Chromobacterium violaceum sepsis in an infant.

Chromobacterium violaceum is a rare pathogen that can cause potentially fatal infections in humans. Till date, 150 cases are reported worldwide including 7 from India. We report a 6 month old infant who presented with high grade fever, respiratory distress and multiple vesicular skin lesions. Chromobacterium violaceum was isolated from blood, bone marrow aspirate and from skin lesions. Infant responded to treatment with piperacillin and ciprofloxacin, and is doing well on follow up.

Coronary Artery Dilatation in Incomplete Kawasaki Disease.

We conducted this study to compare the incidence of coronary artery dilatation in children with Incomplete and Classical Kawasaki disease, diagnosed as per AHA criteria. Subjects were included on a retrospective review of records (2002-2007); those with a discharge diagnosis of Kawasaki disease were enrolled. A total of 29 patients were identified (3.1 per 1000 pediatric admissions), out of which 22 were boys (median age: 4.8 years; range: 4 months-11 years). Seventeen (58.6%) had Classical KD and twelve (41.4%) children had Incomplete KD. All children received IVIG and underwent echocardiography. Coronary involvement was more in Incomplete KD (11/12 = 91.6 %) as compared to Classical KD (7/17= 41.1%). The sensitivity, specificity and predictive value of AHA criteria to detect coronary artery dilatation was 39%, 9%, and 41%, respectively. We conclude that children presenting with Incomplete Kawasaki disease are at a higher risk of coronary artery abnormalities.

Tolerability and efficacy of single dose diethylcarbamazine (DEC) alone or co-administration with Ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, South India.

The tolerability and efficacy of single dose DEC (12mg/kg body weight) or co-administration of DEC (6mg/kg body weight) with Ivermectin (200 or 400 mcg/kg of body weight) was studied in 60 asymptomatic W. bancrofti microfilariae (Mf) carriers following a double blind randomized design. The drugs were tolerated well. The incidence of adverse reactions of DEC (85.0%), DEC + Ivermectin 200mcg (95.0%) and DEC + Ivermectin 400mcg (100%) did not vary significantly (P>0.05). The mean score of adverse reaction intensity due to DEC + Ivermectin 200mcg (1.41) was significantly higher compared to DEC (0.61) (P<0.05). However, there was no significant difference between and DEC +Ivermectin 400mcg (0.89) and DEC + Ivermectin 200mcg (1.41) and DEC + Ivermectin 400mcg and DEC. The major adverse reactions were fever, headache and myalgia in all groups. The incidence and intensity of the adverse reactions were maximum between 24 to 48 hours of post therapy. The haematological and biochemical parameters did not vary significantly between pre and 7-day post therapy values in any of the study groups (P>0.05). Efficacy was measured in terms of proportion of cases clearing microfilaraemia completely and reduction in geometric mean parasite density in comparison to pre therapy levels. At the end of one year, DEC with Ivermectin 400mcg group showed significantly higher efficacy in complete clearance of Mf (94.4%) than that of DEC with Ivermectin 200mcg (60.0%) or DEC alone (52.6%) (P<0.05). However, no significant difference was observed in reduction of geometric mean Mf density (99.9%, 99.7%, 99.5% respectively). In all the groups, the tolerability and efficacy of the drugs were independent of host age and gender.