Rare presentation of mycoplasma pneumonia: a case report

Mycoplasma is a frequent cause of community acquired pneumonia in children accounting for 20 percent of the cases. Though CNS complications are the most common extra pulmonary manifestations of M. pneumoniae stroke is a rare entity. Here we report a case of 7 years old male child with macrolide resistant M. pneumoniae complicated pneumonia that developed right hemiparesis and dysphasia. Brain magnetic resonance imaging and angiography showed left fronto parietal infarct and left carotid artery stenosis. He responed to non-macrolide antimicrobial regimen. This potential yet rare complication should be considered and closely monitored for in children presenting with complicated pneumonia.

Bone Mineral Content and Density in Indian Children with Congenital Adrenal Hyperplasia

Objective: To study the bone mineral content and density in children with congenital adrenalhyperplasia (CAH). Methods: 35 children with congenital adrenal hyperplasia and 35 healthycontrols. Bone mineral content and density were studied by Dual Energy X-rayabsorptiometry. Results: The mean (SD) of lumbar spine bone mineral density (g/cm2) [0.590(0.100) vs 0.589 (0.088) (P=0.97)], total Body less head bone mineral density (g/cm2) [0.536(0.090) vs 0.548 (0.111) (P=0.64)], lumbar spine bone mineral content (g) [29.85 (27.63) vs31.03 (29.19) (P=0.86)], and total body less head bone mineral content (g) [254.27 (281.25)vs 273.07 (330.71) (P=0.79)] were not different between children with CAH and controls,respectively. Conclusion: Bone mineral density and content in children with congenitaladrenal hyperplasia are maintained in the normal range.

Congenital hypoaldosteronism.

Congenital hypoaldosteronism due to an isolated aldosterone biosynthesis defect is rare. We report a 4 month old female infant who presented with failure to thrive, persistent hyponatremia and hyperkalemia. Investigations revealed normal serum 17 hydroxy progesterone and cortisol. A decreased serum aldosterone and serum 18 hydroxy corticosterone levels with a low 18 hydroxy corticosterone: aldosterone ratio was suggestive of corticosterone methyl oxidase type I deficiency. She was started on fludrocortisone replacement therapy with a subsequent normalization of electrolytes. Further molecular analysis is needed to ascertain the precise nature of the mutation.

Transient methemoglobinemia in an infant.

We report a case of transient methemoglobinemia in an infant due to gastroenteritis. Methemoglobinemia should be suspected in infants with a history of diarrhea and cyanosis that is out of proportion to the history and clinical examination. Methemoglobinemia can be life threatening, but outcome is good when treated with IV methylene blue.

Interstitial lung disease in infancy.

OBJECTIVE: To describe the clinical profile of interstitial lung disease in infancy. METHODS: A retrospective analysis of cases diagnosed to have ILD was carried out in Kanchi Kamakoti CHILDS Trust hospital over a period of 2 yr. Infants aged 1 month to 1 yr of age were included if they had (1) respiratory symptoms (Cough, tachypnea or crepitations) for at least 1 month (2) diffuse infiltrates on chest radiography (3) Hypoxemia as defined by oxygen saturation less than 90% by pulse oximetry and (4) High Resolution Computed Tomography (HRCT) of the chest revealing findings of interstitial infiltrates or ground glass pattern. Their case records were analyzed for clinical data, treatment and follow up details. RESULTS: Of the 9 children, who were diagnosed to have ILD, 5 were boys and 4 were girls. The male: female ratio was 1.25: 1. The median age of onset of symptoms was 5 month. The common clinical features observed were tachypnea associated with chest indrawing (100%), cough (100%), hypoxia (100%), failure to thrive and fever (55%) each. The following radiographic patterns were observed in the chest skiagrams: reticulo-nodular pattern in 6(67%) and ground glass pattern in 3(33%). HRCT showed interstitial infiltrates in 6 (67%) and ground glass pattern in 3(33%). Evidence for cyto megalo virus (CMV) infection was detected in 5(56%), Adenovirus in 1 (11%) and Pneumocystis carinii (PCP) in 1(11%) infant. Open lung biopsy was performed in 2 infants, which detected CMV in 1 and PCP in the other. All children received oxygen therapy and systemic corticosteroids (oral/IV) in addition to specific therapy for infection and 3 of these infants succumbed to respiratory failure. CONCLUSION: CMV Infection was the commonest cause of ILD in infancy in our study. However, the consequences on long term follow up in these infants need to be ascertained.

Neonatal Bartter syndrome.

Bartter syndrome is an inherited renal tubular disorder with hypokalemia, hypochloremic metabolic alkalosis, normal blood pressure with hyper-reninemia and increased urinary loss of sodium, potassium and chloride. We report an infant with neonatal Bartter syndrome, who improved with potassium supplements.

A reappraisal of the criteria to diagnose plasma leakage in dengue hemorrhagic fever.

A study was undertaken to analyze the usefulness of radiographic and ultrasonographic findings and area specific hematocrit cut off values in Dengue Hemorrhagic Fever (DHF). Of the 65 cases, 35 were DHF and 30 were Dengue Fever as per the WHO case definition. Among the DHF cases, hemoconcentration (>20%) was detected in 20 cases (57.14%), hypoproteinemia in 11 (31.42%) and clinical evidence of pleural effusion and or ascites in 25 (71.42%). Hemoconcentration based on area specific hematocrit cut off values was observed in 32 cases (91.42%). Ultrasonographic evidence of plasma leakage was seen in 32 cases (91.42%). In detecting plasma leakage, area specific hematocrit cut off values and ultrasonography had the highest sensitivity (91.42%), while ultrasonography had the highest negative predictive value of 84.21%. Clinical evidence of plasma leakage was more frequent than hemoconcentration or hypoproteinuria. Ultrasonography is an ideal non-invasive investigation to detect plasma leakage and area specific hematocrit values are useful as evidence of plasma leakage.

Richner Hanhart syndrome.

Richner Hanhart syndrome is a rare inherited disorder involving the metabolism of tyrosine, a semi-essential amino acid and it should be considered in the differential diagnosis of a child presenting with ocular and skin lesions. We report a case of Richner Hanhart syndrome in a 19-month-old child, who presented with ocular and skin lesions.

Pediatric Advanced Life Support (PALS): the current guidelines.

Every 5 years the American Heart Association (AHA) updates the Guidelines for CPR and Emergency Cardiovascular Care (ECC). The ECC Guidelines 2000 incorporates all the current consensus of experts, from not only a variety of disciplines, but also a variety of countries and cultures and is evidence based. The new Guidelines emphasize interventions to reduce the risk of sudden deaths, early identification of respiratory failure and shock and implementation of Advanced Life Support (ALS) to treat respiratory and cardiac arrest.