV infected children and effects of
antiretroviral therapy. Materials & Methods: A cross-sectional study conducted at Pediatric
HIV clinic of a tertiary care hospital from Sep 2010 to Aug 2012. All the enrolled HIV
positive children were categorized into clinical and immunological status as per WHO
guidelines and blood samples were taken for lipid profile and blood glucose. Results: Total
140 HIV positive children were enrolled in the study. Mean age was 8.8 yrs with male to
female ratio of 1.02:1. The mode of transmission was vertical in 137 (96.8%) children.
Clinical category at the time of enrolment were cat I, II, III and IV in 56,55,28 and 1, while
immune cat was 58,25,23 and 34 cases respectively. 93 (64%) children were on HAART. A
total 165 abnormalities were observed among 80 (57%) children and more commonly in
children on HAART. Most common lipid abnormalities were high triglycerides levels in
79(56.7%) cases followed by low HDL 64(46%), high cholesterol levels in 19 (13.5%) and
high LDL in 03(02%) children. Mean levels of cholesterol, triglycerides, LDL, HDL in ART
group were 156,126,50 and 56 mg/dl high as compared to HAART naive group with levels of
129,119,39 and 50 respectively, however association between the two was not statistically
significant. In three children, fasting glucose were high, however their glucose tolerance tests
were within normal limits. Conclusion: Lipid abnormalities were commonly observed in
HIV-seropositive children, mainly triglycerides and cholesterol. The prevalence of lipid
abnormalities seen in children on HAART is more as compared to HAART naïve children.
These metabolic abnormalities may contribute to the risk of cardiovascular diseases in these
children, who are likely to be facing a life time exposure to antiretrovirals, hence regular
screening is recommended.
ID/23 (P) HAEMOLYTIC ANAEMIA A PRESENTATION WITH CONGENITAL
RUBELLA
Manish K Arya, Payal Shah, A.D. Rathod, S.K. Valinjkar, Kiran M, Rahul P
201, Darshan Apt, Opp Sonivadi, Chikan Villa Road, Borivali (W), Mumbai 92
Email: wildbluewind@gmail.com
Introduction: Congenital rubella occurs when the rubella virus in the mother affects the
developing baby at a critical time, in the first 3 months of pregnancy. Case report: 1 day old
girl born to registered immunized mother with no significant perinatal history by LSCS i/v/o
genital warts. Baby was preterm iugr with birth weight 1.1 kg and having left humerus
fracture. Baby was euthermic with stable vitals. Pallor was present, Microcephaly was
present with no other dysmorphic feature. Hearing and ophthalmologic evaluation were
normal. On systemic examination continuous murmur was present with bounding pulsation.
There was firm hepatosplenomegaly. On investigation CBC with PS was s/o anaemia with
thrombocytopaenia. CRP and blood culture were normal. Retic count was also s/o haemolytic
anaemia. Hb electrophoresis, coombs test and enzyme studies were normal. SGOT and SGPT
were deranged. 2D Echo: s/o PDA 3.5 mm with left to right shunt with N biventricular
function. X Ray left Arm s/o Displaced fracture of humerus after splinting for 21 days there
was exuberant callus formation with union of fracture ends. TORCH titer was positive for
IgM rubella for both mother and baby. USG abdomen and skull was Normal. Baby was given
blood transfusion and started on antifailure measures . Phototherapy was given i/v/o neonatal
jaundice and child was managed conservatively. Congenital rubella can be associated with
autoimmune haemolytic anaemia.
ID/24 (O) SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN
PERINATALY TRANSMITTED HIV.
Neha Bansal, Anju Aggarwal, Neelam Wadhwa, Hema Mittal, Sourbhi Das, Ashish Kumar.
Department of Pediatrics and Pathology, University College of Medical Sciences and Guru
Tegh Bahadur Hospital, New Delhi.
Email: aanju67@gmail.com
Introduction: Hemophagocytic lymphohistiocytosis(HLH) results from the abnormal
proliferation of histiocytes in tissues and organs. HIV as a cause of HLH is rarely
reported.Case Report: A 9 year old boy presented with fever for two years. He complained of
swelling in cervical and inguinal region and progressive abdominal distension since 2 years.
H/O recurrent infections and paleness of body since 1 year. He received a blood transfusion 1
year back. Antenatal, natal and postnatal history was uneventful. There were two sibling
deaths at 1yr and 4yr. On examination- weight-16kg,height-102cm, BMI was15.38. Pallor
and significant lymphadenopathy was present. Chest -Bilateral crepitations. Liver palpable 7
cm, spleen-6 cm. Haemoglobin- 7.8 g/dl, TLC 2800/mm3, DLC P60L37M3N0, peripheral
smear showed dimorphic anemia. MCV was 91 fl, MCH 31.1 pg, MCHC 31.3 g/l, platelet1.79lakh/mm3, ESR-92mm. Urea-30mg/dl, Creatinine-0.7mg/dl,. Mantoux non-reactive,
Blood culture and urine culture were sterile.Widal test-tires were not significant,PS for
malaria and rapid diagnostic test for malaria were negative. Ultrasound abdomensplenomegaly with enlarged lymph nodes with absent right kidney, TSH 4.62 µIU/ml(0.305.5), Hb electrophoresis- normal. Serum iron 57 µg/dl, total iron binding capacity 310 µg/dl,
% transferrin saturation 18.4, direct Coomb’s test positive, indirect Coomb’s test negative.
FNAC reactive lymph nodes with increased number of plasma cells. Child was treated with
ceftraixone and vancomycin, did not improve clinically. Bone marrow aspiration revealed
fair number of histiocytes, few showing lymphophagocytosis with fair number of degenerated
cells. Chest X-ray-right sided patchy infiltrates. Leishmania RK 39 negative. Other
investigations were Serum ferritin 59.40 ng/ml(7.00-140.00), LDH 269.00 U/l(110-295), anti
double stranded DNA 37.94 IU/ml(<35.00), serum triglyceride 253.0 mg/dl(<150.00),
fibrinogen clotting activity 383.00 mg/dl(200-400).In view HLH and clinical deterioration
test for HIV-1was done. Both the child and mother were HIV-1 positive. Conclusion:
infection should be considered as a cause of HLH. Implications on therapy will be discussed.
ID/25 (P) RARE PRESENTATIONS OF HEPATITIS A INFECTION
Saurabhi Das, Anju Aggarwal, Hema Mittal, Ashish Kumar, Pradeep Dhingra.
Department of Pediatrics, University College of Medical Science and Guru Tegh Bahadur
Hospital, Delhi-110095, India.
Email: aanju67@gmail.com
Introduction-Hepatitis A infection in children is usually self-limiting. Complications like
hepatic encephalopathy and glomerulonephritis are rare.CASE 1- 9yr female child presented
with fever for 8 days. She had abnormal behavior since one day. There was decreased
response to stimuli, faliure to recognize parents, she was biting and picking at objects.
Sibling had jaundice 15 days back. On examination there was no icterus, mild pallor, no
hepatosplenomegaly. Haemoglobin was-13.5g/dl, TLC-5700/mm3, Platelet-262x109 ,Malarial
antigen test and peripheral smear was negative. Blood glucose-96mg/dl, PT/PTTK- 13/20.3,
36/30,INR<1.5. Blood urea-28 mg/dl, Serum sodium-142mg/dl, potassium-4.5meq/l, CXRnormal, Fundus- within normal limits. Lumbar puncture- normal, G6PD- normal. WIDALtitres <1:60. Urine microscopy- Normal. Hepatitis A IgM Ab 14.2IU/ml(Normal <0.08) ,
HBsAg -negative. Total bilirubin was-4.55mg/dl, Direct -2.07mg/dl, Albumin-3.6g/dl, Total
protein-6.0g/dl, SGPT-954 IU/l, SGOT-762 IU/l Alkaline Ph-356 IU/l. S.Ca-9mg/dl. USG
abdomen- mild hepatomegaly .Hence a diagnosis of hepatic encephalopathy without
fulminant hepatic failure which is rare. CASE 2- 7 year male child presented with fever and
vomiting for 4 days. There was decreased urine output along with edematous swelling of
whole body for 3 days. He had not passed urine for 48 hrs. On clinical examination vitals
were stable , BP-105/55mmHg,icterus was present, liver was 2 cm, spleen1 cm. Haemoglobin
was-10.2gm/dl, TLC-7600/mm3, Blood urea-110mg/dl(day1), Creatinine-5.16mg/dl,
Sodium-138meq/L, Potassium-5.6meq/L, RMA-negative, PS for MP negative. Total bilirubin
was8.4mg/dl, direct bilirubin-4.8mg/dl, Alb-4.3g/dl, Total Protein-6.2g/dl, Calcium-8.3mg/dl,
Phosphate-4.0, SGOT-299 IU/l, SGPT- 384 IU/l, urine microscopy-few RBC’s, Urine C/S-no
growth, PT/PTTK- 17/11, 39/30. The patient was given a fluid challenge and frusemide . The
child passed urine. Anti IgM hepatitis A -9.6IU/ml(0.08), serum C3 level-80µg/dl(90-180
µg/dl) . USG abdomen mild hepatomegaly with renal parenchymal disease. The child
improved in 10 days. Diagnosis of acute glomerulonephritis with hepatitis was made.
Conclusion: These complications of hepatitis should be considered.
ID/26 (P) A STUDY OF CLINICAL AND IMMUNOLOGICAL RESPONSE TO
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN HIV INFECTED CHILDREN
AT A TERTIARY CARE HOSPITAL
Gupta R, Pathania A, Gupta A, Sondhi V, Gupta G
Armed Forces Medical College, Pune
E mail: colrgupta@gmail.com
Introduction: Highly Active Antiretroviral Therapy(HAART), has modified HIV as a chronic
manageable disease, rather than terminal illness. Studies of effectiveness in children are
scarce and hence this study was conducted to evaluate the clinical and immunological
effectiveness of HAART in HIV infected children. Material & Methods: A prospective study
was conducted at Pediatric HIV clinic of a tertiary care hospital from Jan2007 till Jul2012.
All HIV infected children on HAART were evaluated for the response to their clinical and
immunological status. Data were analyzed using unpaired ‘t’test using GraphPad Prism.
Results: Total 350 HIV+ children enrolled, 177(51%) were initiated on HAART. Mean age
of study population was 9.25 years with male to female ratio of 1.05:1. Mean age of starting
ART was 7 years. The proportion of children in WHO clinical cat I,II,III and IV before ART
initiation were 34%,47%,15% and 4%. There was a statistically significant(p<0.0001)
improvement in clinical cat after receiving ART for a mean period of 3(range1-9) years to
76%,20%,3% and 0%. Concurrently median CD4count improved from 209(range 8-3680) to
565cells/cumm(53-3034)(p<0.0001) and improvement in bodymass index(BMI) from
13.90(95%CI13.6-14.2) to 14.62(14.6-15.2)(p<0.0001). 26(14.6%) children developed
adverse effects, like anemia, skin rash, and lipodystrophy. Four children developed primary
treatment failure and put on second line therapy and 10 children on ART died. Conclusions:
There was a statistically significant improvement in their BMI, clinical, and immunological
status of children post HAART. 26(14.6%) children developed adverse effects like anemia,
skin rash and lipodystrophy. Key for successful treatment is motivation, good adherence and
close monitoring.
ID/27 (P) A STUDY OF PREVALENCE OF HEPATITIS INFECTION AMONG HIVINFECTED CHILDREN AT A TERTIARY CARE HOSPITAL
Arvind Bhagat, Abhishek Pandey, Rakesh Gupta
Department of Pediatrics, A F M C Pune
Email - colrgupta@gmail.com
Introduction: With improved survival of HIV-infected patients due to universal availability of
highly active antiretroviral therapy(HAART), liver diseases (resulting from chronic infection
with hepatitis B virus(HBV) and C virus(HCV) due to their overlapping natural course) has
become an important cause of morbidity and mortality among these patients. There is paucity
of data of HIV-hepatitis co-infection in children; hence this study was carried out to
determine the prevalence and clinical profile of HIV-Hepatitis co-infection. Method: The
study was conducted at Pediatric HIV clinic of a tertiary care hospital from Jan2007 till
Jul2012. All children were screened for HBsAg and Anti HCV. Demographic data, mode of
transmission, disease profile, investigations including hepatitis B & C were obtained. Data
was analysed. Result. Total 189 children were evaluated in the study. Mean age of study
population was 7.91 years and male to female ratio 3:1. During the screening, 4
children(2.11%) were found positive for HBV and 1(0.52%) positive for HCV infection.
Mean age in co-infected children was 10.4 years. Mode of transmission was vertical in 3
cases & blood transfusions in other two patients. All children with HBV/HCV infection had
significant malnutrition, and multiple opportunistic infections and their mean CD4 count was
319cells/cumm. Three children were on HAART. Liver functions were deranged in three
children. One child with HCV co-infection died following severe sepsis. Conclusion. The
prevalence of HIV/HBV-HCV co-infection was 2.64%. These children had significant
opportunistic infections and malnutrition. Since the natural history of these co-infections in
children is not known, it is imperative that all HIV infected children should be immunized
against hepatitis B vaccine and should be closely followed up.
ID/28 (P) AEROCOCCUS VIRIDANS BACTEREMIA IN A HEALTHY CHILD
Shalini Hajela
Vijayshree, HIG-2, Rajivnagar, Tili, Sagar, M.P.470001. India
Email-shalinihajela@gmail.com
Abstract: A 1½ y old girl presented with multiple episodes of vomiting, yellowish green, foul
smelling, large volume loose motions and fever for 1 day. Next morning she had temperature
104°F with rigors, cold clammy extremities, rapid thready pulse, peripheral cyanosis and
normal hydration and systemic examination. Considering septic shock, blood culture was
done. Blood culture performed using Bact alert 3D (BioMerieux SA, France) yielded a rare
organism, Aerococcus viridans (98% probability, Bionumber 44301021). It is a gram
positive, catalase negative coccus, forming tetrads, belonging to the family Aerococcaceae,
genus Aerococcus. A.viridans is an airborne saprophyte, commonly present in dust and air,
and in crustaceans suffering fatal graffkaemia. Although A.viridans frequently contaminates
microbiological cultures, in hospitals it is recovered from recovery room, intensive care unit,
delivery room, treatment room and premature nursery. Rarely inhabiting human upper
airways and skin, Aerococcus viridans has been reported a potential human pathogen in
endocarditis, meningitis, bacteremia, urinary tract infection. Bacteremia due to Aerococcus
viridans has been rarely reported in immunocompromised adults, agranulocytopenia and in
functional asplenia. Pediatric cases reported due to A.viridans infection are rare; include
meningitis, endocarditis, bacteremia, and urinary tract infection. First described in 1953 by
Williams, A.viridans simulates staphylococcus on gram stain; although biochemically it
resembles streptococcus and enterococcus. As far as it could be ascertained from available
literature, this appears to be the first reported case of Aerococcus viridans bacteremia in a
healthy child, first reported case of A.viridans bacteremia in India and first reported case of
A.viridans bacteremia with gastroenteritis.
ID/29 (P) STUDY OF MANAGEMENT AND COMPLICATIONS OF PLASMODIUM
FALCIPARUM MALARIA IN CHILDREN
Geetanjali Srivastava, K.M.Mehariya, Charul Purani
B.J.Medical college, Ahmedabad, Gujarat.
Email: geet.med@gmail.com
Aims and Objective: • To study the complications and outcome of P.falciparum malaria. • To
study efficacy of antimalarial drug therapy. • Retrospective observational study conducted
from August 2008 to July 2010. Setting: Tertiary care hospital affiliated to Government
Medical College, Ahmedabad, Gujarat. Material and methods: • All patients with peripheral
smear and/or a rapid diagnostic test positive for P.falciparum were selected for the study. •
Treatment of severe P.falciparum malaria was given as per National and WHO guidelines.
Results: • Out of 51 patients severe anemia was the commonest complication(37%),followed
by cerebral malaria (27%) ,hepatitis and acute renal failure(17.6%). •
Acidosis,hypoglycemia,hypotension and DIC comes next. • 2/3 of patients received Quinine
as first line therapy and majority of them responded well(82%) while Artesunate was used in
rest 1/3 of the group.The response to antimalarial therapy was 100% in the patients who
received artesunate therapy. • Among the group of patient(n=6) who did not respond to
Quinine as first line therapy,all responded to Artesunate except for one who expired due to
DIC during the course of illness. • Outcome: 92% patients responded to the standard drug
therapy and mortality was found in only 1.9%. Conclusion: Though there are many
complications associated with P.Falciparum malaria, timely drug therapy with appropriate
antimalarial has good outcome with 92% cure rate.
ID/30 (P) COMPLICATED ENTERIC FEVER
PREVENTIVE MEASURES
Jaswir Singh, Manpreet Sodhi, Neha
Department of Pediatrics, Govt Medical College, Patiala
Email:kaursodhi2007@gmail.com
–NEED
FOR
STRINGENT
Aims and objectives: The study was conducted to know the incidence of complications in
enteric fever. Material & Methods: The study included 20 patients with enteric fever admitted
to Deptt. of Pediatrics, Government Medical College, Patiala. Basic information is in the
form of age, sex, address, socioeconomic status and complaints were recorded. Children were
diagnosed based on serology (Widal test positive i.e. titre >1:80), blood culture, liver and
renal function tests, serum electrolytes, RBS and USG abdomen were done in every case.
Lumbar puncture & plain x-ray abdomen were done if indicated. Course of disease was
followed on treatment & outcome was noted. Results: Maximum number of cases(7) were
above 10 years of age. Equal numbers of cases (8 each) were in upper and middle
socioeconomic status. All presented with fever. Eight (8) cases had abdominal pain, 7 had
vomiting and 6 cases had cough and respiratory difficulty. Four (4) had diarrhoea and 3 had
increased urinary frequency and one had seizures. Complications were observed in 90% of
cases. Eight (8) had urinary tract infection,4 each had hepatitis and pneumonia. One of case
developed pyopneumothorax. One had intestinal haemorrhage and one had peritonitis.
Thrombocytopenia was observed in one case. Cholesterol gall stones with intraluminal biliary
sludge was noted in one case. Ascites & meningitis was observed in one case each. One case
had meningo-encephalitis and expired during stay. Conclusion: Complications were observed
in 90%of cases with enteric fever.
ID/31 (P) HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A CHILD WITH
VIRAL MENINGOENCEPHALITIS
Vivasvan Parekh, Parul Khanduja, Dhananjay Shukla, Sheetal Aggrawal, Vikram Patra,
Vijay Kamale Jeetendra Gavhane, Revati N
c/o, Dr Revati N, Flat # 503, Sohum Exotica, Plot-69 Sector 21, Kharghar, Navi Mumbai,
Maharashtra
Email: dr.vivasvan@live.com
Introduction: Hemophagocytic Lymphohistiocytosis (HLH) is a rare, but potentially fatal
disease. It is a macrophage related hyper inflammatory disorder that presents as fever and a
sepsis like syndrome. There are 2 types - Primary (familial) and Secondary or Reactive HLH
(associated with viral, bacterial, fungal or parasitic infections, as well as with autoimmune
disorders or malignancy).A number of systemic infection are known to cause HLH, however
very few cases have been reported of CNS infection like meningoencephalitis leading to
hemophagocytosis. Here we report a case of HLH secondary to viral meningoencephalitis.
Case report: We report on a 9 yr old girl child with no significant family history and normal
development. Patient was admitted in the PICU with history of fever and convulsions with
altered sensorium since one day. At the time of admission child had GCS 5/15, normal vitals
and respiration with no organomegaly. On investigations, Hb-11.8gm%, TLC-10,800 /mm 3,
platelets – 63,000/mm 3 ,ESR- 70mm/hr.CSF examination was normal & HSV IgM was
negative. MRI s/o multifocal intracerebralencephaliticchanges. Later, patient required
supportive mechanical ventilation.Patient continued to have fever and investigation on day 4
showed pancytopenia with low Hb – 6.8gm %,TLC- 600,ANC- 12, plt – 13,000/mm 3 with
raised hepatic enzymes (AST – 301, ALT -226). Thus, serum ferritin and triglycerides were
done which were 990 micro grams/Land210mg/dl respectively. Bone marrow aspiration was
performed which confirmedhemophagocytosis.Patient was started on methylprednisolone ,
which resulted an improvement in lab parameters in form of Hb - 11.4gm%, TLC- 5300
/mm3, ANC- 4500/mm3,plt – 60,000/ mm3 .Nevertheless ,patient eventually succumbed to
illness. Various organisms are known to cause infection assosciatedhemophagocytic
syndrome. In our patient we had viral infective etiologyleading to meningoencephalitis
associated with HLH.
ID/32 (P) TRANSIENT BLINDNESS IN AN INFANT WITH CEREBRAL MALARIA:
AN UNUSUAL PRESENTATION
Sandip Ray, Kirtisudha Mishra, Srikanta Basu, B. Rath
Department of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi, India
Email: raysandip09@yahoo.in
Abstract: Introduction: Malaria is one of the most commonly encountered vector borne
disease in children in India, cerebral malaria being a dreaded complication. Eye
complications in this set up is well reported in adults with varying spectrum of involvement.
But total transient blindness in an infant with vivax malaria is worth mentioning. Case: An 8
months old male child, product of a non-consanguineous marriage, presented with fever for
last 8 days and abnormal movements of body and eye for last 1 day. On examination the child
was sick with stable hemodynamics and irritability, universal hypertonia with brisk deep
jerks, neck rigidity and upgoingplantars, normal shaped reacting pupils and a just palpable
liver. Normal CSF study excluded the working diagnosis of meningitis and positive report of
rapid malaria antigen and peripheral smear for P. Vivax led us to stamp this case as
“complicated vivax malaria – cerebral malaria”. On 3rd day of admission he had vision loss (
absent menace reflex ) and ophthalmology consultation was taken which revealed “bilateral
partial optic atrophy”. On 5th day he regained his vision gradually and at discharge he was
following moving hand. Report of Serology for viral studies came negative later. Discussion:
Predominantly retinal changes form the milestone of eye complications in cerebral malaria
while optic atrophy as in our case is not unknown. A child with vision problem with even
vivax malaria should be worked up and searched for the cause vigorously.
ID/33 (P) HIV/AIDS EXPERIENCE AMONG CHILDREN ADMITTED IN R.K.M.S.P.
AND PARK CLINIC, KOLKATA
Asha Mukherjee, Sayani Sadhu, Somosri Ray
31 Lake Temple Road, Kolkata- 700029, West Bengal, India
Email: sayaniagarwal@yahoo.in; mukherjee31@yahoo.com
Abstract: Pediatric HIV/AIDS infection is a major world health problem, which is
progressing at an alarming rate. Children with HIV/AIDS compared to immune competent
ones present with disease patterns that are different in nature, severity and/or frequency. The
objective of our study was to study the clinical profile of HIV/AIDS among children admitted
in RKMSP and Park Clinic, Kolkata. A retrospective study of 7 children with HIV infection,
aimed at evaluating the clinical manifestations of HIV/ AIDS infection in patients admitted in
these Hospitals over a period of one year was conducted. Seven children having HIV/AIDS
infection were studied. Two children of mothers with HIV/AIDS infection were found to be
RNA PCR positive when tested for the virus but were lost in the followup. The ages of
remaining children ranged from 6 months to 12 years. The main presenting complaint were
cough and/or pneumonia 1 (14.3%) and diarrhea 2 (28.6%). Commonly seen physical
findings on admission were hepatosplenomegaly 2 (28.6%), fever 1 (14.3%), skin lesions 3
(42.7%) and generalized lymphadenopathy 2 (28.6%) All of the patients were malnourished.
The main diseases that were identified were pneumonia, diarrhea, candidiasis and skin
manifestation. From the study thus we came to the conclusion that the manifestations of HIV
infection in children are protean and mimic a number of other illnesses. A high index of
suspicion would therefore help in making early diagnosis and a management plan.
ID/34 (P) EXTENSIVE SUBCONJUCTIVAL HEMORRHAGEMANIFESTATION IN DENGUE
Kailashpatra, Savitakhadse, Arpanchauhan, Anjali Kalbhande,
Department of Paediatrics, ESI PGIMSR, Andheri.Mumbai 400093
Email id: drkailashcp@yahoo.co.in
OCULAR
Abstact: •Dengue haemorrhagic fever is most severe form of the disease, characterized by
multisystem haemorrhagic manifestations, thrombocytopenia, increased vascular
permeability and plasma leakage(1).Dengue fever is considered to be rarely associated with
ocular manifestation.(2). Case history We report a case of 12 year old male child a diagnosed
case of congenital heart disease (ASD with PS) with fever with rash, body ache and vomiting
since 5 days, no bleeding from any site. • On examination child was having tachycardia with
hypotension ( BP-82/42) and mild right hypochondriac tenderness, no peteche or other
bleeding manifestations. • On investigation child was having thrombocytopenia, malarial
parasites negative, lepto-negative, dengue-IgM positive. • Child was started on symptomatic
treatment with IV fluids and symptomatic treatment. • On 2nd day diffuse subconjuctival
hemorrhages were seen in eyes and few peteche on trunk, no ocular pain or visual
disturbances, bilateral fundus examination was normal. • In view of severe thrombocytopenia
(platelets-22,000) and subconjuctival hemorrhage was given platelet transfusion. Discussion:
• DHF is a mosquito-transmitted viral disease (3) that is endemic in tropical countries. Patient
typically develops sudden onset of fever with severe headache, retro bulbar pain, backache,
chills, gastrointestinal disturbances, and generalized myalgias and arthralgias. A
maculopapular rash usually appears on trunk spreading to face and extremities. Fever is
accompanied by leucopenia and thrombocytopenia. The diagnosis can be made by detecting
IgM antibodies or a rise in IgG titres during the convalescent phase or by isolation of virus or
polymerase chain reaction dengue viral genome.(4,5). • Thrombocytopenia and abnormal
coagulation profiles(PT,PTT) have predictive value for spontaneous systemic bleeds in
dengue infection(6,7) • Kapoor et al reports various ocular findings of which most common
was subconjuctival hemorrhages (37.3%), superficial retinal hemorrhage (2.2%), retinopathy
(1.5%) • Ocular alterations in dengue are self limiting. According to Haritoglou et al most of
the finding resolve without specific treatment, but occasionally visual recovery may be
prolonged or vision may remain permanently impaired in patients with severe
maculopathy.(8) Conclusion: • Pediatrician should be aware of various ocular manifestation
of dengue, as early diagnosis and referral for appropriate supportive therapy. • Furthermore
patients with dengue fever with marked thrombocytopenia (platelet count<50,000/uL) are
predisposed to spontaneous ocular hemorrhage which, while primarily subconjuctival, if
present in the macula can lead to impairment of vision.
ID/35 (P) EPIDURAL ABSCESS,A COMPLICATION OF UNTREATED
PARANESAL SINUSITIS
Kailash Chandra Patra, SharikNavrungabade, VaishaliGhane, MukundShirolkar
Department of Paediatrics, ESI PGIMSR, Andheri. Mumbai 400093
Email id: drkailashcp@yahoo.co.in
Introduction:- The most common cause of orbital cellulitis in children is paranasal sinusitis.
The spread of infection to the orbit from the sinuses is more prevalent in children hence
orbital cellulitis must be recognized promptly and treated aggressively.We present a case of
orbital cellulitis a complication of untretedparanesalsinusitis,complicated as a epidural
abscess. Abstract:- The most common cause of orbital cellulitis in children is paranasal
sinusitis. An infection from sinuses can easily spread to orbit or to intracranial cavity as this
structure are very closely interrelated, thinner bony septa and sinus wall, greater porosity of
bones, open suture lines, and larger vascular foramina. we present a case of orbital cellulitis a
complication of untretedparanasal sinusitis, complicated as a epidural abscess. Nine years old
female child presented with high grade intermittent fever w ith chills since 5 days and with
acute onset of gradually increasing left periorbital swelling noticed since 2 days .O/E there
was significant inflammatory swelling of left periorbitalarea.All systemic examination was
normal. Hence a clinical diagnosis of periorbital cellulitis was kept and treated with IV
antibiotics.Patient responded to therapy and became afebrile with reduction of swelling.On
day ten of antibiotic therapy patient had one episode of right focal convulsion with secondary
genralization. A clinical suspicion of orbital cellulitis complicating as brain abscess was
kept.CT scan brain plain and contrast showed a well defining ring enhancing collection
involving sinuses. Hence a radiological diagnosis of epidural abscess in left frontal region
secondary to paranasal sinusitis was made. Patient responded to IV Vancomycin and
Metronidazole.At the end of three weeks of antibiotics therapy CT scan brain was repeated
which showed complete resolution of epidural abscess with minimal white matter edema.
Clinically child has no convulsion or neurological deficit and doing well. Conclusion:Children at the age of 7 year or older, absence of response to initial treatment , a risk of
simultaneously developing orbital and intra-cranial complication should be suspected. The
indicated treatment usually requires a hospital commitment, multidisciplinary evaluation and
wide spectrum intravenous antibiotic therapy.
ID/36 (O) DISSEMINATED BCG DISEASE IN A TWIN INFANT WITH SCID
Pankaj Kumar, MMA Faridi, Hema Mittal, Anju Aggarwal, Deepti Nair, Yogender
Aggarwal, Sonal Sharma
Department of Paediatrics, University College of Medical Sciences and Guru Teg Bahadur
Hospital, Delhi, India
Email: hema_g10@hotmail.com
Introduction: BCG is a live vaccine and contraindicated in immunodeficiency. We report
disseminated BCG vaccine disease with SCID with skin lesions. Case A 7 month old male
(1sttwin) product of in-vitro fertilization, presented with diarrhoea for 3 days. After 48 hours,
loose motions improved but fever, cough and tachypnea developed. Unsatisfied parents left
hospital. Infant now presented after 3 days with pneumonitis and skin rashes. Past history
revealed rota virus diarrhoea, bronchiolitis and oral thrush. Infant received Hepatitis B,
BCG, OPV and DPT vaccine as per national schedule. On examination child had fever
(102°F), tachypnea (56/minute), pallor, oral thrush and red-purple, papulo-nodular, skin
lesions (0.5-2 cm) over neck and trunk and bilateral crepitations. Chest X-ray showed
pneumonia. A diagnosis of pneumonia with drug rash or vitamin K dependent bleeding
(VKDB) was kept. Child was started on injectable antibiotics. An abnormal coagulation
profile suggested VKDB. Investigations showed anaemia (Hb- 10.0gm/dL), normal total
leucocyte count (6200cells/mm3), platelets (2.8 lakhs/mm3) and sterile blood and urine
cultures, Mantoux test (0mm) and gastric aspirates for AFB (negative). Ultrasound abdomen
was normal. Skin biopsy showed sheets of macrophages, neutrophilic micro abscess; species
stain AFB positive (6+, globii). A diagnosis of disseminated tuberculosis was kept and
antitubercular therapy (HRZE) with steroids was started. HIV testing of mother, child and
(negative). Immunological profile suggested SCID. Skin Biopsy sent for culture and PCR
analysis (immune chromatographic test MPT64 and oligonucleotide probe liquid
hybridisation protection assay) confirmed MTB complex. Pyrazinamidase screening (species
resistant) and further molecular and biochemical tests confirmed mycobacterium bovis. Infant
deteriorated and died on day 15. Despite counselling family refused for screening of other
twin for SCID. Discussion Children with severe combined immunodeficiency (SCID) carry
high risk of fatal disseminated BCG disease after BCG vaccination.
ID/37 (P) IMPACT OF HIV ON CLINICAL SPECTRUM OF CHILDHOOD
TUBERCULOSIS
Abhishek Pandey, Gajender Kumar, Rakesh Gupta, Girish Gupta
Department of Pediatrics, A F M C Pune
Email-colrgupta@gmail.com
Introduction: HIV and tuberculosis(TB) are intersecting epidemics and have overlapping
symptomatology. Few studies on clinical spectrum of tuberculosis in HIV infected children
have been reported. This study evaluates the impact of HIV infection on clinical presentation
in HIV-TB co-infected children. Materials and Methods: A retrospective study was
conducted at Pediatric HIV clinic of a tertiary care hospital from Jan2007 till Jul2012. All
HIV infected children diagnosed as tuberculosis were evaluated for the response to their
clinical and immunological status and data were analyzed. Results: Total 350 cases of HIV
infected children looked for evidence of tuberculosis. 108 episodes of tuberculosis were
found among 97 children(27.7%). 11 children had two episodes of tuberculosis. Mean age of
study population was 9.25 years with male to female ratio of 1.4:1. Predominant symptoms
were fever, cough and failure to thrive. Among the type of tuberculosis, Extra-pulmonary
TB(EPTB) cases were more common 59(55%) and manifested as disseminated-27,
abdominal-12, lymphnode-3, military-6 and CNSTB in 11cases. Mean CD4 count was
458/cumm in pulmonaryTB group and 343/cumm in EPTB. 65 patients were on antiretroviral
therapy. Three cases had multidrug resistant tuberculosis and 7 children succumbed to their
illness. Conclusion: The prevalence of HIV-TB co-infection in our study was 27.7%. TB
manifestations were more severe and extra pulmonary like disseminated, abdominal and CNS
TB in HIV-infected children. The changing pattern of presentation and the high prevalence of
tuberculosis in HIV have made it imperative to have high index of suspicion, early diagnosis
and treatment to have better outcome.
ID/38 (O) CONGENITAL SYPHILIS STILL IN 21ST CENTURY : A CASE REPORT
Hardik Gandhi, Sunil Pathak, Dulari Gandhi
Department of pediatrics, Dhiraj Hospital, Pipariya, Gujarat
Email: hardikgandhi26@yahoo.co.in
Introduction: Sexually transmitted disease continues to be serious health problem all over the
world. In recent years increase in incidence of congenital and acquired syphilis has been
reported from both developing and developed countries. Congenital syphilis is a preventable
disease and its presence reflects a failure of prenatal care delivery systems, as well as syphilis
control programmes. Case: We report 2 month old male, second born to a nonconsanguineously married couple who presented with complain of abdominal distention,
lethargy, decreased movement of limbs and decreased urination since 5 days. Antenatal
history of mother was uneventful with birth history not suggestive of any complication. On
examination child had bilateral crepitation, systolic murmur with hepatospenomegaly. Child
also had bilateral knee and thigh swelling. Investigation revealed Hemoglobin- 3.0 gm%,
total count- 44,000 with neutrophils- 40%, lymphocytes- 50%, monocytes- 5% and
eosinophils-5%, CRP- 13.6 mg/dl (positive), SGPT-59 u/l, SGOT- 216 u/l, total billirubin0.8 mg%, with normal RFT and electrolytes. Ultrasonograpy of abdomen showedhepatospenomegaly with hypoechoeic lesion in liver with free fluid in peritoneal cavity
suggestive of ascites. Echo-cardiography of heart was normal. Orthopedic reference was done
for bilateral knee and thigh swelling. They suggested for ultrasonography of bilateral hip and
knee which showed subcutaneous edema in both thigh with synovial effusion in both side hip
and knee joint. On further evaluation of these patient VDRL and HIV testing was done which
showed VDRL – 1:64 (reactive), HIV- negative. CT scan of whole body showed- hypodense
lesion in right lobe of liver and violin string adhesions between liver and anterior abdominal
wall suggestive of syphilitic granuloma. Retrospectively parents testing were also done,
which showed- mother’s VDRL- 1:32 (reactive) and father’s VDRL- 1:16 (reactive). Both
parents are asymptomatic VDRL positive. They were also screened for HIV, but it was
negative. Parents were also treated in our hospital. Child was discharged on completion of his
treatment and follow up was done every 15 days. After 2 month child VDRL was negative
and became completely symptoms free. Conclusion : Diagnosis of congenital syphilis
remains complicated and requires high index of suspicion. Because of high morbidity
associated with congenital syphilis, screening of all pregnant women should be done at the
first prenatal visit, in the third trimester and at delivery is important.
ID/39 (P) ISOLATED PLEURAL EFFUSION PRESENTING AS POTT’S SPINE
Manish kumar Arya, Rathod.A.D , Valinjkar.S.K , Payal shah. , Sharma.B, Gaurav, Sunil S.
201, Darshan Apt, Opp Sonivadi, Chikan Villa Road, Borivali (W), Mumbai 92
Email: wildbluewind@gmail.com
Osteoarticular tuberculosis is almost always secondary to primary focus from where it
disseminate by haematogenous route. Response to tuberculous lesion is often exudative; leads
to formation of cold abscess which then track down the fascial plane or neurovascular
bundles and can present at different sites. Spine is most common bone involved in
tuberculosis .We present a case of 6 year old boy a case of isolated pleural effusion which on
later investigation had pott’s spine with cold abscess. Child came with complaints of cough,
cold and low grade fever.On examination he was thinly built with pallor and long eye lashes ;
decreased air entry on left side of chest and no other stigmatas of TB. His chest x-ray
revealed minimal left side pleural effusion with lateral; x-ray revealing lower thoracic
vertebra destruction with increased intervertebral space. Mantoux came positive , ESR was
raised ,CT –Thorax revealed findings of pulmonary Koch with destruction of T12-L1
vertebra with left psoas abscess. child was started on 5 drug AKT to be given for 18 mnths.
During stay in ward child did’nt had any neurological deficit or complaints of parasthesias
and root pain ; SLR was negative .Senior orthopaedician adviced for thoracic brace ,MRI
spine and continue AKT. Presently our patient is on AKT and advised to avoid contact sports
with MRI thoracolumbar spine awaited .He is doing well on AKT with weight gain present.
ID/40
(P)
TUBERCULAR
EMPYEMA
THORACIS-SUSPECTED
POLYRESISTANCE IN A CHILD
Devki Nandan, Amieleena Chhabra,Vivek Dewan, Sarman Singh
Associate Professor, Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi
Email- devkinandan2002@yahoo.com
Case Report: A 12 year old girl presented to us as a case of non resolving left sided empyema
for last 21 months. She was diagnosed as tubercular pulmonary effusion and had received
Cat I-Anti tubercular treatment for 7months. She still had persistence of symptoms in the
form of low grade fever, anorexia and not gaining weight and had dull note on percussion
with decreased air entry on left side. Pleural aspirate revealed pus and ICD was inserted.
Pleural fluid TB PCR and ADA was positive therefore Cat II ATT was given for an
extended 3 months before she presented to us This was continued for an extended 3 months
when she presented to us. She was febrile, not gaining weight and had generalized weakness
along with dullness on the left side of chest with diminished breath sounds when she
presented to us. USG thorax revealed left sided effusion with low level internal echoes and
multiple septations.80 ml of thick fluid was aspirated. Other investigations were: Hemoglobin
11.9gm%,WBC 10200 P(74%) Platelets were 2.8 lakh,LFT KFT normal. Pleural fluid
aspirate pus cells.>1000/L, proteins 6gm/dl and Adenosine deaminase 361.4U/L Gastric
lavage and Pleural fluid aspiratefor acid fast bacilli (AFB) & culture for mycobacterium
tuberculosis was negative. TB and genus specific PCR was positive.2nd line of tubercular
therapy with Kanamycin,Ofloxacin and Ethionamide along with Isoniazide,Rifampicin and
Ethambutol was started. On follow-up at 6 months X ray had become normal. Therapy for 18
months was planned. However after 8 months of treatment geneexpert was found to be
positive for strain sensitive to rifampicin .The treatment was stopped after 1 year of therapy
as clinical and radiological resolution was complete. Conclusion: Mono resistance alone in
this case is unlikely as the child did not improve even with adequate dosage and duration of
CatI and Cat II. As the strain was sensitive to rifampicin, MDR TB was ruled out as per
WHO definition. As the culture was negative this child was most probably a case of poly
resistant tuberculosis.
Figure 1Xray before initiation of tx
Figure 2CT after Cat I & II –showing persistence
Figure 3 Xray after 2nd line tx
Figure 4 Normal USG after treatment
ID/41 (P) CLINICO- LABORATORY PROFILE OF CHILDREN
NEUROBRUCELLOSIS IN BIKANER, NORTHWEST INDIA
Chetan. M, Preeti Wadhwani, G. S. Tanwar, G.S. Sengar, C.K. Chahar
Department of Pediatrics, S.P Medical College, Bikaner, Rajasthan
Email ID: drchetankalkura@gmail.com
WITH
Abstract: Objective: The aim of this clinical study is to establish the evidence of
neurobrucellosis in children in Bikaner (Northwest India). Methods: The study is related to
patients with brucellosis whose principal presenting features were neurological symptoms
(headache, vertigo, dizziness, vomiting, seizure, altered sensorium and encepalopathy) along
with fever. It included eleven patients amongst 68 patients of active brucellosis seen at Sardar
Patel Medical College Hospital, Bikaner. The diagnosis of active brucellosis was confirmed
by raised brucella agglutination titre of 1:320 or more in the serum and confirmation of
neurobrucellosis was done by raised brucella agglutination titre of 1:640 or more in the
cerebrospinal fluid. Results: The median age was 5 years and boys were twice in number than
girls (2:1). Median duration of fever was 15 days. Fever with seizures was the most common
presentation (100%). Other associated neurological manifestations included irritability
(88.9%), headache (77.8%), neck rigidity (77.8%), vomiting (66.7%), upper motor neuron
signs (44.4%) and impaired consciousness (33.3%) with median GCS scale 9 (range 2-15).
Hepatosplenomegaly and joint pain were found in 88.9% and 33.3% children respectively.
CSF lymphocytosis was observed in seven (77.8%) cases. CSF Culture and staining was
negative in all the cases. The response to treatment started within 10-15 days and all the
children became symptom-free at the end of six weeks. Conclusions: Neurological
manifestations of brucellosis are rare. Treatment combination of cotrimoxazole, rifampicin
and doxycyclin showed marked clinical and radiological improvement. All children were
completely disease-free at the end of one year follow up.
ID/42 (O) PRIMARY DENGUE FEVER WITH ACUTE TRANSVERSE MYELITIS A RARE CASE
More Prabha W, Parihar Mahendrasingh, Savaskar S V
Department of Pediatrics, Government Medical College, Latur- 413512, Maharashtra, India
Email: dr_mahen_parihar@hotmail.com
Abstract: - A 8 month girl presented as a case of acute febrile encephalopathy with
hepatomegaly. Investigations showed thrombocytopenia, positive IgM for dengue and normal
liver echotexture on ultrasonography. During hospital stay she developed paraplegia with no
signs of abnormal hemostasis or plasma leakage. MRI showed signs of acute tranverse
myelitis at T8-T12 spinal level. This is first infantile case of primary dengue fever with acute
tranverse myelitis to be reported. Autoimmune demyelination and direct viral invasion are
suggested pathophysiological mechanism. Keywords :- dengue fever; acute transverse
myelitis. Introduction:- Dengue fever and dengue hemorrhagic fever are one of the most
important human viral infection prevalent in South East Asia, Africa and America. The
tropical population is mainly at risk along with the travelers at these areas. The incidence of
DHF is steeply rising in past two decades with simultaneously rise in morbidity and mortality
[2]. About 3.6 billion people world wide (i.e. 55% of world population) in 124 endemic
countries are at risk of dengue infection, according to Pediatric Dengue Vaccine Initiative [1].
Although dengue has been considered as a non neurotropic virus [3], there are reports
describing neurological complication involving both central and autonomic nervous system.
The various neurological manifestation includes acute disseminated encephalomyelitis,
encephalitis, Guillian Barre syndrome and Miller Fisher syndrome and neuropathies [4-7].
The spinal cord involvement (especially transverse myelitis ) with dengue viral infection is
rarely mentioned and only five cases have previously reported[8-12]. These cases were
observed in the age group of 14-65 years[8-12] and we hereby report a first infantile case of
primary dengue fever with acute transverse myelitis. Case Report: 8 month female born by
non- consangious marriage was referred for intermittent fever since 8 days and generalized
tonic clonic convulsions 2 episodes in three days. There was no history of vomiting, loose
motion, cough and cold, trauma to head or spinal cord, irritability. No significant family and
birth history. Anthropometric measurement were acceptable. On examination; baby was
febrile and hemodynamically stable. Facial flush and conjunctival congestion were present.
The sign of raised intracranial tension or meningeal irritation were absent. Abdominal
examination revealed hepatomegaly of 4 m which was soft, smooth and non tender. Other
systemic examination was normal. The hematological parameter showed thrombocytopenia (
platelet count 6300/mm3 ). The biochemical parameter were normal. Cerebrospinal fluid
analysis was within normal limit. CSF culture showed no bacterial growth and Indian ink
stain for cryptococcus was also negative. Dengue fever serology was ordered which showed
IgM positive but negative IgG.Chest X ray was normal; USG abdomen showed
hepatomegaly .A diagnosis of primary dengue fever with acute encephalopathy was kept and
conservative treatment was started as per WHO guidelines[4]. However on day 3 of
admission, we noticed decreased movements of both lower limbs; the power of the bilateral
hip, knee, ankle joint flexors and extensors was grade 0/5 on Medical Research Scale. The
bilateral plantar reflexes were upgoing. Abdominal reflexes were absent; but scapular
reflexes were present. Beside this patient was hemodynamically stable and no metabolic
disturbance were documented.Her MRI spine which showed edematous spinal cord at T8 –
T12 level with abnormal signal intensity suggestive of infective etiology s/o acute transverse
myelitis. Baby was started on pulse therapy of methyl predisolone for 5 days. She improved
over 10 days and recovered completely over period of 2 months. Discussion: Dengue, is an
arboviral disease caused by four antigenically distinct viral serotype (DEN1, DEN2, DEN3
and DEN 4). The dengue virus belongs to flavivirus group in the Flaviviridae family and
transmitted by bite of infected female Aedes mosquitoes. The dengue virus infection results
in spectrum of clinical presentation from subclinical to fatal manifestations called dengue
hemorrahgic fever and dengue shock syndrome. The primary dengue infection is more
common in infant who posses maternal IgG dengue antibody[3,4]. The differential diagnosis
includes bacteremia , leptospirosis, rickettsial fever, malaria and acute HIV infection
syndrome. Diagnosis is confirmed by isolation of virus from blood during the viremic
(febrile) phase and the presence of IgG and IgM antibody by ELISA during the post febrile
peroid. The treatment aims at maintaining adequate hydration and managing potentially fatal
complications[2,12].Increasing spread of dengue infection has lead to rise in atypical
manifesatation of dengue which were previously under reported due to lack of awareness.
Dengue virus is an non neurotropic virus however there are recent reports of neurotropism or
neuroinvasion[3]. The virus has been detected in CSF and demonstrated by immune
histochemistry in CNS biopsies of fatal cases[5]. Acute transverse myelitis is an acute
intramedullary spinal cord dysfunction involving both halves. Dengue myelitis showed
differential gray matter involovment corresponding to anterior horn cell involvement similar
to poliomyelitis which differ in sensory dysfunction[12,13].The duration between the onset of
infection and development of acute tranverse myelitis ranged from 2 to 16 days in all the
previously reported cases. The development of neurologic symptoms in close association
with the initial dengueinfection (peri infectious) and flaccid paraplegia are attributed to direct
viral invasion of the nervous tissue[13]. Whereas the late appearance of neurologic disorders
(post infectious) and spastic paraplegia are considered immunologically mediated neural
injury[4,13]. Reports of isolation of dengue virus, detection by PCR, dengue immunoglobulin
M assays in CSF indicates the virus is able to directly invades the brain and cause
encephalitis. Occurrence of delayed neurological manifestation suggest autoimmune
demyelination may be further mechanism of neurological damage[4,5]. History of fever and
convulsioin with transient decrease in platelet count and positive IgM and negative IgG
dengue suggests that the patient is suffering from acute febrile encephalopathy with primary
dengue infection. In this particular infant, the clinical picture was that of complete loss of
spinal cord function at T8-T12 level along with platelet count of 63000/mm3 and no clinical
sign of abnormal hemeostasis or the evidence of plasma leakage. There was no metabolic
disturbance, while the spinal MRI at corresponding level showed edema with no bone
abnormalities. All this indicates that bleeding or no other systemic factor was responsible for
the development of transverse myelitis in this patient. Unfortunately tests to detect the virus
in CSF was not available.
ID/43 (P) NEONATAL DENGUE
Shrikant Jamdade, N.Kannan, Nibedita Mitra, G.Kavitha, V.Senthil Kumar , Midhun Ramesh
Department of Pediatrics & Child Health, Southern Railway Headquarter Hospital, Chennai23.
Email: nibeditamitra1@yahoo.co.in
Case: Mother 23years with term pregnancy was admitted with high fever, headache and
myalgia for3days. Dengue NS1 and IgM were both positive and IgG was negative. She
delivered on the third day of admission, had severe post partum hemorrhage, subconjunctival
hemorrhage, bilateral pleural effusion. Platelet count reached a nadir of 8,000
/cumm.Repeated blood transfusion, fresh frozen plasma and platelet transfusions were
needed. Platelet count started rising on the4th post natal day after which she recovered.
Female baby was delivered vaginally on day6 of maternal illness. Birth weight2.7kg, and
APGAR score was 7/10&9/10 at1and5minutes respectively. Baby was well till day3. when
she started having fever, septic screen was negative. Dengue NS1 was positive and IgM and
IgG were negative. Fever setteled.Blood culture was sterile. Baby again started having fever.
On Day10, had refusal of feeds, tachypnea, tachycardia, hepatomegaly, lethargy,IV fluids
were started. Petichiae lesions noted on Day 11.Platelet count was 10000.Platelet transfusions
were given. Supportive management was given. Baby recovered well &discharged on day20
of life on breast feeds. Conclusion: With the emergence of dengue epidemic, if a pregnant
woman gets the primary infection in late pregnancy and delivers at the height of viremia, both
mother and newborn are at risk of life threatening complications. A new born with dengue
infection should monitored for signs and symptoms well into second week of life before
being discharged.
ID/44 (P) VIVAX CEREBRAL MALARIA WITH PSYCHOSIS: TWO UNUSUAL
CASES
Parul Khanduja, Vikram Patra, N. Revathi, Jigyasha Sinha, Nakul Kothari
Department of Pediatrics, M.G.M hospital, Kalamboli , New Bombay
Email: parul_khanduja@yahoo.com
Vivax malaria was once considered a benign form of malaria. But over the years, several
complications like severe thrombocytopenia, Acute respiratory distress syndrome, Cerebral
malaria occur, not infrequently with vivax malaria also. Malarial psychosis secondary to
vivax malaria is comparatively uncommon. Here, we report 2 cases of complicated vivax
malaria presenting with neuropsychiatric involvement. Case 1 - 11 year old male presented
with fever of 2 days duration, hypotension, status epilepticus followed by unconsciousness
for 12 hours. On arousal, child had poor sensorium. treated with injectable Artesunate
followed by oral Artemether and Lumefantrine. Sensorium improved within 12 hours but
child had inappropriate speech, visual and auditory hallucinations, that gradually resolved
after completion of antimalarial course. Case 2 – 13 year old child came with fever of 10 days
duration with generalized tonic clonic seizures. He was started on Quinine in view of cerebral
malaria but later shifted to Artemether as he had abnormal behavior. With anti malarial
therapy, smear cleared and liver function normalized. However, he developed auditory and
visual hallucinations on day 5. He was treated with Haloperidol with gradual resolution of
symptoms over a month. In both cases, Peripheral smear and Malarial Antigen test were
positive for Plasmoodium Vivax. In both, other causes of psychosis like febrile delirium and
drug toxicity were ruled out. There was no past history of any psychiatric illness Thus, It can
be concluded that psychosis of variable duration can be associated with Plasmodium vivax
cerebral malaria.
ID/45 (P) CHANGING TRENDS IN MORTALITY IN PAEDIATRIC TETANUS
CASES
Rathod.A.D, Dhale.S.N, Sharma.B, Rasal.G
Prof Of Pediatrics, Bldg-1, Flat # 15, Sir JJ Hospital Campus, Byculla, Mumbai- 400008,
Maharashtra
Email: bharti2000.2008@rediffmail.com
Abstract:- Tetanus is a neurological disorder with spasticity, muscle spasms and autonomic
disturbances caused by the neurotoxin ‘tetano-spasmin’ produced by Clostridium tetani.
Inspite of simple preventive measures, tetanus remains a major cause of mortality in the
developing countries. A 3 year retrospective study of 25 cases of tetanus was done in a
tertiary care centre .Aims of study is to see changing trends in mortality in paediatric tetanus
cases with timely intervention and early diagnosis. Cases were between 1 month and 12
years of age. Information including–sex, age, duration of stay in the hospital, mode of
infection (otogenic/post-injury/unknown), grade of tetanus, incubation period (IP), period of
onset, duration of spasms, requirement of endotracheal (ET) intubation or tracheostomy, need
for mechanical ventilation (MV), complications and out-come was recorded.The management
of tetanus cases was as per protocol. Strict aseptic technique was employed for tracheal toilet
which was undertaken every 2 hourly or more frequently if required. All patients received
2000 units of tetanus immunoglobulin and 0.5 ml tetanus toxoid intramuscularly. They also
received injection crystalline penicillin intravenously (1 lac units/kg/day; 4 divided doses) for
10 days.The Chi square test was applied to study the significance of factors affecting
mortality. Conclusion of study revealed decrease in mortality from 20% to 9.2%.This study
presents our experience as regards to the etiology, complications and outcome of postneonatal tetanus with proper intensive care.
ID/46 (P) RISK FACTORS FOR DEVELOPMENT DIARRHOEA
DEHYDRATION AND MEASURES TO PREVENT IT
N. L. Phuljhele
Kanchanganga phase II, Danganiya, PO-RSU, Raipur- 492010, C.G.
Email: drnsph@gmail.com.
AND
Around 3 million under 5 years of age die each year in the developing countries due
environment and sanitation related issues. Diarrhoea and associated morbidities is the major
cause for such deaths. Most of these mortalities are preventable with the healthy and hygienic
living. However there is ignorance among common public in general and rural population in
particular, about the common risk factors for diarrhoea. There is also lack of understanding
about the healthy and hygienic practices. As they say “prevention is better than cure”; the
poster discusses the common risk factors for diarrhoea and also explains the preventative
methods that can be practised to combat the same. The chart is for the use of health
professionals to illuminate the common public about the simple methods to avoid diarrhoea
and its associated morbidities.
ID/47 (P) AWARENESS OF CLINICAL FEATURES AND HOME BASED
MANAGEMENT OF DIARRHOEA AND DEHYDRATION, AMONG COMMON
PUBLIC
N. L. Phuljhele
Kanchanganga phase II, Danganiya, PO-RSU, Raipur, C.G.
Email: drnsph@gmail.com.
According to the latest UNICEF report-2012 around 19,000 children die under 5 years of age
every day, and 50% these children belong to India alone. In India around 15.55 lakhs children
under 5 years of age died within last 1 year. Diarrhoea and dehydration amount to majority of
these cases. Early diagnosis and timely treatment can prevent majority of such fatalities. But
there appears a lack of awareness among the common public in recognizing the early signs
and symptoms of diarrhoea thus causing delay in management. The chart deals with the
clinical feature and treatment of diarrhoea; highlights the role of time tested oral rehydration
therapy and stresses upon the prevention of malnutrition in such cases. This DVD chart has
been created or the use of health professionals to make common public aware about the signs
and symptoms of diarrhoea and simple home based way to handle it.
ID/48 (P) SENSITIVITY OF ANTIMICROBIALS IN GASTROINTESTINAL (GI)
TRACT INFECTIONS
N.L Phuljhele, Arun SR
Dr. B.R. Ambedkar Hospital, Raipur, C.G.
Email: drnsph@gmail.com.
Introduction: The irrational use of antibiotics in order to achieve hasty result has led to
emergence of resistance strains of pathogenic bacteria. Moreover patients today have become
more and more demanding and want evidence based health choices. There are several time tested antibiotics, which could still be effective and there is need to re-establish their efficacy
in today’s scenario. Therefore this study was conducted to know the bacterial profile and
antibiotic sensitivity of gastrointestinal tract (GI) infections in our hospital. Aim: To study the
culture profile and antibiotic sensitivity of common GI tract infection causing pathogens in
our wards. Methods: This was a cross section observational study about patients of 1 month
to 15 years of age admitted in Paediatric wards of our hospital, with GI tract infection.
Detailed history and clinical examination was done. All standard investigations were
obtained. Weight of the patient was obtained at the time of admission and grading of
malnourished patients was done according to IAP classification. Results: Out of 300 patients
admitted in our ward due to infections within time duration of 10 months, 14.3% suffered
from acute gastroenteritis. In acute gastroenteritis and dysentery 70% of culture were sterile
which is lower than that observed by Uppel B et al. The commonest organism isolated was
E.coli (14.8%) of cases and is supported by B.S. Naruka et al and B.D. Bhatia et al. E.coli
bacteria showed maximum sensitivity to Vancomycin (93.3%) and Chloramphenicol
(93.3%). Vancomycin’s high efficacy could be explained by its infrequent use in clinical
practice as explained by Pallucha et al & Assadulla et al. Co-trimoxazole (80%) and
Gentamicin (86.6%) were also highly effective against E coli and is similar to that reported
by Naruka et al and Goldstin et al. Other antibiotics like Amikacin, Ciprofloxacin,
Ceftazidime showed reduced sensitivity against E. coli and similarly crystalline Penicillin and
Cloxacillin were also less efficacious. Co-trimoxazole (58%)was the most commonly used
drug followed by Gentamicin (32.5%), Cloxacillin (25.5%), Ceftriaxone (23.2%) and
Amikacin (14%). Conclusion: Cheap and easily available drugs like chloramphenicol and
gentamicin are still effective and could be used in poor area of Chhattisgarh and MP where
cost factor plays a major role in management of the patient.
ID/49 (P) STUDY THE MAGNITUDE OF HIV INFECTION IN TUBERCULAR
CHILDREN AND THEIR CLINICAL PROFILE:
Virendra Gupta, Jagdish Singh, Rambabu Sharma, Chaman Verma
Department Of Pediatris, SPMCHI, S M S Medical College, Jaipur
Email: vkhindustani@gmail.com
Abstract: Introduction: Tuberculosis was noted to be the most frequent cause of death
amongst people living with HIV not only in India but all over the world. Aims and
objectives: To know the magnitude and differences in clinical profile of HIV infection in
tubercular children. Study design and setting: Hospital based cross-sectional & descriptive
study. Material & method: Study group included patients attending hospital during period
Sept. 2011 to Sept. 2012, diagnosed with tuberculosis as per NACO guidelines and screened
for HIV infection. Results: Out of 315 tubercular children, 22 were HIV positive giving a
magnitude of 6.98%, Most patients were in the school going age (5-12yr)group (43.80%).
The male to female ratio was1.21:1. Mean weight for age was 69.94%. History of contact
with tuberculosis was present in 47.94%. Out of HIV positive cases Fever(81.81%),weight
loss(81.81%) and weakness(81.81%) were most frequent complaints followed by
cough(68.18%).
Examination
showed
hepatosplenomegaly(41.81%)
and
lymphadenopathy(18.18%). Chest X-ray revealed miliary findings in 10.8%. Out of total
number, 57.46% were rural patients. 52.06% of cases had one or more extra-pulmonary
tubercular sites, and 03.17% disseminated or military tuberculosis. BCG vaccination was
seen in only 34.92% cases. Overall Mantoux test positivity was 8.49%. Conclusion:
Increasing magnitude of HIV seropositivity with positive patients more likely to suffer from
pulmonary tuberculosis while HIV negative with extra pulmonary involvement. HIV-positive
children suffer from prolonged symptoms. Health personnel need to recognize such dual
infection and take proper steps to manage the epidemic. HIV screening should be carried out
in patients with prolonged illness resistant to usual mode of treatment. Keywords: HIV,
Paediatric tuberculosis, Magnitude, seropositivity
ID/50 (P) CROSS SECTIONAL STUDY REGARDING KNOWLEDGE OF HIV
INFECTION AMONG URBAN SCHOOL GOING ADOLESCENTS
Kunal Kumar, Neelam Grover, Shayam L Kaushik , Anmol Gupta
Senior Resident (Pediatrics), C/O JMS Office, Advanced Pediatric Center, PGIMER,
Chandigarh- 160012
Email: drkunalkumar@yahoo.com
Introduction: Twenty five percent of the country’s population between 15-29 years account
for 31% of AIDS burden. Proper knowledge about AIDS is essential for adolescents to
survive in this everchanging world. Aims & Objectives: To estimate the knowledge of
adolescents regarding HIV infection and attitude towards HIV infected patients. Material &
Methods: 1281 students(720 boys and 561 girls) from 8 coeducational schools of Shimla
studying in classes X- XII and aged between 15-19yrs participated in this cross sectional
study. The schools were selected by simple random sampling and the study period was
between 1/7/2008 to 31/12/2008.Data was collected through a predesigned, pretested, semi
structured, self administered, anonymous questionnaire with 29 questions on various aspects
of HIV, adapted from National Behavioral Surveillance survey 2006 and Format of
adolescent preventive Services (FAPS questionnaire). Data was analyzed using Epi Info TM
3.5.1 and p value <0.01 was considered significant. Results: 94.7% respondents had heard
of AIDS &70% were willing to share food with a patient.Lesser number of females compared
to males were aware of testing facility for HIV(p=0.001)&use of condoms for preventing
HIV (p=0.001).More girls (83.76 %) were willing to attend awareness programs compared to
boys(77.1%) (p=0.004).Majority (65.8%)didn’t have sex education classes at school and TV
was the most popular source of information(60%)on AIDS. Conclusions: Overall attitude of
adolescents towards people living with AIDS is positive and should be encouraged.
Considering the lack of universal sex education at schools other sources of mass media
should be used optimally for spreading awareness
ID/51 (P) ETIOLOGICAL FACTORS OF SLOWLY RESOLVING PNEUMONIA
IN CHILDREN BELOW 5 YRS AGE GROUP IN A TERTIARY CARE
CENTER IN EAST INDIA
Subhajit Bhakta, Asis Banerjee. Prabhabati Banerjee
Dept Of Paediatrics , Medical College, Kolkata
Email: subhajitbhkt@gmail.com
Abstract: Introduction: Pneumonia is one of the major cause of under- 5 mortality in
India. Most children respond well with empirical therapy. The empirical management
depends on the clinical profile of the patient. But few patients do not respond to this due
to some underlying factors that hinder the resolution of pneumonia. Aims And
Objectives: To determine the relative frequency of underlying factors of slowly
resolving pneumonia in under-5 age group. Materials And Methods : descriptive study
for a 1 year period from august,2011 to july,2012 at pediatric dept ,medical
college,Kolkata. Slowly resolving pneumonia defined as “ persistence of symptoms or
radiographic abnormalities beyond 72 hrs of initiation of empirical therapy( 3 rd
generation cephalosporin). Results: Of 166 under 5 children admitted with pneumonia
33( 19.87%) fulfilled the criteria of slowly resolving pneumonia. Of these EMPYEMA in
10 ( 30.30 % ) ASSOCIATED ASTHMA in 6 ( 18.18 % ) PULMONARY
TUBERCULOSIS in 4 ( 12.12 % ) ,COLLAPSE CONSOLIDATION in 2 ( 6.06%
),LUNG ABCESS in 2 (6.06%) , IMMUNODEFICIENCY(HIV +) in 2 (6.06 %),
BACTERIAL RESISTANCE in 1 ( 3.03 % ), PNEUMATOCELE in 1(3.03%),
FOREIGN BODY ASPIRATION in 1 (3.03%) and CYSTIC FIBROSIS in 1(3.03 %).
Rest 3 cases (9.09% ) we are unable to find out any etiology. Conclusion : Slowly
resolving pneumonia is fairly common (one fifth) amongst all admitted pneumonia
cases in tertiary referaal centre in Kolkata. Most of them have a known etiological
factor ,most common being associated empyema.
ID/52 (P) HUMAN IMMUNODEFICIENCY VIRUS DISEASE SEVERITY,
PSYCHIATRIC SYMPTOMS, QUALITY OF LIFE IN PERINATALLY INFECTED
ADOLESCENTS
Amrita Roy, Swapna Chakraborty
Department of Paediatrics, Medical College, Kolkata
Email: preences.amri3107@gmail.com
Introduction: Since the advent of highly active antiretroviral therapy (HAART), perinatally
human immunodeficiency virus–infected (HIV+) youth are surviving childhood in increasing
numbers and they need significantly higher behavioral, educational and psychiatric
intervention. Aims: To evaluate associations between HIV disease severity and psychiatric
manifestations & quality of life in perinatal HIV+ adolescents. Methods: In this hospital
based cross-sectional study conducted in Regional Paediatric ART Centre at Medical College
& Hospitals, Kolkata from August 2011- July 2012, 79 adolescents were included. Inclusion
criteria: HIV+ perinatally infected adolescents aged 12-19 years, living with the same
primary caregiver for > last 12 months Exclusion criteria: mental retardation. Informed
consent and assents were obtained. The Child and Adolescent Symptom Inventory–4R which
is a caregiver-completed scale was used for evaluating the psychiatric manifestations of 12 to
18 years old. WHOQOL-HIV BREF; School Functioning Scale; the Social Functioning Scale
were also assessed. Each participant’s WHO classification of HIV, current receipt of
HAART, years of HAART exposure, current CD4 percentages were recorded. Statistical
methods: by SPSS version 17.0. 2-sided P<.05 was considered statistically significant.
Results: Of the 79 HIV+ adolescents aged 12 to 19 years, 51% were male. 81% were
receiving HAART at study entry. 23% were classified as WHO Stage 3/4, 74% had a current
CD4 percentage of 25% or greater. 32% metDSM-IV symptom cutoff criteria for at least 1 of
7 targeted psychiatric illnesses. A lower CD4 percentage at study entry was associated with
more severe Conduct Disorder symptoms but with less severe depression symptoms.
Treatment with a regimen of HAART and a PI was associated with less severe ADHD
symptoms (p=0.04). Adolescents with a lower nadir of CD4 percentage, older age at the nadir
had lower QOL, worse social functioning. Adolescents with depression had poorer academic
functioning and lower QOL than did those without depression. Conclusions: HIV illness
severity is associated with the severity of some psychiatric symptoms, academic and social
functioning.
ID/53 (P) HERPES VIRAL MENINGOENCEPHALITIS- INCIDENCE AND
OUTCOME IN TERTIARY CENTER OF EASTERN ODISHA
Kamalakanta Swain, Pradip Kumar Behera. Arati Mallick, Niranjan Mohanty
Dept Of Paediatrics SCB Medical College, Cuttack, Odisha.
Email: drkamalakant78@gmail.com,pradip02011@gmail.com
Objective-To assess the incidence and outcome of morbidity & mortality of herpes viral
meningoencephalitis in children of age group 1-14 yr. Design:-Prospective study. Setting-
Children of age group 1-14 yr admitted to paediatrics dept of SCB medical college with
history of fever altered sensorium with or without convulsion are taken into study.Children
having mental retardation ,seizure disorder delayed development or CNS structural anomaly
excluded in the study. Method:-A detailed history of prodromal symptoms
,presentation,clinical examination,hemogram,MP –ICT,CSF study ,neuroimaging,viral
antigen study by PCR method.Their clinical course was assessed till recovery& persistence of
neurological morbidity or complication followed up upto 1 yr. Results-out of 250 cases of
patients having symptoms of CNS infection 63 cases-25% cases are found to have herpes
type 1 viral infection confirmed by viral antigen by PCR.The distribution of cases are found
to be perennial with increased incidence during july to September male outnumbered female,1.8:1).Most cases 48% cases are found to be in chidren of age group 5-10yr.32% cases are
without prodromal symptoms.40% cases within 3 days of febrile episode,15 cases presented
between 4-7days,4 cases after 7 days of fever.All cases -100% presented with altered
sensorium,50 cases -83% presented with convulsion. CSF STUDY-only lymphocyte20%
cases,predominantly, lymphocytes 80%., ↑protein 40 %., ↑sugar 30%., Neuroimaging:Done
in all cases,CT/MRI show swelling of brain parenchyma mainly temporal lobe in 60% cases.
Outcome:- Treatment with-acyclovir -25% with neurological sequel,30% death,45%
recovered without sequele. Treatment without acyclovir -70% death ,30 % sequel.
Conclusion: Herpes type 1 viral meningoencephalitis is one of the common cause of
neurological morbidity and mortality in children of our hospital .The disease prevention by
vaccine introduction against herpes virus may step forward to accelelate child survival in
India.
ID/54 (P) ATYPICAL COMPLICATION OF DENGUE HEMORRHAGIC FEVER HYDROCEPHALUS
Vykuntaraju K.N, Raghunath, Ramu
Consultant Pediatric Neurologist, Bangalore Child Neuro and Rehabilitation Center, HANS
complex, 8/A 1st main 1st cross, Manuvana, Near Adhichunchanagiri Choultry, Vijayanagar,
Bangalore, 560040, Karnataka, India
E-mail: drknvraju@hotmail.com, drknvraju@yahoo.co.in
Introduction: Dengue infection is known to have varied clinical presentations. The incidence
of neurological manifestation varies from 0.5% to 6.2%. We present a case of dengue with
hydrocephalus. Case: A 12 years old male presented with 5 days fever and two episodes of
seizures. On examination, BP was 90/60 mm hg. Flushing of palms and soles with petechiae
was present. GCS was 12/15. Investigations showed increased hematocrit, thrombocytopenia,
elevated SGOT and SGPT. CT at admission showed hypodensity in bilateral thalamus and
cerebellum. Dengue rapid test was positive. MRI showed signal changes in bilateral thalami
and cerebellum. The child started deteriorating with decerebrate posturing, so CT was done
which showed significant dilatation of third and lateral ventricles due to increase in mass
effect in posterior fossa. Subsequently external ventricular drainage tube was placed to drain
the CSF. CSF Xcyton was strongly positive for dengue virus. Subsequently patient showed
clinical improvement. Then EVD was removed after 3 days and repeat CT showed reduced
size of ventricles. Patient was discharged without any neurological deficits. Discussion: We
present a proven case of dengue encephalitis with increased ICP due to hydrocephalus.
Hydrocephalus probably due to edema in cerebellum causing obstruction to CSF flow. The
patient showed clinical improvement only after CSF drainage. CSF was positive for dengue
antigen suggesting possible direct invasion of the virus in our case. Conclusion: In dengue
fever neurological deterioration can be due to hydrocephalus, treatment of which can be life
saving.
ID/55 (P) KNOWLEDGE, ATTITUDE AND PRACTICE OF COMMERCIALLY
AVAILABLE ORAL REHYDRATING SALT SOLUTION AMONG THE MOTHERS
IN THE MANAGEMENT OF ACUTE DIARHOEA
TagoN ,Nayak L ,Chandan C.K , Digal K.C , Das L ,Mohanty N
Dept. Of Pediatrics SVPPGIP & S.C.B Medical College Cuttack, ODISHA
Email: nanitago@rocketmail.com
Introduction: Acute diarrhoea is one of the leading causes of childhood morbidity and
mortality. The World Health Organisation recommends use of Oral rehydrating salt solution
(ORS) in all types of diarrhoea along with oral zinc. Objectives: The aim of the study was to
assess knowledge, attitude and practise of ORS among the mothers inthe management of
acute diarrhoea in children. Method And Materials: This cross sectional study was done at
Pediatric OPD of SVPPGIP & SCB Medical College over the period of 6 month (April –Sept
2012). Mothers, whose children (age between 6 month – 5 years) had acute diarrhoea, were
interviewed through a questionnaire designed for the study. The questionnaire was designed
and administered by the authors. Information was obtained on the knowledge, attitude and
practise of ORS in the management of acute diarrhoea. Results: Of the mothers (n = 1450)
interviewed, majority (n=1276, 88%) of the mothers knew or could recognize the
commercially available ORS. The same mothers (n=1276, 88%) claimed that they had
experience of using ORS for acute diarrhoea. However, the amount of ORS administered to
children was inadequate, with the majority consuming only spoonful or a few sips. Refusal of
ORS by the children was the reason for poor use. Plain water (n=783, 54%), glucose water
(n= 551, 38%) and sugar salt solution SSS (n= 87, 06%) were used invariably. Of the mothers
(n=1276, 88%) who knew or could recognize ORS, only 574 mothers (45 %) knew the proper
reconstitution method of the commercially available ORS. Conclusion: Mothers need to be
educated about the benefits and proper use (i.e.reconstitution) of ORS and encouraged to use
ORS when their children have acute diarrhoea.
ID/56 (P) CLINICAL UTILITY OF HOSPITAL ANTIBIOGRAM DATA TO ASSESS
PNEUMOCOCCAL RESISTANCE TO ANTIBIOTICS
Abraham Paulose, Shareen George, Mathew Ma, Isac Mathai, George Noble, Simi Anish,
Chitralekha C
Department of Pediatrics, Malankara Orthodox Syrian Church Medical College, Kolenchery,
Kerala
Email: drabrahampaulose@hotmail.com
Introduction: Although Streptococcus pneumoniae (pneumococcus) is recognized as an
important cause of morbidity and mortality worldwide, in India few data are available on the
pattern of invasive pneumococcal disease (IPD) and the antimicrobial susceptibility pattern of
the organism. Aims & Objectives: To assess the antibiotic susceptibility pattern of
pneumococcus and also to collect the patient characteristics of invasive pneumococcal
disease. Materials and Methods: A retrospective study to determine the antibiogram
surveillance of pneumococcus was conducted from January 2005 to September 2012 in a
tertiary care centre in Ernakulam district,Kerala. The minimum inhibitory concentration
(MIC) values of penicillin, erythromycin, chloramphenicol and cefotaxime were determined
by agar dilution method and for confirmation; E test was carried out for penicillin alone. The
MIC range obtained for penicillin was between 0.125-1.0 microgram/ml. Kirby-Bauer disc
diffusion method was adopted for testing of erythromycin, chloramphenicol, co-trimoxazole,
cefotaxime, tetracycline and vancomycin. Results: Altogether there were 24 isolates (19 from
CSF and 5 from blood). Out of the 24 isolates, 31.6% showed resistance to penicillin. These
penicillin-resistant pneumococci were also found to be multi-drug resistant strains. The
susceptibility to vancomycin was 100%. Mortality was high with penicillin resistant
pneumococci presenting with meningitis and septicemia. Conclusions: Penicillin resistant
pneumococcus is on the rise.The emergence of multidrug resistant pneumococcus makes it
important to propagate the judicious use of antibiotics. Antibiograms are relatively
inexpensive and easy to use method of measuring antibiotic resistance and incorporation of
patient related data to antibiogram would make it more reliable and useful in monitoring
trends of antibimicrobial resistance.
ID/57 (P) A CASE REPORT OF SCRUB TYPHUS FROM ROHTAK, HARYANA
Kundan Mittal, Nikhil Vinayak, Haripal Kashyap, Jaya Shankar Kaushik
Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak,
Haryana, India-124001
Email: jayashankarkaushik@gmail.com
Abstract: Background: Scrub Typhus (Tsutsugamushi fever) is caused by rickettsiae ,Orientia
tsutsugamushi manifesting with fever, hepatospleenomegaly and lymphadenopathy. Scrub
typhus is endemic in hilly and coastal areas of India and is has not been reported from
Haryana. We report a case of Scrub Typhus in an adolescent girl who presented with fever,
severe anemia, jaundice, hepatosplenomegaly and pneumonitis. Case report: A 13 year old
girl, resident of Haryana, presented with fever for 20 days, jaundice and multiple episodes of
vomiting for last 5 days. On examination the girl was malnourished, sick looking, was
tachypneic (RR=30/min) and had pallor, icterus and puffiness of face. She had diffuse
bilateral coarse crepts involving all lung fields. Abdomen was distended, hepatomegaly (5 cm
BCM) and splenomegaly ( 8 cm BCM) were present. On CNS examination sensorium was
normal, Neck rigidity and Kerning sign were present. Investigations revealed severe anemia
(hemoglobin of 4 g/dL) and thrombocytopenia (platelet count of 1 lakh). She had a blood
urea of 99mg/dL, creatinine of 0.8 mg/dL, total bilirubin of 5.5 mg/dL, SGPT of 64 U/L and
INR 1.9. Smear for malarial parasite, Rapid malarial antigen test and serology for enteric test
were negative. CSF was normal. Blood culture was sterile. CXR showed bilateral extensive
fluffy shadows. Child was started on IV antibiotics with no clinical improvement in 72 hrs
an alternative diagnosis of rickettsial infection was thought. IgM antibodies against Scrub
Typhus came positive. Child was given a 7 day course of Doxycycline after which her
clinical and laboratory parameters improved. Liver and spleen regressed within 5 days. The
child was discharged on 10th day of admission. She was followed up one week after discharge
and was found to be normal. Conclusion: Scrub Typhus should be kept as a possibility in a
child with prolonged fever, severe anemia, jaundice and hepato-spleenomegaly when other
common causes have ruled out.
ID/58 (P) DOGBITE – A MENACE
Jhancy.M, Tulasi,P.G, Pavan Kumar, Chandrika, M.S.Raju, D.Manikyamba
Assistant.prof, Rangaraya Medical College, Kakinada, A.P.
Email: jhansimalay@yahoo.com
Introduction: Rabies is a fatal, preventable zoonosis, but it is not effectively controlled in
developing world. Human rabies has been eradicated in some developed countries. Because
rabies is not a notifiable disease in India and there is no organized surveillance system of
human or animal cases, the actual number of deaths may be much higher. Most animal bites
in India (91.5%) are by dogs. A person is bitten every 2 seconds, and someone dies from
rabies every 30 minutes. Aims & Objectives: To study retrospectively incidence, morbidity,
mortality profile of pediatric dogbite victims in a single hospital. Materials And Methods:
Number of Dog bitten children attended and admitted to GGH , Kakinada during Jan to Aug
2012 collected from OP,IP registers. The morbidity and mortality profiles compared in
relation to population. Results: 7.4% of child population of Kakinada metropolitan seeking
medical attention due to stray dogbite. 8.4% child op was due to dog bites.Admissions due to
fatal bites requiring average duration of hospital stay of 7 days were 84. 3 children died of
rabies contributing 2.12% of total mortality. Remaining treated with Immunoglobulin worth
Rs308000. Conclutions: There must be strict implementation of the legal provisions for
licensing and regular vaccination of pet dogs. Control the population of stray dogs by strict
ABC,Vaccine bites. Surveillance and diagnosis of animal rabies must be improved in quality
and offer wider coverage, human rabies must be made a mandatory reportable disease.
Research centres to prevent and treat rabies (6 survivals reported) to be established.
ID/59 (P) IMMUNISATION IN SLUM DWELLERS
Shashi Kant Dhir, Amarpreet Kaur, Gurmeet Kaur, R K Goyal, H V Gupta, Pankaj Bansal,
Meenal Batta
GGS Medical College, Faridkot
Email: shashikant_dhir@yahoo.com, dr.amarpreet12@gmail.com
Introduction: Inspite of government’s efforts to prevent vaccine preventable diseases through
immunisation schedule, there are areas in the country where the coverage is still very less
leading to the load of infectious diseases and morbidity associated with it. Aim and objective:
To find the immunisation coverage and awareness about need for immunisation in slum area
of Faridkot. Material and methods: Immunisation coverage was divided into categories of
fully immunised, partially immunised and unimmunised (as per national immunisation
schedule). Fully immunised in the study meant BCG, DPT1+ + OPV1, DPT2+OPV2,
DPT3+OPV3 and Measles till 1 year of age and BCG plus 3 doses of DPT and OPV till 9
months of age. Partially immunised meant omission of any of the required vaccines.
Unimmunised meant no vaccination was given at all. Results: Out of 75 children 65% were
males. BCG coverage was 54.6%. The coverage for DPT3+ OPV3, DPT2+ OPV2 and
DPT1+OPV1was 26.6%, 46.6% and 65.3% respectively. Measles vaccine was received by
38.6% children. Children were divided into two age groups i.e. less than 9 months and more
than 9 months. In less than 9 months age group 15%, 30 % and 55 % were fully immunised,
unimmunised and partially immunised respectively. In > 9 months age group 14.5% were
fully immunised, 37.82% were unimmunised and 47.68% were partially immunised. As per
the study 4% of the mothers had received primary education, 13.3% went to school but never
received primary education and 82.7% had never been to school. Conclusion: The
immunisation status followed a downward trend over time considering the number of doses
of vaccine to be given as in case of DPT and OPV. Education status of mother affected
awareness about the need for vaccination. Keywords: immunisation coverage, slum dwellers
ID/60 (P) PYODERMA AND LARYNGITIS AS A PRESENTING FEATURE IN
COMMUNITY ACQUIRED BURKHOLDERIA IN AN INFANT.
Tapobrata De, SurbhiRathi, SantoshKondekar, Rameshwar Gore.
Dept. of Pediatrics, 1st Floor, College Building, B.Y.L.Nair Ch. Hospital and T.N. Medical
College, Mumbai-8
Email- tde608@gmail.com
Introduction:Burkholderia is a classical opportunist saprophyte for children with pre-existing
damage to respiratory epithelium, especially persons with cystic fibrosis. We had one
operated case of Tracheo oesophageal fistula(TEF) with extended course of laryngitis with
burkholderia sepsis. Case history: A 2 months old boy,a case of small sized VSD; an
operated case of tracheoesophageal fistula at birth; presented with acute fever, pyoderma
,hoarseness of voice, harsh cough and post tussive vomiting, almost 50 days after surgery. A
clinical impression of viral laryngitis was made. On examination, child was relatively stable
with respiratory distress. X ray chest and complete blood counts had no abnormality except
physiological anaemia of infancy. Fever persisted despite empirical antibiotic therapy with
amoxicillin-clavulinic acid for 7 days; septic screen revealed only an elevated CRP of 231.6.
Blood culture report received on day 7 grew Burkholderia resistant to meropenem and
sensitive to ceftriaxone. But throat swab was negative. Fever responded within 72 hours to
ceftriaxone; and respiratory distress & hoarseness settled with the same; mild cough persisted
for 4 more days. Repeat CRP negative.A 14 days course of IV antibiotic was completed.
Infant was discharged without any complications. Discussion: Burkholderia is known to be
an opportunistic pathogen in immunocompromisedhost.Infants being highly susceptible and
relatively immunocompromised are at an increased risk of community acquired burkholderia
infection in the background of heart disease.This child had pyoderma over scalp and forehead
and fever with hoarseness of voiceat the onset; with bacteremia suggesting clinical course
same as that of burkholderia.There have been many cases of burkholderia most often
presenting as severe abscesses with pneumonia.But pyoderma and laryngitis as presenting
features of burkholderia are not commonly known in community. Conclusion: Burkholderia
though an opportunistic or nosocomial pathogen primarily affecting respiratory system; can
also be considered as a community acquired especially in case of paraneonates at risk without
any recent hospital stay or antibiotic course. We would like to emphasise that presenting
features of skin and respiratory infections in a case of prolonged fever should arouse
suspicion of burkholderia,especially in a compromised paraneonate. Early suspicion of same
may help one avoid life threatening sequalae.
ID/61 (P) TRANSIENT REACTIVE HEMOPHAGOCYTIC SYNDROME IN A CASE
OF BRUCELLOSIS
SamruddhiKhopkar, SurbhiRathi, SantoshKondekar, Tapobrata De.
Dept. of Pediatrics, 1st Floor, College Building, BYL Nair Ch. Hospital and TN Medical
College, Mumbai-8
Email-samruddhi2487@yahoo.co.in
Introduction: Human brucellosis usually manifests as an acute or subacute febrile illness,
which may persist, and progress to a chronically incapacitating disease with severe
complications. The clinical picture is not specific and laboratory testing should support the
diagnosis.Human brucellosis can be treated with a combination of antibiotics but is very
difficult to diagnose.The disease may be overlooked and misdiagnosed.Here, we describe
brucellosis associated transient HS in an 7 year-old male patient. Case history:7 year old boy
r/o surat,and consumption of unpasteurised milk presented with fever, hepatosplenomegaly,
andweight loss since 3 months. Laboratory investigations revealed bicytopenia. Bone marrow
done was non-neoplastic but showing hemophagocyticcells . This child had high serum
ferritin levels but normal triglycerides and fibrinogen levels. Chest x ray showed right pleural
effusion which resolved after 20 days . The child was prophylactically started on 4 drug
AKT and etoposide with dexamethasone after consultation with haematologists.However
high grade fever persisted along with bicytopenia involving erythroid and leucocyte cell
series. A repeat bone marrow was done after 1 month did not show any hemophagocytes, was
cellular, nonneoplastic. The total leukocytic count and haemoglobin both showed a steady
rise. Extended widal test revealed 1:320 titres of anti- brucellaabortus antibodies. Diagnosisof
brucellosis was established and patient improved after doxycycline and rifampicin(15
mg/kg/day) combination. Discussion:Hematologic manifestations are variable in brucellosis
and abnormalities such as anemia, leucopenia,bicytopenia,pancytopenia complicatethe course
of acute brucellosis mimicking a primary haematological disease. Hemophagocytic syndrome
(HS) may be primary, or secondary, to malignancy, or to metabolic, collagen vascular, and
infectious diseases such as brucellosis, miliary tuberculosis and some viral and fungal
infections. The diagnostic findings of HS are high fever, hepatosplenomegaly, cytopenia,
high serum ferritin and triglycerides, and low serum fibrinogen level. Brucellosis may occur
in association with HS. Conclusion: We wish to emphasize the importance of obtaining a
detailed history, including ingestion of high-risk foods and remember hemophagocytic
syndrome as an unusual presentation of brucellosis. Accordingly, Brucella infection should
also be ruled out in patients with pancytopenia with or without hemophagocytic syndrome,
especially in endemic regions such as our country.
ID/62 (P) COMPARATIVE STUDY OF DOT ENZYMEIMMUNOASSAY
(TYPHIDOT) AND WIDAL TEST IN THE DIAGNOSIS OF TYPHOID FEVER
M Nithya, N.Kannan, Nibedita Mitra, G.Kavitha, V.Senthil Kumar
Department of Pediatrics & Child Health, Southern Railway Headquarter Hospital, Chennai23.
Email: drvinca@gmail.com
Introduction: ● Typhoid fever is a life threatening systemic infection occurring in lesserdeveloped areas of the world and continues to be a major public health problem. ● India is
the second most populous country of the world with majority inhabiting the rural areas with
little access to modern diagnostic tools. Iaims and objectives: 1. To study the reliability of
typhidot as a diagnostic test in terms of sensitivity and specificity and its comparison with
widal. 2. Clinical profile of culture positive typhoid cases. 3. Sensitivity pattern to drugs.
Material & Methods: Blood culture, widal test , typhidot test , Complete blood count were
entered in proforma; compared and analyzed statistically using SPSS version 17 software.
Results: Total 92 children were included in the study out of 37 was culture positive and Typhi
dot M was positive in 84 cases and widal was positive in 42 cases. Conclusions: In children
with fever of less than 7 days duration, Typhidot-M was positive in 91.3%, compared to 45.6
% by Widal test. Typhidot-M is a simple and sensitive test for early diagnosis of typhoid
fever in children.
ID/63 (P) COMPLICATED MALARIA-A RANDOMIZED CONTROL STUDY
COMPARING THE EFFICACY OF QUININE AND ARTESUNATE IN ITS
MANAGEMENT
Anurag Singh, Rakesh Jora, Manish Goyal, Deepak Saini, Pramod Sharma
C/o Dr Anurag Singh, Saroj Hospital, A-3 Saraswati Nagar, Basni-I, Jodhpur.
E-mail-: singha@live.in; jorarakesh@gmail.com
Abstract: Background: Malaria is one of the most dreaded and widespread disease of
humanity. Antimalarial drug resistance has emerged as one of the greatest challenge today.
This study is therefore, planned to compare the hematological changes in children admitted
with different types of malaria and to compare the effects of quinine and artesunate in
management of complicated malaria Method: A single center non blinded, randomized
control trial study examining the clinical presentations and laboratory features of malaria in
two parallel groups conducted at Umaid hospital, Jodhpur from December 2010 to November
2011. All children(103) aged ≤ 17 yrs and who were positive for malaria parasite and one or
more features of malaria were enrolled. Results: In uncomplicated malaria, P.vivax was the
major parasite(86.95%), In complicated malaria, P.falciparum was the major
parasite(48.05%).Most common complication associated with malaria was severe anaemia
documented in 59% patients. In complicated malaria, the mean time for complete splenic
regression was 7.28±1.33 and 7.11±1.23 days in quinine and artesunate group respectively
but the difference was statistically not significant (p>0.05). The mean duration of hospital
stay was less for quinine (6.93±2.18) as compared to artesunate (7.83± 3.21). The difference
was not statistically significant (p> 0.05). Mean blood volume requirement was less in
quinine treated group (14.43±10.30) as compared to artesunate group (15.83±10.83). The
difference was not statistically significant (p >0.05). Conclusion: In cases presenting with
fever, anaemia and thrombocytopenia, one should keep a diagnostic possibility of malaria in
mind. There is no significant resistance to artesunate and it was found effective in the
management of severe complicated malaria in this region .Quinine stills seems to be as
effective as artesunate in management of complicated malaria in Western Rajasthan.
ID/64 (P) CLINICO-EPIDEMIOLOGICAL PROFILE OF CONGENITAL MALARIA
AT A TERTIARY CARE CENTRE IN ENDEMIC AREA
Ali S Manazir, Adnan M, Ahmed S Moiz
Neonatology section Department of Pediatrics JNMCH, AMU Aligarh.
Email: manazir1958@yahoo.com
Introduction: Congenital malaria is defined as malarial parasites demonstrated in the
peripheral smear of the newborn from twenty four hours to seven days of life. Overall it is a
very rare disease and less than 500 cases are reported in literature. Also there is dearth of
knowledge about its clinical spectrum owing to its rarety. We present the clinicepidemiological profile of congenital malaria at our centre from September 2010- October
2011. Aims and objective: To study the clinical and epidemiological spectrum of congenital
malaria. Material and Methods: The study was conducted on babies delivered to mothers who
had history of fever. Such babies were tested for malaria species from peripheral smear.
complete blood count, RFT, LFT and urinalysis was performed in all babies. Babies with
microscopically confirmed malaria were treated with Chloroquine in standard dose (25mg/kg
body weight). Data were analysed using the Statistical Package for Social Science (SPSS)
version 17 for windows. Results: Among the 568 mothers who gave consent, 94 were
positive for malarial parasite(73 vivax and 21 falciparum). Eleven babies from the mothers
who were positive for MP, tested positive for malarial parasite (9 vivax and 2 falciparum).
Among the babies who were positive for vivax, 6 had asexual forms and 5 had both asexual
form as well as gametocytes in their peripheral blood. From the mothers who were negative
for MP, 5 babies tested positive for MP. However, 4 of these had only gametocytes of vivax
and only 1 had gametocytes form of falciparum in their peripheral blood respectively. Fever
was the most common symptom in our study (50%) followed by LBW AGA(42.8%) and
jaundice (28.6%). Other manifestations were splenomegaly, IUGR, poor feeding, anemia,
diarrhea, petechae and hypothermia in that order. In our study 28.6% patients(N=4) were
asymptomatic. However, all of these babies were positive for gametocytes only. Conclusion:
Congenital malaria although a rare entity, is an important cause of morbidity in endemic
areas and as such timely diagnosis and treatment is paramount.
ID/65 (P) CLINICAL PROFILE AND SEROLOGY IN SUSPECTED DENGUE
FEVER
J. Nadkarni, N. Upadhyay, R. Dwivedi
Dept of Paediatrics, Gandhi Medical College and Associated Kamla Nehru Hospital, Bhopal
(M.P.)-462016
Email: jayadn2007@gmail.com
Introduction: Dengue is a vector-borne viral infection of global importance The diagnosis of
dengue viral infection is essentially clinical, although confirmation requires laboratory tests.
Aims and Objective: We evaluated the clinical profile, serology and outcome of children
admitted with suspected dengue fever in a teaching hospital of Central India during a three
month interval from August-October 2009. Methods: A hospital based retrospective
observational study. 154 children with suspected dengue fever hospitalized during this period
were studied. Traditional WHO case definition criteria were used for clinical identification of
cases. Serological diagnosis was carried out with IgM ELISA. Results: 40/154(26%) cases
had positive serology. The clinical profile of IgM Elisa proven Dengue cases has been
presented. The common symptoms seen were fever with chills (57.5%) nausea and vomiting
(57.5%), abdominal pain and myalgia (37.5% each) and rashes (27.5%). Hemorrhagic
manifestations were petechiae (35%) and epistaxis (12.5%). Third space losses manifested as
ascitis (24%) and effusion (12.3%). Hepatomegaly was noted in half the cases. Among these
40 cases with positive serology, incidence of thrombocytopenia was 84.5%. CNS complaints
were noted in very few patients. Conclusion: The disease manifestations in dengue fever can
range in intensity from in apparent illness to severe manifestations. 17(42.5%) of cases had
DF and the remaining had various grades of DHF. A combination of clinical and laboratory
features can aid in early identification of these cases
ID/66 (P) TO STUDY THE PREVALANCE OF ROTAVIRUS DIARRHOEA IN
CHILDREN BETWEEN AGE GROUP (6 month – 3 year)
Gursharan Singh, Gagandeep Singh, Karuna Thapar, Aruna Aggarwal, Sunita Arora
Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar
Email: gagan_5784@hotmail.com
Introduction: Rotavirus poses a serious health problem in resource poor settings such as
India. Number of children suffer from the Rotavirus diarrhoea each year. Rotavirus vaccine is
also available but it is not cost effective and still greater number of children suffer from
rotavirus diarrhoea and getting hospitalised.Objective: The present study was undertaken to
study the prevalence of Rotavirus diarrhoea in children between 6 months to 3 years. Material
And Methods: It is a hospital based cross-sectional study during the period of 1st December
2011 to 30thSeptember 2012. 40 consecutive hospitalized children aged between (6 month-3
year) with diarrhoea were included. Stool samples were collected and sent to microbiology
department for rotavirus antigen detection by enzyme immuno assay method by rotavirus
card test and direct microscopy and culture of stool for identifying any bacterial or parasitic
cause of diarrhoea. Data so obtained was analysed.
Results: Out of 40 consecutive stool samples of children tested for rotavirus diarrhoea, 16
(40%) of the stool samples were tested positive for rotavirus,21 (52.5%) were positive for
infective diarrhoea,1(2.5%) was due to cholera, 1(2.5%)was due to lactose intolerance,
1(2.5%) was due to giardiasis.
Of 16 cases for rotavirus diarrhea it was seen that rotavirus infection is seen in 10 (62%)
female and 6(38%) male.
Rotavirus diarrhea is seen in age group 6-12 months
6(38%),19-24 months 5 (31%) ,13-18months(25%),31-36 months 4(6%).The observed cases
were seen maximum in Oct-Dec 6(37.5%) followed by 5(31%) in Jul-Sep,4(25%) in JanMar,1(6%) in April-June.
In our study we found out that fever was present in (44%) cases, loose stools which were
watery (88%),not associated with mucous(69%), increased in amount, frequency 11-15 times
a day(50%),duration of diarrhea 5-6 days(44%) .Most of them had some dehydration (56%)
followed by no dehydration (25%) and severe dehydration (19% ).
Discussion: Rotavirus infection has a worldwide distribution and is the single most important
cause of gastroenteritis 50-60 percent of instances of acute gastroenteritis in hospitalized
children.1The virus mainly spreads via the fecol-oral route, through respiratory route, personto-person contact, or contaminated environmental surfaces and fomites. While some studies in
India have found no association between rotavirus infection and time of year most have
observed an increase in rotavirus-associated diarrhoea during the winter months, October to
February, throughout the country. It is estimated that close to 100,000 annual deaths are
caused by rotavirus in India, 1 in every 250 children born in India die from rotavirus by the
age of 5 yr 3. India accounts for 17 percent of the world’s estimated rotavirus associated
deaths. A number of studies have been conducted on the prevalence of childhood rotavirus
diarrhoea in which rotavirus was detected in 5 - 71 percent of the hospitalized children less
than 5 yr of age with acute gastroenteritis.3,4,5,6. This variation may be due to the duration of
the study, number of children studied and the seasonal variation of rotavirus diarrhoea in
different regions of the country. In India, New Delhi study by Rajiv Bahl, Umesh Parashar et
al found most cases of diarrhoea (98%) occurred during the first 2 years of life, peaking at 911 months of age. The prevalence of childhood rotavirus in thenorth Indian cities of Delhi,
Chandigarh and Aligarh has been reported to vary from 6-45 percent. 3,4,5 In the western
states of India, in Pune 6,7rotavirus was detected in 28-30 per cent of children ≤5 yr of age
with acute diarrhoea. In eastern India, in Kolkata the incidence of rotavirus associated
diarrhoea varied from 5-22 per cent.7,8In Manipur the incidence was as high as 41 percent.3.
Recommendation: 1. Hand hygeine. 2. Proper disposal of sewage. 3. Exclusive breast
feeding till 6 months of age. 4. Safe drinking water. 4. Vaccination: Rotavirus vaccine is
available. It is given orally as 2 or 3 doses and schedule is completed before 6 months. It is a
live attenuated vaccine. It’s efficacy is 16-18%. Currently available vaccines are Rotarix
and Rotateq. The Rotarix series is given in 2 doses. The series should be initiated at 6 to 14
weeks of age. The second dose should be given at least 4 weeks later but before the infant
reaches 24 weeks of age. The RotaTeq is given in 3 doses, and the first dose should be given
at 6 to 12 weeks of age, with 2 subsequent doses administered at 4- to 10-week intervals. The
complete series of RotaTeq should be administered by 32 weeks of age. Message: 1. Vaccine
should be cost effective. 2. Information, education and communication materials to be
distributed among general population.
ID/67 (P) EFFECT OF PROBIOTICS VSL#3 ON PREVENTION OF SEPSIS IN THE
0-2 MONTH PERIOD: A RANDOMIZED CONTROLLED TRIAL
Anju Sinha, Subodh Gupta, Harish Chellani, Chetna Maliye, Vidya Kumari, B.S. Garg,
Vasantha Mahesh, Ajit Mukherji, Reeta Rasaily, Malabika Roy
Safdarjang hospital, New Delhi
Email: apradhandr@gmail.com
Introduction: Neonatal infections are major cause of morbidity & mortality. Antibiotic
treatment has limitation since drug resistance outweighs fast pace of antibiotic production.
Search for alternative infection control measures must be on. Microbial interference
treatment with Probiotics may be an option. Aims & Objective: To examine the possibility of
preventing neonatal sepsis (septicemia, pneumonia, meningitis) by supplementing the
neonates with probiotics in a community setting. Material & Method: A facility- linked
community study was conducted at two sites in India. 1340 LBW infants were randomized to
receive Probiotics (VSL #3 10 billion doses for 30 days) or placebo, mixed with expressed
breast milk for 30 days. Follow up visits were conducted at home, by trained field workers, as
per a predefined schedule. Morbidity information was collected according to IMNCI
algorithm. Infants diagnosed with possible serious bacterial infection were referred and
examined by a physician at the facility. Results: Fewer episodes of PSBI were observed in the
probiotics group (98 vs 128). Incidence rate for PSBI was 0.157 per thousand days in the
probiotics arm as compared to 0.204 per thousand days in the placebo group, (RR 0.77; 95%
CI 0.59, 0.99). Effect was more pronounced in 1.5-1.99 Kg birth weight strata ( 6 vs 19
episodes of PSBI), (RR 0.36; 95% CI 0.15-0.87). Conclusion: Supplementing LBW infants
with probiotics VSL#3 reduces the occurrence of suspected sepsis (PSBI) as diagnosed by the
field workers. Owing to its immense public health significance, findings should be confirmed
in a larger study with physicians’ diagnosis as the primary outcome.
ID/68 (P) SCRUB TYPHUS AMID MALARIA AND DENGUE SEASONAL
OUTBREAK FROM SEMI DESERT AREA OF RAJASTHAN: A CASE SERIES
Virendra Gupta, Rambabu Sharma, Jagdish Singh
Department Of Pediatris, SPMCHI, S M S Medical College, Jaipur
Email: vkhindustani@gmail.com
Abstract: Introduction: Scrub typhus is a zoonotic disease caused by rickettsial bacteria
Orientiatsutsugamushi. The disease is endemic in many parts of India. Recent appearance of
cases from semi desert district of Rajsthan is highly concerning. Aims and Objectives: To
present epidemiological distribution, demographic profile, clinical manifestation, laboratory
findings and treatment outcomes of scrub typhus in children. Design and Setting: Hospital
based cross sectional observational study. Materials and Methods: In this study ten cases
were included having positive IgM antibody against Orientiatsutsugamushi. Their clinical
details were taken alongwith complete physical examination. Laboratory testing included
complete blood count, liver function tests, renal function tests, urine analysis, blood & urine
cultures. Results: Of ten children, mean age were 9.7±2.40 years, male to female ratio 1.5:1,
mean duration of hospital stay 7±2.35 days. Fever(100%) was most common presenting
symptom and mean duration was 6.8±2.78 days. Other features were tachycardia(80%),
tachypnoea(70%), hepatosplenomegaly(70%), swelling(60%), vomiting(60%), abdominal
pain(40%), rashes(40%), bleeding(30%) and seizures(20%). Thrombocytopenia(80%), and
mild elevated liver enzymes were present in most of the cases. Eschar mark was present only
in two(20%) cases. Nine cases were successfully treated with doxycycline and one mortality
due to CNS involvement. Conclusion: Our study emphasizes that pediatric scrub typhus
should be suspected when patient presents with high grade fever with hepatosplenomegaly
with or without eschar mark alongwith thrombocytopenia and elevated liver enzymes. Early
diagnosis could reduce the morbidity and mortality. Drugs useful are Doxycycline,
Azithromycin or chloremphenicol. Key words: Scrub, Zoonotic, Eschar, Thrombocytopenia,
Hepatosplenomegaly.
ID/69 (P) SYSTEMIC ROTAVIRUS ILLNESS – REPORTING
ASSOCIATION: ENCEPHALOPATHY WITH
VASCULITIS
Siba Prosad Paul, David Candy
Department of Paediatrics, St Richard’s Hospital, Chichester PO19 6SE (UK)
Email: siba@doctors.org.uk
A
NEW
Introduction: Over a decade, rotavirus has been recognized to cause systemic illness. Isolated
associations such as encephalopathy, cutaneous vasculitis have been reported previously. We
report a new association in systemic rotavirus illness: encephalopathy with vasculitis. The
aim of the case series is to make clinicians aware that rotavirus can mimic serious bacterial
pathologies. Case studies: Three children aged between 6-months and 3-years presented to
the emergency department with an irritability/drowsiness, fever, non-blanching petechial
spots (in non-SVC distribution), diarrhoea, vomiting and looking unwell. In view of fever and
non-blanching rashes all the 3 children were initially treated as suspected meningococcal
disease. 2 children were initially acidotic which resolved within 12 hours after fluid
replacement. One child needed transfer to the PICU for 24 hours; all 3 suffered significant
morbidity. Blood inflammatory markers were reported within normal limits in all 3 children.
The children recovered within 48 to 72 hours and blood culture and meningococcal PCR
were reported as negative. Stool ELISA were reported as positive for rotavirus in all 3 cases.
Discussion: ● Encephalopathy previously reported with rotavirus; demonstrated in CSF ●
Fluid resuscitation and replacement necessary, ● Vasculitis demonstrated in laboratory
studies and following rotavirus immunization, ● Previous studies showed only 11% of nonblanching rashes were due to meningococcal disease, and ● Oral rotavirus vaccines will
prevent morbidity and mortality. Conclusion: This case series demonstrated a new dimension
in systemic rotavirus illness. Stool samples should be sent if a child presents with
encephalopathy, non-blanching rashes and gastroenteritis.
ID/70 (P) OPEN-LABEL TRIAL OF THREE DOSAGE REGIMENS OF FIXEDDOSE COMBINATION OF ARTEMISININ AND NAPHTHOQUINE FOR
TREATING UNCOMPLICATED FALCIPARUM MALARIA IN CALABAR,
NIGERIA
Meremikwu M, Odey F, Oringanje C, Effah E, Esu E, Eyam E, Oduwloe O, Asiegbu V,
Alaribe A, Ezedinachi
Department of Paediatrics, University of Calabar, Calabar, Nigeria
Email: mmeremiku@yahoo.co.uk
Introduction: The use of anti-malarial drug combinations with artemisinin or with one of its
derivatives is now widely recommended to overcome drug resistance in falciparum malaria.
This study assessed the therapeutic efficacy and tolerability of fixed-dose combination of
Artemisinin (125mg) and Naphthoquine (50mg) for treating uncomplicated Plasmodium
falciparum malaria among adolescents and adults in Calabar, South-east Nigeria. Method: A
total of 121 patient aged ≥15 years with uncomplicated Plasmodium falciparum malaria were
enrolled and randomly assigned to three dosage schedules : (A) 700 mg (4tablets) single
dose; (B) 700mg 12-hourly x 2 doses; and (C) 1400 mg (8tablets) single dose. Patients were
observed for 28 days, with clinical, parasitological, and haematological assessments. Results:
A total of 108 patients completed the study. The overall 28-day cure rate was 88.9%. Day
28-cure rates of the three dosage schedules were 85.3%, 93.1% and 88.9% for Group A
(700mg once), B (700mg twice) and C (1400mg once) respectively. Adverse events were
few and mild, the commonest being weakness and headache; there was no serious adverse
event. Conclusion: Concerns for emergence of parasite resistance due the use of ArtemisininNaphthoquine as single dose regimen is likely to compromise the usefulness of this
potentially important combination treatment. We recommend a robust multi-centre trial to
evaluate a three-day regimen with potentials to achieve high cure rates while minimizing the
risk of emergence of resistant parasite strains.
ID/71 (P) SEASONAL CHEMOPREVENTION OF MALARIA IN PRESCHOOL
CHILDREN: A SYSTEMATIC REVIEW
Martin M Meremikwu, Sarah Donegan, Ekpereonne Esu, Chioma Oringanje
University of Calabar, Calabar, Nigeria
Email: mmeremiku@yahoo.co.uk
Abstract: Introduction: Malaria causes repeated illness and high mortality rates in children
living in endemic areas. Preventive treatment with antimalarial drugs is being advocated as an
effective public health intervention. Objective: This systematic review evaluates seasonal
antimalarial treatment for prevention of malaria in preschool children. Methods: Search
strategy based on key subject terms was used to search The Cochrane Library, MEDLINE,
EMBASE, LILACS, mRCT, and reference lists of identified trials. Randomized controlled
trials that fulfilled eligibility criteria were selected. Meta-analyses (random-effects and fixedeffect models) were performed using Review Manager Version 05. Results: Seven trials
(12,589 participants) met the inclusion criteria. All were conducted in West Africa in areas
with seasonal malaria transmission. Seasonal malaria treatment resulted in significantly fewer
episodes of clinical malaria (RR 0.26; 95% C I 0.18 to 0.39), fewer severe malaria (RR 0.22,
95% CI 0.09 to 0.54), lower risk of moderately severe anaemia (RR 0.70, 95% CI 0.51 to
0.95) and severe anaemia (RR 0.24, 95% CI 0.06 to 0.94). Seasonal preventive treatment in
children already using ITN caused further reduction in the incidence of malaria and severe
anaemia. There was no significant difference in the number of deaths from any cause (RR
0.66, 95% CI 0.32 to 1.39; 9934 participants, 6 trials), but the direction of effect is beneficial
and CI do not exclude a potentially important difference. No trial reported drug-related
serious adverse events. Conclusions: Chemoprevention significantly reduced the incidence of
clinical malaria, severe malaria and severe anaemia in preschool children living in areas of
seasonal malaria transmission with no rebound effect during the transmission season postintervention.
ID/72 (P) A RETROSPECTIVE STUDY OF CHANGING CLINICAL PATTERN OF
MALARIA IN WESTERN U.P INDIA
Subhash Chandra
Flat # 7036 Crossing Infra, Plot # 7 Crossing Republic, Ghaziabad, Uttar Pradesh
Email: drsubhashchandra810@gmail.com; drsubhash.chandra@yahoo.com
Abstract: Background & objectives: The incidence of malaria is on the rise in western UP,
India in the recent years and there is not much information on malaria from this region. This
study was under taken to analyze and introspect the presentation of this disease in a tertiary
referral centre. Methods: This retrospective case analysis was done on patients between the
age group of 2-15 years admitted with diagnosis of malaria to the Pediatrics Department of
SIMS, Hapur and School of Medical Science & Research, Greater Noida, U.P. India .The
records from April 2010 to March 2012 were retrieved and scrutinized using a prepared case
sheet Performa on the basis of patient’s demographic profile, clinical findings, investigations,
treatment and complications. Results: A total of 343 patients were diagnosed and treated for
malaria, out of them, males (62.68%) outnumbered females (37.32%) and many were below
the age of 7 years (69.05%). Plasmodium vivax was the major parasite (68.51%), followed
by P. falciparum (20.99%), and mixed malarial infection (10.49%).Fever was the most
common symptom observing 96.2% cases and thrombocytopenia was the commonest lab
hematological abnormality seen in 46.6% cases of plasmodium vivax. Conclusion: Malaria is
a common disease but severe and complicated vivax malaria is an emerging recognized
clinical entity and challenges the perception of vivax malaria as a benign disease.
ID/73 (P) LEPROSY IN CHILDREN AND ITS CLINICOHISTOPATHOLOGICAL
CORRELATION
Molugan. M, Rp Singh, Yk Rao, Sk Arora, M Singh
Department Of Pediatrics Gsvm Medical College, Kanpur UP-208002
Email: drmolugan@gmail.com
Abstract: Objectives: To study (1) Clinical pattern of leprosy in children (2) Correlation of
histopathological features of leprosy in children (3) Incidence of disabilities occurring in
children due to leprosy. Design-Prospective hospital based study Setting-A tertiary care
centre Methods-all(n= 22 )children in the age group 1-18 years with sign and symptoms
suggestive of leprosy attending outdoor of deptt of paediatrics and dermatology and patient
admitted in our children hospital between January 2011 and august 2012 were included in the
study.All subjects and their attendants were interviewed thoroughly for eliciting history and
indepth clinical examination of the patients was done and all the patients were exposed to
biopsy.Those
children which are already on treatment ,children <1year and >18
years,children with immunocompromised
status and children with congenital
deformities,drug which change the histopathological features of leprosy were excluded.
Results:A total of 22 cases of leprosy were registered during this period. Majority of patients
were more than 9 years of age 16,(72.73%).there were 14(63.64%)males and 8 (36.36%)
females with male:female (1.75:1).History of contact was present in 9(40.91%)patients.
Among the total cases Borderline tuberculoid was the commonest clinical type 9
(40.91%),followed by borderline type in 7(31.81%)patients. Other types borderline
Lepromatous (BL)seen in 4 (18.18%)patient,.indeterminate type 1(4.55%) tuberculoid type
seen in 1((4.55) patients.50% of the patients had 2 to 5 lesion. Nerve thickening was
detected in 13(59.09%) patients. Clinico-histopathological correlation was observed in
6(27.27%) patient .Deformities seen in 4(18.18%) patients. Conclusion:Despite the stastical
elimination of leprosy in this region, childhood leprosy cases continue to present in alarming
numbers .early detection ,treatment and contact tracing may be helpful in reducing the burden
of leprosy in the community .there is need to continue leprosy control activities with full
effect even in areas where stastically it has been eliminated. Key words: Leprosy,
histopathology
ID/74 (P) STUDY OF CSF ADA IN TUBERCULOUS MENINGITIS
Ruchi Mehta
Resident, VS general Hospital, Ahmedabad
Email: shalmi_ruchi@yahoo.com
Introduction: Neurotuberculosis is one of the serious complications of primary tuberculosis.
ADA (Adenosine deaminase) as a marker of cellular immunity, its activity is elevated in
diseases with cell mediated immune response. This study examines CSF-ADA as a diagnostic
tool in TBM in comparison with other types of meningitis. Aim: To study the predictive
value of CSF-ADA as an early diagnostic measure in TBM and its usefulness in
differentiating it from other groups of meningitis. Materials and methods: Type of study:
Prospective. Selection criteria: All patients admitted in pediatric ward with clinically
meningitis; haemorrhagic CSF excluded. Method: Total 50 patients fulfilling selection
criteria were enrolled. Detailed history/clinical examination carried out including CNS
examination. Samples of CSF for cells, biochemistry and ADA were sent. Data recorded in
preformed proforma and analysed. Cut off values of ADA was taken as 9.5IU/L. Results:
Total patients: 50. Out of which: TBM: 34(68%), Others: 16(32%), TBM with positive ADA:
21/34(61.7%)
Others: 3/16(18.7%). Conclusion: 1) CSF ADA had 61.77% sensitivity and 81.25%
specificity for TBM 2) Positive predictive value of CSF ADA was 91.3% where as negative
value 65% 3) No correlation found between CSF ADA levels and %CSF proteins 4) CSF
ADA can take place as a baseline investigation in any suspected case of meningitis as it can
differentiate TBM & others early & avoid unnecessary long therapy
ID/75 (P) STUDY ON CLINICAL PROFILE OF ENTERIC FEVER IN A TERTIARY
CARE HOSPITAL
A.Vidhyadevi, A.Logesh Anand, M.Balasubramanian, M.Kulandaivel, M.Mathivanan,
G.Mathevan
42, Sivamurugesan Illam, Kumarasamy Raja Street, Shenoy Nagar, Madurai College
Email: dr.vidhyasankar@gmail.com
Introduction: Typhoid fever is a global health problem. The clinical picture is often
confused with many other febrile infections. Cefixime and Ceftriaxone are now being
increasingly used but they are associated with high rates of relapse. Aims And
Objectives: 1. To study the clinical profile of enteric fever in children < 12 years. 2. To
study the sensitivity pattern and period for defervescence to various antibiotics in
enteric fever. Materials And Methods: Observational study included 238 Enteric fever
patients aged ≤ 12yrs admitted at ICH&RC, GRH, Madurai between July 2011 to
June 2012. Results: Of 238 children 2.5% were infants, 38.65% were in 1- 5 years,
58.82% were in > 5 years. 56.72% were males and 43.27% were females. Symptoms:
Fever present in 100%, Anorexia in 72.2% , Abdominal pain 56.3%, Vomiting 45.3%,
Altered bowel habits 39.4%, Headache 34.8%, Chills and rigors 19.3% Signs:
Hepatomegaly present in 47%, Splenomegaly 57.1%, pallor 18%, Coated tongue in
26.4% Complications: Hepatitis seen in 7.5%, Meningism 3.3%, Ataxia 2.9%, Intestinal
haemorrhage 1.6%, Meningitis 0.85%, 59.5% cultures were sensitive to Amikacin,
53.4% sensitive to Ceftriaxone, 32.8% to Ciprofloxacin, 28.7% to Piperacillin
Tazobactem, 28% to Cefoperazone Sulbactum, 19.1% to Ampicillin , 16.4% to
Chloramphenicol. Period of defervescence with Ceftriaxone is 4.1 days, Ciprofloxacin
6.1 days, Ceftriaxone and Amikacin is 3.8 days, Azithromycin 4.7 days. Conclusions:
The most common complications in Enteric fever are Hepatitis followed by
Encephalopathy and Intestinal haemorrhage. There is an increase in resistance to
Ceftriaxone and increase in the sensitivity to Amikacin. Ceftriaxone is better than
Ciprofloxacin in the treatment.
ID/76 (P) STUDY OF HEMATOLOGICAL CHANGES AFTER SWITCHING FROM
STAVUDINE TO ZIDOVUDINE BASED ART IN HIV INFECTED CHIDREN
Archana Singh, Alok Hemal, NK Dubey, Sheetal Aggarwal, Euden Bhutia
Department of Pediatrics, PGIMER, DR RML Hospital, New Delhi
Email: archanasingh.rmlh10@gmail.com
Abstract: Introduction: Zidovudine (ZDV) despite causing myelotoxicty and higher cost is a
better drug in long term management of HIV in children. Stavudine (d4T) causes high
incidence of lipodystrophy. Aims and objectives: To study the hematological changes and
magnitude of myelosupression after switching from d4T to ZDV in HIV- infected children.
Materials and Methods: A prospective observational study was carried out in children aged 218 years, having received first line ART regimen consisting of d4T for at least 48weeks; with
hemoglobin (Hb) of >9gm% and immunologically stable. Children were switched to ZDV
and followed every 4weeks for 48weeks. Results: Of the 60 children analyzed, 45(75%)
showed a significant drop in Hb (>1g/dl) with an absolute fall of 2g/dl (IQR 1.5, 3). The drop
was significant in children 2 to 15 years of age. Majority developed grade1 anemia
[14(31%)]. Only 3(6%) developed grade4 anemia. The lowest Hb recorded was at 12weeks in
31% and 16weeks in 20%patients.There was trend towards improvement in Hb after 28 to
36weeks in 15(33.3%) children. The drop in Total Leucocyte Count was significant in
children aged 2 to 5years. The Absolute Neutrophil Count dropped from 5067(SD1392)
cells/mm3 to 3625 (IQR 2800, 4800) cells/mm3 (p=0.004). No child developed grade3/grade4
neutropenia. There was no significant change in platelet and CD4 count in any age group.
Conclusion: ZDV produces high incidence of anemia. However, incidence of severe drug
toxicity is low. Majority of children recovered without intervention. Therefore, anemia
should not preclude its routine use in poor countries. Key words: Zidovudine, Stavudine,
substitution, hematological changes, hemoglobin, myelosupression
ID/77 (P) SPECTRUM OF METABOLIC ABNORMALITIES IN CHILDREN ON
ANTIRETROVIRAL THERAPY
Jyoti Raghunandan
MD Paediatrics, Maulana Azad Medical College, New Delhi
Email: jyoti_711@hotmail.com
Objectives - To study the occurrence of fat redistribution and metabolic disorders in HIV
infected children on antiretroviral therapy and to make associations with epidemiological
parameters pertaining to child and family, clinical and immunological stage of disease and
duration and type of antiretroviral therapy. Design – observational study Setting – Tertiary
care teaching hospital Participants – 40 HIV infected children within the age group of 1-12
years, who had been receiving ART for at least 6 months. Major outcome measures –
Lipodystrophy and fat redistribution was assessed clinically along with certain
anthropometric measurements like weight, height and BMI and laboratory parameters like
lipid profile ,blood sugar and serum insulin levels. Results – In the study, we found that
29.7% subjects had features of lipodystrophy in the form of lipoatrophy. 7.5% of the subjects
had increased weight for age and 2.5% of the subjects had their BMI above the 95th centile.
Out of the 40 subjects, 27 subjects (64.7%) had dyslipidaemia.No significant correlation was
found with duration of disease, type of drug or between coexistence of lipodystrophy with
dyslipidaemia or stage of disease. Conclusions –In this study although evidence of
lipodystrophy and dyslipidaemia was found, the associations between the above parameters
were not found to be statistically significant. It is possible that larger studies with longer
follow up may reveal significant correlations between occurrence of lipodystrophy and lipid
abnormalities and the duration of ART. Occurrence of lipid abnormalities, prior to ART
initiation, also needs to be studied.
ID/78 (P) A RETROSPECTIVE STUDY OF CHANGING CLINICAL PATTERN OF
MALARIA IN WESTERN UP INDIA
Subhash Chandra, Yogesh Kumar Goel, Daya Chand, Deepak Gupta
Assistant Professor, Department of Pediatrics, School of Medical Science & Research,
Greater Noida, U.P. India
E-mail: drsubhash.chandra@yahoo.com; drsubhashchandra@gmail.com
Abstract: Background & objectives: The incidence of malaria is on the rise in western UP,
India in the recent years and there is not much information on malaria from this region. This
study was under taken to analyze and introspect the presentation of this disease in a tertiary
referral centre. Methods: This retrospective case analysis was done on patients between the
age group of 2-15 years admitted with diagnosis of malaria to the Pediatrics Department of
SIMS, Hapur and School of Medical Science & Research, Greater Noida, U.P. India .The
records from April 2010 to March 2012 were retrieved and scrutinized using a prepared case
sheet Performa on the basis of patient’s demographic profile, clinical findings, investigations,
treatment and complications. Results: A total of 343 patients were diagnosed and treated for
malaria, out of them, males (62.68%) outnumbered females (37.32%) and many were below
the age of 7 years (69.05%). Plasmodium vivax was the major parasite (68.51%), followed
by P. falciparum (20.99%), and mixed malarial infection (10.49%).Fever was the most
common symptom observing 96.2% cases and thrombocytopenia was the commonest lab
hematological abnormality seen in 46.6% cases of plasmodium vivax. Conclusion: Malaria is
a common disease but severe and complicated vivax malaria is an emerging recognized
clinical entity and challenges the perception of vivax malaria as a benign disease. Keywords:
Cerebral, Complications, Malaria, Plasmodium vivax, Thrombocytopenia,
ID/79 (P) BACTERIAL ETIOLOGY OF RESPIRATORY TRACT INFECTIONS IN
PEDIATRIC POPULATION
Prema.A, Shabana Praveena
Department of Pediatrics ,SRM
Kattankulathur,Tamil Nadu,India.
Email: draprema_ped@yahoo.com
Medical
College
&
RC.,
SRM
University,
Abstract: Acute Respiratory infection is a significant public health problem. One of the major
causes of mortality in children under 5 years of age. The pattern of microbial isolate vary
with place and also the antibiotic resistance. The aim of the study is to detect the current
prevalence of bacterial etiology of Respiratory tract infection in pediatrics population and to
detect their antibiotic sensitivity pattern. This is a hospital based study for three years done in
a teaching hospital. Samples such as throat swab, sputum; pleural aspirate , blood etc were
collected and processed by standard microbiological protocols .Out of total 750 cases , 430
were from upper Respiratory tract infection and 320 were from Respiratory tract infections
.In upper Respiratory tract infection, among the positives ,most common isolate was Group A
Streptococcus 40%, followed by Group G Streptococcus 24%, Group C Streptococcus
18%, Staphylococcus aurous 12%, Moraxella catarrhalis 4%, Streptococcus pneumonia 1%.
In lower respiratory tract infection, the most common was Streptococcus pneumonia 27%
and Klebsiella pneumonia 24%, followed by Streptococcus aureus 17%, Hemophilus
influenza 7%, E.coli 10%, GAS 10%.Most of the bacteria showed varied resistance to
commonly used drugs. There is a need to study the prevalence of bacterial isolate
periodically, and use appropriate antibiotics judicially, in order to prevent drug resistance.
Key Words:, Respiratory tract infection, bacterial etiology, Antibiotic resistance.
ID/80 (P) FACTORS AFFECTING ART ADHERENCE AMONG CHILDREN –
PARENT’S PERCEPTION
Roshan J Machado, Sandhya Jadhav
4/A-10, UNITU Apts, BAAE – Hira nagar, Marve road, Malad (W), Mumbai -400095
Email: drroshanmachado@gmail.com
Introduction: Human immunodeficiency (HIV) infection is a major cause of morbidity and
mortality ever since the condition has been recognized. HIV poses a unique challenge due to
its rapid replication and mutation rates, hence very high levels of adherence (greater than
95%) to Anti-retroviral treatment (ART) is required to achieve long-term suppression of viral
load.Aims and Objectives: To identify the factors determining ART adherence among
children. Materials and Methods: It was a single centre observational cross-sectional study
involving children 0-12 years of age diagnosed as HIV seropositive and started on ART. Data
was collected using a structured interview schedule and analyzed using Statistical Package
for Social Sciences, Version 16.0. Adherence was considered sub-optimal if below 95%.
Results: Among the 100 HIV seropositive children studied, 76% of the children showed
optimal adherence i.e. above 95% while the rest (24%) showed sub-optimal adherence. The
mean age of the patients was 7 years with a male to female ratio of 1.8:1. Patient factors like
lack of education, knowledge of ART drugs, treatment regimen and co-management of other
morbidities, toxicity/ side effects of ART drugs, forgetting to administer the drugs, stigma/
fear of disclosure, pill burden, attitude and perception of parents/ guardians towards ART
were the major factors that influenced ART adherence. However, factors like economic
burden did not affect adherence. Conclusion: The study thus highlights the need to address
the social and other factors affecting adherence to ART in pediatric population for better
management of HIV in this age group.
ID/81 (O) CONGENITAL SYPHILIS: A FORGOTTEN DISEASE?
Dibyajyoti De, Sriparna Basu, Ashok Kumar
Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu
University, Varanasi
Email: drdibyajyotide1@gmail.com
Abstract: Availability of cost-effective treatment and better prevention of sexually
transmitted infections along with emergence of human immunodeficiency virus, have made
congenital syphilis an almost forgotten disease entity. Unfortunately a resurgence of the
disease has currently been noted. Over last 3 years we came across five low birth weight
neonates with unusual symptoms which subsequently proved to be manifestations of early
congenital syphilis. Case 1 was admitted for prematurity and had persistent unilateral
mucopurulent nasal discharge, case 2 was born with large vesicular skin lesions filled with
serosanguineous fluid, case 3 developed bilateral arthritis of knees and hepatosplenomegaly
at the age of 1 week, case 4 presented with cervical lymphadenopathy and
hepatosplenomegaly at birth and case 5 developed dactylytis of left middle finger on day 3.
All the mothers belonged to lower socio-economic status and had apparently uneventful
antenatal period. No investigation was done during pregnancy. They were unaware about
their disease and were found to be positive for syphilis by Venereal Disease Research
Laboratory (VDRL) Test and fluorescent treponemal antibody (absorbed) IgM test only after
childbirth. Screening for HIV, TORCH and hepatitis B were negative in all. Sepsis screen
and blood culture were negative in the neonates. Cerebrospinal fluid examination and
biochemical investigations were normal. All the neonates were positive for VDRL. After
diagnosis, the infants were treated with intravenous crystalline penicillin G (50000 U/kg body
weight) for 10 days. Recovery was uneventful. We reemphasize the importance of routine
antenatal screening for all sexually transmitted diseases including syphilis. Keywords:
Congenital syphilis, newborn
ID/ 82 (P) UNCOMMON EARLY NEUROLOGICAL PRESENTATION OF
ENTERIC FEVER: CEREBELLAR ATAXIA
Virender Kumar Gehlawat and Vandana Arya
Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak,
Haryana, India-124001
Email: gehlawatv@gmail.com
Background: Enteric or typhoid fever is a common systemic illness with a wide spectrum of
presentations and complications. Neuropsychiatric complications in enteric fever are not
uncommon and usually presents in second week of illness but ataxia as an isolated
neurological manifestation is rare. We report an adolescent boy presenting with ataxia in first
week of enteric fever. Case report: A 12 year old boy presented with history of high grade
fever, difficulty in walking and slurring of speech for 4 days. On examination child was
conscious, oriented, with intact cranial nerves. Motor examination revealed normal tone and
power in all four limbs. Child had positive cerebellar signs in the form of wide based gait,
slurring of speech, dysdiadokinesia, and positive finger nose test with pendular knee jerk
reflex. Investigations revealed normal hemoglobin (12.2 g/dl) and TLC (6600/cumm) but low
platelet count (50000/cumm). In the initial work up for acute cerebellar ataxia blood culture
revealed growth of salmonella typhi and serum widal titres performed on day 6 of illness
showed To titres of 1:320. Child was started on injectable antibiotics along with short course
of steroids (Dexamethasone) for 48 hours. Thrombocytopeniaenia improved within 5 days
and by day 10 gait almost returned to normal and child could walk without support with
return of normal speech by 12th day of admission. Conclusion: Enteric fever should be
considered in differential diagnosis of febrile children presenting with ataxia in the first week
of fever. Short course steroid along with injectable antibiotics could probably shorten the
duration of neurological illness.
ID/ 83 (P) NS 1 REACTIVE: WARNING CALL FOR ADMISSION OR NOT?
Ruchi Gupta
Institute Of Child Health, 11 Dr Biresh Guha Street, Kolkata, India
Email: ruchigupta.md@gmail.com
Objectives: To determine admission requirement in NS 1 positive patients according to high
risk clinical criteria and laboratory parameters. Duration: August – October 2012 (study in
progress). Design: Prospective observational case analysis. Setting: In-patient department of a
pediatric tertiary care hospital. Subjects: All NS1 reactive children (1 month to 12 years) with
fever. Methods: Clinical and laboratory details of 50 children (NS 1 positive) on admission
were statistically analyzed from medical charts. The trend of platelet count was followed until
discharge. Results: Of the 50 patients analyzed till now 90 percent belonged to Kolkata.
Majority of those admitted were above 1 year of age. The youngest patient being 7 months
old. Incidence was 44% in males and 46% in females. Of those admitted WBC count was
<5000 in 30 % of the patients. Of all the patients admitted 6 % (3 out of 50) presented in
shock. 2% (1 of 50) of the patients presented with hemorrhagic manifestations. Total 10%
had platelet count below one lakh on admission and in another 6% patients the platelet count
fell below one lakh after admission. One mortality occurred amongst the 50 admitted the rest
were discharged when clinically stable. Conclusions: We experienced a dengue epidemic in
Kolkata this 2012. Thus we can safely conclude that admission was warranted in only those
patients presenting with a platelet count of less than 1 lakh or those presenting with clinical
features of dengue shock/hemorrhagic manifestation. Other patients could have been
managed on an outpatient basis thus reducing the huge burden on the hospital and the
country’s health care system and also cutting down on the cost of patient management. Key
words: NS 1, admission, platelet count, shock.