Tuberculosis: a great masquerader

Central nervous system tuberculosis caused by Mycobacterium tuberculosis is the most severe form of tuberculosis, accounting for 1% of all TB cases. Intracranial tuberculosis can present as Tuberculous meningitis, Tuberculous encephalopathy, Tuberculous vasculitis, CNS tuberculomas and Tuberculous brain abscess. Here authors present a case of a 10-year-old girl who presented with insidious onset of early morning vomiting, excessive sleepiness with classical neuroimaging findings of intracranial tuberculosis. Authors emphasise that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial space-occupying lesion with or without pulmonary involvement.

Evaluation of Signs of Inflammation that Can Kill score in predicting mortality in an urban tertiary care centre for children in South India

Background: Mortality in critically ill children is maximum in the first 24 hours. Need of the hour is a rapid clinical scoring system that predicts mortality on admission. This study aims at using the Signs of Inflammation that Can Kill (SICK) score in a tertiary care pediatric hospital in India, to evaluate its usefulness in predicting mortality on admission.Methods: The study design is a hospital based prospective study for evaluation of diagnostic test for a duration of one year.' The assessment using SICK score was done on arrival prior to initiation of treatment for children admitted through the emergency room and paediatric ward. The variables of SICK score - temperature, heart rate, respiratory rate, systolic BP, oxygen saturation, CRT, sensorium by AVPU scale were measured using standard guidelines.Results: The study includes a population of 369 children. Children between 1 month to 12 years were included in the study. Out of 369 children studied 24 died. The mortality in the study is 6.5%. The area under the ROC curve is 0.94, which indicates the scores based on regression could predict mortality in 94% subjects correctly. Further a score of 2.5 showed maximum discrimination with a sensitivity of 87.5% and specificity of 87.2%.Conclusions: The assessment of SICK score in the population will provide objective measure of severity of illness on admission, prediction of mortality, early triage of patients, effective allocation of resources and personnel, enables early intervention, which helps in reducing mortality.

Orbital cellulitis: early intervention saves vision

Orbital cellulitis describes an infection involving the soft tissues posterior to the orbital septum including the fat and muscle within the bony orbit. This condition is associated with severe sight and life-threatening complications. Distinguishing it from preseptal cellulitis is difficult, but important. Acute sinusitis is the commonest predisposing factor. Clinical findings alone are not specific enough to distinguish between preseptal and post septal orbital cellulitis. Early diagnosis using CT orbit is important to rule out complications such as orbital cellulitis, subperiosteal abscess. The most common location of subperiosteal abscess is the medial wall of the orbit. Transnasal endoscopic drainage of the abscess is a functional and minimally invasive technique and is the treatment of choice at present. Early diagnosis and intervention are mandatory to prevent the visual loss and life-threatening complication.Here, the authors describe a 2 months old infant with orbital cellulitis and medial subperiosteal abscess and treated with transnasal endoscopic drainage of the subperiosteal abscess.