Predictors of Severity of Scrub Typhus in Children Requiring Pediatric Intensive Care Admission.

Objective of our study was to determine the clinical characteristics and laboratory profile of scrub typhus patients requiring pediatric intensive care admission and to find out risk factors for the severity of illness. This was a cross-sectional observational study conducted on 1-month to 12-year-old children admitted with scrub typhus in a tertiary care pediatric intensive care unit (PICU). Relevant demographic, clinical, laboratory, treatment, and outcome-related data were documented. The severity of the disease was measured in the form of multiple organ dysfunction syndrome (MODS). With further correlation, and univariate and multivariate analyses, factors associated with severe disease were identified. During the study period, out of 586 PICU admission, 62 patients (10.6%) were diagnosed with scrub typhus. The mean age was 63.85 ± 52.78 months, where infants constituted 32.3% of the total population. Fever was present in 100% of the cases. Common indications of PICU admission were: respiratory distress 42 (67.7%), altered sensorium 41 (66.1%), convulsion 37 (59.7%), and shock 31 (50%). Total number of patients with MODS was 40 (64.5%). The case fatality rate was 8%. On multivariate analysis, infant age group ( p = 0.02), altered sensorium ( p = 0.001), reduced urine output ( p = 0.02), thrombocytopenia ( p = 0.001), raised C-reactive protein ( p = 0.004), hyponatremia ( p = 0.005), hypoalbuminemia ( p = 0.01), deranged international normalized ratio ( p = 0.02), and hyperferritinemia ( p = 0.02) came out to be independent factors in predictability for development of MODS. Multiorgan dysfunction is a life-threatening manifestation of scrub typus in children, which necessitates PICU admission. Infant age group, presence of altered sensorium, reduced urine output, thrombocytopenia, elevated inflammatory markers, coagulopathy, hypoalbuminemia, and hyponatremia predict risk for MODS.

Ultrasound detected changes in joint cartilage thickness in juvenile idiopathic arthritis.

AIM: The purpose of this study was to investigate the changes in joint cartilage thickness in different subtypes of juvenile idiopathic arthritis (JIA) using ultrasound, comparing them with healthy children and to evaluate the relationship with disease duration and inflammatory markers. METHODS: We conducted a cross-sectional study comprising of 27 cases of JIA and 54 age- and sex-matched healthy children. Bilateral wrist, knee and ankle joint cartilage thicknesses were measured by ultrasound as per European League Against Rheumatism standard guidelines and compared them between JIA subtypes as well as between cases and control. RESULTS: Descriptive analysis of the whole cohort revealed the mean age of the study population was 8.3 ± 3.2 years with mean cartilage thicknesses at the wrist, knee and ankle being 1.40 ± 0.89 mm, 1.57 ± 0.78 mm and 1.41 ± 0.85 mm, respectively. The median cartilage thicknesses of wrist, knee and ankle joints of JIA cases (n = 27) and healthy controls (n = 54) were 1.01, 1.35, 1.05 and 1.95, 2.00, 1.95, respectively. The joint cartilage thickness was significantly reduced in JIA in comparison to the healthy cohort (P < 0.01). Diseased boys suffered greater cartilage damage in knee joints compared to girls; the polyarticular variety of cases had thinner knee cartilage in comparison to the oligoarticular subtype. Further, it was found that joint cartilage destruction is independent of inflammatory markers and disease duration. CONCLUSION: Significant cartilage thinning in addition was found in JIA children, particularly in the polyarticular subtype, and more in boys than girls, which is independent of disease duration and inflammatory markers, using ultrasound as a primary investigative tool.

Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies.

AIM: Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. METHODS: A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. RESULTS: Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2) = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not. CONCLUSION: Malnutrition may be a potential predictor of mortality in febrile neutropenia.

Disseminated staphylococcal disease in healthy children-experience from two tertiary care hospitals of West Bengal.

OBJECTIVES: To assess the etiology, precipitating factors, treatment and outcome of disseminated staphylococcal disease (DSD) in healthy immunocompetent children. METHODS: This hospital based observational prospective study was conducted in two tertiary care hospitals of West Bengal, India during the period of March, 2011 through February, 2012. Inclusion criteria were 1) children between 1 and 12 y and 2) clinical features DSD characterized by i) involvement of at least two distant organs with presence of gram positive cocci in clusters and/or growth of Staphylococcus aureus from at least one normally sterile body fluid, ii) fever, persistent bacteremia despite antibiotics and focal involvement of two or more separate tissue sites (skin, bone, joint, kidney, lung, liver, heart). RESULTS: Thirty six cases fulfilled the criteria of DSD with mean age in years 6.03 ± 3.04 (range 1-12). The age group of 5-12 y was found to be more vulnerable (p < 0.001). Septic arthritis following accidental blunt closed trauma, was the significant precipitating factor for DSD in this age group (p = 0.031). Methicillin resistant Staphylococcus aureus (MRSA) was the causative agent in all the cases. Vancomycin resistant Staphylococcus aureus (VRSA) was detected in 88.9 % of cases. All cases were sensitive to linezolid. No significant side effects were observed with 28 d of linezolid therapy. CONCLUSIONS: DSD is more common in 5-12 y age group. Trauma is a significant precipitating factor for DSD in this age group. Linezolid may be considered as the first line drug in DSD with MRSA.

Profile of child labor in Indian railways.

OBJECTIVES: To determine the socio-medical profile of child workers in Indian railways. METHODS: This was a prospective longitudinal survey over one year. The children up to the age of 14 y entering the reserved second class sleeper compartment of long distance trains in Indian railways were included. The data were collected regarding their profile by the investigators either by interviewing or observation as per situation in the moving train in a predesigned proforma. Data pertaining to the social, demographic and medical aspects were collected. RESULTS: A total of eighty one children were noted in 22500 kilometers of train journey. Sex distribution (8:1) was unequal with males outnumbering females. CONCLUSIONS: This study, first of its kind, attempted to delineate a distinctive socio-medical profile in a special group of children. It might, on the behalf of social pediatrics, increase the awareness and help the society to formulate a rehabilitation policy in collaboration with national and international organizations.