Co-infection of hepatitis A and E with Salmonella infection; a case report

Ours is a developing country so infectious diseases contribute maximum to the morbidity and mortality. Among these, water borne diseases like diarrhea, typhoid, infectious hepatitis etc. are on rise. Sometimes more than one type of infection coexists which makes the diagnosis and management a challenging task. We report a case of Coinfection of Salmonella typhi with Hepatitis A and E. A 5 year old male child came to us with complaints of fever and jaundice for last 9 days. Blood culture of patient was positive for Salmonella typhi. Viral markers turned out to be positive for Hepatitis A and E. To the best of our knowledge coinfection of Hepatitis A and E with Salmonella has rarely been reported earlier. In view of the restricted finances in our country vaccines against typhoid and Hepatitis A can not be incorporated in the national immunization schedule at present but these vaccines can be offered on an individual basis

Clinical profile and outcome in children of dengue hemorrhagic fever in north India

The number of dengue fever [DF]/dengue hemorrhagic fever [DHF] cases reported in India has risen in recent years. This study was undertaken to evaluate clinical profile and outcome of children admitted with DHF/dengue shock syndrome [DSS], in the 2006 DHF epidemic in Ludhiana, Punjab. Eighty one children with dengue hemorrhagic fever were hospitalized in the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, India. All patients were diagnosed, managed and monitored according to a standard protocol. Children between 10-15 years were most commonly afflicted [59%]. Infants were the least affected sub-group [3.7%]. Ninety two percent of all children were of DHF and 8% cases presented in DSS. The common symptoms seen were fever [91%], vomiting [41%], poor intake [21%], abdominal pain [16%] and significant bleeding [15%]. Hepatomegaly was present in 60% of cases. 85% of cases had petechiae alone, 15% had evidence of significant bleeding manifestation. Gastrointestinal bleeding was the commonest observed bleeding. The complications seen were liver dysfunction [14.8%], coagulopathy [3.7%], renal dysfunction [3.7%], and acute respiratory distress syndrome [2.4%] and disseminated intravascular coagulation [1.2%]. Mortality in the study was 3.7%. Refractory shock and coagulopathy were seen in all cases with poor outcome. Increased awareness, better transport facilities and case management according to the WHO guidelines, is needed to further reduce mortality of DHF/DSS cases