Rapid Diagnostic Tests in Childhood Infections

Presumptive treatment of infections often results in irrational antimicrobial use resulting in detrimental spread of drug resistance anduntoward side effects. A rapid diagnostic test (RDT) is a test that delivers a result earlier than conventional testing methods employed inthe past to identify the offending microorganism. RDTs help in early definitive therapy, reduction in hospital stay and cost, and in degree ofmorbidity and mortality associated with the infection. To select a proper RDT, one should consider how specific and sensitive the test is.Most RDTs gives a qualitative result not quantitative; hence disease severity, monitoring of the disease, prognostication and therapeuticefficacy cannot be assessed. A RDT should be easy to perform, should not require sophisticated machines, and kits should be stable inextremes of temperature. RDTs may be of immense help in remote places where conventional diagnostic facilities are unavailable or lackquality. RDTs hold promise of reasonable diagnostic accuracy if done in a optimal clinical background. They should never be ordered asa shotgun approach to exclude all possible infections but should be used judiciously with appropriate interpretation.

Antibiotic Sensitivity and Clinico- epidemiological Profile of Staphylococcal Infections.

This hospital-based study describes the antibiotic sensitivity of 66 S. aureus isolates from the admitted children (age 0-18 y) in a tertiary hospital of Kolkata, India. Methicillin-resistant S. aureus constituted 16.7% (n=11) of the isolates. Clindamycin-resistance was observed in 60% and 82% of methicillin-sensitive and methicillin-resistant strains, respectively.

Macrophage Activation Syndrome in Kawasaki Disease.

Background: Kawasaki disease is an acute febrile vasculitis of childhood. Macrophage activation syndrome is a rare life threatening complication. Case characteristics: 4-yearold boy with Kawasaki Disease treated with intravenous immunoglobulins. Observation: He developed encephalopathy, hepatosplenomegaly and pancytopenia. Blood investigations and bone marrow aspiration suggested macrophage activation syndrome. Outcome: Good response to pulse methylprednisolone (30 mg/kg/d) for 5 days. Message: Macrophage activation syndrome may complicate Kawasaki disease.

Management of malaria in children: update 2008.

JUSTIFICATION: The first guideline on diagnosis and management of malaria in children was formulated by Infectious Diseases Chapter of IAP in 2005. In subsequent year WHO proposed artemisinin based combination therapy in all cases of uncomplicated falciparum malaria. The number of falciparum malaria as well as multidrug resistant falciparum malaria cases are constantly on the rise. So there was need to revise the existing guideline. PROCESS: The first recommendations on the diagnosis and management of malaria in children were formulated in 2005. The same protocol was revised on 12 October 2007 in NIMHANS, Bangalore in the light of various recommendations of WHO, where all the members of the Task Force Committee on Malaria in Children were present. OBJECTIVE: To revise and update treatment guidelines for malaria with special reference to artemisinin based combination therapy. RECOMMENDATIONS: The need for Artemisinin based combination therapy (ACT) is emphasized in chloroquine resistant falciparum malaria. Monotherapy with artesunate will further increase the resistance. Once malaria treatment is initiated it should be completed. In severe malaria the maintenance dose of artesunate is revised.

Plasmodium vivax cerebral malaria.

We report two cases of Plasmodium vivax malaria (both aged 12 years) complicated by seizures and symptoms of diffuse meningoencephalitis. One had predominantly meningeal signs while in the other, purely encephalitis features were present. Both cases were treated with artesunate. Rarely, cerebral malaria is a presenting complication or occurs during the course of P. vivax infection.