Spectrum of COVID-19 Disease in Children: A Retrospective Analysis Comparing Wave 1 and Wave 2 from a Tertiary Hospital in South India

Objective To describe COVID-19 in children and the diferences between the two waves. Methods The electronic medical records of children younger than 16 y of age with laboratory-confrmed COVID-19 infection between June 1st 2020 and May 31st 2021 at Christian Medical College, Vellore were retrospectively reviewed. Demographic, clinical, and laboratory data were collected on a predesigned case record form and analyzed. Results A total of 988 children were diagnosed with confrmed COVID-19 during the study period. Of these, there were 585 children diagnosed during the 1st wave (June 2020–Feb 2021) and 403 children during the 2nd wave (March 2021–May 2021). It was found that loose stools and rash were signifcantly more frequent during the 1st wave and fever, cough, coryza, heart rate and temperature were signifcantly more during the 2nd wave. There was no signifcant diference between the two groups in terms of requirement of oxygen therapy, need for ICU admission, duration of ICU stay or hospital stay, or severity of illness. Mortality was signifcantly higher during the 2nd wave (0.3% vs. 2%). Conclusion The COVID-19 pandemic among children during the 1st and 2nd waves were similar in severity, though there was a higher mortality during the 2nd wave.

Comparison of Scrub Typhus Meningitis with Acute Bacterial Meningitis and Tuberculous Meningitis

Objective: To compare scrub typhus meningitis with bacterial and tuberculous meningitis.Methods: Children aged<15 years admitted with meningitis were screened and those who fitcriteria for diagnosis of scrub typhus meningitis (n=48), bacterial meningitis (n=44) andtuberculous meningitis (n=31) were included for analysis. Clinical features, investigationsand outcomes were compared between the three types of meningitis. Results: Mean age,duration of fever at presentation, presence of headache and, altered sensorium and presenceof hepatomegaly/splenomegaly were statistically significantly different between the groups.Scrub typhus had statistically significant thrombocytopenia, shorter hospital stay and a betterneurological and mortality outcome. Conclusions: Sub-acute presentation of meningitis inolder age group children, and good outcome is associated with scrub typhus when comparedto bacterial and tuberculous meningitis

Antimicrobial Susceptibility Profile of Isolates from Pediatric Blood Stream Infections.

We describe the pathogens and their antimicrobial profile causing blood stream infections in children over a 4-year period. The commonest pathogens were: non-fermenting Gram negative bacilli other than Pseudomonas, Salmonella species, Escherichia coli, Staphylococcus aureus and Klebsiella species. High rates of drug-resistance were observed.

Acute pancreatitis as the initial presentation in systemic lupus erythematosus.

It is exceptionally rare for acute pancreatitis to be the presenting manifestation of childhood systemic lupus erythematosus. We report a 14-year-old girl who presented with a history of fever, generalized rash, arthralgia and abdominal pain. Her serum amylase was 1472U/L and lipase 3316 U/L suggestive of acute pancreatitis. Other investigations revealed pancytopenia, low complement, high 24-hour urinary protein and elevated ANA and dsDNA. She was treated with IV methylprednisone, followed by oral steroids.

Intermittent clobazam therapy in febrile seizures.

OBJECTIVE: To evaluate the efficacy of intermittent clobazam therapy in preventing the recurrence of febrile seizures and to assess its safety. METHODS: The study was a prospective, randomized, double-blind placebo-controlled trial conducted in the Department of Child Health, Christian Medical College Hospital, Vellore between July 2001 and September 2002. Neurologically normal children between 6 months and 3 years of age with a history of febrile seizures and no evidence of acute CNS infection or EEG abnormality were included into the study. 19 children in a clobazam group and 20 in the placebo group were randomly allocated. Temperature reduction measures with paracetamol and tepid sponging were advised to all children. In addition the dispensed medication was to be administered at the onset of fever and continued for 48 hours irrespective of the duration of fever. The children were then monitored for seizures and adverse effects of clobazam. The children were followed up for a mean period of 9.9 months. The analysis was done on the number of febrile episodes in both the groups. RESULTS: There were a total of 110 episodes of fever during the study period. Mean number of febrile episodes in the clobazam group was 3.1 and in placebo group 2.56. Six (12.5%) of the 48 episodes in placebo group and one (1.7%) of 60 episodes in clobazam group had seizure recurrence. This was statistically significant (p = 0.01). Drowsiness and weakness were present equally in both clobazam and placebo groups whereas ataxia was present only in the clobazam group, the difference being statistically significant (p=0.04). CONCLUSION: Intermittent clobazam therapy is an effective measure in the prevention of recurrence of febrile seizures. The ataxia due to clobazam was much lower than that reported with diazepam.