ABSTRACT
Introduction. Childhood tuberculosis meningitis is a severe form of tuberculosis with high morbidity and mortality. The diagnosis is frequently missed and delayed due to lack of sensitive tests like acid-fast bacilli (AFB) smear and delayed results by culture.Aims. To compare the role of IS6110 and protein antigen b PCR in cerebrospinal fluid (CSF) for rapid diagnosis of tuberculous meningitis (TBM) in children.Methodology. Forty-five cases of TBM and 20 controls were enrolled in this prospective study.Results. The mean ages of cases and controls were 4.2±0.5 years and 4.5±0.7 years, respectively. In the TBM group, two-thirds of the children were <4 years of age, and 62â% were males. Sensitivities of AFB smear examination, Löwenstein-Jensen (LJ) medium and bactenecin (BACTEC) culture in cases were 4.4, 0 and 2.2%, respectively. The protein antigen b PCR was most sensitive as it was positive in 35 (77.8â%) of TBM patients; IS6110 PCR was positive in 27 (60â%) patients. Both PCR-based tests had higher positivity than conventional tests and BACTEC culture. No significant difference was seen between the PCR tests. Excellent agreement was observed between both PCR-based tests as they were concordant for 26 positive samples and 35 negative samples.Conclusion. Protein b PCR is a sensitive and rapid method for the diagnosis of TBM (sensitivity 77.8â%). Both PCRs were more sensitive than smear, LJ and BACTEC. The specificity of both PCR was 100â%.
Subject(s)
Mycobacterium tuberculosis/genetics , Polymerase Chain Reaction/methods , Tuberculosis, Meningeal/diagnosis , Antigens, Bacterial/genetics , Cerebrospinal Fluid , Child, Preschool , DNA Transposable Elements/genetics , DNA, Bacterial , Female , Humans , Male , Prospective Studies , Sensitivity and Specificity , Tuberculosis, Meningeal/cerebrospinal fluidABSTRACT
AIM: Kawasaki disease (KD) is a medium vessel vasculitis of childhood. In infancy KD is often characterized by incomplete and atypical forms. There is paucity of literature on KD in children below 6 months and there are no data from any developing country. This study defines the profile of children with KD below 6 months at our centre. METHODS: During January 1994 to March 2015, 460 children were diagnosed with KD and 17 (3.6%) were below 6 months. Diagnosis was based on American Heart Association (AHA) criteria. All children were treated with intravenous immunoglobulin and aspirin; three also received infliximab. RESULTS: Mucosal changes were present in 11 patients (64%); extremity changes in 11 (64%); rash in nine (53%); conjunctival injection in eight (47%); and cervical lymphadenopathy in three (17%). Irritability was noted in 15 patients (88%); four (23%) had respiratory symptoms; and two (11%) had bacille Calmette-Guérin scar reactivation. Fifteen (88%) had incomplete KD. Twelve patients were diagnosed beyond day 10 of illness. Thrombocytopenia was seen in four. Coronary artery abnormalities were present in six (35%) patients. Two children died from disease-related complications - one of these had giant coronary artery aneurysms. CONCLUSION: Our data show that incomplete forms of KD are commonly seen in children below 6 months of age, thereby resulting in delayed diagnoses. Pediatricians need to have a high index of suspicion of KD when dealing with a young infant with unexplained fever beyond 5 days. The AHA criteria appear to be inadequate for diagnosing KD in infants below 6 months.
Subject(s)
Mucocutaneous Lymph Node Syndrome/diagnosis , Age Factors , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Delayed Diagnosis , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/therapeutic use , India , Infant , Infliximab/therapeutic use , Male , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/drug therapy , Mucocutaneous Lymph Node Syndrome/mortality , Predictive Value of Tests , Time Factors , Treatment OutcomeABSTRACT
In patients with tuberculosis, abnormal extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in granulomatous tissues may result in hypercalcaemia. More commonly reported in adults with active pulmonary tuberculosis, this complication may rarely occur in extrapulmonary tuberculosis, and children. The hypercalcaemia may be precipitated by usually recommended vitamin D and calcium supplementation in patients with tuberculosis. We report here an infant with tubercular meningitis who developed hypercalcaemia 12 days after starting routine vitamin D and calcium supplementation. This communication highlights the importance of close monitoring of calcium levels in patients with tuberculosis, especially if started on vitamin D and calcium replacement before anti-tubercular therapy.
Subject(s)
Bevacizumab/administration & dosage , Infliximab/administration & dosage , Mucocutaneous Lymph Node Syndrome/complications , Retinal Vasculitis , Vitreous Hemorrhage , Angiogenesis Inhibitors/administration & dosage , Antirheumatic Agents/administration & dosage , Child, Preschool , Diagnosis, Differential , Humans , Intravitreal Injections , Male , Retinal Vasculitis/diagnosis , Retinal Vasculitis/diagnostic imaging , Retinal Vasculitis/drug therapy , Retinal Vasculitis/etiology , Retinal Vasculitis/physiopathology , Retinoscopy/methods , Treatment Outcome , Visual Acuity , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/drug therapy , Vitreous Hemorrhage/etiologySubject(s)
Mucocutaneous Lymph Node Syndrome/complications , Muscle Weakness/etiology , Child , Female , HumansABSTRACT
We report a case of mediastinal mass caused by a fungal infection in an immunocompetent child. The patient presented with superior mediastinal syndrome along with a swelling in the chest wall. Cytology and culture demonstrated Aspergillus flavus. The child was treated with voriconazole, which resulted in clinical response.
